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Biographical entry Treves, Sir Frederick (1853 - 1923)

CB KCVO 1901; Baronet 1902; GCVO 1905; MRCS April 21st 1875; FRCS Dec 12th 1878; LSA 1874.

Born
15 February 1853
Dorchester
Died
7 December 1923
Lausanne, Switzerland
Occupation
General surgeon

Details

Came of an old Dorset yeoman stock, the family records being traceable back for several centuries, nearly all his ancestors having married Dorsetshire women. He was born in Dorchester on Feb 15th, 1853, where his father, William Treves, was in business as an upholsterer. His mother was Jane, daughter of John Knight, of Honiton.

At the age of 7 he went to the school in South Street kept by the Rev William Barnes, the Dorset poet, whose writings preserve the Dorset dialect. Treves has handed down an account of his schooling in his Highways and Byeways of Dorset. A man of varied accomplishments, Barnes was an engraver, artist, musician, naturalist, and he composed a philological grammar from sixty-seven languages. Unsuccessful in keeping a school, he ended his days happily as Rector of Winterborne Came, and his statue stands in front of Dorchester Church. Treves entered Merchant Taylors' School, then in Suffolk Lane, City of London, in May, 1864, was in the School XV, left in 1871, and subsequently attended University College, London. He entered the London Hospital in 1871 and was appointed House Surgeon for three months from May 25th, 1876, his colleague being Mr S A Fisher, after which he was Resident Medical Officer at the Royal National Hospital for Scrofula at Margate, where his elder brother, William Knight Treves (qv), was one of the Hon Surgeons.

He married in 1877 and bought a share in the practice of William Milligan of Wirksworth, Derbyshire. In 1879, having obtained the FRCS in the previous year, he applied for and was elected Surgical Registrar at the London Hospital, where he had Dr Francis Warner as his medical colleague. On Sept 23rd, 1879, he became Assistant Surgeon, being promoted to Surgeon on Sept 30th, 1884, and Consulting Surgeon on Dec 7th, 1898. In the medical school attached to the London Hospital he was Demonstrator of Practical Anatomy, 1881-1884; Lecturer on Anatomy, 1884-1893; Teacher of Operative Surgery, 1893-1894; and Lecturer on Surgery, 1893-1897.

Treves founded his surgery on anatomy, and was fortunate in practising at a time when Lister's teaching allowed of a great extension of abdominal surgery. To this he added a remarkable energy, rising early to write, with facility as well in illustrating as in intercalating anecdote. He was an expert dissector, and operated neatly, quickly and cautiously. He was myopic and generally wore spectacles, but in operating, especially in the days of the spray, he laid aside his spectacles and held his head close to his work. He taught without elaboration. He would remove a uterine fibromyoma as one would amputate a limb, turn down flaps, clamp and tie blood-vessels, suture the flaps over the stump.

He rapidly became known beyond the London Hospital owing to his genius as a writer. In 1881 he was appointed Erasmus Wilson Professor at the College of Surgeons and lectured "On the Pathology of Scrofulous Affections of Lymphatic Glands". In 1882 he published his first book, Scrofula and its Gland Disease (12mo, London, 1882) - the experience gained at the Margate Hospital forming the foundation. His knowledge of German allowed him to add a good résumé of previous knowledge and of advances made in the pathological histology of the disease. Four histological plates are included in the book, for he was preparing at the same time an article on 'Scrofula' for Holmes and Hulke's System of Surgery (3rd ed, 1883), of which there were also two American editions, a New York one of 1882, and a Philadelphian edition of 1883. Unfortunately the publication just preceded Koch's revolutionary communication of the tubercle bacillus. Treves brought the vague scrofula pathology nearest to tuberculosis when he quoted statistics to show that 'phthisis' in the father (not so much in the mother) predisposed to scrofula in the child; but there was still confusion with congenital syphilis. In 1884, in his paper "The Direct Treatment of Psoas Abscess with Caries of the Spine" (Med-Chir Trans, 1884, lxvii, 113), he was following Lister's lead.

