Tonsillectomy

“The elevated status of surgery thus contributed toward the heightened interest in tonsillectomy. “Perhaps the most important development in promoting the widespread expansion of tonsillectomy was the appearance of a new paradigm, namely, focal infection theory. . . . Increasingly, clinicians began to argue that circumscribed and confined infections could lead to systemic disease in any part of the body. Edward C. Rosenow of the Mayo Clinic,. . . was one of the most important advocates of the belief that many diseases were the result of the dissemination of pathogens through the bloodstream from a local focus.” His experimental work was echoed by Frank Billings & Henry Cotton (Grob II, 387-88). After 1930, focal infection theory was abandoned as grounds for tonsillectomy and was accompanied by growing skepticism about the efficacy of the procedure in general (399-401). “Parental enthusiasm for tonsillectomy was largely driven by medical advice that began in the 1920s and persisted among practitioners in subsequent decades despite growing conservatism among elite practitioners. . . . The rapid spread of voluntary health insurance plans after World War II also played a role” (406). . . . “The manner in which medical practice was structured clearly assisted in the persistence of tonsillectomy. Tonsillectomy rates were in part a function of geographical location. There were much higher rates in urban than rural areas, largely because the latter tended to have fewer physicians and hospital facilities. The experience of World War II also hastened medical specialization and increasingly these specialties .. . . tended to be surgical in nature (412-13). Slow and uneven decline of tonsillectomy began in 1965. Why so slow? “Clearly, the absence of an agreed upon method to determine efficacy play a role in the persistence of tonsillectomy. . . . Hence physicians, whatever their specialty, could find data that purportedly supported the manner in which they practiced” (416).