Ross, son of an Army Major, a brilliant and polyvalent
mind, poet of romantic lyrics, part time novelist, playwright,
painter, musician and mathematician, who never wanted
to be a medical practitioner, became a researcher by
accident, designed some of the most elegant experiments
with sheer instincts and his own shrewd observations
and ultimately won the second ever Nobel Prize in Medicine
in the year 1902. Having faced a lot of hardship and
administrative interference and apathy (what he called
"administrative barbarism") and spent from
his own pocket to pay the assistants and 'volunteers'
for his research, he converted adversity to advantage
and overcame all odds with his single minded pursuit
to carry out his well designed and elegant experiments.
With his penchant for writing, he has left for posterity
detailed and poetic accounts of his path-breaking research
and work thereafter.
Sir Ronald Ross
Ross was born
on May 13, 1857 at Almora near the Himalayan Mountains, India
only three days after the outbreak of the Indian Sepoy mutiny. Ross
was the first of ten children of Sir Campbell Claye Grant
Ross, a Scottish officer in the British Indian army, and Matilda
Charlotte Elderton. Ross' grandfather, Lieutenant Colonel
Hugh Ross, had also been a fierce Indian border fighter. Young
Ross was witness to his father falling seriously ill with
malaria. At the age of eight, young Ronald was sent to England
for his education. After completing his early education in
two small schools at Ryde, he was sent to a boarding school
at Springhill, near Southampton in 1869. When he was 14 years
old, he won a prize for mathematics. The prize was a book
titled Orbs of Heaven. It was later that this book inspired
Ronald to study mathematics in depth. At the age of 16, Ronald
was bracketed first in England in the Oxford and Cambridge
local examination in drawing. He had made a pencil copy of
Raphael’s painting titled Torchbearer, and that too in just
a few minutes! At age 17, Ross declared his ambition to become
a writer. But his father would have none of it. He was told
in no uncertain terms what career to pursue. In Ross's own
words later: "I wished to be an artist, but my father
was opposed to this. I wished also to enter the Army or Navy;
but my father had set his heart upon my joining the medical
profession and, finally, the Indian Medical Service, which
was then well paid and possessed many good appointments; and,
as I was a dreamy boy not too well inclined towards uninteresting
mental exertion, I resigned myself to this scheme...."
Forced by his father, he joined the St. Bartholomew's Hospital
in London in 1875. Most of his time in medical school was
spent composing music or writing poems and plays. During the
course of his medical school, Ross came across a woman from
the Essex marshes who was complaining of headaches, pains
in her muscles and feeling very hot and then very cold. Essex
marshes who was complaining of headaches, pains in her muscles
and feeling very hot and then very cold. Ross questioned her
exhaustively and diagnosed her as suffering from malaria,
which was unusual, as it was only found in hot tropical countries
such as South America and India. His detailed diagnosis however,
frightened the woman away and she never returned, so Ross
was unable to prove his diagnosis. Not surprisingly, he completed
his medical studies "without distinction" and flunked
the qualifying examinations for the Indian Medical Service.
When his father threatened to cancel his allowance, he took
a job as ship's surgeon on a vessel sailing between London
and New York. In 1881 he repeated the qualifying examinations
and this time ranked seventeenth of twenty-two successful
candidates. After four months' indoctrination at the Army
Medical School, Ronald Ross finally fulfilled his father's
wish by entering the Indian Medical Service in 1881.
With his not-so-impressive
result, Ross was commissioned for the Madras service, the
least prestigious of the three Indian Presidencies (Bengal
and Bombay were the more desirable appointments) and worked
in many places like Mysore and Madras and also served in the
Burma War and in the Andaman Islands. While in Madras, a large
part of his work was treating soldiers ill with malaria. The
treatment with quinine was successful, but many died because
they failed to get treatment. He also studied mathematics
which he applied to the study of malaria later on [See below].
From the early
days of his work in India, mosquitoes engaged Ross one way
or the other. In 1883, Ross obtained the post of Acting
Garrison Surgeon at Bangalore. Although Ross found the bungalow
that was provided for his accommodation pleasant to live in, he was irritated by the large number
of mosquitoes which constantly buzzed around the rooms. He also
noticed that there seemed to be more mosquitoes in his bungalow
than in others and that there was a particularly large swarm
around a barrel with water that was kept outside the window.
When Ross looked in to the barrel he saw lots of "wriggling"
grubs breeding in the water, which he identified as mosquito
larvae. Ross tipped the barrel to empty the water and found
that the number of mosquitoes reduced. This started him thinking
that if the places where mosquito bred were removed it might
be possible to eliminate them completely.
But everyone did not approve of this solution. "When
I told the adjutant of this miracle," Ross wrote, "and
pointed out that the mess house could be rid of mosquitoes
in the same way (they were breeding in the garden tubs, in
the tins under the dining table and even in the flower vases)
much to my surprise he was very scornful and refused to allow
men to deal with them, for he said it would be upsetting to
the order of nature, and as mosquitoes were created for some
purpose it was our duty to bear with them! I argued in vain
that the same thesis would apply to bugs and fleas, and that
according to him it was our duty to go about in a verminous
condition." Ross held these views on mosquito control
till the very end and found the same apathy from governments!
