Sometime in the early1900s a surgeon performed colectomy for a patient who suffered from schizophrenia. Post-operatively, not only was the patient’s colonic pathology cured, but it appeared that their schizophrenia was as well.
Not too long after, another surgeon noted the same thing… he had operated on a patient with schizophrenia who was less psychotic after removal of part of their colon. These two anecdotes became a theory… which led to a large number of schizophrenic patients undergoing removal of their (healthy) colons.
This doesn’t make sense, right? Except that it turns out that major trauma (like a big operation in the early 1900s!) can lead to a temporary relief of psychosis in some patients with schizophrenia. In other words, it probably would have been just as effective – and just as temporary – to induce a high fever…which was also a form of treatment for schizophrenia in the early 1900s. (Ebaugh et al., 1938)
There’s a parable here, one that helps us navigate dangerous, unproven theories that are proposed by (usually) well-meaning people …
In the early 1900s there were many well-respected physicians who thought schizophrenia was caused by “autointoxication”.1 Baynard Holmes, Professor of Surgical Pathology and Bacteriology at the College of Physicians and Surgeons in Chicago, was one of them. His foray into the surgical treatment of schizophrenia was personal; His son Ralph had his first psychotic break as a second-year medical student. Holmes abandoned his other academic work to concentrate on “curing” schizophrenia. He first published a paper showing that schizophrenic patients had delayed transit in the colon and hypothesized that stool “stuck” in the cecum was therefore the cause of schizophrenia.(Holmes, 1920)
Holmes operated on 22 patients, creating an appendicostomy to flush the stool out of the colon.(Noll, 2006) There was a 10% mortality rate… and one of the 2 patients who died was his son, Ralph.(Davidson, 2016)
Henry A. Cotton, Sr, was another authority who promoted, and took advantage of, the autointoxication theory of schizophrenia. He was a psychiatrist who oversaw, and then performed (!), colectomies on over 200 patients with schizophrenia. He reported a success rate of over 80%…. and a mortality rate of 25-30%.(Davidson, 2016)
In 1923, a group of physicians did what needed to be done from the beginning – a randomized controlled trial. Not surprisingly, there was no difference in outcome between patients treated with surgery and those who did not have surgery.(Kopeloff & Kirby, 1923)
It took a long time for these dangerous operations to stop, despite the proof that they didn’t work. We can only imagine how many hundreds of patients underwent this futile and very dangerous procedure before it was finally abandoned. In today’s world of rapidly available communication it takes 17 years for new evidence to change clinical practice. (Morris et al., 2011) We can assume that in 1924 it took longer than that. In addition, there were physicians (like Henry Cotton) who ignored this new data and continued to remove healthy colons from schizophrenic patients because they personally benefitted from doing the operation, either financially or because of their reputation. (Davidson, 2016)
So what “instructive lesson or principle” does this parable illustrate?
You may add to this list, but I think we can start with these…
- We can be blinded by our desire to end suffering (especially if it’s someone we love)
- As human beings, our desire to heal can limit our ability to be objective about outcomes… which is why we have clinical trials (and the scientific method).
- And finally (and unfortunately), there are charismatic but evil people who take advantage of people who are afraid and/or suffering.
- By the way, there are remnants of this theory still with us today in the form of “detoxificaiton” of the body by cleaning out the GI tract with diet, purging, and/or enemas. (It still doesn’t work…) ↩︎
- Davidson J. Bayard Holmes (1852–1924) and Henry Cotton (1869–1933): Surgeon–psychiatrists and their tragic quest to cure schizophrenia. J Med Biogr. 2016;24(4):550-559. doi:10.1177/0967772014552746
- EBAUGH FG, BARNACLE CH, EWALT JR. PSYCHIATRIC ASPECTS OF ARTIFICIAL FEVER THERAPY. Archives of Neurology & Psychiatry. 1938;39(6):1203-1212. doi:10.1001/archneurpsyc.1938.02270060093003
- Holmes B. Dementia Praecox: The Insanity of the Young. Dementia Praecox Studies: A Journal of Psychiatry of Adolescence. 1920;3:105-138.
- Kopeloff R, Kirby G. Focal infection and mental disease. Am J Psychiatry. 1923;80:1490191.
- Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-520. doi:10.1258/jrsm.2011.110180
- Naumann DN, Marsden MER, Brandt ML, Bowley DM. The Bouffant Hat Debate and the Illusion of Quality Improvement: Annals of Surgery. 2020;271(4):635-636. doi:10.1097/SLA.0000000000003623
- Noll R. Infectious insanities, surgical solutions: Bayard Taylor Holmes, dementia praecox and laboratory science in early 20th-century America. Part 2. doi:10.1177/0957154X06059446