Letter to Lord Chamberlain Hugo Radolinski

Rudolf Virchow and Cellular Pathology

Letter

By: Ruldolf Virchow (translated by Thor Yager, M.D.)

Date: January 1, 1888

Source: Clendening History of Medicine Library. University of Kansas Medical Center.

About the Author: Rudolf Virchow (1821–1902) was a pioneer in pathology and cell biology. He was the first to recognize leukemia, in 1845, and he also investigated thrombosis (blood clots), embolism, cancer, and inflammation. Born in Schivelbein in Prussia, Virchow was educated in medicine at the University of Berlin and took up a position at the Charité teaching hospital in that city. Virchow showed that cells came from other cells, rather than being spontaneously generated, and that diseases, such as cancer, originate within the cells of the body. He was a political liberal who used his influence to draw attention to public health issues such as infection and lack of sanitation.

INTRODUCTION

Rudolf Virchow addresses this letter to Hugo Radolinski, senior aide to Crown Prince Frederick III of Prussia. Radolinksi was an ally of Bismarck, the "Iron Chancellor" to whom Virchow was opposed. The crown prince, referred to here as "His Imperial Highness," had been ill for some time with a growth on his larynx and had been residing in the Italian seaport and health resort of San Remo since November 3, 1887. The printed materials Virchow refers to are pathology reports he had written on biopsy samples taken from the growth. His comments underline the difficulty of making a firm diagnosis of malignancy (cancer) in this case.

The tissue had been taken from the larynx by Dr. Morell Mackenzie who was later knighted by Queen Victoria for his services to the crown prince (who was her son-in-law, having married Victoria, her eldest child). The tumor was thought, by some of his doctors, to be cancerous. However, Virchow was unconvinced of the diagnosis. The prince, for his part, had refused radical surgery, believing his prognosis to be favorable. His father died on March 10, 1888, and the crown prince became kaiser, returning immediately to Berlin. However, his condition deteriorated and he died on June 15 of that year. A postmortem examination revealed destruction of the larynx by cancer and secondary disease in the lymph glands. Three of Virchow's four reports on the pathology of the tumor were translated into English and published in the journals The Lancet and The British Medical Journal in late 1887 and early 1888.

PRIMARY SOURCE

Berlin, 1 January 1888

Your Highness,

Today I wanted to express my personal thanks & good wishes for the New Year. Since I missed you at home, I don't want to fail to make up for it in writing.

At the same time, I left behind an envelope with a few small printed materials with the door-keeper, which could perhaps be of some interest to His Imperial Highness. I ask the materials be permitted to be taken along to S. Remo at some time.

I would also like to add some words of reassurance. However, I can not say anymore than what in fact other statements have already made known, that so far the evidence does not prove the cancerous nature of the growth. This finding is unfortunately very incomplete & not without great contradictions.

Dear Count, please accept the assurance of my very special high esteem.

R. Virchow

PRIMARY SOURCE

LETTER TO LORD CHAMBERLAIN HUGO RADOLINSKI

See primary source image.

SIGNIFICANCE

Virchow had written a major 1,800-word text on cancer, Die Krankhalten Geschwülste (The Tumor Sickness). He also was experienced in the microscopic examination of biopsy material, which been an established method of clinical investigation since the 1830s. He knew that findings could often be misleading because the biopsy sampling could have missed the malignant part of the tumor. In other words, even if the specimen looked normal, there still was no guarantee that the tumor was, in fact, benign.

The German press was highly critical of Dr. Morell Mackenzie, the attending physician, and Virchow, believing that they had misdiagnosed and mishandled Crown Prince Frederick's illness. Mackenzie had been brought over to England to treat the prince at the instigation of his wife, Crown Princess Victoria. Prior to the date of this letter, Virchow had examined biopsies of growths on the prince's larynx that Mackenzie had removed and declared them cancer-free, although, as he points out here, the findings were not definitive. As the prince's illness worsened, Mackenzie was demoted and another physician carried out an emergency tracheotomy. In February 1888, Mackenzie wrote in The Lancet that cancer had still not been officially diagnosed in the prince's case. He also felt that the tracheotomy had not been well performed. The prince certainly suffered significant complications from the process and was not well enough to attend his father's funeral. Indeed, the treatment may well have hastened his death. After the prince's death, the German press severely criticized Princess Victoria for having allowed a British physician to treat her husband.

Frederick was succeeded by his son, Wilhelm II, who led Germany into World War I. Had Frederick lived longer, his experience in diplomacy might have averted this catastrophic war and saved millions of lives. But, would he have survived, if Virchow and his other physicians had made a diagnosis of cancer of the larynx earlier? It seems unlikely. In the late nineteenth century, major surgery, such as removal of the larynx, often resulted in the patient's death, either during the procedure or shortly thereafter.

FURTHER RESOURCES

Books

Rather, Lelland J. A Commentary on the Medical Writings of Rudolf Virchow. San Francisco: Norman Publishing, 1990.

Web sites

American Academy of Otolarynology Virtual Museum. "Famous Figures: Morell Mackenzie." 〈http://www.entnet.org/museum/mackenzie.cfm?renderforprint=1〉 (accessed October 29, 2005).