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The tracheotomy — a medical procedure in which a tube is inserted through an incision in the windpipe to create an airway — has been performed by physicians for over five thousand years. When done properly, it can save lives; yet the tracheotomy was not readily accepted by the medical community.
The tracheotomy began as an emergency procedure, used to create an open airway for someone struggling for air. For most of its history, the tracheotomy was performed only as a last resort and mortality rates were very high. Only in the past century has the tracheotomy evolved into a safe and routine medical procedure.
One famous American whose life could have been saved by a tracheotomy was President George Washington. At the end of the 18th century, however, the procedure was still considered too risky. In December of 1799, Washington lay in his bed at Mount Vernon, Virginia, suffering from a septic sore throat and struggling for air. The youngest of his three doctors, Elisha C. Dick, recommended that a tracheotomy be performed to create an unobstructed airway. He was vetoed by the other two physicians, who preferred more traditional treatment methods like bleeding. Washington died that night.
Learn about President Washington and the proposed tracheotomy.
George Washington was undoubtedly one of the most influential and well-known presidents of U.S. history. Washington proved to be a dynamic factor in all of the major events that helped shape the United States, from the Revolutionary War to the Constitutional Convention. His possibly untimely death lead to a controversy surrounding his diagnosis and the medical procedures practiced at the time.
In December 1799 Washington took his daily ride in heavy, wintry weather. He developed a sore throat and a malarial type of fever during the following days. Amongst the several physicians called to Washington's bedside was his personal friend, Dr. James Craik. Craik and his colleagues diagnosed Washington with an "inflammatory quinsy", an inflammation of the throat accompanied by fever, swelling, and painful swallowing. Elisha Cullen Dick, one of the physicians present, proposed a tracheotomy to help relieve the inflammation of the throat, but his suggestion was rejected. Instead, the doctors prescribed bleeding, which was undertaken approximately four separate times, equaling to a total loss of five pints of blood. Modern day doctors now believe that Washington died from either a streptococcal infection of the throat, or a combination of shock from the loss of blood, asphyxia, and dehydration. A streptococcal infection relates to any organism of the genus Streptococcus, or a genus of bacteria that is responsible for numerous infections such as tonsillitis or scarlet fever. One historian has stated that "whatever was the direct cause of General Washington's death, there can be little doubt that excessive bleeding reduced him to a low state and very much aggravated his disease."
View a list of famous people who have had tracheotomies.
Pope John Paul II
William Rehnquist (Chief Justice of the Supreme Court)
Luther Vandross (singer)
Catherine Zeta-Jones (actress)
Elizabeth Taylor (actress)
Stephen Hawking (physicist)
Gordon Lightfoot (singer)
Laura Innes (actress)
What is a Tracheotomy?
The tracheotomy is a procedure in which an incision is made into the windpipe, or trachea, through the front of a person's neck. When a person's upper airway is blocked, a laryngologist can perform a tracheotomy to create an alternate airway. Air can then be drawn into the lungs via an opening in the trachea, bypassing foreign bodies, secretions, or swelling. This opening may be temporary or permanent, depending on the needs of the individual patient. Over time, the tracheotomy has gone by several different names, among them pharyngotomy, laryngotomy, bronchotomy, tracheostomy, and tracheotomy. The word tracheotomy first appeared in print in 1649, but was not commonly used until a century later. Tracheostomy refers specifically to the opening, or stoma, created by the tracheotomy procedure. Sometimes this term is used interchangeably with tracheotomy to refer to the operation itself.
A Brief History of the Tracheotomy
The early history of the tracheotomy is sketchy and somewhat legendary. The earliest known depiction of a tracheotomy is found on Egyptian tablets dating back to circa 3600 B.C.E., during the First Dynasty. However, it was not readily accepted. Coelius Aurelianus, writing in the fifth century C.E., refers to it as "a fantastic operation" and "a futile and irresponsible idea." Therefore, it wasn't until the Renaissance, when interest in scientific study increased, that surgeons grew more open-minded about experimenting with surgery on the trachea and performed tracheotomies for a variety of reasons.
