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The charts show that after the first injection the temperature rose to 102° in only two cases, that in all the others it did not exceed 101°, and that it did not remain above 100° for more than two days in any instance.

After the second injection with the drug.-A second injection of 1', grain Salvarsan was administered seven days after the first in the first four cases. The 5th case received only one injection of 1'/, grain, as it was very doubtful whether the case was one of yaws.

The following variations were noticed in the temperature after the second injection:

Case I-100° on 2nd, 3rd, 4th, and 5th days (p.m.), and falling to 98-99° subse- quently.

Case II-102° on 3rd day; 104° on 4th day; 105° on 5th day, and falling to 100° on 6th day to 99° on 7th day, and reaching normal on the 9th day.

Case III-100° on 3rd and 4th days, 99° on 5th day, and normal subsequently. Case IV-100° on 3rd day, 101° on 4th and 5th days, 99° on 6th and 7th days, 100 on 8th and 9th days, and subsequently 98-990.

Case (After one injection of 1'/, grain), 100° on 2nd, 3rd, 4th, 5th, 6th, 7th, and 8th days, 99° on 9th day, 100° on 11th day, 99° on 12th day.

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The case in which the temperature rose to 105° after the second injection was

a doubtful one, and its symptoms may have been those of syphilis.

The variations in the temperature observed in these cases correspond with those noticed by others in treating cases of syphilis with the drug. Alt is reported to have noted a rise but not higher than 38 8° C. Neisser found it at a higher range, viz., 39.5° C., but stated that it soon falls again. Most observers find it varies in cases of syphilis between 38° and 39° C., ie., between 1004° F. and 102 2° F. after an injection of Salvarsan. A rise to 40° C. has been reported, and this corresponds to the rise to 105° F. reported in one of the cases under my care.

9915

No. 7.

SOUTHERN NIGERIA.

THE ACTING GOVERNOR to THE SECRETARY OF STATE. (Received April 1, 1912.)

(No. 189.)

[Answered by No. 11.]

Government House, Lagos, Southern Nigeria,

13th March, 1912.

SIR,

I HAVE the honour to acknowledge the receipt of your despatch, No. 976 of the 19th December,* on the subject of the work of the Medical Research Institute.

2. The question of separating clinical and medico-legal work from the purely research work of the Institute has been referred to the Principal Medical Officer and the Director of the Institute, and I annex a copy of a letter from the latter, together with a copy of Dr. Hood's remarks thereon in his capacity as acting head of the Medical Department. I note from your despatch, No. 42 of the 12th January,† that it is proposed to discuss the matter with Dr. Langley during his leave of absence in England.

3. I agree with the views expressed by Dr. Hood, especially as regards placing under the Medical Officer of the Yaba Asylum the dispensary in that locality advo- cated by Dr. Graham.

4. The proposal to appoint an additional Medical Officer in Southern Nigeria, in order that members of the West African Medical Staff may be seconded periodi- cally for study at the Institute, was put before you in Sir Walter Egerton's despatch. No. 757 of the 13th December last.

I have, &c.,

D. C. CAMERON,

For Acting Governor (who drafted despatch).

↑ No. 23 in African No. 984.

No. 144 in Miscellaneous No. 252.

No. 1 in African No. 984.

SIR,

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Enclosure 1 in No. 7.

Medical Research Institute, Yaba, 24 February; 1912. I HAVE the honour, in reply to your letter, No. 126 of the 20th February, to submit the following statement:-

The object with which the Medical Research Institute was founded, as I under- stand it, was that through its instrumentality some advance might be made in the knowledge of tropical diseases, their causes, vectors, incidence, &c. Hence the work done at the Medical Research Institute was to lead to an advance of knowledge.

In so far as the doing of clinical work opened the road for an advance, in so far the doing of this clinical work was a legitimate activity. As soon as the doing of this clinical work ceased to lead forward it became simply a guide to diagnosis for the local Medical Officers, and, though very useful, it no longer leads to any advance in the theoretical knowledge of tropical disease and should not occupy the time of the staff of this Institute. For example, clinical work done this year legitimately with the object of discovering the incidence or pathology of a native disease may next year have ceased to form legitimate work for the Medical Research Institute should the knowledge sought have been secured in the meanwhile.

Now every effort has been made to induce the Medical Officers of the West African Colonies to send interesting material found among their cases to the Medical Research Institute, and necessarily and correlatively they have been led to seek its help in all cases of difficult diagnosis.

not.

It cannot be expected that only pathological material of interest to the staff of the Medical Research Institute will be sent for examination, and it is often im- possible to decide, previous to examination, whether it is likely to be of interest or All material, therefore, which cannot be dealt with by the Medical Officer must be accepted by the Medical Research Institute if it should continue to receive even occasionally interesting material likely to lead to an advance of knowledge.

Having this year induced all Medical Officers to send in certain material for the furtherance of some research, similar material cannot be refused next year simply because it has ceased to interest the Medical Research Institute Staff. This would be a step backward, and would lead to a total disorganisation of the established communication between the members of the Medical Department and the Institute, for the Medical Officers have already been taught to rely upon the help of the Medical Research Institute in those newer methods of diagnosis which are not at their own disposal.

It was with the object of overcoming this difficulty and meeting an urgent and increasing need that, in my letter of the 23rd December, 1910, I made the proposal that a Medical Officer of the West African Medical Staff should be seconded to the Institute for some portion of his tour, to carry out under the help and supervision of the Medical Research Institute Staff all work of a local nature which, while not legitimate work for a research laboratory, cannot, in the interests of the health of the Colony, be left undone any longer.

There are certain methods of diagnosis almost in universal use in Europe which cannot be carried out by the Medical Officer on his station:-

Firstly, for lack of instruments.

Secondly, for lack of required skill.

The most certain way to increase his interest in his cases is to let the Medical Officer know that in such cases, when unable to investigate his material himself, he can send his difficulties to the Medical Research Institute.

The most certain way to damp ardour is to withhold the means of arriving at a certain diagnosis.

Under such circumstances the evil becomes cumulative and the Medical Officer will say: "Why bother with the case? I had a similar one recently in which I could not arrive at a certain diagnosis as I was unable to cut sections, do a Widal's re- action, &c."

Every such diagnosis made at the Medical Research Institute forms a direct addition to the knowledge of the Medical Officer, and, therefore, increases his ability to preserve the health of his district. I can conceive of nothing of greater importance to a tropical Colony.

In my letter of the 23rd December, 1910, I proposed, after careful reflection, that the Medical Officer should be quartered at the Medical Research Institute in