Gayathri Vaidyanathan: Today, we’re traveling to Bangalore in 1895. We’ll go with Sir Ronald Ross as he tries to stop a devastating cholera outbreak.
Mary-Rose Abraham: Ross is a 38 year old British scientist. He’s quite a snazzy dresser… his dark hair is closely cropped, it’s parted at the center and plastered to his head. He has a handlebar mustache. He’s wearing a 3 piece suit and tie.
GV: Ross doesn’t yet know this — but just weeks later, he’s going to meet a man from a tribe near Coonoor who’ll tell him that mosquitoes transmit malaria. He’ll go on to prove this — and in 1902, he’ll be awarded the Nobel Prize for Medicine for his efforts.
MRA: We’re going on this journey with Sanjeev Jain. He’s a psychiatrist at NIMHANS in Bangalore who studies the history of Indian medicine as a pastime.
Sanjeev Jain: So, he goes to Coonoor, which is a hill station just outside Mysore. When he meets a tribal on the Sigur Ghat, which is a steep incline all the way to Ooty. And he tells him that this is the mosquito you’re looking for. It’s a speckled mosquito. And this is the one which causes disease. So Ronald Ross gets the first hand information about the actual mosquito, which is likely to cause the disease from a tribal somewhere in Sigur Ghat. Now, this again points out how those doctors were actually learning from Indian medicine. But Ronald Ross was going to Coonoor because he just finished his very exhaustive eight week trip on handling the cholera of Bangalore.
GV: You’re listening to Chatroom number eight, A Disease Sleuth in Bangalore. This is a bonus episode on Scrolls & Leaves. I’m Gayathri
MRA: And I’m Mary-Rose. We’ll be back with the rest of season one next year. In the meantime, do let us know if there’s any topic you’d like to hear about. And could you let at least one other person know about Scrolls and Leaves? Or even rate or review us on Apple podcasts or Spotify?
GV: So let’s get to the story. Sanjeev became interested in the history of medicine while doing his post-doc at Cambridge University…
SJ: the Cambridge library which was next door to where I was working, had these enormous records on the history of psychiatry and the Commonwealth, which meant that their records for almost every hospital in India, from the time that they started building hospitals in 1810, or 1820, so one could just sit there and look at how illnesses, diseases, syndromes, management developed in India from the early 19th, and through the 20th century.
MRA: Sanjeev first heard of Ross from his professor, who was writing a biography of the famous scientist. The professor showed him a photograph of Ross taken outside Bangalore. He’s wearing…
SJ: cycling clothes of any English gentleman. So there’s a big party of I think 30 or 40 people sitting out on the cycling trip with their long skirts for the women and clip trousers, and coats and those bicycle clips for the gentlemen with their straw hats and it looks like a typical English outing.
MRA: Sanjeev went to the archives at the London School of Tropical Medicine and Hygiene and looked up Ross’ medical notes, which are kept there in pristine condition.
SJ: Ronald Ross is a member of the Indian Medical Service. He joins service, I think in Calcutta. And he’s very research oriented. He’s trained with the, with the person called [Patrick] Manson-Bahr, who’s a big, infectious disease specialist in London. And understanding diseases as they occur in the tropics is very much a preoccupation of medicine at that point of time. This is a time when Koch and Pasteur have changed the notion of infectious disease and bacteria and mechanisms of infection are being discovered almost round the clock.
GV: Around this time, European scientists were developing the scientific concepts around the germ theory of disease… which is, basically, the idea that an infectious agent causes disease. In the 1850s, John Snow, an epidemiologist in London had shown that cholera is tied to dirty water. In 1884, a German bacteriologist named Robert Koch discovered the cholera bacterium under a microscope.
MRA: That’s not to say the basic idea of germ theory didn’t exist before 18th century European science… in India, smallpox inoculations were developed around the year 1000…
SJ: And so the effort to understand all these big diseases — smallpox, malaria, cholera plague — is very much a focus of interest. So in these 30, 40 years, of 1890 to 1930, the Indian Medical Service actually does all this research. So Ronald Ross gets sent to Calcutta. And he gets a bit bored and apparently is quite cantankerous about obeying rules of the army. So he gets moved to Hyderabad, which is another big cantonment.
GV: His next stop will be Bangalore, a hill station that’s part of Mysore State — what is known these as Karnataka
SJ: In 1878, Mysore has a famine, it has a plague epidemic soon after. And then it has a cholera epidemic in 1895. Bangalore till then has the reputation of being the healthiest cantonment in the whole of British India, and they are British are very, very concerned about the decline in health of Bangalore.
GV: They turn to Ronald Ross and ask him to investigate the outbreak…
MRA: When Ross gets to Bangalore, he would’ve found the cantonment looks like an English village…
SJ: big bungalows for the officers, smaller houses for the European soldiers, and then barracks for the Indian soldiers. And the central quadrangle has a Protestant church, the Catholic Church, a Presbyterian Church and a Scottish church.
GV: Most Indians live outside the cantonment walls. And some live inside are the ones who serve the Brits
SJ: people who are attached to the army, the workers and the lower ranks and the soldiers. The milk sellers, the water sellers, the vegetable sellers, and all these kind of occupations and then there’s the tradesmen. So they have an area which is now called Shivaji Nagar, but that time was very appropriately called Black Pully, or blacks village, which is in the center of the cantonment, which basically provide sustenance to the cantonment as far as the nuts and bolts of life are concerned — water, milk, vegetables, fruits for everyone. And that’s a very congested area and that’s where the cholera starts.
