How Did They Treat Appendicitis in the Past?

For most of recorded history, appendicitis was a death sentence that nobody even had a name for. Patients suffered what physicians vaguely called “inflammation of the bowels” or “disease of the caecum,” and treatment ranged from bloodletting and purgatives to simply waiting and hoping the body could fight it off. The condition was not formally identified until 1886, and the surgery we consider routine today only became widely practiced in the decades that followed, after breakthroughs in anesthesia, germ theory, and surgical technique converged to make cutting into the abdomen survivable.

Centuries of Suffering Without a Diagnosis

The appendix was first described anatomically during the Renaissance, but for roughly two hundred years after that, nobody connected it to the agonizing abdominal crises that regularly killed otherwise healthy people. Physicians observed inflamed tissue in the lower right abdomen during autopsies, yet the idea that a small, worm-shaped pouch at the base of the large intestine could be the culprit took a remarkably long time to gain acceptance.¹ Part of the problem was that the appendix itself was considered useless, a view shaped heavily by Charles Darwin’s characterization of it as a vestigial organ with no real function.² If the organ was insignificant, the reasoning went, how important could its diseases be?

In the meantime, doctors treated acute abdominal pain with the standard tools of pre-modern medicine. Opium provided some pain relief. Purgatives and enemas were prescribed to clear what physicians assumed was a blockage. Leeches and bloodletting were applied to reduce what was understood as excess inflammation. Poultices of varying composition were placed on the abdomen. None of these treatments addressed the underlying problem, and when the appendix perforated and infection spread through the abdominal cavity, the patient almost always died.

The First Recorded Appendectomy

The earliest documented surgical removal of an appendix happened in 1735, performed by a London surgeon named Claudius Amyand. The case was unusual even by historical standards. Amyand operated on an 11-year-old boy who had a chronic groin fistula, and during surgery discovered that a straight pin had become lodged in the boy’s appendix, causing inflammation and abscess formation.³ He removed the appendix, and the boy survived. It was a remarkable achievement, but it did not spark a wave of appendectomies. In an era without anesthesia or any understanding of infection control, abdominal surgery was so dangerous that it remained a desperate last resort for another century and a half.

Why It Took 150 Years for Surgery to Become Viable

Even if a surgeon in the 1700s or early 1800s had correctly diagnosed appendicitis, operating would have been almost as lethal as the disease itself. Two enormous obstacles stood in the way. The first was pain: without anesthesia, surgery meant physically restraining a conscious, screaming patient while cutting through muscle and tissue. The second was infection. Surgeons operated in street clothes, with unwashed hands and instruments, in rooms that were anything but sterile. Post-surgical infection killed patients at staggering rates.

These barriers began to fall in the mid-nineteenth century. In 1846, William T.G. Morton demonstrated the use of ether anesthesia in Massachusetts, and in 1868, Joseph Lister introduced antiseptic technique in Glasgow using phenol to sterilize surgical environments.⁴ These two advances did not transform surgery overnight. Adoption was slow and uneven across hospitals, with widespread use not taking hold until after 1880.⁴ But once surgeons could reliably render patients unconscious and keep wounds from becoming fatally infected, abdominal surgery went from near-suicidal gamble to a real therapeutic option.

Fitz Names the Disease, McBurney Maps the Surgery

The single most important moment in the history of appendicitis care came in 1886, when a Harvard pathologist named Reginald Heber Fitz published a landmark paper identifying the appendix as the true source of the inflammation that had been killing patients for centuries. He coined the term “appendicitis” and argued forcefully that early surgical removal was the correct treatment.⁵ Before Fitz, physicians lumped appendicitis together with other conditions under vague labels like “perityphlitis” or “inflammation about the caecum.” His work gave the disease a clear identity and, just as importantly, a clear treatment plan.

