The Remedy

by Thomas Goetz

  Why did Koch’s discovery resonate when his predecessors’ theories had not? As Francis Darwin, Charles’s son, observed, “In science the credit goes to the man who convinces the world, not to the man to whom the idea first occurs.” In the face of profound disbelief, Villemin’s science, as promising as it was, could not convince the world.

  It’s worth noting that Koch’s paper does acknowledge Villemin’s work in its very first words: “The discovery of Villemin that tuberculosis can be transmitted to animals has been confirmed a number of times.” No sooner did he acknowledge the discovery, though, than he observed that it had proven unconvincing: “but has also been opposed on seemingly good grounds, so that up until recently it has not been possible to state for certain whether tuberculosis is an infectious disease or not.”

  Given credit or not, until his death in 1892, Villemin would hold a grudge. In 1882 he confessed to Pasteur that he felt Koch’s glory had come at his own expense. “I have been so much discussed, so often attacked, that I suffer a certain amount of distress in thinking that the leading scientific academy still gives, at least, a sort of toleration to my former enemies. . . . Koch will enter the Académie des Sciences through widely flung doors, in the triumphant way that has made a conquest of him of all the honours of his country.”

  Villemin might as well have been fighting the movement of the spheres. His complaint—that Koch, who had gotten so much glory, was getting still more—is known today as the Matthew effect. The term was coined by Robert Merton in a 1968 paper in Science: “The Matthew effect consists in the accruing of greater increments of recognition for particular scientific contributions to scientists of considerable repute and the withholding of such recognition from scientists who have not yet made their mark.” (The term gets its name from a passage in the Gospel of Matthew: “For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.”)

  Villemin was partly right, insofar as Koch’s research was quickly hailed around the world partially because Koch had established himself as a man of meticulous methods. But this is tautological in the sense that Koch’s work on tuberculosis was characteristically meticulous. Yes, it helped that in the twenty years since Villemin’s work, the germ theory had become much less speculative, with a growing weight of evidence behind it. But Koch, as much as anybody, had been responsible for creating that evidence. His postulates, which by now were well-established protocols in his laboratory work, were surely part of the winning argument. The links in the chain of evidence fit together.

  • • •

  ROBERT KOCH MAY HAVE EXPECTED A YEAR OF FIGHTING, BUT IT would not take a year to convince the world. His theory was, all at once, accepted as proven. Rarely had medicine ever experienced, wrote the British Medical Journal, “so sudden and complete casting aside of tradition.” In a report published just a month after the Berlin demonstration, The London Medical Gazette cautiously praised Koch’s work. “To those old-standing questions which have hitherto baffled the penetration of the wisest of our profession, Dr. Koch has returned an answer that is singularly free from ambiguity. Tuberculosis . . . is a parasitic disease of the internal organs; the parasite is a bacillus.” (The Gazette editors were particularly pleased that Koch’s work might create less tolerance for public spitting.)

  Word of Koch’s breakthrough took longer to cross the Atlantic, though, and by the time The New York Times caught wind of the discovery, in early May, the paper’s correspondent was appropriately peeved that such essential news was just then reaching the States. “The rapid growth of the Continental capitals, the movements of princely noodles and fat, vulgar Duchesses, the debates in the Servian Skupschina, and the progress or receding of sundry royal gouts are given to the wings of the lightning; a lumbering mail-coach is swift enough for the news of one of the great scientific discoveries of the age.” The paper went on to compare Koch to Darwin, praising him for giving “new force and meaning [to] the command, ‘Know thyself.’”

  But the Times dispatch also made clear that this was just the start of what it expected from Dr. Koch. The real glory would come with a treatment or a cure. “The popular interest in the little parasite Dr. Koch has introduced to the world will deepen in proportion as medical science demonstrates its power to annihilate him or rob him of his fatal power,” suggesting inoculation as the most probable course.