But even with
all this, he was not at all enthused. He spent his free time
concocting equations he hoped would revolutionize mathematics
and writing poetry, music, plays, and bad novels that he published
at his own expense. However, he did develop some interest
in tropical diseases, like all his peers would have during
the period when these were rampant in most parts of India,
particularly malaria that killed more than a million in India
each year. His experience with malaria as a student also probably
stirred Ross's interest in malaria. True to his style, Ross
composed this verse about his first impressions of malaria
that killed millions:
In this, O Nature, yield I pray to me.
I pace and pace, and think and think, and take
The fever'd hands, and note down all I see,
That some dim distant light may haply break.
The painful faces ask, can we not cure?
We answer, No, not yet; we seek the laws.
O God, reveal thro' all this thing obscure
The unseen, small, but million-murdering cause.
for 7 years in India from 1881, he got bored and returned
to England on a furlough in 1888. But he was aware that his
literary career was not promising, being unable to establish a
readership beyond his family and friends. So he took a course of Diploma
in public health in London and acquainted himself with microscopic
skills and laboratory techniques. In between he found time
to write another bad novel, invented a new shorthand system,
devised a phonetic spelling for the writing of verse, and
was elected secretary of a local golf club. During
the same period, he courted and married Rosa Bessie Bloxam
in April 1889 and returned to India with her. Their first
daughter was born in 1891 and the second one in 1903.
Back in India, he was posted
to a small military hospital in Bangalore. Here, Ross began
to formulate theories of malaria. Ignorant of Laveran's work,
he hypothesized that malaria was probably due to some form
of poisoning from the bowel and published his first paper
with this claim. Even later, although he learned
of Laveran's discovery in 1892 from several papers published
in Indian medical journals, he was not convinced. He pricked
the fingers of anyone who came to him with fever and spent
hours peering through his microscope at blood smears, yet
was unable to see the crescents. Thoroughly exasperated, he
strongly questioned the soundness of Laveran's observations
and concluded that the parasite had been some lucky
microscopic finding without any value and turned this parasite
into ridicule, even wondering if the Frenchman might have
falsified his data. This inability
to confirm Laveran's work, a problem shared by many investigators,
was apparently due to the crude microscopic techniques of
the day and the inferior illustrations in the original articles.
When he took
his second furlough to England in 1894, Ross believed he had
accumulated overwhelming evidence that Laveran was incorrect.
"Everything I had tried had failed," he told his
colleagues. But they informed him that the parasites
did indeed exist and sent him to Dr. Patrick Manson, the
foremost authority on tropical diseases in London.
Dr. Patrick Manson
On 9 April 1894, he called on Patrick Manson. But Manson
was not at home, but with the help of the London post that
had five or six deliveries a day, they got together the following
day. "Within a few minutes," Ross wrote, "he
showed me the Laveran bodies which are technically called
crescents' in a stained specimen of malaria blood, and
I recognized at once that no such bodies could exist in healthy
blood. My doubts were now removed...." Then Ross spent
many hours following Manson on ward rounds at the Seamen's
Hospital and in Manson's private laboratory. Manson was impressed
with this eager, capable student and chose to expound upon
his ideas to Ross. In 1894, one November afternoon at "half-past
two", as they were walking down Oxford street on the
way to the hospital, Sir Patrick Manson told Ross: "Do
you know, I have formed a theory that mosquitoes carry malaria
just as they carry filaria." This was to change Ross's
life forever. Ross saw himself as the man to prove it. Manson
suggested that the filaments in the crescents were actually
living bodies and the mosquito sucked the filamented crescents
into its stomach while feeding on the blood of a malaria patient.
The filaments proceeded to travel through the stomach into
the insect's tissues. After the mosquito died laying its eggs,
the "flagellated spores" emerged into the water,
ready to infect anyone who came to drink. These theories,
which had earned for Manson the titles "pathological
Jules Verne" and "Mosquito Manson," sent the
young Ross into raptures of ecstasy. Suddenly the fame that
had eluded him despite years writing poems, music, plays,
novels, and equations seemed within his grasp. He had but
to prove what Manson had presented to sound like gospel truth.
Ross returned to India in March 1895, determined to prove
what he called Manson's "grand induction" and went
about it with an almost manic enthusiasm.
Manson guided Ross throughout his research, suggested new
approaches, encouraged Ross when he became depressed and came
to his aid whenever superiors thwarted him. There was a continuous
exchange of ideas between the two men, first directly and
then by letters. The 173 letters that the two men exchanged
between 1895 and 1899 constitute one of the great scientific
correspondences and offer a wonderful insight into the research
that led Ross to his Nobel Prize. The two men were separated
by thousands of miles and a 3-week transit time for a letter
or a slide to reach the other; nevertheless, their intimacy
grew apace. The avuncular Manson acted as Ross's London agent
and sounding board, offering advice, both good and bad, on
the best way to nail down the mosquito hypothesis. Above all,
he tried to cheer his young protégé in his frequent periods
of discouragement and despair. He lost his temper only once,
when Ross threatened to throw up his medical career, take
early retirement from the Indian Medical Service, and devote
himself to literature.
On the ship to India, Ross rushed among passengers and crew
members, frantically pricking fingers and examining blood.