Treves published his most widely known book in 1883, Surgical Applied Anatomy (12mo, London and New York, 1883), and continued to lecture on anatomy until 1893. The fifth and later editions were revised by Sir Arthur Keith; the eighth edition by Professor C C Choyce was published in October, 1926. In 1883 he was awarded the Jacksonian Prize for his dissertation on "The Pathology, Diagnosis and Treatment of Obstruction of the Intestines in its Various Forms in the Abdominal Cavity". This was published in 1884 (12mo, London and New York); a new and revised edition appeared with the title, Intestinal Obstruction: its Varieties, with their Pathology, Diagnosis and Treatment, in 1899, and again still further amended in 1902. He followed up the subject as Hunterian Professor of Comparative Anatomy and Physiology at the College of Surgeons in 1885 and 1886, founding his descriptions on numerous dissections, including dissections of animals at the Zoological Gardens. His observations were illustrated by pen-and-ink drawings, and by others in watercolours. They described mechanical disarrangements of the intestines, congenital and acquired, which induce phases of intestinal obstruction. The lectures were published as The Anatomy of the Intestinal Canal and Peritoneum in 1885 (4to, London). The fatal condition of intestinal obstruction had in olden days got the name of 'the Miserere Mei' from the psalm said over the patient; it had been treated by repeated clysters, and occasionally, as in animals, by paracentesis. Abdominal exploration was just becoming a practicable measure, and his description was that of a fresh investigator of the anatomy of the abdomen from the standpoint of active intervention.

In 1885 (12mo, London) appeared his Influence of Clothing upon Health, which included much anticipatory of the changes which women have come to make. Subsequently he wrote the article on "Physical Education" in A Treatise on Hygiene and Public Health, edited by T Stevenson and Shirley F Murphy (1892, 537-613). In 1886 he edited A Manual of Surgery - treatises by various authors, in three volumes - with preface, February, 1886. In 1891 he published A Manual of Operative Surgery (8vo, London and Philadelphia) in two volumes, and in 1892 The Student's Handbook of Surgical Operations, abridged from the author's Manual of Operative Surgery (12mo, London and Philadelphia). In 1895-1896 he edited A System of Surgery (8vo, London), in two volumes. Of the foregoing it may be said that they represented the highest level of the surgery of his day, and subsequently he was assisted in revised editions by Mr Jonathan Hutchinson, junr. But as distinguished from his Surgical Anatomy they have aroused only a temporary interest.

Meanwhile 'appendicitis' surgery gave Treves an enormous development of private practice. He became the most successful of London surgeons, receiving more often than others the 100-guinea fee, then the upper limit. Private patients were so plentiful that in 1898, at the age of 45, he resigned the post of Surgeon to the London Hospital.

Hospital practice changes and advances from year to year. On his visit the surgeon has around him the keen and critical minds of his students urging him on. Private practice lags behind hospital practice; without hospital practice a surgeon becomes stereotyped. Treves as Surgeon to the London Hospital was recognized as the leader of English Surgery. After his resignation he gradually ceased to lead.

He had been for several years an Examiner in Anatomy and in Surgery at the Universities of Cambridge, Aberdeen, and Durham. At the Royal College of Surgeons he was a Member of the Court of Examiners from 1892-1894, and a Member of Council from 1895-1903.

Appendicitis - From various causes the importance of disease in the appendix vermiformis of the caecum was ignored until after the middle of the nineteenth century. All evidence supports the conclusion that appendicular disease has always been common, for the appendix is a remnant of the distal portion of the mecum of lower animals, and as such is prone to disease.

Galen's physiology of the caecum as a second stomach, wherein the liquid contents tend to dry up, was the basis of the clinical pathology described under the terms 'iliac passion', 'typhlitis (caecitis)', 'perityphlitis', 'paratyphlitis'. As an anatomical structure, the appendix was first described and figured by Vesalius. In the early part of the nineteenth century post-mortem observations were made, in particular at Guy's Hospital by Hodgkin, Bright, and Addison; at Westminster Hospital by Burne; but the bearing of these observations were unnoticed in general practice - the clinical pathology held sway. Active treatment by surgery developed first in the United States. It is sufficient here to note the writings of Fitz in 1886, and his introduction of the term 'appendicitis' which concentrated attention upon the vital pathology of the disease. When Treves called 'appendicitis' an uncouth term he missed the mark.

