Medical indemnity - was Sir Morell Mackenzie negligent in his treatment of Crown Prince Frederick?

In the late 19th Century medical indemnity insurance didn't yet exist - websites such as PIIHUB (www.piihub.co.uk) didn't exist. Which was just as well, because there could have been a lot of claims against many doctors for professional negligence!

Sir Morell Mackenzie was physician to Frederick III, Crown Prince of Germany. Frederick was father of Wilhelm II who became Kaiser and led Germany into World War I. Unlike his son, Wilhelm, who grew to hate England, Frederick had pledged to a peaceful friendship between England and Germany.

Dr Morell Mackenzie

An Englishman, MorellMackenzie was born in 1837. A graduate of London Hospital College, Mackenzie went on to study in Vienna, Paris and Prague. Studying under Professor Czermak Mackenzie learnt to use the laryngoscope, a newly-invented surgical instrument. In 1863 Mackenzie won the Jacksonian Prize at the Royal College of Surgeons for an essay about the ‘Pathology of the Larynx’. After this he specialised in diseases of the throat.

Mackenzie became the leading surgeon using the laryngoscope and was foremost in operations regarding the larynx.

The Development of Frederick’s Condition

Problems with Frederick’s throat became apparent in January 1887; he had become hoarse and was experiencing difficulty in clearing his throat. An early assumption that these symptoms were attributable to the common cold proved unfounded as they persisted and the Surgeon-General Wegner summoned a professor of medicine, Dr Karl Gerhardt from Berlin. On March 6 1887 Gerhardt found a small growth on Frederick’s left vocal cord; he could not determine whether the growth was benign or malignant.

Following his diagnosis Dr Gerhardt performed surgery upon Frederick, attempting to remove the growth. Gerhard first used a snare and then a ring knife to attempt to remove the growth; he failed and closed the procedure by simply cauterising the growth. Upon Gerhard’s recommendation Frederick subsequently went to the North German coastal town of Ems to recover.

In May 1887 Frederick and his wife Victoria – daughter of England’s Queen Victoria – returned to Berlin. Upon examination of Frederick Dr Gerhardt found that the original growth had become larger. Surgeon Professor Ernst von Bergmann was consulted and recommended that the growth be removed by thyrotomy, which would have split the larynx in order to remove the growth. This planned surgery, which would have meant the Crown Prince Frederick would have been unconscious, was to be carried out without his knowledge. This was abhorrent to the German Chancellor Bismarck, who made an intervention that prevented the surgery progressing.

Dispute in Medical Opinion

A further consultation with Professor Tobold, eminent laryngologist, together with five further physicians resulted in the unanimous diagnosis that Frederick had cancer and surgery was necessary. It did not take place. On 20 May 1887 Dr Mackenzie returned to Berlin. Dispute between Mackenzie and German physicians followed. Mackenzie took the decision to take another sample from the growth, but insisted that German instruments were not good enough and sent for another from England. He removed a small piece of tissue and analysis subsequently showed no proof of cancer. Dr Gerhardt made comment that Mackenzie was clumsy in acquiring the specimen and even suggested it had been taken from the wrong, unaffected, vocal cord.

Dr Mackenzie’s Decision Making

Dr Mackenzie was favoured by Frederick’s wife Victoria. As an Englishwoman she naturally preferred the advice of her countrymen and was most insistent that English physicians cared for her family. This resulted in Dr Mackenzie’s opinion being matched against that of German physicians and surgeons, resulting in some tension.

Dr Gerhardt and other attending physicians had diagnosed Frederick’s condition as cancer on 18th May 1887. Mackenzie based his opinion on a microscopic analysis of some of the removed growth tissue by R. Virchow, and was absolutely insistent that this could not be conclusively demonstrated. The analysis of the tiny amount of tissue showed there was no cancer in that sample, but it was tiny. Nonetheless, given this Mackenzie argued against surgery planned for the 21st of May during which most if not all of Frederick’s larynx would be removed. Mackenzie maintained that, given there was not conclusive evidence of cancer such surgery was unnecessary, and that recovery might yet be made.

Frederick ultimately followed the advice of Dr Mackenzie. Frederick went to England to be treated by Mackenzie who was awarded the Grand Cross of the Hohenzollern Order for his services. He was also knighted in September 1887.

In June of 1887 Dr Gerhardt re-examined Frederick and found that the growth was not diminishing and moreover had spread to Frederick’s other vocal cord.

By November of 1887 Frederick’s condition had so deteriorated that during a consultation on 6 November of that year Mackenzie admitted to Frederick that the German had been right and that it was likely he had cancer.

Frederick underwent an emergency tracheostomy which entailed making a hole in his windpipe to help him to breathe more easily.

After the death of his father Frederick reigned as Emperor for 98 days until his death on 15 June 1888.

Dr Mackenzie was vocal in his criticisms of the German physicians involved, who had published a pamphlet detailing Frederick’s illness and treatment. Mackenzie responded with his own book ‘The Fatal Illness of Frederick the Noble’ but was censured by the Royal College of Surgeons for breaking patient confidentiality and unethical conduct.

Alternate Outcomes

Did political agendas influence the decisions made about Frederick’s condition? If Frederick was rendered unable to carry out his official functions, family tradition would call into question his suitability to reign.

Frederick was succeeded by his son Wilhelm II, otherwise known as Kaiser Wilhelm II who so vigorously pursued his hatred of England during World War I. Wilhelm blamed English physicians for the deformity he had suffered as a result of his breech birth, and also for his father’s death. This undoubtedly contributed towards his hatred of England and the English. Had Frederick survived the hostilities between England and Germany would quite likely not have flourished, and the horror of World War I may have been averted altogether.

Sadly, for most of his illness, Frederick had little say in his treatment and it is clear that personal as well as national pride, as well as political agendas contributed to decisions about his treatment. Was Doctor Mackenzie negligent? Fortunately for the insurers on piihub.co.uk's panel, it is too late for a claim!