Sir Charles and His Journey to Discover a Palsy – Part 2: From Expressions to Palsy

Sir Charles Bell
Sir Charles Bell

Charles Bell left his position as a surgeon at the Edinburgh Royal Infirmary and, in 1804, moved with his brother John to London, where they set up a private school of surgery and anatomy.   While John did not have to deal with the jealousy and arguments with his Edinburgh colleagues, Scottish medical people were not very highly thought of in London at the time so he and Charles

Hunter School of Medicine, Circa 1820
Hunter School of Medicine, Circa 1820

had many people to impress. They joined the Great Windmill Street School, often referred to as the Hunterian School of Medicine, a major medical school that had been founded by the 18th century anatomist William Hunter. While he had begun his treatise on anatomy of expression prior to leaving Edinburgh, he published Essays on the Anatomy and Philosophy of Expression in 1806. Through hard work and ingenious publications, Charles became a Professor of Anatomy and Principal Lecturer at the Hunter school from 1812 to 1825.    By 1816, John had moved to Rome to nurse an injury that he sustained in a fall off his horse and Charles was left in London to develop his reputation on his own. He gained further recognition by serving as a military surgeon, making elaborate recordings of neurological injuries at the Royal Hospital Haslar, and famously documenting his experiences at Waterloo in 1815.  His experience in serving the wounded left him with a great pity for the plight of Privates and a deep scorn for the thick-headed Generals that sent them into battle.  Bell was a founder of the Middlesex Hospital Medical School in London and in 1824, became the first professor of Anatomy and Surgery of the College of Surgeons in LondonIn 1829, the Windmill StreetSchool of Anatomy was incorporated into the new King’s College London and Charles became its first professor of physiology and was Knighted by King William IV in bp121831 for his service developing medical schools and his contributions to knowledge through his drawings of the nervous system. Bell’s legacy is that he clearly demonstrated that spinal nerves carry both sensory and motor functions and that sensory fibers traverse the posterior roots whereas the motor fibers run through the anterior (Bell’s Law).  He also demonstrated that the cranial nerve Vwas sensory to the face and motor to mastication, whereas cranial nerve VII controlled muscles of expression. The eponyms of the respiratory nerve of Bell and Bell’s

Diploma - Signed by Charles Bell
Diploma – Signed by Charles Bell

Palsy perpetuate his name. Between 1822 and the late 1830s Bell and a former student, Herbert Mayo, engaged in a highly personal priority dispute over the motor and sensory functions of the Vth bp16and VIIth cranial nerves. Their competing claims were presented in newspapers, journals, and textbooks. But by the time of Bell’s death, Mayo had been discredited. Believing that London was a great place to work but not a great place to die, in 1836, he returned to Scotland, accepting the position of Professor of Surgery at the University of Edinburgh.  Charles Bell died in the Midlands while travelling from Edinburgh to London, in 1842. 

Anatomy of Expressions

bp11
Bell’s Famous Drawing of the Facial Muscles

Charles Bell was a prolific author. While John Bell was an accomplished artist, Charles was even more so and was probably happiest when drawing his expressions and dissections.  Shortly after arriving in London in 1804, he set his sights on becoming the Chair of Anatomy at the Royal Academy and, in his movement toward this career goal, he published Essays on The Anatomy of Expression in Painting (1806), later re-published as Essays on The Anatomy and Philosophy of Expression in 1824. Bell hoped that this book and recommendations would lift him into the vacant Chair of Anatomy that so wanted in the Royal Academy. While he did not achieve this goal, his work on facial expressions and nerve function would perpetuate his name in medical history.   In this work, Bell followed the principles of natural theology, asserting the existence of a uniquely human system of facial muscles in the service of a human species

Bell's Drawing of the Expression of Jealousy
Bell’s Drawing of the Expression of Jealousy

 with a unique relationship to the Creator.  For obvious reasons his natural theology of expressions was not well accepted by the medical community and in 1824 caused some issues with the Royal Academy president.  Cummings (1964), however, says of his drawings and research, “His various essays on the nerves of the face, and his illustrations of these nerves under disease, are of the highest importance and deepest interest, and the greatness of the work can only be realized when compared with what was known, or rather not known, in his day of the physiology of the nervous system.

“His various systems of anatomy, dissections, and surgery, still stand unrivaled for facility of expression, elegance of style, and accuracy of description. In this work he points the importance of a knowledge of anatomy to the artist and displays the error into which artists may be betrayed by an exclusive attention to the antique.

He treats of the skull and form of the head, of the muscles of the face in man and in animals, depicts the several passions by a comparison of these, marks what is peculiar to man, embodies the idea of a living principle in the expression of emotion, and finally treats of the economy of the living body as it relates to expression and character in painting.”  

