“Sic transit gloria mundi”

The glories of this world are brief (Thomas à Kempis, 1379–1471)

To give a talk at a world congress is a great privilege, but when the speaker is well past his prime and has nothing new to say, attendance is likely to be frugal. A strategy that might gain a modicum of attention is to add the above title to your intended talk. Experience indicates that you may thus gain unwarranted attention of many, including senior physicians, from many countries who may listen in unspoken hope that you might mention their names in your differential diagnosis. Failure to do so could lose many old friends. To avoid this hazard, your talk should also contain two safety clauses. ‘Best known’ should be construed as a name familiar not only to neurologists, neurosurgeons, neuroscientists and general physicians but also to the general public and the world at large, including the media; a second precaution is to emphasise that fame should be enduring. The audience could be reminded that at the inaugural ceremony of each newly elected pope, ashes are thrice scattered across his path accompanied by recitation of above quotation.

Distinguished clinicians are no exception to this salutary reminder. Recall the fate of once eminent physicians. Influential lectures, authoritative books and publications soon fade from library shelves and contemporary reference lists; portraits which once graced the walls of medical schools and universities are gradually replaced, and within a generation or so memories of great neurologists are all but forgotten. How many present readers can recall the names of eight of my outstanding teachers (figure 1)?

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Figure 1

Eight outstanding teachers.

At this point, members of your audience may show signs of disappointment as the odds against nomination increase; others may then reflect on possible candidates from their own countries who might fulfil the proposed harsh criteria for sustained global fame. The potential field is large, stemming back to the early 19th century, and there have been many worthy candidates for the accolade of enduring fame. According to the Oxford English Dictionary, in the late 17th century, the physician and anatomist Thomas Willis introduced the term ‘neurology’; however the title ‘neurologist’ did not appear until 1832 in John Thompson's Life of William Cullen. Another early source, a review in the Medico-Chirurgical Journal of 1817 states, “This little pamphlet [relevant to my nominee] is highly deserving of perusal and deserves the attention of the medical public though neurologists have not yet classed it”.

For example, Aloysius “Alois” Alzheimer (1864–1915) (figure 2) might well come first in the alphabetical stakes. With ageing populations and widespread awareness of the hazards of dementia, Alzheimer's name is increasingly mentioned but has not yet, I suspect, entered the global vocabulary; critics might object that he was not a practising neurologist but a neuropathologist–psychiatrist. He began his career as an assistant physician at the Frankfurt Hospital for Lunatics and Epileptics and later trained with Kraepelin in Munich, whose distinguished students included Creutzfeldt, Jakob, von Economo and Lewy. Alzheimer fell ill in 1915 while on a train to Breslau intending to take up the appointment of Director of the Clinic of Psychiatry and Neurology and died soon after. Other possible proposals of distinguished neurological names tend to be known only to a relatively small section of the public and may not fulfil the two conditions of global and enduring fame. Thus Charcot and Gowers, both revered neurological giants, acknowledged by neurologists even to this day, are not often remembered by the general public.

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Figure 2

Royal Psychiatric Clinic, Munich. Alois Alzheimer (4th from left), Friedrich Heinrich Lewy (2nd from right). Others include: Emil Kraepelin (Director), Karl Kleasi, Hans-Gerhard Creuzfeldt, Alfons Jakob, Constantin von Economo, Luwig Merzbacher, Gaetano Perusini and Ugo Cerletti. (Photographed in Alois Alzheimer's house).

My proposal is a man who ironically was unknown at the time of his death in 1824. James Parkinson was a surgeon–apothecary, a prolific writer of radical political pamphlets and medical topics, pioneer of geology and classifier of fossils, an astute clinical observer, author of the famous Essay on the Shaking Palsy and deeply committed to the welfare of his patients; correctly described by Roy Porter1 as a “doctor with impeccably enlightened credentials”. His lifetime achievements have been well documented2,–,9 but the only contemporary reference to his death appears to be in the Gentleman's Magazine of 1826, “Surgeon, late of Hoxton Square, and that on the 5th of May, the parishioners of St. Leonard's met to elect another to take his place as a trustee of the vestry”.

