The mere size of the tonsil, it is shown, is no indication for removal except it be large enough or diseased enough to interfere with respiration, speech or deglutition--that is, swallowing; in which case only a sufficient portion should be taken away, and that without delay. The tonsil may be greatly enlarged or buried deeply in the palatine arcade and yet not interfere with the well-being of the individual. Such tonsils are the special prey of the tonsillectomist. If they are not interrupting function they are best left alone. Moreover, it occasionally happens that the resurrection of a "buried" tonsil is followed shortly by the _burial of the patient_.
The practical illuminating lesson to be gleamed is this: That if in infancy and childhood, we pay more attention to the neglected nasal cavities and to the hygiene of the mouth and teeth, we will have less tonsil disease and fewer tonsil operations.
"The partial enucleation of the tonsil," the writer asserts, "with even the removal of its capsule if desired, is complete enough for all necessary purposes and practically free from danger; moreover, it produces equal or better results than complete enucleation with its many accidents and complications, to say nothing of its long roll of _unrecorded death_."
Another point: From the professional vocalist's point of view. The tonsils are phonatory or vocal organs and play an important part in the mechanism of speech and song. They influence the surrounding muscles and modify the resonance of the mouth. Enlarged by disease, they may cripple these functions and if so, their removal may increase the compass of the voice by one or more octaves; but it is a capital operation and a dangerous one in which a fatal result is by no means a remote possibility.
The object of this interesting paper, it is pointed out, is not to assail operation for definite and legitimate cause, but to warn against the "busy internist"--the hospital surgeon--too busy for careful differential diagnosis--and his "accommodating tonsillectomist" who is "in the business for revenue only." But the onus for the existing deplorable state of affairs he lays frankly upon the shoulders of the teachers and insists that the cure of the evil is largely educational. "When," says he, "_pre-eminent authority proclaims in lecture and text book as indisputable truth the relationship between a host of diseases and the tonsils of the child and advises the removal of the glands as a routine method of procedure, what can we expect of the student whose mind is thus poisoned at the very fountainhead of his medical education by ephemeral theory that masquerades so cheerily in the garb of indestructible fact_?" "How," he exclaims, "are we to offset the irresponsibility of the responsible?" But we hear on all sides--"Look at the results." Results? Here is a partial list from the practice--not of the ignorant, but of the most experienced and skilled: Death from hemorrhage and shock, development of latent tuberculosis, laceration and other serious injuries of the palate and pharyngeal muscles, great contraction of the parts, removal of one barrier of infection, severe infection of wound, septicemia, or bacterial infection, troublesome cicatrices, suppurative otitis media and other ear affections, troubles of voice and vision, ruin of singing voice, emphysemia, or destruction of the tissues, septic infarct,--infected arterial obstruction, pneumonia, increased susceptibility to throat disease, pharyngeal quinsy and last, but not least tonsillitis!