The sickly Stuarts

Neither in Milo Keynes' review of Professor Holmes' book The Sickly Stuarts—the Medical Downfall of a Dynasty (June 2004 JRSM¹) nor in Graham Brack's comments on the review (August 2004 JRSM²) is mention made of Holmes' view of the hypothesis that James VI/I suffered from familial porphyria. Having described the renal findings at the necropsy of James VI/I, Holmes writes 'this finding negates and lays to rest the presumption of Dr Ida Macalpine and her colleagues that James and his mother had acute intermittent porphyria... unfortunately this idea has had a life of its own....' Having cited publications opposing the porphyria hypothesis, Holmes concludes 'James did not have porphyria. Nor, for that matter, did any of the Stuarts or Hanoverians'. In the subsequent paragraph, he states 'The clinical description of de Mayerne and the autopsy report of Walton provide a clear description of chronic kidney stone disease'.³

Although Macalpine and Hunter⁴ are supported by Rohl, Warren and Hunt,⁵ Holmes' contrary view needs to be made known to a wider readership than those who have read his book.