The year 2021 marks the quatercentenary of the birth of Thomas Willis (1621–75),Footnote ¹ English physician, Sedleian Professor, natural philosopher, Oxford virtuoso, noted neuroanatomist and author of fourteen treatises (1659–75). As a corpus, his writing successfully aimed to define understanding of mid-seventeenth-century medicine, and in turn became an instrument in the evolution of clinical knowledge. Only R.-T.-H. Laennec (1781–1826) has more entries than Willis in Ralph H. Major’s Classic Descriptions of Disease. Footnote ² Described as ‘the Harvey of the Brain’, Willis was the founder of clinical neuroscience; was one of the first to use, if not indeed to coin, the very term neurology and finally, would be remembered for his ‘circle’.

On this anniversary, an opportunity presents itself for an innovative, scholarly, multidisciplinary book to contextualise fully Willis’ work. This book was written over two decades by an eminent retired professor of adult neurology. Does it live up to the All Manner of Industry and Ingenuity of its title?

This book is very enjoyable to read and has considerable depth. It brings together a great deal of material and for that alone is a welcome addition to the published literature on Thomas Willis. It is richly illustrated with many documents that most Willisian scholars will not have previously seen. It taught this reviewer many new facts, not only about seventeenth-century publishing practices, but also about Willis ie. where Willis did his guard duty as part of the 600-strong University Legion (Magdalen College Grove), and surprisingly that in the Cerebri Anatome (1664), he never cites Versalius’ De Humani Corporis Fabrica (1543).

The bibliobiography section, a catalogue and not a descriptive bibliography of Willis’s publications, is very extensive and truly fascinating, but not part of a review on medical history. Suffice it to say that it shows in detail not only seventeenth-century publication practices, but also the breadth of Willis’ interests: from chemistry, the workings of the brain or the soul and Willis’ own successful attempt for a system of rational therapeutics. Eighty five of the 103 entries cited in the bibliography come from the author’s, Alistair Compston’s, own collection. In separate, later chapters, the author relates in detail the evolution of Willis’ ideas which is also fascinating as we read of Willis struggling to make sense of what he is observing. Comments made in William Osler’s famous 1916 talk on ‘Willis the anatomist’ about Willis’ writing on fermentation (that ‘Willis studied this mystery and made it still greater in the pages he devoted to it’) do strike a chord.Footnote ³ Willis’ treatises can be extremely repetitive and disordered, but are rich in metaphor.

This reviewer does not understand why, for a book which is part bibliography itself, inspite of extensive footnotes there is no bibliography specifically listing all sources that were used in its creation. It cites access to unpublished works by John Wing and Phillip Oldfield eg. which are unobtainable.

The author admits the biographical account is ‘without original research or identification of new archival material’ (p. 3), emphasising ‘no claim is made to having provided a comprehensive summary of the recent literature’ (p. 3). It is unclear what literature search strategy was used here. The author explains ‘even with filters, an Internet search on Thomas Willis [received] several million hits’ (which this reviewer does not dispute but neither sees as a valid argument). This reviewer found that a PubMed search using ‘Thomas Willis’ gave 155 results, some of which were found in the footnotes. The author acknowledges that ‘with few exceptions, recent scholarship on Thomas Willis and his times has not rigorously been included’ (p. 3). Similarly, ‘Authorities on book history will readily identify material that ought to have been mentioned’ (p. 3). Perhaps for such an expensive, long-planned and substantial book, the necessary professional experts could have been commissioned.

Readers of Willis have long been frustrated by seventeenth-century translations (often very wide of the original Latin), and with many omissions. These translations, and there being no move to correct systematic errors, mean that for Willis’ translated works, there are no perfect copies. It is noteworthy that one major treatise – Affectionum quæ dicuntur hystericæ et hypochondriacæ (1670) – has never been translated into English at all. It is a shame that Compston’s book largely restricts itself to seventeenth-century translations and the few new ones are not by Latinists. A Latinist would have commented that five terms Willis used to describe distinct grades of mental retardation – ‘stulti, stolidi, fatui, fungi and bardi’ – are derived from line 1 088 of Bacchide, by the Roman comic playwright Plautus (c. 254–184 BCE).

Concerning John Locke (1632–1704), there is no mention of the importance to Locke of Willis’ highly influential ideas, either of the Tabula Rasa or also of support for the learning disabled, both of which were transmitted through Locke’s writings.

Unfortunately, this book only partly interrogates the underlying principles that drove Willis within medical practice. The author cites Willis’ preface of his Treatise on Fevers (1659) with the ‘aim to adapt general Notions from particular events’. But Willis’ aim was far bolder. A 2002 Lancet paper by this reviewer is cited but not fully appreciated (as well as having a misspelt co-author).Footnote ⁴ This explains how a mother lost four infants through seizures and after a post mortem and interpretation, Willis’ devised treatment led to three surviving healthy children. Any currently practicing paediatrician knows that this is still highly unlikely within present twenty-first-century clinical practice. The diagnosis does not matter here, only that Willis’ intervention, at least in this case series, apparently worked. It is thus the first full realisation of the idea within clinical neuroscience that drives all medicine to this day ie. an intervention, based upon state-of-the-art medical knowledge, clinical observation and investigation up to and including post mortem (when being put all together) led to prevention of suffering, progressive disability and death. One particular curiosity of this intervention, a Fontanelle, is a now obsolete French term being defined in the Oxford English Dictionary as ‘An artificially created or naturally occurring opening in the skin through which pus or other body fluids can drain’Footnote ⁵ (It is not to be confused with the term ‘fontanelle’ currently used to describe an anatomical feature of the infant human skull). Why this term is significant is because the English Civil War denied Willis the opportunity to train abroad and there has always been a question mark about how much Willis’ practice may have been adversely affected by this, but the author does not discuss this. Yet here Willis is using a continental practice. Is this possibly due to the influence of his friend Sir William Petty (1623–87) or indicative of a deeper personal understanding by Willis of contemporary continental practice? This is just one case, as an illustrative example. What other examples of continental practice are buried within the original Latin text? We do not know. Why did the author not take this approach, taking the defining short segments of the original Latin texts, one for each speciality? There is surely much more to discover from within here.

Thomas Willis’ works are foundational within clinical neuroscience, psychology, psychiatry, epidemiology and endocrinology. Books beget books. This reviewer believes this could have been a golden opportunity for a more definitive book based upon completely new translations by Latinists, with interpretation from medical historians and input from appropriate current medical specialists and others. These foundational texts deserve nothing less. Nevertheless, this impressive book clears ground for a future challenge.