Mar Fathom

Mar Fathom

John Langdon Down's Autism: A Stealth Disease [PART 1]

                                                                    

                                                                                  by Dr. Lawrence Broxmeyer, MD

© 2011 All Rights Reserved

Registered: US Library of Congress

 

Lawrence Broxmeyer, MD, is currently a licensed internist and medical researcher. He was on staff at New York affiliate hospitals of SUNY Downstate, Cornell and New York University for approximately 14 years. He pursued as lead author and originator, a novel technique to kill TB and the mycobacteria with outstanding results. [The Journal of Infectious Diseases 2002 Oct 15;186[8]:1155-60]. Recently he wrote a chapter in Sleator & Hill's textbook Patho-biotechnology, published by Landes Bioscience. Http://drbroxmeyer.netfirms.com

 

FORWARD:

Were he alive today, John Langdon Down, a subset of whose children were autistic, would certainly have felt almost vindicated.

The U.S. National Institutes of Health reports that Indiana University, in (http://clinicaltrials.gov/ct2/show/NCT01086475) collaboration with the Department of Defense is currently and actively recruiting participants to determine the effectiveness of an anti-tubercular antibiotic to determine if it can improve social impairment in children with autism, Asperger's Disorder, and the Pervasive Developmental Disorders. This particular anti-tuberculosis drug, first tested in the laboratory at the Eastern Virginia Medical School, previously worked to improve the sociability of mice with limited social behavior. Study investigators there said that the study held potential towards similarly changing  the social skills in kids with autism. It also worked against schizophrenia. Why is a drug heretofore used only for tuberculosis now being tested to treat autistic children? The answer lies partially in the history of medicine itself.

The consensus that autism is from intrauterine infection has been growing.In a 2007 issue of Science, Patterson [1] hypothesized that by far the most important environmental risks for autism and also schizophrenia, consists of intrauterine infection before birth. Fatemi [2] mentions the same: that based on major agreement and several decades of studies, again that maternal infection is responsible, leading towards autism and schizophrenia.

Child psychiatrist Leo Kanner first shaped our present notion of autism. Yet there is nothing really new about what Kanner called "autism", and psychiatrist D.A. Treffert of the University of Wisconsin presents convincing evidence to this effect. Treffert points out that autistic disorders, like mental retardation, have been with man from the earliest times. In fact, until 1943, autistic disorders were simply incorporated into the larger category of "mental retardation", and both, to this day, cause mistaken diagnosis.

What Down thought of as "mental retardation" included what Kanner then labeled infantile "autism". But clear and unmistakable evidence of the autistic disorder can be found in J. Langdon Down's 1887 "developmental" form of mental retardation.[3]

Desperate to put some space between himself and Down,  Kanner, in 1964 calls Down ‘one of the outstanding lights in the history of mental retardation'.[4] Yet the American Psychiatric Association's DSM (Diagnostic and Statistical Manual of Mental Disorders) of 1968 not only mentions mental retardation while defining autism, but insists that its true classification is "Schizophrenia, Childhood Type". Today it is realized that well over half of all autistic individuals are mentally retarded.

By  refusing to acknowledge that his autism could include mental retardation, Kanner attempts to skirt the delicate issue that his cases were indeed a subset of Down's "mentally retarded" children. But really Down got there first and fully a century after Down, autistic disorders are still classified as "developmental", just the way Down named them.

However, even beyond such omission of proper credit, Kanner's more serious exclusion was his inability to come to grips with what  Down considered the most prominent root cause for his children's mental disabilities. Down's children, Down said "for the most part", originated from tuberculosis in their parents.[5]  Thus, by using the term "developmentally disabled", Down was really creating a euphemism which the public found more palatable than "the developmentally disabled from tuberculosis".[Ibid][6]

Today, Langdon Down is considered wrong for saying that Down Syndrome was from parental tuberculosis and rather that it is a "genetic" abnormality, an extra chromosome on Chromosome 21, called "trisomy". But to this day no one has come up with the actual cause for this genetic abnormality. This was probably why the discoverer of the extra chromosome, Frenchman Jérome Lejeune, hesitated to publish results that were  otherwise clear cut . When Lejeune faced McGill geneticists at a 1958 Montreal International Congress of Genetics, announcing that he had located an extra chromosome in the karyotype of Down's patients, he was received with interest but skepticism. Considerable skepticism.

Since then, Warthin [7], Rao [8], Lakimenko [9] and Golubchick [10] have all shown how tuberculosis itself can cause chromosomal change reminiscent of those found in Lejeune's trisomy. Warthin showed tuberculosis's early penitration right into the corpus luteum itself, in which 90% of Down's abnormal meiotic chromosomal splitting occurs. Rao also found that the tubercle bacillus is capable of inducing such chromosomal changes as result in Down's nondisjunction of the human egg. And Lakimenko   and Golubchick  both proved just how devastating TB could be to the chromosomal apparatus of cell cultures of the human amnion,  in not one, but two separate studies. These investigators showed an increase in  pathological mitoses, arrest of cell division in metaphase, and the actual appearance of chromosomal adhesions absent in control cultures. Indeed Lakimenko and Golubchick demonstrated  that early tubercular involvement was not only destructive against chromosomes, but the very spindles that separated them. Total ovarian destruction occurs in 3% of woman with pelvic tuberculosis[11], again the site where Down and autism's chromosomal abnormalities usually occurs.

Until about 1980, autism and schizophrenia (splitting of the mind) are considered basically one and the same, separated only after a "genetic" link for autism and schizophrenia isn't found in the same family. But as late as 2010 Ploeger[12] still sees schizophrenia and autism as probably sharing a common origin, both with physical abnormalities which form during the first month of pregnancy. Ploeger sees this as happening, to be more precise, from 20 to 40 days after fertilization, when the embryo is highly susceptible to disruption.

Three years before this, Rzhetsky[13], using a proof-of-concept biostatistical analysis of 1.5 million patient records, finds significant genetic overlap in humans with autism, schizophrenia……..and tuberculosis.

REFERENCES:

1. Patterson, PH Maternal effects on schizophrenia risk. Science 2007; 318:576-577

2. Fatemi, SH Multiple Pathways in Prevention of Immune-mediated Brain Disorder: implications For the Prevention of Autism. J Neuroimmunol 2009 December 10;217(1-2):8-9

3. Treffert DA Dr. Down and "developmental disorders", J. Autism Dev Disorder. 36(7):965-6 2006, Oct

4. Kanner L.  A history of the care and study of the mentally retarded. Springfield, Illinois, Charles. C. Thomas 1964. 150 pages.

