by Thomas Goetz
The story abounds in laboratory work and medical references: Heart disease, hypochondria, malaria, and addiction all make an appearance. Holmes informs Watson that he has published several scientific monographs, “all upon technical subjects,” from the 140 types of tobacco ash to the influence of a trade upon the form of a hand, “a matter of great practical interest to the scientific detective.” This is where Holmes first offers his precept “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”
The Sign of Four was well reviewed; The Daily Telegraph praised “the excellence of its style [and] the intense interest of its plot.” Wilde himself wrote Conan Doyle to praise the “strength and sincerity” of the book. More significantly, in October he received a letter from Lawson Tait, one of Britain’s most prominent surgeons. Conan Doyle had only heard of Tait, and he never imagined Tait would reach out himself to write a fan letter. Though we don’t have the letter, we do have Conan Doyle’s proud description of it to his mother: “He said that He and Lord Coleridge were both great admirers of my ‘Study in Scarlet’ and of my ‘Sign of Four.’ He spoke in the kindest way of them.” Accolades from Lord Coleridge were a special bonus; the poet’s grandnephew, Coleridge was one of the nation’s great solicitors, with the rank of lord chief justice of England. If Conan Doyle thought he was toiling in obscurity, suddenly here were twin endorsements from the most accomplished of Britons. It was just the boost in confidence that he needed, and a keen validation of his technique.
At this point, Conan Doyle had been in Southsea for eight years and had been writing stories for a decade. He was happy enough, as he’d recall later in his memoirs. “My life had been a pleasant one with my steadily-increasing literary success, my practice, which was enough to keep me pleasantly occupied, and my sport” (Conan Doyle was an ardent amateur athlete).
But in November 1890, while making notes on proofs of his latest novel, The White Company, Conan Doyle took a break and picked up the day’s mail. Amid the bills and correspondence was a special supplement to the British Medical Journal, published that day: Friday, November 15. Curious as to what would require such a rare dispatch, Conan Doyle began reading.
The report consisted of an update by Robert Koch, the brilliant German bacteriologist. Back in August, at the Tenth International Medical Congress in Berlin, Koch had hinted at a remarkable finding, greater perhaps than the sum of all his previous discoveries. This new dispatch, translated in the BMJ from a just-published German article, elaborated on that research. Now Koch explained in detail what he’d alluded to at the congress: He believed he had discovered nothing less than “a remedy which conferred on the animals experimented upon an immunity against inoculation with the tubercle bacillus, and which arrested tuberculous disease,” Koch wrote. “There is no question of a destruction of the tubercle bacilli in the tissues.” The BMJ reported that there would be a public demonstration of Koch’s remedy in Berlin on November 17—just two days away. Every medical man of caliber in the world would be there.
As was evident from his “Life and Death in the Blood” essay, Conan Doyle was already a great admirer of Koch’s talents. The two men were, in many ways, accidental partners in a profound social shift toward science and away from superstition. Where Koch had proven the merits of science and outlined the methodology, Conan Doyle had put it into action, placing it in the hands of an odd, cantankerous, and rigorous detective who was peculiarly gifted at scientific analysis, to great result. Robert Koch’s postulates were not so different from Sherlock Holmes’s science of deduction: Both demanded a close analysis of the facts, an absolute fidelity to the truth, and a faith that, properly followed, the process would bring desired results. Both men, after all, swore by the same weapon: the microscope (the instrument shows up in more Holmes stories than even the now-iconic magnifying glass).
In his memoirs, Conan Doyle tells what happened next: “A great urge came upon me suddenly that I should go to Berlin.”
I could give no clear reason for this, but it was an irresistible impulse and I at once determined to go. Had I been a well-known doctor or a specialist in consumption it would have been more intelligible, but I had, as a matter of fact, no great interest in the more recent developments of my own profession, and a very strong belief that much of the so-called progress was illusory. However, at a few hours’ notice I packed up a bag and started off alone upon this curious adventure.
