Virchow and the Pathophysiological Tradition in the 19th Century

Abstract

Chapter 5 traced the mechanistic materialist tradition of blood coagulation studies through the biomedical schism of 1847. This chapter follows the alternative (pathophysiological or ‘vital-materialist’) tradition from the 1830s to the late 19th century, focusing mainly on Virchow’s contribution to our understanding of venous thrombosis. The ‘doctrine of Cruveilhier’ is discussed and the use of the word ‘phlebitis’ is evaluated. Virchow’s life, times and philosophy are briefly reviewed, and we emphasise his familiarity with the work of Boerhaave and Hunter as well as Cruveilhier and the early 19th-century microscopists. Virchow effected a synthesis of these contributions to knowledge, demonstrated that pulmonary emboli originate by metastasis¹ of distant venous thrombi, proved that thrombi and emboli form in moving not static blood, illustrated thrombi apparently anchored on the cusps of venous valves, distinguished clearly between thrombi and clots, and surmised that oxygen is required for thrombosis. We suggest that the ‘Virchow’s triad’ concept originated from a misapplication of his work, and we discuss his opposition to Cruveilhier and his philosophy of biology and medicine.