[Otto Lanz; colourful appendectomist and art collector]. / Otto Lanz.

Otto Lanz (1865-1935) was a Swiss surgeon trained by Theodore Kocher in Berne. In 1902, he was invited to become professor of surgery at the Binnengasthuis hospital in Amsterdam. He was an outstanding surgeon who was well known for his surgery of the thyroid gland and the appendix. He introduced the eponymous Lanz's point in acute appendicitis and also the girdle incision for appendectomy. He was a strong proponent of 'early' appendectomy, as opposed to the conservative approach, at that time the treatment of choice. He was a great connoisseur and passionate collector of Italian Renaissance art. His Italian works of art have been exhibited in a special 'Lanz Hall' at the Rijksmuseum in Amsterdam. During World War II, his collection was acquired for Hitler's proposed Führermuseum but was returned to Amsterdam after the war. A portrait by Jan Toorop and Lanz's former villa on the Museum Square in Amsterdam remind us of this colourful surgeon.

[Manfred Pflanz (1923-1980), Health Services Researcher: his Early Contribution to the Medical Care Pattern of Appendectomy]. / Manfred Pflanz (1923­1980), Versorgungsforscher ­ sein früher Beitrag zur Versorgungsepidemiologie der Appendektomie.

This article is a reminder of an early example of health services research and quality assurance in Germany. The occasion for this was the 50th anniversary of the opening of the Institute of Social Medicine and Epidemiology at Hannover Medical School in 1968. The founding director of the institute, Prof. Dr. med. Manfred Pflanz, a board-certified internist, had gained reputation by publishing on psychosomatic and medico-social issues. In 1971, Sigrid Lichtner, a doctoral student, and Pflanz published a paper on the epidemiology and medical care pattern of appendectomy [1]. In the late 1960s certified appendicitis mortality in the Federal Republic of Germany used to be 3 times higher than in comparable countries. A regional analysis of all appendectomies in Hannover discovered further "odd" findings such as a weekly profile of operations not in line with an acute emergency condition and clear social as well as regional differences in the appendectomy rate. The most probable reason why the mortality from appendicitis was 3 times higher in the Federal Republic than in any other country, the authors conjectured, was that appendectomy was performed 3 times more frequently than elsewhere - questioning the doctrine of early surgical intervention in suspected appendicitis. Since then, management of appendicitis has changed, quality assurance has been implemented, evidence broadened, laparoscopic and non-operative treatment evaluated in RCTs. Appendicitis mortality has continued to decline with an acceleration of the falling trend in the early 1970s. Absolute numbers of deaths are now very low. Numbers of appendectomies are declining. In this respect, health services have become more effective and efficient.

Five lessons in uncomplicated appendicitis: Can we remove the surgery?

Appendicectomy has remained the treatment of choice for appendicitis for over a century and is the most commonly performed emergency operation in children. However, emerging evidence suggests that appendicectomy may not always be necessary in uncomplicated appendicitis, with early paediatric trials demonstrating that antibiotic-only therapy can be safe and effective. Further rigorously designed and appropriately powered studies are necessarily to establish the place of non-operative management of uncomplicated appendicitis in the future.

[Murphy's Law]. / Appendicitis, appendectomie en de wet van Murphy.

Non-surgical treatment of acute phlegmonous appendicitis has been receiving increasing attention in recent years, representing a reversal of policy. The appendectomy came into vogue at the beginning of the 20th century. It is true that prompt surgical intervention in all patients with appendicitis or an indication thereof almost guarantees success, but it gradually came to be forgotten that this intervention was not always necessary. In this article we will document the historical development of this disease and its treatment, and return to the original reports made by pathologist Reginald Fitz and the internist William Osler to show that their opinion was not black and white. Many surgeons in the Netherlands were also initially more restrained. In the course of time recognition of the natural progression of the disease vanished, until new developments placed this more sharply in the limelight.

A history of the treatment of appendicitis in children: lessons learned.

During the latter half of the 19th century, surgeons increasingly reported performing appendicectomies. Fitz from Harvard, Groves from Canada and Tait from Britain all recorded successful removal of the appendix. McBurney described the point of maximal tenderness in classic appendicitis and also the muscle-splitting incision centred on this point. Priority is given to McArthur in describing the lateral muscle-splitting incision. The direction of the cutaneous incision was later modified by Elliott and Lanz. Incisions that healed well were essential to recovery. Appendicectomy became a 'fashionable' operation after the London surgeon, Treves, removed the appendix of King Edward VII. Through the 20th century, the mortality from appendicitis fell notably with the advent of sulphonamide and penicillin, improvements in fluid therapy and safer anaesthesia. By 1990, diagnostic delay was the main cause of death. Semm performed the first laparoscopic appendicectomy in 1990, roundly criticized at the time for what is now a routine procedure. We view contemporary debates on the indications for appendicectomy, the best approach and how to optimize recovery in the light of the history of this intriguing disease.

William Cookesley, William Hunter and the first patient to survive removal of the appendix in 1731 - A case history with 31 years' follow up.

William Cookesley, a surgeon in Devon, England, successfully operated on a patient with an Amyand hernia in 1731, incidentally excising the appendix. His patient is the earliest documented to have survived appendicectomy. This was confirmed by a post mortem examination 31 years later. Part of the remaining bowel was preserved by William Hunter and this specimen remains in the Hunterian Museum in Glasgow.