5. Down JLH: Observations on an ethnic classification of idiots. Lond Hosp Clin Lect Rep 3: 259-262, 1866)

6. Down JL: On Some of the Mental Affections of Childhood and Youth, J & A Churchill, 1887.

7. Warthin AS Cowie DM A contribution in the casuistry of placental and congenital tuberculosis. Journ. Inf. Dis. 1:140 1904

8. Rao VV Gupta EV Thomas IM        Chromosome damage in untreated tuberculosis patients. Tubercle 1990 Sep;71(3):169-72

9. Lakimenko LN Changes in the mitotic regime of a cell culture under the influence of sensitins Biull Eksp Biol Med 1976 Feb;81(2):237-9

10. Golubchik IS Iakimenko LN Lazovskaia AL  Effect of tuberculin on the mitotic regime in cell cultures Biull Eksp Biol Med 1972 May;73(5):105-7

11. Nogales-Ortiz F Tarancon I  The Pathology of Female Genital Tuberculosis. Obstet. Gynecol. 53:422, 1979

12. Ploeger A Raijmakers ME  The association between autism and errors in early embryogenesis: what is the causal mechanism?    Biol Psychiatry 2010 Apr 1;67(7):602-7. Epub 2009 Nov 22

13. Rzhetsky A  Wajngurt D  Park N and Zheng T  Probing genetic overlap among complex human phenotypes.  Proceedings of the National Academy of Sciences, Chicago, Vol. 104  No. 28 pp. 11694-699 July 10, 2007

 

California Department of Developmental Services, Sacramento, 1999

California had been on high alert for some time. Level-one autism, without any of its "spectrum", went from almost 5,000 cases in late summer, 1993, to approximately 20,377 by December, 2002. As California's  Department of Developmental Services stood by incredulously, they witnessed a tripling of California's autism , and all but 15% were children.

Although California wasn't alone,  Autism had become the fastest-growing group in that State's developmental disability system and a number of Bay Area school districts where forced to fill entire classes with youths with different forms of autism.

But even in the midst of California's mini-epidemic, it's  Santa Clara County seemed particularly signaled out. The Department of Social Services aid, brokered by SARC (the San Andreas Regional Center) staggered to its breaking point and their forecast  for autism in Santa Clara wasn't good.

What was behind this epidemic? A major clue, overlooked from a critical standpoint, was   contained in the timeline of the Department's own 1999 Autism report, which concluded that had increased dramatically between 1987 and 1998.

What had happened inside California in and around 1987 which could have sewn the surplus of autism that California now reaped?

 

Division of Communicable Diseases, Sacramento California 1999

While autism exploded in California, and beginning in 1987, was a major spike in the number of tuberculosis cases reported by the Tuberculosis Control Branch of  California's Division of Communicable Disease. There, head Dr. Sarah Royce, proclaimed A TB epidemic in California, which peaked in 1992,   an epidemic with the same male preponderance as autism, that took off at precisely the same moment in time.

If California's TB epidemic peaked in 1992, this didn't stop it from continuing to contributing the greatest number of cases to the nation's total tuberculosis morbidity[1]. But as with autism, the problem was worldwide, and by 1993, the World Health Organization (WHO), traditionally slow to react, declared a global tuberculosis emergency[2], a warning that has been in existence ever since.

It had to be more than a coincidence therefore, that since the 1980's, California experienced a dramatic increase in the number of children diagnosed with autism as well[3].

REFERENCES:

1. Ussery XT, Valway SE, McKenna M, et al. Epidemiology of tuberculosis among children in the United States. Pediatr Infect Dis J 1996;15:697-704

2. Dolin PJ, Raviglione MC, Kochi A. Global tuberculosis incidence and mortality during 1990-2000. Bull. WHO;72:213-20 1994

3. Autistic Spectrum Disorders Changes In The California Caseload: An Update: 1999 Through 2002. California Department Of Developmental Services. Sacramento, California April 03, 2004

 

Santa Clara County, California, March, 2006

If California was experiencing autistic tremors, then surely its Santa Clara County was at epicenter, and by 2006 Santa Clara had some of the highest rates for autism in the entire country. And although this was "for unknown reasons", again the question became, why Santa Clara? And the answer pointed in a similar direction. By 2002 it had become apparent that TB was on the rise in Santa Clara, and by 2006, that County had the highest number of new TB cases in California.

Santa Clara's Health Department sounded the alarm. Santa Clara now knew that it had two problems on its hands. It's medically trained Psychiatrists and personnel  just never stopped to think that they might be related.

 

Office of the Medical Superintendent, The Earlswood Asylum for Idiots in Surrey England, 1887

Thus it was in the teachings of John Langdon Down, a subset of whose  "mentally retarded" children were autistic, that Leo Kanner really found his "autism".

Down, one of the outstanding medical scholars of his day, was certain to gain entrance into the prominent London Hospital when he decided instead to go into an avenue few would even entertain, as Superintendent of the Earlswood Asylum for Idiots in Surrey.  But for Down it was pre-ordained. At the age of 18, he had what might be described as a transformative experience. A heavy summer storm drove his family to take shelter in a cottage. Down: "I was brought into contact with a feeble minded girl, who waited on our party and for whom the question haunted me - could nothing for her be done? I had then not entered on a medical student's career but ever and anon... the remembrance of that hapless girl presented itself to me and I longed to do something for her kind."[1]

Down therefore becomes a doctor for reasons that were the purist of them all, and soon excels to the head of his class.  His pursuits are brought to a temporary halt when he acquires tuberculosis, sending him back to his family's home in Torpoint. Gradually he recovers. Down then goes through an obstetrics residency before obtaining his MD to assume the position of head of the Earlswood Asylum. He is now quite knowledgeable about pregnancy, the complications and diseases of pregnancy, and the neonates that come as a result of pregnancy. In addition to that his surgical skills allow him to do autopsies during which he contributes much to expand knowledge of conditions of the brain such as cerebral palsy.

In his Lettsonian Lectures[2], Down follows the psychiatric nomenclature of his time, classifying his most severe cases of mental retardation in the young under the category of ‘idiocy'.  Like Kanner, he specifies that some of his  mentally retarded children had exceptional intellect in specific areas, such as memorization, music or mathematics. In fact, a noticeable subset of Down's patients did not appear physically to even have mental retardation.

In a more recent survey of the literature, Gillberg and Coleman[3]  relate that quite a number of reports of individuals with Down Syndrome also meet the criteria for autism.

By 1867, Down had appeared, in the Lancet, linking childhood mental illness with tuberculosis.[4] To Down, in fact, children who inherited Down Syndrome "for the most part, arose from tuberculosis in the parents," and not genetics.[5] Capone mentions  Down's original report attributed the condition to maternal tuberculosis.[6]  As a result of such tuberculosis from conception or soon thereafter, and nothing else, such children's life expectancy would be shortened, as the same tuberculous infection would lead to their early demise.

The only thing really wrong about John Langdon Down's theory was that it was way ahead of its time.

He knew that tuberculosis was, as it still is, the most common cause of death from a single infectious agent in children[7], killing upwards of 250,000  children each year[8], yet exceedingly difficult to diagnose[9]. He also knew that TB was the  single leading cause of death among women of reproductive age between 15-44, one million of whom presently die, according to WHO, each year.[10]

Moreover, brain and central nervous system tuberculous account for 20-45% of all types of tuberculosis among children, much higher than its 2.9-5.9% for all adult tuberculosis.[11] In fact tuberculosis of the nervous system has consistently been the second most common form of TB in the very young outside of the lung.

