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Sir Frederick Treves (1853-1923)

Frederick TrevesSir Fredrick Treves was born in Dorchester, Dorset on 15th February 1853 where his father was a furniture upholster. At the age of 7 years,  Treves went to the school in south street run by the Dorset poet, the Rev William Barnes.  Treves later in life expressed the views of his school days in his book the Highways and Byeways of Dorset (1906).  Treves' secondary education was at the Merchant Taylors School, then in Suffolk Street in the City of London.  He left there in 1871 and entered University College before joining the London Hospital later that same year.  He became a house surgeon in 1876 and for most of the remainder of his professional life he was associated with that institution. In 1879, having obtained his FRCS the previous year, he was appointed surgical registrar at the London Hospital.  On 23rd September 1879 be became assistant surgeon and on 7th December 1898 he was appointed consulting surgeon.  In the medical school attached to the London Hospital he was Demonstrator of Practical Anatomy (1881-1884), Lecturer in Anatomy (1884-1893), Teacher of Operative Surgery (1893-1894) and Lecturer on Surgery (1893-1897).

Treves founded his surgery on anatomy and was fortunate to be practicing at a time when Lister's teaching had allowed a great proliferation in the extent of abdominal surgery. He was an expert dissector, operated neatly and quickly but was always cautious.  He was myopic and generally wore spectacles, but whilst operating, especially in the days of carbolic spray, he removed his glasses and operated with his head close to the wound.  He rapidly developed a reputation outside of the city of London.  In 1881, he was appointed Erasmus Wilson Professor at the College of Surgeons and lectured On the Scrofulous Affections of the Lymph Glands. In 1882, he published his first book Scrofula and its Gland Diseases.  Treves published his most widely known book in 1884, Surgical Applied Anatomy. In 1883, he was awarded the Jacksonian Prize for his dissertation entitled The pathology, Diagnosis and Treatment of Obstruction of the Intestine in its Various Forms in the Abdominal Cavity

Meanwhile 'appendicitis' surgery gave Treves an enormous development of his private practice.  He became the most successful of the 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 at the London Hospital.  In his paper, Relapsing Typhilitis treated by Operation, Treves described how he had operated for the first time on  patient with appendicitis. He had cut down on the appendix kinked by omental adhesions, divided the adhesions and straightened it out. The inflamed appendix was not removed. The patient recovered and remained symptom free.  Treves developed his pathology of typhilitis, perityphilitis and paratyphilitis and in chronic cases advocated operating on patients between attacks.  In acute cases he advocated delaying surgery until the 5th day of the attack when peritoneal suppuration would have become circumscribed.  Unfortunately, Treves' youngest daughter died from perforated appendicitis.

Treves had two famous patients. He was sergeant surgeon to the King Edward VII and performed an appendicectomy and drainage of an appendix abscess on him in 1902. The operation was performed two days before the king's intended coronation. The king made and uncomplicated recovery from his surgery and the following year Treves was made a baronet. His other infamous patient is Joseph Merrick, otherwise known as the Elephant Man.  It was originally thought that he suffered from neurofibromatosis but it has recently been suggested that he suffered from a rare congenital hamartomatous disorder called Proteus syndrome.

Treves married in 1877 to Ann Elizabeth, youngest daughter of Mr Mason of his home town of Dorchester.  Treves practiced at 6 Wimpole Street.  After his retirement King Edward lent him the Thatched House Cottage in Richmond park.  He soon developed heart failure and 1920 he went to live in the south of France and on Lake Geneva at Evian.  In 1922 he survived an episode of severe pneumonia, but the following year he developed acute cholecystitis and peritonitis.  He died on 7th December 1923, was cremated, and his ashes were brought back and buried at Dorchester Cemetery.  Amongst those who attended his funeral was Thomas Hardy.  Treves is eponymically associated with ileocaecal fold.

Original papers

Treves F.  A series of cases of relapsing typhilitis treated by operation.  Br Med J 1893;  i:  835.

Treves F.  Relapsing typhilitis.  Br Med J 1895;  i: 420.

Treves F.  The subsequent course and later history after operation of cases of acute appendicitis.  Med Chir Trans 1905;  lxxxvii;  431.

Recent papers

Cohen M M.  Further diagnostic thoughts about the Elephant man.  Am J Med Genet 1988;  29:  777-782.

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