Sir Charles Bell and His Controversial Legacy by Michael J. Aminoff, - - PDF document

Sir Charles Bell and His Controversial Legacy by Michael J. Aminoff, MD, DSc, FRCP In the early nineteenth century, a little-known general surgeon wrote an arresting pamphlet that has since been described as the Magna Carta of neurology, even though it is unknown by many. Its author, whose achievements have been likened to William Harvey’s, has passed into obscurity. Why is he forgotten? Is it simply because fame is ephemeral? Or does it reflect on his conduct, which may have breached the expected standard of intellectual honesty? Regardless, Charles Bell (1774-1842) accomplished much as a clinician, scientist, artist, and educator. His achievements merit wide appreciation as they relate to the place of an individual—warts and all— in the development of biological concepts and ideas. Bell’s famous monograph was titled Idea of a New Anatomy of the Brain. It was printed privately more than two hundred years ago, at a time when understanding of the nervous system—

• f its structure and the way that it operated—advanced remarkably and in a manner that made

possible all subsequent progress. But to whom is due the credit for these advances? Bell’s claims for priority in making certain discoveries regarding the nervous system—initially seemed quite proper but were shown later to be based on tampered evidence. When Bell began his work on the nervous system, the concept of functional specialization within the brain was unknown. The anatomical complexity of the brain seemed of little consequence—the entire brain made up the sensorium commune, which received sensory input and somehow generated an appropriate motor output. The nervous system was not divided into subsystems that accounted for its operation. Bell’s recognition that nerves differ in functions— motor, sensory, and “vital” (autonomic)—and in their central connections suggested that the various parts of the central nervous system have different functions. This, in turn, provided a means

• f categorizing the functions of yet other parts of the nervous system, based on their connections.

This concept, now seemingly so obvious, indeed provided a new anatomy of the brain, as Bell suggested in the title of his monograph. Bell recognized and reported in his 1811 monograph that the spinal nerve roots had different properties, and in the early 1820s, he published detailed accounts of related work in the Philosophical Transactions of the Royal Society. He correctly determined that the anterior but not the posterior roots had motor functions, but he did not conclude that the anterior roots were motor and the posterior roots were sensory. This was shown by Francois Magendie in Paris after elegant experiments based in part on Bell’s approach. With regard to the cranial nerves, Bell and Herbert Mayo, initially in collaboration, studied the motor and sensory innervation of the face. The fifth cranial nerve has two roots, one without and the other with an associated ganglion, analogous to the anterior and posterior spinal roots, respectively, whereas the seventh nerve has a single root without a ganglion, similar to an anterior spinal root. It was Mayo who correctly showed that the seventh cranial nerve supplied the muscles of facial expression, while the fifth nerve provided

sensation to the face and also innervated (by its non-ganglionated root) the muscles of mastication. The concepts, the initial experimental approach, and any misinterpretations of his earlier studies

• f the spinal and cranial nerves were due to Bell.

There can be no question that Bell made subtle alterations to writings that he originally had published in the early 1820s to give the impression—but without explicitly stating—that he alone was responsible for these discoveries. It is conceivable that he originally altered his publications simply to improve the accuracy of their content, to ensure that they were up-to-date. In this case, however, he should have included an explanatory note and he should not have used the amended publications to support his claims for priority. Bell probably made the alterations in order to claim priority for the specific discoveries that they described. If he falsified the written record deliberately and with the intent of deceiving others, his claim must be regarded as fraudulent. It seems more likely, however, that he regarded his claims as justified. He must have found it particularly difficult to understand—let alone accept—that he had “missed the boat” and that Magendie and Mayo, following through on his ideas and utilizing his experimental approach, had arrived at the definitive conclusions that he claimed as his own—conclusions that at last put some

• rder into the organization of the nervous system. But, given his nature, he was able to persuade

himself of the truth of his own fiction and thereby came to believe in his own imagined results. Both Magendie and Mayo tried, at least initially, to credit Bell for his achievements, but Bell would not settle for anything less than totality for the discoveries. He had many other achievements in the medical sciences, including the discovery of the sixth sense. He was hard- working, cultured, dedicated to his work, and talented in its performance, and he tried to project himself as a kind and thoughtful man. Behind this facade, however, the impatience, intolerance, and certainty of his own views shone through as he became more senior. It is foolhardy to make psychiatric diagnoses at a distance, but at least it can be said that a flavor of mild bipolar disease comes through in his published correspondence. Anxious for recognition, taking all intellectual challenges as a personal affront, he advanced in his chosen profession with his head held high, but his self-assurance was partly a sham and he needed constant reassurance from his wife, recognition from his peers, and acclaim from the medical and scientific community. As regards the controversy with Magendie and Mayo, he never seemed to have had any doubt that he was in the right. Charles Bell was an accomplished surgeon-scientist and clinician, a brilliant educator who founded in London his own private school of anatomy, eventually bought William Hunter’s school, and then became the first professor of physiology, of surgery, and of clinical surgery when the University of London was founded. He was a renowned medical artist—a painter, sculptor, and draughtman—who published now-famous books on anatomy and made remarkable paintings of the war-wounded after the retreat from Corunna and then the battle of Waterloo. In 1806 he published his famous Essays on the Anatomy of Expression in Painting. It went through seven editions, becoming a favorite of Queen Charlotte and Queen Victoria, and inspired the pre- Raphaelite movement and Charles Darwin who in 1872 wrote The Expression of the Emotions in Man and Animals, acknowledging his debt to Bell. Many preferred Bell’s book, with its marvelous artwork and comments on art and sculpture, and several reviewers saw Darwin’s book as just an extension of Bell’s work.

Bell died in 1842. His achievements were immense. His quarrels over priority should be recalled—if they must be—with regret for behavior that marred an otherwise exceptional career. Despite his flaws as a human being, Charles Bell was a person of brilliance. Disclosure: I receive royalties from Oxford University Press for my monograph on Sir Charles Bell, published in 2017. Reference: Aminoff MJ: Sir Charles Bell: His Life, Art, Neurological Concepts, and Controversial Legacy. Oxford University Press, 2017