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Patrick Watson-Williams and the concept of focal sepsis in the sinuses: An historical caveat for functional endoscopic sinus surgery

Published online by Cambridge University Press:  29 June 2007

James W. Fairley*
Mr J. W. Fairley, ENT Department, Royal Hallamshire Hospital, Sheffield SlO 2JF.


From 1900 to 1940 the theory of focal sepsis was invoked to justify a number of dubious surgical procedures. Surgeons believed they were acting rationally. Patrick Watson-Williams advocated suction exploration of the paranasal sinuses for mental patients, claiming to cure criminal insanity by sphenoidotomy. Favourable contemporary reviews showed international approval. The rational basis of treatment was emphasised, but there was little systematic evaluation of outcome. Current enthusiasm for functional endoscopic sinus surgery is also based on a rational approach, logical deductions from pathophysiological ‘facts’. Outcome has still not been evaluated scientifically. We should learn from history. Treatment should not be based too readily on what seems to be rational now. Ideas of physiology and pathology change. What seems logical today may appear ridiculous tomorrow. Careful analysis of outcome, preferably by controlled clinical trials, is needed as a rational treatment requires empirical validation just as much as any other.

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Copyright © JLO (1984) Limited 1991

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