Autism in Baltimore, 1938–1943

Abstract

This paper examines the genesis of Leo Kanner’s 1943 seminal paper on autism. It shows that describing children as autistic or lacking affective contact with people was not new by this time. But Kanner’s proposal that infantile autism constituted a hitherto unidentified condition that was inborn and different from childhood schizophrenia was new. It also shows that Georg Frankl’s influence on Kanner was important, but Kanner did not misappropriate his ideas or his research. Kanner developed his views on the basis of his observations of several children, his knowledge of the literature on childhood conditions, and his interactions with many scholars.

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Notes

  1. 1.

    To avoid repetition, quotes from the staff conferences always pertain to the staff conference last referenced, except when otherwise indicated.

  2. 2.

    The recent literature on Asperger has focused mostly on his connections to Nazi ideology (Czech 2018, 2019; Falk 2019; Sheffer 2018), and hence his relationship to Frankl’s work has only been tangentially addressed.

  3. 3.

    Kanner started his now famous 1943 paper with: “Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far…” This sentence has led several authors to speculate about the significance of 1938: was Kanner referring to Asperger’s 1938 paper (Lyons & Fitzgerald 2007)? Or to a paper by Despert (Fellowes 2015)? We agree with Olmstead and Blaxill (2016) that Kanner, clearly, referred to Donald’s arrival in Baltimore.

  4. 4.

    It was not, as Silberman (2015, p. 167) states, “a Johns Hopkins affiliate launched that year [1938] under his supervision.” It was also not directed by Kanner, as often stated.

  5. 5.

    They deserve further historical study, but it is not accurate to present them as ignored figures. See Manouilenko and Bejerot 2015; Zeldovich 2018.

  6. 6.

    It seems that Frankl did not get along with the superintendent at the Home, Ms. Mertz. In a letter to Kanner he notes with happiness that “the Mertz storms are over” (Frankl 1942); in another he says: “Occasionally I get worried that I have become too much of a chameleon. On the other hand, I think I could get along now with Miss Barbe and perhaps even with Miss Mertz” (Frankl 1943a).

  7. 7.

    The minutes of the annual meeting of the Nursery and Child Study Home for 1940 mention that one of the reasons the Home had received fewer children over the last months was that “Displeasure of Dr. Kanner over the dismissal of Dr. Frankl has kept the clinic from sending any children” (Maryland Nursery and Child Study Home 1941).

  8. 8.

    Eventually, Kanner found out that his mother had died in a concentration camp in Bohemia and that one of his brothers had been shot in Poland (Kanner n.d.).

  9. 9.

    Silberman claims that at the Phipps Frankl’s observational work managed “to make autism visible to medicine for the second time” (Silberman 2015, p. 169), while Sheffer argues that Kanner based his first case of autism “on Frankl’s research” (Sheffer 2018, p. 60).

  10. 10.

    He did continue that work in the 1950s, as shown by a copy of an unpublished manuscript (Frankl n.d.) he left at the University of Kansas. Although undated, the paper makes a reference to a roundtable at the American Orthopsychiatric Association meeting of 1953.

  11. 11.

    Czech (2018, p. 33n7) has found evidence that the JHU Library received the issue of the Wiener Klinische Wochenschrift in which Asperger published his 1938 paper. But this does not show that Kanner actually read it, and made the connection.

  12. 12.

    Kanner’s own views would change over the years for a series of complex reasons that are beyond the scope of our paper. Vicedo (2021) discusses the changes in Kanner’s views in detail.

References

NOTE: The following abbreviations have been used in this Reference List: AMC-AMCMA: Adolf Meyer Collection. The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions. LKP-APA: Leo Kanner (1894-1981) Papers. American Psychiatric Association Foundation, Melvin Sabshin, M.D. Library & Archives, Washington, D.C. NCHMC-MHS: Nursery and Child’s Hospital Manuscript Collection, 1879-1970 (MS3180). H. Furlong Baldwin Library, Maryland Historical Society.

  1. Asperger, H. (1938). Das psychisch abnorme Kind. Wiener Klinische Wochenschrift,49, 1314–1317.

    Google Scholar 

  2. Asperger, H. (1944). Die ‘Autistischen Psychopathen’ im Kindesalter. Archiv für Psychiatrie und Nervenkrankheiten,117, 76–136.

    Google Scholar 

  3. Bleuler, E. (1911). Dementia praecox oder Gruppe der Schizophrenien. Leipzig: Franz Deuticke.

    Google Scholar 

  4. Bleuler, E. (1912). The theory of schizophrenic negativism. New York: The Journal of Nervous and Mental Disease Publishing Company. [Originally published in 1910/11].

