Hall, Marshall

(b. Basford, near Nottingham, England, 18 February 1790; d. Brighton, England, 11 August 1857)

physiology, clinical medicine.

Hall’s father, Robert, a successful Wesleyan cotton manufacturer, was the first to use chlorine gas on a large scale for bleaching cotton; nothing is known of his mother, other than that she was eighty-four when she died. After general education until the age of fourteen at the Nottingham Academy, Hall studied chemistry and anatomy at Newark. In October 1809 he entered the Edinburgh University Medical School, where he was graduated Doctor of Medicine with distinction three years later. His ability was further recognized by an appointment to the much-coveted post of resident medical officer at the Edinburgh Royal Infirmary, which he held for two years. The customary Continental tour (1814–1815) allowed him to visit the medical schools of Paris, Göttingen, and Berlin; he traveled alone and on foot from Paris to Göttingen.

From 1816 to 1826 Hall practiced medicine in Nottingham, where he built up a large practice and was elected an honorary physician to the Nottingham General Hospital on 12 October 1825. His reputation as a physician was established by means of his clinical acumen and ability, as well as by his 1817 book on diagnosis, then a new topic. His fame also rested on his advocacy of diminished bleeding, based on the revolutionary statistical analyses of the French physician P. C. A. Louis.

In 1826 Hall moved to London, where he stayed for the rest of his professional career. Although he occasionally lectured at medical schools, he was never on the staff of a hospital, as were other men of comparable clinical caliber. He conducted his large private practice from his home, where he also carried out his experimental work. Hall was elected a fellow of the Royal Society in 1832 but, although he served on its council, he received none of its honors. In 1841 he was made a fellow of the Royal College of Physicians of London and delivered there the Gulstonian and Croonian lectures. He retired from practice in 1853 and died four years later of an esophageal stricture; he was survived by his wife, whom he had married in 1829, and by his son, also named Marshall Hall, who became a famous barrister. The Marshall Hall Fund provided until 1911 a prize every five years for the best work done in the anatomy, physiology, and pathology of the nervous system; recipients include J. Hughlings Jackson, David Ferrier, and C. S. Sherrington.

Opinions differ concerning Hall’s personality. Most seemed to find him insufferably conceited and overly aware of his brilliance and capacity for work. He was thus unable to make the usual personal contacts; and since he could not suffer injustice without protest, the resultant rancor and sense of persecution dominated his professional relationships. Consequently he had more detractors and opponents than friends and supporters. Yet the notorious Thomas Wakley, founder and editor of Lancet, was a firm friend and supported Hall’s claim that the merits of his work equaled those of William Harvey’s. Another acquaintance saw him as a courageous, extremely sensitive man who did not deserve the unjustifiable, bitter attacks leveled against his person and his work by those who envied his many talents. His wife’s biography of him, as might be expected, is entirely laudatory.

A prolific writer, Hall published over 150 papers and nineteen books; his style was monotonously repetitive, for he was constantly claiming priority, defending, refuting, or attacking. Although aware of the work of others, he did not make adequate reference to it and instead usually emphasized the importance of his own.

Hall’s importance lies in his studies on the physiology of reflex function. These began in 1832 and continued for twenty-five years; he claimed that he had spent 25,000 leisure hours on them.

The concept of the reflex has its origins in antiquity, but Hall’s work was built upon the advances made in this field by Robert Whytt of Edinburgh, Albrecht von Haller of Göttingen, Georg Procháska of Prague, J. J. C. Legallois of Paris, and many others. By 1830 considerable knowledge existed of the isolated spinal cord and the reflex act, although virtually nothing was known of the underlying morphology. It was Hall’s contribution to elaborate the reflex concept, from an isolated action of the cord as he found it, into an established and essential physiological function.

His numerous experiments were carried out on such animals as turtles, hedgehogs, frogs, toads, lizards, and eels, and from them Hall formulated what he considered to be an independent spinal cord system of nerves subserving only reflex function. This mechanism had nothing to do with the nerves of volition and sensation or with consciousness and psychic activity, functions which were mediated by the brain. Thus evolved what he termed “the excito-motory system”—afferent-efferent, in modern terminology. It existed in “the true spinal marrow,” whereas the nerves connecting the brain with the body were mediated through “the spinal chord.” Reflex activity took place through the spinal marrow, and thus Hall later termed his system “diastaltic”; this and many other terms he introduced have long since been forgotten.

