Perhaps the most amazing mathematician of all time was Srinivasa Aiyangar Ramanujan (1887-1920). He worked out incredibly complicated problems and expanded our knowledge of elliptic functions, continued fractions and infinite series. During his 32 years of life, he wrote about nearly 4000 math problems and almost all of his solutions have proven to be correct. It is incredible that this was done by a very poor young man, born in a tiny town in India. His father was uneducated and worked as a clerk in a cloth merchant’s shop. He went to a public school for poor children and had no early exposure to mathematicians.
A Self-Taught Mathematician
Ramanujan was such a good high school student that in 1904 he was given a scholarship to the Government College in Kumbakonam. When he was there, he found a dust-covered book in a local library, A Synopsis of Elementary Results in Pure and Applied Mathematics, written to help math students in England understand complicated problems. The book was 48 years old at that time (published in 1856) and was already out-of-date on some subjects. Ramanujan devoted so much of his time to this book that he did little else and failed his school examinations in other subjects. He lost his scholarship and had to leave school.
In 1906 Ramanujan went to Madras to take courses in a school that would prepare him to enter the University there. However, he became ill and was so sick that he failed all his examinations except in mathematics. He now was destitute and had to ask his friends for money just to meet his bare necessities. He sought out an Indian mathematician named Ramachandra Rao who helped him get a job as a clerk in a bank and encouraged him to write to mathematicians at Cambridge University in England, one of the leading mathematics centers in the world.
G. H. Hardy Receives a Letter
In 1913 one of the world’s leading mathematicians, G. H. Hardy, received a 10-page letter from a 25-year-old clerk in India. It contained more than 120 theorems on infinite series, improper integrals, continued fractions and number theory. Most world-famous professors would have thrown the letter away since it would have taken days or even weeks just to read and prove or disprove what Ramanujan had written.
However, G.H. Hardy was intrigued and asked another Cambridge mathematician, J.E. Littlewood, to review the letter with him. Both Hardy and Littlewood thought the letter was written by a genius. Hardy wrote back to Ramanujan that he believed that many of his theorems were correct. Ramanujan showed Hardy’s letter to people at the University of Madras in India and he was named a research scholar, even though he had neither college training nor a college degree. This doubled his clerk’s salary.
Hardy invited Ramanujan to come to Cambridge, so in March 1914, Ramanujan headed for England to start five years of incredibly productive collaboration with Hardy. On March 16, 1916, one of the most prestigious universities in the world gave him a Bachelor of Science Degree by Research. This was later made the equivalent of a Ph.D. In May 2, 1918, he became the youngest person and the first Indian to be elected a Fellow of the prestigious Royal Society of London.
Hard Life in England During World War I
Ramanujan grew up in a tropical climate and now had to live through freezing English winters. He was a strict vegan and had very little that he could eat during the severe war-time shortages. In 1917 he became ill and was hospitalized in several different nursing homes. Early in 1919 Ramanujan sailed back to India, but he never recovered from his illness and died within a year.
Ramanujan’s Health History
We have detailed information on Ramanujan’s medical history (1), so we can review his symptoms over the years and try to diagnose the chronic disease that is most likely to have killed him.
In his productive early years, he was short and fat. In his last 10 years he lost weight and was sick most of the time. He would work for 30 hours at a stretch, then sleep for 20 hours. He cooked his own meals and would eat only once a day.
In the spring of 1917 at age 30, Ramanujan went into a nursing home in Cambridge and stayed in and out of nursing homes until the autumn of 1918. Early in 1919 he appeared to have recovered. He returned to India but his health deteriorated after that until he died in April 1920.
Symptoms
• Chronic recurring illness starting in his early 20’s in Madras (a coastal city in India)
• Night fevers over many years
• Diarrhea,
• Point tenderness in his belly
• Large liver with no jaundice
• Weakness and tiredness
• Swelling in his groin at age 21 that required surgery
• Constant stomach pain, incorrectly diagnosed as a stomach ulcer.
• Constant night sweats and night-time fevers that were attributed to tuberculosis, but TB was not the cause of his death.
• He was previously fat, but by June 1918 he lost so much weight that he became emaciated and his clothes were too large for his body.
