Chapter 20 Neurological illustration

Handbook of Clinical Neurology, Vol. 95 (3rd series) History of Neurology S. Finger, F. Boller, K.L. Tyler, Editors # 2010 Elsevier B.V. All rights reserved

Chapter 20

Neurological illustration: from photography to cinematography GENEVIE`VE AUBERT * Chef de Clinique, Université Catholique de Louvain, Brussels, Belgium

INTRODUCTION Clinical neurology, at the beginning of the third millennium, cannot do without photography and moving pictures. This is particularly true for conditions characterized by seizures and abnormal motor activity. The advent of easy-to-use video cameras in the 1980s has rendered this practice very common. Recently, video technology has given way to high-quality, durable digital images. Today, specialized neurological journals, such as Movement Disorders, Epileptic Disorders, and Neurology, include video clips as part of their illustrations. Up to the mid-1800s, medical documentation consisted essentially of describing, often somewhat imaginatively, the signs and symptoms of illnesses. Early descriptions were sometimes accompanied by artists’ renditions of patients’ postures or movements, but these illustrations carried the subjective bias of the artist. The important visual part of neurological diagnosis explains why photography was adopted very early in neurological services. Further, physiologists and neurologists played important roles in the development of chronophotography and cinematography (Tosi, 1984; Aubert, 2002a; Tosi, 2005). These tools, which offer an objective means of documentation, have become essential elements for diagnosis, follow-up, evaluation of treatment, teaching and research. This chapter will explore iconography in neurology from the birth of photography up to the early medical applications of cinematography before 1914.

BIRTH OF PHOTOGRAPHY: THE DAGUERREOTYPE In 1839, the French physicist Franc¸ois Arago presented the daguerreotype before the Acade´mie des Sciences in Paris. This invention of the French painter Louis Jacques Mande´ *

Daguerre, based on previous research by Nice´phore Niepce, would revolutionize science by providing an objective document largely independent of artistic subjectivity. It quickly opened the way to a new visual means of scientific communication. Thanks to its extraordinarily high resolution of details, the daguerreotype was fully appropriate to scientific studies. Nevertheless, the daguerreotype had several drawbacks. The procedure was slow, with a lengthy exposure time of several minutes in its early stages and, even after technical improvements, several seconds of exposure time were required. As such, it lent itself poorly to recording any element of movement. Although landscapes and architecture were perfectly well rendered, all fleeting or transitory phenomena remained uncaptured. Portraiture rapidly became a popular topic for photography, but it was poorly applied to medicine, because it required the subject to hold a pose in complete immobility. Other problems with the daguerreotype were that it was a fragile document and it produced a single positive image, on the polished surface of a copper plate. Because it was not possible to make a direct reproduction from the daguerreotype, mass- (or even limited) duplication was impossible. Extensive additional expertise was necessary to engrave the image for publication. Early medical applications were preferably directed toward dead or immobile subjects rather than toward living ones and the first medical applications focused on microscopic photography (Taureck, 1980). Alfred Donne´, who taught microscopy to physicians in Paris, had a microscope-daguerreotype built by an optician. With Le´on Foucault, the famous physicist, he succeeded in obtaining the first picture of human blood cells. The way was open to photomicrography. However, several decades would pass before this technique would really become part of everyday laboratory life.

Correspondence to: Genevie`ve Aubert MD, PhD, Universite´ Catholique de Louvain, Cliniques Universitaires Saint-Luc, Center of Sleep Medicine, Avenue Hippocrate 10, B-1200 Bruxelles, Belgique. E-mail: [email protected], Tel: +32-2-764-1929, Fax: +32-2-764-2831.

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PAPER PHOTOGRAPHY AND PICTURES OF PATIENTS The impracticality of the original Daguerre methodology was solved by new techniques. The English scientist William Henry Fox Talbot developed the calotype process, which was patented in 1843. This procedure allowed the rendering of a positive print from a paper negative. This process would become the basis of photography throughout the 20th century. Nevertheless, the paper negative was far from being perfect: coarse-grained, it yielded a soft image, lacking the clarity and sharpness of the daguerreotype, and the procedure was not sensitive enough. In 1851, the Englishman Frederick Scott Archer described the wet-collodion method, which represented a great improvement over previous photographic processes. The support was a glass plate, resistant and transparent. This solved the problem of making multiple positive images from one negative. The collodion emulsion was more light sensitive, and it gave a remarkable sharpness of detail. Nevertheless, the procedure was a cumbersome and finicky business: the sensitized plate had to be exposed while still wet, and developed immediately after exposure. The whole operation required fastidious attention to detail at each step of the process. The photographer was necessarily his own chemist. The exposure time progressively decreased from several seconds to less than 1 second. This advance justified the use of the epithet instantaneous. Physicians immediately applied this new tool to document their cases. They assembled picture collections of patients for research and teaching purposes. In the field of neuropsychiatry, the pioneer was Hugh Welch Diamond, working at the Surrey County Asylum in Twickenham, England. As early as 1852, he began to take Photographs of the Insane, as these documents are known (Taureck, 1980; Kemp and Wallace, 2000). Looking at those images today, one suspects that Diamond preferentially selected the quietest and least mobile patients – melancholics or catatonics (Fig. 20.1). Because all elements of movement, agitation, and frenzy are absent, it is difficult to identify a specific diagnostic trait. In many ways, these documents evoke middle-class portraiture more than the imagery of psychiatric institutionalization.

PUBLICATIONS ILLUSTRATED WITH PHOTOGRAPHS: DUCHENNE’S CONTRIBUTION Once the problem of multiplying positives was solved, books illustrated with photographs could be published. Between 1861 and 1867, Nikolaus Ru¨dinger, anatomist in Munich, published an Atlas des Peripherischen

Fig. 20.1. Photographic portrait of a patient, c. 1852. The Diamond collection. By kind permission of The Royal Society of Medicine, London.

Nervensystems des Menschlichen Körperes, in 10 parts. It was illustrated with 46 extra large, high-quality photographs, glued in the atlas. They were taken by Joseph Albert, photographer to the Bavarian Court. This first achievement can be considered to be a masterpiece, on a scientific ground as well as technically, but whether photographs enhanced scientific information transmission better than good drawings is arguable. In the United States, an anatomist, John Dean, published The Grey Substance of the Medulla Oblongata and Trapezium in 1864. This work was produced under the support of US Surgeon General and influential neurologist, William A. Hammond. Dean incorporated photographs into his treatise, showing numerous transverse brainstem sections. This work became well known internationally, and, though limited to a small neuroanatomical topic, served as an important scientific resource to early clinical neurologists. Guillaume Benjamin Duchenne (known as “de Boulogne,” after his native town) was an eccentric maverick of neurology, with a particularly inquiring and inventive mind (Cuthbertson, 1990; see also Chapter 40). In his practice and research, he introduced