The Early History of the Tracheotomy
"A Futile and Irresponsible Idea": The Tracheotomy in Ancient and Medieval Times.
The tracheotomy first appears as an emergency procedure for bypassing a blocked airway. Its early history is sketchy and somewhat legendary. Coelius Aurelianus, writing in the fifth century A.D., refers to tracheotomy as "a fantastic operation" and "a futile and irresponsible idea."
The earliest known depiction of a tracheotomy is found on Egyptian tablets dating back to circa 3600 B.C., during the First Dynasty. Each of the two slabs depicts what scholars interpret to be a tracheotomy operation. To the untrained eye, the pictures may appear to be of a ritual execution, but the angle of the knife and the relative positions of the knife-wielder and patient indicate a surgical procedure instead. Eber's Papyrus, an Egyptian text which dates to circa 1550 B.C., references an incision in the throat.
Evidence of the tracheotomy also appears in ancient India. The Rig Veda is a sacred book of Hindu medicine, written as early as 2000 B.C. The text mentions "the bountiful one who, without a ligature, can cause the windpipe to re-unite when the cervical cartilages are cut across, provided they are not entirely severed."
The Greeks also have a long history relating to the tracheotomy, although some of it is based in legend. The poet Homer is said to have made a reference to the procedure in the eighth century B.C. He supposedly referred to an operation whereby one could relieve a choking person by cutting open the windpipe. The Greek ruler Alexander the Great is rumored to have performed a tracheotomy himself. In the fourth century B.C., he allegedly used the tip of his sword to open the trachea of a choking soldier.
The medical writers Galen and Aretaeus, both of whom lived in the second century A.D., credit Asclepiades of Bithynia (c. 124-40 B.C.) with being the first individual to perform an elective (non-emergency) tracheotomy, in the first century B.C. However, Aretaeus condemned the operation in his writings, for he believed, like many of that time, that incisions made into the cartilage of the trachea could not heal.
The second-century Greek surgeon, Antyllus, may also have performed the surgery. He is one of the first advocates of the procedure. The writings of Antyllus, quoted by Paul of Aegina (625-690 A.D.), provide a description of the surgery, although Antyllus referred to it as pharyngotomy. Paul of Aegina provides us with the earliest written account of a tracheotomy and is another early supporter of the operation.
While the rest of Europe suffered the drought of scientific discovery that was the Middle Ages, the scientific culture in Arabic Spain flourished. El Zahrawi (936-1013 A.D., known to Europeans as Albucasis), an Arab who lived in Andalusia, published the first illustrated work on surgery. He never performed a tracheotomy, but he did treat a slave girl who had cut her own throat in a suicide attempt. Albucasis sewed up the wound and the girl recovered, thereby proving that an incision in the larynx could heal. Ibn Zuhr (1091-1161 A.D., also known as Avenzoar) successfully practiced the tracheotomy procedure on a goat, justifying Galen's approval of the operation.
Part 2: Trial and Error: The Renaissance Period
The European Renaissance brought with it significant advances in all scientific fields, particularly surgery. Increased knowledge of anatomy was a major factor in these developments. The tracheotomy remained a dangerous operation with a very low success rate, but as interest in scientific study increased, surgeons grew more open-minded about experimenting with surgery on the trachea. During this period, many surgeons attempted to perform tracheotomies, for various reasons and with various methods. Many suggestions were put forward, but little actual progress was made toward making the procedure more successful. The majority of these suggestions, some of them very useful, fell by the wayside, ignored or unheard by the medical community at large.
Many surgeons still considered the tracheotomy to be a useless and dangerous procedure, and the statistics for this era do not disagree. For the period from 1500 to 1833, we have reports of a paltry twenty-eight successful tracheotomies.