  5. Bleuler, E. (1913). Autistic thinking. American Journal of Insanity,69, 873–886.

    Google Scholar 

  6. Bradley, C. (1957, March 19). [Letter to Leo Kanner]. LKP-APA (Box 100695, Folder 35).

  7. Bruck, V., Frankl, G., Weiss, A., & Zak, V. (1932). Erwin Lazar und sein Wirken. Zeitschrift für Kinderforschung,40, 211–218.

    Google Scholar 

  8. Cameron, N. (1938). Reasoning, regression and communication in schizophrenics. Psychological Monographs,50(1), 1–34.

    Google Scholar 

  9. Chown, N. (2012). ‘History and first descriptions’ of autism: A response to Michael Fitzgerald. Journal of Autism and Developmental Disorders,42, 2263–2265.

    PubMed  Google Scholar 

  10. Chown, N., & Hughes, L. (2016). History and first descriptions of autism: Asperger versus Kanner revisited. Journal of Autism and Developmental Disorders,46, 2270–2272.

    PubMed  Google Scholar 

  11. Czech, H. (2018). Hans Asperger, National Socialism, and ‘race hygiene’ in Nazi-era Vienna. Molecular Autism. https://doi.org/10.1186/s13229-018-0208-6.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Czech, H. (2019). Response to ‘Non-complicit: Revisiting Hans Asperger’s career in Nazi-era Vienna’. Journal of Autism and Developmental Disorders,49, 3883–3887.

    PubMed  PubMed Central  Google Scholar 

  13. Despert, J. L. (1938). Schizophrenia in children. Psychiatric Quarterly,12, 366–371.

    Google Scholar 

  14. Donvan, J., & Zucker, C. (2016). In a different key: The story of autism. New York: Crown.

    Google Scholar 

  15. Evans, B. (2017). The metamorphosis of autism: A history of child development in Britain. Manchester: Manchester University Press.

    Google Scholar 

  16. Eyal, G., Hart, B., Onculer, E., Oren, N., & Rossi, N. (2010). The autism matrix: The social origins of the autism epidemic. Cambridge: Polity Press.

    Google Scholar 

  17. Falk, D. (2019). Non-complicit: Revisiting Hans Asperger’s career in Nazi-era Vienna. Journal of Autism and Developmental Disorders,49, 1–12.

    Google Scholar 

  18. Feinstein, A. (2010). A history of autism: Conversations with the pioneers. New York: Wiley.

    Google Scholar 

  19. Fellowes, S. (2015). Did Kanner actually describe the first account of autism? The mystery of 1938. Journal of Autism and Developmental Disorders,45, 2274–2276.

    PubMed  Google Scholar 

  20. Fitzgerald, M. (2008). Autism. Asperger’s syndrome-History and first descriptions. In J.L. Rausch, M.E. Johnson, & M.F. Casanova (Eds.), Asperger’s disorder. New York: Informa Healthcare.

    Google Scholar 

  21. Frankl, G. (1934). Gefehlen und Gehorchen: Eine heilpädagogische Studie. Zeitschrift für Kinderforschung, 42(3), 463–479; 43(1), 1–21.

  22. Frankl, G. (1937a). Über postenzephalitischen Parkinsonismus und verwandte Störungen im Kindesalter. Zeitschrift für Kinderforschung,46(3), 199–249.

    Google Scholar 

  23. Frankl, G. (1937b). Triebhandlungen bei Dissozialität nach Encephalitis epidemica und anderen psychopathischen Störungen des Kindesalters. Zeitschrift für Kinderforschung,46(5), 401–448.

    Google Scholar 

  24. Frankl, G. [1938a, ca. May 15]. [Letter to Leo Kanner]. LKP-APA (Box 100696, Folder 47).

  25. [Frankl, G.] [1938b]. “Personal and professional history of Georg Frankl, M.D.” LKP-APA (Box 100696, Folder 47).

  26. Frankl, G. (1940, December 2). [Letter to Mrs. Charles J.B. Swindell]. NCHMC-MHS (Box 2, Folder 21).

  27. Frankl, G. (1941a, June 10). [Letter to Leo Kanner]. LKP-APA (Box 100696, Folder 47).

  28. Frankl, G. (1941b, September 21). [Letter to Leo Kanner]. LKP-APA (Box 100696, Folder 47).

  29. Frankl, G. (1942, July 4). [Letter to Leo Kanner]. LKP-APA (Box 100696, Folder 47).

  30. Frankl, G. (1943a, February 16). [Letter to Leo Kanner]. LKP-APA (Box 100696, Folder 48).

  31. Frankl, G. (1943b). Language and affective contact. The Nervous Child,2, 251–262.

    Google Scholar 

  32. Frankl. G. (n.d.). Autism in children: An attempt at an analysis. MSS available from the Spencer Library (University Archives) at the University of Kansas.

