William Boyd - Bamboo - Essays and Criticism

Treves was credited with saving the King’s life (and was duly made a baronet) yet there is a school of thought which would allege that in fact he needlessly endangered it. His insistence on waiting for some days before operating, his surgical intervention occurring finally when the King was in extremis and then his decision not to remove the appendix and only to drain the abscess were in line with prevailing medical orthodoxies. But they were far from being unchallenged orthodoxies, even in 1902. Indeed there was a consensus of well-informed medical opinion and overwhelming evidence that indicated that the swift removal of the appendix was the only truly successful method of treating these abdominal inflammations. Each of Treves’s decisions could have resulted in King Edward’s death: the delay and the reliance on opium could have caused the abscess to rupture; the tendency to operate only at the last minute often provoked peritonitis rather than relieved it, or was so late as to be redundant; and to leave the remains of the ulcerated appendix in the wound and to rely on chance that it would heal properly can be argued, with even a little hindsight, to be instances of malpractice.

Why was Treves, who throughout his career was such an innovator, such an advancer of surgical practice, so remiss when it came to the saving of his sovereign’s life? The answer lies, I would suggest, in a curious blend of xenophobia, vanity and shameful remorse.

In 1888 Frederick Treves removed a vermiform appendix and laid claim to be the first man in Britain to do so. However there is no doubt that the honour in discovering that the appendix was the root of so many abdominal inflammations went to American surgeons. Treves, for all his pioneering work, was an also-ran and his substantial ego was unhappy with this state of affairs. He then sought repeatedly to denigrate all the American advances in this field using every resource of patronizing mockery and pompous cynicism at his disposal. His disappointed vanity led him uncharacteristically to adopt the most conservative of approaches in this area of his expertise. Most surprisingly for a surgeon, as Trombley observes, Treves did not advocate surgery. His preferred method of treating “perityphlitis” was by medical means — bed rest and opiates. His wil-fulness was to have tragic consequences.

In 1900, Treves’s daughter Hetty, aged eighteen, fell ill with abdominal pain. Treves did not diagnose appendicitis. Hetty became iller and iller, feverish and vomiting. For some reason Treves refused to see what was happening. Eventually, inexorably, other symptoms appeared that indicated that, as a result of her father’s delay, Hetty had contracted peritonitis. Treves decided to operate but two colleagues persuaded him that it was pointless. Hetty died in great physical distress.

It is almost impossible to imagine Treves’s feelings at this time and he never spoke of the enormous grief and guilt he must have felt. Yet he did write about it, obliquely. In 1923, the year he died, Treves published a curious story called “The Idol with Hands of Clay.” It tells the story of a young surgeon who, so convinced of his own mastery of his craft, decides to operate on his own wife when she falls ill with appendicitis. During the operation he makes a fatal mistake and his wife falls into a coma, the surgeon struggles to save her and yet is unable to do so and she dies in his arms. Some glimpse of Treves’s response to his own tragedy is made available here:

[The surgeon] caught a sight of himself in the glass. His face was smeared with blood. He looked inhuman and unrecognizable. It was not himself he saw: it was a murderer with the mark of Cain upon his brow. He looked again at her handkerchief on the ground. It was the last thing her hand had closed upon. It was a piece of her lying amidst this scene of unspeakable horror. It was like some ghastly item of evidence in a murder story. He could not touch it. He could not look at it. He covered it with a towel.

And yet this terrifying object lesson made him an even stauncher opponent of the new advances being made in America. By ironic happenstance, a few days before he operated on Edward VII, Treves gave a lecture on appendicitis in Hammersmith Town Hall, a talk which was a sneering exemplar of his contempt for the American surgeons as well as being both patently wrong and purblind about medical matters. He stated with arrogant confidence that “The very great majority of all cases of appendicitis get well spontaneously … [another fact] which I think should be emphasised as strongly as the last one, is this: operation during an acute attack of appendicitis is attended with great risk to life.”

Four days later, the man who held these opinions had to operate on his king.

Treves was very lucky. Edward VII was even luckier, and no thanks to his sergeant-surgeon. Treves’s hubris, negligence or wilful obstinacy had caused the death of his daughter. That same wilful obstinacy could easily have caused the death of Edward VII. It is intriguing to speculate what the course of the nation’s history, and perhaps Europe’s history, might have been if George V had come to the throne in 1902 instead of 1910.

In Treves’s case, however, the analysis is not so speculative. The death of his daughter, as the story demonstrates, shocked him terribly. In such a situation what could he have done? To admit all his thinking and public statements about appendicitis were wrong would be to compound the guilt unbearably. The only way I can understand this aberrant behaviour in an otherwise innovatory and brilliant surgeon is that for Treves so doggedly to persist with his old discredited theories, to continue to think he was right and the Americans were wrong, allowed him to live with himself more easily; the more he scoffed and sneered the more it allowed him to see his daughter’s death as a tragedy and not as something of which he was directly culpable. More relevantly, when the same set of symptoms recurred in his monarch, for Treves then to advocate the swift removal of the royal appendix would also have been a tacit admission of the fatal misdiagnosis of his daughter, just two years earlier. Because of his personal grief, the barely admitted guilt he felt, Treves had to recommend bed rest and opiates to his dangerously ill king. He nearly got away with it. The remission of 21, 22 and 23 June seemed to bear out everything he had said in the Hammersmith lecture. But when the pain and the vomiting returned Treves had to contradict his own best medical advice and undertake an operation during an acute attack of appendicitis. But even then he could not go all the way and remove Edward’s appendix. The ruined vestigial organ was left in the King’s body, almost, one might say, as a small symbolic gesture of medical defiance — the final act of a man who could not admit he had been wrong.

1994

During a stormy night in the middle of World War Two — Wednesday, 7 July 1943—in Nassau, in the Bahamas, a multi-millionaire called Sir Harry Oakes was murdered in his bedroom. The cause of death was a blow to the head by some sort of spiked weapon or club causing four circular wounds an inch deep and a quarter inch in diameter. Shortly after, an attempt was made to set the victim on fire. Petrol was doused on the body and bedclothes and lit. The murderer — or murderers — then left, but the fire did not take. A house guest discovered the badly scorched corpse before breakfast the next day.

During the 1980s I visited the Bahamas on many occasions and heard all sorts of lurid tales about the Oakes murder — tales embellished with rumours of currency speculation, sexual innuendo, Mafia gangsters and millionaire Nazi sympathizers. I decided to feature the murder as an episode in a new novel to see if I could elucidate the mystery and began to read everything I could find on the subject. The truth, as far as I can determine, is more banal, but, in a way, no less sinister.