‘A Wicked Operation’? Tonsillectomy in Twentieth-Century Britain

Abstract

Histories of twentieth-century surgery have focused on surgical ‘firsts’ – dramatic tales of revolutionary procedures. The history of tonsillectomy is less glamorous, but more widespread, representing the experience and understanding of medicine for hundreds of children, parents and surgeons daily. At the start of the twentieth century, tonsillectomy was routine – performed on at least 80 000 schoolchildren each year in Britain. However, by the 1980s, public and professional discourse condemned the operation as a ‘dangerous fad’. This profound shift in the medical, political and social position of tonsillectomy rested upon several factors: changes in the organisation of medical institutions and national health care; changes in medical technologies and the criteria by which they are judged; the political, cultural and economic context of Britain; and the social role of the patient. Tonsillectomy was not a mere passive subject of external influences, but became a potent concept in medical, political, and social discourse. Therefore, it reciprocally influenced these discourses and subsequently the development of twentieth-century British medicine. These complex interactions between ‘medical’ and ‘non-medical’ spheres question the possibility of demarcating what is internal from what is external to medicine.

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review

“…21 Consequently, by the late 1960s, tonsillectomy was predominantly performed to prevent acute tonsillitis, rather than to prevent secondary streptococcal infections throughout the body. 22…”

Paediatric patient bleeding and pain outcomes following subtotal (tonsillotomy) and total tonsillectomy: a 10‐year consecutive, single surgeon series

“…16,17 As surgical safety improved, full tonsillectomy became established as the standard technique and was performed on a huge number of children in the post-war era. 17 With the improving general health of the paediatric population and attempts to reduce health care budgets, the number of tonsillectomies performed worldwide for recurrent tonsillitis has significantly reduced with sleep-disordered breathing emerging as the main diagnosis for consideration of tonsil surgery. 1,2 As the indications for surgery transformed, in the 1980s in Sweden, subtotal tonsil surgery emerged again as a potentially safer option to a full tonsillectomy for the relief of pharyngeal obstruction.…”

“…Subtotal tonsil surgery was actually performed commonly in the early part of the 20th century when haemorrhage rates for complete tonsillectomy were unacceptably high, largely due to poor methods of haemostasis 16,17 . As surgical safety improved, full tonsillectomy became established as the standard technique and was performed on a huge number of children in the post‐war era 17 .…”

“…Subtotal tonsil surgery was actually performed commonly in the early part of the 20th century when haemorrhage rates for complete tonsillectomy were unacceptably high, largely due to poor methods of haemostasis 16,17 . As surgical safety improved, full tonsillectomy became established as the standard technique and was performed on a huge number of children in the post‐war era 17 . With the improving general health of the paediatric population and attempts to reduce health care budgets, the number of tonsillectomies performed worldwide for recurrent tonsillitis has significantly reduced with sleep‐disordered breathing emerging as the main diagnosis for consideration of tonsil surgery 1,2 .…”

Molecular Detection of Mycobacterium tuberculosis in Oral Mucosa from Patients with Presumptive Tuberculosis

“…Recent studies have reported it is possible to recover MTBC DNA from the oral cavity of individuals with bacteriologically confirmed TB [ 3 , 4 , 5 ]. Although this is an unusual location, MTBC was frequently detected from the tonsils and adenoids of individuals undergoing tonsillectomies in the 19th and 20th centuries, and was proposed as a method to assess the prevalence of TB in the 1930s, and thus the presence of MTBC in the mouth is biologically plausible [ 6 ].…”