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