An Essay on the Shaking Palsy by James Parkinson (e book reader pc TXT) 📕

la Boë into those tremors which are produced by attempts at voluntary motion, and those which occur whilst the body is at rest[3]. Sauvages distinguishes the latter of these species (Tremor Coactus) by observing, that the tremulous parts leap, and as it were vibrate, even when supported: whilst every other tremor, he observes, ceases, when the voluntary exertion for moving the limb stops, or the part is supported, but returns when we will the limb to move; whence, he says, tremor is distinguished from every other kind of spasm[4].

A small degree of attention will be sufficient to perceive, that Sauvages, by this just distinction, actually separates this kind of tremulous motion, and which is the kind peculiar to this disease, from the Genus Tremor. In doing this he is fully warranted by the observations of Galen on the same subject, as noticed by Van Swieten[5]. “Binas has tremoris species[6] Galenus subtiliter distinxit, atque etiam diversis nominibus insignivit, tremor enim (τϱὁμ &) facultatis corpus moventis et vehentis infirmitate oboritur. Quippe nemo, qui artus movere non instituerit tremet. Palpitantes autem partes, etiam in quiete fuerint, etiamsi nullum illis motum induxeris palpitant. Ideo primam (posteriorem) modo descriptam tremoris speciem, quando quiescenti homini involuntariis illis et alternis motibus agitantur membra, palpitationem (πἁλμον) dixit, posteriorem (primam) vero, quæ non fit nisi homo conetur partes quasdam movere tremorem vocavit.”

Under this authority the term palpitation may be employed to mark those morbid motions which chiefly characterise this disease, notwithstanding that this term has been anticipated by Sauvages, as characteristic of another species of tremor[7]. The separation of palpitation of the limbs (Palmos of Galen, Tremor Coactus of de la Boë) from tremor, is the more necessary to be insisted on, since the distinction may assist in leading to a knowledge of the seat of the disease. It is also necessary to bear in mind, that this affection is distinguishable from tremor, by the agitation, in the former, occurring whilst the affected part is supported and unemployed, and being even checked by the adoption of voluntary motion; whilst in the latter, the tremor is induced immediately on bringing the parts into action. Thus an artist, afflicted with the malady here treated of, whilst his hand and arm is palpitating strongly, will seize his pencil, and the motions will be suspended, allowing him to use it for a short period; but in tremor, if the hand be quite free from the affection, should the pen or pencil be taken up, the trembling immediately commences.

II. A propensity to bend the trunk forwards, and to pass from a walking to a running pace.

This affection, which observation seems to authorise the being considered as a symptom peculiar to this disease, has been mentioned by few nosologists: it appears to have been first noticed by Gaubius, who says, “Cases occur in which the muscles duly excited into action by the impulse of the will, do then, with an unbidden agility, and with an impetus not to be repressed, accelerate their motion, and run before the unwilling mind. It is a frequent fault of the muscles belonging to speech, nor yet of these alone: I have seen one, who was able to run, but not to walk[8].”

Sauvages, referring to this symptom, says, another disease which has been very rarely seen by authors, appears to be referable to the same genus (Scelotyrbe, of which he makes Chorea sancti viti the first species); which, he says, “I think cannot be more fitly named than hastening or hurrying Scelotyrbe (Scelotyrbem festinantem, seu festiniam).”

Scelotyrbe festinans, he says, is a peculiar species of scelotyrbe, in which the patients, whilst wishing to walk in the ordinary mode, are forced to run, which has been seen by Carguet and by the illustrious Gaubius; a similar affection of the speech, when the tongue thus outruns the mind, is termed volubility. Mons. de Sauvages attributes this complaint to a want of flexibility in the muscular fibres. Hence, he supposes, that the patients make shorter steps, and strive with a more than common exertion or impetus to overcome the resistance; walking with a quick and hastened step, as if hurried along against their will. Chorea Viti, he says, attacks the youth of both sexes, but this disease only those advanced in years; and adds, that it has hitherto happened to him to have seen only two of these cases; and that he has nothing to offer respecting them, either in theory or practice[9].

Having made the necessary inquiries respecting these two affections, Tremor coactum of Sylvius de la Boë and of Sauvages, and Scelotyrbe festinans of the latter nosologist, which appear to be characteristic symptoms of this disease, it becomes necessary, in the next place, to endeavour to distinguish this disease from others which may bear a resemblance to it in some particular respects.

CHAP. III. SHAKING PALSY DISTINGUISHED FROM OTHER DISEASES WITH
WHICH IT MAY BE CONFOUNDED.

