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Edward Jenner was not the “hero” who first discovered VACCINATIONS in the 1790s for smallpox as most people are taught. The word “vaccination” was coined by one of Jenner’s friends to distinguish his inoculation with cowpox from inoculations with smallpox developed by Chinese physicians 800 years earlier. But both meet that same biomedical definition of vaccine — a biological preparation that provides acquired immunity to a disease, typically made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins.In the medieval period (900–1000 AD) Chinese physicians observed that smallpox transmitted by applying pus to a small scratch in the skin was less severe than transmission by someone coughing aerosolized sputum onto another person who breathed that in. They also noticed that dried scabs applied to scratches or nasal membranes did the same thing. That developed into a ritualized practice in which boys would receive the innoculation in the right nostril and girls in the left. Back then smallpox was not just severely disfiguring but deadly; 20–30% of cases were fatal.Because these practices did not control the “dose” of virus being given sometimes the result was a desirable mild rash followed by immunity against smallpox for life — but other times it induced full-blown smallpox that resulted in death. Thus it was not widely known and practiced until the mid 1500s, according to the author Yu T'ien-Chih and recorded in the book Miscellaneous Ideas in Medicine by Yu Chang in 1643. Meanwhile this information had spread to India where the preferred inoculation was scratching or injecting small amounts of smallpox pus under the skin. (BTW, these differences in reduced infectiousness of inoculations compared to natural smallpox transmisstion was confirmed in animal studies in 1906 by Americans Brinckerhoff & Tyzzer who inoculated monkeys in different ways and sites and produced data that matched the Chinese and Indian observations.) Smallpox innoculations spread west in the Ottoman Empire reaching Turkey by the 1700s and also being practiced in North Africa (Sudan).In 1700 English physicians Lister and Havers each published reports in the Transactions of the Royal Society on Chinese inoculations. In 1714 Greek physicians Timonis and Pylarinos who practiced this procedure in Constantinople published a report on their work in Transactions also. Reaction was skeptical until some famous people took note. One was American Cotton Mather who was prominent Massachussets Colony minister, amateur scientist, and notoriously involved in Salem Witch trials. More importantly was English Lady Mary Wortely Montegu who was a poet, writer, and wife of England’s ambassador to Turkey who had gone through her own bout of smallpox and had been disfigured. To protect her children, she had her six-year-old son inoculated while in Turkey, and in 1721, in the presence of Royal Society Members, she had her daughter inoculated in England. This led to adoption of smallpox inoculation, mainly by the aristocracy in England and Central Europe and partly in the American colonies.During America's War of Independence, George Washington had his army inoculated. British troops had the advantage of being exposed to smallpox or being inoculated, but the isolated American colonists were vulnerable. Boston, under military occupation, suffered a smallpox epidemic in 1775, and Philadelphia was hit in 1776. Concern that this would spread to the army was realized when American forces sent to Quebec were decimated by smallpox, not the British, causing Benjamin Franklin to say the army’s downfall would come from smallpox not warfare. There were fears of inoculation in America, stoked partly by a backlash to Cotton Mather’s attempts to promote it, such that the Continental Congress issued a proclamation in 1776 PROHIBITING smallpox inoculation. But Washington wrote Congress in 1777 informing them of his plan to proceed — active soldiers would not be inoculated as to incapacitate them for month of recovery making the army vulnerable to British attack, rather, inoculation would be applied only to new recruits so that they would have gotten over the mild sickness by the time they were trained, outfitted, and ready to fight. Disaster was averted.So inoculation was not a secret in Jenner’s time. In fact, Edward Jenner himself, when he was young boy, was inoculated for smallpox in 1757 .The first *recorded* smallpox vaccination was by Jenner in 1796, but the first *documented* smallpox vaccination was by Benjamin Jesty in 1774, a quarter century earlier. What’s the difference? In one case it was a matter of being published in a scientific or medical forum, and thus properly reported and “recorded” in the scientific literature. In the other case, it was a matter of having been done and written about somewhere like a newspaper or a correspondence. This is not a minor distinction, as the following will show.Jenner did the famous experiment in 1796. He then sent a communication to the Royal Society in 1797 which was rejected with the statement that Jenner “ought not to risk his reputation by presenting to the learned body anything which appeared so much at variance with established knowledge, and withal so incredible.” So he published a booklet himself about his successful cases in 1798 -- that's the date which tends to be cited as the first recorded vaccination.Anyway, the more interesting thing to this discussion is Jesty the Dorset farmer, depicted above. He did vaccinations on his own family decades earlier. It was written about in the local press of his region. Here is Jesty’s story… “Faced with a local outbreak of smallpox in 1774, Jesty devised the idea of inoculating his family with cowpox as a safer alternative to the conventional variolation method. To achieve this goal, he took his family to the hamlet of Chetnole, where he had heard there were cows with symptoms of cowpox. Jesty transferred material from lesions on the cows’ teats to the skin of the arms of his 3 subjects by insertion with a stocking needle. This act occurred 22 years before Jenner’s vaccination of James Phipps. The news soon spread... Correspondence indicates that knowledge of Jesty spread over a significant area of the south of England. This extraordinary event was validated and chronicled by sources in Dorset, including letters from William Dolling, the Reverend Hermann Drew, and the noted physician Dr Richard Pulteney. Direct evidence was recorded by the Reverend Andrew Bell, who interviewed Jesty at Swanage, and again later by the officers of the Original Vaccine Pock Institution in London.... Jesty received some recognition from the Original Vaccine Pock Institution but never from the Jennerian Society or the Royal Society.” (From: Pead, Vaccination’s Forgotten Origins, 2017)Despite lack of official recognition, there was some knowledge of Jesty’s role that circulated British medical circles. Jesty’s wife had a