Keywords Neurosciences - Neurology - Circle of Willis - Neuroanatomy
Palavras-chave Neurociências - Neurologia - Círculo Arterial do Cérebro - Neuroanatomia
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 Source: The Wellcome Collection. Thomas Willis (1621–1675). Licensed under a public
domain mark.
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
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 Source: The Wellcome Collection. Cerebri Anatome (1664). Licensed under a public
domain mark.
THOMAS WILIS AND THE BEGINNINGS OF NEUROLOGY
THOMAS WILIS 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 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 anatomo-clinical 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.
