Scull’s Madhouse gives a meticulously researched account of the actions of Dr Henry Cotton, a psychiatrist working in the New Jersey State Hospital at Trenton in the early 20th century. Cotton believed that mental illness resulted from undetected infection in various parts of the body, and with the aim of eradicating said infections, he and his team operated on hundreds of patients, with significant rates of resulting morbidity and mortality. This article gives a summary of Professor Scull’s book, as well as a series of learning points from the book that can be used to guide reflective practice.