King's evil
FELIX MARKHAM
George III and the Mad-Business I McAlpine and Richard Hunter (Allen I.: The Penguin Press 70s)
This is an important book, of interest bo to physicians and to historians, and fascinating piece of medical detection. is rare, possibly unique, for the medi case-history of a historical personage survive in detail. For the first time evidence, much of it hitherto inaccessib has come under the expert scrutiny of British neurologists. Their findings u announced in the British Medical Jour in 1966, but there is such a wealth material that a book on the subject is fu justified. They concluded that the Kin illness was not a form of insanity (as u loosely assumed in the nineteenth centu though not, significantly, by the King's o doctors who were frankly puzzled) porphyria, a rare inborn error of met. lism, one symptom of which is delirium toxic origin.
The disease of porphyria was not ide fied until 1841, nor scientifically diagn till this century. In the absence of labo tory tests, which now provide the posit diagnosis of porphyria, there can be absolute proof in George III's case: the massive array of evidence presented the authors is convincing and the %erd must be, at least, one of a high degree probability.
Misled by medical opinions in the n teenth century and the Freudian
historians have made some rum speculations about the personality of George III: 'This unstable man could not tolerate his own timorous uncertainty and broke under the strain.' Perhaps his madness can best be explained as the breakdown of a costly struggle—the reserve and equanimity im- posed upon a hot temper and anxious nerves, to say nothing of his resolute fidelity to a hideous queen.' Often trem- bling on the brink of melancholy mania, George was to be thrust from gloom to years of madness by the death of a favourite child.'
All this will have to be reconsidered, and justice rendered to a much maligned monarch, who had to endure terrible physical suffering. But how does this new evidence affect the interpretation of George III's reign? Probably not much, except in the case of the Regency crisis of 1788. If the King's illness was not insanity but porphyria, his sudden recovery in the spring of 1789 in time to avert the passing of a Regency Bill is much more intelligible. As the King himself said after his recovery, 'If the Regency had been established, I should not have come forward to over- throw it.' In that case, the Prince of Wales and Fox would have come into power. Fox might have avoided war with revolu- tionary France or negotiated peace with France by 1797, in time to block Napoleon's rise to power. There might have been no Emperor Napoleon.
The health of rulers is probably even more important in this century than it was in the eighteenth century, and a whole new field of historical analysis is opening up, demanding the cooperation of medical experts and historians.
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