SEPT. 1936 LINACRE AND THE SCHOLAR-PHYSICIANS OF OXFORD medicine was scholastic and sterile. Powerful thinkers Nova et Vetera .of the times recognized the necessity of direct contact with the Hellenic writings. John Basingstoke, an Oxford man, travelled to Greece, and there learnt Greck THOMAS LINACRE AND THE FIRST from a learned Athenian woman, Constantina. He re- soon * turned to England with Greek manuscripts, and was SCHOLAR-PHYSICIANS OF OXFORD in contact with the great churchman and scholar Robert BY Grosseteste (1175-1253). Grosseteste's life is in large part bound up with Oxford, where he was educated. A. P. CAWADIAS, O.B.E., M.D., F.R.C.P. Wishing to increase his knowledge of true science he PHYSICIAN TO TIIE ST. JOHN CLINIC AND INSTITUTE OF PHYSICAL MEDICINE studied Greek not only at second hand in Paris but at Oxford with a native Greek, Nicolas or Elicheros, and began to translate Greek authors, unfortunately not im- Thomas Linacre and Leonicenus were the greatest portant writers. His friend and Oxford contemporary, physicians of the early Renaissance. Around the former Roger Bacon, the Doctor mirabilis, with the courage radiated a group of other eminent physicians who, with and energy which characterized his whole life, pointed the exception of Caius, were all of Oxford. The studies out that the knowledge received from the Arabian writers and medical preparation of Linacre belong to the last was imperfect because of faulty translation, and he quarter of the fifteenth the period of active century; blamed the professors for not learning Greek so as to life, as in the case of the other great Oxford scholar- be able to read Aristotle and other writers in the original. physicians, belongs to the first quarter of the sixteenth This thirte2nth century revival of the Greek language century. Thomas Linacre and his satellites represent and of science at Oxford did not long continue. was that period of Oxford in which Greek learning Grosseteste was too much occupied with political activi- introduced and modern or Western European medicine ties, and Roger Bacon was too much persecuted by the originated. Church. The movement, however, was the beginning of Greek Learning and that greater renaissance at the same university in the Medicine days of Linacre. Greek learning was intimately bound up with the in- ception and development of modern medicine, and Thomas Linacre Thomas Linacre was a great Greek scholar as well as Thomas Linacre was fortunate in his studies, in his a great physician-a combination exhibited also by his Oxford contempararies and associates, Edward Wotton, teachers, and in his fellow-students. His first teacher John Clement, Richard Bartlot, Thomas Bentley, John at the school of the Christchurch convent of Canterbury was an man a Chambre, as well as by his Cambridge counterpart, William Selling, Oxford and Fellow of All Caius. It is easy to understand the relation between Souls. Selling had travelled in Italy at a time when that was a Greek learning and medicine if we follow in broad out- country fostering great renaissance of Greek line the history of our science. teaching under Greek scholars. He had thus learned Medicine-scientific medicine and not the mystical magic Greek at first hand, and he had brought back with him and empirical healing art of the ancient Eastern-peoples- Greek manuscripts. The teaching he gave his favourite began with the ancient Greeks. From the seventh cen- pupil was not the scholastic teaching of the period but tury B.C. to the seventh century of our era, from the more classical. At the age of 20 Linacre went to Oxford, Ionian physiologists, Pythagoras and Alcmaeon, to and although we do not know his first college we find Alextnder of Tralles and Paul of Aegina, medicine was him four years later a Fellow of All Souls. At Oxford essentially Greek. The Romans had no medicine as he continued his Greek studies under the Italian, Vitelli, a man they had no science, and the only medical work in Latin, of noble birth, who had learned Greek from Greeks and was that of Celsus, was an elegant compilation of Greek medi- probably the first teacher of that language in cine written by a dilettante. When, in the eighth century the university. At Oxford Linacre became intimately A.D., the Arabs felt the urge to practise and develop acquainted with William Grocyn and William Latimer, who were medicine their only source was the writings of the pursuing classical studies, and who, like Linacre, Greek physicians and scientists. Under the Abbasides in were among the principal figures in the revival of Greek Bagdad remarkable translations were made of the Hellenic language and learning in England. writings, of which the Arabian physicians gave various A few years after the beginning of his Oxford life interpretations, without, however, adding any