20 NOVEMBER 1926, Page 16

Letters to the Editor

A DEFENCE OF SIR MORELL 1L1CKENZIE —A REPLY TO THE EX-KAISER [To the Editor of the SPECTATOR.] SIR,---Everyone who cares for the prestige of the English medical profession, and for the fame of those great men in the past who have made it what it is, are bound to take exception to, and express their indignation at, that portion of the closing chapters of the ex-Kaiser Memoirs, dealing with the "Tragedy of the Crown Prince," which you publish in your issue of November 5th.

Having had free access to the private papers of the late Sir Morell Mackenzie, also of his chief assistant, the late Mr. Mark Hovel, I am in the position emphatically to refute the scandalous and malicious charges levelled by the ex-Kaiser against this distinguished specialist, whose scientific attain- ments were so well known, and whose memory is still held in such high esteem, not. only in this country, but throughout the world.

It is obvious that the ex-Kaiser's motive is to attempt to explain away the estrangement between himself and his mother, the Empress Frederick, which was entirely brought about by his own erratic and unfilial conduct, by trying to place the blame on Sir Morell Mackenzie's shoulders. The unkind way in which he treated her, though past history, will for ever remain a blot on his character, and is now apparently a disturbing spectre in the later years of his life. The accusa- tions made by the ex-Kaiser against Sir Morell Mackenzie, so obviously false, fall under two headings, viz., " Specialists Called In," and " The Decisive Intervention of Sir Morell Mackenzie."

He does not deny the fact that Sir Mcirell Mackenzie, at that time acknowledged to be the greatest throat specialist in Europe, was called into consultation at the request and upon the advice of the German physicians, in view of their " sus- picion " that the Crown Prince was suffering from cancer of the larynx, for which they had advised an operation, known as thyro-fissure, for the removal, not of the whole larynx, but of the diseased portion of the vocal cord.

The ex-Kaiser expresses doubt as to whether Sir Morell Mackenzie " really pronounced his diagnosis in good faith," charges him with " being out not only after money, but also after the English aristocracy," and states that " the decisive proof is that, on the journey back to England after the death of my father, he admitted that his only reason for not diagnos- ing the disease as cancer was that the poor Crown Prince should not be declared incapable of assuming the Govern- ment !"

Can anyone, in their sane senses, believe for one moment that there is a particle of truth in this scandalous allegation ? Why has the ex-Kaiser allowed thirty-eight years to elapse before making this accusation ? Where is the decisive proof to which he refers ? I challenge him to produce any evidence whatever which can confirm his statement.

As for the accusation that Sir Morell Mackenzie was " not only out for money, but also Later the English aristocracy," does the ex-Kaiser for one moment suggest that any payment that Sir Morel received for his devoted and untiring services to the Crown Prince in any way compensated him for the monetary loss incurred by absence from his practice for so long a period ?

It will be remembered that when Sir Morel Mackenzie arrived at Berlin to see the Crown Prince, the German doctors had got no further in their diagnosis than a " suspicion " (admitted by the ex-Kaiser), that his father might be suffering from cancer of the larynx, and the advice . of Sir Morell Mackenzie had been sought for the purpose of clearing up the diagnosis. He considered that the German doctors had not sufficiently investigated the case, and further that their suspicions were not based on the acknowledged procedure of the day, i.e., on microscopical evidence. It was apparent that only a rough guess had been made of the patient's disease. Although so uncertain of their diagnosis they had

made preparations for performing the operation_ of thyro. fissure, i.e., dividing the larynx in the middle line and removing the growth.

Sir Morell Mackenzie advised that a portion of the growth should be removed through the mouth in order that a micro. scopical examination might be made, a procedure which they considered impossible, but which he was able to carry out. The report of the great pathologist, Professor Virehow, gave no indication that the growth was malignant.

At the time of the suggested operation, Sir Morell published a statement as follows :—

" I think it well to define, with the utmost possible clearness, the exact position which I took up with reference to this most difficult case. This is the more necessary inasmuch as my attitude has been misunderstood and misrepresented to an extent almost without precedent in medical practice ; I repeat that I gave no opinion one way or the other as to the nature of the disease. I did not say that it was not cancer; I only said that that opinion was not proven,' and in the absence of positive proof I refused to sanction procedures which at present are, at the best, more or less of the nature of experiments, which are always dangerous to life, and which, even when successful,' too often leave the patient unfit for the business of life, or even sometimes in a con- dition worse than death itself. Till the nature of the case should be clearly proved, it seems to me to be my duty, not merely as a physician, but as a man, to optok se the application of a remedy al

which the patient might justly worse than the disease."

What would have happened if the operation on the Crown Prince had been sanctioned can be gathered by a study of the operative mortality of those days. Existing records prove conclusively that nearly all the patients died from causes attributable to the operation itself, or its sequences, such as pneumonia or bronchitis.

With such a high mortality, in those days, it is easy to understand why Sir Morell Mackenzie refused his consent to the proposed operation on the Crown Prince, until the question of malignancy of the growth had been established, or was more definite.

It was shown by post-mortem that the growth, in the case of the Crown Prince, was deep-seated, extensive, and of a rare type.: nothing short of complete removal of the larynx would have sufficed to eradicate the disease. Had complete removal of the larynx been decided upon, it is pretty safe to surmise that the patient would not have survived the operation, for up to the year 1881, we know that out of a total of 25 cases of laryngectomy, only two patients survived for nine and ten months respectively.

It would seem clear, therefore, that the accusations against Sir Morell Mackenzie are founded on nothing more sub- stantial than the distorted and perverted imagination of the ex-Kaiser. Sir Morell Mackenzie's greatness was demon- strated, and may be estimated, in the case of the Crown Prince, by his superior knowledge and experience of con- temporary 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.—I am, Sir,