THOMAS WILLIS (1621-1675)
March 12, 1974
Joan said you have to talk so that she could have this. This is all just a film and stuff. I thought you might enjoy seeing this book. I think it is a very unusual example of the facsimile reproduction. This is actually a facsimile that involves four different books. Four different original copies. Four perfect copies, actually every perfect copy has a few blemishes and this is a composite of four different works; one is from the University Library at Yale, one from the Guild, and one from the National Library, and one from Oxfords. As far as I am aware, I think this book is complete and is perfect. You might enjoy browsing through it. I put this mark at the actual illustration that didn’t come out very well.
Willis was quite an unusual…one of the whole group of quite an unusual 17th century men. He was born in 1621, lived to the age of 54, and it has now been 310 years since the publication of his book, which is the book you have here, that you are looking at. This is a man I think of interest both for his own accomplishments and with respect to the caliber of the associates that he was able to induce to work with him, either his pupils or as co-workers in the production of this book. I’ll talk about some of them a little bit later. You should know that Willis coined and was the first to use the term neurology. He described and numbered the cranial nerves in such an elegant fashion for his time, that his description in numbering the cranial nerves was used for a period of almost 200 years and was the terminology that overturned the Galenic nomenclature … that’s a hard word to pronounce. He demonstrated not only the anatomy of the circulation of the brain, but demonstrated the Physiological importance of what he showed anatomically. This is something that hasn’t been widely appreciated. This is probably why he has been so well recognized as he not only showed the anastomized circle at the base of the brain but showed very clearly in his writing, and I’ll point this out, the part that he discusses that is actually reproduced in back part of the facsimile that you have in front of you, discusses the physiological importance of what he showed anatomically. This is something that hasn’t been widely appreciated. This is probably why he has been so well recognized as he not only showed the anastomized circle at the base of the brain but showed very clearly in his writing, and I’ll point this out, the part that he discusses that is actually reproduced in back part of the facsimile that you have in front of you, discusses the physiological importance of this collateral circulation, something that is unrecognized. He was a founding member of the Royal Society of London and as I said, had a wide number of unusual friends. His own personal history is not particularly striking. I don’t think it would lead you to expect or suspect that he would be as productive as he turned out to be. He was born in a small town about seventy miles west of London. There’s a… On this little itinerary is Willis’ life, on the third page… second page is the facsimile reproduction of the first page of the book. The next one is kind of a ghostly like picture of Willis himself, and then the next page is a chronology of Thomas Willis. You can follow along with me a little bit there, to say he was born in a small town about seventy miles west of London. His family moved to North Hixie, across the Thames, from Oxford where he attended as a school boy, a private grammer school and apparently he was suppose to be very generous at a very early age and his family had to watch him very closely… that he didn’t give his lunch… his lunch away to people along the way to school, so the tale goes, either insisted that he eat his meals before he left the school and after he came back from school to make sure he actually ate the meals himself.
His mother died when he was ten years old. He went on to Oxford and just after having obtained both his Bachelor of Arts and Master of Arts from that institution, at the age of 21 his father died. Now his father’s profession has never clearly stated in anything I’ve seen. He was apparently a man of substance who managed an inheritance and without a specific occupation. After his father died Thomas Willis spent a short period of time in the King’s Forces during the Civil War and then returned to obtain his Bachelor of Medicine in 1646 and he began the active practice of medicine in Oxford at that time. He stayed in Oxford for approximately twenty years. It was during this interval that he wrote his book. In 1657 he married Mary Thelb, sister of Dr. John Thelb who was dean of Christ Church and Vice Chancellor of Oxford and you all have heard of Dr. Thelb, this little quotation that I have on the next page… Dr. Thelb and Dr. Tom Brown as well achieved immortality. Dr. Thelb was supposed to be quite a disciplinarian. Young Tom Brown was in process of being expelled from Oxford. Dr. Thelb told Tom Brown that if he could translate this doctrine accurately, that he would be permitted to stay in school and the… below has brought Tom Brown translated the way he did it, and it has stayed with us ever since. He not only translated it, he managed to work Dr. Thelb’s name into the translation in rather a nice way. This is the Dr. Thelb, who is brother of Thomas Willis. Now, I mentioned that he had a group of unusual pupils and associates. He had pupils, Robert Hook, John Locke… He had as an associate, who worked for him as an assistant reproduction of this book, Christopher Wren. He did most of the illustrations for the book. Richard Lowell was his prosector and did most of the dissection, the actual dissection, that is depicted. Richard Lowell and