Abdominal pain is one of the most frequent complaints that present to the emergency department. With every physical examination of the abdomen we note if there is pain in the right lower quadrant (RLQ) over that most famous of landmarks, McBurney’s point.
Abdominal pain is one of the most frequent complaints that present to the emergency department. With every physical examination of the abdomen we note if there is pain in the right lower quadrant (RLQ) over that most famous of landmarks, McBurney’s point. We should appreciate the innovative American surgeon behind that anatomical landmark who advocated a radical approach to the treatment of appendicitis. Charles McBurney (1845-1913) received his undergraduate degree from Harvard in 1862, his M.D. from the College of Physicians and Surgeons in 1870, followed by an internship at Bellevue Hospital. As was common in his time he then studied abroad in Vienna, Paris, and London.
Upon returning to New York City he established his practice primarily at Roosevelt Hospital. In 1887 he showed that appendicitis could be diagnosed by noting a point of maximal tenderness in the RLQ at the point that now bears his name. Once diagnosed he advocated immediate surgery. To have some appreciation of surgical practice of that time it was only in 1884 that Rudolf U. Kronlein (1847-1910) first recognized a perforated appendix. In that landmark case he removed the offending organ, though the 17-year- old patient subsequently died. In this era where there were no antibiotics, anesthesia was still open-drop ether or chloroform, and surgical sterility was still not only in its infancy but was strongly opposed by the American medical establishment. Surgical mortality was over 60% and an infected appendix was typically allowed to rupture with the abscess later drained. Typical opinions of the time were expressed by Dr. C.B. Nancrede who cited McBurney’s push for early intervention as “extremist”. He felt that opium could adequately treat the peritonitis and rushing to surgery often endangered the patient as some 50% of such patients recovered. However, McBurney persisted in his views and with time his approach prevailed. Five years later McBurney described the muscle splitting incision that became the classic approach to remove the appendix. He was the first New York City surgeon to introduce the use of sterile rubber gloves a year after William Halstead developed them and developed a popular method of repairing inguinal hernias. He died of cardiac disease in 1913 and was hailed as one of the great surgeons of his time.
- McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. New York Medical Journal, 1886.
- Nancrede CB. The treatment of appendicitis. Editorial inThe Physician and Surgeon – A Journal of the Medical Sciences, F.W. Mann, MD editor, Volume XII, 1890 83-84.
- McGavran SB. What should a physician in general practice know and do in a case of appendicitis. Ohio State Medical Journal, 1908;4:335-339.
- Rutkow IM. American Surgery – An illustrated history. 1998 Lippincott-Raven, Philadelphia, PA. Pg. 277.