“Well, gentlemen,” he concluded in a rather shaken voice, “at least we shall not encounter that difficulty in the present case. No doubt you will wish to hear my latest news about the Emperor.”
“To be sure,” said Sherlock Holmes. “The Queen’s physicians have instructed us to request from you a definitive statement of her son-in-law’s prognosis, assuming that such a thing is possible.”
“So your visit’s purpose is medical as well! In this case, sir, a ‘definitive statement’ is hazardous indeed!” Obviously flustered, Sir Morell turned to me as a potential ally. “As you may know, Dr. Watson, the slow progress of laryngeal cancer is widely recognised. The organ’s hard, encasing cartilage resists the growth of the disease. On average, the duration of life is two years after onset, but there are well-documented instances of untreated patients living three years or even four.”
“You are convinced, then,” I guardedly enquired, “that the disease is cancer, and not perichondritis? I ask only because others with whom we have spoken seem unsure upon that point.” (“Excellent, Watson!” I heard my friend mutter.)
“I never said it was not cancer,” cried Mackenzie, “not from my first examination of the patient! I only said that cancer was not proven. And lacking proof, I refused to sanction surgical procedures which - as even you, Doctor, must surely be aware - are always dangerous to life; nearly always destructive to the voice; and which, even when technically ‘successful,’ often leave the patient in a condition worse than death! Should I have inflicted that fate upon the Emperor?”[46]
“Why not,” demanded Sherlock Holmes, “if it was the only chance of saving him?”
“Saving him for what, Holmes,” I retorted, “a life of abject misery? Remember that Sir William Jenner and even Dr. Semon shared Sir Morell’s view of the effects of laryngectomy!” I turned back to Mackenzie, who was regarding me with some surprise.
“I fully understand your reservations, Sir Morell, about the surgery. Had I been in Frederick’s position in November, I would have refused the knife as well. Yet, surely it is time to be definitive about the diagnosis! Dr. Waldeyer’s discovery of cancer cells in the Emperor’s sputum demonstrates that more than perichondritis is involved.”
“It was stronger evidence than any I had hitherto received,” the specialist admitted. “Nevertheless, perichondritis is certainly present. This sloughing of cartilage from the trachea and larynx is more characteristic of that disease than cancer. His Majesty coughed up two large pieces yesterday. Cancer may be there as well - although,” he doggedly insisted, “the first pathologist of the world found nothing of the kind!”
“Dr. Semon,” Holmes interjected, “was convinced that it was cancer from the first.”
“I trained Felix Semon, sir, and his opinion” - Mackenzie returned my friend’s derisive smile - “is one I should undoubtedly respect! Need I remind you, however, that he has never seen the patient?”
“Well, well,” sighed Sherlock Holmes, “we have wandered rather far afield. I apologise most humbly, Sir Morell, if our questions have offended you. Let us return to our original query. If - as Dr. Watson has reminded us - the preponderance of evidence suggests that His Imperial Majesty is suffering from cancer, how much longer do you expect him to survive? I might add (without any intention of offending further) that Professor von Bergmann has given him six months.”
“I am aware of that prediction, Mr. Holmes. As usual, my renowned colleague was unduly pessimistic when he spoke to Crown Prince William. I myself told the young man in November that if his father’s tumour was malignant, he might reasonably hope to live for eighteen months.[47] Sadly, a great deal has happened since that time.”
Mackenzie shook his head indignantly. “You must understand, gentlemen, that the case has been deplorably mismanaged by the German doctors. When the tracheotomy was performed in February, Dr. Bramann insisted upon using a canula that was much too large. It damaged the trachea and led to chronic coughing, bleeding, and infection. In the weeks before I was permitted to replace it, that canula caused as much destruction as the disease itself would have done in as many months. If not for Bramann’s error, and the patient’s resulting loss of strength, the operation recommended by von Bergmann might have been attempted when the disease’s nature was confirmed by Dr. Waldeyer.”[48]
“An operation you had consistently opposed!” sneered Holmes. “So, you do now admit that the diagnosis of cancer is confirmed?”
