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 Looking Back www.jpgmonline.com Sir Charles Bell: The artist who went to the roots!

Kazi RA, Rhys-Evans P

Department of Head and ir Charles Bell was born on 12th November 1774, , as one of three sons of a Neck, Royal Marsden S minister of the Church of .1-3 His father died when he was only 5 years old and so Hospital, Fulham Road, the personality and career of Charles Bell was greatly influenced by his mother. Widowed, she SW3 6YT, UK. assumed the responsibilities of rearing and educating her three sons. She was a remarkable woman, intelligent and artistic, who instilled in her sons high ideals, ambition, cultural interests and a Correspondece: devotion that bordered on reverence. It is not surprising then, that Charles became a sensitive, Rehan A Kazi, MS E-mail: aesthetic person and an accomplished artist. [email protected] Charles Bell was the younger brother of (1763-1820), who was to become a well-known surgeon, famous as a teacher and author.4,5 Received : 05-02-04 Review completed : 01-03-04 Accepted : 02-03-04 Charles Bell was also tutored in art and attended High School for three years. Spurred PubMed ID : by the example of his elder brother, he commenced studying medicine at Edinburgh, attending J Postgrad Med 2004;50:158-9 John’s lectures. While still a student there, under the guidance of his brother, he taught

anatomy and published “A system of dissection explaining the himself an excellent teacher while continuing his research on anatomy of the body, etc.” - a work on anatomy con- the anatomy and the function of the nerves. He ran the hospi- taining extraordinary illustrations of his own. tal famously until 1825.

In 1799, Charles Bell graduated from the University of Edin- In 1814, he accepted a position as a surgeon at the Middlesex burgh, and was admitted to the Royal College of Surgeons.2,3 Hospital and was instrumental in the founding of the Middle- During the surgical operations he carried out at the Royal in- sex Hospital and Medical School in London in 1828. firmary, he proved himself able in surgery as well as in anatomy. At the battle of Waterloo (June 18, 1815), Bell operated on In 1802 and 1803, Volumes 3 and 4 of his book “Anatomy of the wounded soldiers until “his clothes were stiff with blood the human body” were published. In this joint publication of and his arms powerless with the exertion of using the knife”.3,4 John and Charles Bell, Charles prepared the parts on the nerves, It was at Waterloo that he produced the oil paintings and the sensory organs, and the viscera.2-5 etchings of gunshot wounds now on display in the custody of the Royal College of Surgeons of Edinburgh. About a soldier The success of John Bell’s anatomy classes aroused the jeal- that Bell had painted, but did not operate upon himself, he ousy of the members of the Faculty of Medicine at the Univer- wrote: “The ball struck the head of the humerus, and shat- sity of Edinburgh, who succeeded in barring him and Charles tered it, passed through and wounded a rib. It was resolved to from practice at the Royal Infirmary or positions at the Uni- amputate at the shoulder joint. It was reported to me that the versity. In 1804, with his career in Edinburgh blocked, Charles patient sunk from loss of blood. I thought myself entitled to Bell went to London to make his own future and fortune. In say that the method followed by our army surgeons was too his baggage, he had the manuscript of his first book on his bold, and not suited to common practice, and especially in a own, “Essays on the Anatomy of Expression in Painting” (1806), case like this, when the patient was reduced by a complication the first textbook of anatomy for painters. Besides being a land- in the wound.” mark in the exposition of the anatomical and physiological basis of for artists, the book included much Bell’s most important works are in the fields of research on the philosophy and critical history of art.4,5 brain and the nerves.2-4 His book “An Idea of a New Anatomy of the Brain” (1811), has been called the “Magna Carta of In 1809, during the war, following the retreat from La Coruna, Neurology.” It was first published in private printing – he only the wounded soldiers were brought to London, where Charles circulated one hundred copies to his acquaintances – then Bell had further ample opportunity to prove his skills as a sur- published nothing more on the subject for ten years. geon. Later, Bell opened a private school of anatomy, and in 1812, took over the Great Windmill Street School of Anatomy, In the book, he discusses the functions of the brain and the founded by William Hunter (1718-1783).4,5 Here he proved cerebellum. He describes the double roots of the spinal nerves

