An Essay On The Shaking Palsy

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Hardly any clinical examination as we know it today undergirds what remains an exemplary account of disciplined medical witness.

The set out a closely observed clinical account of a progressive, disabling condition, which was swiftly recognized to be an important description that since has attained the status of a classic medical text. Parkinson redefined a hitherto imprecise term, “paralysis agitans,” as the “Shaking Palsy,” so as to designate henceforth a specific conjunction of major symptoms which manifest in afflicted patients as a slowly debilitating disorder of movement that ultimately proves fatal. The first of these is its most important and capacious section, presented in three parts: “DEFINITION—HISTORY—ILLUSTRATIVE CASES.” Parkinson first defined the condition, then located its features as the conjunction of already described components of movement disorders previously believed separate and unrelated, and contended that the different components coexisted in the Shaking Palsy.

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In addition to his daily work in general practice, James Parkinson was a public health reformer, an advocate of infection control in London workhouses, a medical attendant to a Hoxton madhouse, a writer of political pamphlets and children’s stories, a geologist and fossilist, and the author of a textbook of chemistry. Parkinson defines the Shaking Palsy thus: “Involuntary tremulous motion, with lessened voluntary 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.” Although this was a definition not previously advocated, its elements were not in themselves novel: they had long been recognized separately and placed in different classes, species, and genera of prevailing nosologies, or disease classifications.

The components Parkinson believed necessary for the diagnosis were these: entitled “History” that set out a generic account of the Shaking Palsy, featuring details selected from the cases.

This diversity of observational base generates an exceptionally detailed clinical and human picture that incorporates external appearances, functional losses and the frustrated volition which patients experienced, and their attempts to ameliorate the situation.

Involuntary tremulous motion, with lessened voluntary 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 of tremor ‘when supported’ with disorders of posture and gait that had not previously been perceived, and which marks Parkinson’s clinical breakthrough.

Parkinson’s biographer wrote of this London physician: "English born, English bred, forgotten by the English and the world at large, such was the fate of James Parkinson." This meeting is being held to correct that fate by the English – organizing a meeting in London to celebrate the contribution Parkinson made to the global illness that now carries his name.

This course is directed toward neurologists, geriatricians, neurology fellows and students, and to specialist nurses.

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