NEUROLOGICAL ILLUSTRATION: FROM PHOTOGRAPHY TO CINEMATOGRAPHY many technical innovations: electrodiagnosis, electrotherapy, needle muscle biopsy, and photography. As early as 1852, Duchenne sought to depict the action of individual muscles that were electrically stimulated. Actually, it was for this purpose that he studied photography with Adrien Tournachon, the brother of the great French photographer Nadar. In 1862, he published in Paris the first medical book illustrated with photographs of patients, the Album de Photographies Pathologiques (Duchenne de Boulogne, 1862). With this book, he initiated the great tradition of photographic illustration of neuromuscular diseases (Endtz, 1983). Even more original is the second book that Duchenne published in the same year, Mécanisme de la Physionomie Humaine, illustrated with 84 photographs (Fig. 20.2) (Duchenne de Boulogne, 1862,1990). In this work, Duchenne systematically studied the action of facial muscles in response to local electric stimulation, in order to capture the various emotions of the human face. Given the slowness of the wet-collodion

Fig. 20.2. Duchenne: Plate 64 from Mécanisme de la Physionomie Humaine. Combined contraction of mm platysma and mm corrugator supercilii, with voluntary dropping of the lower jaw: terror mixed with pain, torture. From the personal album of Duchenne, 1855–1856. Inventory of the E´cole Nationale Supérieure des Beaux-Arts, Paris: PC 4366, Fig. 45.

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procedure, Duchenne had to devise a system to freeze the expressions of his subjects during the experiments. He had to adjust the electric current to suit the excitability of each muscle, in order to hold the contraction long enough to be photographed. To achieve this goal for most of these experiments, Duchenne recruited an old man as a subject who suffered from a facial anesthesia. Hence, he did not feel the pain associated with electrical stimulation. From a technical point of view, the achievement was particularly important and this book is probably Duchenne’s most inspired work. It caused a great sensation, not only in neurology and neurophysiology, but also in experimental psychology and fine arts. Ten years later, Charles Darwin cited Duchenne’s book and used several of Duchenne’s photographs in his own landmark book The Expression of the Emotions in Man and Animals (Darwin, 1998).

THE PHOTOGRAPHIC ACTIVITY AROUND CHARCOT AT THE SALPÊTRIÈRE Photographic departments soon opened in several hospitals, and numerous fields of medicine included medical photography in journals and other publications. In Paris, under the leadership of Jean-Martin Charcot, photography officially entered clinical neurology. Photography fit in well with Charcot’s known interest in all the iconographic means of illustrating neurological diseases (Goetz, 1991; Goetz et al., 1995). Duchenne was influential in this introduction and many close associates of Charcot were soon involved in photographic activities at the Salpeˆtrie`re: Bourneville, Gilles de la Tourette, Luys, Marie, Regnard, Richer, Voisin, and the photographer Londe. Photography rapidly took an important place in teaching and publications at the Salpeˆtrie`re. The key person in the development of this photographic activity was the “citizen” De´sire´-Magloire Bourneville. This extraordinarily active man simultaneously pursued three careers: medical, editorial and political (Poirier and Signoret, 1991). From 1871, he ran the first medico-photographic journal, the Revue Photographique des Hôpitaux de Paris. This journal had been founded 2 years earlier by A. de Montme´ja, physician and ophthalmologist, who directed the photographic department of the Hoˆpital Saint-Louis, where he worked with the famous dermatologist Hardy. In 1876, with Regnard, Bourneville founded the Iconographie Photographique de la Salpêtrière, where they published observations primarily on hysteria and epilepsy (Didi-Huberman, 1982, 2003; Endtz, 1983). This journal was published in

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a limited edition with hand-pasted photographs, but ceased publication in 1880. In 1878, thanks to Bourneville’s political leverage, the French public health system (Assistance Publique) supported the creation of a photographic laboratory in Charcot’s department. Shortly thereafter, a spacious teaching amphitheater was installed. It could accommodate 400 persons and was equipped with the most modern instruments of demonstration, including a projector for photographs and microscope preparations, all electrically powered. Albert Londe became the key figure responsible for medical photography under Charcot (Bernard and Gunthert, 1993; Goetz et al., 1995). In 1882, he had started in Charcot’s clinic, as a chemist assistant to Loreau, who was in charge of the photographic activities. Londe quickly demonstrated his skills as an amateur photographer. Two years later, he became director of the fully renovated photographic service, equipped with indoor and outdoor facilities (Fig. 20.3). Patients were systematically photographed to document static neurological disorders, as well as the evolution of neurological deficits. The pictures of the patients were kept in their records alongside clinical

notes, tremor recordings, and other medical documents. The photographic department became one of the most famous annexes of Charcot’s service. There, among other important novelties, Londe introduced the use of silver-bromide gelatin dry plates. The gelatin emulsion had been developed in 1871 by the English physician Richard Leach Maddox, as a replacement for collodion. The light sensitivity of the plates was considerably increased and real snapshots were now possible, with exposure times of 1/25th s. Dry photographic plates changed the entire nature of photography. Easy to make, they would soon become commercially available, rendering photography accessible to a large public. With these technological advances, the way was clearly open for the analysis of movement. In 1888, with Richer and Gilles de la Tourette, Londe founded the Nouvelle Iconographie Photographique de la Salpêtrière, under the direction of Charcot, as a complement to the Archives de Neurologie. The Nouvelle Iconographie, which was published until 1916, was an international journal, with authors from Europe and South America. Thanks to new reproduction processes, it published articles purposely selected because of their photographs or other visual documentation.

Fig. 20.3. The outdoor photographic studio at the Salpeˆtrie`re, 1893. Londe is operating his 12-lens camera and Marey is sitting on the bench at his right. # Socie´te´ Franc¸aise de Photographie, Paris. Tous Droits Re´serve´s.