Hall was, therefore, the first to provide a basis for the concept of the neural arc of the spinal cord. Admittedly Charles Bell had hinted at this in 1826 and Hall had made use of the earlier work of François Magendie and of Bell concerning the motor and sensory spinal roots of the cord, but his originality is unassailable. Unfortunately, he paid no attention to the new knowledge of the microscopic appearances of nervous tissue in the 1830’s, and he totally ignored the possible influence of such cerebral mechanisms as psychic activity.

Opposition to Hall’s concept was immediate and sustained. No doubt some of it was due to his unfortunate personality; but of equal importance was the fact that his reflex system excluded the soul, which many still held to be essential for all functions of the human body. He thus found himself embroiled in theological entanglements as well; the famous controversy centering on the “spinal cord soul” of E. F. W. Pflüger of Bonn lasted until the end of the century. The tenor of the ensuing polemics can be judged from the damning accusation leveled at Hall that he had plagiarized the work of Procháka. This episode has never been fully explained, but although the attack was probably unjustified, it illustrates the kind of reaction Hall engendered among contemporary scientists.

Support in Britain, other than from Wakley, who crusaded tirelessly in Hall’s favor, and from a few others, was small; yet abroad Hall found many powerful protagonists. The great physiologist Johannes Müller of Berlin, whose experiments, completed after those of Hall, were in accord with his, was an ardent supporter; his name is frequently associated with that of Hall in discussing this phase of growing knowledge of spinal-cord reflex activity. The more receptive atmosphere on the Continent may have been due partly to the fact that Hall’s personality factors had little influence and partly to the materialism which was then beginning to pervade the physiological laboratories of France and Germany and which eventually brought an end to consideration of the soul in experimental medicine.

The work of Hall and Müller was faulty in detail, yet the basic principle it established was correct and of the greatest importance, even if Hall’s contribution has usually been exaggerated. It led naturally to the more significant advances made at the end of the nineteenth century by Sherrington of Oxford, I. M. Sechenov of St. Petersburg, and F. L. Goltz of Strasbourg. Hall must also be credited with illustrating his physiological theories and observations with clinical examples and with making broad applications to diagnosis and treatment. He was often in error—as when, for example, he considered parturition to be a spinal reflex phenomenon—but he nevertheless pioneered an approach which was to increase in importance. Hall also extended the scope of the reflex to sneezing, coughing, and swallowing and described the grasp reflex, although its significance eluded him. Other aspects of reflex function that interested him were the effects on it of such drugs as strychnine and opium.

Hall’s insistence that the cerebrospinal axis is a functional segmental series, although not original, was recognized by Sherrington as a significant contribution. Hall noted tonus in skeletal muscle as well as in sphincters, but his conclusion that it is maintained by the “diastaltic arc” was not warranted by his experimental evidence. Whytt had recognized spinal shock almost a century before Hall, who gave the first clear account of it and differentiated it from vascular collapse.

In clinical medicine the critical and scientific approach used by Hall in his experimental studies was often absent. His suggestion that epilepsy was due to irritation of the cervical spinal cord no doubt resulted from his misinterpretation of adversive seizures. His books on diseases of the nervous system were moderately successful but were displaced to some extent by the work of Moritz H. Romberg of Berlin. It is said that Hall coined the term “paralysis agitans.”

Hall is remembered for a method of resuscitating the drowned, the Marshall Hall method, which was widely employed until other ways of restarting respiration were introduced by Henry R. Silvester and Edward Sharpey-Schafer. According to the Hall method, the subject was first placed in the prone position and pressed upon the back, causing an active expiration. He was then turned over on his side, with the shoulder raised, to bring about an active inspiration. Hall also perfected a biological test for strychnine.

Hall’s versatility and diffuse interests are demonstrated by the wide range of topics, both medical and nonmedical, about which he wrote. In the latter area he published on geometry and Greek grammar and was always ready to use his pen and his tongue to attack social evils. He campaigned for the abolition of slavery in America and of flogging in the British army, as well as for the improvement of sewage disposal and for the safety of railway compartments.

