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with serious difficulties and dangers and, therefore, eschewed by
the great majority of surgeons. The introduction of the sharp
guillotine just over a hundred years ago facilitated the partial
removal of the organs, but their complete removal, tonsillectomy,
as we know it, dates as a common operation only from 1908 when
Waugh elaborated the technique of removal by blunt dissection.
For three years this operation reigned unchallenged in the field
till in 1911 Whillis and Sluder, simultaneously on the two sides of
the Atlantic, introduced their methods of enucleation by means of
the blunt guillotine.
"The surgical world now possessed two methods, both safe
and both comparatively easy, of removing the tonsils and it naturally
made full use of the new techniques presented to it. On the
whole I incline to blame the blunt guillotine for much of the slaughter
of tonsils which has taken place during the last twenty years.
While dissection still demanded a prolonged operation for which
efficient hospital accommodation was desirable, the other technique
was free from these disadvantages. It was swift and, in most cases,
sure. It required only a short anaesthesia. Moreover, the
technique was such that it could be acquired in a short time by
any reasonably competent House Surgeon. Every practitioner
learned to carry it out before he entered general medical practice,
and it remained with him as the only operation which he could
satisfactorily perform in a best bedroom or parlour. One cannot
be surprised that, faced on the one hand with the knowledge
that his peers and superiors were blaming the tonsil for every
illness which baffled their medical skill and on the other with the
consciousness that in this operation, at least, he could well emulate
the specialist, he was swift, if not always sure, in carrying out
tonsillectomy, until, as Alison Glover has recently pointed out,
seventy per cent. of the entrants to one of our great Public Schools
had had their tonsils removed before the age of thirteen.
"A reaction was inevitable. Modern developments in
pathology and physiology had brought forward new and surer
ground for the old theory that the tonsils possess a protective
function. Lay statesmen, seeking to reduce public health expenses,
challenged the value of tonsillectomy, not on scientific grounds,
but merely because many operations were carried out under the
Public Health Service and because there exists a basic principle for