Madhouse: A Tragic Tale of Megalomania and Modern Medicine

This book describes the treatment of a variety of psychiatric disorders using radical surgery by the American psychiatrist Joseph Cotton. He was a advocate of the doctrine of 'focal sepsis' which located the seat of mental illness in bacteriological infections of various body organs. While this may appear crank thinking now, Cotton was simply elaborating one trend in medical thinking at the time. Admittedly his elaboration was robustly surgical. 'Infections' leading to psychoses were found in the teeth, the sinuses, the ileum, colon, almost all parts of the intestines, the cervix, testicles, and naturally the stomach. Cotton's 'enucleation' of offending organs and parts was intended to cure the patient. However, with mortality rates of 30%, the treatment was much worse than any disease. Cotton was effectively little more than a butcher that rountinely cut up his patients involuntarily. How did he get away with it for so long? What events finally opened a window on the horror of his methods? Well these are the stuff of the book. If you know any Kuhn or Lakatos, this book will absolutely grab your attention. Well worth reading.

Andrew Scull meticulously exposes blinkered practice, faulty ego, and inertia in the face of overwhelming facts. At times this book felt like a nightmarish novel but all the evidence was there-thousands of people experienced and witnessed a medical holocaust. I found it compelling and tragic. Little wonder that evidenced based medical practice emerged from catastrophes like these. Not to be missed by any patient who has ever thought of seeking a second opinion. Madhouse was my `read` of the year.