Observing from the Margins: James Parkinson and the Shaking Palsy
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Abstract In 1817, James Parkinson (1755-1824) published An Essay on the Shaking Palsy, describing paralysis agitans, or the shaking palsy, a condition he believed to be a specific and newly characterized disease. The disease concept specified both a constellation of signs and symptoms, including an abnormal gait, tremor, and difficulty initiating movement, and a specific order in which these signs and symptoms appeared, regardless of sufferers’ individual constitutions. Existing biographical and scholarly work about Parkinson and what is now known as Parkinson’s disease explicates the Essay but does not explore how Parkinson came to write it; his initial observations and subsequent conceptualizing of the disease have not been examined. Using the framework of the history of disease, this dissertation explores the early history of the shaking palsy, beginning with the training in observation that enabled Parkinson to envision the disease. He acquired this training in several settings: in his apprenticeship as a surgeon-apothecary and subsequent hospital experience; through his later period of study with John Hunter; and through his intensive study of fossils and chemistry. Next, it explores Parkinson’s neighborhood in Shoreditch, an increasingly impoverished suburb of London, where his medical work included attendance at madhouses and the parish workhouse. It then examines what inhabiting that environment would have allowed Parkinson to see. At a time when disease was increasingly seen as localized in the body’s tissues, correlatable with characteristic pathologic lesions visible at autopsy, the shaking palsy lacked a characteristic lesion to justify its classification as a new disease. To identify, bound, and define the disease, Parkinson needed a different conceptual framework to structure his ideas. This he accomplished using the framework of case histories and case series, a method he had employed in earlier published work. The shaking palsy continued to lack a pathologic explanation for many decades after Parkinson published the Essay. The dissertation ends by exploring how the disease concept survived and came into general use during the first decades following the Essay’s publication.