The Remedy

by Thomas Goetz

  In 1894, Biggs wrote a polemic, “To Rob Consumption of Its Terrors.” Even with the disaster of tuberculin fresh in medical minds, Biggs reminded readers of the importance of Koch’s original discovery. “The knowledge we now have of the causation of tuberculosis makes possible the formulation of perfectly efficient means for its prevention.” Biggs recommended a municipally driven system of education, segregation, and disinfection, with a great increase in the number of sanitariums, for both isolation and recovery. With these measures, Biggs believed, “we have it in our power to completely wipe out pulmonary tuberculosis in a single generation.”

  By 1897, New York City had passed an ordinance requiring the mandatory reporting of tuberculosis cases in the city. Soon Biggs had a map of disease in Manhattan as powerful as John Snow’s cholera map of London. No longer a disease lurking in the shadows, TB, as Biggs showed, could be counted, tracked, evaluated, and combated.

  Though governments rarely went as far as Biggs would have them, in record books from Paris to New York to London, a pronounced drop-off in tuberculosis cases can be traced to the 1880s, when Koch’s discovery began to spread. In New York, fatalities from pulmonary tuberculosis had hovered around four hundred per hundred thousand annually for most of the nineteenth century. But beginning in 1880, that rate began to drop precipitously, to three hundred per hundred thousand in 1890 and one hundred per hundred thousand by 1920. By 1950, when the first antibiotics effective against the disease were developed, the rate was already down to a mere twenty-seven per hundred thousand. Other cities that embraced hygiene experienced a similar drop-off; deaths in Paris, for instance, fell from five hundred per hundred thousand in 1870 to three hundred per hundred thousand in 1910.

  Tuberculin may not have led to the glory Koch yearned for, but thanks to people such as Hermann Biggs, who took Koch’s ideas and built on them, Koch’s science became a kind of remedy nonetheless.

  • • •

  IN MAY OF 1891 THE GERMAN GOVERNMENT AT LAST APPROVED funding for Koch’s Institute for Infectious Diseases. As the institute’s director, Koch was granted the salary of twenty thousand marks—not the fortune he may have expected from tuberculin, but a robust salary nonetheless.

  This time, though, there would be no profit from discoveries and no covert experimentation. “There must be no more secrecy,” insisted a member of the German parliament during the funding debate. “There must be no more experimenting on human bodies with a secret remedy.” The deal required Koch to agree that any inventions or discoveries “would be placed unconditionally and without any compensation whatsoever at the government’s disposal.” In addition, it required him to come clean on tuberculin and deliver a full analysis of its chemical composition before he could take his new post. (He would publish a full accounting of tuberculin that fall.)

  With that, the next chapter of Koch’s life began. In 1892 he was officially divorced. He married Hedwig, nearly thirty years his junior, in September 1893—three years after he’d first met her.

  At the new institute, Koch’s subordinates began to take center stage. In 1893, Paul Ehrlich and Emil von Behring began to investigate an antitoxin for diphtheria, a dangerous bacterial infection that caused severe respiratory distress. It typically occurred in epidemics, often killing hundreds of children in an outbreak. Von Behring would independently develop and perfect the serum in 1894 (much to Ehrlich’s dismay). Meanwhile, Ehrlich would continue to investigate how the body produces antibodies and how it develops immunity to disease, the basis for our conception of the immune system.

  It was this notion of an immune system that Koch lacked in his analysis of tuberculin. Today we understand that the substance was, in fact, causing an immune response in the body. Koch mistook a reaction for a remedy, and that mistake was everything.

  As the decade progressed, Koch became more and more detached from the work at his institute, until his role was largely ceremonial. In 1895, word came from Paris that Louis Pasteur, his great rival for more than fifteen years, had died. In 1896, Koch and his young wife set off for South Africa, this time to begin a years-long investigation of tropical diseases: mainly malaria and sleeping sickness. At the time, critics gossiped that he was leaving Germany to escape the dual disgrace of tuberculin and divorce. In truth, however, he was leaving at the behest of the German government, which increasingly saw infectious disease as an enemy to the growing empire and Koch as its field general. Whatever the impetus, Koch seemed to be more than willing to leave his laboratory behind. Now in his midfifties, he was following the dream he’d had as a teenager back in Clausthal. He was following the path of von Humboldt, exploring the world.

