Harmony Hunter: Hi, welcome to the podcast. I’m Harmony Hunter. King George III is remembered as “The Mad King,” and “The King who lost America.”

It was this English King who reigned over the American rebellion and subsequent loss of England’s 13 American colonies. So was he crazy

Author Ed Crews joins us today by phone to talk about the legendary madness of King George. Ed, thank you for being here with us today.

Ed Crews: Well thank you for having me, Harmony.

Harmony: You wrote an article for the Colonial Williamsburg Journal that focused on the madness, or the sickness perhaps, of King George III. In your research did you find that King George started out with some signs of mental illness or was this something that crept up on him?

Ed: I think what we have with King George III is basically a 200-year-old medical mystery. One that we’ve only begun to solve here actually in the last decade. People have wondered for an awfully long time what was wrong with him, and then why did he act the way that he did? It’s fascinated scholars, historians and physicians as well. And again, it’s only now that we’ve begun to get some real insights as to what was going on with him. Basically I think the correct answer to your question about George III and his sanity was this: that for the vast bulk of his life George III, I believe, could be seen as a sane and stable individual.

Harmony: When did his madness begin? How did it begin to manifest itself?

Ed: George III had four incidents in his life that can be referred to as illness, or were in his time referred to as madness. These incidents occurred in 1788, 1801, 1804 and 1810. And with each of these the King demonstrated certain symptoms and they were physical as well as mental as symptoms.

The physical ones included stomach pain, cramps, rashes, he had trouble sleeping, his vision was blurred, he also lost weight. But in addition to these sort of physical manifestations of his condition, he suffered from a mind that would be called erratic, delusional. At some point he hallucinated and began to talk to people who had been long dead. So his symptoms were a mix of the physical as well as the mental and they accompanied each of these four incidents that occurred later in his life.

Harmony: You mentioned that before the onset of his madness, he had a sane and stable life. What were some of his accomplishments as ruler of England before his madness? What was his sort of career record before it all started going downhill?

Ed: I think the truth is that George III can’t really be called a great monarch of England. Certainly he’s not in the same category with great influential rulers like Elizabeth I or Henry VIII. What George really was for the vast bulk of his reign, which was fairly lengthy, was a figurehead. Certainly during this time we have to remember that Great Britain had a constitutional monarchy and that the government was run day-to-day by a large bureaucracy, that government policy was set by a prime minister and his cabinet, and of course that was done in conjunction with the House of Commons and the House of Lords as much as it is today.

Now the King exerted soft power and certainly he set a tone and certainly in terms of the social life of Great Britain and the aristocracy, what he did was very important. But George really didn’t launch any initiatives. He didn’t really reshape England or Great Britain in any meaningful way.

The time in which he lived was certainly a very exciting one. He presided over the American Revolution and the loss of the American colonies. He also during his time was an age of great exploration and colonization – Cook’s exploration of the Pacific, the settling of Australia. And then beyond that it was the start of the Industrial Revolution, but George really was more an observer of his age than a catalyst for change in his age.

Harmony: When his symptoms of his illness began, was he aware that he was kind of losing his mental faculties?

Ed: Yes. Obviously he knew that he had the physical manifestations. There’s no way he could have missed that. He was in great pain and deeply disturbed by it. He also was well aware that he was not in command of his mental faculties. On at least one occasion we have reports of where he was with his son, the Prince of Wales, and was sobbing on his shoulder and the King saying, “I fear that I’ve gone mad, that I’ve lost my mind.”

So it’s not a case where the King passed into a period of delusion in which he was unaware of his surroundings or that he assumed another personality or something like that. He was well aware that something was wrong with him. He had no idea and he was, he had no idea why, and he didn’t have much confidence in his physicians that they knew why either.

Harmony: And rightly so; they really didn’t.

Ed: No. They didn’t. 18th-century medicine even in the late 18th century is not very advanced certainly by our standards today. The great gains that we have made in medicine begin to occur about middle of the 19th century and then accelerate in the 20th century and into our own period. So they really didn’t understand the body, they didn’t understand psychiatric conditions so they really didn’t do much, nor was their treatment particularly effective.

Harmony: Now this illness that he had wasn’t constant. He had periods where he seemed to recover?