At the ship's ports of call, he besieged the local hospitals
for blood specimens of malarious patients. He even tried to
prepare himself for anatomical studies of Indian mosquitoes
by dissecting the ship's cockroaches.
Soon after returning to India, Ross continued looking for
cases of malaria in his Military hospital. Patients ran from
him for fear of getting their fingers repeatedly pricked and
colleagues kept proven malaria cases from him. Spurned in
his hospital, he haunted the municipal hospitals and the other
regiment infirmaries looking for cases of malaria. He even
offered a rupee a prick. Following Manson's instructions,
Ross captured the mosquitoes and tried to induce them to bite
malaria patients. But they obdurately refused to bite any
one, even Ross. He made the mosquitoes raised from the larvae
bred in captivity to feed on persons carrying malaria crescents
in their blood, by putting the patient under a mosquito net
and releasing the insects into it. He then expressed their
ingested blood on a glass slide, and examined it with his
microscope. Just as Manson had prophesied, there were the
parasites. To be certain of the results, Ross tried the same
experiment with six more mosquitoes the next day. "Every
point that you predicted seems to come true," he wrote
to Manson. "Certainly there is nothing contrary to the
theory. The parasites are present in the blood of the mosquito,
and what is even more, they appear to be there in greater
numbers than in blood from the finger. Also, the development
of the crescents, and the formation of the flagella, seem
to be favored by conditions in the mosquito's stomach. Yes,
the crescent-sphere-flagella metamorphosis does go on inside
the mosquito to a much greater degree than in control specimens
of finger blood."
Manson immediately wrote back with more instructions. "Let
mosquitoes bite people sick with malaria," he advised,
"then put those mosquitoes in a bottle of water and let
them lay eggs and hatch out grubs. Then give that mosquito-water
to people to drink." So Ross allowed four mosquitoes
to feed on a patient named Abdul Kadir. These insects were
then kept in a bottle full of water until they died. After
the promise of a suitable emolument, Lutchman, Ross's native
servant, and two others were persuaded to drink the sample
of water in which mosquitoes had died. Lutchman developed
a fever, but recovered three days later, and Ross could not
find any malaria parasites in his blood; the other men remained
Ross was thoroughly discouraged and he began writing poems
again. But Manson desperately tried to re-energize hm: "Above
everything, don't give it up. Look upon it as a Holy Grail
and yourself as Galahad and never give up the search, for
be assured that you are on the right track. The malaria germ
does not go into the mosquito for nothing, for fun, or for
the confusion of the pathologist. It has no notion of a practical
joke. It is there for a purpose and that purpose, depend upon
it, is its own interests--germs are selfish brutes."
Manson was also worried that someone else who would give him
no credit might appropriate his precious theory. "The
Frenchies and Italians will pooh-pooh it, then adopt it, and
then claim it as their own," he warned Ross in one letter,
"see if they don't. But push on with it, and don't let
them forestall you. They won't have this autumn, and they
will not have a chance to work seriously at the matter until
next June or so. You have got a year ahead of them."
But his superiors had other ideas for Ross. He was transferred
to Bangalore on the 9th September 1895 to combat a serious
outbreak of cholera. During his eighteen months stay at Bangalore,
he tried to continue his work on malaria finding time in between
with great difficulty. Finding that he was unable to transmit
malaria through the 'mosquito water', he wrote to Manson at
the end of May 1896: "The belief is growing on me
that the disease is communicated by the bite of the mosquito...
She always injects a small quantity of fluid with her bite
- what if the parasites get into the system in this manner."
To test this
idea, Ross allowed mosquitoes that had fed on a malaria patient
to bite a healthy man. Nothing happened. The experiment was
repeated again and again but in vain. Unfortunately, as he
was using Culex mosquitoes, which do not transmit malaria,
experiments to test this theory came to nothing. Writing to
his wife he said: "I have failed in finding parasites
in mosquitoes fed on malaria patients, but perhaps am not
using the proper kind of mosquitoes ". On the other,
who believed that the mosquito bit only once during its life,
was not convinced about that Ross's idea. "Follow the
flagella," he wrote back, and forget this crazy idea.
obediently went back to dissecting mosquitoes and in February
1897 was able to observe the true fate of the flagella. Within
a blood smear he saw two parasites near each other. The first
was giving off flagella, while the second, which was spherical
and unsegmented, had a single flagellum wiggling slowly inside.
that the single wiggling flagellum was trying to escape the
sphere rather than fertilize it. When McCallum in Baltimore
correctly interpreted the process a few weeks later, Ross
was deeply humiliated, and "always felt disgraced as
a man of science" for incorrectly interpreting his own
In 1897, he
went to the Sigur Ghat near the hill station of Ooty. Three
days later he went down with malaria, despite having slept
under a mosquito net and behind closed windows. Feeling depressed
with no success in sight, he wrote poetry:
What ails the solitude?
Is this the Judgment Day?
The sky is red as blood;
The very rocks decay
And crack and crumble, and
There is a flame of wind
Wherewith the burning sand
Is ever mass'd and thin'd
The world is white with heat;
The world is rent and riven;
The world and heavens meet;
The lost stars cry in heav'n
Then one day,
his attention was drawn to a mosquito that was sitting on
a wall in a peculiar posture and had what he called "dappled-wings".
