A FULL ABSTRACT OF ITS CONTENTS. GERMAN DOCTORS BADLY USED UP. A CLAIM THAT THEY KILLED THE PATIENT BY BUNGLING SHARP COMMENT.

Te Aroha News, Volume VI, Issue 316, 14 November 1888, Page 5

A FULL ABSTRACT OF ITS CONTENTS. GERMAN DOCTORS BADLY USED UP. A CLAIM THAT THEY KILLED THE PATIENT BY BUNGLING SHARP COMMENT.

A vjsiiY full abstract of Sir Morell Mackenzie's book, which is announced for next week, apjjeared in bhe " British Medical Journal " ot Oct. 11th. The book is divided into three parts, historical, controversial and statistical. It contains twenty-one illustrations, showing the condition of the late Emperor's larynx at the diffluent periods, of the various canulas used in the latter stages and of measurements made by Mi Hovell, with a view of proving the symmetrical position of the tracheotomy wound and the lesions which are alleged to have followed the attempts of Piofessor Yon Bergmann to push the canula into the windpipe. iSir Morell deals solely with the medical aspects of the case, without touching on political questions. He complains that he has been refused access to important documents, which have been at the disposal of his assailants. In the narrative portion of his work he describes the piogress of the cibe Jrom the time he was called in till the Emperor's death. He denies the allegation that he deceived his Majesty as bo his condition, and states that he can bring forward unimpeachable pioof of this assertion. He ulco denie> that he ever taid the disease wuj not cancer. All that he did was to point out that the conclusion had been driived at on insufficient grounds and that the first step toward a thorough diagnosis, namely, the removal of a piece of the growth ior microscopic examination, had been omitted by the German physicians. This Mackenzie was able to do, and Professor Vhchow gave a favourable report on the fragments extracted, so that the proposed radical operation was abandoned and the case handed over to the English physician. With regard to the charge made against him by Professor Gerhardt of having wounded the right vocal chord in his second opera'ion, Sir Morell points out that such an accidtnt is almost impossible with his forceps. He has never known it to occur even to a beginner, and, as a matter of fa< t, in the case of the Emperor Frederick theie was no objective sign ot such an injury having been inflicted, nor did the august patient afterward complain of any pain such as he must have felt if the supposed wound had ha-d any existence outside Professor Gerhardt's imagination. Mackenzie accuses: the Geiman physician of having made a charge which he knew to be false, in order to shake the confidence of the Crown Prince in his new adviser. f He maintains that his German colleagues fully , share his responsibility for the line ot treatment which was adopted, and if they distrusted him they should at once have openly dissas-sociated themselves fiom him. They made no sijn, howevei, and even as late as the beginning; of October, Piofessor Yon Bcrgjnann i-> said to have admitted that the course which Mackenzie had pursued was right. in so far from his having spirited the down Prince away to England, as he is accused of having done, Mackenzie affirms that the illustrious patient came over to this country mainly in order to be present at the Queen's jubilee, in accordance with arrangements made before the English physician had been called in. He complains that Dr LandgratF was appointed to accompany the Prince, without any hint having been gi\ en that the surgeon was one oi Professor Gerhardt's assistants. Mackenzie describss the clinical incidents of the case very much as they were set forth in the medical journals at the time. We aie admitted behind the scenes at the eventful consultation atSanßemoin the early part ot November, when the great crisis in the evolution of the disease occurred. Interesting details are given as to the heroic fortitude with which the Prince received what was in fact a sentence, not only of de'ith, but of prolonged previous suffering. Amusing °ketches arc also given of the attitude of the various physicians who took part in the consultation. Our author informs us that on that occasion Dr. Schmidt, so far from thinking the case was one of cancer running a normal course, maintained, in opposition to all the others, that the disease was specific, a notion which Professor Schother characterised as an old wife's tale. Notwithstanding this, Dr. Schmidt took an early opportunity of expressing the same opinion in a public lecturo at Frankfort, an indiscretion which caused the greatest annoj'ance to the Prince. Tn de&cribing the tracheotomy, Mackenzie admits that the operation was, on the whole, performed by Brammin in a satisfactory manner, but affirms that the tiachca was opened three millimetres to the right of the middle line. This was proved by Hovell by an ingenious method of measurement, which is fully described and illustrated. Dr. Brammin inserted a canula of altogether unusual size and shape. The lower end of this instrument, according to Dr. Mackenzie, impinged on the posterior wall of the trachea, cant-ing destruction of the tissue and intense discomfort, with consequent exhaustion. There was at this time great tension in the relations of the English medical attendant with his German colleagues, and he complains that the latter obstinately refused to listen to his suggestion as lon moie suitable tube till it was too late, and then the ca~c was restored to the English physician. He substituted Durham's tube for the German canula, with tela<i\ely satisfactory results, but irretrievable mischief had already been done. Professor Yon Bergmann is accusftd of having diagnosed secondary cancer of the iung from finding dullness in the back of the liver. Professor Kusf-meul had to b9 ! brought all the way from Stra&burg to con\ince him of his mistake. Mackenzie's account of the events of the fatal April 12 | is very different from Professor Yon Bergi mann's. Mackenzie does not hesitate to I «ay that Frederick 111. received his death blowonthataccount. The false passage uiade by the tube gave rise to extensive suppuration around the trachea, which steadily drained away the remaining strength of the patient and shortened his life by about ten months. An interesting statement is made in connection with this subject, that, except at the time the false passage was made and especially when Professor yon Bergmau thrust his finger into the wound, the j Emperor never suffered any actual pain. After the death of Frederick 111., Mackenzie alleges that an attempt was made to entrap him into a false position. It w r as settled that there should not be a postmortem examination, and the English physician was urged to give his opinion in writing as to the nature of the disease, in the hope, no doubt, that, thinking himself safe from any possible exposure, he would leturn an ambiguous answer. He disconcerted his enemies, however, by stating unequivocally that the Emperor had suiVered from cancel' of the. larynx. In the controversial part of his loply, ; Mackenzie contends that tiacheotomy m

