He would cut out your spleen to cure your dementia
In 1907 a young psychiatrist by the name of Henry Cotton joined the New Jersey State Hospital at Trenton - today known as the Trenton Psychiatric Hospital. Even as a young doctor he’d been considered innovative, at the top of his field, and he had a revolutionary concept. A means to help his mentally disturbed patients, take away their insanity and give them a normal life.
By pulling out their teeth.
The very idea of pulling out teeth to cure insanity sounds particularly ludicrous, but there was some form of method to the madness.
Henry A. Cotton had studied at John Hopkins Hospital and was a student of Dr Adolf Meyer, a true pioneer of psychiatry. Cotton's field of study specifically was his autointoxication theory. Essentially where the body could poison itself through infections. He believed that lunacy was caused by these poisons and that by removing them, one could also then, by extension, remove the madness.
For its time the theory was quite revolutionary, and even to an extent plausible. Many mental disorders can be attributed to a poor biological balance in the brain, and so we could make the assumption that infections could be the cause of this imbalance. It's not as far-fetched as we would like to think.
One example of this theory in practice would be partial colectomies. This was a type of surgery where part of the colon was removed. It was believed to cure dementia. The theory was based on the old concept of ‘humours’ in the body: tempers, or liquids that needed to be balanced to maintain one’s health. The colon handled some of these humours, and so by removing a ‘dangerous’ part of the colon (one where faeces might ferment and cause sickness), a doctor could, in theory, cure or even prevent dementia.
So, when Cotton walked into Trenton, he was ready to apply his method with vigour. However, he soon realized that most of his patients (even after pulling several teeth) did not show any improvement. He then adjusted his theory: perhaps the infection had instead spread to other parts of the body. Subsequently, the patient would need to have follow-up surgeries, where tonsils, appendixes, gallbladders, parts of the stomach, and of course parts of the colon, were also removed to fight the infection.
He declared it a wonderful success, citing an 85% success rate. Many doctors sang his praises, and his methods spread all across America and even to Europe. A total of 645 patients would land under his scalpel in his 26 years as a medical doctor, and an average of about 11 000 teeth would be removed in total.
But the dark reality of the situation would eventually come to light.
It turned out that most of Cotton's patients would die from peritonitis. An infection in the lining of the internal organs. Between 1918 and 1925 he performed 300 colectomies, only 25 percent actually recovered and around 33 percent died almost immediately from complications in surgery or resulting infections.
However, Cotton would still promote his methods in papers, medical journals, and public gatherings, pushing his theories as the only true cure for insanity.
He even encouraged parents to use colectomies as a sort of 'cure-all' for children. He had done so with his own children, so he deemed himself an authority on the matter. Despite the high death toll, his peers seemed quite enamoured with Cotton’s theories, and more and more surgeries in America began to apply this ‘Cotton Method’.
But unrest was brewing. Despite his growing fame, his former patients and their families began complaining: of their uncured disease, mutilations, and even the deaths of their family members who’d been former patients of Cotton. Despite the number of unhappy customers though, Cotton seemed untouchable, as the scientific community rallied around him and sang his praises above his detractors.
This is an image from Cotton's book: The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention.
Cotton would continue to push his theories unabashedly, but this ambition would be his downfall.
In his eager chase to ensure that Trenton Hospital became one of the leading medical facilities in America, he inadvertently brought hordes of attention upon his practices. An investigation was launched into the hospital and, by extension Cotton’s surgeries.
This was done as part of the Bright Investigation, to identify waste and fraud in the Government. The investigation discovered a slew of unhappy patients, employees, and family members, who were described as:
“A parade of disgruntled employees, malicious ex-patients, and their families, testifying in damning detail about brutality, forced and botched surgery, debility and death.”
Trenton Psychiatric hospital still practiced Cotton's method by pulling until in the 1960's.
The intense pressure from the investigation would be too much for Cotton who became erratic and disorganized to the point that he was asked to quietly step down from his position at Trenton. During his recovery, his former mentor, Adolf Meyer, got wind of his practices and sent one of his trusted younger students to investigate the hospital.
Doctor Phyllis Greenacre, headed into the looming Trenton Psychiatric building to see for herself the condition of these patients, and what she discovered was horrific.
Most of the patients had little to no teeth making it difficult to swallow, eat or even speak. Very few showed improvement in their battle with insanity, even after surgery, many others were close to death, and those that weren’t were still as deranged as they’d been before. But even trying to prove this was made difficult by the chaotic state of their files. Nothing was organized, much of it was even contradictory, so to make an accurate judgment on how many patients were in fact being cured was next to impossible.
In complete disbelief by the poor administration, horrible conditions, and downright blind loyalty from his staff, Greenacre decided to do a bit of research herself. She selected 62 patients which had gone under Cotton’s scalpel. 17 had died right after surgery, several others died a few short months after, who were not included in the mortality rate. Those that did show signs of improvement were only a handful, and of them, some were still sick from the infection.
The four humours theory comes from Ancient Greece, and was considered a valid theory up until the 20th century when we finally accepted germ-theory.
Following up with house visits to former patients, she confirmed, with no shadow of a doubt that his patients were better off not getting surgery: “… the least treatment (little to no surgery) was found in the recovered cases and the most thorough treatment (extreme surgery) in the unimproved and dead groups.”
Tragically, despite all of her work and the parallel investigation by the Bright Investigation, all of it was dropped due to Cotton’s supporters. With the sheer amount of outcry levied at the investigations it was deemed useless to continue and everything was dropped. Leaving Cotton, now recovered, to continue into private practice, and start working with wealthy families. His popularity once again began to grow.
Another investigation would be launched only eight years later when another slew of accusations was levied at Cotton. But before they could find any traction to take him to court, it was shut down when Cotton suddenly died of a heart attack in 1933.
To look back in retrospect at this tragedy, it is difficult to believe that an entire country could be swept up by one man’s madness. After all, so much evidence existed at the time to prove his theories false. But still, educated people like doctors and surgeons believed in his theory so whole-heartedly they protected him from ever being prosecuted. But the whole situation does say something about charismatic people, that no matter how much nonsense they talk, even smart people, educated people, can be duped into listening to what they have to say. No matter how stupid or even dangerous it might be.
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Encyclopedia of Asylum Therapeutics, 1750-1950s