Eminent doctors: Their lives and their work; Vol. 1 of 2

by G. T. Bettany

FOOTNOTES:

[17] Life of Sir Astley Cooper, i. 334-448.

[18] Memoirs of John Abernethy.

[CHAPTER VIII.]
SIR CHARLES BELL AND THE FUNCTIONS OF THE NERVOUS SYSTEM.

It will have been gathered that scientific medicine and surgery were as yet scarcely in a condition to begin. After the discovery of the circulation of the blood physiological research seemed to halt, waiting on anatomy. It now took an immense and decided leap forward.

Charles Bell was descended from a family long settled in Glasgow; but his grandfather becoming a minister of the Scotch Church, settled in Gladsmuir, Haddingtonshire, and died young; and his father, William Bell, born 1704, was a minister of the Scottish Episcopal Church in Edinburgh. Here he suffered from all the persecution inflicted on Episcopalians in Scotland after the Young Pretender’s rising in 1745. Episcopal ministers were forbidden to officiate to more than four besides the family; and later, an Act was passed to forbid any one in holy orders to officiate in a house of which he was not the master. William Bell’s first wife dying in 1750, leaving no surviving children, he married in 1757 Margaret Morice, grand-daughter of Bishop White, who became the mother of Robert Bell, author of the Scotch Law Dictionary; John Bell, the celebrated surgeon; George Joseph Bell, Professor of the Law of Scotland in the University of Edinburgh, and author of the Commentaries on the Law of Scotland; and Sir Charles Bell. The father of these four eminent sons died in 1779, when Charles was but five years old.

The straitened circumstances in which the family were left at the father’s death resulted in knitting them closely together in their common struggle. The affection which existed through life between George Joseph Bell and Charles, four years younger, is one of the most delightful on record. Much of the brothers’ education was the result of their own efforts. George relates that although his schooling cost but five shillings a quarter, it had to be discontinued when he was eleven years old. Mrs. Bell aided her children with French and drawing, and had a considerable share in bringing forth that talent for drawing which afterwards was of such advantage both to John and Charles.

Although Charles was some time at the High School at Edinburgh, he most emphatically declares that he received no education but from his mother, and the example set him by his brothers, all of whom showed a true independence and self-reliance. He says: “For twenty years of my life I had but one wish—to gratify my mother and to do something to alleviate what I saw her suffer.” When she died, the blank and indifference produced in his whole nature were so great, that all ambition seemed to die out of him for a long time.

His brothers made a plaything of him in childhood, but yet appeared confident of his future. They were wont to say: “Oh, never mind, Charlie will do very well. No fear for Charlie.” Yet in after life he greatly regretted that his early education was limited, and he took very great pains to improve what was deficient. Even within the last few years of his life he engaged French and Italian masters to read with him, although he could read both languages before he left Edinburgh.

Taking up the study of medicine under the guidance and tuition of his elder brother John, who was already becoming notable as a lecturer, he very rapidly found his true vocation, and gained such proficiency that before he was twenty-one he was able to take part of his brother’s lectures. In 1799 he published the first part of his “System of Dissections.” Edinburgh, then embittered by the controversy between his brother and Dr. Gregory, and other untoward occurrences, did not give him fair scope for his talents; and it was decided that Charles should adventure himself in London. This was an enterprise of hardihood at that time, for Scotchmen were still looked upon with suspicion; yet he had already become known in London by his association with John Bell in the “Human Anatomy,” by the first two volumes of his “System of Dissections,” and by his engravings of the arteries, brain, and nerves. The impression made upon him by his first experience of London, on a Sunday in November, was thus expressed: “If this be the season that John Bull selects for cutting his throat, Sunday must be the day, for then London is in all its ugliness, all its naked deformity; the houses are like ruins, the streets deserted.” He was soon rather unceremoniously told by a hospital surgeon that they could manufacture their own raw material, and if he had difficulties in Edinburgh, he would have more in London. Some of his early friends in London were cautioned that he was a sharp insinuating young man, who would drive them out of their hospitals. His friend Lynn answered such an innuendo thus: “I liked his brother, and I like himself. He is no humbug. His conversation is open and free.” Lynn indeed discerned that a worthy successor of William Hunter was among them.

