Those in workhouses were increasingly elderly and often chronically sick. Infirmary wings developed, often with poor standards of nursing and medical supervision. Against growing criticism of the conditions faced by the poor (and in particular those who were sick) in workhouses, the Metropolitan Poor Act 1867 was introduced and provided for the establishment of asylums for the sick and other classes of the poor in London. Though restricted to London, the act began to influence services nationally.
The act gave the Poor Law Board powers to bring unions or parishes into districts. Each district was to have an asylum or asylums as directed by the board. The act allowed the board to raise contributions to the Common Poor Fund, which would bear the cost of specified medical appliances, the salaries of Poor Law officers or new hospitals.
The 1867 act led to the establishment of the Metropolitan Asylums Board (MAB), which was a Poor Law institution. The MAB managed the Metropolitan Asylum District, which brought together the unions and parishes of the metropolitan area to manage smallpox or fever in a coordinated way.