Part 1 of 3. In February, we began this ongoing series of articles on the roots and rise of autism. Now, at the end of the year, here's a summary of our story so far:
-- Something happened among children born in the early 1930s to bring autism to the attention of Leo Kanner, the eminent and experienced Johns Hopkins University psychiatrist who first described the disorder in a landmark 1943 paper. At the same time, a Viennese pediatrician named Hans Asperger was noticing a remarkably similar, though somewhat less severe, syndrome that came to bear his name.
In our first column, "Donald T. and Fritz V.," we found it amazing that these first two patients -- Donald in the United States and Fritz in Austria -- were born within four months of each other in 1933. Yet these unique, impossible-to-miss children with Autism Spectrum Disorders had been around in similar numbers since the dawn of time?
Experts disagree, but our first and still-tentative conclusion is that's just plain unlikely. Scattered cases, sure. But 1 in 166, the current U.S. autism rate in children? We don't see it.
-- Instead, it appears more likely something happened around 1930 to set off the age of autism. Clearly, there are clues in the striking commonalities among the first U.S. families stricken with the disorder. They were college-educated; many had advanced degrees; four of the fathers in the first 11 families identified by Kanner were medical doctors -- psychiatrists, to be precise. There were professors, lawyers, scientists, engineers. One mother was also a doctor, and all of them were smart, accomplished women.
Some think that suggests a "geek effect," in which gummed-up genes finally find each other and generate offspring who aren't just brainy and distracted, they're downright autistic. Based on our own reporting, we don't buy that -- where were all the autistic offspring of geeks before 1931, the year the oldest child ever diagnosed by Kanner was born?
Coincidence or not, 1931 appears to be the first year in which U.S. vaccines contained a mercury preservative called thimerosal, and that yields an alternate hypothesis that could explain the decisive increase in cases that we think is probable. Some parents and a minority of scientists now believe thimerosal -- which is about half ethyl mercury by weight -- is behind most autism cases, perhaps triggering the disorder in a genetic subset of children who lack the ability to excrete it.
Although it wasn't fully understood at the time, organic mercury is a potent neurotoxin in even minute quantities; beginning in 1999 thimerosal was phased out of routine childhood immunizations, though federal health authorities say it is safe in that form, and they stand by its continued use in flu shots for pregnant women and toddlers.
An alternative to the "geek theory" is that those first 11 families back in the 1930s -- especially the ones with links to the medical world -- would have had had the information, income and access to take advantage of the latest health innovations and vaccinate themselves and their children.
A related hypothesis was proposed to us by Mark Blaxill, a director of the anti-mercury-in-medicine group SafeMinds. He suggested an association between several more of those first 11 cases and ethyl-mercury-based fungicides that came on the market at the same time, patented by the same scientist who developed thimerosal.
Case 1 in Kanner's study -- Donald T., born in 1933 -- came from an area surrounded by a forest being replanted with seedlings by the Civilian Conservation Corps.
Case 2's father was a plant pathologist. Case 3's was a forestry professor at a Southern university. Case 4's was a mining engineer. Case 8's was a chemist-lawyer at the U.S. Patent Office. All of them might have come in contact with mercury or other toxic compounds.
Given this intriguing though by no means conclusive set of associations, it's possible those parents were not in fact passing on malignant mutations of the genes that made them doctors, forestry professors, plant pathologists, chemists. Rather, through their particular professions they might have exposed their children to something wholly new in commercial medical and agricultural products, something they did not know was devastatingly neurotoxic to developing brains.
That might make the age of autism, in effect, the age of organic mercury.
Not that it proves anything, but looking back recently through the groundbreaking book "Infantile Autism" by Bernard Rimland, something struck us that we hadn't noticed before. This 1964 work is widely credited with single-handedly debunking the idea that "refrigerator mothers" or aloof fathers caused autism.
Reviewing the rare descriptions of children with autistic-type behavior prior to Kanner's 1943 paper, Rimland noted a case that "sounds very much like autism." That child's father, Rimland said, "was a Ph.D."
A professor of chemistry.
That's the kind of detail that means nothing to the experts looking for incredibly complex gene interactions to explain autism, but it makes our layman's hair stand on end.
As we pressed to find more about those early cases, the trail led all the way back to Case 1 himself, and to a small town in Mississippi.
We'll go there next.