In the development of this branch of surgery, concurrent developments must be borne in mind. Lister's method permitted the active treatment of pistol-bullet wounds of the intestines in the United States, and of the immediate surgical interference for perforated gastric ulcer which arose in Germany. British surgery had overlooked the subject. In Holmes and Hulke's System of Surgery (3rd ed, 1883), in Erichsen and Beck's Surgery (8th ed, 1884), in Heath's Dictionary of Surgery (1886) - indeed, in Treves' own Manual of Surgery, issued in 1886 - there is less about perityphlitic abscess than older surgical books gave to the iliac passion and abscess. Samuel Fenwick, Physician to the London Hospital, in the Lancet (1884, ii, 987, 1039) gave a full description of perforations of the appendix. He added (p 1041) that theoretically it would seem much better to cut down directly upon the appendix as soon as the diagnosis is tolerably certain, and tie off the appendix above the seat of the perforation, removing any concretion and decomposing material. Treves did not refer to his colleague's observations: in his Hunterian Lectures in 1885 he described merely the anatomical variations he had met with in the examination of 100 bodies.

In July, 1883, (Sir) Charters Symonds instigated by his colleague, Dr F A Mahomed, had removed a concretion from the appendix, closing the opening by Lembert's sutures. The patient, a man in Guy's Hospital, aged 25, had suffered two attacks of pain and had developed a swelling. There had been no return of pain eighteen months later, although the appendix had not been removed (Lancet, 1885, i, 895).

In his paper "Relapsing Typhlitis treated by Operation" (Med-Chir Trans, 1888, lxxx, 165) and "Discussion" (Proc Roy Med-Chir Soc, 1886-8, ii, 333), Treves described how he had operated for the first time for such a condition upon a patient under Stephen Mackenzie, Physician to the London Hospital. He had cut down upon an appendix kinked by omental adhesions; after dividing the adhesions he had straightened out an appendix, two and a half inches in length, distended towards its tip, but not containing a concretion. The patient had recovered and had remained free from symptoms. Timothy Holmes had operated similarly, but symptoms had recurred. Howard Marsh and W J Walsham, operating late on cases of septic peritonitis at St Bartholomew's Hospital, had removed a diseased appendix, but neither patient had survived.

Treves developed his pathology of typhlitis, perityphlitis and paratyphlitis, and the operation on chronic and recurring cases in the interval between the attacks. In acute cases his general prescription was delay until the fifth day, when peritoneal suppuration would have become circumscribed. He continued the same advocacy in his paper on "A Series of Cases of Relapsing Typhlitis treated by Operation: a Series of 14 Cases" (Brit Med Jour, 1893, i, 835), and again "Relapsing Typhlitis" (Ibid, 1895, i, 420, 517) - a further series of 18 cases; he had removed the appendix during the quiescent period in 16, with recovery except in one ease which died on the fourth day, apparently from peritonitis. In two the removal was abandoned owing to adhesions; 14 were private cases, and 4 were in the London Hospital.

Meanwhile, in spite of Treves, attention was given to the fatalities ensuing from perforation: the tragic deaths, especially in children and young people, and to the life-saving immediate operation. Treves underwent the bitter experience of losing his younger daughter, who was so attacked that she could only have been saved by an immediate operation. Yet he never seems to have fully accepted for himself the lead given by the American surgeons. Treves contributed an article on "Perityphlitis and its Varieties" to Allbutt's System of Medicine (1897, iii, 879). He also published separately The Surgical Treatment of Perityphlitis (2nd ed, revised and enlarged, 1895), also Perityphlitis and its Varieties: their Pathology, Clinical Manifestations and Treatment (8vo, London and New York, 1897).

The advances made in London may be gathered from a discussion opened by Treves on "The Subsequent Course and Later History after Operation of Cases of Appendicitis" (Med-Chir Trans, 1905, lxxxvii, 431). Reports from various hospitals are included, that from the London Hospital relating 1,000 cases.