original Thomas Linacre was again blessed by fortune. His work. From the eighth century to the end of the twelfth teacher, William Selling, was sent on a mission to and the learned man medicine was again Greek, but in Arab dress. The Italy, took with him his favourite Arabian interpretation of medicine was inferior to the pupil. This Italian journey is the crux of Linacre's life. In purely Hellenic healing art, not only because it was not Florence and in Rome he was in touch witb original but because Greek writers taught, besides facts, the three great humanists, Demetrius Chalcocondylis, and Hermolaus was a technique of reasoning and observation, whereas the Politian, Barbarus. It the Greek art of reasoning cannot be found among Arabian Chalcocondylis who exercised the greatest influence on Linacre. Chalcocondylis was one of those whom the physicians. Greeks call " teachers of When in the thirteenth century men appeared who great the race." His learning was extensive but his felt the need to develop medicine two routes lay open teaching was not purely philo- to them: they could read and study medicine in the logical. His aim was to inspire his pupils, some of whom illustrious original Greek, or study it through Arabian interpreta- became men, with the spirit of clear tions. They chose the latter, and from the end of the thinking and of logic, and with the high ideals of thirteenth century to the end of the fifteenth European ancient Greece. He was a great character as well as a at medicine was Arabian-that is, second-hand Greek. The great scholar, and this time was director of the Greek school of " reason for this devious method of study can be found Florence founded by another great teacher in the fact that it was difficult for Western Europeans of the race," Emanuel Chrysoloras. He was also of those days to study Greek. The mediaeval Church had tutor to the sons of Lorenzo de' Medici. The other set its face against Greek. Knowledge of that language teacher of Linacre, Politian, was a man of considerable meant studying Greek science and enlightenment, and learning too, but his character and moral standards fell the Church stood firm against science and enlighten- short of the ideals of the classical thinkers whose princi- Hermolaus a ment. Greek was the language of a great Christian ples he taught. Barbarus, lover of natural Graeco-Byzantine empire, Christian but not bowing to history and translator of Dioscorides, was an eruAite the Roman pontiff. and slightly epicurean dilettante. From Florence Linacre proceeded to Venice, where he * Read in the Section of History of Medicine at the Annual helped Aldus Manutius, the famous printer, in the cor- Meeting of the British Medical Association, Oxford, 1936. rection of Greek texts, and thence to Padua, where he THE BRITISH 551 SEPT. 12, 1936 LINACRE AND THE SCHOLAR-PHYSICIANS OF OXFORD MEDICAL JOURNAL

a crowned this period of study in Italy by completing his reform by giving it a safe organization. Through his scientific and medical studies and graduating M.D. After influence with Henry VIII and Cardinal Wolsey he graduation, probably in 1490, Linacre returned to Oxford, obtained in 1518 letters patent for the foundation of the where he continued teaching Greek and medicine. He and College of Physicians of London. He probably took as his friends Grocyn and Latimer fought for the introduc- a model similar institutions existing in Italian towns. tion of Greek classical teaching. The fight was hard, His object was to incorporate the physicians practising because the Church continued its opposition. It is even in London into one body which would promote the said that a monk was preaching so vehemently in Oxford advancement of science and would control medical prac- against Greek teaching that he was stopped by Royal tice, which was then very irregular and had fallen into command. The early Tudors showed great interest in the hands of quacks and the ignorant. Through this the renaissance of learning. Oxford, with Linacre aild foundation Linacre initiated the history of British medi- his circle, became a centre of classical learning, and cine. Later in life he founded the Linacre lectureships, Erasmus himself came there to learn Greek with Grocyn, two at O:tford and one at Cambridge. This he did at Latimer, and Linacre. The fame of Linacre as scholar a time of suffering, which for long periods made him an and physician, however, was already very considerable, invalid, and which he bore with great fortitude until his and led to the interruption of his academic career, for he death in 1524. was called to London as tutor and physician to Prince On the flyleaf of the remarkable Life of Thomas Linacre Arthur, the first-borm son of Henry VII. by John Noble Johnson, Fellow of the Royal College of Physicians, published in 1835, we