essay on the skaking palsy .pdf



Nom original: essay on the skaking palsy.pdfTitre: An essay on the shaking palsyAuteur: Parkinson, James, 1755-1824

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AN

E

AY

S S

ON THE

SHAKING PALSY.
BY

JAMES PARKINSON,
MEMBER OF THE ROYAL COLLEGE OF SURGEONS.

LONDON:
PRINTED BY WHITTINGHAM AND ROWLAND,
GosweU

at reel,

POR SHERWOOD, NEELY, AND JONES,
PATERNOSTER ROW.
1817.

Reprinted by photo-litho for

DAWSONS OF PALL MALL
16. Pall

MaU

London. S.W.I

8?

3
iO.

33

'2^

^ ^ ^"^

JULIO :%3

Lithe plates and print by

Edwards & Brune Ltd.
31, Eyre Street Hill
London. E.C.I

PREFACE.
The

advantages which have been derived

fix)m the caution with

which hypothetical

statements are admitted, are in no instance

more obvious than
more

in those sciences

particularly belong to the healing art.

It therefore

is

necessary,

that

present

publication:

some con-

be offered for

ciliatory explanation should

the

which

in

which,

it

is

acknowledged, that mere conjecture takes
the place of experiment;

logy

is

and, that ana-

the substitute for anatomical ex-

amination,

the only sure

foundation for

pathological knowledge.

When, however, the nature of the subject,
and the circumstances under which

it

been here taken up, are considered,

has
it

is

PREFACE.

ii

hoped

that the offering of the following pages

to the attention of the medical public, will

The

not be severely censured.

disease, re-

specting which the present inquiry
is

of a nature highly

standing which,
place in

made,

Notwith-

has not yet obtained a

it

the classification of nosologists

some have regarded
toms

afflictive.

is

its

and

as distinct

others have given

its

ing essentially from

characteristic

symp-

different diseases,

name

sufferer has considered

to diseases differ-

whilst the

it;
it

and

as

an

evil,

unhappy
from the

domination of which he had no prospect of
escape.

The

disease

of long duration

is

nect, therefore, the

history

several years.

which mark

its

requires a continuance of

observation of the
correct

to con-

symptoms which occur

in its later stages with those

commencement,

:

of

Of

same
its

case, or at least

symptoms, even

a

for

both these advantages

the writer has had the opportunities of avail-

PREFACE.

Ill

ing himself; and has hence been led parti-

observe several

cularly to

which the
of

its

disease existed in different stages

By

progress.

vations,

other cases in

these

repeated obser-

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,

employed before

if

the disease had been too long established.

He

therefore considered

submit

his opinions to

others,

even

turity

it

duty to

to be a

the examination of

in their present state

of imma-

and imperfection.

To delay their

publication did not, indeed,

The

appear to be warrantable.
escaped particular notice
ascertaining

its

;

disease

had

and the task of

nature and cause by anato-

mical investigation, did not seem likely to be

taken up by those who, from their

and opportunities, were most
complish

it.

That

abilities

likely

to ac-

these friends to

huma-

PREFACE.

iv

nity

and medical science, who have already

unveiled to us

many of the morbid

by which health and

life is

processes

abridged, might

be excited to extend their researches to this

malady, was much desired; and

it

was hoped,

by the

that this might be procured

publi-

cation of these remarks.

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

mere

which the

precipitate

publication of

conjectural suggestions

but shall think himself

fully

may

incur;

rewarded by

having excited the attention of those,

may

point out the most appropriate

who

means

of relieving a tedious and most distressing

malady.

CONTENTS.

Chap.

Definition

I.

— history — illustrative cases
Chap.

1

II.

Pathognomonic symptoms examined — tremor

— scelotyrbe festinans

coactus

Chap.

III.

Shaking palsy distinguished from other
eases WITH which it

dis-

may BE CONFOUNDED

Chap.

Proximate cause

19

27

IV.

—remote

causes— illustra-

tive cases

33

Chap. V.
considerations respecting the means of cure. 56

AN

ESSAY
ON THE

SHAKING PALSY.
CHAPTER

I.

DEFINITION— HISTORY— ILLUST RATI V E CASES.

SHAKING PALSY.

fPara/j/sis Agitans.)

Involuntary tremulous motion, with lessened

muscular power,

in parts not in action

even when supported
to

;

with a propensity

bend the trunk forward^ and

from a walking
senses

and

to a

intellects

and

to pass

running pace

:

the

being uninjured.

The

term Shaking Palsy has been vaguely
employed by medical writers in general.

By some

it

has been used to designate orB

dinarv cases of Palsy, in which some slight
tremblings have occurred
it

by others
anomalous af-

whilst

;

has been applied to certain

fections, not

belonging to Palsy.

The shaking of the

limbs belongingto this

was particularly noticed, as will be
seen when treating of the symptoms, by
disease

Galen,

who marked

its

peculiar character

The same symp-

bv an appropriate term.
tom,

it

will

also be

seen,

was accurately

treated of by Sylvius de la Boe.

seems

also

tom

:

to

have referred

to

Juncker

this

symp-

having divided tremor into active and

passive,

he says of the

latter,

" ad affectus

semiparalyticos pertinent; de qualibus hie

agimus, quique tremorcs paralytoidei vocantur."

