Created by Thomas Carnwath
29 Apr 1935
Description:

‘Minute Sheet.

1. Chief Medical Officer [signed: ‘A.S.M[?].’]

2. Secretary.

1. I must preface my minute by saying that the suggestion put forward by me in September last was made before I had opportunity of consulting all the persons concerned. It was primarily a request for permission to pursue enquiries in consultation with Colonel James.

2. On receiving the Secretary’s instructions I got into touch with the Medical Research Council and the School of Hygiene and arranged a preliminary interview with Professor Jameson, Mr. Curtis, the Executive Head of the L.C.C. Mental Hospital Service, and Dr. Nicol, the Medical Superintendent of Horton.

3. Dr. Thomson was quite clear that the Medical Research Council would be unwilling to take over our repsonsibility for Horton, either financial or administrative and for reasons given below such a transfer might conceivably be embarrassing to the L.C.C. Their small grant of £100 per annum to Colonel James will presumably be continued as long as he remains in charge of the work, and no doubt the Council would consider favourably a continuance of the grant to Colonel James’ successor if his work seemed to merit that recognition.

4. Any arrangement made for the continuance of the Horton unit must have the approval of the L.C.C. and as the primary purpose of its establishment was the treatment of the general paralysis of the insane rather than a research into malaria it is important from the L.C.C. point of view that this purpose should be kept prominently in the foreground. Formal transfer of the work of the malaria side to the M.R.C. or the School of Hygiene and the consequently greater emphasis thereby laid on the research aspect of the work would, in Mr. Curtis’ opinion be very unwelcome to the Council, and might give rise to unpleasant and embarrassing questions about helpless patients being used as raw material for research on malaria. On the other hand, so long as the L.C.C. can look to the Ministry as the controlling and responsible body for the supply of malaria therapeutic material they would not concern themselves with the arrangements which the Ministry see fit to make with the School of Hygiene for carrying on the work hitherto done by Colonel James.

5. Professor Jameson, on the other hand, is particularly anxious to see the work at Horton linked up with that of the School as it affords exceptional opportunities for studying the effect of various remedies in the treatment and control of induced malaria. It is a necessary adjunct to the experimental work on animals now carried on at the School by Christophers. The value of conclusions derived from work at the School and at Horton would, of course, have to be tested later in the tropical field.

6. As regards the allocation of financial responsibility for Horton, it is quite clear that neither the M.R.C. not the School have funds on which they could properly draw for the maintenance of the unit. The bulk of the work done there may now be regarded as routine, that is, as work necessary for the maintenance and supply of suitable and adequate therapeutic material for the treatment of G.P.I. cases in London and elsewhere throughout the country. It is, in other words, primarily a National rather than and Imperial service and the fact that work of imperial value and importance has been grafted on to it does not affect the position.

7. From its nature the work has to be carried on in association with a Mental Hospital, and hitherto we have been fortunate in having most cordial and helpful co-operation from the L.C.C. for which we are indebted principally to Mr. Curtis. They have provided the laboratories and the associated clinical units, and this, I think, is as much as we can reasonably ask them to do. [note beside this para: ‘I agree. A.S.M.’]

8. On the other hand, the Ministry has provided (i) the laboratory staff, the travelling expenses and some of the equipment – amounting in all to about £900 per annum (see statement above) and (ii) Colonel James’ services as Director and General Consultant. The consultations I have had so far show me no way by which we can relieve ourselves of responsibility for (i), but if possible no part of this work should be any longer a charge on our small special inquiries fund. As regards (ii), however, it is suggested that if the Ministry is successful in inducing the Treasury to continue Colonel James for another year

(a) The School of Hygiene should appoint as soon as possible an officer of suitable qualifications and experience who would act as understudy to Colonel James and make himself thoroughly familiar with the work done at Horton so that he could continue to direct it after Colonel James retires.

(b) Colonel James’s place should not be filled when he retires but that we should look to the School not only for the service hitherto given by Colonel James at Horton but also for any advice and assistance we may require on tropical diseases either at home or internationally in Paris and Geneva.

(c) and that in consideration for this this assistant a yearly grant should be made by the Ministry to the School equivalent to about half the salary of the officer to be appointed, say £500 or £600.

It is to be hoped that the Colonial Office may be brought into this scheme so that a closer liaison may be established between them, ourselves, and the School of Hygiene than has been possible in the past.

Although this arrangement would mean some extra expense to the Ministry during 1935/1936 there would be an ultimate net saving so far as the Department is concerned amounting to about half Colonel James salary.

9. Much emphasis was laid by Mr. Curtis and Dr. Nicol on the importance of maintaining Dr. Nicol’s full and complete responsibility as hitherto for the treatment of the patients at Horton, but in order that Dr. Nicol’s exceptional clinical experience in the treatment of malaria may be made available to the School, it is hoped to secure his appointment as next term lecturer.

10. If the arrangement outlined above proves acceptable, certain consequential administrative details will require consideration and settlement, for example, applications from hospitals. Local Authorities and others for malaria treatment should be addressed, as hitherto, to the Ministry where they would be noted and from which they would be referred either to the school or direct to Horton as may be arranged.

I presume the Board of Control will wish to be consulted.

T. Carnwath, 29th April 1935.’