History of Medicine

 PHOTOGRAPHY AT THE SALPÊTRIÈRE: GUILLAUME-BENJAMIN DUCHENNE 

         The tumult of the French Revolution of 1789 swept away the existing structure of medicine. A new feature was the utilization of “hospices,” institutions where the poor, aged, and mentally ill were housed, as places of medical instruction. The Salpêtrière, for example, grew into an important teaching institution, made especially famous by the astute and flamboyant neurologist, Jean-Martin Charcot. 

         Charcot had served an internship at the Charité Hospital on the service of Pierre-François Rayer, a prominent physician and the first to see the anthrax bacillus. At the Charité, Charcot met a curious,

Jean-Martin Charcot (Wikipedia)

quiet man usually carrying a wooden box containing a battery pack and electrodes. His name was Guillaume-Benjamin Duchenne de Boulogne (de Boulogne added to distinguish him from other Duchennes) and he was a fervent believer in electricity as a diagnostic agent and treatment modality. While most doctors eyed him with skepticism, Charcot saw value in his work and befriended him.

         Guillaume-Benjamin Duchenne was born in Boulonge-Sur-Mer in northern France in 1806. His father was a ship captain and corsair during the Napoleonic Wars. Guillaume turned to

Guillaume-Benjamin
Duchenne (Wikipedia)

medicine, studying in Paris under notable teachers such as the surgeon Guillaume Dupuytren and pathologist Jean Cruveilhier, graduating in 1831. He returned home, prospered in private practice, and married. His wife died of sepsis after childbirth and, because he had been involved in the birth, his wife’s family considered him responsible and refused him custody of the surviving son. Duchenne remarried a few years later and, at about this time, became intrigued by the possibilities of electricity in medicine. Jean-Baptiste Sarlandière, a collaborator of the experimentalist Magendie, advocated a technique of enhancing acupuncture treatments by introducing an electric current through the needle. Duchenne sought a less painful approach and designed a portable apparatus that employed small surface electrodes to the skin. He soon found that by stimulating individual muscles he could study their function. Though a quiet man, Duchenne had a determined will and, to employ his new invention on a larger scale, he moved to Paris.

Diagram of Duchenne's apparatus ( from De L'Électrisation
Localisée, Internet Archive)

         Being unknown in the Paris medical scene, Duchenne survived by working long hours in charity hospitals, carrying his batteries and electrodes with him. Quietly, he mapped muscular function and could show exactly which muscles functioned poorly or not at all in various conditions. Contrary to his general reception, he was appreciated by Armand Trousseau at the Hôtel Dieu and by both Rayer and Charcot at the Charité. When Charcot became a professor at the Salpêtrière in 1862, he brought the much older Duchenne with him, offering him freedom and funds to pursue his studies among the over 5,000 residents, primarily elderly women.

         Duchenne found much to study. He combined detailed clinical observations with careful electrical stimulation data to describe several new conditions. At the time, knowledge of the neural connections behind movements was still incomplete and Duchenne’s inveestigations added much to clarify various points. His work influenced Charcot in his decision to focus on neurology. Duchenne eventually published a large tome on the results of his studies, revised in two further editions.

          Though he was not the first to describe it, his name is associated with the childhood disorder of pseudohypertrophic

Child with pseudohypertrophic 
muscular dystrophy, photo by
Duchenne (Album de photographies pathologiques)

muscular dystrophy, or Duchenne muscular dystrophy. He added much clinical detail and, probably based on an instrument used in Germany to biopsy cases of trichinosis, invented a smaller, relatively painless needle for in vivo biopsies. He also described a variant of amyotrophic lateral sclerosis, other muscular dystrophies, the consequences of syringomyelia, and found through electrical studies that “essential paralysis of childhood,” now called polio, was a motor neuron disease (unknown at the time). He investigated a common gait disorder, locomotor ataxia (tabes dorsalis), already described by Moritz

Duchene's biopsy 
needle (De L'Élect-
risation Localisée,
3rd edit., Bib Nat Paris)

Romberg, providing additional clinical detail and, by demonstrating the integrity of the muscles through electric stimulation, showed that the disorder was spinal in origin. Neither he nor Charcot associated tabes with the true cause, syphilis.

         Another great medical contribution of Duchenne was the use of photography. His cameras recorded pathology specimens, including histologic sections, and photographed neurons for the first time. Most impressive was a publication showing that the stimulation of various facial muscles produced expressions of emotional states. For this he was assisted by Adrien Tournachon, brother of Felix Tournachon (famous as Nadar, famous portrait photographer). Duchenne applied his electrodes many times to an elderly, obliging ex-cobbler (less often to other subjects) to reproduce emotional facies.

Creating a grimace with electrodes
(Mécanisme de la Physionomie Humaine)

The publication, Mechanisms de la Physionomie Humaine, generated wide admiration, especially in artistic circles. Charles Darwin used samples when he wrote The Expression of the Emotions in Man and Animals. He discusses several known works of art in which the facial expression, in his opinion, does not match the emotional situation. He cites, for example, the Laocoön (a copy in Brusssels), whose large, struggling figure had, he felt, a “physiologically impossible forehead.” It is significant that Duchenne left his personal photograph album to the École de Beaux Arts.

       

The Laocöon in the Vatican. Duchenne referred to a copy in Brussels (Wikipedia)

  Duchenne’s talents and discoveries became widely appreciated. He received the Chevalier de la Légion d’Honneur and honors from abroad, though he never had a university appointment. Tragedy darkened his last years. In 1870, after the Franco-Prussian War broke out, his estranged son, who had joined him in Paris in 1862 and opened a practice in neurology, succumbed to typhoid fever and his wife also died that year. Duchenne carried on, keeping company with medical friends, until 1875 when he suffered a stroke, dying shortly thereafter. Charcot, who frequently declared how much he learned from Duchenne and shared an interest in art, was at his bedside in his final hours.

 

SOURCES:

 

Parent, A, “Duchenne De Boulogne: A Pioneer in Neurology and Medical Photography.” Canad J Neurol Sci. 2005; 32: 369-77.

 

Nelson, K R, Genain, C, “Duchenne de Boulogne and the Muscle Biopsy.” J Child Neurol 1989; 4: 315.

 

Borg, K, “The Man Behind the Syndrome: Guillaume Duchenne.” 1992; 2: 145-54.

 

Duchenne (de Boulogne), G.-B, Mechanisms de la Physionomie Humaine ou Analyse Électro-Physiologique de l’Expression des Passions. 1862, Paris.

 

Berry, D, “Pierre-François Olive Rayer: Biography.” Medical History Suppl. 2005; 24: 7-13.

 

Siegel, I M, “Charcot and Duchenne: Of Mentors, Pupils, and Colleagues.” Perspect Biol Med 2000; 43 (4): 541-47.

 

Goetz G G, Bonduelle M, Gelfand T, Charcot: Constructing Neurology. 1995, Oxford Univ Press.

 

Duchenne de Boulogne, G-B, Album de Photographies Pathologiques Complémentaires du Livre Intitulé De l’Électrisation Localisée. 1862, Baillière, Paris.

 

Cuthbertson, R A (Editor and Translator), The Mechanism of Human Facial Expression by G-B Duchenne de Boulogne. 1990, Cambridge Univ Press.

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https://museumofmedicalhistory.org/j-gordon-frierson%2C-md