Sent from Sydney Price James
13 Jun 1930
Description:

'S.M.O. I.

In the letter of December 928, to the Treasury it was stated that the Minister was not in a position to give an indication of the date on which the central control now exercised would cease, but that it was probable that present arrangements must necessarily continue for the next two or three years. The latter period would be to the end of 1931. But, since that letter was sent, the position has changed.

Towards the end of 1929 new procedures for the treatment were called for. They arose as a result of requests for the re-inoculation of patients who had shown some improvement from a first course of malarial therapy but who, it was thought, would benefit still further from a second course. In complying with these requests we found that patients who have passed successfully through a full primary course become to a considerable degree immune to the strain of organism with which they were first infected, and for this reason cannot be given a therapeutically effective second course except by employing a malarial organism of a different species (that is to say a quart[an] or subtertian organism instead of a benign tertian). Thus our work at Horton now requires us to keep three kinds of malaria going in the patients under treatment there (instead of only one kind as was the case in 1928), and we are now engaged in trying out these different types and ascertaining how they can be safely used for the purpose of the treatment.

It is a long procedure but quite essential in view of the fact that malarial therapy still remains the only hope of cure for the patients concerned, and that its use is increasing every year. Changes and improvements of this kind are inevitable in every new form of treatment and it would be premature to hope that this new experimental stage will soon be over.

Other circumstances which make it inadvisable to change present arrangements should also be mentioned. One of them is that I have lately been appointed to assist the Chemotherapy Committee of the Medical Research Council in testing the efficacy on cases of human malaria of the synthetic drugs (substitutes for quinine) prepared by Professor Robinson and selected after trial on bird malaria by Professor Keilin at Cambridge. Any diminution or transfer of our existing helpers at Horton (who are technically expert in tests of this kind) would be detrimental to this important duty. Another is that our centre at Horton has come to be regarded as a very suitable training centre for medical officers who are to be appointed to posts as “malariologists” in British Dominions and Colonies. At the request of the Colonial Office we recently undertook to give a course of study to an officer from Kenya and another from Uganda, and several medical officers from India have previously been instructed in the same way. We have also given technical instruction to medical research workers from Egypt, Germany, Italy, the United States & other countries and it has become almost a routine for us to supply material for teaching purposes to the London School of Tropical Medicine and Hygiene. A third circumstance is that our laboratory and treatment centre at Horton (although it is on a small scale) happens to be the only organisation in the world where the practice of malariatherapy with the use of mosquitos enables research to be done on the clinical, therapeutic and epidemiological features of malaria contracted in the natural way. This has led to the solution of some important practical problems. The action of our ministry in establishing the centre has been warmly praised in Europe and America, and distinguished professors from France, Germany, Italy, Greece and other countries have made special journeys to England to visit the centre and study the technical arrangements and methods. A fourth is that (as I understand) a proposal is on foot to establish, in a hospital in London, a special ward (50 beds) for the malarial treatment of cases of incipient neuro-syphilis, and that it is in the minds of the promoters to look to the Ministry of Health to supply the necessary infected mosquitos and to assist in organising the arrangements.

I must also note that to meet increasing needs (in accordance with my note of 7th December, 1928), the authorities at Horton are now increasing the accommodation of the treatment and laboratory centre there. It is thought that the extensions will be completed within the next two or three months. Colonel Lord consulted me about the new buildings; the laboratory accommodation will now be sufficient to enable us to appoint the third laboratory assistant sanctioned by the Treasury in January. 1929, and for the proper accommodation and instruction of the Colonel and other medical officers for whom (as mentioned above) we have undertaken to provide instruction.

It is obvious, of course, that the success of the Ministry’s centre at Horton is due very largely to the collaboration and assistance received from Colonel Lord, the Medical Superintendent of Horton Mental Hospital, and from Dr. W.D. Nicol, the Deputy Medical Superintendent, who has shared with us all the work of the centre since its establishment. Without his continued services the work could not be carried on satisfactorily. Now that the new circumstances detailed in this note have brought about an increase in the scope and activities of the centre his continued assistance is more than ever necessary. The use of the new strains of malarial organism (one of which – the so-called “malignant tertian” – requires extreme care if the life of patients is not to be endangered) has made it impossible, when these strains are used, to utilise a laboratory assistant for visits to hospitals. For these reasons I cannot now advise that there should be any change in existing arrangements for refunding travelling expenses to Dr. Nicol in connection with the work which he does voluntarily for the Ministry.

The appointment of the third laboratory assistant was postponed for the two reasons of which Establishment have been kept informed from time to time (e.g. my note of 22nd February, 1929). The first was lack of accommodation at Horton; the second, difficulty of finding a suitable man. I hoped that, as stated in my note of 22nd February, 1929, our collaboration with Professor Dodds would have solved both these problems. But the distance between his laboratory and Horton was too great, and it appears that it is not possible to get a male laboratory assistant with the required qualifications (Intermediate B.Sc.) at the salary offered. The problem of accommodation has now been solved by the Horton local authorities, and we have found that although it is hopeless to get a qualified male assistant at the sanctioned salary, it may be possible to get a temporary female assistant (equally well qualified) on that scale. I have an application from Miss H. Rushby of University College Hospital who is about to take the 2nd M.B. examination of the University of London (equivalent to Intermediate B.Sc.). For domestic reasons she has to relinquish her medical studies and desires a temporary post for two years. She is well qualified for our work and I therefore suggest her appointment from the date on which her examination (2nd M.B.) ends.

S.P. James, 13/6/30.

[separate hand:

‘W. Leggett.

I agree.

G. Buchanan,

18 June/30.’]