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Parkinson of the disease

Awakenings

Oliver Sacks. AwakeningsHarmondsworth: Penguin, 1976.

King’s College London Archives, Dame Cicely Saunders Collection RC141.E6 SAC

The neurologist Oliver Sacks (1933-2015) published Awakenings to bring the effects of the drug L-DOPA on people with Parkinson’s disease and postencephalitic Parkinsonism to the attention of an international audience.

The Swedish neuro-pharmocologist, Arvid Carlsson, had demonstrated that a mouse and rabbit equivalent of Parkinson’s diseases could be caused by low dopamine* levels in the brain, and was reversed by the dopamine precursor, L-dihydroxphenylalanine, levodopa (L-DOPA). Ehringer and Hornykiewicz showed that administration of L-DOPA enabled people who were bed-ridden from the condition to stand, run and jump around. Cotzias, Papavasillou and Gellene reported in 1969 that L-DOPA conferred benefits on patients’ memory and intellectual capacities, which they called its ‘awakening effect.’

In Awakenings, Sacks described the effects of L-DOPA on post-encephalitic patients at New York’s Beth Abraham Hospital, many of whose residents were survivors of the encephalitis lethargica epidemic from 1918. The worldwide epidemic had a high rate of mortality. It left many of the survivors with complex abnormal movements and prolonged sleepiness, some symptoms of which resembled Parkinson’s disease.

In Awakenings, Sacks wrote of an ‘explosive awakening’ in people previously regarded as ‘effectively dead.’ Although Cotzias had used the term ‘awakening’ in 1969, Sacks explained that the title of the book came to him from Ibsen’s play When we dead awaken, when he saw L-DOPA enabled people ‘irremediably blighted’ suddenly ‘to bloom’.

The account blurred some of the boundaries between clinical case reports and illness memoirs, and brought the plight of people with these conditions to the attention of audiences beyond the confines of neurology.

The copy of Awakenings which was displayed in the original exhibition belonged to Dame Cicely Saunders (1918-2005). Saunders qualified as a nurse and doctor at St Thomas’s Hospital Medical School, now part of King’s College London. She devoted her life to improving the care of the dying and promoting hospice care.

In this opening, we see her marginal markings in a passage in which Sacks discusses the effects of L-DOPA in terms of ‘awakening’, ‘tribulation’, and ‘accommodation.’ 

*Dopamine. An organic chemical that functions inside the brain as a neurotransmitter released in response to the arrival of nerve impulses and outside the brain as a vasodilator.

This item featured here remains in copyright, so a link to the catalogue record (above) is provided, instead of an image of the work.

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