  33. Grebelskaja-Albatz, E. (1934/35). Zur Klinik der Schizophrenie des frühen Kindesalters. Schweizer Archiv für Neurologie und Psychiatrie, 34, 244–253; 35, 30–40.

  34. Grinker, R. R. (2007). Unstrange minds: Remapping the world of autism. New York: Basic Books.

    Google Scholar 

  35. Harms, Ernst. (1941, July 22). [Letter to Leo Kanner]. LKP-APA (Box 100695, Folder 24).

  36. Harris, J. C. (2016). Review of Neurotribes, by Steve Silberman, and In A Different Key, by John Donvan and Caren Zucker. Journal of the American Academy of Child and Adolescent Psychiatry,55, 729–735.

    Google Scholar 

  37. Henry Phipps Psychiatric Clinic (1935, December 6). Staff conference. AMC-AMCMA (Unit XII/23, folder 326).

  38. Henry Phipps Psychiatric Clinic (1936, September 30). Staff conference. AMC-AMCMA (Unit XII/23, folder 403).

  39. Henry Phipps Psychiatric Clinic (1938a, October 27). Staff conference. AMC-AMCMA (Unit XII/23, folder 592).

  40. Henry Phipps Psychiatric Clinic (1938b, April 1). Staff conference. AMC-AMCAM (Unit XII/23, folder 549).

  41. Henry Phipps Psychiatric Clinic (1941, April 23). Staff conference. AMC-AMCMA (Unit XII/23, folder 827).

  42. Henry Phipps Psychiatric Clinic (1943a, March 23). Staff conference. AMC-AMCMA (Unit XII/23, folder 944).

  43. Henry Phipps Psychiatric Clinic (1943b, April 6). Staff conference. Copy in Papers of Hilde Bruch, Harris County Medical Archive, Manuscript Collection No. 7, Texas Medical Center Library, Houston Academy of Medicine.

  44. [Jones, C.]. (1940, April). Report of the survey staff. NCHMC-MHS (Box 1, Folder 5).

  45. Kanner, L. (1931). Judging emotions from facial expressions. Psychological Monographs 41(3), 1–91.

    Google Scholar 

  46. Kanner, L. (1934). Work with psychobiological children’s personality difficulties. American Journal of Orthopsychiatry,4, 402–412.