strong reaction which necessitated medical treatment, prompting some public criticism that labeled him a “brute.” A century later, a physician happening upon Jesty's gravestone reported on the inscription in an 1895 issue of British Medical Journal and attested to the validity of Jesty’s experiment prior to Jenner (Vaccination before Jenner). The modern, restored headstone can be seen in this photo: Jesty’s Grave, History of Vaccines.The idea that cowpox prevented smallpox was fairly well known, and this was discussed in various medical and scientific correspondences prior to Jenner’s 1796 experiment. Several physicians wrote about the belief. Among several examples that can be found, a clear statement came from a Shaftsbury surgeon by the name of Nash who died in 1795. Upon his death it was discovered that he left behind a manuscript written in 1781 which stated that cowpox in humans was not contagious, does not cause lesions, and provided reliable protection against smallpox. While that wasn’t published it’s clear that many medical men knew that cowpox blocked smallpox. A Mr. Daniel Sutton, an uncredentialed practitioner who developed a successful technique for smallpox inoculation (variolation) became well known: “In 1766 after thirteen years of activity [he] apparently inoculated twenty thousand persons without long a single one by the Inoculations.” He also became rich — he charged 10 pounds per patient. Sutton had started out testing his technique on poor peasants, and later remarked that many of them had no reaction to the variolation procedure because their resistance to smallpox was due to the fact “that they previously suffered a disease contracted by milking cows with cowpox. [Fewster & Sutton] conducted further research to test this assertion, which appeared to be true; Mr. Fewseter conveyed the information to a medical Society of which we has a member but no one thought to put this valuable observation to good use.” (From H Bazin, Vaccination: A History from Lady Montagu to Genetic Engineering).As for Jetsy’s and Jenner’s actual tests, the issue was well document when it was taken up a in court testimony from Dorset, and in an inquiry by the House of Commons in 1805 that requested evidence.Why court proceedings? Money.The story about Jenner observing the dairy maids getting cow pox and being protected from small pox is known to be apocryphal. Jenner as a lone discoverer was a myth that was purposefully cultivated and concocted later by his biographer. But in the 1800–1805 period, Jenner would be awarded £30,000 in grants by the Crown only after "Originality" had been established. That was a TON OF MONEY in those days. Jenner had a lot to be gained by having the official record show him with sole credit. There's reason to believe Jenner purposely inflated his contribution at the expense of long-known information before him.Here is another excerpt from the Pead article regarding Jenner not mentioning Jesty… "Although Jenner made no mention of Jesty in his writing, it should be noted that he rarely gave credit to the work of predecessors. These included his friend John Fewster, who had discussed cowpox with Jenner at length. Fewster must have influenced Jenner, rather than the dairymaid fable created by Jenner’s biographer John Baron, which has now been discounted. After Jenner’s death, much of his correspondence was burned without permission by Sir Everard Home, but recent scrutiny of associated communications with practitioners in Dorset indicates ways that he could have had knowledge of Jesty…. In 1807, Jenner had published a sevenfold classification of the human intellect, and it is clear from his “fair summary of the common eighteenth century wisdom on mental attitudes” that, believing himself descended from gentry (Baron Kenelem Jenour), he would never have acknowledged a tenant farmer from the “middling sort” class as having the intelligence to conceive and perform a vaccination procedure."But Jesty wasn’t the only one who felt stiffed. There was also a French hospital founder who was cut out. Jacques Antoine Rabaut-Pommier (depicted below) worked out cowpox vaccinations in 1780–84, fifteen years before Jenner.“ His plans to test his observations were interrupted by the French Revolution. However, “through a mutual friend, a Bristol merchant named James Ireland, Rabaut-Pommier passed his observations to an English physician, Dr. Pugh, who promised to pass them on to his colleague Edward Jenner, who was interested in the same problem. After the publication of Jenner's book on vaccination (1798), Rabaut was surprised not to find in it any reference to the suggestions he had made.” In the 19th century the French claimed to have discovered vaccinations before Jenner based on the story of Rabaut-Pommier, but the claim was ignored by the English and everyone else.Throughout this narrative, the word “innocuation” was carefully used as a generic term. Other terms in this story include “vaccination” and “variolation.” Sorting them out is part of the story. During Jenner’s time, the experiments caused the situation to change, so it could be confusing and he felt the need to distinguish what he did. Innoculation is a general term that can be applied to technique pioneered by the earlier Chinese physicians. What they did and everything prior to Jesty/ Rabaut-Pommier/ Jenner involved the use of live smallpox virus itself. Innoculation could also be applied to what Jesty did, but that involved the use of live cowpox virus. Understandably, a distinction became important. Jenner credited his friend and fellow physician, Richard Dunning, with combining “vacca” the the Latin root for “cow” with innocuation and came up with the term “vaccination,” which we continue to use today. But Jenner didn’t stop there. He also wanted a more specific term for the older kind of innoculation, so he combined “variola,” the name of the smallpox virus, with innoculation and came up with the term “variolation.” That distinction was important back in the turn of the 1800–1805 period. But in reading more modern sources one encounters the term “variolation” applied to the old Chinese-based method — that’s fine for being clear about things, but again, that term was invented AFTER Jenner’s experiment by Jenner. It’s a useful distinction for everyone because variolation isn’t completely safe but vaccination is — and it was personally useful for Jenner back then because he needed that ruling on Originality.Jenner tried to take the credit, he succeeded, and went down in history as the guy who conquered smallpox. But he “discovered” something essentially the same as was being done for the previous 800 years outside of Europe, and he “discovered” something that was openly discussed before and during his time, and actually performed right in his own back yard 25 years earlier by Jesty the Dorset farmer.Sources:Gross CP, Sepkowitz KA. The myth of the medical breakthrough: Smallpox, vaccination, and Jenner reconsidered Int J Infect Dis 3(1):54-60, 1998. PubMed PMID: 9831677. (PDF download is free, open source)Pead PJ, Vaccination's Forgotten Origins. Pediatrics 139(4):e20162833, 2017. doi: 10.1542/peds.2016-2833. PMID: 28270548 (PDF download is free, open source)Pauli GC. Vaccination before Jenner. British Medical Journal 2:871, 1895. doi: https://doi.org/10.1136/bmj.2.1814.871-bMilton DK. What was the primary mode of smallpox transmission? Implications for biodefense. Front Cell Infect Microbiol. 