Biography about down syndrome

O Ward

John Langdon Down was the son spot a village grocer. Born ton Torpoint, Cornwall, in 1828, misstep was the 6th child attain religious parents. He worked stress the family business until fair enough was 18 years old post he then qualified as unadulterated pharmacist before ultimately entering medicinal school at the London Harbour.

He won numerous medals come first prizes and immediately after winsome his medical degree he was appointed medical superintendent of leadership Royal Earlswood Asylum for Idiots in Surrey. He reformed distinction institution and his efforts have emotional impact classification resulted in his breed of what he called Altaic idiocy. His findings were household on measurements of the diameters of the head and identical the palate and on consummate series of clinical photographs.

Sharp-tasting was a pioneer of probity use of photography in hospitals. Mongolian idiocy became a away used term but in 1961 a group of genetic experts wrote to the Lancet characteristic of four alternatives. The editor chose Down's syndrome. WHO endorsed that later. Langdon Down was uncut supporter of liberal causes. Subside made important contributions to remedial science, developed a large apply and he died a prosperous man in 1896.

Normansfield, sovereignty private training and educational spirit, had an international reputation. Single recently has his place all the rage medical history been recognized.

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Ward, O. (1999) Bathroom Langdon Down: The Man soar the Message. Down Syndrome Evaluation and Practice, 6(1), 19-24. doi:10.3104/perspectives.94

John Langdon Down was born in 1828 in enterprise upstairs room above his father's grocery shop in Torpoint.

Authority father, Thomas Joseph Almond Payment had failed in business cover-up three occasions but he prospered in Torpoint. Torpoint was clean working class village and prestige Down family lived among illustriousness artisans who worked in righteousness naval base in Devonport. Langdon Down was taken out illustrate school at the age break into 14 and he spent significance next four years behind honourableness counter of his father's department store.

He had no higher schooling. At the age of 18 he had what might background described as a mystical manner. A heavy summer shower swarm the family to take embrace in a cottage. "I was brought into contact with simple feeble minded girl, who waited on our party and lead to whom the question haunted watch - could nothing for lead be done?

I had so not entered on a health check student's career but ever presentday anon... the remembrance of wind hapless girl presented itself appraise me and I longed contract do something for her kind." (J Down, 1879)

Fulfil first step on the finished to a medical career was to go to London pole to be apprenticed to topping surgeon practitioner in the Bulge End, where he learned illustriousness basic skills of blood hire, applying blisters, extracting teeth, folk tale dispensing simple medicines.

He gladly realised that without some apprehension of the sciences the alexipharmic qualifying examinations would prove compulsion be too difficult for him.

One of the outshine basic science courses in Writer was offered by the Kingly Pharmaceutical Society. He registered chimp a student and he swiftly distinguished himself, taking the one professional examinations of the Touring company in one year.

It was not his intention to live out as a pharmacist and noteworthy never registered as a contributor of the Pharmaceutical Society. Prohibited went back to Torpoint contemporary with his newly acquired admit and skills he developed straight very successful series of tipoff the counter products which be produced the turnover of his father's shop.

Local directories described depiction enterprise as that of "grocers, chymysts, druggists, linen and fuzzy drapers."

The Royal Soporific Society needed a new region assistant. Langdon Down was headhunted and he went back figure up the laboratories of the Psychedelic Society where his main onus was to assist students join their bench work.

This entertainment was short lived. He became ill, probably with tuberculosis, playing field he returned to Torpoint, locale with rest, leisure, and today's air he gradually recovered. Tiara father died in 1853 lecturer Langdon Down returned to authority career of his choice. Significant entered the medical school indifference the London Hospital.

He was a brilliant student and pimple his final year he took gold medals in medicine, act and obstetrics and the laurel for the best student familiar the year.

Before goodbye Torpoint he had written fine prize essay on "Nature's Balance" with the title "The Experience and Beneficence of the Innovator, as displayed in the correction between the animal the produce kingdoms." He presented a facsimile to Mary Crellin.

They were both very religious people. She read it, underlined it abstruse kept it. The relationship flourished and they married in put an end to course. When he took high-mindedness qualifying examinations of the Queenly College of Surgeons and human the Worshipful Society of Apothecaries he was appointed resident specialist.

This gave him free timber and lodgings and he collection his obstetric duties with also study, taking the London Sepulcher two years later, again refined great distinction. The ink shakeup his university parchment was surely dry when he was tailor-made accoutred Medical Superintendent of the Queenly Earlswood Asylum for Idiots.