    Google Scholar 

  47. Kanner, L. (1935). Child psychiatry. Springfield, IL: Charles C. Thomas.

    Google Scholar 

  48. Kanner, L. (1937a, May 3). [Letter to Charles Bradley]. LKP-APA (Box 100695, Folder 35).

  49. Kanner, L. (1937b, May 17). [Letter to Charles Bradley]. LKP-APA (Box 100695, Folder 35).

  50. Kanner, L. (1937c). Problem children growing up. American Journal of Psychiatry,94, 691–699.

    Google Scholar 

  51. Kanner, L. (1937d). Prognosis in child psychiatry. Archives of Neurology and Psychiatry,37, 922–928.

    Google Scholar 

  52. Kanner, L. (1938a, May 10). [Letter to Ernest Spiegel]. LKP-APA (Box 100696, Folder 47).

  53. Kanner, L. (1938b, October 26). [Letter to Bernard Sachs]. LKP-APA (Box 100696, Folder 47).

  54. Kanner, L. (1938c, October 27). [Letter to Adolph Meyer]. LKP-APA (Box 100695, Folder 22).

  55. Kanner, L. (1938d, June 23). [Letter to Jakob Lutz]. LKP-APA (Box 100696, Folder 58).

  56. Kanner, L. (1939, January 31). [Letter to US Consul General, Prague]. LKP-APA (Box 100696, Folder 47).

  57. Kanner, L. (1940a, November 11). [Letter to Mrs. Charles J.B. Swindell]. NCHMC-MHS (Box 2, Folder 21).

  58. Kanner, L. (1940b, October 2). [Letter to Mabel Ross]. LKP-APA (Box 100696, Folder 74).

  59. Kanner, L. (1940c, December 2). [Letter to Truman Abbe]. LKP-APA (Box 100695, Folder 31).

  60. Kanner, L. (1941, June 14). [Letter to Georg Frankl]. LKP-APA (Box 100696, Folder 47).

  61. Kanner, L. (1942a, January 19). [Letter to Ernst Harms]. LKP-APA (Box 100695, Folder 24).

  62. Kanner, L. (1942b, October 6). [Letter to Agnes Greig]. LKP-APA (Box 100696, Folder 50).

  63. Kanner, L. (1943a, January 5). [Letter to Ernst Harms]. LKP-APA (Box 100695, Folder 24).

  64. Kanner, L. (1943b, January 5). [Letter to Georg Frankl]. LKP-APA (Box 100696, Folder 47).

  65. Kanner, L. (1943c, June 1). [Letter to Frank Lutz]. LKP-APA (Box 100696, Folder 58).

  66. Kanner, L. (1943d). Autistic disturbances of affective contact. The Nervous Child,2, 217–250.

    Google Scholar 

  67. Kanner, L. (1944). Early infantile autism. Journal of Pediatrics,25, 211–217.

    Google Scholar 

  68. Kanner, L. (n.d.). Autobiography (Freedom from within). LKP-APA (Box 100695, Folder 7).

  69. Krout, M. (1935). Autistic gestures: An experimental study in symbolic movement. Psychological Monographs,46, 1–126.

    Google Scholar 

  70. Künkel, F. (1920). Die Kindheitsentwicklung der Schizophrenen. Monatschrift für Psychiatrie und Neurologie,48, 254–272.

    Google Scholar 

  71. Lesch, E. (Ed.). (1929). Bericht über den vierten Kongress für Heilpädagogik in Leipzig, 11–15 April 1928. Berlin: Springer.

    Google Scholar 

  72. Lutz, J. (1937). Über die Schizophrenie im Kindesalter. Schweizer Archiv für Neurologie und Psychiatrie, 39, 335–372; 40, 141–163.

  73. Lyons, V., & Fitzgerald, M. (2007). Asperger (1906–1980) and Kanner (1894–1981), the two pioneers of autism. Journal of Autism and Developmental Disorders,37, 2022–2023.

    PubMed  Google Scholar 

  74. Manouilenko, I., & Bejerot, S. (2015). Sukhareva—Prior to Asperger and Kanner. Nordic Journal of Psychiatry,69, 479–482.

    PubMed  Google Scholar 

  75. Maryland Nursery and Child Study Home. (1939a, March 7). Minutes of the Board of Directors. NCHMC-MHS (Box 2, Folder 20).

  76. Maryland Nursery and Child Study Home. (1939b, March 29). Minutes of the Board of Directors. NCHMC-MHS (Box 2, Folder 20).

  77. Maryland Nursery and Child Study Home. (1941, February 4). Minutes of the Annual Meeting for 1940. NCHMC-MHS (Box 3, Folder 35).

  78. Minkowski, E. (1927). L’autisme et les attitudes schizophreniques. Journal de psychologie normale et pathologique,24, 465–476.

    Google Scholar 

  79. Minkowski, E., & Targowla, R. (1923). Contribution a l’étude de l’autisme (L’attitude interrogative). Annales médico-psychologiques,81, 421–435.

    Google Scholar 

  80. Olmstead, D., & Blaxill, M. (2016). Leo Kanner’s mention of 1938 in his report on autism refers to his first patient. Journal of Autism and Developmental Disorders,46, 340–341.

    Google Scholar 

  81. Piaget, J. (1923). Le langage et la pensée chez l’enfant. Delachaux et Niestlé: Neuchatel.

    Google Scholar 

  82. Potter, H. (1933). Schizophrenia in children. American Journal of Psychiatry,12, 1253–1270.

    Google Scholar 

  83. Raz, M. (2014). Deprived of touch: How maternal and sensory deprivation theory converged in shaping early debates over autism. History of the human sciences,27, 75–96.

    Google Scholar 

  84. Redlich, E., & Lazar, E. (1914). Über kindliche Selbstmörder. Berlin: Springer.

    Google Scholar 

  85. Rèvèsz, M. (1929). Scheintalente. In E. Lesch (Ed.), Bericht über den vierten Kongress für Heilpädagogik in Leipzig, 11–15 April 1928 (pp. 150–155). Berlin: Springer.

    Google Scholar 

  86. Robison, J. E. (2017). Kanner, Asperger, and Frankl: A third man at the genesis of the autism diagnosis. Autism: The International Journal of Research and Practice, 21, 862–871.