He was inspired again and was reminded of the fact that only
one species of mosquito among the four found in Amoy, Culex
fatigans, was capable of carrying filariasis. Manson had also
suggested that each form of the malarial plasmodia might require
a particular mosquito species. Ross suddenly realized he had
used the wrong species of mosquito.
to Secunderabad in June 1897 but was down with cholera, only
to recover with a cup of hot tea. Once up, he commenced work
by making a careful survey of the various kinds of mosquitoes.
He continued his study by examining the dissected mosquitoes
under the microscope. After feeding on patients, the gorged
insects were collected in small bottles containing a little
water and were kept for several days before being dissected.
Almost every cell was examined under the microscope, even
the integument and legs were not neglected. With the facilities
that he had in the hot Secunderabad weather, Ross really toiled
hard. In his own words: "But the weather became very
hot again in August. At first I toiled comfortably, but as
failure followed failure, I became exasperated and worked
till I could hardly see my way home late in the afternoons.
Well do I remember that dark hot little office in the hospital
at Begumpett, with the necessary gleam of light coming in
from under the eaves of the veranda. I did not allow the punka
to be used because it blew about my dissected mosquitoes,
which were partly examined without a cover glass; and the
result was that swarms of ' eye-flies '-minute little insects
which try to get into one's ears and eyelids-tormented me
at their pleasure, while an occasional Stegomyia revenged
herself on me for the death of her friends. The screws of
my microscope were rusted with sweat from my forehead and
hands, and its last remaining eye-piece was cracked".
On the 15th August, 1897, one of his assistants brought a
bottle of larvae, many of which hatched out next day and among
them he found several "dappled-winged mosquitoes".
Delighted with this capture, on August 16th, he fed them on
his malaria patient, Husein Khan,with crescents in his blood.
(Husein Khan was paid 1 anna per mosquito he was bitten by;
he came away with 10 annas.) That evening he wrote to his
wife: "I have found another kind of mosquito with
which I am now experimenting, and hope for more satisfactory
results with it." On the 17th he dissected two of
these mosquitoes but found nothing unusual. On the 19th he
killed another and found "some peculiar vacuolated cells
in the stomach about 10 microns in diameter." On August
20th, a dull, hot day, Ross went to the hospital at 7 a.m.,
examined his patients, dealt with his correspondence and had
a hurried breakfast in the mess. One of his mosquitoes had
died and this he dissected without noting anything significant.
He had two mosquitoes left of the batch fed on Husein Khan
on the 16th and at about 1 p.m. he began to sacrifice one.
Dissecting it he scrutinized the tissues micron by micron,
when suddenly, in the stomach wall he "saw a clear and
almost perfectly circular outline.. of about 12 microns in
diameter. The outline was much too sharp, the cell too small
to be an ordinary stomach-cell of a mosquito.." On looking
a little further, there "was another and another exactly
similar cell ". He changed the focus of his microscope
and there within each of these new cells was a cluster of
black pigment. He made rough drawings in his notebook, sealed
his specimen, went home to tea and slept for an hour.
Page from notebook where Ronald Ross recorded his
discovery of the mosquito transmission of malaria, 20
Oocysts in the mosquito gut
pigment puzzled him, for the flagella contained no pigment,
but the thought struck him that if the cells were really parasites
they should grow in size in the last remaining mosquito during
the night. He spent the night in agony lest his last remaining
mosquito should die and decompose before morning. Next day
he killed and dissected this remaining specimen. There were
the cells again, twenty-one of them, just as before, only
now much larger... The cells were therefore parasites, and,
as they contained the characteristic malarial pigment, were
almost certainly the malaria parasites growing in the mosquito's
wrote to Manson with his exciting news: "Now prick
up your ears because the hunt is up again."
Next morning Ross wrote a poem which he sent to Manson on
This day relenting
Hath placed within my hand
A wondrous thing; and God
Be praised. At his command,
With tears and toiling breath,
I find thy cunning seeds,
O million-murdering Death.
I know this
A myriad men will save,
O Death, where is thy sting?
Thy victory, O Grave?
continues to be celebrated as Mosquito Day! On the 4 September he joined
his family at Bangalore where he wrote a paper on his findings.
This paper titled "On Some Peculiar Pigmented Cells Found
in Two Mosquitoes Fed on Malarial Blood," was published
in the British Medical Journal on December 18, 1897.
Yet Ross still
had his doubts. Perhaps, circular cells might not be related
to the malarial parasites at all. "I really believe the
problem is solved," he wrote to Manson, "although
I don't like to say so. I look at them myself daily; those
of the fifth day have grown bigger than those of the fourth
day....Pigment-it is almost proof already! What else can the
thing be? What are we to think: What do you think?"
Now eager to take his work to its logical conclusion, Ross
wrote to Manson on September 22, 1897: "I shall be much
disappointed if I don't get a practical proof in a week's
time," and continued his attempts to transmit malaria
with the newly found mosquitoes. But two days later, he was
asked to proceed to Bombay.
Then he was transferred to Kherwara, a distant village in
the deserts of Rajasthan where malaria was very rare. But
true his style, Ross did not quite languish. He knew of Danielewsky's
studies of bird malaria, and verified for himself that some
types of pigeons carried the disease. At the time, many biologists
believed that mosquitoes did not attack birds. After studies
of pigeons, sparrows, and crows, Ross verified that birds
were indeed bitten by mosquitoes, as well as by other insects.
