Item of the Month, April 2012: 'On Indigenous Malaria'

As today is World Malaria Day, our Item of Month for April focuses on one of the thousands of works the Library holds on the disease. 

The term ‘Tropical Disease’ can be a misleading one. Take this image: in the book it comes from, the caption reads that it shows “a variety of tools used in anti-malarial work”. Given we think of malaria as the most familiar tropical disease, where in the world is the anti-malarial work taking place? Given the uniforms are of soldiers from the Royal Army Medical Corps, perhaps it’s a distant part of the British Empire? Surely somewhere south of the equator?

No – it’s from the English county of Kent.

The photograph is one of a number of images from a report entitled 'On Indigenous Malaria and on Malaria Work performed in connection with the troops in England during the year 1918' by Major Angus Macdonald, RAMC. It’s one of a number of reports collected together in a volume produced by the War Office, Observations on malaria by medical officers of the army and others, published in 1919 and edited by Sir Ronald Ross, then as now familiar for discovering the key role played by mosquitoes in the transmission of malaria.

Macdonald’s report acts as a reminder – perhaps a surprising one - that malaria was indigenous in the British Isles into the 20th century, particularly in the marsh land areas of Kent and Essex. Before the 19th century, terms such as “ague” and “marsh fever” would have been used to describe the malaria-like illnesses suffered by the local population.

Macdonald’s report consists of the response of the Army to outbreaks of malaria in 1917 in areas such as Romney Marsh, Sandwich and Sheppey – in particular, in in its effects on soldiers stationed in Army camps in these areas.

The report describes in detail the soldiers who caught malaria in England in this period, contrasting them with cases of malaria amongst civilian population in Essex and Kent, and proving that the cases of malaria were locally transmitted. Macdonald also includes testimonies from local residents on previous outbreaks, offering up perspectives on the diseases stretching back to the nineteenth century: the locals give different reasons for a decline in ague during their lifetimes, ranging from the cutting down of elm trees to the coming of the railways.

Macdonald goes into detail on the link between the structure of watercourses in these counties and why they were ideal breeding grounds for different species of mosquitoes, before recording the record of sanitary operations in Sandwich, Sheppey and Lydd - under Macdonald’s supervision - which aimed to disrupt the mosquitoes breeding grounds. 

These methods – including lime washing stables, the drainage and the maintenance of dykes and swampy areas – resulted (for Macdonald) in a measurable decrease in cases of malaria amongst soldiers stationed in Kent. However, outbreaks in the county would continue, up to the 1950s.

The contents of the War Office volume inadvertently point to an outbreak which would have a greater effect on health in 1919. The report which follows Macdonald’s in the volume is 'Observations on the Pathology and Treatment of Malaria' by R W Harold Row. It contains a prefatory note which hints at the pandemic the world was facing: “It is with deep regret that I have to report the death of Mr Harold Row from Influenza…”.

Images:
- 'Shows a variety of tolls used in anti-malaria work'
- 'A. maculipennis, photographed on a wall in a bedroom in Kent'
- 'Anti-malaria detachment setting out. Sandwich'
- 'Breeding-place of A. bifurcatus. Moat Farm, Iwade' (all from the report 'On Indigenous Malaria and on Malaria Work performed in connection with the troops in England')
-  Romney Marsh drainage scheme: gate at low tide (c.1960s, photograph by Leonard Bruce-Chwatt.  Wellcome Images, W0010475) 

A remarkable man

We recently received, from his granddaughter's executor, a couple of manuscripts of Colonel Frederick Smith (1858-1933) of the Royal Army Medical Corps. When cataloguing these, and turning to the usual sources of reference for information on his career, I discovered that Col. Smith had had a most remarkable career. He had enlisted in the ranks of the Medical Service Corps at a time when it was not expected that this would lead eventually to an officer's commission. After serving all over the Empire, Smith was posted to Dublin, where he was able to pursue medical studies, alongside his arduous official duties, as well as managing to spend time with his growing family. On his receiving the Licentiates of the Colleges of Physicians and Surgeons of Ireland, the War Office was petitioned to grant him a commission.

As a Surgeon on probation he was sent to the Army Medical School at Netley, where he not only passed the relevant courses, but achieved the Herbert Prize for the best man of the year. In 1890, aged 32, having already served over a dozen years in the ranks, he was commissioned Surgeon-Captain.

He was then posted to the Far East for several years, spent some time working with Sir Almroth Wright in the Bacteriological Laboratory at Netley, and in 1898 was sent to Sierra Leone in West Africa. This was already known, because of its climate and local diseases, as 'the white man's grave', and was about to erupt into what was known as the Sierra Leone Rising or Hut Tax Rebellion against the imposition of exorbitant taxes on dwellings and demands for labour on public works by the authorities of the newly established British Protectorate.

