On the diagnostic term “Down's disease”

UNTILu vEY recent years the genetically determined condition now generally known as Down's disease or syndrome had been known for about a century as "mongolism" or "mongolian imbecility", and it is perhaps of some interest to recall how it acquired both this and its present designation.In 1866 a London physician, John Langdon Haydon Down (1828-1896),' published a paper entitled 'Observations on an ethnic classification of idiots'.2In this he started by pointing to the lack of a satisfactory classification of "congenital mental lesions".He suggested that a "natural system" of classifying "the feeble-minded" might be achieved by "arranging them around various ethnic standards", as "a considerable proportion can be fairly referred to one of the great divisions of the human race other than the class from which they have sprung".The divisions to which Down referred were the five of the ethnographic classification that had been proposed by Johann Friedrich Blumenbach in a dissertation presented for a doctorate of medicine of the University of Gottingen on 16 September 1775.3Down had no lack of subjects for study, as he was the Medical Superintendent of the Earlswood Asylum for Idiots,4 whom he tried to classify by reference to a supposed facial resemblance to each of Blumenbach's ethnic groups.First came, according to Down, those who resembled the "great Caucasian family".5 Next came "several well-marked examples of the Ethiopian [i.e.African] variety", followed by the "Malay variety", those resembling the "people ... who originally inhabited the American Continent",6 and finally those whose facies suggested the "great Mongolian family" more than any of the other great divisions of mankind.It should be recalled that