In the meantime, after much lobbying by Manson and others
he was transferred to Calcutta on January 29, 1898.
Ross, Mrs. Ross, Mohammed Bux and assistants at the
laboratory in Calcutta
He managed to get a dilapidated laboratory of a recently
retired physiologist. Now Ross advertised for assistants who
would be paid from his own pocket. Of the twenty or so job
applicants, Ross chose one Mohammed Bux, because "he
looked the most rascally of the lot and was therefore likely
to have considerable intelligence" and another named
Purboona who disappeared after the first payday. But Mohammed
Bux became quite devoted to Ross, so much so that he would
even sleep on the laboratory floor at night to keep stray
cats from killing the experimental animals.
Ross directed Mohammed Bux to capture mosquitoes, hoping
again to find the circular, pigmented cells within the insects'
stomachs. Bux climbed through the sewers, the drains, the
stinking tanks that abounded in Calcutta and brought back
all kinds of mosquitoes. At this time, plague was raging and
the people were scared of inoculations. Ross tried his best
to get some human volunteers for his study. He sent his assistants
into the bazaar (the market) to try to induce patients to
come to him on payment. Although several beggars with fever
were induced to come on large payment, they generally
left their money, took up their crutches, and fled without
a word when he proposed to prick their fingers to examine
their blood! Left with no choice, Ross turned to the
birds again. His laboratory soon became filled with a number
of live crows, pigeons, weaver-birds, sparrows and larks that
Mohammed Bux had snared. Into the cages covered with mosquito
netting went the mosquitoes. Ross found that five out of nine
mosquitoes fed on birds infected with Proteosoma contained
the pigmented cells in the stomach and he brought in his mathematics
to calculate the probability suggesting that the pigmented
cells had been derived from the Proteosoma. He then
commenced a long series of differential experiments in order
to establish the fact thoroughly. It was also established
that the common gray mosquito (Culex) was the carrier of bird
malaria and that the brown, dapple-winged vector of human
malaria could not be infected by the bird parasite.
These studies were carried on in desperate haste, haunted
by the fear that hostile superiors would once again interrupt
his work. He was forbidden to publish any of his results,
though compelled to send detailed summaries to headquarters.
The only outsider aware of the research was Manson, who often
received whimsical accounts, like this one with Ross taking
the role of the pigmented circular cell:
"I find that I exist constantly in three out of four mosquitoes
fed on bird malaria parasites, and that I increase regularly
in size from about a seven-thousandth of an inch after about
thirty hours to about one seven-hundredth of an inch after about
eighty-five hours... I find myself in large numbers in about
one out of two mosquitoes fed on two crows with blood parasites..."
period, Ross tried to obtain some assistance for his work.
But his superiors never obliged him for reasons he found inexplicable.
by all this, Ross continued his single-minded work. To test
Manson's hypothesis that the parasites were ingested with
water in which the mosquitoes had died while laying eggs,
Ross fed the infected mosquitoes to healthy sparrows but the
birds remained free of malaria. Now convinced that malaria
did not spread that way, he continued to study infected mosquitoes.
On the 2nd July 1898, he found in the thorax of a mosquito
a large cell which contained within it several of the thread-like
bodies. On July 4, 1898, examining the insect's head, he found
the the part
of the mosquito to which these bodies were destined - the
gland lay in the neck and upper thorax and it was the salivary
gland. By July 8th, he was very sure: Malaria was passed
back to the birds in the mosquito's saliva during the act
of biting. The
exact route of infection was thus revealed.
finding, Ross later wrote, "brought him up standing."
As a final verification, he sent Mohammed Bux to capture a
group of healthy sparrows. Mosquitoes that had fed on infected
birds were allowed to bite these healthy ones. Within a few
days the blood of the new birds was loaded with malarial parasites.
same time he kept as controls a number of healthy birds in
mosquito-nets, safe from the bites of mosquitoes, and found
that none of them became infected.
Ross communicated his results
to Manson in a state of intense excitement. "I think
I may now say Q.E.D.," he wrote, "and congratulate
you on the mosquito theory indeed. The door is unlocked, and
I am walking in and collecting the treasures. Well, I have
become unbearable with conceit.... I brag openly about it!"
the news at a meeting of the new Tropical Diseases Section
of the British Medical Association. When he read Ross's report
to the assembled delegates
it was greeted with a standing ovation. "I
am sure you will agree with me," Manson said, "that
the medical world, I might even say humanity, is extremely
indebted to Surgeon Major Ross for what he has already done,
and I am sure you will agree with me that every encouragement
and assistance should be given to so hard-working, so intelligent,
and so successful an investigator to continue his work."
But the Indian
Medical Service was again not on his side. Ross was ordered
to abandon the malaria work and report to a new post in Assam
to do research on kala azar. "Columbus
having sighted America was ordered off to discover the North
Pole," he remarked bitterly. "No, the man who can
do is not allowed to do, because the man who cannot do is
put in authority over him."
with the administrative apathy
and exhausted by work and heat, Ross decided
to quit. He closed his small laboratory, set his feathered
prisoners free from their cages, emptied the jars of mosquitoes.
