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Editorial

Alastair Compston
DOI: http://dx.doi.org/10.1093/brain/aws319 3517-3520 First published online: 18 December 2012

Fearing that he had developed locomotor ataxy, the Edwardian diarist Bruce Cummings [aka W.N.P. Barbellion (1889–1919)] confided in his journal and, on 30 April 1913 ‘went . . . to see the well-known nerve specialist Dr H–- who asked . . . suspiciously if I had ever been with women . . . H–- chased me round his consulting room with a drumstick, tapping my nerves and cunningly working my reflexes. Then he tickled the soles of my feet and pricked me with a pin—all of which I stood like a man. He wears a soft black hat, looks like a Quaker, and reads the Verhandlungen d. Gesellschaft d. Nervenartzen’ (see Fig. 1).

Figure 1

A cartoon depicting Dr Henry Head drawn by William Morris (nd) a medical student at the London Hospital in 1913. The musical notation characterizes one of his mannerisms; also referred to by Robert Graves in Goodbye to All That (1930) [from the collection of Dr Ronald Henson (1915–94), subsequently in the possession of Professor Ian McDonald (1933–2006)].

Not until 27 November 1915 did Barbellion learn that Dr H— had immediately diagnosed disseminated sclerosis, but communicated this only to his relatives. In 1920, the painter Jacques Raverat (1885–1925), who suffered from the same condition as Barbellion, tired of seeing Henry Head (1861–1940), whom he had first consulted in 1919 on the recommendation of E.D. (Edgar) Adrian (1889–1977), on the basis that ‘he wd. only tell me to rest and I am anyhow spending 18 hours out of 24 in bed’. As her health deteriorated in the summer of 1913, Virginia Woolf (1882–1941) consulted Sir George Savage (1842–1921) who ‘thought her rather bad’ but offered no practical advice; therefore, on the recommendation of Roger Fry (1866–1934), Leonard Woolf (1880–1969) arranged for Virginia to see Dr Head; but there was little that he could do other than advise a holiday and venture the opinion that she was not at serious risk of attempting suicide. In that Head was proved somewhat too optimistic for Virginia took an overdose of veronal on 8 September 1913. Head was immediately summoned to her home and, with Geoffrey Keynes (1887–1982) who was lodging at the house, dashed her across London and arranged for a stomach wash-out at St Bartholomew’s Hospital: ‘at nine pm, Dr Head returned and was able to say that she was practically out of danger. She remained unconscious all that day’. In addition to his society practice, Head’s work on neurological injuries suffered by soldiers in the Great War, and the contact with W.H.R. (William) Rivers (1864–1922), provided a wide circle of literary friends notably Siegfried Sassoon (1886–1967), Robert Nichols (1893–1944), Robert Graves (1895–1985) and Thomas Hardy (1840–1928). Retiring from hospital work in 1918, aged 58 years, and although maintaining for a while his private practice, Head then devoted his time to poetry and writing scientific articles on aphasia.

