JMS Pearce
Hull, England

The turn of the twentieth century marked an era when throughout Europe clinical neurology was evolving rapidly as an erudite specialist discipline based mainly on clinicopathological observations and correlations. Its English leaders were John Hughlings Jackson and David Ferrier followed by Henry Charlton Bastian, William Gowers, and Victor Horsley. By the 1920s, Kinnier Wilson and Gordon Holmes led an unusually talented group of neurological physicians. Amongst their ranks were: WJ Adie, Francis Walshe, Wilfred Harris, Macdonald Critchley, Hugh Garland, Derek Denny-Brown, and W Russell Brain.

Wilfred Harris (1869–1960)

Wilfred Harris is remembered especially for his original descriptions of cluster headaches, which he called periodic migrainous neuralgia, and for his techniques of injecting the Gasserian ganglion for the agonizing pain of trigeminal neuralgia.

He was born in Madras, third son of William Henry Harris, MD, a veteran of the Crimean War and professor of midwifery and diseases of women and children in Madras. He was educated at Sherborne School, Dorset; University College School, London; and Gonville and Caius College, Cambridge. He won a scholarship to St. Mary’s Hospital Medical School, where he gained prizes in clinical medicine and ophthalmology and qualified M.B., Ch.B. (Cantab) in 1894. He was a house physician at St. Mary’s Hospital (1895) and spent two years as resident at the National Hospital, Queen Square, where Hughlings Jackson and Sir William Gowers were still active.

He was appointed tutor, then casualty physician at St. Mary’s Hospital. In 1902 he was elected to the staff of the Maida Vale Hospital for Epilepsy and in 1905 became assistant physician at St. Mary’s. There, in 1907, he established the first department of neurology in any undergraduate teaching hospital; in 1919 he was appointed part-time director of the new medical unit at St. Mary’s where he served until temporary retirement in 1935. He continued at Maida Vale until 1945.¹

Headaches and neuralgias

Wilfred Harris was an outstanding neurologist who early in his career became interested in headaches and the neuralgias.² His research led him to identify the characteristics (and treatment with ergotamine) of “periodic migrainous neuralgia,”^3,4,5 later known as cluster headache and elaborated amongst others by Symonds,⁶ Ekbom,⁷ and Horton.⁸ Rooke, Rushton, and Peters noted when Horton and colleagues described this headache in 1939, “they were actually redescribing a syndrome about which Harris had written in 1926 and again in 1936 under the terms ‘ciliary’ or ‘migrainous’ neuralgia.”

Harris wrote:

In 1911, I began to use the terms “migrainous neuralgia” and “ciliary neuralgia” to describe two forms of severe unilateral neuralgia, recurrent and sometimes periodic, affecting the region round one eye and temple and upper part of the cheek, and even occasionally spreading behind the ear and down the side of the neck. In some cases the eyeball is the site of the pain, which then becomes congested and lacrimating. This variety of migrainous neuralgia I call ciliary (Harris, 1926b) neuralgia, because of the marked ocular congestion and the ring of peri- uveal reddening around the cornea. The pain differs in type from trigeminal tic in many respects…⁹

He observed: “I look upon these cases as an anterior migraine in which the vasomotor spasm does not affect the posterior cerebral branches but the dural meningeal vessels—thus accounting for the reference of the pain over trigeminal areas through the recurrent meningeal branches of the fifth nerve.”¹⁰

He furthered the treatment of trigeminal neuralgia by devising selective injection techniques to abolish the pain. After numerous experiments on cadavers, in 1910 he perfected a technique for injecting alcohol into the Gasserian ganglion through the foramen ovale by the lateral route. Symptoms were generally suppressed for six months to three years, but he reported what was probably the first permanent cure by injection in a man, “living another twenty-seven years with no recurrence of neuralgia.” He initially described seven patients, in six of whom he injected the infra-orbital nerve with good results, and subsequently an additional sixteen cases, in some of whom he injected the Gasserian ganglion with alcohol, with apparently lasting cure.

He also successfully used Gasserian injection for “intractable migraines, periodic migrainous and ciliary neuralgias…and trigeminal tic in disseminated sclerosis.” For fifty years, until shortly before his death at home at the age of ninety, he continued to apply this treatment and achieved remarkable results. He treated “not less than 2,500 patients with trigeminal neuralgia.”¹¹ This was long before the introduction of carbamazepine and microvascular decompression of aberrant vessels irritating the nerve.

Harris wrote more than 200 papers and several books: Nerve Injuries and Shock (1915), Neuritis and Neuralgia (1926), The Facial Neuralgias (1937) (Figs 2,3), and The Morphology of the Brachial Plexus: With a Note on the Pectoral Muscle and its Tendon Twist (1939).

Wilfred Harris invented the term “glossopharyngeal neuralgia” and noted how it resembled trigeminal neuralgia.¹² He also studied the brachial plexus, and in 1939 published The Morphology of the Brachial Plexus with illustrations based on his many dissections.¹³ In 1917 Harris gave two lectures at the Royal College of Surgeons of England on the brachial plexus and surgery. He was president of the section of neurology of the Royal Society of Medicine, the Association of British Neurologists, and the International League Against Epilepsy. He was an examiner for the Royal College of Physicians and the Universities of Durham and Cambridge. He could be impatient, but was a precise clinician and an excellent teacher.

He played rugby as a boy and remained keen on the game.¹³ Eighty of his substantial collection of old silver spoons were sold at Christies in 1957 for £14,876. In 1906 he married Mabel, eldest daughter of Rear-Admiral Richard Mayne. They had two sons and one daughter. He died in 1960, aged ninety-one; Mabel died in 1962.

References

1. Nieman, E. “Wilfred Harris (1869–1960).” In Twentieth Century Neurology: The British Contribution, pp. 77-86. 2001.
2. Pearce JMS. Cluster Headache and its variants. Festschrift for Lord Walton. Postgraduate Medical Journal 1992;68:517-21.
   qv. Pearce JMS. Natural History of Cluster Headache. Headache: The Journal of Head and Face Pain, 1993;33:253-6.
3. Harris W. The Facial Neuralgias. Oxford University Press 1937:70-3.
4. Harris, W. (1926). Neuritis and Neuralgia. Oxford Publications, London. 1926:293-307.
5. Bickerstaff ER. The periodic migrainous neuralgia of Wilfred Harris. Lancet. 1959 May 23;1(7082):1069-71.
6. Symonds CP. A particular variety of headache. Brain 1956:79,217.
7. Ekbom KA. Ergotamine tartrate orally in Horton’s ‘histaminic cephalgia’ (also called Harris’s ‘ciliary neuralgia’): a new method of treatment. Acta Pyschiatr Neurol Supplement 1947; 46: 105-13.
8. Horton BT. Histaminic cephalgia. J Lancet 1952; 72: 92-8.
9. Harris W. Migrainous, ciliary, and post-traumatic dural headaches. Br Med J. 1946 May 18;1(4454):754-7.
10. Harris W. Ciliary (Migrainous) Neuralgia and its treatment. British Medical Journal 1936;1: 457-60
11. Harris W. An analysis of 1,433 cases of paroxysmal trigeminal neuralgia (trigeminal-tic) and the end-results of gasserian alcohol injection, Brain 1940;63:209-24.
12. Pearce JMS. Glossopharyngeal Neuralgia. Eur Neurol 2006;55(1):49-52.
13. RR. Wilfred John Harris. In: Inspiring Physicians, also known as Munk’s Roll, Royal College of Physicians Vol V, pg. 175.