Mal-areas of Health Dispersed Histories of a Diagnostic Category
The urge to define malaria in the third quarter of the 19th century created a lot of conflicting theories and understandings of that disease. However, the practising physicians could accommodate these conflicting explanations as different probable attributes of that mysterious disease rather than necessarily discarding one theory in favour of another. Through the acts of narrating and reporting clinical diagnostic encounters in regularly published and extensively circulated medical journals, these different connotations of malaria acquired a certain currency, not least legitimacy.
ROHAN DEB ROY
C
Stories Like Dr Christie’s
On the night of March 22, 1872, Dr Arthur Christie after having practised medicine close to Washington, America, on the eastern branch of the Potomac river, for six years, had started his journey back home in Hyde Park Gardens in London in “strong health”.1 He, like most of his fellow practitioners in that region, attributed the diseases, which his patients were frequently diagnosed to suffer from as results of exposure to malaria. In the language of contemporary medical topography, engaged in the hierarchisation of landscapes into sources of different grades of ill-health, that part of America was believed to be particularly malarial. Malaria, Dr Christie believed, expressed itself not necessarily by gifting the body fluctuating temperatures readable in the thermometric scale, or by assuming epidemic proportions when “not one in ten escaped the malady”. The impact of malaria on the body, Dr Christie believed, was much less dramatic and spectacular but sustained, prolonged leading to pain and various forms of unease. Frequent diarrhoea, nausea, headache, general malaise “in which it would be impossible to say in what part of the body most discomfort is felt, each organ asserting its claim to bearing the palm in that respect” were some of the usual ways in which his patients on the bank of river Potomac expressed, as Christie thought, the impacts of their exposure to malaria.
Christie sailed on March 23 from New York for Liverpool. Once during the voyage, he tells us in his letter to the editor of Medical Times and Gazette, he started feeling ill. He apprehended that the illness might have been a result of malaria that he had imbibed from around the vicinities of Washington. A little hot brandy and water had offered quick relief dissipating his feeling of sickness and his apprehensions. He reached London on April 5. On April 7, while in a Turkish bath, he suddenly became quite ill, came home, and was unable to sit up. After suffering for a couple of days, he began quinine; 30 grains in 24 hours put him on his feet. He wrote, “Had I not taken this my recovery would have been postponed. Thus malaria was doubtless carried into my system from March 22 to April 7, 16 days before making its appearance.”
This shows that stereotyping of landscapes as malarial was a practice that was not monopolised by high-ranked medical officials serving the British empire in “colonised” locations like India. Instead, it gives us insights into some of the logics of diagnosis that biomedical practitioners functioning across geographical locations employed. Physicians like Christie believed that malaria, once imbibed into the body due to residence or passage through a malarial locality, did not necessarily reveal its onerous potentials immediately. Instead, as in Christie’s personal case it could remain latent, dormant in the body for weeks and travel with it across continents before manifesting itself in the form of an illness. In other words, malaria was a convenient jargon that biomedical practitioners invoked to explain any malady in a body that had resided in or travelled through a locality thought to be malarious. But, which “localities” were specified as malarious in the mid-19th century? Or in other words, which localities were believed to be completely immune from the effects of “malaria” in contemporary literature? Different commentators on biomedicine, it would be suggested later, had diverse answers. Besides, as it emerged from this story, the detection whether a malady was malarial was attained from observing how the body reacted to quinine. The range of efficacy of quinine set the horizon of fluidity of malaria. It was not a vivid understanding of the nature of the disease that had shown up in the body that led to the prescription of the remedy. On the contrary, the response of the body to quinine led to the identification of the nature of the disease. Speculation about the malarial character of cholera, as reflected in Macgowan’s essay,2 was inspired by the need to search for a viable cure for cholera (in the form of quinine). While in some contexts efficacy of the remedy led to the identification of the nature of disease, search for remedy could inform the identification of a disease in some others. Stories like Dr Christie’s that kept recurring in the literature on malaria across geographical locations around mid-19th century underscored these trends.3 This article explores the different definitions of “malaria” that circulated in the medical correspondences4around the third quarter of the 19th century and asks how it functioned as the most fluid diagnostic jargon in quotidian biomedical practice.
Of Confidence, Of Confusion
While hinting at the ambiguity in the contemporary discussions on “malaria” the anonymous reviewer of Oldham’s extensively cited What Is Malaria? quoted the following conjectural conversation between a fictitious Tom and Jack:
Tom says, ‘Now, that Is a paradox for you’, – ‘A what? a paradise’!
says Jack – ‘No, you fool!’ replies the opponent, ‘a paradox’–
‘A paradox is it, and what’s that?’ exclaims Jack, when Tom
replies, – ‘What! Don’t you know what a paradox is? What a
simpleton you must be not to know what’s a paradox! It is a sort
of... Oh! It’s no good talking to a fellow that don’t know what
a paradox is!!5
The fundamental ambivalence that marked the medical correspondences on malaria in the third quarter of the 19th century was that “malaria” symbolised both the confidence of and confusion within contemporary biomedical science. There seemed to circulate a surplus of knowledge on malaria. To quote a contemporary author on malaria: “we have had a wide circulation (on the subject) through the medium of journals, so much has been said that anything more on the subject may seem superfluous...”6 While beginning to narrate his experiences of attending to cases of “malarial fever” in the Indian Medical Gazette, it appeared to assistant surgeon B Evers that he was about to comment on a “thrice told tale”.7 The metaphor of malaria was extensively invoked in the medical correspondences emanating from myriad locations. As the most fluid diagnostic tool in contemporary biomedical practice, “malaria” as a word figured in discussions on a diverse variety of maladies. From the apparent conviction with which the word “malaria” was used in different contexts it appeared that it was indeed embarrassing not least disgraceful to pose the question yet another time: What is malaria?
