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Guillaume Benjamin Amand Duchenne was French neurologist, who was first to describe several nervous and muscular disorders and, in developing medical treatment for them, created electrodiagnosis and electrotherapy. He applied electrodes for recording the path that electricity took in a contracting muscle’s fibres. Duchenne investigated every major superficial muscle with his development and application of surface electrodes, which were used to measure abnormal and normal muscle action. Born in 1806 in the French seaside town of Boulogne, Duchenne was the son of a line of seafarers.
He studied at Douai and Paris. Although he turned his back on family tradition when he chose to become a doctor, there’s a definite touch of the maritime in one of his unique contributions to neuromuscular science. For example, Duchenne fashioned a “harpoon,” a small hollowed-out instrument used to penetrate the skin of living subjects and extract samples of muscle tissue for examination. He used the technique - the forerunner of today’s muscle biopsy – to examine muscle tissues of the same patients at various ages.
Duchenne, a quiet, introspective young man, had begun his medical practice in Boulogne treating fishermen and their families. Then Duchenne’s wife died shortly after giving birth to their son; the wife’s family blamed Duchenne for her death. Prone to depression and acting perhaps from an unfounded sense of guilt, Duchenne agreed to let his mother-in-law take over his son’s upbringing. As a result, Duchenne would remain estranged from his son for many years. Although only in his 20s, Duchenne nearly gave in to melancholy at this point. He neglected his patients and virtually abandoned his practice.
But he was revitalized by an odd fascination: his growing interest in the ability of electricity, when applied to a patient’s skin, to cause muscles to contract. He resumed his medical practice. Then, at age 36, he moved to Paris. Lacking a formal appointment, he visited hospital wards across the city, seeking out intriguing cases of nerve and muscle disorders. Duchenne continued his use of “faradism,” the application of electricity to the skin for diagnostic or therapeutic purposes. He built his own electrical box-like machine and carried it with him on rounds to stimulate the nerves and muscles of patients. This was important in that it allowed him to map the muscles of the body and note their functions.
Electrization apparatuses used by Dr. Duchenne
Guillaume Duchenne was the first person to extensively use the induction coil in for research and medical purposes. Duchenne, who is considered the father of electrotherapy, began in the 1840s to use the induction coil to extensively study muscles and paralysis. He noted that by varying the interrupter rate on the induction coil (and thereby varying the frequency of the high voltage pulses) he could cause muscles to either twitch (slow interrupter rate) or be in a tetanic or constant contraction state (fast interrupter rate). Duchenne then went on to extensively study the muscles of the hand, arm, foot and face.
He did this by passing the high voltage from the induction coil through a muscle (which he called “localized faradization") and seeing what sort of movement its contraction caused. Duchenne discovered that a movement (raising a finger, moving the arm in a certain direction, creating a smile) was usually not caused by the contraction of just one muscle but rather required coordination between a number of muscles. Duchenne also studied paralysis and developed a technique for determining its various causes. He determined that if a paralyzed muscle contracted due to localized faradization then the cause of the paralysis was in the brain. In other words, the muscle was fine but the control mechanism was damaged. If the muscle did not contract due to localized faradization, then the muscle or nerve was damaged. Duchenne also used the induction coil for therapy in certain cases of paralysis.
He noted that in the case of nerve injuries if some electrical contractility remained in the muscle (i.e. he could get the muscle to contract by putting high voltage through it) that recovery with localized faradization was rapid but if there were no contractions the recovery was very slow. Duchennes study of muscles and paralysis through the use of the induction coil eventually laid the groundwork for the field of neurology.
“In the 1850 ‘Bulletin de l’Academie,’ Duchenne made his first public reference to his lengthy study of the relationship between muscular contraction [facial] and expressed emotion, via a process he delineated as ‘faradism,’ in which electrical stimmulus is applied directly to or through the skin by rheopore. Duchenne enacted this mechanism on both the bodies of his patients and still-malleable cadavers which were photographed during the electrical activity in order to isolate and classify their muscular actions.”
In “The Mechanisms of Human Facial Expression", first published in French in 1862, his fascinating photographs and insightful commentary provided generations of researchers with foundations for experimentation in the perception and communication of human facial affect. Duchenne’s principal photographic subject, “The Old Man", was afflicted with almost total facial anaesthesia. This circumstance made him an ideal subject for Duchenne’s investigations, because the stimulating electrodes he used were certainly somewhat uncomfortable, if not actually painful.
Guillaume Duchenne mapped 100 facial muscles in 1862. In the course of that work, he had something to say about smiling. He pointed out that false, or even half-hearted, smiles involved only muscles of the mouth. But “the sweet emotions of the soul,” he said, activate the pars lateralis muscle around the eyes.
Duchenne investigated facial expression in a crude but effective manner of ’shocking’ the facial muscles using galvanic current. He was able to document and classify muscles using this technique. This was one of the very first and certainly defining studies in the study of facial expression. Dr. Duchenne was a pioneer in the use of photography as a medium for observation, representation and knowledge in the medical domain. As such, he has his place as much in the history of medicine as in that of photography.
Duchenne electrically stimulates the musculature of the face of an actress of the French Comedy with the purpose of modifying emotions expressed by her face.
Self-portraits of Dr. G.B. Duchenne using his electrization apparatus, 1862
The eccentric and somewhat socially awkward doctor from the provinces was initially held up for ridicule by some Paris colleagues. Eventually, though, recognition began to reward Duchenne’s pursuits. He received a prize for his work mapping the muscles of the face; the “Duchenne smile” referred to his observation that genuine smiles showing real happiness and delight utilize not only the muscles of the mouth but also those of the eyes.
Duchenne was considered one of the greatest clinicians of the nineteenth century. Charcot, in a tribute to Duchenne called him “My Master. He was also identified as great neuropathologist. He will be remembered for developing the elements for meticulous neurological examination to which he added electrical stimulation as a diagnostic test in localization. The accomplishments also included a delineation for tabetic locomotor ataxia, research on acute poliomyelitis, and description of a disease entity known as Progressive Bulbar Paralysis. He also identified Pseudohypertrophic Muscle Dystrophy as a primary muscle disease. He wrote much on lead poisoning.
Guillaume Benjamin Amand Duchenne died on September 15, 1875, in Paris.
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