Sent from H. A. Leggett
May 1928
Description:

‘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.’