496 THE TREATMENT OF DISEASES. 



SHAKING PALSY, OR PARALYSIS AGITANS. 



This is an affection not uncommonly met with in old people. It is characterised 

 by the occurrence of involuntary tremulous or shaking movements of the limbs, 

 head, or body. It occurs almost exclusively in men, and the large majority of cases 

 are met with above the age of fifty. In some instances it appears to be hereditary ; 

 for we had recently under our care a patient with this complaint whose father had 

 suffered in the same way for many years. It is said that it may be caused by 

 violent muscular exertion, by injuries or wounds, by excessive terror or mental 

 emotions, but the evidence on this point is far from conclusive. It is supposed that 

 in some cases rheumatism has laid the foundation for this lamentable disease. 



The onset of the complaint is generally insidious, and the progress is so slow that 

 the patient has often a difficulty in saying exactly when it began. A feeling of 

 weakness or a disposition to tremble fastens upon some particular part, most 

 commonly one hand or arm. The tremors are aggravated by mental emotion or 

 agitation, whilst rest and quiet diminish or stop them. Usually they may be con- 

 trolled by grasping a weight, or by a slowly and deliberately-performed voluntary- 

 act. These tremors, at first slight and occasional, gradually increase, and after a 

 time extend to other parts. The patient experiences considerable difficulty in 

 performing any act requiring manipulative dexterity. He becomes unable to read 

 or write or hold a book, and often has considerable difficulty in dressing and feeding 

 himself. He finds it almost impossible to drink in the ordinary way, the fluid being 

 spilled and the glass or cup knocked to and fro against the mouth. Patients 

 deprived of assistance have sometimes been obliged to lap water like a dog. It is 

 very painful to witness the struggles of the sufferer in his efforts to effect some 

 desired movement j the more he tries the worse he becomes. He is even obliged to 

 walk with circumspection, and the legs are not raised to the height nor with the 

 promptness the will directs, so that much attention is requisite to prevent falling. 

 Sometimes a difficulty is experienced in preserving the upright posture when sitting 

 or standing, but especially in walking there is a propensity to lean forwards, which 

 gradually increases, and the patient is in constant danger of falling on his face. The 

 forward tendency may become invincible. Forced to walk on the toes and fore part 

 of the feet, while the body is thrown forwards, the patient is irresistibly impelled to 

 take short quick steps, and to adopt unwillingly a running pace in fact, he is 

 obliged to run to keep up with himself. Sometimes, in advanced cases, an attendant 

 has to step backwards in front of him, with his hands placed on his shoulders, in 

 order to maintain his equilibrium. This forward tendency is not observed in every 

 instance, and the tremors often occur alone. Occasionally, though rarely, there is a 

 disturbance of balance in the opposite direction, and the patient is impelled to run 

 backwards. We are told of a man who had to be balanced to and fro before start- 

 ing, and who, if arrested in his forward movement, immediately began to hurry 

 backwards, and could not stop himself. 



Our description refers chiefly to severe and advanced cases. In many instances the 

 complaint is so mild and its progress so slow, that were it not for the inconvenience 

 arising from the unsteadiness of the hand in writing and other manipulations the 



