Malaria kills more than one million people yearly in tropical countries, it is described as a silent tsunami under way all the time? (Dr J. Sachs, Columbia University). Deaths, occurring in many poor sub Saharan places, are often ignored by local authorities; sanitary measures and medicine are not always there from lack of funds or initiatives.

Mauritius, one hundred years ago, was a sick colony suffering from malaria and other diseases. Today, we can redeem from oblivion those who laboured to save the lives of many. This retrospect is not on the disease, it is a small tribute to Major Ronald Ross who, in spite of considerable odds, solved the mystery of malaria, which has haunted men of medicine since Hippocrates.

In Mauritius, the first outbreak of malaria occurred in 1866; it was treated with quinine. At that time, scientists believed that it was caused by ?bad air? emanating from the marshes. By the turn of the century, the socio economic conditions were alarming, after the terrible cyclone of 1892, the plague of 1899 and the sporadic epidemics of malaria. The local elite became hysteric and accused the British government of negligence and lack of initiatives to provide remedies. Sanitary measures like drains were made only in the capital. The Malaria Committee (1902) was allocated only Rs 10,000 for various works. When the plague subsided by 1905, the authorities focused once again on malaria. Dr Eugene Laurent as Mayor of the Municipality of Port Louis was actively combating diseases. Laureate of the Royal College, he studied medicine in London, and, during one of his visits in Europe, he met Sir Patrick Manson, an authority in tropical diseases. It was after an important conference on malaria held in 1907 by Dr Laurent in Port Louis that the colonial government decided to seek the service of Major Ronald Ross.

Ronald Ross was born in India in 1857 at the start of the Mutiny. Sent to England, he showed no keen interest in medical studies, preferring literary activities. He was appointed medical officer in the Indian Medical Service in Madras in 1881. He spent his extra time playing golf, hunting and writing a novel. It was after following a course in bacteriology during a visit to England that his interest in malaria was aroused. Back to India, he worked on the theory of Alphonse Laveran on the link between fever and mosquitoes. He was at first unsuccessful, and he wrote an article where he attributed malaria to bowel disorders. It is only after a meeting with Sir Patrick Manson during a second visit to England that his researches became more focussed. On his return to India, he had to face administrative interference in his researches, ?administrative barbarism? as he said.

«(...) he worked on the theory of Alphonse Laveran on the link between fever and mosquitoes. He was at first unsuccessful, and he wrote an article where he attributed malaria to bowel disorders. (...) On his return to India, he had to face administrative interference in his researches, ?administrative barbarism? as he said.»

On the 20 August 1897, at a small military hospital at Seekunderabad in South India,? Ross succeeded in proving that malaria was transmitted by Anopheles mosquito bites. That day he called it ?Mosquito Day?. His discovery was later confirmed by Robert Koch and other scientists. In 1899, he resigned from the Indian Medical Service and returned to England. In 1902, he obtained the Nobel Prize for Medicine and he was appointed to professorship to the newly founded Liverpool School of Tropical Medicine. He went on missions to Egypt (1902), Panama (1904) and Greece (1906) to devise anti-malarial schemes. It is in this context that Professor Ross arrived in Mauritius on 21 November 1907 on board the ?Natal?.

Major C.E.P. Fowler from the Royal Army Medical Corps also arrived on 21 October 1907 to assist Ross and at the same time to investigate the prevalence of malaria among the troops. Both stayed at the military quarters at Vacoas. They interacted with Dr H. Lorans and the staff of the Medical and Health Department, who accompanied them to various sites for investigations. Ross read widely on malaria, the notes of the conference on malaria by Dr E Laurent, the report of the Commission of Enquiry on malaria of 1868, reports of Dr A Davidson and Dr A Lesur and so on. Ross held three main conferences to inform and sustain the confidence of the public, one at his residence at Vacoas for a select group of guests; a second one was organised by the ?Societé Médicale? (he was appointed the honorary chairman of the society), a third one at the Town Hall of Curepipe, which was chaired by Governor Cavendish Boyle, and a last one at the Theatre of Port Louis. He told the elite at Curepipe that mosquitoes carrying malaria existed in their locality, and the rich inhabitants needed to raise funds for anti-malaria works. In Port-Louis, he advised the inhabitants to remove the trees of the town. In general, all sanitary works should continue all the time. The press hailed him as the ?Conqueror of Malaria.? His lectures were very much informative and he was also much appreciated for his wit and his style.

Investigations ended by February 1908 and Ross left for Europe on 26 February 1908. Before his departure, a banquet was given by the ?Société Médicale? at the hall of the Mauritius Turf Club. The ship ?S.S Melbourne? on which Ross was travelling back to England stopped at Reunion, but it was quarantined and he was unable to visit the island to carry out some enquiries on malaria. The official report of Ross was tabled in the Mauritius Legislative Assembly on 13 October 1908. He made it clear that all generations have to be vigilant to keep diseases at bay. The report triggered vast anti-malaria campaigns: draining marshy lands, the use of quinine, the use of mosquito nets, regularly inspecting school children and inhabitants. Malaria remained a scourge in Mauritius until the mid twentieth century.

Some time after his return to England, Ross was awarded various honours. In 1911, he was knighted. But he complained that he had not been financially rewarded for discoveries and missions abroad. In 1911 and 1923 he published two books on malaria. In 1926, he was appointed Director General of Ross Institute and Hospital of Tropical Diseases and Hygiene, (where he passed away in 1932). Although he spent his time and energy to improve the health conditions of people in India and Africa, his memory lives on mainly in England. His archives (about 100 boxes have been preserved at the London School of Hygiene and Tropical Medicine. In Mauritius, a street in the suburb of Quatre Bornes bears his name and that is all. The road to Seekunderabad in India has been renamed after him only recently.

Various lessons could be drawn from this dark episode of Mauritian history. The prevalence of malaria in Asian and African countries with which Mauritius has direct communication may be a matter of concern. In the past, scientists made extensive reports on diseases on which they worked. Today, more than ever, it has become necessary for scientists and practitioners to communicate regularly to society at large on current diseases and also on new discoveries in medicine. A reading of the colonial past may still help in directing sanitary measures and moving towards sustainable development. A Medical Archives and Museum showing the evolution of medical care in Mauritius from the colonial times to the present could be helpful to medical students and the general public. Researchers are hopeless because newspapers, reports and accounts on medical history of Mauritius have disappeared.

Raj BOODHOO

13 October 2008 [email protected]

R. RossReport on the Prevention of Malaria in Mauritius. London 1908. W. F. Bynum, Mosquitoes Bite More Than Once, Science 4 January 2002 Dictionary of Mauritian Biography.