The advent of Cotton’s ‘Focal Sepsis was
initially considered revolutionary. At the time Cotton began his practice,
mental illness was considered an incurable ailment that had a heritable origin.
Cotton’s theory that originated from Germany reformed this view with focal
sepsis deeming mental illness as curable with a physical cause(Scull 2005). Cotton was
determined to remove inconclusive theories such as ‘eugenics ’from psychiatry
and implement somatic treatment that had a scientific merit .Thus the Harvard
trained physician’s decision to adopt a more empirical approach eradicated the
view of psychology being “witchcraft” and re-established the position of
psychology in the medical field .
Hence
in the early part of 20th century, the rise of focal sepsis seemed
inexorable. Patients all over the country seemed to consider Cotton a genius
- with 2186 major operations performed in just two years of the introduction of
the theory. Cotton’s education and training also meant there were great changes in patient care (Wesley 2009). Asylums, madhouse where patients were treated
with restraint and forcible confinement were replaced by better therapeutic
spaces. Furthermore Cotton’s focus on the germ theory meant that the sanitary
conditions at Trenton improved dramatically. Prior to Cotton, Trenton hospital
was considered disease ridden, with patients often suffering from Cholera,
Malaria etc. Cotton upon his arrival however created a more hygienic hospital
which did decrease chances of patients falling unnecessarily sick.
Although Cotton’s work did have some
positive influences in the history of medicine, his work was far from
angelic. Despite promoting a scientific
approach in psychiatry, Cotton later in his career transgressed from his
principles. When studies and statistics indicated that focal sepsis had no real
benefits to patients, Cotton chose to ignore the evidence and foolishly
continue. He surgically removed tooth, tonsils and other parts of the body that
he thought were the origins of disorder despite the high death rate.
Like
other physicians at the time he adopted an autonomous approach to his patients
operating without consent, he blatantly declared, ‘if we wish to eradicate
focal infection we must bear in mind that it is only by being persistent, often
against the wishes of the patients". Powerless individuals who were unable to
refuse the treatment such as children were the obvious victims, he made
compulsory screening of all children and removed any suspicious infection sites
but that was not the end, he removed ‘sections of colon as a treatment for
“sexual aberrations” such as masturbation for boys.
The medical history has always
been plagued with controversy and Henry Cotton is just another fickle and
scandalous edition in the evolutionary tale of medicine. It is clear that his
work had both positive and negative impacts in medicine. His focus on the germ
theory resulted in a more hygienic hospital with improved patient care. The
study of psychology also earned its place in medicine as a logical and necessary
practice due to Cotton’s work. However his decision to disregard scientific
evidence and unnecessarily operate on mentally ill patients perhaps outweighs these benefits.
