Recipient of H.M. Frampton to T. Carnwath, 15th April 1935.
15 Apr 1935
Description:

‘Dr. Carnwath.

An estimate of our annual expenditure on Horton is attached. No expenditure in respect of Colonel James’ time and travelling expense has been included as we have no information on which we could allocate the expenditure. His full consolidated salary is £1,261.19s. and his travelling expenses have averaged £38 the last two years.

We have not a complete record of our expenditure on equipment, but since 1929 it has totalled £965, including £80 expenditure in 1933-4 on structural alterations.

H.M. Frampton. 15^th[?] April 1935.’

[attached:

‘Estimate of Annual Cost of Horton Laboratory to the Ministry (apart from Colonel James’ time and travelling expenses).

(a) Salaries and Wages (full consolidated)

(i) Established First Class Laboratory Assistant.) £215.3.0

15% for Superannuation 32.5.6

(ii) Two Temporary Laboratory Assistants (£2.10 per week)) 260.16.8

Insurance 7.0.0.

£515.5.2.

(b) Travelling Expenses.

(i) Laboratory Assistants 200. (approx.)

(ii) Dr. Nichol of Horton Hospital. 25. (approx.)

£225.0.0

(c) Arrangement with Pig Keeper. Isle of Graine for supply of Mosquitoes 12.0.0.

£12.0.0.

(d) Equipment (estimate based on 6 years actual expenditure). 145

£145

Total. £897.5.2.’

Recipient of P.G. Shute to T. Carnwath, 12th Aug. 1937.
12 Aug 1937
Description:

‘Dear Sir,

As on two previous occasions, I spent some of my annual leave on a study tour in Romania this year, having received a grant from the League of Nations Malaria Commission. I have just received the enclosed from the secretary of Jassy University. May I have permission to have it noted on my personal file please?

I am, Sir,

Yrs. obediantly,

Shute.

[separate hand:

‘Mr Rucker.

I have spoken to you of the excellent work Mr Shute is doing but it is gratifying to have this recognition of it from as far afield as Rumania [sic].

T.C. 14/9/37.’]

[attached to above:

Societatea de Medici So Naturalisti Din Iasi to P.G. Shute, 15^th Aug. 1937.

‘Dear Mr. Shute,

It is a pleasure to inform you that, in recognition of your scientific achievements and of the personal interest which you have shown in promoting the improvement in the teaching and practice of malaria research in Romania, the “Societatea de Medici So Naturalisti din Iasi,[“] elected you Membre. Corresp. Etrang. at the 28^th June 1937 meeting.-

President, Prof. Dr. L. Ballif.

Executive Sectretarty, Dr. I. Alexa.’]

[attached with above:

A. Nevil Rucker to T. Carnwath, 20^th Sept. 1937.

‘Dr. Carnwath,

I am very pleased to see this. A copy of the letter from the Jassy University has been placed on Mr. Shute’s personal file.

A. Nevil Rucker.’]

Recipient of S.P. James to T. Carnwath, 10th July 1934.
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.’

Recipient of S.P. James to T. Carnwath, 11th June 1934.
11 Jun 1934
Description:

‘Dr. Carnwath,

As we must not lose the opportunity of utilising the infected mosqiutoes now available I have provisionally arranged to undertake the proposed enquiry at Horton instead of at Exminster. It will be necessary, however, for me to live at Epsom during the week or ten days of the enquiry because the cases must be studied by night as well as by day. I have therefore provisionally arranged to stay at [the?] Woodcote Hotel, Epsom, from Wednesday the 13th but it has just occurred to me that perhaps A.G.D.[?] may object to the grant of subsistence allowance for a place so near to London as Epsom.

But it would be quite impossible for me to do the enquiry unless I can be on the spot night & day. May I ask, therefore, that you will be good enough to arrange that the usual substce [sic] allowance will be allowed me?

S.P. James.’

[Separate hand:

‘Establishment (Mr Poyser).

Here is what appears to be a most important development of this malaria therapy work - the discovery of a Plasmodium which causes only a mild attack in man and is easily controlled by Atebrin. The study proposed by Col. James will involve close observation of the cases day & night for at least a week or ten days, and will necessitate his staying in Epsom. I should be glad to have your approval to enable him to draw the usual subsistence allowance during this period.’

