How an early psychiatric treatment lead to widespread mutilationS

Henry Cotton got into psychiatry with noble goals, and ended up as one of the historical horrors of the medical profession. How did he transform from visionary to monster? It had to do with his habit of curing psychiatric disorders by chopping things off his patients.

In 1907, when Henry Cotton took over the Trenton Psychiatric clinic in New Jersey, he must have felt the way geneticists felt in the 1990s. A new world was opening up in science, and he was in the position to use it to alleviate a massive amount of human misery. His focus wasn't genetics. In fact he would have recoiled from the idea that madness was locked in people's genes. Psychiatry, especially of the extremely mentally disturbed, had for too long, in his opinion, looked on the insane as genetic defects. Eugenics was prevalent in the field, and it disgusted him.

He put his faith in the newly-discovered world of microbiology. Bacteria and infection were being studied for the first time, and it was shown that they were the root cause of thousands of different diseases that were previously thought to be unconnected. Cotton's mentor, Adolf Meyer, had come to the conclusion that infection didn't just cause diseases of the body, but of the mind as well. He postulated that mental illness was caused by "focal infection," and that it could be cured by cutting away the source of the infection, something he called surgical bacteriology.

How an early psychiatric treatment lead to widespread mutilationS

Cotton's review of the Trenton clinic backed up Meyer's way of thinking. The place was a shambles, with abusive guards and patients living in filth and misery. And in each patient's mouth, he found rotted teeth. Cotton realized that teeth, which so often were infected for years without people knowing they had cavities, were the way for infection to enter the body. He began removing patient's rotten teeth, and often had their tonsils out as well. As his practice grew, he started taking out more teeth, and then gave patients appendectomies. When this didn't clear anything up, he moved on to colectomies, taking out sections of bowel. When patients did improve, it was because he'd taken out enough infection. When they did not, it was because he hadn't taken out enough. And when they died - as the daughter of a personal friend did when Cotton ordered part of her cervix removed after she started hearing voices - that was a tragic side effect of a necessary treatment.

Some people didn't agree. When people noticed the alarmingly high mortality rate at his clinic, he came under review. Around the same time, another student of Dr Meyer's came to see him. Phyllis Goldacre was an enthusiast for surgical bacteriology, until she started looking at the numbers. She found that few patients recovered, that rates of improvement were not correlated with surgeries, and that considerably more patients died than Cotton let on. Unfortunately for the patients, she was sending her work to Meyer, who was not pleased with the idea that his celebrated therapy was causing useless damage. Goldacre's time at the clinic was cut short, and her reports buried.

The review was not as easily put off, but it was run, in part, by the people at the clinic. They protected Cotton. Cotton also protected himself. During the hearings he broke down, declaring himself too sick to continue. He then had some of his teeth removed and declared himself cured. Although he was gradually, but inexorably, eased out of power at Trenton, he responded by becoming ever more radical. He had his own teeth removed. He had his wife's teeth removed. He had his two sons' teeth removed. He began recommending and performing colectomies on children to prevent madness developing, and to stop habits like masturbation. At times, he even condemned dentists, because they attempted to save teeth instead of pulling them.

There are few satisfying conclusions in the story of surgical bacteriology. Cotton and Meyer both died while their ideas were riding relatively high in public opinion. Cotton, in fact, became quite wealthy when he opened a private clinic for people hoping for miracle surgical cures. Cotton's two sons, victims of their father's surgical mania, both committed suicide in middle age. Hundreds of mental patients died, and thousands were maimed for life. (One Swiss psychiatrist was horrified at the number of miserable, toothless people who were suffering from malnutrition because they couldn't eat properly anymore.) And when the Trenton clinic finally did leave surgical bacteriology behind, they moved on to lobotomies.

The only happy ending in the story is that of Goldacre. She went on to be well-respected in her field, and published multiple papers.

[Via Madhouse: A Tragic Tale of Megalomania and Modern Medicine, Meanderings In New Jersey Medical History, Schizophrenia: The Bearded Lady Disease, Minnesota Medicine, ]