Tremor

has been adopted, as a genus,

by almost every
marked,

;

but always un-

in their several definitions,

characters as

The

nosologist

would embrace

by such

this disease.

celebrated Cullen, with his accustomed

accuracy observes, "Tremorem, utpote semper symptomaticum, in

nnmerum generum

recipere nollem; species

autem aSauvagesio

recensitas, prout
sios,

mihi vel asthenias vel paraly-

vel convulsionis

symptomata

esse viden-

I

tur,hissubjungam*. Tremor can indeed only
be considered as a symptom, although seveof

ral species

it

must be admitted.

In the

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

which

is

chosen to furnish the epithet by

this species

may

of Palsy,

be distin-

guished.

HISTORY.

So
the

slight

first

and nearly imperceptible are

inroads of this malady, and so ex*

tremely slow

is

progress, that

its

rarely

it

happens, that the patient can form any recollection of the precise period of

mencement.

The

first

com-

its

symptoms perceived

are, a slight sense of weakness, with a prone-

ness to trembling in

sometimes
in

some

in the head, but

particular part;

most commonly

one of the hands and arms.

symptoms gradually
first

affected;

but seldom

and
in

increase in

part.

the

part

at an uncertain period,

less

than twelvemonths or

more, the morbid influence
other

These

is

felt in

some

Thus assuming one of the

* Synopsis Nosologic Methodicce.

b2

— Tom,

ii.

p. 195.

4
hands and arms

to

be

attacked, the other,

first

period becomes similarly affected.

at this

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

Sometime after
symptom, and dur-

whilst sitting or standing.

the appearance of this
ing

its

slow increase, one of the legs

covered

slightly to tremble,

to suffer fatigue sooner

and

is

is

also

dis-

found

than the leg of the

other side

:

in

a few months this limb

becomes

agitated

by similar tremblings,

and

suffers

and

a similar

Hitherto the

enced but

little

loss

of power.

patient will have experi-

and be-

inconvenience;

friended by the strong influence of habitual

endurance, would perhaps seldom think of
his

being the subject of disease,

when reminded of it by
his

the unsteadiness of

hand, whilst writing or employing hinn-

self in

But

except

any nicer kind of manipulation.

as the disease proceeds, similar

employ-

ments are accomplished with considerable
difficulty,

the hand failing to answer with

exactness to the dictates of the

will.

Walking

becomes a task which cannot be performed

The legs are

without considerable attention.

not raised to that height, or with that promp-

which the

titude

most care

is

will directs, so that the ut-

necessary to prevent frequent

falls.

At
much

patient experiences

period the

this

inconvenience, which unhappily

found daily to increase.

The

is

submission of

the limbs to the directions of the will can
hardly ever be obtained in the performance

of the most ordinary offices of

The

life.

fingers cannot be disposed of in the proposed

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

proceed,

now

increase

difficulties

be hardly at

all

:

writing can

accomplished

reading, from the tremulous motion,

complished with some

difficulty.

and

;

is

ac-

Whilst

at meals the fork not being duly directed

frequently
plate

:

fails to raise

which,

difficulty

when

conveyed

period the

the morsel from the

seized,

to the

is

with

mouth.

patient seldom

much
At

this

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

commence,

to

minute
the

in

time stopped

generally,

one of the

other

legs,

in

than

less

or in the

Harassed

side.

in that limb,

by

arm of

this

tor-

menting round, the patient has recourse
walking, a
sufferers

mode

from

a

to

of exercise to which the

malady are

this

in

general

owing to their attention being
thereby somewhat diverted from their unpleasant feelings, by the care and exertion
partial;

required to ensure

its

safe

performance.

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

as the

agitation

of the limbs

is

The

denied.

pro-

pensity to lean forward becomes invincible,

and the patient

is

thereby forced to step on

the toes and fore part of the

upper part of the body

ward
on

as to render

the face.

of the malady

In
is

it

is

feet, whilst

thrown

difficult to

some

cases,

the

so far for-

avoid falling

when

this state

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

much

impelled to take

irresistibly

time,

quicker and shorter steps, and thereby to
In
adopt unwiHingly a running pace.

some

cases

it

is

found necessary entirely to
since other-

for walking;

running

substitute

wise the patient, on proceeding only a very

few paces, would inevitably

fall.

much

In this stage, the sleep becomes

The

disturbed.

tremulous motion of the

and augment
until they awaken the patient, and frequently with much agitation and alarm.
limbs

occur

The power
mouth
is

is

during sleep,

of conveying the food to the

at length so

much impeded

that he

obliged to consent to be fed by others.

The

all

along torpid,

demand

stimulating

bowels, which had been

now,

in

most

cases,

medicines of very considerable power

:

the

expulsion of the faeces from the rectum some-

times requiring mechanical aid.
ease proceeds towards
is

its last

As

the dis-

stage, the trunk

almost permanently bowed, the muscular

more decidedly diminished, and
the tremulous agitation becomes violent.
power

The

is

patient walks

now with

and unable any longer

great difficulty,

to support himself

8
with his

he dares not venture on

stick,

exercise, unless

assisted

this

by an attendant,

who walking backwards

him, pre-

before

vents his falling forwards, by the pressure of
his

fore part of his shoul-

hands against the

ders.