King Edward's Coronation [Dict Nat Biog, Supplement 2, i, 591 (Treves is not mentioned by name in this brief notice of the King's illness)]. - King Edward VII at the age of 30 had suffered gravely from typhoid fever, which had been followed by varicose veins and phlebitis, limiting his exercise. He was stout, and bronchitic. His Coronation had been appointed for June 26th, 1902. At Windsor, on June 13th, he had an abdominal attack which Sir Thomas Barlow and Sir Francis Laking attributed to appendix trouble. Treves was called in on June 18th. The local swelling having subsided somewhat and the temperature having fallen, the King journeyed to London on June 21st. That evening the lump increased and the temperature rose. Early on the 24th, Lord Lister (qv) and Sir Thomas Smith (qv), the senior Serjeant Surgeons, joined the physicians in consultation, and came to the conclusion that an operation was imperative and should be performed immediately. The King's thought was to keep faith with his people and go to the Abbey, and he did not give way until after a scene of prolonged and painful pleading. Treves said bluntly to him, "Then, Sir, you will go as a corpse." The operation followed at 11 o'clock am. Treves laid open an abscess containing decomposing pus and inserted two large drainage tubes. Convalescence ensued, and the Coronation took place on Aug 9th. Nothing was reported concerning the appendix, nor is there any report of further abdominal trouble. The King died of bronchopneumonia on May 6th, 1910, and no account of any post-mortem examination was issued. Treves was made a Baronet, with honourable augmentation of a lion of England in his coat armour.

Honours followed, including that of LLD Aberdeen, and his election as Lord Rector of the University. Before his Address he gave notice in the local press that if there was the slightest noise he would immediately leave the room and deliver no Address. The students gave him a most enthusiastic welcome and the most attentive hearing. He was elected first President of the Club of "Dorset Men" and was succeeded in this position by Thomas Hardy. His myopia doubtless was against sport, but in his early days he would bicycle fifty miles, was a first-rate swimmer, was a certificated master mariner: with his brother and McHardy, the ophthalmologist, he yachted from Margate, and fished off the West Country coast. He joined in the protests against the pigeon-shooting at Monte Carlo, although he would catch or even shoot dogfish.

War Services and Public Work - Towards the end of 1899, following on the outbreak of the war in South Africa, Treves along with others was appointed a civilian Consulting Surgeon. On arrival he was placed in charge of a Field Hospital, which starting from Frere accompanied the Ladysmith Relief Column. Treves was present at the Battle of Colenso and at the entry into Ladysmith. His Tale of a Field Hospital (4to, London, 1900) described his experiences. The bullets mostly used - unless in some way they had become deformed - penetrated the soft tissues with extraordinarily little damage. Tetanus was absent, because the fighting was over uncultivated ground. Enteric, as yet uncontrolled by vaccine, was the great enemy as in former wars. Civilian influence overcame the military objections to trained nurses, and when a few ladies seeking notoriety tried to make a sort of picnic and interfere with the nursing, Treves exclaimed against "the plague of women which had descended upon South Africa", in which he was supported by Lord Milner. Treves received the CB and KCVO for his services.

He continued private practice until 1908, after which he devoted himself to public work, travel, and writing books; was one of the founders of the British Red Cross Society, and became Chairman of the Executive Committee. He had much to do with the organization of the Radium Institute, and was Chairman of the Committee of Management. He served as a member of the Territorial Forces Advisory Committee of the Territorial Force Association, and also of the Army Sanitary Commission. During the European War, 1914-1918, he was President of the Headquarters Medical Board and the primary adviser on the higher personnel of the Force. He ranked as Honorary Colonel RAMC (T), Wessex Division.