An Italian physician, Antonio Musa Brasavola (1490-1554), performed the first documented case of a successful tracheotomy, and he published his account in 1546. The patient, who suffered from a laryngeal abscess, recovered from the surgical procedure.
Sanctorius (1561-1636) is believed to be the first to use a trocar in the operation, and he recommended leaving the cannula in place for a few days following the operation. Marco Aurelio Severino (1580-1656) used the tracheotomy to save multiple lives during the 1610 diphtheria epidemic in Naples; he also developed his own version of a trocar.
The studies of anatomists such as Hieronymus Fabricius ab Aquapendente (1537-1619) and his successor Julius Casserius (1561-1616) contributed much to the field of surgery. Fabricius, an anatomist and surgeon in Padua, never performed a tracheotomy, but his writings include descriptions of the surgical technique. He favored using a vertical incision and a straight, short cannula with wings (to prevent the tube from disappearing into the trachea), but he recommended the operation only as a last resort. He called the tracheotomy a "scandal," although he later relented in his condemnation and advocated the procedure in cases of blockage by foreign bodies or secretions. Fabricius' description of the tracheotomy procedure is similar to that used today. Casserius succeeded Fabricius as professor of anatomy at the University of Padua and published his own writings regarding technique and equipment for tracheotomy. Casserius recommended as a cannula a curved silver tube with several holes in it.
In 1620 the French surgeon Nicholas Habicot (1550-1624) published a report of four successful "bronchotomies" which he had performed. One of these is the first recorded case of a tracheotomy for the removal of a foreign body, in this instance a blood clot in the larynx of a stabbing victim. Habicot suggested that the operation might also be effective for patients suffering from inflammation of the larynx. He developed equipment for this surgical procedure which displayed similarities to modern designs (except for his use of a single-tube cannula).
As the Renaissance came to a close, surgeons continued to experiment with tracheotomy methods and equipment. Lorenz Heister (1683-1758) reintroduced the term tracheotomy in 1718 and campaigned for its usage. He described the tracheotomy operation in 1739 and recommended the use of a straight tube and trocar.
George Martine (1702-1743), the earliest known British tracheotomist, in 1730 published the first recorded case of a tracheotomy with a double cannula. He recommended the double tube because the inner tube could be removed for cleaning without disturbing the patient.
In 1765 Francis Home, a Scottish physician, advocated the use of tracheotomy for the relief of upper airway obstruction caused by croup. Jean Charles Felix Caron (1745-1824) performed the earliest known tracheotomy on a small child in 1776; the patient was a seven-year-old boy with a bean caught in his throat.
Part 3: All in the Timing: Nineteenth Century
It was not until the 1820s that tracheotomy began to gain widespread acceptance as a legitimate surgical procedure. Pierre Bretonneau (1778-1862) accomplished this in 1826, when he published his description of diphtheria (previously known as croup) and reported his successful use of the tracheotomy to relieve diphtheritic obstruction of the larynx. After this report more and more surgeons performed tracheotomies on their patients, but only as a last resort.
The problem with waiting until the last possible moment is that, by that point, irreversible damage to the body has already occurred due to lack of oxygen. Yet surgeons continued to postpone the tracheotomy, often until it was too late to do any good. It was considered a dangerous procedure, and not one to be attempted unnecessarily. Morrell Mackenzie’s 1880 textbook on laryngology addresses the issue of how a surgeon must determine “whether the symptoms are sufficiently urgent to render the operation necessary.”
Bretonneau’s pupil, Dr. Trousseau, kept records of the hundreds of tracheotomies performed under his leadership at the Hopital des Enfans in the 1850s. His 73% mortality rate was judged “very satisfying” by one reporter. This is partly due to the timing of the procedure and its use as a last-ditch effort instead of an early treatment.