read: " As this book Linacre's Most Active Years did not sell I destroyed all but a few for presents only." With the beginning of the sixteenth century-the Linacre was simply an uninteresting relic to the nine- appointment was made in 1501-Thomas Linacre entered teenth century, "the century without histbry." Our upon the most active period of his life. Tutor and ideas have greatly changed, and to-day we can but render physician to Prince Arthur, first physician probably to homage by interest in the life of the man who embodied Henry VII, although only in conjunction with the Italian to a high degree the noblest qualities of the physician, Giovanni Battista de Boeria (who was more astrologer scholarship, science, clear thinking, and, above all, those than physician), and physician to Henry VIII, he was at lofty standards of character which made his personality the head of medicine in the British Isles. His eminence radiate kindness and sympathy in the sixteenth century. and skill as a physician, due to the clear rational thinking with which he had been imbued by study of the Greek The First Scholar-Physicians of Oxford masterpieces, spread far beyond court circles. He was physician to all the great of his time, including Cardinal When a man possesses the qualities that Thomas Wolsey. He frequented the house of Sir Thomas More, Linacre did he becomes a source of mental energy which and his advice was asked by many. There are charac- reacts on his immediate surroundings. Pupils, friends, teristic letters from Erasmus asking the opinion of and contemporaries draw from him inspiration. Around Linacre, and lamenting the distance between them which Thomas Linacre were grouped the first humanist-physi- deprived him of his friend's personal skill in the allevia- cians, who, with the exception of Caius, all belonged to tion of his sufferings. this university. Among them were John Chambre, About nine or ten years after settling in London Linacre Richard Bartlot, and Thomas Bentley. John Clement entered the priesthood. It must be remembered that and Edward Wotton were younger, and can be considered priesthood and medicine, even at that time formed all as his immediate pupil successors. All of them except excellent combination. The retiring and scholarly dis- Chambre were presidents of the Royal College of position of Linacre made him take this step. His friend- Physicians. with William John Chambre (d. 1549) was a Fellow of Merton ship Warham, Archbishop of Canterbury, College he studied also in Padua and in Paris, where he facilitated his course of ecclesiastical preferment, but his into orders made no difference to graduated M.D. He succeeded Linacre as physician to entry holy his medical Henry VIII. He does not, however, seem to have been activities. It was at this period that he began his trans- lations from Galen. In 1517 De Sanitate Tuenda was very active at the Royal College of Physicians, but after printed, and in 1519 Methodus Medendi. Other trans- the death of Linacre he was the greatest physician of lations followed: De Temperamentis, De Naturalibus the realm. His portrait by Holbein the younger at the Facultatibus, De Pulsuutm Usu, and lastly De Sympto- Lichtenstein Gallery in Vienna shows a powerful intellec- matum tual physiognomy. With Linacre he was instrumental Differentiis, published posthumously. These in the creation of the Royal College of Physicians, but translations brought him great renown among all the and of Europe. apart from that we do not know how he influenced the physicians humanists medical reformation. It may seem remarkable that so many scholar-physicians of the Renaissance Galen and not Richard Bartlot (1470-1556) belongs to All Souls chose Hippocrates. College, the college of Linacre. Caius spoke of him as This may be due to the fact that Galen gives a system for his of of more a "very famous knowledge ,phys c." He was medicine easily understood, system in broad extensively learned not only in Greek mediaeval writings outline based on the ideas of Hippocrates. In fact, Galen had fallen into disrepute because of the faulty but also in those of mediaeval authors, and he thus tried translations of the but to balance the two schools of thought. He was the first and interpretations Arabs, actually Fellow elected in the Royal College of Physicians, of he was a great Hippocratic physician. He had the mis- fortune to have bad pupils, and through them his reputa- which he became president at three different early periods. was The work Thodmas Bentley of New College closes this incomplete tion clouded. of Linacre and others was of the of Oxford. to show the real the man who list early scholar-physicians Like the Galen, taught facts-facts, others he was President of the Royal College of Physicians it is true, which could not remain unchallenged-the man of like