member name:   password:       For the history of Dr. John Langdon Down, please click here For the history of Normansfield, please click here Dr. John Langdon Down of Normansfield Written by Professor O Conor Ward, Chairman, Langdon Down Centre Trust Torpoint John Langdon Haydon Down was born on November 18th 1828 at Torpoint in Cornwall. He was baptised in the Bethel Independent Chapel. In 1868, he changed his name to John Haydon Langdon Down. His father, Joseph Almond Down described himself in the census return and other official documents as a grocer. As a young man Joseph Almond Down had had some experience of the drug trade and when the Act for the better regulation of the practice of apothecaries was brought in in 1815, it was possible for him to lay claim to the title apothecary. After that date apothecaries, who from then on were recognised to have a medical function, were required to be registered by the Worshipful Society of Apothecaries and examinations were required. Proof of qualification for the period prior to 1815 only arose if an apothecary's bill was challenged in the courts. Joseph Almond Down's claim to the title of apothecary was put to good use later when Langdon Down presented himself for Certificate of the Worshipful Society. He was in a position to state that he had been apprenticed to an apothecary. Apprenticeship was one of the routes which could be taken towards certification. In 1830 Joseph Down was listed as a druggist, grocer, and linen draper. He had failed in business on three occasions. Langdon Down, in his later years, often referred to the perils of bankruptcy. The family home was at 26 Fore Street. This was a small terraced house. It had been converted into a shop and in 1836 the house next door was purchased and the ground floor was knocked into one. The Downs' neighbours were artisans. Carpenters, joiners, masons, shipwrights, sail makers and rope makers lived in the houses nearby. The Family Business John Langdon Down was a very bright pupil at school, but at the age of 14 years he was put behind the counter to learn his trade. Dividing lines in the retail trade were not clearly defined. Many grocers sold drugs and many chemists sold groceries. The shop opened at 7.00am and closed at 9.00pm. This acclimatization to a long working day stood him in good stead when he was older. Among his contemporaries he was renowned for his energy and endurance. Joseph Almond Down, his father, was of good family but he was not a good businessman. The diverse nature of the Torpoint business gave an opportunity to his very talented wife Hannah to prove her worth. Richard was the eldest of the family. He was 18 years older than John and he with his mother built up, expanded and diversified the business. Richard had gone to London for one year to learn about retail pharmacy. He returned in 1832. The business was now Down and Son, and they added the description of woollen draper to their repertoire. The name of the business changed again in 1847, for by now it was Down Brothers. The brothers were Richard and Kelland and they were wholesale and retail grocers, tea dealers, coffee roasters, provision merchants, chemists, druggists, oil and colour men, ironmongers, stationers, booksellers, linen and woollen drapers and agents for the Norwich Life and Fire Insurance Office. Langdon Down had no taste for the retail trade. At the age of 18 years he had, by his own account, what could only be described as a providential experience. On a family picnic in Devon, heavy rain forced the family to take shelter and they were served tea by a girl with a developmental disability. This was something new in Langdon Down's experience. Seeing her, in a moment of inspiration, he formed a resolve to make the care of the disabled his life's work. He made this experience public in 1879 when he spoke at the opening of Normansfield Theatre. Pharmaceutical Training He worked in the business until he was 18 years of age and then he went to London where he was apprenticed without formal indenture to Dr. Matthew Coleman of 265 Whitechapel Road. Here he learned about blood-letting, the application of leeches, the raising of blisters and the extraction of teeth. He progressed no further however for the family pushed him into training as a pharmacist in the School of the Pharmaceutical Society in Bloomsbury Square. There was a great deal of public debate at the time concerning education and the licensing of pharmaceutical chemists. If the retail pharmacy activity of Down Brothers were to continue it might be necessary to have a pharmaceutical chemist in the business. Langdon Down threw himself into the practical and theoretical studies on a course which catered for only 80 students out of the national total of 3,000 who were engaged in the study of pharmacy. He won the prize in organic chemistry, his first major academic distinction and he passed the two examinations of the Society in quick succession in the months of June and July, 1848. He was still reluctant to commit himself to life as an assistant in a striped apron and behind a counter. He never registered as a member of the Pharmaceutical Society. One month after he had taken his final examination his brother Richard was admitted a member of the Society without examination, probably on the basis that he was the head of Down Bros. and that there was a qualified pharmaceutical chemist in the business. Theophilus Redwood, the Professor of Chemistry in the Pharmaceutical Society head- hunted John Langdon Down and he was offered an appointment as Laboratory Assistant. His duties in the main were to do with assisting students of the following year with their laboratory bench work. Back to Torpoint Langdon Down's health broke down before he could savour the opportunities of his post. The description of his symptoms suggests that he developed tuberculosis. Over the next three years he made a slow