His words are

and he

is

now scarcely intelligible;

not only no longer able to feed

when the food is conve\^ed to
mouth, so much are the actions of the

himself, but

the

muscles of the tongue, pharynx,

Sec.

im-

peded by impaired action and perpetual

agi-

tation, that the food
in the

mouth

difficultly

is

with difficulty retained

until masticated

swallowed.

Now

;

and then

from the

also,

same cause, another very unpleasant
cumstance occurs: the saliva

as

fails

cir-

of being-

directed to the back part of the fauces, and

hence

continually

is

draining

mouth, mixed with the
which he

is

As

the

particles of food,

no longer able to clear from the

inside of the

/-

from

mouth.

the debilit}^ increases and the influ-

ence of the

will

over the muscles fades

away, the tremulous agitation becomes
more vehement. It now seldom leaves him
for

a

moment

;

but even

when exhausted

9
nature seizes a small portion of sleep, the

motion becomes so violent as not only to
shake the bed-hangings, but even the floor

and sashes of the room. The chin is now
almost immoveably bent down upon the
The slops with which he is atsternum.
tempted

to be fed, with the saliva, are con-

tinually trickling

from the

mouth.

The

The urine
power of articulation is lost.
and faeces are passed involuntarily; and at
the

last,

lirium,
tion,

constant sleepiness, with slight de-

and other marks of extreme exhaus-

announce the wished-for

Case

release.

I.

Almost every circumstance noted in the
preceding description, was observed in a case
which occurred several years back, and
which, from the particular symptoms which
manifested themselves

in its progress;

from

knowledge of its nature, acknowledged to be possessed by the physician who
attended ; and from the mode of its termination; excited an eager wish to acquire
some further knowledge of its nature and

the

little

cause.

10

The

subject of this case

more than

fifty

was a man rather

who had

years of age,

in-

dustriously followed the business of a gar-

dener, leading a

ance and sobriety.
the malady was

of remarkable temper-

life

The commencement of

first

manifested by a slight

hand and arm, a circumstance which he was disposed to attribute to his having been engaged for several
trembling of the

days

in

left

a kind of employment requiring

considerable exertionof that limb. Although

repeatedly questioned, he could recollect no

other circumstance which he could consider

have occasioned

as having been likely to

malady.

He

had not

suffered

his

much from

Rheumatism, or been subject to pains of the
head, or had ever experienced any suddeji
seizure which could be refered to apoplexy
or hemiplegia.

In this case, every circum-

stance occurred which has been mentioned
in the

preceding history.

Case

The
noticed
It

II.

subject of the case which

was

casually

met with

in

was next
the street.

was a man sixty-two years of age; the

11

greater part of whose

life

had been spent

as

an attendant at a magistrate's office. He
had suffered from the disease about eight or
All the extremities were consi-

ten years.

derably agitated, the speech was very

much

and the body much bowed
and shaken. He walked almost entirely on
the fore part of his feet, and would have
fallen every step if he had not been supinterrupted,

ported by his

stick.

ease as having

He

described the dis-

come on very gradually, and

as being, according to his full assurance, the

consequence of considerable
his

mode of living, and

gence

in spirituous

irregularities in

particularly of indul-

He was

liquors.

the

inmate of a poor-house of a distant parish,

and being

fully assured

of the incurable na-

ture of his complaint, declined

attempts for

relief.

Case

The next
in the street.

making any

III.

case was also noticed casually

The

subject of

it

was a man

of about sixty-five years of age, of a remarkable athletic frame.

The

agitation of the

and indeed of the head and of the
whole body, was too vehement to allow it

limbs,

12

be designated as trembling. He was enthe body being so
tirely unable to walk
to

;

bowed, and the head thrown so forward, as
to oblige him to go on a continued run, and
to

employ

force

his stick

him more

every five or six steps to

into

an upright posture, by
with great force

projecting the point of

it

against the pavement.

He

had been a
plaints to

sailor,

stated, that

and attributed

having been

he

commonths

his

for several

confined in a Spanish prison, where he had,

during the whole period of his confinement,

upon the bare damp earth. The disease had here continued so long, and made
such a progress, as to afford little or no proHe besides was a poor
spect of relief.
mendicant, requiring as well as the means
lain

of medical experiment, those collateral aids

which he could only obtain in an hospital.
He was therefore recommended to make
trial if

any

yielded him.

relief could, in

The

that

mode, be

poor man, however, ap-

peared to be by no means disposed to make
the experiment.

13

Case IV.

The next case which

presented

itself

was

that of a gentleman about fifty-five years,

who had

first

experienced the trembling of

the arms about five years before.
plication

His ap-

was on account of a considerable

degree of inflammation over the lower ribs

on the

side,

left

in the

beneath the

fascia.

of matter

formation

About a

which terminated

was removed on making the
necessary opening;
and a considerable
quantity discharged daily for two or three
pint

On

weeks.

his

change appeared
original

recovery

to

from

no

this,

have taken place

in his

complaint; and the opportunity of

learning

its

future progress

was

lost

by

his

removal to a distant part of the country.

