The History of Appendicitis

leonardo appendix

The earliest known drawing of the human appendix - Leonardo DaVinci (1492)

The vermiform appendix is a small tubular structure, about the size of a stubby pencil, that lies off the cecum, the first section of the colon, in the right lower quadrant of the abdomen, near where the small and large intestines join. The appendix was first depicted in Western medicine by Leonardo Da Vinci in his dissection sketches.(Da Vinci) Vesalius also depicted the appendix in 1541, in an excellent drawing that also depicts the central cause of pathology of the appendix, a fecalith, or a small, inspissated ball of stool obstructing the appendiceal lumen.(Vesalii)

No one has ever been entirely sure of the function of the appendix; it is attached to the gut, but appears to have no role in digestion. The appendix is also only variably present in animals – hominid apes have appendices, but monkeys do not. Rabbits and wombats have appendices, but dogs and cats do not.(Theobald) The lack of obvious function and the variability of presentation led the Natural Philosophers, Darwin included,(Darwin) to classify the appendix as vestigial, a harmless little evolutionary accident that could be safely ignored.

As a result, the sudden onset of pain in the right lower quadrant associated with fever, chills, and then peritonitis was thought for centuries to be due to an inflammation of the cecum, and diseases of the cecum were noted with the Greek root typhos, or blind, since the cecum represents a “blind pouch” of the colon.(Williams) Pain in the right lower quadrant with evidence of inflammation was typhlitis, except when there was bloody dysentery as well, in which case the diagnosis was typhoid.

There were countervailing arguments variably made through the 18th and 19th centuries that the vermiform appendix was in fact the source of this sudden, often catastrophic illness. In 1711 Lorenz Heister described the blackened stump of an acute gangrenous appendix in his dissection of an executed criminal (who presumably went to the gallows with significant abdominal pain). Hunter, Bright, Addison, and Parkinson all described appendiceal disease in monographs published between 1767 and 1839. In 1880, the appendix was first removed in a planned operation by Dr. Lawson Tait.(Williams)

In 1886 Reginald Fitz of Boston published his monograph on diseases of the vermiform appendix, and coined the term appendicitis to separate this disease from inflammations of the cecum and small bowel. (Fitz) Frederick Treves, author of the well regarded 1883 monograph Applied Surgical Anatomy,(Frederick Treves Surgical Applied Anatomy) performed the first appendiceal surgery in England for the “new disease” appendicitis in 1887.