A human experiment in nerve division by W. H .R. Rivers MD FRS, Fellow of St John's College, Cambridge and Henry Head MD FRS, Physician to the London Hospital, Brain 1908: 31; 323-450

Abstract

Despite having studied in detail the symptoms and signs of recovery from peripheral nerve injury in patients at the London Hospital with Mr James Sherren, Dr Head knows that much of importance is missing from these accounts. Moreover, Dr Rivers—who has advised Sherren and Head on psychophysical aspects of their work throughout—is frustrated by the relative paucity of his own observations. The solution is simple. Dr Rivers will cut and suture all cutaneous branches of Dr Head's radial nerve at the left elbow sparing any muscular innervations and, together, they will study the patterns of recovery. Surgery takes place on 25 April 1903 in the house of Mr Dean, with Mr Sherren assisting. Continuing with his practice at the London Hospital but travelling to Cambridge for examination in Dr Rivers's College room at weekends—in order to avoid ‘the ordinary distractions of a busy life … fatal to the detachment required by the sensory tests we wished to apply’—Dr Head summarizes his responses to the examination of the affected and his normal parts over the next 4 years. Overall, Dr Head is examined over several hours on each of 167 days at intervals between 26 April 1903 and 13 December 1907, during which he is not aware of the precise nature or order of the tests being applied (Fig. 1). Sensation is mapped systematically in a grid of 1 cm squares. A variety of instruments are used: reliance is placed on the use of cotton wool; graduated tactile and pain hairs provided by Professor Maximilian von Frey that stimulate at between 8 and 266 g/mm2; Cattell's pressure algometer; temperature applied by a flat-bottomed 1.25 cm diameter silver tube; heat and cold spots detected using the 1 mm2 tip of a soldering iron; discrimination of the two points of …