page_title: Henry Cotton (doctor)
section_title: Education and career
hierarchical_section_title: Henry Cotton (doctor) / Education and career
caption_attribution_description: English: Illustration of an open mouth with removed teeth from The Defective Delinquent and Insane by Henry Cotton. Princeton: Princeton University Press; London: Oxford University Press, 1921
context_page_description: Henry Andrews Cotton was an American psychiatrist and the medical director of New Jersey State Hospital at Trenton in Trenton, New Jersey from 1907 to 1930.
  He and his staff practiced experimental surgical bacteriology on patients, including the routine removal of some or all of patients' teeth, their tonsils, and frequently spleens, colons, ovaries, and other organs. These practices continued long after careful statistical reviews falsified Cotton's claims of extraordinarily high cure rates, and demonstrated very high mortality and morbidity as a result of these aggressive and dangerous measures. In spite of the medical horrors he forced upon the patient/victims, Cotton still instituted many progressive ideas after becoming medical director of the Trenton State Hospital at the age of 30. These included abolishing mechanical restraints and implementing meetings of daily staff to thrash out patient care.
  His enthusiasm for the scientific medicine that was taking hold at the opening of the 20th century led him to an unshakable belief that mental illness of all kinds was the result of untreated infections in the body.
context_section_description: Henry A. Cotton had studied in Europe under Emil Kraepelin and Alois Alzheimer, considered the pioneers of the day, and was a student of Dr. Adolf Meyer of Johns Hopkins School of Medicine, who dominated American psychiatry in the early 1900s. He studied medicine at Johns Hopkins University and at University of Maryland.
  Cotton began to implement the emerging medical theory of infection-based psychological disorders by pulling patients' teeth, as they were suspected of harboring infections. If this failed to cure a patient, he sought sources of infection in tonsils and sinuses and often a tonsillectomy was recommended as additional treatment. If a cure was not achieved after these procedures, other organs were suspected of harboring infection. Testicles, ovaries, gall bladders, stomachs, spleens, cervixes, and especially colons were suspected as the focus of infection and were removed surgically.
  Being before even rudimentary scientific methods such as control groups—and by extension, double-blind experiments—existed, statistical methodology for applications in human behavior and medical research did not emerge during the lifetime of Cotton. He could only follow faulty methods to compile data, much of it allowing for projection of anticipated results. He reported wonderful success with his procedures, with cure rates of 85%; this, in conjunction with the feeling at the time that investigating such biological causes was the state of the art of medicine, brought him a great deal of attention, and worldwide praise. He was honored at medical institutions and associations in the United States, the United Kingdom, and Europe and asked to make presentations about his work and to share information with the others who practiced the same or similar methods. Patients, or their families, begged to be treated at Trenton, and those who could not, demanded that their own doctors treat them with these new wonder cures. The state acknowledged the savings in expenses to taxpayers from the new treatments and cures. In June 1922, the New York Times wrote in a  review of Cotton's published lectures:
  At the State Hospital at Trenton, N.J., under the brilliant leadership of the medical director, Dr. Henry A. Cotton, there is on foot the most searching, aggressive, and profound scientific investigation that has yet been made of the whole field of mental and nervous disorders... there is hope, high hope... for the future.
  Unfortunately, in an era before antibiotics surgery resulted in a very high rate of postoperative morbidity and mortality, largely from postoperative infection. Among his patients at this time was Margaret Fisher, daughter of wealthy and famed Yale economist Irving Fisher, who believed in the hygienic movement of the period. Diagnosed by physicians in Bloomingdale Asylum as schizophrenic, which was before the modern development of some pharmaceutical agents, Fisher had his daughter transferred to Trenton. However, because Cotton attributed her condition to a "marked retention of fecal matter in the cecal colon with marked enlargement of the colon in this area" for which she was subjected to a series of colonic surgeries before dying of a streptococcal infection in 1919. The danger of surgery was recognized by some patients in the institution, who, despite their mental illness, developed a very rational fear of the surgical procedures, some resisting violently as they were forced into the operating theater in complete contradiction of what are now commonly accepted medical ethics. A paternalistic attitude and the permission of the family of seriously insane patients was the basis of intervention at the time.
  Differences of professional opinion existed among psychiatrists regarding focal sepsis as a cause of psychosis and not all believed in the benefits of surgical intervention to achieve cures. Dr. Meyer, head of the most respected psychiatric clinic and training institution for psychiatrists in the United States, at Johns Hopkins University, accepted the theory. He was encouraged by a like-minded member of the state board of t
caption: 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.
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