NEUROLOGICAL ILLUSTRATION: FROM PHOTOGRAPHY TO CINEMATOGRAPHY 293 In 1893, Londe published the first book dedicated to med(Marey, 1873), which was translated in English the ical photography, with extensive details on adaptations of following year (Marey, 1874). This scientific work defiphotographic techniques to clinical medicine (Londe, nitely impressed Stanford who redirected Muybridge’s 1893). project (Mozley, 1979). Muybridge now expanded his Although Charcot had the best-equipped facilities of photographic experiments, going from one single the time, and engaged probably the best technician in instantaneous photograph of fast motion to a series the field, he did not include extensive medical photoof photographs, taken sequentially. He aligned a batgraphy in his personal publications. In the nine tery of 12 cameras (later 24 and even 40 cameras), volumes of his Oeuvres Complètes and the two sets equipped with an ingenious electromagnetic triggering of the Leçons du Mardi, one finds only six lessons illudevice. This yielded, in 1878, the first successful serial strated with photographs: in all, there are just 11 plates photographs of horses in motion, and 1 year later of and 19 figures, whereas sketches, drawings and engravhuman subjects. ings are much more numerous. This dichotomy This early photographic investigation of motion between the objectivity of the photographic document caused an international sensation. Muybridge’s photoand the lack of its full incorporation into many of his graphs were reproduced on the cover of Scientific published works is echoed in Duchenne’s career, where American and in the French journal La Nature, and his late works contain few photographs (Endtz, 1983). were admired by Marey. The two men began correClearly, although Charcot invested heavily in medical sponding. At the end of 1879, Muybridge began a lecphotography, the new techniques never replaced the ture tour before fascinated audiences, first in the role of the medical artist. United States and later in Europe. He illustrated his For many years, Charcot was fortunate to have Paul talks with moving photographic slides, using various Richer, faithful assistant, talented artist, and physician, devices derived from the magic lantern. at his side. To visually translate the core message of his In 1881, Marey received Muybridge in his home in thoughts, Charcot relied on Richer’s dual approach, Paris, along with leading scientific and artistic experts – medical and artistic. For the modern neurologist and Helmholtz, Brown-Se´quard, and Nadar, among others. historian, comparison of photographic materials and Marey immediately realized the potential of photography artistic renditions of the same patient offer a clear for recording movement, but at the same time, he was disindication of nuances associated with the two different appointed by the crudeness of Muybridge’s method. From methods (Endtz, 1983). this time on, Marey worked on developing a series of new techniques, both more elegant and more detailed than Muybridge’s. ANALYSIS OF MOVEMENT: It was during this trip to Europe that Muybridge MUYBRIDGE, MAREY AND LONDE discovered the gelatin dry-plate process, and recogThis important chapter in the history of photography, nized its superiority over wet-collodion. At that time which paved the way for cinematography, is essentially too, Muybridge conceived the plan of a huge, systemaa tale of two cities, Paris and Philadelphia, and of two tic study of humans and animals in motion. Back in the men, the physiologist Marey and the photographer United States, Muybridge started looking for a sponsor Muybridge (Mozley, 1979; Braun, 1992; Mannoni, for this undertaking, and finally, in 1883, he obtained 1999). The background setting for what would become the support of the University of Pennsylvania. Located modern moving pictures was definitely scientific: the in Philadelphia, the provost of the university was a Colle`ge de France and the University of Pennsylvania. young physician, William Pepper (Mozley, 1979; It was certainly not by chance that two of the most McVaugh, 1987). The project started in 1884, and Muyimportant neurological centers of the epoch were bridge worked for 3 years under the guidance of a immediately associated. supervisory commission. This commission included During his whole life, E´tienne-Jules Marey, French members of the Academy of Fine Arts, including physician and physiologist, and Professor at the Colhighly regarded painter Thomas Eakins, and professors le`ge de France, studied human and animal locomotion. of scientific studies at the university. He began to explore the movements of flying insects Since 1883, Muybridge had intended to include and birds, and after that the gaits of men and horses, photographs of movements of diseased human bodies. using graphic methods. In 1872, Leland Stanford, GovIn 1885, Francis Xavier Dercum, a physician, helped ernor of California, invited the English-American Muybridge make sequential photographs of patients photographer Eadweard James Muybridge to take with abnormal gait and pathological movements. photographs of horses trotting (Mozley, 1979). In From the beginning of his career, Dercum had been 1873, Marey published his book La Machine Animale interested in neurology. He had received the degrees

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of MD and PhD from the University of Pennsylvania (Burr, 1932; Throckmorton, 1942). He became assistant demonstrator of histology and later demonstrator in the laboratory of physiology under Professor Harrison Allen, at his alma mater. By 1884, he succeeded Charles K. Mills as chief of the nervous disease clinic in the Hospital of the University of Pennsylvania. That same year, he became one of the founders of the Philadelphia Neurological Society (Weisenburg, 1915). In 1887, Muybridge’s masterwork, Animal Locomotion, was published by the University of Pennsylvania. It contains 781 sequences of photographs of movements. More than half of these pictures are human figures: men, women and children. The rest are horses and all kinds of wild and domestic animals. The 29 plates with patients can be found in the eighth volume, titled Abnormal Movements, Males and Females (Nude & Semi-Nude). The great majority show neurological patients with gait disorders, including locomotor ataxia, infantile paralysis, spasticity, lateral sclerosis, paraplegia, muscular atrophy, and hydrocephalus (Fig. 20.4). Other abnormal movements illustrated are chorea and artificially induced convulsions. Some of these patients were recruited from the neurology services of the University Hospital and the Philadelphia Hospital; others were referred by various neurologists, including Weir Mitchell and Lloyd. Curiously, Dercum did not pursue sequential photography outside of this context. He published only two

papers on gait disorders and abnormal movements (Dercum, 1888a, b). The Text-book of Nervous Diseases by American Authors, which Dercum edited (Dercum, 1895), includes portions of four Muybridge plates illustrating spastic diplegia and chorea, myelitis (spastic paraparesis), “lateral sclerosis,” and tabes dorsalis. From his earlier interest in neurology, Dercum turned progressively to psychiatry and philosophy. Meanwhile Marey was beginning his photographic investigations with different new devices, inspired by the unifying principle of a single camera with a single lens. First, as early as 1882, Marey succeeded in taking 12 successive pictures in 1 s, on a single circular plate rotating before a lens equipped with a shutter. To achieve this goal, he developed a photographic gun, inspired by the method used by the French astronomer Pierre Janssen in 1873 to record the transit of Venus across the sun. This apparatus soon evolved into a new camera that could register the successive phases of movement on a fixed plate, thanks to a slotted-disk shutter. These pictures appeared the same year in La Nature as well as in Scientific American. For the first time, the successive components of movement appeared on a single photograph. Marey named this new method “chronophotography.” In the same eventful year, 1882, Marey set up his Station Physiologique, where he performed experiments on comparative analysis of movement, with the collaboration of a talented

Fig. 20.4. Muybridge, Infantile paralysis, child walking on hands and feet. Plate 539 from Animal Locomotion, Philadelphia: University of Pennsylvania, 1887. E´cole Nationale Supe´rieure des Beaux-Arts, Paris, France.

