Literature Review

Henry Cotton was a man of remarkable education, who carried with him a notable resume that earned him much respect in his field. He trained at the University of Maryland and at Johns Hopkins and was mentored by dominant figures in psychiatry at the time such as Adolf Meyer, Emil Kraepelin and Aloid Alzheimer. Cotton worked on the belief that mental illness was simply germ infestations that accumulated in the body and released poisons, which resulted in mentally ill. These infections, referred to as ‘focal sepsis’, were then surgically removed from patients by extracting affected organs and counter parts, leading to thousands of fatalities and mutilations. Since research and science have ruled out the need for such bizarre treatments, many have gone back and analysed Henry Cotton’s practices to determine if he was a well reasoned practitioner of his time or one who arrogantly could not accept the evidence of his failed practices and theory. Anne Hudson Jones’ journal ‘The cautionary tale of psychiatrist Henry Aloysius Cotton’ and Patrick McGrath’s article ‘'Madhouse': Nonelective Surgery’ from the New York Times examine Cotton’s works form some interesting points of views.

Hudson’s journal article draws in on the fact that it was Henry Cotton’s professional egotism that unfortunately lead to the horrific deaths at Trenton Psychiatric Hospital. In assessing Cotton’s nature she draws parallels to the conceited work of a Doctor Truffle who, removed patients belly buttons as they interfered with the straight lines of his stomach incisions. Such a comparison highlights that, much like Cotton, a practitioners need to succeed and ironically help others with a new direction in medicine can result in a clear disregard for the patient. Cotton’s flawed believes were fueled by his uncontrollable desire to be right, which lead to more rigorous treatments even after concerning results. Hudson states, ‘Emboldened by the high rates of cure that he believed he saw, Cotton became such a true believer that in patients recalcitrant to cure he began to remove gall bladders, stomachs, uteruses, ovaries, testicles, even colons.’

Henry Cotton was well respected and therefore it is no surprise he was able to widely enforce his theories of mental illness and execute his dangerous practices for as long as he did. It is with this fact that Hudson emphasizes that blame is ‘not confined to an aberrant, megalomaniac doctor [Cotton] but extended to prominent psychiatrists who endorsed Cotton's theories and emulated his treatments’.  The misguided wealth of support and protection from ignorant believers unfortunately allowed Cotton to prolong his horrific reign. She draws attention and blame to a system that failed many innocent mentally ill patients seeking refuge from their own minds, as investigations into the falsified reports and perceived success of Cotton’s works were sadly hidden and buried.

Brilliant or brutish – who was Dr. Henry Cotton?

       Henry cotton has often been described as a megalomaniac, who ghoulishly tortured and killed hundreds of psychiatric patients without any real scientific merit. Such descriptions not only ignore the complexity of the scandal, but also the numerous amounts of people involved that may have played a part in the horrific treatment.  

Such complexities overlooked include factors that contributed to a drastic transformation in Cotton; from an ambitious young visionary, to a monster accused of medical misconduct and murder. Perhaps in order to truly ascertain Cotton’s true motives, it is necessary to first delve into Cottons life before Trenton hospital.

            To completely understand the scandal, one must consider the historical background that surrounded the controversy and life of Cotton himself. Trained as a psychiatrist, Henry Cotton received the highest quality education available at his time. Completing his studies at John Hopkins under “Adolf Meyer”, a figure who was dubbed the ‘godfather’ of psychiatry, instantly made Cotton one of the most promising psychiatrists of his epoch.  This status was further exacerbated in the scandalous Trenton hospital. Prior to Cotton’s arrival, Trenton hospital was plagued with medical misconduct and mistreatment of patients.  When Cotton arrived at the asylum he was met with “deplorable conditions,” with guards wielding unchecked violence and brutality on patients. Cotton dispensed with most restraints and taught attending physicians that they should not just write off patients as “crazy”.  These actions coupled with his “glittering résumé” ensured Cotton a glorified and possibly, an undeserving status. Cotton was thought of as a messiah of psychiatry, who was going to reform the “old asylum to a modern hospital”.  This enabled Cotton to forward his bizarre ideas without being questioned. No one dared question Henry Cotton.  The lack of questions may have played a role in the scandal that followed.  Hospital staff failed to intervene when Cotton was mistreating his patients with no scientific merit in his methods.

