What does it mean to be dead? Advancing medical science continually challenges our definition. Can we be said to be dead when we stop breathing or if our heart stops? In centuries gone by, perhaps, but in recent decades the technology has been developed to rescue people from the grips of death. One thing though has remained a virtual constant – if we lose our heads, if that amazing brain that makes us who we are is destroyed then we are no more. Throughout history decapitation has represented the most emphatic, most absolute confirmation of death. But is there more to the story than that? Might there still be life after the chop?
“The Guillotine is a terrible torture! We must return to hanging!”
These are the words of the 18th century German anatomist S.T. Sömmering on a visit to Paris. At the time, few would have agreed with him. The general consensus at the time was that the clean decapitation provided by the Guillotine was a far more humane form of execution that hanging, during which people suffered greatly. Sömmering’s claims were based on what would become known as ‘la terrible legende’, reports that heads survived for a brief period of time after decapitation, perfectly aware of their surroundings and of their fate. The concept of the living head had entered the public imagination and the fascination of French medical science had been piqued.
In the following century French anatomists were gruesomely fascinated with the survival of the living head and the restoration – or perhaps it is better to say continuation – of consciousness. The anatomists Legallois and Brown-Séquard described how it was the presence of blood that gave the head its consciousness. The former detailed his belief that ‘une tête separée du tronc’ could be re-animated through the injection of oxygenated blood to the major arteries that supplied the brain, while the latter undertook a series of gruesome experiments on dogs, showing that voluntary movements could be induced up to eight minutes after decapitation through this process. While verging on the kind of science that remains ground-braking even today, the inherent barbarism and rudimentary methodology at play here is summed up by the title of Brown- Séquard’s description of his work, ‘Je décapitai un chien’.
As the fascination with the living head grew into the 19th century, the main limiting factor of these experiments was being defined – time. As Theodor Geisel, better known as Dr. Seuss, eloquently put it, “How did it get so late so soon?” It was becoming clear that there was a very limited window during which heads could be rescued. Brown- Séquard was limited to eight minutes in his experiments, while the physiologist Jean Baptiste Vincent Laborde saw his experiments on human decapitations, in which he attempted to repeat Brown- Séquard’s work on human heads, limited by “that stupid law” that required all deceased to cross the threshold of the city cemetery before being given to science. However, after some liberal bribery of officials and the addition of some extra horse power, Laborde was able to receive a head of an executed criminal just seven minutes after it was relieved of its body; hot off the presses, as it were. Laborde looked to restore the head’s blood supply using a tandem approach. He would inject the major blood vessels on the left side with oxygenated cow blood and, in a bold new approach, he decided to suture the vessels on the right side with those of ‘un chien vigoureux’, though if the dog knew what was about to happen, it would probably have been far more vigoureux. Laborde was met with a truly disconcerting sight – the head displayed a substantial contraction of the facial muscles, a ‘boiling of the tongue’ and at one point its jaw clamped shut so violently it echoed around his lab.
But a substantial question remained. Was this proof of a restored consciousness or simply the stimulation of residual sub-conscious functions? As the 19th century drew to a close, physiologists became concerned with just how long the separated head retained its awareness of the self and its surroundings. Hayem and Barrier defined a period of three to four seconds when discernible consciousness was present in dogs and such suspicions were seemingly confirmed by Beaurieux, a French physician, who noted:
“It was then that I called in a strong, sharp voice, “Languille!” [the name of the executed prisoner] I then saw the eyelids slowly lift up, without any spasmodic contraction…Next, Languille’s eyes very definitely fixed themselves on mine and the pupils focused themselves…I was dealing with undeniably living eyes which were looking at me.”
This action happened a second time before consciousness was clearly no longer present. This was an extremely important observation. The concept of the living head had been suggested at both a purely physiological and metaphysical level, with both the physical function and the presence of the conscious mind having been described.
It is at this stage of the story where we leave France and head across the Atlantic and where the tone shifts dramatically. Since the pioneering work of the French physiologists, the thinking had shifted – if heads retained living characteristics, might that head remain alive if a regular blood supply, perhaps from another body, was found?
