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95
SPECIAL ENQUIRY.
The following report, to which allusion has already been made,
is a valuable contribution to the subject of enlarged tonsils (chronic
tonsillitis) and the value of operation. The conclusions are short
and definite and therefore all the more worthy of note.
" The Value of Tonsillectomy in School-children.
By
John D. Kershaw, M.B., B.S., D.P.H.
"This paper is only one of many which have been published
or delivered during the past two or three years on a subject which
was honoured with a formal discussion at the Centenary meeting
of the British Medical Association in London in 1932. On all sides
we hear of a general calling into question of the operation of tonsillectomy
and its results, even by many who were not long ago
prominent upholders of the operation and its validity. It might
not be amiss, therefore, if I briefly sketched, by way of introduction,
the history of the operation of tonsillectomy before the present
phase or reaction set in.
"T. B. Layton, in March, 1933, published a paper in the Lancet
in which he dealt with something of the historical aspect of the
matter. He went back as far as the days of Morell Mackenzie
who, in 1880, described the enlarged tonsil as being 'often the
size of a chestnut but sometimes attaining the dimensions of a
bantam's egg and, in rare instances, nearly the size of a hen's egg.'
The important indication for operation was respiratory obstruction
and one can appreciate the reasons why Ambroise Pare, in 1509,
went so far as to advocate tracheotomy in severe cases of tonsillar
enlargement. These enormous tonsils, however, would seem to
us of the present day to have a place only in history, which place
is still important, since there is no doubt that such great enlargements
had much to do with the development of the attitude which,
until recently, was invariably taken up by the surgeon toward
the tonsil—that it was an organ essentially vicious, whose only
proper place was in an anatomical museum.
"The removal of the tonsils, though practised long before the
beginning of the Christian era and traceable back into ancient Greek
civilisation, was, until a very few years ago, an operation fraught