Rudolf Virchow

Life and scientific career

Virchow was born in Schievelbein in eastern Pomerania, Prussia (now Świdwin in Poland). He was the only child of Carl Christian Siegfried Virchow (1785–1865) and Johanna Maria née Hesse (1785–1857). His father was a farmer and the city treasurer. Academically brilliant, he always topped in his classes and was fluent in German, Latin, Greek, Hebrew, English, Arabic, French, Italian, and Dutch. He progressed to the gymnasium in Köslin (now Koszalin in Poland) in 1835 with the goal to become a pastor. He graduated in 1839 upon a thesis titled A Life Full of Work and Toil is not a Burden but a Benediction. However, he chose to start studying medicine mainly because he considered his voice too weak for preaching.

In 1839, he received a military fellowship (a scholarship for gifted children from poor family to become arm surgeon), for studying medicine at Friedrich-Wilhelms Institute in Berlin (now Humboldt University of Berlin). He was most influenced by Johannes Peter Müller. He defended his thesis titled de rheumate praesertim corneae (corneal manifestations of rheumatic disease) for medical degree on 21 October 1843, with Müller as his doctoral advisor. Immediately on graduation he became subordinate physician to Müller. But shortly after, he joined the Charité Hospital in Berlin for internship. In 1844, he was appointed as medical assistant to the prosector (pathologist) Robert Froriep, from whom he learned microscopy for his interest in pathology. Froriep was also the editor of an abstract journal that specialised in foreign work, allowing Virchow to be exposed to the more forward-looking scientific ideas of France and England.

Virchow published his first scientific paper in 1845 in which he wrote the earliest known pathological descriptions of leukemia. He qualified the medical licensure examination in 1846, and immediately succeeded Froriep as hospital prosector at the Charité. In 1847, he was appointed to his first academic position with the rank of privatdozent. Because his writings were not receiving favourable attention by German editors, with colleague Benno Reinhardt he founded Archiv für pathologische Anatomie und Physiologie und für klinische Medizin (now known as Virchows Archiv) in 1847. He edited alone from Reinhardt's death in 1852 until his own. This journal began publishing high-level contributions based on the criterion that no papers would be published which contained outdated, untested, dogmatic or speculative ideas. Unlike his German peers, Virchow had great faith in clinical observation, animal experimentation (to determine causes of diseases and the effects of drugs) and pathological anatomy, particularly at the microscopic level, as the basic principles of investigation in medical sciences. He went further and stated that the cell was the basic unit of the body that had to be studied to understand disease. Although the term 'cell' had been coined in the 1665 by an English scientist Robert Hooke, the building blocks of life were still considered to be the 21 tissues of Bichat, a concept described by the French physician Marie Bichat.

The Prussian government never deployed Virchow to study the typhus epidemic in Upper Silesia in during 1847–1848. It was from this medical campaign that he developed his ideas on social medicine and politics after seeing the victims and their poverty. Even though he was not particularly successful in combating the epidemic, his 190-paged Report on the Typhus Epidemic in Upper Silesia in 1848 became a turning point in politics and public health in Germany. He returned to Berlin on 10 March 1848, and only eight days later, a revolution broke out against the government in which he played an active part. To fight political injustice he helped finding Die medicinische Reform (Medical Reform), a weekly newspaper for promoting social medicine, in July of that year. The newspaper ran under the banners "medicine is a social science" and "the physician is the natural attorney of the poor". Political pressures forced him terminate the publication in June 1849 and became expelled from his official position. In November, he was given academic appointment and left Berlin for University of Würzburg to hold Germany's first chair of pathological anatomy. During his six-year period there, he concentrated on his scientific work, including detailed studies on venous thrombosis and cellular theory. His first major work there was a six-volume Handbuch der speciellen Pathologie und Therapie (Handbook on Special Pathology and Therapeutics) published in 1854. In 1856, he returned to Berlin to become the newly created Chair for Pathological Anatomy and Physiology at the Friedrich-Wilhelms-University, as well as Director of the newly built Institute for Pathology on the premises of the Charité. He held the latter post for the next 20 years.

Cell biology

Virchow is credited with several very important discoveries. His most widely known scientific contribution is his cell theory, which built on the work of Theodor Schwann. He was one of the first to accept the work of Robert Remak, who showed the origins of cells was the division of pre-existing cells. He did not initially accept the evidence for cell division, believing it only occurs in certain types of cells. When it dawned on him that Remak might be right, in 1855, he published Remak's work as his own, which caused a falling out between the two. This work, Virchow encapsulated in the epigram Omnis cellula e cellula ("all cells (come) from cells"), which he published in 1855. (The epigram was actually coined by François-Vincent Raspail, but popularized by Virchow.) It is a rejection of the concept of spontaneous generation, which held that organisms could arise from nonliving matter. For example, maggots were believed to spontaneously appear in decaying meat; Francesco Redi carried out experiments which disproved this notion and coined the maxim Omne vivum ex ovo ("Every living thing comes from a living thing" — literally "from an egg"); Virchow (and his predecessors) extended this to state that the only source for a living cell was another living cell.

