Tài liệu An Essay on the Shaking Palsy, by James Parkinsos pptx

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Title: An Essay on the Shaking Palsy Author: James Parkinson

Release Date: December 9, 2007 [EBook #23777]

Language: English

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EBOOK AN ESSAY ON THE SHAKING PALSY ***

Produced by Irma Spehar and the Online Distributed

Proofreading Team at http://www.pgdp.net

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PREFACE

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pathological knowledge

WHEN, HOWEVER, THE NATURE OF TH

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DOMINATION OF WHICH HE HAD NO PROSPECT Of escape

THE DISEASE IS OF LONG DURATION: T'

CONNECT, THEREFORE, THE SYMPTOMS WHIC OCCUR IN ITS LATER STAGES WITH THOSE WHIC MARK ITS COMMENCEMENT, REQUIRES A CONTINUANCE OF OBSERVATION OF THE SAMI CASE, OR AT LEAST A CORRECT HISTORY OF SYMPTOMS, EVEN FOR SEVERAL YEARS OF BOTH THESE ADVANTAGES THE WRITER HAS HA

the opportunities of availing himself; and

HAS HENCE BEEN LED PARTICULARLY T( OBSERVE SEVERAL OTHER CASES IN WHICH THE DISEASE EXISTED IN DIFFERENT STAGES OF I’

PROGRESS By THESE REPEATEL

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HAD SUGGESTED SUCH MEANS AS MIGHT BE PRODUCTIVE OF RELIEF, AND PERHAPS EVEN OF CURE, IF EMPLOYED BEFORE THE DISEASE HAD BEEN TOO LONG ESTABLISHED HE THEREFOR CONSIDERED IT TO BE A DUTY TO SUBMIT HI OPINIONS TO THE EXAMINATION OF OTHER EVEN IN THEIR PRESENT STATE OF IMMATURI and imperfection

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ALREADY UNVEILED TO US MANY OF TE MORBID PROCESSES BY WHICH HEALTH AND LIFE IS ABRIDGED, MIGHT BE EXCITED TC EXTEND THEIR RESEARCHES TO THIS MALAD WAS MUCH DESIRED; AND IT WAS HOPED, THAT THIS MIGHT BE PROCURED BY TE publication of these remarks

SHOULD THE NECESSARY INFORMATION BI

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CHAPTER I DEFINITION—HISTORY —ILLUSTRATIVE CASES SHAKING PALSY (Paralysis Agitans.)

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FROM A WALKING TO A RUNNING PACE: THE SENSES AND INTELLECTS being uninjured

THE TERM SHAKING PALSY HAS BEEN

VAGUELY EMPLOYED BY MEDICAL WRITERS IN GENERAL By SOME IT HAS BEEN USED TC DESIGNATE ORDINARY CASES OF PALSY, IN WHICH SOME SLIGHT TREMBLINGS HAVE OCCURRED; WHILST BY OTHERS IT HAS BEE APPLIED TO CERTAIN ANOMALOUS AFFECTION! not belonging to Palsy

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SEEN, WAS ACCURATELY TREATED OF BY SYLVIUS DE LA BoE JUNCKER ALSO SEEMS TC HAVE REFERRED TO THIS SYMPTOM: HAVINC DIVIDED TREMOR INTO ACTIVE AND PASSIVE, HE SAYS OF THE LATTER, “AD AFFECT SEMIPARALYTICOS PERTINENT; DE QUALIBUS

HIC AGIMUS, QUIQUE ftremores

paralytoidei VOCANTUR.” TREMOR HA

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ASTHENLE VEL PARALYSIOS, VEL CONVULSIONIS SYMPTOMATA ESSE VIDENTUR HIS SUBIUNGAMLIÏ”” TREMOR CAN INDEED ONLY BE CONSIDERED AS A SYMPTOM, ALTHOUGH SEVERAL SPECIES OF IT MUST BI ADMITTED IN THE PRESENT INSTANCE, T AGITATION PRODUCED BY THE PECULIAI SPECIES OF TREMOR, WHICH HERE OCCURS, IS CHOSEN TO FURNISH THE EPITHET BY WHIC

