Note 59 — Chapter XLIX · THE APPENDIX AND ITS DISEASES.[59]

The laity, as well as part of the profession, having not yet ceased to wonder at the great importance attaching today to appendicitis, when twenty years ago it was practically unknown, it is worth while to insert here the following brief historical account: The term “appendicitis” was coined by Fitz for a condition which had not been hitherto unknown, but to which he gave a classical description. That the appendix might be primarily diseased had been known for one hundred and fifty years; that peri-appendicular abscesses were frequent may be seen by reference to works of the middle and latter part of the past century on perityphlitis and perityphlitic abscess, Willard Parker, of New York, being the most prominent writer of his day upon this subject. In the Transactions of the Medical Society of the State of New York for 1875, Gouley reports a case of so-called perityphlitic abscess due to perforation of the appendix, with remarks upon its surgical treatment. The curious feature attaching to this case was that two years previous to its occurrence the patient had swallowed one of his teeth. Although this tooth was not found at the time Gouley alluded to the possibility of it or any other small body lodging in the appendix and finally causing ulceration. He referred also to the case published in 1856 by Dr. Lewis, of New York, who reported an individual dying at the age of eighty-eight, whose appendix was found to contain one hundred and twenty-two deer shot, it appearing that he had been exceedingly fond of game; he supposed that the shot found in the appendix were contained in meat which he had eaten. Lewis also referred to forty-seven cases of foreign bodies which he tabulated, all but one of which died.

Fitz’s article appeared in 1886. In it he claimed that operation should be done much earlier than was then the custom, and he showed that 34 per cent. of these cases died during the first five days of illness. But the first real operation for appendicitis as such was done by Krönlein, of Zurich, according to a suggestion made by Mikulicz in 1884. The second was done by Symonds, in England, in 1885, this being an interval operation. The first operation in the United States was done by Hall, of New York, in May, 1886, although to Morton, of Philadelphia, the credit must be given of the first operation in this country on a case deliberately diagnosticated. This was in April, 1887, Sands doing the next one in December of the same year.

McBurney had assisted Sands in a large number of cases, and in 1889 published his classical paper with an account of “The First Recorded Case where an Acutely Inflamed Appendix had been Removed while Full of Pus.” In the same year Weir also published an elaborate paper, making similar recommendations. It is not necessary to follow the subject later than the year 1889, since to it every surgeon of note has probably contributed.