The poisoning of George III

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During his long reign from 1760 to 1820, King George III had several attacks of an unusual illness. Most of these were mild, but some of them involved mental disturbances that alarmed his family and his Government ministers. The minor illnesses of 1762, 1790, and 1795, were free from such madness, as was the more serious attack of 1765 when he was 26 years old. However, the attacks of 1788, 1801, 1804, and 1810 were all accompanied by alarming mental disturbances.

The illness of 1788 was the most serious because it had political implications that resulted in what was called the Regency Crisis. The Prince of

Wales, his eldest son and eventually successor, favoured the Whig Opposition in Parliament, and he believed his father's madness to be permanent. This would necessitate a regency with himself exercising the royal power. The Tory governing party naturally would have been out in the cold had this happened but they were able to drag their feet over passing the requisite legislation through Parliament. The result of the Tory Party's procrastination was that they remained in office because the King recovered and resumed his role as Head of State. His 'madness' had only been a symptom of his condition. The royal malady and recovery had important repercussions for the treatment of all lunatics, once it was realized that madness could be a curable condition.

The King's illness of 1788 is worth a closer look because it has been clearly documented. Its chief features were severe constipation, colic, weakness in the limbs, difficulty in swallowing, sleeplessness, with progressive mental disturbances that started with talkativeness and advanced irritability to delirium and coma. These read like a textbook case of acute lead poisoning.

It all began on 11 June 1788 when the King returned to Kew Palace after reviewing the Duke of York's Regiment on Wimbledon Common. Sir George Baker, who by now had been knighted and made the King's Physician, was called in the following day. His Majesty was suffering from colic. For two weeks the King was ill but then he left to take the waters at Cheltenham Spa from 9 July to 11 August. There he regained his health, but the recovery was only temporary. A second attack of colic started on Friday, 17 October, and again Baker was called to attend the King at Windsor Castle. He arrived to find him in great distress with stomach pains and cramps in his arms and his legs. For the next three weeks the King's health went steadily downhill although on some days he was much worse than on others. He was also constipated, suffered from insomnia, and was weak in the limbs.

Towards the end of October, signs appeared that his brain was being affected. He became talkative and agitated. He rambled, and at times became giddy. On Wednesday, 5 November he had a big row at dinner with the Prince of Wales when the conversation turned to the subject of murder. Stung by a remark of the Prince's, the King attacked his son physically. The Queen had hysterics and the Prince burst into tears.

What drove the King to such extreme behaviour? It may well have been the suspicion that the Prince would not have been too unhappy to succeed him. Indeed the Prince was in such financial and matrimonial difficulties that only his elevation to the throne could have solved them. Despite a parliamentary grant of £221000 the year before, plus an increase in his annual income, the Prince had again fallen badly into debt. His riotous living eventually piled up a total of £630000 in debts over the next six years (equivalent to something like £50 million at today's prices). Moreover, the Prince had secretly, and illegally, married his mistress Mrs Fitzherbert in 1785 and she was a Roman Catholic. This meant that the marriage was not only unlawful but politically disastrous if the knowledge of it were to leak out because of the intense anti-Catholic feeling in the country.

The weekend of Sunday, 9 November 1788 was a crisis. The King had obviously lost control of his mind and his physical condition deteriorated so rapidly that in London the rumour went round that he had died; by Monday, 10 November the King was only semi-conscious - but then he began to recover physically. His mental condition, however, did not improve and to all intents and purposes he was mad. This symptom of his illness dominated all others, since it was so important to the functioning of government. It has also coloured his popular image ever since. When it became obvious that the King would survive, fresh doctors were called in, doctors who specialized in the treatment of the insane. The King was confined in a straightjacket and strapped to a heavy chair in order to control his irrational outbursts. He was dosed with mercury chloride and castor oil for his obstinate constipation, and given quinine for his fever.

Despite relapses about Christmas and the second week of January, the King slowly recovered his sanity. In the middle of January the doctor in charge started putting antimony tartrate in his food to induce vomiting. This treatment was kept secret from the King and it greatly distressed him. It was continued for six weeks at the end of which time his Majesty was declared to be cured. There was national rejoicing, except among the Prince of Wales and his Whig supporters whose disappointment was ill-concealed. The King suffered similar attacks of colic, constipation, hoarseness, muscular pains, sleeplessness, and delirium in 1801, 1804, 1810, and 1812. The last attack, when he was 73 years old, left him blind and permanently mentally disabled. The Regency was then a necessity, but the Prince of Wales had had to wait 20 years.

The authors of the book George III and the Mad Business were the medical historians, mother and son, Ida Macalpine and Richard Hunter. They made an exhaustive study of George III's illness and deduced from the symptoms that his doctors recorded that he suffered from a metabolic disorder which affected the production of the essential body chemical porphyrin. The condition is called porphyria. They were led to this conclusion by the discovery among the doctors' notes of the period that the King's urine was sometimes red in colour. This can be a feature of porphyria; it can also be a feature of lead poisoning. Macalpine and Hunter thought a genetic defect to be the most likely explanation and indeed it is now known that some of George III's descendants were also afflicted with porphyria. They claim even to have traced the original genetic defect back to Mary Queen of Scots (1542-87), mother of James I of England from when it passed to other royal families of Europe, including members of the House of Hanover of which George III was a member. Anyone with a predisposition of porphyria would be highly susceptible to lead. As we saw in Chapter 6, the level of lead in a sample of his hair was 6.5 ppm, more than ten times the normal level. Clearly he was exposed to lead, although not to the same extent as others mentioned in this chapter. However, if the King suffered from the hereditary defect of porphyria then a relatively low intake of lead could have a disproportionately adverse effect.

Lead poisoning and porphyria exhibit the same kinds of symptoms because they stem from malfunction of the same metabolic process in the body. Without modern aids to investigation there is no way of distinguishing the one from the other. Usually lead poisoning is a mild poisoning and it requires a sudden intake of lead, or a sudden release of the lead which has accumulated in the bones, to threaten life. The King's condition was not diagnosed as either lead poisoning or porphyria, which was not to be recognized as a medical condition for another hundred years. It was the symptom of mental disturbance that blinded those treating the King to the underlying cause.

In a mass lead poisoning of 1849, some of the victims suffered in exactly the same way as George III. In that episode, a 30 pound bag (14 kg) of lead acetate was accidentally mixed with 80 sacks of flour and used to bake bread. Five hundred people were affected, some of them seriously. Instead of the typical ashen look, characteristic of lead-induced anaemia, some of the victims had a ruddy complexion (as did King George) and some passed red coloured urine. Another feature of the poisoning was the recurrence of the symptoms several weeks after they ate the contaminated bread, just as had happened with the King. The effects of a massive dose of lead are different to the effects of slow lead poisoning of the Devon colic type, which is perhaps why Baker failed to realize what he was dealing with.

Could George III have been a victim of lead poisoning? Considering the times in which he lived, it is more than likely that he would have been taking in too much lead from his food and drink and there are two particular sources of the poisoning that we can deduce from his diet. The King was very fond of lemonade and sauerkraut. Both these foods are very acidic and neither should be prepared or kept in a vessel with a lead glaze. Lead poisoning was common in Germany in the spring of each year, when peasants ate their sauerkraut. This was not a common dish in Britain in the 1700s, but the King was certainly known to enjoy it. Other sources of lead could have added to the King's burden of this metal, such as lead decanters, glazed pottery, and even pewter tankards. Whatever the cause, it is more than likely that the King suffered from mild lead poisoning for most of his life.

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