2:150, 2012. doi: 10.3389/fcimb.2012.00150. PMID: 23226686 (PDF download is free, open source)David Perlin, D and Cohen A. “Smallpox 12,000 Years of Terrror” and “Variolation: the earliest smallpox vaccines.” The Complete Idiot's Guide to Dangerous Diseases and Epidemics, 2002Filsinger AL, Dwek R. “George Washington and the First Mass Military Innoculation”. Science Reference Services, US Library of Congress, 2009Wikipedia, VariolationLing, G. Origin of smallpox vaccinationTheodorides, J. Rabaut-Pommier, A neglected Precursor Of Jenner. Medical History, 1979, 23: 479-480.

This answer briefly summarizes some overarching inferences,Autism - Wikipedia / Autism spectrum - Wikipedia (Autism Spectrum Disorders, ASD) rates started greatly increasing in some countries such as the US and UK since the 1980s even as doctors little understood these conditions and offered little of value to increasingly anxious parents desperately seeking definitive answers. Thus, in such an Autism causation vacuum, Andrew Wakefield - Wikipedia et al's 1998 Lancet report (1), the first to offer an explanation for the 'autism epidemic', became a convenient crutch for many frustrated parents who felt either ignored or condescended to by the medical establishment.However, in ~20 years, there's surprisingly scant scientific evidence to support the contention that 'vaccines cause autism'. Surprising because 20 years is a long enough period to be able to bolster the argument with solid data sets.Even taken at face value, many risk factors about Autism/ASD simply cannot be explained by a 'vaccines cause autism' notion. The more facts it can explain about a given phenomenon, the stronger a given hypothesis. That is just not the case with the 'vaccines cause autism' notion, which is simply inherently scientifically weak.On a topic so controversial as a potential vaccine(s)-Autism link, it may be best to start by scrutinizing the original data that got this particular idea started. In 1998, Andrew Wakefield and 12 co-authors published a Lancet article on 12 children, claiming they had identified in them evidence of a novel syndrome they called Autistic enterocolitis - Wikipedia (1).To digress just a bit at first, it's somewhat surprising that there isn't yet an agreed-upon consensus on the etiquette regarding scientific papers that have been retracted (2, 3). Specifically, should they continue to be cited in the literature or not? For example, this Wakefield et al paper continues being cited, 85 times already over six months in 2017 according to Google Scholar.This answer however requires not just citing this paper but also looking at what it actually says since it subsequently served as the launchpad for a purported vaccine(s)-Autism link. While 8 of these 12 children (67%) had received the MMR vaccine by the time of their symptom onset, the authors concluded (see below from 1, emphasis mine),'We identify associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers...We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described...If there is a causal link between measles, mumps, and rubella vaccine and this syndrome, a rising incidence might be anticipated after the introduction of this vaccine in the UK in 1988. Published evidence is inadequate to show whether there is a change in incidence22 or a link with measles, mumps, and rubella vaccine.23'Since these authors did suggest 'a rising incidence [of their newly coined syndrome] might be anticipated after the introduction of this [MMR] vaccine in the UK in 1988', if we give them the benefit of the doubt and assume their autistic enterocolitis concords to some extent with Autism, what do epidemiological data show so far? In a nutshell, nothing that supports their supposition. On the contrary, such studies haven't found a link between vaccines and Autism.A 1999 study of children in North Thames, London, found rising cases of ASD since 1979 without a sharp increase after MMR was introduced in 1988 (4).A 2001 British study found that while Autism rates in 2 to 5 year olds had increased from 8 boys per 10000 to 29, a 3.6-fold increase, from 1988 to 1993, rates of MMR vaccination had remained stable across these birth cohorts, meaning it wasn't possible to attribute the Autism rate increase to the MMR vaccine (5).Thus an examination of the original paper that jump-started the vaccines-Autism controversy finds it did not even make such an assertion and that subsequent studies found no evidence of such a link either. OTOH, one detailed review after another has since found that the MMR vaccineIs safe (6, 7).Is unlinked to Autism (8).The furore, notoriety and controversy about a link between vaccines and Autism begins with this one study of a mere 12 children, only 8 of whom had received the MMR vaccine by the time of their symptom onset, and it turns out the study didn't even make that claim. Also more accurately, the paper explores not a link between vaccines and Autism in general but rather one specifically between the MMR vaccine and autistic enterocolitis, a syndrome that isn’t listed in medical textbooks.So, how did a link between vaccines and Autism even get made? Turns out to have been a subsequent interpretation (3), perhaps helped along by an immediate press conference when this paper was published followed by copious contemporaneous sensationalist front-page coverage by several British newspapers (9) of a kind that suggests (3) many couldn't even be bothered to read what was actually in the paper.Subsequent uncovering of undisclosed conflicts of interest behind Wakefield's study followed by predictable establishment backlash against him then cast him in the potent 'martyr' mode, which further solidified and enhanced his reputation among parents desperately seeking definitive answers to their children's Autism/ASD diagnosis, and who also felt Wakefield took them seriously while feeling the medical establishment didn't (9).How Autism's Causation Vacuum was Fertile Soil for Wakefield's Vaccine-Autism Supposition to take RootOn the face of it, it seems astounding that one small study on 12 patients should have had such an outsize impact. And yet, maybe not so surprising from a sociological perspective. At the time the Wakefield et al paper came out, Autism/ASD rates had already been spiking for several years with no satisfactory explanation from the medical establishment. Perhaps unwittingly, this state of affairs helped stoke and sustain this particular controversy.Autism