Case V.
In another case, the particulars of

which

could not be obtained, and the gentleman,
the lamented subject of which was only seen
at a distance, one of the characteristic

toms of
tion,

this

except

exist in

malady, the inability
in

symp-

for

mo-

a running pace, appeared to

an extraordinary degree.

It

seemed

14
to be necessary that the

gentleman should

be supported by his attendant, standing
before him with a hand placed on each
shoulder, until, by gently swaying backward

and forward, he had placed himself in equiwhen, giving the word, he would
poise
;

start in

a running pace, the attendant

slid*

him and running forward,
receive him and prevent his

ing from before

being ready to

falling, after his

having run about twenty

paces.

Case VI.
In a case which presented itself to obser-

vation since those above-mentioned, every

information as to the progress of the malady

The gentleman

was very readily obtained.

who was

the subject of

years of age.

He

it

has led a

is

seventy-two

life

of temper-

ance, and has never been exposed to any
particular situation or circumstance

which

he can conceive likely to have occasioned,
or disposed to this complaint;

which he

rather seems to regard as incidental

advanced age, than
attention.

He

upon

his

an object of medical
however recollects, that
as

about twenty years ago, he was troubled

15
with lumbago, which was severe and lasted

some

time.

About eleven or twelve, or

perhaps more, years ago, he

weakness

in

the

left

perceived

first

hand and arm, and

soon after found the trembling commence.

In about three years afterwards the right

arm became

affected in a similar

manner

:

and soon afterwards the convulsive motions
affected the whole body, and began to interrupt the speech.

from that time the

Of

late

In about three years
legs

became

affected.

bowels

years the action of the

had been very much

retarded

two or three

periods had,

different

great difficulty, been
action

of very

made

;

and

at

with

to yield to the

But

strong cathartics.

within the last twelvemonths this difficulty

has not been so great;

perhaps owing to

an increased secretion of mucus, which envelopes the passing faeces, and which precedes and follows their discharge in

con-

siderable quantity.

About a year
night,

since,

on waking

he found that he had nearly

in the
lost

use of the right side, and that the face

much drawn

to the lefl side.

the

was

His medi-

16
cal attendant

saw him the following day,

when he found him

languid, with a small

and quick pulse, and without pain in the
head or disposition to sleep. Nothing more
therefore was done than to promote the
action of the bowels, and apply a blister
to the back of the neck, and in about a
a fortnight the limbs had entirely recovered

from their palsied

state.

of their having remained
ther the
side

was

arm nor the
in

in this state, nei-

leg of the paralytic

the least affected with the tre-

mulous agitation
state

During the time

;

but as their paralysed

was removed, the shaking returned.

At present he

is

almost constantly trou-

bled with the agitation, which he describes
as generally

commencing

and gradually

in

a slight degree,

increasing, until

it

such a height as to shake the room

arises
;

to

when,

by a sudden and somewhat violent change
of posture, he is almost always able to stop

But very soon afterwards it will commence in some other limb, in a small degree, and gradually increase in violence
it.

but he does not

remember the thus checking

of it, to have been followed by any injurious

17

When

effect.

the agitation had not been

thus interrupted, he stated, that

extended through

gradually

and

limbs,

To

the whole trunk.

affected

last

the

all

it

at

illus-

trate his observation as to the p>ower of sus-

pending the motion by a sudden change of
posture, he, being then just come in from
a walk, with every limb shaking, threw
himself rather violently into a chair, and
said, " Now I am as well as ever I was in

my

life."

The

shaking completely stopped

but returned within two minutes' time.

He now

but

possessed

little

power

in

giving a required direction to the motions

of any

part.

He

was scarcely able

to feed

He

had written hardly intelligibly for the last three years and at present
could not write at all. His attendants obhimself

;

served, that of late the trembling

sometimes begin
until

was

it

in

On

in his sleep,

awakened him

:

would

and increase

when he always

a state of agitation and alarm.
being asked

if

he walked under much

apprehension of falling forwards
suffered

much from

it

D

;

?

he said he

and replied

in

the

18
affirmative to the question,

whether he ex-

perienced any difficulty in restraining himself

from getting into a running pace

being asked,

if

whilst walking he felt

?

It

much

apprehension from the difficulty of raising

saw arising pebble

his feet, if he

he avowed,

in

a strong manner,

on such occasions
his wife, that

across

;

and

it

his

path

?

alarm

was observed by

she believed, that in walking

the room, he would consider as a

difficulty the

The

in his

having

to step

over a pin.

preceding cases appear to belong to

the same species

:

differing

from each other,

perhaps, only in the length of time which

the disease had existed, and the stage at

which

it

had

arrived.

19

CHAP.

II.

PATHOGNOMONIC SYMPTOMS EXAMINED— TR^MOR CO ACTUS—SCELOTYRBE FESTINANS.
It has been seen

in the

preceding history

of the disease, and in the accompanying
cases, that certain affections, the

agitations,

tremulous

and the almost invincible pro-

pensity to run,

when wishing only

to walk,

each of which has been considered by nosologists

as distinct diseases,

appear to be

patlv)gnomonic symptoms of this malady.

