Claudius Amyand (c. 1680–1740) of the first appendectomy
On the southwest corner of London’s Hyde Park once stood St. George’s Hospital, now relocated to the suburbs. It had been founded in 1733 by a group of surgeons who moved there from the Westminster Hospital. Among them was a surgeon whose Huguenot parents had fled from France after the revocation of the Edict of Nantes (1689). His parents had brought him to England as a two-year-old boy. He was educated in London, naturalized in 1698, and, at an unspecified time, the Frenchman Claude D’Amyand became the Englishman Claudius Amyand.
He qualified as a surgeon and fought in the War of the Spanish Succession against France. On his return, he became surgeon to King George I, Master of the Company of Barber-Surgeons, and Fellow of the Royal Society. In 1722 he inoculated the three children of the Prince of Wales against smallpox, following the introduction of variolation into England by Lady Mary Wortley Montagu.
Amyand practiced surgery in London. He worked on breast reconstruction, treated ankle fractures, biopsied lesions for cancer diagnosis, and used wire mesh to construct a sphincter for the urinary bladder. From his practice, he reported interesting cases to the Royal Society, such as an adult with a patent foramen ovale, a child born with the bowels hanging out of the belly, a woman with urinary obstruction from blood in the vagina pressing on the urethra, and a girl with a stricture in the middle of the stomach dividing the organ into two bags.
In 1735, Amyand saw an eleven-year-old boy with a painful inguinal hernia. It contained an infected, draining appendix that apparently had been perforated by a swallowed needle. He opened the hernia above the site of the infection, located the area of normal bowel, and repositioned it into the abdomen. He then excised the infected part, which contained a perforated appendix. The procedure took about thirty minutes, a long time in the era before anesthesia. The boy made a complete recovery.
An inguinal hernia arises when a weakness in the abdominal muscular coat allows a portion of the bowel to protrude into the groin. As the hernia enlarges, it may descend into the scrotum. On rare occasions, it may contain an infected appendix, which causes it to become known as an Amyand hernia. Medical historians unanimously credit Claudius Amyand for performing the first ever appendectomy. He achieved this distinction not by opening and exploring the abdomen, which was still not possible in his time, but by operatively removing an infected appendix from the kind of hernia that bears his name.
|Etching of the front of St George’s at Hyde Park Corner, Central London, by Toms, c. 1740. Via St. George’s University of London.|
GEORGE DUNEA, MD, Editor-in-Chief