diagnosis remains the purview of behavioral scientists who base the diagnosis on a highly subjective checklist, not an impartial, objective, quantitative diagnostic test.Even as they tweaked and improved their diagnostic toolkit, which in turn led to increasing rates of diagnosis, doctors had no clear answer for why steadily increasing numbers of children were being diagnosed with Autism from the 1980s, especially in the US and UK.Still little understood, neither reliable objective diagnosis nor specific treatment, let alone cure, yet existed for Autism/ASD, a situation little changed in the years since.With increasing numbers of parents desperately seeking answers to their children's predicament, a causation vacuum concerning Autism was precisely calamitous and in hindsight, the Wakefield paper appears to have arrived at just the right moment to fill it with something that no one had proposed thus far, a 'medical explanation for the autism epidemic' (see below from 9, emphasis mine).'However, the fact that there was no other reported or known reason for the ‘epidemic’ did not exactly help matters. Whatever their overall validity, vaccine hypotheses did plug a gaping hole in scientific knowledge about this condition that everyone thought had been measured so precisely and accurately with a wealth of new measurement tools and scales. How could it be that no one actually knew why autism was increasing?...Wakefield’s work was so popular because it promised so much. It promised to fully explain the autism epidemic, thus it was particularly ironic that epidemiological sciences never supported his claims.’Autism/ASD having historically been and tending to remain the purview of behavioral scientists may, in the grand scheme of things, turn out to have been a major stumbling block that stymied accelerated understanding of these conditions.Ironically, by highlighting gastrointestinal issues in autistic children, Wakefield may have done Autism/ASD research a huge service. After all, ~20 years on, the gut microbiota-brain link is so much better appreciated now and indeed gut Dysbiosis - Wikipedia is today well-recognized as a cardinal feature in substantial numbers of Autism/ASD patients (10, 11).There was and is an urgent need for a more multi-disciplinary approach for both research and diagnosis in the Autism/ASD field. Gastroenterologists, immunologists, microbiologists, geneticists and other specialists would only help not impede better understanding of these conditions by helping develop more scientifically robust diagnostic approaches and helping tailor more targeted therapies.Even in 2017, such cross-disciplinary research on Autism/ASD is sorely lacking. A simple literature search is a clear indication of this. My search for 'Autism' in both Nature Reviews Immunology and Nature Reviews Microbiology together turned up a total of only 24 articles, 2001-2017 (12), only 19 in Nature Reviews Gastroenterology and Hepatology, though through 2006-2017, which suggests the gut-microbiota-brain axis is becoming a bigger focus of research (13), while the same search in Nature Reviews Neuroscience turned up almost 10X higher articles (219), 2001-2017 (14). For context, the Nature Reviews series are typically considered among the most influential science review journals for various subjects.History also suggests the Wakefield idea fills the Autism/ASD causation vacuum rather like a square peg in a round hole. After all, it is inherently scientifically weak since there are so many Autism/ASD risk factors that effects of vaccines, adverse or otherwise, simply cannot explain.So many Autism/ASD Risk Factors that Vaccines can't explainHow could vaccines possibly explainWhy Autism/ASD is more common in boys than girls, ranging from ~4:1 in the 1990s (15) to ~9:1 by the 2010s (16, 17, 18)? If vaccines 'cause' autism, a person's gender shouldn't matter.Why Autism/ASD rates are so much higher in monozygotic (identical) (70-90% concordance) compared to dizygotic (fraternal) (0-30% concordance) twins (19, 20, 21)?Found in disparate populations such as in the UK (22) as well as in Scandinavia (23).Monozygotic twin concordance for autism is a long-standing feature, being observed right from the 1970s in pioneering studies by Michael Rutter - Wikipedia (24).Autism thus has an unmistakably strong genetic component (22), something that could not be explained by environmental factors alone such as effects of vaccine(s), adverse or otherwise.If vaccines 'cause' autism, a person's genetic background shouldn't matter.Autism/ASD connection with maternal and child antibiotic use reported in several studies (25, 26, 27)? This alludes to a different environmental trigger, namely, changes in gut microbiota composition.Consistently identified Autism risk factors such as exposure to traffic-related air pollutants, increased parental age, maternal obesity, diabetes and folic acid deficiency, prenatal viral infection, C-section, preterm birth, low birth weight, limited or absent breastfeeding, abnormal melatonin synthesis, hyperbilirubinemia, zinc deficiency, and maternal immigrant status (28, 29, 30, 31, 32, 33)? These factors and vaccines are simply unconnected.Autism/ASD are clearly multi-factorial, with both genetic and environmental factors intersecting in as-yet undeciphered ways, and since rates started to increase dramatically since the 1980s, clearly some environmental factor(s) are key. However, those factors still remain stubbornly unclear. Rather than vaccines, however, multiple studies since at least 2004 have consistently reported altered gut microbiota composition in ASD subjects (10, 11). Whether that's cause or effect still remains to be determined.CodaBasing anti-vaccine sentiment on a purported vaccines-autism link is reckless and dangerous since it inflicts real cost in the form of needless deaths from vaccine preventable diseases. Consider measles where the vaccine is historically one of the safest on record. In June 2017, a six year old Italian leukemia patient died from measles complications after reportedly catching it from his older brother, whom his parents had decided not to vaccinate (34), the latest in a measles 'tragedy' that has so far taken 35 lives across Europe (35).Bibliography1. Wakefield, Andrew J., et al. "RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children." (1998): 637-641. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(97)11096-0.pdf2. da Silva, Jaime A. Teixeira, and Judit Dobránszki. "Highly cited retracted papers." Scientometrics 110.3 (2017): 1653-1661.3. Collins, Harry M., Luis Reyes‐Galindo, and Paul Ginsparg. "A note concerning primary source knowledge." Journal of the Association for Information Science and Technology 68.5 (2017): 1105-1110. https://arxiv.org/ftp/arxiv/papers/1605/1605.07228.pdf4. Taylor, Brent, et al. "Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association." The Lancet 353.9169 (1999): 2026-2029. https://www.researchgate.net/profile/Brent_Taylor3/publication/12921734_Autism_and_Measles_Mumps_and_Rubella_Vaccine_No_Epidemiological_Evidence_for_a_Causal_Association/links/02e7e51d45c2c59b90000000.pdf5. Kaye, James A., Maria del Mar Melero-Montes, and Hershel Jick. "Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis." Bmj 322.7284 (2001): 460-463. https://pdfs.semanticscholar.org/4657/f7bf358ca0d1c5aa341ed33a63df84e52da7.pdf6. Halsey, Neal A., and Susan L. Hyman. "Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12–13, 2000." Pediatrics 107.5 (2001): e84-e84. http://pediatrics.aappublications.org/content/pediatrics/107/5/e84.full.pdf7. Demicheli, Vittorio, et al. "Vaccines for measles, mumps and rubella in children." Cochrane Database Syst Rev 4.4 (2005). https://www.researchgate.net/profile/Carlo_Di_Pietrantonj/publication/221834605_Vaccines_for_measles_mumps_and_rubella_in_children/links/00463517a5aa79a22b000000/Vaccines-for-measles-mumps-and-rubella-in-children.pdf8. Stratton, Kathleen, et al. "Immunization safety review: measles-mumps-rubella vaccine and autism." (2001). https://www.ncbi.nlm.nih.gov/books/NBK223376/pdf/Bookshelf_NBK223376.pdf9. Evans, Bonnie. The metamorphosis of autism. Manchester University Press, 2017. https://www.ncbi.nlm.nih.gov/books/NBK436841/pdf/Bookshelf_NBK436841.pdf10. Mayer, Emeran A., David Padua, and Kirsten Tillisch. "Altered brain‐gut axis in autism: Comorbidity or causative mechanisms?." Bioessays 36.10 (2014): 933-939.11. Hsiao, Elaine Y. "Gastrointestinal issues in autism spectrum disorder." Harvard review of psychiatry 22.2 (2014): 104-111. https://pdfs.semanticscholar.org/ce91/0afdf1c3da4cb6dc814170733a0204611180.pdf12. nature.com search13. nature.com search14. nature.com search15. Baron-Cohen, Simon, and Jessica Hammer. "Is autism an extreme form of the" male brain"?." Advances in Infancy research 11 (1997): 193-218. https://pdfs.semanticscholar.org/ad8c/4b5c9e91059d95e98649c94c7569c492a3f2.pdf16. Whiteley, Paul, et al. "Gender ratios in autism, Asperger syndrome and autism spectrum disorder." Autism Insights 2 (2010): 17. https://www.researchgate.net/profile/Paul_Whiteley/publication/51018620_Gender_Ratios_in_Autism_Asperger_Syndrome_and_Autism_Spectrum_Disorder/links/0ecba90a0ad20b9df3097710.pdf17. Ruzich, Emily, et al. "Sex and STEM occupation predict autism-spectrum quotient (AQ) scores in half a million people." PloS one 10.10 (2015): e0141229. Sex and STEM Occupation Predict Autism-Spectrum Quotient (AQ) Scores in Half a Million People18. Baron-Cohen, Simon, et al. "Elevated fetal steroidogenic activity in autism." Molecular psychiatry 20.3 (2015): 369. https://www.nature.com/mp/journal/v20/n3/pdf/mp201448a.pdf19. Muhle, Rebecca, Stephanie V. Trentacoste, and Isabelle Rapin. "The genetics of autism." Pediatrics 113.5 (2004): e472-e486. https://www.researchgate.net/profile/Isabelle_Rapin/publication/8583430_The_genetics_of_autism/links/00463521b8de571cdd000000/The-genetics-of-autism.pdf20. Rosenberg, Rebecca E., et al. "Characteristics and concordance of autism spectrum disorders among 277 twin pairs." Archives of pediatrics & adolescent medicine 163.10 (2009): 907-914. https://www.researchgate.net/profile/Rebecca_Rosenberg2/publication/26871866_Characteristics_and_Concordance_of_Autism_Spectrum_Disorders_Among_277_Twin_Pairs/links/561f019a08aec7945a271a75.pdf21. Hallmayer, Joachim, et al. "Genetic heritability and shared environmental factors among twin pairs with autism." Archives of general psychiatry 68.11 (2011): 1095-1102. https://pdfs.semanticscholar.org/3c04/5560f824473172027c89eaeefa46260afe55.pdf22. Bailey, Anthony, et al. "Autism as a strongly genetic disorder: evidence from a British twin study." Psychological medicine 25.1 (1995): 63-77. https://www.researchgate.net/profile/Emily_Simonoff2/publication/15407569_Autism_as_a_Strongly_Genetic_Disorder_Evidence_from_a_British_Twin_Study/links/591d4f3c45851540595c8e43/Autism-as-a-Strongly-Genetic-Disorder-Evidence-from-a-British-Twin-Study.pdf23. Steffenburg, Suzanne, et al. "A twin study of autism in Denmark, Finland, Iceland, Norway and Sweden." Journal of Child Psychology and Psychiatry 30.3 (1989): 405-416.24. Folstein, Susan, and Michael Rutter. "A Twin Study of Individuals with Infantile Autism." Autism. Springer US, 1978. 219-241.25. Konstantareas, M. Mary, and Soula Homatidis. "Brief report: Ear infections in autistic and normal children." Journal of autism and developmental disorders 17.4 (1987): 585-594.26. Niehus, Rebecca, and Catherine Lord. "Early medical history of children with autism spectrum disorders." Journal of Developmental & Behavioral Pediatrics 27.2 (2006): S120-S127.27. Adams, James B., et al. "Mercury, lead, and zinc in baby teeth of children with autism versus controls." Journal of Toxicology and Environmental Health, Part A 70.12 (2007): 1046-1051.28. Landrigan, Philip J. "What causes autism? Exploring the environmental contribution." Current opinion in pediatrics 22.2 (2010): 219-225. http://www.autism-society.org/wp-content/uploads/2014/04/Autism-and-Environment.pdf29. Rossignol, Daniel A., and Richard E. Frye. "A review of research trends in physiological abnormalities in autism spectrum disorders: immune dysregulation, inflammation, oxidative stress, mitochondrial dysfunction and environmental toxicant exposures." Molecular psychiatry 17.4 (2012): 389. https://pdfs.semanticscholar.org/552b/c0709407afc962369a322a41d2ae605a8b16.pdf30. Grabrucker, Andreas M. "Environmental factors in autism." Frontiers in Psychiatry 3 (2012). https://www.researchgate.net/profile/Andreas_Grabrucker/publication/235368604_Environmental_Factors_in_Autism/links/0c96052f1f836e4fc0000000.pdf31. Rossignol, D. A., S. J. Genuis, and R. E. Frye. "Environmental toxicants and autism spectrum disorders: a systematic review." Translational psychiatry 4.2 (2014): e360. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3944636/pdf/tp20144a.pdf32. Ornoy, A., L. Weinstein-Fudim, and Z. Ergaz. "Prenatal factors associated with autism spectrum disorder (ASD)." Reproductive Toxicology 56 (2015): 155-169. https://www.researchgate.net/profile/Asher_Ornoy/publication/277408501_Prenatal_factors_associated_with_Autism_Spectrum_Disorder_ASD/links/55756d7d08aeb6d8c01959b7/Prenatal-factors-associated-with-Autism-Spectrum-Disorder-ASD.pdf33. Ng, Michelle, et al. "Environmental factors associated with autism spectrum disorder: a scoping review for the years 2003-2013." Chronic Diseases and Injuries in Canada 37.1 (2017). http://www.phac-aspc.gc.ca/publicat/hpcdp-pspmc/37-1/assets/pdf/ar-01-eng.pdf34. Child's death from measles caught from unvaccinated brother reignites debate in Italy35. Measles 'tragedy' kills 35 across Europe - BBC NewsThanks for the R2A, Marcos Santiago.