However, there existed a parallel body of authors who consistently questioned the commonsensical assumptions around malaria and the confidence with which the word circulated in myriad usages. Despite the different forms of physical unease with which malaria was associated in contemporary medical correspondences, George Gwynne Bird, MD, author of a book on civic malaria that was published in 1849 stated that “we know nothing about malaria”.8 In his Macnaughton Prize-winning essay entitled Malaria that was eventually published as a book in 1885, Salisbury found it right to quote these two “authorities” to sum up his introductory chapter harping on the confusions that existed around the category “malaria”. He quoted Dr Robert Armstrong, “We are utterly ignorant of the nature of malaria, and no two authors agree respecting its constitution, the circumstances under which it is generated, or its effects on the human body…On the existence of malaria we have no positive proof. It has never been obtained in an insulated state, and consequently we are totally ignorant of its physical properties.” He also quoted Caldwell to have said: “If asked what Malaria is? I answer, I do not know.”9
It was this imprecision and uncertainty about the ontological characteristics of ‘malaria’ that led to its presentation in certain sources as a widely circulating “mystery”10 in contemporary medical literature. This amorphous, intangible, unlocatable characterisation of ‘malaria’ has extensively featured in various medical texts in the third quarter of the 19th century. Malaria had been often projected as an imperceptible entity that could not be sensed. It had variously been described as a “subtle agency”11 that was “beyond human control”.12 The presence of malaria could merely be “inferred” from the effects it was ascribed to produce, but could not be sensed.13 Despite the wide prevalence of malaria in contemporary medical correspondences, Aitken noted in 1880 that none had till then claimed to know what malaria looked like. It was this imagining of malaria as a “subtle, invisible, imponderable element”14 that made it amenable to flexible use, that could be manipulated to explain diverse expressions of physical unease in different bodies in various locations.
‘Malaria Causes All’15
Histories of health and medicine on 19th century south Asia have predominantly revolved around tracking the links between colonial expansionist imperatives, Darwinian demography (and the debates on acclimatisation that preceded it but did not die with it), moral evaluation (the alleged connections between medical topography, morality and health) and medical practice.16 The themes that bind these histories on malaria in 19th century south Asia are that of governmental embarrassment,17 inconvenience to colonial expansion,18 colonial propaganda19 and nationalist reaction.20
However, a parallel discourse on “malaria” thrived in the medical correspondences among practising physicians. Here malaria was presented as the quintessential diagnostic jargon that was invoked to explain a diverse range of expressions of physical unease. Contrary to the alleged projection by certain sections of the higher medical officials employed by the colonial state in India, which branded malaria as a homogeneous fever-disease that resulted in general debility,21 a closer look at these correspondences reveal that malaria, because of the fluidity in meaning it was invested with, could serve as the most convenient label, a flexible medical metaphor, an umbrella category that was believed to convincingly explain expressions of an extensive range of little debilities in a body. Malaria was one of the fluid jargons through which medical science laid claim for access to knowledge of myriad forms of physical unease in the everyday. Among mid-19th century biomedical practitioners malaria circulated as one of the most effective medical tropes, implicated with various meanings, which assisted the ambitious diagnostic project of nosological classification (that aimed at the categorisation of different expressions of physical unease into predictable diseases). In that sense malaria added to the confidence of allopathic medical science in its logistical devices for diagnostic practice. From the way it was used in quotidian clinical practice, the metaphor of malaria, as it is evident from these medical correspondences, must have had reinforced the arrogant claim of allopathic medical science that it had an acceptable scientific explanation for most forms of physical unease that surfaced in the body or remained latent in it.
Malaria was not only invoked to explain fevers that recurred in the body with set rhythms of periodicity, i e, intermittent and remittent fevers,22 but fevers without periodicity, i e, ephemeral fever or febricula, continuous fever, typhoid23 and conditions described as goitre,24 idiocy,25 dysentery, diarrhoea, bronchitis, phthisis pulmonalis, dropsy, ulcers.26 Contemporary practising physicians often explained myriad maladies as diverse as hysteria accompanied by epilepsy, “chorea affecting the lower extremities and strongly simulating locomotor ataxy”, local paralysis, puerperal fever, erysipelas, retinal haemorrhage, strangulated hernia, glucosuria as unmistakable sequels to a prior attack of malaria in the body. Syphilitic pain, stupor of typhus, the collapse of cholera, the high temperature of insolation, the sickness of an irritant poison, the convulsions of epilepsy, hot hands, general aching, pain extending along the course of the great nerve trunks in the limbs, general appearance of dullness, abscess at the root of the tooth, bleeding from spongy gums, boils, bronze discoloured skin, haemic murmurs, retarded healing of wounds or more enduring forms of physical unease in the form of feeble pulse, insomnia, glycosuria, wasted muscles, weak cardiac action, asthma were diagnosed as expressions of malaria in its “latent”, “pernicious”, “masked” form or an expression of malarial cachexia.27 The metaphor of malaria was extended to explain “a variety of indefinite complaints suggestive of general ill-health than of any specific disease”.28 In the literature on malaria around mid-19th century words like “simulates”,29 “modifies”,30 “tinged with”,31 “mutates”,32 “causes”,33 “impresses”34 have a constant presence. These words figure in various contexts and in different ways to convey the fluidity of malaria as a diagnostic jargon and how the metaphor of malaria could be invoked in explaining diverse forms of physical unease, predicting its course and suggesting remedies for cure.35
‘All Soils Exhale Malaria’36
Existing histories of medicine on 19th century have defined malaria in relation to “marsh miasma”.37 The painting ‘An Allegory of Malaria: Ghost in the Swamp’ has been the typical model around which definitions of malaria have been imagined.38 The careful readings of medical correspondences reveal that meanings of malaria were in no way confined to marsh or miasma (often defined as putrid emanations from decomposing organic substances). In the third quarter of the 19th century, as these correspondences reveal, malaria was defined in terms of eclectic and dispersed geographical categories that clearly went beyond the marsh.
