What had begun as a fear-filled experience for the young patients had transmuted into a massive, marvelous sleepover.   In the few hours since they had entered the Rochester Dental Dispensary that July afternoon in 1920, the anxious youngsters had been probed and poked by a contingent of examining physicians.   They had survived thorough scrub baths administered by strangers.  They had then been fueled by a nourishing supper of soup and bread with jam.  They had been dressed in identical nightgowns and assigned to hospital cots swathed in sterile white bedding.  Finally, they had been inspired by strobe-like scenes of daring, if silent, sword fights in a swashbuckler starring Douglas Fairbanks or the slap-stick antics of Charlie Chaplin.  When they finally fell asleep, most of them no longer feared the operation they would face when they awoke the next morning.

This event was just a prototype, however.  Because of its successful demonstration of assembly-line efficiency and economy, a second tonsil and adenoid clinic, twice the size and scope of this summer event, would open six months later, in the midst of the largest diphtheria epidemic in Rochester’s history up to that time and at the peak of the influenza season.    Within a year, nearly 10,000 of Rochester’s neediest children had undergone operations to remove their tonsil and adenoids.  When examined together, the clinics can be understood as early examples of America’s Public Health Movement—on steroids.  

It is difficult to identify the most influential factors that led George Eastman and several of his fellow industrialists/mercantilists to become engaged in improving the private lives of Rochesterians in the late 1910s.  Spearheaded in 1915 by Mr. Eastman’s generous gift of the Rochester Dental Dispensary, this group of men annually agreed to contribute $5,000 each to equip and man a clinic designed to improve the oral health care of families that could not afford to visit a dentist.  For a nominal fee, adults were admitted to the dispensary to have debilitating oral conditions, which were making their lives miserable and, in many cases, unproductive, repaired.

In the fall of 1919, the Dental Dispensary’s Board of Directors, a collection of civic-minded tycoons, shifted their attention from adults to children.  Directed by Dr. Harvey Burkhart, Mr. Eastman’s personal dentist, the Dispensary followed Boston’s Forsyth Infirmary’s model: adding, in its second year, a school for hygienists and initiating a biannual program of oral hygiene and prophylaxis in the city’s public and parochial schools.  Dr. Burkhart’s ambition was as great as was his influence on Mr. Eastman.  He managed to expand the service to every town and village in Monroe County.  The Dispensary’s mission, in the founder of Eastman Kodak’s words, became “the betterment of the race...[by] producing the means to [universal] prevention.” The clinic’s inclusion of members from every struggling family in the county makes it clear that “race” was a nationalistic term referring exclusively to an American “race.”

The wedding of the Industrial Revolution’s assembly line concept with tonsillectomies and adenoidectomies, now routine surgical procedures, was an inviting idea.  The innovation was successfully being practiced on a small scale in institutions; children in orphanages and siblings in large, financially challenged families increasingly underwent simultaneous operations, occasionally eliciting “two for one” bargains.   Practicing the procedure on a large scale would be highly efficient and, even better, very economical.  In fact, a small-scale prototype of the plan was executed at the dispensary with no complications in the fall of 1919.

Prominent members of the medical community also endorsed the idea.  Symptoms of contagious childhood diseases – scarlet fever, whooping cough, measles, diphtheria, etc. – all appeared first in throats obstructed by these often-inflamed organs, and medical professionals assumed a cause/effect relationship.  They reasoned that removing the offending organs before they damaged a child’s physical (and presumably mental) development, would be an investment in the future of the American “race” –   healthier children would grow into healthier adults.

Thus, Rochester’s first Tonsil and Adenoid Clinic began to take shape during the early spring of 1920.  The first step was to redesign the interior of the Rochester Dental Dispensary on East Main Street into a kind of hospital.  The third story was transformed into a surgical suite.  In one room, four waist-high wooden platforms dominated an operating room.  An adjoining room housed sterilizing paraphernalia and instruments.  The largest room acted as the patient recovery room.  Like the pre-op dormitory on the mezzanine floor below, it was filled with forty army cots left over from the European War.  In the basement, plumbers installed bath stalls, appliance dealers hooked up refrigerators and stoves, carpenters constructed picnic tables and benches in a large lunch room.

