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Lucy Wills, MA (Cantab), LRCP, MB BS (Lond) (10 May 1888 – 26 April 1964) was a leading English haematologist. She conducted seminal work in India in the late 1920s and early 1930s on macrocytic anaemia of pregnancy. Her observations led to her discovery of a nutritional factor in yeast which both prevents and cures this disorder. Macrocytic anaemia is characterised by enlarged red blood cells and is life-threatening. Poor pregnant women in the tropics with inadequate diets are particularly susceptible. The nutritional factor identified by Lucy Wills (the ‘Wills Factor’) was subsequently shown to be folate, the naturally occurring form of folic acid.
Lucy Wills was born on 10 May 1888 in Sutton Coldfield near Birmingham. Her paternal great-grandfather, William Wills, had been a prosperous Birmingham attorney from a nonconformist Unitarian family. His son, her grandfather, had bought an edge-tool business in Nechells, AW Wills & Son, which manufactured such things as scythes and sickles and which her father continued to run. The family was comfortably off.
Lucy Wills’s father, William Leonard Wills (1858–1911), was a science graduate of Owens College Manchester. Her mother, Gertrude Annie Wills née Johnston (1855–1939), was the only daughter (with six brothers) of a well-known Birmingham doctor, Dr James Johnston. The family had a strong interest in scientific matters. Lucy Wills’s great-grandfather, William Wills, had been involved with the British Association for the Advancement of Science and wrote papers on meteorology and other scientific observations. Lucy Wills’s father was particularly interested in botany, zoology, geology and natural sciences generally, as well as in the developing science of photography. Her brother, Leonard Johnston Wills carried this interest in geology and natural sciences into his own career with great success.
Lucy Wills was brought up in the country near Birmingham, initially in Sutton Coldfield, and then from 1892 in Barnt Green to the south of Birmingham. She went at first to a local school called Tanglewood kept by a Miss Ashe, ex-governess to the Chamberlain family of Birmingham.
Cheltenham Ladies’ College
English girls had few opportunities for education and entry into the professions (particularly medicine) until towards the end of the nineteenth century. Lucy Wills was of a generation which benefited from the work of various radical Victorian reformers, and the three educational establishments to which she went, The Cheltenham Ladies' College, Newnham College Cambridge, and the London School of Medicine for Women, typified their achievements. They also share an elegant, confident, late Victorian architecture.
Lucy Wills went in September 1903 to The Cheltenham Ladies' College, which had been founded in 1854 by Dorothea Beale, a prominent Victorian pioneer of reform of women's education. Miss Beale was a supporter of women's suffrage, having been one of the signatories of John Stuart Mill's 1867 petition to Parliament to give women the vote, and was Principal of the College from 1858 until her death in 1906. Lucy Wills's elder sister Edith was in the same house, Glenlee, two years ahead of her. Glenlee was then more expensive and socially exclusive than the other houses.
Miss Beale created a school which, while being socially and intellectually privileged, was radical and progressive. It provided girls with a high standard of academic education in which there was a strong emphasis on science and mathematics. It encouraged independence, public-spiritedness, and ambition in professional and academic life. Marion Russell Watson, a protégée of Ruskin's, attended the school and Ruskin donated to it a number of important and valuable books and manuscripts.
Lucy Wills's examination record was good. She passed the 'Oxford Local Senior, Division I' in the autumn of 1905; the 'University of London, Matriculation, Division II' in the autumn of 1906; and 'Part I, Class III and Paley, exempt from Part II and additional subjects by matriculation (London), Newnham entrance' in 1907.
Newnham College Cambridge
In September 1907, Lucy Wills went up to Newnham College Cambridge. Newnham was the second of the Cambridge women’s colleges. Girton had been established in 1869, Newnham in 1872, mainly because of the pioneering work of Henry Sidgwick, then a Fellow of Trinity. He died in 1890, but his widow Eleanor was Principal of the College when Lucy Wills arrived. Eleanor’s brother Arthur Balfour had been Prime Minister from 1902 to 1905 and sometimes visited the college when Lucy Wills was there.
Newnham’s first Principal, Anne Clough, and the Sidgwicks all shared a commitment to the higher education of women in a college with no particular religious affiliation.