Of the 54 original articles (3 were printed simultaneously in several journals) that Head published during his working lifetime, 24 appeared in Brain between 1893 and 1923. These cover 2307 printed pages with 12 occupying more than 100 sides, the longest at 222, and with 397 pages devoted to the three-part work on pain in visceral disease. Overall, Brain articles by Henry Head averaged 96 printed pages per article. These are ‘On disturbances of sensation with especial reference to the pain of visceral disease’ Brain 1893; 16: 1–133; ‘On disturbances of sensation with especial reference to the pain of visceral disease. Part II’ Brain 1894; 17: 339–480; ‘On disturbances of sensation with especial reference to the pain of visceral disease. Part III’ Brain 1896; 19: 153–276; (with A.W. Campbell) ‘The pathology of herpes zoster and its bearing on sensory localization’ Brain 1900; 23: 353–523; ‘Certain mental changes that accompany visceral disease. (The Goulstonian Lectures)’ Brain 1901; 24: 345–429; (with W.H.R. Rivers and J. Sherren) ‘The afferent nervous system from a new aspect’ Brain 1905; 28: 99–115; ‘Case of myoclonus’ Brain 1905; 28: 362; (with J. Sherren) ‘The consequences of injury to the peripheral nerves in man’ Brain 1905; 28: 116–338; ‘A case of Huntington’s chorea’ Brain 1905; 28: 98; ‘A case of Huntington’s chorea’ Brain 1905; 28: 362; (with T. Thompson) ‘The grouping of afferent impulses within the spinal cord’ Brain 1906; 29: 537–741; (with W.H.R. Rivers) ‘A human experiment in nerve division’ Brain 1908; 31: 323–450; (with Gordon Holmes) ‘Sensory disturbances from cerebral lesions’ Brain 1911–12; 34: 102–254; (with Gordon Holmes) ‘A case of lesion of the optic thalamus with autopsy’ Brain 1911–12; 34: 255–71; (with J. McIntosh, P. Fildes and E.G. Fearnsides) ‘Parasyphilis of the nervous system’ Brain 1914; 36: 1–30; (with E.G. Fearnsides) ‘The clinical aspects of syphilis of the nervous system in the light of the Wasserman reaction and treatment with neosalvarsan’ Brain 1914–15; 37: 1–140; ‘Hughlings Jackson on aphasia and kindred disorders of speech; together with a complete bibliography of Dr Jackson’s publications on speech, and a reprint of some of the most important papers’ Brain 1915; 38: 1–190; (with G. Riddoch) ‘The automatic bladder, excessive sweating and some other reflex conditions, in gross injuries of the spinal cord’ Brain 1917; 40: 188–263; ‘Sensation and the cerebral cortex’ Brain 1918; 41: 58–253; ‘President’s address. Some principles of neurology’ Brain 1918; 41: 344–54; Aphasia and kindred disorders of speech. (The Linacre lecture for 1920) Brain 1920; 43: 87–165; ‘Aphasia: an historical review. (The Hughlings Jackson lecture for 1920)’ Brain 1920; 43: 390–411; ‘Discussion on aphasia’ Brain 1920; 43: 412–13 and 447–50; and ‘Speech and cerebral localization’ Brain 1923; 46: 355–528.

Henry Head was elected to membership of the Neurological Society of the United Kingdom in 1891; served on Council in 1900; and was Secretary of the Society from 1901–04. In 1905, Council expressed regret that Dr (Robert) Percy Smith (1853–1941) no longer felt able to continue and nominated Dr Head as the next editor of Brain. But the days of the Neurological Society were numbered, and at a special meeting on 6 December 1906, Dr Head was appointed as delegate for the Society on the committee overseeing its amalgamation with the Union of Medical Societies (which became the Royal Society of Medicine in 1907). Now devoid of an affiliated Society, Brain became the responsibility of a group of nominated Guarantors and, at a meeting chaired by Dr (Thomas) Buzzard (1831–1919) at 20 Hannover Square on 15 October 1907, the Guarantors appointed a Committee of Management to act on their behalf: Dr Thomas Buzzard, Dr (David) Ferrier (1831–1919), Sir Victor Horsley (1857–1916), Dr (Frederick) Mott (1853–1926), Dr Alexander Bruce (nk–1911), Professor Charles Sherrington (1857–1952), Dr (Charles) Beevor (1854–1908), Dr Leonard Guthrie (1858–1918), Dr James Taylor (1859–1946), Dr Percy Smith, Dr F.E. (Frederick) Batten (1865–1918), Dr Gordon Holmes (1876–1965) and Dr Henry Head.

Between 1907 and 1924, Head attended each of the 39 meetings of the Committee; other invariable attendees over that period were Taylor, Percy Smith and Holmes (apart from the years of the Great War when he was in France); and Head was usually the instigator of key decisions taken by the Committee.

