History of FASD by Peggy Seo Oba, RDH, MPA, MBA
This paper was accepted for presentation for the Fourth International Elsevier Conference on Child and
Adolescent Mental Health in Mumbai, India in 2006 and the 2005 Fetal Alcohol Spectrum Disorders
Conference sponsored by the University of British Columbia in Victoria, British Columbia.
Peggy Seo Oba, RDH, MPA, MBA
FAS in Japan: http://members.aol.com/psoba/myhomepage/family.html
FAS in Japanese: http://www.geocities.jp/fas_japan/
FAS in Chinese: http://www.jurois.com/JUROWEB/FAS/HOME.htm
Sindrome Alcoholico Fetal en Japon: http://www.jurois.com/JUROWEB/FAS/SPANISH/HOME.htm
Eleven year member and resource person for the FASLink
http://www.faslink.org
Six Year Member Steering Committee
Trainer and Technical Assistant
Member of Expert Panel
FASD Center for Excellence
http://fascenter.samhsa.gov/
Fetal Alcohol Syndrome Information Network
Significance of Study
For many years, it has been assumed that Fetal Alcohol Syndrome is a “new” malady. Although the etiology
of the disorder was first mentioned in 1968 paper by Dr. Paul Lemoine, it does not mean that the symptoms
were not recognized years if not centuries before. Although not each citation is a study in the earlier
centuries, it is evident that these observations detected a connection between drinking alcohol and the
unsuccessful outcomes for the resultant offspring by several observers. As scientific procedures were applied
in the 20th Century, notes and case studies seem to more clearly reflect an obvious pattern of behavior that
might indicate that these modern researchers were observing children with prenatal alcohol exposure. And if
they wrote about these children/adults and included chapters on them, then there must have been enough
cases appearing on a regular basis that they felt the behaviors and their observations were more than an errant
anomaly.
There has often been a question as to the frequency of occurrence of FASD. Many researchers ask, “If
maternal alcohol consumption is such a problem, why did we not hear about it before 1968? Modern
estimates have ranged from 9.7 per 10,000 births to almost 1 per 100. The lower estimates do not reflect the
occurrence of the non-physical forms of FAS [also called Fetal Alcohol Effects (FAE), partial FAS (pFAS),
Prenatal Effects of Alcohol (PEA), Alcohol Related Birth Defects (ARBD) and Alcohol Related
Neurodevelopmental Disorders (ARND)…all of which are now grouped under the term Fetal Alcohol
Spectrum Disorders (FASD)], where only the brain is affected. FAE, pFAS, PEA, ARBD, ARND or FASD
without the physical signs is thought to occur 3-5 times more often than the full FAS which has both physical
and behavioral manifestations. Studies are seldom done on conditions that rarely occur. Therefore, the
existent studies and records of conditions that closely resemble FASD but not properly named could mean
that un-named FASD cases existed in enough numbers to be observed and scientifically recorded as far back
as the 16th Century.
There are some important caveats to this study. The researchers of this period were limited by the number of
patients they could see and the limitation of correspondence and publications available during their lifetimes.
Note that the Gutenburg Press was first developed in 1450. Prior to that time, books were copied by hand and
there was not any widespread use because of the prohibitive cost and educational exclusivity. Also, books
printed for a few centuries after the invention of the movable press are considered to be rare and difficult to
obtain until the general population gained the ability to read and write and generated a greater interest in
printed books and articles.
The words and phrases used in these studies are in the language of the period. The labels and descriptive
phrases do not necessarily have the same connotations then as they do now. And the different combinations
of the words often carry a much different meaning. For example, having a neurosis is very different from
having a neurotic character…the latter considered to be less definitive, more of a lifelong problem and less
likely to have a program of treatment than an episodic condition that might be remedied.
It is also important to note that each of the researchers appears to have recognized a particular facet of FASD
without recognizing there are other behaviors that may be attributed to the same cause. This is due to the
nature of FASD which follows a wide spectrum of physical and behavioral characteristics. Thus, no one
researcher can be said to have found the connection between the various characteristics until after 1973.
Finally, contrary to popular opinion, there are, in all probability, several hundred articles and books that have
dealt with unrecognized FASD over the centuries. I am constantly finding new ones. If I have left some out,
it was because I have not yet found them. This present set of information probably represents only 20% of
my current file. This is a work in progress, therefore, it is very incomplete.
Items offset by a *** boundary are those articles that are considered to be pivotal in refuting the research that
indicated that maternal drinking caused physical and mental problems in the offspring. I included them
because they give an idea of when the researchers started to deny the connection between maternal drinking
and fetal damage.
Editions of the Merck Manual for physicians and medical personnel (1950-2005) have been added in order to
demonstrate what is being taught in psychiatry and psychology classes. This includes description of the
conditions and the treatments and/or recommended therapies.
Notations on the printings of the Special Reports to Congress on Alcohol and Health (1978-2000) were
added because of the extensive amount of current research that was presented in each report and because the
bibliographies indicate the large number of researchers presently in the field. It also marks the entrance of the
federal government into the recognition of Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders.
Other notations on various landmark decisions, laws or studies on FAS were included to compare the action
of the government and of the medical community.
Biblical References. Exodus, 20:5: “…visiting the iniquity of the fathers upon the children unto the third and
fourth generation…” (Fathers, in this case, may be thought of as parents in general.)
Judges, 13:3-5: “…you shall conceive and bear a son…take no wine or strong drink and to eat nothing
unclean…for this boy is to be consecrated to God from the womb.” (Said to Samson’s mother and not to the
Jewish community in general.)
814-146 B.C. Carthage (city-state) in Northeast Africa. From “The Effects of Drinking on Offspring” by
Rebecca Warner and Henry L. Rosett in Journal of Studies on Alcohol, (1975. Warner and Rosett mention
that the ancient civilization of Carthage (814-146 B.C.) forbid the use of alcohol for newlyweds. Cited from
Robert Burton’s Anatomy of Melancholia (1621). This information has also been variously cited J.P. Frank
in System einer vollstandingen medicinischen Polizei (1784) and by Haggard and Jellinek in Alcohol
Explored (1944).
725-371 B.C. Sparta (city-state) in Greece. From “The Effects of Drinking on Offspring” by Rebecca Warner
and Henry L. Rosett in Journal of Studies on Alcohol, (1975. Warner and Rosett mention that the ancient
civilization of Sparta (725-371 B.C.) forbid the use of alcohol for newly weds. This is cited from Robert
Burton’s work, Anatomy of Melancholia (1621).
Plutarche’s Life of Lycurgus, on Sparta, “In order to the the good educationof their youth, he went so far
back as to take into consideration their veryconception and birth by regulating the marriages.” From an
article in the British Medical Journal by Dr. John Haddon (1876). [Plutarche also suggested that pregnant
women exercise.]
500 B.C. Buddhism’s Five Precepts warn against strong drink. From East Asia: The Great Tradition by
Edwin Reischauer. (1958) Harvard: Harvard University Press.
427-347 B.C. Plato’s Laws. From “The Effects of Drinking on Offspring” by Rebecca Warner and Henry L.
Rosett in Journal of Studies on Alcohol, (1975). 1397, Robert Burton’s Anatomy of Melancholia (1621)
noted that Plato (427-347 B.C.) recommended that newly married couples forgo alcohol…”…that the child
that is begotten may be sprung from the loins of sober parents.” The last quote is from Ernest Abel in Fetal
Alcohol Syndrome and Fetal Alcohol Effects (1984).
322 B.C. Aristole’s Problemata. From a journal study by A. Lynn Martin. (2003) “Fetal Alcohol Syndrome
in Europe, 1300-1700: A Review of Data on Alcohol Consumption and a Hypothesis”. Food and Foodways.
Martin mentions the work of Robert Burton’s Anatomy of Melancholia (1621), in which he talks of ancient
Greek authorities (Aristole in Problemata in 322, B.C.) who stated, ” Foolish, drunken or hair-brained
women, for the most part bring forth children like unto themselves, morose and languid.”
120 A.D. Plutarche in Symposiacs. From “The Effects of Drinking on Offspring” by Rebecca Warner and
Henry L. Rosett in Journal of Studies on Alcohol, (1975), Burton in Anatomy of Melancholia (1621) is also
said to have quoted Plutarch (120 A.D.), “..one drunkard begets another…”
130-180 A.D. Aulus Gellius (Roman). From “The Effects of Drinking on Offspring” by Rebecca Warner and
Henry L. Rosett in Journal of Studies on Alcohol, (1975), Robert Burton reported Gellius (130-180 A.D.), a
Roman diarist, is cited as saying, “…if a drunken man get a child, it will never likely have a good brain.”
200-500 A.D. Babylonian Talmud, Kehuboth, 32b, warns, “One who drinks intoxicating liquor will have
ungainly children.” From Michael Dorris’ The Broken Cord (1989).
1450. Gutenberg Press invented. Books printed after this period were expensive and rare. Because of the exclusivity of
education to the upper classes, the majority of the population during the 15th and 16th centuries could neither read nor
write.
1621. Ibid from A. Lynn Martin. Martin mentions the work of Burton’s Anatomy of Melancholia (1621), in which he talks
of ancient Greek scholars and the topic of drinking during sexual activities and the outcome of the children. Burton’s
work is also cited in Warner and Rosett (ibid).
1627. Sir Francis Bacon in Sylva Sylbarum (p.665) writes, “…if the mother eat onions or beans, or such vaporous food;
or drink wine or strong drink immoderately; or fast too much;…it endangereth the child to become lunatic, or of
imperfect memory…” From Ernest Abel’s Fetal Alcohol Syndrome and Fetal Alcohol Effects (1884).
1638. Another writer in Martin’s article in Food and Foodways, Richard Young in his The Drunkard’s Character (1638)
writes, “…many of our children are half killed before they are born with distempered drink.”
Note: Martin also found three references by 17th Century writers who blamed the drinking of the fathers for the
behaviors of their offspring.
At the end of his journal piece, Martin asks, “What became of of those born with fetal alcohol syndrome or fetal alcohol
effects who survived? Did the world we have lost contain many people who were hyperactive with poor attention
spans, who behaved in an impulsive and uninhibited manner, and who had low intelligence?”
(Note: An FAS family from Canada has surmised that many of these children were probably placed in a religious
setting. The strict rules and unwavering schedules would have been perfect for adults dealing with the problematic life
of FASD.)
1714. First official recognition of the insane during the reign of Queen Anne (England). From Victorian
Lunatics: A Social Epidemiology of Mental Illness in Mid-Nineteenth Century England. by Marlene A.
Arieno (1989).
1720 to 1751: Gin epidemic in England. First incidence of vast production of alcohol because of distilling.
1725. “British Physicians on the Dangers of Alcohol: Petition to the House of Commons.” in Drugs in
America: A Documentary History by David F. Musto. (2002) 26-35. In 1725, London physicians petitioned
the British House of Commons to solve the unbridled consumption of distilled spirits using as one of their
arguments that distilled alcohol affected the parents who were “…too often the cause of weak feeble and
distempered children, who must be, instead, of an advantage and strength, a charge to their country.”
Sedgewick, J. (1725) A New Treatise on Liquors, wherein the Use and Abuse of Wine, Malt-Drinks, Water
etc. are Particularly Consider’d in Many Diseases, Constitutions and Ages; with the Proper Manner of Using
Them, hot, Cold, either as Physick, Diet or Both. London: Charles Rivington.
