My interest is the origin. I always thought that Jeanne de Bourbon (mother of Charles VI) was as far back as the disease could be traced, but then I read what David Williamson had to say in his book on the Kings of Europe :
"Charles's son and successor, Charles VI, has gone down in history as Charles the Mad, and we now know that his madness was a symptom of porphyria, the 'royal malady' which can perhaps be traced back as far as Alfred the Great of England and afflicted many of Charles's descendants, the most notable being King George III of Great Britain. Charles VI's father's condition may well have been attributed to the same cause and as his mother, too, had exhibited signs of instability, poor Charles VI probably inherited the disease in good measure.
I never knew about Charles V, I always thought the disease was attributed only to Jeanne de Bourbon. Does anyone know via whom this disease is supposedly to be traced to Alfred the Great?
Many thanks.
Leo van de Pas
Canberra, Australia
< Does anyone know via whom this disease is supposedly to be traced to
Alfred the Great?
No, but I guess tracing it back that far is rather fanciful. The
'accepted' story I thought was that it could only be traced back to
Henry V's wife, Katherine of France, and then via Henry VI --> Henry VII
--> Margaret Tudor --> James IV of Scotland and so via the Stewarts to
Farmer George.
A quick look at the bibliography of porphyria and the Royal Family listed
by the Wellcome History of Medicine library in London comes up with
'George III: a personal history' by Chris Hibbert (pub by Basic Books,
New York, 1998) as the most recent to address the topic, which would
hopefully reference all sources up to then. That library is usually pretty
good at listing anything relevant, even if they do not hold it, and my
guess is that this is the 'latest'. If you cannot get hold of a copy,
I'll try and remember to have a look at it myself when I am next in that
library and let you know what he says.
Best wishes,
--
Paul Moynagh
pmoy...@argonet.co.uk
There are known descendants of George III, and more of his father the
Prince of Wales, who have clinical porphyria.
> King George III
>being probably the greatest victim of this condition.
It was originally theorized that Frederick the Great was also had the
condition.
Just to play the pedant, George III is not known to have suffered from
porphyria - he is known to have suffered from some of the symptoms seen
in porphyria, and his direct descendants suffer from this genetic
disorder. Thus, a strong argument can be made. Actually, a stronger
argument can be made for James VI/I, as one of the most diagnostic
symptoms of the disease is the red urine, something which was noted for
James since he lived in the age of the "piss doctors" when the amount,
color, and taste of urine was thought to be quite useful in diagnosing
disease. In the time of George III, such an approach was dismissed as
witch-doctoring, it being clearly understood that the feces was much
more illuminating, and so nobody noted whether his urine was discolored
or not. James also indicated that he had gotten it from his mother,
establishing a genetic link, further suggesting porphyria.
> My interest is the origin. I always thought that Jeanne de Bourbon
>(mother of Charles VI) was as far back as the disease could be traced,
It depends on what you consider to be 'traced'. As I suggest above, a
strong case can be made that James I suffered from it, yet there is the
nagging question of where it went in the generations in between he and
George. One should keep in mind, though, that porphyria was originally
thought to be caused, not by genes, but by certain medications (in fact,
when the George III-porphyria link was first suggested, it was dismissed
out of hand because everybody knew that porphyria was caused by an
adverse reaction to modern pharmaceuticals, and thus George could not
possibly have suffered from it). It was only when it was observed that
the sufferers were more likely to be related that the genetics were
uncovered. What this means is that one inherits the susceptibility for
the disease, but it may never be unmasked due to differences in diet and
environment.
Having said that, we return to James. He himself said he got it from
his mother. Unfortunately, we now pass to a time before we have any
truly useful medical records, and we are left making guesses based on
one symptom or another. Arabella Stuart certainly appeared to have had
some kind of dementia at times, so it was hypothesized that both she and
Mary got it from their common Tudor ancestor. Next, it had been noted
that Henry VIII's older brother was said to have been light-sensitive,
another symptom of porphyria, seemingly confirming that the Tudors had
it. Next, we note that Henry VI seemed to be quite competent at some
times, and non-functional at others, perhaps reflecting bouts of
porphyria similar to George III. The Tudors and Henry VI were most
closely related through Catherine of France, and her brother was Charles
the Mad, so there we have madness again. Finally, apparently Joanne de
Bourbon had a brother who showed signs of madness, and hence she was the
hypothesized source. That, at any rate, is how the story runs.
