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

by G. T. Bettany

FOOTNOTES:

[19] In December 1835.

[CHAPTER IX.]
MARSHALL HALL, AND THE DISCOVERY OF REFLEX ACTION.

The character of Marshall Hall, who divides with Sir Charles Bell the principal honours of discovery as to the nervous system, presents a contrast to his in that it displays a mind more minutely active, and more distinctly medical in its tone, combined with a marvellous degree of detailed benevolence. Thus Hall’s reputation has, like Harvey’s and John Hunter’s, grown largely since his death. Marshall Hall was born at Basford near Nottingham on February 18, 1790, his father, Robert Hall, having been a cotton manufacturer and bleacher of ingenuity and originality. He first employed chlorine as a bleaching agent on a large scale, his earliest attempts having procured for his establishment the epithet of “Bedlam.” He was of a very religious turn, too, being one of the early Wesleyans. The strict but benevolent piety of his father, and the sweet and gentle disposition of his mother, were favourable to the growth of high morality, strict conscientiousness, and amiability of character in their family, while the inventive ability of the father reproduced itself in his second son, Samuel Hall, a prolific inventor, and no less in his sixth son, Marshall. It is not often that a typically good and inoffensive son has turned out so conspicuously original in his work. But he had a saving fondness for boyish literature such as Robinson Crusoe, and was full of fun and playfulness. He was early sent to Nottingham to school with the Rev. J. Blanchard, the instructor of Kirke White. Here he did not even learn Latin, although his elder brothers had had classical instruction. French appears to have been his only linguistic attainment: and the chief fact recorded of his school-days is his thrashing a tyrannical “big boy” in the school. But school was over for him at the age of 14, and he was placed with a chemist at Newark. Soon finding his position irksome, his friendship with a youth who was preparing for a medical career led him to long for a similar course, and ultimately his father was induced to send him to Edinburgh, whither he went in October 1809. He had already indicated his future eminence by rising very early to study medicine and chemistry, and giving as his reason: “I am determined to be a great man.”

At Edinburgh he quickly distinguished himself by his diligent study of anatomy; he was recognised as a student of the first rank, and was chosen senior president of the Royal Medical Society in 1811. Dr. Bigsby says of him: “Few men have changed during their progress through life so little as Marshall Hall. As he began, so he ended, delighting in the labour—the labour itself—of investigation.... All the stores of knowledge which his predecessors had either gathered or created, Marshall Hall was eager to acquire; a hardy, enduring constitution seconding all his efforts.... All his energies were directed to the formation of the skilful bedside physician, that is, to the alleviation and cure of disease.” It was said of him, “Hall never tires.” During his three years’ studentship he never once missed a lecture. He graduated in June 1812, and was almost at once appointed resident house physician to the Edinburgh Royal Infirmary. Here his love of order, his zeal, and spirit of inquiry found full scope, and he took extreme pains in the study of diagnosis. He gave a voluntary course of lectures on the principles of diagnosis in 1813, which were the basis of his well-known work, first published in 1817. His usefulness to the younger students in the hospital was very great, and equally striking was his good example of purity of life and conversation, and constant cheerfulness. His puremindedness was characteristic through life; Marshall Hall never attached himself to any man of coarse mind or manners.

During his last year at Edinburgh the young physician, attracted towards London practice, was prudently weighing the cost and risk of such an enterprise. He decided in favour of a more modest course of provincial practice, waiting till his book on Diagnosis should be matured. As in later life, so now he was “strong in hope, inflexible for truth and justice, but inexperienced in the ways of the world, and unable to cope with the cunning, or to dissemble with the false.” After a visit to Paris for some months he proceeded to Göttingen and on to Berlin to visit the medical schools, walking alone and on foot from Paris to Göttingen, more than six hundred miles, in November 1814. After a brief period of practice in Bridgewater he commenced practice at Nottingham in February 1817, and with remarkable rapidity attained a leading position. In 1817 his work on the Diagnosis of Diseases appeared, and at once marked him out as a man of the highest originality, applying accurate observation and classification of symptoms to the detection and distinction of diseases. Of this book the Lancet of August 15, 1857, remarked: “Comprehensive, lucid, exact, and reliable, this work has, in the main, stood the test of forty years’ trial. A better has not been produced.” When Dr. Baillie, nephew of John Hunter and President of the College of Physicians, first saw Marshall Hall, he complimented him on being the son of the author of so extraordinary a work as that on Diagnosis. Being modestly told that he himself was the author, Baillie exclaimed: “Impossible! it would have done credit to the greyest-headed philosopher in our profession.”

