Recent research has thrown considerable doubt on the claim that King George III suffered from variegate porphyria, but indicates that he suffered recurrent attacks of mania as part of his bipolar disorder. George III’s last episode of ill health occurred during the final decade of his life (1810–20). This has been diagnosed as chronic mania with an element of dementia. During this period the king was blind and possibly deaf, which may have contributed to his psychiatric condition.
His blindness was due to bilateral cataracts; serious consideration was given at the time to surgery, but this was not carried out. The possible contribution of the king’s blindness to his illness is discussed with respect to the roles of his medical attendants. It was also claimed that George III showed progressive deafness and this claim has been re-examined. However, the medical reports by the attending physicians and psychiatrists (mad doctors) do not support this claim.
King George III of Great Britain
Although George III was born two months premature, his childhood and adolescence seem to have been largely uneventful from a medical viewpoint. The first concerns for his health occurred in 1765, when he had a period of chronic chest disease accompanied by symptoms suggesting a mild degree of depression.
Unfortunately, unlike his later illnesses, there are no extant medical notes and the nature of this episode must remain an enigma. That it was significant is emphasized by the fact that following his recovery George III had discussions over possible regency arrangements.
Young George, Prince of Wales with his brother Edward Augustus
The king’s first and most well-known episode of mental illness occurred between October 1788 and March 1789, at the age of 50. This was a major episode of acute mania lasting almost six months, preceded by an episode of obstructive jaundice (probably cholelithiasis) that may have been the trigger. It was at this time that the psychiatrists Dr Francis Willis and his sons and their assistants took over the care of the king in this and subsequent episodes of mania. Their apparent success in alleviating George III’s illness was a major step in the recognition of the developing specialty of psychiatry. The Regency Bill was passed by the House of Commons, but the rapid recovery of the king meant that it was withdrawn during its passage through the House of Lords.
George III recovered and was essentially mentally and physically well until his second episode of mania in January 1801. A further short-lived episode of acute mania occurred in 1804, but there were no regency discussions. From this time the king’s vision progressively deteriorated, initially in his right eye and subsequently in his left, and by 1810 he was almost totally blind from
bilateral cataracts. On the advice of his prime minister, William Pitt, the king employed a secretary and amanuensis, Sir Herbert Taylor, from 1805 and for the remainder of his active life.
In October 1810, following the death of his favourite daughter Amelia, George III’s mental health seriously deteriorated and chronic mania ensued, which lasted with fluctuations until his death in 1820, aged 81. The Prince of Wales was sworn in as regent in February 1811. There is controversy as to whether George III developed significant fatuity (cognitive impairment) during this final decade, but there was little evidence of overall clinical improvement and the regency was subsequently made permanent.
Prinesses Anne, Amelia and Caroline
A brief résumé of the medical attendants involved in George III’s care during his latter illnesses follows. These attendants may be conveniently grouped into physicians, including those specialising in psychiatry (the mad doctors), surgeons and apothecaries. Sir Henry Halford was the senior physician involved with the king’s care. A distinguished physician educated at Rugby, Oxford and Edinburgh, he practised in London from 1792. He was clearly an astute physician; for example, recognising for the first time the clinical features of hepatic abscesses, most famously in Georgiana, Duchess of Devonshire. In 1809 he was consulted about the chronic chest infection of Princess Amelia during her fatal illness, and subsequently was physician to various members of the royal family.
Sir Henry was also an able diplomat and politician and was president of the Royal College of Physicians of London from 1820 to 1844. The other physicians involved had various degrees of expertise in treating patients with mental illnesses. William Heberden Jr was appointed Physician to the Queen in 1795 and to the King in 1805, but was a general physician with little experience of mental illnesses. Matthew Baillie was a distinguished physician, first consulted by Sir Henry Halford over Princess Amelia’s chronic chest infection.
In his evidence to the Select Committee of the House of Lords, who examined the physicians concerning the prognosis of George III’s illness, he raised the question of the king’s fatuity, his age as an adverse factor, and suggested that his blindness would impair recovery. Henry Reynolds attended George III during his three previous episodes and thus provided some continuity of care. His main function seems to have been to collect details of the fees payable for attendance on the king. His own death was attributed to ‘mental anxiety and fatigue of the body and mind’ in consequence of his onerous attendance on the king.
The Willis family of specialist mad doctors (psychiatrists) were brought in to care for the king during his four episodes of mental illness. The father, Dr Francis Willis, was credited with George III’s recovery in 1789. He went on to treat, albeit unsuccessfully, Maria I, Queen of Portugal, for a similar mental illness. His sons, John, Thomas and Robert Darling Willis were involved in the king’s care during his various episodes of ill health. The Rev. Thomas Willis was confessor to Queen Charlotte and Rector of St George’s, Bloomsbury, and ministered to the king during and between his episodes of illness. He may have been responsible for initially persuading Queen Charlotte to send for the Willis family.
There was constant friction between the recognised physicians and the Willises. Although John Willis was an Edinburgh medical graduate, he was not considered by Reynolds to be appropriately qualified as a physician and was excluded from consultations. In contrast, the psychiatrists eschewed the physical treatment administered by the apothecaries at the behest of the physicians.
King George III booting William Pitt
A further doctor consulted with a special interest in mental illness was Samuel Foart Simmons, but when he was not given sole charge of the king he left Windsor. An Edinburgh graduate, Simmons was elected Physician to St Luke’s Hospital (asylum) in the City of London in1781. He was previously consulted about George III’s relapses in 1801 and 1804. Sir David Dundas was appointed Sergeant Surgeon to the King in 1793. He was Household Apothecary at Kew but not officially Apothecary to the King. The Royal Apothecaries who attended the king were Everard Augustus Brande and Robert Battiscombe. Dundas was a prominent figure in the Royal College of Surgeons and was Master of the College in 1804, 1811 and 1819. He was made a baronet in 1815. The king’s oculists were Chevalier John Taylor from 1760 to 1771, Baron Michael de Wenzell from 1772 to 1790 and Jonathan Wathen Phipps from 1796 to 1814.
The physicians discussed the relationship between the king’s blindness and his mental illness. In order to find objective evidence they conducted a clinical study, much as would be carried out today. A survey was conducted of eight blind lunatics in St Luke’s, Guy’s and Bethnal Green hospitals: there was apparently no deterioration when they became blind.
George III at old age
In spite of the apparent lack of a relationship between blindness and madness, surgery for George III’s cataracts was reconsidered. It was decided against surgery, most likely, as it was thought that no benefit to the king’s mental illness would ensue.
The latter part of the eighteenth and early part of the nineteenth centuries was a period of great change in the recognition, understanding and treatment of mental illness. How much George III’s illness contributed to and benefited from these changes still remains a matter of debate. The relationship between blindness, deafness and mental illness is relevant to current medical practice as well as of historical interest. Blindness itself is said not to have a causal role for mental illness, although sensory deficits may be associated with paranoid disorder.
Illustration shows King on his death bed and Prince of Wales
It is clear from this brief account that the treatment of George III’s final decade of illness was more sympathetic than that which had occurred previously, with the dismissal of the physical and most of the medical treatments. Opiates were used and it is of interest that digitalis was given a therapeutic trial in the king, a treatment used in acute mania by William Withering in 1785. However, the strict isolation from his family, equerries and personal servants while incarcerated in Windsor Castle would be strongly contraindicated today.