NEUROLOGICAL ILLUSTRATION: FROM PHOTOGRAPHY TO CINEMATOGRAPHY assistant, Georges Demeny¨, and a clever mechanic, Otto Lund. The part played by Demeny¨ in this collaboration, before its stormy end in 1893, has been recently re-evaluated, to Demeny¨’s credit (Mannoni, 1997; Lefebvre et al., 1999). Over the following years, the technical capabilities for photographing movement, as well as the chronophotographic camera, were steadily improved by Marey and Demeny¨ (Braun, 1992; Mannoni, 1999). In 1888, the University of Pennsylvania published a companion book to Muybridge’s Animal Locomotion, one containing three essays on Muybridge’s work. The authors were three professors of the university: Marks, Allen and Dercum. All three expressed an interest in Marey’s apparatus. Indeed, as early as 1884 Muybridge himself had used Marey’s wheel, a development of Marey’s photographic gun. This method had been favored by Eakins. Dercum had used it to take photographs of tremor and he had acknowledged its value and accuracy for studying other abnormal movements (Dercum, 1888c). Marey focused primarily on basic experimental work. However, very early on, he considered the possible clinical utility of his methods. Indeed, during a limited period around 1886, a few recordings of pathological gait were made by his team (Demeny¨ and Que´nu, 1888a, b; Marey, 1888). Londe, at the Salpeˆtrie`re, immediately realized the potential of chronophotography for recording movement and gait. In direct and friendly contact with Marey, he participated actively in discussions about the photographic analysis of movement and in the elaboration of solutions to this problem (Fig. 20.3). He built several types of multiple-lens cameras (Londe, 1893). In 1883, he first presented a photoelectric camera equipped with 9 lenses, arranged in a circle and successively uncovered. Ten years later, he refined this approach and designed a 12-lens camera, arranged in three parallel lines (Fig. 20.3). With these devices, he obtained a series of independent consecutive photographs, enabling him to study normal and pathological gait, tremor, epilepsy, etc. (Londe, 1911; Bernard and Gunthert, 1993; Gunthert, 1999). Among the physicians at the Salpeˆtrie`re, Richer showed the greatest interest in this new technique and worked in close connection with Londe. Indeed, during his entire career, Richer stood on the cusp between art and medical science. He used chronophotography not as a means of esthetic expression, but as a crude document in order to reveal the truth of the human body. The first publication of these chronophotographic studies dealt with normal locomotion (Richer, 1895). In his foreword, Richer announced the forthcoming

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publication of an atlas richly illustrated with their best chronophotographs. At that same time, Londe and Richer began to make chronophotographs of pathological gait (Londe, 1911). Those documents, precisely identified with the names of the patients and their diagnoses, have never been published. They constitute an exceptional set of neurological illustrations. They are kept at the E´cole Nationale Supe´rieure des Beaux-Arts in Paris, along with a very interesting unpublished paper on the subject by Richer, who would become professor of artistic anatomy there in 1903. As for the atlas, it was not to appear for another 25 years (Richer, 1921). Actually, unlike the clinical documents, which constitute a unique and original collection, this atlas does not show new material beyond the work done by Muybridge and Marey (Richer, 1921). The photographic activity at the Salpeˆtrie`re tapered off at the beginning of the 20th century for several reasons. Charcot, the mentor and main supporter of Londe and Richer in their photographic activity, died in 1893. Two years later, immediately after the discovery of Xrays by Roentgen, Londe turned to this new technique and personally organized the first radiology laboratory in Paris. After the photographic department was taken over by physicians, Londe handed in his resignation. Outside Paris, several distinguished neurologists made important but isolated contributions. The Romanian Marinesco, Professor of Neurology in Bucharest, published a chronophotographic study of hysteric hemiplegia (Marinesco, 1899a). With an adaptation of Marey’s technique, the Hungarian neurologist Jendrassik undertook a systematic study of gait in 8 normal subjects and 44 patients with various pathological gait disorders. He gathered these observations in an impressive and well-documented article (Jendrassik, 1901).

FROM ANALYSIS TO RECONSTRUCTION OF MOVEMENT: BIRTH OF CINEMATOGRAPHY Chronophotographic recordings had to be made in a very controlled environment. The next step in the study of movement was the recording of free movement in the natural world. Marey experimented with several technical possibilities, using a movable sensitive material. The inertia and weight of glass were definite drawbacks. In 1888, Marey began to use flexible films coated with a gelatin emulsion, developed by George Eastman in America. The first supports – paper, then transparent nitrocellulose – were rather fragile and difficult to work with. In the early 1890s, celluloid films were adopted.

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The last chronophotographic apparatus devised by Marey, using this mobile pellicle, was really the predecessor of the cinematographic camera (Tosi, 1984, 2005; Braun, 1992; Mannoni, 1999). Projecting the reconstructed images and screening films for the public was not Professor Marey’s goal. However, it immediately appealed to several inventors, among whom Demeny¨ was one of the first. In 1894, Thomas Edison, who had met Marey when he visited the Universal Exposition in Paris in 1889, proposed his kinetoscope, a coin-operated machine for individual motion picture viewing. As for most technological advances, no single date or person epitomizes this invention. However, history has remembered 1895 as the founding date of cinematography, with the projection of Lumie`re’s first films before a large audience in Paris and shortly thereafter abroad. Indeed the brothers Louis and Auguste Lumie`re, acquaintances of Marey, had developed an ingenious device for producing an intermittent movement, allowing both the recording and the projection of the sequential photographic frames. Cinematography was born. This opened a new era for the study of movement and gait in neurology (Hennes, 1910; Michaelis, 1955; Tosi, 1984, 2005; Aubert, 2000). What was common to all the early cinematographic equipment was the use of cellulose nitrate film – a highly unstable organic material that could decompose, burn, and explode. This extremely perishable medium partially explained why more than 80% of the world production of silent cinema has been irretrievably lost (Houston, 1994).

BEGINNINGS OF MEDICAL CINEMATOGRAPHY IN FRANCE Cinematographic screenings met with immediate success. First seen as an interesting technical development of photography, the invention was shown everywhere in Europe and America. Within a few months, it became a popular entertainment. Technicians were formed to master the various crafts. New professions appeared: cameraman, director, editor, producer, projectionist. Cinematography was presented in music halls, in variety shows, and in itinerant booths on fairgrounds, where it attracted thousands of curious onlookers (Tosi, 1984, 2005; Convents, 2000). Paris had been the hub of the rich interactions between the nascent disciplines of neurology, photography and chronophotography, and the Salpeˆtrie`re was still the world’s neurologic capital at the close of the 19th century (Goetz et al., 1995). Nevertheless, cinematography did not officially enter the Salpeˆtrie`re for a long time. In 1898, on a personal initiative, Londe purchased a movie camera and experimented with this

new technique. With Richer, he made 10 short films of neurological patients (Londe, 1911). They were never used in any publication. Only isolated blurred frames seem to have survived (Gunthert, personal communication). The first article dedicated to cinematography, and published in the journal Nouvelle Iconographie de la Salpêtrière, dates only from 1900 and came from Romania (Marinesco, 1900a). In 1898, a Polish photographer, Boleslav Matuszewski, drew attention to himself by publishing his ideas on the need to create “cinematographic deposits” (Tosi, 1984, 2005). In a booklet printed at his own expense in Paris, he expounded that cinema was A new source for history. Some months later, again at his own expense, he published a second booklet, La photographie animée, where he enumerated the advantages of cinematographic documentation over static photography in medical studies. He stated that he had filmed patients with nervous or mental diseases in St. Petersburg and Warsaw, as well as at the hospitals of Saint-Antoine and La Pitie´, in Paris. Nothing of this production, however, has been located.