Edmund King together, were the first to carry out a blood transfusion in a human. Richard Lowell also became famous in his own right, became well known I should say, from his work in Cardiac Physiology. Willis had a formidable range of topics, which he wrote. He wrote on fermentation, he wrote on fevers, he describes and named puerperal fever, he described, among others, the description of the sweetness of urine in Chamber pot drosy, as diabetes mellitus was known at that time. He wrote on the of blood, muscular motion, convulsive disorders, scurvy, and he wrote on comparative anatomy of over a dozen different species, one of which was the first detailed anatomy of the edible oyster which… I don’t know whether that indicated a like or dislike. He was an inventive man, he had a very active medical practice. He describes in one of his writings a certain man of Oxford who vomited each time he ate. Dr. Willis designed a slender rod of whale bone with a small button of sponge fixed to one end. This man subsequently survived in good health by eating a modest meal and taking this probing and inserting it out of his esophagus, and opening his esophagal stricture. This man lived for 16 years by the time Dr. Willis reported this and was in good health at that time. A slender rod of whale bone with a sponge affixed. I can’t pronounce the archaic S but affixed to the end of the whale’s own rod he’d insert it down. The interesting thing was he didn’t dilate his esophagus before eating, he apparently took nourishment and then with his esophagus partly full, pushed this thing down into his stomach. I don’t know how many times he had to replace the sponges… with a small button of sponge on the end of it.
People who do this for themselves apparently get pain… Modern day and age, people don’t like too much trouble, dilating esophagal stricture… people will pass there, these things down and pull them back and forth until the stricture dilates. So Charles Simons and Harry Cushing credited Willis as being the first to present the concept of Circulating Hormones from the pituitary and gonads. Something else as I mentioned, his classification of cranial nerves lasted for almost 200 years. In recent years he is gained some comments in Psychiatry, some recognition I should say in Psychiatry. He wrote a fair bit on the nervous disorders, and he swam very much upstream against the current thought of the time. He described hysteria not as a disorder of the uterus but as a nervous infection of the brain. This was a new concept and a very controversial on at the time of his writing. Now let’s see, this next page after Dr. Thelb’s quotations. This is Richard Lowell and this is the man who did most of the dissections… he was the prosector for most of what Dr. Willis wrote about. He was a Cornishman… he was 10 years junior to Willis. He later, as I said earlier, established a reputation in his own right as an experimental physiologist. His book recorded on Cardiac Physiology explained Pulmonary Physiology really. In this, he explained, apparently, for the first time, the actual reason for the difference in color between arterial and venous blood which was described in the pulmonary circulation of the change of color. He gave an accurate estimation of the velocity and volume of the blood. He, along with Edmund King, was the first to carry out a blood transfusion in the human.
Dr. Harkness: Was that when he gave the blood of a sheep to a man, or was that…human blood
Dr. Garretson: I believe that…well I don’t know. It’s interesting, there’s an interlocking business here, with this blood transfusion bit. This was done with a quill and this quill technique apparently was developed by Christopher Wren. It was the next man, the next page, Christopher Wren, who was born in 1632, and was again a man of multiple talents, at the age of 31 he was holding a second chair of astronomy, this one at Oxford… He moved there from Gretchen, to the civilian chair at Oxford. He showed very early on a flare for drawing and mechanical design. He had designed a model showing the function of the extra optic muscles of the eye, the model of the eye with the little and muscles and so forth. He was a skillful mathmetician and he was swayed by Isaac Newton at that time as one of the three best geometrists of the time, and he designed, at about the same time he was doing the illustrations for this book, he designed at the Sheldonian Theatre at Oxford, and actually, this was the point of change in his career. He, from this point on, became known as an architect and dropped all of his previous activities. The illustrations in this book are the only drawings or sketches by Christopher Wren that were published in his lifetime. Now I mentioned that he had developed, in his interests with Willis, quills for the injection of fluids into the vessels of animals. He had been particularly interested and studied the effects of intravenous injection of ale and opium in animals, and had written a very detailed description of how to make these quills and how to affix them into vessels and it was this technique that apparently Lowell and Edmund King adopted for the blood transfusion. They apparently adopted this from Christopher Wren. Also these quills were used apparently in part of the technique used by Lowell and Willis in developing the ejected colored dyes and inks into the cerebral vessels to map out the collateral circulation. Again, they used these quills rather extensively in developing this anatomical demonstration. Now there’s… about this time there was quite a bit of activity in terms of anatomical dissection. The next group of pictures here show where they stood with Versalius in 1543. Now this is the view of the basic base of the brain