Sent from Sydney Price James
10 Jul 1934
Description:

‘Establishment’s minute of 12th June (by Mr. Poyser) seems to indicate that, on the subject of continuing the Ministry’s Malaria Laboratory at Horton, it might be advisable to approach the Treasury now instead of waiting until they bring up the subject next year. I should be very glad if this could be done and I have written the following note in the hope that the information it contains may be useful in connection with the matter.

1. The therapeutic practice of intentionally infecting patients suffering from general paralysis (and some other organic diseases) with malaria = the practice called “malariatherapy” = is no longer in the experimental stage. This method of treatment is now universally approved and demanded, not only for general paralysis, but for a number of other diseases, some of them non-mental. Thus the administrative problem is different from what it was when this new method of treatment was commenced in England. [The] problem is now concerned with deciding what permanent arrangements shall be made for the provision of pure malarial material and other facilities for carrying out the treatment. Up to the present the Ministry of Health has itself fulfilled this duty. If it is decided that [the] Ministry should no longer do so an equally satisfactory and economical plan must be devised.

2. The subject may be considered first with reference to the demands which are now received for malarial material with which to apply the treatment. These demands are not confined to institutions in England and Wales. General (voluntary) hospitals bulk largely among the institutions supplied and some of them are in Scotland and Ireland. Many requests for material are also received from practising physicians who treat their patients in nursing homes. Requests complied with during recent years have been roughly in the following proportions:

Mental Hospitals 86

Practising physicians 100

General Hospitals 144

In addition, in response to specific requests, the material has been successfully conveyed in mosquitoes to Holland, Italy, Germany, Malta, Roumania and Spain for the purpose of malariatherapy in those countries.

Thus it may be said that the provision of pure malarial material for the practice of malariatherapy has become a national (and to some extent an international) service.

3. Secondly, it is now the case that general paralysis of the insane and other mental diseases are not the only disease for which facilities for malariatherapy are demanded. In voluntary hospitals and elsewhere the measure is being tried for carcinoma, sarcoma, asthma, rheumatoid arthriris, leprosy, tabes, epilepsy, chronic skin affections and other diseases for which no satisfactory medicinal remedy is known.

4. Thirdly, to comply with demands it is no longer sufficient to maintain and supply only one kind of malarial material and it has become increasingly necessary to cultivate various kinds of malaria in mosquitoes and to supply these insects for the purpose of infecting patients. At first only one kind of malaria was used, namely benign tertian; now some physicians demand quartan, others ovale, others subtertian. The cultivation of the various species in mosquitoes has become more and more necessary because that is the only mode of infection by which the risk of transferring syphilis or other diseases with which a blood donor may be infected can be eliminated.

5. To meet these demands the Ministry’s malaria laboratory has obtained and cultivated in mosquitoes a number of species and strains of malaria from India, Africa, Italy, Roumania, Germany and other countries. For several years past four different species of malaria have been maintained continuously in the laboratory. In order that this work might be done the authorities of the Horton Mental Hospital, with the approval of the London County Council, were good enough to add a new ward for male patients to the malariatherapy centre (of which the Ministry’s laboratory is an integral part) and to increase the laboratory accommodation by two rooms. Recently additional laboratory accommodation again became necessary in order that the mosquitoes might be reared on the premises instead of being collected in nature and that arrangements might be made to avoid the risk of mixing infected with uninfected insects. The Horton authorities allotted two more rooms for these purposes and the Ministry bore the cost of fitting them up (Mr. Bailey’s letter to the Treasury dated 19th December 1932).

6. Relative to the present practice of using different kinds of malaria for malariatherapy an entirely new departure is now under trial at the laboratory, namely the use of malarial material derived from monkeys, instead of, as hitherto, from the human host. Particulars of the preliminary work in connection with this new even are fiven in my letter of 1st June 1934 to Dr. Eager of which a copy is in Establishment File 1026/82 [Nat. Archives: MH 78/102] dealt with by Mr. Poyser in his note of 12th June. Since then I have worked continuously in this new development but some time must elapse before an opinion can be given on the procedure. If it turns out to be successful and practicable it will be a valuable addition to the procedures hitherto practiced.

