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

by G. T. Bettany

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.