Rudolf Virchow (1821–1902), the German cellular pathologist whose contribution to public health Mackenbach1 discusses in this issue of the Journal of Epidemiology and Community Health (see page 181), is a paradoxical figure. In 1848, he was a modern social reformer and an innovative scientist, but, when it came to public health, he was old-fashioned. He believed that diseases such as cholera and typhus were caused by air pollution, which, since Hippocrates (460 bc–370 bc), has been referred to as miasma. The first two citations in table 1 are explicit in this respect. True, he was in agreement with some of the greatest public health figures of his time: William Farr in England and von Pettenkofer in Germany. Sewage systems, clean streets and hygienic lodging, which Virchow promoted in Berlin, contributed to improving the health of the people. But these were politically progressive ideas backed by scientifically wrong causal thinking.

The praised 1848 “Report on the typhus epidemic in Upper Silesia”,3 commissioned from Virchow by the Prussian Minister of Education, was modelled after the Hippocratic treatise On Airs, Waters, and Places.9 Virchow reviewed the environmental, climatic and anthropological characteristics of Upper Silesia, a poor region of Eastern Europe, located between what is now the Czech Republic and Poland. As in the Hippocratic tradition, he described the clinical manifestations of the disease he himself had observed and illustrated them with a series of individual case descriptions. He still viewed typhoid fever as an abdominal form of typhus, and did not attempt to quantify and compare the traits of the two diseases, as Louis had done in 1829.10

Virchow was old-fashioned too when he proposed, in the sentence that Mackenbach1 cites, that the cell was a citizen of the body just as humans were citizens of …