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The BookBrowse Review

Published May 21, 2014

ISSN: 1930-0018

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The Remedy
The Remedy
Robert Koch, Arthur Conan Doyle, and the Quest to Cure Tuberculosis
by Thomas Goetz

Hardcover (3 Apr 2014), 320 pages.
Publisher: Gotham Books
ISBN-13: 9781592407514
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In 1875, tuberculosis was the deadliest disease in the world, accountable for a third of all deaths. A diagnosis of TB, often called consumption, was a death sentence. Then, in a triumph of medical science, a German doctor named Robert Koch deployed an unprecedented scientific rigor to discover the bacteria that caused TB. Koch soon embarked on a remedy - a remedy that would be his undoing.

When Koch announced his cure for consumption, Arthur Conan Doyle, then a small-town doctor in England and sometime writer, went to Berlin to cover the event. Touring the ward of reportedly cured patients, he was horrified. Koch's "remedy" was either sloppy science or outright fraud.

But to a world desperate for relief, Koch's remedy wasn't so easily dismissed. As Europe's consumptives descended upon Berlin, Koch urgently tried to prove his case. Conan Doyle, meanwhile, returned to England determined to abandon medicine in favor of writing. In particular, he turned to a character inspired by the very scientific methods that Koch had formulated: Sherlock Holmes.

Capturing the moment when mystery and magic began to yield to science, The Remedy chronicles the stunning story of how the germ theory of disease became a true fact, how two men of ambition were emboldened to reach for something more, and how scientific discoveries evolve into social truths.

The Remedy

On a brisk spring evening in March 1882, Robert Koch walked into the library at the University of Berlin, and prepared to change the course of medicine for all time.

There were about 100 men gathered in the room, the greatest scientists in Germany. Koch barely acknowledged them as he began his demonstration. He showed his test tubes and cultures. He explained how he had tested and retested his work. There was no grandstanding, no theater. There was only evidence and explanation—and finally, a declaration.

"All of these facts taken together can lead to only one conclusion," Koch said. "That in the bacilli we have … the actual infective cause of tuberculosis."

Bacteria caused tuberculosis. The statement was so matter-of-fact in its delivery that Koch's claim seemed almost insignificant. There was no applause, no murmuring, no debate; the crowd was simply, utterly, absolutely speechless. Paul Ehrlich, a young scientist in the audience who would go on to win the Nobel Prize, was awestruck by the majesty of Koch's presentation. "I hold that evening to be the most important experience of my scientific life," he said later.

To grasp the gravity of Koch's discovery, we must first get our heads around this: To live in the 19th century was to experience infectious disease as a constant, to have death loom around any corner, and to always live in fear that a cold, a rash, or a cough might soon be the end of one's days on earth. Simply put, more people died of more things back then; the death rate in London in 1850 was 25 per 1,000—nearly five times today's death rate. That means that every year, some 2 percent of the population would die, a rate staggering in its commonness.

Such an existence is almost inconceivable today. In the 21st century, in the developed world at least, infectious disease is more of a threat than a reality. In fact, we have been inoculated from the experience of contagion. We can no longer imagine a disease flourishing in our midst without any explanation, treatment, or cure. Today, few of us have much experience with infectious disease, beyond the occasional cold or flu or stomach bug.

The 19th century, though, was a 100-year dirge from one horrid epidemic to another. Cholera, plague, smallpox, yellow fever, influenza, measles—all of these pulsed through growing urban populations of the 1800s, killing thousands and then stealthily retreating for a generation or two, waiting for immunity to fade, before returning to kill thousands once more. All of these diseases came quickly, both in terms of their attack on the human body, and the speed with which they spread through a community. They were fast and terrifying, and then, after some weeks or months or at most a couple of years, they were gone.

Tuberculosis was altogether different. It was not an epidemic but an endemic disease; it didn't come in waves or explode through a population, its presence was constant, pervasive, and persistent. Though it had afflicted humanity for millennia, in the 19th century tuberculosis went on a rampage, a tide of death known at the time as The White Plague. As Koch noted in his opening remarks, the disease was the largest killer by far in the United States and Europe. At the Hopital de la Charite in Paris, more than one-third of autopsies performed in the early 1800s found the cause of death to be TB. By the end of the century, in 1890, the registrar general's returns showed that nearly one half of those who died between 15 and 35 years of age died of consumption. This toll was particularly painful for the nascent life insurance industry. At the British Empire Mutual Life office, a calculation found that tuberculosis was responsible for more than three-quarters of company benefit payments.

All told, the pervasiveness of tuberculosis and the impotence of medicine to treat it created a specter of misery in 19th century Europe and America. To live in this environment would have been to be always reminded of the presence of death. The constant cough of consumptives, combined with the crackling sound of their lungs straining to breath, known as rales, created a white noise of illness in European and American cities. The only consolation would have been ignorance. Until Koch's discovery of the bacillus, being coughed on, as many inevitably were, would not have prompted much concern.

