An Essay On The Shaking Palsy
James Parkinson: the man behind the shaking palsy
Author: Patrick LewisPublished: 30 March 2017
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James Parkinson, a surgeon and political activist working in London around the turn of the 19th century, was the first person to describe ‘paralysis agitans’, a condition that would later be renamed Parkinson’s disease. Here, to mark the 200th anniversary of the publication of his most famous work, ‘An Essay on the Shaking Palsy’, Dr Patrick Lewis, associate professor in cellular and molecular neuroscience at the University of Reading, UK, reflects on the man and his work
Early life and medical career
James William Keys Parkinson was born on 11 April 1755 in what was then the village of Hoxton, just to the north of the City of London (an area now filled with fashionable bars and restaurants).
We know very few details of his early life. His parents, John and Mary, had three children – James (the eldest), William and Mary. John Parkinson worked as a doctor in and around Hoxton, being a member of the company of surgeons, and this obviously influenced the young James Parkinson.
Following in his father’s footsteps, he enrolled at the London Hospital in 1776. A fascinating insight into Parkinson’s views on training to be a doctor is provided by a series of letters he compiled as a pamphlet on medical education in 1800 entitled ‘the hospital pupil’. In it, he detailed the requirements and system of a medical education, emphasising that “a sympathetic concern, and a tender interest for the sufferings of others, ought to characterise all those who engage themselves in a profession, the object of which should be to mitigate, or remove, one great portion of the calamities to which humanity is subject”.
It is likely that much of the advice in this book came from Parkinson’s own experience of entering the medical profession. He was awarded a diploma of the Company of Surgeons (the precursor to the Royal College of Surgeons) in 1784, just a few months after the death of his father.
In the days before such a job description existed, James Parkinson operated as a general practitioner in Hoxton for several decades, later in partnership with his son (also called James), who took over the running of the practise from his father when he retired. In addition to attending to the general health and wellbeing of the people of Hoxton, Parkinson was also heavily involved in the welfare of patients in the district’s numerous mental health institutions.
London, 1745, just prior to Parkinson’s birth, showing Hoxton square (centre)
Parkinson was an active member of the medical community in London, and was elected a Fellow of the Medical Society of London in 1787. He wrote papers and pamphlets for the medical community and for consumption by the general public, presenting his first paper to the Medical Society of London in 1787 entitled ‘Some Account on the Effects of Lightning’. For a more general readership, he wrote several books of medical advice, for example ‘The Town and Country Friend and Physician’.
Parkinson’s life outside of medicine
Although it is his clinical work that has made its mark on history, during his lifetime Parkinson was as well known for his radical political views and his contribution to the emerging field of geology. As a young doctor, he wrote passionately and profusely on the subject of social reform.
An example of the esteem in which James Parkinson’s peers held him is his involvement with the Association of Apothecaries – an organisation that played an important role in the passing of the Apothecaries act of 1815, which in turn was an important step towards the development of a comprehensive medical education for medical practitioners. Parkinson was heavily involved in the association, and was elected president in 1817, serving two terms.
The shaking palsy
Parkinson’s extensive clinical experience and observational skills, gleaned from several decades of medical practice in Hoxton, served him well in what was to be his outstanding contribution to medical science – his description of the Shaking Palsy. From the outset it is clear that he was well aware of how devastating the disease could be, describing how “the unhappy sufferer has considered it as an evil, from the domination of which he had no prospect of escape”.
It is remarkable, and a testament to Parkinson’s powers of observation, how much of the essay on the Shaking Palsy remains relevant to the description of patients with Parkinson’s disease today. His definition of the Shaking Palsy is worth reproducing in full. He described it as a disease characterised by: “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.”
“From the outset it is clear that he was well aware of how devastating the disease could be”
The major difference between Parkinson’s definition and the modern understanding of Parkinson’s disease is with regard to his final observation, the importance of non-motor symptoms, as there is an increasing realisation that dementia is an important part of the symptomatic spectrum of Parkinsonism.
The centrepiece of the essay is Parkinson’s report of a typical history for the Shaking Palsy, illustrated with a series of six cases from in and around Hoxton, sharing a number of characteristic symptoms. Although varying in detail (only two of the cases were directly examined by Parkinson, and of these a detailed case history was taken in one case), these contain a wealth of information that neurologists today would recognise from their own interaction with Parkinson’s disease patients.
The contents and first page of ‘An essay on the Shaking Palsy’, written by James Parkinson in 1817
Much is made in the essay of the inadequacy of the treatments available to sufferers. The optimism of Parkinson’s humanist tendencies prompted him to suggest that: “there appears to be sufficient reason for hoping that some remedial process may ere long be discovered, by which, at least, the progress of the disease may be stopped”. Sadly it was to be 140 years before the work of Arvid Carlsson and others eventually led to the development of levodopa as a symptomatic treatment for the Shaking Palsy, and we still await an intervention that actually retards the progress of the disease.
It is important to note, when reading an essay on the Shaking Palsy, that Parkinson was working in uncharted territory. The study of neurological disease as we know it today was very much in its infancy, and the degenerative diseases that are so familiar now, such as Motor Neuron Disease or Alzheimer’s Dementia, were still many years from being established as clinical entities. As the medical discipline of neurology took shape over the course of the 19th century, a number of its founding fathers (most notably Jean-Martin Charcot in Paris and Williams Gowers in London) acknowledged the contribution that Parkinson had made in bringing together and synthesising the case reports that he published in his essay on the Shaking Palsy. The most obvious consequence of this was the naming of the disease in recognition of Parkinson’s influence on the field.
“It is important to note, when reading an essay on the Shaking Palsy, that Parkinson was working in uncharted territory”
James Parkinson died on 21 of December 1824 on Kingsland Road, only a few hundred yards from the house where he grew up. His passing was much lamented by the Parish of St. Leonard’s, and was noted with regret in the Parish records, as well as in the Gentleman’s Magazine.
For many years there was no monument to his achievements. However a plaque commemorating James Parkinson and his work was placed in the nave of St. Leonard’s church in 1955, the 200th anniversary of his birth. Unfortunately, no image of James Parkinson has survived, but through his prolific writings, we can generate a good idea as to nature of this man. What emerges is a portrait of someone who was very much a product of the enlightenment, and in many ways ahead of his time clinically, scientifically and politically.
The plaque in St Leonard’s church, Hoxton, London, commemorating Parkinson
What would James Parkinson think now about the Shaking Palsy? He would certainly marvel at the progress that has been made in terms of diagnosing and understanding the causes of the disease that now bears his name. It is likely that he would be pleased at the range of drugs now used to ease the symptoms that he described so clearly in his essay. But undoubtedly he would be both surprised and disappointed to discover that, two centuries after he had first noted the existence of the disease, there is still no cure for this devastating disorder.
This blue plaque commemorates the home of James Parkinson at 1 Hoxton Square, London
This is an edited extract of an article that originally appeared in the Journal of Parkinson’s Disease, and is republished here with the kind permission of the author, Patrick Lewis. If you agree that 200 years of Parkinson’s is too long, join the #UniteForParkinsons campaign on World Parkinson’s Day
Read more: 11 landmark moments in the history of Parkinson’s disease
VIDEO: What do you know about Parkinson’s disease?
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