7. The information given in the above paragraphs 4 to 6 shows that, although the therapeutic practice itself (malariatherapy) has passed beyond the experimental stage, the technique of the practice is still going through many experimental changes. It shows, too, that the provision of the malarial material required for applying the practice has become a highly specialised technical procedure. My knowledge of the means and materials at the disposal of existing research organisations and institutions, public health and mental hospital laboratories, and schools of tropical medicine in England leads me to think that it would be very difficult for any of them to make arrangements for maintaining and supplying the necessary malarial material. The Ministry of Health, on the other hand, already has at its disposal an expert staff who have had nine years’ experience and practice in the procedure and it already has built up the necessary liaisons [sic] with foreign laboraotories engaged in the same work so that it has facilities for obtaining the various species and strains of malaria required. For these reasons I find it difficult to believe that an economical or other useful purpose would be served by devolving the work from the Ministry of Health. Moreover, even if this were done the Ministry would still have to continue its supervision of the procedure and practice to ensure the purity of the malarial material supplied and to guard against various risks which experience has shown are inherent in connection with the widespread use of malaria as a cure for other diseases.

8. There are other reasons why the provision of malarial material for the practice of malariatherapy and other arramgements relating to this method of treatment should remain in the hands of the Ministry of Health. One of them is that transfer to another organisation would almost certainly result in cessation of the national (and international) character of the work. The activities would quickly become limited to the small local needs of the particular body in whose charge they were placed. Difficulties would arise in connection with the supply of material to hospitals and individuals who were not within the area served by the authority whose laboratory was charged with providing the material. From lack of liaison with foreign laboratories engaged in the same work it is probable that only one kind of malaria would be maintained and that kind probably by direct blood inoculation alone. Advice and assistance which at present is freely asked for from the staff of the central government and freely given would not be available. The present practice of taking advantage of the opportunities available for research into malaria and for giving post-graduate instruction to medical officer[s] of the Home and of Foreign Governments would automatically be discontinued. This would be detrimental to the advance of knowledge on a disease which is the greatest scourge of mankind and is of paramount importance to the British Empire. It would also be a loss to the prestige which the Ministry rightly gained and continues to gain in nation[al] and international scientific and public health... [end of line missing]... its decision to create and maintain its existing... [end of line missing]... It is proper to recollect in this connection that England (through its Ministry of Health) was the first country in the world to appreciate the significance of malariatherapy from the point of view of the facilities which it offered for the study of malaria and to create a special organisation serving that purpose as well as the requirements of the new treatment. The organisation was established in 1925 and, from the advances of knowledge on malaria which emerged, other countries quickly realised that the organisation marked a new epoch in malaria research. Germany, Italy, Holland, Spain, Roumania and the United States have sent professors to study the Ministry’s organisation and technical methods with the object of establishing the same arrangements in these countries. Other countries which are not in a position to establish similar centres send workers to learn the method of study and the results obtained. Since 1926 more than 60 research workers from abroad have availed themselves of the facilities for studying malaria placed at their disposal in the Ministry’s laboratory.

I think it is inevitable that this useful service would automatically cease if the work of providing and supplying malarial material were devolved from the Ministry.

I think it is proper to note also that the arrangements created by the Ministry in 1925 enable discoveries and other advances of knowledge on malaria to be made which are considered in scientific and public health circles to be of importance to the British Empire and the World generally. [note: ‘See an Editorial in “Nature” May 26, 1934, page 787 in which it is said: “the results obtained at this laboratory, which has been visited by nearly all the best-known malariologists, and have been copied in other countries, have had a profound influence on malarial thought & action throughout the world.”’] The activities of the organisation in this respect are summarised from time to time in the Annual Reports of the Ministry’s Chief Medical Officer (see particularly the Annual Report for 1931, pages 179-185, for 1932, page 205, and for 1933, page 233, and they have formed the basis of reports compiled for the League of Nations, particularly the Report entitled “Principles and Methods of antimalarial Measures”, published in 1927, and the Report entitled “The Therapeutics of Malaria”, published in 1933 [this on results of prophylaxis experiments - see Quarterly Bulletin of the Health Organisation of the League of Nations 2 (1933)].

S.P. James, 10/7/34.’