Virchow - A strategist of power

Part 1 by  Johann Siegfried Mohr

Rudolf Virchow (1821-1902), whose first name was persistently written by his father with a ph at the end and who wanted his surname to be pronounced like an F as the first letter and of course without the w at the end, is regarded as an epoch-making physician who, with his research and views, put the medicine of the 19th century on a scientific footing and can be regarded as a direct precursor of today's conventional medicine. As a small farmer's son from Pomerania, he quickly embarked on a meteoric rise through his medical studies in Berlin, earning his doctorate and quickly completing his habilitation, and finally becoming professor of pathological anatomy, which established his international reputation. He was also considered a luminary in many other disciplines, such as anthropology, ethnology and as a prehistoric archaeologist, with a total of over 1800 specialist contributions from his hand.

Virchow was already at school Primus with a talent for languages: besides Latin and ancient Greek, he learned Hebrew voluntarily at grammar school, could speak passable French and learned Italian and English autodidactically during his studies, at least he could read Arabic. His special preferences already during his school years were politics and history, in which he was later to become practically involved, including in the Prussian House of Representatives and the German Reichstag - for four decades and with thousands of speeches (Andree, 107)! In addition, he made outstanding contributions to the hygiene of Berlin in terms of drinking water and sewage supply. The introduction of the state meat inspection to prevent trichinosis can be traced back to his initiative. Commissioned by the Prussian Ministry shortly after his doctorate to investigate the medical causes of an epidemic that had occurred in Upper Silesia, young Virchow did not shy away from publishing his convictions of what he believed to be the political causes of the disease, combined with vehement accusations against the government, during the period of hard bargaining and state police repression of Metternich's restoration policy. During the Berlin uprisings in March 1848, he took part in the barricade fights, albeit not as an activist at the last moment. Karl Marx would have liked to have won him over to his cause and made an unsuccessful attempt to acquire him through a doctor. Virchow was a tireless worker, who restlessly managed a huge workload day after day and worked diligently to expand his epochal work, "cellular pathology". Even during his lifetime, his alleged saying that he had not found a soul in all his sections was already haunting the world. With his own sense of humor, he countered this legend in a parliamentary speech on February 22, 1877, by formulating it in such a way that he asked whether he had already discovered religion with his dissection knife and added that I could... say that I had also not succeeded in discovering superstition through the dissection knife... (Andree, 10). 

Even in his private life he apparently succeeded in establishing a solid marriage and family life with six children, without affairs or prostate problems. With his wife, eleven years younger than him, he seemed to have led an intimate marriage that remained in lively exchange until the end. He himself mastered the cliffs of aging with flying colors until he finally, at over 80 years of age, on the way to a lecture of his own, broke the neck of his femur while jumping off the still moving streetcar, whereupon he died about half a year later. A fraction of what he achieved would be enough for others to be an outstanding honor in their lives! He had received enough medals and awards in his life, but they were not important to him. On the occasion of an upcoming award of the rarely awarded Knight's Cross 1st Class, he wrote quickly to the minister that he would like to spare me (letter 25.1.1856), and about his Privy Counselor title, he said to his father, we would rather keep silent; you know that I prefer to be a simple professor (letter 1856). When he finally came to the necessity of taking his medals out for the first time, he hoped to be able to represent a real monkey of civilization (Letter 9/22/1860). 

Was Rudolf Virchow really such a knight without fear and reproach? Now that the subject, the question of the plagiarism of Virchow's central achievement, his "cellular pathology", is being addressed, it may at first seem as if the notorious search for the dark spot on the white vest has begun, because the accumulation of so many and such outstanding achievements and abilities in one person is unbearable to many. But this question, which apparently criticizes him, is in harmony with Virchow's motto: openness and publicity will always be my flags (Letter 26.1.1843). In this question, to let the real facts of the case be proven right is a (medical) historical necessity, which, however, Virchow's biographers, with the exception of Erwin Ackerknecht, never took up! All the more importance is attached here to the statement of the anatomist Koelliker, who was connected with Virchow in a lifelong friendship. In his autobiography, which was published during Virchow's lifetime (1899), he made public the embezzlement by his friend. So if his good friend already made this clarification, which means an accusation, and Virchow made openness and publicity his own, the following critical examination is authorized against objections of principle. 

I. "The young Virchow" and his great career 

Little Rudolph Ludwig Carl was born on October 13, 1821, the only child of Johanna Maria Hesse (1785-1857) and Carl Christian Virchow (1785-1864) in the small town of Schivelbein in the Pomerania region of Germany. Today the town belongs to Poland and is called Swidwin. His father had taken over a house with 1 ½ Hufe Land (approx. 50 acres of land; 1 acre was considered 25,532 a = 2553,22 m² in Prussia) as an heir and, in addition to his work as city treasurer, he did more bad than good farming, which he exclusively practiced from 1828 onwards and to which he belonged as the former son of a master butcher, who was one of the wealthiest and most respected landowners in the village (Vossische Zeitung, c. n. Feddersen, 46) and at the same time ran a distillery and agriculture (Posner). He had some practical experience, but a far greater passion. Apart from the "Meldung zur Reifeprüfung (Announcement on the graduation)" written by Rudolf Virchow at the age of 17, called "Der kleine Virchow (The young Virchow)" by his daughter Maria Rabl and editor of his letters, there are no biographical sources for his childhood and youth, just as little as he himself left autobiographical information. He must have accepted this deficiency quite consciously, since in his acceptance speech on June 25, 1868 for his deceased father-in-law Dr. Carl Mayer, one of the founders of modern gynecology, he spoke clearly and as if for himself: Here I have to admit that I consider it quite impossible to describe in full clarity the course of development of a man who was so little determined by the coincidence of external circumstances, who was so much shaped by inner drives. Only the deceased's own notes can help out here, alone, as exemplary as he was in the immediate writing of his medical diaries, he thought little of continuing diaries of his personal experiences. What is most instructive for the thinking observer, the knowledge of the course of development, what is most appealing to our human interest and therefore most enduring for our memory, the understanding of the personality in its historical change, which can be presented in a sufficient way, is no longer possible (c.n. Letters, 1907, V). The fact that Virchow himself did not change this lack of information about his development due to his modesty to spare others with his personal affairs is an essential reason to assume. But for a personality who has stood as important in medical and contemporary history as he has, such an omission is also linked to questions; for silence about it is at the same time an elegant way of not having to reveal his cards. In the last chapter we will be better able to examine whether silence also means concealment, because since 2001, for the first time, a historical-critical edition of Virchow's letters, in so far as they have not been destroyed, from the period 1839-64 is available, which contains far more letters (about 900 printed pages) than the almost one hundred years earlier edition of letters, and now offers the letters censored by the editor at that time in their entirety. Some conclusions can be drawn from this complete collection of letters in order to draw a picture of his personality.