 158 J Postgrad Med June 2004 Vol 50 Issue 2 Kazi et al: Sir Charles Bell  and how he, as the first ever, experimentally investigated their was his love for fishing! different functions on a living animal – a donkey. Bell found that an irritation of the ventral roots caused cramps, while a In England, he was considered the foremost physician and sci- disturbance of the dorsal roots produced no visible symptoms. entist of his day.3,4 At a visit to Paris, Professor Roux concluded He assumed that the ventral roots connected the peripheral a lecture in his honour with the words “C’est assez, Messieurs, with the cerebrum, which was the centre of vous avez vu Charles Bell”. sensibility and motility, while the dorsal roots connected the periphery to the cerebellum, the centre of the vegetative There was a captivating twinkle behind his eyeglasses, and he functions of the body. It is doubtful if Bell recognized the was genial and unaffected. Renowned physicians from all over significance of his finding at the time, since he still held that the world came to visit him in London, and his travels abroad all nerves were sensory, classifying them as sensible and became triumphant processions. He died on 28th April,1842 insensible. at North Hallow, Worcestershire, a happy and satisfied doc- tor.3,4,6 In the early 1820s, Francois Magendie in Bordeaux, who had heard of Bell’s work from John Shaw, Bell’s assistant at the Associated Eponyms Great Windmill School, demonstrated that the ventral roots of spinal nerves are motor, the dorsal roots are sensory. Bell Bell’s nerve: The posterior or long thoracic nerve had missed the latter fact. A conflict of priority arose, but the scientists reached an agreement, and the rule of the function Bell’s paralysis: Peripheral, usually unilateral, idiopathic pa- of the spinal nerves was called Bell-Magendie’s law.3,4 This dis- ralysis of facial muscles tinction of the nervous traffic is considered the first impor- tant step towards an investigation of the activity of the nerves, Bell’s phenomenon: When a patient with peripheral facial pa- becoming the starting point for Charles Sherrington’s epoch- ralysis attempts to close the eye, there is an upward move- making works. ment of the eye and the eyelid on the paralysed side of the face remains open Charles Bell was even more recognized abroad than at home and in1824, he became the first Professor of Anatomy and Bell’s spasm: Involuntary twitching of the facial muscles Surgery of the College of Surgeons in London. He was known for his well-prepared and elegant lectures. In 1928, at the open- Bell-Magendie law: The anterior spinal nerve roots contain only ing of the University of London, the private Great Windmill motor fibres and the posterior roots only sensory fibres Street School became a part of King’s College. Bell was called upon as Professor of at the University of London.5,7,8 Mona Lisa syndrome: Facial muscle contracture that develops However, he was not satisfied with the conditions at the Uni- after Bell’s palsy when the facial nerves have undergone par- versity and so resigned his position and decided to make a liv- tial wallerian degeneration and have regenerated ing from private practice. References In 1826, he published the second edition of his then dead brother’s “Principles of surgery”. He was a kindly man and 1. Ober WB. Sir Charles Bell, F.R.C.S.E. (1774-1842): Anatomy of expression. Acad Bookman 1969;22:3-10. somewhat a dandy in his dress sense. In 1829, Bell received 2. May M, Schaitkin BM. History of surgery. Facial Plast Surg 2000;16: 301-7. the first medal awarded by the Royal Society – 50 Guineas and 3. Jay V. A portrait in history: Sir Charles Bell-Artist extraordinaire. Arch Pathol Lab later he was knighted by King William IV (1765-1837) in Med 1999;123:463-65. 4,5,7,8 4. Pearce JM. Sir Charles Bell 1774-1842. J Neurol Neurosurg Psy 1993;56: 1831. Despite the honours bestowed upon him, he always 913-16. remained very humble. In 1835, he accepted an invitation to 5. Pearce JM. Sir Charles Bell (1774-1842). J R Soc Med 1993;86:353-4. 6. Loudon IS. Sir Charles Bell and the anatomy of expression. Br Med J 1982;285: become a Professor of Surgery in Edinburgh, and in 1836, left 1794-6. London, because “London was a good place to live in but not 7. Cule J. Sir Charles Bell (1774-1842) and the portraiture of beauty. Rep Proc Scott Soc Hist Med 1992;3:31-40. to die in”. He was by then 62 years of age, but continued his 8. Chikwe J. Art and literature in the anatomy of Charles Bell. J R Coll Surg Edinb. activities as intensively as ever. Another reason for his return 1994;39:201-7.

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