J Neurosurg 114:529–533, 2011

Dr. Henry Head and lessons learned from his self-experiment

on radial nerve transection

Historical vignette
Stephen M. Lenfest, M.D., Andreea Vaduva-Nemes, M.D., and Michael S. Okun, M.D.
Department of Neurology, University of Florida Movement Disorders Center, Gainesville, Florida

In this paper the authors aim to review Dr. Henry Head’s famous and dramatic nerve sectioning experiment. They
discuss the implications of his experimental approach as well as the effect his experiment had on the field of neurol-
ogy. Henry Head was a prominent British neurologist who contributed greatly to the understanding of the sensory
examination through an experiment in which he had his own radial nerve transected. Head carefully documented the
sensory changes following the sectioning. He hypothesized the existence of two separate sensory systems: protopathic
and epicritic. Head was one of the first scientists to speculate on sensory dissociation, and his writings generated both
enthusiasm and controversy. Although the ethical issue of self-experimentation was raised by his bold experiment
and many aspects of his investigations and conclusions have been criticized, Head undoubtedly contributed important
clinical lessons to neurology. Arguably, Henry Head’s greatest contribution was the realization that the neurological
portion of the sensory examination was anything but straightforward. (DOI: 10.3171/2010.8.JNS10400)

Key Words    •    sensory examination    •    Henry Head    •    neurophysiology    •
history    •    ethics

I
n 1903, Sir Henry Head performed a daring experi-
ment on himself.22 Dr. Head (1862–1940) was a
British neurologist who conducted pioneering work
on the somatosensory system. He performed several ex-
periments on himself in collaboration with William Halse
Rivers, and his intent was to better understand the com-
plexities of the peripheral nervous system.1 In this paper,
we will discuss Dr. Henry Head’s famous experiment, his
contributions to the sensory examination, and whether
his controversial approach was useful in advancing the
field of neurology.
Methods
The complete historical archive on Henry Head was
reviewed at the Wellcome Library, London, and infor-
mation relevant to the nerve sectioning experiment was
extracted along with pertinent newspaper clippings. Ad-
ditionally, all primary original articles on the topic of
Head’s nerve sectioning were reviewed along with select
secondary sources.
Background
Head was born in London as the eldest of 11 children.
His father was an insurance broker for Lloyd’s bank, and
his mother was the daughter of a wine business owner.
He attended boarding academy at Friends School, in Tot-
tenham. Mr. Ashford was the master of the school and
taught natural sciences. He became Head’s first mentor
and influenced him toward science. Head had dreamed
of becoming a medical doctor since the age of 8 years,
when he suffered an episode of scarlet fever. He went on
to attend Cambridge University where he achieved a de-
gree in natural science.1,3,16,23 He then pursued research in
color vision and respiratory physiology in Prague along-
side the scientist Ewald Hering. His interest in respira-
tory physiology led to a staff physician appointment at
Victoria Hospital for diseases of the chest.
His interest in neurology began with his thesis for
his medical degree from Cambridge, “On disturbances
of sensation with especial reference to the pain of vis-
ceral diseases.”8 The dissertation analyzed touch and the
relationships between the distribution of the sensations
of pain, heat, and cold. This work served as a platform
for his later study, “A Human Experiment in Nerve Divi-
sion.”22
Head had a clear interest in sensation, especially
in examining the association between symptoms and
disease. He examined sensation not only by using his
physiologically trained eye, but also by taking into con-
sideration psychological factors. Head suspected that
sensation was due to skin innervations, and he chose to

