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'Pain conquered, Fear resolved, or Hope regained’: Henry Head and herpes in the RCP archives

It is all too easy to get distracted while rummaging in archive store rooms. Recently, while searching for something else, I happened to open a volume to find it full of spotty bottoms. This proved to be one of nine notebooks in which neurologist Henry Head (1861–1940) had carefully sketched the blistered bodies of hundreds of people suffering with herpes zoster, or shingles, as part of his quest to explain the mysteries of pain. These records vividly evoke not only the character of a passionate physician, but also the lives of his patients.

As a neurologist, Henry Head was fascinated by the sensation of pain and his interest in shingles came when he realised that mapping rashes on the body could reveal the distribution of sensory nerves emanating from the spine.

As registrar and later assistant physician at the London Hospital, Head began to document cases of herpes zoster. His notebooks often record the name, age and occupation of his patients, and it is these biographical snippets that bring these volumes to life. For example, the bottom below belonged to 27-year-old chair maker Thomas Ayres.
 

Drawing of Thomas Ayres by Henry Head, 1890s.
Drawing of Thomas Ayres by Henry Head, 1890s.


On 25 September 1891, Head examined Ayres, who told him that 2 days earlier ‘he felt sore and got his wife to look. She found the spot was there. Has not altered since. No pain before the eruption came out.’ Head always asked whether the patient had felt pain before the onset of a visible rash as he wanted to understand the relationship between the nervous system, the lesions and the sensation of pain.

The casebook photos are a striking record of the combination of vulnerability and dignity of Head’s patients

 Felix Lancashire, assistant archivist

From the early 1900s, Head made increasing use of photography to document his subjects, perhaps because the technology was becoming more readily available. The casebook photos are a striking record of the combination of vulnerability and dignity of Head’s patients, including 46-year-old carpenter William Clarke and 15-year-old Minnie Woolgar, who kept her hat on while being photographed.

 

Photograph of Minnie Woolgar in the casebook of Henry Head, 1904.
Photograph of Minnie Woolgar in the casebook of Henry Head, 1904

 

When Head encountered good examples of lesion distribution, he would instruct the hospital staff to arrange to photograph those patients. His enthusiasm for his research is often clear in his notes; he wrote excitedly on one patient form ‘The most perfect D9! Fully on[set] vesicles. Photograph.’. D9 was one of the codes for the various dermatomes: regions of skin served by a single spinal nerve. You can see in the photos of Kate English and John Sharp where Head has drawn on the skin around his patients’ lesions to enable him to better map the regions affected.

Head was also keen to conduct post-mortem examinations on the bodies of patients who had had shingles. Since it was not a fatal disease, he did not have easy access to such bodies in hospitals and turned instead to workhouses and asylums, where patients often remained until they died. Our collection includes a notebook about cases at Rainhill County Asylum in Lancashire, where Head collaborated with the asylum’s pathologist, Alfred Walter Campbell (1868–1937).

Fostering close ties with colleagues was important for Head’s work. He was popular among both students and peers, and was able to use his extensive network of friends to gain access to patients in many hospitals and elsewhere. In 1903, Dr Sydney Williams wrote to Head about one of his private patients, a Mrs Hall, whom Williams bluntly describes as ‘a large woman of 62. Looks above her age’. Williams seems to have believed that Head treated people for herpes as well as recording the symptoms, as he wrote:

Would you kindly give advice to Mrs Hall as to prognosis & treatment. In May this year a herpetic eruption came out all over the ‘shoulder cap’ & spread down the arm & on to the thumb & at the same time the power of the arm failed.

Paralysis often accompanied shingles in the patients Head observed. Happily, according to a note written by Head in March 1904, Mrs Hall was by then ‘absolutely well. All paralysis gone. No pain. No scars.’

 

 

Next to medicine, Head’s other passion was literature. The title of this post is a line from ‘The price’, one of a series of poems by Head about the First World War that are collected in his book, Destroyers and other verses. Head and his wife, the author Ruth Mayhew Head (1866–1939), were friends with literary figures including Thomas Hardy (1840–1928) and Siegfried Sassoon (1886–1967). Head met Sassoon when the latter was being treated in hospital by one of Head’s colleagues during the war. Henry and Ruth both appear as characters in the 1991 anti-war novel Regeneration by Pat Barker (born 1943).

Henry Head’s conclusions about the distribution of nerves from his studies of herpes zoster were controversial when they were published, but are now considered a major contribution to the field of sensory physiology. For Head, his findings shed light not only on the secrets of pain sensation and the nervous system, but also on the history of human evolution itself, as the development of the spinal cord is so central to this story. The records of Head’s endeavours and the patients who enabled him to succeed can be found on our archive catalogue, and can be viewed by appointment in the Library Reading Room.

Photographs of Kate English and John Sharp in the casebook of Henry Head, c.1903.
Photographs of Kate English and John Sharp in the casebook of Henry Head, c.1903.
Date
by
Felix Lancashire ,
Assistant archivist

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