historical zyx neurology zy An zyxw essay on Wilhelm von Hurnboldt and the shaking palsy: First comprehensive description of Parkinson’s disease by a patient R. Horowski, MD; L. Horowski, Cand Phil; S. Vogel, MD; W. Poewe, MD; and F.-W. Kielhorn, MD Article abstractTames Parkinson first described what is now known as Parkinson’s disease in his essay in 1817 on the shaking palsy, but the disease became well-known to neurologists only in the second half of the 19th century. In his letters from 1828 until his death in 1835, Wilhelm von Humboldt, a well-known German academic reformer, hu- manist scholar, and statesman, precisely described the manifestations of this disease. These included resting tremor and especially problems in writing, called by him “a special clumsiness” that he attributed to a disturbance in execut- ing rapid complex movements. In addition to lucidly describing akinesia, he was also the first to describe micrographia. He furthermore noticed his typical parkinsonian posture and, in all probability, his rigidity as “internal tremor not vis- ible by others which causes a distortion of the continuity of my movements.” He insisted, however, that he was suffer- ing not from a disease but just from accelerated aging related to the death of his wife. His description of the disease is more complete than the observations and definition by James Parkinson; his attitude toward his disease illustrates why it was not readily accepted as a disease in itself but might have been considered an extreme variant of aging in- stead. NEUROLOGY 1995;45:565-568 An unresolved issue of Parkinson’s disease (PD) is why such a distinct entity was not described until the classic essay in 1817 by James Parkinson’ (ex- cluding Leonard0 da Vinci’s observation of people “whose soul cannot control their movements in spite of the fact that their extremities are shaking continuouslyn2; but see also reference 3). If the dis- ease had indeed been new, this would strengthen the concept of environmental factors, such as toxins or viruses, as the cause, but it is possible that the short life expectancy in earlier centuries did not allow enough people to develop the disease or that it was considered to be only an extreme variety of normal aging.2 Finally, the symptoms (especially hypokinesia) might have caused early death in those affected, as they still did, only a few decades ago, in the Western Pacific region under archaic, nearly stone-age conditions of living (D.C. Gaj- dusek, personal communication). All these factors might have resulted in a low or virtually zero prevalence of PD in the eyes of doctors and of the general population. We believe that the letters of Wilhelm von Humboldt, with his own description of this disease and his interpretation of his symp- toms, may help to clarify these issues. Wilhelm von Humboldt, 1767-1835, was the son of a Prussian officer and his French Huguenot wife. He was a highly influential German diplomat and scholar of the humanities, was a friend of Schiller and Goethe, and is best known as an educational and academic reformer and spiritual founder of the Berlin University. He introduced the concept of unity of research and teaching in “loneliness and freedom” when Undersecretary of State for educa- tion at Berlin from 1809 to 1810.4 He was extremely productive as a man of letters and left a large num- ber of manuscripts; of special medical interest are his “Briefe an eine Freundin” (“Letters to a Lady- Friend). From 1814, when Humboldt participated as a diplomat in the Congress of Vienna, until his death in 1835, he exchanged ideas and philosophy of life with Charlotte Diede, a lady once in platonic love with him. He supported her financially, appar- ently also in compensation for a sometimes strange, secret correspondence about many topics, including intimate feelings and beliefs. After his death, she anonymously published his part of the correspon- dence in a censored Subsequently, these let- ters were re-edited many times, in a complete and corrected form first in 1909 by A. Leitzmann,6 who managed best to decipher Wilhelm von Humboldt’s very illegibly written German characters. From Special Research Projects (Dr. R. Horowski), Schering AG; Free University of Berlin (L. Horowski); Department of Neurosurgery (Dr. Vogel), Hum- boldt-University of Berlin; Department of Neurology (Dr. Poewe), Klinikum Rudolf Virchow, Free University of Berlin; and Department of Psychiatry and Neurology (Dr. Kielhorn), Wenckebach Krankenhaus, Berlin, Germany. Received April 26,1994. Accepted in final form August 16,1994. Address correspondence and reprint requests to Dr. Reinhard Horowski, Special Research Projects, Schering AG, D-13342 Berlin, Germany. March zyx 1995 NEUROLOGY 45 565