cases of cancer, so far from being free from danger, is, in fact, the most deadly operation, showing a mortality equivalent to nearly 90 per cent. He also maintains that ifc is, in the vast majority of cases, inadequate for the complete removal of the growth, which thorefore speedily returns, the average rate of recurrence being almost 90 tier cent. Lastly, he argues that in a case of such importance it would have beeu utterly unjustifiable to perform tin operation of such a nature without tho clearest proof of its necessity. This he maintains was not forthcoming till after the period of illness. Dealing individually with his German assailants, Mackenzie rejects the testimony of Professor Gerhard fc as being that of a discredited rival. He brushes aside the evidence of Landgraf on the score of want of laryngiscopic skill, which wa*s so marked that the Prince was with difficulty prevented from dismissing him. Dr Brammin is objected to on the same ground. To the evidence of these inexperienced lavygiscopists is opposed the testimony of experts like Dr. Krause, Dr. Wolfenden and Dr. Ho veil, j Professor Gerharclt's ruthless cauterisations on so many successive days is condemned in the strongest terms as utterly unexampled in medical practice, and as beinglikely to irritate the disease if uiiginaily benign into malignancy. The statistical portion exhibits the results of twenty-two cases of thyrotomy for cancer, only two ot which were successful ; of thirtyfive cases of partial excision of the larynx, only one of which was successful; and ot 138 cases ot total extirpation, only " eight of which were successtul. Here is Mackenzie's description of the operation ot tracheotomy :—": — " When everything was readjr the Ciown Prince passed through an adjoining room into an ordinary sitting-room, wheie it was arranged that the operation v r as to be performed. A bed was placed opposite one of the windows that was in an excellent light. Braminon proceeded to give the chlorotorm, bat as soon as, the Crown Prince became unconscious the administration was continned by Krause, whilst I kept my finger on the pulse ot the left wrist. Shortly after Brammon had made his first incision I noticed that the pulse had become veiy weak and the face was blanched. In fact, there were evidences of cardiac weakness. On raising the eyelid the pupil was seen to be widely dilated. The administration of chloroform wassuspendedfor a minute or two, ■when the pulse became fairly good again and the operation proceeded. Alter this incision Brammon seemed to become a little fluiried, though not to such an extent as to prevent aim him from operating with skill. On opening the windpipe, however, I noticed that he made his incision a little to the right instead of in the middle line. The deviation appeared to me so slight at that rime that 1 attached no importance to it. "After opening the trachea, instead of at once plunging in a canula, as is usually done by English surgeons, Brammon held aside the sides ot the wound for a minute or two till the bleeding had ceased, and then inserted a very long and somewhat funnel - shaped tube. I will frankly own that Brammon"s method of introducing *"be canula seemed to me an improvement on the ordinary plan of plunging the tube into the windpipe as soon as it is open, a proceeding which usually sets up severe spasms and a cough. When the operation was com pleted, I congratulated Dr. Brammon on its success. 1 have aheady said that in a case like the^Crown Prince's, tracheotomy is not, as a rule, a matter of any difficulty ; but, considering that a young surgeon was operating on his future sovereign, and that he was, not unnaturally, somewhat unnerved by the catastiophe so neatly caused by the chloroform, 1 think he did his work very well. On leaving the room I said to Hovell, ' Did you notice that the trachea was opened a little to the right of the middle line ?' and that gentleman replied, ' I did, but I should say considerably rather than a little.' *' Mackenzie describes the details of the bickerings among