  This was indeed the new standard emerging for the germ hunters: not just discovery, but some sort of treatment or inoculation that might turn bacteriology from the academic to the pragmatic. Koch recognized this; now in the prime of his investigative powers and at the height of his self-regard—it was after his TB discovery, not surprisingly, that Koch uncorked his full fury against Pasteur—he was convinced that tuberculosis was the most likely candidate for such a cure. With his postulates, his analytic skills, and his technical prowess, he had the method down cold. Surely taking the next step, from pinpointing a cause to devising a remedy, was simply a matter of course. Pasteur had done it with anthrax, after all, and with inferior skills, resources, and procedures.

  In the months following his discovery of Mycobacterium tuberculosis, Koch would be promoted by the kaiser and given a larger staff, a larger salary, and larger facilities. He would join the front ranks of scientists in Germany and Europe. And as he told his daughter, Gertrud, now thirteen years old and in boarding school, he would serve as the central attraction during the German Exposition of Hygiene and Public Health. “I have even had the privilege,” he wrote, “of explaining bacteria to the Crown Prince, the Grand Duke of Baden, the King and Queen of Saxony, and many other royal personages.” But he now had the thirst, and the confidence, to make another discovery, better than the last. Koch was determined: Tuberculosis was all his, and it would be he, not Pasteur, who captured the greater glory.

  Part II

  CHAPTER 5

  1882 • The Doctor in Southsea

  Arthur Conan Doyle, circa 1890

  In June 1882, in the town of Southsea, a suburb of Portsmouth on the southern coast of England, Arthur Conan Doyle, just twenty-three years old, admired the bright brass plate newly affixed to his door. “Dr. Conan Doyle,” it read. “Physician and Surgeon.”

  Conan Doyle smiled and then walked down the road to Southsea’s high street, stopping in at the local newspaper. For a few pence, he placed a brief announcement in the next edition: “Dr. Doyle begs to notify that he has removed to 1 Bush Villas, Elm Grove, next to the Bush Hotel.” Back home, he went to his front window and placed a red lamp, the traditional beacon of the British physician, on the sill. He struck a match and lit the lamp. Dr. Arthur Conan Doyle was ready for business.

  Conan Doyle wasn’t from the area; he had earned his medical credentials in his hometown of Edinburgh, Scotland. Nonetheless, after earlier attempts to start a practice in Birmingham and Plymouth failed, he had fixed on greater Portsmouth as a possible perch and found Southsea, a growing seaside resort with pleasure piers, several hotels, and about thirty-four thousand residents. It looked like a promising spot, but there were already several doctors in town. So Conan Doyle began to chart a course. He bought a shilling map of the town, laid it out on a table in his hotel, and planned a series of walks. Day after day, he would amble up and down the roads of Southsea, trying never to pass along the same block twice. As he walked, he kept his eyes peeled for the brass plates and red lamps of the other doctors in Southsea: the competition. Soon he had covered every street in town.

  “On my map I put a cross for every doctor,” he would describe later. “So at the end of that time I had a complete chart of the whole place, and could see at a glance where there was a possible opening.” That spot was 1 Bush Villas, tucked snuggly between the Bush Hotel and St. Paul’s Baptist Church, and less than a mile from the Eye and Ear Hospital. Conan Doyle’s technique was typically resourceful, if not a little ingenious. It wholly suite
d the man who would later create Sherlock Holmes, a character with those same attributes in spades.

  Born in Edinburgh in 1859, of genteel middle-class Irish stock, Conan Doyle was the son of an alcoholic artist and the nephew of successful Irish scholars. (His uncle Henry would serve as director of the National Gallery of Ireland, in Dublin.) These uncles, both faithful Catholics and family men, had generously sponsored a robust Jesuit education for young Arthur, allowing him to go to school in Lancashire and Austria. Though he bristled at the religion, he took to the schooling; it fostered in him expectations typical of Britain’s growing upper middle class.

