The Case of Frederick the Noble; Felix Semon’s Letters to Nikolaus Heinrich Herbert, Count von Bismarck, State Secretary of the Foreign Office

Review by John Riddington Young
North Devon, UK

The story of Morell Mackenzie and his involvement in a bitter international controversy over the death of the Kaiser has been called ‘the most important and eventful case in the history of medicine’. The Crown Prince of Germany had been diagnosed by the Prussian specialists as having laryngeal cancer; they told him that the only treatment was surgery. Laryngectomies had been conducted since 1873, but survival rates were dire (6 per cent). Mackenzie disagreed with the Prussians. He insisted that the disease was not histologically malignant and that such a potentially fatal operation was therefore unnecessary. Ironically, he had based this opinion on a biopsy report by the world-renowned German pathologist, Rudolf Virchow. Mackenzie’s advice was followed and initially the Prince fared well. Further biopsy reports from Virchow were favourable, and the Prince acceded to the Imperial Throne and became Kaiser. The following year, he died from throat cancer. Mackenzie’s advice based on Virchow’s report had gone awry.

The Germans published a vilifying report blaming Mackenzie for the death. Mackenzie then wrote a short, bestselling book explaining the case, and was chastised by the Royal College and the General Medical Council for advertising.

The consequences of the case were profound. ‘Kaiser Fritz’ had hated war, and his successor, ‘Kaiser Bill’, was an unpleasant warmonger, who openly blamed his brother’s death on ‘the British’. Mackenzie has therefore been blamed for the Great War (and ergo the Russian Revolution, World War II and possibly even the Cold War). Much has been written on the matter, by both the British and Germans, most of which is extremely biased. It is impossible therefore to get an unimpassioned view of the true events.

Mackenzie’s own book, The Fatal Illness of Frederick the Noble (1888), is beautifully written and eminently readable. A reprint in 1987 had a Foreword by Harold Ludman, who gives a contemporary view. The Foreword says, ‘…the Crown Prince was very wise to decline excision of his larynx in 1887’. Books and articles surface from time to time, including the French text by De Bonnefon, the title of which translates as ‘Imperial Drama. What must not be mentioned in Berlin’, suggesting that the disease was not cancer but syphilis (acquired in 1869 in Suez).

Wolfgang Pirsig and Rob Ruben have really struck gold with this new find however! Lurking in a Prussian library for 130 years, they found letters from Sir Felix Semon to Count von Bismarck, German Foreign Secretary. They are marked ‘Highly Confidential!’ Semon was a Prussian, but naturalised British. He went to school with von Bismarck and hated Mackenzie. He refers to the patient as ‘our Crown Prince’, and in one letter says, ‘The English fog has clouded this sad case’. The letters, which make wonderful reading, imply right from the beginning that Mackenzie advises a conservative approach to milk money out of Fritz by increasing his own continuing consultation fees. At times, they are little short of a breathless paranoid rant of ‘national spite and hatred’ (Semon’s own words), but I cannot remember enjoying a book so much for a long time.

I recommend, however, that you read Mackenzie’s book first.