the doctors in the gloomy days following this operation about the proper kind of tube to be used in the throat, and says : "' My tube was tried too late."' There is an extended diary aloo of the fatal day, April 12th. The Emperor was rapidly sinking, and Dr. Mackenzie determined to try a new tube. He says : "As soo;> as the new tube was ready I despatched a messenger for Professor Yon Berginann to request him to come as soon as possible ; meaning, of course, that C was anxious to proceed to change the tube without delay. In sending off that message, little did I think it could have such fatal consequences. It id not an exaggeration to say that these hastily scribbled lines proved to be the death warrant of the Emperor. Had I had the slightest idea what was to follow, I should certainly not have allowed any o\ er punctilious notions of etiquette to mislead me into taking so disastrous a step. At the moment, however, il appeared to be the light thing to do." Mackenzie say& that Be-gmann was greatly excited when he arrived, and behaved in amo3t unaccountable manner. He continues : " We then proceeded to the Emperor's room accompanied by Hovell, each of us carrying seveial tubes. We found the Emporer engaged in writing. Hi& inspiration was distinctly audible, but beyond this there was not the slightest indication of any difficulty in breathing. Bergmann placed a coair opposite a window and asked the Emperor to fcit down upon it, and thereupon without making any remark he quickly undid the tape which kept- the canula in position, pulled the latter out, and with considerable force' endeavoured to insert one which he had in his hand and which was not provided with a pilot. The instrument -n as forced into the neck, but no air came through it. The Emperor's breathing thereupon became very much embarra&sed, and the professor withdrew the tube. This was tollowed by a violent fit of coughing, and there was considerable hemorrhage. .Bergtnann next seized a canula covered wish a sponge, cut the pponge quickly off and tried to push the tube into the windpipe again. JMo air came through the canula, and it was clear that instead of entering the air pa&sag-e it had been forced downward in front of the trachea, ploughing up the soft tissues in that situation and making what is technically known as a false passage. Again (he Professor had to pull out the tube, and again its withdrawal was followed by violent coughing and streams of blood. To my consternation Bergmann then pu ,hed hit> finger deeply into the wound and on withdrawing it tried to insert another tube. He again failed, however, and again the attempt was followed, as before, by most distressing coughing and copious bleeding." The result of this bungling, Mackenzie goes on to say, was that Bergmann's assistant was called in to finish the job. " After the operation," says Mackenzie, "the Emperor sent for me and asked : ' Why did Bergmann put his finger into my throat ?' His Majesty .then went on : 'I hope you ■will not allow Professor Yon Bergmann to do any further operations on me.' I answered : ' After what I have seen to-day, sir, I beg most respectfully to suy that I could no longer have the honour of coninuing in attendance on your Imperial

Highness if Professor Bergrnann is to be permitted fco touch your throao again.' Bergman n's roughness was never forgotten by the Emperor, although the nobility of his nature prevented him from showing any resentment." There is nothing particularly new in Mackenzie's account of the last hours of the Emperor, but ho alleged thai a few hours after the Emperor's death Bismarck tried fco get him into a trap by demanding a hasty official report. Be was urged to write his opinion as to the nature of the disease, doubtlese in the hope that, thinking himself safe from exposure, he would answer ambiguously : but he disconcerted his enemies by declaring thifc the disoase was cancer of the larynx. The remainder of the book is devoted to controversial topics and statistical matters which will interest scarcely any but professional men.