" 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.

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.

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:

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:

1. bad people.
2. Bad luck, and
3. 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.