Created by George Seaton Buchanan
14 Apr 1928
Description:

‘The present system represents only a provisional arrangement during the period of testing malaria treatment in different ways and particularly by the utilisation of infected mosquitoes. Horton asylum and its laboratory has been the principal place at which the trials have been made. The laboratory has been the centre for mosquito infection and transmission to mental hospitals in different parts of the country. The scientific work in connection with this has been done by officers of the Ministry, i.e. Colonel James (with occasional assistance from other medical officers) and two laboratory assistants (one of them being Mr. Shute who is highly specialised in all the technique). During Colonel James’ recent absence in India the medical work was taken on temporarily by Dr. Nicol, one of the medical officers of the Horton Asylum, who was paid out of the Ministry’s Special Enquiries Fund. In view of Colonel James’ other arrangements, Dr. Nicol’s temporary employment (his full time) is being continued until the end of May.

The position after May requires consideration. To go on even on the present limited scale, we would have to require that Colonel James should give much more of his time to this work than he could well be spared for. So long as it is a question merely of periodic visits to Horton and advising on the details and progress of the work, Colonel James could manage it – it is helpful to his own studies and it may be doubted whether any other medical officer available could supply the necessary experience. But it is almost out of the question that he should do more than this, and especially that he should be going about the country from asylum to asylum to give or instruct asylum medical officers in the treatment.

If the present position is –

(1) That malaria treatment can now be said to have passed through the probationary stage and to be already established as a definitely successful method which can effect cures in a material proportion of cases of a disease hitherto considered practically incurable, and

(2) that the treatment cannot be given in asylums without a considerable amount of organisation associated with at least one central laboratory with a medical officer and assistants,

we seem to have arrived at the stage at which provision of the treatment and the maintenance of the central organisation for it is rather a matter for the Board of Control than for the Ministry – provided always that the Board has at call the expert malariological advice and assistance which the Ministry can give. Admiral Meagher’s recent investigation of results seems to give us a substantial turning point in this matter. He has been exceedingly careful in the examination of data and very cautious in pronouncing upon it. Wherever possible he has designedly selected data which are unfavourable rather than favourable in the treatment. For example, he enters patients who have been discharged “on trial” as being still in hospital, whereas medical officers of the hospitals concerned enter these patients as having been discharged. He has followed up discharged patients with great diligence; and claims to have accounted personally for every case with which his report deals. Despite his intentional caution and bias he has convinced himself that the treatment is wonderfully effective. After studying his report, I think that the Government Departments concerned must accept that conclusion and must agree that the treatment can no longer be said to be in the experimental stage or to need further enquiry before permanent arrangements for providing it are made.

On the assumption that the nature of these permanent arrangements may require to be settled, and settled soon, in view of the position in which we are in about Horton, I have obtained the following suggestions from Colonel James:-

“The arrangements which would ensure the therapeutic course being given in the best way and with least risk to patients would be to concentrate patients in a selected hospital provided with medical officers and nursing staff who have special knowledge of both mental disease and malaria. This plan would do away with the present loss of time and expense involved in sending a medical officer to hospitals in different parts of England to initiate and advise on the treatment and would certainly tend to lessen the number of deaths which at present occur during the malarial attack. It would also facilitate greatly the desirable aim of giving the attack in all cases by mosquito bites instead of by the injection of blood. The latter practice is acknowledged to be objectionable and its results have now been shown to be inferior to those of the former practice.

Doubtless the plan of setting aside a special hospital where all suitable cases of G.P.I. in England and Wales will be treated by malaria (and where uncertified patients will also be able to get the benefits of treatment) can only be brought into being after a sufficient number of trained staff are available, but I think a beginning should be made by augmenting existing arrangements at Horton and by making it a training centre. I suggest that:

(1) A ward for the treatment of 14 male patients be set aside at Horton, in addition to the present ward for female patients;

(2) that the existing laboratory arrangements for preparing infected mosquitoes be duplicated as regards subordinate laboratory staff and apparatus at Horton in the block to be set aside for male patients;

(3) that a new appointment of medical officer be made under either the Board of Control or the Ministry of Health, the selected officer being placed in charge of the Horton centre. He must be qualified in mental diseases and in malaria. I suggest that Dr. Nicol be offered this appointment on a scale of pay equal to that which he might ordinarily expect to get if he remained in his present service.

(4) Horton should be made the centre for London and the South of England and a second medical officer and subordinate staff might be trained there for the purpose of establishing a similar centre in the North of England which would also serve Scotland.

(5) This plan or a modification of it would need the co-operative action of the Board of Control, the Ministry and the L.C.C. I therefore suggest that in the first place a conference between representatives of those Departments be arranged as soon as possible”.

Colonel James’ suggestion of a conference to go into this or other possibilities seems a good one. In any case it would be well to have a preliminary discussion before the end of the present month at which the necessary arrangements in consequence of the termination of Dr. Nicol’s engagement can be determined. We should need the assistance of Mr. Leggett or someone from Establishment.

G.B.

April 14/28.’