The surgeons of Vanity Fair: Sir Morrell MacKenzie

Sir Morell MacKenzie was Vanity Fair’s ‘Man of the Day’, No. 387: his caricature, entitled Disease of the Throat, the work of Carlo Pellegrini, ‘Ape’, appeared on 15 October 1887.

Vanity Fair noted that he, ‘took to looking down people’s throats for guineas. His success in private practice was great and immediate, and in a few years after setting up, he could give to physicians who had been established a lifetime, a score of patients and a beating. He became a specialist. Sir Morell has long been the physician and friend of all singers and actors.’

Morell descended from the Highlands Scottish family of MacKenzie in Rossshire: his father was Dr Stephen McKenzie, a general practitioner in Leytonstone, Essex, then a country village on the edge of London.

Born on 7 July 1837, the eldest of eight children, Morell proved to be a delicate child. He was earnest and reflective, and his early education was interrupted by illness. At 14, Morrell was called out of school and taken home to find his father dead: his father had been thrown from his gig while visiting patients, never regaining consciousness.

At 16, Morrell MacKenzie became a clerk in the City of London, still dreaming of entering the medical profession and attending evening classes in natural history and chemistry at King’s College. His maternal aunt lent him money for his fees, and he enrolled as a medical student at the London Hospital where subsequently he was described as one of its most distinguished pupils, winning the Senior Gold Medals for Surgery and Clinical Medicine.

In 1858, MacKenzie took the then usual examinations for ‘College and Hall’ diplomas, Membership of the Royal College of Surgeons (MRCS) and Licentiate of the Society of Apothecaries (LSA). On qualifying, he was appointed House Surgeon at the London Hospital.

Again, assisted by his aunt, he spent a year in Paris followed by a year in Vienna and Budapest. In 1859, fate intervened when he encountered Professor Johann Czermak, and the laryngoscope, invented by Manuel Garcia in 1855.

From that time MacKenzie specialised, proposing a hospital for Diseases of the Throat. Sir James Paget declared that he might as well found a Hospital for Diseases of the Great Toe. The laryngoscope was ridiculed as a toy, declared to be useless, and The Lancet observed, ‘without its use, throat diseases were perfectly well treated by every general hospital in London’.

Singing and public speaking interested MacKenzie, who said, “without an artistic enunciation sound loses one of its greatest charms”. He published his lectures to doctors in the form of pamphlets, such as the 1863, On the Treatment of Hoarseness and Loss of Voice.

The correct practice then, as now, was for a consultant to see only such patients as were referred to him by another doctor and not to retain them as his own patients. MacKenzie, however, had no qualms in accepting and treating the numerous patients who came to him directly, in addition to accepting medical referrals, which explains some of the British medical profession’s antipathy towards him.

In 1862, he founded the free dispensary for ‘Diseases of the Throat and Loss of Voice’, which in 1865 moved to larger premises in Golden Square, previously the London Homeopathic Hospital. MacKenzie renamed it ‘The Hospital for Diseases of the Throat’. In 10 years, it treated almost 38,000 outpatients and 949 inpatients. It also achieved a reputation for postgraduate teaching unsurpassed in Europe, involving more than 2300 medical graduates.

In 1863, he married Miss Margaret Bouch, who was to become the mother of two sons and three daughters. In 1864, he passed the examination for Membership of the Royal College of Physicians (MRCP).

Morell MacKenzie’s first book, The Use of the Laryngoscope in Diseases of the Throat, was published in 1865. This was later followed by the two volumes of Diseases of the Throat and Nose. The first volume was published in 1880 and the second in 1884.

In 1870, aged 33, MacKenzie moved to 19 Harley Street, where on the ground floor there were consulting rooms, a laboratory and dispensary, and a huge waiting room. On the first floor, drawing rooms stretched right across the house; MacKenzie said to his wife, “My dear, now you have a new duty in life, fill these rooms!” The couple soon became known for dinner parties attended by the most famous actors and opera singers of the day, although MacKenzie was seldom present.

MacKenzie’s medical practice in the 70s and 80s was said to be the largest in the world. By the 1880s, he was earning upwards of £15,000 a year. His usual fee was two guineas, operations were infrequent and on a minor scale.

MacKenzie dictated all his correspondence to his amanuensis, and although he purchased one of the first typewriters to cross the Atlantic, this was soon abandoned, due to patients’ complaints regarding the ‘impersonal appearance’ of typescript.

At the 1884 International Congress of Medicine in Copenhagen, MacKenzie was elected President of the Inaugural Section of Laryngology.

The Crown Prince Frederick

On 18 May 1887, MacKenzie received a message requesting that he proceed to Berlin urgently, to see His Imperial Highness Frederick, the Crown Prince of Germany, reason unspecified. On his arrival, the German medical staff, none of whom were laryngologists, submitted that the Prince had throat cancer and required an immediate laryngectomy.

MacKenzie’s laryngoscope next confirmed a tumour involving the left vocal cord. However, in an early example of evidence-based medicine, he insisted on confirmatory histopathology. On three occasions MacKenzie resected as much of the tumour as he could, however, each time the eminent pathologist, Professor Rudolf Virchow, opined that the tissue obtained contained no neoplastic element.

A month later, Frederick attended the London celebrations for the Golden Jubilee of his mother-in-law, Queen Victoria: MacKenzie was knighted in September of that year by the Queen for his services to medicine and Frederick.

Frederick the Noble Fig. 21, c) tracheostomy d) false passage e) pre-sternal abscess

However, the tumour continued to grow, and either a tuberculous or syphilitic aetiology was also queried, the latter favoured. In February 1888, Frederick almost died of asphyxia and an urgent tracheostomy was undertaken by an inexperienced German surgeon. Subsequently there were many problems with management of the cannula, culminating with the digital formation of a false passage resulting in a pre-tracheal abscess.

The unfortunate Frederick died on 15 June 1888, with MacKenzie observing, ‘thus passed away the noblest specimen of humanity it has ever been my privilege to know’. The autopsy confirmed cancer.

Frederick the Noble, bookcase

Over this period there had been great antagonism between MacKenzie and his German ‘colleagues’: MacKenzie recorded his account of the case in 1880 with The Fatal Illness of Frederick the Noble, which not only created a sensation but was condemned by MacKenzie’s many British

critics and earned him the censure of the Royal College of Physicians.

Between 1888 and 1892, MacKenzie fell easy prey to various illnesses, including influenza and his old enemy, asthma. He passed his nights dozing in a sitting posture and his sleep was always broken: his former exuberant energy disappeared.

Ape caricature Disease of the Throat, 15 October 1887

He died suddenly at just 54 years of age on 3 February 1892, and was buried near the country home he loved, in the churchyard of St Mary’s Church, Wargrave, close to the river Thames.

Mr Peter F Burke FRCS FRACS DHMSA