The American physiologists Guthrie and Carrel set out to do just that. These men had pioneered the process of anastomosis, the stitching together of vessels, crucial to the success of both organ – and head – transplantation. On May 21st 1908, Guthrie reported the creation of the first man-made two-headed dog, in which the head of one dog was grafted onto the neck of another so that both heads existed chin-to-chin. There is perhaps yet more dark humour in the absurdity of the creature created by Guthrie and continues to show the inherent rudimentary processes these scientists were undertaking. Time was once again the limiting factor in this experiment. Too much time had passed between decapitation and transplantation for much brain function to survive. However, hidden amongst Guthrie’s notes was an horrific suggestion that somewhere within the re-animated head, its personality remained, gruesomely aware of what had happened:
“5:31: Secretion of tears.”
The fascination with the living head was entering into its second century, yet one key achievement was lacking – the proof that a head might retain its consciousness and function as it once did. Soviet experiments in the 1950s would go on to define this and once again shift the public perception of the living head. Dozens of head transplantations, in conjunction with the neck and forelimbs of the donor, revealed that with the improving medical technology of the time, the head might function as it once did, retaining its consciousness and its personality. As noted at the time, a particularly successful experiment achieved was had been thought impossible for centuries:
“09:00 – The donor’s head eagerly drank water or milk, and tugged as if trying to separate itself from the recipient’s body.
22:30 – When the recipient was put to bed, the transplanted head bit the finger of a member of staff until it bled.
Feb 26, 18:00 – The donor head bit the recipient behind the ear, so that the latter yelped and shook its head.”
While the experiments were too ambitious for their own good – immunosuppressive drugs were not good enough at the time to prevent rejection of the numerous limbs and tissues that were transplanted – these experiments paved the way for the medical and philosophical arguments that surround the concept to this very day.
American scientists grew bolder and as subjects grew closer and closer to humans, so the unease among both the scientific and medical world grew. Robert White, an American neurosurgeon, grew fascinated with the potential for removing the brain from the confinements of the head and keeping only this, the core element of our humanity, ‘alive’ in a recipient body. White’s experiments had an air of the barbaric and the downright cruel about them. In one, he kept the brain of one monkey alive in the stomach another, simply by the usurpation of blood flow.
In an interview with White’s neurophysiologist, Dr. Leo Massopust, the true horror of what they may have achieved become clear:
“I suspect that without his senses, he can think more quickly. What kind of thinking, I don’t know. I guess he’s primarily a memory, a repository for information stored when he had his flesh. He cannot develop further because he no longer has the nourishment of experience.”
This concept of the “nourishment of experience” provides a fascinating insight into the changing mind-set of these experiments. Before this, the only form of nourishment that was considered was the purely physiological – blood, oxygen and physical connections – but this is not enough to define a living mind. For something to truly be alive, this second form of nourishment, awareness of the self and of the world in which one exists, is just as important a resource.
The effects of removing this latter nourishment from healthy patients had been observed in isolation experiments undertaken at McGill University by Professor Donald Hebb. Healthy volunteers were isolated from environmental stimuli – they could in no way sense the world around them. Though Hebb had the intention of observing patients for 6 weeks, most barely lasted a few days. Starved of the nourishment of experience, the living head is lost almost as quickly as when its supplies of blood and tissue are no more.
But what of the final frontier? The transplantation of a healthy head onto an undamaged donor body? It would be Robert White who once again pushed the boundaries of medical science. In July 1971, he reported the successful grafting of the head of a monkey onto the shoulders of a donor. The processes he undertook were elegantly complex and involved the careful, coordinated severing of tissue in the neck and the connection of the donor circulation to the transplanted head. Finally, in an action that remains as brutal and as emphatic as at the beginning of this story, the neck was severed and the head officially had a new home.
Amazingly, the ‘cephalons’ showed an awareness of the world around them and the experiment appeared to have been a success.
White himself, speaking a few years before his death in 2010, was fully aware of the ethical concerns associated with such procedures, especially should they become more eligible in humans. Currently, cadavers are a crucial resource for medicine – nearly all organs can be harvested and used to cure patients whose bodies are failing them. Head transplants, or indeed body transplants, is the same as donating all the organs in a body to one patient, and denying others that desperately need them. Furthermore, given that spinal cord reattachment remains highly difficult, these patients would be quadriplegic.
Additionally, given the expense of such procedures, these transplants would only be available to the fabulously wealthy. Such inequality in the provision of life-saving healthcare would be a dangerous road to go down.