  CHAPTER 9

  1892 • The Rise of A. C. Doyle

  Holmes at work, an illustration by Sidney Paget from“The Red-Headed League,” published in The Strand, August 1891

  Arthur Conan Doyle arrived back in Southsea on November 22, 1890, both exhausted and elated. He had done it.

  Entirely on impulse, he had set off to an unfamiliar city (without a single contact or connection), successfully witnessed (albeit by proxy) one of the most significant scientific demonstrations of the past fifty years, and then had the wherewithal to beat every journalist and every physician in Europe to evaluate the evidence. Koch’s remedy may have gestured at a revolution, Conan Doyle recognized, but it could not deliver one—and he was likely the first person in the world to say as much.

  “I came back a changed man,” he later recalled in his memoirs. “I had spread my wings and had felt something of the powers within me.” Once back in Southsea, he wasted no time in cutting the cord. “I am leaving Southsea shortly,” he told the Portsmouth Evening Mail on November 24, just two days after his return from Berlin. “I am going to Vienna in January. I shall remain for three months to study the eye after which I intend to start in London as a specialist.” His plan followed Dr. Morris’s prescription precisely. And indeed, by December 18, Conan Doyle had sold his practice and left Southsea forever.

  By January, when skepticism about Koch’s remedy was rising in Berlin, Conan Doyle was a world away, in Vienna, with Touie. (They had left two-year-old daughter Mary with Touie’s mother on the Isle of Wight.) They arrived during a snowstorm, on a bitterly cold night, “a gloomy, ominous reception,” Conan Doyle noted. And it didn’t get much better from there.

  The couple quickly found room in a pleasant pension on Universitätesstrasse, one of Vienna’s main streets, for four pounds a week. During the days, Conan Doyle attended lectures at the university, but the language was a problem. Though he spoke German well thanks to his year in high school in Austria, he found the technical terminology of the classroom and laboratory frustrating, and he struggled to keep up. Not that he was terribly dedicated to his studies, anyway. In the afternoons, rather than study his ophthalmology texts, he would sit down at his desk and write stories. His output was prodigious: He finished a novel, The Doings of Raffles Haw, a tale about a man who discovers how to manufacture gold (he dedicated it to Dr. Morris); wrote a first draft of The Refugees, a novel set in the time of Louis XIV, which he sold for serialization in the American magazine Harper’s; and turned out several shorter stories, including one titled “The Voice of Science.” He sold that to a new monthly magazine in London called The Strand.

  The couple did their best to enjoy Vienna. They did some sightseeing, went ice-skating, and splurged on the Anglo-American Ball. But Conan Doyle soon grew impatient. Dr. Morris had suggested he spend six months in Vienna, but barely eight weeks passed before he and Touie packed up and left. They stopped for a week in Paris, where Conan Doyle spent some time with the French opthalmologist Edmond Landolt—he would later exaggerate these visits into full-fledged studies in Paris—and then were back in England by late March.

  In London, the Conan Doyles let a flat on Montague Place, in the shadow of the great British Museum. For a consulting room, Conan Doyle went to Regent’s Park, a nei
ghborhood popular with prominent physicians, and rented an office at 2 Devonshire Place (just a few blocks from Baker Street, as it happens). Expectations were great—“our boats were burned behind us,” Conan Doyle wrote in a letter—but patients failed to materialize. Every morning, he would arrive at his office and sit there expectantly. At three or four in the afternoon he would put on his coat and walk back to Montague Place. Day after day the bell never rang, which gave him more time to write at a furious pace. And as Conan Doyle considered his commercial opportunities and the literary landscape, he hatched an idea for a new sort of story. Monthly magazines remained the most promising and lucrative forum for his work, but he had tired of writing novels for serialization. Strung out so, serialized fiction seemed padded, even aimless, and too dependent on dedicated readers who would devotedly buy every issue. Perhaps, Conan Doyle thought, a new structure could take advantage of the monthly format but not punish any readers for missing an installment: a series of independent stories that featured one recurring character. Each story would be self-contained, with a satisfying resolution, but the main protagonist would appear in each one.

