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Commentary

Rudolf Virchow: A Physician and Politician

Bobby Yanagawa, PhD (0T8), Faculty of Medicine, University of Toronto


Ali Okhowat, BSc (1T0), Faculty of Medicine, University of Toronto

Upper Silesia is a resource rich and populous area nested in the Physicians in Politics
Silesian highlands split between Poland and Czech Republic. During Physicians are the natural attorneys of the poor, and social problems
the mid 1800s, this region was a poverty-ridden corner of the Prussian should largely be solved by them
Empire. In 1848, Rudolph Virchow, then a young physician, was -Virchow
commissioned by the Prussian Government to investigate a typhus epi-
demic in the region. Living amongst the impoverished for weeks and Greatly influenced by his experiences in Upper Silesia,
bearing witness to the abject poverty and famine plaguing the mainly Virchow thought of society as a diseased organism, where the
Polish communities, Virchow penned his “Report on the Typhus physician-statesman is the healer and the state, the instru-
Epidemic”1, wherein he offered not purely medical, but social and polit- ment of policy. He was not alone in this regard, and in fact
ical suggestions for reform. From his perspective, overcrowding, poor history is filled with examples of physicians who answered
hygiene, and malnutrition were at the root of the outbreak. Virchow the call of oppression to make positive and lasting change
postulated that the physical ailments of poor and marginalized popu- beyond medicine.
lations paralleled the material and physiological suffering of his José Rizal was a physician and outspoken advocate for
patients. His prescription was thus to institute a vision of democratic peaceful reforms who led an uprising against colonial Spain at
self-governance. This was the initial inspiration behind Virchow’s the end of the 19th century. Considered the first modern pro-
notion of social medicine. ponent of non-violent reform and revered by many as the
father of Philippines, his two books, Nori Me Tangere and El
Who was Virchow? Filibustrimo, became the heart of discontent of an oppressed
Medicine is a social science, and politics nothing but medicine on a people and sparked revolution. Born in a country near 300
grand scale years of Spanish colonial rule, Rizal trained medicine in
-Virchow Philippines, Madrid, Paris and Heidelberg. Politically, Rizal
founded The Philippine League, a progressive organization to
unite the indigenous population and to defend against injus-

A
renaissance man is defined as one with broad intellectual tice by peaceful means. Unfortunately, in 1896, he was exe-
interests and accomplishments in the arts and the sciences. cuted for his role in the revolution. Two years after his death,
Rudolph Ludwick Virchow (1821-1902) was such a man in the first Philippine Republic was established with the
every sense of the word.2 He lived in a formative time in German Proclamation of Independence.
medicine, during the emergence of Koch’s germ theory of dis- Salvador Allende graduated with a medical degree from
ease and Bismark’s Realpolitik. His contributions revolution- the University of Chile and established a practice among pub-
ized the field of cellular pathology, indeed, he is widely con- lic welfare patients in Valparaiso. As the Chilean Minister of
sidered the father of modern pathology. Yet he effected para- Health, he produced an analysis of the social origins of disease
digm shifts in several other arenas as a scholar, a healer, a sci- and suffering in Chile in which he framed illness as a distur-
entist, a politician, and a passionate public health advocate. bance of the individual fostered by deprived social conditions.
Importantly, Virchow developed the notion of social medi- Allende was elected President in 1971 with a socialist platform
cine and conceptualized medicine and politics as falling on a to improve the socio-economic welfare of Chile's poorest citi-
continuum as described in his celebrated statement: zens through wage increases and nationalization of health and
“Medicine is a social science, and politics nothing but medi- education. He held the office of the President of the Popular
cine on a grand scale.” He was a physician by training but Unity government in Chile until his assassination in 1973 dur-
freely crossed traditional disciplinary boundaries for the bet- ing a coup d'état.
terment of people’s health. To Virchow, the advancement of These physician-leaders saw suffering and took a political
society required politics aimed at the social and economic road to resolve their perceived injustice. Although it is diffi-
well-being of man as well as medicine, which was concerned cult to credibly claim that their medical training had an
with the promotion of health. As a member of the Berlin impact on their political philosophies, by their own accounts
Representative Assembly, Virchow’s work in public health their work was strongly influenced by their exposure to health
included modernization of the water supply and sewer system, inequalities during their medical training. In the preface to
and improvement of meat inspection and hygiene in schools. Nori, Rizal juxtaposed the societal ills during the time of
Centuries later, his holistic view of health was echoed in the Spanish occupation with a spreading cancer: “In the catalogue
World Health Organization (WHO) definition of health as “a of human ills there is to be found a cancer so malignant that
state of complete physical, mental and social wellbeing, and the least touch inflames it and causes agonizing pains…a
not merely the absence of disease or infirmity.”3 Given the social cancer.”4 Similarly, Allende wrote “it is not possible to
demands of modern medicine, can physicians nowadays provide health and knowledge to a malnourished people,
engage in politics and, like Virchow, make positive change? dressed in rags and working under merciless exploitation.”5
Even Che Guevara who trained in medicine and led a revolu-