Charles Bell gained considerable notice by his criticisms on artistic anatomy, and by the profound knowledge of the human body which he made evident. The manuscript of his “Anatomy of Expression” being in a forward state, it was shown to many persons of influence, including Sir Joseph Banks (President of the Royal Society), Benjamin West, Sydney Smith, &c., and the general opinion was that he would make a great name. But Charles did not deceive himself into the idea that his path into situations of importance would be easy. “I can make a few good friends,” he says, “but cannot engage the multitude.”

After many discouragements, having at one time resolved to return to Edinburgh, Mr. Bell took a house, formerly Speaker Onslow’s, in Leicester Street, Leicester Square, and fitted up a lecture-room in it. Here he started as a public lecturer on anatomy and surgery, with an attendance of forty, but only three paying pupils, on January 20, 1806; and the second lecture was delivered to an audience of ten. In February he lectured to a dozen artists, much to their delight. On the 10th February 1806, after nearly fifteen months in London, he received his first fee in consultation.

Many years afterwards, looking back upon this period of severe struggle, he wrote: “When I consider the few introductions I then had—to men who could be of no assistance to me—I look back with a renewal of the despair I then felt.... These days of unhappiness and suffering tended greatly to fortify me, so that nothing afterwards could come amiss, nothing but death could bring me to a condition of suffering such as I then endured.... I could not help regretting the noble fields that were everywhere around me for exertion in my profession, and which I found closed against me.” Meanwhile youthful acquaintances in Edinburgh, Horner and Brougham, were getting places in the ministry.

This year his “Anatomy of Expression” was published, and was at once received with high favour, many painters adopting it as their text-book. Flaxman declared he considered Mr. Bell had done more for the arts than any one of that age. Fuseli called it truly valuable.

Charles Bell had more than an ordinary measure of liveliness, good-humour, and geniality. One day he writes: “A band of Pandæans are playing before my window. They make me frisk it. Last night I had a little supper here, with some good flute-playing. It was intended to make Horner know Wilkie, the Scotch Teniers.” All through life he retained this sensibility to lively music. The sound of a familiar Scotch air would start him whistling, and laying aside work, he would take his wife by the hand, and make her dance with him through room after room.

By the autumn of 1807, his note as a surgeon had grown, and patients became numerous. His lectures on surgery, too, became an unqualified success, though the number of paying pupils was small. In 1808, however, he had thirty-six pupils. His studies for his lectures were most faithfully and zealously prosecuted. His lectures were most original: his discoveries were given step by step to his class-pupils. The first record of his results in regard to the nervous system is in a letter of 26th November 1807, when he writes: “I have done a more interesting nova anatomia cerebri humani than it is possible to conceive.” This developed gradually into an introduction to the Nervous System, which was shown to many in manuscript. Meanwhile the Professorship of Anatomy at the Royal Academy was about to become vacant, and Mr. Bell’s candidature was warmly advocated by many of the most eminent surgeons and artists. Abernethy desisted from the idea of candidature in his favour. Wilson was dissuaded from competing. Sir Astley Cooper wrote a letter stating that he beyond all comparison merited the post, and would be an invaluable acquisition to the Royal Academy. But in the end, Mr., afterward Sir Anthony, Carlisle was elected, and lectured to but four pupils in his first course. It is to be remembered that even at hospitals, lectures were by no means common things at this time. Several of the most eminent hospital surgeons did not lecture at all, or only lectured occasionally. So that Bell’s class of thirty-six was really a first-rate one.

A mark of his original and painstaking mode of making progress was seen in the visit he paid to Haslar Hospital, when the wounded soldiers from Corunna arrived home, in January 1809. The scene was a most striking and impressive one to his feeling nature. “I have stooped,” he says, “over hundreds of wretches in the most striking variety of woe and misery, picking out the wounded. Each day as I awake, still I see the long line of sick and lame slowly moving from the beach: it seems to have no end. There is something in the interrupted and very slow motion of these distant objects singularly affecting.” From the cases he saw he gained much; and laid the foundation of his essay on Gunshot Wounds, appended to the second edition of his “Operative Surgery.”

