James Parkinson was already age 62 and in the autumn of his career as a surgeon–apothecary when “An Essay on the Shaking Palsy” appeared in 1817. His assertion that what he had described was a distinct “medical species” (now referred to as a “syndrome”) was accepted and, thanks to Charcot, Parkinson's name has become famous throughout the medical world, even though few practising physicians know anything about his life. Parkinson himself realized the limitations of his findings and couched them in modesty, which has long since disappeared from medical writings. The “shaking palsy” had escaped the attention of medical nosologists up to that time, and he hoped that his monograph would stimulate anatomists to locate the site of damage in the nervous system by post-mortem examination. After its publication, Parkinson's monograph was accepted by the medical establishment without criticism and also received favorable reviews in the press. It was almost as if he had described something that was already recognized, but which no one had made an effort to describe clearly in writing. Charcot recommended the paper to his students, telling them it would provide them with the satisfaction and knowledge that one always gleans from a direct clinical description made by an honest and careful observer. Nevertheless, he considered the account incomplete while emphasizing the fact that, in some patients, tremor may be miniscule and that rigidity played a significant part in the motor handicap. Most of Charcot's original observations can be found in the records of his Lecons du mardi a la Salpetriere made between 1868–1888. The most important embellishment to Parkinson's description, however, came from Armand Trousseau in his “Lectures on Clinical Medicine” delivered at Hotel-Dieu Hospital in 1868. His description of the particular nature of the movement disorder anticipated our modern understanding of bradykinesia, and postulated a lack of cerebral vigor as an important factor in the progressive reduction of amplitude and speed in the performance of sequential motor tasks. It took another hundred years before Konstantin Tretiakoff produced evidence to indicate that loss of nerve cells in the substantia nigra was the most consistent pathological signature. In contrast to Parkinson's clinical findings, which had been rapidly and widely accepted by the medical profession, it took another 50 years before it was generally agreed that the pars compacta was the area that was responsible for the slowness and stiffness in Parkinson's disease. Careful reading of “An Essay of the Shaking Palsy” clearly indicates that Parkinson considered a particular form of weakness to be an integral part of the disease. He also described, but with less emphasis, symptoms such as drooling of saliva and constipation, and considered that rheumatic pain could precede and even cause the malady. Nosography reflects the history of medicine, and what has emerged over the last two centuries is a parkinsonian hybrid informed by clinical methods and patients’ accounts combined with basic and applied science. Technological advances have also played an important part in both Tretiakoff's findings and the “dopamine miracle”; two advances that if Parkinson were alive today would be what he would be most excited about. As our notions of neurological disease continue to extend beyond the traditional clinicopathological paradigm to embrace a more dynamic consideration of pathological events and chemical processes, neurologists may be forced more and more to fall back on the classic clinical methods in which scrupulous observations and descriptions are combined with modern techniques of longitudinal neuroimaging and laboratory biomarkers. Starting from scratch with an open mind may also open up new vistas of understanding and finally lead to the cure that Parkinson hoped his essay would pave the way towards.