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Published: Nov. 9, 2006 at 7:37 PM
By DAN OLMSTED
UPI Senior Editor
WASHINGTON, Nov. 9 (UPI) -- Does it matter that Donald T., the first child
diagnosed with autism in the 1930s, also had a rare and mysterious autoimmune
disorder that nearly killed him?
The disorder, called Still's disease, is a systemic form of juvenile rheumatoid
arthritis (JRA) in which the
immune system inexplicably
attacks the body. The cause is unknown but might be some kind of outside
exposure like a virus, experts say.
As I've noted before, both Donald's arthritis and his autism appeared to improve
significantly after treatment with gold salts, then a standard remedy for JRA.
But doctors at Johns Hopkins Hospital, where Donald and 10 other children were
first diagnosed with the distinct disorder called autism, never seemed to notice
the possible connection.
They credited gold salts with curing his JRA. But they believed the improvement
in his autistic symptoms was due to an unlettered but loving farm couple Donald
went to live with near his hometown in
Mississippi -- at their
suggestion. The clear implication was that Donald's own parents -- his father
was a "brilliant" Yale-educated lawyer -- might have contributed to his autism
through poor parenting or some other family dynamic. That kind of mistaken (and
fundamentally arrogant) assumption has haunted the search for autism's cause
ever since.
But back to Still's disease, which beset Donald in 1947 when he was 12 years old
and living with that farm couple. According to my interview with his brother in
2004, Donald's sudden illness was so baffling that even the Mayo Clinic couldn't
diagnose it. Instead, a doctor in a nearby town finally suggested JRA based on a
conversation with Donald's father, who told him, "It looks like Don's getting
ready to die."
Here's how Leo Eisenberg of Johns Hopkins described it in the 1956 scientific
paper I recently came across:
"The (farm) boarding arrangement had to be terminated when Donald ... developed
an undiagnosed illness manifested by fever, chills, and joint pains. He became
bedridden and developed joint contractures. On the basis of a tentative
diagnosis of Still's disease, he was placed empirically on gold therapy with
marked improvement. ...
"The clinical improvement in his behavior, first observed during his rural
placement, was accelerated during and after his illness and convalescence at
home. He was able to enter and graduate from high school. At present he is doing
well in his studies at a Junior College, where he was elected a class officer.
He plans to attend a small local liberal arts college."
Put aside the glaring lack of interest in gold salts' possible impact on
Donald's autism, and focus instead on how strange this situation was.
Because Donald's was the first case of autism ever formally diagnosed, trying to
estimate its prevalence at the time is no easy thing. Suffice it to say that
autistic children were rare; let's use the widely accepted early figure of 1 in
10,000 children (it's more like 40 per 10,000 today).
Now, how rare is Still's disease? It looks to be even rarer, but for
simplicity's sake let's put it at 1 in 10,000 as well. Doing the math -- 10,000
times 10,000 -- suggests that having the two separate disorders just by chance
is a 1-in-a-billion shot. Effectively, Donald would have been the only person in
America in 1947 who just happened to have both.
And on top of that, he's autism's Case 1?
Oh, brother. This does not compute. In search of answers, I went back and looked
up Still's disease. It's named for Sir George Frederic Still, an English
physician who first described it in 1887. One of the characteristics was a
peculiar, transient "salmon-pink" rash.
That reminded me of something -- Pink's disease. Pink's (also called Pink) was a
mysterious and sometimes fatal affliction in children: "The symptoms include
weepy red rash, peeling skin, lethargy, anaemia, sensitivity to light,
respiratory distress and general ill health," according to the Pink Disease
Support Group. Other sources refer to the "joint pains." It's fatal in about a
quarter of cases.
And what caused Pink's?
"Pink Disease is babyhood mercury poisoning. Some babies are hyper-sensitive to
mercury, and if those babies are exposed to mercury, they get Pink Disease. The
most commonly used product containing mercury was teething powder, but other
products frequently used on babies also contained mercury.
"After it was discovered that mercury was the cause of Pink Disease in 1947,
mercury was removed from all teething powders and Pink Disease became rare."
An intriguing article from 1943 in the Journal of Pediatrics is titled "Pink
Disease (Infantile Acrodynia)," the formal name of the disorder. One section
begins, "The Nervous Child and Pink Disease. -- The manifestation of pink
disease in older children ... has received comparatively little attention by the
English-speaking word. ...
"It is of interest that such children as these are disturbed emotionally; they
are 'nervous children' and ... they conform to the 'nervous child' syndrome. "
"The nervous child." I can't help but remember that the first scientific report
of autism, by Leo Kanner at Hopkins, was in a journal called ... The Nervous
Child. Nor can I forget how Donald's brother described the impact of the gold
salts: "The nervous condition he was formerly afflicted with was gone. The
proclivity toward excitability and extreme nervousness had all but cleared up."
It was, he said, a "miraculous response to the medicine."
I'm not suggesting Donald had Pink's disease. But I do wonder if his remarkable
recovery across the board should have raised a lot more questions a long, long
time ago.
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