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Down’s successors turned their attention to these patients’ hands. The roughly parallel palmar heart and head lines – clearly distinct in ‘normals’ – joined together in one continuous transversal line in ‘congenital idiots’. In the 1870s, a French anthropologist observed similarities between this kind of human hand and the hands of apes – hence the designation of the ‘simian line’ as a then-accepted mark of Down’s syndrome and other mental disorders. Later, the physician Francis Crookshank maintained that Down’s syndrome babies were atavistic evolutionary leftovers. Not all of those with hands so marked were ‘idiots’ or ‘imbeciles’: instead, he insisted, they might ‘pass’ as normal (the title of his notorious study from 1924 was The Mongol in Our Midst), so tapping into a panic about British racial degeneration that had been growing for decades. Physicians’ interest in the shape of hands and their marks persisted into the mid-20th century. Neurologists are now sceptical that the single transverse palmar crease is a reliable diagnostic sign: it is said to appear in only about half of Down’s syndrome people and is associated with foetal alcohol syndrome and other chromosomal irregularities, but it crops up in between 1.5 and 3 per cent of the population, many of whom have no abnormal conditions or health problems at all.

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