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Aspects of the History of Parkinson's Disease J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.52.Suppl.6 on 1 June 1989. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry. Special Supplement 1989:6-10 Aspects of the history of Parkinson's disease J M S PEARCE From the Department ofNeurology and Parkinson's disease Clinic, Hull Royal Infirmary, Hull, UK ASPECTS OF THE HISTORY OF PARKINSON'S AN DISEASE Aspects ofthe history ofParkinson's disease E S SAY Before James Parkinson's classic' "An Essay on the Shaking Palsy" (1817) ancient books recorded many types of paralytic disorders and tremors. None fully ON THa described the distinctive features of the syndrome which so justly perpetuates Parkinson's name. His essay (fig 1) mentioned the earlier writings of Juncker who distinguished tremors, either "Active- SHAKING PALSY. sudden affections of the mind, terror, anger or, Passive -dependant on debilitating causes such as advanced Protected by copyright. age, palsy etc." He credited Sylvius de la Boe for showing the important difference between rest (tremor coactus) and action tremor in 1680. Parkin- BY son cites Sauvages "the tremulous parts leap, and as it wereL vibrate, even when supported: whilst every other JAMES PARKINSON, tremor, he observes, ceases, when the voluntary exer- HUSER OI THE ROYTAL COLLEGE of SUEGEOHI tionfor moving the limb stops ... but returns when we will the limb to move;" He also referred to van Swieten (1749) who had made similar observations about rest tremor. Sauvages had described the festi- LONDON: hant gait which "I think cannot be more fitly named PRINTtD BY WHIrTIGHAW AND ROWLAND. than hastening or hurrying Scelotyrbe (scelotyrbem festinantem, seufestiniam) ", as did Gaubius some ten FOR SHERWOOD, NEELY, AND JONES, years earlier (1758). IATERNORSTER ROW. 1817. James Parkinson Figure 1 http://jnnp.bmj.com/ This brief essay can neither replace nor do justice to the scholarly writings devoted to James Parkinson, his life and work. The reader is referred to McMenemey's essay,2 was Anatomical Warden of the Surgeon's Company Gardner-Thorpe's introduction to the reprint of The which had replaced the Barber's Company in 1745 Shaking Palsy3 and to Kenneth Tyler's comprehen- and was succeeded by the Royal College of Surgeons sive review.4 Cleevely and Cooper' outline his work in 1800. In addition to his substantial medical con- as a social reformer and geologist and append an tributions James was variously described as a radical on September 28, 2021 by guest. extensive bibliography. political pamphleteer (under the pseudonym of "Old James was born on 11 April 1755, the first child of Hubert"), a pacifist, an agitator for parliamentary Mary and John Parkinson. John was an apothecary reform, a member of secret societies and, a campaig- and surgeon who lived and worked at 1 Hoxton ner for social welfare. Interestingly, no verified Square in the district of Shoreditch in London. He portrait of him exists. His writing was prolific. His first work was a Address for reprint requests: Dr J M S Pearce, Department of critical account of medical practice Observations on Neurology, Hull Royal Infirmary, Hull HU3 2JZ, UK. Dr Hugh Smith's Philosophy of Physic etc in 1780. 6 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.52.Suppl.6 on 1 June 1989. Downloaded from Aspects ofthe history ofParkinson's disease 7 The text ofthe Memorial reads: AN IN PIAM MEMORIAM ESSAY JAMES PARKINSON oi TUE OF HOXTON SURGEON AND APOTHECARY DIPLOMATE OF THE COMPANY OF SURGEONS SHAKING PALSY. MEMBER AND THE FIRST HONORARY MEDALLIST OF THE ROYAL COLLEGE OF SURGEONS IN HIS 'ESSAY ON THE SHAKING PALSY' HE FIRST DESCRIBED THE DISEASE CHAPTER I. SINCE KNOWN BYHIS NAME FOUNDER MEMBER OF THE GEOLOGICAL SOCIETY OF LONDON DEFENmON-HISTORY-ILLUSTRATIvE CASES. AND AUTHOR OF *ORGANIC REMAINS OF A FORMER WORLD' HONORARY MEDALLIST OF THE ROYAL HUMANE SOCIETY POLITICAL AND SOCIAL REFORMER Agitans,? BORN AT I HOXTON SQUARE II APRIL 1755 SHAKING PALSY. (Paralysis WHERE HE PRACTISED FOR FORTY YEARS motion, with lessened DIED AT 3 PLEASANT ROW HOXTON Involuntary tremulous 21 DECEMBER 1824 muscular power, in parts not in action and BAPTIZED AND MARRIED IN THIS CHURCH AND BURIED IN THE CHURCHYARD even when supported; with a l)ropensity A LIFE LONG WORSHIPER AT THE PARISH CHURCH to bend the trunk forward, and to pass ERECTED BY THE NURSING STAFF from a walking to a running pace: the OF ST LEONARD'S HOSPITAL Protected by copyright. senses and intellects being uninjured. Figure 2 Figure 3 His most famous book was a palaeontologoical escape." He stressed the need for "a continuance of study Organic Remains of a Former World in 3 vols observation of the same case, or at least a correct (1804-1811) which ran to three editions. His medical history of its symptoms, even for several years. He works included: some accounts of the effects of regretted that "the disease had escaped particular lightning, a case of diseased vermiform appendix notice