SURGICAL CINEMATOGRAPHY: FROM INNOVATION TO SCANDAL Social prejudice against the new medium might explain the slow emergence of medical applications for cinematography in France. Moreover, the aspirations of the surgeon Doyen seem to have played a major role in inhibiting the take-off of medical cinematography. Euge`ne-Louis Doyen was a brilliant and bold French surgeon, who practiced in a private clinic in Paris (Cantacuze`ne, 1973; Tosi, 1984, 2005; Lefebvre, 1994; EssexLopresti, 1997). He tackled all surgical domains, including neurosurgery. In 1898, he hired two established cameramen and asked them to film him while operating. A few months later he presented three films at the British Medical Association in Edinburgh, one of them about craniotomy. However, the official French medical societies objected. The Acade´mie de Me´decine and the French Congress of Surgery prevented him from projecting his films at subsequent scientific meetings. In 1899, he founded his own private journal, the Revue Critique de Médecine et de Chirurgie. In the first issue, Doyen wrote an extensive article on the potential of cinematography in teaching (Doyen, 1899). It could well have further irritated the official teaching powers in France. Meanwhile, one of Doyen’s cameramen had printed and sold numerous copies of his films all over Europe, and soon these films were shown everywhere, even at fairgrounds. Doyen sued his unscrupulous cameraman and won one of the first lawsuits involving a film. The

NEUROLOGICAL ILLUSTRATION: FROM PHOTOGRAPHY TO CINEMATOGRAPHY 297 screening of these films in non-medical circles and at in profile (Barboi et al., 2004). Patients were generally fairgrounds brought cinematography into disrepute filmed nude, with Marinesco in his broad-brimmed among the official medical community and froze hat and laboratory coat urging them along in straight further attempts in France for almost 10 years. Not lines. The films were employed as documentation of until 1909 were films of patients with chorea, athetosis, responses to therapy and disease evolution, and served and tics shot in Pierre Marie’s department at Biceˆtre as excellent education materials. Marinesco must also Hospital (Sainton, 1909). be credited with the first medical thesis documented Of the scores of films directed by Doyen, once conby motion pictures (Tosi, 1984, 2005). served by the Gaumont Company, almost everything Marinesco apparently suspended this cinematohas disappeared. Only a few minutes of film, nothing graphic activity in 1902. The departure of Popesco, his of neurological interest, have survived (CNRS, Paris cameraman, as well as the Parisian whiff of scandal and Centre National de la Cine´matographie, Bois around Doyen, may explain this sudden interruption. d’Arcy). In 1973, reels of Marinesco’s original nitrate films were retrieved in Bucharest and copied onto modern films. The miraculous survival of these films allows PIONEERS OF CINEMATOGRAPHY the replay of archetypal neurological diseases, some IN NEUROLOGY before any specific treatment was available (i.e., ParkinNeurologists immediately foresaw the interest of son’s disease). Only a few short excerpts have been motion pictures for research and teaching. Germany screened and published, although Cantacuze`ne speaks was the first country to welcome cinematography in a of more than 70 patients (Cantacuze`ne, 1973; Barboi neurology department (Sainton, 1909; Nichtenhauser, et al., 2004). Unfortunately most of the collection 1952; Essex-Lopresti, 1997). Recently, Podoll published appears to be of poor quality. The original films are a remarkable in-depth study of these beginnings now catalogued in the Romanian National Film (Schuster, 1898; Podoll and Lu¨ning, 1998). The pioneer Archive in Bucharest, together with their reprocessed was Paul Schuster who used cinematography in Berlin versions. as early as 1897. Movement and gait disorders were The first published mention of moving pictures in the subjects of these first attempts, with a definite pedAmerica dates to 1905 and came from Boston (Chase, agogic objective. Schuster was followed by Kraepelin 1905). After reporting the prior attempts of Alex in Munich, Foerster in Breslau and Westphal and McLane Hamilton, who reproduced pathologic gaits Hennes in Bonn (Weiser, 1919; Podoll and Lu¨ning, with a Lumie`re camera, Walter Greenough Chase 1998). Apparently, nothing of this German cinematoexpounded on the interest of the new medium in medigraphic output before World War I has survived cine. In a paper illustrated with single-frame excerpts, (Podoll, personal communication, 2001). he presented an impressive study of epileptic seizures Independently, in 1898, the Romanian Georges Marat the Craig Colony for Epileptics, in Sonyea, New inesco began to film neurological patients with one of York. With the assistance of Drs. Collier, Shanahan his assistants, Constantin Popesco (Cantacuze`ne, 1973; and Ross, Chase was able to film 21 separate seizures, Tosi, 1984, 2005; Barboi et al., 2004). Following his including one case of status epilepticus. Today, a short medical studies in Bucharest, Marinesco had a very sequence of this study is conserved at the Huntley Film thorough education in Western Europe, where he spent Archives (UK). 9 years (Kernohan, 1970). On his return to Bucharest Around 1908, Theodore H. Weisenburg began to take from Paris, he brought back a cinematographic camera. moving pictures of neurological patients in Philadelphia. His team filmed numerous patients with organic gait By 1912, he had assembled what appears to be the first disorders, hysteria, locomotor ataxia, Parkinson’s discollection on nervous and mental diseases in America ease and myopathies. (Weisenburg, 1912; Nichtenhauser, 1952). He emphaBetween 1899 and 1902, Marinesco published eight sized the scientific value and the interest of motion picarticles that incorporated lined tracings taken from the tures for scientific studies and teaching purposes. His footage from these early movies (Marinesco, 1899b, original films have, unfortunately, not been located. 1900b–e, 1901, 1902). Frame by frame analysis of the In 1908, the Italian Camillo Negro, Professor of drawings executed from film were strongly influenced Neurology at the University of Turin, collaborated with by the chronophotographic studies of Marey and Richer, his friend Roberto Omegna, the owner of the largest and enabled original clinical observations (Fig. 20.5). movie studios at the time in Italy (Tosi, 1984, 2005; Chio` These films show Marinesco among his many and Mutani, 2003). Together, they filmed several patients, usually filmed in groups of similar diagnoses, patients with neurologic disorders, including movement walking toward and away from the camera or walking disorders (tremors, tics, dystonia, parkinsonism), various

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Fig. 20.5. Marinesco, drawings after the photograms. From “Les troubles de la marche dans l’he´miple´gie organique e´tudie´s a` l’aide du cine´matographe.” Sem Med 19: 225–228, 1899b.

gait disturbances, and gaze disturbances. The association of a neurologist with an art director illustrates the growing interest in scientific and medical cinematography around 1908–1909, with the emergence of a professional and institutionalized practice. With the title “La nevropa-

tologia” (neuropathology), the film was presented for the first time in Turin, and in April 1908 at the first meeting of the Italian Neurological Society in Naples. The extant 35-mm original nitrate film is 108 min long and has been preserved at the National Museum of Cinema in Turin.

