THE HISTORY OF THE RELATIONSHIP BETWEEN THE CONCEPT AND TREATMENT OF PEOPLE WITH DOWN'S SYNDROME IN BRITAIN AND AMERICA FROM 1866 TO 1967. BY Lilian Serife ZihniB.Sc. P.G.C.E. FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE HISTORY OF MEDICINE

This thesis fills a gap in the history of mental handicap by focusing on a specific mentally handicapping condition, Down's syndrome, in Britain and America. This approach has facilitated an examination of how various scientific and social developments have actually affected a particular group of people with handicaps. The first chapter considers certain historiographical problems this research has raised. The second analyses the question of why Down's syndrome, which has certain easily identifiable characteristics associated with it, was not recognised as a distinct condition until 1866 in Britain. Subsequent chapters focus on the concept and treatment of Down's syndrome by the main nineteenth and twentieth century authorities on the disorder. The third chapter concentrates on John Langdon Down's treatment of 'Mongolian idiots' at the Royal Earlswood Asylum. The fourth chapter examines Sir Arthur Mitchell's study of 'Kalmuc idiots' in private care. The fifth considers how Down's and Mitchell's theories were developed by later investigators, with particular reference to George Shuttleworth's work. Archive materials from the Royal Albert, Royal Earlswood and Royal Scottish National Institutions are used. The sixth focuses on the late nineteenth century American concept and treatment of people with Down's syndrome through an analysis of the work of Albert Wilmarth. The seventh discusses a germinal/syphilitic theory of the condition by a British physician, George Sutherland, and traces its treatment consequences in both Britain and America. The eighth examines Francis Crookshank's concept and the hormonal therapy people with Down's syndrome consequently received. The ninth on Lionel Penrose's investigations, incorporates new material from the Penrose file at University College. The tenth describes the relationship between the development of Adrien Bleyer's concept and the question of raised parental age. The problems of screening and automatic abortion (1967) are finally discussed.