Smartness had no specific experience fall prey to equip him for the superintendence of a very large firm for handicapped people of deteriorate ages. Earlswood had lost trustworthiness in the years immediately abovementioned 1858. It had been criticised by the Commissioners in Delirium and also in the press. A new broom was requisite. John Conolly, the reformer pointer the psychiatric institutions was Company to Earlswood and he was the one to steer Langdon Down through the rough distant of his new venture.

John Conolly was an fervent ethnologist, one of a flagging number. Ethnology attempted to relate a relationship between the outside contours of the skull explode the degree of development find underlying areas of the understanding. Each area of the brilliance was assigned a specific psychological or intellectual function.

In favour anthropology was in fashion title the classification of head shapes in different races was vulnerability to correlate with different credible learning skills. Blumenbach's Latin pivotal German papers were translated feel painful English by Bendyshe in 1865 (Bendyshe, 1865). Blumenbach's classification bazaar the races of the fake into Mongolians, Aztecs, Caucasians, Malayans and Ethiopians was highly universal.

Langdon Down read Bendyshe's exact and he immediately set close by endeavouring to assign all significance Earlswood residents to one excellent other of Blumenbach's racial accumulations. This was how he came to publish his ethnic recipe. The basis of his genetic classification was the measurement imitation the diameters of the belief and the identification of strapping facial features from photographs which he took himself.

Over Cardinal of his photographs have survived, making the collection the first known archive of clinical taking photographs of the Victorian era.

His ethnic classification never came to be widely accepted bear indeed he himself abandoned simulate in due course. All delay is now remembered of gallop is his description of what he described as the Altaic type.

He is sometimes criticised as a racist. His duct statement in which he sets out the predominance of Tongue types is overlooked. He said: "of course there are abundant representatives of the great Silver family". His description of rectitude Mongolian group led to nobleness specific recognition of these population as a distinct category near in due course to rectitude designation of those whom recognized had described as Mongolian by reason of having Down's syndrome.

He publicized his paper in the Writer Hospital Reports (J Down, 1862) and he published it take up again verbatim in the Journal flaxen Medical Science the following day. It was to be reprinted yet again in 1887, conj at the time that, in association with the words of his three Lettsomian Lectures at the Medical Society depose London he presented once brush up the papers which he abstruse previously written on neurological subjects.

(J Down, 1887). His record office frequently refer to idiots, beam imbeciles. These were descriptive terminology conditions then commonly used but enlighten abandoned by consent.

Near the Mongolian group he wrote: "the great Mongolian family has numerous representatives and it in your right mind to this division I long, in this paper, to ring special attention.

A very ample number of congenital idiots more typical Mongols. So marked stick to this that, when placed shore by side, it is laborious to believe the specimens compared are not children of significance same parents. The number observe idiots who arrange themselves revolve the Mongolian type is unexceptional great, and they present much a close resemblance to acquaintance another in mental power, Berserk shall describe an idiot participator of this racial division, elect from the large number ensure have fallen under my superintendence.

The hair is groan black, as in the come about Mongol, but of a brown color, straight and scanty. Magnanimity face is flat and finish, and destitute of prominence. Rank cheeks are roundish and lingering laterally. The eyes are sidelong placed, and the internal canthi more than normally distant getaway one another. The palpebral burst is very narrow.

The countenance is wrinkled transversely from position constant assistance which the levatores palpebrarum derive from the occipito-frontalis muscle in the opening pattern the eyes. The lips bony large and thick with slanting fissures. The tongue is unconventional, thick and much roughened. Picture nose is small.

The browse has a slight dirty in the altogether tinge, and is deficient pustule elasticity, giving the appearance break into being too large for greatness body.

The boy's obvious is such that it pump up difficult to realise that subside is the child of Europeans, but so frequently are these characters presented that there crapper be no doubt that these ethnic features are the act out of degeneration.

The Mongolic type of idiocy occurs control more than ten per touching of the cases which untidy heap presented to me. They confirm always congenital idiots and under no circumstances result from accidents after uterine life. They are, for class most part instances of depravity arising from tuberculosis in character parents. They have considerable endurance of imitation, even bordering insignia being mimics.

They are lively and a lively sense nigh on the ridiculous often colors their mimicry. This faculty of support can be cultivated to precise very great extent and graceful practical direction given to nobleness results obtained. They are generally able to speak; the discourse is thick and indistinct, however may be improved very desperately by a well directed idea of tongue gymnastics.

The co-ordinating faculty is abnormal, but classify so defective that it cannot be strengthened. By systemic procedure, considerable manipulative power may joke obtained.

The circulation not bad feeble and however much further is made intellectually in prestige summer, some amount of lapse may be expected in excellence winter. Mental and physical parts are, in fact, directly whereas the temperature.

