Let us spray? Papers of Leonard Jan Bruce-Chwatt now available

The distinguished malariologist Leonard Jan Bruce-Chwatt (1907-1989) summed up the feelings of many of his contemporaries when, in 1986, he wrote:

“We all know the main chapters of the sad saga of global malaria eradication and felt, often personally, the rise and fall of our hopes during the past 30 years.” [1]

Those involved in today’s major malaria initiatives seem likewise haunted by the fortunes of the large-scale malaria control programmes of the second half of the twentieth century. An overall lack of “progress” is analysed, attempts are made to draw “lessons” from the past, and bold ambitions for future eradication are greeted with a certain degree of caution.

For an insight into global anti-malaria endeavours from the advent of effective insecticides in the 1940s through the large-scale eradication campaigns of the 1950s and 1960s, and the disillusionment of the 1970s and 1980s, one could do worse than begin with an examination of the papers of Bruce-Chwatt himself, now available for consultation in the Wellcome Library (ref WTI/LBC).

From 1949 to 1958 Bruce-Chwatt headed up the Federal Malaria Service of Nigeria, where he oversaw an early control project in Sokoto, in the north-west of the country. Reports and unpublished papers, maps, charts and photographs relating to this project are all contained within the collection.

In 1958 he moved to Geneva, then the epicentre of international malaria matters, and became Chief of Research and Technical Intelligence in the Malaria Eradication Division of the World Health Organisation. From this position, as a member of the WHO Expert Panel on Malaria (on which he served continuously from 1951 onwards), and later as a consultant, he was witness to the entire span of the Global Malaria Eradication Program launched by the WHO in 1955 and abandoned in 1969. By 1962 he had been convinced that, “It is now plain that nobody can perform the miracle of malaria eradication in Africa simply by saying ‘Let us spray!’”. [2]

Bruce-Chwatt remained an expert commentator on all aspects of the disease, and on malaria policy, right up to his death in 1989. His own published and unpublished writings and the various papers by others which are also included in the collection cover many different aspects of the issue including epidemiology, parasitology, insecticides, antimalarial drugs and drug resistance.

Despite the apparent pessimism of his comments as quoted above, Bruce-Chwatt did, in fact, remain guardedly optimistic about the future, placing his faith in a combination of scientific progress and the efforts of international agencies. We can only wonder whether he would have felt this optimism justified by today’s global programmes such as Roll Back Malaria, the Malaria Vaccine Initiative and the Multilateral Initiative on Malaria, the Wellcome Trust’s continued heavy investment in malaria research, the sequencing of the malaria parasite genome and rising hopes for an effective vaccine.

[1] L. J. Bruce-Chwatt, ‘Malaria control at the cross-roads! Where do we go from here?’, Memórias do Instituto Oswaldo Cruz, 1988, p.1.

[2] L. J. Bruce-Chwatt, ‘Malaria eradication in Africa’, New Scientist, 28 June 1962, p.703.

Images:
- A spraying team at work as part of a malaria control programme in Sokoto, Northern Nigeria. Note from left to right the stages of preparing insecticidal supsension before spraying operations: the drum with the DDT powder, the pouring of the prepared suspension into the container through the sieve, and the compression sprayer. Mid 20th century (Wellcome Images, W0004205) 
- Jan Leonard Bruce-Chwatt (Wellcome Library no. 14530i)

Author: Jenny Haynes

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) 

Papers of P. C. C. Garnham

What do Edgar Allen Poe, protozoology and breeding rabbits have in common? The answer: Percy Cyril Claude Garnham, a rabbit breeding, Poe reading Professor of Medical Protozoology whose papers are held by the Wellcome Library.


Although the majority of Garnham’s papers were catalogued in the early 1980s, the catalogue was not available to view online until now. Additionally, papers given to the library since the collection was catalogued have now been integrated. The whole catalogue can be viewed online via the Archives and Manuscripts online catalogue.

Cyril Garnham, as he was known, was instrumental in the discovery of the pre-erythrocytic and exo-erythrocytic forms of several species of Plasmodia, the malaria causing parasites. The Archives and Manuscripts sources guide on Malaria contains more information about our holdings in this area.

The Royal Society of Tropical Medicine and Hygiene annually awards the Garnham Fellowship, which aims to encourage young scientists to carry out field based projects, something which Cyril Garnham would certainly have approved.

