Sir Charles Bell 
Scottish anatomist, surgeon, and physiologist, born November 1774; died 28th April, 1842, North Hallow, Worcestershire.

Bell's palsy = Peripheral, usually unilateral, idiopathic paralysis of facial nerve.

Bell's phenomenon = upturning of the globe on lid closure.
 


Left lower facial nerve palsy.


Sir Charles Bell was one of three sons of a minister of the Church of England who died when Charles was five. The personality and career of Charles Bell thus reflect the influence of his mother. Widowed, she assumed the responsibilities of rearing and educating her four sons. She was a remarkable woman, intelligent and artistic, who instilled in her sons high ideals, ambition, cultural interests, and a devotion that bordered on reverence. It is not surprising then that Charles was a sensitive and aesthetic person and an accomplished artist.

Charles Bell was the younger brother of John Bell (1763-1820), who was to become a well known surgeon, famous as a teacher, author, and the owner of a well appointed library. 

Charles Bell was also tutored in art and attended Edinburgh High School for three years. Spurred by the example of his elder brother, he commenced studying medicine at Edinburgh, attending John's anatomical lectures and together developing their artistic talent which they shared. While still a student under the guidance of his brother, he taught anatomy and published "A system of dissection explaining the anatomy of the human body, etc." - a work on anatomy containing extraordinary illustrations of his own.

In 1799 Charles Bell graduated at the university of Edinburgh, and was admitted to the Royal College of Surgeons. At the surgical operations he carried out at the Royal infirmary, he proved himself as able in surgery as in anatomy. The patient had no say. He also concerned himself with the production of wax preparations.

In 1802 and 1802 the volumes 3 and 4 of "Anatomy of the human body", appeared. In this joint publication of John and Charles Bell, Charles prepared the parts on the nerves, the sensory organs, and the viscera.

The success of John Bell's anatomy classes aroused the jealousy of the members of the Faculty of medicine at the University of Edinburgh, who succeeded in barring him and Charles from practice at the Royal Infirmary or positions at the University.

In 1804, his career in Edinburgh blocked, Charles Bell went to London to make his own fortune. In his baggage he had the manuscript for the first book of his own, "Essays on the Anatomy of Expression in Painting" (1806), the first textbook of anatomy for painters. Besides being an exposition of the anatomical and physiological basis of facial expression for artists, the book included much philosophy and critical history of art.

In 1809, following the retreat from La Coruna, the wounded were brought to London, where Charles Bell cared for the wounded from Coruna and had ample opportunity to prove his skills as an operator. Bell had opened a private school of anatomy, and in 1812 took over the Great Windmill Street School of Anatomy, founded by William Hunter (1718-1783) and made famous by him and his brother, John Hunter (1728-1793). Here he proved himself an excellent teacher while continuing his research on the anatomy and function of the nerves. He ran the hospital until 1825.

In 1814 he accepted a position as surgeon at the Middlesex Hospital and was instrumental in the founding of the Middlesex Hospital and Medical School in London in 1828.

At the battle of Waterloo (June 18, 1815), Bell operated on the wounded until "his clothes were stiff with blood and his arms powerless with the exertion of using the knife". It was at Waterloo he produced the oil paintings and etchings of gunshot wounds now on display in the custody of the Royal College of Surgeons of Edinburgh. About a soldier Bell painted, but did not operate upon himself, he wrote: "The ball struck the head of the humerus, and shattered it, passed through and wounded a rib. It was resolved to amputate at the shoulder joint. It was reported to me that the patient sunk from loss of blood. I thought myself entitled to say that the method followed by our army surgeons was too bold, and not suited to common practice, and especially in a case like this, when the patient was reduced by a complication in the wound."

Bell's most important works are in the fields of research on the brain and the nerves. His book An Idea of a New Anatomy of the Brain (1811) has been called the "Magna Carta of neurology." It was first published in private printing – he only circulated one hundred copies to his acquaintances – then published nothing more on the subject for ten years.

In the book he discusses the functions of the brain and the cerebellum, he describes the double roots of the spinal nerves and how he, as the first ever, experimentally investigated their different functions on a living animal - a donkey. Bell found that an irritation of the ventral roots caused cramps, while a disturbance of the dorsal roots produced no visible symptoms. He assumed that the ventral roots connected the peripherous nervous system with the cerebrum, which was the centre of sensibility and motility, while the dorsal roots connected the periphery to the cerebellum, the centre of the vegetative functions of the body.

It is doubtful if Bell recognized the significance of his finding at the time, since he still held that all nerves were sensory, classifying them as sensible and insensible.