recovery. When he had recovered he worked again in the family business. As an employee he was paid £50 a year (approximately £3,000 today). When his father died in 1853 he decided he would have no more of it. He had saved enough to pay his medical school fees and he resisted family pressures to stay in Torpoint. The family had even gone so far as to make him joint owner of a cottage. The death of his father relieved him of the filial duty of support. Working in a business in which he was highly qualified but playing second fiddle to his brother, who had no formal qualification, was clearly a recipe for disaster. If he could not do medicine he would become an analytical chemist. His sister Sarah had, by good fortune, met and married Philip Crellin, in 1849. Sarah had probably been back to London where her grandfather had retired to live in a large property in Hackney. The bond between the couple was their Non-Conformist church work and activity. Philip and Sarah gave Langdon Down the help he needed. They brought him to stay with them and gave him board and lodging through his years as a medical student. This made it possible for him to enter the London Hospital, one of the hospitals with higher student fees. In his final year in Torpoint Langdon Down was the winner of an essay competition on the subject "Nature's Balance; on the wisdom and beneficence of the Creator as displayed in the compensation between the animal and vegetable kingdoms". The idea of a prize essay on this subject derived from a legacy of £8,000 left by the Earl of Bridgewater to the Royal Society to fund tracts which would counter the new element of dissent from traditional concepts of creation. Langdon Down presented a copy of his essay to Philip Crellin's sister Mary. She studied it closely underlining the text as she went along. Their introduction in the Crellin household laid the foundation of a life long relationship. The Medical Student As a student in the London Hospital he excelled himself. He had already acquired a greater knowledge of chemistry, materis medica, and physiology than most students in the medical school. One by one he collected an extraordinary series of hospital medals. In 1854 and 1855 he won the silver medals in junior surgery, chemistry, junior medicine, material medica and botany. He also won the medal in forensic medicine. In 1856 he won 4 gold medals, taking the gold medal in each of the senior classes in medicine, surgery and midwifery, and he was awarded the London Hospital Medal for the best overall student in his year. He did not rest on his laurels. He took the basic medical qualification of Licentiate of the Society of Apothecaries in 1856. For this he combined the London Hospital Training experience with a listed period of apprenticeship to his father. At the same time he took membership of the Royal College of Surgeons. He was now entitled to be registered and he was immediately successful in obtaining the post of Obstetric Resident at the London Hospital for six months. This appointment gave him free board and lodging, which must have been a source of relief to the Crellins, with whom he had lodged for three years. His appointment was renewed, renewed and renewed again by special resolution. At his request he was given the title of medical tutor and he had the opportunity of collecting some fees for giving tuition outside of the College courses. During these two years he continued to study so that he could take the University of London degree in medicine, which he did in 1858. In the University he once again distinguished himself, taking gold medals in material medica, chemistry and physiology. The Earlswood Asylum for Idiots Suddenly his life was to change. The Earlswood Asylum for Idiots, set up by the Reverend Andrew Read, had run into serious difficulties. The high ideals and the optimism of the institution had been badly affected by a series of crises. The asylum had the support of many of the titled and the wealthy citizens of London, and the foundation stone had been laid by the Prince Consort in 1852. However, the Commissioners in Lunacy who had overall responsibility for institutional standards had become increasingly concerned about what they saw. The Board wanted to have a new Medical Superintendent. Langdon Down had just taken his University degree. He had no special training or experience in the field of developmental disability. He was, however, a brilliant student with an enquiring mind and in addition he was a man of strong religious conviction. He had a friendly manner and a capacity to inspire trust. A decision was to be made by Sir John Forbes, physician to the Royal Household, Dr. John Connolly, whose prohibition of all forms of restraint in lunatic asylums had made him famous, and Dr. W J Little who had described a special form of cerebral palsy which still carries his name. Little actively encouraged Langdon Down to apply for the post. He was appointed but he immediately had reservations, although the possibility of moving to a well salaried post must have appealed to him to some degree. Once more the Crellins came to the rescue. They backed him up in his decision to accept the post and so that he could concentrate on developing the service they closed their house and moved to Earlswood to support him. He continued to study and, indeed, this may have been why Mary Crellin and he did not move immediately towards matrimony. In his first year he was successful in the examination for membership of the Royal College of Physicians of London, and he took the MD degree, the higher medical qualification of London University. He reformed the whole management of the Institution. He was on his own and was to be psychiatrist, psychologist, social worker, supervisor, counsellor and administrator. As a priority he set about ensuring that the residents were trained in the proper use of knives and forks. He tried to improve