Lectures on Surgical Diseases by Charles Bell & Cases from the Middlesex Hospital

The manuscript contains notes from lectures on surgical diseases given by Sir Charles Bell (1774-1842) at the Middlesex Hospital, which cover folios 3 to 153, and reports of a number of cases seen in the Middlesex Hospital in addition to items of copied correspondence, which cover folios 159 to 185 and can be read when the volume is turned upside down.

Notes on the inside front cover indicate that the manuscript was acquired by the Manchester Medical Society in 1873 and was subsequently allocated the reference O 6231 viz. their 1890 library catalogue. There is also a letter attached to the verso of f.2 written by the creator of the manuscript and addressed to 'Bennett' in which he gives him this copy of Bell's lectures as a token of his gratitude for an unknown reason.

The pages of Bell's lectures are inconsistently numbered 1-199, there is no index and none of the lectures are individually numbered or dated. Clear subject headings, however, are given throughout and indicate that the following subjects are addressed: inflammation (constitutional symptoms, treatment, termination); abscess (distinctions of pus, formation, termination, chronic abscess); ulcers (structure, granulation, connection with the system, treatment, indolent ulcer, scrofulous ulcer, phagedenic ulcer, scorbutic ulcer, ulcers of the legs); erysipelas; carbuncle; hospital gangrene; burns & scalds; scrofula [tuberculosis, lymph node]; deformity from habit of wrong position (twist of the neck, curvature of the spine, disease of the bodies of the vertebrae, distortion from disease in the muscles, distortion in the foot from a sinking of the bones, abscess or spina ventosa [tuberculous dactylitis], necrosis, exotosis, osteous sarcoma [osteochondroma], osteous steatoma, aneurysm of a bone); diseases of the joints (bursa mucosa [bursa, synovial], ganglia, hydrops articuli [hydrarthrosis], loose cartilage, scrofulous inflammation, hip disease, white swelling); syphilis (symptoms, treatment, mortification of the penis); bubo; diseases of the urethra (obstruction of urine, inflammation, stricture, gonorrhoea); fistula in perineo; puncture of the bladder; disease of the prostate (inflammatory & chronic enlargement, treatment); foreign bodies obstructing respiration (tracheotomy, inflammation of the larynx, stricture of the oesophagus); stricture of the prepuce; fistula in ano [rectal fistula]; prolapsus ani [rectal prolapse]; piles [haemorrhoids]; tumours [neoplasms]; military surgery (sabre wound, punctured wound, lacerated wound, penetrating wound, gun-shot wound, treatment, gun-shot fracture, cases for amputation, wounds of the head, wounds of the cheek, suicide, wounds of the fore-part of the neck, wounds of the chest, wounds of the abdomen, penetrating wounds of the belly).

In total there are 8 cases reported in the rear of the volume, which include both men and women and both children and adults. The complaints include curvature of the spine, a broken leg, ganglion, concussion, fracture of the thigh, pain and swelling of the leg, stricture of the urethra, and a limp. The copied correspondence that follows recounts a number of midwifery and obstetric cases between the creator of the manuscript and William Dalziel (c.1792-1837) of Wigtown dated to early 1816.

Charles Bell was born in Fountainbridge, Edinburgh in November 1774, the son of William Bell and Margaret Morrice. He first began attending philosophy classes at Edinburgh University in the 1780s and in the 1790s he began to attend the great range of courses on offer from the University Medical School whilst assisting his brother, a surgeon, in his school of anatomy. Bell was also a skilled draughtsman and honed his skills during this time with the assistance of painter David Allan. In 1799 he was made a fellow of the Edinburgh College of Surgeons and also began working at the Edinburgh Royal Infirmary. That same year Bell's brother had been forced to close his anatomy school amid increasing animosity from physicians at the Royal Infirmary, and a reorganisation of the surgical service at the Infirmary a few years later saw Charles fail to secure one of the new posts. As a result he moved to London to make the most of the greater opportunities.

In London Bell visited a number of medical luminaries but initially struggled to attract both students and patients. In 1805 he tried to establish his own anatomy school in Leicester Street. His fortunes improved when he married Marion Shaw in June 1811 and was able to use the dowry he received to buy a share in the Hunterian School of Medicine on Great Windmill Street from James Wilson. In 1814 he became a member of the Royal College of Surgeons of London and was also appointed as a surgeon to the Middlesex Hospital. Following the death of James Wilson in 1821 Bell began teaching at Great Windmill Street alongside his brother-in-law John Shaw, where they attracted artists as well as medical students.

Bell taught a number of army and naval surgeons and he himself tended to troops during the Napoleonic wars, firstly in 1809 at Portsmouth in the aftermath of the battle of Corunna and also in 1815 at Brussels in the aftermath of the battle of Waterloo. During his career Bell was known for his extensive investigations and research surrounding the brain and the nervous system in addition to his commitment to improving the practice of surgery.

Bell had sold his own school and anatomical collection in 1825 and went on to be instrumental in the establishment of the London University and its medical school and in 1827 was appointed professor of anatomy, surgery, and physiology. The medical department's early days were not without difficulties and with the departure of senior teaching staff Bell also agreed to serve as professor of physiology and clinical surgery as well as lecturing on surgery. In 1830, as tensions grew, Bell gave up his chairs of surgery and clinical surgery and was also relieved of his duties of the teaching of physiology by the university council. Throughout this time Bell continued to give clinical lectures at the Middlesex Hospital and following the rift with the London University, sought along with other members of staff to establish a medical school at the hospital. They were successful and Bell began teaching surgery and anatomy there in October 1835.

Only a few months later Bell was offered the now vacant position of professor of surgery at Edinburgh University and accepted the post, returning to Edinburgh in August 1836. Both his private practice and his teaching work were to prove somewhat disappointing to him but he remained in Edinburgh for the rest of his career. Bell died on 28 April 1842 as a result of heart disease during a visit to Worcester. He had been knighted in 1831 by William IV.

His publications included Systems of Dissections (1798), The Anatomy of the Brain, Explained in a Series of Engravings (1802), Anatomy of Expression (1806), Idea of a New Anatomy of the Brain (1811), A Dissertation on Gun-Shot Wounds (1814), An Exposition of the Natural System of the Nerves of the Human Body (1824), and Animal Mechanics (1838).