Establishment of Hook Norton, one of the earliest private sanatoriums in England. From Victorian Lunatics:
A Social Epidemiology of Mental Illness in Mid-Nineteenth Century England. by Marlene A. Arieno (1989)
24. Dr. Arieno notes that most people in English asylums came from the merchant and labor classes. She
writes that there was a sharp and steady rise in the proportion of the insane in the nineteenth century. In 1807,
the insane made up .00023 percent of the population but by 1890, they made up almost .003 percent of the
population. Among the indigent population, from 1844 to 1860, the increase was 96 percent. Dr. Arieno did
not consider if there was any correlation due to the increase in the consumption of alcohol.Sedgewick, J.
(1725) A New Treatise on Liquors, wherein the Use and Abuse of Wine, Malt-Drinks, Water etc. are Particularly
Consider’d in Many Diseases, Constitutions and Ages; with the Proper Manner of Using Them, hot, Cold, either as
Physick, Diet or Both. London: Charles Rivington.
1730. From Drugs in America: A Documentary History edited by David F. Musto (2002), excerpts from an essay by
Stephen Hales, an Anglican priest and an early researcher on the effects of alcohol. Please note that Hale was
referring to distilled spirits. Like many of his time, he believed that brewed alcohol contained no such dangers; many
people today still believe this.
“Nay, the unhappy influence of these liquors reaches much farther than to the destruction of those who indulge in the
use of them, even to their posterity, to the children that are yet unborn. Of this we have we have too frequent
instances, where the unhappy mothers habituate themselves to these distilled liquors, whose children, when first born,
are often either of a diminutive, pigmy size, or look withered and old, as if they had numbered many years, when they
have not, as yet, alas! attained to the evening of the first day. How many more instances are there of children, who tho’
born with goodconstitutions have unhappily sucked in the deadly spirituous poison with their nurses’ milk.”
Hales goes on to express his opinion. “Whence it is evident that in proportion as the contagion spreads father and
farther among mankind, so must the breed of human species be proportionately more and more depraved, and will
accordingly degenerate more and more from the manly and robust constitution of preceding generations.”
1751. Fielding, H. An Enquiry into the Causes of the Late Increase in Robbers, etc. with Some Proposals for
Remedying this Growing Evil. London: A.Millar.
William Hogarth prints a lithograph called “Gine Lane”. Modern researchers say the baby in the picture has features
resembling a child with full Fetal Alcohol Syndrome.
1759. Morris, C. A Colletion of the Yearly Bills of Mortality from 1657 to 1758 Inclusive. To which are Subjoined…III.
Observations on the past growth and present State of the City of London; reprinted from the edition printed at London.
London: A. Millar.
1781. Foster, E. The Principles and Practices of Midwifery. London: R. Baldwin.
1785. Dr. Benjamin Rush (one of the signers of the Declaration of Independence and described as the first psychiatrist
in America) in Inquiry into the Effects of Ardent Spirit Upon the Human Body, writing about alcoholics and their effect
on their children. He writes in part “…their children, filthy, and half clad, without manners, principles and morals!” From
Drugs in America: A Documentary History edited by David. F. Musto. (2002) New York: New York University Press.
1800s There is a 26 page article, “The Effects of Drinking on Offspring: An Historical Survey of American
and British Literature” by Rebecca Warner and Henry L. Rosett (1975) in The Journal of Alcohol Studies
which cites 19 articles written in this time period that warn against the use of alcohol when pregnant. The
complete articles are not presently included in this study but I have included the citations in the year they
were written.
1804. An Essay, Medical, Philosophical and Chemical on Drunkeness and Its Effects on the Human Body. by
Dr. Thomas Trotter. London: T.N. Longman and O. Rees, Paternoster-Row. Trotter was one of the first
physicians to describe alcoholism as a disease. Dr. Trotter states. “…and when they marry, they get wenches:
they are generally fools and cowards;”.
“…the habit of temulency (drunkeness) has been said to debilitate the offspring, and produce a puny race. It
is a known law in animal oeconomy, that all secreted fluids partake of the vices of the secerning organ. A
healthy action is required in every gland, that it might secrete healthy juices. We have seen that the mental
functions become deranged, when the brain is injured in its structure. And if this happens, can it be too gross
to suppose, that the organs of generation must equally suffer in both sexes, from frequent intoxication; and if
offspring should unfortunately be derived from such a parentage, can we doubt that it must be diseased and
puny in its corporeal parts; and beneath the standard of a rational being in its intellectual faculties?”
“Infants. …It is well known that nurses…are in the practice of giving spirits in the form of punch to young
children to make them sleep. The effect cannot fail to be hurtful: such children are known to be dull, drowsy
and stupid; bloated in the countenance, eyes inflamed, subject to sickness at stomach, costive constipated),
and pot-bellied.”
“…the food of women who suckle their own children is often very improperly selected. The quanity of the
milk, not the quality of it, is studied. It is well-known fact, that this secretion partakes very much of the the
nature of the diet that is used; that is to say, certain articles passthough the breast unassimilated: vegetables
give a more asccsent(?) milk than animal food; but all drinks, containg ardent spirits, such as wine, punch,
caudle (a warm drink of wine or ale mixed with sugar, eggs, bread and spices), ale and porter (a dark beer
brewed with dark malts), must impregnate the milk; and thus, the digestive organs of the baby must be
quickly injured. These must suffer in proportion to the delicacy of their texture; and the disease which flow
from this souce are cerainly not uncommon. Physicians who have prescribed a diet and regimen for nursing
mothers, have not sufficiently attended to the hurtful effects of wine and malt liquors. Porter is generally
permitted in large quantities on these occasions; a beverage, if there is any truth in our remarks, highly
improper and dangerous.”
1812. Formation of the Massachusetts’ Society for the Suppression of Intemperance.
Rush, B. An Inquiry into the Effects of Ardent Spiritis upon the Human Body and Mind: with an Account of
the Means of Preventing, and the Remedies for Curing Them. Boston: Manning and Loring.
1819. From an article by Friedrich-Wilhelm Keilhorn in Addiction in reference to C. von Bruhl-Cramer book
on alcoholism in which he writes, “A plain observation demonstartes that children of dipsomaniacs
(alcoholics) always are feeble, meagre, suffering friom various diseases, really atrophic, often very stupid,
sometimes, however, agile; scarecly have they grown out of their napkins, are they incredibly wicked and
obstinate. Furthernmore, we had observed something in their physiognomy which one can more easily
perceived than describe, and of which one more often cannot observe a trace in their elder brothers and
sisters. Their growth is usually incomplete and inadequate with regard to their age. If there are several
brothers and sisiters, one sometimes is able to determine when their father or mother became dipsomaniac
(alcoholic).”
1826. Formation of the American Temperance Society
1827. Beecher, L. Six Sermons on the Nature, Occasions, Signs, Evils and Remedy of Intemperance. Boston:
Crocker and Brewster.
1831. Gooch, R. (Skinner,G., ed) A Pratical Compedium of Midwifery. London: Longman, Rees, Orme,
Brown and Green.
1837. Ryan, M. The Philosphy of Marriage in Its Social, Moral and Physical Relationships. London: John
Churchill.
1841-1842. Beaumont, T. “Remarks Made in Opposition to the Views of Dr. Clutterbuck.” Lancet.
1847. Edwards, J. The Temperance Manual. New York: American Tract Society.
1848. Forbes, J. The Physiological Effects of Alcoholic Drinks. Boston: Massachuetts Temperance Society.
Howe, Samuel G., Report Made to the Legislature of Massachuetts on Idiocy. Boston: Coolidge and Wiley.
Although couched in the language of the times, Howe does indicate the concern that alcohol consumption by
parents, with particular mention of the mother, affects the minds and physical outcomes of the children.
1857. Morel, Benedict-Augustin. Traite des Degenerescences Physiques, Intellectuelles et Morales de
l’espece Humaine et des causes qui produisent ces varietes maladives. Paris: Masson.
Stevens, J.P. “Some of the Effects of Alcohol upon the Physical Constitution of Man.” Sth. Medical Surgical
Journal. As of this date, I have been unable to locate a copy of this citation.
1872. Bessey, W.E. “On the Use of Alcoholic Stimulants by Nursing Mothers.” Canadian Medical Record.
As of this time, I have been unable to locate a copy of this citation.
1873. Beginning of the Women’s Crusade which later became the Women’s Christian Temperance Union.
1876. Dr. John Haddon in “On Temperance in Women with Special Reference to Its Effects on the
Reproductive System.” British Medical Journal, wrote, “On her family the effects of intemperance are
strongly marked. Children born at the full time (of her intemperance) are generally weak and puny, and likely
to fall at an early age victims to disease. …it is possible that a large proportion of our excessive infant
mortality may be due to the malnutrition ofthe embryo, caused by the use of alcohol.” Dr. Haddon goes on to
say, “…however much it may please the palate and raise our spirits, (wine) is hurtful in health andin disease,
requires the utmost discrimination in its use.”
1876-1897. Criminal Man by Cesare Lombroso, published in five editions from 1876 to 1897. This book was
one of the first to ever attempt to classify criminals by inherited physical features rather than condemning the
criminal for purposeful acts against society. Lombroso felt that criminals, in general, had certain physical
characteristics that indicated that criminality is an inherent trait rather than assumed from the environment.
(From Born to Crime: Cesare Lombroso and the Origins of Biological Criminology by Mary Gibson. 2002.)
Some of the physical features were: small heads, protruding cheekbones*, flat noses, large ears, deformed
skulls, greater height and weight*, protruding jaws, lack of muscular strength, and little sensitivity to pain. In
particular, Lombroso was interested in the size of the head. (*Note: characteristics not normally found in
people with full FAS.)
Lombroso also refers to behavioral characteristics such as the lack of remorse, inability to control their
passions, laziness and ineptness at crime because of the repetitiveness of their behavior. (Note:
Repetitiveness might be interpreted as the inability to learn from one’s mistake.)
Lombroso also had a theory of degeneration which “explain physical and psychological malformations that
had resulted from fetal disease rather than inherited weakness….Their development blocked in the womb,
babies could thus be ‘born’ with predisposition to crime…”
Others from his school of thought also noted that these people had evidently been unable to transition from
childhood to adulthood, had hands like apes (simian crease?) and noted that many were descended from
alcoholics. Lombroso also had a category which he called The Morally Insane. The Morally Insane, he
stated, were “people who looked normal but were unable to distinguish between good and evil behavior.”
They were identical to other criminals because of “…their compulsion to harm others and their lack of
remorse.” These people also exhibited a lack of physical sensitivity. [Note: Lombroso’s work fellinto
disrepute as his observations were used to justify racial profiling and may have been included as a part of the
propaganda that produced the German Aryan race “theory”. However, many people in the modern justice
system and in social work still call some children “FLK” or “funny looking kid”; a remnant of the Lombroso
studies on physical characteristics.]
1877. Fournier., E.H. Annual Oration. Transcript of Medical Association Alabama. As of this date, I have
been unable to obtain a copy of this citation.
1879. Long, J.F. “Use and Abuse of Alcohol.” Transcript of Medical Society of North Carolina. As of this
date, I have been unable to locate a copy of this citation.
1880. Prohibition Party was started.
1883. McDaniel, W.H. “The Effect of Alcohol Upon the Foetus Through the Blood of the Mother.”
Maryland Medical Journal.
