Mongolism and Cretinism.
- Author:
Clemens E. Benda.
Fp. 310, with 103 illustrations ana taoies. Heinemann. London. 1947. 25s.
The purpose of this book is stated to be ” to rid mongolism of the mystery clouding its proper medical recognition and to publish data which were collected in the Wallace Research Laboratory during ten years of continuous research”. It is based upon a study of over 300 cases, which included repeated physical measurements, radiological, biochemical, psychological and aetiological investigations, as well as the post-mortem examination of fifty cases. The book also deals, by way of contrast, with certain aspects of cretinism; but mongolism is its chief concern.
After an account of history, frequency and terminology, and a description of the physical and mental characteristics, the author passes to the results of his histological, biochemical, pathological and endocrine findings. This is the largest and most important part of the book. It is based upon a very thorough and painstaking investigation, particularly of the endocrine glands, and as a result of this Dr Benda comes to the conclusion that the condition known as mongolism is undoubtedly due to congenital inadequacy of the pituitary gland. He finds a deficiency of the secretion of other endocrine glands; but these are activated by the pituitary, and he considers that defect of this is the essential basis. The mongol ” is born with a pituitary deficiency which he is never able to overcome “. In addition, the author finds a number of other pathological changes in the brain and spinal cord, the chief of which are areas of necrosis and demyelination and disease of the nerve cells. These, as he states, are similar to the changes produced by chronic deficiency of oxygen or sugar metabolism, and he draws the conclusion that the whole disturbance is due to some ill health or abnormality of the mother. After giving details of sixty-seven cases of women of various ages who had given birth to mongol children, he states that no one who glances through these can escape the conclusion that the cause of mongolism is to be found in the condition of the mother at the beginning of pregnancy. The final chapters deal with certain precautionary measures which might be taken by medical men in the hope of preventing or diminishing the incidence of mongolism, and with its treatment. If Dr Benda’s views are correct, the obvious treatment is by administration of pituitary gland; but, as he says, an adequate extract of this is not at present available. It may also be doubted whether, if it were, it would have much effect in remedying developmental changes which have been present during some months of intra-uterine life. The book is too medical and technical to allow of more than a summary of the salient points in this place. It may be said, however, that it is obviously based upon a large number of very careful investigations of all kinds, and that it constitutes, in the reviewer’s opinion, the most up-to-date and detailed account of mongolism which at present exists. Dr Benda’s findings await confirmation; but he has certainly made out a prima facie case for his views as to the pathological basis and causation of this interesting and important condition. There are obviously many details to be filled in, particularly with regard to the physical condition of the * This review is reprinted by the courtesy of the Editor of the ” Eugenics Review
mother of a mongol child and other aetiological aspects; but if his views prove to be correct, Dr Benda will have made a most valuable contribution towards the elucidation of a subject which has been a medical enigma for many years. A.F.T.
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