Down Syndrome

1866

John Langdon Down (1828–1896)

One of the most common causes of intellectual disability is the presence of three copies of chromosome 21 instead of the usual two. In much of the world, the resulting condition is known as trisomy 21. How it came to be called Down syndrome, or Down’s syndrome, is an interesting story.

In an era when the term idiocy was broadly used to describe people with a range of mental impairments, the British physician John Down sought a useful classification in order to provide better care. Down had grown up the son of an apothecary, or druggist, and seemed destined for that role himself, but his high marks allowed him to enter medical school. Apparently on his way to a brilliant career in London, Down chose instead to become the superintendent of Royal Earlswood Asylum for Idiots in 1858, which then was a place where little differentiation was made of the patients’ abilities. In 1866, Down published a new classification of “idiocy” based on a theory that it could be related to ethnicity. Because many of the intellectually disabled patients had, at least to the nineteenth-century English, facial characteristics suggestive of the Asian Mongoloid race, Down referred to the condition as mongolism, and for nearly a century, the term mongoloid was widely used in the English-speaking world. When a group of physicians wrote to the important medical journal The Lancet in 1961 to demand that mongolism be abandoned as a medical term, the current term, Down syndrome, was adopted.

Down’s efforts at Earlswood reflected a change in treatment philosophy regarding retardation. The French physicians Jean-Étienne-Dominique Esquirol (1838) and Édouard Seguin (1844) had begun to advocate for the educability of many suffering from mental impairment. At the least, they argued, such patients should be removed from prisons or poor houses. In the United States, the reformer Dorothea Dix sought to have special education provided for those who were “feebleminded.”

The work of Down, Seguin, Dix, and others show us that the lives of those with disabilities still can be improved.

SEE ALSO Moral Treatment (1788), Victor, the Wild Boy of Aveyron (1801)

A c. 1854 engraving by Edmund Evans (1826–1905) of the Royal Earlswood Asylum for “Idiots” in Surrey, England, which catered to people with learning disabilities. John Langdon Down was appointed Medical Superintendent there in 1858.