NEUROLOGICAL ILLUSTRATION: FROM PHOTOGRAPHY TO CINEMATOGRAPHY

ARTHUR VAN GEHUCHTEN’S MOVING PICTURES LEGACY Arthur Van Gehuchten’s cinematographic production, as it survives today, appears unique in its size and diversity, both in his own time and, even more, one century later (Aubert, 2002b). Arthur Van Gehuchten is an important founding figure of the neurological sciences (Papez, 1953; Van Gehuchten, 1974; Shepherd, 1991; Aubert, 2001, 2002a). Born in Antwerp, Belgium in 1861, he was trained as a microscopist and a cytologist. From neuroanatomy, he progressively broadened his interest to neurology and, in 1896, was one of the founders of the Belgian Society of Neurology. The first neurological department in Belgium was created for him in 1908 signaling the recognition of his commitment to the field. His labor was cut short in 1914 with the outbreak of World War I. A few months later, Van Gehuchten died unexpectedly at the age of 53 in Cambridge, UK. He had just completed his neurological textbook, Les Maladies Nerveuses, published in 1920 thanks to the endeavors of his son Paul, who would later succeed his father as Chair of Neurology. As a researcher, Arthur Van Gehuchten took great care in the illustration of his work. As a teacher, he was very eager to adopt new visual aids in order to stimulate the interest of his audience. In 1907, Van Gehuchten published his first paper illustrated with films (Van Gehuchten, 1907) in Le Névraxe, the journal he had founded in 1900. It is a detailed physiopathological study of a patient with a complex traumatic lesion of the spinal cord. To illustrate the peculiar gait of this patient, Van Gehuchten used some strips of film. In a footnote to this paper, he explained that, for 2 years, he had been using cinematography in neurology. From then on, he began systematically to film neurologic patients, with the intention of building up a complete neurological iconographic collection. This is confirmed by a letter to the rector of the university dated 16 July 1911 and kept at the Universiteitsarchief, Katholieke Universiteit Leuven, Belgium. Van Gehuchten personally dealt with all the steps of the process, from shooting to screening. Van Gehuchten used motion pictures to demonstrate neurological semiology (Van Gehuchten, 1908, 1920), to illustrate various neurological diseases (Van Gehuchten, 1910a, 1920), and to document spontaneous evolution of disease or functional recovery following surgery (Van Gehuchten, 1910b, 1920). An avant-garde teacher, he enlivened his lectures for medical students or at scientific meetings with photographic and matographic screenings (Fig. 20.6) (Van Gehuchten, 1910a, 1913). Contemporaries were clearly impressed by these performances (Kappers, 1914).

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The matching of the original films with Van Gehuchten’s publications led to the conclusion that they are the oldest Belgian films surviving at the Royal Belgian Film Archive. Van Gehuchten’s 35 mm original nitrate films (about 100 short sequences, accounting for about 2 h) were rediscovered at the end of the 20th century and restored in the laboratory of the Royal Belgian Film Archive. They are now safely stored in their vaults. Later copies of 16 mm and 8 mm films have been discovered at the Library of the Faculty of Medicine of the Universite´ Catholique de Louvain and in private collections. Additional footage (about 1 h), of which the original had not been conserved, has been found on these later copies. The original films were copied onto acetate and all the films were transferred to videotape and later to a digital submaster. The catalogue is extremely varied with regard to patients’ ages and clinical material, including gait and movement disorders, neuromuscular diseases, and epileptic and hysteric seizures. Sequences were shot both indoors and outdoors, in the university hospital premises or garden, or in patients’ homes. This must have been no small task, considering the weight and how cumbersome the equipment was to transport at the time. In 1910, the first International Congress for Cinematography was held during the International Exhibition in Brussels. Van Gehuchten was one of the vice-presidents of this meeting (Convents, 1979). Among the topics discussed was the application of cinematography to scientific research and teaching, as well as the organization and management of archives. Gathering such a collection of motion pictures was a demanding venture, especially as it was the work of a single person, in turn physician, cameraman, director, editor and lecturer. The difficulties and cost of film making have been emphasized by several authors (Sainton, 1909; Weisenburg, 1912; Michaelis, 1955). Van Gehuchten’s manual skills, developed in preparing microscope slides, anatomic preparations and photographic plates, were an asset (Van Gehuchten, 1974). The unprecedented academic support he received not only alleviated the expense but also gave his undertaking a guarantee of seriousness. It probably also explains why the films have survived. After the war and the death of Van Gehuchten, the films became part of the visual aids used by Van Gehuchten’s successors to the chair of neurology in Louvain. For decades, these films have been screened for medical students.

EPILOGUE The interface between scientific study and entertainment, between innovation and scandal, has haunted medical cinematography since its early years. The integration of photography in clinical practice, particularly

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Fig. 20.6. Caricature of Arthur Van Gehuchten. From Ons Leven, a student journal of Louvain. Courtesy of Universiteitsarchief, Katholieke Universiteit Leuven, Belgium.

in neurology, had been straightforward. By contrast, cinematography faced unexpected social and psychological barriers. The pioneers had to show a great independence of spirit to take a cinematograph in a hospital ward or at scientific meetings. Even decades later, when motion pictures were accepted as a standard visual aid in neurology, cinematographic activity was often not considered worth mentioning. The biographical notes on Marinesco and Van Gehuchten in Haymaker’s Founders of Neurology (Papez, 1953; Kernohan, 1970) ignored their involvement in cinematography. In 1957, Arthur Van Gehuchten’s memory was honored during the International Congress held in Brussels, which marked the foundation of the World Federation of Neurology. But it was as a brilliant neuroanatomist that he was remembered. Not a single word on the subject of his cinematographic activity was uttered (Bailey, 1957). This long eclipse is all the more surprising, since in his own time this achievement had had a fair degree of publicity and his obituaries in international journals reported it with admiration (Batten, 1914; Kappers, 1914). Yet not a single article, chapter or book devoted to medical cinematography mentioned his name up to the end of the 20th century (Weiser, 1919; Nichtenhauser, 1952; Michaelis, 1955).

Motion pictures constitute a hitherto neglected cultural heritage (Cherchi Usai, 1994; Houston, 1994). The majority of all films ever made no longer exist (Houston, 1994). On both sides of the Atlantic, through organizations such as the International Federation of Film Archives, a few scholars and archivists struggle to ensure the survival and revival of images, following the Recommendations for the Safeguarding and Preservation of Moving Images adopted by the UNESCO in 1980. The situation is even more dramatic for medical films (Michaelis, 1955; Tansey, 1993), and particularly for those produced by the pioneers in neurology. Indeed most were isolated amateurs working outside commercial circuits. Important documents might still be lying in forgotten cans – silent witnesses of another neurological era. The films that have survived should receive attention and care before the flickering images of our neurological past irredeemably disappear.

REFERENCES Aubert G (2000). Photographie et cine´matographie me´dicales avant 1914: rapports privile´gie´s avec les neurosciences. Bull Mem Acad R Med Belg 155: 130–140. Aubert G (2001). Arthur Van Gehuchten (1861–1914). J Neurol 248: 439– 440.