Aside from the issue of timing, laryngologists and surgeons in the nineteenth century were debating other aspects of the tracheotomy procedure. Varying techniques were used, as well as varying pieces of equipment. Doctors did not even agree on where the incision should be made; they argued the merits of “high tracheotomy” versus “low tracheotomy.” General anesthesia, particularly on patients with suppressed respiration, was still quite dangerous. And many patients survived successful tracheotomy procedures, only to die from post-operative complications.
During this time period other physicians were looking into non-surgical methods of relieving airway obstruction. Joseph O’Dwyer (1841-1898) performed the first successful intubation of the larynx in 1885. He developed the technique of intubation to aid in the treatment of diphtheria, at this time a major killer of children.
Standardization and Alternative Methods for Tracheotomy
The key turning point in the history of the tracheotomy came early in the twentieth century with the work of Chevalier Jackson (1865-1958). His pioneering methodologies in laryngology helped to pave the way for high standards and low mortality rates in tracheotomy procedures.
While Chevalier Jackson's work greatly decreased the dangers associated with the tracheotomy, other developments in medicine reduced the need for the procedure. The development of an antiserum in 1893 decreased the occurrence of diphtheria, which caused a swelling of the throat. After 1913 it was no longer considered a serious threat. Sulfonamides also aided in the treatment of upper respiratory infections. Tracheotomies did regain popularity in the twentieth century as a treatment for respiratory obstruction caused by poliomyelitis, commonly known as polio, but this was eliminated by Jonas Salk's polio vaccine.
Morell Mackenzie and the tracheotomy of Crown Prince Frederick of Prussia and Germany
Morell Mackenzie was born in 1837, the eldest child of Dr. Stephen Mackenzie, a general practitioner. At the age of 21, Mackenzie took an examination to qualify from the London Hospital College. He had earned his diploma of membership in the Royal College of Surgeons and the Licentiate of the Society of Apothecaries.
Morell Mackenzie decided to spend the next year studying medicine on the Continent, including stays in Paris, Vienna, Budapest, Berlin, and several cities in Italy. While in Budapest, his interest in laryngoscopy was piqued by Johann Czermak. Czermak showed the young man how to use a new invention, the laryngoscope, which was only five years old at the time.
Morell Mackenzie returned to England and began to study medicine and write about laryngology in earnest. In 1861 he graduated from London University with his Bachelor of Medicine. A year later, he earned his Medicinae Doctor and opened his private practice as a physician laryngologist.
Soon Mackenzie's reputation began to grow, allowing him to open a new office in 1863. This office he called the Metropolitan Free Dispensary for Diseases of the Throat and Loss of Voice. The year 1863 also brought Mackenzie's first brush with fame in physician's circles. He earned the Jacksonian Prize of the Royal College of Surgeons for his three volume essay entitled On the Pathology and Treatment of Diseases of the Larynx: The Diagnostic Indications to include the Appearance as Seen in the Living Person. His presentation to the British Medical Association in the same year coined the terms "abductors" and "adductors" to describe two sets of muscles which open and close the glottis.
The year 1865 was another big one for Dr. Mackenzie. he moved his offices once again, opening a larger and more prominent space at 32 Golden Square, London. This new office was named the Hospital for Diseases of the Throat and was the first laryngological hospital in the world.
By 1873 Dr. Mackenzie was a member of the Royal College of Physicians and was appointed as a Physician at London Hospital. This latter appointment he resigned soon afterward due to his "total devotion to laryngology" and the demands of the Hospital for Diseases of the Throat. Indeed, Dr. Mackenzie's practice was so large that Lady Duff Gordon recalled that "his waiting room was always crowded, and it was impossible to see him without waiting for an hour or two, unless one tipped the butler heavily or — like herself — possessed one of Mackenzie's visiting cards with "Admit at once" written upon it in his own handwriting."