Treating of a disease resulting from an assemblage of symptoms, some of which do not appear to have yet engaged the general notice of the profession, particular care is required whilst endeavouring to mark its diagnostic characters. It is sufficient, in general, to point out the characteristic differences which are observable between diseases in some respects resembling each other. But in this case more is required: it is necessary to show that it is a disease which does not accord with any which are marked in the systematic arrangements of nosologists; and that the name by which it is here distinguished has been hitherto vaguely applied to diseases very different from each other, as well as from that to which it is now appropriated.

Palsy, either consequent to compression of the brain, or dependent on partial exhaustion of the energy of that organ, may, when the palsied limbs become affected with tremulous motions, be confounded with this disease. In those cases the abolition or diminution of voluntary muscular action takes place suddenly, the sense of feeling being sometimes also impaired. But in this disease, the diminution of the influence of the will on the muscles comes on with extreme slowness, is always accompanied, and even preceded, by agitations of the affected parts, and never by a lessened sense of feeling. The dictates of the will are even, in the last stages of the disease, conveyed to the muscles; and the muscles act on this impulse, but their actions are perverted.

Anomalous cases of convulsive affections have been designated by the term Shaking Palsy: a term which appears to be improperly applied to these cases, independent of the want of accordance between them and that disease which has been here denominated Shaking Palsy. Dr. Kirkland, in his commentary on Apoplectic and Paralytic Affections, &c. cites the following case, related by Dr. Charlton, as belonging, he says, to the class of Shaking Palsies. “Mary Ford, of a sanguineous and robust constitution, had an involuntary motion of her right arm, occasioned by a fright, which first brought on convulsion fits, and most excruciating pain in the stomach, which vanished on a sudden, and her right arm was instantaneously flung into an involuntary and perpetual motion, like the swing of a pendulum, raising the hand, at every vibration higher than her head; but if by any means whatever it was stopped; the pain in her stomach came on again, and convulsion fits were the certain consequence, which went off when the vibration of her hand returned.”

Another case, which the Doctor designates as 'A Shaking Palsy,' apparently from worms, he describes thus, “A poor boy, about twelve or thirteen years of age, was seized with a Shaking Palsy. His legs became useless, and together with his head and hands, were in continual agitation; after many weeks trial of various remedies, my assistance was desired.

“His bowels being cleared, I ordered him a grain of Opium a day in the gum pill; and in three or four days the shaking had nearly left him.” By pursuing this plan, the medicine proving a vermifuge, he could soon walk, and was restored to perfect health.

Whether these cases should be classed under Shaking Palsy or not, is necessary to be here determined; since, if they are properly ranked, the cases which have been described in the preceding pages, differ so much from them as certainly to oppose their being classed together: and the disease, which is the subject of these pages, cannot be considered as the same with Shaking Palsy, as characterised by those cases.

The term Shaking Palsy is evidently inapplicable to the first of these cases, which appears to have belonged more properly to the genus Convulsio, of Cullen, or to Hieranosos of Linnæus and Vogel[10].

The latter appears to be referable to that class of proteal forms of disease, generated by a disordered state of primæ viæ, sympathetically affecting the nervous influence in a distant part of the body.

Unless attention is paid to one circumstance, this disease will be confounded with those species of passive tremblings to which the term Shaking Palsies has frequently been applied. These are, tremor temulentus, the trembling consequent to indulgence in the drinking of spirituous liquors; that which proceeds from the immoderate employment of tea and coffee; that which appears to be dependent on advanced age; and all those tremblings which proceed from the various circumstances which induce a diminution of power in the nervous system. But by attending to that circumstance alone, which has been already noted as characteristic of mere tremor, the distinction will readily be made. If the trembling limb be supported, and none of its muscles be called into action, the trembling will cease. In the real Shaking Palsy the reverse of this takes place, the agitation continues in full force whilst the limb is at rest and unemployed; and even is sometimes diminished by calling the muscles into employment.

CHAP. IV. PROXIMATE CAUSE—REMOTE CAUSES—ILLUSTRATIVE CASES.

Before making the attempt to point out the nature and cause of this disease, it is necessary to plead, that it is made under very unfavourable circumstances. Unaided by previous inquiries immediately directed to this disease, and not having had the advantage, in a single case, of that light which anatomical examination yields, opinions and not facts can only be offered. Conjecture founded on analogy, and an attentive consideration of the peculiar symptoms of the disease, have been the only guides that could be obtained for this research, the result of which is, as it ought to be, offered with hesitation.

SUPPOSED PROXIMATE CAUSE.