To

which of these points of
view these affections ought to be regarded,
an examination into their nature, and an indetermine

in

quiry into the opinions of preceding writers
respecting them,

seem necessary

to be at-

tempted.

Involuntary/ tremulous motion, with lessened voluntary

I.

muscular power, in parts, not in action, and even supported.

It

is

this

necessary that the peculiar nature of

tremulous motion should be ascertained,

as well for the sake of giving to

it its

proper

20
designation, as for assisting in forming pro-

bable conjectures, as to the nature of the

malady, which

it

helps

to

characterise.

Tremors were distinguished by Juncker into
Active, those proceeding from sudden affection

of the minds, as terror, anger, &c. and

Passive,

such as

dependant on debilitating causes,
advanced age, palsy, &c*. But a

much more satisfactory and useful distinction is made by Sylvius de la Boe into those
tremors which are produced by attempts at

voluntary motion, and those which occur
whilst the

body

is

at rest-f-.

Sauvages

distin-

guishes the latter of these species {Tremor
* Junckeri conspect. de tremore.

t Sect. V. Ubi autem solito pauciores deferunter ad
eadem organa spiritus animales, imperfectae ac imbecillae obseryantur fieri eadem functiones, in motu tremulo et infirmo, nee diu durante, in visu debili, ac raox
defatigato, &c.
Sect. XIX.

Inaequaliter, inordinate, ac praeter con-

traque voluntatem moventur spiritus animales per nerves ad partes mobiles, in motu convulsive, ac tremore,

quassuve

membrorum

coacto.

Distinguendus namque

his

tremor quiescente

licet

ac

decumbente corpore molustus a motu tremulo, de quo
dictum. Sect. v. Quique quiescente corpore cessat,
eodemque iterum moto repetit.
Sect. XXV, Coactus tremor debetur animalibus spi
ritibus inordinate ac continuo,

cum

aliquo impetu

ac

21

by observing, that the tremulous
parts leap, and as it were vibrate, even when
whilst every other tremor, he
supported
Coactus)

:

when

observes, ceases,

moving the limb

tion for

supported, but returns
to

the voluntary exer-

move

;

stops, or the part

when we

will the

whence, he says, tremor

is

is

limb

distin-

guished from every other kind of spasm*.

A

small degree of attention will be

by

cient to perceive, that Sauvages,

distinction, actually separates this

suffi-

this just

kind of

tremulous motion, and which

is

peculiar to this disease, from the

Genus Tre-

In doing this he

mor.

is

fully

the kind

warranted

by the observations of Galen on the same
subject, as noticed by Van Swietenf.
" Binas has tremoris species ^: Galenus sub-

trementium membrorum musculos per nervos propulsis
sive faerit is universalis, sive particuiaris, sive corpus
fuerit

ad hue robustum sive debile, Sylvii de

Prax.

lib.

i.

cap.

la

Boe.

xlii.

* Nosoloff. Methodic, Auctore Fr. Boissier de Sauvages, Tomi. II. Partis ii. p. 54. 116 3.
t Comment,

Tom.
X

ii.

De

200 201.

in

Herman. Boerhaav. Aphorismos.

p. 181.

tremore.

Cap. 3 and

4.

Chart,

Tom.

vii.

p.

tiliter distinxit,

bus

insignivit,

atque etiam diversis nomini*

tremor enim

(t^^/xi^) facultatis

corpus moventis et vehentis infirmitate obo-

non

movere
Palpitantes autem

Quippe nemo, qui

ritur.

instituerit tremet.

artus

partes, etiam in quiete fuerint, etiamsi nul-

lum illis motum induxeris palpitant. Ideo
primam (posteriorem) modo descriptam tremoris speciem, quando quiescenti homini
involuntariis

tur

illis

et alternis

motibus agitan-

membra, palpitationem

posteriorem
nisi

homo

[ituK^ov)

dixit,

[primam) vero, quae non

fit

conetur partes quasdam movere

tremorem vocavit."

Under

may

this authority

be employed to

the term palpitation

mark

those

morbid

motions which chiefly characterise

this dis-

notwithstanding that this term has

ease,

been anticipated by Sauvages, as characteristic

The

of another species of tremor*.

* Sect. xvL

morborum.

Tremor

palpitans,

Preysinger

In tremoribus vulgaribus, aequalibus

temporum

vallis,

non musculus, sed artus ipsemet

tollitur

aut deprimitur, aut in oppositas partes

redit per

classis

Palnios Galeni.

minima tatnen

inter-

alternatini atit

atque

spatiola; in palpitatione vere

23
separation of palpitation of the limbs (Palmos

of Galen, Tremor Coactus of de la Boe) from
tremor,

is

more necessary

the

sisted on, since the distinction

be

to

may

in-

assist in

leading to a knowledge of the seat of the
disease.

that

It is also

necessary to bear in mind,

this affection

distinguishable from

is

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 imme;

on bringing the parts into action.
Thus an artist, afflicted with the malady
here treated of whilst his hand and arm is
diately

seize his pencil,

palpitating strongly,

will

and the motions

be suspended, allow-

will

sine ullo ordine musculi unius lacertus subito subsilit,

nee regulariter eontinuoque movetur, sed nunc semel aut
nune minime intra idem tempus subsilit ; an causa
irritans in sensorio communi, an in musculo ipse palpi-

bis,

tante Quaerenda

Vol.