The problem is that the last few generations of this pedigree are based
on the symptom of madness, but madness is not a disease with just a
single cause. We just don't have enough information to draw these
conclusions.
>but then I read what David Williamson had to say in his book on the
>Kings of Europe :
>
> "Charles's son and successor, Charles VI, has gone down in history
>as Charles the Mad, and we now know that his madness was a symptom
>of porphyria, the 'royal malady'
Except we don't know this. It is simply a hypothesis, with no evidence
other than the madness itself (which creates a bit of a circular
argument) and the fact that a descendant of his sister, six generations
down, had a quite probable case of it.
> which can perhaps be traced back
>as far as Alfred the Great of England and afflicted many of Charles's
>descendants, the most notable being King George III of Great Britain.
>Charles VI's father's condition may well have been attributed to the
>same cause and as his mother, too, had exhibited signs of instability,
>poor Charles VI probably inherited the disease in good measure.
>
> I never knew about Charles V,
Hard to say without knowing what the "father's condition" was that
reference is being made to here.
> I always thought the disease was
>attributed only to Jeanne de Bourbon. Does anyone know via whom this
>disease is supposedly to be traced to Alfred the Great?
This connection must be even more tenuous. I am assuming that someone
noted that some description of Alfred would be consistent with
porphyria, and that the Valois descended from him. Certainly, one is
hard pressed to find any documentation for Alfred's descendants for
generations that would point to any symptom of porphyria. Frankly, this
is stretching things a bit too far. With each generation before Mary of
Scotland it becomes less and less likely that the reconstruction is
correct.
Remember, it need not have come from anyone earlier. Wild hypotheses of
crypto-infidelities aside, it appears that the hemophilia among
Victoria's descendants arose because her father was in his 50s at the
time of her conception, at which age the rate of genetic mutation is
heightened. Most genetic diseases in humans can't be traced further
than a few generations, probably because they arise de novo, severely
reduce the reproductive potential of the carriers, and burn themselves
out. It is only rare ones that, due to some selective advantage (or to
unique sociological conditions) appear to be of great antiquity.
taf
[...]
| The Tudors and Henry VI were most closely related through Catherine of
| France, and her brother was Charles the Mad, so there we have madness
| again.
[...]
Todd A. Farmerie
-----------------------------------------------
No, Charles VI was her FATHER.
Deus Vult.
D. Spencer Hines
Lux et Veritas et Libertas
Vires et Honor
Blood in the urine is a symptom of many diseases, including Plasmodium
falciparum (blackwater fever/malaria), certain kidney diseases, urinary
infections, etc. We'll never know for sure if James, George, and anyone
else long dead had porphyria. I suppose a DNA analysis is possible.
I wish I had my biochem book to do a further analysis of this question.
(It's packed.)
Christina
Follow-up after my library visit, as promised: Refs '[n]' at the end.
1. Hibbert [1] is not the good source I predicted - he just
repeats Macalpine and Hunter's [2-5] arguments and hypotheses
(the two doctor (medic) / historians who first suggested that
George III had porphyra). Lots about it since then, some
'anti', but most 'pro'. The main 'anti' was early on - Geoffrey
Dean, a South African haematologist [6], the then world's top
expert in 'variegate' porphyria - the type of the disease
supposed for GIII; the other, rather more common sort, is
'acute intermittent porphyria', though there are lots of
similarities. Dean argued that it being inherited as a dominant
gene there should be many more cases in the European Royal
family, and also that the symptoms were not right for it. But
few have backed him since then, and most historians and doctors
seem now to agree with Macalpine and Hunter.
The best referenced and most detailed recent text seems to be
Röhl, Warren, and Hunt - a historian and 2 geneticists [7].
They are highly sceptical of porphyria in any royal ancester
before Mary Queen of Scots, whom, with her son James VI/I, they
reckon fairly certainly had porphyria. The case for and against
the two strongest medieval candidate ancestors, Charles V of
France and Henry VI of England, are described in some detail.
