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Historical evidence has been collected attempting to diagnose members of royal houses, perhaps most publicized by Macalpine and Hunter (1969) for George III and his assumed porphyria, claiming that his insanity was a classic case of thereof. This rare metabolic disease presents with a variety of signs and symptoms: skin disease, abdominal pain, tachycardia, and neuro-psychiatric findings. The porphyrias are hereditary and since George III and Frederick William I share ancestors it seemed reasonable to investigate if the latter may also have suffered from porphyria. The pathography of both kings is meticulous, showing for both that abdominal pain, erratic behavior, restlessness, and discolored urine were frequently observed and complete recovery interictally was common. Intercurrent illnesses, fasting, alcohol and even tobacco smoking have been shown to be inducers of attacks and these risk factors are well documented in royal history.--The diagnosis of porphyria was not recognized then and other names were used, such as Cachexia hypochondriaca, Asthma spasmodico flatulentum, dolores arthritici.--We propose that Frederick William I suffered from an inducible porphyria.

Pruritus is an annoying skin disturbance which is often amenable neither to diagnostic nor to therapeutic interventions. Occasionally, generalized pruritus can be ameliorated by treating the underlying disease (e.g. iron deficiency, hyperthyroidism). The good response to ultraviolet radiation opens new possibilities which should be tried in patients with chronic renal insufficiency or cholestasis. The existence of a UV-sensitive pruritogen could explain a multitude of findings and phenomena.

Intravascular haemolysis is frequently seen in patients after heart valve replacement, but is often compensated. The cause of the haemolysis is traumatic damage of the red cells. It is more often seen after aortic, than after mitral replacement, because the transvalvular pressure gradient is higher and is more severe in ball valves than in disc valves. If substitution therapy with iron, folic acid, or even red cells fails, re-operation should be seriously considered.

Seven patients showed deep symmetrical T wave inversions in their electrocardiograms after bilateral carotid endarterectomy. There was no evidence for myocardial ischaemia. These changes reversed completely within three months. Similar disturbances of repolarisation were seen in rats after bilateral denervation of the carotid sinus. These changes are probably of neurogenic origin, like those seen with central nervous system disorders. Their origin seems to be correlated to the acute imbalance of the autonomic innervation of the heart after surgical disturbance of baro- and chemoreceptors.