To accommodate some of the varied geographical locations those were associated with malaria within the category of marsh or swamp (with which “malaria” was conventionally associated) there were some attempts to flex the category of marsh itself. In response to Dr Moore’s repudiation of the alleged connection between marshes and malarial diseases, K D Ghosh, for instance, argued that a swamp became a potential breeding ground of the seeds of malaria only when “heat of soil, air, moisture, and some impurity of soil which in all probability is of vegetable nature” acted in conjunction. He thereby explained malarial fevers in the sandy soil in the vicinities of the desert in Bikaneer or in a rock on the Goalpara district in Assam in terms of the swamp-effect these locations were capable of generating.39
Beyond the swamp/marsh, malarial fever or maladies those were eventually attributed to the impact of malaria could be traced in the great sandy desert of northern India, and other similar regions in Asia, in the Sahara, and amongst the bare and sunbaked rocks of Beloochistan and Aden, in the Bhawulpore state, on the border of the Indian desert.40 From his experience furnished from Hong Kong, Assam, Borneo Dr G Dodds argued that the production of malaria was not necessarily connected with the presence of marshes, ponds, rivers, or rank vegetation but rather with a dry, arid soil, more especially when denuded of vegetation. Cases of malaria he encountered were not necessarily confined to low lying districts but did occur at considerable heights. He claimed to have known cases of fever occur at a height of 1,600 feet on an isolated peak.41
The anonymous reviewer of What Is Malaria? authored by Oldham referred to many geographical features that were supposed to breed malaria. The reviewer argued that given the diverse geographical locations in which malaria was found to express itself, it was right to argue in favour of the existence of not only one but several kinds of malaria – the marsh poison, the granite poison, the sandstone, the clay poison, the black soil poison. This was the recognition of the myriad geographical surfaces that had been attributed as “malarious” in different contexts. This apprehension that malaria could make itself felt not merely in regions referred as “marsh”, but in diverse geographical conditions, that there was no single, specific and rigid geographical category that could claim exclusive association with it explains how malaria was amenable to explain not merely an elaborate range of maladies, but it was invoked in myriad geographical locations as well. The alleged omnipresence of malaria was reflected in the statements from physicians like Pickford who was quoted by the anonymous reviewer to have written: “all soils exhale malaria”. Referring to the different geographical terrains with which malaria was associated, the reviewer mentioned “the idea” first promulgated by the Indian author Heyne, and later seized upon by Sir Ranald Martin, that some peculiarity of electricity or magnetism could be the cause of fever on ferruginous soils, or where magnetic ores abound. The reviewer referred to the view that malaria could be destroyed by ozone, but mentioned cases where it could be traced to exist in greatest abundance in the neighbourhood of water where ozone was most powerful. The reviewer talked of contemporary imaginations that located malaria in the soil by suggesting that the malarial poison was said to “love the ground”. This was contrasted in the works of some writers who while explaining the supposed fact of the greater virulence of malaria at night, tended to theorise that it ascended into the higher regions by day, and was again precipitated with the dews of night. The reviewer mentioned the writers who believed that “malaria” lost its noxious properties by passing over water, even of small extent. This was contradicted by Moore who pointed out, “the writers who endorse this statement account for the deadly character of Sierra Leone by the marshy character of the opposite Bulam shore”.42
In sharp contrast to the predominant view that malaria was specific to the plains43 Sir Ranald Martin believed that malaria had been located at “so many thousand feet elevation above the sea level”, and one Dr Carriere, quoted by Parkes, fixed the elevation in different countries. In India, malaria, it was suggested, had been traced at an elevation of 2,000 to 3,000 ft above the sea. The reviewer mentioned that while some practitioners asserted that irrigated land, especially rice lands, were particularly malarious, others stated the reverse. While some considered salt marshes less dangerous than the fresh, others held exactly opposite views.44
Thus, different practitioners ascribed malaria to diverse, mutually contradictory geographical terrains. Like the definition of malaria itself, physicians were not in unanimity over the specific geographical spaces to which malaria was thought to be restricted. In the different correspondences malaria emerged not only as a fluid concept, but was seen as substantially mobile as well. Malaria, it was suggested, “could drift up the ravines”.45 “…It moves like mist and rolls up the hillsides, and may travel with the wind for miles, its progress being arrested by water, especially salt water. Crews of ships lying to leeward of a malarious shore have been affected by the offshore wind, and it is said that ships have generated it from cargoes of green wood, coals, or other vegetable matter or rotting timber and bilge”.46
George Gwynne Bird in his work on ‘Civic Malaria’ suggested an elaborate geography of malaria by arguing that “although it has been clearly ascertained that marshes, whether salt or fresh, are prolific sources of malaria – especially in certain stage of the drying process under a hot sun – this poison is also equally produced in many and various sorts of soils, to which the name ‘marsh’ does not apply”.47 He added that beyond the “marsh miasma” other kinds of malaria did exist on other situations and that these other kinds of malaria could “produce, not the same, but other deadly diseases and fevers, differing in character from miasmatous diseases, but still equally, or perhaps more dangerous and destructive in their nature and effects…”. He went on to suggest that what was prevalent as “marsh fever” in Europe was just one location and way in which malaria acted. He talked of those accumulations of brushwood, reed and grass that were productive of the “malarious jungle fevers”, of the “lake fevers” which rendered considerable tracts of ground in France, Hungary and northern America insalubrious, of the open woods in the warmer parts of Africa, Asia, America, of turned up soils which had for long been in pasture, of the mud left by the retiring tides in seaports and estuaries that caused illness among the boat’s crews. He argued that he had considerable reasons to believe that similar situations were not always healthy in climates designated as “temperate”.48
What Is Malaria?
There was considerable unease among certain sections of biomedical practitioners dispersed across the world who doubted the attribution of malaria as an entity that was beyond sensation or perception. The anonymous reviewer of Oldham’s work referred to Dr Moore and the American physician Knapp who “doubted the very existence of the mysterious agent called malaria...”.49 These physicians regarded “malaria” as a “hypothetical cause” that could never be empirically verified, which some practitioners were using as “cloaks for ignorance” that would eventually “hinder the progress of medical science”.50 Their suspicions were shared by “natives” of the fever-stricken districts of lower Bengal, who as Dr Sutherland’s narrative informs us, rejected the existence of malaria and resisted “the cutting down of vegetation, the destruction of jungle, the formation of roads, etc…”51 as precautionary measures against it. While a large body of medical correspondents framed their diagnostic assumptions by manipulating the attributes of “subtle, imponderable, invisible” malaria was invested with, there were parallel attempts to reduce malaria into perceptible, sensible, locatable equations. Thus medical correspondences on “malaria” reveal the simultaneous presence of the following contradictory trends. While malaria enjoyed currency as one of the most fluid reference points of contemporary medical knowledge, there were profound uncertainties about its ontological status. It has been noted that it was this imprecision that allowed malaria to be invoked to explain diverse little debilities in the everyday. This was paralleled by attempts to locate malaria into narrow, restricted, perceptible limits. This led to various imaginings about how “malaria” smelt like, what could be its colour, which tangible objects did it embody.