Kerala has a huge tradition in Ayurveda. Its reputed all over the world for its intense Ayurveda traditions. However its not the original home of Ayurveda, as much of the original Ayurvedic traditions originated in Gangetic plains, Himalayan valleys and Narmada banks.However today when someone says Ayurveda, the image of Kerala is evoked only because Ayurveda continues to be a mainstream source of medical treatment in Kerala. In majority part of India, Ayurveda could mean either larger companies like Dabur or much recent Patanjali etc who are focused on cosmetic/health supplements sector OR miscellaneous individuals or babas or some Yoga/ashram institutions etc who have Ayurvedic products mostly related to wellness. Ofcourse there are lot of scrupulous elements among the latter due to the factor of lack of verifiability of their qualifications and expertise.Its common to see Pharmacies (featured in left) that sell ALLOPATHIC medicines highlighting itself as ENGLISH MEDICINE STORE to differentiate it from Ayurvedic pharmacies (featured in right).However things are bit different in Kerala. In the state, if someone looks at a Pharmacy, an unusual terminology is found in the nameboard- ENGLISH MEDICINES (Allopathic medicines). This is primarily because Pharmacy for Malayalees in general could be Ayurvedic Pharmacies as well as Homeopathy Pharmacy too unlike rest of India where the word denotes only Allopathic medicines. That alone shows the extend of popularity of Ayurveda as a mainstream treatment for almost all kinds of illness and health related matters within the state rather as a pure wellness products. There are large scale professional Ayurvedic hospitals, poly clinics apart from some of the much reputed ayurvedic medical brands and qualified practitioners across the state.The most common heard theory why its popular, is that, its because of tourism as well as presence of many rare herbs that grow wildly in Kerala’s lush forests. While the latter is true, former is not so. Because ayurveda isn’t simply all about a massage or rejuvenation treatments, which is just a secondary activity.HistoryAs per mythological belief, Ayurveda was introduced by Parasurama when he created Kerala. Historically its heavily associated with arrival of Buddhist traditions. Prior to Buddhism, local natives had extensive natural treatments and healing culture (a form of Ayurveda as such). But Buddhists helped to integrate the traditional knowledge as well as their extensive knowledge into a codified form which was heavily patronized locally. By 5th century, along with rise of Brahminical power, many ancient Vedic literature on ayurveda also strongly crept into the land, the most noteworthy being the Ashtanga Hridayam written by Vagbhata in Sindh area who was believed to come down to Kerala and settle down near Pattambi. The Ashtanga Hridayam effectively summarized almost all the knowledge put forward by Charaka and to some extend- Suśruta. Ashtanga hridaya soon effectively became the Holy Bible for Kerala Ayurveda and the brahmin community who were seen as flag carriers of vedic civilization as part of their assimilation into local culture effectively absorbed all Buddhist traditions in Ayurveda, thus generating the best of best methods available.As Ashtanga Hridaya focused more on Charaka Samhita (Charaka Methodology) which focused on preventive medicine and less of surgical methods as Susruta proposed, much of Kerala Ayurveda traditions is focused on former method with minimal surgical treatments. Buddhist traditions consider Salyachikilsa (Surgery or open cut treatment) as an act of Himsa (violence) and against the basic principles of Buddhism. Hence due to absorption of this value into Kerala Ayurveda traditions, there is little surgical methods and much more is focused on through consumption of medicines or oil applications aimed for eliminating or suppression of root cause of a disease or illness.The Astanga Hridaya also brought a new tradition of Asta Vaidya cult in Kerala, were 8 families became supreme authority of Ayurveda in Kerala. There was a degree of specialization associated with a family, thus each family became masters in their respective 8 branches of Ayurveda (Ashtanga)The 8 branches of Ayurveda as popular in Kerala areKaya chikitsa (treats the body)Baala chikitsa (pediatrics)Griha chikitsa (psychiatry)Urdhvanga chikitsa or shalakya tantra (eye, ear, nose and parts above neck)Salya tantra (surgery)Damsthra chikitsa (toxicology)Jara chikitsa or rasayana chikitsa (rejuvenation therapy)Vrishya chikitsa or vajeekarana chikitsa (aphrodisiac therapy)Out of this, Salyachikilsa or Surgery is very limited option in Kerala school of Ayurveda mostly limiting to Orthopedic treatments and few Parasurgicial procedures.Why Ayurveda is massively popular?Trust factorOne key factor why this is stream is popular is purely because of trust and acceptance of the treatment by natives. From a very young age, Malayalees are trained to accept that Ayurveda is a science of wellness and healthy living. Its equally a medical treatment that focus on prevention than curation as such.Dhanwanthari Statue in front of State Ayurveda College- Trivandrum. Worship of Dhanwanthari is common for almost all ayurvedic institutions including Non Hindu institutions, due to massive association of this tradition with religious values.One key reason of this awareness and trust is primarily because it has a divine significance. Ayurveda as such carriers a degree of divinity as most of Malayalees associate Ayurveda with Dhanwanthari- the god of Medicines. Its started off as a medicial treatment linked with temples, thus a degree of divinity has been imbibed into it. In olden days, the medicial treatment was heavily associated with divine factors and thus there used to be a blind trust as such. The practitioners in those days, who gained the knowledge also retained the basic divine cover over the medical treatments, thus helping to generate a huge trust factor.This trust and goodwill was successfully converted into proper brands in 20th century and thus these brands enjoy a huge trust. Every Malayalee holds an unquestionable trust and faith in medicines of much acclaimed Kottakkal Arya Vaidya Shala or Ollur Thaikadu Vaidyaratnam Moss etc, which is primarily an inherited trust factor, which originally started with a belief in divinity.Asta vaidya traditionsOne key reason why Ayurveda lost its status in many other parts of county was lack of an organized form of practice. It was learnt by many individuals and rarely transmitted or passed on next generations with a proper inheritance process. As a result, it ended up with so many individual Babas, Sansyasis etc rather a proper family or institution.One key reason why it achieved a legacy in Kerala, was the process of institutionalizing the knowledge and transmitted professionally through rigid schooling methods for each generations.Originally there were 18 Families who were clubbed together under 8 branches of Asta Vaidya traditions, which slowly dwindled to 8 in number (through migration, merging of families, extinction of families etc). 