Historical

Seminal Figures in the History of Movement Disorders:Sydenham, Parkinson, and Charcot: Part 6 of the

MDS-Sponsored History of Movement Disorders Exhibit,Barcelona, June 2000

Christopher G. Goetz,1* Teresa A. Chmura,1 and Douglas J. Lanska2

1Department of Neurological Sciences, Rush University/Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois, USA2Veterans Affairs Medical Center, Great Lakes VA Healthcare System, Tomah, Wisconsin, USA

Thomas Sydenham

Although his contributions to movement disorderswere limited, Sydenham’s name is historically linked tothe field because of the well-known eponym, Syden-ham’s chorea. Born in 1624, Sydenham was a strongadvocate of observation and empiricism who shunnedcontemporary, often elaborate, theories on medical ill-ness. He was practical and relied on bedside experiencemore than book learning. Particularly interested in epi-demic illnesses, he documented the rhythmic periodicityof malaria, scarlatina, and measles, and, as such, he canbe viewed as a very early medical epidemiologist.Sydenham’s last publication (1686)Schedula Monitoriaincluded his now famous description of chorea minor, anentity that later was linked to his name largely due to theuse of this designation by Charcot. An advocate of thehealing properties of fresh air, Sydenham also was anactive adherent to blood-letting therapy, prompting Char-

cot to exclaim in 1888: “Let us throw a veil over Syden-ham’s therapeutic discussions on bleeding, bleeding andmore bleeding. It makes your hair stand on end. How didthose little English children survive all that?”

As part of the International Congress of the Movement DisorderSociety in Barcelona, June 2000, the society sponsored an exhibit de-voted to History of Movement Disorders. With the help of numerousmembers of the MDS and loans from libraries, private collections, andlaboratories, the authors developed a series of explanatory panels, ac-companied by photographs, diagrams, and original artifacts that tracedthe early history of movement disorders from several perspectives.These materials have been adapted for publication inMovement Dis-ordersand are presented in an ongoing series.

*Correspondence to: C.G. Goetz, 1725 W. Harrison Street, Suite755, Chicago, IL 60612. E-mail: cgoetz@rush.edu

Received 25 August 2000; Accepted 25 August 2000Published online 15 May 2001 FIG. 1. Thomas Sydenham (1624–1689).

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James ParkinsonJames Parkinson was a general practitioner who

worked in the Shoreditch area outside London before theneighborhood became engulfed in the sprawling captial.He was an avid writer and published several treatises andmany pamphlets that spanned topics as diverse as crueltyto the insane and fossils. As a member of the LondonCorresponding Society, he used the pen name,OldHubert,in some of his attacks on political policies of thetime. In 1817, he wroteAn Essay on the Shaking Palsy,a short account of six subjects, some of whom he hadnever formerly examined, but only saw on the neighbor-hood streets when making his medical rounds. He notedthe tremulous involuntary shaking that disabled them, thefestinating propulsion of their gait, and the slowness oftheir movements. He did not specifically separate brady-kinesia from rigidity. In noting the tremor that was socharacteristic of the malady, he mentioned former refer-ences to rhythmic shaking in the descriptions of Boissierde Sauvages and de la Bo¨e. The small monograph wasnot disseminated widely, and Parkinson died without amajor contemporary impact on his profession. Charcotdiscovered the pamphlet and, in his classroom lectures,lauded the succinct and clearly drawn descriptions by theEnglishman. Even in the 1880s, original copies of themonograph were difficult to acquire, and today, these

few copies are among the most valued items in neuro-logical rare book collections. Charcot advocated the useof the term, “Parkinson’s disease” over “paralysis agi-tans,” to honor Parkinson, to clarify that the disorder did

FIG. 2. Thomas Sydenham described childhood chorea but did notrecognize its association with cardiac or rheumatological disease.

FIG. 3. Frontpiece of essay on the shaking palsy. James Parkinsonwrote his treatise on paralysis agitans in 1817. The booklet was notwidely disseminated and today remains one of the most coveted trea-tises in rare book collections related to movement disorders.

FIG. 4. The unsuccessful search for a portrait of James Parkinson. Noportrait has ever been discovered of James Parkinson. Another JamesParkinson exists in the British medical world, and in 1937,MedicalClassicserroneously published this photograph along with their repro-duction ofEssay on the Shaking Palsy.If a portrait is eventually found,it will not be a photograph, because the James Parkinson for whomParkinson’s disease is named died in 1828, prior to the development ofthe first daguerrotypes (c. 1839).

