Rudolf Ludwig Carl Virchow (1821-1902)

Rudolph Carl Virchow (13 October 1821 – 5 September 1902) was a German doctor, anthropologist, pathologist, prehistorian, biologist and politician, known for his advancement of public health. Referred to as "the father of modern pathology," he is considered one of the founders of social medicine.

In 1861, he was elected a foreign member of the Royal Swedish Academy of Sciences. In 1892, he was awarded the Copley Medal. Among his most famous students was anthropologist Franz Boas, who became a professor at Columbia University.

The Society for Medical Anthropology gives an annual award in Virchow's name, Rudolf Virchow Award.

Life and scientific career


From a farming family, he studied medicine and chemistry in Berlin at the Prussian Military Academy from 1839 to 1843 on a scholarship. When he graduated in 1843, he went to serve as Johannes Peter Mueller's assistant at the Charité Hospital. At this time, the German medical tradition was inclined more towards ‘romantic speculation’ and ‘naked empiricism’, in contrast with the more scientific approach found in England and France.

At Charité, he learned microscopy alongside with Robert Froriep. Froriep was 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. In 1848, he qualified as a lecturer at the University of Berlin, and became Froriep's successor. Unlike his German peers, Virchow used to have great faith that clinical observation, animal experimentation (to determine causes of diseases and the effects of drugs) and pathological anatomy, particularly at the microscopic level, were 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 1600s, the building blocks of life was still considered to be the 21 tissues of Bichat, a concept described by the French physician Marie Bichat. Because his writing were not receiving favourable attention by German editors, he associated with Benno Reinhardt in founding the Archiv für pathologische Anatomie und Physiologie und für klinische Medizin, world-famous as “Virchow's Archives,” which 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.

In 1849, he was employed as chair of pathological anatomy at the University of Würzburg, leaving his post at Carité where he was experiencing political persecution. During 6-year period there he concentrated on his scientific work, including detailed studies on venous thrombosis and cellular theory. By 1856, Virchow was asked to return from Würzburg to the Charité Hospital in Berlin. Such a reinstatement was evidence of the name he was achieving for himself in scientific and medical circles. He became Director of the Pathological Institute and remained in charge of the clinical section of the hospital for the next twenty years.

Cell Biology


Virchow is credited with multiple important discoveries. Virchow's most widely known scientific contribution is his cell theory, which built on the work of Theodor Schwann. He is cited as the first to recognize leukemia cells. He was one of the first to accept the work of Robert Remak, who showed that the origins of cells was the division of preexisting cells. He did not initially accept the evidence for cell division, believing that 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 ("every cell originates from another existing cell like it."), which he published in 1858. (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 non-living matter. It was believed, for example, that maggots could 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.

Anatomy
Another significant credit relates to the discovery, made approximately simultaneously by Virchow and Charles Emile Troisier, that an enlarged left supra-clavicular 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, coining the term embolism and thrombosis. He noted that blood clots in the pulmonary artery originate first from venous thrombi, stating: "The 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 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 very innovative work may be viewed as sitting 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".

Autopsy
Virchow also developed a standard method of autopsy procedure, named for him, and many of his techniques are still used today.

Anthropology and prehistory biology
In 1869, Virchow 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, and of which he was several times president. In 1879, he made a journey to the site of Troy, described in Beiträge zur Landeskunde in Troas (1879) and Alttrojanische Gräber und Schädel (1882). 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" in 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," furthermore declaring that the "results of craniology" led to "struggle against any theory concerning the superiority of this or that European race" on others.

Virchow famously delivered an anti-Darwinian lecture on human and primate skulls, in which he emphasized the lack of fossil evidence for a common ancestor of man and ape.

Political career
More than a laboratory physician, Virchow was an impassioned advocate for social and political reform, stating that:

"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... The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction."

Virchow made himself known as a pronounced democrat in the year of revolutions in Germany (1848). Prior in the same year, the government-employed doctor Virchow was asked to investigate an epidemic of typhus in the poverty stricken area of Upper Silesia by the Prussian government. His political views are evident in his Report on the Typhus Outbreak of Upper Silesia (1848), where he states that 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 minor part in the revolution caused the government to remove him (1849) from his position, although within a year 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 Würzburg, where he was continued his scientific research. Six years later, he had attained fame at 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 the Berlin citizens, namely working towards modern water and sewer systems. Virchow is also credited with the founding of "Social Medicine", frequently focusing on the fact that disease is never purely biological, but often socially derived or spread.

