Picture the situation. It is 1935: you are an ageing, not particularly attractive American woman in a loveless marriage to a portly and dull businessman. You are having a passionate love affair with the world’s most eligible bachelor, the Prince of Wales, the future King of England. You have just been on a luxurious Mediterranean cruise and holiday with your lover. You are at the very pinnacle of high society: the prince’s terribly smart and aristocratic friends are suddenly your friends. After a difficult and rackety life and two husbands you find yourself breathing the rarefied air of a world you could only have dreamed about. Outside royal and political circles no one in Britain knows of the affair nor of the Prince of Wales’s obsession for you (you have helped him overcome his “sexual difficulty”). So do you pop off to Bruton Street, W1 for some clandestine sex with a Ford Motor Company salesman, however handsome and dashing? Whatever Mrs Simpson was doing when she visited Guy Trundle — if indeed she ever did — it wasn’t to have sex with him. Duff Cooper — one of the Prince’s inner circle and one who had no axe to grind — came up with an assessment that seems to me to be completely valid and true: Wallis Simpson, he thought, “is a nice woman and a sensible woman,” and he concluded, “but she is as hard as nails and doesn’t love him.” She didn’t love him but I believe she remained true to him, in her way, and lived up to the demands her role as his wife required of her — until, that is, she met Jimmy Donahue.
2003
Edward VII and Frederick Treves
On 13 June 1902 Edward VII had under a fortnight to wait until his coronation. On that day the King travelled from Buckingham Palace to Aldershot to review a parade of troops. He did not feel well and it was observed that his normally florid complexion was blanched and drawn. By the 14th he was complaining of pains in the abdomen and nausea. Edward was a prodigious eater and drinker and his personal physician, Sir Francis Laking, suspected that these symptoms were the familiar ones brought on by His Majesty’s compulsive over-indulgence. He prescribed a laxative and confidently expected matters to resolve themselves naturally. It was not to be. On the night of the 14th the King suffered violent spasms of abdominal pain and repeated vomiting. Laking called in an eminent surgeon for consultation, Sir Thomas Barlow. The two men feared the worst: King Edward VII was afflicted with perityphlitis.
Perityphlitis is one of the forgotten names in the medical lexicon. It was used to refer to the mysterious and inevitably fatal “abdominal affections of the right side” that had been killing people for thousands of years. The cause was obscure but the symptoms were remorseless: abdominal pain, followed by vomiting, fever, intestinal inflammation and ultimately death from general peritonitis — the inflammation and corruption of the serous membrane which lines the stomach cavity. The disease was a potent killer: in 1856 one study showed that out of forty-seven cases of perityphlitis only one survived. Over the years countless victims’ corpses had been dissected and their innards poked about and pored over but it wasn’t until 1812 that a surgeon suggested that this fatal inflammation of the stomach cavity may be caused by an initial inflammation of the vermiform appendix, a small worm-shaped attachment of the blind gut.
“Appendicitis,” as the disease came to be known towards the end of the nineteenth century, was very much an American appellation. American surgeons, in particular McBurney and Fitz, were in the vanguard of the treatment of the disease. Unlike surgeons in Europe, they advocated the earliest possible removal of the appendix as soon as the symptoms appeared. In Europe this was regarded as modish, not to say perverse, nonsense. If, in the nineteenth century, as a European, you were afflicted with appendicitis you would be dosed with opium and purgatives and it would be hoped the problem would disappear of its own accord. If not, and if an abscess appeared around the appendix and grew as it filled with pus, it would be hoped that a natural process of capsulation would then occur that would seal off the abscess from the abdominal cavity. The argument ran that the American method of early intervention created greater risks of general infection: it was too precipitate, better to wait until capsulation had occurred and then drain off the offensive matter. There was no greater advocate of this procedure, and no greater sceptic of the American way, than Britain’s most eminent surgeon, Frederick Treves, and it was he who was now called to the King’s bedside.
Frederick Treves (1853–1923) was a self-made man, the son of a cabinet maker who had risen to the heights of the medical profession. In 1902 he was internationally recognized as a brilliant surgeon and the authority on diseases of the abdomen and gut. He was a prolific writer and his medical textbooks were in standard use. More than this, he was a friend and confidant of King Edward and Queen Alexandra and was sergeant-surgeon to the monarch from 1901. Additional renown had accrued in the 1880s over his care and handling of Joseph Merrick, the so-called “Elephant Man.” It was Treves who formulated the adage that a good surgeon needs “a lacemaker’s fingers and a seaman’s grip.” He might have added that, in what we now recognize as the dawn of modern surgery, a good surgeon also required an adamantine ego and an unswervable ambition. Treves possessed all these attributes and in the small world of Edwardian medicine he guarded his pre-eminence jealously.
Treves was called to Windsor on the 18th where he confirmed the earlier diagnosis of perityphlitis. True to his own methods he proposed waiting a while before operating to ensure that the capsulation should be completed. Treves visited the King daily and then, on the 21st, an improvement was observed. The King’s temperature dropped and the abdominal swelling appeared to go down and he felt well enough to travel to London. The coronation, set for the 26th, seemed likely to take place as planned, the abdominal pains apparently cured by the traditional doses of opium. But on the afternoon of the 23rd the pain returned and with it fever and repeated vomiting. The remission had been short and it was decided that an operation should take place on the morning of the 24th. Treves was to act as surgeon; also present were Laking, Lord Lister and surgeons Barlow and Smith.
Edward VII was grossly corpulent — his waist measurement was forty-eight inches — and Treves had to cut to a depth of almost five inches before he found the abscess, fortunately still encapsulated, surrounding the remains of an almost completely destroyed appendix. Treves then cut into the abscess and the pus was discharged. The resulting cavity was cleaned and two rubber drainage tubes were inserted. The wound was dressed with ideoform gauze. As Treves’s biographer Stephen Trombley* comments, “Contrary to contemporary reports and current misinformation, Treves did not remove the King’s appendix. The belief that Treves and the King combined to make appendicitis ‘fashionable’ is ill-founded.”
Treves deliberately did not remove the appendix and he would have been appalled to think that he had done anything to popularize “appendicitis.” But the fact is that Treves took a massive risk in proceeding the way he did and in not removing the appendix. It was now vital that the wound cavity close of its own accord, but from the bottom up, as it were. Any other form of healing might give rise to a sinus which could provoke other complications. The few days or so after the operation were anxious ones as the surgeons and doctors waited apprehensively for any sign of the symptoms of general peritonitis. Luckily for them King Edward made a good recovery and by mid July was fit enough to convalesce for three weeks on the royal yacht. The coronation eventually took place on 9 August.