Thomas Willis’ legacy on the 400^th anniversary of his birth

Abstract

To celebrate the 400^th anniversary of the birth of Thomas Willis, his main contributions to the development of neurosciences, in particular neurology, are presented. Willis coined the term neurology and contributed significantly to the field of neuroanatomy, with the description of the arterial circle—located at the base of the brain—, which bears his name. He also described the striatum and cranial nerves. Furthermore, as a clinical neurologist, Willis participated in the description of various diseases, including myasthenia gravis and restless legs syndrome.

INTRODUCTION

The year 2021 marked 4 centuries since the birth of Thomas Willis (1621-1675), a polymath and eminent British neuroscientist.¹ Among his numerous contributions to neurology, particularly in neuroanatomy, the discovery of the arterial circle located at the base of the skull, which bears his name— the circle of Willis—stands out.^{1, 2, 3}

However, several other contributions by Willis in the field of clinical neurology are noteworthy.^{1, 2, 3} This study reviews Thomas Willis’ main contributions to neurology and discusses his legacy.

SHORT BIOGRAPHY

Thomas Willis (►Figure 1) was born in Great Bedwyn, Wiltshire, United Kingdom, died in London, and was buried in the Westminster Abbey.^{1, 2, 3, 4, 5} He enrolled at the University of Oxford in 1637, initially studying at Christ Church College and obtaining the degree of Bachelor of Arts (Chemistry) in 1639 and Master of Arts (Chemistry) in 1642.

Figure 1. Thomas Willis (1621–1675). Licensed under a public domain mark. Source: The Wellcome Collection.

That year, Willis began his medical studies, but his education was interrupted after the English civil war started and Oxford was turned into a garrison town. He sided with the royalists, and for his loyalty was granted the degree of Bachelor of Medicine in 1646, despite not having a traditional medical education (he only had 6 months of formal medical education).¹ In 1660, he received the title of Doctor of Medicine and Sedleian Professor of Natural Philosophy at Oxford (1660-1675). He was elected an Honorary Fellow of the Royal College of Physicians of London in 1664 and became a fellow of the Royal Society of London 3 years later.^{1, 2, 3, 4, 5}

Initially dedicated to the study of neuroanatomy, Willis later developed a career as a clinician, when he expressed interest in the diseases of the nervous system. In Oxford, he started his practice at The Angel on Oxford High Street, and later in London, becoming a prestigious physician with a widespread reputation, often considered “the most famous doctor in Europe”^2,3.

THOMAS WILLIS AND NEUROANATOMY

Recognized as one of the most important neuroanatomists, Thomas Willis conducted several studies on the anatomy, physiology, and pathology of the nervous system. Most of his original publications were written in Latin and later translated into English.^{1, 2, 3, 4, 5, 6, 7}

His contributions to the anatomy of the central and peripheral nervous systems were numerous. In addition to the famous circle of Willis, he described several structures of the brain, such as the striatum, the internal capsule, the cerebellar peduncles, the anterior commissure, the claustrum, the nucleus inferior olivary, the thalamus, pyramids, and various cranial and peripheral nerves, devising a new classification of the cranial nerves.^{1, 2, 3, 4, 5, 6, 7, 8, 9, 10}

He presented these discoveries in his magnum opus, the book Cerebri Anatome (►Figure 2), containing 29 chapters and 29 illustrative figures. Published in 1664, this manuscript became known worldwide. For this book, Willis received important help from his closest collaborators, such as Sir Christopher Wren (1632-1723), Sir Thomas Millington (1628-1703), and especially the intense collaboration of Richard Lower (1631-1691).^{1, 2, 3,5,9,10} Of the seven books published by Willis, the fifth book, entitled De Anima Brutorum, is a landmark in the field of comparative neuroanatomy.^{1, 2, 3,5,9,10}

Figure 2. Cerebri Anatome (1664). Licensed under a public domain mark. Source: The Wellcome Collection.

THOMAS WILLIS AND THE BEGINNINGS OF NEUROLOGY

Willis’ habit of taking detailed histories combined with astute clinical observations and postmortem studies has left a body of work that still provokes thought and debate.¹

His many contributions to clinical neurology include articles on headache, epilepsy (presenting one of the first descriptions of temporal lobe epilepsy), stroke, paralysis of the insane, narcolepsy, intellectual disability, and hysteria.^1,5

The initial description of myasthenia gravis, in 1672, in a female patient with dysarthria/anarthria, defined by him as “seedlings like a fish” is paramount,^{1, 2, 3,5,9, 10, 11} and Willis established the clinical picture of symptom fluctuation and fatigability.¹¹

In 1672, Willis presented the first description of restless legs syndrome. This condition—later studied and refined by Karl-Axel Ekbom (1907-1945)—is currently named Willis-Ekbom syndrome ^{1, 2, 3,5,9,10,12, 13, 14}

In the field of cognition, Willis discussed the concept of the body-brain-soul relationship and the differentiation of these functions between humans and animals. In this area, his contribution is opposed to that of René Descartes (1596-1650), his contemporary, who launched his work entitled Traité de l'homme, creating a dualist theory of body and mind.^{1, 2, 3,5,10,15,16} Willis is regarded as the first contributor to the field to propose that the higher cognitive functions of the human brain stem from the convolutions of the cerebral cortex ^{1, 2, 3,5,15,16}

THOMAS WILLIS AND THE FOUNDATION OF NEUROLOGY

Thomas Willis coined the term neurology to designate the doctrine (or teaching) of the nerves.^{1, 2, 3, 4, 5,9,10} There is a consensus that Willis was the leader of the first multidisciplinary team in the field of neurological science.^{1, 2, 3,5,10}

As a result of Willis’ expressive contributions to the development of neurosciences, both in basic science and clinical neurology, several authors, including Feindel, consider Willis the founder of neurology. Likewise, Feindel defined Oxford as the birthplace of both neurology and neurosciences.³

Nevertheless, John Hughlings Jackson (1835–1911) is considered the father of English neurology. Among the other paragons of British neurology, we should mention William Richard Gowers (1845–1915), David Ferrier (1843–1928), Kinnier Wilson (1878–1937), Sir Gordon Holmes (1876–1965), and Sir Charles Sherrington (1857–1952).^17,18

Due to its great importance in the history of medicine, Willis’ input to neurology could be compared with the magnanimous contributions of Charcot, the most celebrated Professor of Neurology of the 19th century, considered the father of modern neurology.^19,20 Jean-Martin Charcot’s (1825–1893) works also range widely, including the fields of pathology (with particular emphasis on his anatomoclinical method), neurology (clinical descriptions of amyotrophic lateral sclerosis, multiple sclerosis, Parkinson disease, and locomotor ataxia), internal medicine (descriptions of gout, diabetes mellitus, cholangitis, and peripheral arterial disease) and psychiatry (with a particular interest in the subject of hysteria).^19,20

In conclusion, Thomas Willis, four centuries after his birth, must be remembered as a great neuroanatomist and a leading clinical neurologist. His important contributions to neuroscience earned him a rightful place in the pantheon of the founders of neurology.