Medical indemnity - was
Sir Morell Mackenzie negligent in his treatment of Crown
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
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
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
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
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.
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!