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surviving documents, modern-day British researchers have gleaned conclusive evidence for a posthumous diagnosis of AIP. Aside from jottings regarding the characteristic mental paroxysms, which began when George was in his twenties, the clincher was this notation: “His Majesty has passed . . . bloody water,” by which was meant discolored urine, elsewhere described as “bluish,” dark and “bilious,” and having left “a pale blue ring” around the specimen flask. All are telltale signs of excessive porphyrin production, as are severe abdominal pain and muscle weakness. The medical records also show how royal protocol must have frustrated the doctors, who could never speak unless first spoken to. When King George was at the peak of his delirium, entire visits passed in silence, as on one day in January 1812: “His Majesty appears to be very quiet this morning, but not having been addressed we know nothing more of His Majesty’s condition of mind or body than what is obvious in his external appearances.” Perhaps this explains the preoccupation with the kingly pee.

Having exonerated George III of madness, the British researchers then posed the next logical question: Since AIP is always hereditary, who else in his bloodline carried the disease? By combing through historical accounts and medical records—a search abetted, once again, by the fastidious description of urine samples—they were able to trace the disorder through thirteen generations, spanning more than four hundred years. Among his ancestors, fifteen were identified as sufferers and/or carriers, beginning with his father and going back to Mary, Queen of Scots (1542–1587), where the porphyria paper trail ended. As with George, retrospectively diagnosing Mary with the illness allows for a radically revised view of her reign. Mary, whom the researchers called “one of the great invalids of history,” was so sick so often that her opponents accused her of using hypochondria, to borrow the modern term, as a political ploy. Conversely, her enemies were accused on one occasion of poisoning her, an episode now ascribed not to foul play but to the fickleness of genetics.

Such a rare disease as porphyria would never have manifested in so many family members were it not for the strict controlling of the bloodline through intermarriages, a phenomenon not unique to royal dynasties. A similar kind of inbreeding occurred within isolated and remote communities during the Dark Ages, for example, and, in these shallow gene pools, recessive traits could flourish. Hence, as biochemist and medical writer Nick Lane postulates, a type of porphyria that is among the rarest today—congenital erythropoietic porphyria (CEP), the disfiguring, vampiric form of the disease described earlier—may’ve once been relatively common in spots of Eastern Europe now recognized as the cradle of vampire myths, the valleys of Transylvania. Assuming this to have been the case, it’s easy to imagine how the corpse-like appearance and odd behavior of sufferers may have given rise to whispers of vampirism; how, within these enclaves, certain folk remedies would’ve been embraced; and how, over time, the rumors and remedies would have gradually evolved into legend. Garlic is a good example. It’s now well known that certain chemicals in garlic can exacerbate porphyria symptoms, a lesson that Transylvanian sufferers may have had to learn through painful experience. Little agility is needed to make the next leap, to imagine how a sufferer’s way of averting a flareup could mutate into a superstition among the healthy for preventing the disease and then into a means of warding off a vampire attack. Likewise, the genuine need to avoid the sun could have transmuted into the dramatic literary convention of the bright light of day turning a vampire to toast.

In view of all this, the hypothesis put forth by David Dolphin doesn’t sound so far-fetched: that, hundreds of years ago, victims of this most heinous form of porphyria may have self-medicated by drinking human blood. In a sense, this is evocative of earlier thinking, such as the