For some the disease filmed here, encephalitis lethargica, vindicated inter-war neurology (Foley 2012, 186-187), for others it exemplified neurology’s crisis (Cartwright 1995).
Encephalitis lethargica had struck suddenly in the winter of 1916-1917. Up to a million fell ill over the course of the next fifteen years. Cases were peaking between 1920 and 1924, when this film was being made in Berlin. Five years later, by 1930, cases would already become very sporadic and after 1940 physicians would identify less than 80 new cases, much of them debated. The large and varied syndrome seemed to have vanished. Were it not for the flood of non-acute cases—not shown in this film. Mortality rates in acute patients had fluctuated between 20-50%, but up to half of those who had recovered found themselves beset anew by tremours, contorted by stiffened muscles, tics, and hyperkinetic states, akinesias, disturbed sleep patterns, and disordered mental states, at times decades later. Etiology of encephalitis and post-encephalitic syndrome remained unknown and treatment symptomatic.
The 1925 film conformed to the format of other neurological films. A series of cuts melded together film clips of a young woman, identified as a case of acute encephalitis lethargica. They showed her first limply propped upright by a shadowy figure, then somnolent in bed, flitting in and out of wakefulness within seconds (1:26-1:30). In the shadows, the doctor, holding up her limp body, prodding her to touch her nose, drumming his fingers on her sternum, his hands picked out by his white shirt cuffs.
Unseen, her brain.
Neurologists viewing the film in 1925, however, would have expected to find lesions in her brain stem and other sub-cortical areas post mortem (Economo 1917). Along with disordered sleep, these sub-cortical lesions became a hallmark of the disease, bolstering new studies into the autonomous nervous system and brain functions localisable in the sub-cortical areas (cf WR Hess). In his habilitation defense, a German psychiatrist and neurologist thus described the encephalitis epidemic as a grand experiment, equally important as war-time brain injuries, which were spurring Goldstein’s research (Grünthal 1927). For Grünthal and his peers encephalitis lethargica vindicated inter-war neurology and neuropathology. Its sub-cortical lesions proved that the brain mattered, countering the Freudian turn away from the brain.
Unheard, her psyche.
The film was silent. Neither title cards nor shots discussed the patient’s inner life therefore systematically excluding the significant behavioural changes and emotional imbalances, for which the disease was equally well-known. In contrast to the sprawling case studies of psychoanalysis, this was to be a typical case. Lisa Cartwright thus argues that such films mapped onto other modes of making neurological ‘type specimens’, whether Charcot’s iconographies of madness, race atlases, or neurologists identifying ‘lives not worth living’ in Nazi Germany (Cartwright 1995).
Yet, even as this film flattened out the person pictured, neurologists were also clamouring to document patients’ accounts of the illness. Many encephalitic and post-encephalitic patients remained alert, as if frozen in an unwilled body. The 1925 title care thus emphasised that ‘the patient is completely orientated and ready to react to any command’. Showing the patient’s relaxed face mid-task in a close-up gestured towards her status as a ‘good’ (docile and intelligent) patient. In other, less somnolent cases this dichotomy of frozen body and alert mind made patients neurologists’ privileged subjects, valued for their view of an illness ‘from within’ (Foley 2012).
Patients with encephalitis and post-encephalitic syndrome therefore reinforced neurologists’ preoccupation with localising lesions and visuality. The disorder’s rich somatic symptomatology validated neurologists’ habit of obsessively observing patients, teasing out movement patterns, and documenting patients in film and photography. Yet, they also embodied a challenge to neurologists, desperate to separate neurology from psychiatry and psychoanalysis. The disorder could not be fixed on film.
Comment (LM):
The silent film can “only” show factual images – so it seems!. One can almost forget that the camera not solely registers. It is an active tool and a way of documenting things. The fact that the disorder could not be “fixed” in this – or any – film shows that these films open up new questions. They touch upon the brain and its (new) images, and thus on lively discussions of brain and mind, body and psyche, and thus on the ethics of good patienthood. How did technologies like film reshape the concept of a “good” and “intelligent” patient–or did they?
Readings
Cartwright, Lisa. 1995. ‘An Etiology of the Neurological Gaze’ in: idem, Screening the Body: Medicine’s Visual Culture. University of Minnesota Press. 47-80.
Economo, C von. 1917. ‘Encephalitis lethargica’, Wiener klinische Wochenschrift 30:19, 581-585.
Foley, Paul. 2012. ‘The Encephalitis Lethargica Patient as a Window on the Soul’ in: Jacyna, L Stephen and Stephen T Casper, eds. 2012. The Neurological Patient in History. Rochester: University of Rochester Press. 184-211.
Grünthal, Ernst. 1927. ‘Hirnlokalisation and psychische Symptome‘, Habilitationsvortrag, Würzburg, 18 July 1927 (Grünthal papers, Archiv Universitäre Psychiatrische Dienste (UPK) Bern Waldau, item 8782).
Film produced by F.H.Lewy, Berlin (Charité) 1925.
Film source: Wellcome Collection. The catalogue describes the film as ‘A case demonstration showing loss of equilibrium at an early stage and somnolence at a later stage due to encephalitis lethargica, also known as “sleepy sickness” or “sleeping sickness”‘. See also the blog post at the Wellcome Collection.