THIS SPECIES OF PALSY, MAY BE

distinguished

HISTORY

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POSTURE: THIS BEING MOST OBSERVABLE WHILST WALKING, BUT SOMETIMES WHILS1 SITTING OR STANDING SOMETIME AFTER 1 APPEARANCE OF THIS SYMPTOM, AND DURINC ITS SLOW INCREASE, ONE OF THE LEGS | DISCOVERED SLIGHTLY TO TREMBLE, AND | ALSO FOUND TO SUFFER FATIGUE SOONER TE THE LEG OF THE OTHER SIDE: AND IN A FE MONTHS THIS LIMB BECOMES AGITATED BY SIMILAR TREMBLINGS, AND SUFFERS A SIMILA

loss of power

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WRITING OR EMPLOYING HIMSELF IN AN'

NICER KIND OF MANIPULATION BUT AS TE

DISEASE PROCEEDS, SIMILAR EMPLOYMENTS ARE ACCOMPLISHED WITH CONSIDERABLE DIFFICULTY, THE HAND FAILING TO ANSW WITH EXACTNESS TO THE DICTATES OF THE WI Walking becomes a task which cannot be PERFORMED WITHOUT CONSIDERABLI ATTENTION THE LEGS ARE NOT RAISED TO T HEIGHT, OR WITH THAT PROMPTITUDE WHIC

the will directs, so that the utmost care is

necessary to prevent frequent falls

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OF LIFE THE FINGERS CANNOT BE DISPOSEI OF IN THE PROPOSED DIRECTIONS, ANI APPLIED WITH CERTAINTY TO ANY PROPOSEI POINT AS TIME AND THE DISEASE PROCEED, DIFFICULTIES INCREASE: WRITING CAN NOW BI HARDLY AT ALL ACCOMPLISHED; AND READING

FROM THE TREMULOUS MOTION, ]

ACCOMPLISHED WITH SOME DIEFICULTY

WHILST AT MEALS THE FORK NOT BEING DU DIRECTED FREQUENTLY FAILS TO RAISE T MORSEL FROM THE PLATE: WHICH, WHEN SEIZED, IS WITH MUCH DIFFICULTY CONVEYED TO THE MOUTH AT THIS PERIOD THE PATIE SELDOM EXPERIENCES A SUSPENSION OF THE AGITATION OF HIS LIMBS COMMENCING, FOF INSTANCE IN ONE ARM, THE WEARISOME

AGITATION IS BORNE UNTIL BEYON]

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THE POSTURE IT IS FOR A TIME STOPPED IN TH LIMB, TO COMMENCE, GENERALIY, IN LESS THAN A MINUTE IN ONE OF THE LEGS, OR IN T ARM OF THE OTHER SIDE HARASSED BY THỊ TORMENTING ROUND, THE PATIENT H RECOURSE TO WALKING, A MODE OF EXERCISE TO WHICH THE SUFFERERS FROM THIS MALAI ARE IN GENERAL PARTIAL; OWING TO THE ATTENTION BEING THEREBY SOMEWHA DIVERTED FROM THEIR UNPLEASANT FEELING BY THE CARE AND EXERTION REQUIRED T ensure its safe performance

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OF THE FEET, WHILST THE UPPER PART OF T BODY IS THROWN SO FAR FORWARD AS T RENDER IT DIFFICULT TO AVOID FALLING ON *

FACE IN SOME CASES, WHEN THIS STATE OF

THE MALADY IS ATTAINED, THE PATIENT CAN N LONGER EXERCISE HIMSELF BY WALKING IN HIS USUAL MANNER, BUT IS THROWN ON TI TOES AND FOREPART OF THE FEET; BEING, AT 1 Same TIME, IRRESISTIBLY IMPELLED TO TAKI MUCH QUICKER AND SHORTER STEPS, ANI THEREBY TO ADOPT UNWILLINGLY A RUNNI? PACE IN SOME CASES IT IS FOUND NECESSARY entirely to substitute running for walking; SINCE OTHERWISE THE PATIENT, OD PROCEEDING ONLY A VERY FEW PACES, would inevitably fall

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LIMBS OCCUR DURING SLEEP, AND AUGMENT UNTIL THEY AWAKEN THE PATIENT, AN FREQUENTLY WITH MUCH AGITATION AN ALARM THE POWER OF CONVEYING THE FOOL TO THE MOUTH IS AL LENGTH SO MU IMPEDED THAT HE IS OBLIGED TO CONSENT T'