If he were to make it to Berlin in time, he would have to leave at once. He quickly informed Touie of his plans, kissed his daughter, Mary, good-bye, and raced to the Portsmouth Station to catch the next train to London. An hour later, the train arrived in Waterloo Station, and Conan Doyle dashed to Mowbray House, headquarters of The Review of Reviews. The Review was edited by W. T. Stead, with whom Conan Doyle had corresponded the prior year. Although Conan Doyle showed up unannounced, Stead invited him into his office.
Conan Doyle explained to Stead what was about to happen in Berlin in less than two days. Stead asked why Conan Doyle, of all people, should be the one to cover the demonstration for the Review. Conan Doyle explained that, as both a writer and a physician, he was uniquely suited for the job. He could both assess the credibility of Koch’s remedy and write up an engaging account of the stakes. Stead was impressed with Conan Doyle’s panache and told him that he had intended, himself, to write a medical piece, on Count Mattei, a proponent of electrohomeopathy, for the next issue. The two essays, Stead thought, might complement each other. On the spot, he commissioned Conan Doyle to write a profile of Koch and quickly dashed off both a letter of assignment and one of introduction, to the British ambassador in Berlin, should Conan Doyle need some official assistance.
Conan Doyle was thrilled. He raced out of the office and dashed down Norfolk Street, headed to Victoria Station. He took the next train down to the coast, then hopped a ferry across the Channel. By the next morning, November 16, he was on the Continental Express, rolling toward Berlin’s Central Station.
CHAPTER 7
1890 • The Remedy
A special edition of the American journal Medical News, November 15, 1890
The triumph of discovering the cause of tuberculosis in 1882 stoked something in Robert Koch, an ambition that would have been inconceivable just a few years before in Wöllstein. This was not Koch’s better angel; it was the same beast that had attacked Pasteur in 1881 and kept at it during the months of poisonous exchanges. He was now quite unlike the meek hobbyist who had humbly asked Dr. Cohn to check over his kitchen-sink experiments just a few years earlier.
The competition with Pasteur came to a head in the spring of 1883, when a pandemic of cholera began to race across Asia, erupting first in its endemic home of India and then spreading to Turkey and into North Africa. When the outbreak reached Egypt, European countries began to get nervous. This was the latest of several waves of cholera to break out in the nineteenth century, each time spreading misery and death across Europe. The most recent pandemic had only just relented in the late 1870s, a decadelong outbreak that killed more than a million worldwide, including 113,000 in Italy, 165,000 in Austria, 90,000 in Russia, and 30,000 pilgrimaging Muslims in Mecca. There seemed every reason to expect that the disease was now following a similar course. The difference, though, was that in 1875, the germ theory was still speculation; by 1883, however, microbes had been definitively established to cause several diseases. Cholera seemed certain to be next.
Egypt was particularly hospitable to the disease. Most of the country’s population was crowded into Cairo and the Nile Delta, dense and dirty communities where sanitation was nonexistent. The major source of water in the country was the Nile, where the clothes of cholera victims were routinely washed. Downstream, the same water was used for drinking. The outbreak followed the classic epidemiological pattern of gaps and clusters, with some towns spared the disease entirely, while others were devastated. Of the 14,000 inhabita
nts of Shibin el Kom, a village in the Nile Delta north of Cairo, nearly 2,000 were sickened, and fully one in ten died of the disease in just a few weeks. As the summer stretched on, the national death toll climbed quickly, with nearly 6,000 dead in Cairo alone.
In late July, a desperate Egyptian government requested the help of both France and Germany in identifying the cause of the epidemic. In France, the call went to Louis Pasteur, who remained in Paris but dispatched a team of his most able assistants, including Louis Thuillier. The Germans offered Koch, who quickly made arrangements with his home and lab and then left for Egypt, leading Georg Gaffky and three others. The race was on.
The French team, known as “Le Mission Pasteur,” arrived in Alexandria first, on August 15, 1883, and found quarters in l’Hôpital Européen, the city’s finest medical facility. Koch’s team arrived ten days later and set up in the city’s Greek Hospital.
