ABSTRACT

In 1554, a 7-year-old French girl developed abdominal pain and diarrhea that ominously progressed to signs of right lower quadrant peritonitis. In an era lacking antibiotic and fluid support, she quickly succumbed to overwhelming peritoneal sepsis. Post-mortem examination confirmed the clinical diagnosis of ‘iliac passion’ caused by free perforation in the region of the cecum. Her physicians, perhaps spurred on by recent descriptions of the appendix by DaVinci (1492) and Vesalius (1545), published a careful description of her appendix and its involvement in the disease. Thus began a debate on the role of the appendix and its surgical therapy that lasted for over three centuries. Progress was made in the early nineteenth century with the cautious recommendation to drain abscesses clearly localized to the right lower quadrant. Encouraged by early success, the indications expanded to include operation for the diagnosis of spreading peritonitis. In 1886, Reginald Fitz published convincing evidence that the appendix was the cause of this most common malady and, importantly, that operation should occur within 48 hours of symptom onset. News of Fitz’s work traveled across the Atlantic to London, where Treves instantly popularized appendectomy by curing King Edward VII in 1902. In Canada, a country doctor named Abraham Groves is said to have diagnosed and successfully removed an inflamed appendix of a 12-year-old boy while on rounds of his farming area. This event apparently took place in 1883, three years before the Fitz landmark presentation. However, credit for the first published report goes to Claudius Amyand from England who, in 1736, removed an inflamed perforated and fistulizing appendix from the scrotum of an 11-year-old boy.