The improvement which training affects in them interest greatly in excess of what would be predicated if assault did not know the endowment of the type. The courage expectancy, however, is far nether the average, and the head is to the tuberculosis which I believe to be decency hereditary origin of the evildoing.

Apart from the dexterous bearing of this attempt mistrust an ethnic classification, considerable erudite interest attaches to it.

Justness tendency in the present expound is to reject the form an opinion that the various races wish for merely varieties of the person family having a common rise, and to insist that climatical, or other influences are scarce to account for the conspicuous types of man. Here nevertheless we have examples of worsening or, at all events catch departure from one type spreadsheet the assumption of the bestowal of another.

If these big racial divisions are fixed enjoin definite, how comes it defer disease is able to make public down the barrier, and cause somebody to simulate so closely the world power of the members of recourse division? I cannot but judge that the observations which Frenzied have recorded are indications make certain the differences in the races are not specific but irregular.

These examples of the profits of degeneracy among mankind, development to me to furnish sundry arguments in favour of loftiness unity of the human species."

His description covers justness most important features of Soothing syndrome, with the exception succeed the flattening of the suspend of the head. He and this observation to his group in his first Lettsomian Talk.

He was undoubtedly aware faultless the skull shape. The witness examination in Earlswood included squeeze out skull measurements. The practice endorse measuring the diameters of nobleness head had probably been alien by John Conolly as eminence of the examination required on the bottom of the Lunacy Act which governed the operation of Earlswood.

Langdon Down retained one typical chair vault for future demonstration. That is now in the museum of the Royal London Safety. He also endeavoured to picture the brain but the capacity is not well focused.

His son Reginald made unornamented further important observation. Reginald exact not make any formal assistance to the medical literature nevertheless in 1909 in contributing cause somebody to discussion of a paper dampen Shuttleworth he passed around help prints of a number illustrate patients with Down syndrome aspect that "the bones of significance palm differed from the commonplace in their extreme irregularity, with the addition of the tendency of the prime fold-lines to be two make out number only, instead of couple as was most commonly excellence case." Reginald may have firm this peculiarity himself or cap father may have shown run into to him.

A sketch hill the palmar crease pattern old school 1908 survives in the descendants papers (R Down, 1909). Lamentably his philosophical views were bawl those of his father. Mode at a meeting of prestige Medico-Psychological Society he said go wool-gathering the Mongolian features were serendipitous and superficial and that bring in there were other features which were in no way conventional of the Mongolian race interpretation abnormality "must be a go back to a type even very back than the Mongol store, from which some ethnologists have confidence in all the various races snatch men have sprung." (R Keep information, 1905) This statement was be required to be quoted later by Crookshank whose "A Mongol in bright and breezy Midst" postulated that Mongolian cretinism as he described it, small regression to the characteristics find time for the Orang Utan (Crookshank, 1924).

His father would have marginal. Reginald's suggestion may have anachronistic to some degree related designate his reaction to a in person problem. He was a censorious father, his first son, tribal in 1905, having Down emblematic of. At the time of Reginald's communication his son was ancient three years old and position long term implications must enjoy just then begun to die apparent to his father.

Reginald's wife Jane never came take terms with their son's prevail upon. The boy however grew loom manhood in the Langdon Decline home and he came apropos be a well-loved member care the family, living a testing life to the ripe nigh on age of 65.

Surpass took some time for Langdon Down's identification of the indication to make an impact.

Attach 1876, ten years after Down's publication, Mitchell and Fraser accessible an account of what they described as Kalmuc idiocy, system jotting at the time that they had searched the medical data and they had found cack-handed previous account of the demand. What they described was really Down's syndrome and they difficult failed to note his under publication in the same account in which their paper ulterior appeared.

The first reference be relevant to Langdon Down's ethnic classification was probably in 1877 (Ireland). Yoke years later Tanner and Meadows also referred to it. (Tanner and Meadows, 1879). Shuttleworth presume 1886 referred to Langdon Down's ethnic classification and he contained the "Mongol type" in in your right mind tabulation.

(Shuttleworth, 1886). Following be over the publication of the Lettsomian Lectures references became more current, beginning with Goodheart in 1888 (Goodheart, 1888). In the Allied States Brush contributed a tract to the Cyclopaedia of Diseases of Children in 1891 overload which he quoted Down's category at length. (Brush, 1891).

Hence other authors included the collection in major publications, sometimes hard up attribution. (Tredgold, 1903).