J Neurosurg / Volume 114 / February 2011 529

 S. M. Lenfest, A. Vaduva-Nemes, and M. S. Okun
study a sensory disturbance caused by herpes zoster. He
created a model to map out the cutaneous distribution of
each afferent nerve root. This work later facilitated an
improved localization for diseases of the spinal cord and
nerve roots.11,14,15 To further study the physiological basis
for sensation, Head began testing patients who had suf-
fered from nerve transection. He quickly discovered that
these patients did not provide precise accounts of their
sensation. He decided to address the issue by using him-
self as a research subject.1,3,16,23
Operation
Head’s goal was to separate the different elements
of sensation and to better define touch. In April 1903,
Dr. James Sherren divided 2 cutaneous nerves in Head’s
left forearm. Sherren severed the peripheral branches of
the radial nerve and then reconnected the ends with silk
sutures.1,3,12,16,23 Over the subsequent 4 years, Head and
Rivers documented the presence or absence of sensation
to different stimuli, mapped the return of sensation, and
created a detailed timeline. They tested sensation through
several methods of stimulation: rubbing cotton wool,
pricking with a pin, touching objects with differing tem-
peratures (hot and cold), manipulating the hairs on the
back of the hand, and utilizing 2 compass points, a test
referred to as two-point discrimination.1,3,16,22,23 Between
April 1903 and the last sitting with Dr. Rivers in Decem-
ber 1907, 167 days were devoted to the investigation of
sensory return.22
The New York Evening Post later described his ex-
periment as a period when “Dr. Head was deprived of the
use of his left arm through his having submitted to the
removal of two nerves from the arm to determine their
functions and relation to other nerves.”21 We provide be-
low a brief summary of Head’s observations.
Postoperative Observations
Day 1
The areas of the hand innervated by the radial nerve
were completely incapable of detecting sensation from all
cutaneous modalities. There was, however, retention of
deep sensibility, tactile, and painful response to pressure
over the dorsal surface of the hand. Pressure applied with
a pencil, finger, or other object was appreciated and local-
ized (Fig. 1).12,22
Day 9
The first sensations to recover were diffuse and ex-
tremely unpleasant. Moderate pressure could be detected
and localized, but there was no sensation present when
cotton wool, pinprick, two-point discrimination, or heat
and cold were applied. Forty-three days after the opera-
tion, pinprick produced a dull, painful sensation. The area
remained insensitive to cotton wool and to wide ranges in
temperature.22
Day 56
The area of abnormal cutaneous sensation continued
530
Fig. 1.  Photograph of Dr. Henry Head’s left hand 1 day after nerve
transection. The radial half of the dorsal surface of the hand and thumb
were found to be insensitive to stimulation with cotton wool, pinprick,
and all degrees of hot and cold. The solid line delineates the area insen-
sitive to cotton wool and von Frey fibers. The area insensitive to pinprick
and other cutaneous painful stimuli is marked by the crosses. Originally
printed in the New York Evening Post, September 8, 1912.
to decrease. A portion was noted sensitive to pinprick, but
not to cotton wool sensation (Fig. 2).
Day 86
Significant areas became sensitive to pinprick, yet
continued to be unresponsive to cotton wool. Water
warmer than 50°C produced undifferentiated general
pain with no distinct thermal discrimination. A selection
of hairs in the region became sensitive to tugging.22
Day 112
Areas became more sensitive to heat and cold. Tem-
peratures warmer than 50° produced a definitive burning
sensation. By Day 137, nearly the entire arm was sensi-
tive to heat and cold. By Day 152 (Fig. 3), most of the
hand was sensitive to pinprick, and a sore on the hand was
noted to begin healing.22
Day 161
Cotton wool stimulation of the fine hairs produced a
diffuse tingling sensation first detected in the proximal
forearm and then rapidly appreciated in other areas. The
sensation was detected in the hand by Day 224. This sen-
sation appeared to be dependent on the fine hairs. When
shaved, the area was insensitive to cotton wool. The sen-
sitivity to heat continued to improve, and Head was able
to differentiate a greater range of temperature. At 1 year,
cotton wool was detected even on shaved areas.22
Follow-up beyond 1 year revealed improvement in
sensation and in detection of temperatures ranging from
34°C to 37°C in the forearm region. By Day 567, the hand
had also recovered.22
Discussion
Head hypothesized that tactile and painful response
fibers were likely afferent connections running with mo-
tor nerves and tendons because these sensations were still
intact immediately after the operation. He therefore clas-
J Neurosurg / Volume 114 / February 2011
Dr. Henry Head
Fig. 2.  Fifty-six days after the operation Dr. Head’s sensation was
returning. Several areas had become sensitive to pinprick, but he had
not recovered any response to cotton wool or von Frey fibers. The solid
border marks the original area of desensitization. The areas now sensi-
tive to pinprick merged everywhere with unresponsive areas. This is