In the early 1820s, Francois Magendie in Bordeaux, who had heard of Bell's work from John Shaw, Bell's assistant at the Great Windmill School, demonstrated that the ventral roots of spinal nerves are motor, the dorsal roots are sensory. Bell had missed the latter fact, as he, because of his dislike of vivisection, as he always stunned the animals with a blow to the head. A conflict of priority arose, but the scientists reached an agreement, and the rule of the function of the spinal nerves was called Bell-Magendie's law. This distinction of the nervous traffic is considered the first important step towards an investigation of the activity of the nerves, becoming the starting point for Charles Sherrington's epoch-making works.

Charles Bell was even higher recognized abroad than at home, but in 1824 he became the first professor of anatomy and surgery of the College of Surgeons in London, where he was well known for his well prepared and elegant lectures. In 1928, at the opening of the University of London, the private Great Windmill Street school became a part of King's College, on which occasion Bell was called upon as professor of physiology at the University of London. However, he was not satisfied with the conditions at the university, resigned his position and had to make a living from practicing, which de did not like.

In 1826 he published a second edition of his then dead brother's "Principles of surgery". He was a kindly man and somewhat a dandy in dress. In 1829 Bell received the first medal awarded by the Royal Society – 50 Guineas; he was knighted by King William IV (1765-1837) in 1831. Despite the honours bestowed upon him, in 1835 he accepted an invitation to become professor of surgery in Edinburgh, and in 1836 left London, because "London was good place to live in but not to die in". He was by then 62 years of age, but continued his activities as intensively. Another reason for his return was his love of flyfishing!

In England he was considered the foremost physician and scientist of his day. At a visit in Paris professor Roux concluded a lecture in his honour with the words "C'est assez, Messieurs, vous avez vu Charles Bell".

There was a captivating twinkle behind his eyeglasses, and he was genial and unaffected. Renowned physicians from all over came to visit him in London, and his travels abroad became triumphant processions. He received many honours including knighthood, conferred by the enthusiast Lord Henry Peter Brougham (1778-1868).
 

    «If we select any object from the whole extent of animated nature, and contemplate it fully and in all its bearings, we shall certainly come to this conclusion: that there is Design in the mechanical construction, Benevolence in the endowment of the living properties, and that Good on the whole is the result.» 
    The Hand, Its Mechanism and Vital Endowments as evincing Design. 
    Chapter 1.

    «The public, who are so ready to determine on the merits of our profession, and even the patients who are to suffer, are surprisingly ignorant both of the Surgeon’s motives for what he does, and the propriety of the methods he puts in practice. He is continually operating in secret as a matter of necessity. The most sensible give the decision up to him; so that he is answerable to his own conscience, and to that alone.» 
    Illustrations of the Great Operations in Surgery; Preface.

    «Nor is the public aware of the temptations which men of our profession withstand. Credit for great abilities, gratitude for services performed, and high emoluments are ready to be bestowed for a little deception, and that obliquity of conduct, which does not amount to actual crime.»
    Illustrations of the Great Operations in Surgery; Preface.

    «Pain is the necessary contrast to pleasure; it ushers us into existence or consciousness: it alone is capable of exciting the organs into activity: it is the compassion and the guardian of human life.»
    The Hand, Its Mechanism and Vital Endowments as evincing Design.
    Chapter 7.

    «I thought that all was right in the system of the universe - that consistent with our desires and passions was the shortness of our life and our being liable to suffering and disease - that without this we should have been inanimate, cold, and heartless creatures.»



Bibliography:
  • John Bell and Charles Bell:

  • The Anatomy of the Human Body.
    4 volumes, Edinburgh, Cadell & Davies, 1797-1804. 
    2 volumes; Edinburgh, Mundell & Son, and London, 1798-1803, folio with 20 plates.
    3rd edition, 1809; 4th edition, 1816. New edition 1813, 1817; Baltimore; 1814.
    German translation, Leipzig, 1800. Revised German edition by Johann Christian August Heinroth (1773-1843) and Johann Christian Rosenmüller (1771-1820) in 2 parts, Leipzig, 1805, 1807. 
    This work was published while Bell was still a student. The anatomical work of Charles Bell and his brother John was the most important in the British Isles during the early part of the 19th century.

    The title has also been given as: A System of Dissections Explaining the Anatomy of the Human Body, etc. Can you correct us?n
     

  • Discourses on the Nature and Cure of Wounds. 

  • Edinburgh: Mundell & Son, 1800.
     