Very early on I was interested in illustrated books from his father's book collection, especially animal and plant copper (prints) and the joyful reproduction of smaller stories by his keeper, and my first years of life [...] passed quietly and without more significant events that would have been of greater importance for my later life... (1907, Letters, 1). He learned to read and write almost effortlessly (ibid.) from his father before he even started school. At the age of seven, he attended the municipal elementary school and received additional private lessons in Latin and French from the principal. However, because these lessons were imperfect, he switched to a private school of the Superintendent, which his father had suggested and which was made possible by the lack of compulsory education at the time. After two years, this attempt at school failed and little Rudolf had to return to the old school against his will. There the Primus, who was highly esteemed by the Rector, was overtaxed with tutoring assignments, so that his father again took him to another private school in the fall of 1832. This was dissolved after half a year, but Rudolf's father was able to persuade the teacher, a preacher, to continue to give his son - as the only student - private lessons, which also included Ancient Greek. After this back and forth in school, he now enjoyed the lessons as a privileged individual student with his revered teacher for two years, and was then able to transfer to the grammar school in the town of Köslin, about 50 km away. 

On May 1, 1835, he moved there and entered the Tertia. He showed special inclinations for natural sciences, history and geography, and in Latin the subject teacher liked his knowledge, unusual for a thirteen-year-old (Becher, 1). After four years he passed his high school diploma at Easter 1839, but not without an incident. While his Latin teacher was well-disposed toward him, his Ancient Greek teacher was constantly suspicious of him and suspected him of cheating, since his former private teacher had trained him to translate phrases and whole sentences by heart without any knowledge of grammar. Finally, in the Abitur, the suspicious teacher did not let it be taken from him to vote against him, since he was suspicious of his student's unimaginable knowledge of ancient Greek, and therefore this student did not seem to him to have the "moral maturity for university". Despite this damaging individual assessment, R.Virchow passed his high school graduation, in the rank of first on the list of graduates. 

We know from the father's letters that R. Virchow did not choose to study medicine out of vocation, but that this was the result of his father's considerations. His own wish would have been to study theology in order to proclaim his salvific gospel as a servant of God and to watch over the salvation of the souls of those entrusted to me as a good shepherd (c.n. Goschler, 36). Only his "bad (speaking) organ" prevented him from carrying out this project. However, the poor father was unable to finance his son's university studies, while medical studies at the Friedrich Wilhelm Institute for Military Medicine in Berlin were largely affordable at state expense and "only" required quarterly allowances. However, in the late 1930s there was a great rush for these places, which had been allocated years in advance. Social contacts played a major role in the admission process, while the entrance examination only played the role of an aptitude test (Goschler, 37). The decision to study medicine had to be made 2 years before the Abitur and had to be justified in a German essay. 

The most important "mediator" of the intended place of study was a brother of his father, Johann Christoph Virchow (1788-1856), who was present in Berlin as a major and had enough influence to set the course for admission to the military medical academy. Despite a lack of schooling opportunities, this uncle had distinguished himself as a soldier, later passed the officer's examination and introduced decisive improvements to the military equipment of the army, which had earned him an order from both the King of Hanover and the King of Prussia.

But the role of his maternal uncle, Ludwig Ferdinand Hesse, should not be underestimated in his medical career either. Hesse was an architect and former Schinkel student, headed the castle's building commission, and was the master builder of the Royal Theater, the School of Veterinary Medicine, and the new Charité, among other things. Uncle Hesse sat as a technical member of the curatorium for hospital and veterinary school affairs (letter 7.4.1843), R. Virchow's highest authority, after he was later to work at the Charité. In one of his letters to his father, Rudolf Virchow gives a revealing account of his uncle Hesse, stating that he also held a higher rank among the Maurern brothers. The protector of the order, the Prince of Prussia, united the two large lodges here, and on this occasion, the uncle a, who knows how high, rank was swayed by his uncle (December 4, 1842). Thus, two extremely influential family members were godfathers to his father's idea to help him to a favorable medical education and career.

Thus R. Virchow was able to enter the so-called Pépinière (tree/plant school) on October 26, 1839, when he had just turned 18 years old, and in 1795 the medical training institute, which had been converted into a military academy, as a so-called Eleve (=pupil), where he also received reduced board and lodging during his four-year studies.

The inquisitive new student was particularly influenced by the thinking of his great teacher Johannes Müller, an important physiologist and anatomist. Müller characterized a universal knowledge, which was spread in his versatile lectures and exercises in physiology, anatomy, comparative anatomy, pathological anatomy and embryology. A second great teacher for him was Johann Lukas Schoenlein in special pathology, from whom, in his own words, he received the most powerful inspiration. 

As a seemingly exotic rarity of the study program, which today would be called "Studium generale", he heard about "Arabic poets" from the poet Friedrich Rückert, and was able to attend lectures or talks by such personalities as Alexander von Humboldt, the Brothers Grimm and the philosopher F. Schelling. He sarcastically wrote to his father about Schelling: "We are becoming more and more learned by moving from abroad, and it is already fashionable to listen to Schelling's philosophy. Of course, the philosophers of the profession no longer understand him, or rather, as they claim, Schelling no longer understands himself and brings the most abstruse nonsense to light. This alone does not prevent professors from all faculties, civil servants from all subjects, militairs, local and foreign private persons, Jewish, Christian and Turkish students from hearing him (Letter 13.12.1841). 