And of those infants and children that did survive, nearly 20-25% manifest mental retardation, and mental disorders[12] - serious and long term behavioral disturbances[13]  , seizures[14] and motor (movement) handicaps  in addition to the various other anomalies associated with autistic and Down's "neurodevelopment"  behavior problems.

For his Lancet study, Down submits one-hundred post-mortem records of children who had passed away at his institution. He had found no fewer than 62% of these children to have tubercular deposits in their bodies. For some unknown reason, boys had more than twice the incidence of tubercles in their organs as did girls, a finding which concurred with the male predominance he later notes in  childhood mental disease in general. Such male preponderance is today not only documented in Down Syndrome but autism as well. Tuberculosis might be more frequently transmitted by the mother than the father but it was the male offspring that were more tubercular.Caldecott[15] in a 1909 British Medical Journal, noted that Down showed his children rarely lived beyond 20 years as a consequence of brain and nervous system disease, and that they died of…………. tuberculosis.

REFERENCES:

1. Down, J. Langdon. Address Christian Union, June 27, 1879.

2. Down JL On Some Of The Mental Affectations of Childhood and Youth. The Lettsonian Lectures. London J&A Churchill, 1887.

3. Gillberg C Coleman M The Biology of the Autistic Syndromes in Clinics in Developmental Medicine No. 153/4  3rd Edition Mac Keith Press pp.340, 2000, p. 140

4. Down JL On Idiocy and its Relation To Tuberculosis The Lancet vol ii 1867.

5. Down JLH: Observations on an ethnic classification of idiots. Lond Hosp Clin Lect Rep 3: 259-262, 1866.

6. Capone, GT Down Syndrome: Advances in Molecular Biology and the Neurosciences, Developmental and Behavioral Pediatrics, Lippincott Williams & Wilkins, Inc. Vol. 22, No. 1, February 2001

7. Walia R Hoskyns W Tuberculous meningitis in children: problem to be addressed effectively with thorough contact tracing Eur J Pediatr. 159(7):535-8 2000  Jul

8. Titone L Romano A Epidemiology of paediatric tuberculosis today Infez Med 2003 Sep;11(3):127-32

9. Mahadevan B Mahadevan S Tuberculin reactivity in tuberculosis meningitis Indian J. Pediatr. 2005 Mar:72(3):213-5

10. WHO TB Is Single Biggest Killer Of Young Women Press Release Geneva, Switzerland WHO/40 26 May 1998

11. Molavi A, Lefrock JL: Tuberculous meningitis. Med Clin North Am, 1985; 69:315-331

12. Garg PK tuberculosis of the central nervous system. Post grad Med J 75:133-40 1999

13. Schoeman JF Springer P Adjunctive thalidomide therapy for childhood tuberculous meningitis: results of a randomized study. J. Child Neurol 2004 Apr;19(4):250-7

14. Takamatsu I The current situation and treatment of childhood tuberculosis Kekkaku 1999 Apr;74(4):365-75

15. Caldecott H: Discussion of paper by Shuttleworth GE: Mongolian imbecility. Br Med J 2:661-665, 1909.

 

Department of Psychiatry, Burgholzli Hospital, Zurich Switzerland, 1930

 

The word "autism" originates from Swiss psychiatrist Eugene Bleuler, first appearing in English in an April, 1913 issue of the American Journal of Insanity,[1] heralded at an address he delivered for the opening of Johns Hopkins very own Henry Phipps Psychiatric Clinic. Bleuler uses "autism", Greek for "self", to describe schizophrenics' (literally people with a splitting of the mind) seeming difficulty in connecting with other people, and, in certain cases, withdrawing into their own world, and showing  self-centered thought.  But, to Bleuler, schizophrenia, and thereby autism, still came from an organic cause such as infection, and, as such, were sometimes curable. Until about 1980, autism and schizophrenia are considered basically one and the same. To that point Bleuler's definition holds.

Bleuler also uses "autism" to describe doctors that are not attached to scientific reality, wont to build, on what Bleuler calls "autistic ways",  that is, through methods in no way supported by scientific evidence, an event more and more in evidence as psychiatrists moved away from tissue based outcomes into the realm of subjective behavior labeling.

REFERENCES:

1.  Bleuler E, Autistic Thinking ,American Journal of Insanity Vol 69 No. 5 April 1913 p. 873

 

 

Child Psychiatry Service, John's Hopkins University Hospital, Pediatric Division Baltimore, 1933

Internal medicine trained Leo Kanner teaches himself the basics of child psychiatry and at the instigation of Adolph Meyer, joins the Henry Phipps Psychiatric Clinic at John Hopkins Hospital in Baltimore.

By 1903, Henry Phipps, wealthy partner of Andrew Carnegie, sought charitable outlets for his wealth. He then joined Lawrence F. Flick, a doctor with a vision, to open a center solely dedicated to the study, treatment, and prevention of tuberculosis, hands down the number one infectious killer in the United States.

Not until May, 1908 did Philadelphia steel magnate Phipps get around to visiting Johns Hopkins' tuberculosis division, which he had funded. At that point Phipps turned to ask Hopkin's Dean and legendary pathologist William Henry Welch if he needed help sponsoring other projects at the Hospital. Welch answers Phipps by handing him a copy of "A Mind That Found Itself"[1], an agonizing assessment of mental asylums written by Clifford W. Beers, and published with the help of Swiss born pathologist Adolph Meyer. Phipps turns around and  within a month agrees to donate $1.5 million to fund a psychiatric clinic for Johns Hopkins Department of Psychiatry. By 1912 the Henry Phipps Psychiatric Service at Johns Hopkins Hospital provides the first inpatient psychiatric facility in the United States for the mentally ill.

Welch likes Meyer. Meyer, although unable to secure an appointment from his alma mater, the University of Zurich, is,  like Welch, a pathologist………. a neuropathologist to be exact. Also Welch takes to him because Meyer initially seems to reject Freud as the be all and end all for psychiatry. And there is another level of understanding: Meyer and Welch share the rapport of two superb medical networkers and politicians. Welch sees to it that Meyer becomes the head of Hopkins Psychiatry.

But it is the very same second-rate, vague, "psychobiological" views that characterize Meyer's psychiatric approach that will prove in the end, to be  disappointing. Designed to be all things to all people, Meyer's "psychobiology"  assesses mental patients physical and psychosocial problems concomitantly, but turns out to be all things to no one. Meyer is much more orientated towards taking extensive histories of his patients…….getting all the "facts", then in rooting out the pathology behind mental illness on the autopsy table. Besides, the positions of Meyer and Freud closely resemble one another in that each insists heavily on the study of psychogenic factors in neurotic disorders. Welch, on the other hand, was committed to bringing the German model, which relied heavily on the lab, to US medicine. So with Meyer, Welch didn't precisely get what he thought he was getting.

