(24) Movement orders: so, who was James Parkinson?

NB (24) above indicates the latest post & numerical order

"DIS" A MOVEMENT ORDER 

Parkinson's Disease (PD) is well known for impacting on one's movement. As we know, the specific term movement disorder, may be described as a neurological condition that affects voluntary muscles either by retarding or speeding up movement. The following is a list of some movement disorders:

• Ataxia;
• Chorea;
• Dystonia;
• Tourette Syndrome;
• Progressive supranuclear palsy;
• Tremors/Essential Tremor;
• Dyskinesia;
• Restless Legs Syndrome;
• PD;
• Huntington's Disease (HD) and other movement disorders (click on website above for some detail). 

The above illustration depicting hand tremors, copied from the news-medical.net article (cited above), captures the essence of my PD as a movement disorder. When I am tense or cold or anxious or watching TV my PD generates resting tremors. Right now, end-July 2021, because of the cold (Durban's overnight temperature has hovered between 10℃ and 14℃) I spend a large part of my days and nights "trevering". I first introduced this and another combined concept in Post 9: shivering + tremors = "trevers".

Let me digress, briefly, to examine the word 'tremor' and some related synonyms. For instance, if the earth had an advanced level of PD we'd have one continuous set of foreshocks, shocks and aftershocks all rolled into one, deadly quake. The action of a shiver is often the result of one being cold or sick or in shock. And "shiver me timbers", an expression attributed to assumed pirate-speak, is associated with a pirate expressing mock surprise. A sinister use of the term is associated with land mines and other explosive devices that are triggered by the activation of a "trembler-switch". The term quiver, associated with both the action of the hands and the voice, has a botanical link too.

In the Northern Cape's Namaqualand, there is a tree belonging to the succulent family and resembling a miniature Baobab in shape and structure, called a quiver tree or "kokerboom" in Afrikaans. The word "koker" in Afrikaans refers to a cylindrical container, also a quiver for arrows and has little to do with a resting tremor in PD. Apparently, the San people used the branches to make quivers for their arrows. The quiver tree picture below was taken in 2014 at the Goegab Nature Reserve near Springbok. Had it been a windy day when the photo was taken, quivering branches may have resembled hand tremors 😃.

Movement disorders and variations of the word "tremor" are some of the many that scratch the surface of the notion of being parkinsed. Let's examine the notion of "shaking" and why my affliction is called "Parkinson's Disease".

"DAT'S" A MOVEMENT DISORDER

An internet search will reveal a lot about PD as a movement disorder and present lists of symptoms, stages and various forms of PD treatments but speculate about its causes. So, I have selected James Parkinson's original, speculative essay a few other articles - they appear in the list of references - as a starting point to inform our mutual interest in PD. It is a convenience sample.

Historically, ancient health and wellness observations as well as more recent medical contexts, describe PD as a movement disorder and include categories listed below (Goetz, p1):

• 1000 BC:    Indian and Chinese writings describe tremors, bradykinesia (slow movement) and gait;
• 1680:          Sylvius de la Boë writes of rest tremor;
• 1768:          Sauvages writes of festinating (a shuffling walk);
• 1817:          James Parkinson publishes "An essay on the shaking palsy; and consequently
• 1825-1893: Jean-Martin Charcot recommends this malady be named Parkinson's Disease.

I am impressed that ancient Indian writing had also identified PD symptoms and had discovered natural remedies using Mucuna-Pruriens, a leguminous plant that contains levodopa. This would have been applied using an Ayurvedic approach.   

But, who was James Parkinson and why is his name associated with the disease?

JAMES PARKINSON (1755-1824)

At the age of 29 James Parkinson had qualified as a surgeon in London but it was only when he was 62 that he published his observations regarding the "shaking palsy". In "An Essay on the Shaking Palsy" (1817)  and republished in 2002 in a neuropsychiatry journal (link above), his disclaimer in the essay is that "mere conjecture takes the place of experiment; and, that analogy is the substitute for anatomical examination,"(p.223). His revelation is that "the disease, ... has not yet obtained a place in the classification of nosologists;" (p.223), nosology being a branch of medicine dealing with disease classification.   

Parkinson presents us with his results of six case studies or "clinical vignettes" (Lees, p.843) that describe in varying detail six people observed over a period of time. He suggests that "tremor has been adopted, as a genus, by almost every nosologist,...but always unmarked...by such characters as would embrace this disease." (p.224). The essay is his attempt at marking what he believed had been 'unmarked'. 

The introduction and overview he presents in the essay under the section "History" (pp.224-225) is a real-life but morbid description of the "inroads of this malady" (p.224) we now call Parkinson's Disease. I found this section disturbing to read. The six case studies of men between 50 and 65 years of age are presented between pp. 225-227 of his essay. Each one describes to a greater or lesser extent, something with which parkinsed persons can clearly identify. The essay, therefore, describes varying degrees of stance, gait and tremor, the elimination of other possible medical issues and variables that make symptoms worse. He concludes by distinguishing his observations from other diseases. This is what probably made his observations insightful for other neurologists 300 years ago.    

Obviously, the case presented by James Parkinson was positively received by the medical fraternity, especially by French neurologist Jean-Martin Charcot, who recommended that the 'shaking palsy' ("palsy" being a form of paralysis with involuntary tremors) be named after James Parkinson: hence Parkinson's Disease. 

And there you have it, dear reader, the brilliant James Parkinson: social reformer, palaeontologist and medical professional! Till next time.

  

SOME REFERENCES

The references below were accessed in July 2021.

• Goetz, C.G. (2011) The History of Parkinson's Disease: early Clinical Descriptions and Neurological Therapies. Downloaded from <http://perspectivesinmedicine.cship.org> on July 16 2021. 
• Parkinson, J. (1817) An Essay on the Shaking Palsy. Available at <https://neuro.psychiatryonline.org/doi/pdf/10.1176/jnp.14.2.223>. Link in post above.
• Lees, A. ( 2017) [Lees reviews Parkinsons'] An essay on the shaking palsy.