Dear Sir,

I have recently had a case under my care which I think will interest you. The subject was a Microcephalic Idiot of about 4 years of age— The cause was said, by several Physicians who had seen the child, to have been synostosis of the sutures—¹

I, however, said that the cases of Microcephalism which had come under my notice & which I had been able to examine after death had existed with perfect sutures & in fact with the Medio-frontal existing, which usually disappears during fœtal life:² I regarded this boy as coming under the same category and that the cause was developmental—

The interest about the case is mainly the condition of his ears which had the rudimentary lobe well developed as figured in your last work.³ The right pinna was especially well marked and that I have preserved— Moreover, this condition of ear was associated with a well marked transverse perpendicular fissure which Vogt says is never met with in Idiots.⁴ My experience is quite contrary to Vogt. On one side the Occipital lobe is completely cut off from the rest of the cerebrum by a deep sulcus such as one meets with in Anthropoid Apes—

I have preserved the encephalon & medulla spinalis, right pinna and sacrum with coxcyx.⁵

I am, dear Sir, | Yours truly | J. Langdon Down M.D.