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Title: An Essay on the Shaking Palsy

Author: James Parkinson

Release Date: December 9, 2007 [EBook #23777]

Language: English

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ESSAY

ON THE

SHAKING PALSY.

JAMES PARKINSON ,

MEMBER OF THE ROYAL COLLEGE OF SURGEONS.

LONDON :

PRINTED BY WHITTINGHAM AND ROWLAND,

Goswell Street ,

F O R S H E R W O O D , N E E L Y , A N D J O N E S ,

PATERNOSTER ROW.

1817.

PREFACE.

The advantages which have been derived from the caution with which hypothetical statements

are admitted, are in no instance more obvious than in those sciences which more particularly

belong to the healing art. It therefore is necessary, that some conciliatory explanation should

be offered for the present publication: in which, it is acknowledged, that mere conjecture

takes the place of experiment; and, that analogy is the substitute for anatomical examination,

the only sure foundation for pathological knowledge.

When, however, the nature of the subject, and the circumstances under which it has been here

taken up, are considered, it is[ii] hoped that the offering of the following pages to the attention

of the medical public, will not be severely censured. The disease, respecting which the present

inquiry is made, is of a nature highly afflictive. Notwithstanding which, it has not yet obtained

a place in the classification of nosologists; some have regarded its characteristic symptoms as

distinct and different diseases, and others have given its name to diseases differing essentially

from it; whilst the unhappy sufferer has considered it as an evil, from the domination of which

he had no prospect of escape.

The disease is of long duration: to connect, therefore, the symptoms which occur in its later

stages with those which mark its commencement, requires a continuance of observation of the

same case, or at least a correct history of its symptoms, even for several years. Of both these

advantages the writer has had the opportunities of availing[iii] himself; and has hence been

led particularly to observe several other cases in which the disease existed in different stages

of its progress. By these repeated observations, he hoped that he had been led to a probable

conjecture as to the nature of the malady, and that analogy had suggested such means as might

be productive of relief, and perhaps even of cure, if employed before the disease had been too

long established. He therefore considered it to be a duty to submit his opinions to the

examination of others, even in their present state of immaturity and imperfection.

To delay their publication did not, indeed, appear to be warrantable. The disease had escaped

particular notice; and the task of ascertaining its nature and cause by anatomical investigation,

did not seem likely to be taken up by those who, from their abilities and opportunities, were

most likely to accomplish it. That these friends to humanity[iv] and medical science, who

have already unveiled to us many of the morbid processes by which health and life is

abridged, might be excited to extend their researches to this malady, was much desired; and it

was hoped, that this might be procured by the publication of these remarks.

Should the necessary information be thus obtained, the writer will repine at no censure which

the precipitate publication of mere conjectural suggestions may incur; but shall think himself

fully rewarded by having excited the attention of those, who may point out the most

appropriate means of relieving a tedious and most distressing malady.

CONTENTS.

PAGE

Chap. I.

Definition—history—illustrative cases

Chap. II.

Pathognomonic symptoms examined—tremor coactus—scelotyrbe festinans

Chap. III.

Shaking palsy distinguished from other diseases with which it may be confounded 27

Chap. IV.

Proximate cause—remote causes—illustrative cases

Chap. V.

Considerations respecting the means of cure

ON THE

SHAKING PALSY.

ESSAY

CHAPTER I.[1]

DEFINITION—HISTORY—ILLUSTRATIVE CASES.

SHAKING PALSY. ( Paralysis Agitans. )

Involuntary tremulous motion, with lessened muscular power, in parts not in action and even

when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a

running pace: the senses and intellects being uninjured.

The term Shaking Palsy has been vaguely employed by medical writers in general. By some it

has been used to designate ordinary[2] cases of Palsy, in which some slight tremblings have

occurred; whilst by others it has been applied to certain anomalous affections, not belonging

to Palsy.

The shaking of the limbs belonging to this disease was particularly noticed, as will be seen

when treating of the symptoms, by Galen, who marked its peculiar character by an

appropriate term. The same symptom, it will also be seen, was accurately treated of by

Sylvius de la Boë. Juncker also seems to have referred to this symptom: having divided

tremor into active and passive, he says of the latter, “ad affectus semiparalyticos pertinent; de

qualibus hic agimus, quique tremores paralytoidei vocantur.” Tremor has been adopted, as a

genus, by almost every nosologist; but always unmarked, in their several definitions, by such

characters as would embrace this disease. The celebrated Cullen, with his accustomed

accuracy observes, “Tremorem, utpote semper symptomaticum, in numerum generum

recipere nollem; species autem a Sauvagesio recensitas, prout mihi vel astheniæ vel

paralysios, vel convulsionis symptomata esse[3] videntur, his subjungam [1] .” Tremor can

indeed only be considered as a symptom, although several species of it must be admitted. In

the present instance, the agitation produced by the peculiar species of tremor, which here

occurs, is chosen to furnish the epithet by which this species of Palsy, may be distinguished.