Nevertheless, thanks to neurologist/pathologist Adolph Meyer, Leo Kanner becomes the first "child psychiatrist" at Johns Hopkins,……… and,  by default,  the United States. Meyer is bent on changing American psychiatry, and will dominate psychiatry from his Johns Hopkins chair during the first half of the Twentieth Century. Meyer has long been interested in the psychiatric treatment of children. So he arranges with Hopkins pediatrician Edwards Park for Kanner to become a liaison between pediatrics and psychiatry at the institution. This gives Kanner enhanced influence in reaching an audience of pediatricians who otherwise would have found little value in the psychiatric evaluation of children.  Meyer has already decided that the psychosocial aspects of mental disease are more important than tissue diagnosis of brain pathology. He closes his laboratory, and instead prefers to talk to his patients, taking extensive histories in the manner of Kraepelin and Sigmund Freud.

 

REFERENCES:

1. Beers CW A Mind That Found Itself 232 pages University of Pittsburgh Press; 1st edition June 30, 1981.

 

Vienna, Austria, Office of Sigmund Freud, Neurologist, 1883

"Loudest of all is the cry: tuberculosis! Is it contagious? Is it acquired? Where does it come from? Is Master Koch of Berlin right in saying that he has discovered the bacillus responsible for it?"[1]

-Sigmund Freud  October 9, 1883

 

Long before Leo Kanner, Freud speculated that autism was an impairment in social functioning in which the satisfaction of instincts was, to one degree or another, withdrawn from the influence of other people.

Freud's prior neurophysiological interests leads him to the psychiatry clinic of famous brain anatomist and psychiatrist Theodore Meynert. Under Meynert's direction, Freud proved unusually adept at diagnosing organic brain disorders, particularly the effects of localized injuries. But what he did not seem to pick up was Meynert's absolute belief that the roots and cause of mental illness lie in the diseases and pathology in a human beings brain and central nervous system. Freud is unhappy with a career that might pursue such orthodoxy, as he expresses in a letter to his fiancée in 1884. Instead he is looking for "a lucky hit".

That "lucky hit" would, of course, eventually turn out to be psychoanalysis and his talking cure.

But even after he abandons Meynerts's brain approaches, Freud continues to admit that his wide-ranging psychoanalytic theories would eventually need to be rooted in the tissue neuroscience of Meynert. Otherwise, it would only take "a few dozen years" to "blow away" the "artificial structure of hypotheses" involved in psychoanalysis.[2]

There are obvious holes In Freud's theories. But, for decades, nobody is picking them up. No one could deny the tremendous impact his thoughts had on those working with children with emotional problems. Nevertheless Freud's theories at times seem to distort the treatment of the serious mental illnesses, among them, the notion that bad mothering could cause conditions such as schizophrenia. Not only did this leave irrevocable guilt, in certain cases, on the families involved, but often on the patients themselves. Yet such thoughts influenced a generation of thinkers.  Kanner refers to remnants of it in his cold hearted moms, who he finds often among his "autistic" children. In his book Child Psychiatry Kanner acknowledges Freud's merit more often than not, although he later lashes out that Freud's influence had gone too far in his followers insistence that Freud's theories were just about infallible.

Leaving Maynert, Freud joins neurologist Charcot in Paris, who was working on the medical disorder "hysteria". "Hysteria" was a wastebasket category that included, among other things depression, and "conversion" disorders which produced pain with no obvious organic cause. It was in conversion hysteria, that Charcot could sometimes, briefly, eliminate symptoms through hypnosis.  Freud felt that such hysteria had nothing to do with disease or brain pathology, which immediately put him at odds with most of the medical establishment.

The first to mention tuberculosis induced neuroses such as hysteria was Cardanus[3] , who described a case cured in 20 days because it "merely involved the intellect". Thus the first "talking cure" might have been well over 200 years before Freud.

Once in private practice, Freud persists in using  post-hypnotic suggestion to cure hysterical symptoms, to little avail.  Finally his great breakthrough comes not with one of his own patients but when he utilizes the records of a patient who his friend and colleague Josef Breuer saw, called "Anna O", the first patient upon whom a "talking cure" was affected. "Anna O" was Bertha Pappenheim, a 21 year old who developed a host of physical and mental problems while attending to her father, dying of tuberculosis. Some of her symptoms included an intractable cough, severe headache, malaise, partial paralysis, and vision problems……….all thought by Freud to be "hysterical". Suffering from epilepsy, one of her arms was paralyzed as a result of complex seizures.

Based on all of these symptoms, Breuer, in his chart notes, seriously considers that Anna O. has tuberculosis meningitis. Then, discovering that her paralyzed arm was the arm that cradled her dying father, he makes the leap that she was unconsciously immobilizing her arm as self-inflicted punishment because she inwardly blamed herself for her father's death. Breuer then tries to get her to "talk out" her repressed memories to affect a cathartic cure. Breuer's  case proves pivotal, by Freud's own admission. It would be the beginning of a "psychoanalysis" which Freud would embellish from that point on.

Freud presses Breuer for joint publication of Studies on Hysteria,accomplished in 1895. But even in this book, the gulf between Breuer and Freud became obvious. Breuer was an internist, trained in internal medicine. So he looked for neurologic disease processes behind Anna's hysteria, while Freud used a psychological point of reference. What unfolded In the case of Anna O, would prove to be medical misjudgments with lasting consequences.

As the years went on it became obvious to others that Anna O.'s more noteworthy symptoms pointed towards specific, infectious brain pathology, typical of complex partial seizures, originating in the temporal lobe. German born research psychologist H.J. Eysenck[4] and others speculate that Anna O wasn't suffering from hysteria or neurosis at all, but brain involvement from tuberculosis, a disease that not only did two of her siblings die from at the ages of 2 and 18, but that her mother had and that she was again exposed to from nursing her tubercular ridden, dying father.

According to Thornton's more in depth account, Anna's father had a tubercular abscess  just under the lining (or "pleura") of one lung, a frequent complication of the tuberculosis which was then highly prevalent in Vienna. Nursing him exposed her to constant contact. Moreover, in the midst of Breuer's talking therapy[5], her father's lung abscess was surgically incised and drained at home, subjecting the girl, who changed his dressings, to direct exposure to his tubercular bacilli. The virulence of the strain that exuded out of the purulent drainage from her father's chest tube was best attested to by the fact that it would soon kill him. Thornton makes it crystal clear that Freud's account of Anna O. was totally deceptive and that there had been no "talking cure" or catharsis, something he believed Freud knew very well.

Eysenck, famed for his Eysenck Personality Scale,  says that it was not Breuer or Freud who really cured "Anna O." but repeated hospitalizations for tubercular symptoms which occurred subsequent to their psychoanalytic "treatment".