The Sausage Duel
As a co-founder 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. There are two versions of this anecdote: in one version, Virchow declined 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 states that Virchow, having been the challenged and therefore entitled to choose the weapons, selected two pork sausages: a cooked sausage for himself and an uncooked one, loaded with Trichinella larvae for Bismark. His challenger declined the proposition as too risky.

One area where he co-operated with Bismarck was in the Kulturkampf, the anti-clerical campaign against the Catholic Church claiming that the anti-clerical laws bore "the character of a great struggle in the interest of humanity". It was during the discussion of Falk’s May Laws (Maigesetze) that Virchow first used the term.

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.

He is widely regarded as a pioneer of social medicine, and anthropology.

Family
In August 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:
 * Karl Virchow (1 August 1851 – 21 September 1912) – a chemist
 * Hans Virchow (10 September 1852 – 7 April 1940) – a prominent anatomist
 * Adele Virchow (1 October 1855 – 18 May 1955) – the wife of Rudolf Henning, a prominent Germanist
 * Ernst Virchow (24 January 1858 – 5 April 1942)
 * Marie Virchow (29 June 1866 – 23 October 1951) – the wife of Carl Rabl, a prominent Austrian anatomist
 * Hanna Elisabeth Maria Virchow (10 May 1873 – 28 November 1963)

Virchow died of heart failure. He is buried in the St. Matthews Cemetery in Schöneberg, Berlin, together with his wife.

Works
He was a very prolific writer. Some of his works are:
 * Mittheilungen über die in Oberschlesien herrschende Typhus-Epidemie (1848)
 * Vorlesungen über Cellularpathologie in ihrer Begründung auf physiologischer und pathologischer Gewebelehre, his chief work (1859) The 4th edition of this work formed the first volume of Vorlesungen über Pathologie below.
 * Die Cellularpathologie in ihrer Begründung auf physiologische und pathologische Gewebelehre. (1858; English translation, 1860)
 * Handbuch der speciellen Pathologie und Therapie, prepared in collaboration with others (1854–76)
 * Vorlesungen über Pathologie (1862–72)
 * Die krankhaften Geschwülste (1863–67)
 * Ueber den Hungertyphus (1868)
 * Ueber einige Merkmale niederer Menschenrassen am Schädel (1875)
 * Beiträge zur physischen Anthropologie der Deutschen (1876)
 * Die Freiheit der Wissenschaft im Modernen Staat (1877)
 * Gesammelte Abhandlungen aus dem Gebiete der offentlichen Medizin und der Seuchenlehre (1879)
 * Gegen den Antisemitismus (1880)

Medical terms named after Virchow

 * Virchow's angle, the angle between the nasobasilar line and the nasosubnasal line.
 * Virchow's cell, a macrophage in Hansen's disease.
 * Virchow's cell theory, "omnis cellula e cellula" – every living cell comes from another living cell.
 * Virchow's concept of pathology, comparison of diseases common to humans and animals.
 * Virchow's disease, leontiasis ossea, now recognized as a symptom rather than a disease.
 * Virchow's gland, Virchow's node.
 * Virchow's Law, during craniosynostosis, skull growth is restricted to a plane perpendicular to the affected, prematurely fused suture and is enhanced in a plane parallel to it.
 * Virchow's line, a line from the root of the nose to the lambda.
 * Virchow's metamorphosis, lipomatosis in the heart and salivary glands.
 * Virchow's method of autopsy, a method of autopsy where each organ is taken out one by one.
 * Virchow's node, the presence of metastatic cancer in a lymph-node in the supraclavicular fossa (root of the neck left of the midline). Also known as Troisier's sign.
 * Virchow's psammoma, psammoma bodies in meningiomas.
 * Virchow-Robin spaces, enlarged perivascular spaces (EPVS) (often only potential) that surround blood vessels for a short distance as they enter the brain.
 * Virchow-Seckel syndrome, a very rare disease also known as "bird-headed dwarfism".
 * Virchow's triad, the classic factors which precipitate venous thrombus formation: endothelial dysfunction or injury, hemodynamic changes and hypercoaguability.