HISTORY.

So slight and nearly imperceptible are the first inroads of this malady, and so extremely slow

is its progress, that it rarely happens, that the patient can form any recollection of the precise

period of its commencement. The first symptoms perceived are, a slight sense of weakness,

with a proneness to trembling in some particular part; sometimes in the head, but most

commonly in one of the hands and arms. These symptoms gradually increase in the part first

affected; and at an uncertain period, but seldom in less than twelvemonths or more, the

morbid influence is felt in some other part. Thus assuming one of the [4]hands and arms to be

first attacked, the other, at this period becomes similarly affected. After a few more months

the patient is found to be less strict than usual in preserving an upright posture: this being

most observable whilst walking, but sometimes whilst sitting or standing. Sometime after the

appearance of this symptom, and during its slow increase, one of the legs is discovered

slightly to tremble, and is also found to suffer fatigue sooner than the leg of the other side: and

in a few months this limb becomes agitated by similar tremblings, and suffers a similar loss of

power.

Hitherto the patient will have experienced but little inconvenience; and befriended by the

strong influence of habitual endurance, would perhaps seldom think of his being the subject of

disease, except when reminded of it by the unsteadiness of his hand, whilst writing or

employing himself in any nicer kind of manipulation. But as the disease proceeds, similar

employments are accomplished with considerable difficulty, the hand failing to answer with

exactness to the dictates of the will. Walking[5] becomes a task which cannot be performed

without considerable attention. The legs are not raised to that height, or with that promptitude

which the will directs, so that the utmost care is necessary to prevent frequent falls.

At this period the patient experiences much inconvenience, which unhappily is found daily to

increase. The submission of the limbs to the directions of the will can hardly ever be obtained

in the performance of the most ordinary offices of life. The fingers cannot be disposed of in

the proposed directions, and applied with certainty to any proposed point. As time and the

disease proceed, difficulties increase: writing can now be hardly at all accomplished; and

reading, from the tremulous motion, is accomplished with some difficulty. Whilst at meals the

fork not being duly directed frequently fails to raise the morsel from the plate: which, when

seized, is with much difficulty conveyed to the mouth. At this period the patient seldom

experiences a suspension of the agitation of his limbs. Commencing, for instance in one arm,

the[6] wearisome agitation is borne until beyond sufferance, when by suddenly changing the

posture it is for a time stopped in that limb, to commence, generally, in less than a minute in

one of the legs, or in the arm of the other side. Harassed by this tormenting round, the patient

has recourse to walking, a mode of exercise to which the sufferers from this malady are in

general partial; owing to their attention being thereby somewhat diverted from their

unpleasant feelings, by the care and exertion required to ensure its safe performance.

But as the malady proceeds, even this temporary mitigation of suffering from the agitation of

the limbs is denied. The propensity to lean forward becomes invincible, and the patient is

thereby forced to step on the toes and fore part of the feet, whilst the upper part of the body is

thrown so far forward as to render it difficult to avoid falling on the face. In some cases, when

this state of the malady is attained, the patient can no longer exercise himself by walking in

his usual manner, but is thrown on the toes and forepart of the feet; being, at the same[7] time,

irresistibly impelled to take much quicker and shorter steps, and thereby to adopt unwillingly

a running pace. In some cases it is found necessary entirely to substitute running for walking;

since otherwise the patient, on proceeding only a very few paces, would inevitably fall.

In this stage, the sleep becomes much disturbed. The tremulous motion of the limbs occur

during sleep, and augment until they awaken the patient, and frequently with much agitation

and alarm. The power of conveying the food to the mouth is at length so much impeded that

he is obliged to consent to be fed by others. The bowels, which had been all along torpid,

now, in most cases, demand stimulating medicines of very considerable power: the expulsion

of the fæces from the rectum sometimes requiring mechanical aid. As the disease proceeds

towards its last stage, the trunk is almost permanently bowed, the muscular power is more

decidedly diminished, and the tremulous agitation becomes violent. The patient walks now

with great difficulty, and unable any longer to support himself[8] with his stick, he dares not

venture on this exercise, unless assisted by an attendant, who walking backwards before him,

prevents his falling forwards, by the pressure of his hands against the fore part of his

shoulders. His words are now scarcely intelligible; and he is not only no longer able to feed

himself, but when the food is conveyed to the mouth, so much are the actions of the muscles

of the tongue, pharynx, &c. impeded by impaired action and perpetual agitation, that the food

is with difficulty retained in the mouth until masticated; and then as difficultly swallowed.

Now also, from the same cause, another very unpleasant circumstance occurs: the saliva fails

of being directed to the back part of the fauces, and hence is continually draining from the

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