  • Engravings of the Arteries, Illustrating the Second Volume of The anatomy of the Human Body, by John Bell, Surgeon.

  • London, 1802, 1804.
    All the drawings for this book were made by Charles Bell, and they stand unrivalled for their facility, elegance and accuracy. This volume of engravings was intended, as the title states, to illustrate the work of Charles Bell's brother, John Bell, who had himself done the drawings to illustrate the first volume. 
     
  • The Principles of Surgery. 

  • 3 volumes in 4. Edinburgh, London, T. Cadell & E W Davis, 1801, 1806, 1808.
    New edition with Charles Bell in 4 volumes, 1826-1828.
     
  • John Bell and Charles Bell:

  • i>The Anatomy of the Brain, Explained in a Series of Engravings. 
    Edinburgh, 1801; new edition, 1810.
     
  • A Series of Engravings, Explaining the Course of the Nerves. London, 1804, 1809.

  • 3rd edition, 1816, with an address to young physicians on the study of the nerves
    German edition (Bearbeitung) from the 3rd edition by Jakob Heinrich Robbi (1789-1833), with an introduction by Johann Christian Rosenmüller, Leipzig, 1820; also in Allgemeine Encyklopädie der Anatomie, volume VII. 
     
  • Essays on the Anatomy of Expression in Painting. 

  • London, Longman, Reese, Hurst & Orme, 1896. 
    New edition 1806. 1824 edition entitled Essay on the Anatomy and Philosophy of Expression.
    Bell's artistic and literary skills combined with his knowledge of anatomy and physiology to make his work a tour de force of art history and the anatomical and physiological basis of facial expression.
     
  • A System of Operative Surgery, Founded on the Basis of Anatomy.

  • 2 volumes. London, Longman, 1807-1809; 2nd edition, 1814.
    2nd American edition, Hartford, 1816.
    German translation with foreword by Carl Ferdinand von Graefe, Berlin, 1815; 
    Italian by Giacomo Barovero (died 1831), Torino, 1817: Systema di chirurgia operativa
     
  • Letters Concerning the Diseases of the Urethra. London, 1809; 2nd edition 1810.

  •  
  • A Treatise on the Diseases of the Urethra, Vesica Urinaria, Prostate and Rectum. 

  • London, 1811; 2nd edition, 1820; 3rd edition, 1822, etc, 1832. 
    German translation in Chirurgische Handbibliothek, volume II, Weimar, 1821.
     
  • An Idea of a New Anatomy of the Brain; submitted for the observations of his friends. 

  • London, Strahan & Preston, 1811.
    Contains first reference to experimental work on the motor functions of the ventral spinal nerve-roots,, without, however, establishing the sensory functions of the dorsal roots. This very rare privately printed pamphlet is reproduced in Medical Classics, 1936, 1: 105-120. Facsimile reprint, London, 1966. Bell's own annotated copy, preserved in the library of The Royal Society, is reproduced in Cranefield, The way in and the way out: François Magendie, Charles Bell and the roots of the spinal nerves, Mt. Kisco, N.Y., Futura Publishing, 1974. Cranefield proves that Magendie discovered the Bell-Magendie law.
     
  • Engravings from Specimens of Morbid Parts, Preserved in the Author’s Collection, now in Windmill Street etc. London, 1813.

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  • Dissertation on Gun-shot Wounds. London, 1814.

  •  
  • Surgical Observations; Being a Quarterly Report of Cases in Surgery, Treated in the Middlesex Hospital, in the Cancer Establishment and in Private Practice, etc. 

  • 2 volumes, London, 1816-1818.
     
  • An Essay on the Forces Which Cerculate the Blood; Being an Examination of the Differences of the Motions of the Fluids in Living and Dead Vessels. London 1819.

  •  
  • Illustrations of the Great Operations of Surgery: Trepan, Hernia, Amputation, Aneurism, and Lithotomy. 

  • London, Longman, Hurst, Rees, Orme and Brown, 1821,
    German translation by Carl (Karl). Gottlob Kühn U(1754-1840); Leipzig, 1822, 1823.
    One of the most dramatically and beautifully illustrated works in the entire literature of surgery. Hand-coloured copies show more blood than is usual for surgical treatises of this period. From publication in fascicules, 1820-1821. A second, undated issue appeared circa 1830.
     
  • On the Nerves: Giving an Account of some Experiments on Their Structure an Functions, Which Lead to a New Arrangement of the System. 