1890. Dr. T. D. Crothers’ article in the Journal of the American Medical Association, “Alcoholic Heredity in
Diseases of Children”. Crothers notes of two children whose parents were alcoholics, “…both invalids, and
had been under constant medical care from infancy, the general diagnosis being scrofula (a skin disease), and
general anaemia; both were of pale and delicate appearance, extremely excitable and nervous. They had
continuous irritation of the stomach…were very passionated at the slightest opposition to their wishes, and
after a period of rage would be greatly exhausted and have a distinct fever for a day or more.”
Their family physician found that “…both had suffered from rubeola and scarlatina (scarlet fever), and were
supposed to never have fully recovered. Bronchitis, enteritis, gastritis, neuritis, and various heart diseases
were constantly threatening.” A new physician recognized the alcoholic heredity of these cases and ordered
“…(their) diet restricted and enforced exercise…and frequent bathing.”
Crothers goes on to state, “No fact is more firmly established than that alcoholic ancestors will transmit to
their children a defective brain and nerve power. The form and shape of this defect and its manifestations will
vary greatly.
“In many cases, it might not be prominent until after the higher peripheral brain has reached a certain
development, especially in the growth of the emotional and inhibitory centers. In others thisdefect is seen in
infancy, in anabnormal hyperaesthesia of the senses, and nutrient disturbances. Some children manifest
irritation at all sounds, and all changes of light and surroundings by continuous crying; the skin of the
alimentary canal is also very sensitive, and various skin disorders and nutrient troubles follow. Low powers
of vitality and slow irregular growth are common. This condition may continue for years, then gradually
disappear, and only re-appear at puberty…”
Crothers notes of some other children of alcoholics, “…noted…by their precocious development of brain and
nerve force. They exhibit powers of brain receptivity and instability that is called genius, which gives way
early to some disease or form of nerve degeneration from various causes.” He goes to note, “…their extreme
sensitiveness or obtuseness to sensory impressions, and low powers of vitality and recuperation…”
Other symptoms that are noted are, “…extremes of activity, particularly where there is a tendency to the
sudden liberation of nerve energies, as in violent passion (grief or joy) or work, play or study, which is
followed by extreme prostration. The child is said to be sullen, morose, or melancholy, then suddenly
manifests the other extremes, indicating a great instability of brain cells and functional control. (The child’s)
life seems to be threatened with fevers, prostrations, and inanitions (state of being empty), accompanied by
mental irritations and wandering neuralgias…they always point to a degree of nerve and brain degeneration
or retarded development, and defective co-ordination…”
Crothers states, “From these facts it will be obvious that the diseases of children of alcoholic parentage are
far more complex, and require greater care.” Interestingly, he recommends the following care: “1. No form of
alcohols are safe… 2. The diet should not include meats of any kind…the diet should always be nonstimulating and farinaceous (rich in starch), and should be carried out with military regularity. 3. …avoid
brain and nerve stimulation… 4. …(guard) against every possible extreme, both in the surroundings and
physical conditions.”
1893. “The Effect of Alcoholic Intoxication Upon the Human Brain and Its Relation to the Theories of
Heredity and Evolution.” Quarterly Journal of Inebriety. By A.H. Forel. I have not be able to find a copy of
this article but in an anonymous editorial in a 1910 Journal ofthe American Medical Association, Volume 54.
617., the writer states. “…Forel in particular, having contended that alcoholism injures the germinative cells;
he supported this view with statistics from asylums for the insane and epileptic, and gave to the alteration in
the germinative cells the title of ‘blastophtorie’.”
1895. Anti-Saloon League was formed.
1895. Dr. Lloyd Andriezen at the Neurological Society of London as reported in Journal of the American
Medical Association, “Alcoholism and Its Relation to Heredity.” Dr. Andriezen states, “…that the more
frequent results of alcoholic parentage showing its expression in the offspring, viz; (1) imbecility and weakmindedness; (2) infantile convulsions and meningitis; (3) a large proportion of still births; and (4) brutal
degradation and incapacity in the children, with tics and impulses, including hereditary drink-craving. …The
inebriate as a result of his habits transmitted to the offspringa damaged or diseased germ (ovum and
spermatozoon), and even the most healthy married couple could from temporary intoxication do the same
and beget a child which might exhibit one or another of the abnormalities above mentioned.”
1898. Ballantyne, J.W. “The Pathology of Ante-Natal Life.” Glasgow Medical Journal.
1899. From the notes of a discussion in the Journal of the American Medical Association, “Alcoholism and
Its Relation to Heredity.” Dr. Seymour Turke “…insisted on the fact that inebriety in the parents resulted in
damage to all the tissues of the body–some more than others–and must affect the ovum or the foetus
according to the period when the drinking began.”
Dr. Fletcher Beach “…emphasized the fact that imbecility and even idiocy resulted in the children from
parental intemperance…The effect ofalcohol reaching theovum and germ elements by the circulation could
not for a moment be doubted…”
The (unnamed) President of the section “…summed up the discussion, referring to the special fact of some
form of nervous or mental instability being transmitted to the children of alcoholic subjects and stated that
the evidence of facts in this direction in the field of mental disease was overwhelming.”
“A Note on the Influence of Maternal Inebriety on the Offspring.” Journal of Mental Science. (1899) by
W.C. Sullivan and Stewart Scholar. Both Sullivan and Scholar were medical officers in British prisons. This
study was conducted in the women’s prison in Liverpool.
The main point of this study was to determine the number of fetal and early childhood deaths of children
born to women who drink. As can be expected, the death rate climbs in a direct relation to the birth order of
the child. First born children seem to be less affected, but as the birth order increases, so does the probability
of death or epilepsy (an older term for convulsions which may or may not be caused by epilepsy).
The website of Davidson College, N.C. <http://www.bio.davidson.edu/kabemd/ seminar/studfold/
Fall/Embryo/ethanol/ EthanolontheBrain.html> has this quote from Sullivan and Scholar, “Maternal inebriety
is a condition peculiarly unfavourable to the vitality and to the normal development of offspring. Its gravity
in this respect is considerably greater than that of paternal alcoholism. There is a tendency to still births and
abortions, and a high rate of epilepsy in the surviving children. This influence of alcohol is in part due to a
direct toxic action on the embryo.”
The University of Duisburg Essen’s German site, <http://www.uni-essen.de/~ibp010/
alkemb/FASinfo/depubrig. htm> quotes Sullivan and Scholar as having written, “…that pregnancies of these
women resulted in stillbirths and infant death, 2 1/2 times more often than those of their sober female
relatives.” Also, “…that infants born to alcoholic mothers had a starved, shriveled and imperfect look.”
1900-1949. A 26 page study, “The Effects of Drinking on Offspring: An Historical Survey of American and British
Literature.” by Rebecca Warner and Henry L. Rosett. (1975) The Journal of Studies on Alcohol. cites 33 articles written
in this time period that warn against the dangers of drinking while pregnant. Copies of these articles are not included in
this study. I may include them at a later date if I can obtain them.
1900. “Passage de l’alcohol ingere de la mere su foetus et passage de l’alcohol dans le lait, en particular chez la
femme.” Obstetriq. by M. Nicloux. 5. 97-132. In Streissguth’s Fetal Alcohol Syndrome: A Guide for Families and
Communities, she says he “…documented in dogs, sheep and humans that alcohol consumed by a mother passed
through to her milk and then on to her suckling offspring.”
From a journal article, “Alcohol and the Antenatal Child Welfare” by Dr. J.W. Ballantyne in The British Journal of
Inebriety, on the research of M. Nicloux, “Nicloux…found alcohol in the cord, the placenta, and the blood of the child…
He found, too, that alcohol passes into the milk…”
Sigmund Freud writes his first textbook The Interpretation of Dreams.
1901. Bezzola, D.A. (1901) “A Statistical Investigation into the Role of Alcohol in the Origin of Innate Imbecility.”
Quarterly Journal of Inebriety.
Paul Ladrague wrote “Acoolisme et Enfants.” These pour le doctorat en Medicine. (Alcoholism and Infants. Doctoral
Dissertation.) Paris: Universite de Paris, Faculte de Medicine. (Paris, University of Paris, Faculty of Medicine.)
According to Dr. Ann Streissguth in Fetal Alcohol Syndrome: A Guide for Families and Communities, (he) “…reported
from personal observation that alcoholic mothers had a high proportion of spontaneous abortions, weak and poorly
developed infants, early infant demise and epilepsy, idiocy among their children. He also presented 10 cases in which
infants who were breast-fed by mothers or wet nurses who were alcoholic exhibited diarrhea, vomiting, extreme
agitation and convulsions.”
1903. Hodge, C.F., “The Influence of Alcohol on Growth and Development.” In Atwater, W.O. et al., eds. Physiological
Aspects of the Liquor Problem. Boston: Houghton, Mifflin.
1905. “A Study of the Effects of Alcohol on School Children.” Quarterly Journal of Inebriety. by T.A. McNicholl. I have
this citation but have been unable to locate the original article.
1907. Aiken, J.M. “Brain and Nerve Degeneration.” Journal of Inebriety.
1909. From a lecture by U.S. Congressman Richmond Pearson Hobson as reported in Drugs in America: A
Documentary History. Edited by David. F. Musto. (2002) New York: New York University Press. “Dr. Laitinen of the
University of Helsingfors reports in the Proceedings of the International Congress on Alcoholism. ‘These investigation
uncover the degenerating effect of even the most temperate drinking by parents upon their children, showing the
general use of ‘light wine’ or ‘light beer’ must in time bring about the disintegration of any family, and the decline and
downfall of any nation.’”
1910-1914. Three papers by Charles R. Stockard of Cornell University:
1910: “Influence of Alcohol and other Anaesthetics On Embryonic Development.” American Journal of Anatomy. 10.
369-392.
1913: “Alcoholic Injuries to Germ Cells.” American Naturalist.
1914: “Alcoholic Injuries to Germ Cells.” Journal of Heredity.
A quote from Dr. William Healy, page 263 of The Individual Delinquent (1918), reads, “A fine example of controlled
experiment is that by Stockard, who has most cautiously studied the effect of alcohol on the germ cells of animals. He
finds that the degeneracy caused by alcohol may be passed on by degenerate offspring.” The majority of subjects in
Healy’s book were entire families affected by alcoholism.
Stockard’s experiments were considered to be among the most influential of his time. However, he did cause his
experimental subjects to inhale the alcohol fumes rather than ingest the liquid and his subjects were often purebred
dogs whose genetic dispositions were often questionable.
1910-1911: Keynes, J.M. “Influence of Parental Alcoholism.” Journal of the Royal Stat. Society.
1910. Hoppe, H. “Procreation During Intoxication.” (Translated and abridged by Brown, K.O.) Journal of Inbriety. 32.
105-110.
K. Pearson and E.M. Elderton. A First Study of the Influence of Parental Alcoholism. (2nd ed.) London: University of
London. Quote from Dr. Ann Streissguth in Fetal Alcohol Syndrome: A Guide for Families and Communities, “…after
studying several hundred children in Edinburgh, Scotland, that short stature was associated only with maternal, not
paternal, alcoholism.”
Ribakoff, F. Ye. “Heredity and Alcoholism: Statistical Investigation Based on 2,000 Cases.” Journal of Nevropathology i
Psikhiatry. Korsakova, Mask.
Sazhin, I.V. (1910) “Alcohol and Heredity”. Russk. Vratch.