the quality of recruits. He barred punishments of all kinds and he set about trying to ensure that children were taught to control their behaviour, depriving approval being the mainstay of his management of behaviour problems. Children who had wet or dirty beds were wakened at night. Facilities in the asylum were improved and ultimately a wide range of amusements was provided, with a parallel increase in attention to vocational training. As many as possible were taught trades. Mary Crellin Mary and he married in 1860 in Mare Street Congregational Chapel in Hackney. Mary Crellin was a brave woman. Their first home together was in the main accommodation block of the Asylum, where they had a living room, a bedroom and a kitchen. Everleigh their first son was born in 1861 and Lilian, their only daughter in 1863. A second bedroom was now a matter of necessity. With this small addition to their married quarters they managed their modest domestic life. Mary threw herself into the life of the Asylum. She was a willing volunteer. She worked unpaid in the school room and in addition she organised entertainments. She had artistic flair and when the Langdon Downs came to leave Earlswood her last contribution was the writing of a prologue for a concert. The prologue was delivered by Langdon Down himself. Lilian died tragically at the age of 2 years. Her symptoms suggest that she had suffered from a viral brain infection. Her parents were devastated and the inscription on her tombstone in Reigate Cemetery reads: "In ever loving remembrance of a dear little Lilian who departed this life June 1st 1865 age 2 years. Happy soul to the sight of Jesus gone". The Langdon Down's son Reginald was also born in Earlswood in 1866. Leaving Earlswood The improvement in Earlswood established for it a world-wide reputation. The medical journal The Lancet was high in its praises of the new regime. Langdon Down in the meantime had been active with his research and had published many papers in medical journals on his various observations. His salary had been increased from £400 to £700 a year. In relative terms that was a substantial salary, almost equal to that of the Secretary of the Commissioners in Lunacy. Relations with the Board became difficult when they stood back from giving him financial support to exhibit craftwork from the Asylum at an exhibition in Paris. He resigned in 1868 on a matter of principle. His wife Mary had undertaken the supervision of a number of disabled children who were lodged in the homes of employees and other local houses. The Board objected although she was not on the payroll. Langdon Down wrote to say that she had as much right to earn her living in the provision of a training programme for the disabled, for which there was a demand in the market place, as to make her living as a writer. His resignation was accepted. Suddenly everything changed. The Langdon Downs had to look to living on their savings until his newly established practice in Welbeck Street would begin to support them. With great courage they bought the White House on Kingston Road in Hampton Wick and proceeded to extend it so as to accommodate residents in a new training institution which was to develop around their home. Norman Wilkinson his solicitor helped them to find mortgage facilities. They renamed their house Normansfield in commemoration of his advice and assistance. Their youngest son Percival was born within two weeks of moving into Normansfield. They developed the five acres attached to the house and over the next 20 years acquired all the land and properties between Normansfield Road and Holmesdale Road and between Kingston Road and Broom Road, together with the river field running down to the Thames totalling over 40 acres. Normansfield was to supply a need for residential training and care for the learning disabled of the upper classes. The children of bankers and doctors and clergymen rubbed shoulders with the children of senior army officers and heirs to titles and estates. In 1868, 19 residents were admitted. Ten years later there were 106 and when Langdon Down died in 1896 there were 160. Normansfield Normansfield was registered in the name of Mary Langdon Down and John Langdon Down was the Medical Superintendent. By law an institution catering for more than 100 residents was required to have a resident Medical Superintendent. They equipped Normansfield to the highest standards. In time, foreign visitors came to visit and to comment most favourably on what they saw. Teachers were engaged. Workshops were developed where young people could be instructed in crafts. Weaving was popular. Tennis, croquet and cricket were played. High priority was given to entertainment. An exquisite Theatre was built, which was also used for Sunday Services. A lower floor, the Kindersaal, was a huge playroom, for the younger children. Entertainment had to be provided on site and it could not be supplemented by radio or television. Employment agencies used for the recruitment of staff were instructed to select candidates who could sing, act or play a musical instrument. When they ultimately came to recruit an Assistant Medical Officer even he might be expected to sing for his supper and in 1891 Dr. J H Smith is recorded as having sung "Ever on the Rhine" at a Normansfield concert. His salary was £100 p.a. There was no bonus for concert work. It was part of the job. Langdon Down committed himself enthusiastically to his work as an Assistant Physician at the London Hospital. This unpaid appointment he had held in parallel with his Earlswood post. He became Physician and later Consulting Physician to the hospital and he maintained his commitment to it for over 30 years. At that time many physicians gave up their unpaid hospital work when their private practices became extensive but Langdon Down served the poor without payment until the time of his death. He was also unpaid