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Wednesday, March 11, 2020

AHEAD OF PRINT: WHAT LIES BENEATH

How Did SoMe Become Synonymous with Evisceration?

BY MICHELLE JOHNSTON, MBBS

Most of us cut our basic science teeth on Rudolf Ludwig Carl Virchow and his buffet of eponymous conditions. Virchow had a penchant for naming pathological things.

To be fair, he discovered a good number of them. His colleagues referred to him as the pope of medicine. Not only do we have Virchow's node (the malignant herald in the left supraclavicular fossa) and Virchow's triad (the holy trinity of clotting), we also have Virchow-Robin spaces (perivascular fluid) and Virchow-Seckel syndrome (microcephalic primordial dwarfism). It may surprise you to learn that he was also the first to describe many other pathological entities upon which he selflessly declined to bestow his name, such as leukemia, amyloid, and spina bifida.

Today's column, however, does not sing the praises of Virchow's discoveries, but instead delves into one of his lesser known interactions with a political figure of the time. Before we cross to his opponent, it's worth knowing that in 1865 Virchow took great interest in the parasitic roundworm, Trichinella. Trichinosis was at the time cutting a great swath of often fatal illness through pre-Germany, and our man Virchow was hellbent on getting to the bottom of it. Uncooked sausages were found to be a common culprit, which is where our story gets a little unusual.

Let us turn our attention to Otto Von Bismarck, a shrewd politician who was named Minister President of Prussia by King Wilhelm in 1862. Von Bismarck and Virchow were not friends. Virchow, you see, also dabbled liberally in politics, and the two powerful men clashed over almost all issues legislative. Things took a nasty turn over proposed funding for the Navy. Insults were traded, which then escalated. A savage bout of slander was fought out in public letters. By 1865, Bismarck had had quite enough, and formally requested Virchow to retract his accusations of dishonesty. Virchow refused.

The Unfought Battle
Like all men of honor, the only way to resolve such a dispute was the call to duel. Now, because Virchow was the challenged party, in the longheld stipulations and regulations of duelling, he had the choice of weapon. Not being a particularly brawly man, he chose, allegedly—wait for it—a sausage. A snag. A snorker. A frank. A wiener. A banger (just in case you had any doubt this is an internationally relevant column).

Bismarck and Virchow would eat a single sausage each, one of which was riddled with trichinosis, leading to a delayed and painful death, and the other would have a good meal. Despite a flurry of correspondence (and the fact that duels were pretty much illegal by then) and several more insults, the challenge dissolved. No sausage battle was fought.

This story, however, which has been passed down through the ages and has been the source of much entertainment (and is now established deep in internet folklore), is probably not true. It was first recorded in, of all places, a homeopathic journal in 1893. The challenge to duel was true; the sausage story, sadly just titillation, fittingly, in a journal that even back then was happy to publish untruths and sensationalism.

The point, though, of this vignette is not necessarily to learn about the wurst activities of one of pathology's greats, but to consider a perspective on argument. Duelling was one way of dealing with disagreement, and it was surprisingly tidy (unless you were a second). It was discreet and involved little collateral.

Ferocious Attacks
Fast forward to disagreements today. Consider the blunderbuss approach, the colosseum nature, the rampant pile-on, the fallout that occurs on social media during discourse. Medicine, unfortunately, is not immune. #MedTwitter has somehow become synonymous with ferocious attacks and group evisceration of individuals. It is not a level playing field. Whether it is a group shaming people publicly for an innocent misstep or, at the other end of the spectrum, for a gross breach of professionalism (witness the justifiable ire at recent medical TikTok videos), there are always victims.

It's new territory, what we do on these mass, global, instant communication platforms. And it's been easy to mistake chastising and judging others online for discussion. But without the individualism, the social cues, the nuances of normal discourse, these disagreements have the potential to be devastating. I know I've been guilty of this, and am only now learning how to conduct myself with more decency and integrity online. It's not easy, but it is necessary. The boundaries of respect online are not easy to see, and it behooves us to be mindful of the consequences of our words every time we hit reply.

Without pining for the days of the duel, bratwurst or not, there is something to be said for the resolution of conflict and debate through private correspondence without inviting the world to jump in, half-cocked, like a flintlock pistol. This is our new communication frontier. Well may we learn how to wield it.

Dr. Johnston is a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, http://michellejohnston.com.au/. She also contributes regularly to the blog, Life in the Fast Lane, https://lifeinthefastlane.com. Follow her on Twitter @Eleytherius, and read her past columns at http://bit.ly/EMN-WhatLiesBeneath.

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