Doctor, Spare the Scalpel!

Medicine being a compendium of the successive and contradictory mistakes of medical practitioners, when we summon the wisest of them to our aid the chances are that we may be relying on a scientific truth the error of which will be recognized in a few years' time.

Marcel Proust, The Guermantes Way.

A reputable doctor who agrees with Proust--Dr. Harry Bakwin, associate professor of pediatrics at New York University's College of Medicine--has drawn a shocking bill of particulars against some of medicine's modern fads. This children's specialist thinks there are far too many operations on children, too much hospitalization, too many inhuman rules about care and feeding. In the New England Journal of Medicine he states his case.

Cut It Out! The American Child Health Association made a tonsil study of 1,000 eleven-year-old children in New York City. Some 61% of them had already had their tonsils removed. A group of doctors who examined the other 39% solemnly advised that nearly half of them needed tonsillectomies. The exonerated half were examined by a second group of doctors, and nearly half of them were culled for tonsil removal. After a third examination by still another panel, there remained only 65 children of the original thousand whose tonsils were rated sound.

The association found little rhyme or reason in the doctors' decisions.* Dr. Bakwin seconds the association's conclusion that the current craze for tonsil removal "represents in the main a useless ' expenditure of time, effort and money." Further, he considers it responsible for many cases of pneumonia, bulbar poliomyelitis, deaths from overdoses of anesthetics (80 a year) and children's neuroses.

Some other major medical "errors": examination of children's ears with otoscopes, also surgical puncturing of their eardrums (responsible for many ear infections), mineral oil nose drops (they may cause pneumonia), premature attempts at straightening teeth. Doctors, says Dr. Bakwin, are prone to diagnose flat feet, large tonsils, malocclusion, heart murmur and poor posture as serious ailments when they are only normal variations that would be better let alone.

Scientific Inhumanity. But about the worst menace to children, in Dr. Bakwin's opinion, is the fad for incarcerating them in hospitals. To begin with, he thinks that, in spite of some advantages, a hospital is a poor place for a child to be born in: 1) there is little evidence that hospital delivery has reduced maternal or infant deaths; 2) it exposes the newborn infant to hospital-prevalent diseases (notably diarrhea) and the scientific inhumanity of doctors and nurses. Separating the baby from its mother at birth, instead of allowing it to be cuddled and breastfed, is a bad beginning, says Dr. Bakwin. The crime is compounded when the baby is put on a clock-ruled feeding schedule, a practice which is almost bound to produce overanxiety in parents and loss of appetite in children.

"A major fallacy," the doctor goes on, "is implied in the modern attitude toward diet. It is that appetite cannot be trusted . . . [but] laboratory investigations . . . can. Surely we have been endowed with the sensation of taste for some purpose. Eating should mean roasts, sauces, puddings, pies--not calories, vitamins, minerals."

*A nationwide rural study reported by the U.S. Public Health Service last fortnight also showed wide variations in doctors' standards for recommending tonsillectomy. -Last week a diarrhea epidemic which had killed seven babies closed three nurseries in Manhattan's Misericordia Hospital.

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