Sent H.A. Leggett to G. Buchanan, 5th Jan. 1931.
5 Jan 1931
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‘Sir George Buchanan,

The question of the ultimate arrangements for the anti-malarial treatment of general paralysis of the insane was first raised by your minute of the 14th April, 1928.

You were then of the opinion, with which I agree, that the process was passing out of the experimental stage and that, so soon as this happened, the question of its ultimate organisation was rather a matter for the Board of Control than for us. At the conference that was subsequently held, it was agreed that it was quite justifiable to regard the experimental stage as unfinished and that we could therefore remain as we were for a year or two but that, after that date, we ought seriously to consider the future.

With a view to getting the stage clear for discussion, I approached Mr. Brock and I attack his reply. If you are satisfied that the experimental stage is still not over, and I think it is reasonably clear that it is not, we could certainly justify retaining the work for at least a year or two longer, and it might even conceivably be that there will always be some element of experiment in it and that we should, therefore, continue indefinitely to have some hand in it. But I am quite clear that we cannot possibly do this unless we have some very definite idea as to the future. My own view is that any central control of the treatment, as apart from the experimental side, should be from the Board of Control and not from us and that any negotiation with the Local Authorities should, therefore, be done by them; but the first thing to settle is when and how the final position is to be reached, and perhaps the best thing would be to have a further discussion with a representative from you, the Board of Control, the Assistant-General and myself.

H.A. Leggett. 5th January 1931.’

[separate hand [Buchanan]:

‘Mr Leggett,

I am quite willing, but may it wait for a fortnight? There is to be an important discussion on the Horton work at the Society of Tropical Medicine on the 15th, to which I hope to go, and I feel I should understand the position better after it has taken place.

G.S.B. 5 Jan. 1931.’

Sent H.A. Leggett to L.G. Brock, 20th Nov. 1930.
20 Nov 1930
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‘Dear Brock,

You will remember that in May, 1928 we had some conversation and correspondence on the question of the laboratory at Horton and the arrangements for the treatment of General Paralysis of the Insane by induced malaria.

The conclusion we then reached was that while the experimental and research stage was not then over, the process had reached the stage of recognised treatment and justified the consideration of the future arrangements and that these should in some way or another aim at placing full financial and other responsibility for the operation of the system on to local authorities, subject to such medical supervision as you might think necessary. We had it in mind that possibly within two or three years from that date you would be in a position to make to make some definite suggestions to this end.

We have now to go to the Treasury again for a continuance of their approval to the employment of two temporary laboratory assistants and in so doing we must give them some indication of the progress we have made towards the end we have in view.

Before, therefore, I approach the Treasury on the relatively minor matter of laboratory assistants it is therefore necessary that we should get the position of the major problem somewhat clear. Perhaps you could let me know your views on the matter as it stands: I can then talk to the medical people here.

Yours sincerely,

H.A. Leggett, 20th Nov. 1930.’

Sent H.A. Leggett to [Secretary, H.M. Treasury], 20th Dec. 1928.
20 Dec 1928
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‘Sir,

I am directed by the Minister of Health to state, for the information of the Lords Commissioners of His Majesty’s Treasury, that the arrangements for providing adequate assistance for the work in connection with the malarial treatment of persons suffering from General Paralysis of the Insane has once more been under his consideration.

When the work was originally undertaken by the Department the treatment was entirely in the experimental stage and it was, therefore, essential that the supply of mosquitoes and the control of the treatment should be in the hands of the Ministry. It now appears possible that it shortly will emerge from the experimental stage into a definite and recognised system of treatment. This stage has not, however, yet been reached. There is still difficulty in securing that the mosquitoes are infected with the right type of malaria; the treatment, while becoming more and more recognised, is still looked at with some apprehension by certain of the Medical Superintendents of Mental Hospitals, and these Medical Superintendents still need careful instructions in administering the treatment; and it is essential that all the results should be closely watched and studied in order to perfect the technique of the treatment; and it is essential that all the results should be closely watched and studied in order to perfect the technique of the treatment. It is further the case that was this is the only definitely positive treatment for General Paralysis of the Insane that has ever been successfully tried it is vital that, until the technique is definitely settled, the present control should not be diminished.

While, however, the experimental stage cannot be yet said to be over, it is felt that the experiment is sufficiently advanced to justify the consideration of the future to ascertain whether, and if so, by what means full financial and other responsibility for the operation of the system, subject of course, to such central medical supervision as may be necessary, should be placed on local authorities.

The Minister is not yet in a position to give any indication of the date from which the full control now exercised can cease, and though it is clear that the present arrangements are of a temporary nature only and cannot involve the Department in any permanent commitments, it is probably that the present arrangements must necessarily continue for the next two or three years.

The general medical control of this work is exercised by one of the Medical Officers of this Department but, since the latter part of 1927, it has been necessary to supplement this by obtaining the services of one of the Medical Officers of the London County Council employed a the Horton Mental Hospital, the Minister paying for the cost of the substitute of this officer out of the Special Inquiries and Services Subhead of the Vote. This arrangement comes to an end on the 31st March, 1929, and the Minister does not propose to renew it. The duties of the Medical Officer consist partly in the general supervision of the care of the patients and of the laboratory activities at the Horton Hospital and partly in taking infected mosquitoes to different hospitals throughout the country for inoculating patients and giving advice on the care and management of patients.

