23 volumes of patients' case histories in Peter Freyer's own handwriting, 1896-1921, giving details of Freyer's private patients, their medical problems and his treatment of them. One volume covers each year except for the first volume and the last 3 volumes which all cover more than 1 year. A case history is normally contained on one page but occasionally continues onto a second page or in another volume. Sometimes 2 short case histories may be on the same page. This is most common in the last 3 volumes. From approximately 1910 cross references are made to previous visits of some patients recorded in earlier volumes. Each volume has its own index of patient surnames and a 24th volume contains an overall index.
The details given for most case histories are as follows: the date(s) of consultation; name, address and age of the patient; symptoms and history of the illness; diagnosis and treatment. In many of the early case histories there are details of the patient's family background. The number of children is given for patients who were parents.
Freyer's private practice peaked in the years 1905-1906, when he was consulted by more than 250 private patients in each year. Most of his patients were men, particularly elderly men, once his reputation as a surgeon dealing with problems of a urinary nature was well established in the early 1900s. However the case histories cover patients of all ages and include men, women and children. Many of his male patients were either army officers or clerics and a considerable number had served in India, for example in June 1910 Freyer operated on Surgeon General Sir Benjamin Franklin, previously Inspector General of Hospitals in Bengal, NWP and the Punjab [1910, p108]. Women tended to consult him about problems associated with menstruation and the menopause. Although other problems also feature, for example in Oct 1907 he performed a mastectomy [1907, p173]. Young boys were circumcised as a medical treatment in the early years and other children were treated for a variety of ailments including Bright's Disease [1903, p124]. Some soldiers who had been at the War Front consulted Freyer during 1916.
As Freyer's reputation grew he was consulted by patients from abroad, such as General José de Paiva Conciero, Marquez d'Avantz of Lisbon and godfather to King Manuel of Portugal [1909, p112] and Sir Pherozeshah Mehta 'the great Indian leader' who died in 1915 [1910, p152]. In 1910 Freyer saw patients from Switzerland, Australia, Columbia, France, India and Bucharest. Some patients were of Irish origin, for example Sir Irving Courtenay, described as a 'a pioneer of the electrical industry' in The Times (24 Oct 1912) [1907, pp 244 and 253]. Other patients were living in Ireland. He was visited by Mrs Cloherty of Galway on 31 July 1908 and also by C Wisdom Hely of Rathgar, Dublin [1914, p158]; the Rev Patrick O'Connell PP of Ovens, Co Cork [1915, p124] and Daniel O'Connell Miley of Ballsbridge, Dublin [1919, p143]. H E Barlow, aged 20, with an address at 47 Ladbroke Gardens, London, was examined by Freyer in Jan 1913 with regard to his fitness for the Irish Constabulary [1913, p3]. Some patients were friends of Freyer's, such as George Valentine Martyn, 38 Cambridge Terrace, London [and of Curraghmore, Ballinrobe, Co Mayo, a member of the Galway Archaeological and Historical Society] with whom Freyer records playing golf in his post operation notes [1910, p240].
Snippets of information about the working or social lives of some patients are occasionally portrayed, for example there is a reference to Lord Pirrie's meeting with Winston Churchill in Belfast on '8th' [Feb 1912], 2 weeks before Lord Pirrie's prostatectomy [1912, p45]. The case history of the well-known horticulturist H J Elwes, FRS, of Cheltenham, recorded in July 1913, reveals that Elwes, when travelling in Germany 5 years earlier, had dined with Count Bismarck. He had also visited Formosa and travelled on the Siberian railway [1913, p116]. The medical problems diagnosed and treated by Freyer were concentrated in the areas of the bladder, kidney, liver and prostate but there are case histories of other ailments such as neurosis, knee sprain, diabetes, haemorrhoids, gallstones and abscesses. The early volumes include many case histories of sexual problems in men. A number of these patients were suffering from the effects of venereal disease, in particular gonorrhoea, which caused a problem known as stricture of the urethra. Freyer treated many patients who had vesical or renal calculus with procedures known as lithotomy and litholapaxy. There are a number of cases of nephrotomy. In 1901 the first cases of the total enucleation of the prostate are recorded. The development of this operation by Freyer established his reputation as a leading surgeon in his field. Many of these case histories were used in his published writings on the subject of prostatectomy and are numbered in red ink. They give details of the operation and of the patient's recovery. Some prostates were sent for laboratory analysis and others were kept as specimens. Parts of these case histories have been underlined or marked by Freyer in blue pencil.
As the years progressed Freyer saw an increasing number of cases of cancer of the bladder and the prostate. For some of these patients it was not possible to remove the prostate as the cancer was invading the surrounding tissue. In June 1914 one patient with this problem was fitted with a urinary apparatus, which drained the bladder. He was seen walking in Hyde Park in Aug 1914 [1916, p1]. Another case requiring the fitting of a urinary apparatus for permanent drainage is recorded in Sept 1918 [1918, p227].