1912. Abstract of A. Gordon’s article, “Parental Alcoholism in Mental Deficiency of Children.” in the Journal of the
American Medical Association. Gordon’s study involved 298 cases of mental deficiency. He states that he only
reported on the living members of the family. He also noted that several children died at a very tender age or very
early. The survivors “presented mental and physical stigmata of degeneracy. Therefore, one must logically conclude
that the effect of alcoholism on the offspring is most disastrous.”
1913. Davenport, C.B. “Alcoholism in a Rural Community of Defectives.” Journal of Inebriety.
The Kallikak Family: A Study in the Heredity of Feeble-Mindedness by Henry Herbert Goddard, published in 1913. This
book originally started out as a study of feeblemindedness. In 1995, a group of researchers, lead by Robert J. Karp, reexamined Goddard’s study and came to the conclusion that Goddard had actually been studying a family comprised of
several adults with Fetal Alcohol Syndrome. Goddard had originally believed the father, Martin Kallikak was the carrier
of the “feeblemind” gene. However, his marriage to a “normal’ woman produced a majority of “normal” children while
his illicit affair with a “feebleminded” woman produced a majority of children and grandchildren with physical and
behavioral characteristics that Karp ascribes to FAS.
Photos of members of the family also show the facial features associated with full FAS.
(Photos may be found at http://psychclassics.asu.edu/Goddard/)
1914. Excerpt from Drugs in America: A Documentary History. Edited by David. F. Musto. (2002) New York: New York
University Press. Testimony of U.S. Congressman Richmond Pearson Hobson in the debate over Prohibition. “…it
blights the offspring; it attacks the tender tissues associated with reproduction in both male and female; it affects the
tender system of the embryo in the prenatal period. For both parents to be simply moderate drinkers, to drink but once
a day beer or wine will quadruple the chance of miscarriage for the mother, increasing 400 per cent the suffering and
danger of maternity, will increase nearly 100 per cent the number of children who die in the first year of infancy. The
children of a drinking person die off at a rate of from four to fives times as many as those of abstaining parents. Do not
talk of prohibition invading the rights of individuals–liquor blights the rights of our citizens before they are born.”
Cole, L.J. and Davis, C.L. “The Effect of Alcohol on the Male Germ Cells, Studied by Means of Double Matings.”
Science.
1916. Dr. J.W. Ballantyne in the Journal of the American Medical Association, “Alcohol and the Development of the
Fetus.” “Alcohol is a danger to antenatal health and a menace to to antenatal life at every one of the stages of that
existence and through each of the progenitors.”
Gordon, A. “The Influence of Alcohol on the Progeniture.” Int. Med. Journal.
1917. Ballantyne, J.W. “Alcohol and Antenatal Child Welfare.” British Journal of Inebriety. Dr. Ballantyne makes
another educated argument for not drinking during pregnancy. But what makes this journal article interesting is the
bibliography. Dr. Ballantyne has collected journal articles on alcohol and pregnancy from all over Europe. There are 38
references from France, 31 from Germany, 10 from Italy, 4 from Switzerland, 3 from Austria, 2 from Finland, the
Netherlands, and Spain and 1 each from Russia, Sweden, and Yugoslavia.
1918. The Individual Delinquent by William Healy, MD, published in 1918. Dr. Healy was a meticulous researcher who
was the director of the Psychopathic Institute, Juvenile Court of Chicago and an associate professor of Mental and
Nervous Diseases of the Chicago Policlinic. His massive work of over 800 pages documents his study of young people
who consistently got themselves into trouble during the last part of the 1800s and the first part of the 1900s.
Of particular interest is this Section 152, titled Alcoholism During Pregnancy. “Difficulty that there is in understanding
the bad effect of alcohol upon germ cells is not paralleled by its obviously easy influence upon the growing fetus.
Alcohol circulates with great ease through such membranes as separate the mother’s blood from the embryonic
circulation, and thus the growing brain cells are bathed in it in proportion as the mother takes it into her person. So the
drinking mother stands a very good chance, by all accounts, of bringing forth children with defective or unstable
nervous systems. We know the relation, in turn, of these abnormalities to human inefficiency and to criminalism.
“Proofs of the above as a cause are, very naturally, vitiated by the fact that a later defective environment practically
always is also a factor. Indeed, in cases where we heard of the mother’s alcoholism during pregnancy, we found there
was so much else that might account for the child’s bad conduct that we have been obliged to refrain from ever
including this as a main factor. As in the case of probable alcoholic deterioration of germ cells (vide Section 194) proofs
of actual deterioration will have to come through direct physiological rather than through social and psychological
studies.”
Section 194, parts b and c: (b) Alcohol and Procreation. The effect which the parent, being under the influence of
alcohol at the time of procreation, may possibly have on the offspring stands on the border line between defective
heredity and defective environmental conditions. The time is probably not yet ripe for a definite statement upon this
subject, but certainly one may assert the probably correctness of the view of those who hold that an undue amount of
alcohol in the circulation of either parent at the time of procreation may be the cause of degeneracy of the offspring.
(c) Antenatal Conditions. We have already sufficiently discussed this point in Section 152. There cannot be the
slightest doubt that the ingestion of alcohol by the pregnant mother may have a very deleterious effect upon the
nervous system of the unborn child.
Some of the characteristics Healy tested for were memory, ability to give testimony (attention to detail), attention, motor
coordination, associative process, perception of form and color relationships, learning ability, ability to profit from
experience, language ability, arithmetical ability, mental representation and analysis, foresight and planfulness, visual
perception and analysis, judgment and discrimination, suggestibility, will power, apperception (recognition of the
relationship of parts to parts and then to other more generalized things), moral discrimination, and ability to follow
instructions.
Some interesting chapters in Healy’s book:
Chapter VII: Influence of Pictures especially Moving Pictures
Chapter XVII: Defects in Special Mental Abilities…language deficits…defect in arithmetical
abilities…defect in judgment and foresight…defect in self control.
Chapter XXIII: Abnormal Social Suggestibility
Chapter XXV: Pathological Lying and Accusation
Chapter XXVI: Love of Excitement and Adventure
Chapter XXVII: Kelptomania…Pyromania…Suicide…Vagabondage
Healy did not propose any form of treatment or therapy, rather he simply asked for the recognition of the various
factors that comprised the behavior of the “delinquent” child.
[It is interesting to note that a later researcher, Dr. Hervey Cleckley in 1941, felt there was no connection between the
patients he was observing and the subjects of Healy’s text.]
Glueck, B.A. “A Study of 608 Admissions to Sing Sing Prison.” Mental Hygiene. .
1920-1933. The Volstead Act / Eighteenth Amendment / Prohibition. A paper by Philip Pauly, (1996) “How Did the
Effects of Alcohol on Reproduction Become ScientificallyUninteresting in the Early Twentieth Century?” Journal of the
History of Biology, says that one factor was the illegalization of alcohol made unnecessary to study the effects of
alcohol consumption. Other readings I have done indicate that women in the work force after World War I and
questions about research methodologies also influenced the decline in research.
****************************************************************************** 1923-1930. The Hanson Papers. Between 1923
and 1930, Frank B. Hanson wrote a number of scientifically influential papers that took a neutral approach in regard to
maternal drinking causing problems in the unborn child. This, in effect, made further research into the problem of
maternal drinking, a scientific dead-end. (from Philip Pauly, “How did the Effects of Alcohol on Reproduction Become
Scientifically Uninteresting in the Early Twentieth Century.” Journal of the History of Biology.
******************************************************************************
1925. George, M.D. (Reprinted in 1965) London Life in the Eighteenth Century. New York: Capricorn.
1941, 1964, 1982. The Mask of Sanity by Hervey Cleckley. This book is considered to be such a classic, I
have found citations from three editions published that have covered five decades. Dr. Cleckley based much
of this book on the male patients at the Veteran’s Administration Hospital in Augusta, Georgia, one of the
largest in the country at the time of his writing. He estimated that well over 40% of the patients in the
Augusta, Georgia VA’s psychiatric ward fitted the description that he classified as “semantic dementia”,
Cleckley describes this as “…a mind or personality so damaged that experiences as a whole cannot be
grasped or utilized in its significance or meaning.” Cleckley goes on to say, “…in semantic dementia, the
purposiveness, the significance of all life striving and of all subjective experience are affected without
obvious damage to the outer appearance of the personality.” “…the persistent maladaptation at the
personality level, the inevitable purposelessness of behavior, suggested at times not a lack of purpose so
much as a negative purpose. The person despite all his opportunities, his intelligence and his plain lessons of
experience, seem to go out of his way to woo misfortune.” The families of the patients in Cleckley’s book are
described as “…sound if not superior stock.” even though each of the patients described were alcoholic by
nature and abused it constantly throughout their lives.
Cleckley’s Section XXII: Clinical Profile of the patient with semantic dementia is revealing:
“He is usually a very attractive person superficially and makes a strong positive impression when one first
meets. him.”
“He is free from…any marked …psychoneurosis.”
“…he has no sense of responsibility whatsoever to others.”
“…appears to have a total disregard for truth…”
“…much of his trouble is his own fault.”
“…he cheats and lies without any apparent compunction.”
“…he continues to show the most execrable judgment about attaining…his own ends.”
“…His inability to learn or profit by experience no matter how chastening his experience may be.”
“…distinguished by egocentricity.”
“…shows no more real evidence of object love.”
“His absolute indifference to the hardships, financial, social, emotional, physical, and others, that he brings
upon those for whom he professes love…”
“But mature, wholehearted anger, true or constant indignation, honest, solid grief, sustaining pride, deep joy,
despair are never found within this scale.”
“…he does not show anything that could be called woe or despair or serious sorrow.”
“The emotional poverty, the complete lack of stronger or tragic feeling…”
“…lacks the insight to a degree seldom if ever found in other mental disorders.”
“He has absolutely no capacity to see himself as others see him.”
“…he has no ability to know how others feel when they see him or to feel anything comparable himself about
the situation.”
“…blaming his troubles on others with the flimsiest of pretexts but with elaborate and and subtle
rationalization.”
“…to have little or no ability to feel the significance of his situation, to experience the real emotions of regret
or shame, or determination to improve.”
“…clever statements have been purely verbal, even his expressions without underlying content; an excellent
mimicry of insight.”
“…apparently a total lack of insight as a real and moving experience.”
“…uses all the words that would be used by one who understands and who could define all the words, but
who is still blind to the meaning.”
“The psychopath shows little of the ordinary responsiveness to special consideration or
kindness.”
“Alcoholic indulgence is very frequently prominent in the psychopath’s life story.”
“…an independent and pre-existing personality maladjustment is primarily causal.”
“…their almost total lack of self imposed restraint.”
“…a striking inability to follow any sort of life plan consistently whether it be regarded as good or evil.”
“…seems to go out of his way to make a failure of life.”
“…he cuts short by some incomprehensible and untempting piece of folly or buffoonery, any activity in
which he is succeeding, no matter whether it is crime or honest endeavor.”
“…that some unconscious purpose to fail has been active, some unrecognized drive at social and spiritual
self-destruction.”
“He shows no real insight into his condition. There is a persistent tendency to project the source of his
troubles to the environment. We see a striking lack of normal and appropriate emotional response, a general
flattening or hollowness in affect, such as marked impairment of ordinary judgment that he fails repeatedly to
adapt himself in the social group. His record furthermore reveals not one but a series of follies and disasters
involving himself and others and brought about for no discernible purpose. We may, therefore, say that he is
psychotic, incompetent, and incapable of carrying on the usual activities of life without constant
supervision.”
