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minds of a certain type that anything which exists in large quantity
is extravagant, unnecessary, and wasteful. Even fashion, after
her kind, had changed.
"I propose to question the value of tonsillectomy upon another
ground and, to do so, I must put forward two fundamental propositions
with which, I hope, there is agreement. The first is that an
operation is unnecessary and unjustified if it is performed without
adequate indication. The second defines an adequate indication
as the presence of a harmful condition which we have good reason
to expect will be alleviated by the performance of the operation.
With these as a basis I propose to survey the indications which are
at present regarded as adequate for tonsillectomy and to illustrate
them by my own observations on some fifteen hundred children.
"Layton regards tonsillectomy in a child under the age of
eight as an operation hardly ever necessary or justifiable. At
the other extreme come those who consider the operation to be
one of the greatest boons ever conferred upon suffering humanity
and one which should be extended to all in whom it can possibly
appear desirable. In the hope of finding a satisfactory mean
I have taken a list of indications from the generally accepted textbook
of Irwin Moore, placing his less common indications first.
"Retro-ocular neuritis (three cases quoted), colitis and chronic
appendicitis, gastro-intestinal dyspepsia, impaired nutrition,
possibly associated with anaemia, and chronic ill-health form the
first group. All these indications depend for their validity upon
the effect of the tonsil as a septic focus. Admittedly the tonsil
can and often does act as such a focus, but it is only one of many.
The teeth, the colon, the nasal accessory sinuses may all be equally
guilty and it is both unfair and unscientific to remove the tonsil
merely because it is the most accessible of these possible culprits,
or to treat a case in which a septic focus is suspected by the removal,
seriatim, of all possible foci until symptoms cease or the supply
of foci becomes exhausted. Unless definite indications point to
the guilt of the tonsil it has as much right as the appendix or the
colon to remain in situ.
"Next are cited remote neuropathic reflexes of tonsillar
origin, such as spasmodic cough, vomiting, gastric pain, bronchial
asthma and intermittent otalgia. Again we have to eliminate other
possible causes before we condemn the tonsils. It is humiliating