Full Excerpt

Reprinted from The Remedy: Robert Koch, Arthur Conan Doyle, and the Quest to Cure Tuberculosis by arrangement with Gotham Books, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright Thomas Goetz, 2014.

Medical and literary mystery meet in Goetz's fascinating history of tuberculosis.

Print Article

The Remedy is not only a history of attempts to isolate the cause of tuberculosis and develop a cure for it, but also a dual biography of Dr. Robert Koch, the microbiologist who proved the bacterial origin of TB; and of Arthur Conan Doyle, creator of Sherlock Holmes and a medical man in his own right. Goetz's book is more than the sum of its parts: it reveals the scientific inquisitiveness of an era, and portrays the modern shift from superstition to hard science. As Goetz succinctly remarks, Koch and Doyle "shared a trajectory from the nineteenth century of leeches and cod-liver oil to the twentieth century of microscopes and antibiotics."

Born in a mining village in central Germany, Koch trained as a doctor during the 1870s Franco-Prussian War. Alongside his community practice, Koch kept a lab where he researched anthrax, which killed sheep but also people: it was one of the first zoonotic diseases (transmitted from animals to humans) to receive scientific attention. Koch injected samples of anthrax into rabbits and mice to create a cell culture, thus proving the disease had been caused by bacteria. His research would lead to the hugely influential germ theory of contagious diseases. Moreover, he was an early adopter of the microscope, and one of the first to use white mice as a lab subject.

Koch's work on an anthrax vaccination would lead him into a bitter rivalry with celebrated French scientist Louis Pasteur. Their public feud mirrored the hostilities between France and Germany – wartime enemies a decade earlier. In March 1882, Koch announced that TB was caused by bacteria, and eight years later he proclaimed a remedy. Here is where Doyle comes into the picture. He had studied medicine in Edinburgh under surgeons Joseph Bell and Joseph Lister, early pioneers of antiseptic methods. In June 1882, Doyle opened his first medical practice in Southsea, near Portsmouth on the south coast of England. In his spare time he wrote short stories imitating Sir Walter Scott or Edgar Allan Poe, but in his professional capacity he was celebrated for an essay explaining the Koch-Pasteur research for laymen.

When news came of a TB cure in 1890, Doyle rushed to Berlin to attend a demonstration. To everyone's surprise, Koch's "remedy" was a mistake. Tuberculin was a good diagnostic for TB, but not a cure; the body swiftly developed resistance, and trials showed a low success rate. Doyle's was one of the first debunking voices. Meanwhile, aside from this exciting interlude, Doyle's medical star was fading. He had intended to specialize in ophthalmology and moved to South London to open a practice, but business was not booming. At age 33 he gave up medicine and turned to writing full-time.

The first Sherlock Holmes story, A Study in Scarlet, published November 1887, in Beeton's Christmas Annual, (now the most expensive collector's magazine), had made little impact, but gradually Holmes gained popularity. The first chapter of The Sign of Four is entitled "The Science of Deduction." That science was already a fad in literature (witness the works of H. G. Wells) worked to Doyle's advantage. Working backwards from solutions, he crafted intricate plots prefiguring detection techniques like fingerprint analysis. Doyle wearied of his precocious detective, though, and was determined to kill him off. Holmes would not stay dead long, however; he returned to life for The Hound of the Baskervilles in 1901, around the same time Doyle himself was beginning to take an uncharacteristic interest in spiritualism.

The Remedy is well-paced: it reads like mystery or true crime, not like a history book. The link between Koch and Doyle can occasionally feel somewhat tenuous; the author surely makes more metaphorical use of it than their actual historical intersection can support. If his window on the past feels slightly narrow, however, he still makes good on his dual purpose of tracing both the history of TB and the development of the scientific method through medicine and fiction. Goetz follows each thread of his story through to its finale. As Stephen Jay Gould said, "great ideas, like species, do not have 'eureka' moments of sudden formulation in all their subtle complexity; rather, they ooze into existence along tortuous paths lined with blind alleys." Here we see all the moments of discovery alongside all the failures and missteps. Although Koch continued to make false pronouncements about TB, he was awarded a belated Nobel Prize in 1905 for identifying its cause. It was a great irony of Doyle's life that his beloved wife Touie died of TB – thirteen years after her diagnosis, despite extended sanatorium visits. The real cure for TB, the antibiotic streptomycin, would not be discovered until 1946.

Even today drug-resistant TB strains are evolving, and science continues to find bacterial components to many illnesses: diabetes, ulcers, dementia, heart disease, and cervical cancer. Goetz, co-founder of health technology company Iodine and entrepreneur-in-residence at Robert Wood Johnson public health foundation, warns that the "microbiome" is getting stronger. The last lines are rather chilling: "As any microbiologist or infectious disease expert will tell you, if we treat disease as a battle against microbes, we are destined to lose. The bacteria precede us. They outnumber us. And they will outlast us."

