history

Would This Kill Me in the 1800s: Appendicitis

You voted, and I’m here to answer the question: Would appendicitis kill me in the 1800s?

Why do we even have an appendix? 

Honestly? Your guess is as good as mine. Doctors and anatomical experts are divided on the subject.

The appendix is a little flesh tube that dangles from the point between your large and small intestines, on the right hand side of the abdomen. It’s a bout the size of your pinky. The common belief is that it is an evolutionary “leftover” that we no longer need, though there is a recent theory that it stores “good bacteria” in case of illness, to expedite recovery, or in the production of white blood cells. In fetuses (around 11 weeks), endocrine (hormone) function has been detected in the appendix, but this doesn’t carry through after birth. Either way, unlike things like the heart and lungs, it’s not strictly necessary for survival.

So, if your appendix is just hanging around, not doing much (as far as we can tell), why remove it? Typically it’s only removed if it becomes inflamed. Because we don’t know exactly how this organ works, it’s hard to say what causes it to suddenly become inflamed and painful, but it’s suspected that some sort of blockage causes a buildup of “bad” bacteria and puss. This is painful–in some cases extremely so, with visible abdominal swelling–and can lead to nausea, vomiting, diarrhea, and constipation. In worst case scenarios, the appendix can burst, sending all of that bacteria and puss into the rest of the body, leading to high fevers and death.

Early Diagnostics

Historical, human anatomy has been incredibly hard to study. For centuries the Catholic church limited or completely outlawed the dissection of human cadavers, so dissections would have to be done in secret or on animals–most of which don’t have an appendix. Among those that do (including rabbits, mole rats and some rodents and primates), the appendix frequently still serves a purpose in the digestive system. In koalas it is used to help break down their high-cellulose diet (it’s called a cecum). In primates, however, the purpose is still unknown.

Due to the difficulty in understanding human anatomy in the first place, historians are divided on when it was first recognized. There are infrequent mentions of it dating back to ancient Greece, but it was something of a medical unicorn until the Renaissance. Most people didn’t believe it existed, or thought it was some sort of error or anomaly.

The first “official” description of an appendix was in Berengario da Carpi’s 1521 Commentaria. This was later expanded in 1568 by Andreas Vesalius, who identified the connection to the ileum and the colon.

Early surgeries

The first appendectomy wasn’t actually a treatment for appendicitis. Surgeon Claudius Aymand (1681-1740) was operating on an 11 year old boy for entirely different reasons, and removed the appendix as part of the procedure.

J. Mestivier was the first doctor to remove an appendix, though unsuccessfully. The Bordeaux surgeon operated on a 45 year old patient with a burst appendix, removing a pint of puss from a mass in the abdomen. He died shortly thereafter and it was only during the autopsy that the appendix was identified as the source of the infection.

It wouldn’t be until the middle part of the 19th century that appendectomy patients would begin to survive the procedure. Charing Cross Hospital in London was the home of this procedure, performed by Henry Hancock, while the US followed in 1867 with a surgery by Willard Parker.

Development and modern treatments

The word “appendicitis” wasn’t actually introduced to the medical community or the world at large until 1886, when Boston doctor Reginald Heber Fitz used it to more accurately describe the condition. Previously it had been known by typhilitis, which is a general inflammation of the area the appendix is found in, and perityphilitis, inflamation of the connective tissue between the small and large intestine.

Due to the general danger of surgical procedures in the 1800s, appendectomies didn’t really catch on until the 1880s, as advances in pain relieve and infection prevention made them safer. The diagnostic practice was still iffy, as doctors were still learning about human anatomy.

Starting during WWII, doctors began prescribing antibiotics to patients in war zones where surgery was deemed too risky, and they had good results. During the cold war, soldiers on submarines unable to make landfall for months at a time would be given antibiotics, and often made a full recovery.

It was also common practice that if someone had surgery for an unrelated problem (say, a problem with the uterus, stomach, or intestines), the appendix would be removed as a precaution against future infection.

Today

The actual appendectomy has evolved from a hazardous procedure involving a large, infection prone-incision to a modern “single incision” laparoscopic procedure that is largely outpatient, and one of the most common procedures in the United States. While appendicitis itself is on the decline (again, no known reason exists), the treatment is faster, safer, and more efficient than ever. Doctors are also revisiting their history, and a hospital in California is currently studying the use of antibiotics as a treatment to help avoid surgery altogether.

Conclusion

So, would appendicitis kill you in the 1800s? It’s hard to say. It would depend on when and where you lived, and the quality of the care you received. Overall, you’re probably looking at a 50/50 shot, if we’re being optimistic. If it was diagnosed early, and treated in a clean, professional facility by an experienced doctor, then you’d probably have a pretty good chance.

This topic was chosen by my readers, so if you’d like to help choose the next installment of WtKMit1800s, make sure to follow me on Twitter.

Further reading:

Wikipedia
Pubmed article
The Mysterious Appendix
Early history of the appendectomy
The Evolution of the Appendectomy
Stages of appendicitis
A Brief History of Surgery
What is the function of the human appendix 


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