History of Neurology
The circus sideshow was a smorgasbord of human performers, shrewdly designed to entertain the middle-class public and exploit the attitudes of the time. Under the vernacular of “pinheads,” people with microcephaly and mental retardation were displayed as “freaks.” This article presents original materials from the Ringling Brothers Circus Museum Archives and Harvard Theater Collection, including sideshow banners, circus programs, song lyrics, and performance photographs, in addition to contemporary newspaper articles, major medical journal publications, and other secondary sources regarding microcephaly in the 19th and early 20th century circuses. More than 20 performers were exhibited as “pinheads,” popularly portrayed as “missing links” or children from lost civilizations. People with neurologic disorders were displayed as wild and juvenile and thus, joined a series of hoaxes of the American sideshow. Although incomplete data exist on their true lives, the exhibition of people with microcephaly eventually declined due to protective laws passed in part due to the American circus “freak shows.”
The American circus sideshow began in the late 1850s and reached its zenith by the end of that century.1 Although multiple circuses traipsed across North America, the most famous was P.T. Barnum's Great Traveling Museum, Menagerie, Caravan, Hippodrome and Circus, which originated in Delavan, WI, in 1871.2 Nearly forgotten now, the microcephalic person, or “pinhead,” was a common attraction in the traveling circus sideshows, as integral to the five-and-dime lineup as a fat lady, a sword-swallower, or a tattooed man.
Considerable attention has been paid to other medical disorders in the circus, but the presence of neurologic disease as a human curiosity has not been explored. A variety of nearly forgotten microcephalics exhibited and exacerbated their physical features for the “lay-dese and gentlemen” viewers of the circus sideshow from the mid-1850s until the mid-1940s. Compared to most other circus performers, the pinheads were unique among the medical curiosities of the circus sideshows: most performers were children with mental retardation who were sold to the circus. The “pinheads” were therefore either unwilling or unable to provide factual accounts of their exhibition. Many may not have voluntarily participated. Therefore, little archival material remains, and no autobiographical data survive. Rather, “managers” exalted crowds by concocting exotic stories about the origins of microcephaly and mental retardation. At least 20 pinheads and their managers were successful enough to build a career in performance. Most microcephalics performed under multiple names, changing their act by the season and with the circus they joined.
There was likely a range in the severity of mental retardation affecting the pinheads. The concept of autosomal recessive inheritance of disorders involving mental retardation and microcephaly was unknown. No pinheads have recorded diagnoses, and none are thought to have had trisomy 21. Koo Koo, the bird-headed girl (born Minnie Woolsey, 1880–?), is believed to have had the rare Virchow-Seckel syndrome (figure e-4). Overall, the pinheads were a heterogeneous group, likely representing multiple disorders. The pinheads also represent a group of “doubly vulnerable” people who were both intellectually impaired and largely from racial minorities in the United States (figure 2, figure e-5). Modern sensibilities espouse that perceptions of disability are based on cultural assumptions, availability of services, structures of buildings, and distribution of income among people with human variations.25
By the mid-1900s, all states in the United States of America passed laws attempting to protect people with mental retardation. Four states specifically prohibited their public display, effectively ending the performances of the microcephalics. Although P.T. Barnum's traveling sideshows raised community concern, it was the display of jarred abnormal fetuses that was largely responsible for the new laws.26 Some performers were institutionalized when the sideshow fell out of favor. Improved surgical care and medical advances allowed other “freaks” to appear normal,27 and the crash of the New York Stock Exchange in 1929 forced multiple circus tents to fold up permanently.28 Yet, for nearly a century, microcephalics performed for thousands of circus-goers—feigned in behavior, exaggerated in appearance, and fraudulent in display. Although no neurologist is known to have examined a “pinhead,” in this way, neurologic illness too was a mainstay at the “Greatest Show on Earth.”