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The
greatest question in human biology, or for that matter,
in any other living organism is why does a particular
thing happen at a given time? The great physiologist,
Charles Sherrington, was appointed Professor of
physiology at a very young age of 42 by the University of
Liverpool, in the year 1899. In his acceptance speech to
the staff and students of the University he said: " The question WHY? Is not
answered by positive science, but only the question HOW?
And sometimes the question HOW MUCH? The physiologist
cannot say why a muscle contracts, nor define
`life’. To dogmatise concerning the `why’ of
bird’s existence. We may be able to say how things
have happened or how they will happen; and it is a first
step in the acquisition of positive knowledge to know
that the ratio rei is not the
` reason why ‘.
The above formed the part
of the treatise On The Hand by Sir Charles Bell, a
distinguished Edinburgh surgeon. The latter was the first
of the Bridgewater treatises founded to illustrate
beneficent design, testified to by the mechanisms and
vital endowments of the animal body. Yet we ask the
questions WHY? And HOW? Very often. The former concerns
the mind and the latter the material things in life. We
do not seem to distinguish the differences clearly often.
Have these two questions any meaning except for the
philosopher? For physicians they are vital questions
when patients ask "WHY? Me" doctor ?
I had a ticklish situation recently when a mother of
one of my students wrote a letter to ask me WHY? Did her
son get malaria? How I wish I knew the answer to her
million dollar question! Before our letter could reach
her by post, she had shot off the same question to the
editor of The Hindu with added allegation that we do not
take any precautions in our college against malaria.
"
Quid quisque vitet nunquam hominis satis,
Cautum est in horas "
( No man knows what
dangers he should avoid from one hour to another)
Michel De Montaigne, a
great French philosopher, wrote those lines in his famous
book The Essays recently translated by Professor
M. A. Screech in 1987 and published by Penguin
publishers. How true ? Who believes the truth, although
truth is the basis of our very existence on earth and the
root of all our culture in our great country.
"Sathyam
Brihad Ritam Ugram
.............Prithvim Dharayanthi"
Atharvaveda
XII 1.1
( Truth, eternal
order, that is great and stern... these uphold this
earth)
The truth of the matter is
that Mangalore has an epidemic of malaria and we, in our
college, are at the forefront of fighting it by the
conventional methods. Our head of the community medicine
department, an ex army officer is doing all that could
possibly be done by any human being in that direction. We
have even done what they do in the army, of fogging the
areas, both in and around our hostels, in addition to
other parts of the city. We give our students all the
protection and see that mosquitoes are killed by all
possible means, even using the guppy fish in fresh water
stagnant areas. With the heavy rains abating a bit the
mosquitoes make their appearance gain and it is a
constant fight between man and the mosquito.
As is the common knowledge, even in the WHO, there are
limitations to our fight against this crafty creature.
Mosquito has become resistant to the usual DDT and the
latter is also a dangerous stuff for humans. Mosquitoes
mutate very fast and we can not keep pace with them. The
hope of a vaccine is only a distant dream, if not a
mirage. Malaria has even surfaced in Europe due to many
reasons, one of the main reasons is the fast air travel.
The mosquitoes thrive inside the baggage of people even
in the cold underbelly of the giant Jumbo planes. This
type is called the airport malaria. In our part of the
country it is the "progress" that has brought
in malaria. What with high rise buildings coming up at
breath-taking speed, there are large number of migrant
labour from far off Bihar and other parts of Karnataka,
where malaria is rampant. While they bring this germ from
their original sources, they breed them here in their
concrete curing process of keeping clean water on large
surface areas of the large building roofs. In addition,
we have the usual menace of cocoanut shells strewn all
over the place which collect water during the rains. So
it is a fight against mighty forces to eradicate
mosquitoes.
Does that mean that we will have malaria always in
Mangalore? Far from it, very far. These diseases are
called dynamic diseases and they have their chaotic
periodicity in this world. They come and go at their own
sweet will and we have very little say in the matter.
Malaria was supposed to have been eradicated, but it came
back with a bang and in the sub Saharan Africa alone it
has killed millions of people. It will disappear one day
without our knowledge. In its place another microbial
disease might appear- only God knows. There are the
inflexible laws of Nature which we do not understand.
The connection between a germ and man is not as simple as
most of us think and it is never linear as we believe.
Why does one get malaria is not known but we do known how
does one get malaria. To give an analogy there may be
twenty people with malaria on a given day in greater
Mangalore, and on that same day, with the same mosquitoes
around 9,99,980 people go about their daily routine
without malaria. One who gets malaria gets it again and
again. The difference is in the body resistance.
It was Robert Koch who thought that germs produce disease
as a linear fashion. He laid down the rules called
Koch’s postulates. It took nearly a hundred years
for the profession to realize that it is not the whole
story. It was an American physician, Theobald Smith, who
in the year 1915 postulated the Grimm’s law "
disease is directly proportionate to the virulance of the
cause, but inversely proportionate to the resistance
of the host. Germs are there everywhere but diseases
come only when we lower our resistance. In the order of
the Universe it is the germ that is at a disadvantage
when it infects man. While it is one hundred per cent
death for the germ, ( if it kills man the germ is
destroyed in the dead body and when it fails to kill,
man’s immune system kills the germ), it is only a
50% chance of death for man in any infection.
Life on the Human Skin is an article in the 1969
issue of the Scientific American which quotes the poem of
W.H.Auden:
On this
day tradition allots
to taking stock of our lives,
my greetings to all of you, Yeasts,
Bacteria and Viruses,
Aerobics and Anerobics:
.............................................
By what myths would your priests account
for the hurricanes that come
twice every twenty-four hours,
each time I dress or undress,
when, clinging to keratin rafts,
whole cities are swept away
to perish in space, or the Flood
that scalds to death when I bathe?
...............W.H.Auden.
Germs are our companions
and they are in the Universe always. AIDS virus did not
come in 1981 for the first time. Many blood samples of
people who died of unknown causes have turned out to be
AIDS positive in retrospect. There was an outbreak of
diphtheria in Europe recently, it was possibly due to the
diphtheria germ getting an added viral infection and the
poor diphtheria germ had to produce a very powerful
poison that killed many people there!
Man should not be very proud to think that he has control
over his future because of modern medicine. We should not
delude ourselves to believe that we could control every
thing in our lives. Bad things do happen to good people
and it is not because of our faults or sin. In his
beautiful book When Bad Things Happen To Good People,
a rabbi, Harold J Kushner so beautifully says that
bad things happen to good people because of:
- bad people.
- Bad luck, and
- Because we are human
and live in this world of inflexible laws of
Nature.
God is as much outraged
about bad things happening to good people as we are. We
in our college are as much concerned about malaria in our
city as many good people who pontificate to the world.
Let us pray that we will be able to drive the mosquitoes
away from Mangalore. I think when at the end of the day
it is better to remember the Jobs story.
In this less-than-perfect world of ours the only
salvation for a happy mind is to move on despite any
pain, with love and forgiveness.
The
candles in the churches are out,
The stars have gone out in the sky,
Blow on the coal of the heart,
We will see by and by...........
Archibald
Mac Leish.
The Job Story.
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