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Commentary

Rudolph Virchow

tion to educate and nourish children and distribute the lands among the top 20 causes of morbidity and mortality in the
to the people who worked them wrote in his essay On Western world.10 Against this backdrop, one can better appre-
Revolutionary Medicine, “…I came into close contact with pover- ciate the impact of global conflict on morbidity and mortality.
ty, hunger, and disease; with the inability to treat a child Today, global conflict is synonymous with international ter-
because of lack of money; with the stupefication provoked by rorism and civil war. With few exceptions, the response to con-
continual hunger and punishment, … And I began to realize flict has been military counter-terrorism. However, one simply
that there were things that were almost as important to me as cannot win the contemporary “war on terror” as long as the
becoming a famous scientist or making a significant contribu- structural violence of repressive social forces renders groups
tion to medical science: I wanted to help those people.”6 Each hopeless, helpless, and desperate to seek resolve. To win the
of these physicians ventured outside of the clinical setting to hearts and minds of the disenfranchised, we need to offer a
improve social inequalities with varying degrees of success. better alternative and herein physicians can help.
Can physicians today really offer something unique to
mainstream politics? We argue that appreciation of the impor- Prevention
tance of prevention is an important quality that physicians can My politics were those of prophylaxis, my opponents preferred those of
bring to the many issues in the political arena. Indeed, theo- palliation
ries of preventative medicine can be applied to poverty, crime, -Virchow
education, and environmental sustainability, among others.
Here, we will briefly present the social issue of global conflict Contemporary preventative medicine can be conceptual-
and highlight how physician-let groups are contributing to a ized as primary actions taken before an unwanted event
positive policy change. occurs, secondary actions taken to lessen or reverse the pro-
gression of an event, and tertiary actions undertaken to limit
Global Conflict the sequelae.11 Physicians have already utilized preventative
If disease is an expression of individual life under unfavourable cir- paradigms to help fight infectious diseases, malnutrition and
cumstances, then epidemics must be indicative of mass disturbance improve standards of living for the impoverished. Yet anoth-
-Virchow er example of this occurs where a preventative framework
used to treat social situations of conflict and war.
Century % Deaths per Mid-century Conflict-related Within the scope of conflict resolution, primary preven-
population population deaths tion can take the form of funding for basic health and educa-
(millions) (millions) tion. Here, physicians who appreciate preventative medicine
16th 0.3 493.3 1.6 must encourage their elected representatives to live up to the
Millenium Development Goals to donate 0.7% of their gross
17th 1.1 579.1 6.1
national income.12 Alternatively, physician groups may
18th 0.9 757.4 7.0 become proactive to mitigate risk factors that contribute to
19th 1.7 1,172.9 19.4 war. Prominent examples include organizations such as
20th 4.4 2,519.5 109.7
International Physicians for the Prevention of Nuclear War
Table 1. Conflict-related Deaths Over Centuries
(IPPNW), Physicians for Global Survival (PGS) and Physicians
for Human Rights (PHR).13 Each of these groups target deter-
The face of war and its casualties has changed dramatical- minants of war and conflict and seek to create social and polit-
ly throughout the ages. Indeed, violent conflicts now account ical conditions that maintain peace. An example of this can be
for a greater proportion of deaths than any other cause as we found in countries blessed with natural resources but poor
find more and more efficient ways to kill each other (Table governance, which are breeding grounds for civil wars.
1)7. During the First World War, roughly 90% of those killed Termed the “Resource Curse,” unfortunate examples include
were soldiers and only 10% were civilians. In the Second illegal trading of blood diamonds which have fuelled conflicts
World War, even if one takes into account all victims of the in Angola, Sierra Leone and the Congo, among others.10
Nazi death camps as war casualties, civilians made up about Here, advocacy by organizations such as PHR promote poli-
half of those killed. The conflicts of today are taken to the cies that restrict the exploitation of resource rich countries.
streets and as a result, the proportion of civilian casualties has Similarly, PGS and IPPNW promote “Peace Through Health”
climbed to nearly 75%. Furthermore, for every person killed, initiatives by educating the public and special interest groups
the health of 15 others is negatively impacted by traumatic on framing war as a public health disaster. These and count-
injuries, destruction of infrastructure, poor sanitation, long less other examples demonstrate that physicians can use their
term psychiatric illnesses, and a myriad of other indirect understanding of the determinants of health to advocate for
insults. social and economic reforms to prevent the root causes of
Conflict disrupts social programs such as health and edu- conflict.
cation, destroys infrastructure, and spreads poverty and infec- Secondary prevention is appropriate where war has broken
tious diseases. Consider that eight of the 10 countries with the out and peace must be restored. A prominent example
lowest primary school enrolment have undergone conflict in includes the negotiated ceasefires in the mid-1980’s between
the past 10 years. Consider also, of the 17 countries with UNICEF and the Church in Equador to allow for immuniza-
greater than 100,000 orphaned from HIV/AIDS, 13 were in or tion and other health interventions.12 The Iraq Body Count
on the brink of war.9 In fact, by 2020, war is projected to be Project, is yet another example where private citizens cata-
logue civilian deaths in Iraq in order to quantify the civilian