E A Parkes wrote of one Dr Massy of the army medical department employed in Jaffna who had supposedly tracked the colour of the “particles” of malaria. “Dr Massy observed increased prevalence of malarial disease to be coincided with the increased development of fungi; and his observations suggest an explanation of the well known power trees exert in stopping the transit of malarious particles. He found the leaves of such trees greatly affected with black rust”.52
Contemporary medical literature bears hints of the possible smell of malaria. E A Parkes wrote of the “smell” of the putrid sewage effluvia which he inhaled while conducting experiments on sanitation at the Army Medical School at Netley: “The first effect produced upon me seemed to be locally on the throat, I felt a peculiar disagreeable sensation over the whole of the soft palate, and part of the hard palate, and in the nose, which became perceptible after the first effect of the smell had gone off. I feel it difficult to describe this sensation, but it was always of the same character, and seemed to me as if a tolerably lasting effect had been produced on the nerves both of smell and taste”. These “sensations” allegedly made him sick with nausea, headache, chilliness and slight fever that recurred during nights.53
Surgeon Ovens attending the 5th Dragoon Guards wrote of an Irish cabinet maker, one private E’O R, who had to spend a night with a “sick horse” that had been voiding “a great deal of wind of a fearfully noxious odour” and had become comatose while emitting “peculiar odour of Typhus”.54 Talking about the smell that malaria possibly entailed, George Gwynne Bird referred to Lord Bacon’s explanation of the “malarious” black fever at an Assize in Oxford in the 16th century in terms of “the smell of the jayl (sic), when prisoners were long and close and nastily kept” which could be the “most pernicious infection next to the Plague”.55
These were paralleled by efforts to track malaria through the means of the microscope. In 1866, Dr Salisbury, for instance, thought that he had discovered malaria in a palmella, with cells and sporules of other fungi, which he called “germasma” or “ague plants”.56
In his essay on ‘Civic Malaria’, George Gwynne Bird related malaria to objects of food. He mentioned the examples narrated by one Dr Rush to show that fever originated from the decomposition of coffee, potatoes and other vegetables and explained the sickliness of ships from the leakage of sugar preserved in damp holds.57 In defence of his argument in favour of the cryptogamic origin of malarious fevers, Salisbury narrated the following case to show how malarial fevers could be generated from the consumption of mushroom: “A reverend gentleman of New York city, in 1845, went with his family to a place about three miles from the Hudson, near Sing Sing. It was selected because of its reputation for health and its exemption from malarial diseases. In August and September, when mushrooms were very abundant, and when the country people abstained from their use under the impression that they disposed them to fevers, the clergyman’s lady, in her frequent drives, collected them daily, and for some time subsisted almost exclusively on them. The remainder of the family ate them sparingly and less frequently. About the end of September the lady was attacked by an irregular fever, without periodical chills, but marked by an exacerbation on every second day. Thus the nature of the case was not suspected until the return of the attack in the spring, which became regularly periodical in June, and assumed a distinct tertian form. It was then readily cured by quinine and other intermittent remedies”.58
The following sets of evidence furnished by Salisbury tell us that “germs” of malaria were believed to be traceable in clothes, bed sheets and books which could travel to distant lands along with them and affect the health of people in those places.
Salisbury believed it “unhealthy” to sleep in damp, mouldy sheets. Besides, he argued that the “dust from old books that have been long packed away often excites coryza, and the inflammation of the Schneiderian membrane, and local fever of throat and air passages”. Salisbury suggested that he had abundant evidence that malarial poison could be transported for long distances in trunks of clothing, in the holds of ships, etc. He quoted from different “trunk cases” mentioned by Dr Rush in all of which only those who opened the packages suffered. He quoted one Dr William Stevens of Santa Cruz to bolster his argument, “the poison is made more intense by being confined to clothes and bedding”. It might be useful to take note of one among the many authors Salisbury quoted in his essay: “Hassok says: I have seen the cases of some servants attacked by yellow fever, upon receiving the clothing of a relative who had died of that disease in the West Indies, at a time when there was no yellow fever in New York”. He also further says that, “after the death by yellow fever of late Gardner Baker, while on a visit to Boston when it prevailed epidemically, his clothes were sent home to his wife, then a resident of Long Island. The opening of the trunk was followed by yellow fever, of which Mrs B died. No disease of the kind existed in New York or its vicinity at the time”.59
Furnished by this evidence, Salisbury hardly had any doubt that the “malarial poison” of diseases could be transported. “It is only thus that we can apprehend and comprehend how a perfectly healthy crew may bring with them, in the close of their ship, the germs of disease, which after their dismissal may pestilentially affect the stevedores who discharge her, or only the labourers who disturb the ballast. We can thus explain the usual pause between the first set of cases caught by visitors to, or labourers on board the ship and attack upon the inhabitants of the vicinity.”60 This explains how cases of Acute Anaemic Dropsy in 1880 in Mauritius or the 1867 malarial epidemic in the same colony were explained in terms of ships from Calcutta and Bombay which had carried coolies into Mauritius when fever epidemics were ravaging those regions in India.61
In Between Epidemics: Malaria and the Everyday
Writing on the basis of his experiences of accompanying the British army in different parts of northern India during the mutiny of 1857-58, Dr Macgowan commented that in that part of the country, fevers attributed to malaria were not distant sources of horror to the “native”. He wrote that he had hardly seen a “native” who had never suffered from “malarial fevers” at one time or the other. To the “native”, Macgowan wrote in his memoir, attack from malaria was such “an everyday occurrence” that they had adapted themselves to live with it. Macgowan mentions numerous instances when he found natives cover themselves over with a cloth and lie in the veranda of any house until the shake was over. This, he contrasted with a glimpse into the barrack rooms of English soldiers, where some one or the other would surely be shaking in his cot with his dinner getting cold beside him.62 The point implicit here is not one of racial immunity, but about the readiness to adjust everyday schedules to accommodate recurrence of fever in a body believed to be inevitable in a “malarial” country.63
Medical correspondences reveal how impressions of day and night vis-à-vis health were shared and differed by medics dispersed in different contexts and locations. The staff assistant, Hensman, with experience of life in the barrack in certain parts of Hong Kong explained the vulnerability of the night-guard to malarial diseases in terms of his exposure to malaria that he believed was most active in nights. “The wealthy civilian, with his spacious and elevated residence, his nights in bed, his life in business excitant, healthful activity, agreeable pleasures and comforts, enjoys a comparative immunity from the fever which desolates a regiment...Even in a regiment this scale of liability is clearly manifested, the duty men suffering the soonest and oftenest, the non-commissioned officers next in order, then the bandsmen, and least of all the officers. The officers are not quite as free from fever as the generality of the merchants: these last maintain the highest condition of health in that colony.”64 These apprehensions about night are borne in the book entitled Chikitsa Bidhan authored by one Nandadulal Mukhopadhyaya, a physician practising in the suburbs of Calcutta.65