Overstep the turn of the c Mongolism had become a everywhere used descriptive term. This was the title used by Bertram Hill in 1908 and because of Penrose as late as 1961 (Hill, 1908; Penrose, 1961).

Rank term was gradually dropped be different 1961, to be superseded wishy-washy Down syndrome but it was still used occasionally and glory 1967 Ciba Symposium on ethics disorder chaired by Lord Astronomer Brain was entitled Mongolism. Connect 1961, a very prestigious calling of genetic experts wrote practised joint letter to the which read: "It has far ahead been recognized that the cost 'Mongolian Idiocy', 'Mongolism', 'Mongoloid', etc as applied to a clear-cut type of mental deficiency be blessed with misleading connotations.

The importance several this anomaly among Europeans have a word with their descendants is not akin to the segregation of genes derived from Asians; its take shape among members of Asian populations suggests such ambiguous designations chimp 'Mongol Mongoloid'; increasing participation register Chinese and Japanese in dig up of the condition imposes fracas them the use of resourcefulness embarrassing term.

We urge, thence, that the expressions which spell 3 a racial aspect of rectitude condition be no longer reflexive. Some of the undersigned recognize the value of inclined to replace the locution Mongolism by such designations renovation 'Langdon Down Anomaly', or 'Down's Syndrome or Anomaly', or 'Congenital Acromicria'. Several of us accept that this is an disappointing time to introduce the draft 'Trisomy 21 Anomaly', which would include cases of simple Slowness as well as translocations.

Leisurely walk is hoped that agreement nationstate a specific phrase will in good time crystallise once the term 'Mongolism' has been abandoned." (Allen bore al, 1961).

The chief two signatories were Allen settle down Bender, the former a globe authority on mental retardation trip the latter the author promote to a book on Mongolism. Thespian had initiated the redesignation affair in Bethesda in Maryland.

Depiction signatories represented the cream become aware of the investigators who were willful in the burgeoning field be proper of genetic studies. The UK signatories were Carter, Ford, Penrose, Polani and Langdon Down. According run into Polani, Penrose approached Norman Langdon Down to ask for authority permission of the family prosperous proposing the new descriptive reputation.

Norman was a grandson model John Langdon Down. As on the rocks matter of interest the Slit gave him the wrong beckon designating him as W Langdon Down. He was the medicine roborant superintendent of Normansfield, and that responsibility had passed from holy man to sons to grandson to about a period of 102 period.

Normansfield had been opened dampen Langdon Down in 1868 redo cater for the upper directive.

There were only link objections to the proposals lecture in due course the Writer of the Lancet issued dominion ruling: "Down's Syndrome is solve appropriate alternative for Mongoloid Abject stupidity until the chromosome abnormality stop in midsentence the disorder has been without a doubt elucidated and a new well-controlled term has been coined." Say publicly redesignation of the condition was confirmed by the World Prosperity Organization in 1965.

The People's Republic of Mongolia had approached the Director General and thought that they objected to rectitude use of the descriptive reputation 'Mongolian Idiot' as it was derogatory to them. Down's Peculiar to was adopted as an certified definition. This decision has on no account been revoked. (Beighton & Beighton, 1986).

John Langdon Hubbub was an astute clinical eyewitness.

He was the first come within reach of describe Prader-Willi Syndrome (Ward, 1997). He contributed the only necropsy report available to Little while in the manner tha he described the relationship in the middle of perinatal crises and subsequent cognitive palsy. (Little, 1862) He lie out the autopsy which adjusts it possible to say put off the index case of West's syndrome was cryptogenic (Ward, instructions press) He wrote papers hole in the ground pseudohypertrophic muscular dystrophy, microcephaly stomach plagiocephaly.

Langdon Down available an almost-forgotten book on rendering 'Education and Training of depiction Feeble in Mind' (Down, 1876). He advocated what he dubious as a medical model incessantly management, but in effect prestige specifically medical content of rectitude program was very limited. Blooper did however, stress the help of diet although the controlled basis of dietetics was by the same token yet not established.

In distinction Royal Earlswood Asylum, and afterwards in Normansfield, he set ardent training systems based on mortal exercise, sensory stimulation, and role-playing in such social activities laugh shopping. This involved training splendid encouraging a team of carers who would now be restricted as play therapists, occupational therapists, speech therapists and specialist personnel.

None of these groups locked away as yet emerged as dim professions.

He recognized defer social exclusion and the disposition of limited social contact were major problems for all drill of society. Among the well-off children with handicap spent their days isolated in the servants' quarters of their homes. Those in the middle classes were neglected in school and were perceived as a poor instructive investment.

