Sent from Ronald Murray Clark
13 Jun 1923
Description:

‘Dear Dr. Bond,

I only got your letter this morning on my return from a few days off.

We commenced treating G.P.I.s with Malaria inoculation last July. The first three patients were inoculated with Quartan at the Liverpool School of Tropical Medicine by Prof. Stephens and the two took. We were not satisfied with this strain and did not reinoculate from it. We next brought the blood about 3 c.c. from a Tertian case which had not had quinine from Liverpool in a vaccum flask at about body temperature here & inoc’d it [sic] G.P.I. The blood was first citrated in Liverpool & was quite 2 ½ hours on the way. The inoc’n was successful & this has been the root of our strem[?] which up to now we have been able to keep unbroken by inoc’ing from Patient to Patient. We have injected the citrated blood directly into the vein of the recipient but the simplest way is to bring the recipient to the bedside of a patient with parasites in his blood & inject it without any citration directly subcutaneously into muscles of the recipient’s back – it is better to move the needle about roughly in the mucles & thus cause haemorrhage at the seat of the inoc’-.

In all 23 males and 5 females have been inoc’d and have taken and 2 were given a second course of Malaria 6 months after the first. Last week a Rainhill patient was sent here & inoc’ed; in this way we will have a better chance of keeping our strain going. I do not wish to lose it as I consider it a valuable strain & we call it ‘W’ strain. It is valuable because after a year’s experience we know something about it. ‘W’ strain has caused no untoward results – the rises of T˚ [sic] have been reasonable 104˚ to 106˚ no fulminating[?] cases – no unreasonable splenic enlargements & all cases have at once responded to Quinine – In some cases we followed the malaria with a course of Salvarsan. Six days has been about the average incubation period.

The blood of all patients has been carefully watched for appearance & disappearance of parasites – 1000s of blood films have been made in some cases as often as every ten minutes – Duplicates of these films have been sent to the L. school of Tropical Medicine & Prof. Stephens & Yorke have been keenly interested as well as helpful.

Of late several Germans have found Relapsing fever preferable to Malaria in G.P.I. & this week 3 G.P.I.s were sent to Liverpool where ticks infected with Relapsing Fever spirochaete were allowed to feed on them.

To begin with consent was always asked of relatives & almost always readily given – latterly I have not considered this necessary as Malaria treatment at present may be said to be the usual & recognised treatment for G.P.I. on the continent at any rate. A year is too short a time for a real trial of treatment for such a disease as G.P.I. & I do not commit myself definitely. My impression is that many of our cases would have been dead ere this. There has been marked physical improvement in 90%. One bedridden case with bed-sores & unable to stand is up & about. Two cases are fit, ‘Discharge Recovered’ for the time being & there is I think distinct improvement in others. We did not select our cases but have been very particular about diagnosis only treating those obviously G.P.I. clinically but we have always verified the diagnosis by the more reliable serological tests. The Wass. & the G.P.I. Gold sol[?] curve & the Gambage[?]/ Several cases have shown mental conditions unusual to advancing G.P.I. becoming more hallucinated [sic], more aggression towards others who they accuse of talking ill of them. One periodically refuses food for days and is more masterful, most of them are less facile than we would expect. The best way to start[?] the treatment in another Mental Hospital would be to send a patient here for inoc’n when we have a case with Parasites in the blood.

Of our deaths one was one of the Quartan cases the malaria was of the fulminating type with very large spleen. Another male had shown marked improvement when he died rather suddenly from heart failure. The third death was a female who developed Influenza after malaria, bronchitis & cardiac dilatation followed.

Opinions differ on such questions. When I first read of von Wagner Juaregg’s [sic] article I write to the London School of Tropical Medicine enclosing the article & asked the opinion of an old friend G.C. Low – he was not at all enthusiastic – I then tried the Liverpool S of T.M. and Prof. Stephens at once showed himself very keen and interested. Please excuse such a long letter.

Yours Sincerely,

R.M. Clark.’