Mr.Jinnah’s political and ideological narratives have not been assessed through the prism of his tuberculosis. Patrick French ( historian and biographer) is skeptical that Jinnah ever had tuberculosis, while other historians acknowledge the ailment, but in passing. French sticks to the diagnosis of bronchiectasis without providing any evidence except for notes of Pakistani historian ZH Zaidi. Largely most historians have considered Jinnah’s TB as an innocent bystander that did not in any way influence or compromise his thoughts and attitudes.
Mr. Jinnah lived in times when there was no cure for tuberculosis; except for change of climate or getting admitted to sanatoriums. There were more than 8 million new cases of TB in 2011, with more than one and a half million deaths. The World Health Organization estimates that albeit one third of the world’s population stands infected by dormant tuberculosis bacteria; the bacteria will prevail only in those whose immunity is reduced by malnutrition, HIV or diabetes… a sort of sleeping enemy within the body, waiting patiently till such time the body (it’s prey) has weakened enough to be attacked, conquered and subjugated.
The German physician Robert Koch first isolated the TB bacteria, a few years after Jinnah was born, in 1882. Jawaharlal Nehru and his wife Kamla Kaul were yet to be born. Kamla Kaul Nehru too would suffer from TB and eventually die from it in a sanatorium in Switzerland, before effective treatment for TB was discovered.
George Orwell the famous author of “1984 ” and “Animal Farm” died a couple of years after Jinnah’s expired. TB ravaged Orwell for more than a decade. A chest X-ray and sputum examination had confirmed Orwell’s TB in 1938. Orwell however lived in denial, refusing the diagnosis till it was too late. Orwell succumbed to lung hemorrhage on 21st January 1950 aged 46 years. Orwell who coughed and smoked his life away through the 1930’s avoided doctors and hospitals. Jinnah too, like Orwell, coughed and chain-smoked in the last a decade and a half of his life. Jinnah would smoke more than 50 ‘Craven A’ cigarettes a day.
Orwell tasted success with “Animal Farm” in 1945 and further appreciation in 1949,when he published “1984”. ” I’ve made all this money and now I am going to die”, were Orwell’s famous words. He was to expire in a few months. Orwell did, to his credit, manage to get hold of streptomycin from the USA, but was severely allergic to the new drug; and therefore was unable to use the new drug.
Streptomycin was isolated in 1943. It was studied on TB patients from 1943 to 1946. The first randomized study employing a drug was conducted in the US with streptomycin injected in patients of TB. There is no record of Jinnah, who at one time was considered the highest paid barrister of British India, ever seeking treatment with streptomycin. Jinnah must have known he had TB. His photographs taken in the 1940’s demonstrate a gaunt skeletal figure. He had by now (on record) collapsed on more than two occasions. He may have fainted at other times. He must have suffered fever, night sweats, loss of appetite, loss of weight and hemoptysis…the classic symptoms and signs of a man suffering from tuberculosis. Hemoptysis is the coughing out of blood. Jinnah became the first Governor General of Pakistan but did not consult any expert in Pakistan or elsewhere for his disease. Jinnah may have lived longer had he been injected with streptomycin………at least for the next few years to be able to use the effective drug combination of isoniazid, ethambutol, pyrazinamide and rifampicin.
Tuberculosis is more than 70,000 years old. The bacteria producing TB is spectacularly unimpressive to look at. It is a tiny rod shaped 3 microns long structure, which can only be seen under a microscope. The bacteria are slowly dividing and have a cell wall that is impervious to most antibiotics. More than 90% of new cases of TB are from developing countries. The bacteria are remarkably secular and impartial when selecting a victim. It is least concerned with the sex or religion of the person it gets to invade and occupy. It is spread by cough; it is an air borne disease. The bacteria once inhaled by a victim, manage to seat themselves in the lungs of the victim. The immune cells of the person concerned attempt to localize and isolate the bacteria. The bacteria can lie in such a complex for decades to strike when the person weakens due to malnourishment or ill health. The cell wall of the TB bacteria is very resistant to the immune system of the human body, and therefore is capable to lie dormant for years. The evolutionary explanation is that had the TB bacteria been more virulent it would have wiped out mankind thousands of years ago… and thereby it self too.
TB can affect every organ in the human body. It is capable of attacking the brain, intestine, pericardium, abdominal cavity, lymph nodes, etc. It however most commonly ravages the lungs. One of the commonest symptoms of TB of the lungs is spitting of blood (hemoptysis). Orwell had hemoptysis in the last 3-4 years of his life. Orwell also had low-grade fever and night sweats. There is however no record or eye witnesses account of Jinnah spitting blood, having fever or losing his appetite…yet Jinnah was always seeking balmier climates and abodes. Towards the end he had taken refuge in the hill station Ziarat, above the city of Quetta. He stayed there with his sister Fatima.
There is a long list of people including Nelson Mandela and Ringo Star, who were successfully treated for TB. They fortunately lived in the modern era. But people born earlier, before the discovery of medical cure for TB were condemned to die from it. John Keats born on 31st October 1795 contracted TB from his mother while nursing her in 1810. His mother was to die of TB. Keats then in 1818, took care of his brother Tom who too was dying from TB. In 1820 Keats spat blood and was convinced, ” I must die”. Keats, who had trained to be a doctor at Guys, turned to writing poetry as a full-time profession. Keats wrote the ‘Ode to Nightingale’ in 1819 while recouping in a friends house in Hampstead; TB had already consumed both his mother and brother, and he was aware he had the disease.
