THE “MONGOLOID SPOT’’ I N TURKEY AND IRAQ

HENRY FIELD Field Museum of Natwral History, Chicago, Illinois

INTRODUCTION

The ‘ ‘ tache mongoloide ” or ‘ ‘ tache bleue mongolique, ’ ’ re- ferred to as the “mongoloid spot,” generally occurs in the sacral region of newborn babies of the Yellow-Brown races.

The blue spot appears during the first few days after birth, may be either round or oval in shape and ranges in diameter from a few millimeters to more than 5 cm.

The bluish color varies according to racial groups: it is reported as deep blue among the Japanese; slate gray among the Chinese ; blackish gray among the Polynesians ; greenish gray among the Indian mestizos of South America ; and among European brunet children pale blue. It grows lighter in color as the child develops and by the age of 7 or 8 it disappears.

In March, 1934, while passing through Paris en route to Baghdad, Dr. P. Rivet, Curator at the Trocadero Museum, suggested that search for “mongoloid spots” should be made in Iraq since no records, either positive or negative, were available from the area lying between Egypt and India. Dr. D. A. D. Kennedy, obstetrician at the Royal Hospital, Baghdad, was requested to examine newborn babies for the occurrence of the “mongoloid spot.” Doctor Kennedy called attention to the first case early in April and from time to time other cases were recorded, so that there is now a positive evidence of the incidence of the “spot” in Iraq. No percentages, however, are available.

Upon my return from the Field Museum Anthropological Expedition to the Near East a circular letter requesting data

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120 HENRE’ FIELD

on the “mongoloid spot” was addressed to the Ministers of Health in Syria, Palestine, Turkey, Iran and Afghanistan. No replies were received except from the Republic of Turkey. Three reports were sent by Dr. Asim Arar, Under-Secretary of State to the Ministry of Hygiene and Social Assistance. These three reports have been translated and are summarized in the following pages.

FIRST REPORT

In a letter from Ankara dated June 1,1938, were stated the results obtained in the Clinique de la Facult4 de MQdicine of the University of Istanbul, and in the Service Infantile de 1’Asile. The majority of the 308 children examined were Turkish orphans either from Istanbul and environs or from different parts of Turkey. The “mongoloid spot” was ob- served on forty-seven boys and thirty-eight girls under 5 years of age, there being a greater incidence among the males.

Details regarding <‘Mongoloid Spot” OIL fifty-five individuals Pigmentation o r hair color

of parents Mother Father Per cent

Brunet Brunet 43.6 Brunet Chestnut 32.8 Chestnut Chestnut 14.6 Brown Blond 3.6 Chestnut Blond 3.6 Brown Red 2.0

Location of ‘‘Spot” Per cent Color of “Spot” PET cent

Coccygeal 32.8 Bluish 63.5 Sacral 23.5 Slate gray z9.0 Iliac 9.0 Grny 5.5 Coccygeal and iliac 7.2 Light gray 2.0 Lumbar 5.5 Dorsal 5.5 Sacral and lumbar 5.5 Coecygeal and sacral 5.5 Sacral and iliac 3.5 Dorsal and iliac 2.0

In Turkey country people call the “mongoloid spots” by the generic name of “lek spots” and consider them the result of marks acquired during pregnancy. There exists a belief that children born with auburn hair and bearing these marks later become brunets. In some areas of the country efforts are made to remove these spots either by scarification o r by bloodletting.

THE NONGOLOID SPOT 121

The Tollowing statistics were obtained from this source :

Subjects w i t h “Mongoloid Spots” Number P e r cent Boys 49 56.3 Girls 38 43.7 Up to 1 year old 53 61.0 From 1 to 2 years old 24 27.6 Above 2 years of age 10 11.4

Among 987 children examined eighty-seven (8.8% ) had the “mongoloid spots.’’

SECOND REPORT

The second series of observations is that on 3,560 children examined by Dr. Ihsan Hilmi Alantar in the Clinic at Istanbul. This information was received in a letter from Dr. Asim Arar, dated January 18,1939.