Dr. Mackenzie's reputation was firmly established with his colleagues when he published his text books. The first was The Use of the Laryngoscope in Diseases of the Throat, published in 1865. This text was eventually translated into three languages and ran to three editions. Growths in the Larynx was published next, in 1871. This text documents one hundred cases Dr. Mackenzie treated using the laryngoscope. In it he describes his methods for numbing his patients. In a time before anesthesia he "relied solely on the patient sucking ice immediately before the operation and taking the occasional inhalation of chloroform or bromides."
In 1880 and 1884 Dr. Mackenzie published his most celebrated works, Diseases of the Nose and Throat, volumes 1 and 2. These two books were so important that thirty-seven years later, they were still referred to as the "laryngologist's Bible" by Sir St. Clair Thomson. In 1887 Dr. Mackenzie also helped found the Journal of Laryngology and Rhinology with R. Norric Wolfenden and was a founding member of the British Rhino-Laryngological Association.
By 1887, at the age of 50, Morell Mackenzie had been practicing laryngology for twenty-five years. His reputation as a throat specialist was firmly established in England and abroad. It was at this time that Dr. Mackenzie was called to treat his most controversial patient, Crown Prince Frederick of Prussia and Germany. Sir D'Arcy Power was moved to write of Dr. Mackenzie: "[e]ndowed by nature with great manipulative skill, constant practice had rendered him a master in the use of the laryngoscope and of the laryngeal forceps; but he was also by nature somewhat indiscreet, and his mind was essentially polemical...If it had not been for this episode in his career (the illness of Crown Prince Frederick), Mackenzie would have been remembered as an able practitioner in a special department of medicine, endowed with great mechanical skill and power of invention."
The story of Crown Prince Frederick begins several months before Dr. Mackenzie had been called from London. In 1887 Dr. Gerhardt, Professor of Clinical Medicine at the University of Berlin, attempted to remove what he diagnosed as a polyp from the throat of the 56 year old Prince. Dr. Gerhardt first employed a snare and finally used galvano-electric cautery to remove the "polyp". After thirteen of these procedures, Crown Prince Frederick felt better but his symptoms of hoarseness and vocal cord sluggishness soon returned.
Frederick's physicians suspected that he was suffering from laryngeal cancer and were preparing to perform a thyrotomy when the powerful Chancellor Otto von Bismark and Frederick's father, Emperor William I, discovered their plans. Both men asked that a specialist in throat medicine be sought. Meanwhile, Crown Princess Victoria, wife to Frederick, was increasingly alarmed at his condition. Victoria, the daughter of Queen Victoria of England, wrote to her mother regarding Frederick's illness. While it is not clear which party actually sought him out, Mackenzie was requested to examine Crown Prince Frederick's throat. Morell Mackenzie, therefore, went to Berlin and performed two biopsies on the Prince. Both were examined by Dr. Rudolph Virchow, who proclaimed them to be cancer free. Mackenzie therefore counseled all those involved against surgery.
In the summer of 1887, Queen Victoria held her Jubilee in London to celebrate her ascendancy to the throne of England. Her daughter and son-in-law, the Crown Prince and Princess, were there. Dr. Mackenzie took this opportunity to perform a third biopsy which was again examined by Dr. Virchow and, again, revealed no cancer. Dr. Mackenzie noted a swelling of the mucous membrane in the back of the larynx which he diagnosed as a chronditis of the artyenoid. Dr. Mackenzie applied galvano cautery to remove the growth. Crown Prince Frederick seemed to recover well from the operation and even regained much of his voice. The Crown Prince and his family returned to the Continent with high hopes for the Prince's full recovery.
In November of 1887, Mackenzie was called to San Remo, Italy, where Crown Prince Frederick was spending his winter. Upon arrival Dr. Mackenzie discovered that Frederick's condition had worsened. In particular he found a new growth in the Prince's throat: "its appearance was altogether unlike that of the one which I had destroyed...it had in fact a distinctly malignant look." Mackenzie informed his patient that the diagnosis was most likely laryngeal cancer and told Crown Prince Frederick that he must decide how he wished his illness to be treated.