Smith's experiences in Sierra Leone formed the basis for the fictional work of which we now hold a draft (MS.8701/1) plus an edited clean typescript version prepared by his granddaughter, Jean Overton Fuller MS.8701/2), "Yemma: a Story of ‘The White Man’s Grave’ in ’98" (alternative title "Jungle Savage"). Although he published very extensively on medical research, questions of hygiene, and administrative questions to do with military medicine, Fuller suggested in the foreword to her edited version that 'he had not the technique of writing fiction', and this, as well as its '"advanced" and shocking' nature was the reason why the narrative was never published.

His career took him to South Africa during the years of conflict there. Much of his work involved sanitation - he returned to West Africa as Sanitary Officer to the forces there and served as Divisional Sanitary Officer on the North West Frontier of India.

His distinctions for involvement in military campaigns included the Mendiland expedition medal and clasp for his service in Sierra Leone; mention in dispatches, Queen's medal with four clasps, and the D.S.O. for the Boer War; medal with clasp for service in the Mohmand campaign on the North-West Frontier of India of 1908; and in the war of 1914-18, he was four times mentioned in dispatches, received the C.M.G. in 1917 and the C.B. in 1918. Awards for his work in research, which covered a very wide range of subjects, included the Parkes memorial medal and prize twice, in 1897 and in 1907; the Alexander memorial gold medal twice, in 1903 and1906; and the Enno-Sandes gold medal of the United States in 1903.

Recalled to duty in 1914 on the outbreak of the First World War, Smith was appointed to the command of No. 4 General Hospital in France. The adventures and misadventures in setting up and administering what was intended to be a 'Stationary' Hospital are recounted in "Bloodless Adventures of Colonel Xerxes Wilson, RAMC at the Back of the Front in the Opening Months of the Great War" (MS.8701/3), which is indicated to be a pseudonymous account of Smith's actual experiences.

MS.8701 is not the only material we have illustrating the life, career and opinions of this remarkable man: the RAMC Muniment Collection includes his scrapbook (RAMC/404), a file of miscellaneous papers relating to his activities (RAMC/501), and a copy of his respected work on Modern bullet wounds and modern treatment, with special regard to long bones and joints, field appliances and first aid (1903) (RAMC/713). An obituary may be found in the British Medical Journal for 1933, and an affectionate biographical memoir by Jean Overton Fuller is appended to her edited version of "Yemma". There is also an entry in Peterkin, Johnston and Drew, Commissioned officers in the medical services of the British Army, 1660-1960 Vol 1, no. 7291.

Watercolours from Waterloo: Charles Bell paintings to go on loan

“Johnnie! How can we let this pass? Here is such an occasion of seeing gun-shot wounds come to our very door. Let us go!”

These were the words of the Scottish surgeon, anatomist and neurologist Charles Bell to his brother-in-law on hearing news of the Battle of Waterloo.

Leaving for Belgium on 26 June 1815, Bell took with him his surgical instruments and a sketchbook, in which he could document the injuries he witnessed and tended to. In 1836, he turned his sketches into a series of stunning watercolours, which are on deposit at the Wellcome Library from the [Royal] Army Medical Services Museum. Four of these watercolours are to go on loan to the Art and Exhibition Hall of the Federal Republic of Germany in Bonn for a major exhibition, 'Napoleon und Europa: Traum und Trauma' ('Napoleon and Europe: Dream and Trauma'), which will run from 17 December 2010 to 25 April 2011.

The watercolours provide us with a graphic representation of the dreadful injuries suffered by soldiers fighting at Waterloo. The images of missing arms, protruding intestines and gaping wounds to the chest and neck - together with the pained expressions on the soldiers' faces - all convey the horror of the scenes witnessed by Bell and other surgeons in the battlefield hospitals.

Bell wrote descriptions to accompany his paintings. For one, of a soldier suffering from a head wound, he noted:

"...On the fifth day after the battle was insensible. A portion of the frontal bone, an inch in diameter, was found driven into the brain, and it stood perpendicularly; not possible to extract it, from its being firmly wedged. Trepanning performed. Quite insensible during the operation and showed no sensibility until on the next day, being bled, he shrank….On the removal of the bone a quantity of blood and brain came out, and coagulum was scooped out from betwixt the skull and dura mater. Three days after the operation he became more sensible, and has been improving."

Although the eventual fate of the soldier described above is not known, it seems that he may have fared better than most of Bell's other patients. At Waterloo, the mortality rate of amputations carried out by Bell ran at approximately 90 per cent - a high figure even for the 1800s. Bell went on to have a successful career, however; he was given a knighthood in 1831 and even lent his name to the medical condition of Bell's Palsy, which he described in 1821. These watercolours are yet another string to this prolific and influential man's bow.

Image: Gunshot fracture of skull, Wanstell, Caserne Elizabeth (RAMC/95/4)

'Napoleon und Europa: Traum und Trauma' ('Napoleon and Europe: Dream and Trauma'), Kunst- und Ausstellungshalleder Bundesrepublik Deutschland, Bonn, 17 December - 25 April 2011.

Authors: Rowan de Saulles and Helen Wakely