I have recently found myself with a bit more free time on my hands due to an attack of acute appendicitis and a consequent appendectomy. In these days appendectomies are typically quick, routine surgeries that involve fairly easy recoveries for most patients (as mine has been). However, surgery to relieve appendicitis is a relatively new treatment that has been practiced regularly for only about the past 100 years – previous sufferers of appendicitis typically died of sepsis.
One of the most famous (and at the time controversial) surgeries for appendicitis occurred in the United Kingdom in 1902. After spending more than 59 years as the Prince of Wales, Albert Edward, the eldest son of Queen Victoria, would be beginning his own rule as Edward VII. What occurred a few months into Edward’s reign changed the course of medical and legal history in surprising ways.
Edward had been king for a few months when a brilliant coronation ceremony was meticulously planned for June 26, 1902, at Westminster Abbey. Having spent nearly sixty years in pursuit of the finer things in life, Edward had had plenty of time to consider exactly how large of a celebration his coronation would entail. Several thousand pounds of fowl were ordered for the banquet, viewing stands were constructed along the parade route, and numerous hotels were built to accommodate the influx of expected guests to London.
While Edward was focused on the details of his coronation, his body had other plans. In the two weeks preceding the coronation, Edward had recurrent abdominal pain accompanied by a fever. After being examined by several members of his medical staff, Frederick Treves (once a physician for Joseph Merrick, otherwise known as the Elephant Man), Edward’s accomplished and newly-appointed Sergeant-Surgeon was summoned for his opinion.
Dr. Frederick Treves. Photo credit: Wikipedia
By the time Treves first examined Edward on June 18, Edward was running a constant fever and had developed a mass in the lower right quadrant of his abdomen. For his part, Edward was eager to resume his activities and was annoyed at the thought of rumors of his illness circulating. Edward’s private secretary, Sir Francis Knollys, quickly issued a report denying any problems with Edward’s health.
Although Edward was feeling well enough to attend a lavish banquet on June 23, he was confined to bed the following day with a high fever and intense pain. After another examination of the King, the medical team concluded that Edward was suffering from appendicitis and required immediate surgery.
The regrettable timing aside, Edward was incredibly fortunate to have appendicitis while in the care of Dr. Treves. Although not the first to perform an appendectomy, Treves first did surgery on a patient with recurrent appendicitis in 1888. After the successful surgery, Treves authored a paper presented to the Royal Medical and Surgical Society a few months later recommending the removal of appendices in similar cases. Although his recommendation was not well-received by the medical community, by the turn of the 20th century he had removed more than one thousand appendices.
Insisting on fulfilling his duty, Edward rejected his doctors’ planned course of action. He continued to refuse surgery until Treves bluntly pointed out that Edward would be dead before the coronation took place. This approach seemed to work on Edward as he finally agreed to the surgery – and the coronation was officially postponed until further notice.
Shortly after noon on June 24, the abscess in Edward’s abdomen was drained, irrigated, packed with gauze, and fitted with rubber tubing to allow additional pus to escape. The operation took about an hour and a half. Edward started to choke during the operation, but the team managed to get the King to breathe again by pulling on his beard, thus opening his mouth.
Edward’s appendix was actually not removed, but the draining and cleaning of the abscess prevented further illness. On the following day, Edward was able to sit up in bed and smoke a cigar and within two weeks, it was clear that the King would make a full recovery. The medical team (including Treves) was awarded knighthoods for their actions and authored numerous articles that described the King’s illness and treatment.
Most rejoiced at the King’s miraculous recovery, particularly those in the East End poorhouses who received the thousands of chickens, quails, and game hens intended for the coronation banquet. However, the cancelled coronation took its toll on those contracted to provide supplies, services, and payment for venues booked. A number of so-called “coronation cases” were decided in the British courts surrounding the contracts broken due to the cancellation.
Most of these contracts were voided as the arrangements were typically made with the sole purpose of celebrating the coronation. However, in the case of Herne Bay Steamboat Company vs. Hutton, it was ruled that a river cruise could be booked and enjoyed regardless of whether the coronation was held. Mr. Hutton was one of the few coronation case plaintiffs who were ordered to provide full payment as agreed by contract.
A more scaled-down coronation for Edward was held on August 9. While the practice of surgical intervention for appendicitis gained acceptance from one of its most famous patients, its adoption was not universal nor were the symptoms of appendicitis yet fully recognized. Shortly before Edward’s operation, Treves’ own daughter Hattie died of a ruptured appendix. Edward’s nephew Christian of Hanover had died from appendicitis that was incorrectly diagnosed a few months before. And in a final twist of irony, Frederick Treves himself died of peritonitis in Switzerland in 1923. An autopsy was not performed, but the culprit was assumed to be a ruptured appendix.
There is no word yet on the new date for my coronation.