In 1818 Hall published a work on the affections usually denominated Bilious, Nervous, &c., and in 1820 an essay in which the prevalent custom of bleeding was attacked, especially in certain affections occurring after childbirth, which under that treatment almost invariably proved fatal. In 1822 this was followed by a small volume on the Symptoms and History of Diseases, which was especially valuable in treating of the detection of internal diseases. In 1824 appeared his important paper On the Effects of the Loss of Blood in the “Medico-Chirurgical Transactions,” published also in an expanded form in his “Medical Essays” in the same year. Before this time the lancet was in hourly use, and Marshall Hall termed it “a minute instrument of mighty mischief.” Almost all pain in any complaint, quickness of pulse, headache, intolerance of light or noise, being believed to arise from inflammation, blood flowed in torrents to subdue it. It was by his various papers bearing on this question that Dr. Hall became prominently known; for the dropping of the lancet was an evident change of procedure which the public as well as the profession could lay hold of. In 1825 the young enemy of the lancet was elected Physician to the Nottingham Hospital by a large majority of votes, and the best practice of the neighbouring counties was his. He was unremittingly employed: in his walks and rides almost heedless of external occurrences, absorbed in contemplation; at home ever busy in his library or his laboratory, making chemical experiments from which numerous valuable memoirs arose; never accepting invitations of pleasure; unwearied in his attentions to the sick poor whom he saw gratuitously. He economised time by riding, being a good horseman, riding through the country on pitch-dark nights without accidents. He treated his horses well and earned their affection. “How is it that your horses never fall?” a friend inquired. “I never give them time to fall,” was the reply. The Bible constantly at his side was another mark of Marshall Hall, and he was ever ready to discourse on the wisdom and benevolence of God, as shown in the structure of the human body.

London continued to attract the popular Nottingham physician. Dr. Baillie had predicted that if he came to London, he would be the leading physician in five years; Sir Henry Halford, who succeeded him as President of the College of Physicians, termed Marshall Hall, a few years afterwards, “the rising sun of the profession.” We cannot wonder that a visit to London in August 1826 resulted in his remaining there. His Nottingham patients, deeply regretting his removal, continued to consult him by letter; and his first year in town produced £800, a remarkable instance of quick success.

In 1828 he published “Commentaries on Diseases of Females,” with graphic plates depicting conditions of parts such as the tongue, lips, nails, &c., which he first associated with various disorders of women. He continued his series of careful papers on subjects connected with blood-letting. His writings on these two subjects produced him a considerable portion of his early practice.

Meantime Marshall Hall married, in 1829, and soon afterwards settled in Manchester Square, where he lived for twenty years. Desiring to become a Fellow of the Royal Society, he entered upon a special research on the circulation of the blood, the results of which he might communicate to the Society. After carefully inspecting under the microscope the blood-flow in the transparent parts of frogs, toads, newts, &c., he arrived at the conclusion that all the blood changes, and all nutrition and absorption by the material tissues are effected in the minute or capillary channels between the arteries and the veins. The paper founded upon this research was read before the Royal Society in 1831, but was refused a place in the “Philosophical Transactions;” yet an equally great man, Johannes Müller, the leading German physiologist, pronounced his paper one of extraordinary interest. It was separately published in 1832. The Royal Society, however, did not reject Marshall Hall’s next paper, “On the Inverse Ratio between Respiration and Irritability in the Animal Kingdom,” which has been pronounced “one of the most beautiful examples of widely extended observations, and previously disjointed facts, all brought together and rendered harmonious by the insight and genius of a master-mind.”[20]

From the latter subject the investigator passed to that of hybernation, his views on which also found acceptance with the Royal Society. One feature in his experiments on this subject was an ingenious apparatus for ascertaining the temperature of the bat without disturbing its winter sleep. By this time Marshall Hall had quite a little menagerie in his house, of animals whose physiology he was investigating; mice, hedgehogs, bats, birds, snakes, frogs, toads, newts, fishes were in turn laid under contribution. Abhorring cruelty as utterly as a man could, he yet saw the absolute necessity of discovering in the first instance, by experiments on animals, truths which were of vital importance both to men and brutes. Mr. Henry Smith of Torrington Square was his diligent associate in these inquiries. Dr. Hall said of him: “I never knew a person so accurate in his information and so devoid of selfishness. His interest in my researches never flagged. He was true to his appointments as the clock itself.”