A contingent of adjunct workers would assist the surgical team and the day and night nursing staffs.  Physicians serving as examiners gave each of the admitted patients physical exams to ensure that none of the youngsters had an active disease or a cold.  A motherly registrar would greet each child and collect the permission slip that had been signed by her or his grateful parents, along with $5, a nominal charge; hospitals were charging families $20 per operation.   Cooks and serving staff set out and removed the evening suppers and morning-after-surgery breakfasts of gruel and milk. Off site, a contingent of accounting clerks made sure that family incomes indeed qualified for the subsidized procedure and an army of volunteer dentists and school nurses examined the mouths of children under 16. 

For seven weeks that summer, the Dispensary clinic operated with the efficiency of an assembly line.  From mid-afternoon daily, from Sunday through Thursday, 40 youngsters, still possessing their tonsils, were admitted for the procedure.  Each group was discharged just short of two days later, minus the offensive organs.  Because of this tight schedule, maintenance workers had only Saturday afternoons through Sunday mornings to clean the pre- and post-op dormitories and to restock for the coming week’s production schedule.  

The Dispensary clinic admitted its first patients on Monday July 26, 1920.  Typically, a child would register in the afternoon before his or her scheduled procedure, be ushered downstairs for a sponge bath, dressed in a hospital gown and slippers, and fed a nourishing broth for supper.  Then he or she ascended to the second floor and was assigned a cot in the pre-op dorm where the magnificent sleepover described above would occur.  The next morning the patients ascended to the third floor where, four at a time, they were boosted onto the operating platforms, put to sleep with ether, and operated on.  A second, quieter overnight that included a dish of ice cream followed.  Perhaps the convalescents could hear the laughter and hoots of the next day’s patients on the floor above.  On the third morning, the fully recovered children dressed, ate a simple breakfast, and were discharged to their anxious parents.  Simultaneously, the next group of 40 youngsters were undergoing their operations up on the third level.  

Operations continued throughout the summer, ending on September 10, just before schools reopened for the fall term.  By the end of the summer session, 1,470 youngsters under age 16 had undergone tonsillectomies at the dental clinic, with “not a single surgical accident.” 

The fall school term opened with principals and teachers praising the results they saw in the students who had attended the summer clinic.  Youngsters, who the previous spring had been puny, anemic-looking specimens with stunted physical development, had gained height, weight, and stamina over the summer.  Formerly “dull-eyed mouth breathers” sat up straight at their desks, well rested, alert and refreshed.  Apparently, it did not occur to observers that a concurrent campaign for better childhood nutrition and/or a summer of sun and exercise might have been factors in these children’s improvement.

However, more than 2,000 children diagnosed as needing immediate operations remained on a waiting list.  Using this figure as a base, Health Officer George Goler, M. D., who had become enamored by statistical projections, added more names as children continued to undergo oral examinations at three schools located in poor neighborhoods.  By mid October, the Health Bureau was estimating that 27,748 additional children were in “urgent” need of having their tonsils removed, 18,498 of whom were assumed to be from families that could not afford to pay the $20 hospital rate for the operation.  

Finally convinced that the situation had reached epidemic proportions, Rochester’s elected officials agreed that the program was an investment in the city’s future.  News of the first clinic’s success had spread as far as Europe; film clips of it had been featured in newsreels, visiting dignitaries from across the country had extolled the project.  If all of Rochester’s children could experience the benefits of another clinic, the city’s already envied reputation would be ensured.  Another, larger demonstration of the public health experiment could be well worth an investment of a few public resources.  

Thus, in the fall of 1920, a propaganda campaign was launched, with Health Officer Dr. George Goler as its most enthusiastic advocate: “I regard [the Dental Dispensary Clinic] as one of the greatest and most successful experiments in public health that has ever taken place in a short space of time in Rochester.  It has opened the way for us to make of Rochester children the very best physical children in the world.  If we follow up this splendid work by doing what we ought to do, what an example Rochester could set before the world!”  

A steering committee was appointed to oversee the project.  This second clinic would draw its directors from a more diverse pool of community leaders.  Elected officials and other important community leaders joined the bandwagon.  Mayor Edgerton offered the Convention Hall Annex, a cavernous exhibition structure which stood behind what is now GEVA Theater, as a suitable central site for this second clinic, and Rochester’s Community Chest directors agreed to project its expenses onto the spring 1921 campaign appeal.