• Severe coughing that began at age 30, producing large amounts of phlegm and shortness of breath. He saw a lung specialist in August 1917 and was told that he did not have TB but had metastatic liver cancer. This was also incorrect.
• Irrational thinking beginning at age 30 that led to a suicide attempt and trouble with the law. This was totally out of character.
• He had a very high count of polys (polymorphonuclear white blood cells). This made tuberculosis or brucellosis unlikely as those diseases usually raise counts of other types of white blood cells.
Four Possible Diagnoses
According to D.A.B. Young (2), four diseases are characterized by night sweats and fevers accompanied by increased polys:
• A heart infection called subacute bacterial endocarditis
• Hodgkin’s disease (cancer of the lymph nodes)
• Metastatic cancer of the liver (unlikely because he never became jaundiced)
• An amoebic infection
The Most Likely Diagnosis
All of Ramanujan’s symptoms can be explained by a single disease: Amoebiasis, a protozoal infection of the large intestine.
Diarrhea: Amoebiasis is very common in the coastal cities of India such as Madras. When he first went to Madras in 1906, he developed diarrhea so severe that he had to return home for three months. Amoebiasis usually continues for a few weeks, becomes asymptomatic for a while, and then keeps on recurring throughout life.
Swollen testicle: Later that same year, he developed a swelling in his testicle that required surgery in January 1910. This was incorrectly diagnosed as a hydrocoele, a sack of fluid around his testicle. Instead, it was probably an abscess filled with amoebas.
Abdominal pain: In 1917 Ramanujan developed severe abdominal pain that was diagnosed as a stomach ulcer. They didn’t have sophisticated X rays and did not do biopsies then, so more likely he had an ulcer in his colon caused by Amoebiasis. It is unlikely that he had his diagnosed metastatic liver cancer because he was never jaundiced.
Night sweats and fevers: As a colon abscess full of amoeba enlarges, the infected person develops a high fever and is very sick. The fever is worse at night and causes night sweats and chills. The patient cannot eat, suffers severe weight loss and his white blood cell count goes sky high. This occurred in the winter of 1918.
Mental illness: Amoeba can invade the brain to make a mentally stable person appear to be crazy. In 1917 (age 30) Ramanujan attempted suicide by throwing himself in front of a train at a London railway station, but suffered only superficial leg wounds. He was arrested because attempting suicide was a criminal offence. His mentor, G.H. Hardy, personally intervened and charges against Ramanujan were dropped under the condition that he be kept under medical supervision for at least 12 months. On October 19, 1917, Ramanujan ran out of a boarding house like a crazy man because by mistake, he had swallowed a drink full of eggs, which Hindus are not supposed to eat. At that time the air was full of exploding bombs from a German air raid that killed 27 people. Ramanujan said the air raid was punishment from God because he had eaten animal products. This was abnormal behavior for a man whom Hardy described as sensible and rational.
Lung abscess: When he left for India in 1919, he developed a severe cough and shortness of breath. This means that amoeba collected in his lungs to form an abscess that collapsed the lower parts of his lungs. He probably also had an amoebic abscess in his liver that could have ruptured into his lungs.
He Could Have Been Saved Even in 1920
People who are infected with amoebas usually start their diseases with diarrhea, get better and then go on for years with no symptoms. Then, as they age, their immunity weakens and the amoeba spread from their intestines into other organs and ultimately kills them. Amoebiasis is a tropical disease, but living in England, Ramanujan did not see any tropical disease specialists. He saw only specialists in tuberculosis and stomach diseases. Any patient with recurring fevers and abdominal pain from an area where Amoebiasis is common should have their stool looked at under a microscope for amoeba, or their stool tested for surface proteins of amoeba. The tragedy is that at the time Ramanujan died, a cure was available. Since he was not diagnosed correctly, he did not receive the correct treatment. A drug called emetine was available then and is still available today. The more common treatment now is an antibiotic called metronidazole by mouth for 10 days.
1) D.A.B. Young. ‘Ramnujan’s Illness’, Notes and Records of the Royal Society of London, Jan 1994;48(1):107-119.