his the satellites who a method of clinical London, and, contemporaries, of taught thinking. Linacre, he was well versed in Greek learning. Wraugham To his medical works Linacre added grammatical ones. Appointed to supervise the health and education of in his British Plutarch quotes on the' authority of Cumber- Princess Mary he prepared for her his Rudiments of land a classic anecdote. When Bentley was in his- old but his age Mrs. Bentley lamented that he had bestowed so Grammar; great gramnmatical work, published in a of his time and talents 1524, was De Emendata Structura Latini Sermonis, which great portion upon studies of brought him disillusion in England but great fame ancient Greek authors instead of employing them in the rest of the world. original work. Bentley remained for a considerable time throughout thoughtful and seemingly impressed by her remarks. At Foundation of the Royal College of Physicians and last, recollecting himself, he said: the Linacre Lectureships " Child, I am sensible that I have not always turned my talents to the proper use for which I should presume they Linacre had become a great physician, and life was were given to me. Yet I have done something for the honour drawing to a close before he crowned his work of medical of my God and the edification of my fellow creatures. The THE BRrIsi 552 SEPT. 12, 1936 LINACRE AND THE SCHOLAR-PHYSICIANS OF OXFORD MEDICAL JOURNAL xvit and genius of these old heathenis beguiled me, and as those human qualities which make for medical success. I desired to rais myself to their standard upon fair ground I suspect that the belittlement of the medical calibre I took the only chance I had of looking over their heads to of these scholar-physicians comes from the prejudice, upon their shou'ders." get unfortunately common in the late nineteenth century, John Clement (1490-1572) is probably the most interest- against scholarship for physicians. The history of medi- ing figure of the scholar-physicians coming immediately cine, however, teaches us that nearly all great physicians after Linacre. I do not know why a shadow has fallen of all ages up to the present time had a scholarly mind over the life and work of this great physician, who has and training. been retrieved from oblivion only by the monograph of These Oxonians, as well as their Cambridge contem- Ernst Wenkebach. The year of his birth is not known porary, Caius, were really skilful physicians. The part with precision-he was born at the end of the fifteenth they played in the science and practice of medicine con- century-nor the early years of his studies, although sisted in the introduction of new methods and in the Wenkebach holds that he was a pupil at the school of revival of the Hippocratic approach to disease. They St. Paul's, which the famous Dean Colet had made a taught their contemporaries how to observe, how to centre of classical learning in London. The first event reason clearly, and how to think for themselves instead in his life to colour his future years was his appointment of repeating " parrot-wise ' the texts of authorities. to the household of Sir Thomas More. It is probable Through the introduction of these new methods modern that he received great inspiration from the distinguished medicine was born. It is true that the first physician circle to which belonged the great hero of medical youth to give the humanistic Hippocratic impulse to medicine of those days, Thomas Linacre. In 1518 we find him at was an Italian, Leonicenus (1428-1524), professor at Padua, Oxford, at Corpus Christi, as reader in rhetoric in the Bologna, and Ferrara; he was the first to show that the chair founded by Cardinal Wolsey, and later as professor Arabs had not understood Hippocrates and the other of Greek in the chair founded by the same cardinal and Greeks, and to indicate through study of the original Cardinal Fox. Greek texts the real medical methods. His pupil and Like all the Renaissance scholar-physicians he was successor at Ferrara, Giovanni Manardi (1463-1536), seized by the desire to travel. In 1521 he went first to followed in the steps of his teacher. Louvain, afterwards to Padua, where he met another of However, only a few years after the first works of the lieutenants of Linacre, Edward WVotton. He gradu- Leonicenus, Thomas Linacre and the scholar-physicians ated in medicine at Sienna, and remained in Italy to of Oxford started the movement for the Hippocratic assist Professor Opizo of Pavia in editing Galen and, revival. England always takes in hand the great Mediter- like Linacre, helped with the Greek editions printed in ranean movements. It has been said with truth that Venice. He returned to London in 1526 and married England i an island that often is bathed in Mediterranean the virtuous and learned stepdaughter of Sir Thomas waters. Not