Doctors were baffled by sudden deaths for centuries.
The first successful appendectomy didn’t occur until 1735—and it would take about a century for the surgery to become commonplace. So how did doctors treat appendicitis before that?
Well … they didn’t. In fact, centuries of baffling deaths occurred before medical experts fully understood what was going on. For much of human history, doctors didn’t even know the appendix existed (and today, they still don’t fully understand what it’s there for).
Appendicitis only affects about five percent of people in the United States at some point in their lives, according to the National Institutes of Health. That said, appendicitis is so notorious that most people can recognize the extreme symptoms pretty fast—namely, severe and sudden pain that starts at the belly button and moves to your lower left abdomen. (Learn more about appendicitis symptoms here.)
The Mystery of the Appendix
Unfortunately, many patients throughout history—who probably had appendicitis and didn’t know it—ended up dying.
Part of the problem was that human dissection was rare, and even forbidden due to religious restrictions, during ancient times. Much of early anatomy knowledge came from Galen, a physician in the Roman Empire during the 2nd century CE. Since he could not study humans, he studied human-like animals, such as pigs and monkeys.
Galen’s work was incredibly helpful to physicians. There was one flagrant problem, though: The appendix is pretty rare in other species. That means for centuries, doctors didn’t even know that the tiny, finger-shaped organ was even there. Additionally, no dissection meant no autopsies, so when someone died from a burst appendix, doctors had no way of knowing.
Autopsies in the Renaissance Period
The 15th and 16th centuries, also known as the Renaissance Period, saw massive cultural shifts. One of those changes was the easing of religious restrictions that allowed human dissection and autopsies. This changed medicine forever.
The artist Leonardo da Vinci capitalized off this change and used dissection to draw incredibly realistic diagrams of the human body. In fact, a 1492 drawing of the digestive system included the appendix. (During this era, some called it the appendix, while others insisted it was part of the cecum.)
The appendix was officially described in writing in 1521. The Italian physician and surgeon Jacopo Berengario da Carpi claimed to have dissected hundreds of human bodies, which helped him write his famous anatomy book Isagogae Breves. He described the organ as “empty within, and in breadth less than the smallest finger of the hand, and of a length of three inches or thereabouts.”
The First Appendectomy
A few autopsy reports from the 16th to 19th centuries noted perforated appendices. Doctors took note of the phenomenon and named this “right lower quadrant inflammatory disease.” However, they still didn’t blame the appendix itself.
In 1735, London surgeon Claudius Amyand performed the first surgical removal of the appendix (the procedure wasn't yet named an appendectomy). The patient was a young boy who had swallowed a pin, which pierced the appendix.
While the surgery may have saved the young boy, this procedure didn’t become the norm for more than a century. Why? Because doctors didn’t yet have reliable anesthesia, which would become more common in the 19th and 20th centuries. In other words, surgery was the last resort for an inflamed appendix. Learn more about the history of anesthesia here.
An Explosion of Surgeries
In 1886, U.S. doctor Reginald Fitz presented a study at the first meeting for the Association of American Physicians in Washington, DC. Dr. Fitz stated that most cases of so-called right lower quadrant inflammatory disease actually started in the appendix.
In his presentation, Dr. Fitz used the term appendicitis for the first time (and it quickly became the term of choice). Additionally, he recommended prompt surgical removal for treatment, which he named an appendectomy. This recommendation was possible at the time thanks to the recent (at the time) arrival of anesthesia.
By 1900—just 14 years after Dr. Fitz’s presentation—thousands of appendectomies had been performed. Mortality rates of appendicitis dropped. The invention of antibiotics in the 1940s also helped, which can help prevent sepsis (a life-threatening response to infection) after surgery.
Today, minimally invasive laparoscopic appendectomies—removing the appendix through several small incisions rather than one large one—are par for the course. However, they were met with skepticism in the beginning.
The first laparoscopic appendectomy occurred in Germany in 1981. Kurt Karl Stephan Semm performed the surgery, despite his technique being rejected and critiqued for a decade prior. In fact, the American Journal of Obstetrics and Gynecology rejected his paper on the laparoscopic appendectomy, saying the technique was “unethical.”
Of course, surgeons eventually came around to the idea, and even embraced it. Laparoscopic appendectomies became the norm in the early 1990s, and patients love them since the recovery is faster and leaves less scarring behind. Despite the skepticism of the '80s, laparoscopic surgeries are often safer and less invasive than traditional surgeries, so Dr. Semm's persistence paid off.
Want to learn more historical breakthroughs?
- Appendicitis. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases. (Accessed on July 16, 2020)
- Appendicitis. Washington, DC: MedlinePlus, U.S. National Library of Medicine. (Accessed on July 16, 2020)
- Bhattacharya K. Kurt Semm: a laparoscopic crusader. J Minim Access Surg. 2007 Jan-Mar;3(1):35-36.
- Conner A. Galen’s analogy: animal experimentation and anatomy in the second century CE. Anthos. 2017 Aug;8(1):118-45.
- Deaver JB. Appendicitis: its history, anatomy, clinical etiology, pathology, symptomatology, diagnosis, prognosis, treatment, technic of operation, complications and sequels. Philadelphia, PA: P. Blakiston’s Son & Co., 1913.
- Kelley WE. The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s. JSLS. 2008 Oct-Dec;12(4):351-7.
- Meljnikov I, Radojcic B, Grebeldinger S, Radojcic N. History of surgical treatment of appendicitis. Med Pregl. 2009 Sep-Oc;62(9-10):489-92.
- Williams GR. Presidential address: a history of appendicitis. Ann Surg. 1983 May;197(5):495-506.