Eysenck had a good case and H.F. Ellenberger[6] agreed. Tracking down actual chart records, Ellenberger notes that Anna O.'s condition actually got much worse during Breuer's treatment, to the point where she had to be treated in a TB sanitarium. Again, Freud was aware of all of this but his account still proclaimed Anna O.'s pristine talking cure. Breuer, not nearly so enamored with the treatment he himself had originated, broke with Freud. And Jung was the first to point out publically that the alleged success of the treatment of Anna O. was anything but. Jung insists that there was no cure at all in the sense with which it was originally presented. Again, he mentions, Anna O was not suffering from a neurosis at all, but from the mental and physical changes of tuberculous meningitis.

Even Freud's case study of "Dora", which established Freud's theories about lesbians and female hysterics, was not untainted by physical disease.  "Dora" was Ida Bauer, born in Vienna in 1882, of Bohemian Jewish ancestry. Ida's father, Philip, died of tuberculosis in 1913; one year after her mother died of the same disease.

During the course of their sessions, young Ida mentions to Freud that her father had a lover who Freud labels Frau K and whose husband made sexual advances towards her which she found outright repugnant, coming from the much older man. Her father seemed to ignore this in an attempt to preserve his own illicit relationship with Frau K, who together with her husband, were friends of the family.

Because of this, Ida's father told her that the husband's advances were all a figment of her imagination. But later, Frau K's husband, Herr K, would tell a much different tale. Indeed he had tried to seduce young Ida. Although Freud accepted Ida's account, his take on it was a series of specious leaps at best. Instead of accepting Ida's valid repugnance for a much older man, Freud insists that she was repressing both her own love for Herr K, as well as an incestuous love of her father, and at the same time a homosexual attraction for Frau K.

From a more medically based perspective, Ida's father had in fact developed tuberculosis when she was six years old, a disease he was never able to entirely shake and had constant relapses from, punctuated by fever and coughing until his death in 1913. Furthermore, tuberculosis characteristically doesn't do its greatest damage, for unknown reasons, between age 5 and 15. Dora comes to Freud at 14. Ida's mother also dies from tuberculosis. Freud doesn't chart this, feeling it insignificant. Ida begins to suffer her own lung involvement at age 8 with constant episodes of shortness of breath that seem to assuage with enforced rest for a six month period. Her family doctor, full well knowing the stigma of even mentioning the possibility of tuberculosis, puts down that the shortness of breath was from "nervous causes".[7]

At age 12, Ida's shortness of breath is joined by spasmodic episodes of "nervous" coughing, generally lasting 3 to 5 weeks and associated with loss of voice. Rather than attribute Ida's coughing spells to TB, or her voice loss to a tubercular attack on the 6th recurrent laryngeal nerve, Freud immediately seizes upon a series of hypotheses that few besides himself could even fathom, much less have thought up.

Ida's coughing, claims Freud, expressed her sexual longing for her father, and her rivalry with Frau K regarding this. And her throat irritation and consequent coughing was, Freud maintained, a combined symbolization of her desire to take Frau K's place in performing fellatio on her father.

As if this wasn't enough, supposedly, the ceaseless coughing could also express Ida's desire to replace her father in his affair with Frau K. Freud thereby assumes that Ida K has lesbian tendencies as well. Later she would marry in what proved to be an entirely heterosexual relationship without a mention of any homoerotic tendencies whatsoever.

At the time of its release, Studies on Hysteria was not well received by  European medicine. And It was not until years later that psychoanalysis was recognized as a legitimate psychiatric tool.

In 1918, Sigmund Freud, during  a speech at the Fifth International Congress of Psychoanalysis in Budapest insisted that: ‘The neuroses threaten public health no less than tuberculosis" [8]

But he never saw the possible interconnection between the two.

 

REFERENCES:

1. Freud S Freud  EL Letters of Sigmund Freud Courier Dover Publications, 1992, 470pps. P68

2. Freud, Sigmund. Jenseits des Lustprinzeps. Leipzig-Vienna-Zurich (1920). GW, 13, 1-69; Beyond the pleasure principle. SE, 18: 7-64. p. 60

3. Cardanus, J Dignot, admirared num. 3. Ii, de phthisis, obs 14 . J.G. Schenck, Ed. Francofurti, Beyeri, 1665, p.265

4. Eysenck HJ  Mead M Eysenck SBG  Decline and Fall of the Freudian Empire Transaction Publishers, 2004 224 pages.

5.Thornton, E.M. Freud and Cocaine: The Freudian Fallacy. Blond & Briggs, 1983.

6. Ellenberger HF The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry Basic Books, 1970 932 pages

7. Wenegrat B Theater of Disorder: Patients, Doctors, and the Construction of Illness Oxford University Press US, 2001 292 pages p100

8. Danto, EA Freud's Free Clinics: Psychoanalysis and Social Justice 1918-38  New York  Columbia University Press 348 p. 2005 p.17

 

 

Child Psychiatry Service, John's Hopkins University Hospital, Pediatric Division Baltimore, 1934

Kanner , with little use for medical diagnostics himself, seems made-to-order for Meyer. Kanner will laud Meyer for shifting the emphasis of psychiatry "from organs and their diseases to patients as improperly functioning persons."[1]

But diseased organs can themselves lead to "improperly functioning persons".

Kanner  never  really seemed that interested in "organs and their diseases". While still in Berlin, finishing medicine, his lowest grade on his finals is as a result of being unable to diagnosis a then premier infectious brain disorder leading to mental symptoms.[2]Neurologist Karl Bonhoeffer documents that Kanner misinterpreted the symptoms of tabes dorsalis, a neurologic end-stage syphilis of the brain and nervous system. (Ibid)

Not really attracted to being a  general internist, and still in Berlin, Kanner gravitates into the then new, and relatively limited field of electrocardiography, or EKG tracings of the heart‘s rhythms.

Once at Hopkins, Kanner writes his first edition of Child Psychiatry in 1935, borrowing the name from the German term Kinderpsychiatrie. And by 1943, bent upon making his mark, discovers a "new" syndrome.  Without mention of Bleuler, who originated the word "autism", Kanner uses it  to describe, what he feels to be a novel psychiatric illness in children, emphasizing an "autistic aloneness" and "insistence on sameness". Ironically, Kanner, known to rant and rage over mere psychiatric labels without treatment, creates another one……………. "autism".

REFERENCES:

1. Kanner L The Pediatric-Psychiatric Alliance Can Med Assoc J 1938 Jan;38(1):71-74

2. Neumarker K Leo Kanner: his years in Berlin, 1906-24. The roots of autistic disorder in History of psychiatry 14 (54 Pt 2): 205-18 2003.Jun)

 

 

Office of The Director, Department of Medical Genetics, New York State Psychiatric Institute July, 1936

Leo Kanner and Franz J. Kallmann, have a couple of things in common.  Both have connections with the University of Berlin.  Kallmann worked for 4 years at Berlin's psychiatric institute, under the same Karl Friedrich Bonhoeffer who graded a portion of Kanner's final exams. Although Kanner is only 3 years older than Kallmann, and Kanner is trained in Internal Medicine, both would move quickly, upon their arrival to America, to make their impact on psychiatry.