This piece began with a challenge to define death. Could these transplants complicate our ability to define death even further and might they represent a step too far in our pugnacious stand against ‘natural’ death? Mary Shelley described such concerns in Frankenstein, the titular doctor in which is often used as a literary equivalent of the physicians described here:
“No one can conceive the variety of feelings which bore me onwards, like a hurricane, in the first enthusiasm of success. Life and death appeared to me ideal bounds, which I should first break through, and pour a torrent of light into our dark world.”
And so we arrive to the end, or perhaps a new beginning, of our story. In June 2015, Italian neurosurgeon Sergio Canavero detailed plans to perform the first human head transplant at a conference of the American Academy of Neurological and Orthopaedic Surgeons. Canavero had a volunteer, he had a methodology and all he needs to see out his vision of completing such a transplant in just two years’ time is support and funding. His procedure, described in the video below, is remarkably similar to that used by Dr. White over 40 years ago and has been highly criticised by the scientific community. Concerns have been raised over whether a patient can be kept in a coma for this length of time without adverse effects, whether spinal cord re-attachment technology will work sufficiently and whether Canavero’s estimated “90% chance of success” is realistic.
The possibility of this procedure has also stimulated substantial philosophical argument. In particular, the same questions are asked – what does it mean to be dead, and indeed to be alive?
The philosopher Dererk Parfit has attempted to answer these questions in recent years. He posed the question, ‘What makes someone remain the same person over time?’ Why are we able to point ourselves out in a class photo decades old and essentially exist as the same person at different times? He put forward three main arguments; it was either something metaphysical, such something abstract like a soul, or something provided by a form of physical memory or provided by a psychological basis of our sense of self, in which the connectedness of our beliefs, desires and memories define who were are.
Parfit claimed in his 2012 work, ‘We are not human beings’ that natural intuition would suggest that the head clearly defines who we are. Despite patient A’s body remaining, they would now be defined as person B, if the head was present. Essentially, the psychological argument predominates over the somatic.
But it may not be that simple. The concept of memory remains almost uniquely abstract in the human physiology. The mind and the body appear to be inherently linked, and the consequences of their separation may not be fully understood. Just how much does our physical form define and stimulate our memory, and hence the interconnectedness of the characteristics that define us. Would losing our physical form impact the functioning of our mind – would we indeed still be the same person after such a procedure. The connection between the two can already be somewhat visualised in the ‘Ghost Limb Syndrome.’ Here, patients who have lost a limb experience sensations as if it were still connected, reaching for items with an absent arm, or reporting pain where no tissue exists.
The
response to these philosophical questions can be difficult to gauge but, as
ever, casting an eye to film can provide a good barometer of public opinion.
Transplantation and ‘artificial’ continuation of life has long been a subject
of the horror genre. Avoiding the easy comparisons to Frankenstein, head
transplantation has in particular been addressed in a number of films. 1962’s
‘The Brain That Wouldn’t Die’ tells the story of a girlfriend of a manic
surgeon whose brain is kept alive after a car accident, while he searches for
another body. In this literal exploration of the head in a jar scenario, the
woman becomes unable to cope with her new existence and asks another of the
surgeon’s experiments to free her. This film came with the rather partisan tagline, “It’s
madness, not science!”, just 9 years before Robert White would perform his
infamous experiments.
A Mexican film from the next year, ‘La Cabeza Viviente (The Living Head)’,
tells the story of archeologists that stumble upon the decapitated head of an
Aztec general, who reaps a terrible revenge. This film explores another common
trope used in the description of decapitation. In addition to the despair
described by the victim in ‘The Brain That Wouldn’t Die’, we are shown the
reversion of the decapitated head to its most basic, animalistic
characteristics – the layers of emotion and complexity that make up our unique
humanity have been stripped away; exactly the concerns that some hold over the
fate of a head transplant patient.
The story of the living head is a long and fascinating one that continues to develop to this day. The anatomists, physiologists, physicians and philosophers that have played major roles in this story have posed some of the defining questions in both medical science and in the strive to determine what makes us who we are. The concept of a head transplant has seen resistance from both a medical and a philosophical stand-point, but it would not be the first to overcome such criticism. The technological demands of hand and face transplantation saw these labelled as impossible procedures, and the unease over the effect of the metaphysical part of our humanity by heart transplantation captured the public imagination a mere 50 years ago. Sergio Canavero has caused a storm by his attempts to bring head transplants to humans, but he isn’t the first and certainly won’t be the last to add another chapter to the story of the living head and to our progress in understanding who we are.