in Versalius’ book. Although, when, you glance at it superficially, it looks quite impressive, the more closely you look at it, the more ridiculous it gets, and the more meaningless it is. There’s actually almost no correct anatomical detail in that drawing, other than the optic nerves and eyes. Virtually everything else is wrong. You can’t see a cerebellum hemisphere but when you get up above the Medulla Oblongata there it becomes a mess. This was because almost certainly that the brain liquefies so rapidly that it’s very difficult to get good anatomical dissection of the brain especially back in that day and age. In his quill business, Sir Christopher Wren again comes to importance and apparently they were able to do some primitive fixation of the brain in place before removal of the brain, using Christopher Wren’s technique. So this may be one of the reasons that Willis was able to demonstrate more accurately. Now Dr. Lingus, in 1651, drew a partial circle that’s incomplete… there’s two versions of this, one in 1651, and then one that was modified again by Dr. Lingus in a publication in 1684. There’s a complete circle in the bottom illustration they’re turned up… they’re mirror images of each other, the two illustrations, but then the bottom illustration denotes there are no posterior cerebral arteries, but they did put in an accurate communicating artery that was not present on the top illustration. Then Phesearius in 1645, the next illustration over, came almost all the way in showing, in anatomical sense, the existence of a complete collateral circulation. It’s probable that Phesearius realized that this may have been an anatomical variance and he may well have realized that a compete anastomized circulation did exist in some patients. The left posterior communicating artery was missing in the illustration. That’s in 1645. He did not however appreciate the anatomical meaning. Now the next one over in 1664 is the plate by Christopher Wren. You can see it in the book that’s being passed around. I regret that the Xerox machine somehow didn’t seem to bring this out, but there is a complete circle of Willis and a complete drawing of all the major vessels, middle cerebral, anterior cerebral and post cerebral. But what was more important actually was the fact that the physiological significance of this was recognized by Willis. The detail around the base of the brain and the cranial nerves… this is, one of the most… this, I believe is the most accurate depiction of the cranial nerves at that time, that exists. As I say this depiction and the one that I’ll talk about a little bit later is, as we cut through this, did persist for almost 200 years. This next page where it says the first figure… there’s a listing for that drawing by Wren. Now the next two pages are a copy of his description of the Circle of Willis and of its physiological importance. On page 73, which is the second page, he goes into detail about it, as to the various benefits as to having this collateral circulation. As he points out, should one of the carotids… this is about halfway down the paragraph… first, lest it should happen to one of the carotids being obstructed, the other might supply provision of both, and he goes on in some detail about this and comes back to this in other parts of his book. Third… description of the possibility of one carotid taking over for another obstructed artery and actually in his clinical writings, he describes several patients who had one or more obstructed vessels. It was very interesting. If you go on to the next page, I thought you might be interested in what some thought was, 310 years ago, about some other aspects of the intra-cranial anatomy. This page here runs uses of the pineal gland and the choroidal infolding. And also the orbicular prominences. Now the orbicular prominences which are commonly called eggs and testes and other parts… these two pages that you have here, there’s a clear description of the role of the choroids plexus in the formation of the spinal fluid and the circulation of the spinal cord. I think this is a rather remarkable thing considering the type of anatomical specimen that they had to work with at the time… the fact that this was extremely difficult to work out in a usual sense in that day and age. Now the oblong marrow which you see mentioned in there, on the front page is a literal translation of the Bella Oblongata… the original treatise… was in Latin. Now this is a Portuguese translation of it. It’s really the only translation… and some words he translated literally and others he left in their Latinized form. This does result in some rather curious terms. But some of the things that he translated into English, we have left in Latin and some of the things we have left in Latin are now in English. Now, the final two pages here, show of young Christopher Wren’s drawings showing the base of the skull, and showing the cranial nerves and the page following shows the naming of the cranial nerves according to Thomas Willis. And I think you may really accept that as an excellent drawing for any medical student today. The trends of showing all of the cranial nerves… the errors that were made it you’d like to call them errors, it was the differences in naming between them and now, is that Willis numbered the nerves by the orifices. If three cranial nerves went out of one orifice, they would all just be one number, although he clearly recognized that there were several components to it. You notice down here the seventh and eighth cranial nerves are shown in quite detail. And yet held this one cranial nerve. He recognized that there were several divisions, but he called it by the exit pathways. So that he wound up with ten cranial nerves. .