NEUROLOGICAL ILLUSTRATION: FROM PHOTOGRAPHY TO CINEMATOGRAPHY Aubert G (2002a). From photography to cinematography: recording movement and gait in a neurological context. J Hist Neurosci 11: 248–257. Aubert G (2002b). Arthur Van Gehuchten takes neurology to the movies. Neurology 59: 1612–1618. Bailey P (1957). Great names in neurology. In: Bibliography of Writings by Joseph Babinski, Sir Victor Horsley, Sir Charles Sherrington and Arthur Van Gehuchten. National Institute of Neurological Diseases and Blindness, National Institutes of Health, Bethesda, MD. Barboi AC, Goetz CG, Musetoiu R (2004). The origins of scientific cinematography and early medical applications. Neurology 62: 2082–2086. Batten FE (1914). Obituary. Albert Van Gehuchten. BMJ 2817: 1121–1122. Bernard D, Gunthert A (1993). L’instant reˆve´. Albert Londe. Jacqueline Chambon, Nıˆmes. Braun M (1992). Picturing Time. The Work of E´tienne-Jules Marey (1830–1904). The University of Chicago Press, Chicago, IL and London. Burr CW (1932). Memoir of Dr. Francis X. Dercum. Trans Coll Physicians Phila 54: lxv–lxxi. Cantacuze`ne J (1973). Soixante-quinze ans depuis la cre´ation du cine´ma de recherche me´dicale. Hist Sci Med VII: 291–302. Chase WG (1905). The use of the biograph in medicine. Boston Med Surg J CLIII: 571–573. Cherchi Usai P (1994). Burning Passions. An Introduction to the Study of Silent Cinema. British Film Institute (BFI), London. Chio` A, Mutani R (2003). Arthur Van Gehuchten takes neurology to the movies – correspondence. Neurology 61: 587–588. Convents G (1979). De komst en de vestiging van de kinematographie te Leuven, 1895–1918. In: L Van Buyten (Ed.), Fiets and Film Rond 1900: Moderne Uitvindingen in de Leuvense Samenleving (Jaarboek 1979 edn). Crab, Leuven, pp. 257–422. Convents G (2000). Van kinetoscoop tot Cafe´-cine´. De Eerste Jaren van de Film in Belgie¨ 1894–1908. Universitaire Pers, Leuven. Cuthbertson RA (1990). The highly original Dr. Duchenne. In: RA Cuthbertson (Ed.), The Mechanism of Human Facial Expression. Cambridge University Press, Cambridge, pp. 225–241. Darwin C (1998). The Expression of the Emotions in Man and Animals. Definitive edition. 3rd edn. Harper Collins, London. Dean J (1864). The Grey Substance of the Medulla Oblongata and Trapezium Collins, Philadelphia. Demeny¨ G, Que´nu E (1888a). De la locomotion dans l’ataxie locomotrice. CRAS 108: 963–964. Demeny¨ G, Que´nu E (1888b). E´tude de la locomotion humaine dans les cas pathologiques. CRAS 107: 1550–1564. Dercum FX (1888a). A study of some normal and abnormal movements. Trans Coll Physicians Phila 10: 130–133. Dercum FX (1888b). The walk and some of its phases in disease. Trans Coll Physicians Phila 17: 308–338. Dercum FX (1888c). A study of some normal and abnormal movements photographed by Muybridge. In: Animal Locomotion: The Muybridge Work at the University of Pennsylvania – The Method and the Result. Lippincott, Philadelphia, PA, pp. 103–133. Dercum FX (1895). A Text-Book of Nervous Diseases by American Authors. Lea Bros. Philadelphia, PA. Didi-Huberman G (1982). Invention de l’Hyste´rie. Charcot et l’Iconographie Photographique de la Salpeˆtrie`re. Macula, Paris.

301

Didi-Huberman G (2003). Invention of Hysteria. Charcot and the Photographic Iconography of the Salpeˆtrie`re. MIT Press, Cambridge, MA. Doyen (1899). Le cine´matographe et l’enseignement de la chirurgie. Revue Critique de Me´decine et de Chirurgie 1: 1–6. Duchenne de Boulogne G-B (1862). Album de Photographies Pathologiques Comple´mentaire du Livre Intitule´ De l’E´lectrisation Localise´e. J.B. Baillie`re et fils, Paris. Duchenne de Boulogne G-B (1862). Me´canisme de la physionomie humaine ou analyse e´lectro-physiologique de l’expression des passions applicable a` la pratique des arts plastiques, Renouard, Paris. Duchenne de Boulogne G-B (1990). The Mechanism of Human Facial Expression. Cambridge University Press, Cambridge. Endtz LJ (1983). La neurologie et l’illustration photographique du livre me´dical. Rev Neurol 139: 439–444. Essex-Lopresti M (1997). Centenary of the medical film. Lancet 349: 819–820. Goetz CG (1991). Visual art in the neurologic career of JeanMartin Charcot. Arch Neurol 48: 421–425. Goetz CG, Bonduelle M, Gelfand T (1995). Charcot, Constructing Neurology. Oxford University Press, New York and Oxford. Gunthert A (1999). Albert Londe. Nathan, Paris. Hennes H (1910). Die Kinematographie im Dienste der Neurologie und Psychiatrie, nebst Beschreibung einiger selteneren Bewegungssto¨rungen. Med Klin 6: 2010–2014. Houston P (1994). Keepers of the Frame. The Film Archives. British Film Institute (BFI), London. Jendrassik E (1901). Klinische Beitra¨ge zum Studium der normalen und pathologischen Gangarten. Aus der II. Medicinischen Klinik. Deutsches Archiv f Klin Medicin LXX: 81–132. Kappers CUA (1914). In memoriam A. Van Gehuchten. Psychiatr Neurol Bladen 6: 1–5. Kemp M, Wallace M (2000). Spectacular Bodies. The Art and Science of the Human Body from Leonardo to Now. University of California Press, Berkeley, CA. Kernohan JW (1970). Georges Marinesco (1864–1938). In: W Haymaker, F Schiller (Eds.), The Founders of Neurology. One Hundred and Forty-Six Biographical Sketches by Eighty-Eight Authors. Charles C. Thomas, Springfield, IL, pp. 345–347. Lefebvre T (1994). Le docteur Doyen, un pre´curseur. In: A Martinet (Ed.), Le Cine´ma et la Science. CNRS Editions, Paris, pp. 70–77. Lefebvre T, Maltheˆte J, Mannoni L (1999). Lettres d’E´tienne-Jules Marey a` Georges Demeny¨. 1880–1894. Association Franc¸aise de Recherche sur l’Histoire du Cine´ma. Bibliothe`que du Film, Paris. Londe A (1893). La Photographie Me´dicale. Application aux Sciences Me´dicales et Physiologiques. Gauthier-Villars et Fils, Paris. Londe A (1911). Notice sur les Titres et les Travaux Scientifiques de M. Albert Londe. A. Gauthier-Villars, Masson et Cie, Paris. McVaugh MR (1987). Francis X. Dercum and animal locomotion. Caduceus 3: 1–35. Mannoni L (1997). Georges Demeny¨, Pionnier du Cine´ma, 1850–1917. Pagine, Douai. Mannoni L (1999). E´tienne-Jules Marey, la Me´moire de l’Oeil. Mazzotta. Cine´mathe`que Franc¸ais, Paris.

