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George III: A New Diagnosis

Recent research by medical scientists and historians suggests that George III had manic depression rather than porphyria. Scholars will need to take a fresh look at his reign, writes Timothy Peters.

In the mid-1960s Ida Macalpine and her son Richard Hunter, both psychiatrists and amateur historians, published a series of papers followed up by a bestselling book, George III and the Mad-Business, which argued that George III was not mad as was once thought. Instead, they claimed that George suffered from the inherited metabolic disease, acute intermittent porphyria, a diagnosis they later amended to the milder, though even rarer disorder, variegate porphyria. In spite of considerable criticism by porphyria experts based on their clinical experience, the claims of Macalpine and Hunter have been widely accepted by historians and were popularised by Alan Bennett's successful 1994 play and subsequent film, The Madness of King George.

There is no shortage of data concerning the four major episodes of illness endured by George III - in 1788-89, 1801-1804 and 1810-20. These include around 100 volumes of medical notes and numerous diaries, letters and comments by contemporary courtiers, aides and politicians. The diaries of the author Fanny Burney, who spent five years at court in the 1780s as one of Queen Charlotte's ladies and who observed episodes of the king's madness first hand, are among this rich source of material. But to review all this evidence, especially the medical records, is a daunting task and it is one few historians have undertaken.

Having studied these records in detail, it is clear that Macalpine, who undertook the basic research for her son, was highly selective in reporting the signs and symptoms of the king's illness and there are far more plausible explanations for them. For example, the hoarseness Macalpine and Hunter claimed to be a feature of acute porphyria was attributed by the king's doctors to a head cold from which he recovered within a few days, fn contrast, such symptoms in acute porphyria would frequently be terminal and even today are a serious matter, taking 12-18 months to resolve themselves.

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