The Crown Prince was presented with two treatment options: excision of the larynx or tracheotomy. Frederick decided that when it became necessary, a tracheotomy would be performed. Mackenzie and the other consulting physicians issued an official report to Chancellor Bismark and Emperor William I on the Crown Prince's condition. The German press got ahold of the letter and broke the story of the Crown Prince's illness in all the national newspapers. Mackenzie was the leading physician treating Frederick at this time, but he was able to offer the ailing prince little more than constant checking of his condition and attempts to make him more comfortable. As the news of the Prince's condition spread, the press began to criticize Dr. Mackenzie's treatment of the patient and accused him of mismanaging the case.
In January of 1888 Frederick's condition worsened still and he required the palliative tracheotomy which he had approved as treatment for himself. The procedure was performed by a German physician, Dr. Bramann. Morell Mackenzie was retained as a member of the team of physicians monitoring the Crown Prince's health, but was no longer the leading physician in the case. Dr. Bramann and a colleague, Professor Geheimrath von Bergmann, were now in charge, monitoring the Prince's health and managing the tracheotomy tube. Of these two Dr. Mackenzie wrote: "[i]t certainly appeared to me that neither Professor von Bergmann nor Dr. Bramann, well-informed surgeons though they doubtless are in many matters, had had much experience in the sort of work they had now taken upon themselves to do."
Interestingly, in February of 1888 Morell Mackenzie published a report in the Lancet in which he stated that cancer had still not been officially diagnosed. Due to the lack of pathological evidence, which he felt crucial to such a diagnosis, he instead referred to the disease as a "chronic interstitial inflammation of the larynx combined with perichondritis." This public acknowledgment of his patient's condition is even more unusual if one considers his later reproach of German physicians in making the health of their patient so public. Although he would later lament the lack of patient confidentiality afforded to the Prince, Dr. Mackenzie apparently felt the need in early 1888 to try to clear his name which was being so tarnished in the press at the time.
It would be nearly a year before Mackenzie would publish his private feelings about the case in his book, The Fatal Illness of Frederick the Noble. Complaints regarding the suitableness of his fellow physicians was just one aspect of the book. Dr. Mackenzie further made a much more serious charge of malpractice. It was Mackenzie's belief that the incision made by Dr. Bramann when performing the tracheotomy was not centered properly. Combined with his accusation that the trachea tube inserted by Dr. Bramann was too large, Dr. Mackenzie states that the Crown Prince suffered irritation of the trachea and eventual complications in his condition that lead to his death.
Between January and March of 1888 the physicians surrounding the Crown Prince bickered regarding the Bramman tachea tube. The result was that Frederick was constantly being fitted with new trachea tubes and canulae. Seven trachea tubes and canulae of five different designs were used in all. One was designed by Dr. Mackenzie himself and named the San Remo canula after the city it was manufactured in. The results of these tubes were universal discomfort for the Crown Prince, coughing, and bleeding. Dr. Mackenzie noted that because the tracheotomy had been off-center, "a moderate-sized tube would have been likely to have wounded the walls of the trachea under the circumstances, but an enormous tube such as that (first) used by Bramann, would have been sure to have done so."
Two months after the operation, in March, Crown Prince Frederick's father, William I, died. This prompted Frederick to return from San Remo to Berlin. While he felt too ill to be present at the funeral he was crowned Emperor Frederick III of Prussia and Germany soon after. Emperor Frederick III was ill during his entire reign and Morell Mackenzie never left his side. On March 6th the Emperor restored Mackenzie as leading physician in the case, but as Mackenzie himself noted, "[the Emperor] was now a complete invalid."