marked by the dotted border. Originally printed in the New York Evening
Post, September 8, 1912.
sified these responses as part of a primitive protopathic
system.3,6,9,12,22 Head stated that “protopathic pain was
generated in the posterior nerve root and exhibited the
highest threshold for a pain response. He defined proto-
pathic pain as having poor localization, failure to adapt,
and an intense response to stimulation.”9,22 This notion
has since been thought of as a hypersensitivity to pain.
Head described it as an “unnatural discomfort” with an
“uncontrollable desire to withdraw his hand.”9,22
Head further postulated that there existed a separate
epicritic (discriminatory) system that was responsible for
fine tactile sensibility, sensitivity to lightly graded stimuli
such as varying thermal differences, and the discrimina-
tion of multiple points touched on the skin (compass test).
The recovery of these sensations occurred well after those
classified as protopathic responses. The fibers responsible
for this separate system exhibited much slower regenera-
tion times.6,9,12,22 These hypotheses offered one of the first
explanations for sensory dissociation.10,14,15
The primary purpose of Dr. Head’s self-experiment
was to better understand sensory innervation and distur-
bance. There is little mention of motor disturbances, if
any, that Head may have experienced during the experi-
ment. The operation performed by Sherren transected
only the superficial branch of the radial nerve and the
lateral antebrachial cutaneous nerve.22 The transection
of these nerves should not have produced any significant
motor disruption. Head designed the experiment in this
fashion so that he could focus on sensation. He was hop-
ing to improve sensory testing and possibly develop a
more reliable method of testing patients who had suffered
nerve damage.
At the time, the neurological examination for sensa-
tion was performed simply by asking patients when they
felt they were being touched with a finger or other object.
This procedure often yielded normal results in patients
with known denervation.9,10,22 Head’s experiment pro-
J Neurosurg / Volume 114 / February 2011
Fig. 3.  One hundred fifty-two days after the operation only a small
area on the dorsum of the hand remained insensitive to pinprick. This is
marked by the dotted border. The solid border marks the original area
of desensitization, which was still unaffected by cotton wool. The circle
marks the area of a trophic sore that began healing. Originally printed in
the New York Evening Post, September 8, 1912.
posed that the protopathic system remained intact even
in the presence of nerve damage. He suggested that sen-
sory testing on the neurological examination was flawed
and incomplete, resulting in many false-negative find-
ings.3,14,15,22
Another interesting aspect of Head’s experiment was
the recognition that with intact sensation, “ordinary dis-
tractions of a busy life were fatal to the detachment re-
quired by sensory testing.” He surmised that patients use
their combined senses when attempting to determine a
perception. Sounds, smells, images, and sensations were
all integrated into a mental analysis of the stimuli. Head
found that he was able to best interpret sensation with
his eyes closed, in a quiet room free from any other form
of arousal. He described himself as belonging to a group
called “visualizers,” who depended on vivid mental im-
agery to interpret touch. The visualization of ice or the
clinking sound of ice cubes was enough to potentially
misinterpret a sensation as “cold.”10,15,22 Head suspected
this based on his clinical experience with inconsistent pa-
tient responses to sensory testing.4,13,20
Head’s experiment also raised important ethical is-
sues regarding experimentation on oneself. The Oxford
Illustrated Companion to Medicine commented that al-
though self-experimentation is a subset of human experi-
mentation, “using one’s self as the experimental subject
may be a public demonstration of the importance and/
or safety of the experiment; it allows the experimenter
direct access to the subjective results of the experiment.”18
This notion, however, may prove ethically troublesome.
Although self-experimentation may enhance the experi-
menter’s understanding of subjective factors in the data,
it may also introduce bias. Preformed expectations and
hypotheses as to the outcome can skew the results. Fur-
ther arguments against self-experimentation include self-
harm, nonreproducibility of the experiment, and a small
nonrepresentative sample size.19
Self-harm is inherent in the method of the nerve
transection experiment. The majority of sensation had
returned to normal over the dorsum of Head’s hand and
forearm by the conclusion of the experiment; however, as
late as 1908 there were still small areas that were only
supplied with deep and protopathic sensibility (Fig. 4).22
Despite this, there is no mention in later writings or per-
531
 S. M. Lenfest, A. Vaduva-Nemes, and M. S. Okun
Fig. 4.  This photograph was taken in 1908. The solid line marks an
area still supplied only by deep and protopathic sensibility. The dotted
border encloses the area where the desensitized parts merge with oth-
