Polio: Causes and Effects Part II
During the first half of the 20th century, every parent and child feared the word “polio”. In an epidemic, it attacked male and female, black and white, from rural communities to suburbia. Most people understood that a virus caused polio, but no one knew where the virus came from or how victims would fare. Often, the virus entered the body, created mild, flu-like symptoms, and left it virtually unscathed. Even though, in any community, most people would never get paralysed, pictures of iron lungs and braces would silently ask the question, “Will you be next?” If, rather than immunity, a person got paralytic polio, the outcome of conventional medical treatment might be some sort of deformity, or for the worst bulbar polio cases, weeks or a lifetime in an iron lung, or death. Everyone knew certain aspects of the polio virus: It was highly contagious; struck without warning and preferred children and young adults; and the medical profession could offer neither prevention or cure. 
In 1954 a newspaper article quoted a study published in the prestigious Journal of the American Medical Association:
Analysis of the data suggested that the absence of tonsils and adenoids, regardless of the time of their removal in relation to the onset of poliomyelitis, increased the risk that the bulbar form of the disease would develop. 
Polio at its most horrific:
In the most severe cases (bulbar polio), poliovirus attacks the motor neurons of the brain stem – reducing breathing capacity and causing difficulty in swallowing and speaking. Without respiratory support, bulbar polio can result in death. 
There are many studies which demonstrate the disastrous results of tonsillectomy for children and adults who were unlucky enough to be exposed to polio and become ill – even years after removal.
R.V. Southcott, writing in 1953, provided a little history:
That tonsillectomy could be a predisposing factor to the contraction of poliomyelitis was first suggested by Sheppard in 1910. The suggestion was renewed by Ayer in 1928, and by Aycock and Luther in 1929. (emphases added) 
Franklin H. Top collected extensive data on polio cases in Detroit between 1940 and 1949. He states:
…it is obvious that patients with a severe type of poliomyelitis, or those who die as a result of this infection, are heavily weighted with respect to the absence of tonsils. 
R.V. Southcott found that:
…out of 39 patients with bulbar paralysis, 35 had undergone tonsillectomy–a proportion of 90%. Of these 35 tonsillectomized patients with bulbar paralysis, only four had undergone tonsillectomy in the twelve months, and only one in the two months, prior to the onset of poliomyelitis.
Bulbar poliomyelitis was responsible for most of the poliomyelitis deaths.
Anderson and Rondeau survey of cases in Minnesota align with the other studies of tonsillectomy and bulbar poliomyelitis. 
The American Journal of Public Health pulled much of the research together in an editorial published in August, 1954 and concluded with a bit of a contradiction:
This higher proportion of bulbar cases in tonsillectomized persons occurs at all ages regardless of the time elapsed since operation.
Even though the increased risk of bulbar localization of the virus is exceedingly small for the individual, it should be taken into account in considering the indications for tonsillectomy at any season of the year, but especially during the summer months. (emphases added) 
Doctors who valued the “benefits” of tonsillectomy were fighting back, however (excerpts):
The removal of tonsils and adenoids…has been undergoing considerable criticism from many quarters in the past few years…increase the hazard of bulbar poliomyelitis. Some disfavor originates because of an assumption that the tonsils and adenoids have a value in the establishment and maintenance of an immunity to upper respiratory infections…Persons who are not physicians have a great tendency to accept any medical remark as gospel. Controversy, unfortunately, is too often brought to their attention…They are fearful and do whatever they can to avoid an operation. Now and then needlessly severe repeated infections or permanent disabilities of the ears, nose, throat or jaws are suffered…There is little to substantiate theories that tonsillar function plays a part in blood formation or in the production of immunity…The role of Waldeyer’s ring [tonsils] appears, on this score, to be a poor contribution to the body’s defense mechanism…The solution to the problem may be found when it is discovered why clinical poliomyelitis, especially that of bulbar type, develops in the absence of any so-called inciting incidents such as tonsillectomy, dental extraction or inoculation. The very fact that so many things, some non-surgical, are suspected suggests an unknown factor. It would be worth while of course to prevent even one case, but does postponing inoculation or operation prevent any? And if risk there be, is it great enough to warrant postponing such procedures if there is great need for them? Why is poliomyelitis in many cases so mild that it is not clinically recognized? 