Additional Information
Gravestone The reviewer found an old gravestone in her local churchyard (St. James the Great in Ruscombe, Berkshire, England) with a poem about the subject's death from consumption:

"The pale Consumption gave the silent blow. / The stroke was fatal, but th'effect came slow: / With wasting pain Death found him sore oppress'd. / Pity'd his sighs and kindly gave him rest." [John Bolton, died June 13th, 1805, aged 35.]

Reviewed by Rebecca Foster

A thoughtful, patient, ultimately fascinating account of the struggle of 19th century science, and society, to come to grips with the germ theory of illness, and develop new technologies to take on one of humanity’s oldest scourges, tuberculosis.

Washington Times
A gripping story... with great verve, painting word pictures full of color and telling detail... vividly evokes the rivalries rife in the scientific world.

The Wall Street Journal
An enjoyable chronicle.

The Los Angeles Times
A thoroughly enjoyable and illuminating journey through several decades of European history and an intimate portrait of two once-obscure doctors who shaped it. It's a book that illustrates how the imagination and the intellect can work in concert to cure a disease, or to delight an audience of millions.

Publishers Weekly
An intriguing medical and literary history… fascinating, convergent stories [of] doggedly inquisitive men who discovered that neither germs nor crime are any match for science.

Kirkus Reviews
A beguiling real-life medical detective story.

Author Blurb Steven Johnson, author of The Ghost Map
The Remedy is a rare, thrilling achievement: a book that helps us understand the roots of transformative ideas that simultaneously manages to tell a story worthy of a 19th-century novel, full of surprising links, rivalries, and intellectual triumph.

Author Blurb Carl Zimmer, author of A Planet of Viruses and The Tangled Bank: An Introduction to Evolution
In The Remedy, Thomas Goetz offers a wonderfully original origins story for modern science. He weaves together one of the great achievements of the nineteenth century - the germ theory of disease - with the creation of the fictional superhero of science, Sherlock Homes, with grace and surprise.

Print Article

Tuberculosis and...Sherlock Holmes

Did you know?

Schatzalp Sanatorium
  • At its height tuberculosis killed 1 in 7 people
  • According to Thomas Goetz in The Remedy, TB may have been "the most lethal disease in history, having claimed more than a billion lives since it was first identified in ancient Greece"
  • Two-thirds of active cases of TB would end in death
  • TB, like anthrax, is believed to have originated with agriculture about 9,000 years ago: springing from the soil and passing through the vectors of meat and milk
  • The pasteurization process, which kills off bacteria in milk, reduced the spread of TB
  • In the nineteenth century TB was believed to be caused by "miasma" (bad air) or heredity; only later was the cause revealed to be bacterial (Mycobacterium tuberculosis)
  • Through history, TB has also been known by the names consumption, scrofula, Pott's disease, phthisis, and the White Plague
  • Quack cures, such as a "Microbe Killer" potion, were common, and doctors often resorted to drastic surgeries
  • Sanatoriums (in locations as diverse as New Mexico and Switzerland) were the most common means of treatment
  • As a slow, wasting disease, TB was romanticized and associated with artists (Byron famously wrote, "I should like to die from consumption")
  • TB killed many celebrated literary figures including George Orwell, Samuel Johnson, Henry David Thoreau, Edgar Allan Poe, the Brontë sisters, Elizabeth Barrett Browning, Franz Kafka, Anton Chekhov, Robert Louis Stevenson, D. H. Lawrence, and John Keats
  • TB was the subject of the first mass health education campaign; disinfectants and good hygiene practices (such as no spitting in public) prevented the spread of disease
  • In terms of infectious diseases, TB is still the second most deadly (behind only HIV/AIDS)
  • In 1993 the World Health Organization declared TB a worldwide emergency
  • In 2012, 8.6 million people contracted TB, and of those, 1.3 million died; still, these statistics represent a drop in fatality of 45% since 1990
  • Reversing the spread of TB by 2015 was one of the United Nations' Millennium Development Goals – the number of people contracting TB is now on the wane, so this goal should be achieved

And about Sherlock Holmes...

  • It was illustrator Sidney Paget who created the enduring image of Sherlock Holmes wearing a deerstalker hat
  • The line "Elementary, my dear Watson" never appears in a Doyle story – it originated in the 1901 play, Sherlock Holmes, created by American actor William Gillette – as did Holmes's pipe
  • Holmes was the original fan-fiction subject, and has been the inspiration for more than 250 movies

Picture of Schatzalp sanatorium in Davos from Wikipedia

By Rebecca Foster

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