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BOOK REVIEW

For psychiatry, a cautionary tale

Madhouse: A Tragic Tale of Megalomania and Modern Medicine
By Andrew Scull
Yale, 352 pp., $30

Andrew Scull, a sociologist at the University of California, San Diego who specializes in the history of psychiatry, has unearthed a Gothic horror story of abuse in the early 1900s. ''Madhouse" is a shocking tale about how a doctor at the Trenton State Hospital in New Jersey had for years surgically removed the teeth, colons, stomachs, spleens, tonsils, sinuses, gall bladders, and reproductive organs of patients in a misguided effort to treat mental illness.

Dr. Henry Cotton had trained at Johns Hopkins University under the famed Adolf Meyer, a Swiss-born psychiatrist who became arguably the most influential single psychiatric leader in 20th-century America. Meyer was humanely trying to get away from concentrating on classification and diagnosis and the 19th century's beliefs in heredity and so-called degeneration. Instead, he tried to understand how people respond to the stress they encounter.

In his program of promoting therapeutic improvement, rather than just custodial care, Meyer was open-minded about what his students proposed to undertake. Cotton started his operations in 1917 on the hypothesis that madness could be caused by local infections. Teeth, even when X-rays showed no problems, were only the beginning of the bodily culprits to be removed. If patients were unwilling to undergo these surgical procedures, such obstruction was viewed as a reflection of their diminished mental capacities.

Scull has constructed an engrossing narrative about how Cotton's theories and practices were welcomed in certain medical circles (in Great Britain, for example) at the same time that criticisms began to mount, especially among local denizens of New Jersey.

By mid-1925, when a state legislative committee began to investigate the charge that patients were being abused under Cotton, the doctor himself was too unbalanced to be able to defend himself adequately.

Cotton had claimed to achieve an astronomical ''cure" rate of 85 percent. In reality, the mortality rates resulting from the operations were extraordinarily high, and nobody could confirm his alleged rates of success.

Meyer appointed a young psychiatrist, Phyllis Greenacre, to explore what had happened at Trenton. Although her conscientious findings were distinctly unfavorable to Cotton, Meyer curiously chose to sit on her report initially.

The Trenton State Hospital remained a house of horrors right up until Cotton's death in 1933, after which Meyer somehow wrote an appreciative obituary. Cotton's public standing was such that H.L. Mencken had accepted an essay by Cotton for The American Mercury. Doctors covered for one another throughout the surgical mayhem, and teeth went on being pulled for psychiatric purposes at Trenton State Hospital until 1960.

The misguided penchant toward lobotomies, which were undertaken at Mass. Mental Health Center here in Boston right through the late 1950s, is a much better-known medical scandal than this episode. As Scull's skillful telling suggests, popular treatments in mental illness can be flawed, and we should be on guard about the danger that drugs with serious side effects will get overused.

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