|The first page of the original Down paper. Click the thumbnail graphic at the left to view the full-size version of the same image.|
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.