In 1810 Charles Bell became engaged to his future wife, Marion Shaw, whose sister Barbara had for some years been married to his brother George. Their brothers, John and Alexander, became Charles Bell’s pupils and assistants. In writing to Miss Shaw at one time Mr. Bell revealed to her much of the sadness and melancholy of his first years in London, oppressed by the consciousness of not occupying a position corresponding to his talents, and finding everywhere difficulties. “Many and many a time in the prosecution of my plans of life have I wished that I were with the armies, to rid myself of the load of life without discredit.” He was married on the 3d of June, 1811.

The next year was another important landmark in Charles Bell’s life. He accepted an offer of partnership with Mr. Wilson in the Great Windmill Street School of Medicine. His own preparations and drawings, &c., were added to the museum already there, and his joy at seeing the two united was great and unmixed. His first lecture in the school was to a class of 80 to 100 pupils. He was at the height of his ambition in being connected with the celebrated Windmill Street School. Mr., afterwards Sir Benjamin, Brodie, Dr. Roget, and Dr. Brande were among his associates in lecturing. His new house (34 Soho Square) had as many resident pupils as he could accommodate; and he was not yet forty years old.

In 1813 he was admitted into the Royal College of Surgeons. A formal examination being necessary, he records with amusement that the facetious dogs asked him of what disease he thought Buonaparte would die. In 1814 he was elected by a large majority surgeon to Middlesex Hospital, and immediately began to make great use of his new opportunities. His operations and clinical lectures soon became attended by large numbers of students, and even eminent practitioners. A Russian General, Baron Driesen, having a ball in his thigh, was placed under his care, and especially commended to him by the Czar Alexander. A fee of £200 and two silver cups were his reward, as well as great personal regard from both the General and his aide-de-camp.

When the stirring news of Waterloo arrived in London, the same spirit which had animated him after Corunna, impelled Mr. Bell to start off, accompanied by John Shaw, to render assistance to the wounded. The amount of work was appalling. Nothing was ready, to cope with the mass of misery suddenly accumulated. Mr. Bell, finding after an inspection of the situation that he could do most by taking in hand the needful operations upon the French wounded, commenced his operations at six one morning and continued incessantly operating till seven in the evening, and so on for three consecutive days. While he amputated one man’s thigh, there lay at one time thirteen others waiting, all begging to be taken next. “It was a strange thing,” he says, “to feel my clothes stiff with blood, and my arms powerless with the exertion of using the knife; and more extraordinary still, to find my mind calm amidst such variety of suffering; but to give one of these objects access to your feelings was to allow yourself to be unmanned for the performance of a duty.”

It appears strange that a man who in 1807 had commenced what proved to be such an epoch-making series of discoveries in regard to the nervous system should have so long allowed them to lack general publicity. His manuscript was first shown to his brother and other friends in 1808. But it is to be noted, that when in 1811 he privately circulated a pamphlet under the title of “An Idea of a New Anatomy of the Brain,” submitted for the observation of the author’s friends, they received it with but scant appreciation, and either failed to regard it as remarkably novel, or considered the views it put forth incredible. At this period, while the brain was believed to be the organ of thought, it was also supposed to discharge some nervous fluid through the spinal cord to the nerves. Little was accurately known about the functions of the nerves: even John Bell and Astley Cooper had advised the section of the facial nerve to cure tic, thus paralysing the muscles of the face instead of relieving the pain. Microscopy had not yet revealed the multitudinous fibres of which nerves are composed, and experimental evidence was confined to comparatively coarse forms. Thus on cutting across the main trunk of a nerve, both sensation and motion were lost in the parts supplied by the nerve. Bell first disentangled the functions of sensation and motion, and found that they were carried on through distinct nerve fibres. He noticed the distinct properties of the nerves of the senses, for instance the fact that a prick of the optic nerve in an operation caused a flash of light to be perceived, not a sensation of pain: when the pricking of certain papillæ of the tongue gave rise to a sensation of taste, not of pain, and when a blow upon the ear occasioned the hearing of noises. Thus he acquired the conception that in the brain the powers of the nerves were distinct and peculiar, and due to the portion of the brain from which they started.

