King George III and porphyria: an elemental hypothesis and investigation

A Reanalysis of Historical Figures With Depression and Dropsy

OBJECTIVES

Recent studies suggest a link between chronic kidney disease and brain dysfunctions such as depression and cognitive problems. A review of medieval and early-modern historical figures with aspects of both kidney disease (gout and edema [dropsy]) and depression (melancholia) shows that these conditions were observed together in the past.

MATERIALS AND METHODS

References to the diseases of gout, dropsy, and melancholia were compared in literature on historical subjects. Case studies are reported to detail a previously unremarked com-bination of current kidney disease and depression comorbidity in historical writings.

RESULTS

The poet Boccaccio had gout and melancholia, and some descendants of the Portuguese Avis and Spanish Trastàmara dynasties, known for melancholia and madness, also had gout and dropsy. Historical case series of causes of death for sultans of the Ottoman Empire suggest an association among dropsy, gout, and melancholia.

CONCLUSIONS

In this article, we reviewed the medical research on the comorbidity of kidney disease and depression and shared case studies of historical figures with these conditions and posit not previously noted data supporting comorbidity observations in historical writings.

A History of Coagulopathy in Liver Disease: Legends and Myths

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The Goldwater Rule: Perspectives From, and Implications for, Psychological Science

When, if ever, should psychological scientists be permitted to offer professional opinions concerning the mental health of public figures they have never directly examined? This contentious question, which attracted widespread public attention during the 1964 U.S. presidential election involving Barry Goldwater, received renewed scrutiny during and after the 2016 U.S. presidential campaign, when many mental health professionals raised pointed questions concerning the psychiatric status of Donald Trump. Although the Goldwater Rule prohibits psychiatrists from offering diagnostic opinions on individuals they have never examined, no comparable rule exists for psychologists. We contend that, owing largely to the Goldwater Rule's origins in psychiatry, a substantial body of psychological research on assessment and clinical judgment, including work on the questionable validity of unstructured interviews, the psychology of cognitive biases, and the validity of informant reports and of L (lifetime) data, has been overlooked in discussions of its merits. We conclude that although the Goldwater Rule may have been defensible several decades ago, it is outdated and premised on dubious scientific assumptions. We further contend that there are select cases in which psychological scientists with suitable expertise may harbor a "duty to inform," allowing them to offer informed opinions concerning public figures' mental health with appropriate caveats.

The acute mania of King George III: A computational linguistic analysis

We used a computational linguistic approach, exploiting machine learning techniques, to examine the letters written by King George III during mentally healthy and apparently mentally ill periods of his life. The aims of the study were: first, to establish the existence of alterations in the King's written language at the onset of his first manic episode; and secondly to identify salient sources of variation contributing to the changes. Effects on language were sought in two control conditions (politically stressful vs. politically tranquil periods and seasonal variation). We found clear differences in the letter corpus, across a range of different features, in association with the onset of mental derangement, which were driven by a combination of linguistic and information theory features that appeared to be specific to the contrast between acute mania and mental stability. The paucity of existing data relevant to changes in written language in the presence of acute mania suggests that lexical, syntactic and stylometric descriptions of written discourse produced by a cohort of patients with a diagnosis of acute mania will be necessary to support the diagnosis independently and to look for other periods of mental illness of the course of the King's life, and in other historically significant figures with similarly large archives of handwritten documents.

Porphyria cutanea tarda: an intriguing genetic disease and marker

Porphyrias are a group of intriguing genetic diseases of the heme pathway, of which porphyria cutanea tarda (PCT) is the most common. Resulting from a defect in enzymes in the porphyria pathway, PCT has been linked to several conditions. Recent studies have demonstrated a change in thinking regarding the human immunodeficiency virus (HIV) and development of PCT. The exacerbation of PCT with contraction of HIV is now believed to result from coinfection from the hepatitis C virus (HCV). Blistering of sun-exposed skin, a classic presenting sign of PCT, is not exclusive to the condition. Cutaneous findings must also trigger physicians to consider additional types of porphyrias, such as variegate porphyria. The diagnosis of pseudoporphyria, which does not result from enzymatic absence, must be considered in patients with photosensitivity and cutaneous bullae. Recent health food trends, such as chlorophyll, have been linked to pseudoporphyria. PCT is a serious condition in which accurate diagnosis is necessary for appropriate management.

Use of Saliva Biomarkers to Monitor Efficacy of Vitamin C in Exercise-Induced Oxidative Stress

Saliva is easily obtainable for medical research and requires little effort or training for collection. Because saliva contains a variety of biological compounds, including vitamin C, malondialdehyde, amylase, and proteomes, it has been successfully used as a biospecimen for the reflection of health status. A popular topic of discussion in medical research is the potential association between oxidative stress and negative outcomes. Systemic biomarkers that represent oxidative stress can be found in saliva. It is unclear, however, if saliva is an accurate biospecimen as is blood and/or plasma. Exercise can induce oxidative stress, resulting in a trend of antioxidant supplementation to combat its assumed detriments. Vitamin C is a popular antioxidant supplement in the realm of sports and exercise. One potential avenue for evaluating exercise induced oxidative stress is through assessment of biomarkers like vitamin C and malondialdehyde in saliva. At present, limited research has been done in this area. The current state of research involving exercise-induced oxidative stress, salivary biomarkers, and vitamin C supplementation is reviewed in this article.

