Sir Vincent Zachary Cope (1881 – 1974) was an English surgeon and medical historian
Cope’s major work ‘The Early Diagnosis of the Acute Abdomen’ was first published in 1921; went to 14 editions over the next 50 years; with the final revision by Cope aged 90, due to it’s steady demand.
The book outlined clinical examination and diagnostic signs Cope believed had ‘never previously been recorded or to which insufficient attention is usually paid’ including the localizing diagnostic value of phrenic shoulder pain, the obturator test, the area of hyperaesthesia caused by a distended inflamed appendix, the pathognomonic axillary area of liver resonance in cases of perforated ulcer and the psoas extension test as examples.
On a slightly different tangent, Cope compiled light verse with a serious message in ‘The Diagnosis of the Acute Abdomen in Rhyme’ (1947) with under the pen name ‘Zeta’ and with illustrations by Peter Collingwood
- Born 14 February 1881 in Hull, England
- 1905 – Qualified MB BS (Hons) St Mary’s Hospital Medical School
- 1909 – MRCS, FRCS
- 1912 – Surgeon Bolingbroke Hospital
- 1914 – Royal Army Medical Corps at the 3rd London General Hospital
- 1916- 1919 Served in Mesopotamia
- General surgeon at St Mary’s Hospital, London his name lives on in the Zachary Cope ward
- 1951 – Honorary Fellow (and librarian) of the Royal Society of Medicine
- 1953 – Knight of the British Empire (KBE)
- Died 28 December 1974 Oxford, England
the dexterous hand must not be allowed to reach before imperfect judgement…
Cope obturator test (1919) [aka thigh-rotation test; obturator test ]
- The examiner stands to the right of the patient with the right thigh slightly flexed. The limb is then fully rotated at the hip, first internally and then externally.
- May be positive with conditions causing irritation to the obturator internus muscle e.g. inflammatory fluid in the pelvis, abscess, or perforated appendix. An inflamed appendix located in the pelvic brim may cause a positive test when apposed against the obturator internus muscle.
- Cope obturator sign sensitivity (8%); specificity (94%) in diagnosing acute appendicitis.
The right thigh is slightly flexed (so as to relax the psoas muscle) by the surgeon, who stands on the right of the patient: the limb is then fully rotated at the hip, first internally and then externally, so as to put the obturator internus through a full range of movement. The sign is positive if the patient complains of hypogastric pain when the limb is moved in this mannerCope 1919
Diagram of obturator relations: Cope 1919
Since the fascia covering the obturator internus is fairly dense, the test is not positive unless the inflammation is considerable; and, with a positive result, one always expects the appendix to be adherent to, or even an abscess to be contiguous to, the fascia. I have found this sign of assistance not only in cases of appendicitis, but also in other pelvic conditions such as rupture ectopic gestation, and I have no doubt that it will often prove of value in doubtful casesCope 1919
Figure 42: Relationship of pelvic appendix to the obturator internus muscle. An appendicular abscess seen in contact with the fascia over the obturator internus.
Cope Psoas test (1921) – [aka Ilio-psoas rigidity; psoas extension test; Obraztsova sign]
- The patient is lying in the lateral decubitus position opposite the side where the pain is located. Extension of the thigh causes pain.
- May be positive in retrocecal appendicitis as well as primary/secondary psoas abscess. In appendicitis, the inflamed retrocecal appendix lying against the psoas muscle. In severe cases, the inflammation may cause a fixed flexion deformity of the right hip.
- Cope psoas test sensitivity (13 – 42%); specificity (79 – 97%); a positive likelihood ratio of 2.0 for detecting appendicitis.
It is well known that if there be an inflamed focus in relation to the psoas muscle the corresponding thigh is often flexed by the patient to relieve the pain. A lesser degree of such contraction (and irritation) can be determined often by making the patient lie on the opposite side and extending the thigh on the affected side to the full extent. Pain will be caused by the maneuver if the psoas is rigid from either reflex or direct irritationCope 1921
- Cope VZ. The thigh-rotation or obturator test: A new sign in some inflammatory conditions. Br J Surg. 1919; 7: 537.
- Cope VZ. Surgical aspects of dysentery including liver abscess. 1921
- Cope VZ. The Early Diagnosis of the Acute Abdomen. 1921 [Cope Psoas sign]
- Cope VZ. The diagnosis of the acute abdomen in rhyme [Pseudonym ‘Zeta’]
- Cope VZ. A History of the acute abdomen. Oxford Univ. Press, 1965
- Cope VZ. Pioneers in acute abdominal surgery. Oxford, 1939
- Cope VZ. The versatile Victorian : being the life of Sir Henry Thompson, Bt. 1820-1904. Harvey & Blythe, 1951
- Cope VZ. William Cheselden 1688-1752. E & S Livingstone, 1953
- Cope VZ. Florence Nightingale and the doctors. London : Museum Press, 1958.
- Cope VZ. Six disciples of Florence Nightingale. Pitman Medical Publishing Co., 1961
Be a physician first, then a surgeon’Advice given to Cope by his mentor Dr David Lees
- Biography: Sir Vincent Zachary Cope. Plarr’s Lives of the Fellows Online. Royal College of Surgeons of England.
- Burke PF. The dexterous hand; Zachary Cope, surgeon and author 1881-1974. Surgical News. The Royal Australasian College of Surgeons. 2016;17(1):40-42
- Obituary: Sir Vincent Zachary Cope. Br Med J. 1975 Jan 11; 1(5949): 98–99. [PMC1672187]
- Carling ER. British Surgical Practice: Abdominal Emergencies to Autonomic Nervous System. 1947;I:293-319
- Izbicki JR et al. Accurate diagnosis of acute appendicitis: A retrospective and prospective analysis of 686 patients. Eur J Surg. 1992; 158(4): 227-231 [PMID 1352137]
- Berry J, Malt RA. Appendicitis near its centenary. Ann Surg. 1984; 200(5): 567-575. [PMID 6385879]
- Eponymythology: Appendicitis eponymous signs. LITFL
the person behind the name