The London County Council is prepared to allow the Deputy Superintendent at Horton, who is fully cognisant with this work, to perform the necessary supervision of the patients at that institution, without any payment by this Department, and the Minister is now satisfied that, as most of the other hospitals have been visited at least once and the necessary precautions taken and management of cases are more widely known, the work of visiting the various hospitals with infected mosquitoes can in a number of cases now be devolved upon a competent laboratory assistant.

There are at present two Laboratory Assistants employed by this Department on this work; one a permanent officer who is specially qualified, and the other a temporary officer whole employment was sanctioned for a period of one year by Sir H.H. Scott’s letter of the 15th October, 1927. (E.4102/2).

If the work of conveying infected mosquitoes to the various hospitals is in general to be performed by a Laboratory Assistant, it is necessary, not only that the employment of the present temporary laboratory assistant should be continued, but that an additional officer should be appointed, who, having regard to the considerations set out above, the Minister would propose to be a temporary office.

The Minister would accordingly be glad if Their Lordships would be please to approve, for a period of two years,

(a) the continued employment of the temporary woman laboratory assistant sanctioned by Sir R.R. Scott’s letter of the 15th October, 1927.

(b) the employment on a temporary basis of an additional laboratory assistant on the scale applicable to a Second Class Laboratory Assistant, viz. £91.5 - £5 - ££120 per annum plus bonus.

I am, Sir,

Your obedient Servant,

H.A. Leggett.’

Sent [H.A. Leggett] to L.G. Brock, May 1928.
May 1928
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‘Dear Brock,

It would, I think, be well to set out fairly fully for record purposes the result of our discussion the other day on the future administration and financial arrangements in connection with the malarial treatment of persons suffering from General Paralysis of the Insane.

The present position, as I understand it, is that the London County Council have set aside the isolation block at the Horton Mental Hospital for the treatment of inmates of that hospital who are suffering from general paralysis of the insane; that within that block they provide us with accommodation for a laboratory for rearing and infecting mosquitoes with malaria; and that these mosquitoes, while used mainly at Horton are, as occasion requires, sent to other mental hospitals using the same kind of treatment. Until Dr. James went to India last year he was in general control of the medical side of the arrangements, though so far as Horton was concerned a great deal of teh actual treatment work was performed by Dr. Nichol [sic] (one of the Medical Staff of the Institution employed and paid by the London County Council), and the care of the mosquitoes was undertaken by two laboratory assistants (one permanent and the other temporary) employed and paid by the Ministry. When Dr. James went to India it was necessary to employ Dr. Nichol not only on the Horton cases, but also for general oversight of the results, and he was therefore seconded from the London County Council service, his salary continuing to be paid by them, but the Ministry paying the cost of a substitute from their Scientific Inquiries subhead. Quite apart altogether from Dr. James’ visit to India it would have been necessary to provide him with assistance, partly because he was required for other duties, and partly because the service had developed. It therefore becomes necessary to consider the continuance of the service of Dr. Nichol, or some other equally qualified person, for general supervisory work.

While still in the experimental stage this was quite a proper service for us to undertake, and therefore proper for us to pay from our Scientific Enquiries vote for the additional medical assistance required, but it now appears to be emerging from the experimental stage into a definite and recognised system of treatment. If this is the case it would be quite improper for us to continue to finance the scheme in any way, either by way of provision of the necessary mosquitoes or otherwise and it would seem that it should properly be undertaken and paid for by the Local Authorities, such central supervision as is necessary being provided by you. We understand, however, from you that the experimental and research stage cannot yet be said to have finished; that there is still a difficulty in securing that the mosquitoes are infected with the right type of malaria; that the treatment, while becoming more and more recognised is still looked at with some apprehension by certain of the Medical Superintendents, and that at present the Medical Superintendents still need careful instruction in administering the treatment; and that it is essential that all the results should be very closely watched and studied to complete the technique of the treatment. You made the further point that this is almost the only definitely positive treatment for insanity that has ever been successfully tried, and that it is vital until the technique is definitely developed and stabilised, that the present control should not be diminished.

We are quite prepared to agree that the experimental stage is not yet definitely over but feel that the experiment is sufficiently far advanced to justify the consideration of the future with a view to placing the matter on its proper basis, and in some way or another giving the Local Authorities full financial liability, subject of course to such medical supervision as you may regard as necessary. In any case we feel that, without statutory authority, it would be impossible for us to undertake the responsibility for any central machinery for the supply and distribution of infected mosquitoes, once the experimental stage is definitely over.

We have since our discussion looked further into the financial side and can agree, subject to the definite understanding that within the next year or two the matter is placed on the basis I have indicated above, to continue, at any rate until the end of the present financial year, to pay the salary of Dr. Nichol’s substitute from our Vote for Scientific Inquiries. We, in effect, are prepared to agree that the transition from Research to Treatment has not yet been fully accomplished, and that it is legitimate for us to bridge the gap between the two. This will not in itself involve reference to the Treasury, though we shall in October next have to go to them again on the minor point of continuing the services of the temporary laboratory assistant and might take that opportunity of explaining the position in some detail. By that date we may be in a position to see the position a little more clearly. We can at any rate make it plain that the present arrangements are purely temporary and are in no way preliminary to a permanent scheme.’