On 23rd October 1910 King Chulalongkorn (Rama V) died aged 57 at Amphorn Sathan Residential Hall in Bangkok. He had reigned over Siam for 42 remarkable years. His death was mourned throughout the nation and was reported around the world. The day is still remembered as an annual holiday in Thailand. But what exactly did he die of ?
The King’s Long Illness
The day after the king’s death, thanks to Reuters and the marvel of the telegraph, the London Mail reported his death as due to “uraemia” after several years of suffering from “chronic nephritis”.
So what does that mean?
Uraemia is the condition of having very high levels of urea, one of the primary components of urine, in the blood. It is associated with having terminal kidney failure which is consistent with it being Chulalongkorn’s final symptoms. Nephritis is similarly a kidney problem in which the spaces between the tubules within the kidney become inflamed and swollen. The symptoms include blood in the urine, frothy urine caused by excess protein being passed and high blood pressure.
It all sounds very unpleasant.
A Medical Trip to Europe
In 1907 King Chulalongkorn had embarked upon his second trip to Europe, exactly ten years after his first visit. However, unlike that first trip this second journey was taken in an unofficial capacity, not as a state visit. During the trip he indulged his passion for all things European, buying up jewellery, paintings, statues, furniture etc. But another important facet of this trip was that he was seeking a cure for his illness.
Many of his stops around Europe involved either recuperation or consultations with doctors. For example in August it was reported,
The King of Siam, who left Kiel for Berlin with his entourage on Sunday (August 4th, 1907) at 10:30 a.m., arrived here [Berlin] at 4 a.m…… After the king had warmly welcomed the gentlemen who had appeared, they drove to the Hotel Kaiserhof, where the king took up residence. His illness brought him here, so he only travels incognito…… Prof. Dr. v. Noorden-Wien, Prof. Dr. Krehl-Heidelberg and Prof. Dr. Meyer-Berlin, who met for a one-hour consultation soon after the king’s arrival, advised the patient to stay in a German seaside resort for a longer period of time.
A few days later it was similarly reported
King Chulalongkorn of Siam, who, as our readers know, has come to Berlin for longer stays, is unfortunately not in the best of health. An ailment from which he seeks a cure in Europe has already diminished considerably, but has not been completely cured either on the Riviera or on the king’s trip to the north. A medical college, which he therefore consulted, advised him to undergo a cure in a seaside resort.
On September 20th the king celebrated his 54th birthday in Bad Homburg, Germany, a town famous for its recuperative natural hot spring spas. The following day a grand ceremony was held to name a spring after the king who donated a Siamese style pavilion which still stands on the site.
The king returned home to grand celebrations in November 1907 but the world’s finest doctors had been unable to cure his impending kidney failure. It would be another half century before kidney transplants would become a reality. Chulalongkorn had only three more years to live.
Did Malaria Cause His Death ?
So the question arises what caused King Chulalongkorn’s chronic kidney failure?
One possible culprit could be malaria. Back in 1868 then Prince Chulalongkorn accompanied his father King Mongkut (Rama IV) on a famous expedition to Wakor near Hua Hin to observe an eclipse of the sun. The expedition was a great success in that the eclipse occurred exactly according to the calculations that King Mongkut himself had made using western science thereby bolstering the king’s efforts to modernise his court. Unfortunately many members of the expedition contracted malaria in the remote swamps of Wakor and several, including the king himself, died.
Prince Chulalongkorn, aged 15 at the time, spent several months incapacitated by malaria after returning. By the time he recovered in late 1868 his father was dead and he was king.
Kidney dysfunction is a possible result of malarial infection. But Chulalongkorn was young at the time of his infection and kidney failure from malaria is rarely seen in children. Given that he went onto to live a further forty two years it would appear that Chulalongkorn’s bout of malaria was not the cause of his kidney problems.
The Years of Depression
There is another potential cause for the king’s illness for which we need to go back to 1893 to understand. In July of that year the infamous Paknam Incident occurred in which tensions between Siam and France climaxed with gunboats steaming up the Chao Phraya river and threatening the Grand Palace in Bangkok. Between July and October 1893 the king and his senior officials were under enormous pressure from France and the very survival of Siam as an independent nation was at stake. In October the king was forced to agree to a treaty which imposed heavy penalties on Siam and allowed France to take control of territories east of the Mekong river. But that was not the end with France continuing to press further demands upon Siam throughout the following years.
All this pressure took its toll on the king’s physical and mental health. It is widely reported that Chulalongkorn went through a long period of depression, withdrawing from affairs of state. A few days after the Paknam Incident itself the king’s General Advisor Gustave Rolin-Jaequemyns writes that “The King, whom I saw in the evening, is in an extreme state of agitation.” By September 1893 he is writing about the king’s poor morale whilst in November the Chief Naval Aide Andreas de Richelieu comments that the king “looks poorly”. Later in November Rolin-Jaequemyns writes that he fears the king’s condition to be “even more serious than they tell me”. A month later he discusses with Prince Devawongse what might be necessary if the king is unable to rule. Six months later in June and July 1894 the king continues to suffer serious fevers and sleepless nights to the point that Rolin-Jaequemyns writes “he has been very ill and that they thought they might lose him”.
Despite all the fears the king did eventually recover his physical and mental strength. But it took several years and incapacitated the king through one of the nations most dangerous periods.
Chloral Hydrate, the Smoking Gun
It is clear that from mid-1893 King Chulalongkorn was suffering severe stress causing “agitation” and “sleepless nights”. At that time a popular sedative was chloral hydrate which was used in asylums and general practice. It would seem that at some point Chulalongkorn’s personal physician Dr. E. Reytter began prescribing chloral hydrate for the king because by mid-1894 it is reported that the king was consuming a bottle per day. During August that year action was taken to reduce this dosage.
Today chloral hydrate is generally no longer approved for medical usage. In small doses it acts as a sedative which aids insomnia but at higher dosages it causes respiratory problems, low blood pressure, nausea and vomiting. With long term use a patient not only develops a tolerance to its effects but becomes addicted. Long term side-effects include stomach pains, skin rashes and severe kidney failure.
So here we have a possible suspect for the cause of King Chulalongkorn’s terminal kidney disease. It would appear that he was taking chloral hydrate for a prolonged period which may have been the cause of some of his other medical complaints during this time. With increased tolerance to its effects and perhaps due to addiction by mid-1894 the king was consuming daily a dosage which alarmed his own doctors. We know they reduced his consumption at that point but it is not clear when this treatment actually stopped. By then perhaps it was too late, the damage to his kidneys already done leading to the nephritis which ultimately killed him in 1910.
An Avoidable Death?
King Chulalongkorn was just 57 when he died, six years younger than his father at his own early death from malaria. Could it be that the sedative prescribed to help Chulalongkorn cope with the stress of the threats to his kingdom in 1893 led to many subsequent years of physical suffering and an untimely death in 1910?
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References
- http://www.payer.de/thailandchronik/chronik1907.htm
- https://en.wikipedia.org/wiki/Uremia
- https://kidney.org.au/uploads/resources/nephritis-kidney-health-australia-fact-sheet.pdf
- https://www.malariasite.com/renal-failure
- https://en.wikipedia.org/wiki/Chloral_hydrate
- Benson, Robert. Toxicological Review of Chloral Hydrate (CAS No. 302-17-0). EPA. 2000.
- http://www.thai-blogs.com/2010/11/16/hm-king-chulalongkorns-1897-journey-to-europe
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