When, in 1912, his first biographer, Rowntree described the life and times of James Parkinson, he began, “English born and bred, an English scientist, forgotten by the English and the world at large—such is the fate of James Parkinson”. Others have documented Parkinson's posthumous and late recognition, but even into the 1930s in his own country, many, including Gowers, who disliked eponyms, preferred ‘paralysis agitans’. Thereafter, the world gradually began to honour the hitherto unknown author of the seminal essay. No portrait is known to exist of Parkinson (despite popular folklore, see page 316) but we have a brief description from a fellow geologist, Gideon Mantell, in the the Royal Geological Society: “Mr Parkinson was rather below middle stature, with an energetic intellect and pleasing expression of countenance, and of mild and courteous manners; readily imparting information, either on his favourite science, or on professional subjects”. (Gideon Algernon Mantell FRS (1790 –1825) was a distinguished doctor and amateur fossil collector who, early in his career met James Parkinson and was very impressed. Gideon Mantell became famous because he was the first to discover a fossil tooth from an ancient animal and calculated that the beast was at least 18 m long. His discovery, that there was evidence of a huge extinct monster buried in Sussex, became world news).

My evidence for the ubiquity of Parkinson's name is admittedly only anecdotal. Many years ago in the People's Republic of China, the most populous country in the world, I was in the company of Professor Wang Chin De who was at that time senior neurologist in Beijing, leading a team of neurologists looking after Chairman Mao. In the Forbidden City, appropriately in the shadow of the Temple of Heavenly Truth, we were discussing the wondrous achievements of the world's longest continuous civilisation. He assured me that ancient Chinese physicians had long recognised the manifestations of Parkinson's disease. He kindly wrote the character (figure 3) and I asked him how it was pronounced in Mandarin. Surprisingly he replied, “In Mandarin, we pronounce this character as ‘Parkinson’ disease'!”

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Figure 3

Mandarin character for Parkinson's disease.

In India, the world's second most populous country, I had the opportunity of examining original Sanskrit incunabula dating back to 5000–3000 BC, preserved in the library of the Hindu University of Varanasi. In these documents, the Ayurvedic bioentities of ‘Kamparata’ (the shaking palsy) are clearly described and include mention of effective plant medicines, including paraseekayavanee (Hyoscyamus reticulatus, a belladonna alkaloid) and aswagandha seed (Mucuna pruriens, containing levodopa).10 There are over six major languages and numerous distinct dialects spoken in India, yet I have been reassured by distinguished Indian colleagues that in all of these lay languages, the term ‘Parkinson’s disease' is commonly used to describe a man showing the characteristic posture, gait and tremor.

In most of Europe, demotic languages and the media refer to ‘maladie de Parkinson’ or ‘Parkinson-Krankheit’, or its eponymous equivalent. My last example took place in Eastern Europe when it was still dominated by communist influence. I was a very junior member of a World Federation of Neurology subcommittee, appointed to clarify the clinical classification of disorders of the basal ganglia. The chairman was from the ‘eastern block’ where, at that time, the cult of the personality was discouraged. The prevailing party line maintained that all advances were the results of team efforts and, in particular, eponyms were strongly disapproved. We made brisk progress, unanimously disposing of tremor, rigidity, imbalance, etc, but came to a complete impasse when we encountered Parkinson's disease. At each sitting, a member wanted to add yet another clinical detail to the now ponderous multiple faceted definition. After each abortive meeting we had another vodka. Prolonged but fruitless discussion continued until the early hours. At last, the weary chairman announced, “Comrades, let us have a final vodka. Scrap this ridiculous attempt and agree to call it ‘Parkinson’s disease'.” We gratefully did.

Professional historians will rightly cavil about the danger of ‘false historicism’ and my errors in calling Parkinson a neurologist. He did indeed work as an apothecary–surgeon before the title ‘neurologist’ had been coined. Although devout, he probably would not have been eligible to study medicine in Oxford or Cambridge and gain an MD degree.

Nevertheless, perhaps influenced by my admiration for this remarkable man, I would still encourage my neurological colleagues to dub him the world's best known ‘Emeritus Neurologist’.