It is evident from the latter case histories that Freyer was becoming more of a consultant and some patients were referred to St Peter's Hospital for treatment. Freyer was also consulted when prostatectomies performed by other doctors resulted in complications. A priest from Co Cork had his prostate removed by a Dr Dun[d]on of Cork in May 1915. Freyer treated him for urinary troubles and records the priest revisiting him in Feb 1916 when he was 'quite well' [1915, p124, 1916, p3]. In Jan 1920 Freyer was visited by Sir Maitland Park, editor of the Cape Times, who was suffering from closure of his prostatic urethra, caused by the removal of his cancerous prostate 3 months earlier. Sir M Park had at one time worked for the Indian newspaper the Pioneer. He died in March 1920 [1920, p17].
Most of Freyer's operations were successful. Occasionally a death is recorded following a prostatectomy, particularly if the patient was overweight or very feeble. On the death of one patient in 1914 [p146] Freyer wrote that it was not fair to blame his prostatectomy as the cause of death, as the patient had had a suprapubic cystostomy performed by another doctor a week before and septicaemia had already set in. Operations were carried out by Freyer in a number of locations, 11 Nottingham Place, is mentioned throughout the case books. Other addresses include St Peter's Hospital, King Edward VII Hospital, 11 Duchess St, 29 Devonshire Place, 14A Wimpole St and 13, 52, 53 Beaumont St. Occasionally a patient was operated on in his own home, for example on 22 Feb 1912 Freyer operated on Lord Pirrie at his London home, 24 Belgrave Sq, and on 29 Dec 1913 he operated on A H Melville at his home in Lincoln [1913, p225].A second named doctor attended at each operation, for example Professor Pye of University College, Galway, was present at an operation on 14 June 1914 with 2 other doctors from Ipswich [1914, p97]. Sometimes the attending doctors were from abroad, for example a French doctor was present at an operation on 5 May 1914 [p43] and an American doctor from Colorado watched an operation on 25 May 1916 [p82]. The name of the anaesthetist is also recorded and in many cases this was C Braine.
Some case histories include pencil diagrams and there are a few illustrations of prostates. Additional documents, such as referral letters from doctors, patients' letters and laboratory reports are pasted in beside the relevant case history. Wilson Stoker of Mayfair wrote to Freyer on 13 Nov 1914 informing him that Sir Arthur Birch, who had had his prostate removed by Freyer the previous February, had left London at the end of June 'after which he drifted into the hands of faith healers and Christian Scientists, partly due to an old standing faith in quacks but more especially with a view of economizing on medical fees' [1914, pp12 and 13]. From 1907 reports of radiograms carried out on various patients by Dr W I Bruce, 10 Chandos St, Cavendish Sq, London, are included. Newspaper cuttings and obituaries are also pasted in. These portray the better known of Freyer's patients. A newspaper cutting from Oct 1909 records the death of G W Moore of the famous Moore and Burgess Minstrels, who had been operated on by Freyer in May 1903. Another cutting records the death of a former patient, Capt Frederick Courtney Selous, famous explorer and big game hunter, who was killed in action in East Africa on 4 Jan 1917 [1911, p87]. There are newspaper obituaries to such persons as Mervyn Herbert Nevil Story-Maskelyne, FRS, Professor of Mineralogy at Oxford (died May 1911) [1904, p27]; Sir Charles Crosthwaite, Lieutenant Governor of the NWP in 1892 (died May 1915) [1905, p267]; Sir William Preece, FRS, 'the pioneer of wireless telegraphy' (died Nov 1913) [1908, p228]; Frank Hugh O'Donnell, who 'was among the best known past members of the Irish Parliamentary Party' (died Nov 1916) [1912, p126].
Many patients who benefited from the effects of a prostatectomy wrote letters expressing their gratitude, often many years after their operation and sometimes on its anniversary. Quotations from some of these letters, written in a different hand and dating back to 1914, have been written in at the end of the relevant case history or at the back of the volume. These quotations show the change the removal of the prostate made to the lives of many of Freyer's elderly patients. Dr H C G Moule, Bishop of Durham, wrote on 21 June 1917, almost 3 years after his operation, of being restored 'to perfect and unvaried physical comfort' [1914, p152]. Other patients sent photographs of themselves, for example Dr T de Valcourt who wrote in 1913, 7 years after his prostatectomy 'By the included photo, you can judge that I am still in very good health' [1906, p282]. There are also pictures, among others, of Dr Debout D'Estrees of Nice, France [1909, p250]; George W Perry, Kings Langley, Herts [1918, p178] and Sir Arthur Hargreaves Brown, bart, of Brown, Shipley and Co [1920, p16].
Dark inky blue volumes, except for the first 2 volumes which are all black in colour, with rather brittle black spines, bought from H J Ryman, manufacturer, 8 and 10 Great Portland St, [London]. Size 19x24x2½. The volumes for the years 1899-1902 and 1905-1907 have been rebound. The spines of the other volumes are rather fragile. All the volumes are embossed on the spine with 'Casebooks of Sir Peter Freyer KCB M CH' and the year. [volumes for 1908-1909, 1920/1921 and the general index need rebinding].
