Recipient of R.H. Steen to to C. Hubert Bond, 11th June 1923.
11 Jun 1923
Description:

‘Dear Dr. Bond,

For several months past I have been trying to get hold of a case of Malaria. I wrote to the different Hospitals for Tropical Diseases without success. Dr. Templeton 2nd A.M.O. here wrote a short paper upon the matter in the B.M.J. of May 26th. 1923. The Editor kindly inserted an annotation stating that we were looking out for cases. This brought to light two cases and two of our patients have been inoculated, and one a case of Tabes has apparently “taken” though before coming to a definite decision we are having his blood examined. Unfortunately at the present time our cases of G.P.I. are of a very poor type, but I expect a recent case to-morrow. I can say nothing at all about results as we are only just starting.

During my absence from home the cases were inoculated without communicating with the friends but I have given directions that in all cases in future, the consent of the friends must be obtained first and one consent arrived this morning.

With kind regards,

Yours sincerely,

R.H. Keen, Medical Superintendent.

P.S. It has occurred to me that it might be worth trying in other cases of other diseases [missing from photograph].’

Recipient of R.M. Clark to C. Hubert Bond, 13th June 1923.
13 Jun 1923
Description:

‘Dear Dr. Bond,

I only got your letter this morning on my return from a few days off.

We commenced treating G.P.I.s with Malaria inoculation last July. The first three patients were inoculated with Quartan at the Liverpool School of Tropical Medicine by Prof. Stephens and the two took. We were not satisfied with this strain and did not reinoculate from it. We next brought the blood about 3 c.c. from a Tertian case which had not had quinine from Liverpool in a vaccum flask at about body temperature here & inoc’d it [sic] G.P.I. The blood was first citrated in Liverpool & was quite 2 ½ hours on the way. The inoc’n was successful & this has been the root of our strem[?] which up to now we have been able to keep unbroken by inoc’ing from Patient to Patient. We have injected the citrated blood directly into the vein of the recipient but the simplest way is to bring the recipient to the bedside of a patient with parasites in his blood & inject it without any citration directly subcutaneously into muscles of the recipient’s back – it is better to move the needle about roughly in the mucles & thus cause haemorrhage at the seat of the inoc’-.

In all 23 males and 5 females have been inoc’d and have taken and 2 were given a second course of Malaria 6 months after the first. Last week a Rainhill patient was sent here & inoc’ed; in this way we will have a better chance of keeping our strain going. I do not wish to lose it as I consider it a valuable strain & we call it ‘W’ strain. It is valuable because after a year’s experience we know something about it. ‘W’ strain has caused no untoward results – the rises of T˚ [sic] have been reasonable 104˚ to 106˚ no fulminating[?] cases – no unreasonable splenic enlargements & all cases have at once responded to Quinine – In some cases we followed the malaria with a course of Salvarsan. Six days has been about the average incubation period.

The blood of all patients has been carefully watched for appearance & disappearance of parasites – 1000s of blood films have been made in some cases as often as every ten minutes – Duplicates of these films have been sent to the L. school of Tropical Medicine & Prof. Stephens & Yorke have been keenly interested as well as helpful.

Of late several Germans have found Relapsing fever preferable to Malaria in G.P.I. & this week 3 G.P.I.s were sent to Liverpool where ticks infected with Relapsing Fever spirochaete were allowed to feed on them.

To begin with consent was always asked of relatives & almost always readily given – latterly I have not considered this necessary as Malaria treatment at present may be said to be the usual & recognised treatment for G.P.I. on the continent at any rate. A year is too short a time for a real trial of treatment for such a disease as G.P.I. & I do not commit myself definitely. My impression is that many of our cases would have been dead ere this. There has been marked physical improvement in 90%. One bedridden case with bed-sores & unable to stand is up & about. Two cases are fit, ‘Discharge Recovered’ for the time being & there is I think distinct improvement in others. We did not select our cases but have been very particular about diagnosis only treating those obviously G.P.I. clinically but we have always verified the diagnosis by the more reliable serological tests. The Wass. & the G.P.I. Gold sol[?] curve & the Gambage[?]/ Several cases have shown mental conditions unusual to advancing G.P.I. becoming more hallucinated [sic], more aggression towards others who they accuse of talking ill of them. One periodically refuses food for days and is more masterful, most of them are less facile than we would expect. The best way to start[?] the treatment in another Mental Hospital would be to send a patient here for inoc’n when we have a case with Parasites in the blood.

Of our deaths one was one of the Quartan cases the malaria was of the fulminating type with very large spleen. Another male had shown marked improvement when he died rather suddenly from heart failure. The third death was a female who developed Influenza after malaria, bronchitis & cardiac dilatation followed.