I.

sit,

ignoramus.

Nosologia Mtthodiae,

p. 559. 1768.

But the adoption which Sauvages has made of
term, will not be

this

an absolute prohibition
here ; since the tremor pal'

regarded as

from the employment of it
pitans of Sauvages should be considered rather as a palpitation of the muscles, whilst the motion which is so
prominent a symptom in this disease, may be considered
as a palpitation of the limbs.

24
ing

him

to use

in tremor,

if

it

for

a short period

;

but

the hand be quite free from

the affection, should the pen or pencil be

taken up, the trembhng immediately com-

mences.

II.

A

propensity/

to

bend the trunk forwards^ and

pass from a walking

to

to

a running pace.

which observation seems to
authorise the being considered as a symptom peculiar to this disease, has been menit appears to
tioned by few nosologists
have been first noticed by Gaubius, who
says, " Cases occur in which the musclesduly
excited into action by the impulse of the
will, do then, with an unbidden agility, and

This

affection,

:

with an impetus not to be repressed, accelerate their motion,

and run before the un-

willing mind.

a frequent

It is

fault

of the

muscles belonging to speech, nor yet of
these alone:

I

have seen one, who was able

to run, but not to
* Est

walk*."

ubi muscuH, recte quidem ad voluntatis
actum concitati, injussa dein agilitate atque
impetu non reprimendo motus suos accelerant, menlemque invitam prsecurrunt. Vitium loquelae muscuiis

nutum

in

et

35
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

makes Chorea

the

sancti viti

species)

first

which, he says, "I think cannot be more

named than

he
fitly

hastening or hurrying Scelo-

tyrbe [Scelotyrbem festinantem, seufestiniam).'*

Scelotyrbe festinam,

he says,

species of scelotyrbe, in

is

a peculiar

which the

patients,

walk in the ordinary mode,
are forced to run, which has been seen by
Carguet and by the illustrious Gaubius a

whilst wishing to

;

similar affection

tongue thus outruns the mind,
lubility.

when

of the speech,

Mons. de Sauvages

complaint to a want of

is

the

termed vo-

attributes this

flexibility

in the

Hence, he supposes, that
the patients make shorter steps, and strive
muscular

fibres.

with a more than

common

exertion or im-

petus to overcome the resistance

with a quick and hastened
along against their

will.

non

walking

step, as if hurried

Chorea

frequens, nee his solis tamen propriura
currere,

;

:

Fiti,

he

vidi enim, qui

gradi, poterat*.

Institation. Patholog. Medicinal. Auctore.

£

H. D. Gaubio.751.

26
youth of both sexes, but

says, attacks the

only those advanced in years

this disease

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*.

Ad idem genus morbi

alteraspecies rarissima ab auc-

quam non aptius
quam scelotyrbem festinantem,

toribus praetervisa referenda videtur,

nominari posse putem
seu festiniam.

Sect.

ii.

Scelotyrbe festinans

tyrbes species in qua wgri solito

est pecul'taris

-,

more dum

scelo-

gradi volunt

currere coguntur, quod videre est apud D. Carquet, et
observavit Leydee

illustr.

Gaubius. Patholog. instit. 751,
qua lingua praecur-

et in loquela haec volubilitas dicitur
rit

mentem.

Video acta mulierem sexagenariam hoc

affectam morbo siccitati nervorum tribuendo ; laborat
enim rheumatismo sicco, seu ab acrimonia sanguinis,
dolores nocte a calore recrudescunt, a tbermis non sublevantur

:

ei prsescripsi

phlebotomiam, et praemissis jus-

culis ex lactuca, endivia, et coUo arietis, lene cathar-

ticum, inde vero lacticinia.

cum

Est affinitas
litas in fibris

et conatu

scelotyrbe, chorea

viti,

deest flexibi-

musculorum; unde motus breves edunt,

seu impetu solito majori,

cum

resistentiam

illam superare uituntur, velut inviti festinant,ac praecipiti

Chorea

seu concitato passu gradiuntur.
puellasve impuberes aggreditur

j

viti

festinia vero

pueros,
senes,

duos tantum hactenus observare mihi contigit. Quam
multos autem videmus morbos, paucissimosque observamus. De theoria et praxi nihil habeo quod dicam ;

et

etenim sola experienta praxim cujusvis morbi determinat, et ex hac pro
dein elicienda

est.

Boissierde Sauvages.

felici

vel infausto successu theoria

Nosolog. Methodic. Auctore, Fr.
Torai.

II.

Part

ii.

p. 108.

27

Having made the necessary inquiries respecting these two affections. Tremor coactum
of Sylvius de la Boe 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.

SHAKINGPALSY DISTINGUISHED FROM OTHERDISEASES 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
is

of the profession, particular care

required whilst endeavouring to

diagnostic

characters.

