Meanwhile the standard of equipment, of resident medical attendance, and especially of trained nursing[708] required by the Central Authority in the Poor Law institutions is constantly rising, in correspondence with the progress of hospital science. We see all this reflected in the advice and criticisms pressed by the inspectorate on the boards of guardians. "The workhouses of a past and bygone age," says Mr. Hervey in 1903, "are no longer refuges for able-bodied, but are becoming every day more of the nature of State hospitals for the aged, sick, and infirm. _As such, they should be furnished with the very best nursing procurable._"[709] [708] _See_ the references to nursing in Circulars of 29th January 1895 and 7th August 1897; and the General Order (Nursing of the Sick in Workhouses) 6th August 1897; Twenty-fifth Annual Report, 1895-6, pp. 109-110; Twenty-seventh Annual Report, 1897-8, pp. 27-31. [709] Mr. Hervey's Report, in Thirty-second Annual Report, 1902-3, p. 69. The total cost of Poor Law medical relief in 1904-5 was £518,994 indoor (to which might be added £640,833 for what are now called the "public health purposes" of the greatest of all Poor Law authorities, the Metropolitan Asylums Board); and £268,537 outdoor (Thirty-fifth Annual Report, 1905-6, pp. 251, 589, 590). This aggregate total of £787,531 (excluding the fever hospitals of the Metropolitan Asylums Board) omits the maintenance of the sick themselves, but includes, however, some items not previously included. For comparative purposes we must take the figure for 1903-4 (£423,554), which includes only doctors' salaries and drugs. This may be compared with the corresponding figure for 1881 of £310,456; for 1871, of £290,249; and for 1840 of £151,781 (Twenty-second Annual Report of the Poor Law Board, 1869-70, p. 227; Eleventh Annual Report of the Local Government Board, 1881-2, p. 237). (iii.) _The Municipal Medical Service_