The campaign’s rhetoric drew on language that had been used to vilify the “Hun” invaders of the Great War, in order to demonize tonsils and adenoids.  The organs were a “menace to the whole community” and “nests to dangerous germs which may poison the system.”  The issue even prompted a rare agreement between the major competing medical factions, the Homeopaths and the Allopaths.  One respected allopathic (traditional) physician insisted, “In the case of children who have frequent colds, sore throat, and tonsillitis, tonsils should be removed, even if they are not large.”  The president of the medical staff at the Homeopathic Hospital seconded that opinion: “Opportunity should be afforded for the operative treatment of every child who has adenoids and diseased tonsils.” 

Enthusiasm mounted during the fall months.  At the annex, carpenters filled in the well that extended from the second story roof to the ground floor.  Once the completed floor was in place, an operating suite was situated directly under the skylight.  This allowed the sun’s rays to augment electric powered light fixtures, if and when Rochester’s skies were clear.  The pre-operation and recovery dormitories were also located on this floor.  Since the annex clinic would run during the coldest winter months, new radiators were added throughout the building, and plumbers and electricians installed sponge-bath stalls and kitchen hookups in the basement.  A registration area, along with waiting and examining rooms, occupied the ground floor.

The procedure for this second clinic mirrored that held at the Dental Dispensary in most respects.  This second effort, however, was on a much grander scale.  Each day, five days a week, 80 children or more—along with their tonsils—would enter through the South Street door, and 80 others, minus the offensive organs, left through the South Clinton Avenue door.  Again, every day four surgeons assisted by nurses and anesthesiologists, excised the tonsils and adenoids from 80 youngsters.  The surgical team could complete all of the operations before noon, usually with time out for a coffee break.  One sometimes wonders how all of those excised organs were disposed of.   In the meantime, much smaller clinics at the Dental Dispensary and at all four of the city’s general hospitals were simultaneously performing similar procedures.

The Annex Clinic steering committee estimated that the demand for the subsidized operations would last for 30 weeks, vacating the structure in time for the mid-summer schedule of flower, hog, chicken and farm implement exhibits.  However, the repurposed hospital operated for only half of that time.  In April, parental demand diminished until it was no longer economical to keep the medical and adjunct staffs on site.  The general hospitals and the Dental Dispensary agreed to take patients remaining on the waiting list throughout the summer at the subsidized rates. 

For ten years after the close of the clinics, Dr. Albert Kaiser studied the operation’s effectiveness in 2,200 of the children who had undergone the clinical experience, comparing the results with a like number of children who had not had their tonsils and adenoids removed.  He published his findings in book form in 1932 as Children’s Tonsils, In or Out?  In general, Dr. Kaiser concluded that, while the operation did reduce the incidence of several contagious childhood diseases and chronic conditions in the short term, that benefit evened out over a ten-year period.  

Furthermore, he admonished, hazards associated with the wholesale extraction of these organs needed to be considered.  Serious, sometimes fatal instances of “Shock,” hemorrhage, “thymic disease” and pneumonia had followed the surgical removal of tonsils often enough to be factors in deciding whether a child should undergo the operation.  

Finally, Dr. Kaiser concluded, “intelligence levels are not influenced by the presence or absence of tonsils and adenoids.  One cannot make a normal child out of a subnormal one, nor a superior child from one who showed only average intelligence.” 

While no physical documentation exists that directly states that the founders and promoters of the Dispensary Clinic had an unstated objective, some contemporaneous conditions lead to that suspicion.  For one thing, generous philanthropy was almost endemic among the tycoons of the early decades of the twentieth century who wished to earn reputations as benefactors rather than as robber barons.  They sprinkled their names liberally on cultural and educational establishments throughout their communities.  Rochester still reveres the names associated with one of its major hospitals, several of its parks, its main library and many of its streets.

Industrial paternalism was also a rampant practice during the era.  To anticipate the needs and desires of a workforce before an embryonic union affiliation could come to term was considered good business.  By establishing a free public health program that promised to equalize the haves with the have-nots, industrialists could also counter the arguments of the socialists and the anarchists whose voices were increasing in volume at the time.