While the papers refused a place in the “Philosophical Transactions” were going through the press, to appear as a “Critical and Experimental Essay on the Circulation of the Blood,” a serious accident happened to a portion of the manuscript. It was sent from time to time by stage-coach to Messrs. Seeley, printers, at Thames Ditton, and on the evening of William IV.’s coronation a packet containing the only record of a considerable series of experiments was stolen from the coach. This most serious loss could only be repaired by a repetition of the experiments, which Dr. Hall at once set about with most Christian equanimity.

Early in 1832 Marshall Hall was elected a Fellow of the Royal Society, and in the same year he published another paper on the Effects of Loss of Blood, in the “Medico-Chirurgical Transactions.” The original papers on practical medicine which he produced during this period are too numerous to be mentioned here. We must hasten to give an account of Marshall Hall’s great researches on the reflex functions of the spinal cord.

It was while he was examining the circulation of the blood in the newt’s lung that Marshall Hall noted the fact from which his great discoveries arose. The newt’s head had been cut off; thus its life, in the ordinary acceptation, was destroyed. The tail was afterwards separated. “I now touched the external integument with the point of a needle; it moved with energy, assuming various curvilinear forms! What was the nature of this phenomenon? I had not touched a muscle; I had not touched a muscular nerve; I had not touched the spinal marrow. I had touched a cutaneous nerve. That the influence of this touch was exerted through the spinal marrow was demonstrated by the fact that the phenomenon ceased when the spinal marrow was destroyed. It was obvious that the same influence was reflected along the muscular nerve to the muscles, for the phenomenon again ceased when these nerves were divided. And thus we had the most perfect evidence of a reflex, or diastaltic, or diacentric action.”

The importance of this discovery may be gathered from the fact, that but few considerable advances in the physiology of the nervous system had hitherto been made, the most important being that of Sir Charles Bell, proving that there were separate nerve fibres of motion and of sensation, and that they entered different portions of the spinal cord and brain. Dr. Andrew Whytt of Edinburgh had published in 1751 a work in which he detailed the movements which a frog’s trunk was able to execute after its head had been cut off, and had naturally referred these movements to the spinal cord; but the import of such actions was not understood, nor the mechanism by which they were executed. Somehow these observations led to no new principles. But the truly original mind of Marshall Hall travelled beyond the first facts to trace the process, and he at last comprehended the nature of such acts as the involuntary closure of the eyelids, independent of will, for the purpose of preventing the admission of injurious matter, or of protecting the eye against injury. The processes of swallowing, choking, vomiting, coughing were now for the first time explained. Further, in pursuance of Marshall Hall’s practicality of object, many cases of injury to the nervous system became more or less intelligible. In paralysis of the brain, where the medulla oblongata and spinal cord were uninjured, it was understood how the animal functions could be maintained, and how in cases where the patient was unable by any exercise of the will to clench his hand, yet the stimulus of a rough stick on the sensory nerves of the palm of the hand was sufficient to bring about a forcible grasp, this being a simple reflex act in which the spinal cord was concerned. The first breath of a new-born infant, the spasmodic closure of the larynx in convulsions, fits of spasmodic asthma, &c., were seen to be reflex in their nature; and in many disorders which had hitherto baffled curative efforts, they became possible, because the first great step had been taken, the understanding of the phenomena.

