In the next section of his lectures, Charcot gives an overview of Parkinson's disease with respect to its etiology and diagnostic features. He begins by proposing that the disease itself is a neurosis, absent of a true physiological and pathological basis. This conclusion Charcot based on the absence of clear neuropathological abnormalities seen in postmortem examination of patients who died with Parkinson's. He states, "Paralysis agitans, separated from foreign elements, is, gentlemen, at present a neurosis, in this sense that it possesses no proper lesion."12- p. 134
Charcot next turned his attention to the age of onset and the potential causes of Parkinson's disease.
It assails persons already advanced in age, those especially who have passed their fortieth or fiftieth year. Frequently the causes remain unknown. However, of the etiological data two deserve to be cited: 1, damp cold, such as that arising from a prolonged sojourn in a badly ventilated apartment, or in a low dark dwelling on the ground floor; 2, acute moral emotions. The latter cause appears to be tolerably common.12, pp 134,135
The discussion of the pertinence and applicability of symptoms in the diagnosis of Parkinson's disease serves as the next topic of discussion. In this discourse, Dr. Char-cot refers to the tremors, postural instability, and bradyki-nesia.
The symptoms of paralysis agitans are not all of the same value. The most striking symptom consists of the tremor, existing even when the individual reposes, limited at first to one member, then little by little becoming generalized, whilst respecting, however, the head. To this phenomenon is superadded sooner or later an apparent diminution of muscular strength A singular symptom is that which, frequently at an early, but usually at a late period, comes to complicate the situation—the patient loses the faculty of preserving equilibrium whilst walking. In some patients also we notice a tendency to propulsion or to retropulsion A peculiar attitude of the body and its members, a fixed look, and immobile features should also be enumerated among the more important symptoms of this disease.12, p 135
Charcot then turned his attention to the progressive nature of Parkinson's disease as well as the circumstances surrounding the demise of individuals afflicted with this particular disorder.
The march of paralysis agitans is slow, and progressive. Its duration is long—sometimes it has gone on for 30 years. The fatal term supervenes either by the advance of age, or because of intercurrent diseases. In the first case, an acute disease, such as pneumonia, occurs. In the second, death takes place from a sort of nervous exhaustion, nutrition degenerates, the patient cannot sleep, eschars are formed and conclude the morbid scene.12, pp 135,136
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