126
be made to be payable to the common fund, referred to in the last paragraph of Mr. Chamberlain's circular despatch of the 28th of May,* and not to any particular institution, such as the London School of Tropical Medicine.
It is hardly necessary to add that I make this request, not from any wish to prevent the London Tropical School from benefiting by the liberality of the Ceylon Government, but because the proposal of a common fund to be allotted for kindred objects or between kindred institutions seems a more comprehensive scheme, and likely to produce more effective co-ordination among the various agencies employed, than separate contributions to specific objects.
I have, &c.,
ALFRED LYTTELTON.
127
that that institution would be willing to appoint an advisory board in this country. 4. If you concur in the proposed arrangements, the necessary communications will be made to the War Office and the Admiralty.
I have, &c.,
Enclosure in No. 125.
ALFRED LYTTELTON.
625
43235
No. 124.
FEDERATED MALAY STATES.
MR. LYTTELTON to the ACTING HIGH COMMISSIONER.
[Answered by 6059 in Miscellaneous No. 179.] .
(No. 434.) SIR,
Downing Street, December 4, 1903. I HAVE the honour to acknowledge the receipt of Sir F. A. Swettenham's despatch, No. 501, of the 16th of September,t and to transmit to you a copy of a letter from Sir P. Manson with regard to the Institute for Medical Research at Kwala Lumpor.
2. I am prepared, if you recommend it, to approve the appointment of a permanent Assistant on the terms proposed, except that I think (and Sir F Swettenham agrees with me) that the grant of free passages to and from England every three years is unnecessary, and would tend to cause dissatisfaction in the minds of other medical officers and of members of other Departments.
3. If you consider that a permanent Assistant should be appointed, I should be glad to learn whether you consider that the post should be given to either of the present Assistants.
Fleet-Surgeon P. W. BASSETT-SMITH to Sir P. MANSON.
R.N. Hospital, Haslar,
DEAR SIR PATRICK MANSON,
November 17, 1903.
I AM very sorry to have been so long in replying to your letter, but I have been endeavouring to collect statistics of the incidence of Mediterranean Fever in the Services, which were difficult to get, and are, I fear, far from complete; what I have show the importance of the disease and the great drain that it causes to the personnel.
In the Navy in 1902 the total number of cases was 421.
Of these 42 officers and 134 men, or 176 cases, were treated at Haslar, giving
a total number of 14,408 days' sickness from the onset of the disease, to the date of the discharge, or just under three months for each case, and this underestimates the sickness, as the relapse cases were not included.
If we take then three months as the average duration of a case, we get a total of 37,890 days' sickness for the year, and if we take an average cost of each case as 3s. a day, we have a total cost of £5,683 for the year:
In the Army in 1902 there were 187 cases (an unusually low number, for in 1901 there were 281 cases), which averaged 80 days' sickness each, up to the time of invaliding home, giving a total of 14,960 days.
MEDITERRANEAN FEVER, 1902.
42881
I have, &c.,
ALFRED LYTTELTON.
Invalided-
Cases.
Avenge
Total Sick.
Dead.
Sickness.
Home.
¡From Service,
PUBLIC RECORD OFFICE
C.O.885
Reference :-
PUBLIC RECORD OFFICE, LONDON ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
No. 125.
MALTA.
MR. LYTTELTON to GOVERNOR SIR C. M. CLARKE. [Answered by No. 128.]
(Confidential.)
Downing Street, December 7, 1903.
SIR,
I HAVE the honour to inform you, with reference to Lord Grenfell's confi- dential despatch of the 12th of January last,§ that, my attention having been called to the prevalence and ill-effects of Mediterranean Fever in Malta, I have consulted Sir Patrick Manson, who has sent to the Colonial Office the letter, of which a copy is enclosed, from Fleet-Surgeon Bassett-Smith, a competent authority on the subject.
2. It appears desirable, from the point of view of the Army, the Navy, and the Civil population, that the investigation of the fever should be properly taken in hand, and I should be glad to learn whether, in the event of the War Office and the Admiralty considering that a joint Commission is desirable, arrangements could be made for appointing Dr. Zammit to represent the Civil Government, and for allowing him to devote the whole of 'his time to the matter.
3. Sir Patrick Manson is in favour of the appointment of a joint Commission, and it seems not improbable, from the Royal Society's letter, a copy of which was enclosed in Lord Onslow's confidential despatch of the 16th of December, 1902, ||
[Cd. 1598] June 1903, + No. 105, #No. 112. Not printer.
49997: not printed.
Navy...
Army
421
187
90 days
80 days
37.890
14,900
250
14
3
7
Beyond the days actually on the sick list there is often a long period, some. times extending over months, when the person suffers from neuralgias, and slight attacks of fever, and is unfit for any severe strain or heavy duty, and many of these are finally invalided out of the service.
This being so, the necessity of an organised investigation into the causation, predisposing factors, &c., becomes one of great importance; for some years I, with others, have worked fairly continuously in the hope of finding definite facts which could be of use in the prevention, but I am bound to say with very little result; if anything is to be done seriously, it requires the whole attention of one or more persons for a considerable period, which might, perhaps, be best done as you suggest, by the formation of a controlling board at home of experts, and a few workers on the spot, but whether by mixing members of the services (Navy, Army, and Colonial) would best reach that end I am not certain.
The disease has a very close analogy with Enteric.
Each has a well defined organism, which is known with certainty to be causa- tive of the disease, that this is in each present in the spleen, and in the peripheral blood; that in each relapses frequently occur; that each has a prolonged fever; and that each is in some way connected with bad sanitation.
The points that most require elucidation are:-How does the organism escape from the body?
EL
í
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