Landing in New York, Kallmann establishes the Medical Genetics Department of the New York State Psychiatric Institute. From then on, one thing is certain. With Franz J. Kallman, American psychiatry got much more of the hereditary patterns in mental disease than it was willing to accept or pursue. Prominent British geneticist Penrose judged Kallmann's work unconvincing.

A year after Kanner writes "Child Psychiatry", Kallmann becomes interested in twins and their genetic disposition. But there arises an inconvenient truth: identical twins, who have virtually the same DNA, do not always develop the same mental disorders.

Kallmann focuses on what he calls the "genetics of schizophrenia." In a lecture,  he finds  it desirable to prevent the reproduction of relatives of schizophrenic patients. He defines them as  undesirable from a eugenic point of view, especially at the beginning of their reproductive years.

By 1938, Kallmann, who escaped Nazi Germany because he was half Jewish, has doubled down, calling for the "legal power" to sterilize "tainted children and siblings of schizophrenics" and to prevent marriages involving "schizoid eccentrics and borderline cases."  In his mind, Kallmann feels the need to stamp out every recessive gene behind schizophrenia.[1] It was a thought that began  incubating in him while still in Germany. Leo Kanner is appalled by Kallmann's  thoughts and words. He sees dangerous implications. This time he is correct.

Kallmann is a zealot in every sense of the word. He finds a genetic basis for just about everything. He proclaims that human tuberculosis is genetically based.  His agenda in doing so is quite transparent.

Proponents like Kallmann for a "genetic" or "hereditary" view of mental illness have always relied on identical twin studies. In these, if there is a heavy degree of "concordance", meaning that both identical twins come down with the illness, it is supposed that "genetic" influences are involved. This is so especially if at the same time fraternal twins show a low rate in being "concordant for" or contracting the same disease.

But it was also known that an infectious disease like tuberculosis brought in the same numbers in identical twin studies as did schizophrenia or autism, putting the accuracy of such twin studies deeply in question. Kallmann[2][3]  himself, found that approximately 85% of identical (homozygous) twins had the same disease (were concordant) if their co-twin had either tuberculosis or schizophrenia.

Kallmann's study for the hereditary basis of schizophrenia is published in 1938. It acknowledges  long time boss and Nazi mentor, Ernst Rudin.[5]  While still in Germany, Kallmann saw Rudin catapulted to director of the Kaiser Wilhelm Institute for Psychiatry and its eugenics division through Rockefeller Foundation money, creating the medical specialty known as Psychiatric Genetics. Rudin was not only assisted by Kallmann but another protégée named Otmar Verschuer. Back in Germany, Rudin, a year later, sees to it that the German version of Kallmann's book is used by the Nazi T4 Unit as a blueprint for the murder of mental patients and "defectives", many of them children. 250,000 are killed under this program by gas and lethal injection. The Rockefeller-Rudin operation had become a section of the Nazi state. Rudin was now head of their Racial Hygiene Society.

Meanwhile, in America, geneticist Franz Kallmann becomes an early leader of the American Society of Human Genetics (ASHG), a true pioneer in the study of the genetic basis of psychiatric disorders.

Kallmann's American Society of Human Genetics, organizes the "Human Genome Project". It is the most ambitious project ever dealing with basic genetics. In 1988, Congress provides funds for the National Institutes of Health (NIH) and other groups to begin mapping out human DNA. The project began officially on October 1, 1990, with a projected budget of $3 billion over the next 15 years.

As B. W. Richards points out,  advances regarding the discovery of genetic markers for diseases such as autism, Down Syndrome, and schizophrenia, although good for diagnostics, have done little to get at the actual cause of such chromosomal aberrations. Richards: "Despite dramatic advances in the fields of biochemistry and cytogenetics, revealing many new causes of mental retardation, a large proportion of mentally retarded patients are still undiagnosable in respect of etiology (cause)."[6]

What did result, thanks to such take no prisoners actions like Kallmann's, was that bacteriology was purposely confined to a specialty of medicine outside the schools of biology, botany and zoology, in no small part responsible for bacteriology's slow acceptance.

Bacteriologists, in retaliation, steered clear and gave no credence to any of the proclamations of geneticists. Unbelievably, the situation had gotten so out of hand that  as late as 1945, bacteriologist Rene Dubos, discoverer of the first antibiotic ever, had to muster all the courage in him to name his milestone paper "The Bacterial Cell".  Such are and always have been the politics of medicine.

REFERENCES:

1. Muller-Hill B. Murderous Science: Elimination by Scientific Selection of Jews, Gypsies, and Others in Germany, 1933–1945.Woodbury, NY: Cold Spring Harbor Laboratory Press; 1988: 11, 31, 42–43, 70

2. Kallman FJ Resiner D Twin studies on the significance of genetic factors in tuberculosis. Am. Rev. Tuberc. 47:549, 1943

3. Kallman FJ The genetic theory of schizophrenia. Analysis of 691 twin index families. Am. J. Psychiat. 103:309 1946

4. Torrey EF, Yolken RH Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull. September 2009

5.  B. W. Richards Recent Advances in Medical Knowledge of Causes of Mental Retardation Can Med Assoc J. 1963 December 14; 89(24): 1230–1233.

 

Office of the Director, Child Psychiatry, John's Hopkins Hospital, Baltimore, 1943

To make certain that his theory sticks, Kanner cherry-picks eleven children, leaving out those presently with seizures or mental retardation even though these are very much in today's autistic spectrum. Some studies have mental retardation occurring  in approximately two-thirds of individuals with autism and seizures in approximately one-third.

Kanner produces a 33-page[1] medically sketchy paper.He outlines 11 case histories, all the while convincing himself that despite findings such as a history of seizures, which could point to a brush with serious disease, that his subjects problems were purely psychiatric or behavioral. At the same time he says that unlike childhood schizophrenia, autism is the result of "inborn autistic disturbances of affective contact"   …….a sort of congenital lack of interest in other people. Yet most of his children are thought deaf, neither talking, nor responding if questioned, and could have severe cranial nerve disruption from a serious central nervous system infection.

"Physically", Kanner insists, despite findings which suggest otherwise, "the children were essentially normal".  But five out of his 11 subjects, through measurement "had relatively large heads" , which could indicate possible degrees of hydrocephalous. Hydrocephalous also known as "water on the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or deep cavities in the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsions , and mental disability. One of its causes in infants is perinatal infection. At one time, the diagnosis of acute hydrocephalus was so commonly associated with tuberculous meningitis that the terms were used interchangeably.

But apparently  of more concern to Kanner is the children's parent's: "In the whole group, there are very few really warmhearted fathers or mothers."When, in his first case, Kanner finds out through Donald T's mother that the child had been placed in a "tuberculosis preventorium" for "a change of environment", Kanner never questions her as to why.