Natiouzality. All Turks.

Age. “Mongoloid spots” were recorded on children under 4 years of age, never older. During the first year the number of babies with the “spots” is double that of the second year.

Sex. The frequency is higher among males than among females.

Pigme.ntatioH. The following table shows the pigmentation of the skin or hair of each parent of the children with the spots :

Father Brnnet Brown Brown Chestnut Brown Negroid black

Total .....

Y o t h s r Brunet Chestnut Blond Chestnut Red Brown ...........

Number 89 49

5 22

2 4

171 -

The accompanying drawings indicate that ‘‘mongoloid spots” occur most frequently in the sacro-coccygeal region.

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Details regarding the location and color of the “spots” follow :

Location of “Mongoloid Spote” Re&on Number

Dorsal ........................ 7 Lumbar ....................... 19 Sacral ........................ 31 Coccygeal ...................... 46 Iliac .......................... 30 Dorsal and lumbar . . . . . . . . . . . . . . 3 Dorsal and coccygeal . . . . . . . . . . . . 1 Dorsal, lumbar and sacral . . . . . . . 3 Lumbar and sacral ............. 7 Lumbar and coccygeal . . . . . . . . . . . 4 Lumbar and iliac ............... 2

Color of “Mongoloid Spots’‘ N u m b e r

Blue .......................... 34 Light blue .................... 45 Slate gray ...................... 26 Light gray ..................... 27 Dark gray .................... 19

R e g i o n N u m b e r

Lumbar, sacral and iliac ......... 2 Lumbar, coccygeal and iliac ...... 1 Iliac and dorsal ................. 1 Iliac and coccygeal ............ 5 Iliac, femoral and sacral . . . . . . . . . 1 Iliac and shoulder . . . . . . . . . . . . . 1 Iliar: and sacral . . . . . . . . . . . . . . . . 1 Sacral and scapular . . . . . . . . . . . . . 2 Coccygeal and wrist ............ 1 Coccygeal, shoulder and foot . . . . 1 Dorsal, lumbar and coccygeal .... 2

Total ..................... 171 -

Color of “Mongoloid Spota” Nuinher

Coffee ......................... 5 Light violet . . . . . . . . . . . . . . . . . . . 2 Light squirrel gray ............. 10 Dark squirrel gray . . . . . . . . . . . . . . 3

Total ..................... 171 -

In shape the “mongoloid spots” were seen to vary consider- ably, being sometimes round, sometimes irregular. They were isolated or joined. The color varied with the age and the skin texture of the child. The younger the child and the browner the skin the darker were the spots. With increasing age the spots gradually disappear.

The “mongoloid spots” are termed locally also ‘‘lek spots” and are considered as nevi, and as acquired during pregnancy. -

LEGEND: Mongoloid spots recorded in Turkey: figure 1, 20 months; figures 2 and 3, 15 months; figure 4, 2 years; figure 5, 6 months; figure 6, 18 months; figure 7, 15 days; figures 8 and 9, 64 months; figure 10, 8 months; figure 11, 2 years; figure 12, 18 months; figure 13, 11 years; figure 14, 6 years; figures 15 and 16, front and back views of figure 1, age 20 months; figure 17, 2 months, figure 18, 5 months; and figure 19, 2 months. Black areas indicate location of mongoloid spots. Ruled shading = bluish areas on skin, the result of fading spots. Enclosed white space (fig. 17) = possible area of mongoloid spot, almost completely faded.

THE MONGOLOID SPOT 123

\ A")ii\ A 114

Figure 1

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There is a belief that auburn-haired children bear these spots which later turn brown.

Rdsumd: Children examined for LLMongOloid Spots” at the Clinic in Istanbul Number of Number with

Age 8ubjeCta Spot8 P e r cent

0- 3months 195

6- 3- 9months 6months 9-12 months 259 6.13

2 years 608 41 6.7 3 years 305 13 4.2 4 years 241 4 1.65

‘05} 191 850 1 113 iii 1 13.3

5-14 years 1556 0 . .. . - - - -

0-14 years 3560 171 4.8

As to sex, the “spots” were distributed thus: Ninety-two boys (53.8 ’% ) and seventy-nine girls (46.2 ’% ) .

