Nosology of disorders with Parkinson-like symptoms prior to Parkinson
James Parkinson was clear in his 1817 pamphlet on the disorder named for him that he was by no means describing a new disease, but rather one which until his time had been neglected by the medical profession. The question of the existence of Parkinsonism before 1817 has since been often discussed, and not only as a matter of idle curiosity; the major factor which has impeded development of an effective causal therapy for Parkinson’s disease has been ignorance regarding its precise nature. Examination of 18th century systematic medical texts yields descriptions of a number of nosological ‘species’ which include parkinsonism-like symptoms, particularly with respect to tremor and muscular rigidity. The fact that none of these authors described the total syndrome now termed ‘Parkinson’s disease’ is unsurprising; nosological categories were largely based upon single dominant symptoms and were largely independent of specific etiologies until well into the 19th century. Further, the full significance of symptoms such as tremor was sometimes overlooked because of its attribution to non-specific debility, and the concept of ‘parkinsonism’ as a specific disorder was only gradually accepted even after Parkinson’s description. Finally, the modern symptomatic concept of ‘Parkinson’s disease’ is actually not found in Parkinson’s 1817 description, but rather evolved in stages during the subsequent one hundred and fifty years. Parkinson’s description, however, was revolutionary in that it was one of the first attempts to incorporate a number of distinct neurological symptoms into a single nosological entity.
Tenth Annual Meeting of the International Society for the
History of the Neurosciences (ISHN) and
St. Andrews, Scotland, 2005