Henry Cotton (doctor) - AbsoluteAstronomy.com

Henry Andrews Cotton, MD (1876–May 1933) was an American

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

Psychiatrist

A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

and the medical director

Medical director

As laboratory director,means that you are responsible for the overall operation and administration of the laboratory, including the employment of competentqualified personnel. Even though you have the option to delegate some...

of New Jersey State Hospital at Trenton

New Jersey State Hospital at Trenton

The Trenton Psychiatric Hospital is a state run mental hospital located in Trenton and Ewing, New Jersey. It previously operated under the name New Jersey State Hospital at Trenton and originally as the New Jersey State Lunatic Asylum....

(previously named New Jersey State Lunatic Asylum, now known as Trenton Psychiatric Hospital) in Trenton, New Jersey

Trenton, New Jersey

Trenton is the capital of the U.S. state of New Jersey and the county seat of Mercer County. As of the 2010 United States Census, Trenton had a population of 84,913...

between 1907 and 1930. He embraced the concept of scientific medicine that was emerging among physicians at the turn of the twentieth century, which included a belief that insanity

Insanity

Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity...

was the result of untreated infection

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

s in the body, and to treat them he directed his dental and medical staff to practice "surgical

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

bacteriology

Bacteriology

Bacteriology is the study of bacteria. This subdivision of microbiology involves the identification, classification, and characterization of bacterial species...

" on the patients.

Career

Henry A. Cotton had studied in Europe under Emil Kraepelin

Emil Kraepelin

Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...

and Alois Alzheimer

Alois Alzheimer

Aloysius "Alois" Alzheimer, was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of "presenile dementia", which Kraepelin would later identify as Alzheimer's disease....

, considered the pioneers of the day, and was a student of Dr. Adolf Meyer

Adolf Meyer (psychiatrist)

Adolf Meyer, M.D., LL.D., , was a Swiss psychiatrist who rose to prominence as the president of the American Psychiatric Association and was one of the most influential figures in psychiatry in the first half of the twentieth century...

of Johns Hopkins School of Medicine

Johns Hopkins School of Medicine

The Johns Hopkins School of Medicine , located in Baltimore, Maryland, U.S., is the academic medical teaching and research arm of Johns Hopkins University. Hopkins has consistently been the nation's number one medical school in the amount of competitive research grants awarded by the National...

, who dominated American psychiatry

Psychiatry

Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

in the early 1900s. Based on the observation that patients with high fever often turn delusional or hallucinating, Meyer introduced the possibility of infections (then viewed as the cutting edge concept of scientific medicine) being a biological cause of behavioral abnormalities, in contrast to eugenic theories which emphasized heredity

Heredity

Heredity is the passing of traits to offspring . This is the process by which an offspring cell or organism acquires or becomes predisposed to the characteristics of its parent cell or organism. Through heredity, variations exhibited by individuals can accumulate and cause some species to evolve...

and to Freud's theories of childhood traumas. Cotton would become the leading practitioner of the new approach in the United States.

After becoming medical director of Trenton State Hospital at the age of 30, Cotton instituted many progressive ideas. These included abolishing mechanical restraints that had created nightmare conditions in asylums for hundreds of years and implementing daily staff meetings to discuss patient care.

Surgical removal

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 tonsil

Tonsil

Palatine tonsils, occasionally called the faucial tonsils, are the tonsils that can be seen on the left and right sides at the back of the throat....

s and sinuses

Paranasal sinus

Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity , above and between the eyes , and behind the ethmoids...

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. Testicle

Testicle

The testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...

s, ovaries

Ovary

The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...

, gall bladders, stomach

Stomach

The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...

s, spleen

Spleen

The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...

s, cervix

Cervix

The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...

es, and especially colon

Colon (anatomy)

The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...

s were suspected as the focus of infection and removed surgically.

Exaggerated cure rates and honors

This was before even rudimentary scientific methods such as control groups—much less 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

Death

Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....

, largely from postoperative infection. Among his patients at this time was Margaret Fisher

Irving Fisher

Irving Fisher was an American economist, inventor, and health campaigner, and one of the earliest American neoclassical economists, though his later work on debt deflation often regarded as belonging instead to the Post-Keynesian school.Fisher made important contributions to utility theory and...

