Cotton's fame in the United States and Europe spread rapidly, but as he continued to cut out his patients' insides, postoperative deaths increased alarmingly, mostly from peritonitis. Soon the death rate was 30 percent and higher. Many poor souls, it later emerged, had to be "dragged, resisting and screaming," into the operating theater. Informed consent did not, apparently, come into play.

Enter Phyllis Greenacre, later to become a distinguished psychoanalyst, who had just won a coveted position on Adolf Meyer's staff at Johns Hopkins. The posting proved unusual from the start. Traveling by train from Chicago to Baltimore, she was persuaded by a lab assistant to take with her a pair of sealed buckets -- gifts, she was told, for Meyer and an associate. "Thus it was," Scull writes, "that her intimate companions on the journey to Baltimore came to consist of two containers of pickled human brains."

Circumstances did not work in Greenacre's favor at Johns Hopkins, largely because she was a woman in what was very much a man's world. Eventually, Meyer got rid of her by suggesting that she conduct a study to evaluate Cotton's work at Trenton. She found her new colleague to be "a singularly peculiar man"; in addition, his institution had "that sour, fetid odor so characteristic of mental hospitals." The patients also looked weird: their faces were sunken and, despite their youth, they seemed shockingly aged. Their speech was slurred and their general appearance one of malnourishment. Then she realized why: none of them had any teeth.

UNDETERRED, Greenacre set to work and quickly discovered that Cotton's data collection was problematic, to say the least: the numbers had been organized by a former patient and simply didn't add up. The case records were a shambles. At the same time, a New Jersey State Senate committee investigating waste and fraud had also turned its attention to the Trenton asylum. From out of nowhere, it must have seemed to Cotton, came a succession of "disgruntled employees, malicious ex-patients and their families, testifying in damning detail about brutality, forced and botched surgery, debility and death." Henry Cotton found himself fighting not only for his professional life but for his own sanity.

He won the first battle and (at least temporarily) lost the second: he went mad. Meanwhile, Meyer, eager to protect Cotton, suppressed Phyllis Greenacre's report. Not surprisingly, the State Senate committee dropped its inquiry and gave the hospital a clean bill of health. Cotton, suddenly recovered from his mental breakdown, was relieved to discover its true source: several infected teeth. He promptly had them removed, and felt much better.