Cancer

In 1845, Virchow and John Hughes Bennett independently observed abnormal increase in white blood cells in patients. Virchow correctly identified the condition as blood disease, and named it leukämie in 1847 (later anglicised to leukemia). In 1857, he was the first to describe a type of tumour called chordoma that originated from the clivus (at the base of the skull).

Theory on cancer origin

Virchow was the first to correctly link the origin of cancers from otherwise normal cells. (His teacher Müller had proposed that cancers originated from cells, but from special cells, which he called blastema.) In 1855, he suggested that cancers arise from the activation of dormant cells (perhaps similar to cells now known as stem cells) present in mature tissue. Virchow believed that cancer is caused by severe irritation in the tissues, and his theory came to be known as chronic irritation theory. He thought, rather wrongly, that the irritation spread in the form of liquid so that cancer rapidly increases. His theory was largely ignored, as he was proved wrong that it was not by liquid, but by metastasis of the already cancerous cells that cancers spread. (First described by Karl Thiersch in the 1860s.) But he made a crucial observation that certain cancers (carcinoma in modern sense) were inherently associated with white blood cells (which are now called macrophages) that produced irritation (inflammation). It was only towards the end of the 20th century that Virchow's theory was taken seriously. It was realised that specific cancers (including those of mesothelioma, lung, prostate, bladder, pancreatic, cervical, esophageal, melanoma, and head and neck) are indeed strongly associated with long-term inflammation. In addition it became clear that long-term use of anti-inflammatory drugs, such as aspirin, reduced cancer risk. Experiment also shows that drugs that block inflammation simultaneously inhibit tumour formation and development.

The Kaiser's case

Virchow was one of the leading physicians to Kaiser Frederick III, who suffered from cancer of larynx. While other physicians such as Ernst von Bergmann suggested surgical removal of the entire larynx, Virchow was opposed to it because no successful operation of such kind had ever been done. The British surgeon, Morell Mackenzie, performed a biopsy in 1887 and sent it to Virchow, who identified them as "pachydermia verrucosa laryngis". Virchow affirmed that the tissues were not cancerous, even after several biopsy tests. The Kaiser died on 15 June 1888. The next day a post-mortem examination was performed by Virchow and his assistant. They found that the larynx was extensively damaged due to ulcer, and microscopic examination confirmed epidermal carcinoma. Die Krankheit Kaiser Friedrich des Dritten (The Medical Report of Kaiser Frederick III) was published on 11 July under the lead authorship of Bergmann. But Virchow and Mackenzie were omitted, and they were particularly criticised for all their works. The arguments between them turned into a century-long controversy, resulting in Virchow being accused of misdiagnosis and malpractice. But reassessment of the diagnostic history revealed that Virchow was right in his findings and decisions. It is now believed that the Kaiser had hybrid verrucous carcinoma, a very rare form of verrucous carcinoma, and that Virchow had no way of correctly identifying it. (The cancer type was correctly identified only in 1948 by Lauren Ackerman.)

Anatomy

Another significant credit relates to the discovery, made approximately simultaneously by Virchow and Charles Emile Troisier, that an enlarged left supraclavicular node is one of the earliest signs of gastrointestinal malignancy, commonly of the stomach, or less commonly, lung cancer. This has become known as Virchow's node and simultaneously Troisier's sign.

Thromboembolism

Virchow is also known for elucidating the mechanism of pulmonary thromboembolism (a condition of blood clotting in the blood vessels), coining the terms embolism and thrombosis. He noted that blood clots in the pulmonary artery originate first from venous thrombi, stating in 1859: "[T]he detachment of larger or smaller fragments from the end of the softening thrombus which are carried along by the current of blood and driven into remote vessels. This gives rise to the very frequent process on which I have bestowed the name of Embolia." Having made these initial discoveries based on autopsies, he proceeded to put forward a scientific hypothesis; that pulmonary thrombi are transported from the veins of the leg and that the blood has the ability to carry such an object. He then proceeded to prove this hypothesis through well-designed experiments, repeated numerous times to consolidate evidence, and with meticulously detailed methodology. This work rebuked a claim made by the eminent French pathologist Jean Cruveilhier that phlebitis led to clot development and therefore coagulation was the main consequence of venous inflammation. This was a view held by many before Virchow's work. Related to this research, Virchow described the factors contributing to venous thrombosis, Virchow's triad.

