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PD is NOT an Old Disease

March 16, 2011

Although first described in 1817 London, it is generally assumed that Parkinson’s Disease has long been a problem for humanity. This conclusion is usually based on a handful of ancient texts which describe an affliction characterized by tremor.  But tremor is an initial manifestation of, not only PD, but a dozen other conditions. Observation in my own case and that of other PWP makes it clear that the defining symptoms of the later stages of our shared affliction, if untreated, would more likely be rigidity and slowness of movement (bradykinesia).

If that be so, then the texts, both before and after 1817, should be reflecting that. A man in the later stages would be more accurately described as “turned to stone” or some similar description of what we observe today. Yet, that is not so.

J. M. S. Pearce, in “Aspects of the History of Parkinson’s Disease” (1989), noted:

“Before James Parkinson’s classic’ “An Essay on the Shaking Palsy” (1817) ancient books recorded many types of paralytic disorders and tremors. None fully described the distinctive features of the syndrome which so justly perpetuates Parkinson’s name…..

Pearce also noted:
“Trousseau’s 15th Lecture on Clinical Medicine’° was on senile trembling and paralysis agitans. He described rigidity, a sign Parkinson did not pay attention to,,,”

Pearce’s own essay, published in the Journal of Neurology, Neurosurgery, and Psychiatry,   unintentionally makes two important points:
1) Prior to 1817, the features of PD that we recognize today had not been of particular note; and
2) It was not until Trousseau’s 1868 lecture that rigidity was recognized as a symptom.

I will not attempt to reproduce Pearce’s work here nor is it necessary to do so in order to make my points. PD was not then nor is it now a well-defined, singular syndrome. Instead, it was, and remains, an amorphus and emerging condition that became noteworthy in the years just prior to Parkinson’s booklet in London where his observations were made.

In short, Parkinson’s Disease came into being as a result of the changes wrought by the Industrial Revolution. A number of symptoms define the later stages, but rigidity is one of the three primary ones (the others being slowness of motion and tremor) that define PD.  Chronic rigidity is not easily overlooked by anyone involved with PD at any level.  As such, it is a good marker for the disorder.  And yet it is barely mentioned until the late 1800s..

Either our ancestors were very poor observers, or something else was going on. The former is almost laughable.  What other possibilities are found in the latter that might lead to an explanation?

Both then and now, of PD is shown as a rapidly evolving disorder affecting multiple systems. It originated in the changes in London society during the great upheaval of the Industrial Revolution. Those changes are many, of course, but some seem particularly pertinent in light of what we experience as patients. Increased exposure to pollutants, for example. Others are more subtle. A shift from an agrarian lifestyle where stress tended to be acute and buffered by an extended family to an urban one where stress was chronic and worsened by the loss of the social safety net.

It is here that the origins of PD should be searched for.

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