John Langdon Haydon Down
Biography of John Langdon Haydon Down
John Langdon Haydon Down was born in Torpoint, Cornwall. Down was his father’s Irish family name. His great-grandfather was the protestant bishop of Derry, whilst his mother’s family (Langdon) migrated from Cornwall to Devon 200 years earlier. Down was scientifically interested already whilst a schoolboy, but left school at the age of 13 ½ to assist his father who was a pharmacist. He was a member of the local scientific society and hoped for a future career in science.
At the age of 18 he moved to London, supporting himself as an assistant to a surgeon in private practice on White Chapel Road, where he had the opportunity to concern himself with blood-letting, tooth extraction etc.
A few months later, in 1847, he was allowed to commence work at the laboratory of The Pharmaceutical Society in Bloomsbury Square, London, where he made great progress and concentrated his efforts in organic chemistry. In 1849 he became assistant to professor Redwood and subsequently became research assistant to Michael Faraday (1791-1867) — chemist, physicist and one of the greatest scientists of all times — in some of his experiments on gases. He became ill and spent the next three years recuperating in Dartmoor.
Down lectured at Tropoint in chemistry and wanted to continue research on organic chemistry, but when his father died in 1853 he entered medical school at age 25 in the London Hospital, largely for financial reasons. He excelled as a student, winning a gold medal for physiology, and graduating in 1858 with top marks, coming second to Sir William Broadbent (1835-1907), and after a brief period was elected to the Royal College of Surgeons.
Down was predicted a brilliant career at the university hospital, but surprised his teacher when he, in 1858, became resident physician and subsequently medical superintendent at the Earlswood Asylum for Idiots in Surrey. He was elected assistant physician to the London Hospital in 1859 shortly after Mr. Jonathan Hutchison had been elected assistant surgeon. He was conferred doctor of medicine in London in 1859.
Down wanted to work for the then hitherto gravely neglected mentally retarded children, and for a period of ten years (1858-1868) he shared his time between the Earlswood institution for the mentally retarded and his London practice.
Down became a lecturer on materia medica and therapeutics at the London Hospital Medical College and afterwards lecturer in the principles and practice of medicine. For the first 9 years following this appointment he continued to live at the Earlswood Asylum and to work there and superintend the asylum’s organisation and development. This resulted in a model for the care of the mentally ill in the Unite Kingdom.
Many of Down’s publications related to mental ill health. He published on oedema and its management and on the classification of mental disease. He was an early protagonist for training the mentally retarded. In 1868 he moved to set up consultant practice in London, and the next year established an institution at Teddington for training mentally retarded children of the wealthier classes, naming it Normansfield after his friend, Norman Wilkinson. This was the first institution of its kind. Here he was succeeded by his son. He became a fellow of the Royal College of Physicians in 1869.
Down described mongolism in his Letsom lectures entitled «On some of the mental afflictions of childhood an youth» delivered in 1887. He published relatively little, but was awarded several medals for his publications on psychiatry.
Down passed on to medical students a piece of advice given him by an old man when he left his village, «My lad, you take your aim; be sure you aim high enough. That’s the thing — aim high enough» and he added some advice of his own. «The formula to solve problems, the secret that will command success, the talismanic charm which turns everything to gold, the potent spell at which all difficulties vanish. It is earnest and persistent work. Let it be supplemented by a gentle Christian life, terminated by a peaceful, hopeful death».
Down’s monograph Mental Affections of Childhood and Youth, published in 1887, contained the classic description of the condition which now bears his name. He also mentioned adrenogenital dystrophy, which gained recognition more than 40 years later as Fröhlich’s syndrome (adiposogenital syndrome, entered as Babinski-Fröhlich syndrome or disease, under Joseph François Félix Babinski, French Neurologist, 1857-1932).
Down was a man of liberal views and an advocate of higher education for women and strongly disagreed with the popular supposition that this would make them liable to produce feeble-minded offspring! A man of charming manners, he enjoyed entertaining his friends and involved himself in public duties, becoming alderman of Middlesex County Council.
He had what was called a severe bout of influenza in 1890 and never recovered completely. One morning in 1896 at Normansfield he collapsed at his breakfast and was dead 10 minutes later at his home in Hampton Wick.
Observations on an Ethnic Classification of Idiots
By J. Langdon H. Down, M.D., London
This is the beginning of Down’s original paper, in London Hospital Reports, 1866, 3: 259-262.
Those who have given any attention to congenital mental lesions, must have been frequently puzzled how to arrange, in any satisfactory way, the different classes of this defect which may have come under their observation. Nor will the difficulty be lessened by an appeal to what has been written on the subject. The systems of classification are generally so vague and artificial, that, not only do they assist but feebly, in any mental arrangement of the phenomena which are presented, but they completely fail in exerting any practical influence on the subject.
The medical practitioner who may be consulted in any given case, has, perhaps in a very early condition of the child's life, to give an opinion on points of vital importance as to the present condition and probable future of the little one. Moreover, he may be pressed as to the question, whether the supposed defect dates from any cause subsequent to the birth or not. Has the nurse dosed the child with opium? Has the little one met with any accident? Has the instrumental interference which maternal safety demanded, been the cause of what seems to the anxious parents, a vacant future? Can it be that when away from the family attendant the calomel powders were judiciously prescribed? Can, in fact, the strange anomalies which the child presents, be attributed to the numerous causes which maternal solicitude conjures to the imagination, in order to account for a condition, for which any cause is sought, rather than hereditary taint or parental influence. Will the systems of classification, either all together, or any one of them, assist the medical adviser in the opinion he is to present, or the suggestions which he is to tender to the anxious parent? I think that they will entirely fail him in the matter, and that he will have in many cases to make a guarded diagnosis and prognosis, so guarded, in fact, as to be almost valueless, or to venture an authoritative assertion which the future may perhaps confirm.
