Remembering the Tonsillectomy Riots

Picture 7The humble tonsillectomy has been at the center of controversies over practice variation, inappropriate surgery and avoidable harm for decades; indeed, well before the terms to describe those problems were formally articulated.  Now, thanks to the recently unearthedTonsillectomy Riots of 1906, you can add “patient empowerment” and “informed consent” to that list.

Tablet, an online magazine of Jewish news and culture, rescued theTonsillectomy Riots from historical obscurity. Piecing together old newspaper accounts in English and Yiddish, the magazine told what happened on New York’s heavily Jewish Lower East Side on a steamy day in June when “50,000 immigrant mothers descended on their local public schools demanding to see their children, having heard that there was a Board of Health-sanctioned child slaughter taking place.”

The article continues:

Greeted by locked doors, the screaming throngs surrounded the schools and began smashing windows and pounding on doors….During this rampage, gangs of immigrants cursed out principals, fought police, and attacked anyone in the street bearing the slightest resemblance to a doctor….Some of them raided vegetable pushcarts for ammunition while others, like one young man who pulled a revolver on a member of the Board of Health, used more serious weapons.

Word had spread among the Jews of the Lower East Side that uptown doctors were coming into downtown public schools and were, as described in the daily Varhayt, “cutting the throats of Jewish children!” After a two-hour assault, the rag-tag army achieved victory: Their kids were released early and alive, proving that no such slaughter had taken place.

From the viewpoint of the befuddled Board of Health, this debacle was likely filed under the heading, “No good deed goes unpunished.” After tonsillitis reportedly kept scores of Jewish students out of school, the principal recommended the children have tonsillectomies. (The idea of a contagious sore throat was apparently not part of folk wisdom at the time.) When mothers complained they couldn’t afford either the doctor’s fee or taking time off to go see one, physicians were asked to perform tonsillectomies at the schools. Days before the riot, doctors had performed 83 tonsillectomies at one elementary school. That’s when the trouble began.

The English-language press reported that the operations all had parental consent. But the Yiddish press told of children sent home with slips of paper their parents couldn’t read using terms they couldn’t understand even when translated.

“All they knew was that when the children returned home from school after their procedures, they did so drooling mouthfuls of blood, barely able to speak,”Tablet related. “Shocked, their parents asked what happened. ‘Doctors cut our throats,’ the children replied.’ Rumors of a wholesale slaughter leapt like wildfire throughout the tenements and shops…and street-corner orators got into the act, screaming about the massacres in the schools, comparing them to the pogroms in Russian-ruled Poland.”

The riots quickly fizzled, but the police maintained a heavy presence until the end of the school year.

What might we take away from this story, apart from nostalgia for a time when false rumors could quickly spread without any help from the Internet?

To begin with, it reminds us how strong and durable physician paternalism has been. It was only the year before the riots that the Supreme Court ruled that a doctor had to tell a patient in advance what procedure he was doing. It was not until the 1950s that doctors were required to disclose risks and benefits in advance and not until the 1970s – seven decades after the TonsillectomyRiots – that doctors had to disclose them in layman’s language.

As the physician ethicist Jay Katz wrote doctors, acting as “rational agents” on the patient’s behalf, intuitively believed that sharing information with patients was “inimical to good patient care.”

Even today, how often do physicians engage in genuine shared decision-making? And how well is even basic information conveyed to those who have scant education and even less familiarity with English?

The Tonsillectomy Riots also remind us about the durability of profitable medical procedures even in the face of evidence against them. By the mid-1930s, fully one-third of all operations performed under anesthesia in the United States were tonsillectomies. Around that same time, research that included a pioneering study of New York City schoolchildren began to show that thetonsillectomy rate was more dependent on physician preference than on objective indicators. Nonetheless, the growing medical literature on inappropriate and even dangerous tonsillectomies had little effect on actual practice until Congressional hearings in the 1970s spotlighted parents whose children had been harmed or killed. Only then did the profession react.

On the other hand, the Tonsillectomy Riots also illustrate the dangers of putting consumerism on a pedestal. In medicine the customer is not always right. The mob hysteria and irresponsible rhetoric of a hundred years ago are not so dissimilar from the shrill cries from our own time that vaccines are causing autism in the young while the government is plotting death panels for the old.

Finally, the fact that the Tonsillectomy Riots vanished for so long reminds us that the history of medicine is largely written as a chronicle of physician actions. Putting patients into that picture adds a perspective that is far too often absent.

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