Dr. Charles McBurney: A pioneer in the surgical treatment of appendicitis

The name McBurney (Charles McBurney, MD) is probably second only to that of Cushing (Harvey Cushing, MD, FACS) as a recognized name in American surgery. Dr. McBurney was born in Roxbury, MA; educated at Harvard College, Cambridge, MA, where he rowed crew; and received his medical degree from the College of Physicians and Surgeons (P&S) in New York, NY, in 1870. He trained at Bellevue Hospital, New York City, for 18 months and furthered his medical training in Europe, spending time with Christian Albert Theodor Billroth, MD, in Vienna, Austria. He returned to New York in 1873 and was a busy private practitioner until his retirement in 1905.

Dr. McBurney joined the faculty at P&S, taught anatomy and operative surgery, and became professor of surgery at age 44, though he stepped down five years later due to the demands of his practice. In 1888, he became surgeon-in-chief at the Roosevelt Hospital, New York, NY, where he said he had “the entire surgical service from one end of the year to the other” and “the number of operations is about twelve hundred annually.”1

Dr. McBurney operating at Roosevelt Hospital, 1901.

Dr. McBurney operating at Roosevelt Hospital, 1901.

He was noted for his clinical judgment, his teaching skills, and his expertise in trauma. In terms of technical operating skill, it was said that, “He was not a rapid performer with the scalpel, but exact, progressing without hesitation…. As a result, the patient’s final sutures were placed and the dressings applied in as short a time as those of one who appeared to work much faster.”2 Dr. McBurney was an early proponent of aseptic technique, and among his visiting observers was a young William W. Mayo, MD.

McBurney’s tender point

In 1938, the journal Medical Classics cited 114 publications by Dr. McBurney, including case reports presented at meetings of the New York Surgical Society; but, of course, he is best known for his classic paper, “Experience with early operative interference in cases of disease of the vermiform appendix,” published in the New York Medical Journal.3 This paper was published just three years after Reginald Fitz, MD, described and named appendicitis and recommended operation for perforation.

Dr. McBurney described the early clinical course of the disease, including tenderness at a point “almost exactly two inches from the anterior iliac spine, on a line drawn from the process through the umbilicus.”3 Sir William Osler, MD, noted the importance of “McBurney’s tender point” in the first edition of his text in 1893.4 Dr. McBurney advised that appendectomy was not necessarily easy to perform and stated his “strong feeling that it is well worthwhile for anyone who may have to do this operation to see it done at least once first.”3 Five years later, he described the muscle-splitting incision that bears his name.5

Consummate general surgeon

Dr. McBurney was a true general surgeon. In addition to his contributions to appendectomy, one of his most noted achievements was his description of a technique for repairing fracture dislocations of the shoulder (often a complication of attempts to reduce a dislocation).6 In 1898 he described sphincterotomy for impacted gallstones,7 and in 1901, Dr. McBurney was called to Buffalo, NY, to evaluate the postoperative condition of President William McKinley and was subsequently unfairly criticized for stating an overly optimistic prognosis.

Charles McBurney was an astute observer, master surgeon, and role model for surgeons of all generations.


References

  1. McBurney C. Harvard College Alumni Notes. 1891. Class of 1866.
  2. Cutler CW, Martin AT, Peightal TC, eds. The Roosevelt Hospital, 1871–1957. Roosevelt Hospital, NY; 1957:113.
  3. McBurney C. Medical Classics. 1938;2(5):492-538.
  4. Osler W. The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine. New York, NY: D. Appleton and Company; 1892:406-413.
  5. McBurney C. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Ann Surg. 1894;20(1):38-43.
  6. McBurney C. Dislocation of the humerus complicated by fracture at or near the surgical neck, with a new method of reduction. Ann Surg. 1894;19(1):399-415.
  7. McBurney C. Removal of biliary calculi from the common duct by the duodenal route. Ann Surg. 1898;28(4):481-486.

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