8 families- Aalathiyoor Nambi, Elayidath Thaikkatt Mooss, Thrissur Thaikkattu Mooss (Pazhanellippurath Thaikkatt Mooss), Kuttancherry Mooss, Vayaskara Mooss, Chirattamon Mooss, Velluttu Mooss and Pulamanthol Mooss holds much of the ancient knowledge of Ayurveda.Between the 13th and the 17th centuries, with generous royal and individual patronage, a fertile intellectual milieu developed around temples in Kerala, especially in the Nila valley region in Malabar, where scholarship and scientific research on medicine, mathematics and astronomy made significant progress. The Ashtavaidya culture evolved in this environment, blending the Ayurveda of Ashtangahrdayam with the knowledge and practices of local healers.Each Ashtavaidya family developed its own therapeutic specialties and its specific methods of transmission. Although many of the specialties were guarded as family secrets, students outside the family were accepted as disciples. This helped disseminate their knowledge beyond the family circle and create new lineages of transmission. The Ashtavaidyas have enriched Ayurvedic literature through their Sanskrit commentaries on the Ashtangahrdayam such as Hrdayabodhika and Vakyapradipika, and compendiums in Malayalam such as Alattur Manipravalam, Cikitsamanjari, Sahasrayogam and Sindhuramanjari.These texts and commentaries constantly enriched the Ayurvedic traditions of Kerala.For more details of Kerala school of Ayurveda and its concept- one can check the detailed interview with Indudhara Menon of National Centre for Biological Science who extensively researched on this topic.Indudharan Menon - Ayurveda and folk healing of Kerala - YouTubeMixture of Tantric cult with Ayurveda.Kerala form of worship- Tantra associated with temples has lot of ancient vedic customs and practices widely used on day to day basis. The vedic rituals, particularly large yajnas and homas like Somayaga require a presence of Vaidya to make the ritual complete. This is because in a yajna, Adityas are believed to proprietors of the sacrifice and Aswini Kumaras (the divine physicians) are regarded to be twin Adityas who stand on two sides of the Yajnakuda. Thus Ayurveda forms a very integral part of tantric form of worship and temples heavily fund and promote vaidya traditions to ensure the continuation of their rituals.The illustrious Vaidyamadom family, one of the Astavaidyans of Kerala and the only Nampoothiri vaidyas, reputed for participating in 101 Somayagas of Kerala as well as an authority in Kerala school of AyurvedaThis means Nampoothiri vaidyas or Shala Vaidya have both medical and vedic authority in the society. Vaidyamadom is one such celebrated family and ayurvedic institution who have a huge command and respect in the society.When these families become an ayurvedic brand, it automatically increases the repute and trust factor, which has a degree of religiosity into it.Spread of multiple Ayurvedic communitiesThough much of Kerala’s Ayurveda gains its moral authority because of its Astavaidya traditions, Kerala ayurveda school is much larger in nature.Itty Achudan Vaidyar, celebrated Ezhava physician and researcher who helped Dutch governor Hendrik van Rheede to compose world famous research work- Hortus Malabaricus that highlights the rare flora of Malabar and its medical propertiesThere are 1000s of other communities who are specialized in Ayurveda. Ezhavas community, despite of being regarded as low caste community, are always celebrated as masters of Ayurveda tradition. This is because they retained the original Buddhist traditions of Ayurveda without mixing with Vedic concepts. Ezhava community came to Kerala from Sri Lanka and thus share many original Lankan Buddhist concepts (Lanka have these concepts originally from Gangetic plains as Buddhism brought these knowledge from there, which later got extinct in Gangetic plains). So indirectly Kerala also benefited this knowledge in a big way.Ezhava physicians, being a lower caste community, extended this knowledge to much of the commoners community and among lower castes of the society without any caste bias unlike Nampoothiri physicians who maintained caste laws. This lead to widespread awareness and popularity even with most lowest class which otherwise may be deprived of the tradition. Eminent Ezhava physicians like Kayikkara Govindan Vaidyar successfully translated the highly complex Ashtanga Hridyam which is a Sanskrit work into Malayalam, thus transmitting the knowledge to commoners even today.In addition, several traditions of Nattuvaidyam (Naturalopathy traditions) as practiced by tribal communities also got popular within many other lower caste communities in Kerala and many of these were absorbed into Kerala school of Ayurveda in general.Institutionalization of Ayurveda familiesTraditionally Ayurveda was heavily family institutions, where sons/nephews were expected to learn, specialize and carry forward the family traditions as well as inherit the secrets. However to a limited extend, gurukulam system was also promoted to push the knowledge with others who were expected to be assistants and supporters of the family and their treatment facility. Though family as such were an institution untill 19th century, there was a much larger threat looming over them,The entry of western medicines post 16th century into India and its widespread popularity since 18th century have started making many traditional Ayurvedic families insecure.Western medicines focused on curative treatments, which were more instantaneous in nature. Its was heavily suppressing in nature, so as there is essentially a major pain relief compared to Ayurveda which manifests the pain (as being the preventive treatment, the focus was to pull out the root of the pain rather treating symptoms). As western treatment was getting popular, there was an urgency to change Ayurveda in accordance to the time. Its no more possible with limited number of physicians to treat the mass, unlike Western treatments which can do so.The 10 Ayurvedic Leaders who worked for modernizing ancient system of Ayurveda into much professional modern medical stream in Kerala. All these 10 leaders effectively became stalwarts of Kerala Ayurveda and the institutions they established as have achieved worldwide fame as professional Ayurvedic Medical institutionsSo in 1902 under the patronage of Cochin King H.H Rama Varma XV (popularly known as Rajarishi, being a saintly scholar himself) and titular Maharaja of Kozhikode- Zamorin Manavikrama Ettan Raja who was an ayurvedic physician, decided to convey a Pan Kerala conference to discuss and suggest methods to popularize Ayurveda. All leading ayurvedic physicians, the celebrated Astavaidyans and others participated in the conference held at Shornour. A Society or Samajam called Keraleeya Ayurveda Samajam was established to coordinate methods to popularize Ayurveda was decided. Samajam was the world’s first Ayurvedic Medical society and center which helped in codifying the ayurvedic knowledge in a professional way.The world famous institution of excellence