and the task of ascertaining its nature by (possibly the first account of appendicitis), typhoid anatomical investigation." He hoped pathologists fever, hydrophobia, hints for the improvement of might "be excited to extend their researches to this trusses, gout, and the Essay on the Shaking Palsy. A malady." crinoid Apiocrinuxs parkinsoni, a gastropod Parkinson's inquiring mind shines throughout the Rostellaria parkinsoni, an ammonite Parkinsonia essay in an array of acute clinical observations and parkinsoni and a stemless palm Nipa parkinsoni are inferences. His descriptions leave one in doubt as to other commemorative tokens5 to this phenomenal whether he examined his patients in the conventional and scholarly scientist. fashion, but the sharpness of his eye and his qualities James married Mary Dale in May 1781 and they as a naturalist are self evident. As in his quixotic http://jnnp.bmj.com/ had six children; two died in infancy, one son John excursions into contemporary politics and the right- qualified in medicine and shared his practice. James ing of social ills, the essay betrays his deep compas- was afflicted with gout for many years, but is said to sion and humanitarian qualities. have died of a stroke3 on 21 December 1824. He was Chapter I opens with his classic summary (fig 3). baptised, married and was finally buried in St Leon- The words shaking palsy had been used before, but ard's church where a marble plaque (fig 2) was imprecisely; tremors had been described by Galen, unveiled in September 1955. Juncker (tremores paralytoidei), and by Cullen. "So on September 28, 2021 by guest. slight and nearly imperceptible are the inroads of this The shaking palsy malady, and so extremely slow its progress ... that the The essay spans 66 pages and five chapters. A preface patient cannot recall the onset. The first symptoms offers the reader a conciliatory explanation for a perceived are, a slight sense of weakness with a prone- "publication in which mere conjecture takes the ness to trembling ... most commonly in one of the place of experiment". "It has not yet obtained a hands and arms." ". .. in less than twelvemonths or place in the classification of the nosologists ...; more, the morbid influence is felt in some other part." whilst the unhappy sufferer has considered it an evil, After afew more months the patient isfound to be less from the domination of which he had no prospect of strict than usual in preserving an upright posture." J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.52.Suppl.6 on 1 June 1989. Downloaded from 8 Pearce ... As the disease proceeds ... the hand fails to but not initiated by Marshall Hall, as is often stated). answer the dictates of the will. Walking becomes a A man with paralysis and venereal infection, palsies task which cannot be performed without considerable occasioned by injury to the brain, medulla and upper attention. ... care is necessary to prevent frequent cord, and Pott's carious disease of the spine are falls." "The disease proceeds, difficulties increase: mentioned. This chapter fully portrays the state of writing can now be hardly at all accomplished; and knowledge, the limitations of medical practice and reading, from the tremulous motion, is accomplished the grave difficulties which beset physicians of the with some difficulty." Later, "the propensity to lean day. forward becomes invincible, and the patient isforced to Similarly, chapter 5 devoted to means of cure, step on the toes andfore part of the feet, ... irresis- shows us how frustrating attempts at treatment were tibly impelled to take much quicker and shorter steps, at that time. Optimism prevails however, "there and thereby to adopt unwillingly a running pace. appears to be sufficient reason for hoping that some ... "The bowels which had all along been torpid, the remedial process may ere long be discovered." He expulsion offaeces requiring mechanical aid." Finally discusses in turn: "blood takenfrom the upper part of "his words are now scarcely intelligible ... no longer the neck, . vesicatories applied to the same part and able to feed himself... saliva is continually draining a purulent discharge obtained by use of the Sabine from the mouth, mixed with particles offood he is no Liniment;". Later he remarks "Until we are better longer able to clear from the inside of the mouth." informed regarding the nature of this disease, the Terminally he describes sleepy exhaustion with employment of internal medicines is scarcely warran- incontinence and loss of articulation. table;". Parkinson then provides six beautifully illustrative This classic and exemplary essay ends by case histories of men aged 50, 62, 65, 55, 72 years and generously extolling the virtues of his colleagues a gentleman, the particulars of which could not be professional ardour and devotion and "the benefits obtained ("the lamented subject of which was only bestowed on mankind by the labours of a Morgagni,Protected by copyright.
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