T.C[arnwath]. 11/6/34’

Separate hand again:

‘Dr. Carnwath,

The grant of subsistence allowance during Col. James stay at Woodcote for the purpose of this enquiry is approved.

In view however of the correspondence with the Treasury as to the continuance of this laboratory & in particular to the last para of the letter of the 12 May 1933 the Treasury shd. [illeg.] be told of any new development such as now seems to be proposed before it becomes part of the normal work of the laboratory.

We could hardly embark on a new line of research without the knowledge of the Treasury & it might therefore be desirable to consider this matter now rather than leave it till next year when the whole situation is due to be reviewed by the Treasury.

[signed – ‘A.G.D.’?]. 12/6/34’

Recipient of S.P. James to T. Carnwath, 6th May 1935.
6 May 1935
Description:

‘Dr. Carnwath,

This report will be considered by the Chemotherapy Committee a ta meeting on 13^th July.

From what is said on pages 9 & 15 it will be seen that the continuance of the Ministry’s centre at Horton in something like its present form is regarded as an essential part of the scheme.

With reference to para (2) on page 15 it is probably that I shall be asked at the meeting what period remains during which my services will be available. If I could have any information on that point which I could communicate to the Committee I should be very grateful.

S.P. James, 6/5/35.’

[in separate hand:

‘C.M.O.

Establishment.

You will wish to see this report on the reorganisation of Chemotherapeutic research, as it involves the Horton unit. If does not however affect the present application to the Treasury except to suggest perhaps that we may get what we want for somewhat less than the £500-600 mentioned in my minute. His was Prof Jameson’s figure.

I assume that you will not be in a position to anwer Col. James’ question until you have the Treasury’s decision.

T[?][homas?].C[arnwath?]. 6/VI/35.’]

[attached to above:

‘S.C. 65. Chemotherapy Committee. Report of the Sub-Committee appointed by the Chemotherapy Committee to make recommendations for the organization of Chemotherapeutic work in England.

20^th May, 1935.

...

The Chemotherapy Committee since its appointment about eight years ago has been concerned chiefly with making arrangements for preparing new synthetic compounds and for testing their therapeutic value; e.g. –

I. [testing arsenical compounds [on animals?] in Liverpool and Hampstead, generally not on patients, but in case of single compound, that ‘Professor Yorke has been able to make private arrangements for its test on human syphilis in Liverpool and human trypanomiasis in Africa.

II. New compounds, for the most part on the basis of plasmochin and atebrin, are now being produced at various centres, and these are examined as to their therapeutic action on bird malaria in Cambridge. If further testing against human malaria is desirable, it is carried out at the Ministry of Health’s Malaria Therapy Centre at Horton.

...

Existing Chemotherapy Organisations.

Among the existing activities at present associated with the Chemotherapy Committee are:-

1. The Liverpool unit under Professor Yorke.

2. The London unit under Sir Rickard Christophers.

3. The Ministry of Health unit at Horton under Colonel James.

4. The Cambridge unit under Professor Keilin.

Although these various organizations are all working in close association with the Chemotherapy Committee it must be remembered that in one case (Liverpool) the Committee contributes only a fraction of the cost of the work and in another case (Horton) nothing at all, whilst in the remaining instance the units are housed by the London School of Hygiene and the Molteno Institute, respectively...

...[description of testing facilities and beds available at Liverpool School of Tropical Medicine]...

...[ description of testing facilities and beds available at London School of Tropical Medicine]...

The Ministry of Health and London County Council Malaria Therapy Centre.

This centre in something like its present form is essential, not only to chemotherapeutic research and testing, but in connection with malaria research in England as a whole. The exact relations to the scheme would be a matter for consideration, but inclusion need not restrict its other work in connection with malaria. Apart from small annual honoraria paid to Colonel James and Mr. Shute by the Medical Research Council [note: ‘Total £125’] this centre is financed entirely by the Ministry of Health and the London County Council.

...[ description of researchers employed at the Molteno Institute, Cambridge]...

...

Recommendations.

