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FOR TWENTY centuries, the theory of humoral pathology, in one form or another, influenced
the thinking of medical men. According to this philosophy, the body was controlled
by four humors and sickness resulted from an imbalance of those humors. Effects
of imbalance were thought to encompass the entire body, until Morgagni in 1761 convinced
many of his contemporaries that disease usually gained foothold in one or more specific
organs; and Bichat, in 1800, drew finer lines and argued that issues which made
up organs were focal points of morbid changes. It remained for Rudolf Virchow in
1855 to develop understanding that the basic units of life are self-reproducing
cells of living bodies, and that pathologic conditions result primarily from changes
in life processes of cells, due to external influences and irritations. “The
principles of cellular pathology,” based upon Virchow’s scientific research,
have dominated biology and pathology ever since; and they finally laid to rest remnants
of the old humoral theories to which some medical men still hung in the nineteenth
century.
Virchow also was to take a forward position among German medical scientists who,
in the mid-nineteenth century, were to wrest leadership of world medicine from the
Paris school. dominant since the turn of that century. Though men trained in Paris
had advanced their profession tremendously, their methods, stressing physical examination
and autopsy, were self-limiting. The future was to go with those who understood
and cold apply new scientific tools to clinical medicine; microscopy, experimental
physiology, and chemistry. In these fields, the Germans were to excel for many decades.
Rudolf Ludwig Carl Virchow was born in the small Eastern Pomeranian city of Schivelbein,
October 13, 1821, the only child of a minor city official and farmer. Virchow seems
never to have forgotten his rural beginnings. Early in life he revealed an unusual
aptitude for the sciences, combined with a wide range of interests, including Arabic
poetry, classics, and French, English, Hebrew and Italian languages. In October,
1839, Virchow entered the medical school of the Friedrich. Wilhelms Institute, in
Berlin. Primarily an institution offering free medical education to gifted boys
from the poorer classes in return for future service as military physicians, the
Institute turned out other nineteenth century luminaries, including Helmboltz, Loffler,
and Behring.
At the time Virchow began his studies, the position of German medicine was still
at a very low level, due to the influence of romantic philosophies among physicians;
but the Berlin university had two of the more magnetic teachers of the time: Johannes
Miller, physiologist, comparative anatomist, embryologist, and pathologist, and
Johann Lucas Schonlein, outstanding German clinician. These men influenced Virchow;
he entered upon research activities while still an undergraduate, and he readily
developed abilities to apply exact laboratory methods to investigation of biologic
and pathologic questions. In 1843, he presented his thesis on “Rheumatic Disease,
Particularly of the Cornea,” and received his doctorate in medicine.
As a young student and resident physician, the man who was soon to rise to national
and international prominence in several fields presented anything but an imposing
figure. Short, thin, blond, dark-eyed, he was accorded the friendly nickname, der
kleine Doklor (the little doctor). Evidently his stature was a point of personal
sensitivity; in Wiirzburg, he had constructed a special low desk with an adjustable
center section, to deemphasize his short stature.
In 1843, Virchow was appointed “company surgeon,” to a rotating internship,
in Berlin’s Charite Hospital. There he began advanced work in biochemistry
and in microscopy, a field in which he was to succeed his teacher, Robert Froriep,
only three years later, in 1846. From Froriep, too, he was to gain his interest
in writing and in editing. In 1845, he began publishing papers on his first two
discoveries; continuous flow of papers and other publications for more than half
a century. Meantime, things medical did not prevent Virchow’s mind from being
alert in other fields, including politics, especially as his Pomeranian homeland
was involved.
In that same year, 1846, Virchow also began to give courses in pathologic anatomy,
and in the following year, at the age of 26, Virchow became a Privaldozent, or instructor.
In 1847, also, with Benno Reinhardt, Virchow launched the first volume of Archives
for Pathological Anatomy and Physiology and Clinical Medicine, a periodical which
he was to edit until 1902, and which is still being published.