Three years later, in 1889, New York surgeon Charles McBurney built on Fitz’s insight by developing a practical surgical approach. At a meeting of the New York Surgical Society, McBurney described a technique of making an incision directly over the appendix through the abdominal wall and identified the precise spot on the abdomen where tenderness was most reliably concentrated in appendicitis cases, roughly an inch and a half to two inches from a bony landmark on the pelvis along a line drawn toward the navel.⁶ That spot is still called “McBurney’s point” today, and variants of his muscle-splitting incision technique remained the standard surgical approach for a century.

During this same period, other surgeons in North America and Britain were also successfully removing appendices. Abraham Groves in Canada and Lawson Tait in Britain both recorded successful appendectomies around the same time.⁷ The late 1880s and 1890s represented a genuine tipping point, as the combination of proper diagnosis, anesthesia, antisepsis, and refined technique made appendectomy not just possible but increasingly safe.

When Surgeons Chose Not to Operate

Even as appendectomy became established, not every patient went straight to the operating table. By 1901, surgeon Albert Ochsner was advocating a deliberately non-operative approach, paradoxically for the most severe cases, patients who were so sick from advanced infection that they were unlikely to survive surgery.⁸ His strategy involved keeping the patient still, withholding food and drink by mouth, and applying ice to the abdomen while waiting for the acute inflammation to settle. If the patient survived, surgery could be performed later under calmer conditions.

This evolved into what became known as the Ochsner-Sherren regimen, a formalized protocol of non-operative management for appendiceal inflammatory masses, sometimes followed by a delayed “interval” appendectomy weeks or months later once the inflammation had resolved.⁹ The approach reflected a hard-won understanding that not every appendicitis case was the same. Some patients arrived with a walled-off abscess that the body had partially contained, and cutting into that could spread infection further. For those patients, watchful waiting with supportive care sometimes gave better odds than immediate surgery.

This conservative philosophy persisted well into the twentieth century and has echoes in modern medicine, where antibiotics-first treatment for uncomplicated appendicitis has become a genuine alternative to immediate surgery in select cases. The idea of not rushing to operate is not a twenty-first-century innovation; it dates back over a hundred years.

Diagnosing by Touch Before Imaging Existed

For roughly a century after Fitz named the disease, surgeons had no way to look inside a patient’s abdomen without cutting it open. Diagnosis depended entirely on the patient’s symptoms and what the doctor could feel with their hands. This led to the development of an elaborate set of physical examination maneuvers, many of which are still taught in medical schools. A physician would press on specific spots, ask the patient to move their legs in certain ways, or gently shake the abdomen, all to provoke or locate the distinctive pain of an inflamed appendix.

These bedside tests were genuinely useful but far from perfect. Research into their accuracy has shown that a positive result on these maneuvers makes appendicitis more likely, but a negative result does not rule it out.¹⁰ In practice, this meant that for most of the twentieth century, surgeons frequently operated on patients they believed had appendicitis only to find a normal appendix. The accepted negative appendectomy rate was high, sometimes running above 20 percent, because the prevailing wisdom held that it was better to remove a healthy appendix unnecessarily than to delay surgery and risk a rupture. The arrival of modern imaging technology dramatically reduced these unnecessary operations.

Antibiotics and the Dramatic Drop in Deaths

Even after appendectomy became the standard treatment, appendicitis continued to kill people at significant rates through the early twentieth century. Patients who arrived late, whose appendices had already ruptured, often developed peritonitis, a widespread abdominal infection that was frequently fatal. The introduction of sulfonamide antibiotics in the 1930s and penicillin in the 1940s changed this picture profoundly. Alongside improvements in intravenous fluid therapy and safer anesthesia, antibiotics meant that even patients with perforated appendices and rampant infection had a fighting chance.⁷

The mortality rate from appendicitis fell dramatically over the course of the twentieth century. By the latter decades, deaths from appendicitis in developed countries had become rare, and by around 1990, diagnostic delay had replaced the disease itself as the main cause of the deaths that did occur.⁷ The challenge shifted from “can we treat this” to “can we catch it in time.”