Opinions differ on such questions. When I first read of von Wagner Juaregg’s [sic] article I write to the London School of Tropical Medicine enclosing the article & asked the opinion of an old friend G.C. Low – he was not at all enthusiastic – I then tried the Liverpool S of T.M. and Prof. Stephens at once showed himself very keen and interested. Please excuse such a long letter.

Yours Sincerely,

R.M. Clark.’

Recipient of R.M. Clark to C. Hubert Bond, 30th Aug. 1923.
3 Aug 1923
Description:

‘Dear Dr. Bond,

I shall be very pleased to welcome Colonel James and give him all information I can. Thanks for information re notification of Malaria which I had overlooked, I think I will be able to satisfy Colonel James.

We recognised the possibility of spread of malaria but omitted to consider the possible risk if discharged patients go out to a district where anopheles exist. Mosquitoes are common here and we hunted them up on the wing and at their breeding grounds and satisfied ourselves that no anopheles were present but only culex. Professor Stephens advised me that in his opinion the danger of spread was nil and this was before we knew that inoculated Benign Tertian Malaria does not relapse.

This has been our experience as well as W. Juaregg’s and is probably due to the absence of teh stage in the life cycle of the parasite in the mosquito where only sexual reproduction takes place.

The marked feature about inoculated malaria is the promptness with which it responds to Quinine and the absence of Relapse. What would happen if the plasmodia again passed through the mosquito it is difficult to say. The question is a very interesting one and Professor T. Pantano of the University of Rome is at present working on it.

I am sorry I will not be able to get in touch with Colonel James on Monday night.

I am,

Sincerely yours,

R.M. Clark.’

Recipient of S.P. James to C. Hubert Bond, 14th Nov. 1923.
14 Nov 1923
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‘Dear Bond,

Following the arrangement you kindly made, I visited the City of London Mental Hospital at Dartford on 31st October and I have since made a careful examination of blood films collected with Dr. Steen’s kind co-operation on 6th November. I am less comfortable about the risk of spread in the Dartford Hospital than I was as regards the Whittingham hospital. Although my visit was late in the season we were able to find specimens of Anopheles maculipennis (the malaria-carrying species in England) in the stables near the hospital and I am afraid it is almost certain that during the summer months they would be numerous and would have opportunities of biting the malaria patients who are in bed under open verandahs [sic]. Examination of the films shows that the blood of these patients contains many sexual forms of the parasite – the forms which are potentially infective to mosquitoes – but I cannot be quite sure whether in actual conditions these parasites of inoculated cases would infect mosquitoes until I have fed some mosquitoes on them and observed the results. Dr. Steen has expressed his willingness to give me facilities for carrying out this small enquiry and if you see no objection I should propose to do it as soon as possible. It is quite necessary that we should know whether the blood of these patients is really infective to mosquitoes before we draw up rules for the manner in which the procedure connected with treatment of patients by malaria inoculations should be carried out; and we cannot make a decision on that matter until the suggested feeding experiment has been done.

You are doubtless aware that at Dartford at present the inoculated patients are scattered in several general wards and that the hospital differs from Whittingham in the absence of laboratory facilities for controlling the source of the inoculated disease by regular blood examination. At the moment it seems to me that, when this inoculation treatment is carried out in an area where anopheles mosquitoes are common, the patients should be segregated in a mosquito proof ward during the period of their infectivity and that this period should be ascertained and controlled by blood examinations. But as I have already mentioned the decision to make rules of this kind cannot be placed on an entirely satisfactory basis until we have ascertained by a feeding experiment that parasites which have passed through a series of patients are still infective to anopheles mosquitoes.

I discussed the above points with Sir George Buchanan last evening and he thought it would be well for me to discuss them verbally with you. If you will kindly ‘phone me suggesting a day and time this week I will be at your office then.

Yours sincerely,

S.P. James.’

Recipient of [S.P. James] to [C. Hubert Bond], [c. 5th September, 1923].
Between 4 and 6 Sep 1923
Description:

‘As arranged with Dr. Bond of the Board of Control I visited the County Mental Asylum, Whittingham, on the 4th September. Dr. Clark very kindly met me and gave me every assistance in my enquiry. The conclusions which I have come to as a result of my visit are as follows:-

(1) In this hospital there is no risk that malaria will spread from inoculated patients to other inmates.

(2) In an experience of more than a year no patient who has been inoculated has suffered from a relapse of malaria. The experience is sufficient to justify the conclusion that the type of malaria inoculated is completely cured by the treatment given, and that a patient who might be discharged to his home after going through the course of treatment prescribed would not be liable to malarial relapses. Therefore his discharge would not involve any risk of the spread of malaria to his family.

On these conclusions I am of opinion that from the public health point of view the official notification of these cases under the Malaria Regulations is not necessary and may be dispensed with.’