R. Virchow was an eager student who got by with little sleep and completed a 54-hour work week, after which only private work could begin. He was not a dry geek, however, who only commuted back and forth between lectures and study room, but rather took part in many festivities and was an enthusiastic dancer through his contacts with professors who were well-disposed towards him and through his two uncles, whom he regularly visited at least once a week (" Uncle Major ") or on holidays (" Uncle Hesse ") and who opened up influential circles for him. During the semester break he undertook extensive traveling, which introduced him to the country and its people. At the suggestion of his history professor - even the subject of history, which is not normally taught in medical school, was a speciality of Pépinière, which must have been very much in line with R. Virchow's inclination - who had asked him about his homeland, the man always interested in history wrote a treatise on the history of the Carthusian monastery at Schivelbein, which was published in 1843.

At Easter 1843, in the fourth year of his studies, he received an application for a surgical position at the Charité, for which he successfully fulfilled the condition of 1 ½ years. So on April 1, 1843, he moved there immediately and passed through several departments, where "the little doctor" was sometimes highly appreciated by the patients because of his attentive and devoted manner. In July 1843 he passed his doctor's examination and in October he was finally awarded a doctorate with his dissertation "On rheumatism, especially cornea". However, now he was still missing the state examination.

The leading military doctors continued to seek to protect their "best graduates" (Andree) in order to establish their own interests and modernization intentions with suitable persons and in appropriate positions. Through the mediation of General Staff Doctor Grimm, Virchow worked as an assistant to the pro-sector of the Charité, Associate Professor Robert Froriep (1804-1861), in the mortuary. Froriep enviously supported others who showed sense and inclination for scientific work. He willingly gave suggestions and pointers... Virchow was most extensively supported by Froriep (Weber, 17). Virchow owed him the assignment of the topic of phlebitis and the reference to the available French technical literature, whose own pathological examination made him aware of the pathogenetic connection between thrombosis and embolism. Froriep even personally arranged for the publication of Virchow's work in his own journal. Through Froriep, he was thus able to write his first independent scientific work in the field of pathological anatomy, which he soon after chose as his field of study.

To celebrate the traditional founder's birthday of the Pépinière, Johann Goercke, the young doctor, popular with his superiors, was given the honour of giving the ceremonial speech on a topic of his choice. The General Doctor Eck, who had commissioned him to give the speech, probably knew, along with the Board of Directors, that he had a draught horse in front of him when he added: "One must finally come forward with a scandal" (Letter 7.4.1845)! The speech became a complete medical profession of faith of the young Virchow. It was titled: "The need and the possibility of a medicine from the mechanical point of view, proven by examples. The therapy of bleeding. The inflammatory blood. The dyscrasia of drunkenness." In it he formulated that medicine does not want just one science, it wants to be a natural science, the highest and most beautiful natural science.Long lost thoughts from the philosophical schools of antiquity have been awakened in it. ... By its very nature, life is cellular activity. ...The life of higher organisms, especially of man, is, after the development of the cell into organs and organ systems, mainly conditioned by the three factors blood, nerves and organ mass, whose integrity must not be disturbed beyond certain latitudes (c.n. Andree, 42). He then determined the path of research into disease and healing in three ways: the clinic by means of physics and chemistry under the supreme direction of physiology and anatomy; experimental animal testing; microscopy in pathology. This was strong stuff for the assembled doctors, who still lived in speculative conceptions and found the "mechanical" (meaning: no external cause) and cellular basis of life and disease a challenge. But with this speech the bold doctor had gained respect. His superiors, including the director of the institution, praised him for it.

For this reason, three months later, he was allowed to give a second speech in celebration of the founding day of the Pépinière, this time with the title "The necessity of a treatment of medicine from the mechanical point of view, explained by the example of phlebitis". In the same way, he presented the new mechanical approach to medicine based on natural science, using the example of his research on thrombosis and embolism suggested by Froriep, and this time he received recognition for his revolutionary, at least totally none-prussian, speech only from the senior military physicians of his institution. 

The fact that such a spirit of progress was present in this military academy of all places becomes clear once again, purely outwardly, from its famous graduates, including von Helmholtz and a number of excellent university lecturers. Of particular importance, however, were the ideas of Johannes Müller, the "most famous physiologist in the world" (c.n. Winter, 20) and of Johann Lukas Schoenlein. Müller taught the method of research based on exact scientific facts without obliging his students to dogmas, which is why he did not establish an actual school in the sense of a teaching system. Schoenlein, who wrote only two scientific papers, which together do not exceed four (!) printed pages, was also a pathologist who aimed at scientific observation. His students attested him "little system, a lot of facts" and he used microscope and chemical examination equipment in a unique way in his clinic. The other not unimportant side, in which the progressive spirit and the benevolence of his superiors so unreservedly benefited Virchow, may well lie in the prestige and influence of his two uncles, who owned them with the directors of the military doctors, and in his diligence, intelligence, enormous self-confidence and persuasiveness. From there, the military doctors saw the possibility of extending their influence through their "foster child" (Pépin) Virchow to the Charité (pro-sector position) and the university (habilitation).

The decisive persons in the highest ranks of the military academy who supported him without reservation in later years were Johann Wilhelm von Wiebel (1767-1847), chief of the military medical staff, a rather primitive man [...] who slept blissfully during lectures (Weber, 16). Johann Karl Jacob Lohmeyer (1776-1852), General Doctor and 2nd Surgeon General of the Pépinière, from 1847 1st Surgeon General Heinrich Gottfried Grimm (1804-1884), Surgeon General, who was in charge of the studies at the Pépinière and easily recognized and extensively promoted the peculiar talents of individuals (Weber, 3), since 1851 head of the Prussian military medical service, a fine man of the world (Virchow). Grimm arranged for Virchow to be given the position as pro-sector under Froriep. 

Johann Arnold Joseph Büttner (1768-1844), 2nd surgeon general and deputy of Wiebels, faithful but a little rough behavior (Virchow). Carl Ferdinand von Graefe (1787-1840), 3rd Surgeon General and co-director, o. Professor and director of the clinical-surgical-ocular institute of the Berlin University.

