(A Reprehensible Example)
Gustavo Restrepo Uribe*
* Cardiologist. Santa Fe de Bogotá Foundation.
Occasionally, doctors express rabid, sometimes scandalous, jealousy towards their colleagues, especially when the patient who causes it is a protagonist in public life. The example presented took place in 19th century Germany.
The Napoleonic whirlwind was calmed and the limits of the new Europe were defined, within the German Confederation that brought together several dozen small independent states, the Kingdom of Prussia, in the north, with a Protestant majority, and the Empire of Austria, in the south, with a Catholic predominance. , they were fighting to retain supremacy; In the first, thanks to industrial development, the customs union, nationalist sentiment and the political management of personalities who sought the greatness of the State, after the war victories over Austria (1866) and France (1870-71), led to the consolidation of the German Empire.
The elderly Wilhelm I (William I) reigned, when from the beginning of 1885, serious health problems (kidney problems, anemia, episodes of cerebral ischemia and memory loss) announced the upcoming succession to the heir, Crown Prince, Friedrich III ( Frederick III).
Friedrich was married to Victoria “Vicky” (the first-born of the Queen of England, Victoria, and the Prince Consort, Albert), a couple who would form a family of eight children, headed by Wilhelm (William), who will be the second of his name. and last Emperor, Kaiser of Germany.
In January 1887, Friedrich began to complain of annoying hoarseness, which his doctors initially attributed to a cold aggravated by the harsh winter and having to give long, obligatory speeches. Come spring and seeing that the voice was not improving, Dr. Wegner summoned Professor Karl Gerhardt, from the University of Berlin, who during the examination found a swelling of the left vocal cord, which he was unable to remove, so he resorted to cauterize it with a platinum wire heated to red; On thirteen occasions he repeated the procedure, which was shortly followed by a reappearance of the tumor. In April the Prince traveled to Ems for a health cure and at that spa he found some improvement, with relief from the cough. However, the size of the neoformation continued to increase, which made it necessary to convene a medical board chaired by the president of the German Association of Surgeons, Ernst von Bergmann, and four other specialists, who issued the diagnosis of laryngeal cancer and recommended a surgery to remove it. The patient requested a third opinion and had Dr. Morell Mackenzie travel from London, founder of the Troath Hospital in that capital, a person world-renowned in medical circles and whose texts were consulted in the medical schools of Germany.
On May 20, Dr. Mackenzie arrived in Berlin, and the first thing he did was disparagingly criticize his German colleagues; When performing a laryngoscopy, he decided to take a fragment of the tumor to send to Professor Rudolf Virchow, founder of modern pathology, who found no evidence of malignancy in the sample examined and requested another, larger one, which Mackenzie could not obtain due to inflammation. . The Germans returned with a new laryngoscopy, after which Gerhardt, supported by Bergmann and Tobold, accused the Englishman of having injured the healthy cord, making the gap between the doctors irreconcilable.
Finally, at the beginning of June, Mackenzie performed the second biopsy, on which Virchow once again concluded that there was little probability of a malignant tumor, but without completely ruling it out. The Englishman returned to London, where Friedrich followed him, who would be present during the jubilee of Queen Victoria, his mother-in-law. A third biopsy, on June 28, with the same diagnosis from the famous pathologist and coincidentally the patient’s voice returned almost to normal. Next Fritz (as Friedrich was commonly called) and Vicky went to look for better climates in Toblach (in Tyrol) and San Remo; In this city on the Riviera they rented the Villa Zirio and were accompanied there by Dr. Mark Hovell (Mackenzie’s assistant), who during a checkup found new tumor growth in the throat, so he called his boss, who was in charge of communicating the bad news for Fritz: it was definitely a malignant lesion (November 1887).
Once again a board met, this time with doctors Professor von Schrötter from Vienna and Krause from Berlin (an expert in respiratory diseases). The three gave their bad prognosis to the patient, who received it stoically, without visibly expressing his emotion.
The Prince was presented with the alternative between radical surgery or a tracheostomy to help him breathe when the obstruction reached a critical point. The patient opted for the second. A doctor from Frankfurt, Moritz Schmidt, then appeared, who supported Krause’s opinion on the possibility of a luetic injury.
