Frederick Treve's first surgical operation for appendicitis

191

Frederick Treve’s first surgical

operation for appendicitis

Manoj Ramachandran1 • Jeffrey K Aronson2

1St Bartholomew’s and the Royal London Hospitals, Barts and the London NHS Trust, UK

2Department of Primary Health Care, Rosemary Rue Building, Old Road Campus, Oxford, UK

Correspondence to: Manoj Ramachandran. Email: [email protected]

Sir Frederick Treves, baronet (1853–1923), surgeonand author, was born at 108 Cornhill, Dorchester,

Dorset, on 15 February 1853, the youngest son of

William Treves, an upholsterer, and his wife,Jane (1814–1892). He attended Dorchester

Grammar School and then Merchant Taylors’

School in the City of London. He read medicineat the London Hospital, where, among others,

John Hughlings Jackson and Jonathan Hutchinson

taught him. In 1875 he qualified as a Member ofthe Royal College of Surgeons, having in the pre-

vious year become a Licentiate of the Society of

Apothecaries. After a job as House Surgeon atthe London Hospital, he became Resident

Medical Officer at the Royal National Hospital

for Scrofula (later the Royal Sea Bathing Hospital)at Margate in 1876, to which his brother William

(Frederick’s senior by 10 years) was Honorary

Surgeon. His research on scrofula, the origin ofwhich puzzled him, would be published as a

book entitled Scrofula and its Gland Diseases in

1882, the very same year that Robert Koch demon-strated that it was due to a bacillus.

Treves went into practice in Wirksworth, Der-

byshire, having married Anne Elizabeth Masonin 1877, with whom he had two daughters. He

passed the Fellowship of the Royal College of Sur-

geons in 1878 and in the following year gave uppractice in Derbyshire to return to the London

Hospital as Surgical Registrar. He was appointed

Assistant Surgeon in September 1879 andbecame Full Surgeon in 1884, at 31 years of age.

He became a Demonstrator of Anatomy in the

medical school attached to the London Hospitaland built up a reputation as a teacher and writer

and a leading surgeon. His consulting room at 6

Wimpole Street became one of the most popularin England.

In 1883 the Royal College of Surgeons, of which

he was one of the Hunterian professors of

anatomy in 1885 and Erasmus Wilson Lecturer inPathology in 1881, awarded him the Jacksonian

prize for a dissertation on ‘The pathology, diagno-

sis and treatment of obstruction of the intestine’(1884). Treves had a particular interest in the con-

dition known as perityphlitis. He operated on his

DECLARATIONS

Competing interests

None declared

Funding

None

Ethical approval

Not applicable

Guarantor

MR

Contributorship

Both authors

contributed equally

Acknowledgements

This paper was

originally published

as Chapter 21 of

Doctoring History by

Manoj

Ramachandran and

Jeffrey K Aronson,

published by the

Royal Society of

Medicine Press in

2010

J R Soc Med 2011: 104: 191–197. DOI 10.1258/jrsm.2010.10k055

SERIES

by guest on February 4, 2016jrs.sagepub.comDownloaded from

http://jrs.sagepub.com/

first case on 16 February 1887, and later read areport to the Society, as reproduced here. He advo-

cated the operative treatment of appendicitis,

although he advocated delaying surgery until aquiescent interval had been reached. Note that in

this first operation, Treves did not in fact remove

the appendix; he merely straightened out a kinkand then closed the abdomen,1 though his practice

soon changed to the removal of appendices. After

The Philadelphia Medical News published a reportby Thomas George Morton, who had excised a

partially perforated appendix on 27 April 1887,

Treves wrote the following letter to the journal,published on 5 November 18922:

“I have just read with interest a leading article in the

Medical News for August 6 on the matter of operat-

ive treatment of the vermiform appendix. The fact

that I live in a remote island, and further that a

holiday of 2 months has taken me away from the

haunts of books, must explain this tardy allusion

to that paper.

“The article discusses the origin of the operation

for removing the vermiform appendix, and it is

stated that to Dr Thomas G. Morton belongs the

credit of first devising this procedure; the suggestion

is also made that the operation should be called

‘Morton’s operation,’ and it is asserted that

Morton’s operation embodies one of the most impor-

tant and radical advances of modern surgery. Dr

Morton thus becomes the founder of what will, I

suppose, be known as ‘Appendiceal Surgery,’

should the present love for ridiculous terms survive.