After sadly wishing Mohammed Bux good-bye, Ronald Ross left
on the 13th August, 1898. Before
leaving, he urged upon Government the importance of taking
active measures for the prevention of malaria in accordance
with his observations. Besides advising the strict use of
mosquito-nets for a personal prophylaxis, he urged especially
a campaign against mosquitoes as the best measure for towns
and cantonments, particularly against the dappled-winged mosquitoes,
which breed principally in water on the ground.
did not stop at identifying the vector for malaria and its
habits. He was thrilled at the possibility of controlling
this scourge for millions by controlling the breeding of the
mosquito vector. Ross had proved that malaria was related
more to the stagnant water in the pots, tubs, and tanks scattered around
human dwellings where its vector bred in millions than to
the marshes and pools as was believed until then. Ross's discovery
also explained the seasonal variations, the increase in cases
during the rainy season, and how subsoil drainage that was
practiced for centuries helped in controlling it. It was therefore
enough to clear the breeding sites rather than drain a whole
area, thus bringing down the expenses considerably. Ross
did not stop at writing about malaria control either. He
accepted the challenge to implement his ideas.
General Ronald Ross
He stood at
the vanguard of implementing his ideas till his end. Ross
attempted to eradicate malaria from England by forming ‘mosquito
brigades’ to eliminate mosquito larvae from stagnant pools
and marshes. In August-September 1899, he was sent to Freetown,
the capital of Sierra Leone where he organised a sanitation
drive, clearing the streets of tyres, bottles and empty cans
and levelling roads so that rain water would not gather into
puddles. But the Freetown malaria control programme did not
yield desired results, probably because Ross had underestimated
the number of breeding pools as well as the sheer number of
vectors that he was trying to control. Ross had very limited
funding and the best available technology was to pour oil
on the numerous breeding sites around Freetown. As soon as
the oil treatment stopped, breeding would begin again. Ross
redoubled his efforts with increased funding from private
sources and ensured the removal of all potential breeding
sites, including rubbish, broken bottles and other potential
water containers. Despite these concerted efforts, the programme
was remembered more for its impact on the Freetowns
rubbish than for malaria control. J.W.W. Stephens and S.R.
Christophers, who had worked with Ronald Ross in Freetown,
organised a similar drive in Mian Mir in Lahore, India in
1901, without much success either.
The sanitation drive suggested by Ronald Ross was successfully
tried elsewhere. During the U.S. military occupation of Cuba,
a campaign against yellow fever and malaria was commenced
at Havana early in 1901. Under the leadership of the Assistant
Surgeon General William Crawford Gorgas of the United States
Army the anti mosquito measures produced very marked results.
Pyrethrum, a natural insecticide derived from the chrysanthemum
flower, was first used by William Gorgas in Cuba where it
was burned inside sealed dwellings. Mosquitoes entirely disappeared
from many parts of the city, and were decreased everywhere.
At the end of 1902, Prince Auguste d'Arenberg, President
of the Suez Canal Company asked Ross to save Ismailia, the
city that was built as a base for construction of the canal.
It was gravely threatened by malaria for a long time. Ross
led a sanitation drive so successful that by the following
year, the city officials announced that they no longer needed
mosquito nets and by 1904, a whole year had passed without
a single reported case of malaria in Ismailia. Ross's drastic
sanitary measures were even dubbed as "sanitary Bolshevism".
In the following years, Mosquito Ross, as
he was called, lent his services to Greece, Mauritius, Spain
and Panama and during World War I, at various places on the
always preaching the gospel of war against the anopheline mosquitoes.
His position within malaria research gave him special kudos,
even if his stridency and concentration on mosquito control
at the expense of social betterment or the systematic use of
quinine sometimes marginalized him from the malaria community.
The experience of the US Army in Cuba was replicated during
the construction of the Panama Canal between 1905-1910, where
Ronald Ross and William Gorgas worked together. Yellow fever
was eliminated and malaria incidence markedly reduced through
an integrated program of insect and malaria control.
In 1910, Ross wrote his sanitary axiom:
"Widespread diseases … cause much pain, poverty, sorrow,
expense and loss of prosperity … and the rule is to grudge
spending a hundred pounds for disease which costs
thousands...[Therefore] "for economic reasons alone,
governments are justified in spending for the prevention of
[malaria] a sum of money equal to the loss which the diseases
inflict on the people". [Ross, R. The Prevention of Malaria.
London, John Murray. 1910. pp. 295-296.]
War I (1914-1918) Ross was appointed a consultant physician
on tropical diseases to Indian troops and was sent to Alexandria
for four months to investigate an outbreak of dysentery which
was hampering troops in the Dardanelles.
Ross also initiated
organizations for the prevention of malaria within the planting
industries of India and Ceylon.
Ross's Prevention of Malaria ebook
many contributions to the epidemiology of malaria and to methods
of its survey and assessment, greatest being the development
of mathematical models for the study of its epidemiology.
He worked on the mathematical theory of epidemics. Through
the survey of the parasite index and the assessment of the
spleen rate in children he founded the malariometry as a epidemiological
tool, focused attention on the relation of malaria and the
community and on the complexity of the transmission dynamics.
