King's College London
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Mind Matters: neuroscience and psychiatry

Henry Cotton

Henry Aloysius Cotton (1876-1933) was, in his capacity as medical director of the New Jersey State Hospital at Trenton, responsible for one of the psychiatric scandals of the twentieth century. He was no oddball eccentric, but a protégé of America’s leading anti-Freudian psychiatrist, Adolph Meyer, who, despite his reservations, remained a public apologist for Cotton’s methods and was also an enthusiast for lobotomy.

Henry Cotton thought that tooth decay might have a causal role in mental illness. Image taken from: Henry A Cotton. The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention. Princeton: Princeton University Press; London: Oxford University Press, 1921 [IoPHistorical Collection h/Cot]Henry Cotton thought that tooth decay might have a causal role in mental illness. Image taken from: Henry A Cotton. The defective delinquent and insane: the relation of focal infections to their causation, treatment and prevention. Princeton: Princeton University Press; London: Oxford University Press, 1921 [IoPHistorical Collection h/Cot]By the early 1920s Cotton had come to the conclusion that many cases of mental illness were caused by toxicity in the body. He therefore proposed a number of useless (e.g. total teeth extraction) and potentially dangerous (e.g. colectomy) surgical interventions, which, until public exposure put an end to his practices, caused distress and death, through post-operative peritonitis, for a significant number of his patients. The extent to which he could take a commonplace medical fact - the inadvisability of having decayed teeth - and exaggerate it to such an extent that it lost all relationship with reality is shown in the following extract from his book:

A realization of the fact that infected teeth … may occur in very young people and continue throughout the life of the individual, offers a probable explanation for the peculiar personalities and abnormal dispositions noticed in cases of dementia praecox [schizophrenia] years before the psychosis, as such, develops.

Why were medical professionals willing to believe that bad teeth induced mental disorder? Part of Cotton’s aetiology was not too fanciful. Alienists had long believed that mental disorders had biological origins, but were unable to isolate specific causes. The bacteriological revolution in nineteenth century science and the breakthroughs in neurology, which were beginning to be applied by Alzheimer to specific disorders, had led many psychiatrists to believe that they were indeed on the verge of finding the biological key to unlocking all mental disease. This, together with the fact that infectious disease and insanitary conditions in asylums had been the bugbears of many asylum physicians for over a hundred years, made Cotton’s suggestions seem all too plausible.

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