Central Authority obtained elaborate reports showing, for all parts of England, the practice that prevailed of normally giving outdoor relief to the sick, and of taking them into the workhouse infirmaries only when this was called for by (_a_) the nature of the disease, (_b_) the wishes of the patient, or (_c_) the nature of the home, and then only where suitable infirmary accommodation was available, there is no indication that any objection was entertained to the policy of outdoor relief to this large class.[374] [367] _Official Circular_, Nos. 14 and 15, N.S. April and May 1848, p. 228. [368] Outdoor Relief Regulation Order of 14th December, 1852. [369] General Order of 1st January 1869, in Twenty-first Annual Report, 1868-9, pp. 28, 79-82. [370] Circular of 27th July 1866, in Nineteenth Annual Report, 1866-7, p. 39. [371] _Official Circular_, No. 20, N.S. Nov. and Dec. 1848, p. 297. [372] Fourth Annual Report, 1851, p. 15; 14 & 15 Vic. c. 105, sec. 4. [373] Twentieth Annual Report, 1867-8, pp. 27-8. [374] Twenty-second Annual Report, 1869-70, pp. xxiv-xxvii, 38-108; Twenty-third Annual Report, 1870-1, pp. xliv-lii, 173-188. What is new in this period is the appearance, as a positive policy, of bringing pressure to bear on the boards of guardians to improve the quality of the medical attendance and medicine supplied. This led to an explicit disavowal, so far as regards the sick paupers, of any application to them of the principle of making the pauper's condition less eligible than that of the lowest grade of independent labourers. It is noteworthy that this new departure applied to outdoor medical relief quite as much as to institutional medical treatment, in which it has subsequently been sometimes excused on the ground that the superior treatment is accompanied by a loss of liberty. The new departure took three directions. It was definitely laid down that the medical attendance afforded to the outdoor paupers was to be of good quality, and thus necessarily above that obtained by the poorest independent labourer, or even by "the poor" generally. This was the outcome of a long campaign on behalf of the poorer members of the medical profession, of which Wakley was the leader in the House of Commons, and the _Lancet_ the efficient organ.[375] In 1853 the Poor Law Board considered that the qualifications of the Poor Law medical officers "ought to be such as to ensure _for the poor_ a degree of skill in their medical attendants equal to that which can be commanded by the more fortunate classes of the community."[376] On the suggestion of the House of Commons Committee on Poor Relief[377] it was authoritatively enjoined on boards of guardians in 1865 by a special circular that they were to supply freely quinine, cod-liver oil, and "other expensive medicines" to the sick poor;[378] although it must have been plain that such things were beyond