Consultant to Kingston Provident Dispensary and to Teddington Cottage Hospital. Medical Reputation He became a well-known figure of the medical establishment. He was elected Fellow of the Royal College of Physicians in the year that Normansfield opened and in 1881 he moved from his rented accommodation in Welbeck Street to his own house 81 Harley Street, where he remained in practice until his death. He became a Justice of the Peace and an Alderman. He is best remembered for having, in 1866, identified a specific group of patients whose oriental characteristics he described as Mongolian in character. They had upward slanting eyes, flattening of the back of the head and poorly controlled and fissured tongues. Nobody had identified this special group previously and over the next 20 years the designation "Mongolian Idiot" came into use. In 1961 nineteen international experts, including his grandson Norman, wrote jointly to the Lancet suggesting the name Mongolioan Idiot should be changed to Down's syndrome. At the request of the People's Republic of Mongolia, the World Health Organisation adopted the recommendation in 1965 and Down's syndrome was then to become a universally accepted descriptive term. When he began his work with the learning disabled, John Langdon Down was moving into an area of scientific investigation where until then almost nothing had been accomplished. He set about a detailed study of the physical characteristics of his patients, measuring everything that could be measured and from 1861 onwards taking photographs, which he sat and studied, looking for clues and endeavouring to establish sub-groups among his patients. His photographic collection has been preserved. He carried out autopsies and carefully examined the brains of patients who died. He made many other contributions to medicine, including what was probably the first description of the disorder of gross obesity, with developmental disability, later attributed to Prade, Labhart and Willi. Religious Conviction The Langdon Downs' driving force was a strong religious conviction. Joseph Almond Down, Langdon Down's father, had been one of the original subscribers to the Congregationalist Church in Torpoint. His brother Richard was an elder of the church and his sister Jane had married the Reverend Everard Ford. From 1884 onwards the Langdon Downs maintained a full-time Church of England Chaplain at Normansfield. Sunday service was preceded by choir practice on Thursday evenings. The Chaplain had a free hand but his sermons should never last more than 10 minutes. There were two services on Sunday. The Langdon Downs took success and failure in their stride. The death of their only daughter Lilian was a heavy blow. The later tragic death of their son Everleigh, at the age of 21, was another trauma they had to endure. Reginald, the older surviving son followed his father into medicine. He too made observations on Down's syndrome. Percival also became a doctor and with his brother Reginald took over the medical management of Normansfield after their father's death. In due course, Percival's daughter Mary and son Norman followed on and the supervision of Normansfield remained a family concern for almost 100 years, throughout which the reputation of the institution was consolidated. In 1893, when Langdon Down had lived to see Normansfield free of debt, flourishing and successful, his sons Reginald and Percival established in their careers, and his own position in medicine and in society fully assured, Mary and he re-affirmed their religious convictions. They commissioned a mural which can be seen inset in the wall beside the Theatre staircase. The mural depicts the Divine Creator holding the globe of the world in his hand and bears the inscription; "Blessing and honour and glory and power be to him that sitteth upon the throne". In his addresses to students he always ended with the exhortation that they should lead gentle Christian lives terminated by a peaceful, hopeful death. When he entertained, as he did on a generous and lavish scale, grace was said before the meal. He was in advance of his time in many matters and when the question of the admission of women into the medical school was under discussion, he supported this but also foresaw the admission of women into practice of law and to the ministry in the Church. He held women in high regard and his Harley Street address was used by the movement for universal suffrage. He paid public tribute to his wife Mary who had shared his early struggles and who had contributed greatly to his success. She was the one to develop the training programmes and while he busied himself about his practice and his patients she administered Normansfield combining the roles of manager, finance officer, purchasing officer, administrator, planning officer, entertainment manager, personnel manager and public relations manager. She accomplished all of this while losing nothing of the human touch and she was known to everyone in Normansfield as "Little Mother". Exeunt Langdon Down died on October 7th 1896. He had had a severe illness in 1890. He had failed physically but was back at work and his death was unexpected. When his funeral procession passed through Hampton Wick and Kingston, shops closed with curtains drawn and people stood in silent tribute on the pavements. He was cremated and his ashes were brought back to Normansfield. When Mary Langdon Down died in 1901 his ashes and hers were placed together on the stage for her final funeral service. There is no stone to mark the place where the ashes were scattered but their greatest memorial was the lasting imprint which they left on the public perception of what could and should be done for the learning disabled, both in the scientific and social fields. The theatre which they built is today a listed building and it stands as a permanent memorial in stone to their great work. « back