, daughter of wealthy and famed Yale

YALE

RapidMiner, formerly YALE , is an environment for machine learning, data mining, text mining, predictive analytics, and business analytics. It is used for research, education, training, rapid prototyping, application development, and industrial applications...

economist

Economist

An economist is a professional in the social science discipline of economics. The individual may also study, develop, and apply theories and concepts from economics and write about economic policy...

Irving Fisher

, who believed in the hygienic movement of the period. Diagnosed by physicians in Bloomingdale Asylum as schizophrenic, which was untreatable until 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

Medical ethics

Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...

. 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 trustees who oversaw Trenton State Hospital to provide an independent professional review of the work of Cotton's staff. Meyer commissioned another of his former students who practiced psychiatry on his staff at the Phipps Clinic, Dr. Phyllis Greenacre

Phyllis Greenacre

Phyllis Greenacre MD was an American psychoanalyst and physician who was a supervising and training analyst at the New York Psychoanalytic Institute.-References:...

, to critique Cotton's work. Her study began in the fall of 1924 just after Meyer visited the hospital and privately had expressed concern about the statistical methods being applied to provide an assessment of Cotton's work. Cotton's staff made no effort to facilitate the study.

Investigation and controversy

From the outset, Greenacre's reports were critical, with regard to both the hospital, which she felt was as unwholesome as the typical asylum, and Cotton, whom she found "singularly peculiar". She realized that the appearance and behavior of almost all of the psychotic patients was disturbing to her because their teeth had been removed, making it difficult for them to eat or speak. Further reports cast serious doubt on Cotton's reported results; she found the staff records to be chaotic and the data to be internally contradictory. In 1925 criticism of the hospital reached the New Jersey State Senate, which launched an investigation with testimony from unhappy former patients and employees of the hospital. Countering the criticism, the trustees of the hospital confirmed their confidence in the staff and director, and presented extensive professional praise of the hospital and the procedures followed under the direction of Cotton, whom they considered a pioneer. On September 24, 1925, the New York Times stated 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" and related accolades given in support of Henry A. Cotton by many professionals and politicians.

Falling ill during the public hearing, some assert that Cotton suffered a nervous breakdown

Nervous breakdown

Mental breakdown is a non-medical term used to describe an acute, time-limited phase of a specific disorder that presents primarily with features of depression or anxiety.-Definition:...

, diagnosed himself as suffering from several infected teeth, which he promptly had removed, pronounced himself cured, and returned to work. Soon Cotton opened a private hospital in Trenton which did a hugely lucrative business treating mentally ill members of rich families seeking the most modern treatments for their conditions. Meyer reassigned Greenacre without completing her report and resisted her efforts to complete the report. Admitting a shared belief in the possibility that focal sepsis might be the source of mental illness, Meyer never pressed his protege to confront the scientific analysis of the erroneous statistics the hospital staff provided to Cotton, his silence guaranteeing continuance of the practices. Later Cotton would occasionally admit to death rates as high as 30% in his published papers. It appears that the true death rates were closer to 45% and that Cotton never fully recognized the errors his staff made in analyzing his work.

Retirement

In October 1930, Cotton was retired from the state hospital and was appointed medical director emeritus. Although this ended the abdominal surgeries which were so dangerous before the discovery of antibiotics, the hospital continued to adhere to Cotton's humane treatment guidelines and, to carry out his less risky medical procedures until the late 1950s. Henry A. Cotton continued to direct the staff at Charles Hospital until his death.

In the early 1930s Cotton's rate of postoperative mortality began to be a matter of professional debate in the state department of institutions by some concerned that he intended to press to resume his position at the state hospital. Another report on Cotton's work was begun in 1932 by Emil Frankel. He noted that he had seen Greenacre's report and agreed with it substantially, but his report also failed to be completed.

Henry A. Cotton died suddenly of a heart attack in 1933 and was lauded in the New York Times and the local press, as well as international professional publications, for having been a pioneer seeking a better path for the treatment of the patients in mental hospitals.

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