BE FED BY OTHERS THE BOWELS, WHICH HAD

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BEING DIRECTED TO THE BACK PART OF TI FAUCES, AND HENCE IS CONTINUALLY DRAININ FROM THE MOUTH, MIXED WITH THE PARTICLE OF FOOD, WHICH HE IS NO LONGER ABLE T\ clear from the inside of the mouth

AS THE DEBILITY INCREASES AND TH INFLUENCE OF THE WILL OVER THE MUSCLE FADES AWAY, THE TREMULOUS AGITATIOI BECOMES MORE VEHEMENT IT NOW SELDOM LEAVES HIM FOR A MOMENT; BUT EVEN WHEN

exhausted NATURE SEIZES A SMALL PORTIO?

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CONTINUALLY TRICKLING FROM THE MOUTH 17 POWER OF ARTICULATION IS LOST THE URID AND FAECES ARE PASSED INVOLUNTARILY; ANI AT THE LAST, CONSTANT SLEEPINESS, WI SLIGHT DELIRIUM, AND OTHER MARKS ( EXTREME EXHAUSTION, ANNOUNCE _ TI wished-for release

Case I

ALMOST EVERY CIRCUMSTANCE NOTED I THE PRECEDING DESCRIPTION, WAS OBSERVED IN A CASE WHICH OCCURRED SEVERAL YEARS BACK, AND WHICH, FROM THE PARTICULAI SYMPTOMS WHICH MANIFESTED THEMSELVES IN ITS PROGRESS; FROM THE LITTLE KNOWLED

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POSSESSED BY THE PHYSICIAN WHO ATTENDED; AND FROM THE MODE OF II TERMINATION; EXCITED AN EAGER WISH T ACQUIRE SOME FURTHER KNOWLEDGE OF IT nature and cause

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COULD RECOLLECT NO OTHER CIRCUMSTAN WHICH HE COULD CONSIDER AS HAVING BEEN LIKELY TO HAVE OCCASIONED HIS MALADY HE HAD NOT SUFFERED MUCH FROI

RHEUMATISM, OR BEEN SUBIECT TO PAINS OF

THE HEAD, OR HAD EVER EXPERIENCED ANY SUDDEN SEIZURE WHICH COULD BE REFERRED TO APOPLEXY OR HEMIPLEGIA IN THIS CASE, EVERY CIRCUMSTANCE OCCURRED WHICH HAS

been mentioned in the preceding history

Case II

THE SUBJECT OF THE CASE WHICH WAS

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NATURE OF HIS COMPLAINT, DECLINED MAKINC any attempts for relief

Case III

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POOR MAN, HOWEVER, APPEARED TO BE BY NO MEANS DISPOSED TO MAKE THE experiment

Case IV

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QUANTITY DISCHARGED DAILY FOR TWO (¢ THREE WEEKS ON HIS RECOVERY FROM THIS NO CHANGE APPEARED TO HAVE TAKEN PLACE IN HIS ORIGINAL COMPLAINT; AND TH OPPORTUNITY OF LEARNING ITS FUTI PROGRESS WAS LOST BY HIS REMOVAL TO A2 distant part of the country

Case V

IN ANOTHER CASE, THE PARTICULARS |

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EXTRAORDINARY DEGREE ÍT SEEMEDTO BE NECESSARY THAT THE GENTLEMAN SHOULD 1 SUPPORTED BY HIS ATTENDANT, STANDIN BEFORE HIM WITH A HAND PLACED ON EACH SHOULDER, UNTIL, BY GENTLY SWAYIN BACKWARD AND FORWARD, HE HAD PLACED HIMSELF IN EQUIPOISE} WHEN, GIVING THE WORD, HE WOULD START IN A RUNNING PACE THE ATTENDANT SLIDING FROM BEFORE HIM A? RUNNING FORWARD, BEING READY TO RECEIV! HIM AND PREVENT HIS FALLING, AFTER HI having run about twenty paces