The Role of Dr. Francis Willis in the Madness of George III

In the well-known story of the illness of King George III, what is often overlooked is the part played by Dr. Francis Willis, an inconspicuous doctor who with great success ran an asylum in Lincolnshire. In November 1788, he was called to attend the King whose mania was becoming uncontrollable. Because of his interventions there was a slow but marked improvement. The King’s recovery in 1789 increased Willis’ reputation and expanded his practice.

The human flavoproteome

Vitamin B2 (riboflavin) is an essential dietary compound used for the enzymatic biosynthesis of FMN and FAD. The human genome contains 90 genes encoding for flavin-dependent proteins, six for riboflavin uptake and transformation into the active coenzymes FMN and FAD as well as two for the reduction to the dihydroflavin form. Flavoproteins utilize either FMN (16%) or FAD (84%) while five human flavoenzymes have a requirement for both FMN and FAD. The majority of flavin-dependent enzymes catalyze oxidation-reduction processes in primary metabolic pathways such as the citric acid cycle, β-oxidation and degradation of amino acids. Ten flavoproteins occur as isozymes and assume special functions in the human organism. Two thirds of flavin-dependent proteins are associated with disorders caused by allelic variants affecting protein function. Flavin-dependent proteins also play an important role in the biosynthesis of other essential cofactors and hormones such as coenzyme A, coenzyme Q, heme, pyridoxal 5'-phosphate, steroids and thyroxine. Moreover, they are important for the regulation of folate metabolites by using tetrahydrofolate as cosubstrate in choline degradation, reduction of N-5.10-methylenetetrahydrofolate to N-5-methyltetrahydrofolate and maintenance of the catalytically competent form of methionine synthase. These flavoenzymes are discussed in detail to highlight their role in health and disease.

'Struensee's memoir on the situation of the King' (1772): Christian VII of Denmark

Christian VII of Denmark (1749-1808) was insane throughout his long reign. The royal physician, Johann Friedrich Struensée (1737-72), usurped his power. In 1771 the King appointed him Privy Cabinet Minister. Struensée revolutionized the whole administration of the Danish-Norwegian kingdom and had an adulterous relationship with the Queen, Caroline Mathilda, George III's sister. In January 1772 he was arrested, sentenced to death for lese-majesty and executed. During his confinement, he wrote a memoir on the King's condition, which he considered to be caused by, or the effect of, masturbation. In 1906 Christiansen interpreted it as a case of dementia praecox, i.e. schizophrenia. It is now suggested that Christian's insanity, like that of George III (his cousin), might have been due to porphyria - the 'royal malady', possibly inherited through his mother, Princess Louise of England or his father, King Frederik V, who died from an illness which retrospectively resembles a case of porphyria.

King George III and porphyria: a clinical re-examination of the historical evidence

The diagnosis that George III suffered from acute porphyria has gained widespread acceptance,but re-examination of the evidence suggests it is unlikely that he had porphyria.The porphyria diagnosis was advanced by Ida Macalpine and Richard Hunter, whose clinical symptomatology and historical methodology were flawed.They highlighted selected symptoms, while ignoring, dismissing or suppressing counter-evidence.Their claims about peripheral neuropathy, cataracts, vocal hoarseness and abdominal pains are re-evaluated; and it is also demonstrated that evidence of discoloured urine is exceedingly weak. Macalpine and Hunter believed that mental illnesses were primarily caused by physical diseases, and their diagnosis of George III formed part of a wider agenda to promote controversial views about past, contemporary and future methods in psychiatry.

Mummies

Mummies are human remains with preservation of nonbony tissue. Mummification by natural influences results in so-called natural mummies, whereas mummification induced by active (human) intervention results in so-called artificial mummies, although many cultures practiced burial rites, which to some degree involved both natural and artificial mummification. Since they are so uniquely well-preserved, mummies may give many insights into mortuary practices and burial rites. Specifically, the presence of soft tissues may expand the scope of paleopathological studies. Many recent mummy studies focus on the development and application of nondestructive methods for examining mummies, including radiography, CT-scanning with advanced three-dimensional visualizations, and endoscopic techniques, as well as minimally-destructive chemical, physical, and biological methods for, e.g., stable isotopes, trace metals, and DNA. This article discusses mummification and gives a presentation of various key mummy finds and a brief history of mummy studies. A description of the extant key technologies of natural and medical science that are applied in mummy studies is given; along with a discussion of some of the major results in terms of paleopathology. It is also shown how mummy studies have contributed much to the knowledge of the cultural habits and everyday life of past populations. Finally the impact of mummy studies on analyses of mortuary practices and cultural history is discussed.

When reason reigns: madness, passion and sovereignty in late 18th-century England

In 1788-89, King George III of Great Britain became physically and mentally ill. This has been well documented, in contrast to the sudden influx of mentally distressed patients into private asylums of England shortly after the highly publicized illness of the king. As told by political and social commentators during this period, the crisis of the two bodies of the king--as head of state and as a man--represented a significant threat to the stability of the nation. This essay investigates possible reasons for the increase in asylum populations, and argues that, in the age of reason and temperance as exemplified by George III, the illness and recovery of the king created the space of the asylum as one of the last places to allow the expression of the passions.