Newnham and its founders had to struggle for recognition from the Cambridge University authorities. The University allowed women (then from the two colleges of Girton and Newnham) to sit its examinations, but refused to grant them full degrees until 1948.
Lucy Wills finished her course in 1911 and obtained a Class 2 in Part 1 of the Natural Sciences Tripos in 1910 and Class 2 in Part 2 (Botany) in 1911. Because she could not receive a degree, she received a certificate that she had taken and been successful in the Tripos exams. In 1928 she received the 'titular degree' of MA Cantab, a stage between certificates and full degrees which operated from 1921 to 1948.
1911 to 1914
In February 1911, Lucy Wills’s father died at the early age of 52. She had been very close to him and his unexpected death probably affected her final exam results that summer. In 1913 her elder sister Edith died at the age of 26.
Later that year, Lucy Wills and her mother travelled by sea to Ceylon, now Sri Lanka, where they visited relatives and friends. In 1914 she and her younger brother Gordon travelled by sea to South Africa. A friend from Newnham, Margaret (Margot) Hume, was lecturing in botany at the South African College, then part of the University of the Cape of Good Hope. She and Lucy Wills were both interested in Sigmund Freud’s theories. When the war started in August 1914, Gordon enlisted in the Transvaal Scottish Regiment. Lucy Wills spent some weeks doing voluntary nursing in a hospital in Cape Town, before she and Margot Hume returned by sea to England, arriving in Plymouth in December.
London (Royal Free Hospital) School of Medicine for Women
In January 1915, Lucy Wills enrolled as a medical student at the London (Royal Free Hospital) School of Medicine for Women ('The School'), then already part of London University. The School had been established in 1874 as the London School of Medicine for Women and was the first medical school in Britain to train women. The foundation of the School was due to Sophia Jex-Blake and her supporters. These included Charles Darwin, Lord Shaftesbury, and Thomas Huxley together with a number of pioneering women physicians, among them the first woman in England to obtain a medical qualification, Elizabeth Garrett Anderson. In 1877 the Royal Free Hospital agreed to allow the School students access to the wards and out-patient departments, and in 1898 the two institutions joined forces with the School changing its name to the London (Royal Free Hospital) School of Medicine for Women. It became part of London University. It was in Hunter Street, next to Brunswick Square in Bloomsbury, while the Royal Free Hospital was in Gray’s Inn Road, about a quarter of a mile away.
The School had strong links with India, and had a number of Indian women students, including Dr Jensha Jhirad, the first Indian woman to qualify with a degree in obstetrics and gynaecology in 1919, the year before Lucy Wills graduated.
Lucy Wills became a legally qualified medical practitioner with the qualification of Licentiate of the Royal College of Physicians London awarded in May 1920 (LRCP Lond 1920), and the London University degrees of Medical Bachelor and Bachelor of Science awarded in December 1920 (MB BS U Lond). She was then 32.
1920 to 1928
On qualifying, Lucy Wills decided not to practise as a physician, but to research and teach in the Department of Chemical Pathology at the Royal Free. There she worked with Christine Pillman (later Mrs Ulysses Williams) who had been at Girton at the same time Lucy was at Newnham, on metabolic studies of pregnancy.
In 1928 Lucy Wills began her seminal research work in India on macrocytic anaemia in pregnancy. This was prevalent in a severe form among poorer women with dietary deficiencies, particularly those in the textile industry. Dr Margaret Balfour of the Indian Medical Service had asked her to join the Maternal Mortality Inquiry sponsored by the Indian Research Fund Association at the Haffkine Institute in Bombay (now Mumbai). The Lady Tata Foundation also provided financial support.
Lucy Wills was in India between 1928 and 1933, mostly based at the Haffkine Institute in Bombay. In the summer of 1929, from April to October, she moved her work to the Pasteur Institute of India in Coonoor (where Sir Robert McCarrison was Director of Nutrition Research), and in early 1931 she was working at the Caste and Gosha Hospital in Madras. In each of the summers of 1930, 1931 and 1932 she returned to England for a few months and continued her work in the pathology laboratories at the Royal Free. She was back at the Royal Free full-time in 1933, but there was another ten-week working visit to the Haffkine Institute from November 1937 to early January 1938. On this occasion, and for the first time, Lucy Wills travelled by air to Karachi and onwards by sea.