UTMJ • Volume 85, Number 2, April 2008 73


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Rudolph Virchow

toll of the war in Iraq and, in doing so, arming politicians with access to clean water is about half the cost of ice cream in
facts used to lobby for help.14 Such initiatives share the com- Europe. It is clear that affordability is about political priorities.
mon goal of employing medically related interventions to
lessen the morbidity and mortality associated with the disease Conclusion
of war. In its most general sense, Western medicine is a trade in
When considering tertiary prevention, remember that half the service of compassion as doctors are trained to heal illness
of all countries emerging from conflict relapse within five and promote health. Rooted in the Hippocratic Oath, physi-
years. Foreign aid following conflict resolution typically dries cians are trained to preserve life, to heal ills, and above all, to
up within months to years and falls sharply as international do no harm. At first glance, the realms of medicine and poli-
attention focuses elsewhere. Against this backdrop, tertiary tics seem worlds apart. However, in the broadest sense, they
prevention aims to prevent the cycle of violence through are both based on the interactions between people and the
peace settlements and the rebuilding of communities. Civil application of medicine – its principles, values, and lessons –
service organizations, such as Medicins Sans Frontier and the can be applied to social and political problems. Whether by
International Committee for the Red Cross, work on the front promoting Peace Through Health, negotiating ceasefires
lines to prevent relapse to war and in doing so, use medical around medical priorities, or building health capacity follow-
interventions to build health capacity following episodes of ing the outbreak of war, the threads of humanism that physi-
conflict. Another prominent example is the World Health cians weave through these prevention initiatives have the
Organization’s Health as a Bridge for Peace program, which sup- potential to create a common fabric of shared purpose and
ports health workers in delivering health programmes in con- understanding that are essential to conflict avoidance and res-
flict and post-conflict situations and thus also contributes to olution.
peace-building. Overall, prevention within the tertiary sphere The competing demands of a contemporary medical prac-
rounds out the trilogy of preventative measures that can be tice today are many yet the need for physicians to take on
used within the health care sectors to create the conditions for advocacy and leadership positions must become a greater pri-
a sustainable peace. ority. Realize that we have enormous potential as advocates
for our patients and our communities to engage in the type of
Global Spending US $ (billions) transformational leadership that may empower our commu-
Cosmetics in the United States 8 nities and lead to lasting change.
Ice cream in Europe 11 Virchow once claimed that diseases are “always traceable to
Perfumes in Europe and the US 12 defects in society.” This is a call to engage in political debate,
Pet foods in Europe and the US 17 to have the courage to speak up and a steadfast belief in the
Business entertainment in Japan 35 possibility of reform and the betterment of society for our-
