From the Archives

Thomas Buzzard (1831–1919) never attended medical school but was one of the last doctors to enter medicine through apprenticeship to a general practitioner. Appointed to the staff of the National Hospital for the Paralyzed and Epileptic in 1867, at the suggestion of Hughlings Jackson, Buzzard was one of that small group of physicians who helped ‘Queen Square’ acquire its international reputation (Fig. 1). He doubled-up as a medical journalist; dealt with the Soho (London) outbreak of cholera in 1854; and served with the Turkish army in the Crimean War. He resigned his hospital appointment in 1906. Sir Gordon Holmes did not consider that Thomas Buzzard contributed much to the advance of neurology but acknowledged that he was a sound and practical physician who taught well. Buzzard wrote on The simulation of hysteria by organic disease (1891), delivered the Harveian Lectures for 1885 on Some forms of paralysis from peripheral neuritis (1886) and published on Clinical aspects of syphilitic nervous affections (1874). In 1882, Buzzard published a series of 25 lectures, mostly delivered at the National Hospital, as Clinical lectures on disease of the nervous system. The one on paralysis agitans is also the first article in Brain on Parkinson’s disease (printed without mutual attribution having a few sentences omitted or inserted but otherwise unchanged). So graphic and admirable is James Parkinson’s original description that little remains for subsequent observers to add: ‘involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards and to pass from a walking to a running pace; the sense and intellect being injured’. Sylvius de la Boë had previously distinguished tremors contaminating voluntary movement from those occurring at rest; and—as ‘tremor coactus’—Sauvages (1763) gave a prophetic account of the tremulous parts that leap even when supported in contrast to all other tremors that subside when voluntary exertion ceases. The points are well made by observing Mrs G who sits with the chin resting on her chest, the lower lip and associated muscles shaking, and her mouth drooling saliva. Her arms, at rest, are in a state of constant tremor at a rate of 160–170/min. With attention, the amplitude but not the frequency of the movement increases. She walks with short ‘toddling’ steps, the head carried low, the body stooped forward. Her face has no expression. Pulled by the dress when standing still, Mrs G falls backwards. Reaching for a cup, the tremor stops. Not weak, she is feeble through inability to use the hands; sensibility is normal; her bowels are costive and the bladder unstable. Although tremor persists throughout voluntary movement in some patients, its persistence when the muscles are abandoned differentiates paralysis agitans from diseminated sclerosis. Thus, the artist with paralysis agitans can paint; with intention tremor, he cannot. That said, Dr Buzzard thinks he can recall patients with disseminated sclerosis in whom tremor was present at rest and with movement, and those with paralysis agitans having tremor on movement but nothing at rest. Posture of the hands—the fingers flexed at 45 to the palm against which the thumb appears to roll some object—is characteristic. Not described by Parkinson, but apparent to all who examine as well as observe their patients, is the muscular rigidity. Of course, these features may differ in their intensity and frequency between cases. Although Charcot has drawn attention to the quality of speech in Parkinson’s disease, Dr Buzzard considers that the voice has a characteristic shrill piping note similar to that habitually used by an actor when seeking to mimic extreme old age. Buzzard has not himself noted this tone in elderly healthy individuals of his own acquaintance. Rather, he thinks it likely that an influential thespian might have encountered an aged person with Parkinson’s disease and Fig. 1 The honorary medical staff of the national hospital, Queen Square, 1897. Thomas Buzzard is standing at the back right. From Holmes, G.,The National Hospital Queen Square, 1860^1948 (1954). Edinburgh and London: E. & S. Livingstone. Plate III facing page 41. doi:10.1093/brain/awn315 Brain (2008), 131, 3111^3114