The air journey in October 1937 was in an Imperial Airways flying boat, on their recently inaugurated route carrying mail and some passengers. The flying boat was a Short ‘C’ Class Empire flying boat, the Calypso, G AEUA. The route started at Southampton and involved landings on water for refuelling at Marseilles, Bracciano near Rome, Brindisi, Athens, Alexandria, Tiberias, Habbaniyah to the west of Baghdad, Basra, Bahrein, Dubai, Gwador and Karachi, with overnight stops at Rome, Alexandria, Basra and Sharjah (just outside Dubai). The five-day flight was the first of the Imperial Airways flights to go beyond Alexandria.
Lucy Wills was well introduced in India, probably through Dr Margaret Balfour and Sir Robert McCarrison. In Bombay she was on dining terms with the Governors and their wives at Government House – Sir Leslie Wilson in 1928 and Sir Frederick Sykes in 1929. In 1929 she visited Mysore and wrote to her brother that 'I was most fortunate to be under the wing of Sir Charles Todhunter, who is a very important person there'. Todhunter had been Governor of Madras and in 1929 was secretary to the Maharajah of Mysore, then one of the world’s richest men.
Anaemia of Pregnancy
Lucy Wills observed an apparent correlation between the dietary habits of different classes of Bombay women and the likelihood of their becoming anaemic during pregnancy. Poor Muslim women were the ones with both the most deficient diets and the greatest susceptibility to anaemia.
This anaemia was then known as ‘pernicious anaemia of pregnancy’. However, Lucy Wills was able to demonstrate that the anaemia she observed differed from true pernicious anaemia, as the patients did not have achlorhydria, an inability to produce gastric acid. Furthermore, while patients responded to crude liver extracts, they did not respond to the ‘pure’ liver extracts (vitamin B12) which had been shown to treat true pernicious anaemia. She postulated that there must have been another nutritional factor responsible for this macrocytic anaemia other than vitamin B12 deficiency. For some years this nutritional factor was known as the ‘Wills Factor’, and it was later shown, in the 1940s, to be folate, of which the synthetic form is folic acid.
Lucy Wills decided to investigate possible nutritional treatments by first studying the effects of dietary manipulation on a macrocytic anaemia in albino rats. This work was done at the Nutritional Research Laboratories at the Pasteur Institute of India in Coonoor. Rats fed on the same diet as Bombay Muslim women became anaemic, pregnant ones dying before giving birth. The rat anaemia was prevented by the addition of yeast to synthetic diets which had no vitamin B. This work was later replicated using rhesus monkeys.
Back in Bombay, Lucy Wills conducted clinical trials on patients with the macrocytic anaemia, and established experimentally that this type of anaemia could be both prevented and cured by yeast extracts, of which the cheapest source was Marmite.
Lucy Wills was back again at the Royal Free from 1938 until her retirement in 1947. During the Second World War she was a full-time pathologist in the Emergency Medical Service. Work in the pathology department was disrupted for a few days in July 1944 (and a number of people killed) when the hospital suffered a direct hit from a V1 flying bomb. By the end of the war, she was in charge of pathology at the Royal Free and had established the first Haematology Department there. After her retirement, Lucy Wills travelled extensively, including to Jamaica, Fiji and South Africa, continuing her observations on nutrition and anaemia.
Lucy Wills never married – she was of a generation (and a class) which had lost a large number of its young men on the Western Front. She was close to her parents, her siblings, and their children. She enjoyed a number of close lifelong friendships, including with Christine and Ulysses Williams, with her Cambridge contemporary Margot Hume (with whom she jointly owned a cottage in Surrey whose botanical garden they cultivated), and with Kait Lucan (the dowager countess, mother of the disappearing earl), who was a fellow Labour councillor in Chelsea.
Obituaries and other publications describe her as independent, autocratic, not a sufferer of fools, a joyous and enthusiastic teacher, an indomitable walker and skier, an enthusiastic traveller, a lover of the beauty of nature, mirthful and entertaining.