They conclude that having none of the physical, as opposed to
mental, symptoms of porphyria, there is simply not enough
evidence to say they had it, and what little there is points
more to a solely psychiatric disorder, probably schizophrenia,
than to the mixed mental and physical picture of porphyria.
They are even more sceptical about any others, such as Margaret
Tudor, who has been 'blamed' as the gateway for transferring
any gene to the Stewarts. James VI's cousin Arabella Stuart,
Darnley's sister, is also often said to have had porphyria, but
the evidence is not that convincing.
Thus we are left with good presumptive evidence of a gene for
variegate porphyria, possibly starting as a new mutation with
MQoS, else passed to her by 'god knows who', and transmitted
through the Stuarts to George III. It must be recalled that
then 'porphyria' was not recognised as a disease entity - an
inborn error of metabolism of the blood. Its chemistry only
began to be elucidated in the 19th century and it was not
really until around the 1930s that enough was understood to
start diagnosing it confidently. While it was recognised as
being a hereditary disease, the precise gene causing it has
only very recently been discovered. But being rare, even now
the diagnosis is often missed or delayed. Unless one can
obtain specimens of past bodies - difficult when they are
royals - to do DNA testing (and interpreting this is not at
all straightforward), there can be no certain way of
retrospectively diagnosing past sufferers except by
contemporary description of their symptoms. One 'give away' is
the colour of the urine - variously described as red or purple;
this has been described in some - eg James VI/I and George III,
but by no means all, which does not mean they did not have
coloured urine. Not all have mental symptoms. Some can be mild
and live long; others have it severely and die young, often
apparently suddenly. It has been suggested that some
medieval royals who died suddenly and inexplicably, of
which circumstance some historians impute dirty play such as
poisoning, might instead have had porphyria. But this is pure
sepeculation, the evidence being very thin or non-existent.
Those imputed to most probably have suffered from porphyria
are not 'medieval', - I hope the ng will forgive listing
them here - are:
Mary Queen of Scots;
James VI/I ;
Henry, Prince of Wales (Charles I's brother)
Henrietta Anne, Duchess of Orleans (Ch I's daughter)
Queen Anne (and hence why she had so many miscarriages)
then a bit of a jump of 3 porphyria free generations to:
Friedrich Wilhelm I of Prussia
Carloline Matilda, Queen of Denmark
Frederick II 'the Great'
George III
Willhelm I of Hesse-Kessel
Caroline of Brunswick who married cousin George IV were both
affected, as were 3 of his brothers, Frederick, Duke of York;
Edward, Duke of Kent, and Augustus Duke of Sussex; and their
daughter Caroline (who married Leopold of Saxe-Coberg, later
King of Belgium).
It is felt possible that Queen Victoria may have suffered a
mild version of porphyria. We then have another 3 disease free
generations (which may be because these intervening royals
managed to keep their medical ailments private?) until we get
to modern almost living memory. Princess Adelaide(1870-1948) of
Lippe-Biesterfeld, a ggg grandaughter of William I of
Hesse-Kessel, and her daughter, Princess Feodora of
Saxe-Meiningen (1892-1972) were both affected, as was Kaiser
Bill's sister Charlotte of Prussia (1860-1919).
News to me, and much nearer home to the current British Royal
family, is Prince William of Gloucester who died in an air
crash in 1972, for whom convincing evidence of the disease is
made. That the Queen's sister Princess Margaret had it has been
suggested, but seems doubtful.
DNA testing has been undertaken on Charles I's blood stained
execution shroud and the exhumed remains of Princess Adelaide -
both negative (but there is some doubt that the Princess's
remains were actually hers). However DNA tests on Princess
Charlotte of Prussia's exhumed remains were positive for the
PPOX gene - what one expects with porphyria, so the only one to
be conscusively 'proved' to have had it.
I hope I noted all the above correctly - it was a long book and
I only skimmed it quickly. The relevant references (the last
one further referencing pretty much all the literature on the
topic for those who wish to read further - its a fascinating
read) are:
[1] Chris Hibbert (ref given in my previous post)
[2] Ida Macalpine and Richard Hunter, 'The insanity of King
George III; a classic case of porphyria'. British Medical
Journal (BMJ) 1966, i: on 8 Jan 68 - (sorry, I did not note
the page number)
[3] Ida Macalpine and Richard Hunter, 'Porphyria in the Royal
Houses of Stuart, Hanover and Prussia: a follow-up study of
George III's illness'. BMJ 1968, i: on 6 Jan 68 (ditto re page
No)
[4] These BMJ articles were reprinted with commentaries by
others in a booklet 'Porphyria: A Royal Malady', London,
British Medical Association, 1968.