Cleckley goes on to state:
“…it is a different type of psychosis from all those now recognized, and one which differs more widely in its
general features from any of those than they differ from one another.”
“The first and most striking difference is…in other psychoses, one finds…a more or less obvious alteration
of reasoning processes or of some other demonstrable personality feature. In the psychopath, one…is
confronted by with a convincing mask of sanity. All the outward features of this mask are intact; nor can it be
displaced or penetrated by questions directed toward
deeper personality levels. …The thought processes retain their normal aspect even if
psychiatrically dissected. One finds…a solid and substantial structural image of the sane and
rational mind.”
“…one usually finds verbal and facial expression, tones of voice and all the other signs we have come to
regard as implying conviction and emotion and the normal experiencing of life as we know it …and we
assume it to be in others. Only very slowly, and …by intuitive judgment,
does the conviction come upon us that, despite these intact rational processes and their
consistent application in all directions, we are dealing here not with a complete man at all but
with what might be thought of as a subtlely constructed reflex machine which can mimic the
human personality perfectly.”
On treatment, Chapter 25:
“The present writer humbly confesses he has found all true examples of semantic dementia to be very little
influenced by therapeutic efforts.”
“…..makes it necessary to place him on wards where patients are closely confined and
supervised…”
“An old physician…suggested that they be carefully gathered from all over the earth, placed on some large
habitable island with all the equipment and supplies needed to establish
themselves, and then forgotten by the rest of humanity.”
On occurrence, Chapter 25:
“In this writer’s opinion approximately as many beds as those now occupied by all other
psychotic patients in the nation would scarcely be an exaggerated estimate.
1942. Butler, F.O. ” The Defective Delinquent.” American Journal of Mental Deficiency.
Chesler, A., LaBelle, G.C. and Himwich, H.E. “The Relative Effects of Toxic Doses of Alcohol on Fetal,
Newborn and Adult Rats.” Quarterly Journal Studies in Alcohol.
****************************************************************************** 1942.
Howard W. Haggard and E.M. Jellinek received a grant from the Rockefeller Foundation to conduct a study
that refuted the research that indicated that maternal drinking adversely affected the unborn child. (from
Philip Pauly. “How Did the Effects of Alcohol on Reproduction Become Scientifically Uninteresting in the
Early Twentieth Century.” Journal of the History of Biology.)
E.M. Jellinek became famous for his work, The Disease Concept of Alcoholism, New Haven: College and
University Press, published in 1960. It was the first work that suggested that alcoholism was a disease rather
than a matter of personal choice or a flaw of character.
******************************************************************************
1944. Crime and the Human Mind by Dr. David Abrahamsen of the Department of Psychiatry, Columbia
University. Morningside Heights: Columbia University Press. Dr. Abrahamsen writes in Chapter VI: The
Psychology of the Individual Offender: Classification of the psychopathic offender.
“…we have discussed criminals with neurotic characters, including in this group, those persons who are
known…as psychopathic personalities. Since this term has been in use for over a hundred years…it is
probably impossible to dispense with it…”
“…one is inclined to designate as psychopathic personalities all those persons who do not fit into…other
groups.”
“…the term psychopathic personality has been used to mean a certain person who because of deviations and
inadequacies in his personality and in his mental make up is neither mentally defective nor psychotic, but has
a defect, especially regarding his character or emotions.”
“We…will define a psychopath as an abnormal personality who suffers because his aberrant character or one
who because of his abnormalities disturbs society.”
“A psychopath may…show less valuable qualities.”
“…we find among offenders persons with a superior intelligence who are endowed with a capacity to
accomplish criminal acts which are not only…well done but also eccentric.”
“…most of them should be classified in the near neurotic or in the neurotic character group.”
“…usually self centered, aggressive and emotionally unstable.”
“…superior attitude…showed little inclination to be corrected.”
“There has been an inclination to include practically all chronic criminals in this group and even to restrict it
to the antisocial.”
“The psychopath cannot express love.”
“…earliest childhood…caused trouble by truancy, petty stealing or some other antisocial activity.”
“D.K. Henderson has given this definition: The term psychopathic state is the name given to those
individuals who conform to a certain intellectual standard, sometimes high, sometimes approaching the realm
of defect…who have…exhibited disorders of conduct of an antisocial or social nature…which have proved
difficult to influence by methods of social, penal or mental care and treatment and for whom we have no
adequate provision of a preventative or curative nature.”
“It is usually found that the age distribution varies from about fifteen to thirty-five or forty, the peak age
being about twenty.”
“…the psychological development extends over a longer period of time (than the normal person).”
“..his instability begins in childhood, reaches a peak in young adulthood and then drops down in the late
twenties and early thirties.”
“Partridge wants to change the term psychopath to sociopath…”
In Chapter X, Treatment and Research, Abrahamsen goes onto say about the Neurotic Character: “The
offenders with neurotic characters represent the most difficult problem to the psychiatrist and prison
authorities.”
“Punishment is without success, except that incarceration protects society…”
“…one may consider the possibility of whether a training program…might be considered. This could only be
accomplished by keeping them under a continued disciplined regime in a friendly way.”
“…treat them firmly but at the same time, let them know they are not rejected.”
1947. Developmental Diagnosis: Normal and Abnormal Child Development by Drs. Arnold Gisell and
Catherine Amatruda. Dr. Gisell was a professor in the Clinic of Child Development at the Yale School of
Medicine. Under the chapter, Amentia of High Grade, Section 4 is titled “Inferior Endowment” and contains
the following statements:
“…those individuals who without being definitely defective are nevertheless well below average with respect
to developmental status…”
“…border on amentia without being certifiably feebleminded.”
“…a highly diversified category…distinguished (by) three types: (1) borderline dull (2) borderline unstable
(3) borderline defective.”
“Borderline dull denotes a mild degree of retardation and a general reduction of performance particularly in
the fields of language and adaptive behavior.”
“Borderline unstable denotes a similar inferiority combined with impulsivity, highly changeable and other
atypical emotional reactions.”
“Borderline defective. …The behavior is relatively well organized and balanced. In quality and caliber it is
defective but not sufficiently so as to warrant a diagnosis of frank amentia.”
Gisell warns, “The foregoing distinctions must rest on clinical impressions rather than on precise objective
criteria. They are useful as descriptive diagnoses.” He goes on to elaborate on borderlineunstable: “A
borderline unstable child displays unsteadiness and exaggeration in his emotional reactions and atypical
deviations in one or more fields of behavior. …Discrepancies and disparities become apparent when his
maturity is separately evaluated for the several fields of behavior.”
Gisell goes on to describe four cases:
“…over active, over afraid of men, not interested in toys…touches objects in a gingerly manner…”
“…rapport between himself and the examiner was shallow and variable.”
“…perservative and stereotyped manner…”
“..described as ’stubborn, backward, slow, very jealous, craves an unusual amount of attention’…”
“Screams at about 5 o’clock and refuses to eat supper; moans in bed; wakes at night with weird cries; clings
to bottle; refuses cup.”
“…rocked back and forth incessantly…”
“…failure to carry out differential commands…”
“..her amiable personality cast a spell which tended to conceal her fundamental limitations…”
“The somewhat inferior quality of her intelligence and judgment make it necessary to provide good
supervision and training throughout adolescence. If she is adequately protected, there is an excellent prospect
of her making a satisfactory social and vocational adjustment in adult life.” (Gisell, however, does not follow
this case into adulthood.)
Section 5 is titled “Pseudo-Symptomatic Retardation” and contains the following observations:
“There is a type of retardation which is falsely ascribed to such causative factors (unfavorable institutional or
home environments), but which in reality a true amentia…”
“He does some thing so well.”
“He understands so much.”
“It is though he were thwarted and as though something were holding him back.”
“He has an excellent disposition.”
“He has more abilities than he likes to use.”
“He seems unhappy.”
“…there are residues of behavior which resemble the normal so much…”
“…the child may show extreme fixations on one toy, or on one pastime…”
“There may be an excessive amount of rocking or mouthing, ofjargoning, of chewing, clicking, respiratory
and other mannerisms.”
“…heedlessness to sound or oblivious to persons…”
“…frequently found in association with hyperactivity.”
“…the activity and the bizarre exaggeration are frequently associated with an attractive
countenance and a far-away, wistful expression which builds up an impression of dormant or
obscured normality.”
“Parents go to heroic lengths to re-educate the child and remove the obstructions which they believe are
retarding or deflecting the child’s development.”
“…the parents of these children do a lot of ’shopping around’. They try one expedient or one program after
another.”
“But the retardation is…organic and symptomatic.”
“…the mental deficiency may be of either high or low grade.”
“..heedlessness to the spoken word and the failure to talk.”
“…slow weight gains.”
“Any progress he makes will be exceedingly slow.”
“School, in the ordinary sense, will be quite beyond him.”
Gisell and Amatruda also noted that “The parents are encouraged to believe that the child will find himself in
time.” But they advise, “If you can bring yourself to shaping your child’s need to her needs…your own
distress will be reduced. If there is a remote chance that a change will occur, you will be increasing that
chance more by these means than by constantly sustained efforts to teach her beyond her capacity to learn.”.
Advice often promoted by today’s experts in FAS education.
1950-1972. The 26 page study, “The Effects of Drinking on Offspring: A Historical Survey of American and
British Literature.” by Rebecca Warner and Henry l. Rosett. (1975) in The Journal of Studies on Alcohol.
cites 14 articles written in this period that warn of the danger of drinking during pregnancy. Copies of these
articles are not included in this study. I may include them at a later date if I can obtain them.
1950. The Merck Manual: Eighth Edition. The first six editions of the Merck Manual, starting in 1899, were
pharmaceutical references which listed medicinal remedies for specific conditions. Starting with the Sixth
Edition in 1934, the Merck Company started to include diagnostic indications but did not include pediatric,
psychiatric or psychological sections. Therefore, I have not included the editions prior to 1950.
The Eighth Edition was the first to contain a section on Neuropsychiatric and Psychosomatic conditions,
none of which are recognizable as descriptive of FASD behavior.
In modern times, the Merck Manual is considered to be the “medical handbook” for medical and ancillary
medical personnel. It is used as a reference, diagnostic and therapeutic guide.
1956. The Merck Manual: Ninth Edition. The Neuropsychiatric section is almost always seeped in Freudian Theory and
uses the “id, ego and superego” as well as other Freudian terms for different types of psychoses.
This is the first time that Personality Disorders has its own chapter. Personality Disorders are “…characterized by
developmental defects or pathologic trends in personality structure, with minimal subjective anxiety and distress.
…these disorders are manifested by lifelong behavior patterns, rather than by mental or emotional symptoms.”
Under Personality Pattern Disturbances, “Prolonged therapy may improve functioning … but rarely accomplishes basic
change in their inherent structures.”
The Inadequate Personality is defined as “In response to intellectual, emotional, social and physical demands, these
individuals show inadaptability, ineptness, poor judgment, lack of physical and emotional stamina, and social
incompatibility.”
Under Sociopathic Personality Disturbances, “Individuals…are ill primarily in terms of conformity with the prevailing
cultural milieu, as well as in terms of personal discomfort and relations with others. Sociopathic reactions are often
symptomatic of severe neurosis or or result from organic brain injury or disease.” (The sociopathic personality and the
antisocial personality are combined in later editions of the Merck.)