  Then he realized he already had the perfect character for such an experiment: Sherlock Holmes. Within a week of setting up in London, the first Holmes short story, “A Scandal in Bohemia,” was off to Conan Doyle’s agent; from there, it went on to The Strand Magazine.

  The Strand seemed the ideal venue for the experiment. Published by George Newnes, who promised readers that it would “cost sixpence and be worth a shilling,” The Strand was aimed at a more upmarket crowd than Newnes’s thriving middle-of-the-road weekly, Tit-Bits. It took the bold step of including an illustration on every page, a pioneering use of artwork. Herbert Greenhough Smith, The Strand’s editor, accepted the story and asked Conan Doyle for more. “There was no mistaking the ingenuity of the plot, the limpid clearness of the style, the perfect art of telling a story,” Greenhough Smith said later, noting that it “brought a gleam of happiness into the despairing life of this weary editor.”

  Over time, Conan Doyle honed a precise method for crafting a Holmes story. He would sit down at his desk, writing paper stacked neatly to one side, the oil lamp lit on the other, and notebooks at hand with ideas or sketches. He would first structure the story, starting with the solution to a crime. Working backward, he would chart the clues, setting them out in a certain order, the chain of evidence that would slowly accumulate in the telling. He would have to make sure Holmes didn’t benefit unfairly from his vantage point; the clues would have to be real. At the same time, he couldn’t allow a mystery to be too easy for readers to solve before Holmes brandished his own brilliant solution. There would be real clues, and some facts that seemed like clues but were extraneous to where the story was leading. Only Conan Doyle would know which was which, and Holmes’s only advantage was his method.

  Each story was a puzzle that Conan Doyle had to assemble carefully, but the method let him work quickly; a tale took him no more than a week. And once he laid it out, Conan Doyle wouldn’t consider going back to revise or edit his prose. Any such improvements, he felt, would be “gratuitous and a waste of time.” The stories were slotted to begin appearing in The Strand that summer, and Conan Doyle enjoyed the sublime feeling of being on top of his game.

  And then, one May morning a few days shy of his thirty-third birthday, Conan Doyle was making his early jaunt from Montague Street to Devonshire Place when suddenly he was overcome by a severe chill. It shook him to his bones, and he felt all at once horribly ill. He turned around and retraced his steps, struggling to reach his home on Montague. He went immediately to bed and would not rise again for days. He had come down with a severe case of influenza.

  The disease was not to be taken lightly. His sister Annette had died of the flu just sixteen months earlier. As it happened, 1891, when Conan Doyle was struck, turned out to be a particularly deadly year for flu; nearly seventeen thousand Britons would die of the illness, four times as many as in the prior year.

  Conan Doyle was in great danger for a week, and it would be several weeks before he was up on his feet, hobbling about with a walking stick. Yet the convalescence provided him with an opportunity to take stock. He considered his half measure of moving to London to pursue ophthalmology and writing on the side. Perhaps it was all wrong, a too-timid assessment of his potential. His literary career, he realized, was thriving, while his medical career was, for all purposes, nonexistent. Indeed, while literature was providing him with a comfortable income, medicine was only costing him money. His heart, he realized, was no longer in it.

  For Conan Doyle, the moment came as an epiphany and a profound feeling of utter liberation. “It was one of the great moments of exultation of my life,” he recalled later. It was the second time in a year that infectious disease would provoke a profound shift in Conan Doyle’s life. By the end of June, he had given up medicine for good. Once again, he loaded up the family’s belongings, for the third time in six months, and headed for South Norwood, a neighborhood south of London. He packed away his microscope, his stethoscope, and his other instruments, rarely to use them again.

