Beginning around 1916 at the New Jersey State Hospital in Trenton, its medical director Henry Andrews Cotton announced that insanity was not a disease of the mind but a hidden bacterial infection — “focal sepsis” — seeded in the teeth, tonsils, sinuses, stomach, spleen, cervix, and above all the colon, and curable by cutting those organs out; the gap between his claimed 85 percent cure rate and the documented reality, in which his colon resections killed on the order of 30 percent of patients and cured essentially none, is the entire case. Cotton extracted teeth by the tens of thousands and performed serial abdominal surgeries on institutionalized, frequently non-consenting psychiatric patients, on the theory that a “detoxified” body would yield a sound mind.
The practice was not a fringe horror tolerated in obscurity. It was celebrated. Cotton, a protégé of the most powerful American psychiatrist of the era, Adolf Meyer of Johns Hopkins, was lauded in the press as a humane reformer who had abolished mechanical restraint and replaced it with “scientific” surgical cure. His 1921 book, The Defective, Delinquent and Insane, packaged focal-sepsis theory as the frontier of psychiatry, and visiting clinicians from Britain and the United States toured Trenton to watch the operations.
The reckoning was assembled but then buried. In 1924–25 Meyer commissioned a former student, the psychiatrist Phyllis Greenacre, to audit Cotton’s results; she tracked his surgical patients and found the records chaotic, the cure claims unsupported, the recovery rate no better — in fact worse — than for unoperated patients, and the mortality catastrophic. Meyer suppressed her report rather than publish it, protecting Cotton and his own reputation, and the surgeries continued for years. Only Cotton’s retirement in 1930 and his death in May 1933 finally ended them. The focal-infection theory of insanity collapsed entirely thereafter, and “surgical bacteriology” survives now as a textbook case of how a charismatic clinician, a surrogate endpoint, and a senior authority’s cowardice can sustain a lethal, evidence-free operation on the powerless for the better part of two decades.
The regimen that German obstetricians Bernhardt Krönig and Carl Joseph Gauss perfected at the Freiburg women’s clinic from 1906, and that an American feminist crusade exported to U.S. hospitals from June 1914, promised “painless childbirth” — and the entire case lives in the fact that it never delivered painlessness at all. The injection of scopolamine and morphine did not abolish the agony of labor; it abolished the patient’s memory of it. Women still felt every contraction and still screamed and thrashed through them; scopolamine merely erased the recollection afterward, so that a mother who had been strapped to a padded “crib” bed for hours, blindfolded and plugged with cotton, woke believing she had slept through a miracle. The surrogate endpoint — a patient who reported no memory of pain — was achieved. The actual endpoint — a labor that was safe and painless — was not.
The harms were two-fold and physical. The mothers, delirious from scopolamine, became so disoriented and combative that obstetricians routinely restrained them with leather straps to a screened crib-bed, gauze over the eyes and wadding in the ears, so they could not injure themselves during the thrashing the drug induced. The newborns, whose blood took up the morphine that freely crossed the placenta, were born sedated — flaccid, cyanotic, with depressed reflexes and suppressed breathing, exposed to asphyxia and sometimes requiring resuscitation that early-twentieth-century obstetrics could not reliably provide.
What carried Twilight Sleep was not obstetric data but a consumer movement. A June 1914 McClure’s Magazine article, “Painless Childbirth,” by Marguerite Tracy and Constance Leupp, triggered thousands of letters; Manhattan suffragists founded the National Twilight Sleep Association that year and campaigned through the New York Times, the Ladies’ Home Journal, and lecture halls, framing the right to forget labor as a feminist demand. The reckoning was equally a matter of public sentiment. In August 1915 one of the movement’s own leading advocates, Mrs. Frances X. Carmody of Brooklyn, died of hemorrhage delivering her third child under Twilight Sleep at Long Island College Hospital; her physician and husband insisted the drugs were blameless, but the symbol was lethal to the cause, and demand collapsed within roughly fifteen months.
No statute banned it. The combination simply could not be administered safely outside the quiet, individualized, heavily-staffed Freiburg setting, and once safer regional and inhalational analgesia matured, the regimen was abandoned as a relic — a textbook case of an intervention validated by the memory of the patient rather than by her safety or her child’s.