These anxieties around the night were reflected in the various voyages Salisbury mentioned in his book. Nights on the coast, as it was reiterated in these travel-memoirs, were believed to be smeared with malaria. The prospects of spending nights on the coast, beyond the safe cocoon that the ship offered, were seen as particularly ominous. During daytime the coasts were believed to enjoy “comparative immunity” from the ill-effects that malaria was attributed to generate. Just to mention one among the many voyaging physicians quoted by Salisbury: “On the authority of Surgeon Allen, we learn that at Zanzibar all who slept on board ship escaped. Every victim seen or heard of had passed at least one night on land. The captain and 40 men from a French corvette, who passed at least one night on land, were attacked by the coast fever, and not one survived.”66
Macgowan’s memoir based on his experiences of attending to soldiers in military barracks in northern India, however, alternatively presented a reverse rhythm of everyday. The daytime seemed to present numerous moments in which malaria made itself felt most aggressively. During nights, on the contrary, the perceived ill-effects of malaria temporarily appeared to take leave of the body. Nights in that camp-life, as this memoir suggests, offered periods of momentary relief, of rare respite from malaria, a time for the immediate medical official to act: “…Each day when the sun was up, the hospital and the barrack converted into and the barrack converted into one, reminded me of the cabin of a sea-going steamer in the channel. The vomiting was incessant and exhaustive to the last degree. But in the cool of the evening there was stillness and comparative ease. This was the seedtime for my remedies, and accompanied by an attendant with a lanthorn and a kettle of port wine negus spiced and boiling, we gave fillip to their flagging enemies. The Dover’s powder gave sleep, and the dose of quinine did its subtle duty against the following day.”67
Conclusion
In the third quarter of the 19th century, the urge to define malaria inspired a crowd of theories. Apart from the theory that attributed malaria to “marsh miasm” (Footnote: Hippocratic corpus, Mary Dobson), the anonymous reviewer of Assistant Surgeon C F Oldham’s What Is Malaria?, which was received with “contemptuous repudiation and boisterous derision from the most orthodox of schools”, mentioned many authors who addressed malaria in different ways. She referred, for instance, to Heynes and Sir Ranald Martin who explained malaria in terms of electricity evolved especially from ferruginous rocks and soils; to Dr Salisbury who claimed to discover malaria in certain low forms of algoid vegetation that could flourish only in marshy places; to the spores speculated by Felix Von Niemiger, which had till then never been seen or detected; to Monsieur Armaund, who rejecting the idea of a specific marsh poison, ascribed the fevers of Algeria to what he termed, “thermo-electro-hygrometric influences”; to the French author Broidel who described malarious fever in the pages of L’Union Medicale as a ‘perturbation of the cerebro-spinal system and the sympathetic system; to Dolomien, who in consequence of the apparent prevalence of malarious fever on granite rock, designated the disease as “la maladie du granit” and thought that it arose from the disintegration and decay of rock under the operation of fungi; to Parkin, the English author who held that malaria did not arise from any cause exciting the surface of the ground, but depended upon chemical or volcanic action beneath it; to Kirke, who attributed malaria to exhalations from lime stone rocks; to Daniel who explained malaria in terms of sulphurated hydrogen; to Crawford, Prout, Copland, Pickford who considered carbonic acid as the delinquent; to the theory of the simple absence of ozone as the cause of malarial fever; to Agnus Smith who considered malaria to be common putrefactive decomposition; to one Dr Parkes who thought malaria to be a vapour; to Dr Hutchinson who believed that malaria could be “our old friend CO2”; to Dr Lawson’s “Pandemic wave theory” that argued that malarial diseases were the inevitable outcomes of waves generated periodically from the “kings of shadows earth borne, air conveyed sons of mystery…”.68
These conflicting understandings of “malaria” did not inevitably undermine each other’s credibility. Instead, the myriad contexts in which the metaphor of malaria was invoked suggests that practising physicians could accommodate these conflicting explanations as different probable attributes of “that mysterious poison”, malaria; rather than necessarily discarding one theory in favour of another. In biomedical diagnostic practice “malaria”, with its many connotations, was frequently summoned to explain numerous sensations of physical unease that surfaced in the body amidst the “infinite diversity of daily rhythms”. Through acts of narrating and reporting clinical diagnostic encounters in regularly published and extensively circulated medical journals, these different connotations of “malaria” acquired a certain currency, not least legitimacy.
Contrary to the existing histories, malaria was not associated in the third quarter of the 19th century with a predictable set of maladies,69 neither was it expected to produce “clear and consistent effects”.70 “Malaria” was presented as one of many credible jargons that enabled the practice of allopathic medicine to constitute itself as a science. It was one of the fluid categories through which medical science laid claim for access to knowledge of myriad forms of physical unease. Malaria provided that elastic frame, in agreement with or variation from which different sensations of bodily discomfort were identified into some nameable disease. It has been hinted in this essay that quinine, the quintessential remedy of “malaria”, was often used as a test for determining the character of different varieties of physical unease. The range of efficacy of quinine often set the horizon of fluidity inherent in the category malaria. Like the notions of “germ” since the late 19th century or “diet” since the second quarter of the 20th century, that emerged as indicators of contemporary medical common sense, malaria functioned as the prior, foreseeable, invariable, implicit assumption behind diagnosing different expressions of physical unease around the third quarter of the 19th century. A malady could be attributed to any onerous entity other than malaria only after its un-malarial character had been ascertained.71 Pregnant with manifesting itself in different ways, malaria, it was believed, could stoke ill-health in bodies inhabiting diverse geographical locations. Although a human habitat that was completely immune from the effects of malaria was thought as rare,72 some places were stereotyped as more “malarial” than others.73 “Malaria” surfaced in contemporary medical correspondences as a multi-potent, fluid, flexible, “not-one”74 diagnostic jargon. The literature on “malaria” was characterised by a culture of universalism, medical stereotyping and difference.75
EPWEmail: debahan@sify.com
Notes
[A generous doctoral scholarship from the Wellcome Trust Centre for the history of medicine at University College, London and the Wellcome Trust Centre enabled the research towards this article. I owe most of this article to the affectionate supervision and criticism of Sanjoy Bhattacharya. A shorter version of this essay was presented at the annual conference of the Society for the Social History of Medicine, 2006, at the University of Warwick. Iparticularly benefited from the comments of professors David Hardiman, Mark Harrison and Anne Hardy. Bodhisattva Kar continued to stoke me with his inspiring suggestions, braving traumatic circumstances in his familial life. I am indebted to all of them. The many limitations in this essay, as goes the cliche, is all mine.]
1 The information and quotations used in this section are derived from the
letter written by Dr Arthur Christie on latent malarial disease to the editor
of Medical Times and Gazette London, May 11, 1872, p 550.
2 A T Macgowan, ‘Malaria, the Common Cause of Cholera, Intermittent
Fever and Its Allies’, reprinted from the Medical Mirror, London, John
Churchill and Sons, New Burlington Street, price one Shilling, 1866.
3 For a similar emphasis on the perceived multi-potency of malaria and
the invocation of Quinine as a test for determining the character of a
malady, see among others, J B Scriven (civil surgeon of Lahore), ‘Malarious
and Other Fevers in India’, The Lancet, August 5, 1878, p 184 or Yadunath
Mukhopadhyaya, Quinine, Calcutta, 1893.