THIRD REPORT

The third report accompanied a letter dated June 14, 1939, from Dr. Asim Arar. Observations on the uccurrence of “mongoloid spots” in this case were recorded on 7,916 children, in several medical centers :

Frequency of “Mongoloid Spots” Number Number with

Medicnl Oenter examined “Spots” Per cent

Dispensaire des Enfants des Ecoles et des

Dispensaire des Enfants des Ecolea et des

Service de M6dicine Infantile de 1’HGpital

Nourrissons d ’Uskiidar (Istanbul) 1591 56 8.51

Nourrissons de BBchitktache (Istanbul) 1000 28 2.80

Hasseki (Istanbul) 1164 20 1.71 HGpital ModBle (Ankara) 100 21 61.00

MaternitB-CrBche (Konya) 40Gl 62 1.52

Total 7916 187 2.86 - - -

* High frequency unexplained; record may involve some error.

THE MOXGOLOZD SPOT 125

Race, nationality or religion of children with “Mongoloid Spots”

Turks ..................... 167 Albanian ................. 1 Kurds .................... 9 Trani (Persian) . . . . . . . . . . . 1 Tatar ..................... 1 Jews ..................... 2 Arabs .................... 3 Armenian ................. 1 Ethiopians 2 Total . . . . . . . . . . . . . . . . . . 187

Number Group Number Qroup

- ................

Age of children with “Mongoloid Spots”

0-1 138 73.8 1-4 41 21.9

8 4.3 4-X

Total 187 100.0

Age Number Per cent

- __

Sex of childen with “Mongoloid Spots” Sex Number Per cent

Boys 108 57.7 Girls 79 46.3

Total 187 100.0 - -

Pigmentation of skin and hair in children with “Mongoloid Spots”

White 17 9.1 Black 112 59.9 Dull brown 71 38.0 Auburn 11 5.9 Brown 38 20.3 Blond 3 1.6 Unknown 61 32.6 Unknown 61 32.6

Total 187 100.0 Total 187 100.0

Skin color Number P e r cent Hair color Number P e r cent

- - - -

Lvcation of r 6 Mongoloid Spo t s f f Reoion Number Per cent

Iliac 78 Sacral and coccygeal 48 Lumbar 24 Bacral and lumbar 20 Sacral 6 Coccygeal 5 Dorsal 4 Sacral and iliac 2

41.7 25.7 12.8 10.7 3.2 2.7 2.1 1.1 - -

Total 187 100.0

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Color of Mongoloid Spots”

Light blue 97 61.9 Color Ntmmber Per cant

Dark blue 41 dl .9 Blue 12 6.4 Gray 9 4.8

Mauve 2 1.1 Unknown 24 16.8

Total 187 100.0

Light gray 2 1.1

- -

The “spots” vaned in diameter from 1 to 5 cm. In different localities of Turkey “mongoloid spots” are

called nichan (=mark) or miihiir (= seal). There are dif- ferent beliefs about them among the Turks and among the Armenians: The Turks believe that if during pregnancy a woman receives a blow on the abdomen the child will develop a “mongoloid spot’’ on the corresponding part of its body. The Armenians call the “mongoloid spots” by the name “hizirilyas.” They believe that if during pregnancy a woman works during the day of hizirilyas and if another woman looks a t her while she is working and criticizes her, and if the woman places her hand on her back, a “mongoloid spot” will appear on the corresponding part of the baby.

SUMNARY

Through the researches of Dr. Asim Arar and his colleagues 11,784 children, mainly Turkish, have been examined for the occurrence of the “mongoloid spot.” This was observed on 249 boys and 196 girls, or 445 individuals (3.78%).

Among brunet European children the frequency appears to be from two to three cases per 1000.

Since the “mongoloid spot’’ has now been observed in Turkey and in Iraq it is probable that cases will be recorded throughout Southwestern Asia.