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. Dr. Meyer, head of the most respected psychiatric clinic and training institution for psychiatrists in the United States, at Johns Hopkins University, accepted the theory. He was encouraged by a like-minded member of the state board of trustees who oversaw Trenton State Hospital to provide an independent professional review of the work of Cotton's staff. Meyer commissioned another of his former students who practiced psychiatry on his staff at the Phipps Clinic, Dr. Phyllis Greenacre, to critique Cotton's work. Her study began in the fall of 1924 just after Meyer visited the hospital and privately had expressed concern about the statistical methods being applied to provide an assessment of Cotton's work. Cotton's staff made no effort to facilitate the study.