Category Archives: focal sepsis

Laxative therapy for agitated paranoiacs

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Lomax’s 1921 exposé

For most of their existence, writes Dalrymple, mental hospitals were

custodial rather than therapeutic institutions.

Their methods could be somewhat crude. In The Experiences of An Asylum Doctor, With Suggestions for Asylum and Lunacy Law Reform (1921), Montagu Lomax, a medical officer at Prestwich Asylum,

described how he and his colleagues treated suicidal melancholics and agitated paranoiacs. They sat the melancholics against a wall, placing a bench in front of them to prevent them from moving, while an attendant watched them to ensure that they did not do away with themselves.

Screen Shot 2016-05-12 at 07.49.48Croton oil, a very powerful laxative,

subdued the agitation of the paranoiacs, who became so preoccupied with the movement of their bowels that they had no time or energy left to act upon the content of their delusions.

A leading theory, Dalrymple notes, was that of focal sepsis.

One of the asylums of my city had the best-equipped operating theatre of its time, where an enthusiastic psychiatrist partially eviscerated his patients and removed all their teeth, on the theory that madness was caused by a chronic but undetected and subclinical infection in the organs that he removed.

Screen Shot 2016-05-12 at 08.31.18Later, a visiting neurosurgeon

used the theatre to perform lobotomies on patients who were scarcely aware of what was being done to them.

Doctors also tried

more ‘advanced’ treatments, such as insulin coma therapy, in which they gave schizophrenic patients insulin to lower their blood sugars to the point at which they became unconscious, sometimes with fatal effect.

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Companion volume to the Lomax work

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Prestwich Asylum

Prestwich Asylum

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A leading proponent of focal sepsis theory was Henry Cotton of the New Jersey State Hospital for the Insane, Trenton

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Patients became so busy with their bowels, they had no time to act on their delusions

Colectomy will make you sane

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Henry Cotton

How do we know doctors aren’t in the grip of collective delusions?

Dalrymple notes that an untreated psychotic’s situation can be desperate, but points to the danger of professional abuse once authority is handed over to alleged experts.

He reminds us that among the treatments developed by psychiatrists are

  • frontal leucotomy: nerve pathways in brain lobes are severed from those in other regions
  • Metrazol-induced convulsion therapy: shocks are administered, giving rise to convulsions
  • insulin coma therapy (Insulinschockbehandlung): the patient is turned hypoglycemic with repeated injected insulin
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NJ State Hospital for the Insane, Trenton (John Notman, 1848)

Reviewing Andrew Scull’s Madhouse: A Tragic Tale of Megalomania and Modern Medicine (2005), Dalrymple looks at the case of Henry Cotton, head of the New Jersey State Hospital for the Insane at Trenton.

Cotton believed that madness was caused by focal sepsis — subclinical infection of the teeth, tonsils, sinuses and colon. The answer

was to remove the teeth and tonsils, wash out the sinuses, and cut out the colon. The latter operation, performed in the asylum by Cotton himself — though he had no formal training in surgery — had a death rate of up to 33 per cent.

The operation was a success but the patient died

Phyllis Greenacre with Curt Richter

Phyllis Greenacre with Curt Richter

Cotton was undeterred.

He claimed a very high success rate for his operations, many of which were forced upon unwilling patients: 85% of his lunatics were cured by them, he said. A self-promoter and publicist, he was lionised, especially in Britain.

His claims were disputed,

particularly by Phyllis Greenacre, who proved that the chief clinical effect of his operations was death.

But Cotton

was protected by his mentor at Johns Hopkins, Adolf Meyer, an intimidating pedant rather than a real scientist who was the doyen of US psychiatry for many decades. He wanted to avert a scandal that would damage the standing and power of the profession, and was prepared to countenance the continued mutilation of patients by Cotton to do so.

Adolf Meyer

Adolf Meyer

Meyer suppressed Greenacre’s work and was to write

a laudatory obituary of Cotton, though he must have known by then that Cotton was responsible for hundreds of deaths and untold misery.

How, asks Dalrymple, did so flimsy and, to our eyes, foolish a theory of the cause of madness come to be accepted? Dalrymple points out that

  • the germ theory of disease, which elucidated so many mysteries, was comparatively new
  • the syphilitic cause of general paralysis (from which up to a fifth of the asylum population suffered) had just been discovered
  • hidden infections do often result in acute confusion in the elderly, including hallucinations

It was a short step to hypothesise an infective cause for all madness.

Screen Shot 2016-04-03 at 13.56.25Cotton

believed in his theory to such an extent that, as a prophylactic, he extracted the teeth of two of his sons and subjected one of them to a colectomy. (Both committed suicide as adults.) Later he had his own teeth extracted, believing focal sepsis to be the cause of his angina.

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