The impact of the collaboration between photographer Eadweard Muybridge and neurologist Francis Dercum is detailed within the context of a photographic study of an artificially induced psychogenic non-epileptic seizure. Their contribution served as inspiration to other contemporary European neurologists and photographers to use motion photography to further understand psychogenic neurological disorders, such as seizures.

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Introduction

Video electroencephalogram (video-EEG) has become the 21st century technological gold standard in distinguishing psychogenic non-epileptic seizures (PNESs) from epileptic seizures, albeit the distinction is not always straightforward and it may take several years to arrive at the correct diagnosis [1]. The roots of the video component of the video-EEG can be traced to the advent of photography in the 19th century. Prior to the age of video-EEG, early neurologists utilized photography to capture PNES episodes frame by frame and displayed sequential photographs in rapid succession to recreate PNES episodes. Many other movement disorders were similarly studied and captured using photographic technology. As such, many scholars proposed the theses that the scientific pursuit of capturing motion was a key driver for the development of photographic technology [2]. In the late 1830s, Frenchman Joseph Nicéphore Niépce (1765–1833) exposed a pewter plate coated with bitumen to light by using a portable camera obscura. This is the first image recorded in history that did not fade spontaneously [3]. The frozen moment through the photograph allows for detailed analysis of the action in question, opening the gates for further investigation of human motion and conditions. One of the first to bring photography into neurology was Jean-Martin Charcot (1825–1893). For his study of hysteria, he incorporated visual arts to help illustrate the pathology and presentation to his audience. In addition to photography, Charcot was a fan of medical artwork. He collaborated with his assistant, physician, and artist, Paul Richer (1849–1933), who brought his neurological insights onto canvases and photographs. Perhaps it was Charcot’s use of photographic technology and visual arts in neurology at La Salpêtrière that inspired others to follow suit. Across the Atlantic Ocean, in Pennsylvania, a few years later, Eadweard Muybridge (1830–1904), a generational photographer who pioneered motion photography technology, collaborated with Francis Xavier Dercum (1856–1931), renowned neurologist, to study PNESs, along with other neurological disorders, and capture convulsive episodes [1-4].

Eadweard Muybridge

Edward James Muggeridge was born in Kingston, England, on April 9, 1830. He was described as a daring, duplicitous, and temperamental man. He left his hometown Kingston and immigrated to America at the age of 20 years where he adopted the name Eadweard Muybridge [5]. His life was completely altered after suffering from a severe head injury in 1860 when he was violently thrown off his stagecoach and crashed his head into a boulder. This orbitofrontal injury would have lasting effects on his personality and behaviors. Muybridge went from a pleasant and genial businessperson to a volatile, eccentric, risk-taker. The neurological changes in the brain were not well documented at the time; however, personal anecdotes from individuals who knew him before and after noted significant psychological change after the injury. In 1866, Muybridge was introduced to photography by collaborating with his friend, Silas Selleck (1828–1885). It was not until 1868 that he made a name for himself through his photographs of Yosemite Valley, CA. In the span of 20 years, Muybridge went from a novice acquiring the skills of photography to an eminent photographer whose work influenced the world. He would risk his life to capture photographs, to the extent that “the picture was everything” [6]. In 1872, Muybridge began to dive deeper into the study of photographing motion. He was hired by Stanford University founder and 8th Governor of California, Leland Stanford (1824–1893), to photograph a racehorse to settle an argument that a trotting horse has all four hooves leave the ground simultaneously. His initial attempt failed as his camera did not have a shutter that was fast enough to capture the image he wanted. Muybridge continued to craft his skill and would soon achieve promising results. However, his project was briefly disrupted in 1874. After 3 years of marriage, he discovered his wife’s adultery and shot and killed her lover. Muybridge was later acquitted as the homicide was deemed justifiable on the basis of “seduction of his wife” [7]. In 1877, Muybridge resumed his work in motion photography and found a breakthrough. He utilized a fleet of 12–24 cameras and a unique shutter he developed to provide an exposure of 2/1,000 of a second to capture moving animals and humans which allowed sequential photographs to become animated. The zoopraxiscope, as he named the invention, first shown in 1879, turned photographs into stories, pioneering the technology of motion photography and cinema [5, 7]. Over a decade later, this invention was a sensation in World’s Columbian Exposition in Chicago in 1893 [5].

The Muybridge-Dercum Collaboration

The interdisciplinary collaboration between Muybridge and neurologist Francis Dercum marked an early application of motion photographic technology in neurology. In 1883, provost of the University of Pennsylvania, William E. Pepper, Jr., MD, LLD (1843–1898), invited Muybridge to the university to continue expansion of his monumental work on humans and animals in motion. Due to logistic difficulties, members of the commission, originally assigned to take part in the project, left on vacation. This stroke of luck provided Dercum, previously not assigned to the project, an opportunity to work with Muybridge [8]. While both men were working at the University of Pennsylvania during 1885–1887, it culminated with the photographic catalog Animal Locomotion, with Muybridge as the motion technology powerhouse and Dercum, Chief of Clinic in Nervous Disease at the University of Pennsylvania and pathologist for the insane in Pennsylvania State Hospital, providing the neurological cases [7-9].