It

is

mark

sufficient,

its

in

general, to point out the characteristic dif-

ferences which are observable between dis-

some respects resembling each
But in this case more is required
other.
it
is necessary to show that it is a diseases

in

:

28

any which
are marked in the systematic arrangements
of nosologists; and that the name by
ease which does not accord with

which

it

is

here distinguished has been hi-

therto vaguely

appHed

to diseases

very

dif-

ferent 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 tre-

mulous motions, be confounded with
ease.

this dis-

In those cases the abolition or dimi-

nution of voluntary muscular action takes
place suddenly, the sense of feeling being

sometimes

also impaired.

Eut

in this dis-

ease, the diminution of the influence of the

on the muscles comes on with extreme
slowness, is always accompanied, and even
will

preceded, by agitations of the affected parts,

and never by a lessened sense of

The

dictates of the will are even, in the last

stages of the disease,
cles;

feeling.

conveyed

and the muscles acton

to the

mus-

this impulse,

but their actions are perverted.

Anomalous

cases of convulsive affections

29
have been designated by the term Shaking
Palsy a term which appears to be impro:

perly 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, 8cc. cites the following case, re-

lated

by Dr. Charlton,

to the

class

as belonging,

of Shaking Palsies.

he
*'

says,

Mary

Ford, of a sanguineous and robust constitu-

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

tion,

perpetual motion, like the swing of a pen-

dulum, raising the hand, at every vibration
higher than her head; but if by any means

whatever

it

was stopped; the pain

stomach came on

again,

in

and convulsion

her
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

30
twelve or thirteen years of age, was seized
His legs became
with a Shaking Palsy.
useless,

hands,

and together with
were

many weeks
assistance

in

was

agitation; after

continual

trial

head and

his

of various remedies,

desired.

" His bowels being cleared,

him a
pill

;

grain of

and

Opium

ordered

gum

days the shaking

By

him.'*

left

I

a day in the

in three or four

had nearly

my

pursuing

plan, the medicine proving a vermifuge,

this

he

could soon walk, and was restored to perfect health.

Whether

these cases should be classed

under Shaking Palsy or
to be here determined
;

not,

is

necessary

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:

which

is

and the

disease,

the subject of these pages, can-

not be considered as the same with Shaking
Palsy, as characterised

by those

The term Shaking Palsy
applicable to the

first

is

cases.

evidently in-

of these cases, which

31

appears to have belonged more properly to
the genus Convulsio, of CuUen, or to Hieranosos

of Linnaeus and Vogel*.

The

latter

appears to be referable to that

of proteal forms of disease, generated
by a disordered state of priai« viae, sympaclass

* Corporis agitatio continua, indolens, convulsiva,

cum

Linn.

sensibilitate.

artuum convulsiva continua,
VogeL
resolved by Cullen into that of Con-

Agitatio corporis

chronica,

This genus
vulsio.

vel

cum integritate sensuum»
is

Sj/nops. Nosol. 1803.

Dr. Macbride has given a very interesting and

illus-

trative case of this disease.

"

Morbus

Sacer, so called, as being vulfrom witchcraft, or some extraordinary celestial influence, is a distinct genus of disease,
though a very uncommon one ; the author once had
an opportunity of seeing a case. The patient was a lad
about seventeen, who at that time had laboured under

Hieranas6s, or

garly supposed to

arise

this extraordinary disease for

more than twelve

years.

His body was so distorted, and the legs and arms so
twisted round it, by the continued convulsive working,
that no words can give an adequate idea of the oddity

of

his figure

;

the agitation of the muscles was perpet-

ual ; but in general he did not complain of pain nor
sickness ; and had his senses perfectly, insomuch that

he used to

assist his

mother,

in teaching children to read."
to the

bride,

who kept a

A

little

school,

methodical Introduction

Theory and Practice of Physic.
M,D.p. 559

By David Mac-

S2
thetically affecting the nervous influence in

a distant part of the body.
Unless attention

paid to one circum-

is

stance, this disease will be confounded with

those species of passive tremblings to which
the term Shaking Palsies has frequently been

These

applied.

are, tremor temulentus,

the

trembling consequent to indulgence in the
drinking of spirituous liquors

that

;

proceeds from the immoderate

which

employment

which appears to be
dependent on advanced age and all those
tremblings which proceed from the various
of tea and coffee

;

that

;

circumstances which induce a diminution of

power

But by atthat circumstance alone, which

in the

tending to

nervous system.

has been already noted as characteristic of

mere tremor, the
be made.

distinction

its

muscles be called

into action, the trembling will

Xthe

readily

If the trembling limb be sup-

and none of

ported,

will

In

cease.

Shaking Palsy the reverse of

this

takes place, the agitation continues in

full

real

force whilst the limb
plo3^ed

;

and even

is

is

at rest

and unem-

sometimes diminished

by calling the muscles into employment.

S3

CHAP.

IV.

PROXIMATE CAUSE— REMOTE CAUSES—ILLUSTRATIVE CASES.

Before making the attempt to

point out the

nature and cause of this disease,
sary to plead, that

it is

it is

neces-

made under very un-

favourable circumstances.

Unaided by

pre-

vious inquiries immediately directed to this

and not having had the advantage,
in a single case, of that light which anatomical examination yields, opinions and

disease,

not facts can only be offered.

