Dis­eases such as Alzheimer’s and Parkin­son’s were iden­ti­fied long ago, but re­main un­solved puz­zles, writes Jane McCredie

The Weekend Australian - Review - - Books -

To­wards the end of his ca­reer as a sur­geon-apothe­cary, James Parkin­son no­ticed a num­ber of el­derly men on the crowded streets of Re­gency Lon­don walk­ing pitched for­ward on the balls of their feet, as if about to fall, their limbs shak­ing un­con­trol­lably.

Parkin­son did what any good med­i­cal man would have done, at least at the turn of the 19th cen­tury, and walked up to the un­for­tu­nate men to ques­tion them about their symp­toms. They were ap­par­ently forth­com­ing with their an­swers, though per­haps less en­thu­si­as­tic about par­tic­i­pat­ing in Parkin­son’s pro­posed course of treat­ment.

At a time when lit­tle was known about the phys­i­ol­ogy of the brain, Parkin­son had a the­ory: the symp­toms were caused by mal­func­tions in the medulla and up­per spinal cord.

On the ba­sis of that plau­si­ble, though in­cor­rect, hy­poth­e­sis, he rec­om­mended blood­let­ting from the rel­e­vant re­gion in the up­per part of the neck, fol­lowed by ap­pli­ca­tion of a caus­tic sub­stance to cre­ate blis­ters pro­duc­ing a “pu­ru­lent dis­charge”. The dis­charge was to be kept flow­ing by hold­ing the blis­ters open with cork.

But who are we to be su­pe­rior … Parkin­son’s 1817 es­say on what he termed the “shak­ing palsy” was the first to de­lin­eate clearly the dis­ease that now bears his name. And, ex­actly 200 years on, we still do not have an ef­fec­tive cure for Parkin­son’s dis­ease, or even a clear un­der­stand­ing of its causes. About 80,000 Aus­tralians are af­fected by the dis­ease.

Like many En­light­en­ment men of science, Parkin­son turned his in­quir­ing mind to di­verse fields of en­deav­our, as Cherry Lewis de­tails in The En­light­ened Mr Parkin­son, a lively, if at times slightly am­a­teur­ish, biog­ra­phy.

A trained ge­ol­o­gist, Lewis was orig­i­nally drawn to re­search Parkin­son’s story be­cause, in ad­di­tion to his med­i­cal en­deav­ours, he was also a pi­o­neer of that new science.

Parkin­son was a dis­tin­guished collector of fos­sils at a time when the com­monly ac­cepted ex­pla­na­tion for the pres­ence of such re­mains on moun­tains was that they had been de­posited there by Noah’s flood.

He also dab­bled in the rad­i­cal pol­i­tics of the day, and was a pro­lific pam­phle­teer, writ­ing in favour of ed­u­ca­tion for the poor, ex­panded vot­ing rights, re­duced tax­a­tion and the lift­ing of re­stric­tions on free speech. Dan­ger­ous stuff at a time when English author­i­ties, spooked by the rev­o­lu­tion­ary an­tics of their neigh­bours across the Chan­nel, were more than happy to im­prison or trans­port to the colonies those they con­sid­ered guilty of sedi­tion.

Sci­en­tific un­der­stand­ing of the work­ings of the brain had not moved on all that much when, al­most a cen­tury af­ter Parkin­son’s es­say on the shak­ing palsy, a Ger­man psy­chi­a­trist with a re­form­ing bent found him­self puz­zling over one of his pa­tients at the Frank­furt Cas­tle of the In­sane. Ad­mit­ted to the asy­lum in 1901, Au­guste De­ter ap­peared calm and lu­cid one minute, fright­ened and con­fused the next. Asked to write her name, she be­gan with “Mrs” but then for­got the rest.

“I have, so to speak, lost my­self,” she re­peat­edly told her doc­tor, Alois Alzheimer.

When De­ter died five years later, Alzheimer asked that her brain be sent to him for post­mortem ex­am­i­na­tion. The or­gan was sur­pris- in­gly small, he found, with a large loss of tis­sue through­out the cere­bral cor­tex, and a strange pep­per­ing of an un­known dark sub­stance through­out.

Alzheimer called the sub­stance auf­baum pro­duc­tif or “build-up prod­ucts”. We call it plaque. It is one of the key fea­tures of the dis­ease we now know as Alzheimer’s, a con­di­tion that af­fects an es­ti­mated 46 mil­lion peo­ple glob­ally and is the most com­mon cause of de­men­tia.

Alzheimer’s ex­am­i­na­tion of De­ter’s brain re­vealed a bi­o­log­i­cal ba­sis for an af­flic­tion that had up un­til that point been con­sid­ered purely psy­cho­log­i­cal, writes Bri­tish neu­ro­sci­en­tist Joseph Je­belli in In Pur­suit of Mem­ory, a his­tory of at­tempts to com­bat the dis­ease.

Psy­cho­log­i­cal the­o­ries were in the as­cen­dance at the time, thanks to such thinkers as Sig­mund Freud and Carl Jung. The lat­ter, in fact, was in the au­di­ence when Alzheimer de­liv­ered a talk ti­tled “On a Pe­cu­liar Dis­ease of the Cere­bral Cor­tex” to the 1906 meet­ing of the South­West Ger­man Psy­chi­a­trists. The talk was not well re­ceived. The au­di­ence could not come up with a sin­gle com­ment or ques­tion, and the min­utes recorded un­kindly the pre­sen­ta­tion

When it comes to our in­tri­cate brains, medicine can­not yet de­liver peace of mind

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