Henry Cotton’s Surgical Bacteriology — Yanking Teeth and Colons, Killing a Third of Patients

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.