“My heart aches and a drowsy numbness pains
My sense, as though of hemlock I had drunk,
Or emptied some dull opiate to the drains
One minute past, and Lethe-wards had sunk:
Tis not through envy of thy happy lot,
But being too happy in thine happiness,
That though, light winged Dryad of the trees,
In some melodious plot
Of Beecher green, and shadows numberless,
Singest of summer in full-throated ease.
Fade far away, dissolve, and quite forget
What though amongst the leaves hast never known,
The weariness, the fever and the fret
Here, where men sit and hear each other groan;
Where palsy shakes a few, sad, last gray hairs,
Where youth grows pale and spectre thin and dies,
Where but to think is be full of sorrow
And leaden- eyed despairs,
Where beauty cannot keep her lustrous eyes,
Or new love pine at them tomorrow.
Keats by now was despairing because he knew he was a marked man (he had medical training from one of the best institutions) wished to travel to Rome for relief. In Rome his condition sadly worsened by the starvation diet advised by an English doctor named James Clerk.Dr Clerk who had absolutely no idea how to treat TB began to bleed poor Keats under the mistaken notion that bleeding would reduce his hemoptysis. Keats died on 23rd February 1821. John Keats however never hid the fact that he suffered from TB.
Unlike Keats, D H Lawrence (of Lady Chatterley’s Lover fame) refused to acknowledge that he suffered from TB. Lawrence would insist that his cough was a touch of bronchitis. D H Lawrence a contemporary of Jinnah was born nine years later than him in 1885. A Mexican physician was convinced that D H Lawrence suffered from TB and told him so but the man took little notice. Lawrence was spitting blood in 1926 and was dead in 1930, aged only 45 years. Lawrence not unlike Jinnah lived before combination anti- tubercular treatment had been invented. Untreated TB was then and still is a death warrant.
Tuberculosis killed both Emily and Charlotte Bronte. Emily wrote ‘ Wuthering Heights’ while Charlotte penned ‘ Jane Eyre’. In fact all the Bronte sisters were to die of TB. Charlotte was to write of a dying sister:
‘ The sick girl wasted like any snow wreath in thaw; she faded like any flower in drought ‘.
The day Emily Bronte died, Charlotte had written,” She grows daily weaker…the physicians opinion was expressed too obscurely to be of any use…he has sent some medicines which she would not take…. I pray for Gods support for all of us”.
Charlotte was to die aged 38 in 1855; her death certificate mentioning tuberculosis as cause of death.
Charles Dickens, unlike the newspapers of his generation, which avoided blaming deaths to poverty and unhygienic conditions, ensured that he elaborated on the true causes of disease and mortality. He described TB in ‘ Nicholas Nickleby ’ superbly as:
‘A dread disease in which the struggle between soul and body is so gradual, quiet and solemn, and the result so sure, that day by day, and grain by grain, the mortal part wastes and withers away, so that the spirit grows light and sanguine with its lightening load, and feeling immortality at hand, deems it but a new term of mortal life; a disease in death and life are so strangely blended that death takes the hue and glow of life, and life the gaunt and grisly form of death; a disease which medicine never cured, wealth never warded off, or poverty could boast exemption from; which sometimes moves in giant strides, and sometimes at a tardy sluggish pace, but, slow or quick, is ever sure and certain’.
Fodor Dostoevsky has Katarina Inavova suffering from TB in ‘ Crime and Punishment. Somerset Maugham describes life and death of patients with TB in his short story ‘ Sanatorium’. John LeCarre dilates on the immense dangers of drug resistant TB in ‘ The Constant Gardner’. Richard Yates who had suffered from tuberculosis soon after Second World War, wrote in ‘ No Pain Whatsoever’:
‘She offered him the pack and he took a cigarette. When he bent forward to take the match the yellow pajamas gaped open and she saw his chest, unbelievably thin, partly caved in on one side where the ribs were gone. She could see the end of the ugly newly healed scar from the last operation.’
This was Myra visiting her husband in a TB hospital. The scar must have been testimony to a phrenic nerve injury operation. The phrenic nerve was deliberately damaged to paralyze the diaphragm of the affected side. The lung was now incapable of expansion. This was believed to provide rest and hasten recovery. The other technique employed was to produce pneumothorax; that was to fill air into the membrane enveloping the lung. A pneumothorax was supposed to lessen infectivity by reducing sputum production. Both surgical techniques were rendered obsolete with the advent of antibiotic therapy. Richard Yates timed his short story in the 1940’s before antibiotics became standard treatment for patients of tuberculosis.
Jinnah was not provided these surgical techniques and most probably had never heard of them. The brilliant legal brain that delivered a new nation based on the vision of Mohammad Iqbal apparently was unwilling or incapable of seeking medical advice. Jinnah probably was swayed by Iqbals logic that in an Islamic state polity and religion would merge into one solid mass to manage and cure the ills of a sovereign state… a nation fully evolved and pure… devoid of all non-Muslim elements …capable of seamlessly running institutions of a modern state.