Virchow in later life was to regard the year 1818 as the most decisive in his life;
he was able at that time to crystallize his previous critical and constructive ideas
in politics and in science into one consistent philosophy. Sent on an official mission
to study an epidemic of typhus fever in famine-ridden Upper Silesia, a Prussian
province occupied by a Polish minority. Virchow returned preaching political therapeutics
(education, freedom, and prosperity for all). He was an audacious in criticism of
his government as he was of his medical elders.
When revolution broke out in Berlin in March, 1818, Virchow was among those who
fought on the barricades; and in a weekly publication of his own, Medical Reform,
he discussed changes she believed were needed both in administrative and in medical
practice.
Reactionary persecutions following the revolutionaries’ defeat led to Virchow’s
dismissal from his academic position in Berlin, and induced him in 1949 to accept
the position of Professor of Pathology at the University of Wiirzburg. There he
entered upon seven of the most creative years of his life. His new professorship
at Wiirzburg was the first chair in pathologic anatomy in Germany. Also, recent
improvements in compound microscopes extended the field and the accuracy of the
probing curiosity of “der kleine Doktor,” “Learn to see microscopically!”
became one of his persistent admonitions to students.
Among Virchow’s discoveries while engaged in teaching, in writing, in editing,
and in research during his Wiirzburg years, were chemical substances, such as myelin,
and amyloid; demonstration that connective tissues are composed of cells; and that
granulated cells are in a degenerative, not a formative, state. He continued studies
related to public health and began work on physical anthropology. But of greatest
significance was formulation and exposition of the basic biologic law: Each cell
stems from another cell.
In 1838, another pupil of Johannes Miller, Theodore Schwann, had introduced his
theory that the elementary unit of all animals and of all plants is the cell. This
was not the first cell theory, but better microscopes had made cellular observation
more accurate and convincing. Schwann, however, believed that cells were spontaneously
created from an amorphous substance called “blastema,” Virchow expressed
doubt of the spontaneous generation theory as early as 1845; but in Wiirzburg he
proceeded to disprove this concept by demonstrating conclusively that cells multiply
by division. Disease, Virchow, taught, is not located basically in organs, tissues,
vessels, or nerves, but in cells, and this more specific concept became the basis
of instruction in pathology. He coined the term, “cellular pathology”
in 1855, and his book on the subject was published in 1858.
Virchow was not the first man to look for pathologic changes in cells, nor was she
the first to claim that cells originate only from cells. He was first, however,
to systematize the theory of cellular pathology, and to give medicine again a common
denominator for all diseases-something it had lost in giving on older medical philosophies.
Probably the bases of Virchow’s greater success than earlier observers had
had lay in the soundness of his research, the prolificacy of his publishing, the
crusade like quality of his zeal, land the growth of the influence upon medicine.
Already internationally famous for his teaching in Wiirzburg, Virchow was called
back to Berlin in 1856, Johannes Miller wanted Virchow to succeed him as teacher
of pathologic anatomy. One of Virchow’s conditions for return was erection
of a special building for an Institute in Pathology. This building was to be used
during the entire 46 years Virchow was to spend in Berlin.
The importance of “der kleine Doktor” in his field continued to grow;
in Berlin, he wrote his great book on tumors; he worked on fungi, and he did important
work on trichinosis. Though some writers have claimed that Virchow was an enemy
of bacteriology, the facts deny the claim. He Was an early participant in the trend
toward knowledge of etiology through microbiology. His assistant, Obermeier, discovered
the spirilla of relapsing fever; and Virchow was first to publish in his Archives,
the discoveries of Bravell, Hansen, and Loesch. He exercised healthy skepticism
toward many “new organisms” reported to have been discovered; and frequently
his skepticism was justified by later findings. He did make blunders in his views
regarding tuberculosis and diphtheria; however, his basic positions were sound;
that disease cause and disease process should not be confused; that bacterial toxins
might exist and might e important; and that there are social land constitutional
factors as well as bacteriologic factors to be considered in management of infectious
diseases.