The Laparoscopic Revolution and the Resistance It Faced

For about a century after McBurney described his approach, open surgery through an incision in the lower right abdomen remained the way appendectomies were done. That changed in 1980 when German gynecologist Kurt Semm performed the first fully laparoscopic appendectomy, inserting a small camera and instruments through tiny incisions rather than making a large cut. The reaction from the surgical establishment was hostile. Many prominent surgeons considered laparoscopic technique dangerous, and Semm faced open skepticism and professional resistance for years.¹¹

The criticism reflected a broader pattern in surgical history: transformative techniques are often met with deep suspicion by the generation of surgeons trained in the old way. Fitz’s recommendation of early appendectomy was resisted for years, and Lister’s antiseptic methods were mocked before they were accepted. Semm’s laparoscopic approach eventually won out for the same reason the others did: better outcomes. Laparoscopic appendectomy meant smaller scars, less post-operative pain, shorter hospital stays, and faster recovery. It is now the dominant technique in most hospitals worldwide.

How Imaging Transformed Diagnosis

Before the 1980s, the decision to operate for suspected appendicitis rested almost entirely on clinical judgment. The surgeon listened to the patient’s history, pressed on their abdomen, and made a call. The introduction of ultrasound and, more importantly, CT scanning gave doctors an entirely new way to confirm or rule out the diagnosis before making an incision. CT scans proved to be highly accurate for appendicitis, with studies reporting accuracy rates between 93 and 98 percent.¹²

Ultrasound also played a role, particularly in children and pregnant women where radiation exposure from CT is a concern, though it proved less accurate overall. In patients with low clinical suspicion, CT scans showed greater sensitivity and specificity than ultrasound.¹² The practical effect of imaging was enormous: negative appendectomy rates dropped substantially, and doctors could more confidently distinguish appendicitis from conditions that mimic it, like ovarian cysts, kidney stones, or inflammatory bowel disease. For the first time in the long history of the condition, surgeons could see what was happening inside the abdomen before deciding whether to operate.

Non-Western Approaches to Abdominal Pain

While Western medicine was developing surgical solutions, other medical traditions had their own frameworks for treating the kind of acute abdominal pain that appendicitis causes. Traditional Chinese medicine and its related systems in Korea and Japan used acupuncture, herbal formulations, and moxibustion (the burning of dried herbs near the skin) to treat abdominal crises. A case report in a Korean medical journal documented the use of acupuncture at specific points, indirect moxibustion, and an herbal preparation to treat an elderly patient with acute abdominal pain, with symptoms reportedly resolving within three days.¹³

These traditions operated on entirely different theoretical models from Western anatomy and germ theory. Conditions that we would now diagnose as appendicitis were understood through frameworks involving energy imbalances, organ system deficiencies, and disrupted flow. Whether herbal and acupuncture treatments actually resolved genuine appendicitis or were treating conditions that merely resembled it remains a question that is very difficult to answer retrospectively. What is clear is that across cultures and centuries, acute abdominal pain was one of the most feared medical emergencies, and healers everywhere searched for ways to address it with the tools available to them.

The Appendix Itself Was Misunderstood for Centuries

One reason appendicitis treatment developed so slowly is that the organ at the center of it was so thoroughly dismissed. Darwin’s characterization of the appendix as a vestigial remnant, a shrunken leftover from herbivorous ancestors, dominated scientific thinking for well over a century.² If the appendix was evolutionary junk, then its diseases were simply the unfortunate consequence of carrying around a useless body part, and the logical treatment was to remove it at the first sign of trouble.

More recent research has challenged this view, suggesting that the appendix plays a role in immune function and may serve as a reservoir for beneficial gut bacteria that can repopulate the intestines after illness. This shift in understanding has subtly influenced modern treatment thinking. If the appendix has value, perhaps preserving it when safely possible, through antibiotic treatment rather than automatic surgery, deserves more serious consideration. The history of how we treated appendicitis is intertwined with the history of how we understood the organ itself, and both stories are still being revised.