It was his drawings and interest in how facial expressions were made, the nervous connections that made these expressions possible that caused his interest in the disorders of the facial nerve. 

Bell’s Palsy

Audiologists know of Bell’s palsy as a disorder of the 7th cranial or facial nerve that controls movement of the muscles in the face. Often audiologists in ENT clinics are asked to look at stapedial reflexes to predict the reversal of the disorder. 

The disorder was first described by Sir Charles Bell in a paper at a meeting of the Royal Society in 1821.  The paper described  the long thoracic nerve, which supplies the serratus anterior muscle, and which also now bears Bell’s name. In the bp3same paper he showed that lesions of the seventh cranial nerve produce facial paralysis (now termed Bell’s palsy).  

According to Tiemstra and Khatkhate (2007), Bell’s palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. Affected patients develop unilateral facial paralysis over one to three days with forehead involvement and no other neurologic abnormalities. Symptoms typically peak in the first week and then gradually resolve over three weeks to three months.

Bell’s palsy is more common in patients with diabetes, and although it can affect persons of any age, incidence peaks in the 40s. Bell’s palsy has been traditionally defined as idiopathic; however, one possible etiology is infection with herpes simplex virus type 1. 

A common short-term complication of Bell’s palsy is incomplete eyelid closure with resultant dry eye. A less common long-term complication is permanent facial weakness with muscle contractures. Approximately 70% to 80% of patients will recover spontaneously; however, treatment with a seven-day course of acyclovir or valacyclovir and a tapering course of , initiated within three days of the onset of symptoms, is recommended to reduce tbp15he time to full recovery and increase the likelihood of complete recuperation.

Epilog

As audiologists and hearing care professionals we owe a great deal to the hard work, trials and tribulations of the anatomists, physiologists, surgeons, scientists, and, of course, those that illustrated these structures and phenomena so that we might better understand their structure and function, Sir Charles Bell is one of those individuals.  His work is a testament to an interest in expression leading to real discovery. 

 

 

 

References: 

Bell, Sir Charles (1806).  Essays on the Anatomy of Expression in Painting.  Retrieved January 10, 2015:  http://www.bible.ca/psychiatry/essays-on-the-anatomy-of-expression-in-painting-sir-charles-bell-1806ad.htm

Cummings, F. (1964).  Charles Bell and the Anatomy of Expression.  The Art Bulletin, Vol 46, pp196-203.  Retrieved January 10, 2015:  http://www.jstor.org/discover/10.2307/3048162?sid=21105047259971&uid=3739256&uid=4&uid=3739568&uid=2

Frerichs, R., Hunterian School of Medicine.  Retrieved January 10, 2015:  http://www.ph.ucla.edu/epi/snow/hunterian.html

Tiemstra, J. & Khatkhate, N. (2007). Bell’s Palsy:  Diagnosis and Management.  Am. Fam. PhysicianVol 76, pp.997-1002. Retrieved January 13, 2015:  http://www.aafp.org/afp/2007/1001/p997.html

Unknown, (2008).  Charles Bell:  Essays on the Anatomy of Expression in Painting.  Figure Drawing.  Retrieved January 10, 2015:  http://figure-drawings.blogspot.com/2008/11/charles-bell-essays-on-anatomy-of.html

Wikipedia (2014).  Bell’s Palsy.  Retrieved January 10, 2015:  http://en.wikipedia.org/wiki/Bell%27s_palsy

Wikipedia (2014).  Knighthood.  Retrieved January 10, 2014:  http://en.wikipedia.org/wiki/Knight

 

Images: 

Cummings, F. (1964).  Charles Bell and the Anatomy of Expression.  The Art Bulletin, Vol 46, pp196-203.  Retrieved January 10, 2015:  http://www.jstor.org/discover/10.2307/3048162?sid=21105047259971&uid=3739256&uid=4&uid=3739568&uid=2

Frerichs, R., Hunterian School of Medicine.  Retrieved January 10, 2015:  http://www.ph.ucla.edu/epi/snow/hunterian.html

Wikipedia (2014).  Bell’s Palsy.  Retrieved January 10, 2015:  http://en.wikipedia.org/wiki/Bell%27s_palsy

Wikipedia, (2014).  Order of the British Empire.  Retrieved January 13, 2015:  http://en.wikipedia.org/wiki/Order_of_the_British_Empire

 

 

About Robert Traynor

Robert M. Traynor is a board certified audiologist with 45 years of clinical practice in audiology. He is a hearing industry consultant, trainer, professor, conference speaker, practice manager, and author. He has 45 years experience teaching courses and training clinicians within the field of audiology with specific emphasis in hearing and tinnitus rehabilitation. Currently, he is an adjunct professor in various university audiology programs.