Journal of the Royal Society of Medicine Volume 86 June 1993 353

Sir Charles Bell (1774-1842)

J M S Pearce MD FRCP Department of Neurology, Hull Royal Infirmary, Hull HU3 2JZ

Keywords: Sir Charles Bell; history; facial nerve; spinal nerves

In non-medical circles Joseph Bell (1837-1911) is Alexander Munro and Gregory, being elected Member probably best known as the source of inspiration and of the Edinburgh College of Surgeons in 1799. His example for Conan Doyle's living legend - Sherlock brother John was in dispute with Dr Gregory, and Holmes. Bell's palsy1 is probably better known to both John and Charles were excluded from promotion. doctors, but was not described by Joseph, but by the He left Edinburgh for London in November 1804, unrelated Sir Charles Bell2, though Avicenna had but his coach stopped for the weekend at Huntingdon much earlier described spastic, atonic and convulsive and he walked the remaining journey. types of facial palsy34. His reputation as an artist had preceded him and Born in Edinburgh, Charles Bell was the son of within a few days of arrival he had been received by William Bell, an Episcopalian minister in the Church Astley Cooper, Sir Joseph Banks and by Matthew of Scotland whose second wife Margaret Morice was Baillie, but despite his contacts he secured no the mother of Charles and five other children. His permanent position. He took a dilapidated house in brother John Bell (b. 1763) was a lecturer in Surgery Leicester Street, Leicester Square, with his brother at Edinburgh who wrote, with help from Charles, George; his staple was barely provided for by lectures Anatomy ofthe human body; the family's artistic gifts to students of anatomy and art. There had been little are shown in many of John's engravings of bones, interest in neurology at this time. Bell was frustrated joints and wounds. George Joseph Bell (b. 1770) was by the prevailing doctrine that nervous fluid was a distinguished professor of Scots Law, his preferment derived from the brain and transmitted by nervous in Edinburgh being seconded by the family friend Sir tubes. Walter Scott. In 1806 he published his An essay on the anatomy Charles was the fourth and youngest son. He was ofexpression in painting, intended mainly for artists. devoted to his mother, had an unhappy (and he It was well received, and he was flattered that the deemed unprofitable) education at Edinburgh High Queen read a copy. But Bell remained impoverished School, but at this time he became friends with David despite enjoying the praises and attentions of many Allan the painter, known as the 'Hogarth ofScotland', distinguished and titled doctors and artists. His many who encouraged Charles's draughtsmanship. He lectures and patients eventually brought prosperity, studied medicine in his home town under Black, however, and he continued to prosect on the anatomy of the brain. His publications were numerous: The anatomy of the brain explained in a series of engravings, 1802 including 12 beautiful plates, some coloured; A series ofengravings explaining the course ofthe nerves, 1803 including nine fine quarto plates; A system ofoperative surgery founded on the basis of anatomy, 1807 dedicated to his friend Wm Lynn. On 3 June 1811 he married Marion Shaw and moved to 34 Soho Square. With the help of his wife's dowry he bought a share in the Great Windmill Street School of Medicine owned by the surgeon James Wilson and formerly founded by William Hunter more than 40 years before. It contained a museum where he worked and added his own material. In 1807 he distinguished between the sensory and motor nerves of the brain. In 1813 he was appointed to the Middlesex Hospital and studied gunshot wounds at Haslar Hospital after the battle ofCorunna in 1809. Waterloo was signalled on 22 June 1815; on the 30 June, without a passport he hastened to Brussels, operating from morn till night, but always painting and sketching. Returning to London he was appointed professor of Anatomy and Surgery at the RCS England in 1824. He was prodigiously busy with writing, surgery, art, the foundation of London University, and was awarded the medal of the Royal Society, and received the Guelphic order of Knighthood in 1833. The Edinburgh chair of Surgery took him from Figure 1. Sir Charles Bell London in 1835 at the age of 61. He visited Italy in 354 Journal of the Royal Society of Medicine Volume 86 June 1993

1840, but on return, his health failed, probably with The facial nerve he called 'the respiratory nerve of angina. Visiting a friend near Worcester, he died the face'. suddenly on 29 April 1842 and was buried in the neighbouring Hallow churchyard. In all the exhilarating emotions, the eyebrows, eyelids, the The letters of Sir Charles Bell were published in nostrils and the angles of the mouth are raised. In the 1870 and a long biographical article appeared in the depressing passions it is the reverse6. Edinburgh Review of April 1872. Bell's medical contributions were numerous and Bell entered another controversy when after experi- diverse. These briefnotes only sketch some ofhis more ments on the nerves in the ass, he erred in asserting notable areas of research. Idea of a new anatomy of that the fifth and seventh cranial nerves innervated the Brain,; submitted for the observations ofhis friends the muscles ofthe face. Mayo (1796-1852) had earlier was printed privately in 1811 and provoked little given the correct anatomy, but Bell later corrected attention. He pointed out the separate functions ofthe his error: cerebrum and cerebellum; that spinal nerves were double, the anterior and posterior roots subserving the sensibility of the head and face depend upon the fifth different functions. He was concerned that the doctrine pair of nerves . . . the portio dura of the seventh nerve is that all nerves were the same was in error: the principal muscular nerve of the face7.

Whatever the nature ofthe impulse communicated to a nerve Bell was a brilliant and versatile if controversial ... the perception excited in the mind will have reference figure. The Royal College of Surgeons in Edinburgh to the organ exercised, not the impression made upon it. contains many of his superb pictures of war injuries and anatomical exposures. He was well lauded in his Studies ofthe spinal nerves led to furious arguments lifetime, but perhaps the greatest compliment' was about priority with Francois Magendie. Bell's experi- from Viggio Christiansen of Copenhagen: ments showed that ... He created modern clinical neurology in the same way as stimulation of the anterior portion of the spinal marrow his contemporary Corot created modern French landscape (spinal roots) convulsed animals more certainly than injury painting. to the posterior portions. References He recognized 'four brains': two anterior (cerebral) 1 Bell C. The nervous system ofthe human body. London: and two posterior (cerebellar) . . . with full com- Longman, 1830 munications to ensure 'their acting with perfect 2 Hale-White W. Sir Charles Bell. In Great doctors ofthe '5 nineteenth century. London: Edward Arnold, 1935:42-62 sympathy'5 3 Gruner OC. A treatise on the Canon of Medicine of Avicenna incorporating a translation of the first book. the cerebrum and cerebellum were parts distinct in function London: Luzac & Co, 1930 and that every nerve possessing a double function obtained 4 Avicenna (Ibn Sina). Al Qanun fil-Tib (Arabic (Bulaq) edn that by having a double root. Vol 2, Book 111. Egypt: Cairo Government Press 1877: 103-4 (translated by Nathan B 1992) He worked on the brain which united the mind to the 5 Bell C. Idea ofa new anatomy ofthe brain submitted for body. the observations of his friends. London: Straham and Preston 1811 (private circulation). (Facsimile reprinted, Into it all the nerves from the external organs ofthe senses London: Dawsons of Pall Mall, 1966) enter ... nerves from the surface, nerves oftouch, and nerves 6 Bell C. Essays on the anatomy and philosophy of of peculiar sensibility; ... and from it all the nerves which expression (2nd edn). Edinburgh: Murray, 1824 are agents of the will pass out (via the anterior columns of 7 Bell C. On the nerves of the face: being a second paper the cord and its roots). on the subject. Phil Trans Roy Soc 1829;119:317 The cerebellum governs the operation of the viscera ... their nerves go everywhere for the secret operations of the bodily frame . .. (Accepted 21 January 1992)