These discoveries proved so far-reaching in their bearing that their establishment and following out were the work of years of almost constant toil. It is estimated that from the period of his first experiments to the close of his life no fewer than thirty-five thousand hours were occupied by Dr. Hall in work strictly connected with the subject. The discovery was first made known to the Zoological Society on November 27, 1832: a fuller and further account was given to the Royal Society in 1833, and published in the Transactions. It was immediately translated into German and inserted in Müller’s Archiv. Yet most of the leading authorities in England, with the fatality which attends discoveries in proportion to their greatness, made Marshall Hall the object of obloquy, and denounced him as the propagator of absurd and idle theories. In 1837 a second memoir was read before the Royal Society, but was rejected from its Transactions; and in a most unscientific spirit, Dr. Hall’s offer to show his experiments before a committee was not acceded to. Even his proposal to withdraw from practice for five years, in order to study the subject without interruption, secured him no better reception. Moreover, the medical press, with the exception of the Lancet and a very few others, denounced Marshall Hall virulently. In one number of a quarterly journal no fewer than four articles attacked the discovery, one denying its originality while allowing it to be true, another denouncing Dr. Hall’s views as new but not true. The long persistence of this opposition was almost incredible; for years one journal kept it up through every number; each step was disputed, and what was indisputable was depreciated. “Ancient works were disinterred in the vain hope of robbing him of his originality. ‘Complete anticipations’ were exultingly announced. On the one hand, he was accused of stealing his ideas from old writers; on the other, contemporaries started up and claimed the discovery as theirs; while some combated its truth, and never ceased cavilling.”

While the Royal Society refused him any honours, and in 1847, ten years after the last paper, rejected another which he sent in, detailing an experimental research on the relation of galvanism to the nervous and muscular tissues, Marshall Hall never ceased his investigations. He did not, however, like some few men of originality, disdain to reply to attacks. He was even anxious to refute any and every mis-statement made about him and his work, his view being: “It would not be truthful in me; and why should I fear to declare the truth?” “I appeal from the first half of the nineteenth century to the second.” “I am as certain of the truth of what I have advanced, as I am of my own existence.” But while his opponents denounced him as irritable and thin-skinned, it is testified of him that his temper was never affected; neither petulance nor gloom clouded his life; he never wrote an anonymous unfavourable review. “Nothing delighted his benevolent heart,” says his widow, “more than to praise others, when he could conscientiously do so; and never can I forget the sparkle of his eye and his pleasant smile when he had written something in favour of any professional brother.”

Practice now flowed in upon Dr. Hall. His researches gave him an insight into diseases and disorders of the nervous system which no one had as yet approached. Large numbers of patients came to consult him personally, or sent for him without the intervention of a general practitioner. Dr. Russell Reynolds says that his “New Memoir on the Nervous System,” 1843, described with remarkable ingenuity the mechanism of the convulsive paroxysm, and of many other affections assuming a paroxysmal type. “To Dr. Marshall Hall is due the merit of having rescued the obscure class of convulsive affections from a region of utter unintelligibility. The action of strychnia as a spinal excitant, or, in small doses, as a spinal tonic; the direction—general, regiminal, and medical—of the epileptic patient, in order to avoid all the excitants of convulsive action; the recommendation of tracheotomy in laryngismal epilepsy; and the simple but beautiful ‘Ready Method in Asphyxia,’ were among the later efforts of Dr. Hall’s great genius.... The two prominent features of his treatment were simplicity and perseverance. We have seen numerous cases in which his administration of simple aperients, together with strictly regiminal measures, had wrought extraordinary cures; and we know of previously paraplegic men, now well, who under his direction took strychnia for much longer than a year; and of so-called epileptics who slowly recovered from the most frightful combination of symptoms, while kept by Dr. Hall for sixteen or eighteen months under the influence of mercury.” Even under the heaviest strain of practice he found time to continue his researches, and to publish his experience. In 1845 and 1846 appeared two small volumes of “Practical Observations and Suggestions in Medicine,” in which a great number of medical subjects were treated in so concise and telling a way that they were immediately welcomed by a large class of readers. A chapter on the use of the Alcoholic Lotion in Phthisis Pulmonalis is said to have been the means of saving many lives; another on “the Temper Disease” is most interesting to the student of human nature as well as of medicine.

