The Weekly Dose: The British and the Bombay fever
We often blame urbanisation for its omnipresence, but malaria has prospered in India’s commercial capital for centuries before it became a city.
When the medical unit to which you are attached as an intern admits 97 cases of dangerously high fever within 24 hours in July, you no longer romanticise the rains. In Mumbai - where I live - the first showers are associated with longer commutes, roasted corn on the cob, and stunning skyscapes; in its public hospitals, dark clouds of gloom descend upon overworked doctors, who brace for overflowing wards with two or more patients to a bed, and more on the floor. When an intermittently high fever presents itself with signs of dehydration, body-ache, joint pains, nausea, loss of appetite and other familiar complaints, the diagnosis is made at an almost spinal level: leptospirosis, dengue, or most commonly - malaria.
We often blame urbanisation for its omnipresence, but malaria has prospered in India’s commercial capital for centuries before it became a city. Originally a group of seven major, sparsely populated islands, Bombay was a marshy nowhere, parts of which were overrun by the sea during high tide. Its original inhabitants drove the British to despair by persisting in using a fertiliser made of fish-meal, which attracted alarmingly large swarms of ‘scooties’ (mosquitoes). The rains brought death with them and were particularly dreaded by the white sahibs. Describing a Britisher’s tenure in Bombay, a 17th-century reverend declaimed: ‘Two monsoons are the age of man’ - after this, one retired to Britain, or a place six feet under.
The story of the first train journey in India - between Bombay and Thana - is well-known; forgotten are the thousands of Indian labourers who perished of unknown fevers during the extension of the line through the Sahyadris to Poona. The architect of the city’s most magnificent edifice - the Victoria Terminus railway station - also died of malaria. It wasn’t until the latter half of the 19th century that the causative organism was identified; people died of a fever in which ‘in the cold stage, there is a sedative influence exercised by the morbific cause on the action of the heart, and a tendency in the blood to move languidly’. So rampant was it that in Mauritius - where Indians were transported as slaves - it was called ‘Bombay fever’.
The discovery of the malarial parasite was a lifesaver, literally - it could be identified in blood samples, and drugs were developed to kill it. In 1928, the Assistant Director of the Malaria Survey of India published a report titled ‘Malaria in Bombay’ - a record of the authorities’ efforts to combat malaria, and the neglect that persists unto this day. It is a fascinating document, which reveals how official attitudes have changed, and how much remains the same.
It was in Bombay that a Britisher confirmed the existence of the malarial parasite in India; it was found in 13% of the blood samples from cases of ‘malarious fever’; at the time, only the pigmented forms were known, and identifiable. Malaria infected three out of five British troops in the Bombay Presidency every year and caused one in four deaths amongst resident Europeans. It was responsible for the deaths of two in every five Mumbaikars.
It was only at the beginning of the last century that authorities began to look for the ‘Anopheline mosquito’ - whose bite introduces the parasite into our blood - and its breeding spots in Bombay. A committee comprising representatives of the Government Medical Service, Sanitary Service and ‘mosquito experts’ was charged with inquiring into the spread of malaria; it took two years to produce a report that mostly described the epidemiology of plague instead. Meanwhile, malaria struck close to the nerve centre of British power; one-fifth of the Governor’s Bodyguard was laid hapless by it.
It is pertinent to note that the two mainstays of Bombay’s economy - docks and mills - were also responsible for its malaria burden. The construction of the Alexandra Docks (named after a British queen) employed labourers who lived in huts at the site; while passengers were spared, malaria attacked those members of the crews of docked ships who had remained on board. In five years, the Bombay Port Trust lost over 12,000 man-days to malaria. Water cisterns on the roof of the nearby St George Hospital - which would have treated some of the cases - were also identified as mosquito breeding sites!
The report also emphasised that ‘the correlation between the intensity of malaria and the proximity of mills was most striking’. With ill-drained compounds scattered with discarded equipment, every morning, swarms of mosquitoes greeted lakhs of workers, who also lived in nearby housing chawls.
The disease burden in residential areas was unpredictably skewed; Dharavi - then a village which later developed into Asia’s largest slum - was almost malaria-free; my public hospital is adjacent to it, and I can assure you this is no longer the case. The southern, more prosperous neighbourhoods suffered the most; fountains and garden-tanks of the uber-rich were hotbeds of malaria. The report states: ‘one cannot help wishing that the contractors had spent a little less money on providing marble floors, and a little more on properly levelling and grading the terraces and gutters.’
Open wells - of which the city had over 4,000 - were ordered to be covered. Many residents opposed this on religious grounds; a compromise was arrived at wherein the well-covering would have a trapdoor that could be opened to draw water; naturally, residents left it perpetually open, defeating its purpose.
A special Malaria Department was created (and disbanded in a few years, to save money), and staffed with inspectors, sub-inspectors and ‘coolies’. They formed well-gangs and fish-gangs - a British official advocated stocking wells with fish that would consume mosquito larvae; the plan failed because young boys took to fishing as a pastime!
So much has changed in the city in almost a century, but malaria still holds sway over Bombay. The reason is the same as from 91 years ago:
“The continued presence of malaria is not (only) due to the habit of the ignorant masses of the population, but to causes - for the most part - within the control of the educated and wealthy property-owning classes of the community. It is among the very classes who, if they chose to do so, could eradicate malaria from the greater part of the City within a year.”