In Berlin, too, Virchow became involved in municipal and in national politics. In
1859, he was elected to the Berlin city council, and he served as a member of that
body continuously thereafter until his death. His studies in public health and his
growing influence permitted him to bring about construction of better sewerage for
Berlin , to build new hospitals, and to bring about improved hygienic conditions
in schools and in other municipal institutions. In 1861, Virchow was elected to
the Prussian diet (legislative body) in which he led a desperate fight against Otto
von Bismarck’s internal dictatorship and external policies of “blood
and iron.” This was one of the few times Virchow failed to get what he wanted.
Bismarck’s ambition to “unify” Germany was fulfilled following
three campaigns which took place during 1864, 1866, and 1870. Birmarck became so
annoyed with “der Kleine Doktor” that at one point he challenged Virchow
to a duel, but this never came about.
Virchow now had friends, pupils, and admirers in every country. Among students who
studied under him were many whose names were to become famous in medical research
and in medicine’s progress, who were to add impetus to the tremendous advances
in world medicine during the latter half of the nineteenth century.
Once more, the center of gravity in Virchow’s life shifted. While continuing
his interest in medical teaching and in politics (he served in the German national
Reichstag from 1880 to 1893), his main interest now turned to anthropology and to
archaeology. Great interest had been developed in Darwin’s theories. While
Virchow recognized their merit, he warned against exaggerated claims of evolution
enthusiasts, such as those of his erstwhile assistant, Ernst Haeckel. In the field
of racial research, Virchow organized and directed a gigantic project involving
the examination of nearly seven million German school children. Aim of the study
was to determine whether or not there was a true “German type,” Virchow’s
findings proved that less than one third of German children were blond and that
there was no evidence of a predominant skull type among them.
At an age when many men would have begun to slacken their activities, Virchow embraced
his new field of interest with enthusiasm. He founded the German Anthropological
Society in 1869, and in the same year, the Berlin Society of Anthropology, Ethnology,
and Prehistory. He also edited the journal of the Society. His activities then spread
to the Near East, where he sponsored Heinrich Schliemann in excavations on the sites
of ancient Troy and of Hissarlik. In 1888, he went with Schliemann and Schweinfurth
to Egypt; and in 1894 he did his own field work in the Caucasus.
Meanwhile, Virchow continued to be the dominant figure in international medicine.
It is said that he could demolish an adversary in a discussion without even raising
his voice. A certain coldness of character probably facilitated his ability to analyze
situation and persons objectively and to get what he wanted. However, he was easily
approachable; he liked, for example, to sit down with friends and students after
meetings for a glass of beer and for singings. He was hospitable and could be very
gay, especially in his family circle. He could be particularly warm toward the lowly
and the sick. With medical men and with students, however, he could be ferocious,
insisting on precise logic and order in relation to mere trifles. Still, he was
tremendously popular as a teacher. Virchow continued to lecture, to write, to edit,
to research, to serve in political bodies, and to influence international medicine,
into his eighty-first year and until his death, September 5, 1902, of cardiac failure
following an accident. Berliners accorded him his final honor – a public civic
funeral.
THE PICTURE
Just past his thirty-fourth year, in 1855, Dr. Rudolf Virchow, while professor at
Wiirzburg University, Germany, propounded his theory of cellular pathology. Lecturing
and demonstrating at his specially made desk in the Wiirzburg Krankenhaus, the slight,
short, fiery professor used microscopes to convince students that cells reproduced
from other cells, and taught that disease results from disturbance of cells by injury
or irritants. Later, in Berlin, Virchow continued to lead international medical
thought, and to teach, to engage in research, to write, to edit, to explore new
fields, land to serve his community politically, until his death in 1902.
REFERENCES:
Ackerknecht, E.H., unpublished monograph.
Ackernecht, E.H: Rudolf Virchow, Doctor, Statesman, Anthropologist, Madison, University
of Wisconsin Press, 1953.
Edgar, I.L. Pathology and Rudolf Virchow, Journal of the Michigan State Medical
Society, Vol.59, 626-631, April, 1960.
Garrison, F.H.: An introduction to the History of Medicine, 4th Ed. Philadelphia,
W>B. Saunders, 1929.
Sigerist, H.E.: The Great Doctors, New York, W.W. Norton and Co., 1933.
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