Throughout the period of this scandal,
there were many major developments in medicine and psychiatry especially in
relation to aetiology. Before the emergence of germ theory, the main cause of
disease was thought to be related to an imbalance, whether of the humours or
environment etc. In the 19th century, germ theory was making headway
– playing an important role in changing the way people thought about disease
and disease transmission.
History and emergence of germ theory
The work of Casimir-Joseph Davaine
between 1863 and 1870 built on the earlier discoveries of ‘stick-shaped
corpuscles’ found by French and German scientists in the blood of anthracic
sheep. By considering Pasteur’s work on fermentation around that time, Davaine
became convinced that the sole cause of disease was the presence of these
microbials (Waller, 2002, p104). However it would take the contributions of
other scientists like Robert Koch to fully demonstrate the various aspects of
this disease model. Koch discovered that not all microbial agents caused
illness; people could become infected with many microbial agents, but a specific
agent caused a specific disease. He developed a set of 4 postulates that would
aid in the identification of pathogens that could be isolated using the
techniques of the day. Furthermore in 1881, Pasteur experimentally demonstrated
that anthrax was indeed caused by a specific microbial agent.
From this point onwards, international
efforts towards research in germ theory resulted in public acceptance of the
paradigm, with people becoming surprised when scientists did not find microbial
agents to be the cause of an illness (Waller, 2002, p131).
Germ
Theory’s application to psychiatry
Given the overwhelming paradigm of germ
theory and the following gains to both etiological understanding and
therapeutic efficacy, many were seeking to apply the theory further. Advancements
in surgery at the time, in antisepsis and anaesthesia also increased the
technical capacities of surgeons, hence expanding the opportunities for
surgical intervention, which led to vast improvements in therapeutics. In the
early 20th century, the prestige of medicine and its practitioners
soared as the anticipation for a bacteriological revolution and its potential
benefits to therapeutics grew seemingly limitlessly (Scull, 2005).
Psychiatry during this revolutionary
time however, was still in turmoil. Many took the view that the rising
bacteriological paradigm reinforced the idea that numerous serious forms of
mental illness were incurable. And hence this would account for psychiatry’s
therapeutic failures at the time. Deeply rooted in this was a belief that
mental illness was the product of defective genes, passed on and possibly
intensified through the generations. The mentally disturbed were treated as
lesser beings, and eugenics tactics were employed to restrict marriage, in
order to prevent further degeneration to the human species. Cotton however,
refused to take on this perspective, instead, actively seeking to find a
somatic cause.
By the late 19th century, it
was discovered that the terminal stage of syphilis resulted in paresis. In
1913, Hideyo Noguchi and J.W. Moore published results to ultimately prove that
a bacterium, the syphilitic spirochete, led to brain lesions, therefore causing
paresis. This discovery took hold in the mind of Henry Cotton as he speculated
whether other mental disorders had a similar etiology. It wasn’t just Cotton
however; the prospect of extending the bacteriological paradigm was a
temptation to many physicians over America and Europe. Many previously deadly
diseases were effectively treated from application of the germ theory and
“increasingly, a variety of influential voices suggested that chronic diseases…
‘might be caused by bacteria disseminated through the lymph or blood-streams
from a hidden primary focus of infection’” (Scull, 2005, p31). It was thought that
hidden pockets of infection could produce powerful toxins which would harm the
body, resulting in a range of baffling diseases. Furthermore, focal sepsis
gained an influential advocate – a leading figure in early 20th
century American medicine – Frank Billings. He delivered the Lane Lectures in
1915 to the Stanford Medical School, converting a new generation of physicians
to consider the importance of focal sepsis. Though there were many sceptics,
focal sepsis gained support from more and more prominent figures in medicine.
By 1925 the number of surgeries at
Pennsylvania Hospital rose from 870 (in 1900) to 4180, with a similar increase
in New York, evidently showing the “penetration of the ideas associated with
the doctrine of focal infection into the center of routine American medical
practice” (Scull, 2005, p33).
The attraction of focal infection was
not isolated to the medical community. Its correspondence with the notion of
“regularity” and cleansing of the body played on the popular belief in the interconnectedness
of health and hygiene. Cotton was not the first psychiatrist to apply focal
sepsis in his practice. Practitioners like Lewis Bruce and Henry Upson had
written about this idea as early as 1906, however to Cotton, they seemed to
lack conviction, for psychosis was still seen as deeply rooted in hereditary
defects. In 1916, he “embraced the theory of focal infection with an enthusiasm
no one else could match” (Scull, 2005, p37), insisting that it was the sole
source of his patient’s mental disturbance. However Cotton’s view became widely
popular. He was offering a cure in many ways to an otherwise “incurable” group
of people, giving hope to society that mental illnesses could be easily treated
via the removal of the infected organ.
In effect, Cotton’s application of
focal sepsis was not necessarily unusual considering the context of medical
developments of the time. The influences and encouragement of physicians before
him may have sparked the theory in his mind. However it can be argued that Cotton’s
infatuation with the theory and his single-mindedness in considering the focal
sepsis as the sole source of mental illness is an act of arrogance and
ignorance to the critique of the general medical community. In some ways, his
conviction of the truth of this theory is commendable as this is the rigor in
which scientific progress is made, however his blatant dismissal of critique
and consideration of other theories may well be what led things to get out of
hand.