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CONSIDERING THE FREQUENCY with which appendi- ceal pathology is diagnosed and treated today, it is surprising that the term ''appendicitis'' and the re- commendation for cure by removal of the appendix were first proposed by Dr. Reginald Heber Fitz (Fig. 1) a mere 125 years ago. This does not however imply that the cause of right lower quadrant pain and its appro- priate treatment had not been sought for a long time. From ancient times through the first half of the 19th century, almost all inflammatory conditions localized to the right lower quadrant were mistakenly attributed to the cecum. As one prominent surgical historian noted in the 1920s, ''so many times does it appear that acute observers stumbled on the very threshold of the dis- covery that the original lesion in these conditions (of the right iliac fossa) was in the vermiform appendix, that it seems scarcely credible that for less than 45 years have we had any adequate knowledge of appendicitis.''1 The history of appendicitis is an excellent anecdote for the history of surgery itself. In his presidential address at the 94th meeting of the Southern Surgical Association, G. Rainey Williams noted that ''the history of appen- dicitis includes examples of great resistance to changing concepts, brilliant but unaccepted early observations, emotional support for unsupportable views, the im- portance of timing, and, finally, the development of a highly satisfactory solution.''2
Ancients
Disease of the appendix is likely as old as man. One of the earliest examples, right lower quadrant adhesions suggestive of previous appendicitis, was discovered in an Egyptian mummy during the Byzantine era. Much of what was known about human anatomy before the Renaissance was from the second century observations of Galen. No anatomical description of the appendix is seen in his work, which was based largely on the dissection of primates.1 However, he did comment on right lower quadrant pain in his writing. He noted that ''the colic passion, situated in the large bowel, was found below the umbilicus, more often on the right, and was very apt to recur.'' At that time, surgical treatment was often delayed until the last possible moment when the abscess was actually ''pointing.'' Physicians were careful not to cause discomfort from surgery and to avoid the...