A friend, Mr. Henry Gregory, of Herne Hill, who had much professional and friendly intercourse with Dr. Hall, says of him: “In debate or conversational argument nothing seemed to escape his penetration. His minuteness in bringing out little things which others thought not of, was remarkable; with one little atom, so to speak, a light would shine forth from him so brilliantly that I could only sit and admire his remarkable mental gifts. He was a great man and a genius, and, like all the truly great, made no parade.... He was the educator of the intellect; his domain was pure scientific research. The earnest activity of his mind made him proceed, and every advance he made was a clearing away of error and an establishment of truth.... In emergencies he was both prompt and cautious; when anxious excitement surrounded him, it did not disturb his judgment. In dangerous and difficult cases he was always calm. His deep sense of duty and responsibility was unbending.” There is a universal concurrence of testimony as to his great success in gaining his patients’ confidence; young and old looked with delight for his visits. He would always direct the responsible nurse most precisely, and endeavour by every possible device to secure that his special treatment should be carried out. His searching and pointed questions not unfrequently discovered “hidden seizures,” as he called them, which had been totally unsuspected or uncomprehended by patients or friends. His power of devising a remedy is amusingly illustrated by his prescription to an indolent lady that she was to walk daily to the Serpentine from her home, and dip her finger in it. The desirability of healthy mental occupation, and the encouragement of happiness and pleasing customs generally, were favourite subjects of his injunctions. Sympathy and kindliness shone through his whole manner. A Scotch minister said to him: “You place your soul in the stead of your patient’s soul.” But he abhorred all coaxing and wheedling; he hated cant. He would not lower his own lofty sense of independence by anything approaching to it. One might have supposed so sympathetic a nature would have been compliant; but his spirit and dignity were consistent with and equal to his sympathy. It was but another phase of his noble character that he could attend the poor and the needy middle-class without allowing or causing them to feel the slightest difference between themselves and the rich.

This was the great physician who could never find a post as physician in any London hospital. His medical teaching was almost entirely confined to the schools that were outside the close circle of the hospital schools. In 1834-6 he lectured on medicine at the Aldersgate School, and then joined the Webb Street School (that of the Graingers), taking a similar post. He also gave lectures for two years at “Sydenham College,” established near University College. But the exertion of lecturing concurrently at these two was too much for his voice, and he could not complete his course in 1839. In 1842-6 he gave lectures on nervous diseases, at St. Thomas’s Hospital Medical School. In these he illustrated many points by remarkable diagram portraits of paralytic patients. His lectures were given extemporaneously after careful preparation, and delivered extremely clearly, without any showiness. When lecturing at a school unattached to a hospital he would invite his pupils by turns to breakfast at his house, that they might then see some of his poorer patients, and go over their cases with him. One instance of his thoughtfulness for his pupils is enough to mark out any man from among his fellows. A student was confined to his room for three or four weeks by illness, and Dr. Hall came regularly to his lodgings to give him a resumé of his lecture, and of what followed it. No wonder that an affectionate feeling bound his class to him, and that no lecturer ever was more attentively followed. The instances of the affection and regard displayed in various ways between him and his pupils are among the most interesting records in medical biography.[21]

Though he had been denied the Fellowship of the College of Physicians until 1841, Marshall Hall was at last fully recognised by the College in being appointed to deliver the Gulstonian lectures in 1842, and the Croonian in 1850, 1, and 2. In these courses, which were largely attended, he fully explained his views and discoveries on the nervous system and nervous diseases, as well as on general medical treatment. They were published later, in the form of “Synopses” of each course, in quarto.

Notwithstanding his aversion to anything like strife in medical politics, Marshall Hall took a prominent part in the formation of the British Medical Association, and was at once elected on its Council, and delivered the oration on Medical Reform in 1840. He was in his true place in every philanthropic scheme that needed medical advocacy. The open railway carriages were doomed when he denounced them as dangerous to health; inhuman flogging of soldiers was evidently condemned when he expounded the character of the injuries inflicted on the cutaneous nerves, and the decree of shock to the heart. He even wrote on the Higher Powers of Numbers, in the Mechanics’ Magazine, and took an interest in devising new forms of conjugation for Greek nouns and verbs. He strongly advocated a new Pharmacopœia, based on the decimal system. He suggested in a pamphlet as early as 1850 new works for the sewerage of the Thames, developing his ideas more elaborately in 1852 and 1856. Many of his views and plans have since been adopted: others must and will still be carried out if London is to be properly and healthily drained.