BIBLIOGRAPHY

I. Original Works. There is an incomplete and inaccurate list of Hall’s works on pp. 514–518 of his wife’s biography (see below).

Hall’s main reports on reflex function range from 1832 to 1850. The first is “A Brief Account of a Particular Function of the Nervous System,” read at a meeting on 27 Nov. 1832 and reported in part in Proceedings of the Zoological Society of London, 2 (1832), 190–192. See also “On the Reflex Function of the Medulla Oblongata and Medulla Spinalis,” in Philosophical Transactions of the Royal Society, 123 (1833), 635–665, also pub. separately as a repr. (1833); Memoirs on the Nervous System (London, 1837); New Memoir on the Nervous System (London, 1843); and Synopsis of the Diastaltic Nervous System: Or the System of the Spinal Marrow, and Its Reflex Arcs; as the Nervous Agent in All the Functions of Ingestion and of Egestion in the Animal Economy (London, 1850).

Only a few of Hall’s clinical publications are worthy of mention: On Diagnosis. In Four Parts (London, 1817); Researches Principally Relative to the Morbid and Curative Effects of Loss of Blood (London, 1830); On the Diseases and Derangements of the Nervous System, etc. (London, 1841); and Essays on the Theory of Convulsive Diseases, etc., Marshall Hall (his son), ed. (London, 1857).

Among several publications on nonclinical and nonmedical topics are Work on the Thames and the Sewerage of London (London, 1850); and The Two-fold Slavery of the United States: With a Project of Self-Emancipation (London, 1854).

II. Secondary Literature. The following biographical sketches (listed chronologically) are available, but an unbiased critical account of Hall has yet to be written: “Biographical Sketch of Marshall Hall, M.D., F.R.S.,” in Lancet (1850), 2 , 120–128, probably by T. Wakley, and therefore effusively laudatory; obituary for Hall, Lancet (1857), 2 , 172–175, perhaps also by T. Wakley; Charlotte Hall, Memoirs of Marshall Hall, M.D., F.R.S. (London, 1861), a detailed work by his widow that tends to be a tedious eulogy of a misunderstood genius; J. F. Clarke, Autobiographical Recollections of the Medical Profession (London, 1874), pp. 327–330, also in praise of Hall (in the copy consulted, the owner had added the following revealing marginal comment: “Hall was the most pompous little man I ever met.”); G. T Bettany, in Dictionary of National Biography, VIII (1908), 964–967, mostly copied from Lancet material noted above; W. Hale-White, Great Doctors of the Nineteenth Century (London, 1935), pp. 85–105, a good account of Hall’s clinical work; J. H. S. Green, “Marshall Hall (1790–1857); A Biographical Study,” in Medical History, 2 (1958), 120–133, useful for biographical data but an inadequate account of the content of his writings; and T. J. Pettigrew, Medical Portrait Gallery, IV (London, n.d.), with a brief bibliography.

Hall’s contribution to the physiology of the reflex is surveyed in “Reviews. A New Memoir on the Nervous System. By Marshall Hall, M.D., London: Baillière 1843,” in Lancet (1846), 2 , 154–157, 187–189, 244–247, 250. Like the biographical material in Lancet, this article is uncritical and mostly effusively complimentary; the author is unknown but it may have been Wakley. The charge of plagiarism from Procháska and Hall’s responses are in J. D. George, “Contributions to the History of the Nervous System,” in London Medical Gazette, 2 (1837–1838), 40–47, 72–73, 93–96, 128, 160, 248–249, 252–254,

The briefest yet most accurate assessment of Hall’s work is a passage by C. S. Sherrington, in W. Stirling, Some Apostles of Physiology (London, 1902), p. 86. See also D’Arcy Power, “Dr. Marshall Hall and the Decay of Bloodletting,” in Practitioner, 82 (1909), 320–331; F. Fearing, Reflex Action. A Study in the History of Physiological Psychology (London, 1930), pp. 122–145; G. Jefferson, “Marshall Hall, the Grasp Reflex and the Diastaltic Spinal Cord,” in E. A. Underwood, ed., Science, Medicine and History... in Honour of Charles Singer, II (London, 1953), 303–320; and E. G. T. Liddell, The Discovery of the Reflexes (Oxford, 1960), pp. 63–76.

Edwin Clarke