. A treatise on nervous and mental diseases, for students and practitioners of medicine. mung. Shaking palsy. Parkinsons dis-ease. History. Paralysis agitans was first described in 1817, byParkinson, of London. It is a singular tribute to Parkinsonsintellectual capacity that nothing essential has been added to hisdescription of the disease, although almost all the well-knownwriters have considered it. Clixtcal HiSToriY. The onset of the affection may be gradualor sudden, very generally the former. It usually commences in oneof the extremities, although occasionally it begins in the lips, as it
. A treatise on nervous and mental diseases, for students and practitioners of medicine. mung. Shaking palsy. Parkinsons dis-ease. History. Paralysis agitans was first described in 1817, byParkinson, of London. It is a singular tribute to Parkinsonsintellectual capacity that nothing essential has been added to hisdescription of the disease, although almost all the well-knownwriters have considered it. Clixtcal HiSToriY. The onset of the affection may be gradualor sudden, very generally the former. It usually commences in oneof the extremities, although occasionally it begins in the lips, as it 506 NERVOUS DISEASES. did in one case of my own, which had a duration of fifty tremor gradually extends throughout the extremities, the mus-cles of the neck and head, and sometimes the facial muscles and thetongue. This extension is usually bilateral, exceptionally tremor is usually coarse, and in pronounced cases or in mildcases suffering from temporary exacerbation it may consist of acoarse tremor intermingled with movements that almost* resemble Fig. Photograph of a case of paralysis agitans, showing the attitude, the position of thehands, and the fades. a mild localized muscular convulsion. The speech soon becomesaffected, and grows to be deliberate and solemn, like the idealspeech of a wise man, or that of a slow, hesitating, and deliberateindividual. The attitude soon becomes peculiar. The patientholds the head and shoulders stiffly, bending the head and neckslightly forward, and walks with a short, shuffling step. The fades DISEASES OF UNKNOWN PATHOLOGY. 507 is as peculiar as the attitude, and consists of a blank immobility thatis very difficult to describe, but that is admirably represented inFig. 159. At this stage of the disease the hands are apt to assumethe so-called bread-crumbling position, i. e., the thumb and the fingersapproximate and move restlessly over one another, as in the actof crumbling bread. There is often a tendency on
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