As an ardent Oslerphile, I have a thing for medical aphorisms. Osler, aside from being a master clinician, legendary teachers, and nerdy prankster (look up the publications of Egerton Yorick Davies, if you do not believe me), also had a knack for coming up with aphorisms that would stand the test of time. Another medical prodigy who had a knack for aphorisms was Rudolph Virchow - pathologist, polymath, socialist, and an elected politician! Yes, indeed, he wore several hats with aplomb. I was reminded of the quotability of Virchow's aphorisms over a small quibble in a Public Health WhatsApp group, about whether or not politics should be included in the discussions on health. Now, I am wise enough to know not to come anywhere near that discussion, so, I vamoosed after dropping off one of the best known, oft quoted, and more often misquoted, Virchow aphorism:
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. Rudolph Virchow. From the original German "Die Medicin ist eine sociale Wissenschaft, und die Politik ist weiter nichts, als Medicin im Grossen." In his weekly medical newspaper, 'Der Armenarzt' (Poor Doctor), Die Medizinische Reform, (3 Nov 1848), 3, No. 18, 125. As translated in Henry Ernest Sigerist, Medicine and Human Welfare, (1941) 93.
Now, he belonged to an era when medical education was considered a privilege. In line with Osler's proclamation that found its way into the pages of Harrison's Internal Medicine, Virchow came up with a quip for the times:
Medical education does not exist to provide student with a way of making a living, but to ensure the health of the community. Rudolph Virchow. Epigraph, without citation, in Robert Perlman, Evolution and Medicine (2013), xiii.
From Tinsley R. Harrison's enduring masterpiece
if it is not already apparent, Virchow was big on Social Medicine, and the role that medicine, and doctors, needed to play in ensuring the continued health of society at large. Many of the Virchowisms I am referring to in this largely copy-pasted list of quotables, were first introduced to me by the various works of Paul Farmer, a physician who has perhaps moved mountains in his journey to surmount montains beyond mountains (see what I tried to do there, but probably did not quite manage to pull off? #nerdalert). One such quote was the onus which medicine, and by extension, healthcare workers, carry...
For if medicine is really to accomplish its great task, it must intervene in political and social life. It must point out the hindrances that impede the normal social functioning of vital processes, and effect their removal. Rudolph Virchow: In Die einheitsrebungen in der wissenschaftlichen medicin (1849), 48. As quoted and citefd in Paul Farmer, Pathologies of Power (2004), 323.
A natural extension of this sentiment was when Virchow stated:
The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction. Rudolph Virchow. As translated in Rudolf Virchow and L.J. Rather (ed.), Collected Essays on Public Health and Epidemiology (1985), Vol. 1, 4. Rudolph Virchow.
The French philosopher Victor Cousin famously stated "l'art pour l'art" - art for the sake of art - when he intended to take the stance that true art was "divorced from any didactic, moral, or utilitarian function". Whilst history has largely forgotten Cousin, and more so in the Anglophone global majority, his words have been rendered immortal.
Virchow chose to take a sharp left turn from this stance. Quite succinctly, he stated the obvious - a sentiment that my forays into policy research has only strengthened. I am actually surprised that this aphorism is not more popular than it is right now.
"Science for its own sake" usually means nothing more than science for the sake of the people who happen to be pursuing it. Rudolph Virchow. In 'Standpoints in Scientific Medicine', Disease, Life, and Man: Selected Essays (1958), 42.
As sharp as Virchow was, my reading seems to indicate that there was a Chandashok-Dharmashok moment in his life, which turned him squarely towards the importance of social medicine and colored his political viewpoints as well.
In 1847-1848, a massive outbreak of typhus broke out in Upper Silesia, and Virchow was asked to investigate the cause of this. Although he did run an assiduous investigation, he was not very successful in quelling the outbreak. He did submit a 190 page report, which basically rewired the politics of public health in Germany.(1,2) He was shocked to see the squalor and penury that affected this region, and quite rightly linked the economic deprivation to the occurrence of infectious diseases. One of the most powerful Virchowism that I have ever read, was actually part of this report:
It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation, that it forgets the most shameful happenings in the daily shame of events, and that it can hardly understand when individuals aim to destroy this infamy. Virchow RC. Report on the typhus epidemic in Upper Silesia. 1848. Am J Public Health. 2006 Dec;96(12):2102-5. PubMed PMID: 17123938; PubMed Central PMCID: PMC1698167.
As a public health doctor, I am still waiting to write that outbreak investigation report where I actually say something immortal like these words. And as far as public health and epidemiology is concerned, I am happy to see that my specialty also finds its place in the anthology of Virchowisms!
Medical statistics will be our standard of measurement: we will weigh life for life and see where the dead lie thicker, among the workers or among the privileged.
Rudolf Virchow, 1848 (quoted in Infections and Inequalities by Paul Farmer, page 1.
Well, a pretty pointless post, hopefully you have enjoyed the Virchowisms!
References:
1. Taylor R, Rieger A. Medicine as social science: Rudolf Virchow on the typhus epidemic in Upper Silesia. Int J Health Serv. 1985;15(4):547-59. PubMed PMID: 3908347.
2. 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 Oct;1(1):65-71. PubMed PMID: 9869827.