Given the seriousness of the Crown Prince, it did not take long for some politicians to propose their resignation from the succession. There were also those who accused Mackenzie of having taken the biopsy in a healthy place to hide the truth about the patient’s condition and thus help Vicky seize power; She clung to the hope that the diagnosis was wrong. German doctors claimed that if the operation had been performed, Fritz would have continued to head the government.
Meanwhile the inflammation of the larynx increased and the patient resorted to sucking on ice chips and applying ice packs around the neck. On February 9, 1880, Dr. Bramann performed a tracheostomy to relieve the unbearable respiratory difficulty, but when a thick cannula was inserted, considerable bleeding occurred, which increased the discomfort and insomnia. A microscopic examination by a new pathologist no longer left any doubts about the cancer diagnosis and was made public.
News arrived in San Remo about the terminal condition of the King (Wilhelm I) before which Fritz and Vicky prepared to travel to Berlin, but the old sovereign died at 08:20 am on March 9, 1888 before they arrived. to the capital by special train on Sunday the 11th at 11:00 pm, in the middle of a heavy snowfall. The short reign of Friedrich III began and more than one commented: “The Emperor is dead, long live the dying Emperor.”
The patient’s situation worsened on the night of April 12: in addition to the mortifying cough, there was an associated “peculiar sound” in the throat, evidence of the increase in the narrowness of the airway. Mackenzie was there, who called the new Kaiser’s official surgeon, Ernst von Bergmann, with the idea of changing the cannula; He found the patient suffocated and cyanotic and prepared for the proposed change, which, despite new bleeding, brought some relief.
The English version was different: according to him, the surgeon, drunk, took too long to arrive; The procedure was carried out without respecting the rules of asepsis and the bleeding it caused was copious. In any case, from then on Fritz refused to allow himself to be treated by Bergmann; However, the German press defended his compatriot, while he attacked the Englishman.
A few hours after the intervention, the temperature began to rise until three days later it reached 39.5 o C and purulent and malodorous sputum appeared. Mackenzie diagnosed an abscess following the surgeon’s examination.
Despite his pitiful state and cadaverous appearance, the sovereign mustered his strength to greet from his window the crowd that gathered waiting for news. The conservatives once again insisted on his abdication, alleging the president’s inability to speak.
The end seemed to have come and Vicky called her children; His wife quenched his thirst by making him suck on a sponge soaked in white wine. She asked for her diary to write: “Victoria, me, the children…”, then she fell unconscious, coughed hard, squeezed her eyes as if in pain and it all ended at 11:00 am on June 15, 1888. .
The ultraconservative reign of the new Kaiser, Wilhelm II (William II), began. As soon as he learned of his father’s death, the first thing he did was put guards at all the palace doors to prevent Vicky from taking out official documents to send to England. From now on, the Dowager Empress would receive indifference from her son, who stated that her father had been an aberrant Hohenzollern, subject to the harmful influence of his wife and her mother-in-law (Victoria).
Less than a month had passed since Fritz’s death, when the German doctors, Bergmann and Gerhardt, published a 62-page pamphlet in which they accused Mackenzie of malpractice and defended the indication of surgery as low risk (despite that in the hands of the former the procedure carried a high mortality rate). The Englishman did not remain silent: three months later his book appeared, “The Fatal Illness of Frederick The Noble”, which was a resounding success; 100,000 copies were confiscated in Germany. Accused of indiscretion, he was forced to resign from the Royal Colleges of Medicine and Surgery; Three years later he died of pneumonia.
During Fritz’s short reign, ultraconservative voices called for an absolutist government; When the new Kaiser ascended the throne, they were given their request. The new leader, backed by the Prussian “junkers”, would be largely responsible for the outbreak of the First World War.
Bibliography
• Alexandre P, L’Aulnoit B. La dernière reine. Victory 1819-1901. Paris: Editions Robert Laffont SA 2000.
• Pakula H. An Uncommon Woman. The Empress Frederick.” London: Phoenix Press, 1997.
• Restrepo G. Clinical Histories of the English court. Bogotá: Planeta Colombiana Editorial, 1998.