Centenary: Stacey Hopper, born 28 April 1909

The artist Stacey Hopper was born exactly 100 years ago, at Aberaman, now part of the town of Aberdare, South Wales, on 28 April 1909. Thousands of people will have seen his work without knowing his name. His claim to fame is that, in the role of cartoonist and illustrator, he saved many Allied soldiers in World War II from the horrors of such diseases as malaria and syphilis, and thereby played a part in the Allied victory.

Left: Mussolini and Hitler. Wellcome Library no. 583972i

The Wellcome Library has two collections of Stacey Hopper's works, one from the Royal Army Medical Corps and one from Stacey Hopper himself; the latter was acquired from his family in 2003, together with valuable contextual information about his life and work. Other works by him are in the Imperial War Museum and the National Army Museum in London.

Before the war, Stacey Hopper taught art in Ealing and was an accomplished caricaturist. In 1934 he published a caricature "The origin of the Nazi salute" which was reproduced in newspapers at home and abroad: it showed the Nazi salute evolving from the action of Hitler holding up a paintbrush when painting. Stacey Hopper was called up and joined the Royal Corps of Signals in August 1941, and was initially posted to Prestatyn, North Wales. In November 1942 he was among the troops sent to Algeria. There his artistic ability and sense of humour brought him to the attention of Major General Ernest Cowell, who asked him to help with health promotion for the Army Medical Department (the initials "AMD" appear on many of his works).

In Algeria the main problem was malaria. The disease was attacked in several ways. In the first place it was necessary to get into the minds of soldiers that mosquitoes were vectors of disease. As the Australian hygiene expert Neil Hamilton Fairley impressed on General Wavell, there was a danger of losing more men through malaria than through military casualties at the hands of Hitler and Mussolini.

These mosquitoes (right) discuss sucking blood from the troops as if they were ladies discussing tea at the Ritz.

Wellcome Library no. 584189i

Practical measures included blocking off the mosquitoes' breeding grounds, for example by excluding them from the latrines …

Wellcome Library no. 584263i

Another method was to spray everything in sight with "Paris Green" (copper (II) acetoarsenite), a toxic substance used as an insecticide …

"But he distinctly said - spray every drop of water and all the female adults".

Above: Wellcome Library no. 584264i

The medicine of choice against malaria was Atebrin, which was strongly supported by Hamilton Fairley and eventually replaced quinine as the main prophylactic against malaria. However, compliance was so difficult to enforce that eventually officers were ordered to place the pills in the men's mouths themselves. This exercise (below) in the style of H.M. Bateman refers to Atebrin.

"Tablet day -- the man who forgot". Wellcome Library no. 584428i

In November 1943 Stacey Hopper was promoted to Second Lieutenant and took part in the invasion of mainland Italy. Some wash drawings by him in the Wellcome Library record the bringing of casualties by air from the Anzio campaign in Lazio to Capodichino airport near Naples. This example, dated Naples 1944, shows the wounded being carried by stretcher-bearers into a tent where they are served with mugs of tea by the Red Cross. A lot of casualties are anticipated, for the first arrivals are being laid down at the back of the tent, and the tea urn and a quantity of mugs are on a table near the front. After tea, they were taken by ambulance to military hospitals for treatment. Above left: Wellcome Library no. 583973i

As the troops fought their way northwards towards Rome, Stacey Hopper's artistic skills were again called on to protect the troops, no longer from malaria but from typhus and dysentery.

Left, Wellcome Library no. 585129i. Above, a detail from it.

Right: Wellcome Library no. 585148i

And as Italians went over to the Allies in the areas liberated from the Axis, thought was given to Italian women who were infected with sexually transmitted diseases by Allied soldiers. Right: Wellcome Library no. 585150i

It was also now in the Allies' interest to make sure that Italian cooks recruited to serve the troops obeyed the stricter hygiene regulations that were required when catering for large numbers. Left: Wellcome Library no. 585122i

Having returned safely from the war Stacey Hopper returned to his pre-War profession as a teacher of art, at first in Ealing in West London and later in Somerset. He also continued to produce caricatures for publication, especially of popular entertainers and of actors in the West End theatres: his work was published in the Musical Express. He died in Bristol on 6 February 1996.

Works by Stacey Hopper are in copyright and are reproduced here under a licence granted to the Wellcome Library.