Created by George Seaton Buchanan
23 Jan 1932
Description:

‘Origin and Purpose.

Until 1917 “general paralysis of the insane” (G.P.I.) which accounts annually for more than 1,000 deaths in the mental hospitals of England and Wales, was believed to be an incurable disease, fatal in most cases within 2 years. Though a form of insanity which results from syphilis, it is not curable by anti-syphilitic drugs, ancient or modern, when the syphilitic organism has established itself in the central nervous system.

In 1917 Professor Wagner-Juaregg of Vienna proved that at any rate some of these patients can be cured by inoculating them with malaria and allowing them to have 10 or 12 malarial “rigors,” and then curing the malarial infection with quinine. The inoculations were performed by withdrawing a little blood from the vein of a previous malarial patient and injecting it subcutaneously into the new patient.

Malariatherapy of G.P.I. was tried tentatively in England in 1922. In 1923 the Board of Control, acting on a report by Col. S.P. James, M.D., F.R.S. (the Medical Officer of the Ministry of Health who advises on Tropical Diseases) made official arrangements to provide the treatment on approved lines. There are important objections to the method of inducing malarial attack by the inoculation of blood from patient to patient, and because of them, and for other reasons, it was decided to induce the necessary malarial attacks by the bites of infected (anopheline) mosquitoes.

Col. James became responsible for collecting and preparing the mosquitoes, and for infecting patients by their bites. The authorities of the Horton Mental Hospital (L.C.C.) established a treatment centre and laboratory for the work. Expenses of buildins, furnishing, and upkeep of the centre, including medical care and nursing, are met by the L.C.C. The Ministry of Health meets charges for laboratory staff, equipment, and services, and for travelling and other expenses connected with the use of the centre to send out malaria-infected mosquitoes to other hospitals. Since the centre was started over one hundred batches of infected mosquitoes (some 300 insects per batch) have been used successfully for infecting patients in more than 200 hospitals in England and Wales and in Scotland.

Value of Malariatherapy as a Remedy for G.P.I.

Of more than 3,000 certified patients who have undergone a course of malariatherapy in mental hospitals in England and Wales, nearly 20 per cent. were able to be discharged from their certificates and sent home, nearly 12 per cent. of them being in a condition which was described in “recovered”. This means, for the “recovered”, that in many instances patients with characteristic delusions of grandeur and other symptoms which formerly would have entailed permanent detention in the asylum, have returned to their ordinary work or professions. The Board of Control reported in 1929, on the authority of Surgeon Rear Admiral E.T. Meagher and Sir Hubert Bond, that the remedy at present holds the field as offering the best, and perhaps the only, chance of recovery to a person suffering from general paralysis of the insane.

Value of the Work for the Study of Malaria.

At the Horton malariatherapy centre psychiatric studies on the effect of induced malaria on G.P.I. go hand in hand with investigations into the malarial infection itself, its natural history in man and in mosquitoes, its treatment and its prevention.

As, (1) the cases are infected in the natural way by the bites of mosquitoes; (2), they are under continuous observation for months or years; (3), the infections are allowed to persist instead of being cured after a short period; (4), each of the three species of the malaria parasite is worked with, and (5), in this country there is not the complication of malaria being contracted otherwise, a unique opportunity has been afforded for the scientific study of the natural course of malaria and for experiments on the drugs which influence it.

Knowledge of the action of quinine, curatively, has been greatly extended by Col. James’ work at Horton. Other studies which have made a striking appeal to research institutes in England, Germany, France, etc., are those pursued continuously since 1927 in order to find a drug which will be as effective in preventing malarial infection, in preventing its spread by mosquitoes, and in preventing relapses, as quinine is effective in curing the clinical attack. The centre at Horton is, and for some years has been, the only place in the world where experimentally controlled chemotherapeutic tests with the object of finding such a drug can be conducted.

Use of the Centre for Post-Graduate Instruction.

At the Horton centre all three kinds of malaria (Benign, Tertian, Quartan and Subtertain) are maintained continuously in patients undergoing the course of malariatherapy, and the cycle of each parasite can there be studied in man and in the mosquito in ways impossible elsewhere. Mosquitoes from England, Italy, Holland and Africa are available for study in the living state, while a unique series of chemotherapeutic experiments with quinine and other drugs is continuously in progress.

Medical Officers and specialists from various countries have asked to use the opportunities for the study which these and other features of the centre affords, and on several occasions the Colonial Office, the Rockefeller Foundation and the League of Nations have required definite courses of training for selected students. This casts a great deal of additional work on Col. James and his colleagues but it has been thought right to undertake it in the general interest of malariology and of British Empire needs. At the present time Dr. [Donald Bagster] Wilson of the Colonial Medical Services, who is to be in charge of an antimalarial research unit in Tanganyika, and Dr. (Mlle.) Vieru, Assistant to Professor Ciuca at Jassy in Roumania are at the centre for specialist study.

G.S.B.

January 23rd, 1932.’