Book Review: The Adventure of the Cure That Wasn’t

Marzieh Ghiasi and Madhukar Pai from McGill University & McGill International TB Centre, Montreal, review “The Remedy” by Thomas Goetz

Robert Koch raised the hopes of millions of tuberculosis patients with his remedy (i.e. tuberculin) that turned out to be ineffective. Today, tuberculin is a widely used diagnostic test for latent tuberculosis infection (picture). Image credit: Madhukar Pai

Robert Koch raised the hopes of millions of tuberculosis patients with his remedy (i.e. tuberculin) that turned out to be ineffective. Today, tuberculin is a widely used diagnostic test for latent tuberculosis infection (picture). Image credit: Madhukar Pai

No image is more iconic of the Victorian age than that of a detective with a deerstalker cap, pipe, and magnifying glass roaming the dark streets of London in search of criminals and murderers. Hidden in plain sight, the real killers of the nineteenth century were infectious diseases such as tuberculosis, responsible for as many as a quarter of all deaths in that era.

In The Remedy (2014) science journalist Thomas Goetz recounts the stories of Robert Koch, the founder of modern bacteriology, and Arthur Conan Doyle, the physician-author of the Sherlock Holmes series. In two narratives that run in parallel and eventually intersect, Goetz introduces a cast of pioneering medical detectives, from Koch’s scientific rival Louise Pasteur, to Conan Doyle’s inspiration for Sherlock Holmes, Joseph Bell. We follow a search for causative agents, preventive vaccines, and remedies for some of the deadliest infections in the Victorian era. Goetz describes how the principles of evidence-based science and systematic experimentation guided these ground-breaking discoveries, and how overlooking these principles led to setbacks.

The Remedy begins by tracking Robert Koch working as a town doctor in Germany. Limited by resources, but moved by his experience tending the wounded in the Franco-Prussian war, he investigated the causative agents of infections. Secluded from the continental scientific community, he developed tools and methods to study bacteria which we still use, from the white mouse lab to culture media. He also developed a set of postulates, a step-wise checklist for demonstrating that a disease is caused by an organism. These real as well as thinking tools allowed him to find and track the life course of the causative agent for anthrax—Bacillus anthracis, an irrefutable proof for the then-nascent germ theory.

The strength of the book is Goetz’s page-turning account of one of science’s greatest rivalries, between Koch and the French scientist Louise Pasteur who was gaining fame for his work on vaccinations for anthrax and rabies, microbial fermentation and pasteurization. Goetz masterfully weaves primary sources, including letters and conference notes, to describe a race driven by a clash of egos, nationalism, and ambition. This competition ended in a breakthrough for Koch, who became the first to identify the infectious agent for tuberculosis— Mycobacterium tuberculosis. According to Goetz, Koch’s ambitions went further as he sought to find a cure for tuberculosis.

The Remedy takes us from the continent to idyllic Southern England where Arthur Conan Doyle practiced medicine by day and wrote by night. While Koch’s energies were focused on finding a cure for tuberculosis, Conan Doyle was focused on making science accessible to a mistrustful Victorian public. The Remedy describes how the character of Sherlock Holmes was inspired by Conan Doyle’s former professor, Joseph Bell, and his methodical approach to solving medical mysteries. The character was also an embodiment of ideals held by Conan Doyle’s contemporaries, including Koch.

Back in the continent, Koch’s ambitious plan of finding a remedy for tuberculosis came to fruition, at least in his mind. He developed a crude, heat-killed extract of tuberculosis culture, called tuberculin. Until then, remedies for tuberculosis had included things from donkeys’ milk to goats’ blood, and, of course, bed rest, fresh air, and sun light.

Koch’s premature declaration that he had a remedy represented a new hope, and drew thousands of hopefuls to Berlin. Through fortuitous events, Conan Doyle covered the conference in which the ‘remedy’ was announced, without significant clinical proof and shrouded in secrecy of its exact nature and contents. Although the two never crossed paths, after visiting wards where patients were being treated with tuberculin, Conan Doyle reported that he was unconvinced. There was no evidence that the remedy worked. According to Goetz, Conan Doyle’s paper was a turning point, as it was followed by others who debunked Koch’s remedy, and questioned his integrity.

The Remedy is not a biography of either Koch or Conan Doyle, or a history of tuberculosis and its remedies. Rather, Goetz captures the lives of these men and their work in broad, impressionist strokes. This is both a strength and a weakness of the book. Descriptions ranging from Koch and Pasteur’s encounters at conferences to the frenzy of “the walking dead” streaming into Berlin create unforgettable imagery. However, the book has cursory descriptions of Koch’s process for discovering Mycobacterium tuberculosis and his supposed remedy. The book also fails to credit Koch adequately for the contribution he eventually made by producing tuberculin – the tuberculin skin test has survived a century of use and is still the most widely used test for latent tuberculosis infection (picture).

The Remedy meticulously constructs how Sherlock Holmes emerged from the scientific movements of the late Victorian age, and brought the process of scientific thinking to the public consciousness. Every chapter of the book is packed with interesting facts about science and medicine, past and present. Goetz’s work is an astounding success in conveying the necessity of constant vigilance in science, and sharing information with the public. Nevertheless, a large portion of the main narrative drives towards the intersection of Koch and Conan Doyle’s lives. Ultimately, the link between the two proves to be tenuous and overinflated, as the evidence presented by Goetz does not indicate that either man played a significant role in the life of the other. One wonders how things would have turned out, if they had actually met and collaborated.

In A Scandal in Bohemia Sherlock Holmes says “It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.” Goetz gives us insight into Koch’s capital mistake, driven by nationalistic pressure, competition, and his own blinding ambition. Conan Doyle, like his character Holmes, was able to see through the remedy because of his adherence to the science of deduction. Despite this, Conan Doyle, in his later life, was enticed by supernaturalism and mystic traditions.

We live in an age where scientific publications continue to be plagued with bias, highly cited findings that never get replicated, selective publication of positive findings, and a tendency by the media and researchers to sensationalize early and unproven findings. Meanwhile, the public continues to be duped by pseudoscience, quackery, and false remedies. More time dedicated to exploring what led Koch to neglect his own postulates and Conan Doyle to abandon his clear-eyed rationalism would have served modern readers (and scientists) well.

“The Remedy” by Thomas Goetz is published by Gotham Books, New York, NY. ISBN-10: 159240751X

Marzieh Ghiasi, BSc completed her undergraduate training in environmental health at McGill University in Montreal, and will begin her Master’s degree in epidemiology in fall. She is passionate about science communication, infectious diseases, and global health.

Madhukar Pai, MD, PhD, is an Associate Professor of Epidemiology at McGill University in Montreal and an Associate Director of the McGill International TB Centre. He also serves as a consultant for the Bill & Melinda Gates Foundation. He is also a member of the PLOS Medicine Editorial Board and the PLOS ONE Editorial Board. Madhu is passionate about improving the diagnosis and treatment of tuberculosis, particularly in high-burden settings like India.

The authors declare no conflicts of interest.

Books reviewed in Speaking of Medicine are independent of the book’s publisher. Reviewers do not receive a fee but are allowed to keep the review copy of the book.

 

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