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not have weakness as a hallmark, and to emphasize thatall patients did not have tremor. Even with Charcot’s useof the eponym, Parkinson was not a familiar name in theearly twentieth century. To highlight this unwarrantedobscurity, in 1912, L.G. Roundtree, wrote an article inthe Bulletin of the Johns Hopkins Hospital,titled “En-glish born, English bred, forgotten by the English and bythe world at large, such was the fate of James Parkinson.”No known portraits exist although early publicationshave mistakenly printed a photograph (a technology thatdid not exist during his lifetime) of another James Par-kinson.

Jean-Martin CharcotJean-Martin Charcot, frequently referred to as the Fa-

ther of Clinical Neurology, was born in 1825 and spenthis entire career in Paris. He worked as a student at theHospice de la Salpeˆtriere, which at that time was achronic care facility for elderly and destitute women.Here, he found material for his student thesis on rheu-matoid arthritis and started his career with a primaryinterest in gerontology. Recognizing the overlap of neu-rological diseases with arthritic and other chronic ill-nesses, he returned to the Salpeˆtriere as a staff physicianand associate professor and began to develop a special-ized service that focused increasingly on neurologicalissues. His research efforts primarily were based onclinical-anatomical correlations that were provided bythe extensive patient population and the regular autopsyservice he developed.

In the realm of movement disorders, Charcot madefundamental contributions to the description of Parkin-son’s disease and several other tremorous conditions. Hedeveloped diagnostic methods to detect tremors and todifferentiate the movements of Parkinson’s disease fromthose seen with multiple sclerosis, various intoxications,and “senile tremor.” Under his direct supervision, theyoung Georges Gilles de la Tourette described multifocaltic disorders in great detail and likened the condition toother entities associated with echolalia and echopraxia.Charot had extensive experience with Sydenham’s cho-rea and helped in delineating the nosology of chorea as aneurological phenomenon. After his death in 1893, hisformer student Brissaud proposed midbrain involvementin Parkinson’s disease. Charcot favored a hereditary ba-sis for almost all primary neurological disorders and feltthat the phenotypic expression of a neurological deficitcould be widely variable. He left a legacy of carefulanatomical-clinical correlations and a heritage of clinicalprioritization and reliance on visual observation, twoelements that remain major themes to modern movementdisorder specialists.

FIG. 5. Jean-Martin Charcot (1825–1893).

FIG. 6. Charcot contributed to several areas of movement disorderresearch and especially to the clinical evaluation of patients. This trem-orous patient wears a headband with a feather attached, which Charcotused to amplify tremor trajectories and facilitate visual recognition ofmild tremors.

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Though some considered Charcot a therapeutic nihil-ist, he advocated anticholingeric drugs and ergot-basedproducts for Parkinson’s Disease. For Sydenham’s cho-rea, he adamantly condemned blood-letting, in all treat-ments, he favored rest, seclusion, and good diet overpotent drugs of unestablished benefit.

SELECTED HISTORICAL REFERENCES

Charcot J-M. De la paralysie agitante (lec¸on 5). In: Oeuvres comple`tes,Vol 1. Paris: Bureaux du Progre`s Medical; 1869:161–188. (In En-glish: On paralysis agitans (lecture 5) In: Sigerson G., trans. Lec-tures on the diseases of the nervous system. London: New Syden-ham’s Society; 1877:129–156.)

Charcot J-M. Lec¸ons du mardi: policlinique de la Salpetriere. Paris:Bureaux du Progres Medical; 1887–1888.

de la Boe F (Sylvius F). Disputationes medicarum. Amstelodami: vanden Bergh; 1663.

Goetz CG, Bonduelle M, Gelfand T. J-M Charcot: construting neurol-ogy. New York: Oxford University Press; 1995.

Goetz CG. Charcot, the clinician: the Tuesday lessons. New York:Raven Press; 1987.

Guillain G. J-M Charcot, sa vie son oeuvre. Paris: Masson; 1955. (InEnglish: J-M Charcot: his life, his work. Bailey P., trans. NewYork: Hoeber; 1959).

Medical Classics. James Parkinson: essay on the shaking palsy. Balti-more: Williams and Wilkins; 1937–1938. [Reprinted photographof James Parkinson from Jubilee Book of the British Dental As-sociation (no author), London: John Bale Sons and Danielsson;1930.]

Parkinson J. Essay on the shaking palsy. London, Whittingham andRowland for Sherwood, Neely and Jones; 1817.

Parkinson J. Medical admonitions to families. Portsmouth: NS and WPierce; 1803.

Roberts S. James Parkinson 1755–1824: from apothecary to generalpractitioner. London: Royal Society of Medicine Press. 1997. InEponymists in Medicine Series.

Roundtree LR. English born, English bred, forgotten by the English andby the world at large, such was the fate of James Parkinson. BullJohns Hopkins Hosp 1912;15:123–131.

Sauvages FB. Nosologia methodica. Amstelodami: Sumptibus FratrumTournes; 1763.

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