BACKGROUND:
·
Prior to the establishment of Trenton Psychiatric Hospital, mentally
ill patients were institutionalised in jails, almshouses or even private homes,
where they were often “lived” in attics, cellars or outbuildings.
·
All of these places of “care” featured very poor living conditions and
typically displayed little evidence of humane treatment.
HOSPITAL HISTORY:
Year
|
Details
|
1848
|
·
New Jersey State Lunatic Asylum in Trenton, the first of its kind in
New Jersey, was founded and began providing services on May 15.
·
The institution was founded by Lynde Dix, a renowned advocate and
pioneer for humane treatment and care of the mentally ill who looked upon the
asylum as her “firstborn child.”
·
For a period of time, however, the Asylum could not be located on any
map.
|
1887
|
·
Lynde Dix died at Trenton, after spending her declining years there as
a guest of the hospital.
·
In its debut year of operation the Hospital operated under
superintendent Dr. Horace A. Buttolph, treating a total of 86 patients.
Buttolph studied medicine and New York University, and was employed at Utica
State Hospital in New York as superintendent for 5 years before being
appointed superintendent at Trenton.
·
Although initially treating a small amount of patients, numbers grew
quickly and remorselessly.
·
Treatment at this time involved general and location depletion,
medicine, baths, exercise and regulation of diet. The medical aspect of
treatment was also accompanied by “moral treatment”, which emphasised
creating an environment conducive to serenity and peacefulness.
·
During his time at New Jersey State Lunatic Asylum, Buttolph often
published articles in the American Journal of Insanity, writing about phrenology
and its relation to insanity.
|
1876
|
·
Dr. Buttolph was appointed superintendent at a newly opened second
hospital for the insane in New Jersey, thus ending his service at Trenton.
|
1893
|
·
The name of New Jersey State Lunatic Asylum was changed to New Jersey
State Hospital at Trenton.
|
1907
|
·
An outbreak of typhoid at Trenton was mistaken for endemic diarrhoea
and dysentery, spreading to staff and beyond the walls of the asylum. Subsequent
enquiry revealed corruption, negligence and endemic violence.
·
In late 1907 Dr. Henry A. Cotton was appointed as medical director. Cotton,
an American psychologist, studied in Europe, under psychiatric pioneers such
as Emil Kraepelin and Alois Alzheimer. He was also a student of Dr. Adolf
Meyer of John Hopkins School of Medicine, in the United States.
·
Upon entry to Trenton, Cotton was credited with the abolishment of
mechanical restraints, implementing daily staff meetings to discuss patient
care and expanding its training program from nursing to social work,
occupational therapy, and psychiatric residency. He also established a new
laboratory and appointed the best and brightest using his extensive network
of contacts.
·
He embraced germ theory; an emerging and popular scientific theory of
the twentieth century, believing that mental illness and insanity resulted
from untreated infections in the body termed ‘focal sepsis.’ In order to
treat these he instructed his dental and medical staff to practice “surgical
bacteriology” on the patients, resecting organs suspected of containing
infection (Freckelton, 2005).
·
His theories were widely regarded by medical organisations and fellow
psychiatrics across the globe.
·
He began with teeth, and if this failed to cute patients’ mental state
progressed other organs.
·
Over the years news treatments such as hydropathy, occupational
therapy, heavy metal therapy, insulin and Metazol also became available, as
well as electroconvulsive therapy (1940) and psychosurgery (1947).
·
Cotton was honoured at medical institutions and associations across
the US, UK and Europe, and patients and their families begged to be treated
at Trenton.
|
1916
|
·
Upon admission patients had their teeth extracted, and many has
tonsils removed,
·
“Improvement” in recovery rates lead to more aggressive treatment, as
did failure in cure rates.
·
Treatment at this time extended to include the removal of: testicles,
ovaries, gallbladders, stomachs, spleen, cervixes and especially colons.
·
There were no antibiotics at this time, so risk of post-operative
infection was extremely high.
