Gowers on paralysis agitans

Woodcut images of two drawings by Gowers, showing a stooped manSir William Richard Gowers’s textbook, A manual of diseases of the nervous system, first published in 1878, was regarded during Gowers’ lifetime as ‘the bible of neurology’. 

It made a major contribution to the understanding of the paralysis agitans by relaying a picture of the condition based on Gowers's clinical experience with 80 patients, and followed other neurologists in holding physical and psychic trauma to be the cause. 

Frequent causes, Gowers wrote,

are emotion, physical injury and acute disease. Prolonged anxiety and severe emotional shock often precede the onset. Sudden alarm may cause general tremor…    

Gowers confirmed Sanders’s view that the disease was slightly more prevalent among men than women and shared Charcot’s belief that it could also be caused by damp, dark living quarters and by damage to peripheral nerves.

He believed gravity was only partially implicated as the cause of the forward moving gait, writing that 'this is not the whole explanation…[as] some patients, suddenly jerked backwards, may exhibit a tendency to walk backwards which they are unable to avoid (‘retropulsion’)…It is…not uncommon for patients to be able to walk backwards better than forwards.’ 

Gowers had woodcuts made of his own drawings of the front and side views of figures of an expressionless stooped man in an 1879 French MD thesis. The images, shown in the reproduction here, show his flexed fingers at the metacarpo-phalangeal joints* thumbs extended with their tips pressed against his fingers.

*Metacarpo-phalangeal  The bone between two joints of fingers. 

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