The eminent laryngologist stared at his tormenter like a beaten man. “I can no longer find sufficient reason to deny it,” he said finally.
“Then possibly you should convey that fact to the Empress! And Frederick’s life expectancy? Your best guess will naturally suffice.”
Sir Morell waved a weary hand, his exhaustion all at once apparent. “He has recovered a good deal in recent days. Barring any further setbacks, he could well last another year.”
“And for the duration of his life, the Emperor will remain capable of ruling?”
“Mentally capable, you mean? Laryngeal cancer, Mr. Holmes, kills the body, not the mind. At present, His Majesty is suffering no pain, and there will be none of any consequence before the end. For as long as his physical strength endures, Frederick III should remain in full possession of his faculties and able to fulfil his role as sovereign.”
“For, you say, another year. Still long enough, in theory, to implement the political reforms that he and the Empress have envisioned.”
“Well, sir,” laughed Mackenzie, having at last recovered his composure, “you take me from my province there. I can offer little aid to you in predicting the political future of the German Empire! I speak as His Majesty’s physician. Have you or Dr. Watson any other questions for me?”
“No, sir,” said Sherlock Holmes. I mutely shook my head, appalled at this merciless interrogation and feeling nothing but sorrow for its victim.
“Then, gentlemen, I suggest we pay a visit to the Emperor. No doubt it will enable you to draw your own conclusions, rather than humouring the fantasies of us poor fools who have attended him these past eleven months.” Sir Morell rose and quit the room, not waiting for us to follow him.
As we left the library, I noticed a youngish, military-looking fellow who stood just across the hallway, admiring one of Boucher’s voluptuous renderings of unclad female flesh. Although I had never met the man, I learned afterwards that it was Major Lyncker, one of the two attachés.
“Good day to you, sir,” called Sherlock Holmes. I trust you enjoyed our morning stroll into Charlottenburg? On your next visit, do try Appelmeyer’s. The Brötchen there are quite delicious!”
The attaché bowed and silently departed. We did not pursue him, for Mackenzie was fast disappearing in the opposite direction.
The Great Orangery of Charlottenburg was in a side wing of the palace, a handsome edifice built of the same yellow stone. Save for its entrance, it was all upon one level, with large, arched windows that gave it a relatively light and airy look. We overtook Sir Morell just before he entered. He immediately turned to challenge Holmes.
“I wonder, Mr. Holmes, if you are truly aware of the lamentable state of a patient who survives a laryngectomy. The conditions of existence are so utterly miserable, with food having to be taken in so distressing a way, that suffocation is constantly imminent, and death from starvation not infrequently occurs. Only last week, a Socialist deputy of the Reichstag died in Breslau, one week after extirpation of the larynx. Very few ‘survivors’ live more than a few months. Several I know of have committed suicide![49]
“I would also have you know,” he continued, raising a hand to forestall my friend’s response, “that last November it was Professor von Schrötter, from Vienna, who communicated to Crown Prince Frederick the situation facing him, with all of his physicians present.[50] For reasons you may understand, I declined to take tha
t responsibility upon myself. After hearing the surgical alternatives, and consulting briefly with his wife, the Crown Prince declined extirpation but agreed to tracheotomy. It was not I, sir, who urged upon him that decision!”
Holmes took a breath before replying. “Dr. Mackenzie, I am neither a physician nor a surgeon, although I have spent time in Barts to gain a knowledge of anatomy. Possibly, it was presumptuous of me to question your professional conduct or advice. The fact that Dr. Watson supports your view carries far more weight with me than the opinions of your German colleagues. My quarrel with you, sir, is that you have not been forthright with the Empress about her husband’s prospects of survival. I have not yet met the Emperor and can form no judgement there. But you have allowed Her Majesty to hold onto hopes which the facts - as you yourself explain them - can no longer justify.”
Sir Morell looked deeply troubled. “That may be true, sir. Over the past year, I have spent much time with the Imperial couple, and I have come - perhaps unwisely - to think of them as friends as well as patients. I know of their enlightened and far-reaching plans for the internal development of Germany. Having met their son, I also know that all those hopes and plans now hang upon a very slender thread. It is possible that my respect for them, and my sorrow for the end that almost certainly awaits His Majesty, have at times clouded my professional judgement.”
