Other Nineteenth Century Contributions

The Parkinson's-Reversing Breakthrough

Treatment for Parkinson Disease

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FIGURE 20 Dysautonomia in Parkinson's disease. This drawing by Daniel Vierge (1851-1904) shows the Salpetriere inpatient wards with a single central furnace for heat (18). In this context, Charcot recognized the distinctive dysautonomia of Parkinson's disease, noting how patients experienced a sense of hyperthermia even in the drafty, cold wards of the French hospitals:

FIGURE 20 Dysautonomia in Parkinson's disease. This drawing by Daniel Vierge (1851-1904) shows the Salpetriere inpatient wards with a single central furnace for heat (18). In this context, Charcot recognized the distinctive dysautonomia of Parkinson's disease, noting how patients experienced a sense of hyperthermia even in the drafty, cold wards of the French hospitals:

In the midst of winter (everyone on my service will substantiate this), you can see the parkinsonian patients with no blankets covering them and with only the lightest of clothes on . . . they feel hot especially around the epigastrium and back, although the face and extremities can also be the focus of their discomfort. When this heated sensation occurs, it is often accompanied by such severe sweating that the sheets and pajamas may need changing. I assure you that regardless of how hot these patients feel or how much they shake, their temperature remains normal (18).

FIGURE 21 Micrographia and tremorous handwriting. Charcot recognized that one characteristic feature of Parkinson's disease was the handwriting impairment that included tremorous and tiny script. Charcot collected handwriting samples in his patients' charts and used them as part of his diagnostic criteria, thereby separating the large and sloppy script of patients with action tremor from the micrographia of Parkinson's disease (16).

FIGURE 21 Micrographia and tremorous handwriting. Charcot recognized that one characteristic feature of Parkinson's disease was the handwriting impairment that included tremorous and tiny script. Charcot collected handwriting samples in his patients' charts and used them as part of his diagnostic criteria, thereby separating the large and sloppy script of patients with action tremor from the micrographia of Parkinson's disease (16).

FIGURE 22 William Gowers' work. William Gowers' A Manual of Diseases of the Nervous System shows sketches of patients with Parkinson's disease (left) and diagrams of joint deformities (right) (22). More known for written descriptions than visual images, Gowers offered one of the most memorable similes regarding parkinsonian tremor:

FIGURE 22 William Gowers' work. William Gowers' A Manual of Diseases of the Nervous System shows sketches of patients with Parkinson's disease (left) and diagrams of joint deformities (right) (22). More known for written descriptions than visual images, Gowers offered one of the most memorable similes regarding parkinsonian tremor:

the movement of the fingers at the metacarpal-phalangeal joints is similar to that by which Orientals beat their small drums (22).

FIGURE 23 William Osler. Osler published his celebrated Principles and Practice of Medicine in 1982, one year before Charcot's death. As an internist always resistant to the concept of medical specialization, Osler was influential in propagating information to generalists on many neurological conditions, including Parkinson's disease. Osler was less forthcoming than Charcot in appreciating the distinction between bradykinesia and weakness, and sided with Parkinson in maintaining that mental function was unaltered. Osler was particularly interested in pathological studies and alluded to the concept of Parkinson's disease as a state of accelerated aging (23).

FIGURE 23 William Osler. Osler published his celebrated Principles and Practice of Medicine in 1982, one year before Charcot's death. As an internist always resistant to the concept of medical specialization, Osler was influential in propagating information to generalists on many neurological conditions, including Parkinson's disease. Osler was less forthcoming than Charcot in appreciating the distinction between bradykinesia and weakness, and sided with Parkinson in maintaining that mental function was unaltered. Osler was particularly interested in pathological studies and alluded to the concept of Parkinson's disease as a state of accelerated aging (23).

FIGURE 24 Eduard Brissaud. Brissaud was a close associate of Charcot and contributed several important clinical observations on Parkinson's disease in the late 19th century. Most importantly, however, he brought neuropathological attention to the substantia nigra as the potential cite of disease origin. In discussing a case of a tuberculoma that destroyed the substantia nigra and in association with contralateral hemiparkinsonism, he considered the currently vague knowledge of the nucleus and its putative involvement in volitional and reflex motor control. Extending his thoughts, he hypothesized that, "a lesion of the locus niger could reasonably be the anatomic basis of Parkinson's disease" (24).

FIGURE 24 Eduard Brissaud. Brissaud was a close associate of Charcot and contributed several important clinical observations on Parkinson's disease in the late 19th century. Most importantly, however, he brought neuropathological attention to the substantia nigra as the potential cite of disease origin. In discussing a case of a tuberculoma that destroyed the substantia nigra and in association with contralateral hemiparkinsonism, he considered the currently vague knowledge of the nucleus and its putative involvement in volitional and reflex motor control. Extending his thoughts, he hypothesized that, "a lesion of the locus niger could reasonably be the anatomic basis of Parkinson's disease" (24).

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