General Doctor Gottlieb Wilhelm Eck (1795-1848), Director of the Institute and Royal Privy Medical Councillor In the spring of 1846 Virchow passed his state examinations "very well with the predicate Operateur" and now pursued his habilitation. His boss at the Charité, Froriep, informed him of his intention to leave Berlin and propose him, Virchow, as his successor. This opened up the possibility for Virchow to finally leave the career of military doctor instead of continuing the long road of the military medical army road (letter 15.10.1845), and to take a scientific one, because the pathological anatomy, he wrote to his father, lacks any treatment (letter 14.12.1845). R. Virchow actually received the post as pro-sector at the Charité, i.e., the management of the dissecting room, on May 11, 1846, despite preliminary objections by other departments, namely by Schoenlein, "on an interim basis," that is, temporarily. He also benefited from the power struggle between Prussian military medicine and civilian medicine, which sought to prevent the intrusion of civilian doctors by this move. After all, he was one of them. As prescribed, he was discharged from military medical service on April 6, 1847. In the meantime he held private lectures at the university and was able to habilitate on November 6, 1847. Without the necessary waiting period of three years from the state examination, he was again granted admission as a private lecturer by the favor of his superiors, who were convinced of his abilities. In the meantime Virchow had been working for years on the hitherto unknown connections between thrombosis and embolism, as well as on leukemia, and he emerged in specialist articles with his new findings and at the same time with new technical terms originating from him. Together with his colleague Benno Reinhardt, he then published his own medical journal "Archive for Pathological Anatomy and Physiology and for Clinical Medicine" from April 1847 onwards, whose reputation steadily gained from the first issue. The title of his journal was similar to and distinct from that of his great teacher Johannes Müller, whose title was: "Archive for Anatomy and Physiology and for Scientific Medicine". Virchow's self-confidence can be described as extremely strong, and he knew that in this uncharted territory the pioneer was king. Although a true Danaiden work is still to be done, since nothing is properly researched in medicine, the satisfaction that I am now considered an authority in scientific matters by everyone at the Charité, and that everyone believes my statements ... was an encouraging price to pay. I, who worked for such a short time and who do not know so much, I am an authority? It is really ridiculous! How little do those who ask me those who know little need to know first (Letter 24.7.1845)!

On his travels in 1847, during which he made many visits to German and foreign universities and their scholars, he also made contact with the Dutch physiologist, hygienist and ophthalmologist Franz Cornelis Donders, who exhausted all the possibilities of microscopic work, and did so in such an innovative way that later generations of physicians could hardly ever or only again be done with electron microscopy, as the medical historian Andree (p. 49) writes. So he told his parents about these journeys: I now know almost all German universities and most of the German medical greats, and what is no less important, they know me. (letter 27.10.1847)

The decisive event of my life (c.n. Andree, 14), as he put it in retrospect to celebrate his 80th birthday, occurred in February 1848, when the young spur was entrusted by the government with a research trip to Upper Silesia together with the highest Prussian medical officer, Senior Medical Councillor Stephan Friedrich Barez. There, a disease was prevalent which was considered to be the hunger pest/typhus and for whose scientific explanation of the cause R. Virchow alone was responsible. From today's perspective, this epidemic is identified as typhus transmitted by clothes lice. In those 16 days Virchow made extensive inquiries on site and in discussions with colleagues, which led to a comprehensive causal-medical connection of soil conditions, weather conditions, eating habits, social and political grievances etc., which he held responsible for the development of the epidemic. 

Virchow's approach clearly shows how strongly anchored in him was the historical and political, which he had favored since his school days, as is particularly evident in his probably personally motivated notebooks of the last four school years, in which he recorded the most important political events of the day in chronological order (Vasold, 20). His later studies in the fields of anthropology, ethnology and as a prehistoric archaeologist also reveal this historical-political as the center of his scientific being. Hence his definition of medicine as a social science as well as his formulation: The organism is not a uniform but a social institution, not catchy or tendentious metaphors, but coherent classifications from his point of view, which also, conversely, clarify his views on politics: it is nothing more than medicin on a large scale (Vasold, 100). 

The result of his official trip was thus a rather ruthless indictment of the state conditions at his ministerial employer, combined with his demand for free and unrestricted democracy. This in the tension-loaded time of the pre-march 1848! In his accompanying letter to the government authorities, he boldly added: "I do not think I need excuse the frankness with which I wrote this treatise; the interest of humanity demanded that I say what I considered to be scientific truth (c.n. Andree, 16). His report had no negative consequences, however, for at that time some things were in ferment. Those who dared nothing could win nothing, and R. Virchow, who never let his scientific career out of his sight (Balkhausen, 84), played for stakes. In addition, Virchow enjoyed the protection of high military and civil officials. His special protector was now privy councillor J.H. Schmidt (1804-1852) (Ackerknecht, 9), who sat in the ministry. Schmidt was a member of the scientific deputation for the medical profession and an extraordinary professor of obstetrics and director of the corresponding department at the Charité. He had himself written a "pseudo-radical" (Ackerknecht) paper on medical reform. Virchow had become known to him through a medical circle around his future father-in-law, the gynecologist and privy medical officer Carl Mayer. Mayer as president was assisted by Josef Hermann Schmidt as vice president. After all, at the beginning of the revolution almost ¾ of the Berlin doctors (Balkhausen, 91) organized themselves into a medical reform society. The most active leader was Robert Remak, followed by Rudolf Virchow.

After his return to Berlin, he was caught up in the March riots there, which intensified after the bloody military riots against the population at a large rally and led to barricade fighting. Virchow, who was neither privately nor politically a hothead, but a thoroughly convinced Republican, took part in the riots and described to his father in what way he had "gone to the barricades": ... my participation in the riot was a relatively insignificant one. I helped to build some barricades, but then, since I was given only one pistol, I could not be of much more use, since the soldiers usually shot at too great a distance, and a scuffle was not possible among the small number of citizens, at least at my barricade (...). The extent to which we will intervene tomorrow will be discussed in a meeting with Privy Councillor Mayer tomorrow (Letter 19.3.1848). What would have become of Virchow if he happened to have a long-range firearm or a larger number of citizens around him? - But it was only after he had laid out leaflets at the Charité for his democratic goals and was denounced, that he was deprived of free board and lodging at the Charité because of "agitational electoral activities". 

