One of Dr Down's contemporaries was Dr Isaac Kerlin, then considered a leader in the field of 'mental retardation'.  He was the superintendent of the Pennsylvania Institute for Feeble-Minded Children in the US for many years: a school whose pupils included those with intellectual and developmental disabilities (some of whom also fit the criteria for ASD) alongside those with minor behavior problems and even some who would probably be considered delinquent today.  

Kerlin was a deeply religious man who would not tolerate ill-treatment of his patients; prohibiting  switches, canes and sticks, although his views on castration and sterilization were certainly unpalatable. Even so he has something to add to the tale because he chronicled his work with what he termed 'imbeciles' in his book The Mind Unveiled. 

And it is there that we find Beckie,  a mute girl whose 'eyes dance with intelligent delight'.   We also learn that she hadremarkably good hearing and was initially thought to be in relatively good health - until she began teething.  At that point everything changed and she developed 'repeated nervous twitchings' and, although initially slow to walk, she then became hyperactive. 

We also find that she preferred solitude,  had 'eccentric' amusements and seemed 'more like a spiritual than a physical existence' - and was very mischievous (similar to the behavior later  noted by Hans Asperger amongst some of the children he assessed).  Thus Beckie would approach her teacher as if she was going to kiss her - and then bite her cheek instead; store various bits and pieces in the chimney flue, or knock things over.  He also notes that she would fly into a rage if her routines or habits were interrupted and could become self abusive at times. 

Interesting too to note that she eventually began to say a few words but after a fever, would only speak when she thought she was unobserved.    

Kerlin also gives details of some of his other charges who also seem to fit the criteria for ASD of whom I'll mention just two.  Thus Lizzie was semi mute, partially deaf and eccentric and scared of noise and,  as he wrote, was  ' . . in continual apprehension; dread was graven deeply in the tracings of her otherwise pretty face'.   Edwin, the second, never spoke and whose needs had to be anticipated. 

Dr Martin W. Barr,   Kerlin's successor,  would also work at the Institute for many years finally retiring in 1930.   Even though he too is a very controversial figure (advocating sterilization) his books add to the picture by giving an insight into the family background of his charges.  Thus in several instances he noted: 'grandfather always angry and reclusive;  father/mother very eccentric/peculiar' and so on. 

Barr also found that several of the children had some 'difference' at birth although most seemed to develop normally until illness or fever struck; after which they began to have seizures or developed noticeable  'peculiarities'. 

Thus J,   who had 'deficient animation at birth',   developed epilepsy when teething  and MR, who was normal until she had typhoid at the age of 3,  became mute, excitable and - after initially losing the ability to walk - was constantly on the move. 

He also noted that (like Beckie) such children would also often regress if they became ill later - mentioning one child (already echolalic to a degree) who after contracting diphtheria when he was ten  began to spend all and every day instantly repeating everything he heard  –   in the tone of voice, accent and even language it was spoken in. 

Meanwhile back in the UK Dr George Grabham, one of Dr Down's  successors at Earlswood, published his own observations of such children in the British Medical Journal (BMJ) - a magazine that continues today.  He added typhoid and whooping-cough to the list of things that could cause such problems and also noted that many such children had digestive problems saying:

Assimilation is very imperfectly performed ; the food, if not very digestible, sometimes passing most unchanged. Diarrhea in some is the rule rather than the exception. . . .

   He also observed that some children seemed to be more under-sensitive than their peers, writing:

In many patients, general sensation is very low in degree, the extraction of a tooth or a toe-nail causing little or no pain. A child, who had severely burned his hand by holding it in a gas-flame, took the first opportunity after recovery to endeavor to renew an experience which to him did not appear painful. . .

Time now to leaving the institutions behind and turn instead to one particular hospital: Great Ormond Street Hospital for Children (GOSH) in London, England.  Researchers Mitzi Waltz and Paul Shattock OBE (who has a personal interest in autism) have examined some of the case histories of Dr William  Howship Dickinson,  who worked there between 1869 and 1874.  

Dr Dickinson took a keen interest in the effects of ill-health on brain function and behavior in children, meticulously noting his observations on around 390 children with a wide variety of conditions; of whom Waltz and Shattock believe 24 to have had symptoms which today would be characteristic of ASD

One such was Ralph,  who was admitted to the hospital when only 2½ years old.  His birth was described as normal and rapid rather than prolonged, although he had developed severe feeding and gastrointestinal problems (multiple bouts of diarrhea) at around 8 months, the first attack of which lasted 5 weeks. By the time he was just 3 months old his parents were concerned for they had began to notice that he displayed some unusual behaviors, like fixing his gaze on one thing for long periods of time whilst ignoring everything else. His development was slow and by the age of 18 months they found that he 'follows things with his eyes, but they often roll.'

Still unable to walk, when admitted to hospital the staff also observed that, whilst he apparently saw and heard, he did not understand when spoken to and, although he had screaming fits, his speech was almost non-existent. Ralph also made various repetitive movements which included rubbing his eyes with his fists or hitting them, kneading his hands, watching his hands move, pulling his toes, rolling and jerking his head, and stretching his neck in an odd way whilst hitting himself in the face with any toys he was given.   While we may not know what happened to young Ralph,  Dr Dickinson's description certainly seems to correlate to what today we would associate with that of severe autism.

So once again all the evidence suggests that such problems existed long before Kanner and Asperger came on the scene:  some being left to fend for themselves, some sheltered by their families, some confined to institutions; others found in hospitals. 

But what of those whose symptoms were less severe?  Will we find them in the past too?  Perhaps my next article will answer that question.

Adapted from The Cracks in the Code - the first book in the new series The Autism Code.

Author's Bio: 

Stella Waterhouse is a writer and therapist who has worked children and adults with a variety of learning differences since the late 1960’s.

In the mid 1980s Stella worked at a residential home for approximately 40 adults with Autistic Spectrum Disorders (ASD), where she became Deputy Principal.

In the 1990s Stella set out to write a short book on the role of anxiety in autism., which at that time received little attention. Her research led her to investigate the causes of ASD as well as role of sensory disorders - particularly those of an auditory or visual nature.

The original ‘short’ book evolved into a much larger project and has so far spawned two full length books including A Positive Approach to Autism - Jessica Kingsley Publishers, plus a series of short books for parents and teachers all of which are currently available as e-books.

Stella is currently completing her new series The Autism Code. For more information on Stella and her products please visit