Appendicitis historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Discovery

• The knowledge of the appendix itself dates back to ancient Egypt. Coptic jars from from the ancient egyptian times refer to "the worm of the intestine". The earliest known drawing of the appendix was by the great artist and scientist, Leonardo da Vinci, in 1492. The first description of the appendix was by Physician and Anatomist Jacopo Berengaro Dan Carpi in 1521. In 1543, Andrea Vasulius portrayed a clear illustration of the appendix in "De Humani Corporis Fabrica.
• The first description of appendicitis is thought to date back to the early 1500's by French doctor and prolific writer, Jean Francois Fernel, in the "Universa Medicina". He describes a patient:

"A girl of seven afflicted with diarrhoea passed for many days from the bowels a white putrid and foul material. She swelled up with increasingly severe pains and repeated loss of consciousness and vomiting of a fecal liquid. She died miserably two days later. On opening the body, the caecum intestinum was narrowed and constricted....and material opened up itself an unusual route by necrosis and perforation".

• Lorenz Heister in the late 1600's was the first person to perform post-mortem sections of appendicitis, and gave an unequivocal description of a perforated appendix and abscess
• Francois Melier suggested surgical removal of the appendix in 1827, although his paper was largely ignored. Guillaume Dupuytren, a leading surgeon in Paris gave strong opposition to Melier's suggestion, and was convinced that the cause of right lower quadrant inflammatory disease was due to the cecum. Finally in the 1840's, four well known physicians of the time Thomas Hodgkin, Voltz, Addison and Bright all pointed towards the appendix as the source of the disease.
• There was no definitive treatment for over 50 years after Melier's paper, and the disease was called many names, such as typhilitis, pertyphilitis, tuphloenteritis, paratyphilitis, cecitis and iliac passion.
• Reginald. J. Fitz, anatomic pathologist from Harvard University, described his paper "Perforating Inflammation of the Vermiform Appendix" on 18th June 1886 to the Association of American Physicians. He was the first person to provide a clear description of the pathology, diagnosis and treatment of appendicitis. This is when the term "appendicitis" was used for the first time.
• The first actual surgical removal of the appendix was done by Caudius Amyand at St. Georges Hospital in London, when he removed a perforated appendix found in a scrotal hernia.

Development of Treatment Strategies

• Charles McBurney from the College of Physicians and Surgeons in New York city, pioneered the diagnosis and early operative intervention of appendicitis.
• The McBurney point was described in 1889, which is one third of the way from the anterior superior iliac spine in the right upper quadrant of the abdomen.
• The McBurney incision was coined in 1894.