I have for some time had my attention directed to the possibility of making a classification of the feeble-minded, by arranging them around various ethnic standards, -- in other words, framing a natural system to supplement the information to be derived by an inquiry into the history of the case.
I have been able to find among the large number of idiots and imbeciles which come under my observation, both at Earlswood and the out-patient department of the Hospital, that a considerable portion can be fairly referred to one of the great divisions of the human race other than the class from which they have sprung. Of course, there are numerous representatives of the great Caucasian family. Several well-marked examples of the Ethiopian variety have come under my notice, presenting the characteristics malar bones, the prominent eyes, the puffy lips, and retreating chin. The woolly hair has also been present, although not always black, nor has the skin acquired pigmentary deposit. They have been specimens of white Negroes, although of European descent.
Some arrange themselves around the Malay variety, and present in their soft, black, curly hair, their prominent upper jaws and capacious mouths, types of the family which people the South Sea Islands.
Nor has there been wanting the analogues of the people who with shortened foreheads, prominent cheeks, deep-set eyes, and slightly apish nose, originally inhabited the American Continent.
The great Mongolian family has numerous representatives, and it is to this division, I wish, in this paper, to call special attention. A very large number of congenital idiots are typical Mongols. So marked is this, that when placed side by side, it is difficult to believe that the specimens compared are not children of the same parents. The number of idiots who arrange themselves around the Mongolian type is so great, and they present such a close resemblance to one another in mental power, that I shall describe an idiot member of this racial division, selected from the large number that have fallen under my observation.
The hair is not black, as in the real Mongol, but of a brownish colour, straight and scanty. The face is flat and broad, and destitute of prominence. The cheeks are roundish, and extended laterally. The eyes are obliquely placed, and the internal canthi more than normally distant from one another. The palpebral fissure is very narrow. The forehead is wrinkled transversely from the constant assistance which the levatores palpebrarum derive from the occipito-frontalis muscle in the opening of the eyes. The lips are large and thick with transverse fissures. The tongue is long, thick, and is much roughened. The nose is small. The skin has a slight dirty yellowish tinge, and is deficient in elasticity, giving the appearance of being too large for the body.
The boy's aspect is such that it is difficult to realize he is the child of Europeans, but so frequently are these characters presented, that there can be no doubt that these ethnic features are the result of degeneration.
The Mongolian type of idiocy occurs in more than ten per cent. of the cases which are presented to me. They are always congenital idiots, and never result from accidents after uterine life. They are, for the most part, instances of degeneracy arising from tuberculosis in the parents. They are cases which very much repay judicious treatment. They require highly azotised food with a considerable amount of oleaginous. They have considerable power of imitation, even bordering on being mimics. They are humorous, and a lively sense of the ridiculous often colours their mimicry. This faculty of imitation may be cultivated to a very great extent, and a practical direction given to the results obtained. They are usually able to speak; the speech is thick and indistinct, but may be improved very greatly by a well-directed scheme of tongue gymnastics. The co-ordinating faculty is abnormal, but not so defective that it cannot be greatly strengthened. By systematic training, considerable manipulative power may be obtained.
The circulation is feeble, and whatever advance is made intellectually in the summer, some amount of regression may be expected in the winter. Their mental and physical capabilities are, in fact, directly as the temperature.
The improvement which training effects in them is greatly in excess of what would be predicted if one did not know the characteristics of the type. The life expectancy, however, is far below the average, and the tendency is to the tuberculosis, which I believe to be the hereditary origin of the degeneracy.
Apart from the practical bearing of this attempt at an ethnic classification, considerable philosophical interest attaches to it. The tendency in the present day is to reject the opinion that the various races are merely varieties of the human family having a common origin, and to insist that climatic, or other influences, are insufficient to account for the different types of man. Here, however, we have examples of retrogression, or at all events, of departure from one type and the assumption of the characteristics of another. If these great racial divisions are fixed and definite, how comes it that disease is able to break down the barrier, and to simulate so closely the features of the members of another division. I cannot but think that the observations which I have recorded, are indications that the differences in the races are not specific but variable.
These examples of the result of degeneracy among mankind, appear to me to furnish some arguments in favour of the unity of the human species.
- Natures balance. Awarded a medal.
- On the condition of the mouth in idiocy. 1863.
French translation by Désiré-Magloire Bourneville (1840-1909).
- Observations on an ethnic classification of idiots.
Clinical lectures and reports by the medical and surgical staff of the London Hospital, 1866, 3: 259-62.
- On the education and training of the feeble in mind. 1876.
- On the relation of the teeth to mental disease.
Transactions of the Odontological Society of Great Britain, London, 1876.
- Mental Affections of Childhood and Youth. London, Churchill, 1887.
- Lancet, London, 1896; 2: 1104.
- British Medical Journal, London, 1906; 2: 1170.