Appropriately, he received a call from the Lower Franconian University of Würzburg, which was looking for a suitable successor to the deceased owner Bernhard Mohr for its chair of pathological anatomy. After Virchow, somewhat irritated, had to give his assurance that "if the opportunity arose, he would not make Würzburg the romping place of his previously announced radical tendencies", he accepted a professorship at the Julius Maximilian University in the winter semester of 1849/50. 

His colleagues included above all the anatomist Koelliker, with whom he was to form a lifelong friendship, and among others Franz von Leydig, a researcher who gave the decisive impulses for the theoretical development of cellular pathology (Andree, 55). Soon after, he told his parents that he had fallen in love with the daughter of the Privy Counselor Mayer, a co-founder of modern gynecology, whom he married soon after. Under her influence, R. Virchow grew a beard, which would adorn him for well over 50 years. The marriage produced six children. 

Through his constantly growing reputation as an innovative pathological anatomist, Virchow managed to attract a steadily growing number of medical students at his new university, from 85 students at first to 400 enrolled in 1856. In his letter to his father of January 2, 1855, he modestly relativized his own share of this steep rate: "It is probably certain that my presence attracts many people, but it is equally certain that the poor condition of the Prussian medical faculties contributes to this very much. Among his students in Würzburg was Ernst Haeckel, who later came to prominence with his exaggerated Darwinian monism. In 1852 Virchow received a commission from the Bavarian Ministry to investigate the "distress in the Spessart", in which he then proceeded more moderately in judging the political causes. 

The fruit of his Würzburg work was then to be found in his return to Berlin in 1856, where, after two years, he formulated the manifesto of scientific medicine in 20 lectures: "cellular pathology". After the death of Heinrich Meckel von Hemsbach, a.o. professor and prosector of the Charité, Johannes Müller himself had proposed a separate chair for pathological anatomy at the University of Berlin, with R. Virchow as its holder, which was surprisingly approved by the king and ministry. Müller did not want to have anyone else but Virchow, so that his competitors R. Remak and Th. Billroth were left without a chance. Billroth then wrote to a friend: "Everything is a mess (...) There is hardly any question of scientific consideration; everything is cabal, party interest, the cavalry of individual parties; and on the whole, one does not know what one wants (c.n. Goschler, 158). But Müller knew exactly who and what he wanted. Although Müller had never worked so closely with any of his students as he had with his former student Robert Remak, whom he held in high esteem, the latter did not stand a real chance because of his Jewish denomination and scientific activities, which were not primarily focused on anatomical pathology. Even Virchow's former opponents were meanwhile taken with his reputation! His conditions after the construction of a new pathological institute, his own sick bay at the Charité and a certain annual salary were willingly accepted.

His further career was now greatly influenced by his interests and commitment, as he put into practice the combination of social science and medicine that he saw: medicine is a social science and politics is nothing more than Medicin on a large scale. As an elected representative, he regularly and actively participated in the Berlin City Council since June 1859. Together with Theodor Mommsen and others, he founded the "German Progress Party" in June 1861 and was elected to the Prussian House of Representatives in May 1862. In 1880, he was elected to the German Reichstag, a position he held until 1893. This highly committed activity resulted in thousands of speeches with the result of significant improvements for the Berliners and the German Reich, which can only be listed incompletely here: the official meat inspection for trichinosis, an exemplary sewage system and drinking water supply for Berlin. 

Virchow was from the outset a declared opponent of Bismarck, whose "theory" of the gap regarding the budget approval denied by the Prussian deputies he clearly accused of arbitrary ignorance of constitutional rights. Even on Bismarck's 80th birthday in 1895, he remained adamant, keeping his party away from the official homage ceremony for the 'Iron Chancellor', whose removal was a precondition for the recovery of the popular spirit (c.n. Vasold, 369). He was to get into a personal argument with Bismarck, when he felt his honor had been injured by his remark in a sharp (Andree, 97) speech in Parliament on June 2, 1865, and the next day, in his reply in Parliament, he called for a duel with the professor, unless Virchow averted this necessity by a declaration of honor! Virchow's core statement, which Bismarck criticized, was rhetorically skilfully formulated in an if-then conditional sentence: "But, if he has read it and can say that there are no such declarations in it, then I do not know what to think of its truthfulness. Bismarck had already fought a duel with a member of parliament in 1852, but both duelists had not met from a short distance. Thus Virchow rejected the charming and honorable advantage of having, with a single, unpunished hit, put the fate of the future Germany and of European history on a different track, which in retrospect would have given him the greatest merit and fame! In his "Diary of War of 1870/71" the later Frederick III, who reigned as Emperor for only a few months, wrote the following about Bismarck: "Bismarck made us great and powerful, but he robbed us of our friends, the sympathies of the world, and - our good conscience. Even today I firmly hold to the view that Germany without blood and iron ("iron and blood" was Bismarck's characteristic formula in his speech before the Prussian House of Representatives on September 30, 1862) could make "moral conquests" and become united, free and powerful solely by his good right. Then it gained a completely different preponderance than that which was achieved merely by the force of arms, because German culture, German science and German mind had to win respect, love and - honor for us. The bold, violent Junker wanted it differently. Virchow's omission was thus a world-historical one. By interpreting the mischief of "old pigtails" like a duel between the Prime Minister and a member of parliament as argumentatio ad hominem, he refused Bismarck's demand and could rely especially on the support of the President of the Chamber of Deputies, who sought to prevent such an apolitical practice. 

On June 17, 1865, in his parliamentary speech, R. Virchow skilfully reaffirmed his previous statement with a proof and exposed the tactics of Prime Minister Bismarck, who had launched the matter of a duel through the back door into the sensationalist press - for whose basic right to press freedom many had stood up for in the decades of the Carlsbad resolutions under Metternich's restoration policy - in order to put pressure on Virchow. - A procedure that Bismarck reissued with great success in 1870 with the Emser Depesche. - But Virchow had not allowed himself to be intimidated and escaped the attempt to make an example of himself by being publicly bitten off by the power politician Bismarck. On the contrary, he managed to use clever means to prevent Bismarck from getting his way and to speak his mind with impunity. 