Cigarettes in Europe 50 selves, our profession, and ultimately, our future patients. The
Alcoholic drinks in Europe 105 possibility of providing a fresh perspective is too great, the
Narcotics drugs in the world 400 potential to make positive change too valuable.
Military spending in the world 780
Basic education for all 6 References
Water and sanitation for all 9 1. Virchow R. Communications about the typhus epidemic in Upper Silesia.
Arch Pathol Anat Physiol Med. 1849 2: 143-322.
Reproductive health for all women 12 2. Boyd A. Rudolf Virchow: The scientist as citizen, New York: Garland; 1991.
Basic health and nutrition 13 3. WHO. Preamble to the Constitution of the World Health Organization as
adopted by the International Health Conference, New York, 1946.
Table 2. Global Spending Priorities 4. Rizal J. Nori Me Tangere. Makati City, Philippines: Bookmark Inc.; 1996.
5. Gossens SA, Cockcroft JD. Aukland, New Zealand: Ocean Press; 2000.
6. Gerassi J. Venceremos! The Speeches and Writings of Che Guevara, London,
UK: Simon and Shuster; 1968.
Regardless of where physician efforts fall on the continu- 7. Taipale I, Mäkelä HP, Juva K, Taipale V, Tapanainen H. War or Health? A
um of prevention, they can lobby on behalf of the disenfran- Reader. London, UK: Zed Books; 2001
8. Southall D. Protecting Children from Armed Conflict. BMJ, 1998, 316: 1549-
chised and offer relevant expertise regarding the determi- 50.
nants of health to guide policy decisions. The current 9. “Trade and Development Report 2004: Policy Coherence, Development
Strategies and Integration into the World Economy.” Geneva.
response to conflict leaves much to be desired. It was elo- [http://www.unctad.org/en/docs/tdr2004_en.pdf]. May 2005.
quently described in the 2005 Human Development Report: 10. Murray CJL, Lopez AD. The Global Burden of Disease: A comprehensive
“Today’s security strategies suffer from an overdeveloped mili- assessment of mortality and disability from diseases, injuries and risk factors
in 1990 and projected to 2020. Cambridge: Harvard University Press; 1996.
tary response to collective security threats and an underdevel- 11. Yusuf S, Anand S, MacQueen G. Can medicine prevent war? Imaginative
oped human security response.” This gap is further widened thinking shows that it might. BMJ. 1998, 317: 1669-70.
12. Yeo SE. Programme of Action: Raising resources. UN Chron. 1999, 36:11.
as preventative foreign aid suffers at the expense of funding 13. Buhmann C. The possibilities for the health sector to actively contribute to
military counter-terrorist initiatives. When the affordability of peace processes, Dan Med Bull 2007, 54: 60-1.
prevention programs is questioned, it is helpful to consider an 14. Arya N. Peace through Health How Health Professionals Can Work for a Less
Violent World. Bloodfield, CT: Kumarian Press; 2008.
analysis of global spending priorities that reveals military 15. Human development report 2005. International cooperation at a crossroads:
spending to trump all other spending (with the exception of Aid, trade and security in an unequal world. New York.
(http://hdr.undp.org/en/media/hdr05_complete.pdf). November 2007.
narcotic drugs) is sobering (Table 2)15. Total funds spent on
basic health, sanitation and education represent approxi-
mately 5% of military spending. Illustrated another way, the
annual 7 billion dollars needed for 2.6 billion people to have

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