MADHOUSE: A Tragic Tale of Megalomania and Modern Medicine

By Andrew Scull

352 pp. Yale University Press. $30

Reviewed by PATRICK McGRATH

Andrew Scull is a Professor of Sociology at the University of California, San Diego, and a specialist in the history of psychiatry. In Madhouse: A Tragic Tale of Megalomania and Modern Medicine he describes the extraordinary career of Dr. Henry Cotton, superintendent of the Trenton State Hospital from 1907 to 1933. This man was so obsessed with what seems today an utterly bizarre theory of insanity that in applying it, he killed hundreds of his patients and eviscerated thousands more. A riveting account of psychiatric malfunction, Madhouse reads as much like a novel as it does a work of medical scholarship: narrative pace and structure are nicely judged throughout, character and setting vividly evoked. It is not, however, for the faint of heart.

Dr. Cotton had studied under the great Adolf Meyer of Johns Hopkins, a giant of American psychiatry in the first decades of the 20th century and a believer in “germ theory.” This was a revolutionary paradigm which transformed medical science by identifying the bacterial basis of many diseases previously thought untreatable. Meyer was among the first in his field to suspect that germ theory held significant potential not only for surgery and general medicine, but for psychiatry as well.

Henry Cotton absorbed these ideas so avidly that he came to believe that no other psychiatrist, Meyer included, had gone far enough in applying the theory to madness. Within a few years of taking over the Trenton State Hospital he was removing the infected teeth and tonsils of dozens of his patients, not to mention stomachs, gall bladders, colons, testicles and ovaries, with especial emphasis on the right side of the hind gut, which had particularly “decadent tendencies.” [p.52]

He reported cure rates as high as an incredible 85%. Such figures hugely impressed many in his profession eager to embrace a simple but apparently efficacious approach to treatment which, simply stated, claimed that all manifestations of madness were merely symptomatic of a deeper underlying pathology, that of bacterial infection. Remove the infected part and you cure the madness. Cotton’s fame in both the US and Europe spread rapidly.

But as he continued to cut out his patients’ insides, post-operative deaths increased alarmingly, most of them from peritonitis. Soon the death rate was 30% and higher, and many poor souls, it later emerged, had had to be “dragged, resisting and screaming,” [55] into the operating theatre. Informed consent did not enter the picture. There were nightmare stories of patients, usually women, terrified that if Dr. Cotton operated on them they would die horrible, lingering deaths. Often enough their fears were borne out.

Enter Dr. Phyllis Greenacre, later to become a distinguished and prominent psychoanalyst, who had just won a coveted position on Adolf Meyer’s staff at Johns Hopkins. Traveling by train from Chicago to Baltimore, she was persuaded by a lab assistant to take with her a pair of sealed buckets, gifts, she was told, for Dr. Meyer and an associate. “Thus it was,” writes Professor Scull, “that her intimate companions on the journey to Baltimore came to consist of two containers of pickled human brains…” [137]

Circumstances did not work in Dr. Greenacre’s favor at Johns Hopkins, largely due to her being a woman in what was very much a man’s world. Eventually Meyer suggested she conduct a study to evaluate Henry Cotton’s work at Trenton, and she agreed. She found Dr. Cotton “a singularly peculiar man,” [163] the institution had “that sour, fetid odor so characteristic of mental hospitals,” [165] and the patients looked weird: their faces were sunken, and appeared aged despite their evident youth. Their speech was slurred and their general appearance one of malnourishment. Then she realized why: none of them had any teeth.

Undeterred, she went to work, and what quickly became apparent was that Cotton’s data were bad. The numbers had been organized by a former patient and simply did not add up. The case records were a shambles. At the same time, a state senate committee investigating waste and fraud in government had also begun to focus its attention on the Trenton asylum. From out of nowhere, it seemed, came a succession of “disgruntled employees, malicious ex-patients and their families, testifying in damning detail about brutality, forced and botched surgery, debility, and death.” [176] Henry Cotton found himself fighting not only for his professional life, but for his very sanity.

He won the first battle but lost the second: he went mad. Adolf Meyer, meanwhile, eager to protect his former student, effectively suppressed Phyllis Greenacre’s report and so averted a scandal. The committee gave the hospital and its superintendent a clean bill of health. Phyllis was deeply disillusioned by Meyer’s betrayal while Henry Cotton, recovered from his breakdown, was relieved to discover its true source: he had several infected teeth. He promptly had them removed, and felt much better.

Years passed, and Cotton moved forward with greater vigor than ever. But once again, in the early 1930s, storm clouds gathered. A new report concluded that his surgical interventions were still killing around a third of those he operated on. Once again he fought back, as did his supporters, including the pusillanimous Meyer. Then, in the middle of the fight, to the shock of all involved—-Henry Cotton died. “World Famous Alienist Drops Dead,” [270] read the headline in the Trenton Evening Times. His obituary the nexy day called him a “great pioneer.” [270]

Professor Scull ends the story by reflecting that “scarcely anyone doubted [Cotton’s] right to experiment on his patients, or raised … any questions about the propriety of maiming or mangling the bodies of the mad.” [276] He points out that such brutal experiments on the mentally ill are far from uncommon. And he damns Adolf Meyer for his cowardice and hypocrisy in supporting a project which he knew to be creating “a piling up of the edentulous, the eviscerated and the extinguished.” [277]

Today the Trenton State Hospital is derelict, its atmosphere dank and dismal, mold and putrefaction and filth everywhere, a place of broken glass and uninhabited wards. In what was once a “noisy and noisome cemetery for the still-breathing, now an eerie silence and emptiness reigns.” [15] Only one part of the institution still functions: the forensic unit that houses the criminally insane.

Patrick McGrath’s most recent novel is “Port Mungo.” A collection of stories, “Ghost Town: Tales of Manhattan Then and Now,” will be published this fall.