Thomas Willis (1621-75) lived through a period of political and religious turmoil that also saw the birth of the scientific revolution in Britain. He is remembered by diabetologists because he rediscovered that the urine of those who suffered from it tasted of honey, and he accordingly referred to the condition as "diabetes mellitus", or "honey diabetes". He noted that diabetes had apparently been rare in antiquity, and considered that "in our age given over to good fellowship and guzzling down of unallayed wine, we meet with examples enough, I may say daily, of this disease". He also thought that melancholy brought on the condition, anticipating the modern association with depression. Diabetes was however no more than a footnote to a career in which he made many discoveries and helped to lay the foundations of neuroscience and to establish the chemical basis of bodily functions.
Willis lived in tempestuous times. The son of a Wiltshire farmer, he took his first degree from Christ Church college, Oxford, in 1637, and enlisted on the royalist side in the English Civil War in 1643. He witnessed the birth of the scientific revolution in the UK, and worked closely with Christopher Wren, an anatomist now remembered as the architect of London following the great fire, the philosopher John Locke, who also trained as a doctor, Robert Boyle the chemist, and other members of the talented group that founded the Royal Society.
He is chiefly remembered for his rationalist approach to the human brain, as celebrated in Soul Made Flesh by Carl Zimmer. He set out to “unlock the secret places of man’s mind”, and thus “addicted myself to the opening of heads”. Before his time neuroanatomists including Vesalius had made many errors in depicting the brain, chiefly because of its floppy consistency. The brain easily loses its shape when sliced, and rapidly turns putrid. With Christopher Wren, Willis devised an early means of “fixing” the brain, allowing its anatomy to be studied more effectively.
As was then common across Europe, his dissections were performed upon condemned criminals, hastily removed from the place of execution to a private house where the procedure was carried out. This led to notoriety on one occasion when a housemaid called Anne Green had an unwanted baby, born prematurely, and attempted to hide the body. She was convicted of murder and hanged in the Cattle Yard at Oxford in 1650. Hanging at that time caused death by suffocation, not by breaking the neck, and onlookers tugged at her legs to hasten her demise. When she was cut down after being suspended for half an hour the body was rushed away for dissection but, to the dismay of all concerned, she attempted to take a breath. Willis and others resuscitated her and she eventually recovered her speech and (after 2 weeks) her memory. Since you cannot be hanged twice for the same offence by English law, she lived on for another 15 years, had three children, and kept the famous coffin by her as a memento.
The Circle of WillisIn his Cerebri Anatome, cui accessit Nervorum descriptio et usus (1664; “Anatomy of the Brain, with a Description of the Nerves and Their Function”), the most complete and accurate account of the nervous system to that time, he described the ring of arteries at the base of the brain (the circle of Willis) for which he is known to all medical students. He was not the first to describe it, but took the credit, which is how medical reputations are made. He was the first to describe the 11th cranial nerve, the Accessory, and the first to list the cranial nerves by number.
His more important contribution was towards a materialist conception of the workings of the human body. He proposed that the brain and body operated, not by the action of animal spirits, but on chemical principles. More specifically, he was fascinated by the process of fermentation, which appeared to give life to inanimate matter: “We are not only born and nourished by means of ferments but we also die” he wrote, “every disease acts its tragedies by the strength of some ferment”. Two centuries were to pass before the first enzymes (literally “in yeast”) were identified.
Willis was one of the iatrochemists (medical chemists) of the school of Paracelsus, and his last book (1674-5) was called Rational Therapeutics, expressing an aim towards which medicine still aspires. His description of the sweet tasting urine of diabetes appears in Section IV, Chapter 3 of this work.
A Taste of Honey
Diabetes, as can be seen, was a mere footnote to Willis’ life. He rediscovered that the urine tasted sweet (previously described by Avicenna many years before), and was the first to refer to condition as “diabetes mellitus” (literally “copious honey flavoured urine”), but did not appreciate that this was because it contained sugar. He noted that it had not been mentioned by some classical authors, and deduced from this that it had been rare in antiquity. He associated diabetes with depression (“diabetes is caused by melancholy”), an observation that was only rediscovered three centuries later.
Willis was a short man who spoke with a stammer and had hair described as “like a dark red pigge”. He married Mary Fell, the daughter of the former Dean of Christ Church, in 1657; 6 of their 8 children died in childhood. When Charles II became king at the Restoration in 1660, Willis (then 39) became a royalist hero, and was rewarded with the position of Sedleian Professor of Natural Philosophy at Oxford, which he held until his death in 1675. He caused consternation when his lectures, which were expected to consist in readings from Galen and other authorities, actually proposed new ideas. He moved to London in 1666-7 and established a lucrative medical practice. He died of pleurisy and is buried in Westminster Abbey. His gravestone, replaced in 1961, repeats the original inscription (translated from the Latin):
"Mary, most beloved wife of Thomas Willis Doctor in Physick and daughter of Samuel Fell, D.D. and Dean of Christ Church in Oxford, valuable for piety, prudence and sweetness of manners, of all, but chiefly of her husband. She died loved and lamented on the vigil of All Saints 1670 and is buried here, expecting the eternal daybreak of that festival. In the same grave was buried their daughter Katherine, on the day after Michaelmas 1667. Here also lies the above mentioned Thomas Willis, most famous doctor of medicine, who died on the 11 November 1675 aged 54".
Nathaniel Williams, a poet of the time eulogized the departed physician as follows:
"The unactive carcass thou hadst preyed upon/ And stripped it to a skeleton,/ But now alas! The art is gone,/ And now on thee/ The crawling worms experience their anatomy"
There appears to be no definitive scientific biography of this fascinating man. Soul Made Flesh by Carl Zimmer provides an inspiring reconstruction of his life and times, but only mentions diabetes once. The historical novel An Instance of the Fingerpost by Iain Pears gives a vivid picture of C17 Oxford and the resurrection of Anne Green. There are numerous entries about Thomas Willis on the web, many of which are remarkable for the inaccuracies they contain. One credits Willis with describing diabetes four years after his death.