Week 12 - September 2nd, 2003

"The Shaking Palsy" - The History of Dr. James Parkinson

Parkinson’s Disease was named after James Parkinson. He was a surgeon, apothecary, social reformer, political agitator and pamphleteer, founding member of the Geological Society and author of Organic Remains of a Former World – the definitive work on paleontology in his time.

Dr. James Parkinson was the son of John Parkinson, a surgeon and apothecary. He was born in 1755, in Hoxton, England. To put things in perspective, James Parkinson was born in the same year as Marie Antoinette, saw the abolition of the French Monarchy, the rise and fall of Bonaparte, and the independence of the United States of America.

The close of the 18^th century was one of the great periods in history. The factory system was replacing the cottage workshop, there was wealth to the manufacturer, power to the political parties and hardship to the working classes. James Parkinson, conscious of the political struggle of the times from a very early age, found himself a Whig in a society of Tories. (Note: A “Whig” was a member of the of the British reforming and constitutional party, succeeded in the mid-19^th century by Liberals; A “Tory” was a member of the political party in the 17^th to 19^th centuries that was opposed to Whigs and gave rise to the Conservative Party.) Behind closed doors, James Parkinson planned for better days in England. He proposed several recommendations for social reform in anonymous publications that were published in 1794 – such as amending the Poor Laws so that a poor man would not be liable to be sent to prison for moving out of his own parish to seek employment.

Although his early publications were largely related to political reform, by the end of the century his interests seemed to concentrate on medical education and on medicine itself. He presented a number of publications that provided his patients with ways to help themselves – The Villager’s Friend, Medical Admonitions, Dangerous Sports and The Hospital Pupil all focused on the prevention and treatment of disease and injuries.

Undoubtedly the greatest contribution that Dr. James Parkinson made to medicine, however, was his remarkable essay on The Shaking Palsy, published in London in 1817. The essay begins:

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.

He reviewed the case histories of six patients but only two were typical of the disease and three were, in fact, acquaintances met casually in the street. The posture, the tremor, the accelerated gait and the speech were accurately described. Rigidity was not mentioned and this confirms the belief that Parkinson relied entirely on observation rather than clinical examination.

Dr. Parkinson proposed that the “supposed proximate cause” may be “a disease state of the medulla spinalis, in that part which is contained in the canal, formed by the superior cervical vertebrae, and extending, as the disease proceeds, to the medulla oblongata.” His proposal was based on “the absence of any injury to the senses and to the intellect; that the morbid state does not extend to the encephalon.”

Many unusual suggestions had been made for the treatment of the disease but Parkinson wrote that “until we are better informed respecting the nature of this disease, the employment of internal medicines is scarcely warrantable.” About sixty years after the publication of The Shaking Palsy, the condition was referred to by Charcot as “Parkinson’s Disease.” In 1877, he presented the first account of the accompanying rigidity and akinesia, and provided the following detail in his clinical description: “Far from trembling, the muscles of the face are motionless, there is even a remarkable fixity of look and the features present a permanent expression of mournfulness, sometimes of stolidness …. There is no real difficulty of speech, but the utterance is slow, jerky and short of phrase: the pronunciation of each word appears to cost a considerable effort of the will.”

Dr. James Parkinson died in 1824, On the wall of the church in Hoxton, where he was born, a plaque has been erected in memory of Dr. James Parkinson, and reads: