The Best of April 2014

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The Remedy


“The bacteria precede us.  The outnumber us.  And they will outlast us.”

In the nineteenth century twenty-two out of every thousand people died each year, more than 2% of the population– today only 5 out of a thousand people die each year.  In the nineteenth century the average lifespan was thirty-six years – today it’s about eighty.  The biggest killer in the nineteenth century?  Tuberculosis.  Also known as consumption, this disease was rampant, believed to be hereditary, and in spite of numerous claims of ways to cure the disease, no cure or effective treatment was available.

Then in 1882 a German doctor, Robert Koch, presented to the world the cause of tuberculosis.  It was not hereditary, but caused by bacteria.  Using unparalleled and unprecedented scientific methods, Dr. Koch had identified, isolated and replicated the deadly bacteria, injected it into healthy animals, watched as the animals developed tuberculosis, found the bacteria in their blood and tissue, isolated it, and repeated the process, proving without a doubt the cause of the world’s number one killer.  Spurred on by a professional and contentious rivalry with Louis Pasteur, Koch tackled the next problem, finding a cure.  In his haste to satisfy both his professional pride and national pressures, driven by a desire for recognition, Koch threw aside the very scientific methods which had made him well-regarded and presented the world with the cure that was not.

Enter Arthur Conan Doyle, a young small-town English doctor and writer, headed towards Berlin to cover the announcement of Koch’s cure.  When he sees the German doctor’s cure at work he is horrified and quickly returns to England to report on the farce.  While Koch stubbornly insists that his cure will work, the ill descend upon Berlin desperate for help where none can be found.  Koch’s reputation destroyed, in spite of his groundbreaking work in germ theory and discovering the cause of tuberculosis, flees to other parts of the world to work away from the scrutiny of his critics.  Meanwhile, Arthur Conan Doyle, unsuccessful as a doctor, ironically employs the very scientific methods that made Koch famous in the creation of Doyle’s most famous character, Sherlock Holmes.

The epilogue is as interesting and terrifying as the rest of the book.  Tuberculosis, once thought to have been cured, is coming back in new and drug-resistant forms as a whole new generation of scientist begin to look at how microbes affect our health in other ways including heart disease and cancer.   Smart, insightful, and interesting, this book is the tale of the egos of ambitious men, an unparalleled time of scientific discovery, and the resulting societal changes.  It leaves one to ponder where we will go from here…

And we are lucky enough to have a Q&A from the author, Thomas Goetz!

Q&A with Thomas Goetz, author of The Remedy

What is the Germ Theory, and why was it so important?

The Germ Theory is the hypothesis that many diseases are caused by microbes, not by the body itself or by some other cause such as miasma – bad air. The idea that some diseases were pathogenic or contagious had been around for centuries, but it wasn’t until Louis Pasteur in the 1860s and then Robert Koch in the 1870s that enough evidence was marshaled to make the argument convincing. In particular, it was Koch, with his Postulates – a series of conditions that must be met to prove a microbial cause of disease – who produced a method by which science could definitively establish the cause of disease.

Pasteur and Koch’s work on the Germ Theory constitutes the birth of modern medicine, when science finally began to explore the true causes of disease – and therefore to determine vaccines or treatments for those diseases. Once the germ theory was established in laboratories, at last hygienists and social reformers could finally attack the causes of infectious disease, which were by far the leading cause of death in the 19th and early 20th centuries. This insight into causes pushed hygiene forward. Within a few decades, infectious disease was no longer the looming threat it had been, and people’s lives grew longer and healthier.

Why does it take society so long to believe science?

Any scientific discovery takes about a generation to manifest – to work its way from discovery to publication into practice. That was true in the 1870s and it’s true in the 2010s. This lag is vexing, especially for scientists, but it’s understandable. It simply takes time for consensus to emerge, and for an academic consensus to actually change practice – how science is applied in the field. The fact that society often needs to be convinced of the new truth only adds to the lag. This sounds old fashioned – the germ theory is entirely common sense now, and it seems absurd to think that anyone would doubt the existence of germs. But we have the same slow process today. Think about something seemingly obvious, like vitamins. The 1980s saw a new wave of research into Vitamin D deficiency and various disease risks – but we are still muddling towards some sort of consensus on what people should actually do 30 years later. Same with the science around sugar and nutrition and obesity. It takes science a long time to establish a proof, and it takes society a long time to believe that proof.

Why should we care about infectious disease today?

There are some scientists would believe we’re on the precipice of a new era of infectious disease, due to a few convergent trends. One is the fact that we’re exhausting our antibiotics and new superbugs are emerging. Second is the idea that many diseases we have considered chronic – such as heart disease or obesity or auto-immune disorders – may actually have significant microbial components. I think one thing to understand is that our understanding of all microbes as ‘germs’ may be misplaced. There are many microbes that actually help us more than hurt us – and we need to be aware that purging all germs from our environment can have profoundly negative unintended consequences.

What does Sherlock Holmes have to do with tuberculosis?

Sherlock Holmes is a character of his age – he personifies the late 19th century’s appetite for all things scientific and for this new notion that science can actually solve human problems. In creating Sherlock Holmes, Arthur Conan Doyle borrowed not only from his med school mentor Joe Bell, but also from the great scientists of the day, particularly Robert Koch’s, who diligent laboratory methods Conan Doyle admired and wrote about. When Koch discovered the bacteria that causes tuberculosis, Conan Doyle was inspired by the rigor and tenacity of Koch’s methods, and his single-minded focus on rooting out the cause. The fact that Conan Doyle’s own wife would die of the disease decades later – and the fact that tuberculosis was part of the ruse at Reichenbach Falls that allowed Holmes to be “killed” – well, that’s the consequence of tuberculosis being such a ubiquitous disease, common to everyday experience at the time.

Why did the last quarter of the 19th century create more technologies that the last quarter of the 20th century?

Those 25 years from 1875 to 1900 were abuzz with discovery, with invention after invention transforming everyday life. Everything from toilet paper to paperclips to electronics were invented in those years. In part, this was a result of the previous decades of industrialization, where factory processes were at last turned toward addressing the toils of daily life. A century later, by 1975, so much of modern life had already been optimized and improved upon. That’s not to say there weren’t transformative discoveries afoot – the personal computer, the cell phone, and so many other pieces of modern technology emerged in those last 25 years, technologies that we’d consider essential today. But I’d argue that the pace and impact of new technologies was much more profound in the 19th century. For many, the landscape of daily life on either end of those 25 years would be unrecognizable, where life in 2000 wasn’t all that different from 1975. Even bell bottoms were making a comeback!

Title: The Remedy: Robert Koch, Arthur Conan Doyle, and the Quest to Cure Tuberculosis
Author: Thomas Goetz
Genre: Non-Fiction, History
Pages: 320
Publication: Gotham, April 2014

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