The question is, was the king mad or was he ill? Today's diagnosis: metabolic disorder


LONDON -- The question of just how barmy George III really was has vexed physicians, politicians, playwrights, historians and just plain gossips for two centuries.

"Quite mad," said Dr. Richard Warren, the gilded society doctor called in to treat the king during the crisis of 1788 that inspired Alan Bennett's play, "The Madness of George III."

The modern diagnosis is that the king suffered from porphyria, a genetic disorder of the metabolism whose symptoms mimic madness. Porphyria was not identified until the 20th century.

The porphyria was suggested by two psychiatrists, Dr. Ida Macalpine, who pops up in Mr. Bennett's play, and her son, Dr. Richard Hunter, a lecturer in the history of psychiatry. They were the first to study the voluminous medical records.

They dismissed the conventional hypothesis that George suffered from a manic-depressive psychosis as untenable, based more on fashionable psychological theory than medical evidence.

The king's recent biographers accept the porphyria theory, as does Charles, the Prince of Wales, who's done a bit of digging in the royal archives himself.

The king had certainly exhibited bizarre symptoms. He was delusional. He babbled incessantly and incoherently for up to 26 hours at a stretch. He was sleepless. He refused to eat. He became violent with pages and doctors and their assistants.

He thought he could see Hanover from Westminster through a telescope. He believed London was "drowning." He spoke with the dead and the living who were not present.

In one famous, but perhaps apocryphal, episode recorded in the diary of a notorious gossip, he got off his horse in Windsor Park and shook hands with a tree he believed was the king of Prussia.

As a page in Mr. Bennett's play says: "If he wasn't mad but had all the symptoms, what's the difference?"

The king's doctors -- a crew of seven eventually -- didn't have a clue. Modern medicine was barely conceived, let alone in its infancy. Simple blood tests were unavailable. They couldn't take blood pressure. They couldn't even agree on the king's pulse rate.

And they could never agree on whether the king was delirious or deranged. Dr. Warren made his first diagnosis without seeing the patient.

Their treatment was more horrendous than his madness. The king was bled, purged, fed emetics to make him vomit, blistered with irritants that caused open sores which invariably became infected.

They gagged him, frequently wrapped him in a straitjacket, and eventually restrained him in a specially built chair, a potent symbol in the play.

The queen believed he was mad, and so did the disaffected and ambitious Prince of Wales, who was in a hurry to be king, and the rest of the royal family, the court, the rumor-mongers of London, the Whig opposition and even his Tory prime minister, William Pitt.

The citizens of the newly liberated American Colonies had drawn up the longest list of grievances against him in the Declaration of Independence, but hadn't called him insane, merely a tyrant who desired to reduce them to victims of absolute despotism.

"The hardened, sullen-tempered Pharaoh of England," snarled Tom Paine, in his revolutionary call to arms, "Common Sense."

But George III was essentially a simple, frugal, somewhat priggish, mutton-and-potatoes man, old-fashioned and stuffy at court, faithful to his wife for 50 years, hard-working at being king for 60, and unhappily subject to intermittent bouts of illness.

He was, generally speaking, beloved by his subjects. They called him "Farmer George" and mourned him at his death.

Copyright © 2021, The Baltimore Sun, a Baltimore Sun Media Group publication | Place an Ad