·
For more severe surgery, the mortality rates top 40% in some periods, and
never drop below 18%. Despite this, patients continue to flock to Trenton.
·
In a time where ethics were not overly prominent, Cotton did not
always obtain consent from his patients or family members, sometimes even
performing these removals despite their protests.
|
1922
|
·
Journalist for the New York Times, Thomas Quinn Beeslay reviewed the
published version of Cotton’s lecturers (from a series presented at Princeton
in 1921) stating: "At the State
Hospital at Trenton, N.J., under the brilliant leadership of the medical
director, Dr. Henry A. Cotton, there is on foot the most searching,
aggressive, and profound scientific investigation that has yet been made of
the whole field of mental and nervous disorders... there is hope, high
hope... for the future" (Beeslay, 1922).
|
1924
|
·
Phyllis Greenacre, former student of Adolf Meyer, was commissioned to
enquire into, and critique, Cotton’s work.
·
Her report began after Meyer visited the hospital and privately
expressed concern about the statistical methods employed to assess Cotton’s
practice.
·
Greenacre’s reports found deep flaws in research and concoction of
statistics, with some even being internally contradictory, as well as noting
chaotic staff records.
·
Meyer, head of the American Psychological Association
(APA) at the time, reassigned Greenacre before the completion of her report, resisting her attempts to complete it, and refused the release of her current findings. |
1925
|
·
Criticism of the hospital reached New Jersey State Senate, which,
together with testimony from unhappy former patients and hospital employees,
launched an investigation into the practice.
·
In an attempt to counter claims, hospital trustees reaffirmed their
confidence in the staff and director of Trenton, providing extensive
professional praise of the hospital and Cotton’s procedures.
·
On the 24th of
September of that year, the New York
Times stated that, “eminent physicians and surgeons testified that the
New Jersey State Hospital for the Insane was the most progressive institution
in the world for the care of the insane, and that the newer method of
treating the insane by the removal of focal infection placed the institution
in a unique position with respect to hospitals for the mentally ill.”
·
Cotton became mentally unstable during the public hearing, some saying
he suffered from a ‘nervous breakdown’. He diagnosed himself as suffering
from numerous infected teeth and subsequently removed them, pronouncing
himself cured, meaning he could return to work.
|
1930
|
·
Cotton’s rate of post-operative mortality began to be a matter of
professional debate. As a result Cotton was retired to medical director
emeritus in October of that year, continuing Cotton’s patient treatment
guidelines but ending his controversial and most risky surgeries.
|
1932
|
·
Emil Frankel began another report on Cotton’s work, noting that he had
seen Greenacre’s report and greatly agreed with it. His report, too,
unfortunately failed to be completed.
|
1933
|
·
Cotton died suddenly, on the 8th of May, of a heart attack.
·
Cotton was reported in the New York Times to be a pioneer, seeking
better patient treatment for all patients on mental hospitals.
|
Mid-1950’s
|
·
Tranquilizing drugs were developed.
·
This meant that patients, under proper medication, who had been
hospitalised for years could return to the community, while others became
more open to psychotherapy and other treatment methods.
·
Furthermore, this meant that the doors of many ward were able to be
unlocked for the first time in 100 years, giving the mentally ill a degree of
freedom, while still progressing to recovery.
·
This also lead to a significant reduction in patient numbers, with
Trenton housing 4,237 patients in June 1954, and only 2,800 in 1968, a mere
14 years later. This was especially impressive given that the patient
admission rate was increasing exponentially prior to Cotton.
|
1971
|
·
The hospital was renamed to Trenton Psychiatric Hospital, the name is
retains today
|
TRENTON TODAY:
·
Trenton Psychiatric Hospital is still operational, and the centre of the
Kirkbridge building is still in use. Some parts of the campus however have been
abandoned and have fallen into disrepair.
·
Today the psychiatric hospital has a capacity of 450 beds and serves a
designated New Jersey population, one of five governed by the State of New
Jersey.