For Koch, this was a welcome head-to-head contest against his French rival: one disease, one country, two teams. Fresh from the triumph of his tuberculosis discovery, Koch thought his laboratory precision held the upper hand against the French team’s more shotgun-style approach to microbe detection. Within a month, Koch had identified one characteristic organism in several cholera victims; he failed to culture the microbe, nor could he produce an infection in mice, but he was hopeful he was on the right path and published a preliminary but inconclusive report. But just then, the epidemic began to wane, making further experiments impossible. “Cholera has almost disappeared in Alexandria,” he soon wrote Emma, “which for our purposes is too early. . . . I am afraid we are without either cholera patients or cholera victims.”
The French team, meanwhile, had gotten hold of more cadavers and was still working. It had isolated several different bacteria but couldn’t be certain that any one might be causal. But the team did suggest that some “tiny bodies” in blood smears of cholera victims might somehow be involved. (Later Koch would insinuate that the French team had simply found blood platelets.)
On the morning of September 18, Thuillier, the lead French scientist, had a bout of diarrhea. He walked over to a colleague’s room. “I feel very ill,” he said, then swooned and crumpled to the floor. His alarmed colleagues picked him up, carried him to his bed, and gave him a dose of opium. He seemed to recover slightly but then had what Émile Roux, his fellow team member, described as “a copious watery stool”—the telltale sign of cholera. Thuillier said he felt cold; his legs began cramping. Despite frantic measures, including iced champagne and injections of ether, he died on the morning of the nineteenth. He was twenty-seven years old.
The death was a shock to both teams. A comrade in arms in the battle against microbes had succumbed, a risk that everyone, French or German, knew he faced. Koch and his colleagues hastened over to l’Hôpital Européen and offered their respects. At the funeral, Koch himself served as a pallbearer. The French team left for Paris soon after, its mission incomplete.
Koch, though, was not yet done. With the outbreak all but over in Egypt, he requested permission from the German government, which was funding the expedition, to hunt the disease at the source: India. On November 13, the Germans left Suez en route to Calcutta, home of the Ganges River, which they believed to be the headwaters of the microbe. Once there, Koch spent two months holed up in the Medical College and Hospital, hunched over microscopes and avoiding the stifling heat outside. Despite his being halfway around the world, Koch’s progress was surprisingly public: His regular dispatches to the health minister in Berlin were printed in full in German newspapers, reports that were then excerpted and translated in the BMJ. Laying out his progress step by step, the dispatches chronicled his methods with characteristic exactitude.
In Calcutta, Koch had plenty of organisms to study. His first material came from a twenty-two-year-old man who had died just ten hours after first showing symptoms; he was only three hours out of autopsy when his intestines were harvested for Koch’s investigation. By early February, Koch was confident he’d found the germ, a comma-shaped bacillus that was, finally, growing actively in culture. But he continued to test and retest his results, interrogating his own conclusions until he’d isolated the organism in twenty-two corpses and seventeen living patients. “In all cases,” he wrote in his report, “the comma bacillus and only the comma bacillus has been found. These results, taken together with those obtained in Egypt, prove that we have found the pathogen responsible for cholera.”
To his frustration, Koch was still unable to transfer the disease successfully to animals, failing to satisfy his own criterion for true causality. Instead, he took a page from John Snow and made a map of the water tanks in one neighborhood where seventeen had recently died. The homes of the deceased formed a neat ring around the tank, not just the source of drinking water in the neighborhood but also a place for bathing and doing laundry. Even the clothes of the cholera victims had been washed in the tank, a sure way to keep the disease active in the neighborhood. His investigation was complete, and on April 4, 1884, he and his team headed home. It would be a brutal trip: Koch would suffer a bout of malaria, forcing a long detour to Cairo. On May 2 he arrived home in Berlin, nearly nine months after he’d left.