only did England take up the movement More, Margaret Giggs, and began medical practice there. but she it. The reform of medicine through and organized Success came rapidly on account of his great skill Greek study, initiated in Italy, reached its zenith in was. consulted by the great important connexions. He England through Thomas Linacre and his contemporary and was even among the physicians of the King. He was The French humanist-physicians like to scholar-physicians. elected to the College of Physicians and appointed (1472-1539), Pierre Brissot (1478- College. With Symphorien Champier the important post of concilarius in the 1522), and, it must not be forgotten, Rabelais (1490-1553), the disgrace and death of Sir Thomas More his fortunes came a little later, and the German humanist-physicians suffered eclipse, but, all the same, we find him nine years Cornelius Agrippa (1487--1534), John Gauthier afterwards of Royal College of Physicians. Henry President the d'Andernach (1487-1574), and Janus Cornarius (1500-1558) Again, however, his fortunes sank with the persecution later still. as by his religion. of the Catholics, John Clement stood fast Thomas Linacre, John Chambre, Richard Bartlot, was a foreign land. not He forced to leave London, and died in Thomas Bentley, John Clement, Edward Wotton, did Like the other Renaissance physicians his Greek wearning discover new facts in anatomy, physiology, or nosology. to his medical thought and practice. His intro- gave precision They did something more important, however, in work consisted more in interpretation and made published ducing the method by which great discoveries were translation from the Greek; but there can be no doubt, later. When we see what medicine was before Thomas methods of the however, that contact with the natural Linacre, a collection of Galenic and scholastic teachings, to opinions ancients must have led him, like Linacre, and when we realize the strength of the impulse based on his own observation. the wholly given by Linacre and his Oxford contemporaries to Edward Wotton (1492-1 555) belongs to Magdalen observa- development of true medicine founded on fact, on where he was Fellow. In 1516 he College, Oxford, tion, and on clear thinking, we must admit that these became of Greek at Corpus Christi, but a short critical professor men did something more than mere translation and time afterwards Bishop Richard Fox, founder of the work. If it had not been for Linacre we should have gave Wotton leave to travel in Italy " to improve college, had neither Harvey nor Sydenham, Pasteur nor any of his learning and chiefly to study Greek." In Italy we the modem scientists who find the road of clear thinking find him at Padua with John Clement and other English so because those sixteenth-century pioneers traced and here he M.D. Returning to easy students, graduated it with such energy and sacrifice of their health and often Oxford and very soon afterwards settling in London, he of their liberty and life. practised medicine with success, became President of the Royal College of Physicians, but studied zoology in par- ticular. He can be considered as the first British zoolo- B. W. Carey (Journ. of Pediat., May, 1936, p. 626), gist and the first Fellow of the Royal College of Physicians who reports an illustrative case, maintains that infection to insist on the introduction of zoology into medical with a member of the genus Listerella is more frequent studies. than the number of published cases indicates, and that Foundation of Modern Medicine probably such organisms have been classed among the diphtheroid group. Agglutination of the organism in Dr. Arnold Chaplin remarked in his Harveian Oration normal horse serum suggests that this may be of diag- for 1922 that an unjustified neglect has beset the memory nostic value in establishing the identity of similar of these scholar-physicians, and that their part in the organisms in human or animal infections. Carey's case history of medicine has not been sufficiently emphasized. was that of a boy aged 3 years and 8 months, admitted I can go further and attribute to them the foundation to hospital with symptoms of acute meningitis of four of modern medicine. It is true that they were scholars days' duration. From the cerebro-spinal fluid a small first of all, but they were equally good physicians. There Gram-positive bacillus was grown presenting all the is abundant testimony of the diaggnostic and therapeutic characteristic features of the genus Listerella, including skill of Linacre and also of John Clement. Study of the agglutination of the organism by the patient's serum and Greek physicians had trained them in careful observation agglutination in normal horse serum in a dilution of and clear reasoning. At the same time, it had developed 1 in 640. Recovery took place.