“As has, perhaps, the responsibility of a mistaken diagnosis?”
Mackenzie gave my friend a bitter smile. “You are a hard man, Mr. Holmes. But, yes, there may be that as well.”
“Then I propose that we begin again.” Sherlock Holmes held out his hand, which, after a slight hesitation, Sir Morell accepted.
“Shall we go in, gentlemen?” he asked.
The interior of the Orangery, which preserved the imperial fruit collection over the winter months, belied its promising façade. The old, thick-stemmed orange trees had not yet been moved outdoors for spring. Their leaves covered most of the windows, blocking the sunlight and giving the long corridor a dark, depressing air. The place, Mackenzie grumbled, had been “better than nothing” for the Emperor to walk in during the snowy weather of mid-March; but it was hardly equal to the sunshine of San Remo.[51]
“But there is no one here!” he noticed suddenly.
The remark was not entirely accurate, for an unknown apparition was now lurching towards us through the gloom. Upon arrival, it bowed with studied insolence and handed a note to Sir Morrell. Then, to my surprise, the man gave me what appeared to be a letter. Having received a warning look from Holmes, I put it unopened in my pocket.
“That was Beerbaum,” Mackenzie confided when Beerbaum had disappeared. “He is, at best, an adequate nurse to wait upon our patient; but his more important role is as von Bergmann’s spy! Ah,” he continued upon examining the note, “Mr. Hovell writes that he has taken His Majesty to the palace mausoleum. So, gentlemen, we have another walk in store.”
He led us from the Orangery and down a cobbled avenue lined with lofty pines. Visible at this alley’s end was a stone mausoleum, built in the Doric style. Originally, Sir Morell informed us, it had housed only the tombs of Frederick’s grandparents; but in March the late emperor’s bier had been placed there as well.[52]
“His Majesty had hoped to arrive from San Remo before his father’s death, and I had quite a struggle to dissuade him from marching in the funeral procession. Unhappily, the weather last month was far too inclement. He has visited the mausoleum twice since then, both times with an unfavourable effect upon his health. As you know, Dr. Watson, melancholia can be a deadly foe in cases of this kind.”
Indeed, on entering the mausoleum we beheld a distant figure, bowed in grief before a coffin crowned with laurel wreaths. In a fresco just above the altar, the long-dead king and queen knelt in adoration of their Saviour. Light from two elaborately carved candelabra cast its glow upon the marble walls. It was an affecting scene; and Mr. Hovell, who stood respectfully aside, put a finger to his lips to silence us. For the moment, I gave my attention to the tomb of Queen Louise, who had implored the first Napoleon in vain to spare Prussia from dismemberment. The lady was as beautiful in effigy as she had been in life; and I fancied that I saw something of my own, dead Constance in her face. A cough from Holmes recalled me from this idle vision. The imperial mourner had finally turned to greet us, and we bowed in unison to Emperor Frederick III.
His Majesty was much changed from the commanding horseman I had admired, ten months before, in the Jubilee procession. He wore civilian dress, his hair and beard were greying, and he had lost at least two stone in weight. His eyes had now a haunted look,[53] and the noise of his breathing through the canula was audible from where we stood. Yet, on that morning few would have taken the Emperor for a dying man. He held himself erect, regarded us with interest, and smiled with genuine warmth as we approached. When we reached him, he playfully tapped the order on Sir Morell’s lapel, as though gently chiding him for wearing it. After Holmes and I had been presented, Frederick took a pad and pencil from the pocket of his coat, scribbled for a moment, and handed the note to Mr. Hovell.
“His Imperial Majesty apologises for receiving you in such a solemn setting,” the young surgeon self-consciously recited. He writes: ‘At times of late, I feel more at home among the dead than with the living.’” The Emperor waved a hand to deprecate the force of this remark, but I saw the remnants of tears upon his cheeks. He resumed writing and soon handed a second note to Sherlock Holmes, who had been introduced to him as an emissary from the Queen.