“WELCOME VICTORS!” hailed the front page of the Berliner Tageblatt on May 3. Koch was received by the kaiser and met with Otto von Bismarck, the imperial chancellor of Germany, who bestowed on him a medal. The celebration culminated in a banquet with seven hundred guests. The program celebrated Koch’s expedition as a quasi-military victory, with allusions toward the Franco-Prussian War. “Just as 13 years ago the German people celebrated a glorious victory against the hereditary enemy of our nation, so does German Science today celebrate a brilliant triumph over one of humanity’s most menacing enemies.” Koch himself was hailed as a national hero and anointed Germany’s finest scientist. “In less than a decade, he presented to the world an amazing array of discoveries,” one speaker proclaimed, tallying Koch’s quarry of anthrax, tuberculosis, and now cholera.
Koch loved every bit of it. He had set off to Egypt in competition with Germany’s greatest national rival and his own personal adversary, and he, not Pasteur, had solved the case and had shown himself the world’s greatest medical detective. Koch would later say that the medal from von Bismarck was his favorite honor, since he could wear it like a military decoration.
Within a year, Koch was invited to run a new Institute of Hygiene at the University of Berlin and was given a medical professorship at the university. Virchow continued to push against Koch. “As far as we are concerned,” he said, “hygiene is in the same category as forensic medicine, an applied science which has neither its own methods nor its own concepts.” But he lost this argument; Koch’s star now shone brighter than Virchow’s. The new institute opened on July 1, 1885.
No sooner had the institute opened its doors, though, than word of a new discovery came from Paris: a new vaccine. It seemed that while Koch was in India chasing cholera, Pasteur’s colleague Émile Roux had been investigating rabies, a disease more notable for the terror it caused than its overall mortality. Roux had developed what appeared to be a promising vaccine, but he had been unable to test it until a rabid dog mauled a nine-year-old boy. Throwing caution aside, Pasteur (a nondoctor) took it upon himself to administer the vaccine. It’s not certain that the boy would have in fact developed the disease—the risk after such exposure is estimated at about 15 percent—but he lived, and Pasteur was hailed as a savior once again. After a few months, he had assembled further evidence for the vaccine; more than seven hundred people had been given inoculations after bites, with just one case of rabies and death. It seemed that for each of Koch’s discoveries, Pasteur answered with one of his own.
Unfortunately, his new institute forced Koch to put aside his detective work and concentrate on administrative and teaching duties. His lab, by this point, had drawn some of the greatest scientists in Germany. There was Paul Ehrlich
, of course, and also Emil von Behring, who began to work with Ehrlich on diphtheria. Their effort would result in the development of an antitoxin for the disease. (The work would earn von Behring the Nobel Prize in 1901.) There, too, was Kitasato Shibasaburo, the Japanese physician who came to Berlin in 1885 to study under Koch and who would later discover both the tetanus and bubonic plague bacteria. Though all this work took place under his leadership, Koch himself had little involvement in the research. He had several courses to teach, weekly lectures to give, and numerous laboratories to supervise. He established a new Journal of Hygiene to publish the work, but he was principally an administrator, not a researcher. “Herr Koch has nothing directly to do with our work,” noted an American scientist who worked at the institute during this time. “He has just now something of more importance than the teaching of ‘bugs.’”
Meanwhile, Koch’s marriage was disintegrating. The relationship hadn’t been particularly happy for several years, which wasn’t helped by Koch’s frequent absences. He began to take long vacations to Switzerland with friends, leaving Emma and daughter, Gertrud, at home. On at least one occasion, he wrote his wife that he was extending his stay for two weeks; would she please send Trudy along by herself to join him?
Surely it could have gone this way for years; a marriage gone cold was not out of the ordinary in those days when divorce was the greater sin. Except that in 1890, Koch, forty-six, met a young art student, just seventeen years old, by the name of Hedwig Freiburg. The girl seemed to spark something in Koch, a resolve to shake off his administrative yoke and return to the laboratory. Perhaps he wanted to impress young Hedwig. Perhaps he wanted to best Pasteur yet again. Whatever the reason, Koch began to spend more time in his private lab, down a long hallway from the general facilities. His colleagues had little sense of what he was doing in there, what sort of experiments he was conducting, but judging from the many dead guinea pigs coming out of the lab, they knew he was hard at work.