The essay

An essay on the shaking palsyThe Essay appeared as Parkinson neared retirement. He had a reputation as an accomplished writer, known as much for his studies on fossils as for his medical work. In the preface he forewarned readers of his lack of insight into the cause of the ‘shaking palsy’:

…some conciliatory explanation should be offered for the present publication : in which, it is acknowledged, that mere conjecture takes the place of experiment; and, that analogy is the substitute for anatomical examination, the only sure foundation for pathological knowledge.

This degree of caution is striking but is balanced by the vivid portrait of the condition which the Essay develops. This is based on observations across differing time intervals, varying from momentary glimpses to periods of observation lasting over a decade, and differing vantage points: in patients’ homes, Parkinson’s consulting room and on London streets.

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.

Contents page of An essay on the shaking palsyThe Essay is divided into five chapters, the first of which concerns three issues: definition; clinical history; and illustrative cases. This chapter defines shaking palsy as:

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.

These clinical elements were not newly identified by Parkinson: each had been recognised previously but were viewed by previous clinicians as separate phenomena. It was the coexistence of tremor ‘when supported’ with disorders of posture and gait that had not previously been perceived, and which marks Parkinson’s clinical breakthrough.

He called this the ‘shaking palsy.’

Parkinson added the Latinised paralysis agitans to ensure that it found a place in a Linnean taxonomy of disease. Its key components were: tremor coactus (a term referring to an involuntary trembling) and scelotyrbe festinans (the conjunction of scelotyrbe – the ancient Greek term for hustle or totter – and festinans: the Latin signifying hurry).

In subsequent chapters Parkinson sought to anchor the account in different classificatory schemata of his day, distinguishing the ‘shaking palsy’ from other forms of trembling and referring to additional cases not included in his own case series.

The contemporary reception of An essay on the shaking palsy

As soon as the Essay appeared it was recognised to be an important description of an overlooked medical condition, and was favourably reviewed in the medical press.

Sections were reprinted in The London medical and physical journal, which announced the work worthy of ‘universal perusal.’  The eminent physician John Cooke, Fellow of the Royal Society, declared the work ‘highly deserving of our attention’ in his Treatise on nervous diseases (1820).

In contrast to Cooke, who addressed the mainstream medical profession, Thomas Graham’s Domestic medicine (1827) was directed at ‘clergymen, heads of families, and invalids.’ With unashamed literary piracy he plagiarised large chunks of the Essay without acknowledging Parkinson.

The Essay was also cited in the Lancet by clinicians at the height of their careers, including John Elliotson in 1830 and Marshall Hall in 1838. Later in the century it proved influential on international clinical authorities developing the field of clinical neurology, including Moritz Romberg, Armand Trousseau, Jean-Martin Charcot, Edmé Vulpian and William Gowers.

It was, however, not re-published until the 20th century, and was, as such, less successful than other works by Parkinson, such as Organic remains (1808) which features earlier in this online exhibition. 

The reproductions of the Essay shown here are taken from the facsimile edition held at King’s, which was re-printed in 1974.

The original exhibition also displayed a copy of the 1817 first edition of the Essay, kindly lent by the Library of the Royal College of Surgeons of England.

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