“I gather that Dr Morton’s first operation was

performed in 1888, and was reported in the Philadel-

phia County Society’s Transactions for that year.

The nature of the transaction is not stated. Who

first excised the appendix some musty and forgotten

tome will no doubt reveal in the course of time … In

1886 a patient with relapsing typhlitis came under

my care at the London Hospital, and after due con-

sideration, I proposed to ‘deliberately seek for and

remove his appendix.’ I operated on him during a

period of apparent health, on February 16, 1887,

and was able to correct the distortion of the appendix

without removing it. He made a perfect recovery. On

September 19, 1887, I brought the matter before the

Royal Medical and Surgical Society. The paper was

read in February, 1888. I advised the treatment of

selected cases of relapsing typhlitis by the deliberate

removal of the offending appendix during a quies-

cent period. The proposal was not well received. In

due course, however, an exuberant reaction took

place, and of late appendices have been removed

with a needless and illogical recklessness which

has brought this little branch of surgery into well-

merited disrepute.

“Discussions on questions of priority constitute

the most pitiable and petty items in the literature

of medicine. The object of [this] letter is merely to

bring up from oblivion an unpretending paper

which lies buried in the annals of an ancient society.

Believe me to remain, yours faithfully,

FREDERICK TREVES”


Journal of the Royal Society of Medicine

192 by guest on February 4, 2016jrs.sagepub.comDownloaded from


In his account of a case of relapsing typhlitis

treated by operation, Treves wrote that the terms‘typhlitis’, ‘perityphlitis’, and ‘paratyphlitis’

meant much the same, namely “an inflammation

in the vicinity of the caecum”. However, hepointed out that the term ‘typhlitis’, implying

inflammation of the caecum, was usually a misno-

mer, since it was inflammation of the vermiformappendix that was important. He had presumably

not read a paper by the American pathologist R.H.

(Reginald Heber) Fitz that had been published in1886 in the American Journal of Medical Sciences,

in which he wrote that “As a circumscribed perito-

nitis is simply one event … in the history ofinflammation of the appendix, it seems preferable

to use the term appendicitis to express the primary

condition.”3 It has been said that when James

Murray proposed including the word ‘appendici-tis’ in the New English Dictionary (later to be called

the Oxford English Dictionary) he was dissuaded

from doing so by the Regius Professor of Medicineat Oxford, William Osler, who said that the word

was medical jargon and would not last.

However, the word would have appeared in thesecond fascicle, Ant–Batten, which was published

in November 1885, so this story seems doubtful.

The word was included in the first supplementto the dictionary, which was published in 1933.

Treves himself inveighed against the term: “One

knows that the academical-minded have a greatobjection to this uncouth term ‘appendicitis’; it

lacks precision, but it has found its place in the


Frederick Treve’s first surgical operation for appendicitis



clumsy nomenclature of medicine, and has beenaccepted by the public with an extraordinary

amount of generosity”.4

Treves retired from the active staff of theLondon Hospital in 1898 at the age of 45,

primarily as a result of his extensive private

practice. In 1899, on the outbreak of war inSouth Africa, he volunteered to serve as Consult-

ing Surgeon in the Boer War, and on his return to

England was appointed Surgeon-Extraordinaryto Queen Victoria in 1900. In 1900 Treves pub-

lished an account of his experiences of the

South African War, under the title The Tale of a

Field Hospital. He was made Companion of the

Most Honourable Order of the Bath and Knight

Commander of the Royal Victorian Order in

1901. Many further honours were conferred

upon him in his lifetime; for example, he was

appointed Sergeant-Surgeon to Edward VII(1902) and to George V (1910), and created

Knight Grand Cross of the Royal Victorian

Order (1905).On 24 June 1902, 2 days before the date fixed for

his coronation, Edward VII became acutely ill with

perityphlitis. His physicians in attendance calledfor Treves and, after consultation with Lord