Seeing that in the vast number of the nerves of the body the functions of sensation and motion were evidently combined, Bell imagined that these nerves consisted of different portions tied together, and he sought for a method of determining how they were combined. The separate portions in which the spinal nerves enter the spinal cord, forming two roots, anterior and posterior, occurred to him as furnishing a possibility of experimental inquiry. He now resolved to make crucial experiments on living animals, which should settle the question by a well-devised plan of procedure. No man was more averse to giving unnecessary pain than Charles Bell; no man felt more keenly the sufferings of his patients. The first brief record of the results is as follows: “Experiment 1. I opened the spine and pricked and injured the posterior filaments of the nerves—no motion of the muscles followed. I then touched the anterior division—immediately the parts were convulsed. Experiment 2. I now destroyed the posterior part of the spinal marrow by the point of a needle—no convulsive movement followed. I injured the anterior part, and the animal was convulsed.” It was at once inferred that the anterior root of the spinal nerves was motor in its functions, the posterior root sensory.

This simple fact revolutionised the physiology of the whole subject. We cannot now realise the novelty which there was in attaining this extent of knowledge of the nervous system, or how valuable this firm basis was in commencing to unravel the nervous mechanism. We cannot here detail the experiments and trains of reasoning by which it was shown that the fifth cranial nerve was similar in its general plan to the spinal nerves, including distinct sensory and motor portions; and by which the knowledge of the cranial nerves generally was widely extended. We note now that Bell’s first paper on the Nervous System was read before the Royal Society on the 21st July 1821, and was received with great approbation. It soon became generally known throughout Great Britain and on the Continent, being by almost every one acknowledged as strikingly original. The dispute which afterwards arose as to his perfect originality and independence having been so conclusively settled in Mr. Bell’s favour by the production of his original pamphlet, manuscript and letters, no account of the controversy need here be given. He himself fully felt the importance of his discoveries: “I have made a greater discovery than ever was made by any one man in anatomy,” he says, not vaingloriously, but as a simple perception of the fact.

The application of the new knowledge to the elucidation of many obscure diseases, where the nervous system was affected, engaged Charles Bell’s zealous attention. He speedily classified and arranged cases illustrative of the action of the motor and sensory nerves, cases where the muscles of the face were paralysed, as well as various kinds of paralysis throughout the body. Instances of partial or local pain were explained in their relation to the nerves concerned; disorders of the eye, tongue, muscles of respiration, &c., all received new illumination from his researches.

A further discovery was that of the muscular sense, by which we perceive many of the qualities of objects surrounding us, and which even enables us to stand upright. The sensation of the degree of muscular effort put forth in every action, in every resistance, to a large extent builds up our judgments about external objects, and determines our actions; and the recognition of the fact that we perceive this by a sense distinct from touch is due to Bell. The study of the eye entered very largely into this question, as the muscular movements of the eye are of such extreme import in our perceptions. In 1818 he wrote: “I think I have made out that squinting depends on the over-action of one of the oblique muscles, and that it may be cured by an operation. I am looking out for a patient to try this upon.” But for want of a squinting monkey to make the first trial upon, the thought was not carried to practical results, and it remained for others to mature the operation for the cure of squinting.

As a specimen of Bell’s style in popular writing, to which he devoted great pains, we quote from his Bridgewater Treatise on “The Hand” a passage dealing with the movements of the eye. “On coming into a room, we see the whole side of it at once—the mirror, the pictures, the cornice, the chairs; but we are deceived: being unconscious of the motions of the eye, and that each object is rapidly, but successively, presented to it. It is easy to show that if the eye were steady, vision would be quickly lost; that all these objects, which are distinct and brilliant, are so from the motion of the eye: that they would disappear if it were otherwise. For example, let us fix the eye on one point, a thing difficult to do, owing to the very disposition to motion in the eye: but by repeated attempts we may at length acquire the power of fixing the eye to a point. When we have done so, we shall find that the whole scene becomes more and more obscure, and finally vanishes. Let us fix the eye on the corner of the frame of the principal picture in the room. At first, everything around it is distinct; in a very little time, however, the impression becomes weaker, objects appear dim, and then the eye has an almost incontrollable desire to wander; if this be resisted, the impressions of the figures in the picture first fade: for a time, we see the gilded frame; but this also becomes dim. When we have thus far ascertained the fact, if we change the direction of the eye but ever so little, at once the whole scene will be again perfect before us. These phenomena are consequent upon the retina being subject to exhaustion.”

