06 June 2013

Identity Formation through Sacrifice: Marshall Hall’s Post-Mortem

Marshall Hall
“Saturday, August 15th, 1857”. Enclosed in a black box, appearing like an advertisement gracing the pages of the British Medical Journal, is a brief notice of the “Death of Dr. Marshall Hall,” who “like a true man” gave everything to work “to the last”. Subsequent lines promised a later “sketch of the life of this eminent labourer in the field of physiological inquiry.”  One wonders what more was needed - manliness, the exemplary characteristic of the Victorian worker having been thus established. What else of the eminent physiologist’s life required iteration? Obviously, to our modern sensibilities, his Methodism might have merited attention, his various lectureships and appointments, his private practice, his entanglements with members of the Royal Society, or the development of his original theories on reflex action. The body of work left in Marshall Hall’s (1790-1857) wake was enormous and important and might alone have been illustrative of his life’s achievements. Yet in this instance, Hall’s actual body proved expository on its own and therefore able to continue his important labours even following its expiration.

At the request of the deceased, “Dr. Marshall Hall: The History of his Case and the Post Mortem Appearance” appeared a few weeks later in the same organ. With manifest adulation, an anonymous author opined that readers could obtain no more interesting case for their consideration then the conclusions of an actual inquiry into the causes of death of “one of the most distinguished, most talented, and most industrious of [Britain’s] professors.”

The travails of Hall’s illness make disconcerting reading. He had been ill for many years and suffered from some obstruction of the pharynx and oesophagus. Thought at first to suffer from the colloquial “clergyman’s throat”, it soon became apparent to Hall and his physicians and surgeons that the illness was serious. He had retired from practice, “though it entailed a sacrifice of a large professional income”, and following tours in the United States and Italy, had returned to Britain somewhat weakened by an attack of malaria. His throat, almost completely obstructed, began to bleed profusely. “I don’t wish you to mention this to Mrs. Hall,” he had admonished one doctor. But as for himself, “I have no hope of recovery…I have no fear of death, and cannot be alarmed by the truth. My only wish to live is for the sake of others….” It was with this fortitude that this “unselfish, considerate, and affectionate” man confronted his mortality. Attempts at self-medication failed. He coughed blood continuously. “I am intensely susceptible to cold,” he wrote, and added, “Everything I take is apt to leave particles in my pharynx, even a light-boiled egg.” He slowly starved. “By his own desire” on August 11th, he had been taken on a carriage ride to the aggravation of his symptoms. His breath became short, his bowels uncontrolled. At twenty past eight in the evening, he expired, having maintained his “consciousness to within a few minutes of his death.” Such a history demanded a fitting conclusion. “All who knew and watched him during the progress of his disease, and witnessed the high courage and true resignation with which he submitted to his sufferings and to the prospect of death, will feel that [the] estimation and record of him was only what was just to the character of the greatest of English physiologists.”

The post-mortem, conducted by a Dr. Ransom, revealed an alternative history of the same. The body, emaciated, showed no further signs of decay. The heart was compromised only by age, while the lungs, the pathologist noted, appeared stressed. The larynx had thickened, while the pharynx had become thin and filled with a “dirty-brown flaky fluid, of a creamy consistency.” The pharynx, furthermore, had perforated in places. The trachea suffered from ulceration and some half-pea size masses. The doctor then observed that the mucous membrane of the tracheal area showed evidence of cancerous cells. The cancer however had not spread beyond the trachea. The ulcer cells, for example, were a bit fatty, but the pharynx normal: “nothing was found but globular corpuscles and cells filled with fat granules, of various sizes, and one beautiful hexagonal crystal-like cystin…”.

Now this ego-document appears somewhat strange. It was not then or now a typical obituary record, but it was an obituary nonetheless. It fashioned a final, grand portrait of Hall – one, however, that fit only slightly the image depicted by Hall’s biographer, Diana E. Manuel. From her work, we may easily conjecture reasons for some discrepancies: Hall had admirers and detractors. His reputation, clouded by unsubstantiated charges of plagiarism, had not been aided by the early support of Thomas Wakley (1795-1862), the controversial medical reformist and editor of the then new medical journal The Lancet.   His scientific inclinations, almost purely physiological, went against the prevailing tendencies of the English school of anatomy. He was an anti-establishment figure. To sum his career (and sins) up in a word, he was new.

Yet by the time of his death, Hall had probably become somewhat conventional. His attitudes and outlook, new in his youth, had influenced a new cohort of physiologists. His associations in philosophical and scientific circles, his election to the Royal Society, and indeed his success as a physician had further conferred, no matter how imperfectly, legitimacy to his position. Through his own wishes and the fashioning of anonymous authors, Hall’s body not only added to his body of work, it further legitimated the ethos of his corpus.

Of course, in no way did Hall’s body (or indeed his labour) solely establish the English school of physiology and its application to medicine – that is a far more complicated story. Hall’s name, however, consecrated the pedigrees of many later illustrious students of the nervous system. A prize established by the Royal Society in his honour in 1873 eventually decorated the resumes of John Hughlings Jackson (1878), David Ferrier (1883), Walter H. Gaskell (1888), William H. Gowers (1893), Charles Sherrington (1898), and Henry Head (1903).  Hall’s post-mortem was symbolic. Like the prize in his name, it consecrated a new social mode of production and practice in medicine. Underlying the logic of his obituary was a social value of sacrifice for the greater good.  Sacrifice, was a habit of mind, one necessarily cultivated by an ideal scientist or physician. It is difficult not to see this account as part of the story of medical and scientific self-experimentation, a practice common in neurology.

While sacrifice was the implicit theme of Hall’s post-mortem, his distinction among his peers arose from his early commitment to a physiological approach to medicine. Over the next one hundred and fifty years, that physiological approach would become part-and-parcel of the lore of neurology – through their pioneering labours, so the story goes, such figures as Hall had used the torches of pathology and physiology to guide scientific inquiries into the nervous system from the darkness of mysticism. The veracity of this narrative is somewhat dubious and the continual effort to place Hall selectively into a single medical tradition limiting. But, for all that, he was an early exemplar of a wider movement in medical society, a movement that certainly influenced the science and medicine of the nervous system and also became increasingly common among his peers.

[1] “Death of Dr. Marshall Hall”, BMJ, August 15th 1857, 692.
[2] Dr. Marshall Hall: The History of His Case, and the Post Mortem Apperances.”, BMJ, September 5, 1857, 760-3.
[3] Diana E. Manuel, “Marshall Hall F.R.S. (1790-1857): A Conspectus of his Life and Work” Notes and Records of the Royal Society of London Vol. 35 No. 2 (1980), 135-166.