Illness and decline
Frederick had been a heavy smoker for many years. At a ball held by William on 31 January 1887, a guest reported the Crown Prince "was so hoarse that he could hardly say a word." His hoarseness continued through February, and was diagnosed as a thickening of the mucous membrane over the vocal cords, caused by "a chronic laryngeal catarrh." On 7 February, Frederick consulted a doctor, Karl Gerhardt, who scraped a wire across the membrane for 10 days in an attempt to remove thickened tissue. After the procedure proved unsuccessful, Gerhardt cauterised the left vocal cord with an electric wire on 15 March in an attempt to remove what was then thought to be a vocal fold nodule. Due to Frederick's highly inflamed throat, Gerhardt was unable to remove the entire growth. After several cauterisations, and with no signs of improvement, Frederick and his wife went to the spa of Bad Ems, where he drank the mineral waters and underwent a regimen of gargles and inhaling fresh air, with no effect.
On 17 May, Gerhardt and other doctors, including Ernst von Bergmann, diagnosed the growth as laryngeal cancer. Bergmann recommended consulting a leading British cancer specialist, Morell Mackenzie; he also recommended a thyrotomy to gain better access to the inside of the larynx, followed by the complete removal of the larynx – a total laryngectomy – if the situation proved serious. While Victoria was informed of the need for an immediate operation, Frederick was not told. Despite the tentative diagnosis of cancer, the doctors hoped the growth would prove to be a benign epithelioma. A room on the top floor of the Crown Prince's palace was then equipped as an operating theatre, but Bergmann elected to put the operation on hold until Mackenzie could provide his assessment. Mackenzie arrived in Berlin on 20 May, but after examining Frederick recommended a biopsy of the growth to determine whether or not it was malignant. He conducted the biopsy the following morning, after which he sent tissue samples to the distinguished pathologist Rudolf Virchow for microscopic examination. When Virchow was unable to detect any cancerous cells despite several separate analyses, Mackenzie declared his opposition to a laryngectomy being performed, as he felt it would be invariably fatal, and said he would assume charge of the case. He gave his assurance that Frederick would fully recover "in a few months." While Gerhardt and Physician-General August Wegner concurred with Mackenzie, Bergmann and his colleague Adalbert Tobold held to their original diagnosis of cancer. In addition to Mackenzie's opinion, Bismarck strongly opposed any major operation on Frederick's throat, and pressed the Kaiser to veto it. On 9 June, Mackenzie again biopsied the growth and sent the samples to Virchow, who reported the following day that he was again unable to detect any signs of cancer.
On 13 June, the Crown Prince left Potsdam for London to attend his mother-in-law's Golden Jubilee and to consult Mackenzie. He never saw his father alive again. He was accompanied by Victoria and their three younger daughters, along with Gerhardt; on 29 June, Mackenzie reported that he had successfully operated at his Harley Street clinic, and had removed "nearly the entire growth." Frederick spent July with his family at Norris Castle on the Isle of Wight. However, when Frederick visited Mackenzie's office on 2 August for a follow-up examination, the growth had reappeared, necessitating its cauterisation the same day, and again on 8 August – an ominous indication that it was indeed malignant. Felix Semon, a distinguished German throat specialist with a practice in England, and who had been closely following Frederick's case, submitted a report to the German Foreign Secretary in which he strongly criticised Mackenzie's cauterisations, and gave his opinion that the growth, if not malignant, was suspect, and should continue to be biopsied and examined. On 9 August, Frederick travelled to Braemar in the Scottish Highlands with Dr. Mark Hovell, a senior surgeon at the Throat Hospital in London. Although a further examination by Mackenzie on 20 August revealed no sign of a recurrent growth, Frederick said he had the "constant feeling" of something "not right inside"; nonetheless, he asked Queen Victoria to knight Mackenzie, who duly received a knighthood in September.
Despite the operations on his throat and having taken the sea air at Cowes, Frederick remained hoarse and was advised by Mackenzie to spend the coming winter on the Italian Riviera. In August, following reports that his father was gravely ill, he considered returning to Germany, but was dissuaded by his wife, and went to Toblach in South Tyrol with his family, where Victoria had rented a house. He arrived in Toblach on 7 September, exhausted and hoarse. Concerned by Frederick's lack of visible improvement after a brief meeting with Frederick in Munich, Philipp, Prince of Eulenburg, consulted the distinguished laryngologist Max Joseph Oertel, who urged a drastic and thorough operation on Frederick's throat, and said he suspected a benign tumour which could soon become malignant. By this time, Mackenzie's treatment of Frederick was generating strong criticism. After a fortnight in Toblach, Mackenzie arrived to reexamine Frederick, who had continued to suffer from colds and hoarseness; in public, however, the doctor remained largely unconcerned, and attributed the hoarseness to a "momentary chill." However, he recommended that Frederick should leave Toblach for Venice, to be followed by Victoria. The weather soon turned cold, and Frederick's throat caused him pain, for which he received cocaine injections.
