Willis's Oxford casebook (1650–1652)

158 of methysergide in narcolepsy and the unestablished role of progesterone in sleep apnoea. Most of the clinical data on sleep disturbances in general practice, sleep apnoea syndromes and narcolepsy is factual and well presented and Bruyn gives an excellent brief review of sleep disturbances in neurological disease, although the account by Thi+baut (Rev. neurol., 1967, 116:491 546) of this subject remains outstanding. This book is altogether a useful though uneven teach-in on sleep disorders. Like most recent books on sleep it is spoilt by meaningless diagrams, the use of jargon and misuse of English. Perhaps the bed-time reading of the novels of Jane Austin should be obligatory for all sleep researchers. J.D. Parkes

Willis's OxJord Casebook (1650-1652), pages, 6 illustrations, Sandford

edited

Publications,

by Kenneth

Oxford,

Dewhurst,

xi + 199

1981, £ 1 2 . 0 0 .

Willis is generally known to the world as an anatomist, neurologist, and chemist, a lbunder-member of the Royal Society, and a successful London physician. The Casebook gives us a clear glimpse of his beginnings as a physician, and, of medical practice in the seventeenth Century. The manuscript of the Casebook has come down to us by a set of lucky chances. It was lent by Willis's grandson to Dr. Stephen Chase, and never returned. It was next heard of in a library in Wales, whence it was bought by a private collector, and eventually purchased by the Wellcome Trustees in 1961. There is no doubt about its authenticity, and it is of additional value because it was clearly not written for publication. The circumstances in which the notes were made are of interest. Willis's career in medicine was seriously interrupted by his service in the Royalist Army from 1644 to 1646, that is from the age of 23 to 25. On leaving the service he returned to Christ Church, and had qualified in medicine by the end of the year a very brief training. He then started practice by attending local fairs, on a horse which he shared with Richard Lydall, a future Warden of Merton. Here he learnt the truth of Sydenham's advice to the young Hans Sloane " ... you must go to the bedside, it is there alone that you can learn disease". At the same time Willis was studying chemistry and attending meetings of the Oxford Experimental Club. He was specially interested in the processes of fermentation. Associated with him in his studies were Ralph Bathurst, William Petty, Seth Ward, Jonathan Goddard, and other leading scientists of the day. By the age of 39 he was elected to the Sedleian Chair of Natural Philosophy. The Casebook describes 50 patients. With one exception, all were seen in towns and villages within a few miles of Oxford. The exception was a patient in Worcester, nearly 60 miles away. Only 6 were seen in Oxford itself, probably because Willis had no university appointment, and there was still political prejudice. In the reports the patients' symptoms are well described, but there was no physical examination beyond mention of the pulse and breathing, and any discharges from the bowels, bladder or reproductive tract. Willis attempted explanations of the diseases, what would nowadays be called the pathophysiology, but these are of necessity matters of humours, and highly speculative. The treatment is described in great detail. The case reports are well documented. Dr. Dewhurst has gone to great trouble to identify where possible the patients, their political backgrounds, addresses, occupations, their diagnoses and treatment. In these endeavours he has succeeded remarkably well. Willis was frank about prognosis. If he thought the illness likely to be fatal, he told the patient so and bade him farewell. The diseases seem to fall into the following g r o u p s - respiratory 14, digestive 7, psychiatric 7, infectious fevers 6, venereal and dermatological 6, orthopaedic 5, urinary 3, obstetrical 1, and rheumatic fever 1. The treatment was varied and vigorous. Robert Wyld was advised to use over 50 remedies, including bee-stings, mercury, antimony, oil of scorpions, powdered cherry stones, asses' milk, pig's grease, spirit of billy goat's blood, and a plaster of warm ox dung. Do not let the modern reader sneer. Three hundred years hence present day medication will be viewed with amused contempt. The case reports are supplemented by chapters on the chronology of Willis's career, biographical details, his scientific work with the Oxford Experimental Club, his early medical practice, summary and conclusions. Two other Casebooks are known to exist, but are not likely to be discovered. In short, this is a very interesting and well documented book. A. Cooke