Virchow's deep-rooted historical interests are particularly evident in his rich work in prehistoric archaeology, anthropology and ethnology. He had friendly relations with Heinrich Schliemann, who is still considered the discoverer of Troy (see R. Schrott, Gilgamesh), and traveled there to undertake his own studies. As a researcher as well as a sought-after scientist he visited places and meeting places in Europe and worldwide. The range of his extensive work and his activities as a pathologist, medical reformer, hygienist, anthropologist, ethnologist, prehistoric archaeologist, politician, has been catalogued for years in a historical-critical complete edition in about 71 volumes. 

In my opinion, however, there is not yet any work that meets the requirements of such a company and has developed a convincing personality profile for his biography. Therefore, in the final chapter of this article (part 2), we will attempt to analyze the accents of his personality without offering a comprehensive biographical description. As preliminary work for this, I consider the profound works of W. Becher, C. Goschler and Chr. Andree to be indispensable, whereby the latter, as editor of the historical-critical Virchow edition, has deciphered Virchow's handwritten notes and, together with other found objects, made valuable material accessible.

II: The "Cellular Pathology" Virchows 

Virchow's "cellular pathology" of 1858 marked a new era in the history of medicine, whose manifesto he wrote with it. To understand it better, it is necessary to go back from our present location to the time of Virchow, when completely different ideas shaped the thinking and acting of medicine. In retrospect, this epoch is referred to as the Biedermeier and Romantic periods. In it, the countercurrents to idealism gradually formed, with the enthronement of materialism, as, for example, in theology by D.F. Strauß' "The Life of Jesus", in the natural sciences by Buechner's "Power and Substance" and Darwin's "On the Origin of Species by means of Natural Selection, or the Preservation of favoured Races in the Struggle of Life", in philosophy and social sciences by Marx and Engels "Historical Materialism", and others. Now materialism became the new idol. More or less scientific methods instead of speculative ideas became the hallmark of the new medical era, as they were successfully passed on to their students by the Berlin ancestors J. Müller and J. Schoenlein. Virchow, with his nucleus sentence omnis cellula e cellula , i.e. every cell emerges from a cell (Note: The Latin diminutive form cellula, which Virchow reused, is supposed to express the microscopic smallness of the cell compared to the usual meaning of cella = monk cell. In German this is unnecessary. For this reference I would like to thank Dr. R. Volz) who classified the cell as the smallest unit of the organism in the "pathological" processes, thus referring to a biological basis of the disease, which he maintained in all consistency. What this means is particularly evident in his attitude towards cancer, to which he devoted his special attention. He refused to acknowledge any kind of external control and only allowed cell-specific modifications. Virchow represented a new type of the scientifically trained researcher who now used the microscope, animal experiments and a chemical laboratory to gain insight into the "disease process". 

Until then, after the gradual drying up of the humoral pathology, which will be discussed in a moment, the ideas of the already mentioned philosopher F. W. Schelling, who as the "high priest" (Fischer-Homberger) of the so-called "romantic medicine" had undertaken a spiritual system as an attempt to explain all known natural phenomena in his "Bible" "Draft of a System of Natural Philosophy" of 1799, were decisive. For Schelling, all natural phenomena were the result of an infinite, but never complete effort of a world spirit [...] to realize itself. ...The natural phenomenon was always only an unfinished realization of the "idea," it was always "visible" only in its incompleteness, but its essence had to be "seen" on the background of its idea by virtue of the spirit. ... Thus, the view of science as a vision of God and the scientist as a partial revelation (...) was obvious (Fischer-Homberger, 96f.). In Schelling's view, illness represented a relapse to a deeper stage of evolution (ibid.): With this degree of irritability, with which you feel ill, a deeper organization would be well situated (ibid. 97). If illness had originally been theologized as sin, anachronistic development had now become the measure of the illness that is in any case erroneously occurring. Old wine in new skins. 

Another speculative "method" was the concept of humoral pathology or also called "Krasenlehre" in German, which originated in antiquity and aimed at the composition of the four bodily fluids: bile, black bile, mucus and blood as a basis for diagnosis and therapy. In Virchow's time, it received its modern application from the leading pathologist of his time from the leading 'Viennese School', Carl Rokitansky, who had performed thousands of sections like nobody else. His endeavor was to show that all diseases in each of their stages were accompanied by a material change in the body. 

But how can this be reconciled with the view that instead of leaving the only tangible substances of the organs and tissues to the formless juices, which virtually melt between the fingers of a pathologist, he should leave the sovereignty to the formless juices? It was not possible for pathologists to establish such anatomical-pathological findings in many general diseases and some specific others. Therefore, the only way out for Rokitansky was to look for the primary process of all diseases in the blood (Diepgen, 145). When he published his three-volume "Handbook of Pathological Anatomy" in 1846, in which he laid down his seemingly paradoxical Krasenlehre, the newly licensed 25-year-old Virchow resolutely took the opportunity to launch a devastating attack on the leading head in the Viennese medical stronghold. The 17 years older professor was initially acknowledged by the newcomer as the "Linné of pathology" and had no objections to his findings, which he cited as a pathologist in his book, but then he dismissed him with his Krasenlehre like a stupid schoolboy. Virchow rejected the unproven assumptions of the great pathologist as not scientifically justified, showed that he constructs chemical differences where only physical or morphological ones are found, differences of such a peculiar kind that they completely contradict all our chemical knowledge (c.n. Weber, 49), and added that Rokitansky performs a trick - perhaps unconsciously used - which consists in elevating every possible combination to the rank of a factual matter (ibid.). The fact that Rokitansky took the view that "every disease [could] be the object of anatomical studies at every stage of its development" was a salto mortale! For in certain cases there is no anatomical correlate for it, but this altered appearance belongs to the sphere of responsibility of (pathological) physiology, so that Rokitansky's dogma that pathological anatomy contains everything "that there is of positive knowledge and of the foundations and of such in the Medicin" [contradicts] our conviction and our experience in the most decisive way (ibid., 50). Virchow's criticism was both merciless and competent. Rokitansky reacted by deleting the criticized passages in the new edition.