  In 1876 young Conan Doyle entered the University of Edinburgh’s medical school, then as now considered one of the finest medical colleges in Europe. He went into medicine dutifully, if not passionately. It seemed a reasonable way to make good on the investments his family had placed in him and a way to avoid the wanton path his father had followed. When he graduated from medical school in 1881, Conan Doyle was a young man of honor, family responsibility, and most of all ambition. He seethed with the need to do something of distinction. But as it was for so many young men pining to make their mark, the world didn’t yet know who he was and was rudely indifferent to his potential anyway. Instead of the glorious adventures he believed he was capable of, here he was trawling for business in Southsea, where every patient and every shilling were a struggle.

  Physically, he was a big man—more than six feet tall and nearly two hundred pounds, with a sixteen-inch neck and a broad build befitting an occasional boxer—and wore a full mustache. While in medical school, he had taken leave to sign up as a ship’s surgeon on a whaling expedition to the Arctic. It was the first great adventure of his life, and he had relished the physical challenge, learning how to harpoon whales and smash the skulls of seals. He had spent six months doctoring the crew, though his happiest moments were passed thrashing about with his shipmates. “I went on board the whaler a big, straggling youth, I came off it a powerful, well-grown man,” he wrote in his memoirs.

  So, after graduating school, he signed up for another tour as a ship’s surgeon, this time aboard the steamship Mayumba, en route from Liverpool to West Africa. This was a far less satisfying journey, marred by fires aboard the ship and a bout of malaria. He returned to England after three months, grateful to have made it back alive.

  Those adventures were long behind him by the time he’d gotten to Southsea. To pass the time, or to forget his loneliness, Conan Doyle would pick up his pen and write a story. It was a chance to drift away from his reality. His early stories mimicked his favorite boyhood authors, Sir Walter Scott and Edgar Allan Poe. His first story had been published in 1879, while he was still a medical student. “The Mystery of Sasassa Valley” involved a treasure hunt in South Africa (where he had yet to travel). In 1881 “A Night Among the Nihilists” took readers to Odessa (again, where Conan Doyle had never been) for a night with Russian millionaires. He wrote adventure tales of ghost ships and the jungles of Africa. Every once in a while, after many submissions, a story would even be published.

  While his stories were full of imaginative details, his letters home were, on the contrary, strikingly pedestrian. To his mother, he would confess all the anxieties and concerns of a newly independent bachelor, providing a dutiful accounting of bills owed him and debts he owed others, and a nod to the occasional patient who rang his bell. “Just a line to say that we have had another lucky hit,” he wrote to his mother in February 1883, just seven months into his Southsea practice. “A man broke his jaw & fractured his skull just outside the house today in a carriage accident . . . and I had to take him home and received 2 guineas for my trouble.” If his stories contained Conan Doyle’s dreams of where he aspired to be, his letters home were frank confessions of where he was.

  In between were the letters he wrote to The Lancet and the British Medical Journal. In these, Conan Doyle drew on his meager caseload and his experiences in Edinburgh to offer (what he hoped would be) a novel scientific observation. While still in school, he’d had one such letter published, in the BMJ, chronicling his experiment (upon himself) in taking ever greater doses of Gelsemium, an herbal medicine related to strychnine. “I determined to ascertain how far one might go in taking the drug, and what the primary symptoms of an overdose might be.” Conan Doyle boosted his dose steadily until, after a week, a severe depression and “diarrhoea . . . so persistent and prostrating” forced him to give up the experiment.

  He’d had another bit of luck on March 25, 1882—the day after Koch’s TB presentation, as it happened, though Conan Doyle would not have known this—when The Lancet published a case note on leucocythemia (an old term for leukemia). Technically, it was a letter to the editor, not a work of research, and to the chagrin of the exuberant young doctor, they got his name wrong, mistakenly crediting “A. Cowan Doyle.” Nonetheless, the letter was testimony to the fact that, though this physician had been living a circumscribed existence, he had his eyes on broader horizons.