On March 12th Morell Mackenzie felt that the tracheotomy tube needed, once again, to be replaced. As a matter of courtesy, Mackenzie agreed to allow Professor von Bergmann to replace the tube. Bergmann's attempt, however, was unsuccessful. Bergmann missed the tracheotomy hole and plunged the tube, instead, into the front of the Prince's neck creating what Mackenzie named "a false opening". This injury to the Emperor caused him much pain and quickly became infected. According to Mackenzie the infection drained the last of the Emperor's strength.
On June 15, 1888, Emperor Frederick III died, he had reigned only 99 days. Prior to his death, the 57 year old monarch felt so indebted to the care of Morell Mackenzie that he honored him with the Cross and Star of the Hollenzollern Order. An honor that Frederick's son, Wilhelm II, implied was coerced in his memoirs written in 1926. He wrote, "[it is questionable] whether the Englishman really pronounced his diagnosis in good faith. I am convinced that this was not the case....he was out not only after the money, but also after the English aristocracy."
After Emperor Frederick III's death, the German press denounced Morell Mackenzie and the Empress Victoria for their parts in the management of the Emperor's disease. Empress Victoria was blamed by German press for asking a British physician to attend her husband. Emil Ludwig wrote, "She stands indicted for serious indiscretion. She summoned from her native land an undistinguished physician, simply because she attributed a shortcoming of Nature to the physicians of the land she had adopted." Mackenzie felt the added scrutiny of world press and fellow physicians who criticized Mackenzie's handling of the case. Lady Duff Gordon recalled that "it was impossible to imagine the furor created by the case of the German Crown Prince; nothing else was talked of for months, and Mackenzie's name was on everybody's lips every hour of the day". She had even "known people to stand on chairs in a hotel restaurant to watch Mackenzie at dinner."
As noted earlier, Dr. Mackenzie sought to protect himself by publishing an angry book, The Fatal Illness of Frederick the Noble, which discusses his diagnosis and treatment of the Emperor as well as his feelings toward the German doctors he worked with. The book was received with unfavorable criticism and led to his censure by the Royal College of Surgeons and the British Medical Association. Mackenzie resigned from the Royal College of Physicians. During this period Mackenzie also sued The Times of London for reporting that his treatment of the Emperor was inadequate. The court awarded him substantial damages and costs, but the criticism did not abate. Morell Mackenzie's return to London was also marked by a decline in his practice which, in his absence from England, appears to have been usurped by the physician he left in charge. Morell Mackenzie died four years after Emperor Frederick from influenzal pneumonia.
It has been felt by many that had Emperor Frederick III lived, his son Wilhelm II, aka Kaiser Wilhelm, would not have come to power so young. Wilhelm II led Germany into World War I and many felt that the tragic deaths associated with the Great War could have been averted by the marked diplomacy of Frederick III. It seems unlikely, however, that the Crown Prince Frederick could have survived removal of his larynx had the correct diagnosis been made early enough. Deaths on the operating table or shortly after surgery were common and it is doubtful that Frederick could have averted his death longer than his delayed diagnosis had already afforded him. Irwin Morre wrote in 1926, "Sir Morell Mackenzie's greatness was demonstrated, and may be estimated, in the case of the Crown Prince, by his superior knowledge and experience of contemporary surgery, for whatever can be said for or against his diagnosis and treatment the fact remains that, by his opposition to operation, he saved for the German nation the Crown Prince's life for a considerable time."
Bibliography:
Otolaryngology: An Illustrated History Neil Weir, Butterworths, 1990.
Biographical History of Medicine John H. Talbott, 1970.
"Sir Morell Mackenzie Revisited" Ned I. Chalat Laryngoscope, Vol. 94 no. 10, 1984.
Morell Mackenzie R. Scott Stevenson, William Heinmann Medical Books, Ltd., London, 1946.
The Fatal Illness of Frederick the Noble Morell Mackenzie, Sampson Low, Martson, Searle, and Rivington, Ltd., London, 1888.
Material provided courtesy of the
American Academy of Otolaryngology — Head and Neck Surgery
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