The emergence, decline and persistence of modern medical procedures: The case of tonsillectomy

The emergence, decline and persistence of procedures in modern medicine have seldom been examined from a perspective that is both historical and analytical. This study is an attempt to look at one procedure, tonsillectomy, from such a perspective. The study focuses upon the dynamics behind the initial emergence of the procedure, its rapidly expanding use and the subsequent relinquishment of all but a few indications. Particular attention is paid not only to the causal factors behind major trends in the practice of tonsillectomy, but also to the very nature of both the intellectual framework of reference and the scientific evidence that accompanied the use of the procedure. Archival materials, aggregate data on practice trends and information gathered from physician interviews provide the primary sources in this reconstruction of the history of tonsillectomy. Although the generalizability of conclusions from case studies can always be questioned, this study of a once most common and most popular operation raises fundamental questions concerning both the cognitive structures and the scientific methodology that underlie modern medicine and its practice. Principally, our study shows that both the rationale and proof of efficacy that provided the scientific context for the procedure were ambiguous, often inconsistent and susceptible of different readings. Moreover, the study strongly suggests that extra-scientific or social factors may well be at work to bring about a resolution of closure that is at once epistemological, social and normative