[5] and for public consumption, in Macalpine and Hunter's book:
'George III and the Mad-Business', London, Allen Lane Penguin
Press, 1968.
[6] - Geoffrey Dean, 'The Porphyrias', London, Pitman & Sons,
1971 (2nd Edition of what is basically an ordinary medical
textbook, but ending with a vituperative anti Macalpine/Hunter
polemic).
[7] John CG Röhl, Martin Warren, & David Hunt
"Purple Secret. Genes,'Madness' and the Royal Houses of
Europe", London, New York, Toronto, Sydney & Aukland, Bantam
Press, 1998
If there is anything later of substance, then the usually
excellent Wellcome library catalogue has overlooked it and I am
unaware of it.
--
Paul Moynagh
pmoy...@argonet.co.uk
Just one comment with regard to Paul's excellent summary about porphyria.
Röhl et alia's DNA testing on Princess Charlotte of Prussia's exhumed
remains showed only one altered nucleotide in the PPOX gene (it was a single
T-to-C mutation, in a non-protein-coding area).
What wasn't shown was that this was a mutation that could cause porphyria,
so Charlotte's diagnosis can't be said to be proven by DNA testing.
Two pages on the "Online Mendelian Inheritance in Man" site might be of
interest:
[1] <http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?176200> describes
porphyria variegata, its molecular genetics, and has links to pertinent
references.
[2] <http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?600923> describes
the protoporphyrinogen oxidase gene and lists those allelic variants that
have been demonstrated to cause disease.
- Dennis J. Cunniff
The following additional relatively recent references come up with PubMed:
Warren MJ, Jay M, Hunt DM, Elder GH, Rohl JC, "The maddening business of
King George III and porphyria.", Trends in Biochemical Sciences. 1996
Jun;21(6):229-34.
Brownstein S, "George III: a revised view of the royal malady", Journal
of Historical Neuroscience. 1997 Apr;6(1):38-49
Hurst L, "Royal porphyria", Southampton Medical Journal. 1988
Autumn;5(2):53-9.
Pierach CA, Jennewein E., [Friedrich Wilhelm I and porphyria - Article
in German], Sudhoffs Archiv; Zeitschrift fur Wissenschaftsgeschichte.
1999;83(1):50-66.
Miller JM, "Vignette of medical history: porphyria in royalty", Maryland
Medical Journal. 1993 Oct;42(10):1015-7
Several appear to be simple recasting for a local audience. The Pierach
article, based on its English abstract, appears to be a clinical
analysis of Frederick with an eye towards whether or not the hypothesis
is correct, concluding that it probably is.
There are several letters in the BMJ discussing the theory right after
it was put forward, at least two by Dean arguing against. I also recall
a Scientific American article by Macalpine and Hunter that did a good
job of describing it for a lay audience, ca. 1972. Finally, there was a
brief article in a medical history journal where I first read of the
attempt to extend it back past Henry VI to the Capets - unfortunately,
someone borrowed my copy and didn't return it, so I can't give a citation.
taf
> The following additional relatively recent references come up with PubMed:
< numerous references >
Thanks Todd. I think most of these are also described and referenced in
Röhl, Warren & Hunt's 'Purple Secret' which I would guess is the best
single source for anyone interested who does not want the fag of
trawling through an extensive literature. Whatever they all say, it is
basically just speculation with larger or smaller degrees of
(un)certainty / scepticism, and unless one can examine and test a living
patient a sure diagnosis is not possible. Even testing exhumed DNA, as
Dennis comments, is by no means that reliable.
But speculation is fun, and for George III, and probably some others of
his family, porphyria is as good an explanation of his illness as one is
ever likely to get. Attempting a genetic trace back to medieval royalty
and France is I fear just a bit too fanciful for the known facts.
--
Paul Moynagh
pmoy...@argonet.co.uk