Conjecture

founded on analogy, and an attentive consideration of the peculiar

have been the only guides that could

disease,

be obtained

which

symptoms of the

is,

as

for this research, the result of
it

ought to

be, offered

with he-

sitation.

SUPPOSED PROXIMATE CAUSE.

A diseased

state of the medulla spinalis, in

that part which
canal,

is

contained

in

the

formed by the superior cervical

34
vertebrae,

and extending,

as the disease

proceeds, to the medulla oblongata.

By

the nature of the

taught, that the disease

symptoms we are
depends on some

irregularity in the direction of the nervous

influence;

by the wide range

which are

affected, that the injury

of

parts

is

rather

in the source

of this influence than merely

in the nerves

of the parts; by the situation

of the parts whose actions are impaired, and
the order in which they

become affected, that

the proximate cause of the disease
superior part of the medulla spinalis

in

is
;

the

and by

the absence of any injury to the senses and
to the intellect, that the

morbid

state does

not extend to the encephalon.

Uncertainty existing as to the nature of
the proximate cause of this disease,

mote causes must

its

re-

necessarily be referred to

Assuming however the
mentioned as the proximate cause,

with indecision.
state just
it

may

result

be concluded that

this

may

of injuries of the medulla

be the

itself^

or of

the theca helping to form the canal in which
it is

inclosed.

35

The
tion

great degree of mobility in that por-

of the spine which

is

formed by the

superior cervical vertebrae, must render

it,

and the contained parts, liable to injury from
sudden distortions. Hence therefoie may
proceed inflammation of quicker or of slower
progress, disease of the vertebrae, derange-

ment of

structure in the medulla, or in

its

membranes, thickening or even ulceration
of the theca, effusion of fluids &c.

But

,

no case which has been noticed,
has the patient recollected receiving any
injury of this kind, or any fixed pain in
early life in these parts, which might have
in

led to the opinion that the foundation for
this

malady had been thus

laid.

On

subject indeed of remote causes, no
factory

accounts

from any of the
attributed

this

has yet
sufferers.

affliction to

spirituous liquors,

the

satis-

been obtained
Whilst one has
indulgence in

and another

to long lying

on the damp ground the others have been
unable to suggest any circumstance what;

ever, which, in their opinion, could be con-

sidered as having given origin, or disposed,
to the calamity

under which they

suffered.

56
Cases

illustrative

of the nature and cause

malady are very rare. In the following case symptoms very similar are ob-

of

this

servable, so far as affecting the lower extremities.

That the medulla

affected,

and

doubted

:

in its

but

ascertained

this,

spinalis

lower part,

is

was here

not to be

unfortunately, was never

by examination.

It

must be

however remarked, that this case differed
from those which have been given of this
disease, in the

suddenness with which the

symptoms appeared.
A. B. aged twenty-six years, during a
course of mercury for a venereal affection,

was exposed
for several

to severely inclement weather,

hours,

and the next morning,

complained of extreme pain

in

the back,

employ voluntarily
the muscles of the lower extremities, which

and of

total inability to

were continually agitated with severe convulsive

motions.

The

physician

who

at-

tended him employed those means which

seemed best calculated to relieve him but
with no beneficial effect. The lower extremities were perpetually agitated with
;

strong palpitatory motions, and, frequently.

37
three or four times in a minute, suddenly
raised with great

vehemence two or three

from the ground, either

feet

a forward

in

or oblique direction, striking one limb against
the other, or against the chairs, tables, or

any substance which stood in the way. To
check these inordinate motions, no means
were in the least effectual, except striking
the thighs forcibly during the more violent
convulsions. No advantage was derived from
all the means which were employed during
upwards of twelvemonths. Full ten years
after this period, the unhappy subject of
this malady was casually met in the street,
shifting himself along, seated in a chair; the

convulsive motions having ceased, and the

limbs having become totally inert, and insensible to

any impulse of the

will.

must be acknowledged, that in the
well-known cases, described by Mr. Potts,
It

of that kind of Palsy of the lower limbs

which

frequently

is

found to accompany

a curvature of the spine, and
a carious
to exist,

able

;

state

no

of the vertebrae

instructive analogy

slight convulsive

motions

is

in
is

which
found

discover-

may

indeed

58

happen

in

the

proceeding

from

but palpitating

mo-

disease

curvature of the spine

;

of the limbs, such as belong to the

tions

disease here described,

do not appear to have

been hitherto noticed.

Whilst striving to determine the nature

and

origin of this disease,

it

becomes neces-

sary to give the following particulars of an in-

by a fall,
attended with uncommon symptoms, related by Dr. Maty, in the third volume of
the Medical Observations and Inquiries.
teresting case of Palsy occasioned

The

subject

of this case,

had the

Lordat,

the

misfortune

Count de

to be

over-

turned from a pretty high and steep bank.

His head pitched against the top of the
coach, and was bent from left to right;
his left

shoulder, arm,

and

especially his

hand, were considerably bruised.
a good deal of pain along the

he

felt

of

his neck,

At

first

left

side

but neither then, nor at any

other time, had he any faintings, vomitings,
or giddiness.

—On

the sixth

day

he

was

on account of the pain in his
shoulder and the contusion of his hand,
which were then the only Symptoms he
let blood,


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