“‘Please assure my august mother-in-law,’” my friend declaimed, “‘of the love and reverence I feel for her, and of my sincere and earnest wish for a close and lasting friendship between our two nations.’ The words ‘close’ and ‘lasting’ have been underscored.[54] I shall, indeed, Your Majesty,” he added, with an inclination that approached a bow.
The third and longest note went to Mackenzie, who read it aloud with signs of discomfiture. “‘I shall look forward to seeing Dr. Watson’” - Sir Morell paused to glance at me uncertainly - “‘along with you and Mr. Hovell, at our evening consultation.’ In fact, Your Majesty...” Frederick, after an enquiring look, gestured for him to continue. Instead, the specialist abandoned whatever he had been about to say and went on reading. “‘And now, gentlemen, let us return to the palace. I wish to take an early luncheon, for I have much work to do this afternoon.’ Very well, sir... as you command, of course.”
On our walk back up the cobbled pathway, His Majesty set a steady pace, and it was obvious to all of us that he enjoyed being out-of-doors. Before re-entering the Schloss, he took us on a tour of its gardens, pointing out a belvedere across the pond and various shrubs and statues for Hovell or Mackenzie to describe. Sherlock Holmes said very little; but he intimated by several covert glances that Frederick, in this initial meeting, had both surprised and impressed him. From a medical perspective, the Emperor seemed stronger physically than I had expected, and more than capable of exercising his imperial prerogatives. I saw no reason, on that sunny April morning, why he should not remain a wise and benevolent ruler to his people for many days to come.
40 Stevenson (p. 106) described Mackenzie dressed in such Holmesian garb (“a large-checked Inverness cape and a soft grey hat”) as he drove in an open victoria during Crown Prince Frederick’s sojourn in San Remo.
41 Berlin and its environs had boasted horse-drawn trams since 1865. The nearby village of Groß-Lichterfelde had opened the world’s first electric tramway in 1881, but electrification of the capital’s standard-gauge lines was completed only between 1895 and 1902. We can assume, therefore, that Holmes traveled in a horse-drawn tram. See Wikipedia at: https://en.wikipedia.org/wiki/Trams_in_Berlin. A telegraph office adjoined the Brandenburg Gate, which connected the Charlottenburg Road (now Straße des 17. Juni) to Unter den Linden (Baedeker, p. 21).
42 Watson’s physical description of Mackenzie compares well with an 1887 caricature by “Ape” (Carlo Pellegrini) in Vanity Fair, which served as the frontispiece of Stevenson’s biography. Stevenson describes his appearance on page 70, and notes his problems with asthma and sleeplessness on page 50.
43 Mackenzie summarized Frederick III’s daily schedule at Charlottenburg on pp. 129–130.
44 See pp. 137–141, for Mackenzie’s description of the Emperor’s visits to Berlin and his own irritation with “the reptile press” depicting him as “Moritz Markovicz.”
45 According to his biographer, Dr. Mackenzie “was always ready to visit a sick patient in a poor locality who craved to see him.” On learning that a clerk was unable to afford a second visit, he undertook the cost of sending his patient on a therapeutic sea voyage. See Stevenson, p. 49.
46 Sir Morrell’s statements in this passage were later embodied in Frederick the Noble. See pp. 30 and 205, as well as Stevenson, p. 114.
47 In his autobiography, My Early Life, Kaiser William II wrote that Mackenzie, in May 1887, had promised not only to save his father’s life, but to restore his voice “so that he would be able to command a corps at a review.” By November, Sir Morell (as he told Holmes) admitted “that in his opinion [William’s] father ... would not live more than eighteen months.” “I thought,” the Kaiser recalled, “that Mackenzie would die of shame, but his face, which I was watching narrowly, showed no trace of emotion.” (Stevenson, pp. 13–14, 95).
48 Mackenzie repeated this claim in Frederick the Noble. Page 132. His biographer believed that the book exaggerated the effects of Bramann’s too-large canula (see p. 107).
Sherlock Holmes and the Case of the Dying Emperor Page 6