The Antisocial Personality is described as: “…individuals who are always in trouble, profiting from neither from
experience nor punishment, and maintaining no real loyalties to any person, group or code. They are callous and
hedonistic, showing marked emotional insecurity. They lack judgment and a sense of responsibility but can rationalize
their behavior so that it appears reasonable and justified. The term includes cases previously classified as
‘constitutional
psychopathic state’ and ‘psychopathic personality’.”
There are no suggestions for treatment or therapy.
1957. Jacqueline Rouquette in “Influence de l’intoxication alcoolique parentale sur le development physique et
psychique des jeunnes enfants.” (Influence of intoxicated parents on the physical and psychological development of
their young children.) These, Paris. Streissguth (in Fetal Alcohol Syndrome: A Guide for Families and Communities)
says of her work: “…a medical thesis from Paris described 100 foundling home children born to alcoholic mothers and
fathers who had malformations very similar to those now recognized as constituting FAS. She concluded that maternal
alcoholism, in particular, posed very grave dangers for the developing fetus and child.”
From Steissguth’s Fetal Alcohol Syndrome: A Guide for Families and Communities, reports that D. Papara-Nicholson
and I.R. Telford administered alcohol to pregnant guinea pigs and observed the resultant offspring had problems with
low birthweight, poor locomotion, incoordination , feeding and sucking. Streissguth notes that this may have been the
first report of the neurobehavioral effects of prenatal alcohol.
1960. Many physicians who graduated this year are nearing retirement in 2005.
1961-1966. The Merck Manual: Tenth and Eleventh Editions. These editions are nearly identical to the Ninth Edition.
The theories of Sigmund Freud are quoted. Almost the same wording occurs in all three editions.
Again, Personality Disorders are deemed to be “lifelong problems rather than mental or emotional symptoms.”
In the Tenth Edition under Neuropsychiatric, Personality Disorders, Sociopathic Personality Disorders, Antisocial
Reaction and in the Eleventh Edition, Section 16: Neuropsychiatric, Chapter 2; Personality Trait Disturbances,
Psychopathic Personality Disturbances, Antisocial Reaction, “This term refers to individuals who are always in trouble,
profiting neither from experience nor from punishment, and maintaining no real loyalties to any person, group, or code.
Frequently they are callous and hedonistic, showing marked emotional immaturity. They lack judgment and a sense of
responsibility but can rationalize their behavior so that it appears reasonable and justified.”
Note that the term changes from Sociopathic Personality Disorders to Psychopathic Personality Disturbances from the
Tenth to the Eleventh edition.
The Inadequate Personality in also mentioned in both editions. The definition is the same, “In response to the
intellectual, emotional and physical demands, these individuals show inadaptability, ineptness, poor judgment, lack of
physical and emotional stamina, irresponsibility and social incompatibility.”
There are no recommended therapies.
The 10th Edition starts to include a section on Organic Brain Damage but that is almost exclusively of traumatic origin.
1966. Coffey, T.G. “Beer Street: Gin Lane Some Views of 18th Century Drinking.” Quarterly Journal Alcohol Studies.
Fuchs, A.R. “The Inhibitory Effect of Ethanol on the Release of Oxytocin During the Parturition of the Rabbit.” Journal
of Endrocrinology.
October, 1996. The Interagency Coordinating Committee on Fetal Alcohol Syndrome (ICCFAS) was created in
response to recommendations of an expert committee of the Institute of Medicine (IOM) to coordinate Federal activities
on FAS and other disorders associated with prenatal alcohol exposure. The ICCFAS is chaired by Dr. Kenneth R.
Warren, Associate Director for Basic Research, NIAAA. The ICCFAS seeks to improve communication, cooperation,
and collaboration among disciplines that address health, education, developmental disability, research, justice, and
social service issues relevant to FAS and related disorders caused by prenatal alcohol exposure. The committee
meets semi-annually.
The ICCFAS includes representatives from the following agencies:
The Department of Health and Human Services (DHHS): Agency for Healthcare Research and Quality (AHRQ);
Centers for Disease Control and Prevention (CDC); Health Resources and Services Administration (HRSA)’s Maternal
and Child Health Bureau (MCHB); Indian Health Service (IHS); National Institutes of Health (NIH): National Institute on
Alcohol Abuse and Alcoholism (NIAAA), and National Institute of Child Health and Human Development (NICHD);
Substance Abuse and Mental Health Services Administration (SAMHSA); Department of Education (ED), Office of
Special Education and Rehabilitative Services (OSERS); and Department of Justice (DOJ), Office of Juvenile Justice
and Delinquency Prevention (OJJDP).1968: Dr. Paul Lemoin publishes “Les infants de parents alcooliques; anomolies
observees a propos de 127 cas.” Ouest. Med. This was not published internationally and received relatively little
notice.
1970. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) is formed.
1972. Cantwell, D.P. “Psychiatric Illnesses in the Families of Hyperactive Children.” Achives of Genral Psychiatry.
The Merck Manual: Twelfth Edition. This edition is notable for finally dropping the Freudian theories that were
predominate in the prior editions that covered nearly 25 years of psychiatry. It also includes a pediatric section for the
first time.
This is an excerpt from the 1972 edition of the Merck Manual.
Under Section 18: Psychiatric Disorders, Numbers 3. Mental Subnormality and 4. Disorders of Childhood:
Number 3. “Mental Subnormality (Mental Deficiency, Mental Retardation, Feeblemindedness)” “Etiology (includes)…(3)
Birth trauma or physical agent (6) Unknown prenatal influence (Alcohol is not mentioned as a possible cause in either
case.)
Number 4. “Minimal Brain Dysfunction (also known as) Minimal Brain Damage (and) Hyperkinetic Impulse Disorder.”
“This syndrome has received much attention over the past decade and is being diagnosed with increased frequency”
[* Minimal Brain Dysfunction is cited in the 1978 Third Special Report to Congress on Alcohol and Health as possibly
being part of the FAS spectrum of physical and behavioral disorders.]
Under symptoms and signs:
“…characterized by inappropriate activity, either hyperkinesis or listlessness and withdrawal.”
“Activity is impulsive and occasionally destructive or aggressive.”
“Emotional lability, low stress tolerance and intellectual deficits…”
“The child’s attention span is short and he is hyperresponsive to environmental stimuli, as if there were no selective
filtering out of less meaningful stimuli.”
“Intellectual deficits…may include difficulty with arithmetic, slowness in learning to read and write, and deficits in
abstract concept formation.”
“…coordination difficulties, perceptual motor difficulties, and a delay or failure in developing (right-or left-handedness).”
“…various signs of psychiatric disability, possibly the result of ‘innate’ high anxiety or an impaired ability to handle
stresses.”
“These children are often developmentally slow and require more and longer lasting support than normal children.”
Under diagnosis:
“The neurologic examination may show a variety of ’soft’ neurologic signs such as clumsiness, impairment in rapid
successive movements , mild choreo-athetosis, mixed laterality of with right-left confusion, finger agnosia and evidence
of dyslexia or dyspraxia.”
“The EEG may be useful in detecting a seizure disorder or cerebral dysrhythmias.”
“Psychological testing …should include standard intelligence tests and perceptual-function test to document the visual
perceptual difficulties, problems with spatial organization and distractable behavior…”
Under prognosis:
“The syndrome appears to be self limited, since many of the characteristics fade during early adolescence. Though the
hyperkinesis and behavioral order usually subside, some of the
learning or emotional difficulties continue and the child is often left with school problems,
continued high levels of anxiety and low self esteem.”
Under treatment:
Amphetamines are mentioned as a way to increase attention span.
“Special education, geared to the child’s individual needs, is necessary, especially for
children…regarded as poorly motivated or retarded…”
“Raising these children in a supportive atmosphere requires education inunderstanding by most parents.”
“It is important that parents and school both provide the child with sensory experiences that are more clearly defined
and of controlled intensity.”
The edition prior to this one, the Eleventh Edition, published in 1966 does not mention minimal brain dysfunction. The
edition following this, the Thirteenth Edition, published in 1977, lumps minimal brain dysfunction under learning
disorders and Fetal Alcohol Syndrome is not mentioned even though the international paper on FAS appeared in 1973.
Under Section 18: Psychiatric Disorders: Disorders of Psychogenic Origin,
Personality Disorders are discussed as being “…relatively fixed and inflexible… Individuals may show patterns of
repetitive, maladaptive and…self defeating patterns of behavior, inadequate handling of impulses, or restricted and
inappropriate feelings. …limited variety of responses to stress. …tends to show little anxiety or mental or emotional
symptoms. …low self esteem, paucity or relative superficiality of intimate relationships, difficulty in sustaining interests,
low frustration tolerance, difficulty in postponing gratification and inability to learn from experience. (It is recommended)
…that early interpersonal relationships are important to establishing modes of defense and their rigidity.”
Number 8: Antisocial Personality ..”formerly referred to as ’sociopathic’” still remains the same.
Other Personality Disorders that have been added in this edition are:
Number 4: Explosive Personality: “…characterized by sudden tantrum-like outbursts of rage or verbal or physical
aggressiveness. Despite guilty and regretful feelings, these individuals are unable to control their outbursts. They are
easily excited by environmental frustrations. Recently, questions have been raised as to whether underlying minor
organic brain changes predispose to this explosiveness.”
Number 6: Hysterical (*histronic) (*quote is from the Merck Manual) Personality: “…characterized by dramatic and
attention-seeking behavior, excitability, emotional instability and over-reactivity, self-centeredness, and a
provocativeness or sexualization ofnon-sexual relationships often with sexual frigidity or fears. Though superficially self
assured, such people have major doubts as to their identity and goals. Their difficulty in expressing genuine feelings
further intimate relationships. Such relationships are affected by the individual’s need for affection.”
(In the 15th edition of the Merck Manual under Antisocial Personalities, it states “In our culture, men are more often
labeled as antisocial and women as histronic personalities but the two patterns have much in common.”)
Number 7: Asthenic Personality: “…characterized by lack of enthusiasm, low energy and capability, difficulty in
developing a broad sense of enjoyment and pleasure, and a poor response to even small physical or emotional
stresses.”
Number 10: Inadequate Personality: “…describes individuals whose response to any form of stress seems ineffectual.
Their behavior shows poor judgment, ineptness, lack of energy, poor long-range planning, and poor performance.
Incentive is lacking, especially to achieve culturally desired levels. These people are marginally involved in social
relationships, tend to drift and take non-demanding jobs. There is no evidence for physical or mental defects.”
The “Nervous” section found in previous manuals has been changed to “Neurological Disorders” and covers most
diseases of the brain and spinal cord. Reactions to exposure to toxins are limited to the adult experience.
Ulleland, Christy. “The Offspring of Alcoholic Mothers.” (1972) Annals of New York Academy of Sciences. 1972.
1973. Fetal Alcohol Syndrome was first presented in an internationally recognized study published by a team of
researchers at the University of Washington (Dr. Christy Ulleland, Dr. Kenneth Jones, Dr. David Smith, and Dr. Ann
Streissguth).
1974. University of Washington Fetal Alcohol and Drug Unit (FADU) began in 1974. FADU received its first federal
funding for work on various aspects of alcohol and pregancy. This is the date of the beginning of the NIAAA support for
“Alcohol in Pregnancy: Offspring Development”, which was known locally as the “Pregnancy and Health Study” and
later as the “Seattle 500. Initially a 3-year grant, this research project is still in progress, and was awarded an NIH Merit
Award several years ago. Dr. Ann P. Streissguth is still the primary investigator (P.I)., and the work is continuing in her
retirement.