Upon arriving in Venice, Frederick again caught cold; privately, Mackenzie was growing seriously concerned, having observed a continued tendency for Frederick's throat and larynx to swell. He forbade Frederick from speaking at any length, noting that if the Crown Prince insisted on speaking and contracted further colds, he could give him no more than three months to live. At the beginning of October, Victoria noted that "Fritz's throat is giving no cause for fresh anxiety & he really does take a little more care and speaks a little less." On 6 October, Frederick, his family and Mackenzie left for a villa at Baveno on the shore of Lake Maggiore, with Mackenzie leaving Baveno on 8 October, after predicting Frederick's recovery "in 3 or 4 months," wrote Victoria. Their elder son Wilhelm joined them at Baveno on 17 October for Frederick's 56th birthday the following day. At the end of October, Frederick's condition abruptly worsened, with Victoria writing to her mother on 2 November that Frederick's throat was again inflamed, but not due to any cold, and that he was "very hoarse again" and easily became depressed about his health. General Alfred von Waldersee observed that Frederick's health had grave implications as if William died soon and his son succeeded, "a new Kaiser who is not allowed to speak is a virtual impossibility, quite apart from the fact that we desperately need a highly energetic one." His son Wilhelm reported to Albert, King of Saxony that his father was frequently short-tempered and melancholic, though his voice appeared to have slightly improved, and that Frederick's throat was being treated by "blowing in a powder twice a day to soothe the larynx."
On 3 November, Frederick and his entourage departed for San Remo. At San Remo two days later, on 5 November, Frederick entirely lost his voice and experienced severe pain throughout his throat. Upon examination, Dr. Hovell discovered a new growth under the left vocal cord; when the news reached William and the German government, it caused great consternation. The following day, Mackenzie issued a bulletin stating that while there was no immediate danger to the Crown Prince, his illness had "unfortunately taken an unfavourable turn," and that he had requested advice from other specialists, including the Austrian professor of laryngology Leopold Schrötter and Dr. Hermann Krause of Berlin. On 9 November, Schrötter and Krause diagnosed the new growth as malignant, and said it was unlikely Frederick could live another year. All the doctors in attendance, including Mackenzie, now concluded that Frederick's disease was indeed laryngeal cancer, as new lesions had appeared on the right side of the larynx, and that an immediate and total laryngectomy was required to save his life; Moritz Schmidt, one of the doctors, subsequently said that the earlier growths found in May had also been cancerous. Frederick was devastated by the news, bursting into tears upon being informed by Mackenzie and crying, "To think I should have such a horrid disgusting illness ... I had so hoped to have been of use to my country. Why is Heaven so cruel to me? What have I done to be thus stricken and condemned?" Even at this stage, however, Frederick, in a private discussion with his wife, decided against the laryngectomy as it was itself highly risky. He sent his doctors a written statement that he would remain in Italy and would only submit to a tracheotomy if he was at risk of suffocating due to his condition. The news was greeted with shock in Berlin and generated further hatred against Victoria, now seen as a domineering "foreigner" who was manipulating her husband. Some politicians suggested that Frederick be made to relinquish his position in the line of succession in favour of his son Wilhelm, but Bismarck firmly stated that Frederick would succeed his ailing father "whether he is ill or not, [and] whether the K[aiser] is then unable permanently to perform his duties," would then be determined per the relevant provisions of the Prussian Constitution. Despite the renewed diagnosis of cancer, Frederick's condition appeared to improve after 5 November, and he became more optimistic; through January 1888 there remained some hope that the diagnosis was incorrect. Both Frederick and Victoria retained their faith in Mackenzie, who re-examined Frederick's throat several times in December and gave a good prognosis, again doubting whether the growths had been cancerous.
On 26 December 1887, Frederick wrote that his "chronic catarrh" appeared to be taking "a turn for the better", and that "a further bond has been forged between our people and myself; may God preserve it by giving me, when I resume my duties, the capacity to prove myself worthy of the great trust that has been shown me!" A week later, however, on 5 January 1888, his hoarseness and the swelling under his left vocal cord returned, with the previously unaffected right side of his throat becoming inflamed. He ran high fevers and began coughing violently, with his breathing becoming more laboured. The doctors diagnosed perichondritis, an infection of the throat membrane. Frederick again became unable to speak, and suffered violent headaches and insomnia. On 29 January, Mackenzie returned to San Remo from a trip to Spain, and after examining his patient recommended an immediate tracheotomy. The operation was conducted at 4 p.m. on 8 February, by which time Frederick was continually suffering from insomnia and "embarrassing bouts of suffocation". A tracheal tube was fitted to allow Frederick to breathe; for the remainder of his life he was unable to speak and often communicated through writing. During the operation, Bergmann almost killed Frederick by missing the incision in the trachea and forcing the cannula into the wrong place. Frederick started to cough and bleed, and Bergmann placed his forefinger into the wound to enlarge it. The bleeding subsided after two hours, but Bergmann's actions resulted in an abscess in Frederick's neck, producing pus which would give Frederick discomfort for the remaining months of his life. Later, Frederick would ask "Why did Bergmann put his finger in my throat?" and complain that "Bergmann ill-treated [me]".
Even after the tracheotomy, Frederick continued to run high fevers and suffered from headaches and insomnia. His violent coughing continued, bringing up bloody sputum. Apart from Mackenzie, the other doctors, led by Bergmann, now held the firm opinion that the Crown Prince's disease was cancer and that it had possibly spread to his lungs. The diagnosis of laryngeal cancer was conclusively confirmed on 6 March, when the anatomist Professor Wilhelm Waldeyer, who had come to San Remo, examined Frederick's sputum under a microscope and confirmed the presence of "so-called cancroid bodies...from a cancerous new growth" in the larynx. He further said that there were no signs of any growths in the lungs. Though it finally settled the question, Waldeyer's diagnosis threw all of Mackenzie's treatment of Frederick into doubt. The diagnosis and treatment of Frederick's fatal illness caused some medical controversy well into the next century.
