[citation needed]Cotton began to implement the emerging medical theory of infection-based psychological disorders by pulling patients' teeth, as they were suspected of harboring infections.

[2][6] Being before even rudimentary scientific methods such as control groups—and by extension, double-blind experiments—existed, statistical methodology for applications in human behavior and medical research did not emerge during Cottons' lifetime.

He reported wonderful success with his procedures, with cure rates of 85%; this, in conjunction with the feeling at the time that investigating such biological causes was the state of the art of medicine, brought him a great deal of attention and worldwide praise.

In June 1922, the New York Times wrote in a review of Cotton's published lectures: At the State Hospital at Trenton, N.J., under the brilliant leadership of the medical director, Dr. Henry A.

The danger of surgery was recognized by some patients in the institution, who, despite their mental illness, developed a very rational fear of the surgical procedures, some resisting violently as they were forced into the operating theater in complete contradiction of what are now commonly accepted medical ethics.

[citation needed] Differences of professional opinion existed among psychiatrists regarding focal sepsis as a cause of psychosis, and not all believed in the benefits of surgical intervention to achieve cures.

Her study began in the fall of 1924, just after Meyer visited the hospital and privately expressed concern about the statistical methods being applied to provide an assessment of Cotton's work.

[citation needed] From the outset, Greenacre's reports were critical, with regard to both the hospital, which she felt was as unwholesome as the typical asylum, and Cotton, whom she found "singularly peculiar".

[citation needed] Soon Cotton opened a private hospital in Trenton that did a hugely lucrative business treating mentally ill members of rich families seeking the most modern treatments for their conditions.

Admitting a shared belief in the possibility that focal sepsis might be the source of mental illness, Meyer never pressed his protégé to confront the scientific analysis of the erroneous statistics the hospital staff provided to Cotton, his silence guaranteeing the continuance of the practices.

Although this ended the abominable surgeries which were so dangerous before the discovery of antibiotics, the hospital continued to adhere to Cotton's humane treatment guidelines and to carry out his less risky medical procedures until the late 1950s.

Cotton died suddenly of a heart attack on May 8, 1933, in Trenton, New Jersey[8] and was lauded in The New York Times and the local press, as well as international professional publications, for having been a pioneer seeking a better path for the treatment of the patients in mental hospitals.