Sent from Sydney Price James
14 Nov 1923
Description:

‘Dear Bond,

Following the arrangement you kindly made, I visited the City of London Mental Hospital at Dartford on 31st October and I have since made a careful examination of blood films collected with Dr. Steen’s kind co-operation on 6th November. I am less comfortable about the risk of spread in the Dartford Hospital than I was as regards the Whittingham hospital. Although my visit was late in the season we were able to find specimens of Anopheles maculipennis (the malaria-carrying species in England) in the stables near the hospital and I am afraid it is almost certain that during the summer months they would be numerous and would have opportunities of biting the malaria patients who are in bed under open verandahs [sic]. Examination of the films shows that the blood of these patients contains many sexual forms of the parasite – the forms which are potentially infective to mosquitoes – but I cannot be quite sure whether in actual conditions these parasites of inoculated cases would infect mosquitoes until I have fed some mosquitoes on them and observed the results. Dr. Steen has expressed his willingness to give me facilities for carrying out this small enquiry and if you see no objection I should propose to do it as soon as possible. It is quite necessary that we should know whether the blood of these patients is really infective to mosquitoes before we draw up rules for the manner in which the procedure connected with treatment of patients by malaria inoculations should be carried out; and we cannot make a decision on that matter until the suggested feeding experiment has been done.

You are doubtless aware that at Dartford at present the inoculated patients are scattered in several general wards and that the hospital differs from Whittingham in the absence of laboratory facilities for controlling the source of the inoculated disease by regular blood examination. At the moment it seems to me that, when this inoculation treatment is carried out in an area where anopheles mosquitoes are common, the patients should be segregated in a mosquito proof ward during the period of their infectivity and that this period should be ascertained and controlled by blood examinations. But as I have already mentioned the decision to make rules of this kind cannot be placed on an entirely satisfactory basis until we have ascertained by a feeding experiment that parasites which have passed through a series of patients are still infective to anopheles mosquitoes.

I discussed the above points with Sir George Buchanan last evening and he thought it would be well for me to discuss them verbally with you. If you will kindly ‘phone me suggesting a day and time this week I will be at your office then.

Yours sincerely,

S.P. James.’