Stephen Jacyna's seminal portrait of physiologist-turned-clinical-neurologist Henry Head (1861–1940) reinvents medical biography and positions it at the cutting edge of several rejuvenated historiographies, on the relations of mind and body, science and art, and, crucially, science and the clinic in late nineteenth- and early twentieth-century British medicine. In this holistic account of a holistic thinker, Jacyna locates Head's work on sensation both within the context of his life history and as central to the wider modernist turn in early twentieth-century European thought and culture, which sought a return to subjectivity on the basis of a reconceptualization of man's relationship with the natural world. Head held that, since each person creates external reality via the interaction of common human biological processes with sensibilities mediated by individual inheritance, environment and lifestyle, medicine needs the art of clinical experience as well as the science of laboratory knowledge. Just as no fixed boundary can exist between the mind and the body, so, for Head, there can be no fixed boundaries between science and art in medicine, or in the more general culture in which medicine shares. Jacyna reflexively applies Head's logic to medical biography: there can be no full understanding of Head unless he is located in the whole of his life.
Head's neurology was characteristically modernist. Intended as a revolutionary break with classical neurology, it underlined the importance of the subjective illness experience as integral to understanding disease, yet was simultaneously progressive, teleological, inscribing highly elitist views of sensibility and morality. Head was much influenced by Michael Foster and especially Walter Gaskell at Cambridge in presuming an evolutionary understanding of nervous-system development, dividing sensation into evolutionarily earlier, lower, animalistic ‘protopathic’ impulses governing basic instinctual drives and later, higher, ‘epicritic’ impulses. The epicritic represented the civilizing process (and progress) and had come to exercise general control over the protopathic – a control which could, however, be broken by disease, resulting in partially individualized illness experience.
Head's holistic vision eschewed the perceived classificatory impulse of contemporary medicine; disease and illness were infinitely more complex and fluid than the current diagnostic labels. Health was not framed in terms of adherence to norms, but as the individual's ability to adapt successfully to changed conditions. The historiography of science–clinic relations has often overlooked such holistic perspectives, in which both ‘scientific’ and ‘human’ facts were essential to diagnosis and therapy. Jacyna shows how such a perspective was forged in the crucible of early twentieth-century British evolutionary modernism. Head was, in fact, proposing a type of ‘Romantic Science’ akin to the explorations of William James, Ludwig Binswanger and, later, Oliver Sacks: an attempt to bridge the oft-perceived incommensurability between science and experience on the basis that both are crucial to understanding the human individual in health and disease.
This integrationist perspective underpinned Head's position on science–clinic relations. He preserved what he called ‘the old alliance between the Laboratory and the Wards’ (p. 56), in which there was no oppositional disjunction based on socialized boundaries between them. Both were simply essential parts of a unified clinical medicine. For Head, the clinic was an extension of the laboratory – a place where experimentally derived knowledge could be understood experientially; both were equally necessary and mutually complementary. That similar positions were maintained by other British clinicians and physiologists may be a neglected perspective in the over-polarized historiography of science–clinic relations.
Head's patients, especially the more aristocratic, epicritic ones (above all, his patient and friend Robert Nichols), were treated in Head's case narratives as, Jacyna argues, ‘rounded characters that play an active part in … unveiling … the truth of their condition. The doctor … is … more an involved primus inter pares … than … detached representative of a disinterested clinical gaze. The understanding of the disorder appears to occur through a process of mutual negotiation and cognition’ (p. 2). The self is malleable; the doctor helps the patient to understand the impact of the illness and rebuild a new self. Pain, like beauty, is relative, not absolute. Both emerge out of the interactions of observer with environment. They are not fixed but contingent. As well as remaking his patients, Head and his wife Ruth self-consciously – and, one might add, rather painfully pretentiously, to modern sensibilities – remade themselves in letters and scrapbooks. As Head noted, ‘Man perpetually builds up a model of himself, which constantly changes’ (p. 135).
However, Jacyna's holistic ‘Romantic History’ shares Romantic Science's dilemma: how to retain the rationality and intellectual rigour of scientific ways of knowing while coopting experiential human perspectives? Jacyna confesses to losing ‘the detached neutral voice of the academic historian’, admitting that it was ‘difficult not to develop an emotional engagement’ (p. 8). However, this statement subtly reiterates Head/Jacyna's underlying point: like all knowledge, history can only be subjective. Both medical case narratives and biography should thus include all relevant ‘facts’ so that the individual in focus can be more fully understood.
Oliver Sacks seems wrong, then, to portray Head as one of classical neurology's reductionist ‘diagram makers’ (p. 140). In fact, so-called subjective factors were integral to his understandings. In Head's view, physicians should facilitate the retrieval of adaptability by developing the patient's (epicritic) ability to take control of self-image (including body image) to incorporate the disease/illness into a new functional normality. This is very similar to Sacks's own framing of the physician-as-facilitator of the new narrative of the self. In Jacyna's interpretation, Head also harmoniously combined clinical with scientific work and thus emerges as sophisticated pioneer and exemplar of the heterogeneous ways medical workers integrated science and the clinic, science and art, and mind and body in the twentieth century.
However, the sum is greater even than these parts. Jacyna's holistic portrait of Head reveals the sources of medical holism in twentieth-century British medicine to have been not only psychological discourses but also physiology, evolutionary thought, physics, economics, literature, art and other cultural manifestations of cognitive and aesthetic modernisms. Even in the local educational and personal development of individual workers, holism was holistically embedded.