We have now to consider what steps should be taken to remedy the defects of the existing organisation and to put into operation the principles which, in our opinion, are essential for the development of chemotherapy in this country. There appear to us to be two possible lines of action:-

(a) The first plan which presents itself is the establishment of a single large chemotherapeutic organisation or institution. The establishment of such an institution would be an exceedingly costly matter. Not only would it be necessary to provide a building of considerable size and to equip it, but it would be necessary to provide a large and experienced staff familiar with the various infections – malaria, trypanosomiasis, syphilis, etc. – for which it is hoped to discover new methods of treatment. Apart from the financial considerations, this might well prove a difficult matter, as the number of individuals in this country who have interested themselves in chemotherapy is very limited. Furthermore, it is very doubtful whether such a scheme could be brought into operation without considerable delay.

(b) A more practical and economical plan, and one which we recommend, would be to build upon organisations which already exist, and to endeavour to establish two adequately equipped chemotherapeutic centres, one primarily for malaria in London, and the other for trypanosomiasis and syphilis in Liverpool...

...

The London Centre.

The organisation of an adequate malaria centre is obviously a much more difficult matter. In our opinion the first step necessary is the amalgamation of the activities at present going on in Cambridge and London. This we believe to be unavoidable, not only on economic grounds, but because we hold strongly that testing and cognate scientific research should be carried on in the same place and under the same direction. Laboratory testing and chemotherapy research should clearly be combined in one organisation under one roof. Further it is most desirable that it should be located in close association with other laboratory activities particularly those relating to the investigation of the different aspects of malaria. This is only possible in London. With provision of the necessary accommodation and staff the London Unit of experimental malaria could be readily converted into the organisation required. It could either remain as the Unit of Experimental Malaria, its function being those indicated above, but not exclusive of future extension to other aspects of experimental malaria, or be made a purely Chemotherapy Research Centre. A decision on this point should be come to after consideration of the general position in respect to malaria research in London. An important point relevant to the present scheme is that “testing” of anti-malarial compounds could scarcely remain on a purely routine and stereotyped basis, without gravely limiting its scope and usefulness. Testing is, for example, dependent on maintenance of bird malaria; it must use mosquito-induced infection as well as blood-inoculated material and thus must include arrangements for mosquito culture on an adequate scale etc. It should also be in a position to select and cultivate various types or strains of parasite used and to ascertain which of various standards of “cure” etc. are desirable. It is evident also that it could not neglect such an obviously desirable line as testing toxicity and therapeutic effect on monkey malaria. All this means a very considerable amount of the so-called biological type of work. It will be seen, therefore, that a London “testing” centre would be enormously helped by being associated with experimental work on malaria generally. The idea of a Centre for Malaria Research in London has already received a certain amount of consideration and hence there might be considerable advantages when creating a testing and chemotherapy research organisation in leaving the exact limits of future development as open as possible. In this case it might be desirable to retain the designation of Experimental Malaria Unit even though its staff and functions were for the present entirely designed to cover chemotherapy requirements.

Until the location, accommodation and form of such a centre has been decided exact details of staff are probably best left open, but the staff already given as necessary for a Chemotherapy Testing and Research Centre may be taken as a fairly correct guide.

As regards accommodation we attach a sketch [schematic map] of what we think should serve. Existing accommodation at the London School is roughly indicated at A. It could not accommodate, however, any more workers than at present and increased accommodation as roughly indicated at B would be required.

Clinical testing and research for a London Centre would require to be arranged for at the Horton Centre of Malaria Therapy. Certain provisions would be necessary in this respect.

(1) Some recognised working basis would require to be arranged with the Ministry of Health and L.C.C. by which the necessary facilities for testing and research could be made available to the Centre and a proper working association brought about.

(2) Whilst for the present Colonel James’s services would serve to maintain the necessary control and supervision of clinical testing at Horton it would eventually be necessary to ensure continuance of such control and supervision.

(3) It is very desirable that arrangements should be made through the L.C.C. for a centre for the application of malariatherapy in the pre-mental stage of G.P.I. according to the plan which has already been put up officially by Colonel James on several occasions. The malariatherapy work of this centre should be run as a branch of the Horton Centre according to plans already put up. The establishment of the centre would make available an unlimited supply of human material and would obviate the present practice of conducting experimental trials of new drugs in hospitals as far away as Devonshire and other counties.

