Sir William Gowers (1845-1915): a centenary celebration, with an examination of his comments on cognitive dysfunction

Abstract

marks the 100th anniversary of the death of Sir William Gowers (Figure), one of the towering figures of clinical neurology in the late 19th and early 20th centuries, who has rightly entered the pantheon of neurological greats. 1,2 A splendid recent biography has provided many insights into his life and career. 3 Gowers' neurological contributions are manifold. Most, if not all, neurologists will be familiar with Gowers' sign or manoeuvre observed in patients with proximal lower limb and trunk weakness as they attempt to rise from the ground, a sign also known as " climbing up oneself " or, in North America, as the " butt-first manoeuver " , most typically seen in boys with Duchenne muscular dystrophy, a disorder which Gowers knew as pseudohypertrophic muscular paralysis and on which he wrote a monograph. Those familiar with the anatomy of the spinal cord will know of Gowers' tract (ventral or anterior spinocerebellar tract). Gowers was a fecund and lucid writer, author of many publications, both papers (more than 300) and books (Box), which culminated in the Manual of Diseases of the Nervous System. This book has been variously described as " the greatest single-author comprehensive textbook of clinical neurology ever published " (Ref 3, p. 250) and as the " Bible of Neurology " , 4 and is perhaps Gowers' most enduring monument. Its two volumes first appeared in 1886 (" Diseases of the nerves and spinal cord ") and 1888 (" Diseases of the brain and cranial nerves. General and functional diseases of the nervous system "), with a second edition in 1892 (Volume 1) and 1893 (Volume 2). A third edition of volume 1 appeared in 1899, co-authored with Dr James Taylor, but although preparations for a third edition of volume 2 were made this was never published. Parts of a manuscript marked with Gowers' proposed corrections survive in the Queen Square archives (Ref 3, p. 149), with new information particularly relating to nystagmus and myasthenia. 4 Gowers' neurological interests were very broad, but perhaps particularly related to epilepsy, 5 syphilis (especially tabes and locomotor ataxy), movement disorders, including " paralysis agitans " (Parkinson's disease) and " scrivener's palsy " (writer's cramp), and migraine. The student of cognitive neurology is disappointed to learn from his biographers that " from a survey of all Gowers' publications one gains the impression that he was not particularly interested in higher cerebral …