Problems in neurology

Opening showing graphical representations of different tremorsThe neurologist Samuel Alexander Kinnier Wilson (1874-1937) was born in the USA, but spent his medical career in Britain.

As a resident medical officer at the National Hospital for the Paralysed and Epileptic, Queen Square, London, he was much influenced by the teaching of Sir William Richard Gowers, one of the distinguished clinicians at that institution, whose work features in the previous section of this online exhibition. In 1928 he also became a senior neurologist at King’s College Hospital.

From an early stage in his career, Kinnier Wilson had shown a strong interest in disorders of movement and muscle tone.

Soon after his graduation from Edinburgh University, he described a rare form of hepato-lenticular degeneration* in which patients suffer from tremor, involuntary movements, and changes in mood and mental state. These symptoms arose from both degeneration of the lenticular part of the brain’s basal ganglia** and from cirrhosis of the liver. 

Wilson's Modern problems in neurology (1928) reflected this interest in disorders of human movement. The chapter on tremor characterised frequency, rhythm, regularity, changeability and significance of different tremors, including those of paralysis agitans. Graphical representation of tremor had been a feature of Charcot’s case reports.

However, Kinnier Wilson’s research went beyond measurement and patterns to include changes in response to different stimuli and stresses within and between patients, and carefully compared tremor over time in different neurological conditions, as shown in the opening here. 

*Hepato-lenticular degeneration. Progressive disease, usually starting during adolescence, characterised by association of cirrhosis of the liver with degeneration of nerve cells, leading to defects of articulation and mental debility. 

**Basal ganglia. The large masses of grey matter embedded deep in the cerebral hemispheres and the midbrain. The ganglia have complex connections with the central nervous system, and are concerned with the regulation of movement.

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