Case VI

IN A CASE WHICH PRESENTED ITSELF T

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ABOVE-MENTIONED, EVERY INFORMATION AS TO TE PROGRESS OF THE MALADY WAS VERY READILY

OBTAINED THE GENTLEMAN WHO WAS THE

SUBJECT OF IT IS SEVENTY-TWO YEARS OF AG

HE HAS LED A LIFE OF TEMPERANCE, AND HA‘

NEVER BEEN EXPOSED TO ANY PARTICULAF SITUATION OR CIRCUMSTANCE WHICH HE CA CONCEIVE LIKELY TO HAVE OCCASIONED, OR DISPOSED TO THIS COMPLAINT; WHICH HE

rather seems to regard as incidental upon

HIS ADVANCED AGE, THAN AS AN OBJECT OI

MEDICAL — ATTENTION HE HOWEVEI

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quantity

ABOUT A YEAR SINCE, ON WAKING IN THE

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AGITATION; BUT AS THEIR PARALYSED STAI was removed, the shaking returned

AT PRESENT HE IS ALMOST CONSTANT

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LIMBS, AND AT LAST AFFECTED THE WHOI TRUNK TO ILLUSTRATE HIS OBSERVATION AS ° THE POWER OF SUSPENDING THE MOTION BY / SUDDEN CHANGE OF POSTURE, HE, BEING THEI JUST COME IN FROM A WALK, WITH EVERY LIMB SHAKING, THREW HIMSELF RATHEI

VIOLENTLY INTO A CHAIR, AND SAID, “Now

AM AS WELL AS EVER I WAS IN MY LIFE.” THE SHAKING COMPLETELY STOPPED; BUT

returned within two minutes' time

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HIS SLEEP, AND INCREASE UNTIL IT AWAKENED HIM: WHEN HE ALWAYS WAS IN A STATE OF agitation and alarm

ON BEING ASKED IF HE WALKED UNDER

MUCH APPREHENSION OF FALLING FORWARDS‘

HE SAID HE SUFFERED MUCH FROM IT; ANI

replied in the AFFIRMATIVE TO THE QUESTIO!

WHETHER HE EXPERIENCED ANY DIFFICULTY It RESTRAINING HIMSELF FROM GETTING INTC RUNNING PACE? IT BEING ASKED, IF WHILS’ WALKING HE FELT MUCH APPREHENSION FROM THE DIFFICULTY OF RAISING HIS FEET, IF SAW A RISING PEBBLE IN HIS PATH? HE AVOWED, IN A STRONG MANNER, HIS ALARN ON SUCH OCCASIONS; AND IT WAS OBSERVED BY HIS WIFE, THAT SHE BELIEVED, THAT IN WALKING ACROSS THE ROOM, HE WOULE

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over a pin

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CHAP II PATHOGNOMONIC SYMPTOMS EXAMINED —TREMOR COACTUS—SCELOTYRBE FESTINANS

It HAS BEEN SEEN IN THE PRECEDING

HISTORY OF THE DISEASE, AND IN TE

ACCOMPANYING CASES, THAT CERTAIR

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WHICH HAS BEEN CONSIDERED BY NOSOLOGISTS AS DISTINCT DISEASES, APPEA TO BE PATHOGNOMONIC SYMPTOMS OF THIS MALADY TO DETERMINE IN WHICH OF THESE POINTS OF VIEW THESE AFFECTIONS OUGHT ° BE REGARDED, AN EXAMINATION INTO THEI NATURE, AND AN INQUIRY INTO THE OPINION OF PRECEDING WRITERS RESPECTING THEN seem necessary to be attempted

I Involuntary tremulous motion, with

lessened voluntary muscular power, in

parts, not in action, and even

supported

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OF THIS TREMULOUS MOTION SHOULD E ASCERTAINED, AS WELL FOR THE SAKE C GIVING TO IT ITS PROPERDESIGNATION, AS FOI ASSISTING IN FORMING PROBABLE CONJECTURES, AS TO THE NATURE OF 1 MALADY, WHICH IT HELPS TO CHARACTERISE TREMORS WERE DISTINGUISHED BY JUNCKER INTO ACTIVE, THOSE PROCEEDING FRO? SUDDEN AFFECTION OF THE MINDS, AS TERRC