Ed: Yes. In three of the four incidents that he had – 1788, 1801, 1804 – the King went through a period of illness and then through a period of recovery. In 1810, his condition was so severe that basically he slid into a long decline that would last roughly for a decade. He never did recover during that last period. But yes, in between in 1788 it began probably about the middle of the year and then by early in 1789 he was on the mend. And yes, he returned to full functioning, everybody was very relieved that the King was well and so in those periods in between he manifested every sign of stability and sanity that he had prior to his first attack.

Harmony: We alluded to some of the medical care that he received at the time, which I guess we should forgive the past and understand that they were doing the best they could by their lights. What were some of the treatments that he was offered and what were they expected to cure?

Ed: The treatments that he received were pretty standard for the day. They were completely ineffectual. They reflect a lot of 18th century notions about the bodies and humors and balance and the sort of thing that of course we don’t think about today. And I’ll list some of those in just a minute, but I should note that the King resisted a lot of them. They were painful, they were degrading and he fought his physicians very hard. He was not an easy patient.

Typical treatments included things like bleeding, blistering, purging, sedatives. At times when his erratic behavior got serious enough they put him in a straightjacket. On some occasions they tied him to a chair. Other occasions they tied him to a chair and gagged him. They gave him medicine, what they believed would restore him to sanity, but in fact none of it was very effective. They were particularly interested in giving him something called emetic tartar and that’s a purgative and he got a lot of that and he didn’t like it and fought it every time they brought it in his room.

Harmony: Can’t blame him for that.

Ed: No.

Harmony: You’ve called this an ancient medical mystery. From a modern perspective, when medical historians look at this today, what are some of the theories about what was really happening to George and whether these medicines would have helped him or harmed him?

Ed: Modern medicine has taken a look at King George’s condition for decades now, and the question what became of him and why, what happened to him happened has been a matter of intrigue particularly in the 20th century. In the early 20th century, with the rise of psychiatry there was a belief that he in fact did suffer from a psychiatric condition, and this of course had to do with the rise of Sigmund Freud, interesting America in psychotherapy. And a very influential book was published in 1941 that decided the King suffered from what we would call bi-polar depression today. That in fact he did have a psychiatric problem.

In the 1960s, the late 1960s, there was a sea change in the analysis of what was wrong with him. People began – scientists, doctors, psychiatrists themselves began – to look at his condition and said that what they actually believed was that he had a genetic disorder and this is called “porphyria.” And there began to be a growing body of belief that the King was not suffering from a psychiatric condition, like bipolar depression or schizophrenia, but in fact had a physical malady of which the symptoms manifest themselves in some of this delusional behavior.

A huge breakthrough has come through in just since certainly in the last six years or so, it turns out that some strands of his hair were clipped from his head when he died, and there was a hope that there could be some DNA analysis done of those. As it turned out it couldn’t, but what they did find were extraordinarily high concentrations of arsenic. And arsenic is a trigger for porphyria. What the doctors now theorize is that the very medicine that the 18th century physicians gave him aggravated this condition and made him even more ill.

And I should say, just real quick, to describe this condition it’s important to remember that even today, sufferers from this condition are often interpreted as having psychiatric problems instead of in fact having a genetic disorder. In short, the disorder has to do with the formation of hema, which is a component of red blood cells. If your body can’t correctly make these conversions, then what can happen is you get the very symptoms that the king was described as having; muscle pains, abdominal pains, confusions, hallucinations, disorientation and even paranoia. So while physicians today cannot say categorically this is what the king had, the evidence really is pretty compelling. And as far as I’m concerned, I think the case has been made. That in fact he had this genetic disorder, not in fact a psychiatric condition.

Harmony: So when we look back on the legacy of King George III, instead of concluding that he was mad, we might conclude that he was poisoned by his own doctors although inadvertently?

Ed: Yes, yes. Exactly. Now he had this condition that existed and it was in their treatment of him and the giving him of this medicine that actually contained arsenic – which that alone should give you some pause about 18th century medicine&ndash that the doctors were doing the very worst thing for him unknowingly. They had no idea, but it’s hard for me to see how what they had done could not be any worse and in many ways it makes for an uncomfortable thought that the last 10 years of his life, which were spent in isolation, delusion, blindness and illness were due to the ministrations of his physicians.

Harmony: Ed it’s a fascinating and somewhat tragic story. Thank you for sharing it with us today.

Harmony: If you’d like to read Ed’s article about the poisoning of King George III, visit History.org/foundation/journal to read Ed’s article and lots of other articles from journal contributors. Ed thank you for being our guest today.

Ed: You’re certainly welcome. Thanks for having me.