Charles H. McBurney

Biography

• Born on February 17, 1845, in Roxbury, Massachusetts
• 1866 – Graduated from Harvard University with a Master of Arts degree
• 1870 – MD, College of Physicians and Surgeons, Columbia University in New York
• 1871 – Postgraduate studies in Vienna, Paris and London
• 1872 – Assistant Demonstrator of Anatomy at Columbia University
• 1889 – Professor of Surgery at Columbia University
• 1901 – Professor of Clinical Surgery at Columbia University
• 1901 – Attended President William McKinley after being shot at close range
• 1907 – Professor Emeritus of Surgery
• Died on November 7, 1913, in Brookline Massachusetts, aged 68 from heart disease.

Medical Eponyms

McBurney’s point (1889)

McBurney’s point (McBurney’s sign): A point that lies one-third of the distance laterally on a line drawn from the umbilicus to the right anterior superior iliac spine. Classically used as a guide to the location of the base of the appendix, determined by the pressure of a single digit.

First described in a paper entitled ‘Experience with Early Operative Interference in Cases of Disease of the Vermiform Appendix’

The seat of greatest pain, determined by the pressure of one finger, has been very exactly between an inch and a half and two inches from the anterior spinous process of the ilium on a straight line drawn from that process to the umbilicus

McBurney 1889

Soda et al in 2001 reported on McBurney sign in the initial clinical examination in appendicitis and found sensitivity (83%); specificity (45%); positive predictive value (76%); and negative predictive values (56%).

McBurney’s Incision (1894)

McBurney’s Incision was designed to run parallel to the external oblique muscle, allowing the muscle to be split along its length, and so minimise anatomical disruption and reduce recovery times. The incision is still used today for open appendicectomies.

The incision is an oblique one about four inches long. It crosses a line drawn from the anterior iliac spine to the umbilicus nearly at right angles about one inch from the iliac spine, and is so situated that its upper third lies above that line

McBurney 1894

McBurney later gave the credit for the incision to Louis L. McArthur as he was the first to describe it. [1894; 7(1): 289-292]

Other Works

1898 – Devised new approach to common bile duct (CBD) stones via the duodenum and through the sphincter of Oddi, rather than the traditional approach through the wall of the CBD itself. He developed this operation because of the relative ease of suturing duodenal wall compared to that of CBD wall and described his approach as ‘quicker, cleaner and safer, in my opinion, than the operation which is usually done’

Controversies

The majority of modern textbooks refer to ‘McBurney’s Point’ as being two thirds of the distance between the umbilicus and the anterior superior iliac spine, though McBurney himself never actually specified this location.

Whilst ‘McBurney’s Incision’ bears his name, it was not, in fact, him that first proposed it. Fellow American surgeon Louis L. McArthur first described it in his paper ‘Choice of incisions for abdominal wall; especially for appendicitis’ in the Chicago Medical Recorder in 1894. McBurney later attributed full credit to McArthur for first describing the incision.

When President William McKinley was assassinated in 1901, McBurney was embroiled in some controversy surrounding his assessment of the President’s condition. He was quoted as saying that the President would ‘surely recover’ and would ‘would be back at his desk within six weeks’. Despite his optimistic pronouncements, the President died from complications ten days after the initial surgery. The story was sensationalized in the press, with many believing the medical team, including McBurney, to have mismanaged the situation, however, in a joint statement from all attending medical staff they stated that ‘The unfortunate result could not have been foreseen before the unfavorable symptoms declared themselves late on the sixth day and could not have been prevented by any human agency

Major Publications

• McBurney C. Operations for Pyloric Stenosis. Annals of Surgery. 1886; 3(5): 372–380.
• McBurney C. Experience with early operative interference in cases of disease of the vermiform appendix. New York Medical Journal, 1889; 50: 676-684.
• McBurney C. The Indications for Early Laparotomy in Appendicitis. Annals of Surgery. 1891; 13(4): 233–254.
• McBurney C. Dislocation of the Humerus Complicated by Fracture at or near the Surgical Neck, with a New Method of Reduction. Annals of Surgery 1894; 19(4): 399–415
• McBurney C. The incision made in the abdominal wall in cases of appendicitis, with a description of a new method of operating. Annals of Surgery 1894: 20: 38–43
• McBurney C. The Reduction of Dislocation of the Humerus complicated by Fracture at the Anatomical Neck; Operative Treatment of Separation of the Lower Epiphysis of the Femur. Annals of Surgery. 1896; 23(5): 501–509
• McBurney C. Direct Intra-Abdominal Finger-Compression of the Common Iliac Artery during Amputation at the Hip-Joint. Annals of Surgery. 1897 May; 25(5): 610–613.
• McBurney C. The Use of Rubber Gloves in Operative Surgery. Annals of Surgery. 1898; 28(1): 108–119.
• McBurney C. Removal of biliary calculi from the common duct by the duodenal route. Annals of Surgery 1898; 28: 481–486

References

Biography

• Morgenstern L. Charles McBurney (1845–1913). Afield from the appendix. Surg Endosc 1996; 10: 385–386.
• Yale SH, Musana KA. Charles Heber McBurney (1845 – 1913). Clin Med Res. 2005; 3(3): 187–189.
• Bibliography. McBurney, Charles 1845-1913. WorldCat Identities

Eponymous terms

• McArthur LL. Choice of incisions of abdominal wall; especially for appendicitis. Chicago medical recorder 1894; 7(1): 289-292.
• Soda K et al. Detection of pinpoint tenderness on the appendix under ultrasonography is useful to confirm acute appendicitis. Arch Surg. 2001; 136(10): 1136-1140.
• Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004; 91(1): 28-37
• Grover CA, Sternbach G. Charles McBurney: McBurney’s point. The Journal of emergency medicine. 2012; 42 (5): 578-81.
• JAMA Review: Charles McBurney (1845–1913)—point, sign, and incision. JAMA 1966; 197: 1098–1099
• Eponymythology: Appendicitis eponymous signs. LITFL

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