In a case which presented itself to observation since those above-mentioned, every information as to the progress of the malady was very readily obtained. The gentleman who was the subject of it is seventy-two years of age. He has led a life of temperance, and has never been exposed to any particular situation or circumstance which he can conceive likely to have occasioned, or disposed to this complaint; which he rather seems to regard as incidental upon his advanced age, than as an object of medical attention. He however recollects, that about twenty years ago, he was troubled with lumbago, which was severe and lasted some time. About eleven or twelve, or perhaps more, years ago, he first perceived weakness in the left hand and arm, and soon after found the trembling commence. In about three years afterwards the right arm became affected in a similar manner: and soon afterwards the convulsive motions affected the whole body, and began to interrupt the speech. In about three years from that time the legs became affected. Of late years the action of the bowels had been very much retarded; and at two or three different periods had, with great difficulty, been made to yield to the action of very strong cathartics. But within the last twelvemonths this difficulty has not been so great; perhaps owing to an increased secretion of mucus, which envelopes the passing fæces, and which precedes and follows their discharge in considerable quantity.
About a year since, on waking in the night, he found that he had nearly lost the use of the right side, and that the face was much drawn to the left side. His medical attendant saw him the following day, when he found him languid, with a small and quick pulse, and without pain in the head or disposition to sleep. Nothing more therefore was done than to promote the action of the bowels, and apply a blister to the back of the neck, and in about a fortnight the limbs had entirely recovered from their palsied state. During the time of their having remained in this state, neither the arm nor the leg of the paralytic side was in the least affected with the tremulous agitation; but as their paralysed state was removed, the shaking returned.
At present he is almost constantly troubled with the agitation, which he describes as generally commencing in a slight degree, and gradually increasing, until it arises to such a height as to shake the room; when, by a sudden and somewhat violent change of posture, he is almost always able to stop it. But very soon afterwards it will commence in some other limb, in a small degree, and gradually increase in violence; but he does not remember the thus checking of it, to have been followed by any injurious effect. When the agitation had not been thus interrupted, he stated, that it gradually extended through all the limbs, and at last affected the whole trunk. To illustrate his observation as to the power of suspending the motion by a sudden change of posture, he, being then just come in from a walk, with every limb shaking, threw himself rather violently into a chair, and said, “Now I am as well as ever I was in my life.” The shaking completely stopped; but returned within two minutes' time.
He now possessed but little power in giving a required direction to the motions of any part. He was scarcely able to feed himself. He had written hardly intelligibly for the last three years; and at present could not write at all. His attendants observed, that of late the trembling would sometimes begin in his sleep, and increase until it awakened him: when he always was in a state of agitation and alarm.
On being asked if he walked under much apprehension of falling forwards? he said he suffered much from it; and replied in the affirmative to the question, whether he experienced any difficulty in restraining himself from getting into a running pace? It being asked, if whilst walking he felt much apprehension from the difficulty of raising his feet, if he saw a rising pebble in his path? he avowed, in a strong manner, his alarm on such occasions; and it was observed by his wife, that she believed, that in walking across the room, he would consider as a difficulty the having to step over a pin.
The preceding cases appear to belong to the same species: differing from each other, perhaps, only in the length of time which the disease had existed, and the stage at which it had arrived.
CHAP. II.
PATHOGNOMONIC SYMPTOMS EXAMINED—TREMOR
COACTUS—SCELOTYRBE FESTINANS.
It has been seen in the preceding history of the disease, and in the accompanying cases, that certain affections, the tremulous agitations, and the almost invincible propensity to run, when wishing only to walk, each of which has been considered by nosologists as distinct diseases, appear to be pathognomonic symptoms of this malady. To determine in which of these points of view these affections ought to be regarded, an examination into their nature, and an inquiry into the opinions of preceding writers respecting them, seem necessary to be attempted.