Considering the warmth with which the originality of Charles Bell’s views was contested, it is indeed striking to notice how early he composed himself to answer only by silence. “This must be,” he says, “the mode in which my opinions shall come to be acknowledged: without some agitation and controversy they would never be propagated. I am satisfied I have a secure ground.”

In 1821 Wilson died, and Bell’s assumption of the chief responsibility for the Windmill Street School, with heavy pecuniary liabilities, followed. In 1824 he was appointed to the Professorship of Anatomy and Surgery at the Royal College of Surgeons. So he set himself with renewed energy to make his lectures of the utmost value to practising surgeons. His first lecture was given to an audience crowded to suffocation. The crowding continued at subsequent lectures, many being unable to get admission.

On the 19th July 1827 his beloved brother-in-law and assistant, John Shaw, died. His suffering from this loss was intense. In his discoveries, his first great object had always been “to convince Johnnie.” This faithful brother-in-law was fortunately replaced by another, Alexander Shaw, afterwards surgeon to the Middlesex Hospital, notable in after times as a defender of his fame and expounder of his doctrines. In the same year was matured the project long incubating, of a new London University (now University College), in which Charles Bell was to be the head of the Medical School. He delivered the inaugural lecture, and for some years took an active part in its organisation. The arrangements, however, which were made by the governing body were in many respects inconsistent with the high ideal of teaching which Charles Bell had, and with the freedom of procedure to which he had been for so many years accustomed at the Windmill Street School. Consequently in 1830 he finally retired from the new College, and felt in some respects stranded, for discovery and teaching were his very life. Practice was to him an irksome necessity. Thus a time of life in which practical success might have made him wealthy was characterised by depression and sadness, principally relieved by a very unusual recreation for a hard-worked London practitioner, namely, fly-fishing. He was first attracted to this sport by spending a day at Panshanger with his bosom friend, John Richardson. The evident delight of his friend in this occupation, and the freshness and relaxation which it afforded, convinced him that he had found the thing he wanted to sweep from his mind the cobwebs of professional life. Lady Bell says, “He was often on the waterside before sunrise—indeed, before he could see his flies; and he did enjoy these morning hours. I came down with his breakfast, bringing books and arrangements for passing the whole day, even with cloaks and umbrellas, for no weather deterred us. He liked me to see him land his fish, and waved his hat for me to come.” In the intervals of angling many of the best parts of his popular works on the Hand and on Animal Mechanics were written.

In spite of the feelings of disappointment which oppressed him severely on some occasions, it must not be imagined that he was predominantly unhappy. Lord Jeffrey described him as “happy Charlie Bell;” Lord Cockburn wrote: “If I ever knew a generally and practically happy man, it was Sir Charles Bell.” Alexander Shaw said of him: “His mind was a garden of flowers and a forest of hardy trees. Its exercise in profound thought gave him high enjoyment; yet he would often avow his pleasure in being still a boy, and he did love life and nature with the freshness of youth. I therefore repeat—if ever I knew a happy man, it was Sir Charles Bell.” Yet, seeing that he was convinced, “that the place of a professor who fills his place is the most respectable in life,” we may believe that a painful sense of ungratified desire was largely present if not continually expressed. In 1835 he writes: “My hands are better for operation than any I have seen at work; but an operating surgeon’s life has no equivalent reward in this world... I must be the teacher and consulting surgeon to be happy.”

In 1831, in connection with the accession of William IV., the Guelphic order of knighthood was conferred on several distinguished men of science, among whom Charles Bell was included. His association with Herschel and Brewster in this honour was gratifying and appropriate. A complete school of medicine was now projected in connection with the Middlesex Hospital, in which he was to take a prominent part. It had not, however, passed through three complete months of its history, when the Town Council of Edinburgh elected Sir Charles[19] to the Chair of Surgery in the University, and the offer proved attractive enough to induce him to leave London. He had always cherished the idea of a return to Edinburgh at some future time, and it appeared to him that there was a possibility of a sphere of more elevated usefulness there, than he could now hope for in London. Moreover, his heart was in Scotland, in the streets of Edinburgh—in the theatre where Monro had lectured to him—in the society of his old friends Jeffrey, Cockburn, William Clerk, Adam Ferguson, and most of all his brother George. “London is a place to live in, but not to die in,” he said. “My comfort has ever been to labour for some great purpose, and my great object of study has been attained.... There is but one place where I can hope to fulfil the object of my scientific labour, and that is Edinburgh; and that is an experiment.”