It provided the basis for calculating the rate at which malaria
spreads and the quantity of material and personnel required
for checking the epidemic. By demonstrating how much malaria
cost the governments of malarious countries, and how it was
much more efficient to prevent it in the first place, Ross
offered a sober reminder of the economics of prevention. He
demonstrated mathematically how reducing the concentration
of anopheline mosquitoes could have a real and potentially
cumulative effect, but his mathematics went over the heads
of his contemporaries. His pioneering contributions to malarial
epidemiology were not appreciated until two decades after
his death. Ross's analysis of the economics of malaria control
also went largely unheeded. The message is still relevant
and is still too little-heeded by politicians and health planners.
Ross had lot
of appreciation for Laveran, Koch and of course his mentor,
Sir Patrick Manson. Koch's suggestions on immunity in malaria
also impressed Ross. Koch's support for control efforts was
also praised by Ross.
But Ross had
a bitter feud with Italian physician Giovanni Battista Grassi,
who in September 1898, reported that Anopheles claviger was
the carrier of human malaria. Grassi, Amico Bignami and and
Giuseppe Bastianelli made the mosquitoes bite a human volunteer
and on the eleventh day, the patient developed a malarial
chill. Examination of his blood revealed large numbers of
plasmodia. But when he published, Grassi failed to give credit
to Ross. Ross was furious. Thoroughly convinced that Grassi
was trying to steal his discovery from him, Ross sent angry
letters to the journals that had published Grassi's papers,
asserting that Grassi was a mountebank, a cheap crook, a parasite
who survived on the ideas of others. Grassi replied in equally
acrimonious terms. So vicious did the correspondence become
that journal editors, fearful of libel, hesitated to publish
the letters. But Ross and Grassi did not stop feuding. Both
enlisted the aid of the authorities on tropical medicine.
Ross was able to obtain letters from Dr. T. Edmundston Charles,
an English observer of the Italian work in Rome. Using this
evidence, Ross asserted that Grassi had been aware of the
studies on bird malaria, though Grassi later denied such awareness.
When Ross could not find a publisher for a book containing
his case against his Italian adversary, he paid for the printing
himself, carrying the work through two editions. This bitter
conflict lasted for more than two decades. But the Nobel Committee
had no difficulty in identifying the merits. Ross was awarded
the Nobel Prize in 1902.
recognition came behind Ross. In 1901 Ross was elected a Fellow
of the Royal College of Surgeons of England and also a Fellow
of the Royal Society, of which he became Vice-President from
1911 to 1913. In 1902 he was appointed a Companion of the
Most Honourable Order of Bath by His Majesty the King of Great
In 1902 he
was awarded the Nobel Prize for Medicine "for his work
on malaria, by which he has shown how it enters the organism
and thereby has laid the foundation for successful research
on this disease and methods of combating it". (Nobel
Prize in physiology and medicine has never been awarded for
work in biostatistics or epidemiology. The “exception who
proves the rule” is Ronald Ross, who won the second medical
Nobel; but Ross himself considered the mathematics of
epidemic theory as his most important scientific contribution).
That Sir Patrick
Manson missed the Nobel Prize also did not go down well with
those who knew of his contribution to Ross's work. The 100
or so letters that they wrote to each other in the two decades
afterward poignantly document the gradual cooling of a creative
friendship and the difficulty of a teacher-pupil relationship
evolving naturally into one of equals.
In 1911 he was Knighted. In Belgium, he was made
an Officer in the Order of Leopold II. He was given Honorary
Membership of learned societies of most countries of Europe,
and of many other continents. He got an honorary M.D. degree
in Stockholm in 1910 at the centenary celebration of the Karolinska
Institute. Whilst his vivacity and single-minded search for
truth caused friction with some people, he enjoyed a vast
circle of friends in Europe, Asia and America who respected
him for his personality as well as for his genius. He was
the Editor of Science Progress from 1913 until his death in
1932. In 1926, Ross Institute and Hospital for Tropical Diseases
was opened and the Prince of Wales came down to honour Ross,
who was named its director in chief.
awards and recognitions brought him little contentment. Despite
receiving many other awards and honours during his life, he
felt embittered that he did not receive monetary reward for
his discovery and petitioned the Government on this subject.
He resented the fact that his medical practice (and income)
had never thrived (like Manson's), and that his life as a
researcher seemed undervalued and underpaid. He had always
longed to be in London, not Liverpool, although by the time
he settled there in 1912, even London offered him no real
peace. Above all, he was aggrieved that the growing band of
malariologists did not support his ideas on the control of
malaria and was not satisfied with the attitude of the administration
towards malaria control efforts. Ronald Ross hoped that the
difficulties that he faced during his research and work would
open the eyes of the powers-that-be and hoped that the life
would be easier for the future generation of scientists.
literary works include the novel The Child of Ocean (1899
and 1932); The Emigrants; Edgar; The Judgement of Tithonus;
Philosophies, Psychologies, and other Poems; novel, The Revels
of Orsera; novel, The Spirit of Storm; selected Poems (1928);
Fables and Satires (1930); collection of melancholy poems
In Exile (1931); Lyra Modulatu (1931); five mathematical works
(1929-1931). He also compiled an extensive account The Prevention
of Malaria in 1910 and another Studies on Malaria in 1928.