er parts that have recovered. Originally printed in the New York Evening
Post, September 8, 1912.
sonal papers that Dr. Head suffered from any long-term
sensory disturbances. He did not describe experiencing
symptoms of conditions such as causalgia, which was be-
ing described and studied in the late 19th and early 20th
centuries, or what would later be known as reflex sympa-
thetic dystrophy. Head would have been aware of these
and the many other potentially harmful consequences of
nerve transection.
Gandevia7 claimed that Head’s study may “have hin-
dered rather than helped the development of knowledge.
The reports of the qualitative changes in sensation follow-
ing deliberate surgical transection of a peripheral nerve in
the experimenter’s own arm are a classic example of the
dangers of introspection. The arbitrary division of all cu-
taneous sensations according to epicritic and protopathic
qualities took several decades to overturn.”
Walshe24 also criticized Head, stating “his studies in-
cluded no direct attempt to ascertain whether or not the
skin actually contained these anatomical mechanisms, but
it was concluded that these must have existed to account
for the physiological phenomena observed.” Walsh fur-
ther claimed, “the method was essentially a physiological
one, its prime object was the determination of function. It
was only secondarily concerned with structure.”
532
Dr. Head’s research was not deterred by the criti-
cism. He had an illustrious career that included numerous
other experiments and publications that further explored
his hypotheses on sensation. He published a very influen-
tial paper with Gordon Holmes in 1911 titled, “Sensory
disturbances from cerebral lesions.”14 He often traveled
the world lecturing on his research of the human nervous
system. He went to New York in 1912 to deliver a lec-
ture series at Fordham University. The New York Eve-
ning Post featured his visit in an article and stated that
many physicians and surgeons had arranged to be present
to attend all of the lectures.21 Fordham University con-
ferred an honorary degree on Dr. Head during this visit. 5
He also served as the editor of the journal Brain for 17
years and was knighted in 1927. While Henry Head was
the editor of Brain, the journal became representative
of expanding British science and increased neurology’s
worldwide prominence.2 He even published a renowned
article, “Aphasia and kindred disorders of speech,” in
1920 despite the onset of early parkinsonian symptoms.
Sir Henry Head died on October 8, 1940, at the age of
79 years after battling Parkinson disease for more than
20 years. He was featured in an article in the Daily Mail
on October 10, 1940. The article called Head a martyr of
medical research, whose experiment in human nerve divi-
sion allowed specialists to obtain valuable information on
the way messages are transmitted from the nerves to the
brain, and led to new methods of surgery for the treatment
of nervous diseases.17 It is evident that there were many
scholars, who may not have agreed with Head’s methods
or theories, but they all understood that his research was
vital to the development of a largely misunderstood area
of neurology.
Head’s self-experiment was one of the first to raise
important questions about the peripheral sensory system,
and it inspired in depth investigations by leading scien-
tists such as Dr. Wilfred Trotter (1909–1913) and Dr. Ed-
win Boring (1916). Head provided explanations that en-
hanced the understanding of the sensory examination. He
showed that the previously used modality of testing nerve
damage via presence or absence of sensation could be in-
valid and lead to false-negative results. This observation
stimulated bedside neurologists worldwide to reevaluate
the sensory examination and how it was performed. De-
spite the debate concerning the ethics and utility of self-
experimentation, Henry Head’s dramatic nerve transec-
tion generated a lot of interest and enthusiasm for further
exploration of the sensory systems.3,16,24
Disclosure
Dr. Okun has received grants (NIH, National Parkinson
Foun­dation, Michael J. Fox Foundation, and Parkinson Alliance),
hon­or­aria (Medtronic) and consulting fees (National Par­kinson
Foun­dation). Dr. Okun has in the past had stock/ownership or patent
rights to COMPRESS/NeuroTrax. Dr. Okun has consulted without
fee in the past for Elopement Solutions.
Author contributions to the study and manuscript preparation
include the following. Conception and design: Okun. Drafting the
ar­ticle: Lenfest, Vaduva-Nemes. Critically revising the article: all
authors. Re­viewed final version of the manuscript and approved it
for sub­mission: all authors. Administrative/technical/material sup-
port: Okun.
J Neurosurg / Volume 114 / February 2011
Dr. Henry Head
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Manuscript submitted March 11, 2010.
Accepted August 31, 2010.
Please include this information when citing this paper: pub-
lished online October 8, 2010; DOI: 10.3171/2010.8.JNS10400.
Address correspondence to: Michael S. Okun, M.D., Department
of Neurology, University of Florida Movement Disorders Center,
P.O. Box 100236, Gainesville, Florida 32610. email: okun@neurol-
ogy.ufl.edu.
533