                 The medical revolution in germ theory occurring during Cotton’s time at Trenton somewhat explains his controversial treatment plans for his patients. Cotton was no maverick in accepting that germs were the source for illness.  Early 20^th century was marked by the paradigm bacteriology which revolutionised the medical word. “Medicine embraced the laboratory as a source of cultural authority”. With prominent clinicians at such major centres of modern scientific medicine as the Mayo Clinic in Minnesota and the Johns Hopkins medical school in Baltimore all promoted the treatment of toxins as the key to curing mental illness.  Thus the introduction of Cotton’s radical “Focal Sepsis Theory” in 1913 almost seemed logical, as it stemmed from ideas put forward by pioneering figures in medicine.  With this historical context under consideration, Cotton’s actions initially seemed brilliant rather than brutish – in fact, at the time Cotton introduced his model, he was commended for his contribution to psychiatry.

       Despite the lack of evidence and results, Cottons “focal sepsis “was a highly supported theory in the first half of his career. His work was feted by the media, with the New York Times heralding Cotton as a scientific genius whose theories gave “high hope” for the future. In light of this, it becomes more obvious as to how Cotton carried out his callous treatment without intervention; that in fact, Cotton was not the only one contributing to this mistreatment.   In 1924, another student of Adolf Meyer Phyllis Greenacre began investigating Cotton’s work and found that Cotton’s statistics were falsified.  Despite numerous attempts in publishing her work, Meyer rigorously defended Cottons work, suppressing the damaging report to save Cotton’s reputation. Thus, one can see that Cotton’s transformation from brilliant to brutish was fuelled by many factors.  Without criticism and questioning of his treatment plan, how was Cotton to be stopped from assuming he was in fact, a pioneer?  Without any criticism, it seems Cotton’s ego was allowed to grow to dangerous levels.

 

   The latter part of Cotton’s career was plagued by accusations and scandals. It is his actions during this period that allude to Cottons’ ulterior devious motives.  Towards the end of his career Cotton’s initial regard for the patient’s emotional wellbeing seemed to have disappeared altogether. No longer did he care for whether the treatment caused pain or even death among patients.   Despite having no training in surgery, Cotton, with his inflated ego, decided to take over and perform the surgeries himself – removing teeth, tonsils and even portions of the intestine. Doctors that observed the patients that survived Cotton’s operation described the scene as gruesome and disturbing, with patients having difficulty in eating with all their teeth removed. Cases like these were described as lucky; with almost 45 % of the patients perishing during agonizing treatment. This instils doubt as to Cotton’s motives. If Cotton really cared about the wellbeing of his patients why did continue operating when the results were a failure?  This is further accentuated by Cotton’s warped justifications for his damning results, claiming “psychotic patients in whom the infection has been long-standing and of great and specific virulence, are not good surgical risks and yield a higher mortality rate”

Cotton disdain towards patient care extended to operating without consent.  Despite protests from families and the patients, Cotton claimed that “being persistent, often against the wishes of the patient was the only way to be successful.  With numerous accusations against Cotton and a plethora of suffering patients, one would think that Cotton would have eventually stopped promoting his theory if not stopped all together. On the contrary, Cotton continued ot publish his “falsified results” in the paper, welcoming visitors to observe his work at Trenton, right till end of his career . So firm was his belief that he along with himself convinced his wife and his two children to remove their teeth to prevent sepsis. When considering such behaviour on can’t help but question Cotton’s sanity and his true wishes for the patients.

So who was henry Cotton – a brilliant man turned to a brute or just a visionary that was misinterpreted by the contemptuous society .