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Painting is earliest example of portrayal of Down's syndrome

BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7381.126/b (Published 18 January 2003) Cite this as: BMJ 2003;326:126
  1. Roger Dobson
  1. Abergavenny

    Psychiatrists have identified what is believed to be one of the earliest paintings of someone with Down's syndrome.



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    The 1515 Flemish painting, by an unknown artist, considerably predates John Langdon Down's first description of the condition in 1866. It shows an angel (next to Mary)—and possibly one other figure, the shepherd in the centre of the background—with the syndrome.

    “If our diagnosis is correct, this implies that Down's syndrome is not a modern disease,” say the psychiatrists (American Journal of Medical Genetics 2003;116:399-405).

    The diagnosis of Down's syndrome in the angel was based on a number of features: a flattened mid-face, epicanthal folds, upslanted palpebral fissures, a small and upturned tip of the nose, and downward curving of the corners of the mouth. The hands, crossed over the breast, have short fingers, especially on the left.

    The painting, The Adoration of the Christ Child, which is in New York's Metropolitan Museum of Art, may also be evidence of an approach to people with a minor mental disorder that differs from the situation today. Because the physical signs of Down's syndrome were not then recognised as a predictor of disability, people with the syndrome may not have been treated by society on the basis of appearance.

    The authors write: “It is possible that those with milder degrees of mental handicap were not recognised as having what we now call mental retardation; individuals who were perceived as being slightly slow, in contrast to those with severe handicaps, might have been fully integrated into society. In this context, a surviving teen or adult with Down's syndrome, no life-threatening malformations, and relatively high intellectual function might not have been recognised as sufficiently different to warrant unusual treatment in a social context.

    “Thus, the individual or individuals in this painting could have been only mildly affected, or mosaic. He or she, or they, could well have been beloved or at least accepted in a family or village group, even a member of the unknown artist's family.

    “After all the speculations, we are left with a haunting late-medieval image of a person with apparent Down syndrome with all the accoutrements of divinity. It is impossible to know whether any disability had been recognised or whether it simply was not relevant in that time and place.”