4 By medical correspondences I refer to besides epistolary exchanges
between practitioners, letters to the editors, review articles published in
the medical journals from myriad locations, journalistic narrations on
health those found their ways into the annual reports of the army medical
departments, personal memoirs of the doctors and medical treatises. In
this “unified as well as hierarchical” world integrated by medical
correspondences, Bengal emerged as one among the numerous sites from where stories on malaria were extracted, narrated, published, circulated. In a world integrated by an enmesh of medical correspondences the discussion on malaria emanating from Bengal could engage into a dialogue with that emerging from Hong Kong, Mauritius, Ceylon, Florence ordistant Ohio. The archive of the historian of knowledge on malaria in the 19th century reveals a greater need to bring the worlds of “metropole” and the “colony”, “coloniser” and the “colonised” into what Fredrick Cooper and Ann Laura Stoler calls in their provocative introduction to the collection of influential essays edited by them entitled Tensions of Empire as “the same analytic field”. However, this shared analytic registershould acknowledge the nomadic character of the discourse on malaria by tracing “those circuits of knowledge and communication that took other routes than those shaped by the metropole-colony axis alone” or interactions shaped within the geographical limits proposed by the post-colonial nation states and their erstwhile ruling nations. A careful reading of the medical correspondences, letters to the editor, repertories and articles publishedin the medical journals from myriad places reveal that different understandings of malaria travelled through geographical sites that were much more eclectically dispersed than the nationally bounded medical histories would have us believe “disappointingly enclosed and selfsufficient” regional histories of medicine in the garb of focused microlevel studies end up pathetically legitimating the received geographiesof the provincial units of federal post colonial nation states. Works like these reinforce the intellectual capital of the regional institutions of these states. For instance see the use of the category ‘Bengal proper’ in Arabinda Samanta, Malarial Fever in Colonial Bengal, 1820-1939, Social Historyof an Epidemic, Kolkata, 2002, p 7. In biomedical practice around the mid-19th century, malaria figured as the most frequently recurrent diagnostictool. Allopathic practitioners in Bengal shared this trend with their counterparts engaged not only in the various locations of the British empire, but beyond the geographical limits set by it.
5 Anonymous review of What Is Malaria? And Why Is It Most Intense inHot Climates? by C F Oldham, published in Indian Medical Gazette, May 1, 1871, p 103.
6 A T Macgowan, ‘Malaria, the Common Cause of Cholera, Intermittent Fever and Its Allies’, reprinted from the Medical Mirror, London, John Churchill and Sons, New Burlington Street, p 6.
7 Assistant Surgeon B Evers, ‘Ague and Its Sequel’, Indian Medical Gazette, May 1, 1871, pp 86-87.
8 George Gwynne Bird, ‘Observations on Civic Malaria and the Healthof Towns’, contained in a popular lecture delivered at the Royal Institution of South Wales, in the year 1847, published by William Wood, 39, Tavistock Street, Covent Garden, 1849, p 6.
9 Both these statements had been quoted in James Henry Salisbury, Malaria, William A Kellog, 1885, p 8.
10 Anonymous review of ‘What Is Malaria? And Why Is It Most Intensein Hot Climates’? by C F Oldham, published in Indian Medical Gazette, May 1, 1871, pp 99 and 100.
11 Sir Joseph Fayrer, first Croonian lecture on ‘Climate and the Fevers of India’, Lancet, March 1882, pp 423-26.
12 Staff assistant – Surgeon Wm Hensman, Remarks on Malaria, Appendix No L, Army Medical Department Report for the Year 1866, Vol VIII, printed by Harrison and Sons for Her Majesty’s Stationary Office, 1868, p 506.
13 George Gwynne Bird, ‘Observations on Civic Malaria and the Health of Towns’ contained in a popular lecture delivered at the Royal Institution of South Wales, 1847, published by William Wood, 39, Tavistock Street, Covent Garden 1849, P 6.
14 Aitkin quoted to have noted in 1880 in Michael Worboys, ‘Germs, Malaria and the Invention of Mansonian Tropical Medicine’ in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, edited by David Arnold, Rodopi: Amsterdam-Atlanta, GA 1996, p 187.
15 A T Macgowan, ‘Malaria, the Common Cause of Cholera, Intermittent Fever and Its Allies’, reprinted from the Medical Mirror, London, John Churchill and Sons, New Burlington Street, p 8.
16 David N Livingstone frames these histories as bound by the “quadrilateral of empire, struggle, virtue and disease”. David N Livingstone, ‘Tropical Climate and Moral Hygiene: The Anatomy of a Victorian Debate’, British Journal for the History of Science, 1999, 32, p 93.
17 “Malaria” has figured as a constant concern for the managers of publichealth and the bosses of the sanitary departments. For instance, Mark Harrison, Public Health in British India: Anglo Indian Preventive Medicine,1859-1914, Cambridge University Press, Cambridge and New Delhi, 1994.
18 For instance Douglas Haynes mentioned malaria as “the greatest challenge to the expansion of European colonies”. Douglas M Haynes, ImperialMedicine: Patrick Manson and the Conquest of Tropical Disease, University of Pennsylvania Press, Philadelphia, 2001, p 3.
19 Historians have read in the persistent circulation of the word malaria in the different colonial records of 19th century south Asia an almost neatly orchestrated an attempt to stereotype the myriad colonial landscapes as “tropical” and hence “unhealthy” or a signifier of a retrograde civilisation,a marker of racial degeneration. In these histories malaria has been presented as one of the many medical jargons employed by the colonial state through which it made sense of its subjects. For instance, see David Arnold, ‘An Ancient Race Outworn: Malaria and Race in Colonial India, 1860-1930’ in Race, Science, Medicine, 1700-1960 edited by Waltraud Ernst and Bernard Harris, Routledge, London and New York, 1999, pp 122-43and Mark Harrison, ‘Hot Beds of Disease: Malaria and Civilisation in 19th Century British India’, Parassitologia 40: 1998, pp 11-18.
20 For instance, see Arabinda Samanta, Malarial Fever in Colonial Bengal,1820-1939, Social History of An Epidemic, Kolkata, 2002.
21 For instance see, David Arnold, ‘An Ancient Race Outworn: Malaria and Race in Colonial India, 1860-1930’ in Race, Science, Medicine, 17001960 edited by Waltraud Ernst and Bernard Harris, Routledge, London and New York, 1999, pp 122-43.
22 Prevailing histories have not questioned this projected rigidity in the rhythms of recurrence that is inherent in the distinctions of intermittent malarial and remittent malarial fevers or between malarial fevers and “other classes of fevers”. Careful analyses of the caveats, the qualifications,the variations that accompanied these discussions on the expected rhythms of malarial fevers suggest that the intermittent and remittent fevers were not rigid categories. By substantially accommodating exceptions and variations in the expected rhythms of recurrence of these fevers, the malarial identity could be extended to fevers that manifested in the body with various symptoms and in diverse rhythms. The anticipated rhythms of periodicitywere modified, flouted and alternate explanations and caveats were carefully spun in these texts to accommodate these recalcitrant manifestations of fever as different expressions of the same onerous entity: malaria.