Pathology

Furthermore, Virchow founded the medical fields of cellular pathology and comparative pathology (comparison of diseases common to humans and animals). His most important work in the field was Cellular Pathology (Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre) published in 1858, as a collection of his lectures. This is regarded as the basis of modern medical science, and the "greatest advance which scientific medicine had made since its beginning." His very innovative work may be viewed as between that of Morgagni, whose work Virchow studied, and that of Paul Ehrlich, who studied at the Charité while Virchow was developing microscopic pathology there. One of Virchow's major contributions to German medical education was to encourage the use of microscopes by medical students, and he was known for constantly urging his students to "think microscopically". He was the first to establish to link between infectious diseases between humans and animals, for which he coined the term "zoonoses". He also introduced scientific terms such as "chromatin", "agenesis", "parenchyma", "osteoid", "amyloid degeneration", and "spina bifida". His concept on pathology directly opposed humourism, an ancient medical dogma that diseases were due to imbalanced body fluids, hypothetically called humours, that still pervaded.

Parasitology

Virchow worked out the life cycle of a roundworm Trichinella spiralis. Virchow noticed a mass of circular white flecks in the muscle of dog and human cadaver, similar to those described by Richard Owen in 1835. He confirmed through microscopic observation that the white particles were indeed the larvae of roundworms, being curled up in the muscle tissue. Rudolph Leukart found that these tiny worms could develop into adult roundworms in the intestine of a dog. He correctly asserted that these worms could also cause human helminthiasis. Virchow further demonstrated that if the infected meat is first heated to 137 °F for 10 minutes, the worms could not infect dogs or humans. He established that human infection occurs through contaminated pork. This directly led to the importance of meat inspection, which was first adopted in Berlin.

Autopsy

Virchow was the first to develop a systematic method of autopsy, based on his knowledge of cellular pathology. The modern autopsy still constitute his techniques. His first most significant autopsy was on a 50-year-old woman in 1845. He found from the body an unusual amount of white blood cells, and gave a detailed description in 1847 and named the condition as leukämie. One on his autopsies in 1857 was the first description of vertebral disc rupture. His autopsy on a baby in 1856 was the first description of congenital pulmonary lymphangiectasia (the name given by K. M. Laurence a century later), a rare and fatal disease of lung. From his experience of post-mortem examinations of a number of cadaver, he published his method in a small book in 1876. His book was the first to describe the techniques of autopsy specifically to examine abnormalities in organs, and retain important tissues for further examination and demonstration. Unlike any other procedure before, he practiced complete surgery of all body parts with body organs dissected one by one. This has become the standard method.

Ochronosis

Virchow discovered the clinical syndrome which he called ochronosis, a metabolic disorder in which a patient accumulates homogentisic acid in connective tissues and which is indicated by discolouration under the microscope. He found the unusual symptom from an autopsy of the corpse of a 67-year-old man on 8 May 1884. This was the first time this abnormal disease affecting cartilage and connective tissue was observed and analysed. His description and coining of the name appeared in the October 1866 issue of Vichows Archiv.

Forensic

Virchow was the first to analyse hair in criminal investigation, and made the first forensic report on it in 1861. He was called as an expert witness in a murder case, and he used hair samples collected from the victim. He became the first to recognise the limitation of hair as a conclusive evidence. He found that hairs can be different in an individual, and individual hair has characteristic features, and that hairs from different individuals can be strikingly similar. He concluded that evidence based on hair analysis is inconclusive. His testimony runs:

[T]he hairs found on the defendant do not possess any so pronounced peculiarities or individualities [so] that no one with certainty has the right to assert that they must have originated from the head of the victim.

Anthropology and prehistory biology

Virchow developed an interest in anthropology in 1865, when he discovered pile dwellings in northern Germany. In 1869, he co-founded the German Anthropological Association. In 1870 he founded the Society for Anthropology, Ethnology and Prehistory (Gesellschaft für Anthropologie, Ethnologie und Urgeschichte) which was very influential in coordinating and intensifying German archaeological research. He edited its journal Zeitschrift für Ethnologie (Journal of Ethnology), which he founded in 1866, until his death, and was several times (at least fifteen times) its president. In 1870, he led a major excavation of the hill forts in Pomerania. He also excavated wall mounds in Wöllstein in 1875 with Robert Koch, whose paper he edited on the subject. For his contributions in German archaeology, the Rudolf Virchow lecture is held annually in his honour. He made field trips to Asia Minor, the Caucasus, Egypt, Nubia, and other places, sometimes in the company of Heinrich Schliemann. His 1879 journey to the site of Troy is described in Beiträge zur Landeskunde in Troas ("Contributions to the knowledge of the landscape in Troy", 1879) and Alttrojanische Gräber und Schädel ("Old Trojan graves and skulls", 1882).

