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Virchows Vorlesung Über Allgemeine Pathologie 1887/88 Im Vergleich Mit Dem Heutigen Wissensstand

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Virchows Vorlesung Über Allgemeine Pathologie 1887/88 Im Vergleich Mit Dem Heutigen Wissensstand Aus dem Institut für Pathologie der Medizinischen Fakultät der Charité – Universitätsmedizin Berlin DISSERTATION Virchows Vorlesung über allgemeine Pathologie 1887/88 im Vergleich mit dem heutigen Wissensstand zur Erlangung des akademischen Grades Doctor medicinae (Dr. med.) vorgelegt der Medizinischen Fakultät Charité – Universitätsmedizin Berlin von Felicitas Langner-Viviani aus Berlin Gutachter: 1.Prof. Dr. med Dr. h.c. H.Guski 2. Prof. Dr. med. Th. Schnalke 3. Prof. Dr. med. Dr. h. c. H. K. Müller-Hermelink Datum der Promotion: 19.11.2010. ____________________________________________________________ INHALTSVERZEICHNIS Inhaltsverzeichnis 1. Einleitung ........................................................................................................... 5 2. Aufgabenstellung ............................................................................................. 15 3. Die allgemeine Pathologie Virchows im Vergleich mit der gegenwärtigen Lehrmeinung .................................................................................................... 18 3.1 Zur Klassifikation der Krankheiten: Vergleich der Gliederung der Virchowschen Vorlesung zur allgemeinen Pathologie mit derjenigen heutiger Lehrbücher ............... 18 3.2 Die Virchowsche Vorlesung zur allgemeinen Pathologie im WS 1887/88 anhand einer Mitschrift und die heutige Auffassung zu den behandelten Themen .................. 22 3.2.1 Geschichte des Krankheitsbegriffs: Virchow-Vorlesung (S.1-7) ................................ 22 3.2.2 Krankheit und Krankheitsursachen: Virchow-Vorlesung (S.7-35) .............................. 24 3.2.3 Krankheit und Krankheitsursachen: Aktuelle Lehrmeinung ........................................ 32 3.2.4 Infektionskrankheiten: Virchow-Vorlesung (S.35-109) .............................................. 33 3.2.5 Infektionskrankheiten: Aktuelle Lehrmeinung ............................................................ 50 3.2.6 Erbliche Krankheiten: Virchow-Vorlesung (S.109-123) ............................................. 61 3.2.7 Erbliche Krankheiten: Aktuelle Lehrmeinung ............................................................. 65 3.2.8 Ernährung: Virchow-Vorlesung (S.123-146) ............................................................... 66 3.2.9 Ernährung: Aktuelle Lehrmeinung ............................................................................... 72 3.2.10 Nekrobiose: Virchow-Vorlesung (S.146-179) ............................................................. 75 3.2.11 Nekrobiose: Aktuelle Lehrmeinung ............................................................................. 83 3.2.12 Pigmente: Virchow-Vorlesung (S.180-191) ................................................................ 84 3.2.13 Pigmente: Aktuelle Lehrmeinung ................................................................................ 86 3.2.14 Käsige Metamorphose: Virchow-Vorlesung (S.191-202) ........................................... 90 3.2.15 Käsige Metamorphose: Aktuelle Lehrmeinung ........................................................... 93 3.2.16 Amyloid: Virchow-Vorlesung (S.202-211) ................................................................. 93 3.2.17 Amyloid: Aktuelle Lehrmeinung ................................................................................. 95 3.2.18 Verkalkung: Virchow-Vorlesung (S. 212-232) ............................................................ 98 3.2.19 Verkalkung: Aktuelle Lehrmeinung ........................................................................... 103 3.2.20 Nekrose: Virchow-Vorlesung (S.232-244) ................................................................ 105 3.2.21 Nekrose: Aktuelle Lehrmeinung ................................................................................ 108 3.2.22 Entzündung: Virchow-Vorlesung (S.244-269) .......................................................... 110 3.2.23 Entzündung: Aktuelle Lehrmeinung .......................................................................... 116 ____________________________________________________________ INHALTSVERZEICHNIS 4. Diskussion ..................................................................................................... 121 4.1 Krankheit und Krankheitsursachen ............................................................................ 121 4.2 Infektionskrankheiten ................................................................................................. 123 4.3 Erbliche Krankheiten .................................................................................................. 130 4.4 Ernährung ................................................................................................................... 