Literary Genius - Treves, in addition to being a great surgeon, possessed the seeing eye, the inquiring mind, and a great love of natural beauty. He was an admirable conversationalist and a stimulating companion. He had a facile pen and an abundant fund of anecdote. He got through much by rising early: with a love of travel was joined that of writing at every spare moment. Of his surgical writings, his Surgical Applied Anatomy was the first book to give full play to his literary talent and is the one which may claim to reach the standard of a medical classic. Of his general writing, the highest level of his literary work may be considered to be The Tale of a Field Hospital (1900), although its subject has been thrown into the shade by the greater happenings in the European War of 1914-1918. He was not blind to a drawback that a tale of typhoid fever and gunshot wounds might be deemed by the general reader to be sombre or even gruesome, as he mentioned in his preface. Certainly the term 'sombre and gruesome' may be given to The Country of the Ring and the Book (1913). It is a work which must have involved much research and elaborate preparation of 106 photographs, plans, and maps, but is concerned with the most revolting of mediaeval stories, and the 'Browning furore' which inspired it has cooled. Sombre and even gruesome may also be applied to his Elephant Man and other Reminiscences (8vo, London, 1923). An unfortunate patient in the London Hospital was afflicted with congenital diffuse neurofibromatosis, which not only disabled him but gradually killed him by changing to cancer. Other reminiscences of the London Hospital in its unregenerate days were included in this book. His other books, full of attraction and charm, will continue to be read by those following his travels. His Highways and Byeways of Dorset (1906, reprinted 1906 and 1911) not only forms one of a series descriptive of English counties, but allies itself with the Hardy and Barnes literature.

He travelled widely from 1903, and wrote The Other Side of the Lantern: An Account of a Commonplace Tour round the World (8vo, London) in 1905. The second part of the title indicates a tour in 1903-1904 by way of the Mediterranean, Red Sea, India, Burma, Ceylon, China, Japan, and America. The quaint first part of the title is explained in a Preface:- "A paper lantern, round and red, hangs under a cloud of cherry blossoms in a Japanese village. There is a very familiar flower symbol painted upon one side of it. Some children have crossed the Green to see what is on the other side of the lantern. A like curiosity has led to the writing of the travel book."

Other books by Treves are: A German-English Dictionary of Medical Terms (with Hugo Lang) (8vo, London, 1890); The Cradle of the Deep (1908), which includes descriptions of the West Indies; Uganda for a Holiday (1910), which noted a visit to the Great Rift Valley, the Lake Victoria Nyanza, and the sources of the Nile; The Land that is Desolate (8vo, London, 1913), a tour of Palestine, before the War and the subsequent Mandate to England: starting from Jaffa, to Jerusalem, Bethlehem, Jericho and the Dead Sea, Haifa, Acre, Nazareth, Lake of Galilee, Damascus, ending with a railway accident on the return to Haifa; The Riviera and the Corniche Road (1921); The Lake of Geneva (1922).

Treves practised at 6 Wimpole Street. After his retirement from practice King Edward lent him the Thatched House Cottage in Richmond Park. His heart began to give trouble, and he went in 1920 to live in the South of France, on the Lake of Geneva at Evian, and lastly on the opposite or Swiss side at Vevey. In 1922 he passed through a severe attack of pneumonia from which he appeared to recover. But on Dec 3rd, 1928, he was seized in his flat at Vevey with acute infective cholecystitis and peritonitis; he was removed to a Nursing Home in Lausanne; when Sir Hugh Rigby arrived he was moribund, and he died on Dec 7th. He was cremated, and his ashes were brought back and buried in Dorchester Cemetery. Among those who attended the funeral was Thomas Hardy.

Treves had married in 1877 Anne Elizabeth, youngest daughter of A S Mason, of Dorchester, who survived him, as also his elder daughter, Enid Margery, married to Brigadier-General Sir Charles Delme-Radcliff.

There are several portraits of Sir Frederick Treves. The best is that in early middle age, at the height of his career as a surgeon. This portrait by Sir Luke Fildes in oils was left in reversion to the College of Surgeons in case of nonacceptance by the National Portrait Gallery. The Vanity Fair one represents him in khaki. He left estate of over £102,000.

Sources used to compile this entry: [The Times, 1923, Dec 10. Brit Med Jour, 1923, ii, 1185, with portrait. Lancet, 1923, ii, 1325. Additional information kindly given by E W Morris, Esq, House Governor of the London Hospital].

The Royal College of Surgeons of England