[The story of Appendix]. / Príbeh apendixu.

Acute appendicitis is the most frequent acute abdominal emergency. Appendicitis may have been recorded by Aretaeus the Cappadocean in 30 AD. A description of the appendix was provided by the anatomist Berengario de Carpi in 1521. The first appendicectomy was performed by Claudius Amyand in 1735. Turning point in the story of appendix was public lecture of pathologist-physician Reginald Fitz in 1886. Fitz used the term "appendicitis". The area of maximal tenderness with appendicitis was immortalised by Charles McBurney. In the story of appendicitis many names figure, for example Niels Thorkild Rovsing, Jacob Moritz Blumberg, Otto Lanz, Frederic Treves and other. Kurt Semm introduced laparoscopic appendicectomy in 1988.

The first royal appendix abscess drainage.

On January 22nd 1901, at Osborne House on the Isle of Wight, Queen Victoria, nearing her 82nd birthday and having ruled for 64 years, drew her last breath. Edward Prince of Wales, 59 years of age, was now King Edward VII. A year of mourning was proclaimed and his coronation scheduled for June 26th. It was unexpectedly delayed by an attack of royal appendicitis. On Saturday June 14th 1902, less than two weeks before the coronation, Edward travelled to Aldershot to attend a military review. It was a cold, rainy day and the King did not feel well. That night, his abdominal discomfort was getting worse and by five next morning the King's personal physician, Sir Francis Laking, was called to see him. Laking asked Sir Thomas Barlow, Physician-Extraordinary to the King, for a second opinion. By now there was fever, rigor and distinct tenderness in the right iliac fossa of the very obese abdomen. Under heavy sedation, the King was transferred to Windsor Castle, leaving his Queen, Alexandra, to review the parade of 30,000 soldiers gathered at Aldershot.

The evolution of early appendectomy as standard treatment from appendicitis: what we can learn from the past in adopting new medical therapies.

Dr. Reginald Fitz popularized early appendectomy for the treatment of appendicitis with his treatise, "Perforating Inflammation of the Vermiform Appendix," published in 1886 while he worked at the Massachusetts General Hospital along with Dr. Maurice Howe Richardson, the inventor of the Richardson retractor. Their collaboration over the ensuing years led to improvement in outcomes for patients with appendicitis. This historical article describes the importance of this collaboration with information from operative reports, letters, and manuscripts and echoes the discussion today of safely adopting new medical technologies.

Historical aspects of appendicitis in children.

Evidence of appendicitis exists from ancient Egyptian mummies but the appendix was not discovered as an anatomical entity until the renaissance in Western European literature. Much confusion reigned over the cause of right iliac fossa inflammatory disease until the late 19th century, when the appendix was recognized as the cause of the great majority of cases. Coining the term 'appendicitis' and making the case for early surgery, Fitz in 1886 set the scene for recovery from appendicitis through operative intervention.

The appendiceal stump closure during laparoscopy: historical, surgical, and future perspectives.

During a laparoscopic appendectomy, the closure of the appendiceal stump is an important step because of postoperative complications from its inappropriate management. The development of life-threatening events such as stercoral fistulas, postoperative peritonitis, and sepsis is feared and unwanted. The tactical modification of the appendiceal stump closure with a single endoligature, replacing the invaginating suture, adjusted very well to laparoscopic appendectomy, and nowadays is the procedure of choice, whenever possible. Among the alternatives that do not make use of an invaginating suture, studies advocate the use of an endostapler, endoligature (endo-loop), metal clips, bipolar endocoagulation, and polymeric clips. All alternatives have advantages and disadvantages against the different clinical stages of acute appendicitis, and it should be noted that the different forms of appendiceal stump closure have never been assessed in prospective randomized studies. Knowledge about and appropriate use of all of them are important for a safe and more cost-effective procedure.

The life of John Wishart (1850-1926): study of an academic surgical career prior to the Flexner Report.

BACKGROUND: The 1910 Flexner Report on Medical Education in the United States and Canada is often taken as the point when medical schools in North America took on their modern form. However, many fundamental advances in surgery, such as anesthesia and asepsis, predated the report by decades. To understand the contribution of educators in this earlier period, we investigated the forgotten career of John Wishart, founding Professor of Surgery at Western University, London Ontario. METHODS: Archives at the University of Western Ontario, University of Toronto, London City Library, and Wellington County Museum were searched for material about Wishart and his times. RESULTS: A fragmented biography can be assembled from family notes and obituaries with the help of contemporary documents compiled by early 20th century medical school historians. Wishart assisted Abraham Groves in the first reported operation for which aseptic technique was used (1874). He was considered locally to perform pioneering surgery, including an appendectomy in 1886. Wishart was a founding member of the medical faculty at Western University in 1881, initially as Demonstrator of Anatomy and subsequently as its first Professor of Clinical Surgery, which post he held until 1910. Comprehensive notes from his undergraduate lectures demonstrate his teaching style, which mixed organized didacticism with practical advice. The role of the Flexner review in the termination of his professorship is hinted at in minutes of Faculty of Medicine meetings. Wishart was a foundation fellow of the American College of Surgeons and a founding physician of London's Catholic hospital, St. Joseph's, despite his own Protestant background. CONCLUSIONS: Wishart's career comprised all the elements of modern academic surgery, including pioneering service, research, and teaching. Surgery at Western owes as much to Wishart as it does to university reorganization in response to the Flexner report.