Through restricted to London, this act began to influence services nationally. Those in the workhouses were increasingly elderly and often chronically sick, so infirmary wings developed, with scandalous standards of nursing and medical supervision. The revelation by The Lancet of vile conditions in London workhouses led to the Metropolitan Poor Act 1867, which imposed national standards on the locally elected guardians. The same act established a state service, the Metropolitan Asylums Board (MAB), which provided a well organised service for fevers such as smallpox, typhoid and cholera that presented too big a problem for individual Boards of Guardians.
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 for a ‘Common Poor Fund’, which would fund the cost of specified medical appliances, the salaries of Poor Law officers or new hospitals.