(4) It is very desirable that more use should be made than at present of clinical material at Horton in connection with the biochemistry of malaria. The appointment of a chemical assistant to work with Colonel James and Dr. Nicol at this Unit is recommended. It is believed that the L.C.C. would provide all accommodation, but the salary of the assistant and all laboratory equipment should be provided by the Chemotherapy Committee. The introduction of malariatherapy in England has led to great advance of knowledge on the biological aspects of malaria and perhaps equal advance on the chemical side may be expected by associating a trained chemist with the official combined clinical and laboratory organisation which already exists.

...’]

Recipient of W.W. Jameson to T. Carnwath, 16th Sept. 1937.
16 Sep 1937
Description:

‘Dear Carnwath,

As you know, Sinton very kindly undertook Thomson’s duties at Horton for the last few months. Now that Thomson has died it will be necessary to make some more permanent arrangement and I can imagine none better than that Sinton should continue in administrative charge of the Ministry’s laboratory. If this suggestion appeals to you, I shall raise it at the meeting of our Board of Management next month and have a formal communication sent to the Ministry immediately afterwards.

Yours sincerely,

W.W. Jameson.’

Recipient of W.W. Jameson to T. Carnwath, 19th July 1937
19 Jul 1937
Description:

‘Dear Dr. Carnwath,

As I daresay you know, Professor J.G. Thomson is still under treatment in the Hospital for Tropical Diseases and is not likely to be available for duty in your laboratory at Horton Mental Hospital during the month of August. Colonel Sinton will be going on leave during that month and I have ascertained that Sir Rickard Christophers will be in London and prepared to act for Professor Thomson and Colonel Sinton. I hope this arrangement will prove satisfactory to you.

Yours sincerely,

W.W. Jameson.’

Recipient of W.W. Jameson to T. Carnwath, 24th Oct. 1935.
24 Oct 1935
Description:

‘Dear Dr. Carnwath,

You will recollect that on the 17^th September I had a conversation with you in your room at the Ministry on the future of the Ministry of Health’s malaria laboratory at Horton Mental Hospital. You pointed out that Colonel James would retire from the staff of the Ministry on the 31^st August, 1936, and that it was advisable that any arrangement made for the carrying on of the work should come into operation before that date.

I understand that the London County Council is responsible for the maintenance of the premises of the malaria unit at Horton Mental Hospital and that the care of the patients in the two wards attached to the unit is entirely the concern of Dr. Nicol, the Medical Superintendent of the Hospital. The Ministry of Health on the other hand is responsible for the provision of adequate laboratory staff and for the general upkeep of the laboratory itself.

These arrangements I assume will be continued and I have discussed with my Board of Management the proposal that a senior member of our staff should undertake the supervision of the laboratory on behalf of the Ministry of Health. I have been instructed by my Board to submit for your approval the following scheme:-

(1) A senior member of staff of the School would be placed in charge of the laboratory and would be answerable to the Ministry for its proper conduct. The choice in the first instance would fall on Professor [J.G.] Thomson, who holds the University Chair of Medical Protozoology and is in charge of the Department of Protozoology. Professor Thomson has had a wide experience of malaria and would, I feel certain, prove a most competent officer. He would be prepared to spend a very considerable part of his time at Horton Mental Hospital.

(2) With the approval of the London County Council Dr. Nicol would be invited to associate himself with the teaching work of the School.

(3) Other departments of the School would undertake to facilitate the work of the Ministry’s laboratory in every way possible and would be given opportunities by Professor Thomson of so doing.

(4) The cost of the services provided by the School would be met by an annual grant from the Ministry of Health. This cost would amount to not less than £500 a year and would include the charges incurred by Professor Thomson for transport between the School and Horton Mental Hospital but would not include the expenses of any travelling between Horton Mental Hospital and other institutions undertaken at the request of the Ministry.

(5) Some provisions should be made for terminating the agreement on due notice being given by either party.

(6) If the scheme is approved, Professor Thomson would be prepared to enter upon his new duties at any time convenient to the Ministry.

It only remains for me to add that the School welcomes such an opportunity of co-operating with the Ministry and realises fully the value to its work of such an association as is contemplated.

Yours sincerely,

W.W. Jameson.’

Recipient of [unknown] to T. Carnwath, 6th March 1934.
6 Mar 1934
Description:

‘Dear Carnwath,

We were speaking about this laboratory the other day and I promised to let you have the file. You will see that we have next year again to take up the question with the Treasury and that the position is by no means free from difficulty.

Yours sincerely,

[signed].’