Infectious Insanity: Dr. Henry Cotton and the Practice of “surgical bacteriology.”

Illustration of a mouth with teeth removed from Cotton's book The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention.

Illustration of a mouth with teeth removed from Cotton’s book The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention.

The mind is a mystery. For as long as humans have been human, they have sought to solve the mysteries that lurk in their own skulls. Nowadays, research into the mind lay more in the realm of the scientific than the spiritual. While many scientists believe in the concept of the soul (one even tried to measure its weight), most confine their investigations into the nature of human behavior to the more quantifiable realm. Early work in psychology and neuroscience was largely a shot in the dark. They naturally lacked modern technology and techniques, and so had to fumble around and figure out how things worked. That fumbling mixed with questionable ethics sometimes resulted in horrifying experiments.

Few experiments in the field of psychology were more horrifying than those conducted by Dr. Henry Cotton in the Trenton State Hospital in Trenton, New Jersey. While some doctors in the history of psychiatry have advocated for surgery to heal the mind, Dr. Cotton took matters a step further. In many cases, he all but butchered his patients in an effort to heal their minds.


Focal sepsis and insanity

Dr. Henry Cotton had an esteemed educational pedigree. He studied under Emit Kraepelin and Alois Alzheimer–who lent his name to the terrible degenerative disease–and Dr. Adolf Meyer. All of these men were pillars in the field of psychiatry in the early 1900s. Dr. Meyer was especially impactful in America. He observed that patients with very high fevers could suffer hallucinations. From this, he hypothesized that infections might be the root cause of behavioral abnormalities. His idea entered an arena where two contrasting hypotheses were already battling it out. Eugenic theories posited that behavioral problems resulted from heredity. According to eugenicists, selective breeding of humans could change the make up of a society and breed more desirable citizens (it also resulted in some strange Soviet experiments that attempted to crossbreed apes and humans.) Sigmund Freud held that behavioral problems stemmed from childhood trauma. Essentially, the two opposing ideas set up the nature vs. nurture argument that still rages today.

An infectious cause for insanity was a pretty attractive option. The idea of bacterial infections was a pretty cutting edge one at the time, after wide acceptance of the Germ Theory of disease had finally taken root. But more than being a sexy new theory, the idea that bacteria caused psychological illness offered hope for a relatively simple treatment for devastating ailments that nobody really understood.

Dr. Cotton became a champion for the concept. He took over as the medical director of Trenton State Hospital in 1906 at the relatively young age of 30. There he implemented the practice of surgical bacteriology. Basically, if infection of certain body parts–dubbed focal sepsis–caused insanity, removing that body part would cure the psychological ailment. Cotton would begin by pulling patient’s teeth. If the patient failed to show improvement, he might remove the tonsils next. If again there was no improvement, he would move to steadily more major surgeries, including removing–partially or in total–testicles, ovaries, gall bladders, stomachs, and spleens. Dr. Cotton was especially interested in how suspected colon infections would impact psychological health, and he often removed whole sections of people’s intestines.


A severely flawed method

If it sounds like the doctor was more insane than his patients, well, you aren’t far off. The methodology behind surgical bacteriology was flawed from the get go. Dr. Cotton did not approach the matter skeptically, testing for results carefully and holding his results to strict scrutiny of the scientific community. He proceeded as if focal sepsis was the one and only cause of mental illness. Horrible things happen when people assume they’re correct. For one thing, they ignore any evidence to the contrary; for another, they exaggerate their successes. Dr. Cotton claimed an 85 percent success rate, a statistic that gained him a lot of praise from the scientific community of the day. Subsequent investigations did not paint such a rosy picture. Patients, their families, and former employees of the hospital began to raise a ruckus about both the treatments and the conditions in the hospital. During the period of the investigations and public hearings, Dr. Cotton apparently suffered a nervous breakdown, which he treated by pulling several teeth. He pronounced himself cured. After the period of controversy, he was retired and appointed as medical director emeritus in 1930. He died of a heart attack three years later. Even the brief period of controversy did not much tarnish his reputations as a pioneer in the field of psychiatry.

As for his patients, well, their lot didn’t improve substantially. Many were left toothless and suffered unnecessary surgeries in pursuit of a cure that didn’t exist. Dr. Cotton, who was not a trained surgeon, performed abdominal surgeries in the age before penicillin. Death rates from the needless procedures were as high as 45%. Less extreme forms of surgical bacteriology were performed in Trenton State Hospital until the 1950s. After that point, the advent of anti-psychotic drugs led to more noninvasive treatments for mental illness, and the need to cut people apart to cure their mind fell by the wayside.




“Henry Cotton (doctor).” October 20, 2013. Wikipedia. May 24, 2014.

Daniels, Anthony. “The madness of a cure for insanity.” May 8, 2005. The Telegraph. May 24, 2014

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