Billy was 59 years old that spring or summer of 1846, when a well-dressed man from Boston rode into his Massachusetts village on horseback, and began measuring and testing him in all sorts of ways. The visitor, as we imagine the scene, placed phrenologist’s calipers on his skull, ran a tape measure around his chest and asked many questions relating to Billy’s odder behaviors. It was those behaviors that had prompted this encounter. In the parlance of the mid-19th century, Billy was an "idiot," a label that doctors and educators used not with malice but with reference to a concept that owned a place in the medical dictionaries and encompassed what most of us today call, with more deliberate sensitivity, intellectual disability.
Billy’s name (but not the village he lived in) was on a list of the commonwealth’s known "idiots," hundreds of whom would be visited that year. A few months earlier, the legislature had appointed a three-man commission to conduct, in effect, a census of such individuals. In Billy’s case, however, the man who examined him soon realized that no commonly accepted definition of intellectual impairment quite fit this particular subject. Although Billy was clearly not "normal," and was considered by his family and neighbors to be intellectually incapacitated, in some ways he demonstrated solid, if not superior, cognition. His ability to use spoken language was severely limited, but he had perfect musical pitch and knew more than 200 tunes. Billy was not the only person whose combination of skills and strengths puzzled the examiners. As the leader of the commission would acknowledge, there were "a great many cases" seen in the course of the survey about which it was "difficult to say whether...the person should be called an idiot."
But what diagnosis might have fit better? If Billy were alive today, we think his disability, and that of others documented then in Massachusetts, would likely be diagnosed as autism. True, the actual word "autism" did not exist in their time, so neither, of course, did the diagnosis. But that does not mean the world was empty of people whose behaviors would strike us, in 2016, as highly suggestive of autistic minds.