John Erichsen's Tonsillectomy Scissors

Abstract

Removal of the tonsils is reported by Celsus in the first century AD when he recommended working a finger round them before extraction with same finger or alternatively elevation with a hook and excision by scalpel. Cultivation of a long index finger nail for tonsillectomy and umbilical cord division, and of a thumbnail for circumcision, etc. is authenticated in certain communities. (1) As I Moore’s historical account indicates, tonsillectomy was eventually avoided when the organ was inflamed and vascular due to post-operative haemorrhages. Fear of the latter also induced partial tonsillectomy by scalpel, sometimes after ligaturing the base; by the 18th century the scalpel was substituted by scissors and in the 19th century by the guillotine first introduced by Benjamin Bell for the uvula. (2) Meanwhile scissors were modified to both incise and prevent the remnant falling into the pharynx, as evident in Erichsen’s variations (Figure 1(g) and (h)). Sir John Erichsen FRS, FRCS (1818–1896), born in Copenhagen of a Danish father and English mother, was educated in London and qualified in 1839. After teaching anatomy and writing ‘An Essay on Asphyxia’ to win the Fothergillian Gold Medal, he was appointed Assistant Surgeon at University College Hospital in 1848 and Professor of Surgery there in 1850. He established a reputation for sound judgement and vast experience, becoming President of the Royal College of Surgeons in 1880 and Surgeon Extraordinary to the Queen. He attracted men of talent as house surgeons including Joseph Lister and wrote widely, including a treatise ‘Concussion of the Spine’ based on his experience of railway accidents. Importantly his textbook ‘The Science and Art of Surgery’ of 1853 achieved fame with 10 editions, plus American versions, and German, Italian, Spanish and Chinese translations. 3 Apart from ophthalmic cases, Erichsen was a complete general surgeon, operating initially without the aid of anaesthesia. Curiously, despite accepting Schimmelbusch’s work on post-mortem prophylaxis, initially he failed to embrace phenol wound antisepsis, a product of his pupil Lister. References