ANGER, &C AND PASSIVE, DEPENDANT OD

DEBILITATING CAUSES, SUCH AS ADVANCED

AGE, PALSY, &cl2!_ Bur A MUCH MORE

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species (Tremor Coactus) BY OBSERVING, THAT THE TREMULOUS PARTS LEAP, AND AS WERE VIBRATE, EVEN WHEN SUPPORTED: WHILST EVERY OTHER TREMOR, HE OBSERVES CEASES, WHEN THE VOLUNTARY EXERTION FC MOVING THE LIMB STOPS, OR THE PART I: SUPPORTED, BUT RETURNS WHEN WE WILL TH LIMB TO MOVE} WHENCE, HE SAYS, TREMOR IS DISTINGUISHED FROM EVERY OTHER KIND O spasm|* |,

A SMALL DEGREE OF ATTENTION WILL E SUFFICIENT TO PERCEIVE, THAT SAUVAGES, B" THIS JUST DISTINCTION, ACTUALLY SEPARAT THIS KIND OF TREMULOUS MOTION, AND WHIC IS THE KIND PECULIAR TO THIS DISEASE, FRO? THE GENUS TREMOR IN DOING THIS HE I FULLY WARRANTED BY THE OBSERVATIONS O

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VAN SWIETENISIL “BINAS HAS TREMORIS

species!©! GaLenus suBTILITERIistinxit, AIQUE ETIM DIVERSIS NOMINIBUS INSIGNIVIT, TREMOR ENIM (TPM & FACULTATIS CORPUS MOVENTIS ET VEHENTI

INFIRMITATE OBORITUR QUIPPE NEMO, QUI

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UNDER ‘THIS AUTHORITY THE TE PALPITATION MAY BE EMPLOYED TO MARK THOSE MORBID MOTIONS WHICH CHIEFLY

CHARACTERISE THIS DISEASE NOTWITHSTANDING THAT THIS TERM HAS BE ANTICIPATED BY SAUVAGES, AS

CHARACTERISTIC OF ANOTHER SPECIES (

tremor!’ THE SEPARATION OF PALPITATION

OF THE LIMBS (Palmos OF GALEN, Tremor Coactus OF DE LA BOE) FROM TREMOR, | THE MORE NECESSARY TO BE INSISTED ON SINCE THE DISTINCTION MAY ASSIST I LEADING TO A KNOWLEDGE OF THE SEAT OF T DISEASE IT IS ALSO NECESSARY TO BEAR ID MIND, THAT THIS AFFECTION

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UNEMPLOYED, AND BEING EVEN CHECKED BY THE ADOPTION OF VOLUNTARY MOTION; WHIL IN THE LATTER, THE TREMOR IS INDUC IMMEDIATELY ON BRINGING THE PARTS INT( ACTION THUS AN ARTIST, AFFLICTED WITH ' MALADY HERE TREATED OF, WHILST HIS HAN AND ARM IS PALPITATING STRONGLY, WIL SEIZE HIS PENCIL, AND THE MOTIONS WILL BE SUSPENDED, ALLOWING HIM TO USE IT FOR short period; but in tremor, if the hand be QUITE FREE FROM THE AFFECTION, SHOULD 1 PEN OR PENCIL BE TAKEN UP, THE TREMBLING immediately commences

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a running pace

THIS AFFECTION, WHICH OBSERVATION

SEEMS TO AUTHORISE THE BEING CONSIDEREL AS A SYMPTOM PECULIAR TO THIS DISEASE HAS BEEN MENTIONED BY FEW NOSOLOGISTS: IT APPEARS TO HAVE BEEN FIRST NOTICED B‘ GAUBIUS, WHO SAYS, “CASES OCCUR IN WHICH THE MUSCLES DULY EXCITED INTC ACTION BY THE IMPULSE OF THE WILL, D¢ THEN, WITH AN UNBIDDEN AGILITY, AND WIT AN IMPETUS NOT TO BE REPRESSED ACCELERATE THEIR MOTION, AND RUN BEFOI THE UNWILLING MIND IT IS A FREQUENT FAL OF THE MUSCLES BELONGING TO SPEECH, NO

YET OF THESE ALONE: I HAVE SEEN ONE, WHC

was able to run, but not to walklŠÌ,”