Lucy Wills died on 26 April 1964. The obituary in the British Medical Journal the following month included the following comments:
The excellence of her work on tropical megaloblastic anaemia has long been recognized by nutritionists and haematologists. Every medical student has heard of its cure by her discovery of the Wills factor in yeast extract, which paved the way for the subsequent work on folic acid. It was one of the simple but great observations which are landmarks in the history and treatment of the nutritional anaemias...
Lucy Wills even in her seventies was always a tireless worker, and seeing her example other people found themselves working harder than they had believed possible. Though impatient with laziness and with half-baked opinions, she was compassionate to other human failings. She held strong convictions on social questions, and steadily upheld them as a borough councillor in Chelsea during the last decade of her life. She had wide interests, particularly loving books, gardens, music, and the theatre, and enjoying life always with keen intelligence and humour. Her generosity and magnanimity, combined with outstanding ability and resolution, made friends of all who ever worked with her and found her worthy of profound respect and deep affection.
Lucy Wills’s first learned paper was in 1914, on plant cuticles. There were a further two papers in the 1920s before she started her work in India. Four reports of her field and laboratory studies in India were published in the Indian Journal of Medical Research in 1930 and 1931. After her return to England, there were a number of further papers concerning her work on tropical macrocytic anaemia. A list of her main publications is set out below.
- Wills, L (1914), Plant Cuticles from the Coal-measures of Britain. Geological Magazine I 385–90
- Wills, L & Warwick, J (1924), The adenoid child: a histological and clinical study. Quarterly Journal of Medicine 17 No 66 162–9
- Pillman-Williams, EC & Wills, L (1929), Studies in blood and urinary chemistry during pregnancy: blood sugar curves. Quarterly Journal of Medicine 22 493–505
- Wills, L & Mechta, MM (1930), Studies in ‘pernicious anaemia’ of pregnancy. Part I Preliminary report Indian Journal of Medical Research 17 777–92
- Wills, L & Talpade, SN (1931), Studies in ‘pernicious anaemia’ of pregnancy. Part II A survey of dietetic and hygienic conditions of women in Bombay Indian Journal of Medical Research 18 283–306
- Wills, L & Mechta, MM (1931), Studies in ‘pernicious anaemia’ of pregnancy. Part III Determination of normal blood standards for the nutritional laboratory’s stock albino rat Indian Journal of Medical Research 18 307–17
- Wills, L & Mechta, MM (1931), Studies in ‘pernicious anaemia’ of pregnancy. Part IV The production of pernicious anaemia (Bartonella anaemia) in intact albino rats by deficient feeding Indian Journal of Medical Research 18 663–83
- Wills, L (1931), Treatment of ‘pernicious anaemia’ of pregnancy and ‘tropical anaemia,’ with special reference to yeast extract as a curative agent. British Medical Journal 1 1059–64
- Wills, L (1933), The nature of the haemopoietic factor in Marmite. Lancet 221 1283–5
- Wills, L (1934), Indian Journal of Medical Research 21 669
- Wills, L & Stewart, A (1935), British Journal of Experimental Pathology 16 444
- Wills, L & Clutterbuck, PW & Evans, BDF (1937), A new factor in the production and cure of certain macrocytic anaemias. Lancet 229 311–14
- Wills, L & Evans, BDF (1938), Tropical macrocytic anaemia: its relation to pernicious anaemia. Lancet 232 416–21
- Wills, L (1945), Nutrition surveys. London School of Medicine Magazine 6–7 NS 2–5
- Roe, Daphne (September 1978). "Lucy Wills (1888–1964): A Biographical Sketch" (PDF). Journal of Nutrition 108 (9). Retrieved 21 March 2011.
- Obituary (1964), Lucy Wills. Lancet 283 1225–6
- Bastian, H (2007), Lucy Wills (1888-1964): The life and research of an adventurous independent woman. The James Lind Library
- Hoffbrand, AV & Weir, DG (2001), Historical Review The History of Folic Acid. British Journal of Haematology 113 579–89
- Roe, DA (1978), Lucy Wills (1888–1964): "A biographical sketch", Journal of Nutrition 108 1379–83 http://jn.nutrition.org/cgi/reprint/108/9/1377