1848
- The New Jersey State Lunatic Asylum at
Trenton, New Jersey, is founded on May 15th. It is the first mental
hospital in state of New Jersey. The superintendent is Horace A. Buttolph.
Late 1800s
- Henry A. Cotton is educated by top
psychiatrists: first in Europe under Emil Kraepelin and Alois Alzheimer
and then in the US under Adolph Meyer. Meyer is the head of the most
respected psychiatric clinic and training institution in the US, at John
Hopkins University.
- Germ theory, the concept that some diseases
are caused by microorganisms, is developed and dramatically changes
medical practice.
- New Jersey State Lunatic Asylum becomes the
New Jersey State Hospital.
1907
- Cotton becomes the medical director of the New
Jersey State Hospital. His first contributions include the removal of
mechanical restraint, the prioritisation of good patient care, the
establishment of a laboratory, the initiation of daily staff meetings, and
the expansion of the medical training programme.
- Following the emergence of germ theory comes
the rise of focal sepsis theory, the view that mental illness is the
result of untreated bacterial infections and can be cured by surgical
bacteriology, the removal of possibly infected organs. These theories fit
in the way of thinking about health and disease of the time and were
highly regarded by medical organisations worldwide.
1916
- Cotton puts focal sepsis theory into practice
and starts removing mainly the teeth and tonsils of mentally ill patients.
If no favourable result is achieved he proceeds to removing the stomach,
spleen, testicles, ovaries, colons, gall bladders, and cervixes, and so
on, just as long until the patient recovers or dies.
- Cotton claims to have reached a cure rate of
85% through his methods.
- The mental hospital in Trenton becomes
increasingly popular. People plead to be treated at Trenton and pay
excessive amounts of money for it.
1918
- Cotton receives critique from Meyer because of
his thoroughly reductionist biological account of mental illness.
- Cotton's tenure at the head of the hospital
comes under threat
- Despite critique and risk of losing tenure,
Cotton starts investigating secondary sites of infection with abdominal
surgeon J.W. Draper. "Cotton believed science was on his side".
"Both men were sure they were on the right track" (Scull, 2005).
1919
- Margaret Fisher, the daughter of Irving
Fisher, who was previously diagnosed with schizophrenia, enters Trenton
and is treated by Cotton with colonic surgeries. She dies from
streptococcal infection several months later.
- The danger behind Cotton's practice is first
recognised by patients and fear develops in the hospital. Patients are
often treated involuntarily.
- Cotton attributes the high post-operative
mortality rate of mentally ill patients at Trenton to their 'much lower
vitality' to begin with.
- Cotton publishes papers in New York Medical
Journal and Journal of Dental Research
1921
- Cotton starts a lecture series at Princeton
University on his medical theory.
- Cotton is highly respected in the medical
field - even Mr Fisher insists on his correctness.
1922
- Journalist Thomas Quinn Berslay of the New
York Times reviews the published version of Cotton's lectures and writes a
lauding piece about Cotton's methods at the New Jersey State Hospital.
1924
- Meyer privately expresses his doubt about
Cotton's statistical methods applied to Cotton's work and sends
another former student, Phyllis Greenacre, to evaluate Cotton's work.
1925
- Greenacre reports disorganized staff records
and flawed statistics. A recovery rate of 32% and a mortality rate of 45%
among patients whose colons were removed, were found.
- Meyer protects Cotton. He prevents Greenacre
from completing her study and doesn't press Cotton to confront the faulty
statistical analysis. Meyer's silence allows Cotton to proceed his
practice of surgical bacteriology.
- Criticism reaches the New Jersey State Senate,
which initiates an investigation.
- Countering the criticism, Cotton receives
international professional praise. The New York Times states that
"eminent physicians and surgeons testified that the New Jersey State
Hospital for the Insane was the most progressive institution in the world
for the care of the insane, and that the newer method of treating the insane
by the removal of focal infection placed the institution in a unique
position with respect to hospitals for the mentally ill".
- Cotton becomes ill, supposedly with a nervous
breakdown. He diagnoses himself with infected teeth, removes them, and
pronounces himself cured.
1930
- Cotton retires from position as medical
director of New Jersey State Hospital
- Cotton's retirement marks the end of the
invasive abdominal surgeries. Less risky procedures such as teeth removal
remain regular practice until the 1950s.
1932
- Emil Frankel begins a report on Cotton
agreeing with Greenacre, but this report is never completed.
1933
- Cotton dies of a heart attack on May 8th.
- Lauded in New York Times and the local and
international press as a pioneer seeking better treatment of mentally ill
patients.
Mid 1950s
- After Cotton, antipsychotic drugs and
psychotherapy became common psychiatric practice, which made it possible
for many patients to return to the community. As a result, the hospital's
patient population reduced considerably. Its name changed to Trenton
Psychiatric Hospital.