On the origin of tonsillectomy and the dissection method.

ABSTRACT

OBJECTIVES: To identify the person or persons responsible for the conception and description of the operation that we know of today as tonsillectomy and to determine whether this was accomplished by an American otolaryngologist(s) before the description by George Waugh of London in 1909. STUDY DESIGN: A review of the English language medical literature from 1879 to 1910. METHODS: Three hundred seventy-five articles relating to tonsil surgery or instrumentation for tonsil surgery were identified. It was possible to obtain and review only 67 articles. In addition, 20 textbooks relating to the tonsils and tonsil surgery (published between 1880 and 1966) were identified and reviewed. RESULTS: An attempt to remove the entire tonsil intact was described by Edwin Pynchon in 1890 with the use of galvanocautery. He recommended that only one tonsil be removed at one time with approximately 2 weeks between operations. In 1903, Charles Robertson advocated the removal of both tonsils at one operation using scissors but did not mention the capsule. J. Gordon Wilson published a description of the tonsillar capsule in 1906 but did not comment on tonsil surgery or the importance of any particular structure as a surgical landmark. In that same year, William Lincoln Ballenger of Chicago, Illinois, clearly recommended the complete removal of the tonsil with its capsule intact but commented that he usually used an écraseur-tonsillotome to finally remove the tonsil. Also in 1906, Ovidus Arthur Griffin of Ann Arbor, Michigan, described the use of a knife and a specially designed pair of scissors to remove the tonsils in their entirety in one operation without the use of a guillotine or an automatic instrument. CONCLUSION: The operation that we know of today as tonsillectomy, the removal of the entire tonsil with the capsule intact, and the term tonsillectomy itself were conceived, described, and published by American otolaryngologists before the description by George Waugh of London in 1909.