Anti-Darwinism

Virchow was an opponent of Darwin's theory of evolution, and particularly skeptical of the emergent thesis of human evolution. On 22 September 1877, he delivered a public address entitled "The Freedom of Science in the Modern State" before the Congress of German Naturalist and Physicians in Munich. There he spoke against the teaching of the theory of evolution in schools, arguing that it was as yet an unproven hypothesis that lacked empirical foundations and that, therefore, its teaching would negatively affect scientific studies. Ernst Haeckel, who had been Virchow's student, later reported that his former professor said that "it is quite certain that man did not descend from the apes...not caring in the least that now almost all experts of good judgment hold the opposite conviction."

Virchow became one of the leading opponents on the debate over the authenticity of Neanderthal, discovered in 1856, as distinct species and ancestral to modern humans. He himself examined the original fossil in 1872, and presented his observations before the Berliner Gesellschaft für Anthropologie, Ethnologie und Urgeschichte. He stated that the Neanderthal had not been a primitive form of human, but an abnormal human being, who, judging by the shape of his skull, had been injured and deformed, and considering the unusual shape of his bones, had been arthritic, rickety and feeble. With such an authority, the fossil was rejected as new species. With this reasoning, Virchow "judged Darwin an ignoramus and Haeckel a fool and was loud and frequent in the publication of these judgments."

On 22 September 1877, at the Fiftieth Conference of the German Association of Naturalists and Physician held in Munich, Haeckel pleaded for introducing evolution in the public school curricula, and tried to dissuade Darwinism from social Darwinism. His campaign was because of Herman Müller, a school teacher who was banned because of his teaching a year earlier on the inanimate origin of life from carbon. This resulted in prolonged public debate with Virchow. A few days later Virchow responded that Darwinism was only a hypothesis, and morally dangerous to students. This severe criticism of Darwinism was immediately taken up by the London Times, from which further debates erupted among English scholars. Haeckel wrote his arguments in the October issue of Nature titled "The Present Position of Evolution Theory", to which Virchow responded in the next issue with an article "The Liberty of Science in the Modern State". The debate made Haeckel write a full book Freedom in Science and Teaching in 1879. That year the issue was discussed in the Prussian House of Representatives and the verdict was in favour of Virchow. In 1882 the Prussian education policy officially excluded natural history in schools.

Years later, the noted German physician Carl Ludwig Schleich, would recall a conversation he held with Virchow, who was a close friend of him: "...On to the subject of Darwinism. "I don't believe in all this," Virchow told me. "if I lie on my sofa and blow the possibilities away from me, as another man may blow the smoke of his cigar, I can, of course, sympathize with such dreams. But they don't stand the test of knowledge. Haeckel is a fool. That will be apparent one day. As far as that goes, if anything like transmutation did occur it could only happen in the course of pathological degeneration!".

Virchow's ultimate opinion about evolution was reported a year before he died; in his own words:

The intermediate form is unimaginable save in a dream... We cannot teach or consent that it is an achievement that man descended from the ape or other animal.

Virchow's antievolutionism, like that of Albert von Kölliker and Thomas Brown, did not come from religion, since he was not a believer.

Anti-racism

Virchow believed that Haeckel's monist propagation of social darwinism was in its nature politically dangerous and anti-democratic, and he also criticized it because he saw it as related to the emergent socialist movement in Germany, ideas about cultural superiority, and militarism. In 1885, he launched a study of craniometry, which gave surprising results contradictory to contemporary scientific racist theories on the "Aryan race", leading him to denounce the "Nordic mysticism" at the 1885 Anthropology Congress in Karlsruhe. Josef Kollmann, a collaborator of Virchow, stated in the same congress that the people of Europe, be they German, Italian, English or French, belonged to a "mixture of various races", further declaring that the "results of craniology" led to a "struggle against any theory concerning the superiority of this or that European race" on others. He analysed the hair, skin, and eye colour of 6,758,827 schoolchildren to identify the Jews and Aryans. His findings, published in 1886 and concluding that there could be neither a Jewish nor a German race, were regarded as a blow to anti-Semitism and the existence of an "Aryan race".