All but forgotten, tuberculosis preventoriums were  America's answer to preventing  tuberculosis epidemics among the  urban poor. This was accomplished by ripping "pre-tubercular" children from their homes and placing them into residential institutions.[2] From the very beginning of the 20th century and well into it, such primitive "preventoriums" where looked towards as the only solution to break the chain in a disease which by 1900 killed at least 15% of urban populations, with no treatment in sight. By 1907 von Pirquet came up with a children's tuberculin skin test with all the flaws of our present adult tuberculin skin test. Not only were there false negative tests done on seriously infected children whose immune system could not muster a positive skin reaction, but even when the test proved positive it was often impossible to distinguish mere previous exposure from active disease. Nevertheless, the imprecise designation "pre-tubercular" was used to designate children with positive skin tests who didn't seem to have active disease. These were the children targeted for preventoriums.

Kanner knows from the onset that his "autism" will  be challenged,  on many levels. Other psychiatrists, presented with these same children would call them mentally retarded or schizophrenic.The fact was that psychiatrically, all would be considered by many as a form of childhood schizophrenia. To make the differentiation stick, Kanner emphasizes ‘extreme solitude from the very beginning of life' and a preserved intelligence. But many of Down's developmentally disabled children had normal intelligence also, and certainly did not appear to have mental retardation.[3] Kanner argues that his children, unlike schizophrenics, did not seem to have delusions or hallucinations. In addition, he says, schizophrenia doesn't emerge in as early as the 30 months after birth that autism seemed to.

But more tellingly, in 1949, Kanner vacillates, admitting that he sees no need for his ‘infantile autism' to be separated from ‘schizophrenia'.[4] The American Psychiatric Association (APA) balks in accommodation, and decades later still won't acknowledged autism as anything other than just that:  ‘schizophrenia, childhood type.'[5]    By then, Kanner deplores the APA's decision.[6]  Yet despite this, until 1980 his "autism" is not[7] "autism", it is childhood schizophrenia.

One year after the APA's 1968 decision, prominent Bellevue child psychiatrist Lauretta Bender argues that children with autism generally grow up to have schizophrenia anyway. And on top of that, despite the ever increasing rallying cry by American psychiatric gurus as to childhood schizophrenia's extreme rarity, Bender documents thousands of cases of it while at Bellevue.[8] German psychiatry, which long maintained its influence over Europe, the Soviet and Eastern Bloc countries, also insists that childhood autism is the initial form of schizophrenia, with development into schizophrenia more or less inevitable.

Moreover, some in the field understood that clear and unmistakable evidence of the autistic disorder could be found in J. Langdon Down's 1887 "developmental" form of mental retardation,[9]  which Down attributed mostly to tuberculosis in the child's parents.[10][11]  The stage was set for a battle royale.

REFERENCES:

1. Kanner L Problems of Nosology and Psychodynamics of Early Infantile Autism American Journal of Orthopsychiatry 19:416-26 1949

2. Connolly CA Saving Sickly Children: The Tuberculosis Preventorium In American Life, 1909-1970 New Brunswick Rutgers University Press 182pp. 2008

3. Treffert DA Dr. Down and "developmental disorders", J. Autism Dev Disorder. 36(7):965-6 2006, Oct

4. Kanner L Problems of Nosology and Psychodynamics of Early Infantile Autism American Journal of Orthopsychiatry 19:416-26 1949

5. APA (1968) Diagnostic and Statistical Manuel of Mental Disorders, Second Edition Washington, DC American Psychiatric Association

6. Neumarker K Leo Kanner: his years in Berlin, 1906-24. The roots of autistic disorder in History of psychiatry 14 (54 Pt 2): 205-18 2003.Jun

7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 3rd Ed Washington DC 1980

8. Bender L A Longitudinal Study of Schizophrenic Children with Autism Hospital  and Community Psychiatry 20(8):230-37 1969).

9. Treffert DA Dr. Down and "developmental disorders", J. Autism Dev Disorder. 36(7):965-6 2006, Oct

10. Down JLH  Observations on an ethnic classification of idiots. London Hosp Clin Lects Reps 3:259-262, 1806

11. Down JL: On Some of the Mental Affections of Childhood and Youth, J & A Churchill, 1887.

 

Johns Hopkins Department of Pathology, Baltimore, 1946

Though his office was but a short distance away from Leo Kanner's, Johns Hopkins TB pathologist Arnold Rich lived in a completely different world. In Rich's world there were no psychiatric hypothetical's, no diagnoses not verifiable by laboratory reagents and microscopic findings. Although it appeared that Rich and Kanner worked in completely different arenas, at times they unknowingly touched directly on one another's work, but never more closely than when Rich began to focus on perinatal infectious disease.

Rich was a teaching dynamo at Hopkins, completing his authoritative Pathogenesis of Tuberculosis in 1944, with a second edition in 1951. It took him nine years to compile, and still remains a model of what a scientific monograph should be. By  virtue of his astute powers of observation, Rich had always stood out from the rest, even at Hopkins. His name still remains on the lung condition called "The Hamman-Rich Syndrome", as well as  the small tuberculous masses (tuberculomas) that metastasized, not infrequently, to among other areas, the human brain, and became known as "Rich's foci". He was also the first to describe the high prevalence of occult prostate cancer in elderly males, as well as first to describe widespread vascular obstruction of the lungs in children with the hereditary heart condition called Tetralogy of Fallot.

During Rich's tenure, much as in the past, the prevailing emphasis at Hopkins laboratory research was either with the living or recently deceased but the way in which Phipps psychiatry under Meyer neglected its bench work research gave it a somewhat remote character to the rest of Hopkins, preventing closer association.

In addition it seemed that Meyer's protégée, Dr. Leo Kanner was looking only at the very tip of the very same extensive iceberg that John Langdon Down had come to grips with so long ago. When Kanner spoke of an "inborn" condition affecting mentation, Rich, as well as Down previously, had a fairly good idea of what he was speaking about and to Rich it was no more a condition caused by heredity than the nonsensical documents that crossed his desk weekly claiming human TB to be hereditary or caused by the wrong genes.

Rich, like Down, knew that TB was the most common cause of death from a single infectious agent in young children and neonates[1] , commonly attacking their central nervous system.[2] The German's had their own name for childhood tuberculosis, "kindertuberkulose", and in the many that survived, besides leaving their tiny bodies gnarled, nearly 20-25% manifested mental retardation and psychiatric disorders.[3] And for various reasons many did survive.

So until this significant pool of neonates infants and toddlers was fully evaluated for such protean mental complications, Arnold Rich truly couldn't understand the psychiatrist's  fussing over "inborn" features of a "psychiatric" disease whether labeled "autism" or anything else that very possibly was caused by organic infection.  It just didn't make sense.

A neurologist friend had confided in him that Kanner's autism seemed more like a disease caused by post-encephalitic phenomena than anything else. Rich knew that tuberculosis was fully capable of causing such an encephalitis, described by one pediatric infectious disease specialist[4] as indolent or slow to develop  and heal, often as painlessly as any other central nervous infection around.

Rich looked up at the picture of William Henry Welch (1850-1934). Welch had been both Rich's predecessor at Hopkins Pathology, as well as Dean of Medicine  and founder of the Johns Hopkins University Medical School. Welch was unique. Welch was different. He was a mover and a shaker, an organizational genius who would single-handedly  force American medicine up to and eventually beyond what they had in Europe.  A bacteriologist and a pathologist, he would one day be called the Dean of American Medicine. During his watch American life expectancy would jump by at least twenty years. And Welch would be a major factor in that leap.

Rich was proud both of the association and to have personally known the physician considered both the father of American medicine and one of its most influential members. Welch had studied in Germany under the great masters, including stints with Koch, Cohnheim, and psychiatrist/neurologist Meynert. Welch therefore full well realized the importance of seeking out diseased tissue in the mentally ill.  Meynert decried those like Kraepelin and Meyer, who seemed preoccupied with labeling symptoms instead of going after the real tissue cause of brain or central nervous system illness.[5] And having also worked with Koch, Welch held a keen appreciation for the destruction, both inside and outside of the mind, that tuberculosis could cause.

With regards to the immediate problem in front of him, Rich had read Knoph's review[6]   in which he mentioned of Welch that: "He too was of the opinion that a direct bacillary transmission, that is to say, prenatal infection (of tuberculosis), takes place much more frequently then believed".

Like Rich, Knoph also knew that few fetal autopsies and exhaustive studies where done to prove fatal tuberculosis on dead fetuses. And those studies preformed had to contend with the fact that tuberculosis, a microbe which grew only with sufficient oxygen, was most often impossible to isolate in the low-oxygen content of fetal blood or tissue. It's not that TB had any trouble surviving under low-oxygen conditions. It just did so in undetectable forms, causing a diagnostic nightmare.

Rich questioned the wisdom of Welch in choosing someone like Adolph Meyer to run Hopkin's psychiatry. Meyer seemed such a far cry from Hopkins neurologist D.J. McCarthy, previously on staff at Phipps Tuberculosis[7], and an authority on tuberculous of the nervous system in infants and children. McCarthy not only knew that cerebral tuberculosis occurred with much greater frequency in infancy and childhood than realized, but reported a distinct and causative relationship between tuberculosis and adolescent schizophrenia itself. In fact McCarthy's investigation at Johns Hopkins Phipps tuberculous pavilion  for the mentally ill revealed that practically all of the patients isolated there where schizophrenic.  This seemed particularly relevant when taken in the light of Lauretta Bender's argument that children with autism generally grow up to have schizophrenia anyway. [Ibid]

Although eventually the term "childhood schizophrenia" was displaced altogether, there were nevertheless some children who displayed both the early-appearing social and communicative deficits characteristic of autism and the emotional instability and disordered thought processes that resembled schizophrenia.

Rich wondered if either Kanner or Meyer had as extensive a knowledge of the infectious orientation of German psychiatry as did pathologist William Henry Welch, who once walked with its giants.

REFERENCES:

1. Walia R Hoskyns W Tuberculous meningitis in children: problem to be addressed effectively with thorough contact tracing Eur J Pediatr. 159(7):535-8 2000 Jul

2. Weaker NJ Jr Connor JD Central nervous system tuberculosis in children: a review of 30 cases. Pediatr Infect Dis J 9:539-543 1990

3. Garg PK tuberculosis of the central nervous system. Post grad Med J 75:133-40 1999

4. Gutierrez KM, Prober CG Encephalitis Postgraduate Medicine 103(3): 123-5, 129-30, 140-3 March 1998)

5. Meynert T Uber die Nothwendigkeit und Tragweitge einer anatomischen Richtung in der Psychiatrie Wiener Medizinische Wochenschrift, 18:573-76, May 1868

6. Adolphus Knoff,   The Period of Life At Which Infection From Tuberculosis Occurs Most Frequently, The American Journal of Public Health, pp. 934-952, Sept, 1915).

7. McCarthy D.J.    Tuberculous Affectations of The Nervous System In Infancy and Childhood in Tuberculosis in Infancy And Childhood Ed. By T.N. Kelynack, MD. William Wood and Company pp. 376,  p.43-54, 1908.

 

Psychiatric Asylums on the European and American continent, late Nineteenth Century

 

When Johns Hopkins pathologist William Henry Welch studied under psychiatrist Maynert, it was in the late nineteenth century, a time during which there was fear that tuberculosis would destroy the entire civilization of Europe. It was also the time that the first massive increase in psychiatric illness and confinement to mental asylums occurred.[1]

And although there was a sociological shift of patients going from family care and poorhouses to 19th century asylums, this in itself could not account for the inexorable increase in asylum census. To distinguished psychiatrist/writer E. Fuller Torrey, severe psychiatric illnesses, such as schizophrenia are comparatively new diseases, less than 250-years-old, the confinement for which, even as a college student, reminded Torrey of the tuberculosis sanitariums of a slightly earlier era.[2]

The upward spiral had became obvious. By 1884, in Germany, Karl Kahlbaum, perhaps the most underrated psychiatrist in history, and the true  originator of American outcome based psychiatric classification, first described schizophrenia as a separate entity. Kahlbaum: "It must be the experience of all psychiatric institutions that the number of youthful patients has recently undergone a considerable increase".[3][4]  It was between  1700 to 1900 that tuberculosis was responsible for the deaths of approximately one billion (one thousand million) human beings. The annual death rate from TB when Koch discovered its cause was an incredible seven million people per year.

During this time frame there was no autism as understood by Leo Kanner, just the autism Bleuler used to describe schizophrenia.

There were others who also saw this 19th century ground-swell of mental illness as representing something new, including auditory hallucinations as never witnessed before. Historians like Hare and Wilkins, among others, point out that it was only then that schizophrenia, with its a hallucinations and delusions, was really even mentioned, representing no small part of the late Nineteenth century psychiatric flare-up.[5][6]

Almost unheard of in the medical literature before this, chronic delusions and hallucinations – such as hearing voices, became common in asylum admissions at the same time Clouston, by 1892, was documenting them in mental illness as a result of a killer pandemic of tuberculosis.[7]

Max Jacobi, the originator of the school that infectious illness led to mental illness, was the first to ascribe characteristic symptoms for this associated with tuberculosis[8].  Just as

About the Author

Jack Kelly is a freelance writer.

Lawrence Broxmeyer, MD, is currently a licensed internist and medical researcher. He was on staff at New York affiliate hospitals of SUNY Downstate, Cornell and New York University for approximately 14 years. He pursued as lead author and originator, a novel technique to kill TB and the mycobacteria with outstanding results. [The Journal of Infectious Diseases 2002 Oct 15;186[8]:1155-60]. Recently he wrote a chapter for Sleator & Hill's textbook Patho-biotechnology, published by Landes Bioscience. Http://drbroxmeyer.netfirms.com



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