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Theodore M. Brown is with the Departments of History and the Department of Community and Preventive Medicine, University of Rochester, Rochester, NY. Elizabeth Fee is with the History of Medicine Division, National Library of Medicine, National Institutes of Health, Bethesda, Md.
Correspondence: Reprint requests should be sent to Theodore M. Brown, PhD, History Department, University of Rochester, Rochester, NY 14627 (e-mail: theodore_brown{at}urmc.rochester.edu).
GENERALLY REGARDED AS one of the most brilliant and influential biomedical scientists of the 19th century, Rudolf Carl Virchow was, remarkably, also one of the most courageous and inspiring proponents of social medicine.1 He was born on October 13, 1821, in Schivelbein, Pomerania, then in eastern Prussia, but since 1945, part of northwestern Poland. Rebellious and intellectually gifted, in 1839 Virchow won a scholarship in 1839 to the Friedrich-Wilhelms Institut in Berlin, Germany, where he received his medical education.2 After obtaining his MD in 1843, he was appointed to an internship at Berlin’s Charite Hospital where he began his clinical career.
He also initiated chemical and microscopic research, which led to his first publications and bold proclamations of the need for a drastic overhaul of medical research. In 1847, the 26-year-old Virchow co-founded a new journal, Archives for Pathological Anatomy and Physiology and Clinical Medicine (later Virchow’s Archives), which became a major force in the modernization of medical science. In 1849 he left Berlin for Würzburg to accept Germany’s first chair in pathological anatomy. Soon after launching a comprehensive, 6-volume Handbook on Special Pathology and Therapeutics in 1854, Virchow returned to Berlin to head a new pathological institute and in 1858 published his classic Cellular Pathology. In the 1870s, while remaining a prolific biomedical scientist, Virchow also turned his attention increasingly to anthropology and archaeology. He died on September 5, 1902, much honored worldwide as one of the towering scientists of his era.
Virchow’s career in social medicine was equally remarkable. His most famous contribution was his "Report on the Typhus Epidemic in Upper Silesia" excerpted here. The report originated when Virchow was asked by the Minister of Education to help investigate scandalous conditions in this poor rural area under Prussian control, with a large population of "ethnic Poles." Although he studied many dimensions of the epidemic, his 190-page report is best remembered for its final 30 pages.3,4 Here Virchow applied ideas on the social causation of disease, derived from French and English sources, to conditions in Silesia and showed a close and sympathetic familiarity with Friedrich Engels’ stirring indictment, Condition of the Working Class in England (1844). Caught up in the heady atmosphere of his revolutionary times, Virchow enthusiastically endorsed what he proudly labeled "radical" political recommendations: introduction of Polish as an official language, democratic self-government, separation of church and state, and the creation of grassroots agricultural cooperatives.
After returning to Berlin in March 1848 to participate in "revolutionary" political action on the streets, in July, Virchow helped found Medical Reform, a weekly newspaper that promoted the cause of social medicine under the banners "medicine is a social science" and "the physician is the natural attorney of the poor." He continued until June 1849, when increasingly reactionary political pressures forced him to suspend publication. He became politically quiet in the early 1850s (as did many European radicals). When he returned to Berlin later in the decade, he again became active, although now in more moderate ways. In 1859 he was appointed to Berlin’s City Council, a position he held until his death, and there worked on sanitary and other public health reforms.5 In 1861 he helped found the German Progressive Party and was elected to the Prussian diet as a leader of the constitutional forces opposed to Otto von Bismarck. Virchow later continued that fight as a member of the German Reichstag from 1880 to 1893.
Virchow’s dual career has been widely inspirational. He is often credited for being one of the first to make the case for the social origins of illness and the multifactorial etiology of epidemics.6,7 But beyond that he has also served as a powerful icon, hero, and role model because he was both a leading scientist and an insistent proponent of the social grounding of medicine, public health reform, and political engagement.8,9
Accepted for publication September 11, 2005.
References
1. Risse GB. Virchow, Rudolf Carl. In: Gillispie CC, ed. Dictionary of Scientific Biography. XIVVol 14. New York, NY: Charles Scribner’s Sons; 1976:39–44.
2. Ackerknecht EH. Rudolf Virchow: Doctor, Statesman, Anthropologist. Madison, Wis: University of Wisconsin Press; 1953.
3. Pridan D. Rudolf Virchow and Social Medicine in Historical Perspective. Medical History. 1964;8:274–278.[Medline]
4. Azar HA. Rudolf Virchow, not just a pathologist: a re-examination of the Report on the Typhus Epidemic in Upper Silesia. Ann Diagn Pathol. 1997;1:65–71.[CrossRef][Medline]
5. McNeely IF. "Medicine on a Grand Scale": Rudolf Virchow, Liberalism, and the Public Health. London, England: The Wellcome Trust Centre for the History of Medicine at University College London, Occasional Publication, No. 1; 2002.
6. Waitzkin H. The social origins of illness: a neglected history. Int J Health Serv. 1981;11:77–103.[ISI][Medline]
7. Taylor R, Rieger A. Medicine as social science: Rudolf Virchow on the typhus epidemic in Upper Silesia. Int J Health Serv. 1985;15:547–559.[ISI][Medline]
8. Eisenberg L. Rudolf Ludwig Karl Virchow, where are you now that we need you? Am J Med. 1984;77:524–532.[CrossRef][ISI][Medline]
9. Silver GA. Virchow, the heroic model in medicine: health policy by accolade. Am J Public Health. 1987;77:82–88.
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