A health librarian at the theatre: The Madness of George III

It's been several weeks since I "went" to the theatre, but I have just watched the Nottingham Playhouse's production of this Alan Bennett play, on the National Theatre Live YouTube channel.

I saw the film (called The Madness of King George) some years back and I was aware of the idea that the King was not mad, but had porphyria.   The clue was the blue urine, which none of the doctors (in the play) thought was important.

But I had not realised that view has been questioned.   There are several articles in the medical literature, many by Timothy Peters of the University of Birmingham (UK).   It is argued in those that the authors who advanced the porphyria theory were rather selective when it came to symptoms, and misinterpreted the ones they did choose, and did not consider the King's mental health.

There were several things that caught my health librarian eye while watching.

All of this is, of course, Alan Bennett's portrayal of the characters involved.

There were three doctors involved in the King's care, before Dr Francis Willis.    All seemed glued to their view of diagnosis and treatment.   One was sure that blistering was the treatment needed to draw out the bad humour that was the cause.  Another based all their diagnosis on the King's stools.    The third was set on prescribing a particular thing.    They, and the King's servants, noticed the blue urine, but it seems as it did not fit anyone's scheme of treatment, it was not thought relevant. 

It seems physical examination was the last resort, and not the first.   Perhaps that was a reflection of the class divide, in the context where no one addressed the King directly, and all conversations were carried out through someone else.

Then there was Dr Willis.   Dr Willis, who maintained an asylum in Lincolnshire, did address the King directly, and not only that, told him off for his random conversations and inappropriate talk.   Contact with others, including the Queen, was restricted, and if he misbehaved, he was put into a straitjacket.

The manoeuvring of politicians of the time was shown too, and obviously (in Bennett's view, anyway) had a role to play - who was Prime Minister, and whether the Prince of Wales should be Regent.

And the King got well.   The random talk and inappropriate talk subsided, and the urine went back to a more usual colour.

So, did Francis Willis cure him?   And what was it?

Searching PubMed for George III or King George III requires a specific search for George III porphyria, or George III[ps].     An earlier diagnosis, before the one of porphryia, was bipolar disorder (1,2). 

And searching PubMed for willis f[ps] finds a few including this one (3).  

This Patient article for professionals discusses symptoms and treatment of porphyrias.

1.           Peters T. King George III, bipolar disorder, porphyria and lessons for historians. Clin Med. 2011 Jun 1;11(3):261-4.

2.           Peters T. FitzPatrick Lecture: King George III and the porphyria myth – causes, consequences and re-evaluation of his mental illness with computer diagnostics. Clin Med. 2015 Apr 1;15(2):168-72. 

3.           Pearce JMS. The Role of Dr. Francis Willis in the Madness of George III. Eur Neurol. 2017;78(3–4):196–9.