Journal of the History of Medicine and Allied Sciences Advance Access originally published online on April 10, 2007
Journal of the History of Medicine and Allied Sciences 2007 62(4):383-421; doi:10.1093/jhmas/jrm003
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The Rise and Decline of Tonsillectomy in Twentieth-Century America
Correspondence: * Institute for Health, Health Care Policy and Aging Research, 30 College Avenue, Rutgers University, New Brunswick, New Jersey 08901 Email: ggrob{at}ifh.rutgers.edu
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Abstract |
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This article explores the rise and decline of tonsillectomy/adenoidectomy (T&A) in twentieth-century America. Between 1915 and the 1960s, T&A was the most frequently performed surgical procedure in the United States. Its rise was dependent on novel medical concepts, paradigms, and institutions that were in the process of reshaping the structure and practice of medicine. The driving force was the focal theory of infection, which assumed that circumscribed and confined infections could lead to systemic disease in any part of the body. The tonsils in particular were singled out as "portals of infection," and therefore their removal became a legitimate therapy. Nevertheless, what kinds of evidence could prove that tonsils were portals of infection? How could the effectiveness of tonsillectomy be determined? An inherent difficulty was the absence of any consensus on the criteria that would be employed to judge its efficacy. Yet tonsillectomy persisted despite ambiguous supportive evidence. Although criticisms of the procedure were common by the 1930s, its decline did not begin until well after 1945 and involved debates over the nature of evidence, the significance of clinical experience in the validation of a particular therapy, and the role of competing medical specialties.
Key Words: tonsillectomy • adenoidectomy • focal theory of infection • clinical experience • pediatrics • laryngology