Doctor's dilemma
Sir: Among William Boyd's observations on Sir Frederick Treves's surgical practice (`How King Edward VII nearly wasn't', 17/24 December) was the conclusion that the King would have been better treated by the removal of his appendix. This is flawed.
Treves was asked to give his opinion on the King on the fifth day of his illness. By the standards of any surgical era this is a relatively late presentation, and the sur- geon obliged to operate at this stage is often confronted at operation with an abscess surrounding the scarred remnant of the appendix which has already perforated and done its mischief. The purpose of surgery would then be simply to drain the pus to resolve the acute illness. Removal of the remains of appendix in addition would not contribute further to the recov- ery.
Treves's judgment in the King's late-pre- senting case, therefore, was entirely sound by modern standards.
Jonathan Pollock
Senior House Officer in Surgery, Queen Elizabeth Hospital, King's Lynn, Norfolk
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