A Crown Prince and his controlling wife, a pathologist, and a laryngologist walk into a bar. They didn’t actually walk into a bar, but they created a medical drama that exasperated global tensions preceding World War I (WWI).
It started with a cold, or so thought then-German Crown Prince Fredrick who, in January 1887, felt hoarse and couldn’t clear his throat. Friedrick visited a German physician, Dr. Gerhardt, who found a small growth on his left vocal cord. Gerhardt unsuccessfully attempted to scrape the lesion off and instead cauterized it.
The following month, Fredrick’s wife, Vicky, wrote to her mother, Queen Victoria, explaining that, while Fredrick felt better, the growth remained. Vicky expected that removal of the remaining lesion would eliminate Fredrick’s hoarseness.
The lesion continued to grow, and surgeon Ernst von Bergmann recommended surgery to remove the growth. Vicky, who managed Fredrick’s treatment, feared surgery, and consulted more doctors. Six more German experts all suspected cancer and called for surgery.
An English laryngologist, Dr. Morell Mackenzie, examined Fredrick in May, sending a biopsy to renowned pathologist Rudolf Virchow who declared the sample cancer-free. The German doctors pushed for surgery, but Mackenzie wanted histological proof of cancer. Virchow evaluated two more biopsies that he accessed as benign. A heated disagreement where the Germans accused Mackenzie of sampling the left/normal vocal cord!
In June, Gerhardt warned that the surgery would become increasingly difficult as the lesion continued to grow. Vicky did not trust the German doctors, and put her faith in her countryman, Mackenzie. Despite strong objections from the Germans, Vicky moved Fredrick to London, where Mackenzie treated him.
In November, Mackenzie examined Fredrick while vacationing in Italy, and upon seeing the still-growing lesion, he finally admitted he had misdiagnosed his patient and that the German doctors had been right- Fredrick had laryngeal cancer.
Eleven months after symptoms arose, Fredrick made his first decision about treatment; he wanted a tracheostomy. Fredrick’s father, German Emperor William I, asked the German physicians why this operation hadn’t occurred upon their recommendation six months earlier. The doctors blamed Mackenzie and his denial that the growing lesion was cancer. With the health of 90-year-old William declining and the life of his heir in jeopardy, the German people became infuriated. Would Germany lose her Crown Prince because of an Englishman’s mistake?
In February, a German surgeon, Dr. Bramann, performed a tracheostomy. One month later, William I died, and Fredrick became German Emperor, a reign that would only last 99 days. By April, the new Emperor’s tumor protruded through the tracheotomy site, his skin appeared blue, and his breathing had become labored and loud. Fredrick’s required a feeding tube, and the growing tumor smelled awful. On this day, June 15, 1888, Fredrick died and his son, William II, became Emperor.
William II’s reign endured extensive conflict. One of his first orders as Emperor included a postmortem examination of Fredrick seeking tangible proof of Mackenzie’s misdiagnosis to embarrass the English. William II discontinued a non-aggression treaty with Russia, and ambivalent relationships with English cousins in prominent positions throughout Europe influenced his diplomacy. Historians suggest that William II’s actions contributed to the causes of WWI. Tensions within Germany also grew, and William II abdicated, abolishing the German monarchy in 1918.
By today’s standards, it’s not surprising that Fredrick developed throat cancer, given his 30-year smoking history. But none of the players in this story had the luxury of modern medicine to guide them. Had Fredrick’s surgery occurred six months sooner, he may not have survived. Had Fredrick died in surgery or shortly after, William II would have become Emperor a few months earlier without drastically rewriting history. But what if Fredrick had a successful operation curing him of cancer so he could rule for decades? Whether Fredrick’s liberal policies could have stabilized relations throughout Europe and prevented WWI remains a question lost to history but a topic of much speculation!
Sources: Eye Ear Nose Throat Mon, BMJ, Laryngoscope (Minnigerode), Laryngoscope (Chalat), Emerg Infect Dis, Virchows Arch, Ann Diagn Pathol, Am J Surg, Strahlenther Onkol, J Laryngol Otol, Eur Arch Otorhinolaryngol, J Med Bio