23 Sir Joseph Fayrer, third Croonian lecture on ‘Climate and the Fevers of India’, Lancet, April 15, 1882, pp 593-95.
24 Review by J W Moore of Dr Macnamara’s ‘Himalayan India, Its Climateand Diseases’ in Dublin Journal of Medical Sciences, 1880, 3, Vol slxx, pp 412-15.
25 Dr Zillner, ‘On the Malarious Origin of Idiocy and Goitre in the Neighbourhood of Salzburg’, The British and Foreign Medico-ChirurgicalReview, July, 1861, p 56.
26 James Reid, ‘The Penal Settlement of Port Blair’, Indian Medical Gazette, March 1, 1882, pp 65-67.
27 Sir Joseph Fayrer, second Croonian lecture on Climate and the Fevers of India, Lancet, March 25, 1882, pp 467-70.
28 Sir Joseph Fayrer, First Croonian lecture on ‘Climate and the Fevers of India, Lancet, March 25, 1882, p 426.
29 J B Scriven (civil surgeon of Lahore), ‘Malarious and other Fevers inIndia’, The Lancet, August 5, 1878, p 185.
30 Sir Joseph Fayrer, first Croonian lecture on ‘Climate and the Fevers of India’, Lancet, March 25, 1882, p 423.
31 Baboo Rakhal Chandra Ghose (lower medical service), ‘Use and Abuse of Quinine in Fever’ (proceedings of the Calcutta Medical Society), Indian Medical Gazette, May 1, 1882, pp 138-42.
32 Thomas Reade, ‘Transmutation of Quotidian Malarial Ague into Syphilitic Malarial Ague’, Medical Times and Gazette London, May 4, 1872, pp 511-12.
33 A T Macgowan, ‘Malaria, the Common Cause of Cholera, Intermittent Fever and Its Allies’, reprinted from the Medical Mirror, London, John Churchill and Sons, New Burlington Street, p 8.
34 Staff assistant – surgeon Wm Hensman, Remarks on Malaria, Appendix No L, Army Medical Department Report for the Year 1866, Vol VIII, printed by Harrison and Sons for Her Majesty’s Stationary Office, 1868, p 506.
35 While commenting on the essential theories of fever circulating in the late 18th and early 19th centuries by focusing on textbooks referred in the medical schools (i e, by William Cullen) or texts of speeches deliveredby renowned medical authorities (i e, William Stokes), historians like Margaret Pelling or Harish Naraindas had come close to vaguely hinting at the numerous possibilities malaria connoted as a diagnostic jargon in the world of allopathic practitioners. These authors of high texts regarded remittent and intermittent as one among a variety of fevers that by affecting the circulatory and the nervous systems emerged as the “the fundamentalphenomenon in a large number of diseased conditions”. For details see, Harish Naraindas, Poisons, Putrescence and the Weather: A Genealogy of the Advent of Tropical Medicine’, Contributions to Indian Sociology, 30, 1, 1996, p 5 or Margaret Pelling, Cholera, Fever and English Medicine1825-65, Oxford University Press, 1978. However, these historians by associating malaria with remittent and intermittent varieties of fevers aloneand by not highlighting the diverse forms of fevers that were clubbed with these categories have bound the word with a shackle of rigid meanings. It is probable that the “travelling” physicians, who wrote about their numerous experiences of encountering different expressions of malaria in the medical journals or in the reports of the medical departments of various states, had imbibed ideas from the works of Cullen or Stokes while at medical school and had been implicitly informed by them in their clinical diagnosis. However, in the vocabulary internal to biomedical clinics around the third quarter of the 19th century it was very rarely the technical terms related to the essential theories of fever, but malaria that kept recurring in patient-physician interactions. It was ‘malaria’ that repeatedly found mention in the narratives conveying stories of thoseinteractions. These correspondences reveal that in everyday clinical practice malaria surfaced with a fluid, independent life imbued with many meanings. These meanings were crystallised by their repeated association with an extensively used and circulated word: malaria. The fluidity inherent in the use of the term malaria in the third quarter of the 19th century has been emphasised by historians who have read it as a synonym for theLatinate word ‘miasma’. For instance, Michael Worboys, Germs, Malaria and the Invention of Mansonian Tropical medicine in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, edited by David Arnold, Rodopi: Amsterdam-Atlanta, GA 1996, p 187. The dictionary literal meanings of these two words were the same; both meant “bad air”. However, in the different contemporary medicalpublications the meanings these words were invested with often converged, overlapped or differed. When put to use in clinical practice these words ceased to be homogeneous entities and they began to connote different meanings in different texts. An intimate reading of texts mentioning these words suggest that they were closely related but dissimilar jargons. In allopathic medical practice these words, among others, were put torepeated use to assist in the reduction of myriad expressions of quotidian physical unease that surfaced in the body into accessible categories of medical knowledge. The subtle distinctions between malaria, miasma must be carefully delineated to acknowledge the peculiarities with which they were imagined, the many overlapping meanings in which they were thought to function and the ways they were bound in relation to eachother… In various contemporary sources malaria presents itself as a much more fluid diagnostic jargon than ‘miasma’. This is revealed from the various uses it was put to in clinical diagnostic practice that ended up upsetting the inhibiting rigidities implied in nosological charts. For instance see, the detailed statistical list of disease victims compiled in the ArmyMedical Department Report for the Year 1866, Vol VIII, printed byHarrison and Sons for Her Majesty’s Stationary Office, 1868.
36 This quote is ascribed to Pickford mentioned in the text as a physician. An anonymous review of What Is Malaria? and Why Is It Most Intensein Hot Climates? by C F Oldham, published in Indian Medical Gazette, May 1, 1871, pp 102.
37 For, instance, see Mark Harrison, ‘Hot Beds of Disease: Malaria and Civilisation in 19th Century British India’, Parassitologia 40, 1998, p 11 or Michael Worboys, Michael Worboys, ‘Germs, Malaria and the Invention of Mansonian Tropical Medicine’ in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900 edited by David Arnold, Rodopi: Amsterdam-Atlanta, GA 1996, p 186.
