Pulling Teeth to Treat Mental Illness

There's a scene in the finale of The Knick, the Cinemax show about an early-1900s New York hospital, where one of the doctors, Everett Gallinger, enters a room in a mental asylum to which his wife, Eleanor, had recently been committed. He sees something that's possibly even worse than whatever imagery might be conjured by the phrase "early 20th-century insane asylum."

Earlier in the season, the couple's baby daughter died. After Gallinger hastily brought home an abandoned orphan girl to replace her, Eleanor, depressed and seemingly dissociated, drowned the child in an ice bath.

As Gallinger enters the room, Eleanor turns to her husband. Her face is swollen. Her hair is matted. Her mouth is open, black, and vacuous. Her teeth have been pulled by her doctor, Henry Cotton, in order to cure her of "madness." Cotton believes “all mental disorders stem from disease and infection polluting the brain." If the teeth don't fix it, he tells Gallinger, he's next going to remove her tonsils, then her adenoids, and possibly her colon.

It's even creepier that Cotton, played by John "I'm a PC" Hodgman, was a real person, as Wired points out. As medical director of the New Jersey State Lunatic Asylum in Trenton between 1907 and 1930, he routinely practiced what he called "surgical bacteriology," the extracting of potentially diseased parts of the head and body, based on the observation that people who run high fevers sometimes suffer hallucinations.

This "focal infection therapy" seemed so scientific and promising that Cotton and his assistants yanked more than 11,000 teeth. He also removed those of his wife and children as a precautionary measure. When patients who lost their molars and incisors didn't recover, Cotton saw it as a sign he hadn't gone far enough: He'd remove their spleens, stomachs, and colons, too.

Unfortunately, this was before antibiotics, so many of his patients died on the operating table. Still, Cotton was lauded as a leader in his field by medical journals and his peers at the time. Occasionally allegations would surface that he was abusing his patients, but he always seemed to placate critics. Once, he escaped scorn by replacing all his male nurses with female ones, according to a 1910 New York Times story. "Men are naturally too rough with the patients," the article's author wrote. "[Cotton] believes the presence of women nurses is restful to the diseased mind."

Eventually, Cotton got the sense he was losing his own mind. He removed several of his teeth in an attempt to cure himself and kept on working. Cotton died of a heart attack in 1933.

Cotton's experiments were unethical and awful, but they weren't that illogical if you consider the knowledge that was available at the time. This was before surgeons operated with gloves on, before doctors knew that people shouldn't stand in front of X-ray machines for 45 minutes, and before people knew about blood types or heroin addiction or that eugenics is not a thing.

If you had no idea about neurotransmitters or lobes, it makes a weird sort of sense that micro-infections in the head would be the true cause of schizophrenia. To quote the tagline from my Knick screeners, "Modern medicine had to start somewhere."

We've come a long way, but as a health writer, it's also a reminder of how little we still know about the brain. Certainly, science has progressed to the point where patients aren't subjected to painful and permanent procedures without their consent, and we obviously now know the basic mechanisms behind mental illness. But we still don't know, say, the very best way to prevent schizophrenia or to treat addiction. It was just a few years ago that a major study found that antidepressants are basically useless for mild depression.

To some extent, the brain remains a bit of a black box, as puzzling to modern-day psychiatrists as it was to turn-of-the-century charlatans. The difference is, most doctors today have the humility to admit what they don't know.