in Ayurveda- Kottakkal Arya Vaidya Sala, is one of the pioneers in professionalizing ancient traditions into modern medical stream. For his contributions in medical field, The Viceroy of British India confered the highest title for medical practitioners in India- Vaidyaratnam in 1933In meantime, one among them- PS Warrier already started a small scale dispensary called Arya Vaidya Sala in his place- Kottakkal to popularize the concept of Ayurveda among poor as well as middle class. He opened free hospital and subsidized medicines which soon led to its popularity. He himself learnt English and understood the complexities of Western treatment and started taking best of English medical concepts into Ayurveda.This includes mass production of medicines at physician’s permises (something unheard untill then in Ayurveda) which actually lowered the cost of production per capita basis as well as helping patients with providing pre-prepared and packed medicines.This was the first revolutionary change, as untill then patients have to collect the plants and prepare the medicine as per formulations prescribed by physicians where the key reasons for switching to much easier English Medicines.The Samajam acted like an Academy or society (much akin to Royal College of Physicians in UK), where all physicians commonly report various diseases and illness they observed as well as suggested medicines/formulations. This sort of uncodified medical treatments soon achieved a near universal standardized practice with common medical protocols coming up among physicians. A common medical magazine were published to inform the common protocols and observations as well as suggested procedures.Traditional Ayurvedic families who successfully institutionalized them into major medical brands and currently ranks as some of the country’s best known Indian Ayurvedic brandsThe success of Kottakkal Ayur Vaidya Sala’s pre-packed medicine tradition, immediately made other ayurvedic families to start similar system, thus an array of brands started coming up. At the same time, in back-end, lot of mutual coordinated deliberations and medical conferences held, to ensure formulations were near uniform and helped to achieve desired outcome.Later in 1913, Samajam itself became a hospital brand and all its constituent members individually decided to be become its own private medical brands.By 1920, AVS adopted a new concept- AGENCY SALES after being inspired from American model of franchiese system. By agency sales, agents opened pharmacies of the brand in various part of the states and medicines being sold in such pharmacies.This eliminated the need of small local physicians to privately produce medicines at their clinics or recommend the formulations to patients to prepare at home. However once agency sales increased, there was a rapid consumption of all common medicines. People started buying various oils for smaller ailments at pharmacies which traditionally they have to prepare at home. This lead many Ayurvedic families to convert their home made mass production into proper automated industrial scale of production. This was first big step of large scale ayurvedic production of medicines which almost resembled to same style of English Medicines.Fully packed medicines and tablets started appearing and people were indeed comfortable in buying Ayurvedic medicines much like Allopathic medicines. This slowly converted family into institutions. Almost all the families today have companies and corporate institutions specialized in Ayurvedic medicial treatment.Institutionalization helped people to have a strong trust factor that can be verified (as it follows GMP pratices) as well as ensures a strong medicial protocols much like western medicine system.Codified procedures and standardized treatmentsIn 1889, Travancore Kingdom opened first Ayurvedic Medical college, which was a long cherished dream of H.H Vishakam Thirunal Maharaja who was a qualified botanist and an ayurvedic scholar, realized during the reign of his successor- Sree Moolam Thirunal. The aim of Vishakam Thirunal to impart the Ayurvedic knowledge to all class of society without any bias of traditions or customs, out of the traditional gurukula system.This concept got a much appreciation from Kerala Ayurveda fratenity as it was first step of codifying the procedures and making a standard. Once Kerala Ayurveda Samajam started, they too intitated its own medical college. So as most of the Ayurveda families soon started proper medical college where they could teach the science and concepts without traditional bias.This lead to proper standardization of all protocol procedures under a government level itself. By 1940s, Ayurveda medical college hospitals were common and much serious in-patient treatments happened in these hospitals like any western institution apart from standardized professional level training and doctor certification.The start of educational institutions helped students to be trained professionally and this also helped them to have an equal status as that of doctors. Today the state has more than 30 large scale ayurveda medical colleges in both Government and private sector following standardized medical learning and churning out more than 1000+ professional ayurvedic doctors annually apart from several para medical staff.Large scale Ayurvedic hospitals and doctors are today much common in any part of Kerala. Almost a majority of Ayurvedic physicians in Kerala are professionally trained doctors who are also familiar with western medicines/allopathic concepts (even if not trained as so). Presence of professional trained doctors as well as listing majority of Ayurveda medicines under Drug Control laws that ensures quality has helped them to achieve almost an equal status as that of Allopathic medicines.Saying so, Kerala’s highly positive healthcare indices were reflective of massive level of adoption of Ayurveda into commoner’s life which hasn’t happened extensively in other parts of India. Perhaps a Malayalee may prefer to use a Kottamchukkadi or Kapooradi Oils for muscular or joint pains more than a Moov or Deep heat balms . So as one may apply Nalpamardi Thailam as such for blemish free faces rather than soaps or face washes of MNCs highlighting themself as Herbal.Kerala’s ayurveda focus much as a medical system, rather a wellness system. Its also a mainstream medical system unlike alternative medicine as seen elsewhere. Due to this, Ayurveda is often seen for various treatments including cancer as well as various tumors etc. There are even proper Ayurvedic hospitals specialized in areas like Ophthalmology, Cardiology, Gastroenterology, Neurology etc.However, such institutions are rarely known to outsiders, as Ayurveda for many still means rejuvenating massages or oil treatments for fairness enhancement procedures etc. The popularity of Kerala as a tourism spot, often lead mistaking Ayurveda as a tourism product, rather a serious mainstream medicine.