Anderson and Rondeau speculated:
Unfortunately no reliable data are available as to the number of children at various ages who have lost their tonsils, but it is common knowledge that there are few operations performed before the age of 5 years and that the percentage of children who have had tonsillectomies increases rapidly in the early school years…Thus the shift in age distribution has meant that more of the victims of poliomyelitis are in the age group of persons who have undergone tonsillectomy and in whom a bulbar response is more likely to develop if infected. The greater frequency with which tonsil operations are performed today than 30 years ago may be a further factor in the greater proportion of bulbar cases.
Similarly these data offer an explanation of the comparative absence of bulbar poliomyelitis in certain foreign countries where the age distribution is so different from that currently observed in the United States. In certain of these countries, such as Egypt, Chile, and Japan, most of the infections occur in children under 5 and bulbar involvement is almost unknown. This lack of bulbar involvement may well be due to the almost invariable presence of the tonsils at the ages at which the vast majority of the infections occur. 
However, much of this was left unsaid to parents, for several reasons. Doctors thought that tonsils and adenoids, like appendixes were merely vestigial organs,  something useless which evolution had left by mistake, yet on the other hand, a rubbish dump contrived to cause trouble. Once surgery had been made safer courtesy of Lister, taking out “troublesome” tonsils, was swiftly turned into a thriving industry, though not without dissent, with Henry Heiman stating in 1922:
“During the past few years there has been engendered in the minds of medical men an unbounded spirit of antagonism toward the faucial tonsils. The pendulum has been swinging toward extreme radicalism. The tonsils have been held responsible for almost every disease of childhood. As portals of entry and foci of infection they have been accused of producing every form of pathological condition. The obsession has spread to the laity who are now, with or without medical advice, demanding the complete removal of the tonsils as a routine hygienic measure.” 
By 1938, Albert Sabin had replicated bulbar polio in tonsillectomised monkeys. 
In the UK, by 1948, surgeons were performing 200,000 tonsillectomies a year, and in the children of the well-to-do, tonsillectomy was three times more common than children who attended public elementary school. 
Stories like this one became well known in most communities in the Western world, and examples were cited in medical journals:
“Everyone has heard of the five children of one family in Akron, Ohio, who had their fonsils removed in August, 1941, and all developed bulbar poliomyelitis, of which three died. The sixth and youngest child, who was not operated upon, did not develop poliomyelitis, although excreting poliomyelitis virus in the faeces.” 
Tonsillectomy had become a rite of passage for children.
Although tonsillectomy is performed less often than it once was, it is still among the most common surgical procedures performed in children in the United States. In 1959, 1.4 million tonsillectomies were performed in the United States. 
By the height of the polio epidemics in the Western world, finding a child with intact tonsils would have become a mission and a half, and… just maybe, … tonsils weren’t as useless as they thought.
You have to ask the question as to how many of the people in iron lungs got there, one way or another, courtesy of the medical profession.
For the research wonks, more information on the immune functions of the tonsils and some specifics on the role of tonsils in defending against polio.
Module 6: Poliomyelitis (The Immunological Basis for Immunization Series). Susan Robertson. World Health Organization. 1993. http://www.who.int/vaccines-documents/DocsPDF-IBI-e/mod6_e.pdf
Love Your Tonsils: They’re Our First Defense Against Illness. Dr. Max Pemberton. Mail Online. January 31, 2009. http://www.dailymail.co.uk/health/article-1133026/Love-tonsils–theyre-defence-illness.html
Toll-like receptors in tonsillar epithelial cells. Lange MJ, Lasiter JC, Misfeldt ML. International journal of pediatric otorhinolaryngology. 2009 Apr;73(4):613-21. Epub 2009 Jan 22. http://cat.inist.fr/?aModele=afficheN&cpsidt=21376914
Function of mucosa-associated lymphoid tissue in antibody formation.
