The Relation of Chronic Sepsis to the So-called Functional Mental Disorders

Abstract

It is extremely befitting that this Association should be interested in the relation of chronic sepsis to mental disorders, principally for the reason that this idea had its origin in England. As early as 1875, Savage, the English alienist, reported the recovery of cases of mental disorder following the extraction of infected teeth. The full significance of this report, of course, was not realised at the time, for if it had been recognised, an entirely different history of the care and treatment of mental disorders during the last century would have been written.

Desperate remedies: a Gothic tale of madness and modern medicine

“…As part of his programme of bringing the asylum into the medical mainstream, he en-couraged his assistants to publish and to attend conferences, engaged a series of local physicians as consultants, built an infirmary and an isolation ward for tuberculosis cases, established a clinical laboratory, and set up a modern operating room. Convinced, as he later put it, that 'even if we did not have the evidence of cortical lesions in the "functional" psychoses, we would have to assume their existence, if we accept modern biological teachings' (Cotton (1923), p. 436), he pursued any and all means of physical treatment for the underlying brain disease: hydrotherapy, salvarsan for syphilitics injected intraspinally and intracranially, the use of glandular extracts, all without result. By 1916, almost a decade after he had assumed control of the hospital, Cotton had to confess that his therapeutic gains from all this activity were non-existent, his cure-rate as dismally low as ever, and the prospects for realizing his ambition to make a major breakthrough in psychiatric therapeutics apparently hopeless (Trenton State Hospital, 1916;Cotton (1923), pp.…”

“…The results, he claimed, were immediately gratifying, producing a dramatic surge in hospital discharges. Thus encouraged, 'we started to literally "clean up" our patients of all foci of chronic sepsis' (Cotton (1923), p. 438). At the same time, he launched a many-sided campaign to publicize his achievements, justifying his self-promotion by arguing that 'in no other field of medicine can such results be obtained by educating the laity to the dangers of chronic foci of infection ' (Trenton State Hospital (1920), p. 29).…”

“…Furthermore, if his own results could be replicated, such a rapprochement could at once be expected to have a spectacular effect on cure-rates -and hence on hospital populations and state mental health expenditures. Within twelve months of adopting aggressive techniques to counter infection, he claimed his recovery rate had grown by some 23% (Trenton State Hospital (1919), p. 8), and with greater experience and more extensive intervention, it soon became as high as 85% of those treated (Cotton (1923), p. 438), producing savings for the state of almost $250000 over a three year period. 10 Follow-up visits had demonstrated ' that those we consider recovered are earning their living, taking care of families, and are normal in every respect' (Trenton State Hospital (1921), p. 16).…”

“…182-183). 14 Less often, but still in 25-40% of cases, male patients required resection of the ' seminal vesicles' and in some cases ' these infected vesicles have been enucleated with gratifying results' (Trenton State Hospital (1920), p. 20; Cotton (1922a), p. 185;Cotton (1925), p. 12). Such regions as the gall-bladder and sinuses might also require attention.…”

“…All this proved was that' the longer the duration [of the psychosis] the less effective detoxification is in restoring the patient's mental health. Such failures can be explained on the ground that the brain has become permanently damaged, and no amount of detoxication has any effect in restoring the mental condition' (Cotton (1923), p. 460). Since 'nothing can be done for chronic patients' because 'the brain tissue has probably become permanently affected,' the work of' arresting the ever-increasing number of mental derelicts' must necessarily embrace efforts at prophylaxis rather than cure (Cotton (1921), pp.…”