Lister and Thomas Smith, he operated to drain

the abscess. The king protested, “I must go theAbbey,” but Treves was adamant: “Then Sire,

you will go as a corpse.” The king made a good

recovery and was crowned on 9 August. Trevesbecame known worldwide and was created a





baronet in the same year. By 1901, Treves had

removed a thousand appendices. Yet appendicitisthat progressed to peritonitis claimed Treves’

daughter Hetty in 1900, despite his belated surgi-

cal intervention.Treves has also found fame for the case of

Joseph Carey Merrick (1862–90), better known as

the Elephant Man. Merrick was disfigured by acongenital condition that until recently was

thought to have been due to neurofibromatosis,

but was probably Proteus syndrome.5 He hadbeen exhibited as a freak in an empty shop oppo-

site the London Hospital in Whitechapel Road by

Tom Norman, an entrepreneur acting as his agent.Treves was appalled by Merrick’s treatment, and

after meeting him presented Merrick to the

London Pathological Society at 53 Berners Street,

Bloomsbury, on 2 December 1884. When Merrick

returned penniless in 1886 after touring Europe,Treves took him into a vacant room in the

London Hospital in Bedstead Square and treated

him for exhaustion, malnutrition, and bronchitis,overseeing his treatment and spending time

getting to know him. When Merrick died in

1890, his remains were cast in plaster, specimenswere taken, and Treves dissected the body. The

remains are on display at the Royal LondonHospi-

tal Museum. Treves’ account of the case of JosephMerrick, The Elephant Man and Other Reminiscences,

was published in 1923.

After the First World War, during which heserved at the War Office as President of the





headquarters’ medical board, Treves moved toLake Geneva in Switzerland with his family.

He died at the Clinique de Rosemont in Lau-

sanne on 7 December 1923, most probably fromperitonitis. His ashes were buried on 2 January

1924 in the cemetery of St Peter’s Church,

Dorchester. His friend, Thomas Hardy, whochose the hymns, attended the ceremony and

later wrote a poem for the occasion published

in The Times, titled In the Evening. In Memoriam

Frederici Treves, 1853–1923 (Dorchester Ceme-

tery, 2 January 1924):

In the evening, when the world knew he was dead,He lay amid the dust and hoar

Of ages; and to a spirit attending said:

“This chalky bed? –

I surely seem to have been here before?”

“O yes. You have been here. You knew the place,

Substanced as you, long ere your call;

And if you cared to do so you might trace

In this gray space

Your being, and the being of men all.”

Thereto said he: “Then why was I called away?

I knew no trouble or discontent:

Why did I not prolong my ancient stay

Herein for aye?”

The spirit shook its head. “None knows: you went.

“And though, perhaps, Time did not sign to you

The need to go, dream-vision sees

How Aesculapius’ phantom hither flew,

With Galen’s, too,And his of Cos – plague-proof Hippocrates,

“And beckoned you forth, whose skill had

read as theirs,Maybe, had Science chanced to spell

In their day, modern modes to stem despairs

That mankind bears! …

Enough. You have returned. And all is well.”

Eponyms associated withFrederick Treves

Treves’ folds: two inconstant folds of peritoneumTreves’ ileocaecal fold: an ileocaecal fold of

peritoneum associated with the appendix

Selected bibliography by FrederickTreves

Scrofula and its Gland Diseases (1882)

Surgical Applied Anatomy (1883; 7th edition, 1918)Intestinal Obstructions (1884)

A Manual of Surgery (1886)

A German–English Dictionary of Medical Terms, with

H. Lang (1890)

A Manual of Operative Surgery (2 volumes, 1891)

The Student’s Handbook of Surgical Operations (1892;5th edition, 1930)

A System of Surgery (2 volumes, 1895)

The Tale of a Field Hospital (1900)The Other Side of the Lantern (1905)

Highways and Byways of Dorset (1906)

The Cradle of the Deep (1908)Uganda for a Holiday (1910)

The Land that is Desolate (1912)

The Country of ‘The Ring and the Book’ (1913)Riviera of the Corniche Road (1921)

The Lake of Geneva (1922)

The Elephant Man and Other Reminiscences (1923)





References

1 Gibbs DD. Sir Frederick Treves: surgeon, author andmedicalhistorian. J R Soc Med 1992;85:565–9

2 Mirilas P, Skandalakis JE. Not just an appendix: Sir FrederickTreves. Arch Dis Child 2003;88:549–52

3 Fitz RH. Perforating inflammation of the

vermiform appendix; with special reference to

its early diagnosis and treatment. Am J Med Sci

1886;92:321–45

4 Treves F. The Cavendish Lecture on some

phases of inflammation of the appendix. Br Med J

1902;1:1589–94

5 Tibbles JA, Cohen MM Jr. The Proteussyndrome: the Elephant Man diagnosed. Br Med J

1986;293:683–5





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