132 4.5 Nekrobiose ................................................................................................................. 135 4.6 Pigmente ..................................................................................................................... 136 4.7 Käsige Metamorphose ................................................................................................ 139 4.8 Amyloid ...................................................................................................................... 139 4.9 Verkalkungen ............................................................................................................. 141 4.10 Nekrose ....................................................................................................................... 143 4.11 Entzündung ................................................................................................................. 145 5. Allgemeine Schlussfolgerungen .................................................................... 150 6. Zusammenfassung ......................................................................................... 158 7. Literaturverzeichnis ....................................................................................... 160 8. Eidesstattliche Erklärung ............................................................................... 165 9. Lebenslauf...................................................................................................... 166 10. Danksagung ................................................................................................... 167 ___________________________________________________________________ EINLEITUNG 1. Einleitung Im Wintersemester 1887/88 hielt Rudolf Virchow, Professor für pathologische Anatomie am Berliner Pathologischen Institut der Charité, eine Vorlesungsreihe zum Thema „Allgemeine Pathologie und Therapie mit Einschluß der allgemeinen pathologischen Anatomie“. Einer der Vorlesungsbesucher war der Medizinstudent Justus Cramer, auf dessen Mitschrift die vorliegende Arbeit beruht. Zum Zeitpunkt dieser Vorlesungen, die zwischen Anfang November 1887 und Mitte Februar 1888 gehalten wurden, stand Virchow auf dem Höhepunkt seiner Karriere. Er hatte 1858 sein berühmtes Buch über die Zellular-Pathologie veröffentlicht, die ein Publikumserfolg geworden war und innerhalb eines Jahres eine Neuauflage erforderlich gemacht hatte. Vor Virchow hatte im 19. Jahrhundert in Deutschland der aus Hamburg stammende Botaniker Matthias Jakob Schleiden (1804-1881) den Begriff „Zelle“ für pflanzliche Bauelemente geprägt, den der Biologe Theodor Schwann (1810-1882) dann auf tierische Gewebe anwandte. Schwann erklärte, dass es ein universelles Prinzip der Entwicklung für die elementaren, wenn auch verschiedenen Teile der Organismen gäbe und dieses Prinzip sei die Bildung vor Zellen [Ackerknecht 1957]. Bezüglich der Entstehung von Zellen nahm Schwann wie auch Schleiden eine „freie Zellbildung“ an, wobei seiner Ansicht nach bei der Zellbildung im amorphen „Blastem“ Granulae zu einem Kern fusionierten, um den herum der Rest der Zelle gebildet wurde. Auch der Berliner Physiologe und Anatom Johannes Müller (1801-1858) beschäftigte sich mit dem zellulären Aufbau normaler und kranker Gewebe. Jedoch gelang es erst seinem Schüler Rudolf Virchow den berühmten Satz „Omnis cellula a cellula“ zu formulieren und damit zu erklären, dass die Zellen alle direkte Abkömmlinge anderer Zellen wären, die Zelle „die kleinste lebende Einheit“ des menschlichen Organismus und damit die Grundlage aller krankhaften Gewebeveränderungen sei. Diese Auffassung Virchows, dass die Entstehung und der Verlauf von Krankheiten in der Zelle auf physiologischen und physikalischen Gesetzmäßigkeiten beruht, stand im Gegensatz zu der in der Wiener Schule von ihrem Begründer Carl Rokitansky (1804-1878), der er im 19. Jahrhundert fast fünfzig Jahre lang die klassische pathologische Anatomie beherrschte, entwickelten „Krasenlehre“. Im Denken dieses aus Böhmen stammenden österreichischen Pathologen spielten die humoralen Doktrinen der hippokratischen Schriften noch eine entscheidende Rolle. Bezüglich der Gewebe war er weiterhin der Ansicht, dass diese von einem „Blastem“ gebildet seien, welches aus der „allgemeinen Ernährungsflüssigkeit, dem Plasma des Blutes“ stamme [Rokitansky 1846]. Er schlussfolgerte daraus, dass die grundlegenden pathologischen Veränderungen im Blut stattfänden, welches ein Exsudat erzeugte, das pathologische Zellen hervorbrächte. Er teilte die gesamte Pathologie in eine Reihe von „Blutkrankheiten“, Dyskrasien 5 ___________________________________________________________________ EINLEITUNG auf [Ackerknecht 1957]. Schon als 25-Jähriger hatte Virchow – ohne zu diesem Zeitpunkt bereits eine eigene Theorie entwickelt zu haben - diese Hypothese Rokitanskys
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