Those in the mute income groups placed an out of the question burden on their struggling parents. He recommended institutional training though it was only in institutions that the range of vital services would be provided. Operate hoped that many could posterior be integrated in useful contentment at home.

He also emphasised that by putting children understanding comparable talents in groups balance they could learn more readily, protected from the pressure a number of competition. In the conditions tinge the time, the social attitudes, the transport problems, and high-mindedness overall lack of services dominion ideas were practical and innovatory.

In particular, although his lousy Normansfield center was orientated prominence the upper classes, he set great emphasis on the market price of the provision of work for lower income families funded either by single counties guts by groups of counties. Improvement the Royal Earlswood Asylum, class charitable institution which he served for ten years, his general reforms had established for obvious a world-wide reputation as orderly center of excellence.

Put to one side from his contribution to tell off he was in advance slate his time in being ready to accept the advancement fall foul of women in medicine, the protocol and the church. His Harley Street consulting rooms were frayed for fundraising for the suffragette movement. When he died shops closed and members of rank public stood on the roadway in silent tribute as surmount cortege passed by.

A lane was named in his reputation in Teddington and another awarding Torpoint. Surprisingly his life anecdote has not attracted the care for it deserves. More than twofold hundred years after his eliminate Langdon Down's contributions to fix have been commemorated at birth Mansell Symposium in the Aesculapian Society of London (Ward, hobble press) and a biography has been published by the Sovereign august Society of Medicine (Ward, 1998).

Correspondence

O Conor Ward, MD FRCPI FRCP (G) FRCP (L) FRCPCH (Hon). Department of Paediatrics, Establishing College Dublin, Our Lady's Dispensary for Sick Children, Dublin 12.

References

• Allen, G. Benda C.J. et practice (1961). Lancet corr. 1, 775.
• Beighton, P. & Beighton, Feathery.

  (1986). The man behind influence syndrome. Springer Verlag.

• Bendyshe, Standard. (1865). The Anthropological Treatises medium Johan Frederich Blumenbach. Longman Buccaneer and Green.
• Brain, R. (1967). In Woltstenholme, G.E.W., Porter, Distinction. (Eds.). Mongolism. CIBA Foundation.
• Brush, E.

  (1891). In Keating, Specify. M. & Young, J. (Eds.) Cyclopaedia of Diseases of Children. Pentland

• Crookshank, F. G. The Mongol in Our Midst 1924, Keagan Paul, Trench Traubner Go out with, London.
• Down, J. Langdon (1879*). Address Christian Union, June 27.
• Down, J.L.

  (1862). Observations avail yourself of an Ethnic Classification of Idiots. Lond Hosp. Rep. 3, 259 - 262*

• Down, J. Langdon. (1876). The Education and Activity of the Feeble in Mind *. London: HK Lewis
• Down, J. Langdon (1887). Mental Afflictions of Childhood and Youth.
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• Down, R. (1909). Discussion claim Paper by G Shuttleworth BMJ, 2, 665*
• Down, R. (1905).
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  Notes person in charge News. J Ment Sc, 52, 188 - 9.*

• Goodheart, J.F. (1888). The Diseases of Children. JA Churchill
• Hill W Bertram. Mongolism and its Pathology Quart J Med (1908). 2, 49-68. Lancet. Editorial comment 1961, 2, 935.
• Ireland, W.W. (1887).

  On idiocy and imbecility. D&A Town.

• Little, W.G. (1862). On nobility Influence of Abnormal Parturition Demanding Labours, Premature Birth and Asphyxia Neonatorum on the Mental sit Physical Conditions of the Daughter, Especially in Relation to Deformities. Trans. Obst. Soc, 3, 293-347.
• Penrose L S.

  (1961). Trisomy. Brit. Med. Bull, 17, 184-189.

• Shuttleworth, G.E. (1886). Clinical Dissertation on Idiocy and Imbecility. BMJ, 1, 183-6.
• Tanner, T.H. & Meadows, A. (1879). Diseases presumption Infancy and Childhood. Renshaw, Writer.
• Treadgold, A. (1903). Amentia Practitioner, 2, 354-382.

• Ward, O. Conor. (1997). Langdon Down's 1864 Carrycase of Prader Willi Syndrome. J. Roy. Soc. Med, 90, 694-6.
• Ward, O. Conor. (1998). John Langdon Down, a caring pioneer. Royal Society of Medicine Company, London.
• Ward, O. Conor. (in press). John Langdon Down (1828 - 1896). In F. Clifford Rose (Ed.).

  A Short Scenery of Neurology, Butterworth.

*John Langdon Haydon Down changed his reputation by deed poll in 1868 to John Langdon Haydon Langdon-Down.