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.

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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.

Years passed, and Cotton moved forward with even greater vigor. But once again, in the early 1930's, storm clouds gathered. Although Cotton had by then become medical director emeritus, a new report concluded that his surgical interventions were still killing about a third of those he operated on. Once again he fought back, as did his supporters, including the pusillanimous Meyer. But in the middle of the fight, to the shock of all involved, Henry Cotton died of a heart attack. "World Famous Alienist Drops Dead," read the headline in The Trenton Evening Times. The obituary declared him a "great pioneer" in the field of mental health.

Scull ends this grisly story by reflecting that "scarcely anyone doubted" Cotton's "right to experiment on his patients, or raised in any serious or sustained manner any questions about the propriety of maiming and mangling the bodies of the mad." He also points out that such brutal experiments on the mentally ill have been far from uncommon. Scull damns Adolf Meyer for his cowardice and hypocrisy in supporting a project Meyer knew to be creating "a piling up of the edentulous, the eviscerated and the extinguished."

Today, Scull says, Trenton State Hospital is derelict, a dank and dismal place with mold and putrefaction and filth everywhere, a warren of broken glass and uninhabited wards. In what was once a "noisy and noisome cemetery for the still-breathing," he observes, "now an eerie silence and emptiness reigns." Perhaps fittingly, he adds, only one part of the institution still functions: the forensic unit that houses the criminally insane.

Patrick McGrath's most recent novel is "Port Mungo." His collection of stories, "Ghost Town: Tales of Manhattan Then and Now," will be published in September.