MRA: Ross finds the Black Pully congested and dirty…
SJ: most people are living, like now, six or seven to a hut. And very often in the hut is also the animals, the cows and the goats.
And as he puts it, in fairly acerbic terms, it can safely be said that as far as the residents of Bangalore, they live in and amongst their own excreta.
GV: the black pully is in the middle of the cantonment so there’s a real danger it can spread to the European quarters as well. Ross rushes to track the disease…
MRA: He learns that this outbreak began
SJ: with a person who’s coming on a train from Madras, starts affecting the person in his household and his neighbors, then down the street, and then from people who get water from the same water seller or from the same water tank and this chain of water sellers and water sources are common to the whole area.
GV: Ross knows this disease is tied to water…
SJ: he just says, disinfect, disinfect, disinfect. That’s all I can do. Potassium permanganate in every well, boil everything
MRA: He knocks on doors of patients– imagine him standing there with his assistants and maybe a constable or two…
SJ: they quarantine the house and Ronald Ross insists that we take over the house and destroy as many of the goods that they have, and the clothes that they have. But they pay compensation for that, obviously people felt very upset about seeing their pots and pans and everything being destroyed. This becomes necessary because milk is stored in earthen pots, foodstuff is in earthen pots, and Ross is unable to make out whether the earthen pots have now got water impregnated with bacteria lining the food containers. So rather than disinfect, they just destroy the containers. That’s the way they handle it, they quarantine in the house, they establish the links of all the people who have had the disease, and where they’ve gone. And then they keep a record. Ross repeatedly refers to the map that he uses to track the movement of everybody at that point of time, because he’s very surprised when a person a mile away gets cholera. And then he goes all the way there and then tries to figure out how it could have reached a mile and a half away at the other end of the cantonment.
GV: At first, Ross’ notes are brief, based on what he’s heard…
SJ: Initially, it is just, a boy Mohammedan, a female Hindu, or a traveler from Srirangapatna. But by next day, he has got names for every one of them. And he’s got names of every possible person, you know, a pension sepoy who lives on North Broadway, he had the disease, and then I went to his house, and it was a very squalid condition. The sewers were made of this kind of material. The angle of the sewage line from the house to the street, or as he says, was anti-gravity.
“This is a note of 23rd September 1895. 13 fresh cases of cholera occurred in the 11 days since my arrival here on the 10th. They are as follows: Kanchi cootie, Balu, Anumathy, Madhar, Ammai, Imam Sahib, Ponnamma, Sundaramma, Shahzadi B, Sakina B, İbrahim Sahib, Munniswami and Millie de Gama. Millie de Gama is a very young girl of 19. Ibrahim Sahib is a two year old boy. Ammai Ammal is a four year old girl, and they die within a day or two. The virulence of the cholera microbe in the present epidemic may be judged from the fact that of the 13 persons attacked, not less than 10 have died.”
MRA: At this time, there’s only one microscope in all of south India, in Bombay, and that’s brought to Bangalore. Ross wants to find the cholera bacterium in samples from the field
SJ: he collects stool samples, he collects water samples, he collects whatever open organic material he can find whether it’s milk or sweet meat, prepared food or raw food, he collects samples from everywhere. whether or not this is this should be taken with a pinch of salt because a typical IMS Medical Officer typically had a staff of eight or 10 under him, which would typically include one or two Indian doctors from the Madras medical college who was sub-surgeons and a whole number of Indian staff, other people who would run the, actually do the sample preparation and sample collections. But he would be handling it to see it under the microscope himself.
MRA: His interventions seem to work..
SJ: by the time he ends, let’s say in October, he is reporting only three new cases in each zone. Munni Swami, Vaithi Jagganthan, and Jonas Muniswami, who’s the who’s the coach driver for the senior officer of the cantonment, so that’s really serious
And that’s how he does this very systematic inquiry over 2 months, puts in systems to control the epidemic, observes the infection rates coming down as a result of his interventions, measures the effect of that using microscopes assessing the water and things like that. So it’s a very comprehensive 8 week description of how to handle epidemics, which was quite fascinating.
GV: Ross also issues recommendations to improve sanitary conditions in Bangalore and avoid future outbreaks…and the authorities do take some action…
SJ: Bangalore is famous for its lakes so two of them were drained or became dry completely. A new lake was created which would take in water from the cantonment only after filtration, what is now Ulsoor lake.That water was then piped back into the residential areas.
GV: Ross also recommends they..
SJ: put in a system of sewage collection, night soil or fecal matter collection, from the city. There is no running water drainage. And Ronald Ross in typical efficiency also calculates the amount of money that could be made by selling this as compost and how over a few years, the sale of the compost would earn sufficient amount for it to be a self sustaining enterprise.
MRA: Sanjeev says that at the heart of treating any disease outbreak — whether cholera or Covid today — there should be information and investigation… {start music}
SJ: the responses to the disease, unless they are governed by information, just like Ross points out that one microscope in the whole of southern India is not good enough. If you really are serious about removing this disease in its entirety, you have to reform your sewage collection, Now, those are the systemic changes that you need to think of when a disease like this occurs.
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GV: You were listening to Sanjeev Jain on Chatroom. For episode notes, please visit scrollsandleaves.com/chatroom8. Thank you for listening and we’ll be back in the new year! Advance Happy New Year!