It is not to be imagined that Hall was so absorbed in study and practice that he could not take recreation. No one enjoyed more than he the pleasure of travelling, the tonic of the open air, the change to the Continent, a tour to America; and he rigorously took these, and enjoyed himself with the abandon of a child. His delight in splendid scenery was extreme; and he gratified his taste, in season, by tours extending very widely over Europe. His visit to America was specially undertaken in 1853 with the object of studying slavery by personal observation. In New York and other cities he gave lectures by request illustrative of his discoveries. From Quebec to New Orleans, and even the Havana, his fame had preceded him, and he was feted and listened to with as much ceremony and enthusiasm as his retiring nature could be prevailed upon to endure. At the Havana he lectured in French for two hours, and the medical students of the city visited him again and again, thirsting for information at first hand. Dr. and Mrs. Hall returned to England in April 1854; and very soon after he published his little volume on “The Two-fold Slavery of the United States.” The subject was one which most deeply interested Marshall Hall’s philosophical and religious mind; and it is significant of the depth of his philosophy that he was far-seeing enough to be certain that unprepared abolition would be far from a perfect boon for the slave, while yet he regarded the continuation of slavery as wicked and degrading, financially ruinous, and tending to generate wars. His remedies were first, education; second, the appointment of fair task-work; third, the privilege of over-work, to be paid for, and the payments accumulated till freedom could be purchased with the aid of proportionate additions by the Federal and States’ Governments. Whether his plan could ever have been worked out will now never be known. That many of the evils he foresaw have followed persistence in slavery and sudden abolition is matter of certainty.

Marshall Hall’s physical frame had been overtaxed by his exertions and struggles, and he became increasingly liable to severe laryngitis. Taking another continental trip in the winter of 1854-5, he showed his vivid intellectual energy by applying himself at Rome to the study of Hebrew. He engaged a Rabbi to teach him, and when awake at night or at early dawn, he worked at his new study with the zeal of a tripos candidate, and never did a pupil make more rapid progress. He ascended Vesuvius during the eruption of May 1855, a serious undertaking for a man of sixty-five. At Paris, in the summer, he wrote in three months a work in French, detailing his investigations on the spinal system, dedicated to M. Flourens, who had always shown the most generous appreciation of his labours as constituting a great epoch in physiology. Louis, the great physician, and his wife, were equally warm in their appreciation of and attachment to him. On December 5, 1855, Marshall Hall was elected a corresponding member of the French Academy of Science, by 39 votes out of 41.

On returning to England towards the end of 1855, Marshall Hall’s mind fastened with characteristic eagerness on a new subject, suggested by reading the Humane Society’s “Rules to Restore the Apparently Drowned.” He remarked: “There is nothing in the treatment to restore respiration.” He at once thought out the question in the light of his researches on the physiology of respiration, and when he had mentally devised his system of restoration, proceeded to make experiments to test them. Hitherto it had been believed that it was useless to attempt to restore those who had been immersed three or four minutes. He said to the Secretary of the Humane Society: “If we take this for granted, we shall do nothing; surely it is worth while to make the effort to restore after a longer period.” His plan for producing artificial respiration, by turning the body first on the face, then on the side, and repeating the motion for a quarter of an hour, making equable pressure on the back of the chest when in the prone position, removing it when rotating on to the side, is known all over the world as the Marshall Hall method, and has saved thousands of lives. Numerous details are added to increase the efficiency of the treatment. But the Humane Society looked coldly on the novel plan, and long persisted in ignoring it. The National Lifeboat Institution wisely adopted it; the medical profession received it with acclamation; it was applied to the revival of still-born infants, and the restoration of those in danger of dying from asphyxia from other causes than drowning. At the same time when Palmer’s trial for poisoning was occurring, Dr. Hall drew attention to the facility with which the presence of strychnia could be proved by administering any suspected matter to young frogs, which would be affected by the five-thousandth part of a grain of strychnia.

But he now began to succumb to the effects of his long-continued malady in the throat. Expectoration of blood became more frequent, difficulty of swallowing increased; at times he was near absolute starvation, and his sufferings were horrible, but his patience and resignation marvellous. After months of terrible illness, during which his cheerfulness never left him, he died on the 11th August 1857, of ulceration of the upper part of the gullet and windpipe. During his illness his mind was as active as ever, he wrote continually his new ideas, and worked out to fuller ends his former discoveries. Throughout he was especially bright and affectionate to all little children; the manner in which he entered into children’s delights was most exquisite to witness. His Christian faith was unclouded; as he said, religion was to him the principal thing. In the simplicity, beauty, and happiness of his character he resembled Sir Charles Bell, of whom he was the true successor.