George III’s Illnesses and His Doctors A Study in Early Psychiatry
Pen and Sword (2023)
Illustrations: 16 mono illustrations
The long reign of George III (1760-1820) covered many significant events in British, American, and European history. His very public afflictions remain amongst the most notorious in medical records.
The author states that the book’s aim is ‘to examine how the diagnosis and treatment of this most famous, and almost certainly best documented case of ‘insanity’ in history had such a profound impact on popular and professional perceptions of insanity and on how it should be managed.’
Michael Ramscar is a history graduate of Hull University, who served for many years in the diplomatic service. He has produced a scrupulously well researched account of the dilemmas and difficulties surrounding King George III’s illness, accentuating through the narrative that the Royal physicians or the specialist ‘mad doctors’ had not the knowledge or ability to treat the royal patient in the ways that he would be managed today. He relates that the King, who had crucial constitutional responsibilities, when ill had to be restrained physically, kept away from most people, given a low diet and managed with the antiphlogistic regimen (bleeding, emesis and catharsis) and also given sundry toxic drugs many of which contained arsenic, antimony or mercury.
The onset of the monarch’s insanity was in 1788/9 and episodes recurred in 1801 and 1804 with a final spiral downwards in health, including blindness from 1810, leading to the passing of the Regency Bill. Hypomanic episodes were often accompanied by delusional and highly inappropriate language and behaviour. The notorious Drs Willis – Francis, Robert and John (prominent amongst the specialist ‘mad doctors’) were heavily engaged in control of the King, largely to the exclusion and frustration of the court physicians. The Willis family’s crude and insensitive objectives were perceived by themselves to effectively sedate and restrain the King’s hypomania and violence thus preventing the patient harming himself and others, also hiding the patient’s embarrassing behaviour from society.
There are interesting references to the many institutions for the insane, which were often merely insanitary brutal repositories rather than treatment centres. Contemporary ‘therapies’ were not curative and were crude and uninformed by modern standards. So as was the way at these times, recourse had to be made to consultation with ‘quack’ and unqualified ‘practitioners’, in desperation for a resolution. There were many unqualified persons in the kingdom since frequently access to, or affordability of, many doctors promoted practice by herbalists, bone setters and ‘midwives’ amongst others.
One such with a claim to a ‘cure’ for this form of insanity was a certain employee of the Bank of England, James Lucett. Lucett had no medical qualifications and had apparently learned of his ‘cure’ from some ‘foreign’ physician, who had successively used the method to treat a Hanoverian officer with similar patterns of erratic and violent behaviour to the King. The actual details of the cure remain a little cloudy, but involved no restraint, outside activities, hot and cold water applied locally and in a general way. Around half the 21 chapters deal with well researched details of Lucett’s robust and persistent efforts to promote his gentler treatment of violent and distressing cases of insane patients. With the formal appointment of a balanced committee composed of wealthy, prominent scientific and royal members, he and a qualified surgeon, were allowed to create a simple regulated clinical trial using his method of ‘cure’ (probably the first trial in psychiatry) on a few patients. This proved only partially successful, and he did not get to apply his therapy to the King.
By no means always successful, Lucett’s approach was clearly novel and on the cusp of new and improved trends in psychiatry. Lucett, often devious, fraudulent and a profound self-promoter was frequently castigated, running into financial difficulties and sometimes imprisoned for debt. He had a remarkable resilience to persist with his treatment and form links with medical men and occasionally wealthy patrons to support his efforts in what he believed was better management for his patients.
The final chapter provides a decent chronological summary of the diverse controversies surrounding the theories of King George’s illness. The application of modern medical knowledge to the retrospective evidence of the monarch’s behaviour, symptoms and signs is a fascinating exercise, often fraught with ignorance and reliance on sometimes inadequate data. Whilst perhaps the porphyria theory cannot be entirely ruled out, we can perceive that psychiatric illnesses often cannot be neatly compartmentalised but may merely consist of a melange of abnormal traits, which can direct modern psychiatrists to use the tools not then available to treat our erstwhile often misunderstood monarch. Questions therefore remain and hereditary issues are yet to be solved.
With much carefully researched and assembled detail, particularly of James Lucett’s work and life, there is some repetition, clearly meant to drive home certain issues to the reader. This is an important contribution to an understanding of the management of patients with severe mental illness and distress during the reign of King George III.