  In the days after Conan Doyle’s letter was published, the British medical journals began to report on Koch’s discovery of the tubercle bacterium. “The pathological importance of the discovery of the proximate cause of this frightful scourge of the human race cannot be over-estimated,” The Lancet pronounced on April 22, 1882, “nor is it possible to foretell the practical results to which it may lead.” For the rest of the year, scarcely a week passed without either The Lancet or the BMJ posting an update on Koch’s work; in its retrospective issue for 1882, the BMJ hailed “the splendid series of researches by Koch” as “first in importance among the pathological work of the year.”

  Though the British journals seemed cautious about the broader implications of the germ theory (the BMJ rather more enthusiastic about the promise of bacteriological medicine than the conservative Lancet), both publications diligently covered what was undeniably a powerful idea with a growing body of compelling evidence behind it. If nothing else, clearly the news had shaken up the medical establishment. Both journals dutifully printed letters from august English physicians defending the long-standing theories that Koch’s novel work would undercut. (Most were hesitant to give up their faith in the hereditary origins of tuberculosis, which seemed so self-evident in their clinical observations.) Others, such as Lister, looked at Koch’s work and saw vindication. But the academic debate seemed increasingly petty compared to the pragmatic argument that, with this great killer of humanity finally identified, some progress might be made toward combating it.

  Throughout the summer of 1882, “Koch’s bacilli,” as it began to be called, went on something of a road show in England, with microscopic exhibitions of the tuberculosis bacterium in Norwich, London, and other English cities. One such display, in June at the Royal College of Physicians in London, drew the attendance of two of Queen Victoria’s sons, the Duke of Albany and the Prince of Wales, who peered in the microscope to observe the bacteria and, it was reported, were duly impressed.

  All this sparked something in Conan Doyle’s imagination. He recognized that a new era was emerging, one where men were beginning to gain sight, and insight, into disease. So sometime in late 1882, he picked up his pen and began to write an essay conjuring a fanciful world where men were themselves microbes, set loose in the body:

  Had a man the power of reducing himself to the size of less than the one-thousandth part of an inch, and should he, while of this microscopic stature, convey himself through the coats of a living artery, how strange the sight that would meet his eye! All round him he would see a rapidly flowing stream of clear transparent fluid, in which many solid and well-defined bodies were being whirled along. . . . Here and there, however, on the outskirts of the throng, our infinitesimal spectator would perceive bodies of a very different character.

  These are the opening words to “Life and Death in the Blood,” an essay published in the popular journal Good Words in March 1883. The essay, essentially, w
as Conan Doyle’s go at translating what he’d been reading in the medical journals for a literate but unscientific audience.

  Conan Doyle found his material in the most exciting arena in medical science: the rivalry between Louis Pasteur and Robert Koch and their work identifying those things called germs. “The existence of these little organisms . . . may have been suspected by our forefathers,” he wrote, assuming an authority on the page that he perhaps lacked in his practice. “But it is only in the last few years that their presence has been clearly demonstrated, and their relation to disease duly appreciated.” Despite the Koch-Pasteur rivalry, he astutely noted, the two men were joined in the same goal, observing that “one great thinker stimulates the latent powers of many others.” Though he was a world away from the great labs of Europe, Conan Doyle, writing from his lonely house, had put his finger on a major shift in medical science.

  In a burst of imagination, the essay ended with a vision for the future of bacteriology. Noting Koch’s insights into tuberculosis and Pasteur’s vaccine for anthrax, Conan Doyle issued a bold challenge:

  Given that a single disease, proved to depend upon a parasitic organism, can be effectually and certainly stamped out, why should not all diseases depending upon similar causes be also done away with? That is the great question which the scientific world is striving to solve; and in the face of it how paltry do war and statecraft appear, and everything which fascinates the attention of the multitude! Let things go as they are going, and it is probable that in the days of our children’s children, or even earlier, consumption, typhus, typhoid, cholera, malaria, scarlatina, diphtheria, measles, and a host of other diseases will have ceased to exist.