In contrast to all these speculative conceptions of disease, Virchow now emerged in 1855 with an article of the same name and finally in 1858 in "Cellular Pathology", as the title already indicates, with a biologically founded, cellular concept of disease. Due to the sections he performed on deceased patients over many years, using the best microscopic equipment, and based on his extensive knowledge of original language publications, he was now able to present for the first time a scientifically founded, generally valid concept of disease. The biological basis was the cell as the organic unit, as the simplest carrier of life (c.n. Weber, 78), to which every normal process as well as every pathological event was bound. 

For us today it is almost a matter of course, at that time a novelty, especially because biology at that time had not yet recognized the cell structure (cell organelles) and the question of cell proliferation was not clarified. The prevailing view on this was held by Schwann, who had observed the cellular basis of plant organisms recognized by Schleiden in animal organisms as well. Schleiden and Schwann now postulated a spontaneous cell formation, a free cell formation, which should proceed like crystallization. As a result of this "organic crystallisation", a kind of "solidification process", the cell nuclei, the cytoblasts, were supposed to emerge from a homogeneous protein mass, called "blastem", through a process of abiogenesis. Virchow was also a follower of this theory for many years. On the other hand, since 1832 there had been the view of cell division as a reproduction process in plant organisms. For animal organisms, this view was first established by Virchow's contemporary, Robert Remak, to whom we will return later. Virchow codified (Fischer-Homberger) this new cell theory even before his "cellular pathology" with the key sentence: omnis cellula e cellula, i.e. every cell originates from a cell in his article of the same name from 1855. The spontaneously imagined cell formation thus became a continuous one. Virchow had not only adopted this view, but had himself researched it for a long time. Supposedly, an inflammation should result in the crystallization of cell masses due to the fluid from the blood vessels, the "plastic exudate". Virchow, who had written his dissertation in 1843 "on rheumatism of the cornea", however, also observed inflammation and tissue formation on the avascular cornea after accidents or corresponding eye diseases - but without "plastic exudate". The same was true for the examined cartilage. Cartilage is part of the connective tissue that was considered cell-free in Virchow's time and, due to its discovery, now also contains cells. Even in tissues containing blood vessels, he did not find the postulated amorphous, protein-containing exudate, but cells. However, along with the inflamed cells, the environment, the area of the basic substance belonging to the cell was also affected, which he called cell territory (c.n. Weber, 77) in his terminology. It also included the intercellular substance. Although his observations contradicted the prevailing view, Virchow needed another twelve years to formulate his new insight. 

In between, he made a connection to the so-called vitalism, which believed in a "vital force" as a principle of life that could not be proven scientifically. Every cell is as such a closed unit, which has absorbed in itself the reason, the principle of its life, which carries in itself the laws of its existence and which has a certain autonomy in relation to the rest of the world (c.n. Weber, 78). Although he understood the potency of a cell, its "life force", in such a way that it must ultimately be thought of as the expression of a certain interaction of physical and chemical forces (ibid, 87), the phenomena of life [...] were not simply to be understood by him as a manifestation of the natural forces inherent in the substances, but he believed that the essential reason for life was to distinguish a co-healed, derived force from the molecular forces (c.n. Weber, 87), which he, the natural scientist, did not shy away from calling "vital force". This striking change by Virchow from mechanism to neo-vitalism was mainly due to the fact that his newly chosen point of reference, the cell with which he had only apparently removed the vague notions of the old humoral pathology, had in turn contained an unknown quantity that needed at least a name. One of his critics feared that a new "dogmatism" would thus be established and a renaissance of the poison of empty phrases and romanticism (c.n. Ackerknecht, 47) would set in. 

Even higher organizations, such as the brain, as the center of cell life do not exist - [for Virchow] - (Diepgen, 115). The biological starting point cell now also became the basis for the (pathological) starting point of the disease. If a "disturbance" occurs in the life of the cell, it will also damage the cell territory it supplies. Virchow thus moved the disease from the area outside the cell, from the "juices", into the cell itself. In doing so, he made it clear that there is no essential difference between life and illness (Diepgen, 148). The manifestations of the so-called illness are only unseemly, but not alien, manifestations of life, unseemly according to the measure or place or time of their occurrence, but within the once given limits and forms of human expressions of life. Only the causes of illness, not the manifestations of illness, are of specific peculiarity (c.n. Weber, 105). The illness is life itself, life under changed conditions, whether these conditions are changed by external or internal causes (Diepgen, 148). The essence of the disease, the "ens morbi", is thus located within the cell.

But what about the so-called infectious diseases that were microscopically identified as pathogens by his contemporary Robert Koch? Virchow would by no means admit that such colorful comedies, as he laughingly said under the first impression of the microscoped cholera bacilli, were making an epidemic (c.n. Schleich, 193). Later he described it in an arranging way as a fight of the cells against the parasitic microorganisms or against the bacteria. Apparently, two living microorganisms are hostile to each other: the microscopic cells, the vital elements of the body on the one hand, the even smaller fungi, these lowest plants on the other hand. Both are endowed with their own life, i.e. also with their own activity, with their own forces. Which of them is the aggressor? How does he make his attack? Does the other resist and convey which characteristics? Which of the two is destroyed? These are the questions which, in his opinion, must be answered. That the disease is a fight is an old thesis.... 