His autobiography, The Memoirs was published in 1923; it is
a long (547 pages) and powerful account of his trials and
tribulations. Its subtitle --"with a full Account of the Great
Malaria Problem and its Solution"--speaks volumes about his
assessment of his own worth. Ross saved virtually everything
about himself: correspondence, telegrams, newspaper cuttings,
drafts of published and unpublished material, and all manner
of ephemera; he also retrieved a fair number of his own letters
while preparing his memoirs. In 1928, Ross advertised his
papers for sale in Science Progress, making it known
that he needed the money for the provision of his wife and
family. They were bought by Lady Houston for £2000, who offered
them to the British Museum. They refused the collection, partly
due to Ross' stipulation that his arrangement of the papers
had to be retained and also due to some canvassing from members
of the Ross Institute who thought that the collection would
be better placed with them. The majority of these papers are
now held by the London School of Hygiene & Tropical Medicine
Altogether, there are some 30,000 catalogued items in the
two major Ross repositories, at the London School of Hygiene
and Tropical Medicine (LSHTM), and the University of Glasgow.
Ross and Rosa
had two sons, Ronald and Charles, and two daughters, Dorothy
and Sylvia. He lost his elder son in the British retreat from
Mons and his own health deteriorated during the war. In 1925,
his older daughter died. In 1927, Ross had a stroke. His wife
died in 1931. Ross survived her until a year later and died
at the Ross Institute, London, on September 16, 1932. The
Nobel Prize winning scientist, mathematician, epidemiologist,
sanitarian, editor, novelist, dramatist, poet, and an amateur
musician, composer and artist was buried next to his wife
at Putney Vale Cemetary.
Like many prophets
before and since, he said things that we forget at our peril.
Three things stand out. First, Ross quantified the economic
costs of malaria. Both the figures and the percentages will
have changed over time, but Ross's approach should still command
assent. He showed in hard figures that had the money spent
in treating and burying soldiers and civilians been turned
to prevention, the result would be a world with less malaria.
His bitter contempt for penny-pinching governments who could
respond only to the crisis at hand rather than legislate for
the future earned him few friends. Second, Ross was an eloquent
spokesman for what later would be called the vertical program.
Even during Ross's lifetime, malariologists were divided into
those who believed that socioeconomic amelioration would in
itself largely solve the malaria problem (as was happening
in Europe) and those who held that holoendemic malaria was
itself a block to economic improvement. Despite the fact that
horizontal approaches are now in fashion, focused campaigns
targeted at specific diseases can still pay off. Ross firmly
believed that malaria was one disease ripe for deliberate
control. Ross came to see that anopheline mosquitoes were
not so delicate as he had once thought, and malaria would
require longer and more sustained effort. But the scientific
understanding was in place, he argued, and all that was really
lacking was the political will. Finally, Ronald Ross passionately
believed in the social value of biomedical research. Such
research should be adequately rewarded, he insisted, and society
should always hold its scientists in high regard, whose worth,
he always thought, was socially undervalued. But he also worked
tirelessly on behalf of the scientific community as a whole,
campaigning for comrades who needed his help; and, through
his long editorship of Science Progress, furthering the cause
of what is now called the public understanding of science.
His heart was almost certainly in the right place.
more than a century of Ronald Ross's painstaking efforts at
control of malaria, the 'administrative apathy' towards malaria
control programmes continues for "inexplicable"
reasons as Ross put it. And unfortunately, the building of
the Military Hospital at Secunderabad, where this discovery
was made, now lies in ruins and little is done to remember
the person who worked tirelessly to make a discovery that
would benefit humanity. The super-sensitive, single-minded
Ross went to his grave still holding the firm conviction that
malaria could be eradicated if only weak-willed governments
would commit themselves to exploit his discovery and attack
the anopheline in their watery lairs.
Ross's three part paper on the theory of epidemics is available
on the web:
Ronald Ross, "An Application of the Theory of Probabilities
to the Study of a priori Pathometry. Part I", Proceedings
of the Royal Society of London. Series A, Vol. 92 (1916)pp.
Ronald Ross; Hilda P. Hudson, "An Application of the Theory
of Probabilities to the Study of a priori Pathometry. Part
II", Proceedings of the Royal Society of London. Series A,
Vol. 93 (1917)pp. 212-225.
Ronald Ross; Hilda P. Hudson, "An Application of the Theory
of Probabilities to the Study of a priori Pathometry. Part
III", Proceedings of the Royal Society of London. Series A,
Vol. 93 (1917)pp. 225-240.
- Breslow NE. Are Statistical Contributions
to Medicine Undervalued? Biometrics, Volume 59, Number
1, March 2003, pp. 1-8(8) Available at
- Bendiner E. Ronald Ross and the mystery of malaria. Hospital
Practice. Oct 15, 1994:95-112
- Robert E Sinden. Malaria, mosquitoes and the legacy of Ronald Ross. At
- Ross R.
Researches on malaria. Nobel Lecture, December, 12, 1902.
Nobel Lectures, Physiology or Medicine 1901-1921,
Elsevier Publishing Company, Amsterdam, 1967)
- Chidanand Rajghatta. India's Nobel connections.