[673] Local Government Board to Dr. Mortimer Glanville (_Lancet_ Memorial on Poor Law Medical Relief Reform), 12th November 1878; in Eighth Annual Report, 1878-9, pp. 91-2. In spite of this official answer, we may infer a certain internal conflict of policy with regard to these salaried outdoor Poor Law nurses. Though the Central Authority expressed itself as "desirous of encouraging" the experiment, we cannot find that it issued the Order, without which no board of guardians could create a new salaried office, for nearly fourteen years. The District Nurses Order, which was merely permissive, and which, therefore, could not have been delayed merely because there were, in 1878, not enough trained nurses to supply every union in the Kingdom, was not issued until 27th January 1892 (Twenty-second Annual Report, 1892-3, pp. 12-13). We cannot find that any "paid nurses in the treatment of the poor at their own homes" were sanctioned before that date. Moreover, even then, it is difficult to feel sure that the Central Authority was still, to use its words of 1878, "desirous of encouraging this arrangement as much as possible." In sending the Order to boards of guardians, it accompanied it by a circular, which can scarcely be deemed encouraging. It was of opinion that "it can only be under exceptional circumstances that a sick pauper, whose illness is of such a character as to require that the services of a nurse should be provided by the guardians, can, with propriety, be relieved at home. At the same time it appears ... that where circumstances render it desirable the nurses employed in such attendance should be duly appointed officers of the guardians, having recognised qualifications for the position, and being subject in the performance of their duties to the control of the guardians, and the Board have consequently decided to empower boards of guardians to appoint such officers" (Circular of 1st February 1892; in Twenty-second Annual Report, 1892-3, p. 9). Fifteen more years have elapsed; but we do not gather that the experiment, which the Central Authority in 1878 was desirous of encouraging, has been very strenuously pressed by the inspectors, or the power made publicly known. The result is that we cannot find that it has yet taken shape even to the extent of as many as a dozen salaried Poor Law nurses for the outdoor sick from one end of the Kingdom to the other. (ii.) _Institutional Treatment_