Anti-germ theory of diseases

Virchow did not believe in the germ theory of diseases, as advocated by Louis Pasteur and Robert Koch. He proposed that diseases came from abnormal activities inside the cells, not from outside pathogens. He believed that epidemics were social in origin, and the way to combat epidemics was political, not medical. He regarded germ theory as hindrance to prevention and cure. He considered social factors such as poverty as major cause of diseases. He even attacked Koch's and Ignaz Semmelweis' policy of handwashing as an antiseptic practice. He postulated that germs were only using infected organs as habitats, but they were not the cause, and stated, "If I could live my life over again, I would devote it to proving that germs seek their natural habitat: diseased tissue, rather than being the cause of diseased tissue".

Politics and social medicine

More than a laboratory physician, Virchow was an impassioned advocate for social and political reform. His ideology involved social inequality as the cause of diseases that requires political actions, stating:

Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution: the politician, the practical anthropologist, must find the means for their actual solution... Science for its own sake usually means nothing more than science for the sake of the people who happen to be pursuing it. Knowledge which is unable to support action is not genuine – and how unsure is activity without understanding... If medicine is to fulfill her great task, then she must enter the political and social life... The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.

Virchow actively worked for social change to fight poverty and diseases. His method involves pathological observations and statistical analyses. He called this new field of social medicine a "social science". His most important influences could be noted in Latin America, where his disciples introduced his social medicine. For example, his student Max Westenhöfer became Director of Pathology at the medical school of the University of Chile, becoming the most influential advocate. One of Westenhöfer's students, Salvador Allende, through social and political activities based on Virchow's doctrine, became the 29th President of Chile (1970-1973).

Virchow made himself known as a pronounced democrat in the year of revolutions in Germany (1848). His political views are evident in his Report on the Typhus Outbreak of Upper Silesia, where he states the outbreak could not be solved by treating individual patients with drugs or with minor changes in food, housing, or clothing laws, but only through radical action to promote the advancement of an entire population, which could only be achieved by "full and unlimited democracy" and "education, freedom and prosperity".

These radical statements and his minor part in the revolution caused the government to remove him (1849) from his position, although within a year he was reinstated as prosector 'on probation'. Prosector was a secondary position in the hospital. This secondary position in Berlin convinced him to accept the chair of pathological anatomy at the medical school in the provincial town of Würzburg, where he continued his scientific research. Six years later, he had attained fame in scientific and medical circles, and was reinstated at Charité Hospital.

In 1859, he became a member of the Municipal Council of Berlin and began his career as a civic reformer. Elected to the Prussian Diet in 1862, he became leader of the Radical or Progressive party; and from 1880 to 1893, he was a member of the Reichstag. He worked to improve the health-care conditions for Berlin citizens, especially by working towards modern water and sewer systems. Virchow is credited as a founder of social medicine, frequently focusing on the fact that disease is never purely biological, but often socially derived or spread, and of anthropology.

The Sausage Duel

As a cofounder and member of the liberal party (Deutsche Fortschrittspartei) he was a leading political antagonist of Bismarck. He was opposed to Bismarck’s excessive military budget, which angered Bismarck sufficiently to challenge Virchow to a duel in 1865. Of the two versions, one has Virchow declining because he considered dueling an uncivilized way to solve a conflict. The second has passed into legend, but was well documented in the contemporary scientific literature. It has Virchow, having been the challenged and therefore entitled to choose the weapons, selecting two pork sausages, a normal sausage and another one, loaded with Trichinella larvae. His challenger declined the proposition as risky.

Kulturkampf

Virchow supported Bismarck in an attempt to reduce the political and social influence of the Catholic Church, between 1871 and 1887. He remarked that the movement was acquiring "the character of a great struggle in the interest of humanity". He called it Kulturkampf ("culture struggle") during the discussion of Falk's May Laws (Maigesetze). Virchow was respected in Masonic circles, and according to one source may have been a freemason, though no official record of this has been found.

Family

On August 24, 1850 in Berlin, Virchow married Ferdinande Rosalie Mayer (Rose Virchow; 29 February 1832 – 21 February 1913), a liberal's daughter. They had three sons and three daughters:

Death

Virchow broke his thigh bone on 4 January 1902, jumping off a running streetcar while exiting the electric tramway. Although he anticipated full recovery, the fractured femur never healed, and restricted his physical activity. His health gradually deteriorated and he died of heart failure after eight months, on 5 September 1902, in Berlin. A state funeral was held on 9 September in the Assembly Room of the Magistracy in the Berlin Town Hall, which was decorated with laurels, palms and flowers. He was buried in the Alter St.-Matthäus-Kirchhof in Schöneberg, Berlin. His tomb was shared by his wife on 21 February 1913.

Honours and legacy

Works

He was a very prolific writer. Some of his works are: