The Road to Madness: A Look at Cotton and his Focal Infection Theory
Henry Cotton’s preoccupation with his conceived Focal Infection Theory was his ultimate undoing. The theory itself, however, was not entirely unsound or unfounded.
There had already been conjecture of other parts of the body pertaining to madness, a wandering uterus to explain hysteria had been a long standing myth. Cotton refuted the current accepted view that insanity was due to deteriorating genetics and instead focused his energy to find biological roots for mental disorder. By examining pathological specimens, Cotton began making links with physiological lesions and mental illness. In the 19th century syphilis was strongly linked to deteriorating mental state and Cotton took this finding to be very encouraging. With the guidance of Billings and Rosenow, he seeded the strong ideas of microbial infection being the main causative agent in insanity (Scull 2005).
The recognition that tetanus was caused by a local wound that spread bacterial toxins to the whole body was further evidence in the case for autointoxication. Given this, he was soon on a mission to eliminate focal infection. Cotton insisted that infection in the teeth could be subclinical in nature and that the tonsils harboured all sorts of bacteria that made their way in to the blood and lymphatics. No matter what the value of the organ, Cotton pushed the belief that it was better absent, than present and infected.
Cotton, unlike many other physicians, labelled focal infection as the principal cause of insanity rather than just being a factor in a handful of cases. As speculation about his mortality rates grew, a new state commissioner of institutions, Burdette Lewis was employed and protected Cottons interests. His list of surgeons and consultants on hand was impressive and gained him status in his war against infection (Scull 2005).
Cotton began to report cure rates as high as 85% with the number of patients cured annually ever increasing. Cotton not only recommended removal of infected tissue for therapeutic reasons but also the prophylactic removal of susceptible tissues. However radical this may have seemed, Cotton did insist that he only ever removed organs or teeth when there was reasonable suspicion. There was also insistence that where people failed to respond to tooth and tonsil extraction, it was due only to the fact they had further secondary infection that hadn’t been attended to, such as in the genital or gastrointestinal tracts.
As mortality rates increased with the increase of abdominal surgeries, Cotton claimed that they died due to long standing mental illness and therefore chronic infection that resulted in postoperative peritonitis. Furthermore, those that had died from infection after the surgeries were counted as the ‘benefited’ patients. If this was not questionable enough, Cotton prided himself and his surgeons on superior knowledge and so proper consent of patients was not often gained as they were anaesthetised before they could protest (Skull 2005).
Despite Cotton’s lack of sound evidence and questionable methods of insanity cure, Meyer et al. (2011) found that inflammatory process was closely linked to many schizophrenia cases. Administration of anti-inflammatory drugs, along with the continued use of antipsychotics, was found to alleviate symptoms better than antipsychotics alone. Unlike Cotton, this study acknowledges the other physiological basis of schizophrenia as being all interconnected such as altered dopamine and serotonin levels. Also unlike Cotton, the study tested peripheral lymphocyte concentrations and found that inflammatory cell counts in schizophrenic patients were at an increased level compared to the population norm.
Experiments in rats show that early immune challenges to young and prenatal animals can alter their immune responses for life, causing similar brain changes to people with schizophrenia. It is not so much infection being targeted as a possible causative agent for mental disorder; more the body’s altered inflammatory process (Meyer et al. 2011).
A study of urinary tract infection (UTI) management in the elderly by Beier (1999) also found that one of the side effects of a UTI was a deteriorated mental state. The patients often displayed a worsening in their present dementia symptoms as well as onset of new symptoms, such as confusion. These recent studies show how infection can occasionally account for mental disorder but in no way justify the extraordinary lengths Cotton went to, to defend his hypothesis.
Still on the Road to Madness: Exploring an Alternative Conspiracy Theory
Analysis of the literature relating to the Henry Cotton scandal at Trenton reveals a plethora of largely consistent accounts. From online articles to published books, there exists a consensus on the timeline and details of the ghastly procedures, as well as the blame of psychiatrist Adolf Meyer in his conspiracy to suppress evidence of Cotton’s misconduct. A point of distinction, however, lies in the exhaustive account provided by author and professor, Andrew Scull. As he essentially confers, despite being the most identifiable conspirator involved in the scandal, Adolf was not the sole plotter to be embroiled in the scandal.
Reports of significantly high mortality rates associated with Cotton’s procedures had begun to circulate the medical profession (Scull 2005, 52), thus casting increasing doubt over the promoted efficacy of Cotton’s theory and techniques. Steps toward illuminating his conduct, however, were met with substantial resistance by the authorities at Trenton Hospital.
For members of the hospital’s board of managers, the decision to formally commission an external assessment of Cotton’s work at Trenton had been the subject of significant internal controversy and debate (Scull 2005, 159). Such reluctance to formally investigate Cotton’s medical undertakings stemmed largely from trepidation that the inquest would generate ‘a lot of undesirable notoriety’ for the hospital (Scull 2005, 159). Joseph Raycroft, an emphatic proponent of Cotton’s research, was among those board members most concerned with such negative exposure. As Andrew Scull (2005) revealed, he was to become one of the most instrumental players in the conspiracy to protect the reputation of Cotton’s work.
Joseph Raycroft was resolute in his assertion that the objections to Cotton’s work, made by other psychiatrists and authorities at New Jersey’s other state hospital, was greatly attributable to jealousy and a disinclination to accepting procedures that deviated from traditional medical practices (Scull 2005, 159). With these arguments as a rationale, the board and Commissioner Lewis were persuaded to believe that the establishment of a pre-emptive investigation into Cotton’s work was necessary (Scull 2005, 160). In Raycroft’s view, a study of Cotton’s work was inevitable. He therefore deemed it imperative that they commission their own investigation before a more hostile investigation could be conducted by antagonistic critics (Scull 2005, 160).
In a stroke of perceived genius, Raycroft recruited Cotton’s former mentor: Adolf Meyer (Scull 2005, 160). Adolf Meyer was a well-respected American psychiatrist, considered by many to be the ‘most influential American psychiatrist of the day’ (Wessely 2009, 447). Meyer’s reputable and revered standing within the psychiatric community would afford the investigation the credence it required (Scull 2005, 160). More importantly, however, the fact that Cotton was Meyer’s protégé would furthermore ensure the hasty suppression of any condemning evidence found on Cotton. Raycroft supposedly hedged this bet on the assumption that Meyer would conceal such evidence in order to prevent it from compromising Meyer’s own reputation. He furthermore counted on the fact that Meyer would be loath to allowing any incriminating evidence to jeopardise the power and prestige of the psychiatric profession in general. As it so happened, Raycroft was correct. Raycroft therefore catalysed the establishment of Adolf Meyer as the chief conspirator in the cover-up of Henry Cotton’s malpractice, a fact not at all acknowledged by any other works pertaining to the scandal.