But life as such cannot fight, but only the living being can fight... (c.n. Weber, 89). But it was far from Virchow's intention to provide a uniform explanatory model from one principle before all pathological-anatomical facts had been collected. A clever move, which helped him out of the explanatory difficulty of his limited pathological approach, even if his localism was more refined than that of Rokitansky, because he noticed that not every local pathological disorder leaves an anatomical lesion (Ackerknecht, 47). One focus of his research was cancer. He rejected the view, which at the time was outraged, that cancer develops according to a completely new plan, according to a completely new law (c.n. Weber, 94). In a consistent biological attitude he understood instead that every kind of tumor formation, it may be as it wants to be, essentially corresponds to known typical formations of the body, and that the most essential difference of the different tumors among themselves is that tissues of the body, which are normal in themselves, sometimes appear in the form of tumors in the midst of places, which contain these tissues in the normal state, and sometimes in places, which do not contain these tissues normally. The first I call homology, the second heterology (c.n. Weber, 95). Virchow thus remained absolutely on the path that his teacher J. Müller had taken when he wrote in his 1838 study "On the finer structure and forms of pathological tumors": ...the carcinoma is not a heterologous tissue and the finest parts of its tissue do not differ substantially from the tissue parts of benign tumors and the primitive tissues of the embryo (c.n. Diepgen, 122). Thus Virchow could not share the views of the developing oncology, which frequently observes changes in tumor cells in the form of enlarged nuclei, multinucleation, etc., as this, in his opinion, does not constitute a specific peculiarity in other biological as well as pathological cell processes.

It is no longer the disease we are looking for, but the altered tissue; it is no longer an alien being that has penetrated the human being, but its own being that we are researching (c.n. Weber, 107). Accordingly, there was also no division into benign or malignant cancers for him, as his teacher Müller had set it up, and for him the botanical distinction between poisonous and non-toxic plants was too much of a distinction. As advanced and necessary as the investigation of disease processes on a pathological level was, it happened through him in the "spirit" of the time: Virchow was the materialist of "cell autonomy", where the biological reference level was proclaimed in the form of the cell and "codified" (Fischer-Homberger) as a new manifesto in his "Cellular Pathology", so that now the disease was locked into a cell. Even if illness is an expression of life, only unseemly in terms of place, time and measure, and thus foreign influences or unbiological excesses are excluded, the establishment of the cell in Virchow's sense tears off the possibility of seeking a connection between the mental constitution and the genesis of illness, as it had long been anchored in popular knowledge. Was it ironic when Virchow said about the tender liver of a dissected animal that it had probably never had any trouble in its life? With his medical credo, which introduced a "refined" localism and "mechanism", he thus exerted a profound influence on the attitude of the new generations of physicians, which even today, despite corrected and more complete findings, still shapes the attitude of orthodox medicine. Already during his lifetime, in the last two decades of the 19th century, he began to drift increasingly away from medical development as bacteriology and cancer research advanced, which could not, however, diminish his fame as a pathologist and scientific founder of medicine - and of course as a benefactor of Berlin and the German Empire, as well as a great researcher in other disciplines. When he died of a mild (heart failure) death on September 5, 1902, thousands of Berliners and many delegations from overseas attended his funeral. The city of Berlin remembered his great, dead honorary citizen with the funeral, which was decided for the first time at the expense of the city.

III. Author or plagiarist? Witnesses for the prosecution 

Virchow's epochal significance in the history of medicine is linked to his "cellular pathology", which for the first time placed medicine on a biological and scientific foundation. Since, as indicated at the beginning, some reservations about his priority have been made, these should be considered and the question of whether Virchow is rightly or wrongly entitled to this credit should be examined. In one of his last letters to his father, he argued that he had many enemies, and it is often difficult for me to hold my own in the place I stand, but none of these enemies has yet tried to challenge my honesty. He wrote this on 4/2/1864, six years after the publication of his "cellular pathology". Is this statement alone correct?

Witness no. 1 

Let us turn to the first witness, Albert Koelliker (1817-1905), Professor of Anatomy and Physiology, who taught in Würzburg for fifty years from 1847, where Virchow also held his chair from 1849-56, and where the two remained united in a lifelong friendship. Koelliker was also a student of Johannes Müller, held the Dr. phil. and the Dr. med. and had been prosector of the important microscopist and anatomist Jakob Henle. In the early 1950s, he wrote the first "Manual of Tissue Science" and a "Microscopic Anatomy and Tissue Science of Man", which were so important that almost all other histological textbooks were based on them until the 20th century (Diepgen, 120). Together with Henle, he was considered a master of microscopic research, who everywhere brought new findings or new clarification to already known results (ibid., 119 f). It is thus clear that Virchow's friendship with Koelliker had been based to a great extent on scientific exchange. 

After Koelliker retired in 1897, he published his "Memories from my Life" in 1899, in which the loyal man added interesting details about Virchow's "cellular pathology". After all, Virchow had for years still adhered to the "blastet theory", the spontaneous cell formation from an amorphous mass, although his own studies had shown him otherwise. During the Würzburg period, however, his turning point gradually came, which thus occurred in close proximity to and in a decisive scientific question of Koelliker. Koelliker wrote about Virchow:

"Gradually, however, a change occurred in this question, as Virchow, through observations of connective tissue cells and pathological formations, gradually came to assume that in pathological new formations, cell formation starts from the already existing cells, in which the nuclei multiply by division and form endogenous cells around themselves."

In 1855 Virchow came to an end and expressed this in his famous formula: omnis cellula e cellula in his essay "Cellularpathology". 

"Mine and the efforts of Reichert, Bischoff, Bergmann and Remak, whom we had long since proven the uninterrupted sequence of cell forms for normal development, are not remembered by Virchow in all his deductions with a single word, and so it came about that he was and was regarded as the founder of the keyword just mentioned, even in the field of normal cell theory." (p. 199)

Koelliker, who, notwithstanding the merits of Schwann, considered himself the actual founder of cellular physiology (p. 193), had already in 1845 in all his publications started from the cellular elements as the actual carriers and mediators of life processes. However, he had doubts about the general validity of his findings and therefore granted some rights to spontaneous cell formation, since Virchow himself still held to this theory in 1851. It was only through Virchow's reports on pathological cell formation that I too came to abandon free cell formation altogether and, as with embryonic development, to establish the proposition for adults and for pathological cases that all cells of the organism develop in an uninterrupted sequence from the egg cell itself (p. 200).

From Koelliker's precise description it thus becomes clear that Virchow had taken over the knowledge of continuous cell formation from others and that his achievement should lie in its transfer to pathological cell formation. But it is also clear that he embezzled the researchers cited by Koelliker. In addition, many works on the history of medicine point out that Virchow's famous Latin formula had already been published in 1831 by the founder of histochemistry, François-Vincent Raspail (1794-1878). 

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