Dercum was a man of many talents. In addition to his success in medicine, he was a philosopher, teacher, scientist, and a prolific writer, who published over two hundred papers. Dercum was born on August 10, 1856, in Philadelphia, Pennsylvania, into a German family with a long line of physicians and scientists. He attended the University of Pennsylvania Medical School, earning his doctoral degree in 1877 at age of 21 years [10]. He entered private practice and would earn a membership in the Academy of Natural Sciences the next year. In 1884, Dercum was one of the founders of the Philadelphia Neurological Society. He later became the Chief of Clinic in Nervous Disease at the University of Pennsylvania and served as the President of American Neurological Society. By the early 1920s, Dercum had become a world-renowned physician participating in various American and European neurological societies. He was President Woodrow Wilson’s (1856–1924) personal physician from 1919 when he succumbed to a stroke until Wilson’s passing in 1924 [10-13].

While at the State Hospital for the Insane in Norristown, Pennsylvania, he became interested in PNES, known as hysterical seizures during their time [6]. In the treatise Artificial Induction of Convulsive Seizures (1884), in collaboration with Dr. Andrew Parker, they describe a method by which seizures could be artificially induced which recalled the hystero-epilepsy cases described by Charcot and Richer from La Salpêtrière [14] and served as the inspiration for Muybridge’s photograph A woman on the ground with artificially induced convulsion (Fig. 1.) The induction method was simple, consisting of placing the person in a position of effort and asking them to concentrate their thoughts on any one object on the room. After a lapse of several minutes, tremors will commence and be rapidly magnified into violent movements and contortions, without alteration of consciousness. A curious observation was the contagious nature of the episodes to other similar patients – “very much as a yawn is contagious” [14].

Fig. 1.

A woman on the ground with artificially induced convulsions. Collotype after Eadweard Muybridge, 1887. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk; http://wellcomeimages.org. A woman on the ground with artificially induced convulsions. Photogravure after Eadweard Muybridge, 1887. 1887 by Eadweard Muybridge and University of Pennsylvania. Published: 1887 (public domain mark).

A Woman on the Ground with Artificially Induced Convulsions

Animal Locomotion (1887) is an amalgamation of 781 plates, 95 plates devoted to horses, 124 devoted to other animals, and 562 devoted to human motion. It is a composition of 11 volumes and 19,347 individual photographs. Contributors to the work included prominent figures from the US government, institutions of sciences, and colleges and universities. While this masterpiece was an unequivocal success that propelled Muybridge into international stardom, the contributions from Dercum were left largely neglected. In rare instances where Dercum’s involvement was highlighted, this was condensed and often inaccurate [7, 15].

A woman on the ground with artificially induced convulsions (Fig. 1), plate #544, was one of the 20 neurological subjects photographed by Muybridge in collaboration with Dercum. The photograph of an induced PNES is found in volume 8 of Animal Locomotion along with other neurological cases, such as paraparesis, locomotor ataxia (tables dorsalis), paranoid psychosis, multiple sclerosis, hysteria with psychogenic gait, and psychogenic movement disorder [7, 9, 16]. On the left column, the sequential photographs depict the subject lying in a supine position with her head veering to the right and wrist floating in midair, mimicking the motion of a conductor directing a symphony. The middle column sequence depicts the woman lying on her left side with her eyes closed, head sinking into the canvas, and her right arm placed at an angle in a stiff, tonic position. The right column sequence captures a position with arms angled and flexed along with rhythmic choreoathetoid-like movements of the hands. Based on classification scheme for PNES by Seneviratne et al., the sequence of motions falls under the category of complex motor PNES [17]. All three columns showed minimal lower extremity motor movements. Complex motor PNES in Seneviratne’s cohort represented about 10% of all PNES patients. These seizures are characterized by complex and multifocal movements of the extremities such as varying combinations of flexion, extension, abduction, and adduction with or without clonic-like and myoclonic-like asymmetric-asynchronous movements. Migratory anatomic distribution, back arching, and pelvic thrusting are commonly seen in this group [17].

Concluding Remarks

A woman on the ground with artificially induced convulsions is a part of the early history of photography that marked the transition from still photographs to motion pictures. Muybridge’s invention, the zoopraxiscope (1879), allowed for the sequential photographs to be translated into a movie. The apparatus consisted of a rotating glass lantern that put the sequential photographs in rapid succession to create moving pictures. In 1882, Etienne-Jules Marey (1830–1904), French physician, and physiologist, who realized the potential of motion photography technology after meeting with Muybridge, successfully developed a method to take twelve successive pictures in 1 s, through a single circular plate equipped with a lens shutter [4]. This new method was named chronophotography. Various European neurologists adapted Marey’s chronophotograph to make meaningful contributions to the understanding of psychogenic movements and gait, i.e., Albert Londe (1858–1917) and Paul Richie at the Salpêtrière, Rumanian neurologist Gheorghe Marinescu (1863–1938), and Hungarian neurologist Ernő Jendrassik (1858–1921) [4, 18, 19]. In 1894, Thomas Edison (1847–1931) met Marey and proposed the kinetoscope, a machine for individual motion picture viewing. In 1895, the commercial cinematography was born when the Lumière brothers, Auguste (1862–1954) and Louis (1864–1948), utilizing Marey’s technology, showcased a short film before an audience in France [4].

Muybridge’s developments in motion photography were the beginning of cinema. For our neurology forebears, it was an important use of technology that allows for detailed study and diagnosis of abnormal movements such as PNESs [2].

Acknowledgment

The authors extend their gratitude to Dr. Kore Liow for his kind review of the manuscript.

Statement of Ethics

Not applicable.

Conflict of Interest Statement

The authors have no conflict of interest to disclose.

Funding Sources

This work did not require funding.

Author Contributions

Richard Ho and Enrique Carrazana satisfy all ICMJE authorship criteria. Richard Ho was responsible for literature review, interpretation of the articles, and drafting the manuscript. Enrique Carrazana was responsible for conception of the article, literature review, interpretation, and revision of the manuscript.

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