  • Lecture given at the Royal Society in 1821.
    Philosophical Transactions of the Royal Society of London, 1821, 111: 398-424.
    Bell's palsy – the facial paralysis ensuing upon lesion of the motor nerve of the face is here for the first time described. 
    More detailed in: Lecture given at the Royal Society in 1829, 119: 317-330.
    Reprinted in Medical Classics, 1936, 1: 152-169.
     
  • An Exposition of the Natural System of Nerves of the Human Body.

  • London, Spottiswode, 1824, 1830, 1837; Philadelphia, 1825. 
     
  • Animal Mechanics.

  • Published by the Society for the Diffusion of Useful Knowledge, 1828-1829. This compilation of lectures given at the College was sold in 30.000 copies over three years.
     
  • Observations on injuries of the spine and of the thigh bone; in two lectures. 

  • London 1824.
     
  • The Nervous System of the Human Body. Embracing the Papers Delivered to the Royal Society on the Subject of the Nerves. 

  • London, 1824.2nd edition, London, Longmans, 1830. 3rd edition, London, Spottiswode, 1844. 
    Translated into German by Moritz Heinrich Romberg (1795-1873).
    Records Bell's demonstration that the fifth cranial nerve has a sensory motor function, his discovery of "Bell's nerve" and the motor nerve of the face, lesion of which causes facial paralysis (Bell's palsy). Bell was preceded in some of these discoveries by Mayo. Also includes the first description of myotonia.
     
  • Appendix to the Papers on the Nerves, Republished from the Royal Society’s Transactions. 

  • Includes revisions of papers first published in Philosophical Transaction of the Royal Society. London, 1827.
    French translation by Jean-Louis Genest: Exposition du système naturel des nerfs. Paris, 1827.
    German by Moritz Heinrich Romberg (1795-1873), Berlin, 1832, 1835, 1836. 
     
  • Bridgwater Treatise IV: The Hand; its Mechanism and Vital Endowment, as Evincing Design.

  • London 1833; 2nd edition, 1834; 5th edition, 1852.
    American edition, Philadelphia 1836; New York, 1840
    German translation by Herm. Hanff, Stuttgart, 1836.
     
  • Illustration of Paley’s Natural Theology etc. 

  • Written with Lord Brougham. London, 1835.
    Referring to Natural Theology (1802) by the English Anglican priest and Utilitarian philosopher William Paley (1743-1805).
     
  • Institutes of Surgery Arranged in the Order of the Lectures Delivered in the University of Edinburgh. 2 volumes, Edinburgh, 1838; Philadelphia, 1840, 1843.

  • German translation C. A. Mörer with a preface by Carl Ferdinand von Graefe (1787-1840), 2 parts, Berlin, 1838.
     
  • Practical Essays. 2 volumes, Edinburgh, 1841, 1842.

  • German translation by Bengel, Tübingen, 1842. 
     
  • Of the nerves which associate the muscles of the chest in the action of breathing, speaking , and expression etc. 

  • Philosophical Transactions of the Royal Society of London, 1822.
     
  • On the motions of the eye, in illustration of the uses of the muscles and nerves of the orbit.

  • Philosophical Transactions of the Royal Society of London, 1923.
     
  • Second part of the paper on the nerves of the orbit. 

  • Philosophical Transactions of the Royal Society of London, 1823.
     
  • On the nervous circle which connects the voluntary muscles with the brain.

  • Philosophical Transactions of the Royal Society of London, 1824.
     
  • Herbert Mayo (1796-1852):

  • Anatomical and physiological commentaries.
    Number I and II [All published]. London, T. & G. Underwood, 1822, 1823.
    Mayo discovered and described the functions of the Vth and VIIth cranial nerves on pp. 107-120 of Number I, and did much towards the clarifications of the idea of reflex action. Reprinted, Metuchen, N. J. Scarecrow Press, 1975.
     
  • Alexander Shaw (1894-1890):

  • Narrative of the Discoveries of Sir Charles Bell in the Nervous System.
    London, 1839.

    On Sir Charles Bell's Classification of the Nerves. 
     

  • Amédée Pichot:

  • The Life and Labours of Sir Charles Bell. London, Bentley, 1860.
     
  • Sir G. Gordon-Taylor, E. W. Ealls:

  • Sir Charles Bell: His life and times. Edinburgh, E & S Livingstone, 1953.
     
  • E. W. Walls:

  • Sir Charles Bell. British Medical Journal, 1959, 2: 488.
     
  • L. M. Zimmerman and Veith:

  • Great Ideas in the History of Surgery. Baltimore, Williams & Wilkins, 1961.
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