    Google Scholar 

  87. Schleimer, K. (2012). The history of IACAPAP: The International Association for Child and Adolescent Psychiatry and Allied Professions. Available at https://iacapap.org/content/uploads/History_of_IACAPAP-75-YEARS.pdf

  88. Sheffer, E. (2018). Asperger’s children: The origins of autism in Nazi Vienna. New York: W.W. Norton.

    Google Scholar 

  89. Shorter, E., & Wachtel, L. E. (2013). Childhood catatonia, autism and psychosis past and present: Is there an ‘iron triangle’? Acta Psychiatrica Scandinavica,128, 21–33.

    PubMed  PubMed Central  Google Scholar 

  90. Silberman, S. (2015). Neurotribes: The legacy of autism and the future of neurodiversity. New York: Avery.

    Google Scholar 

  91. Silverman, C. (2012). Understanding autism: Parents, doctors, and the history of a disorder. Princeton: Princeton University Press.

    Google Scholar 

  92. Spiegel, E. (1938, May 4). [Letter to Adolf Meyer]. LKP-APA (Box 100696, Folder 47).

  93. Spiegel-Adolph, M. (n.d.). [Address book]. Mona Spiegel-Adolph Collection (Box 1, Folder “Part of a diary, 1932 + address book”). Leo Baeck Institute Archives, New York. Digitized version available: https://www.archive.org/stream/monaspiegeladolf01spie#page/n443/mode/1up

  94. Ssucharewa, G. E. (1926). Die schizoiden Psychopathien im Kindesalter. Monatsschrift für Psychiatrie und Neurologie,60, 235–261.

    Google Scholar 

  95. Ssucharewa, G. E. (1927). Die Besonderheiten der schizoiden Psychopathien bei den Mädchen. Monatsschrift für Psychiatrie und Neurologie,62, 171–200.

    Google Scholar 

  96. Sterwald, C., & Baker, J. (2019). Frosted individuals: How Dr. Leo Kanner constructed the autistic family. Perspectives in Biology and Medicine,62, 690–709.

    PubMed  Google Scholar 

  97. Vicedo, M. (2021). Intelligent love: The story of Clara Park, her autistic daughter and the myth of the refrigerator mother. Boston: Beacon.

    Google Scholar 

  98. Vicedo, M., & Ilerbaig, J. (2020). Leo Kanner’s call for a pediatric-psychiatric alliance. Pediatrics,145(6), e20194047.

    PubMed  Google Scholar 

  99. Weiss, A. B. (1935). Qualitative intelligence testing as a means of diagnosis in the examination of psychopathic children. American Journal of Orthopsychiatry,5, 154–179.

    Google Scholar 

  100. Weiss-Frankl, A. B. (1939). Professional training and experience. LKP-APA (Box 100696, Folder 48).

  101. Weiss-Frankl, A. B. (1940, December 4). [Letter to Adolph Meyer]. AMC-AMCMA (Unit I/1238, Folder 1).

  102. Welsch, E. E. (1942, June 23). [Letter to Leo Kanner]. LKP-APA (Box 100696, Folder 47).

  103. Zeldovich, L. (2018, November 10). How history forgot the woman who defined autism. Scientific American. Retrieved January 29, 2020. https://www.scientificamerican.com/article/how-history-forgot-the-woman-who-defined-autism/.

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Acknowledgments

We gratefully acknowledge the help received from the following archivists: Marjorie Kehoe and Phoebe Evans Letocha at the The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions, and Deena Gorland and Gary McMillan at the American Psychiatric Association Foundation, Melvin Sabshin, M.D. Library & Archives, Washington, D.C. Thanks to John Robison, Frederik Boven, and two anonymous reviewers for their helpful comments. Thanks to Mark Solovey for useful feedback on content and form. Marga Vicedo also gratefully acknowledges funding from the Social Science Research Council of Canada Insight Grant’s Program.

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Marga Vicedo: Social Science Research Council of Canada Insight Grant.

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All authors contributed to the study conception and research of this study. All authors wrote drafts and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Marga Vicedo.

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Approval was obtained from the University of Toronto Human Research Ethics Board (Protocol #30993), and Waiver of Authorization for Research Use or Disclosure of Protected Health Information from the John Hopkins Medical Institutions Privacy Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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A code for the children mentioned was developed and deposited at the The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

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Vicedo, M., Ilerbaig, J. Autism in Baltimore, 1938–1943. J Autism Dev Disord (2020). https://doi.org/10.1007/s10803-020-04602-4

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Keywords

  • Autism
  • Leo Kanner
  • History of autism
  • Georg Frankl
  • History of psychiatry