A History of Tonsillectomy: Two Millenia of Trauma, Hemorrhage and Controversy
By Ronald Alastair McNeill
Ulster Medical Journal, Vol.29:1 (1960)
Excerpt: Galen (A.D. 121-201) was apparently the first writer to advocate the use of a snare for amputating the tonsil. It is believed that the snare became a more popular method of removing tonsils than that described by Celsus. This method continued to be used until some four hundred years later when Aetius (A.D. 490) advocated again partial removal of the tonsil. He thought that only the part of the tonsil which projects and is easily seen should be removed, that is about half of the enlarged gland. “Those who extirpate the entire tonsil remove, at the same time, structures which are perfectly healthy, and, in this way, give rise to serious hemorrhage.”
Paulus Aegineta (A.D. 625-690) describes clearly and precisely a method of complete tonsillectomy, describing the prevention and treatment of post-operative bleeding. He wrote:
When, therefore, they are inflamed, we must not meddle with them; but when the inflammation is considerably abated, we may operate, more especially upon such as are white, contracted and have a narrow base. But those which are spongy, red and have a broad base, are apt to bleed.
Therefore, seating the person in the light of the sun, and directing him to open his mouth while one assistant holds his hand and another presses down the tongue with a wooden spatula . . . we take a hook and perforate the tonsil with it, and drag it outwards as much as we can without drawing its membranes along with it, and then we cut it out by the root with a scalpel suited to that hand, for there are two such instruments, having opposite curvatures.
After ligation, the patient must gargle with cold water or oxycrate; or, if haemorrhage occurs, he may use a tepid decoction of brambles, roses or myrtle leaves.
Some 1,200 years are to follow before such a refined technique is described again. Unfortunately, after the death of Paulus, Europe descended into the Dark Ages, and tonsillectomy fell into disrepute. In fact, when the School at Salerno was at its height, tonsil surgery was limited to lancing of peritonsillar abscesses.
In 1509 Ambroise Pare, writing of tonsillectomy, thought it to be a bad operation, advocating gradual strangulation, using a ligature. If the tonsils were very big, he advocated a preliminary trachectomy. Guilleameau, a pupil of Ambroise Pare, was also a strong advocate of this method. He pulled the tonsil out of its bed and then a noose of thread or wire was slipped around its base and tightened until the circulation was cut off. Needless to say, this method attained no great popularity with the patient, as it was accompanied by severe infection, not to speak of intense pain. Indeed, one writer of this era was moved to record these words about tonsillectomy:
“This procedure is liable to resolve itself into physical combat between the surgeon and his patient.”