The laryngeal disease of the German Emperor Friedrich III: treatment failure or fateful course

A "royal" total laryngectomy that never was

With this historical vignette, ending the series dedicated to the pioneers of total laryngectomy, published in the EuropeanAnnals of Otorhinolaryngology Head & Neck Diseases to mark the 150th anniversary of the first description of this surgical procedure in humans, the authors recount what history called "The Crown Prince's illness", and wonder what might have happened if the total laryngectomy proposed for Crown Prince Friedrich had finally been performed.

125 years of head and neck radiotherapy: could organ-sparing radiotherapy of larynx cancer have prevented World War I?

PURPOSE

We aim to recapitulate the rapid development of head and neck radiotherapy in the context of otorhinolaryngology (ORL) medicine starting 125 years ago. This is put into context with the unsuccessful treatment of the laryngeal cancer (LC) of the German emperor Frederick III and its historical consequences.

METHODS

The three-step process consisted in the analysis of (1) historical sources of the development of ORL radiotherapy from the discovery of x‑rays and radioactivity until World War I, (2) course and treatment of Frederick's III LC, (3) political context with a special focus on the escalation towards World War I. Pertinent historical illustrations of technical developments of radiotherapy were summarized in a video.

RESULTS

ORL radiotherapy initiated on 03 February 1896, only 65 days after the discovery of X‑rays. By 1914, organ-sparing LC radiotherapy was established with a predominance of curietherapy over roentgentherapy. Correct diagnosis of Frederick III's primarily radiocurable cT1a glottic LC was delayed by one year, which resulted in advancement to a fatal pT4 pN1 Mx tumour stage. Historically, his successor, William II, was assumed to have contributed to the causes of World War I.

CONCLUSION

ORL radiotherapy came only eight years late to treat Frederick III who might have impeded World War I. This illustrates the potential impact of modern curative radiotherapy on the future course of public life beyond the personal fate of the patient himself.

[The tracheotomy of Kaiser Friedrich III in the Year of the Three Kaisers, 1888 : Presentation of the original historical image to the DGHNO-KHC]

The current article describes an image depicting an otorhinolaryngologic surgical intervention being performed on Kaiser Friedrich III. The image was captured by the lithography of an unknown artist and originates from a Cologne printing press. Kaiser Friedrich III was the penultimate German Kaiser and died June 15, 1888, in Potsdam, after ruling for only 99 days (the Year of the Three Kaisers). Toward the end of his period as Prince Regent and during his time on the throne, Kaiser Friedrich III was tracheostomized and wore a silver cannula. This publication on the Kaiser's disease and the background of the lithography marks the occasion of presentation of this historic image to the German Society of Otorhinolaryngology, Head and Neck Surgery by the author.

[Reconstruction of the examination of the laryngeal carcinoma of Emperor Frederick III by Rudolf Virchow]

Rudolf Virchow is one of the founders of modern pathology, and many of his ideas on inflammatory and neoplastic diseases are still valid today. Even for Virchow, determination of malignancy was not always easy. As an example, the laryngeal disease of Crown Prince Frederick William, the later Emperor Frederick III, is presented.The clinical findings at the beginning of the disease were suggestive of a carcinoma, though an inflammatory lesion was also discussed. Several attempts were made to remove the lesion bioptically, but local recurrences occurred and the first tissue samples were not examined histopathologically. Since laryngeal tumour operations had a high mortality at that time, histopathologic examinations were made in order to decide for or against an operation. The samples taken after pre-treatment did not meet Virchow's criteria for determining a carcinoma. Contrary to the present concept of a carcinoma in situ-carcinoma sequence, Virchow's concept was based on the assumption that carcinomas are not derived from the epithelium, but arise from a mesenchymal-epithelial transformation from the connective tissue. The clinical suspicion of a laryngeal carcinoma was confirmed only shortly before the patient's death and later by a post-mortem examination.The question repeatedly asked is whether Virchow should have diagnosed a carcinoma at the beginning of the disease. The answer has been the same for more than a hundred years: the clinician is dissatisfied with the histopathological diagnosis, so the pathologist is to blame.