  Conan Doyle had gotten a great deal out of medicine: an education, a sense of stature and accomplishment, and most of all a worldview. His was by now a thoroughly scientific mind, whether or not he still chose to participate in that science. Medical science informed how he thought; it influenced how he wrote; and quite clearly it was inseparable from what he wrote. “I can testify how great a privilege and how valuable a possession it is to be a medical man, and to have had a medical training, even though one does not use it,” he remarked later. He didn’t need to practice medicine anymore. He didn’t need to pretend that he wanted a successful medical career. He could finally say that he had, at last, surpassed the dream he’d described to his mother fifteen years prior: a thriving practice, a surgical appointment, and some stories on the side. The stories, he could now admit, were everything.

  • • •

  IN THE FIRST DAYS OF JULY, THREE HUNDRED THOUSAND COPIES OF The Strand began to appear in shops around Britain. They were soon all sold out, the public captivated by the tale of that consulting detective. The Book Buyer magazine proclaimed that “Whoever sets sail on a voyage of discovery with Dr. Conan Doyle may fairly expect that romance will preside at the helm.” Such sentiments pleased Conan Doyle—especially since they recognized him as a writer of literature, first and foremost. He was now a man with a reputation, a following, and a steady income.

  Why did these stories captivate the public’s imagination when the two previous novels had not? What had changed in the five years since 1886, when A Study in Scarlet had made scarcely a ripple in the public’s mind? For one thing, The Strand editors recognized the power of images, and they had lavishly illustrated the stories with drawings by Sidney Paget. Paget wasn’t the first choice; the commission was intended for his brother Walter, who had previously illustrated Robert Louis Stevenson’s Treasure Island and Robinson Crusoe. But the end result was inspired. Paget adroitly captured Conan Doyle’s description of Holmes’s profile: the beaked nose, sharp chin, and lean build. But Paget’s Holmes is more elegant and less odd than Conan Doyle describes. He appears handsome, well-dressed, and neat—a worthy hero, in other words, not the drug-addled malcontent of The Sign of Four. It was Paget, not Conan Doyle, who outfitted Holmes in his trademark cape and deerstalker hat. The drawings soon became an essential part of The Strand’s dramatic layout, and the magazine often devoted an entire page to at least one illustration.

  The shorter form, too, made for a brisker pace and a faster plot. “A Scandal in Bohemia,” at just over eight thousand words, streaks from Prague to Warsaw and back to Baker Street. The mysteries, too, were more than routine potboiler detective tales. The central case in “A Scandal in Bohemia” does not concern a murder, but rather a lost photograph—a much subtler sort of intrigue. The second story, “The Red-Headed League,” involves
an ingenious plot about a criminal gang that wants to tunnel into a bank through a shop; to get the shop owner and his “blazing red head” out of the premises, they place a newspaper advertisement offering four pounds a week to all members of the Red-Headed League. Holmes sorts out the case with a flourish.

  But the appeal probably lay most of all in Holmes himself, and his odd combination of zeal and insouciance. By now Conan Doyle had all but perfected the routine: The oddly cold and calculating detective is called, takes the laboratory into the streets, and turns the power of science toward the everyday mysteries of murder and intrigue. Holmes is precise, methodical, and keenly perceptive. He ably appropriates the techniques of the bacteriologist to discern what seems otherwise invisible. As he says in “A Case of Identity,” “it has long been an axiom of mine that the little things are infinitely more important.” This is Sherlock Holmes’s singular quality, and it was particularly well suited to the age.

  By 1891, science was no longer seen as some radical challenge to European culture; instead, it seemed in many ways to define the culture. This was true in Germany and France and especially in Britain, where science seemed to touch something in the Victorian spirit. As a speech published in the British science journal Nature put it in 1890, “Ours would be remembered as pre-eminently the age of science. Our successors might excel us as writers, as politicians, as soldiers; they might surpass even the industrial energies of the present time, but it was not likely—it was scarcely possible—that in the region of science the twentieth century should witness advances greater than, or as great as, those of the nineteenth.”