Marita Aronson, a psychologist in Goteborg, Sweden, began a series of studies on children of mothers who had
alcoholism.
1977. The Merck Manual: Thirteenth Edition. Fetal Alcohol Syndrome is not mentioned in this edition.
Minimal Brain Dysfunction is now under the heading, Learning Disorders and “More common labels include brain
injury, brain damage, minimal brain damage, hyperkinesis, perceptual deficits and dyslexia.”
Under treatments:
“… to keep the child in his regular classroom and to schedule some periods with a teacher who is trained to provide
special help-technics which succeed in improving poor
performance…”
The use of stimulants to improve attention is again mentioned.
Under Personality Disorders, only the Hysterical (*histronic) Personality, Psychopathic (*Sociopathic or Antisocial)
Personality and the Inadequate Personality are still included. The quotes beside psychopathic personality are the
Merck’s quotes. This indicates that for many in the medical field, the sociopathic/antisocial/psychopathic diagnoses are
interchangeable. The etiology of the two conditions are identical to those descriptions in the Twelfth Manual (1972).
The National Institute of Alcohol Abuse and Alcoholism (NIAAA) issues the statement that 6 or more drinks per day
incurred the risk that a woman could produce a child with birth defects.
1978. Third Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome. published by the Department
of Health and Human Services and the National Institute of Alcohol Abuse and Alcoholism (NIAAA). This was the first
time FAS became an integral part of this specially commissioned report to the U.S. Congress. Each report adds
information to the previous report on alcohol and other related topics. Therefore, information presented in these reports
to Congress seldom repeat each other except for the introductions. Contents cover etiology, symptoms, physical signs,
physical damage to organs, psychological aspects, economic costs and current research. Extensive bibliography
accompanies each section.
[The NIAAA determined that the consumption of 2 drinks per day or one ounce of absolute alcohol was the definition of
heavy drinking. (Absolute alcohol is that part of a beverage that is alcohol minus the other non-alcohol ingredients.)
(That would be the equivalent of one 12 ounce can of beer, a four ounce glass of wine or one shot glass of hard
liquor.)]
1979. By this year, over 600 cases of FAS had been reported worldwide. Dr. Ernest Abel in Fetal Alcohol Syndrome
and Fetal Alcohol Effects. (New York: Plenum Press.) reported that incidences of FAS were in articles from Australia,
Belgium, Brazil, Canada, Chile, Czechoslovakia, France, Germany, Hungary, Ireland, Italy, Reunion, South Africa,
Spain, Sweden, Switzerland, and the U.S.
1980. Research Society on Alcoholism (RSOA) issues three criteria for a diagnosis of FAS. “A pattern of characteristic
facial features, pre-postnatal deficit in height and weight, and central nervous system damage.”
1981. Fourth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department
of Health and Human Services and the NIAAA. Pages 59-111.
The Surgeon General of the United States issues a health advisory recommending that pregnant women or women
considering getting pregnant abstain from using alcohol because of possible harm to the unborn child.
1982. The Merck Manual: Fourteenth Edition. Nine years after the first international paper on the etiology of Fetal
Alcohol Syndrome was published, FAS finally appears in the Merck Manual. Under Section 16: Pediatrics and
Genetics, Chapter 189: the Newborn, Metabolic Conditions:
“…The most serious consequence is mental retardation…”
Under Section 23: Clinical Pharmacology, Chapter 274: Drug Toxicity, Drugs in Pregnancy: “…borderline mental
deficiency…” No other serious behavioral problems are discussed.
Under Section 12: Psychiatric Disorders, Chapter 142: Personality Disorders are described for the first time in the
nomenclature of the Diagnostic and Statistical Manual of Medical Disorders (DSM-III).
The diagnostic section, the following has been added to coping mechanisms (5) Turning against one’s self allows
aggression towards others to be expressed indirectly and ineffectively through passivity. It includes failures and
illnesses that affect others more than one’s self, and silly, provocative clowning. The mechanismunderlies most
sadomasochistic relationships.
The Hysterical (*histronic) and Antisocial Personalities (*psychopathic, sociopathic) (*quotes are from the Merck
Manual) are the only two that remain under personality disorders.
” The Histronic (Hysterical) Personality is described in various terms such as ”
egocentric…attention seeking…theatrical behavior…emotional immaturity…childish, emotional response…lively
manner…rarely deeply involved emotionally…insatiable need for affection…easily repress or forget unpleasant or
discreditable experiences…responsiblity for misfortunes and failures is usually ascribed to others.”
” The Antisocial Personality “(previously used designation: psychopathic,
sociopathic) characteristically act out their conflicts and flout normal rules of social order. …impulsive, irresponsible,
amoral, unable to forego immediate gratification. They cannot form affectionate relationships with others, but their
charm and plausability may be highly developed and skillfully used for their own ends. They tolerate frustration poorly,
and opposition is likely to to elicit hostility, aggression, or serious violence. Failure and punishment rarely modify their
behavior or improve their judgment and foresight.”
Suggested therapies or treatments, “Although these mechanisms may not be breached by reason or interpretation,
they respond to improved interpersonal relationships and to supportive but forceful confrontation in prolonged
psychotherapy or peer encounters.”
1983. Fifth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of
Health and Human Services and the NIAAA. Pages 68-82. In this report, one researcher estimated the lifetime cost of
raising a child with FAS was $155 million.
1984. Fetal Alcohol Syndrome and Fetal Alcohol Effects. by Dr. Ernest Abel. One of the first textbooks to overview the
mechanisms and laboratory research on the effects of alcohol upon laboratory animals and selected cases.
1985. A Poison Stronger than Love. by Anastasia Shkilnyk. A book that tells the story of FAS in an American Indian
(Ojibway) community. New Haven: Yale University Press.
1987. The Merck Manual: Fifteenth Edition. Fetal Alcohol Syndrome is comprised of one paragraph on page 1887.
“The most serious consequence is severe mental retardation.” There is no mention of other behavioral problems.
Under Section 12, Psychiatric Disorders, Chapter 137, Personality Disorders the diagnosis section and the Histronic
(*Hysterical) and Antisocial (*Psychopathic, Sociopathic) Disorders section are copies of the Fourteenth Manual (1982)
manual entries. (*quotes are from the MerckManual.)
Under Section 15: Gynecological and Obstetrical Care, Chapter 176: Normal Pregnancy, Labor and Delivery, Prenatal
Care, the Merck states, “Recent studies indicate that…a daily intake of (less than) 2 ounces of wine probably would not
cause fetal abnormalities.”
Sixth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of
Health and Human Services and NIAAA. Pages 79-96.
[The NIAAA determined that the consumption of 0.1 ounce or less of absolute alcohol constituted a light drinker, 0.10.9 of absolute alcohol constituted a moderate drinker and 1.0 ounce or more of absolute alcohol constituted a heavy
drinker. (0.1 ounce is less than 1/4 of a small can of beer, less than one ounce of wine or less than 1/4 of a shot glass
of hard liquor.)]
1988. High Risk: Children Without a Conscience by Dr. Ken Magid and Carole McKelvey. A highly popular book at the
time. It deals almost exclusively with psychopathic (antisocial) personalities. The problems therein are ascribed to
working mothers, day care, teenage pregnancy, divorce, tv violence, schools, lack of religion, too much money, too
little money, lack of bonding/trust, adoption and foster care…everything except prenatal alcohol exposure. The
introduction was written by Congresswoman Patricia Schroeder. The topics brought up in this book are still being
discussed as reasons for children’s behavioral problems.
1988. Alcoholism and Women, Genetics, and Fetal Development by William J. Haugen Light. (1988) Springfield,
Illinois: Charles C. Thomas. Dr. Haugen is from the Institute for the Study of Drugs, Alcohol and Addictive Behaviors.
1989. The Broken Cord by Michael Dorris. The first nationally distributed book on FAS and its effects on a family. Dr.
Dorris cited 165 articles and books and three videos on the dangers of drinking during pregnancy.
U.S. law calls for the mandatory labeling of all containers of alcohol sold in the United States.
1990. Seventh Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the
Department of Health and Human Services and the NIAAA. Pages 138-161.
Formation of the Fetal Alcohol Syndrome Adolescent Task Force organization by Jocie and Don DeVries, Linda
LaFever, Vicky McKinney, Ann Waller and DeLinda McCann. Now known as the Family Resource Institute on FAS
(FAS*FRI), it also publishes the FASTimes newsletter.
August, 1990. NOFAS was incorporated in South Dakota. Patti Munter founded the organization along with Gwen
Packard. Ms. Munter served as NOFAS Executive Director through 1996, and is currently a member of the NOFAS
Board of Directors. NOFAS is currently located in Washington, D.C..
1991. Iceberg, a newsletter devoted to Fetal Alcohol Syndrome, published by the University of Washington Fetal
Alcohol and Drug Unit.
1992. The Merck Manual: Sixteenth Edition. Fetal Alcohol Syndrome is mentioned in
Section 14: “borderline mental deficiency.”
Section 14: “…severe behavioral effects…” “…varying degrees of mental retardation, and abnormal neurobehavioral
development.” “FAS is the leading known cause of mental retardation…”
Section15: “…most serious consequence is severe mental retardation…”
Section 15: “…and MR.”
Section 14 does state “In one study, an increased frequency of abnormalities was not found until 45 ml of alcohol
(equivalent to 3 drinks per day) was exceeded.” [ The Surgeon General of the United States issued his warning against
drinking during pregnancy in 1981.]
Personality Disorders are derived from the Diagnostic and Statistical Manual of Mental Disorders - Revised edition
(DSM III-R) and include the Histronic (*Hysterical) Personality and the Antisocial (*Psychopathic, Sociopathic)
Personality. (*quotes are from the Merck Manual)
Under treatment, the following has been changed and added:
“The physician’s job is to contain the patient’s externalization through setting limits, confrontation, and avoiding his own
tendency to become overinvolved–first to rescue and then condemn. … Over the long term, the anxiety and and
depression…are rarely abolished by pharmacotherapy…(exceptions are associated depression and compulsive
disorders).
“Patients must be confronted with the way their behavior affects other people. Frequently, limits on behavior need to be
set and reality issues dealt with. …the family should be involved, since group pressure seems to be effective. Group
and family treatment, group living situations, therapeutic social clubs, self help groups, milieu hospital therapy–all can
be valuable in treatment. …It is also important that those who undertaken treatment be aware of the difficulties and
avoid the disappointment, annoyance , and moral judgments that tend to creep in.”
Finally, “Life expectancy is diminished but among those surviving, there is some tendency to stabilization after age 40.”
1992 to 1993. The University of Wisconsin’s Family Empowerment Network formed by Dr. Raymond Kessel and Dr.
Georgiana Wilton as a direct response to family members who were asking for help in in dealing with Fetal Alcohol
Syndrome. In 2002, FEN moved to the University of Wisconsin’s Department of Family Medicine.
1993. Eighth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department
of Health and Human Services and the NIAAA. Pages 202-232.
Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention and Treatment. edited by Kathleen Stratton, et al. This
Institute of Medicine textbook was the American effort to consolidate the research and practical knowledge that was
available up to that time and to provide a uniform basis for diagnosis. The term “Alcohol Related Neurodevelpomental
Disorders” (ARND) was suggested as a substitute for the term “Fetal Alcohol Effects” which often mistakenly
considered a mild form of FAS.
Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome and Fetal Alcohol
Effects: Final Report, August, 1996. by Dr. Ann Streissguth. One of the few studies that discusses the outcomes of
FAS/FAE when intervention is not applied.Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention and
Treatment. edited by Kathleen Stratton, et al. This Institute of Medicine textbook was the American effort to consolidate
the research and practical knowledge that was available up to that time and to provide a uniform basis for diagnosis.
Article on the effects of prental alcohol on mRNA (messenger RNA) by Dr.s H.C. Scott, R.T. Zoeller and P.K. Rudeen
from the University of Missouri-Columbia. Implications for the generational affects of prenatal alcohol exposure.
1995-2008. The Merck Manual: Seventeenth Edition is online at http://www.merck.com.
Fetal Alcohol Syndrome is found in this volume. The behavioral aspects of FAS are as follows: Section 21, Chapter
286, “..with mental retardation and behavioral disturbances…”
Section 18, Chapter 250, “…varying degrees of mental retardation and abnormal neurobehavioral development.”
Personality Disorders are in Section 15: Psychiatric Disorders Chapter 191: Personality Disorders. The excerpts
quoted are taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), under
Cluster B: dramatic/erratic.
Antisocial Disorder (*previously called psychopathic or sociopathic) is essentially the same as the previous entries from
prior Merck editions.
There are additional comments on the environment. “Antisocial personality disorder is often associated with
alcoholism, drug addiction, infidelity, promiscuity, failure in one’s occupation, frequent relocation, and imprisonment.
…more men have this personality disorder than women, and more women have borderline personality; these two
disorders have much in common. In the families to patients with both personality patterns, the prevalence of antisocial
relatives, substance abuse, divorces and childhood abuse is high. Often the patient’s parents have a poor relationship,
and the patient was severely emotionally deprived in his formative years. Life expectancy is decreased but among
survivors, the disorder tends to diminish or stabilize withage.”
Histronic (*hysterical) Personality is also essential the same as in previous editions of the Merck. There are no
comments on therapies or treatment for this disorder
(*quotes are from the Merck Manual)
1996. Alcohol, Pregnancy and the Developing Child. edited by Dr. Hans-Ludwig Spohr and Dr. Hans-Christoph
Steinhausen. The European effort toconsolidate the research and knowledge about FAS that was available up to that
time. Spohr and Steinhausen also reported that papers on the occurrences of FAS had appeared in Germany in 1976,
Sweden in 1979 and Japan in 1981.
1997. Fetal Alcohol Syndrome: A Guide for Families and Communities, by Dr. Ann Streissguth, premier researcher on
the behavior of children with FAS. Streissguth gives a partial list of countries reporting cases of FAS, France,
Germany, Iceland, South Africa, and Canada.
Ninth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome. published by the Department of
Health and Human Services and the NIAAA. Pages 192-246.
FASCETS founded by Diane Malbin in Portland, Oregon. Ms. Malbin had been studying and lecturing on FASD for ten
years prior to the foundation of her organization.
1998. NOFASARDwas founded by Sue Miers and incorporated as an association in South Australia in 1998. Anne
Russell came on board as Queensland representative for the organisation in 2001 and Vicki Russell as Tasmanian
representative in 2003.
1999. FASWorld founded by Bonnie Buxton, Teresa Kellerman and Brina Philcox in Ontario Canada. Main purpose
was to form a worldwide FASDay at 9 a.m., September 9th of every year to start a world response to the problems of
FAS.
FASAwareUK founded by Gloria and Peter Armstead of Wigan, Great Britain. [Margaret Murch founded an
organization two years earlier but it has not been active as of late.]
2000. Tenth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department
of Health and Human Services and the NIAAA. Pages 282-338.
FAS-foreningen was founded in August, 2000 in Sweden by Katarina Wittgard. It started with a network in 1999 with
the support of Dr. Marita Aronson, one of the foremost researchers on FASD in Europe.
2001. The SAMHSA FASD Center for Excellence was initiated. The U.S. Congress authorized the Center in Section
519D of the Children’s Health Act of 2000, which included six mandates (Section b of 42 USC 290bb-25d or Public
Law 106-310). The mandates focus on exploring innovative service delivery strategies, developing comprehensive
systems of care for FASD prevention and treatment, training service system staff, families, and individuals with an
FASD, and preventing alcohol use among women of childbearing age.
Craig Lesley writes Storm Riders, a fictionalized account of his adopted son who has FAS. Picodor Pubishers.
2002. FASworld Deutschland was founded on September 7, 2002 by Ann Gibson.
FAS Stichting Nederlands was officially founded on 23 September 2002.
Dr. Nancy Day of the University of Pittsburgh finds that as little as one drink a day can cause physical deficits. (Study in
the journal Alcoholism: Clinical and Experimental Research.) Report in Reuters News Service, October 17, 2002.
2003. CalFAS (California FAS) was founded by Diane Kerchener. It started through a meeting with SAMHSA, who
encouraged CA’s three state representatives, Diane Kerchner, Kathy Page and Michael Monti along with NOFAS to
start a state organization.
2004. NIAAA National Advisory Council approves the definition of binge drinking as 4 or more drinks for a female and 5
or more for a male.
Damaged Angels by Bonnie Buxton. The second internationally distributed book on FASD and its effectson a Canadian
family. It was first published in Canada and soon to be published in the United States in May of 2005.
Dr. John W. Olney of Washington University in St. Louis says even two drinks during pregnancy can cause
neurological damage. (From a presentation to the American Association for the Advancement of Science.) (Reported in
the Associated Press, February 14, 2004.)
Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Published by the National Center on Birth Defects and
DevelopmentalDisabilities, Centers for Disease Control and Prevention, Department of Health and Human Services.
The latest update on diagnostic criteria.
May 10th, 2004, six Japanese brewers voluntarily place warning labels on their products. According to the newspaper
article, Japan joined Brazil. South Korea, and the United States in the use of warning labels for drinking during
pregnancy.
The World Health Organization Global Status Report on Alcohol mentions the effects of prenatal alcohol exposure in
one paragraph.
2005. Stout, Martha. The Sociopath Next Door. In an interview on NBC Saturday Today Show, she states, “Most
sociopaths are not violent.” “They are often have a failure to plan.” “They can be charming.”
Russell, Elizabeth. Alcohol and Pregnancy: A Mother’s Responsible Disturbance. (2005) Burleigh, Australia: Zeus
Publications. One of the only non-fiction books written by an Australian birth mother about her struggles to advocate for
her two sons. Discusses legal issues and residential alternatives.
2006. The Merck Manual: Eighteenth Edition. Will not be online until August of 2006. Two paragraphs are devoted to
Fetal Alcohol Syndrome.
Section 18: Gynecology and Obstetrics, mentions “…increased risk of spontaneous abortion… fetal growth
restriction…facial and cariovascular defects and neurologic dysfunction.” “It is a leading cause of mental retardation
and can cause neonatal death due to failure to thrive.”
Section 19: Pediatrics, mentions, “…a constellation of physical and cognitive abnormalities.” “After birth, cognitive
deficits become more apparent.” “The most serious manifestation is severe mental retardation…” “…lesser degrees of
alcohol use cause less severe manifestations…”
The descriptions of the Antisocial and Histronic Personality Disorders (Section 15) are essentiallythe same.
Antisocial: “…callous disregard for the rights and feelings of others.” “…frustrated easily and tolerate frustration poorly.”
“…act of conflicts impulsively and irresponsibly, sometimes with hostility and violence.” “They usually fail to anticipate
the consequences of their behaviors and typically do not feel remorse or guilt afterward.” “…glibly rationalizing their
behaviors or blaming it on others.” “Dishonestly and deceit permeate their relationships.” “Punishment rarely modifies
their behavior or improves their judgment.”
Histronic: “…conspicuous attention seeking.” “…frequently evoke sympatheticor erotic attention.” “Relationships are
often easily established and overly sexualized but tend to be superficial and transient.”
FASD Center for Excellence produces a report on the economic costs of FAS(D) which estimated the lifetime cost at
$3.5 million. Costs of lost opportunities for caretakers and the person with FAS(D) are undeterminable but might be an
extra $1.5 million.
On October 25th, 2006, the European Union Strategy to Reduce Alcohol-Related Harm very briefly addressed Foetal
Alcohol Disdorders on page 8 of the strategy…
http://ec.europa.eu/health/ph_determinants/life_style/alcohol/documents/alcohol_com_625_en.pdf
On November 20th, 2006 France requires warning labels on alcoholic beverages.
2007. January 31st, 2007: Diane Black of the Netherlands appears before the European Parliment during a seminar on
European Alcohol Policies. Dr. Black makes a speech on Prenatal Acohol Exposure in Brussels, Belgium.
April, 2007. ADHD and Fetal Alcohol Spectrum Disorders (FASD) edited by Dr. Kieran O’Malley is published. One of
the few textbooks that discuss the adult with FASD, epigenetics, similarities between the ADHD and FASD diagnoses,
medications, dual diagnoses, social communication, sexually inappropriate behavior and the judicial system.
May 24th, 2007: http://www.svd.se/dynamiskt/inrikes/did_15531275.asp. [Non-professional translation] “Cuba brought
down Sweden at the WHO” Svenska Dagbladet, published 24 May 2007. Geneva.
A Swedish resolution for a global strategy against alcohol has ended in a fiasco at WHO’s World Health Assembly in
Geneva. In spite of support from many countries, Sweden failed yesterday to push through a resolution after opposition
from alcohol-producing lands, with Cuba foremost.
The Swedish alcohol initiative had been discussed at the WHO meeting and caused
turbulence. From the beginning 40 countries stood behind the Swedish resolution that WHO should develop a “global
strategy to diminish harmful alcohol use”. Sweden got support from the Moslem world and from many European and
African countries.Swedish public health minister Maria Larsson said last week that “alcohol is an increasing problem in
the world, and especially in Europe increasing heavy drinking among youth can be noted”.
But then came increasing opposition from Caribbean countries such as Cuba, the
Dominican Republic and Jamaica. Many western countries were also unhappy that Swedenbased its resolution on a
report on the world’s alcohol problems that had not been published in its entirety; only a three-page summary.
Consensus was lacking for the resolution to be accepted.
It ended up that Cuba defeated the resolution which the Swedish public health minister had proudly introduced to the
WHA the previous week. The alcohol question has now been pushed off to the future.
The question will next be taken up at the WHO’s Executive Board meeting in
January 2008, where no less that six different proposals will be further discussed. The Caribbean lands are worried
that alcohol restrictions will have effects on their production and trade in rum, where sugar production also plays a role.
In recent years restrictions have come from WHO on both sugar and tobacco; two important commodities in these
lands. Now they feel that alcohol also is threatened.
Many nongovernmental organizations regretted that there will not be a global strategy against alcohol.
May 25th, 2007. The United Kingdom recommends no alcohol during pregnancy or conception. [Personal
communication from Gloria Armstead (www.FASAware.co.UK) in the UK.]
July 16th, 2007. Swedish brewers including Carlsberg A/S’s Swedish unit and Spendrups Bryggeri AB will put
information labels on beer to highlight that consumption of alcoholic beverages may be inappropriate under certain
conditions.
The Swedish Brewers Association has recommended to its members to put texts on beer with an alcohol percentage of
more than 2.25 per cent, the association said in a statement Friday. Carlsberg, Spendrups and Kopparbergs Bryggeri
AB agreed to follow the proposal.