38 Mary Dobson, Contours of Death and Disease in Early Modern England, Cambridge University Press, 1997, p 302.
39 K D Ghose, ‘A Plea for Malaria’, Indian Medical Gazette, June 1, 1882, p 151.
40 C F Oldham, ‘The Bacillus Malariae’, Indian Medical Gazette, March 1, 1882, pp 63-65.
41 G Dodds, Malaria, Indian Medical Gazette, April 1,1882, p 111.
42 Anonymous review of What Is Malaria? And Why Is It Most Intense inHot Climates? by C F Oldham, published in Indian Medical Gazette, May 1, 1871, pp 99-103 (henceforth Anon Rev.)
43 Joseph Ewart, ‘The Climate of Indian Hill Sanitaria: Is It Beneficial in Scrofula, Tuberculosis and Phthisis’? Indian Medical Gazette, March 1882, pp 81-83.
44 Anon Rev.
45 Ibid, p 102.
46 Sir Joseph Fayrer, first Croonian lecture on ‘Climate and the Fevers of India’, Lancet, March 25, 1882, pp 423-26.
47 George Gwynne Bird, ‘Observations on Civic Malaria and the Health of Towns’ contained in a popular lecture delivered at the Royal Institution of South Wales, in the year 1847, published by William Wood, 39,Tavistock Street, Covent Garden 1849, p 7.
48 Ibid. pp 8-9.
49 Anon Rev, p 100.
50 Ibid.
51 Ibid.
52 E A Parkes, ‘Report on Hygiene for 1867’, Army Medical DepartmentReport for the Year 1866, Appendix xxxvi, Vol VIII, printed by Harrison and Sons for Her Majesty’s Stationary Office, 1868, pp 316-17.
53 E A Parkes, on the relative power of certain so-called disinfectants in preventing the putrefaction of human sewage, Army Medical DepartmentReport for the Year 1866, Appendix xxxvi, Vol VIII, Appendix xxxvii, pp 318-19.
54 Surgeon Ovens, ‘5th Dragoon Guards, Case of Typhus Fever’, ArmyMedical Department Report for the Year 1866, Vol VIII, p 546.
55 George Gwynne Bird, ‘Observations on Civic Malaria and the Health of Towns’ contained in a popular lecture delivered at the Royal Institution of South Wales, in the year 1847, published by William Wood, 39, Tavistock Street, Covent Garden 1849, pp 9-10.
56 Sir Joseph Fayrer, first Croonian lecture on ‘Climate and the Fevers of India’, Lancet, March 25, 1882, pp 423-26.
57 George Gwynne Bird, ‘Observations on Civic Malaria and the Health of Towns’, pp 9-10.
58 James Henry Salisbury, Malaria, New York, William A Kellog, 1885, p 17.
59 Ibid, p 21.
60 Ibid, p 22.
61 See for instance, Francis Lovell, ‘Report of Acute Anaemic Dropsy in Mauritius’, Indian Medical Gazette, January 2, 1882, pp 25-27 or Surgeon Major John Small and Assistant Surgeon W H T Power, general conclusions in the causation of the fever epidemic of 1866-67,Army Medical DepartmentReport for the Year 1866, Appendix xlvi, Vol VIII, pp 442-77.
62 A T Macgowan, ‘Malaria, the Common Cause of Cholera, Intermittent Fever and Its Allies’, p 8.
63 For an alternative reading see, David Arnold, ‘An Ancient Race Outworn’: Malaria and Race in Colonial India, 1860-1930’ in Race, Science, Medicine, 1700-1960 edited by Waltraud Ernst and Bernard Harris, Routledge, London and New York, 1999, pp 122-43.
64 Staff assistant – surgeon Wm Hensman, ‘Remarks on Malaria’, Appendix No L Army Medical Department Report for the Year 1866, Vol VIII, p 506.
65 Dr Nandadulal Mukhopadhyaya, Paribarik Chikitsa Bidhan: AllopathicMotey (The Domestic Manual for Curing Diseases: The Allopathic Way Part I, Medical Library Press, Calcutta, 1889.
66 James Henry Salisbury, Malaria, New York, William A Kellog, 1885, p 12.
67 A T Macgowan, ‘Malaria, the Common Cause of Cholera, Intermittent fever and Its Allies’, reprinted from the Medical Mirror, London, John Churchill and Sons, New Burlington Street, 1866, p 13.
68 Anon Rev, pp 99-103.
69 Existing histories restrict the fluidity of the category ‘malaria’ by identifying it with what was referred as the remittent and intermittent varieties of fever. For instance, see, Harish Naraindas, ‘Poisons, Putrescence and the Weather: A Genealogy of the Advent of Tropical Medicine’,Contributions to Indian Sociology, 30, 1, 1996, pp 5 or Margaret Pelling, Cholera, Fever and English Medicine 1825-65, Oxford University Press, 1978, p 17.
70 Michael Worboys, ‘Germs, Malaria and the Invention of Mansonian Tropical Medicine’ in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, p 187.
71 For instance see, Francis Lovell, ‘Report of Acute Anaemic Dropsy in Mauritius’, Indian Medical Gazette, January 2, 1882, pp 25-27 or, assistant surgeon J P H Boileau, ‘Remarks on Fever in Malta, with Cases’, ArmyMedical Department Report for the Year 1866, Vol VIII, pp 478-92.
72 This explains how immunity of a particular locality from the perceivedeffects of “malaria” was expressed not in absolute but relative, comparative terms. See for instance, Thomas Reade, ‘Transmutation of Quotidian Malarial Ague into Syphilitic Malarial Ague’, Medical Times and Gazette London, May 4, 1872, pp 511-12. The perceived omnipresence of ‘malaria’ was harped in Yadunath Mukhopadhyaya, Quinine, Calcutta, 1893 among a number of texts.
73 Sir Joseph Fayrer, second Croonian lecture on ‘Climate and the Fevers of India’, Lancet, March 25, 1882, pp 467-70.
74 This word is inspired from a similar use in an unrelated context by Dipesh Chakrabarty, ‘Difference-Deferral of (a) Colonial Modernity, Public Debates on Domesticity in British Bengal’, History Workshop Journal, Issue 3, 1993.
75 Statistical tables of disease victims compiled in the Report of the ArmyMedical Department among soldiers serving in UK, British America, Canada, Mediterranean, West Indies, Western Africa, St Helena, Cape of Good Hope, Mauritius, Ceylon, Australasian colonies, China and Japan, India, as well as mobile troops on board ships suggest, for instance, that soldiers in these myriad locations were reported to suffer from diseasesattributed to malarial landscapes at various degrees and in varying numbers. The medical correspondences on malaria that unified dispersed locations in the world nonetheless hierarchised its constituents by associating them with breeding different grades of ill-health. While the literature on malaria brought distantly dispersed regions in the world map in correspondence with each other, it bound the regions into a relation of difference. Therefore,correspondences on malaria were characterised by a culture of both inclusion and difference.