Brandtzaeg P. Immunological Investigations. 2010;39(4-5):303-55. http://www.ingentaconnect.com/content/apl/limm/2010/00000039/F0020004/art00003
Effect of tonsillectomy and adenoidectomy on nasopharyngeal antibody response to poliovirus. P.L. Ogra. New England Journal of Medicine. 1971 Jan 14;284(2):59-64. http://www.nejm.org/doi/full/10.1056/NEJM197101142840201
 Lessons Unlearned:Long before the Legislature made vaccines optional, Texans united to fight polio. Heather Green Wooten. Observer. January 25, 2010. Accessed September 24, 2010. http://www.texasobserver.org/culture/lessons-unlearned
 Absence of tonsils, adenoids linked to polio susceptibility. Ellensburg Daily Record. April 5, 1954. Accessed October 10, 2010. http://news.google.com/newspapers?id=V8kUAAAAIBAJ&sjid=u-IDAAAAIBAJ&pg=4337,4933254&dq=tonsillectomy+polio+bulbar&hl=en
 The Disease and the Virus. Global Polio Eradication Initiative. World Health Organization. Undated. Accessed September 24, 2010. http://www.polioeradication.org/disease.asp
 Studies on a Long Range Association Between Bulbar Poliomyelitis and Previous Tonsillectomy. R. V. Southcott. The Medical Journal Of Australia. 1953. Aug 22;2(8):281-98. http://www.ncbi.nlm.nih.gov/pubmed/13098558
 Occurrence of Poliomyelitis in Relation to Tonsillectomies at Various Intervals. Franklin H. Top. Journal of the American Medical Association. 1952, 150(6) 534-538. http://jama.ama-assn.org/cgi/content/summary/150/6/534
 Absence of Tonsils as a Factor in the Development of Bulbar Poliomyelitis, Gaylord W. Anderson, Jeanne L. Rondeau. The Journal of the American Medical Association, 1954, 155 (13) 1123-1130. http://www.ncbi.nlm.nih.gov/pubmed/13174358
 Tonsillectomy and Poliomyelitis. American Journal of Public Health, 1954, 44 (8) 1065-1067. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1620872/pdf/amjphnation00361-0092.pdf
 Controversial Problems in Adenotonsillectomy. John W. Arnold. California Medicine, 1953, 75 (5) 444-449. http://ukpmc.ac.uk/classic/picrender.cgi?artinstid=670739&blobtype=pdf
 Vestigial – Definition. wordiq.com accessed on October 8, 2010. http://www.wordiq.com/definition/Vestigial
 “Indications for tonsillectomy in infancy and childhood. Is the modern tendency toward universal tonsillectomy justified?” Henry Heiman. Am J Dis Child. 1922,24(3): 204-210. http://archpedi.ama-assn.org/cgi/content/summary/24/3/204
 Experimental Poliomyelitis by the Tonsillopharyngeal Route: With Special Reference to the Influence of Tonsillectomy on the Development of Bulbar Poliomyelitis. Albert B. Sabin. J Am Med Assoc, Aug 1938; 111: 605 – 610. http://jama.ama-assn.org/cgi/content/summary/111/7/605
 “The Paediatric approach to Tonsillectomy” J. Alison Glover. Arch Dis Child 1948 23:1-6. http://adc.bmj.com/content/23/113/1.full.pdf (free access available with registration)
 “Pros and cons of Tonsillectomy” A. H. Gale. BMJ 1951, 20 January. http://www.bmj.com/content/1/4698/133.full.pdf+html
 Tonsillectomy. Amelia F. Drake. EMedicine from WebMD. Updated May 14, 2010, accessed September 24, 2010. http://emedicine.medscape.com/article/872119-overview