Madhouse: A Tragic Tale of Megalomania and Modern Medicine

An excellent review of the book "Madhouse: A Tragic Tale of Megalomania and Modern Medicine" (Yale University Press, $30). Here's a snippet:

Lobotomy

Psychiatric patients were unusually vulnerable to medical experimentation. (Remember Jack Nicholson in "One Flew Over the Cuckoo's Nest"?)

The lobotomy started in Portugal in 1935 and was revamped in the United States by Drs. Walter Freeman and James Watts. They began the surgery in 1936, drilling holes in the skull and inserting a knife-like object, severing the frontal portions of the brain. This was supposed to dramatically relieve symptoms of mental illness, although the brain damage it caused was permanent. Some patients lost spontaneity or became a bit slaphappy.

To find out when to end the operation, Freeman would put patients under local anesthesia and talk them through the operation, asking simple questions to make sure they were still in touch. He asked one patient, "What's going through your mind?" The reply: "A knife." The doctors later refined their procedure, using an instrument similar to an ice pick, inserting it in tear ducts. Freeman and Watts claimed that 52 percent of their first 623 surgeries were "good," but they did not define what they considered good.

Mental hospital

Scull's book, "Madhouse," recounts the story of Dr. Henry Cotton, a psychiatrist who was in charge of the state mental hospital in Trenton, N.J., from 1907 to 1930. Cotton assumed mental illness was the product of overlooked infections that fed toxins to the brain. His solution was to search for sources of infection and remove them.

Because teeth are close to the brain, Cotton had his patients' teeth pulled. Some of them recovered, a powerful placebo effect. Many did not, so Cotton looked elsewhere for infection. (Or did he wait too long to pull teeth?) He started removing tonsils. Again, no remedy.

Next, he removed colons and other organs, often on unwilling patients, ratcheting up his mortality rate. He had critics, but many followers, too. Cotton was investigated to determine whether his claims of an 85 percent cure rate were true. A report concluded that he was killing his patients, but the report was suppressed. His practices continued until a heart attack killed him in 1933. Long before he died, he had his two sons' teeth removed. They grew up and killed themselves.