Successful as his classes were in Edinburgh, and influential as his position speedily became, it must be acknowledged that the experiment was a failure, for it did not give him the satisfaction he had hoped. Practice in Edinburgh could not possibly yield what London did, and the emoluments of the University chair did not counterbalance this. Some coldness, too, was shown him on the part of his fellow-professors. It was an old case of Scotch undemonstrativeness. “I have had a German professor to breakfast,” he writes, “who brings me a volume from Paris—they make me greater than Harvey. I wish to heaven the folks at home would make something of me. I thought, in addressing the new-made doctors at the conclusion of the session, that I had done well; but not one word of approbation from any professor, nor has one of them in all this time called me in to consultation, except when forced by the desire of the patient.” His income, never very considerable in Edinburgh, diminished considerably. “I put down my carriage with as little feeling as I throw off my shoes,” he says; but when in 1842 a Government proposal appeared likely to end in the extinction of the privileges of his beloved University, his excitement was unbounded. He set off for London as soon as he could. But he was attacked by a spasm of the stomach so severe as to threaten his life. He hastened on towards London, but while at Manchester, assisting at an operation, he thought he should have been obliged to lie and roll on the carpet, or leave the room in the midst of it. On Wednesday April 27, 1842, Sir Charles and Lady Bell reached Hallow Park, the seat of Mrs. Holland, near Worcester. Looking on the winding Severn and the distant hills, he said to his wife: “This is a novel spot; here I fain would rest till they come to take me away.” Here he sketched an old yew-tree, some sheep, and the river; then two children and a donkey. As he went back he looked with his observant eye at every shrub, commented on the birds’ notes, and gathered up their feathers for his flies. After dinner the same evening he gave graphic sketches of medical celebrities he had known, admired and discussed an engraving of Leonardo da Vinci’s Last Supper, and was altogether so happy in mood that he said to his wife: “Did you ever see me happier or better than I have been all this forenoon?” yet he had been several times that day in imminent danger of death from the dread malady that John Hunter had, angina pectoris. We cannot refrain from quoting the account of his end (Letters, p. 400): “The evening reading that night was the 23d Psalm; the last prayer, that beautiful one, ‘For that peace which the world cannot give,’ and then he sank into a deep and quiet sleep. In the morning he awoke with a spasm, which he said was caused by changing his position. His wife was rising to drop his laudanum for him, but calling her to him, he laid his head on her shoulder, and there ‘rested.’”

No more appropriate tribute has been paid to Sir Charles Bell than that in the Edinburgh Review for April 1872. The writer says (p. 429): “Never passed away a gentler, truer, or finer spirit. His genius was great, and has left a legacy to mankind which will keep his name fresh in many generations. But the story of his life has a more potent moral. It is the story of one who kept his affections young, and his love of the pure and the refined unsullied, while fighting bravely the battle of life; whose heart was as tender as his intellect was vigorous and original who, while he gained a foremost place among his fellows, turned with undiminished zest to his home and his friends, and found there the object, the reward, and the solace of his life.”

He was buried near the yew-tree he had so lately sketched in Hallow Churchyard. A plain stone, with his name, dates of birth and death, and the line, “The pure in heart shall see God,” marked the spot. A tablet was afterwards placed in the churchyard, with an inscription written by his lifelong friend Francis (Lord) Jeffrey. Part of it runs thus: “Sacred to the memory of Sir Charles Bell, who, after unfolding with unrivalled sagacity, patience, and success, the wonderful structure of our mortal bodies, esteemed lightly of his greatest discoveries, except only as they tended to impress himself and others with a deeper sense of the infinite wisdom and ineffable goodness of the Almighty Creator.” His letters, edited by his widow (1870), are a lasting memorial of his beautiful and noble nature.