Meetings from 5 November 1907 sought terms with the publishers, Macmillan and Co., on cost, illustrations and other matters relating to publication of Brain—each clause of the contract usually requiring an entire meeting to achieve agreement. By 18 November 1907, the price of Brain was set at 16 shillings (s) per annum (or 4s per issue) except for members of the Neurological Section of the new Royal Society of Medicine and each Guarantor of Brain for whom the annual subscription was 12s. Beevor, Horsley and Head were charged with discussing with Macmillan and Co. the publishers’ one third share of the profits; a contribution to the cost of illustrations; the size (larger paper comprising 8 sheets of 16 pages each); and promotion of sales, especially in the USA through subsidized subscriptions. On 24 June 1908, Dr Head suggested that a supplementary volume be published commemorating the jubilee of the National Hospital; but no decision was reached. On 26 January 1909, he confirmed that the Royal Society of Medicine had relinquished any further claim on income from Brain beyond June 1907. Cheques from Macmillan were now to be paid into a London Joint Stock Bank account in the name of the Guarantors of Brain and not the Neurological Society; with Taylor, Percy Smith, Head and (Sir Edward) Farquhar Buzzard (1871–1945) as signatories. At the outbreak of war, Dr Head proposed on 23 November 1914 (reaffirmed on 20 December 1915) that copies of Brain should be reserved for eventual exchange with German publications once hostilities had ceased. On 24 September 1918, it was agreed that Dr Head be allowed to reprint all his articles in Brain from 1905 onwards, and the blocks illustrating those articles be sold to Oxford University Press and Hodder and Stoughton. These reprinted articles appeared later as Studies in Neurology (1920). On 21 November 1921, in a note written by himself, Dr Head summarized the finances of Brain over the previous few years: a debt to Macmillan of £106.13.9 in 1918 reduced by repayment to £51.2.0 in 1919; but with a net loss in 1920 of £39.14.3 increasing the debt to £97.16.3 and with an increase in subscription returning the journal to £105.10.8 profit in 1921. The number of subscribers was 231 (January 1920); 257 (August 1920); 258 (January 1921) and 328 (August 1921). At that same meeting, knowing that he had early symptoms of Parkinson’s disease, Dr Head resigned as editor and could not be persuaded to stay on despite a proposal from Dr (Charles) Myers (1873–1946). In discussion it was ascertained that Dr Holmes was willing to undertake the editorship of Brain: Holmes left the room and was then elected.

Head had started his editorship in 1905 by retaining the assistance of several neurologists who had assisted his predecessor, Percy Smith: (Charlton) Bastian (1837–1915), Judson Bury (1852–1954), Sir Victor Horsley, W. Julius Mickle (nk–1917), (James) Risien Russell (1863–1939) and Ernest Starling (1866–1927); adding Sir John Batty Tuke (1835–1913: 1905 only), (William) Halliburton (1860–1931: from 1905), (Charles) Mercier (1852–1919: from 1905), Sir Thomas Barlow (1845–1945: from 1906), Beevor (from 1906) and Bruce (from 1906), each of whom served until the Neurological Society of the United Kingdom ceased to exist. When the Guarantors of Brain assumed responsibility for the journal in 1908, Head appointed a new team and edited the journal ‘with the help’ of Bruce (to 1911), Thomas Buzzard (to 1918), Ferrier, (Sir) William Gowers (1845–1915: to 1914), Horsley (to 1912), Mott, Percy Smith and Sherrington; later also inviting (Sir) Byrom Bramwell (1847–1931: from 1912), (Sir William) Bayliss (1860–1924: from 1919), Farquhar Buzzard (from 1919), Holmes (from 1919) and Taylor (from 1919).