302

G. AUBERT

Marey EJ (1873). La Machine Animale. Locomotion Terrestre et Ae´rienne. Baillie`re, Paris. Marey EJ (1874). Animal Mechanism: A Treatise on Terrestrial and Aerial Locomotion. Henry S. King & Co., London. Marey EJ (1888). De la claudication par la douleur. CRAS 107: 641–643. Marinesco G (1899a). Les troubles de la marche dans l’he´miple´gie organique e´tudie´s a` l’aide du cine´matographe. Sem Med 19: 225–228. Marinesco G (1899b). Un cas d’he´miple´gie hyste´rique gue´ri par la suggestion hypnotique et e´tudie´ a` l’aide de la chronophotographie. Sem Med 19: 421. Marinesco G (1900a). Un cas d’he´miple´gie hyste´rique gue´ri par la suggestion hypnotique et e´tudie´ a` l’aide du cine´ matographe. Nouvelle Iconographie de la Salpeˆtrie`re XIII: 176–183. Marinesco G (1900b). Kinematographische Darstellung pathologischer Gangarten. Arch Psychiatr Nervenkr 33: 1051. Marinesco G (1900c). Les applications ge´ne´rales du cine´matographe aux sciences biologiques et a` l’art. Rev Gen Sci Pures Appl February 15: 117–125. Marinesco G (1900d). Sur les troubles de la marche dans les paraple´gies organiques. Sem Med 20: 71–75. Marinesco G (1900e). Verwendung des Kinematographen zum studium der Gehsto¨rungen. Monatsschr Psychiatr Neurol 8: 304. Marinesco G (1901). Les troubles de la marche dans l’ataxie locomotrice progressive. Sem Med 21: 113–119. Marinesco P (1902). La paralysie pseudo-hypertrophique ou myoscle´rosique. In: P Brouardel, A Gilbert (Eds.), Traite´ de Me´decine et de The´rapeutique, JB Baillie´re, Paris, p. 803. Michaelis AR (1955). Research Films in Biology, Anthropology, Psychology, and Medicine. Academic Press, New York. Mozley AV (1979). Introduction to the Dover edition. In: AV Mozley (Ed.), Muybridge’s Complete Human and Animal Locomotion. Dover Publications, New York, pp. i–xxxviii. Muybridge EJ (1887). Infantile paralysis, child walking on hands and feet. In: Animal Locomotion (11 Volumes). University of Pennsylvania, Philadelphia, Plate 539. Nichtenhauser A (1952). The development of the short film in medicine and medical teaching. Sci Film 2: 8–19. Papez JW (1953). Arthur van Gehuchten (1861–1914). In: W Haymaker, F Schiller (Eds.), The Founders of Neurology. 133 Biographical Sketches. Charles C. Thomas, Springfield, IL, pp. 38–41. Podoll K, Lu¨ning J (1998). Geschichte des wissenschaftlichen Films in der Nervenheilkunde in Deutschland 1895–1929. Fortschr Neurol Psychiatr 66: 122–132. Poirier J, Signoret J-L (1991). De Bourneville a` la Scle´rose Tube´reuse. Une e´poque. Un Homme. Une Maladie. Flammarion, Paris. Records of the General Conference of UNESCO, Twenty-first Session Belgrade, 23 September to 28 October 1980, p153–161. Web site: http://portal.unesco.org/fr/ev.phpURL_ID=13139&URL_DO=DO_TOPIC&URL_SECTION =201.html. Richer P (1895). Physiologie Artistique de l’Homme en Mouvement. Octave Doin, Paris. Richer P (1921). Nouvelle Anatomie Artistique du Corps Humain. III. Physiologie, Attitudes et Mouvements. Plon-Nourrit, Paris.

Ru¨dinger N (1861–1867). Atlas des peripherischen Nervensystems des menschlichen Ko¨rperes. J.G. Cotta’schen, Stuttgart & Mu¨nchen. Sainton P (1909). Quelques conside´rations sur l’utilite´ de la cine´matographie dans l’e´tude des maladies du syste`me nerveux. Ence´phale 4: 410–413. Schuster P (1898). Vorfu¨hrung pathologischer Bewegungskomplexe mittelst des Kinematographen und Erla¨uterung derselben. In: A Wangerin, O Taschenberg (Eds.), Verhan¨ rzte. dlungen der Gesellschaft Deutscher Naturforscher und A Versammlung zu Braunschweig, 20–25 September 1897. 3 Ba¨nde. F.C.W. Vogel, Leipzig, pp. 196–199. Shepherd GM (1991). Foundations of the Neuron Doctrine. Oxford University Press, New York. Tansey EM (1993). Film sources in medical history. J Audiov Media Med 16: 148. Taureck R (1980). Die Bedeutung der Photographie fu¨r die medizinische Abbildung im 19 Jahrh. Ko¨lner Medizinhistorische Beitra¨ge, Ko¨ln. Throckmorton TB (1942). Francis X. Dercum: physician, teacher and philosopher. J Nerv Ment Dis 96: 529–541. Tosi V (1984). Il Cinema Prima di Lumiere. Edizioni Radiotelevisione Italiana (ERI), Torino. Tosi V (2005). Cinema Before Cinema. The Origins of Scientific Cinematography. Wallflower Press Distributor of Books from the British Universities Film & Video Council, London. Van Gehuchten A (1907). Coup de couteau dans la moelle lombaire. Essai de physiologie pathologique. Le Ne´vraxe IX: 208–232. Van Gehuchten A (1908). Le mouvement pendulaire ou re´flexe pendulaire de la jambe. Contribution a` l’e´tude des re´flexes tendineux. Le Ne´vraxe X: 263–266. Van Gehuchten A (1910a). Over myopatische ziekten. Voordracht met kinematographische lichtbeelden. Handelingen van het XIVe Vlaamsch Natuur- en Geneeskundig Congres, pp. 1–8. Van Gehuchten A (1910b). La radicotomie poste´rieure dans les affections nerveuses spasmodiques (modification de l’ope´ration de Foerster). Bulletin de l’Acade´mie royale de Me´decine de Belgique December 3: 1–43. Van Gehuchten A (1913). Het doorsnijden der achterste ruggemergwortels als behandeling van zekere vormen van spastische paraplegie (met kinematographische lichbeelden). Handelingen van het XVIe Vlaamsch Natuur- en Geneeskundig Congres, pp. 422–433. Van Gehuchten A (1920). Les Maladies Nerveuses, 1st edn., Librairie Universitaire, Uystpruyst, Louvain. Van Gehuchten P (1974). In: P Bailey (Trans.), The Scientific Work of Arthur Van Gehuchten. Imprimerie des Sciences, Bruxelles. Weisenburg TH (1912). Moving picture illustrations in medicine with special reference to nervous and mental diseases. JAMA 59: 2310–2312. Weisenburg TH (1915). The founders and work of the Philadelphia Neurological Society. J Nerv Ment Dis 42: 419–440. Weiser M (1919). Medizinische Kinematographie. Verlag von Theodor Steinkopff, Dresden and Leipzig.