Month: August 2020 (page 1 of 1)

By J C M Khoo, C G Kwa, L Y Khoo

(Reproduced with kind permission of the authors and the Singapore Medical Journal)

abstract

The authors reviewed a rare autopsy report of Sir Thomas Stamford Raffles and offer a fresh interpretation of the cause of his death, with illustrations on the implied findings.

INTRODUCTION

The history of Sir Thomas Stamford Raffles and the founding of Singapore are well documented. Less well known is the history regarding the later part of his life and the circumstances surrounding his death. We reviewed his last evening and a little known autopsy report by an English physician, Sir Everard Home, and based on his report, feel confident that Sir Thomas Stamford Raffles died of cerebral haemorrhage arising from an arterio-venous malformation affecting the dura and right frontal lobe of the brain.

The report from the Gentleman’s Magazine – July 1826:

“He had passed the preceding day in the bosom of his family, and, excepting a bilious attack under which he had laboured for some days, there was nothing in his appearance to create the least apprehension that the fatal hour was so near.

Sir Stamford had retired to rest on the Tuesday evening between ten and eleven o’clock, his usual hour when in the country. On the following morning at five o’clock, it being discovered that he had left his room before the time at which he generally rose, six o’clock, Lady R immediately rose, and found him lying at the bottom of a flight of stairs, in a state of complete insensibility. Medical aid was promptly procured, and every means resorted to, to restore animation, but the vital spark had fled. The body was opened, under the direction of Sir Everard Home, the same day, who pronounced his death to have been caused by an apoplectic attack beyond the control of all human power.”

DISCUSSION

Only 4 conditions cause a thickening of a portion of the skull. Paget’s Disease, fibrous dysplasia, meningioma and dural arterior-venous fistula or arterior-venous malformation.

The first two conditions are not associated with abnormal vascularity of the dura or brain and are discounted. Likewise, no evidence of meningioma or brain tumour was discovered.

The last, arterio-venous malformation, fits the diagnosis well. The Hypervascularity of the dura was noted as “exceeding anything I have ever seen.” Also, an organised haematoma of about 4 oz was found in the right lateral ventricle indicating the arterio-venous malformation had bleed internally into the ventricle.

The haemorrhage probably led to the fall and final demise of Sir Thomas Stamford Raffles. A Seizure could have well occurred prior to the fall.

Sir Raffles was well known to have frequent severe headaches. He described his health in some detail in his correspondence. Writing to the Duchess of Somerset in December 1821, Raffles stated that his “own health still continues most seriously affected, [he was] seldom well for twelve hours, and always laid up for several days in the month.” In another letter to the Duchess written in February 1822, Raffles informed of the death of another two of his children, the depression of his wife, and as for himself, “had two of the most severe attacks [he] ever suffered. The last, a fever which fell on the brain, and [he] was almost mad. [He was] still an invalid, and confined to [his] room.”

Raffles’ health continued to deteriorate. A year later he wrote that he spent two thirds of his time in “pain and annoyance, from the dreadful headaches [he was] doomed to suffer in this country, but the remaining third has been actively employed.” On his last visit to Singapore from October 1822 to June 1823, Raffles wrote to the Duchess of Somerset that he “had another attack in the head, which nearly proved fatal, and the doctors were for hurrying [him] on board ship for Europe without much ceremony.

However, as [he] could not reconcile myself to become food for fishes, I preferred ascending the Hill [Fort Canning], where, if my bones must remain in the East, they would have the honour of mixing with the ashes of Malayan Kings; and the result has been that instead of dying, [he] almost recovered. [He had] build a very comfortable house [on Fort Canning] which is sufficient to accommodate his sister’s family as well as [his] own.” Raffles’ health, as expected, did not improve following his return to England (3-5).

These symptoms were likely to be due to the arterio-venous malformation, causing minor haemorrages or an ischaemic steal effect, causing headaches and irritability.

Fig 1 & 2 show the official bust and portrait of Sir Thomas Stamford Raffles with hair usually covering the right frontal brow. The prominence is quite suggestive. Fig 3 shows an illustration of the arterio-venous malformation of the brain as described, by Sir Everard Home.

CONCLUSION

This report gives a neurosurgical and neuropathological interpretation to Sir Thomas Stamford Raffles’ last days and the cause of his death, based on his biography and autopsy report.

That the founder of Singapore could have suffered such a condition and yet do all that he did makes him even more remarkable. 

REFERENCES

• Sir Thomas Stamford Raffles: Book of days, Singapore Publishers Antique of the Orient 1993.
• J Hume-Adam, Leo W Duchen (eds): Greenfields’ Neuropathology 5^th edition. Edward Arnold, 1992: 269-302Raffles – Minto Collection (ISEAS – Singapore).
• GR Kayne & EH Johnson, India Office Library.Raffles Collection vol. 1-15, 1785-1825, University of Malaya, Kuala Lumpur.
• Bastin, John, Sturgus 1927. Sir Thomas Stamford Raffles – Singapore National Museum 1994. Publ. National Museum, Singapore in conjunction with “Raffles Reviewed” exhibition from 29.1.1994 – 1.5.1994.