Head celebrated his election to the editorship by publishing five of his own articles in 1905; and the following year, he dedicated much of Volume 29 to articles by or about his mentor John Hughlings Jackson (1835–1911: see Brain 2011; 134: 2791–97). Among the 8876 printed pages of Brain that Head edited between 1905 and 1921 (Volumes 28 to 44) are a large number of articles now listed in Morton’s Medical Bibliography (fifth edition, 1993) as classics in the history of medicine—an astonishing number written by Head himself (and with two others: the three parts of ‘On disturbances of sensation with especial reference to the pain of visceral disease’ and ‘The pathology of herpes zoster and its bearing on sensory localization’, see above, cited from earlier in his career). The ‘Garrison and Morton’ items from this period are ‘The afferent nervous system from a new aspect’ and ‘The consequences of injury to the peripheral nerves in man’ (see above); Sherrington ‘On the proprioceptive system, especially in its reflex aspect’ Brain 1906; 29: 476–82; ‘The grouping of afferent impulses within the spinal cord’ (see above); Horsley and Clarke ‘The structure and functions of the cerebellum examined by a new method’ Brain 1908; 31: 45–124 (and see Brain 2007; 130: 1449–52); ‘A human experiment in nerve division’ (see above; and Brain 2009; 132: 2903–05); Sachs ‘On the structure and functional relations of the optic thalamus’ Brain 1909; 32: 95–186 (and see Brain 2007; 130: 2239–41); ‘Sensory disturbance from cerebral lesions’ (see above); Wilson ‘Progressive lenticular degeneration, a familial nervous disease associated with cirrhosis of the liver’ Brain 1912; 34: 295–509 (and see Brain 2009; 132: 1997–2001); ‘The automatic bladder, excessive sweating and some other reflex conditions, in gross injuries of the spinal cord’ (see above; and Brain 2008; 131: 2237–2239); Riddoch ‘The reflex functions of the completely divided spinal cord in man, compared with those associated with less severe lesions’ Brain 1917; 40: 264–402 (and see Brain 2004; 127: 2150); and Studies in neurology (1920: containing several papers reprinted from those listed above). Also cited is Head’s monograph on Aphasia and Kindred Disorders of Speech (1926) based on the work first published in the penultimate volume of Brain that he edited [‘Aphasia and kindred disorders of speech’ and ‘Aphasia: an historical review’ (see above)].

Six articles in the current issue deal with ‘symbolic formulation and expression’. Anthony Dick (Miami, USA) and Pascale Temblay (Québec, Canada) review consensus and controversy in studies on the connectivity of seven pathways, beyond the arcuate fasciculus, that support language (page 3529). Gemma Northam and a team from London (UK) and Melbourne (Australia) study connectivity of defined pathways in adolescent individuals who were born preterm and show that the high prevalence of language impairment (38%) correlates most clearly with alteration in tracts involving the posterior corpus callosum that connect occipital, parietal and, in particular, the temporal lobes of each hemisphere especially if other pathways (the anterior commissure) connecting the temporal lobes are also abnormal (page 3781). Julius Fridriksson and investigators from Tucson, Columbia and Pittsburgh (USA) show that, compared with the halting spontaneous speech in people with Broca’s aphasia, fluent delivery—a doubling of speech output—can be achieved in these patients through speech entrainment in which audiovisual speech is variously mimicked; and they implicate interhemispheric brain regions connected via the corpus callosum and extreme capsule with strengthening of unilateral connections involving the arcuate fasciculus in this approach to improving speech fluency (page 3815). Myrna Schwartz and colleagues from Philadelphia (USA) study naming and show that phonological accuracy (but not necessarily semantic precision) depends on integrity of premotor cortex, pre- and post-central gyri and the supramarginal gyrus with relative sparing of auditory-related posterior temporal and temporoparietal cortex (page 3799). Sasa Kivisaari and investigators from Basel (Switzerland) and Cambridge (UK) address the ambiguous role of the perirhinal cortex in categorizing objects that are visually confusing and identify the medial perirhinal cortex as critical for the hierarchical process of binding the object that is seen, and processing its perceptual and semantic properties as the basis for accurate naming (page 3757). Paul Hoffman and a team from Manchester and Bath (UK) also consider the anatomy of semantic knowledge and naming to show that, in the context of semantic dementia, conceptual representation for objects varying in familiarity and typicality degrades early as a result of atrophy affecting the ventrolateral anterior temporal lobes but without dependence on specific sensory and motor features; whereas failure to appreciate concepts that do depend on specific visual modalities occurs later as more posterior temporal lobe structures are involved (page 3770). In classifying cerebral disorders of speech as ‘verbal aphasia’, ‘syntactical aphasia’, ‘nominal aphasia’ and ‘semantic aphasia’, Henry Head anticipated many of these concepts relating to ‘symbolic formulation and expression’. In From the Archives, we review ‘Aphasia: an historical review’ (The Hughlings Jackson lecture for 1920) by Henry Head (Brain 1920; 43: 390–411) and ‘Head’s contribution to aphasia’ by Macdonald Critchley (Brain 1961; 84: 551–60).