Created by Thomas Carnwath
7 Sep 1934
Description:

‘See Mr Bailey’s minute of 6.3.34 and Mr Poyser’s minute of 12/6/34. and minutes by Col James & Dr. Hutchinson above.

1. C.M.O. 2. Establishment.

1. I agree that this work of providing malaria infected mosquitoes for the treatment of G.P.I. and allied conditions is no longer a legitimate charge on the Special Inquiries Fund of the Ministry.

2. But there has come to be associated with it a most valuable research into the nature and treatment of malaria which has yielded results of great imperial and international importance. As the outcome of this work which is subsidised by the Medical Research Council, a special malaria unit has been established at the School of Hygiene under the direction of Sir R. Christophers to prosecute malaria research on the animal side. Dr. Stanton of the Colonial Office takes a keen interest in this work and maintains close association with Colonel James.

3. It follows that any scheme which the Ministry may devise for shifting or reallocating financial responsibility for Horton must take account not only of the treatment side of the work done there but also of the research that is being conducted into malaria – the most important health problem in the British Empire but hardly one which can be said to concern closely this department.

4. Hitherto for the obvious reason that our primary concern is with the treatment of G.P.I. chief emphasis has been laid on this aspect of the work, the research into malaria being treated as a bye product.

5. The time has now come, however, when the position might properly be reversed and the main emphasis laid on the research into malaria – which is primarily the concern of the Colonial Office, the Medical Research Council and the Tropical Division of the School of Hygiene.

6. On this basis and subject to the concurrence of everyone concerned, it seems to me that the Ministry’s responsibility for Horton might now be transferred to the School of Hygiene making the malaria investigation the central purpose of the Laboratory and the provision of therapeutic material an incidental but still necessarily a very important function.

7. It may be contended that malaria therapy in G.P.I. being now accepted practice, we should leave the Board of Control or each Hospital Authority to make its own arrangements for carrying it out, but this is impracticable. The breeding of the mosquitoes, the maintenance of a pure strain of plasmodium and the whole technique of mosquito infection, examination, inoculation, control of the fever induced, etc. is a highly complex business requiring great skill and experience, and it would not be reasonable to expect every County Council and County Borough Council to provide the necessary establishment. Nor is the Board of Control equipped to undertake such a service. The Board is concerned only with approved Institutions but as Colonel James points out a majority of the cases for which Horton provides are in other Hospitals or under the care of private practitioners. At present a large part of the cost of running Horton is defrayed by the London County Council as part of their expenditure in the treatment of G.P.I., but I do not think we can expect them to asume a national obligation such as here in view.

8. On the other hand, if the School will undertake to continue the malaria investigation it will be doing work that comes properly within the scope of an Imperial School of Tropical Medicine and the Ministry could then arrange with the school to provide the necessary therapeutic material for our purpose.

9. It is essential, however, that any arrangement arrived at should safeguard Mr. Shute’s position and provide for the work being [conducted] under Colonel James’ direction as long as he is available.

10. The main difficulty will probably be financial. Neither the School nor the Medical Research Council have any money to spare at present, but nevertheless I think that with the assistance of the London County Council it should be possible to get over this difficulty in an equitable way.

11. If you agree, Colonel James and I will make some preliminary non-committal inquiries on these lines.

T. Carnwath.

7th September 1934.’