Analysis of the reported symptoms that preceded the death of King Rajasinghe of Sithawake (1592 AD).

A copy of an ola leaf manuscript, the original of which was written around the late 1590s, was published recently. It describes the sequence of events leading to the death of the warrior King Rajasinghe of the Sithawake Kingdom (1521-1593). A study of the contents of this letter is presented. The dressing applied to a wound on the foot of the King is described in that letter. It is likely that this dressing would have been an ideal medium to produce the highly potent tetanus exotoxin. The toxin would have diffused into the open wound and produced the sequence of symptoms and signs mentioned in the letter. An analysis of the symptoms and signs noted during the King's last illness as described in the letter is presented. Laryngospasm, and tonic and clonic spasms are easily identified. In addition, a group of symptoms attributed in the 1960s to sympathetic over-activity in tetanus are also recognisable. The conclusion is drawn that the King died of tetanus. The intriguing possibility of the wilful use of a lethal dressing on an open wound as a biological contact poison is left open for discussion.