Topics in Public Health

M. Chairman,


Picture if you would....a hot and steamy week

in Berlin, in Germany, in August, in the year ... 1890.

The 10th International Medical Congress

is being held there, sponsored as it is... by

the German Kaiser, Kaiser Wilhelm II ,

who has invited almost 6000 physicians ...from around the world

to consider the latest in medical advances of the time.


The big attraction of the Conference Special Lectures

by the the medical Stars of the time,

amongst them being....such famous names as ...

Joseph Lister..... Rudolf Virchow.... and James Paget.


But ...topping the bill ...on the afternoon of August 6,

is to be a lecture by none other than.... Dr. Robert Koch

Who has become a household name ....throughout Europe

During the preceding 14 years, the distinguished professor

of hygiene and bacteriology at the University of Berlin

has discovered quick succession

the microbial causes of ......anthrax

tuberculosis .... and cholera .

Now Professor a famous fellow

But he is not a commanding speaker.

He has a thin, reedy voice

And his speeches are peppered

with a distracting number of "ums" and "ers".

But.... his colleagues have learned

to pay closer attention to his words...

than to his style of presentation,

because they know that something spectacular

is likely to happen... whenever he speaks.

And indeed.... the eager physicians who fill the seats

of the stifling-hot auditorium.... that afternoon

are not to be disappointed.

Within moments ...of beginning his speech,

Dr. Koch makes a stunning announcement....

He announces... that he has discovered

What he calls .....a "Remedy... for tuberculosis."

Tuberculosis was a leading cause of death and illness

at that time, so news of Koch's apparent discovery

travelled around the world within weeks

by newspaper, and journal, and telegraph.

And in fact, within Hours of the lecture,

physicians began to demand supplies

of what was then called "Koch's lymph"

that they could use to treat their desperate and dying patients.

Dr. Koch's lecture was formally published


A few months the November 15, 1890 issue

of the British Medical Journal

and on the following day... the front page of the New York Times

heralded the remedy as..... "Koch's Great Triumph."

In fact the discovery was hailed as being even more important

than that of Edward Jenner.....who was the English physician,

who 100 years earlier

had discovered the technique of ....Vaccination.

Now of the millions of people who read

about this incredible discovery ... when it was published

was a young General Practitioner.. who was struggling

to establish a practice in Southsea, England at that time.

Things were often quiet the young doctor's office that autumn.

There were long stretches of time

between appointments with his patients,

So the young GP had taken to ....writing....

to fill in ....some of that time.

In 1887, the doctor had published a novel entitled

A Study in Scarlet,... which introduced the world

to Sherlock Holmes, the great detective

who employed the method "deductive reasoning"

The physician author was ......Arthur Conan Doyle.

There was to be a demonstration of the new TB Remedy

in Berlin later that week...

and Conan Doyle ..quickly decided to attend.

Years later, he recollected this decision.

and he said,

"I could give no clear reason for doing 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 tuberculosis,

it would have been more understandable ,

but I had, as a matter of fact, no great interest

in the more recent developments of my own profession."

So for Conan Doyle to travel to Germany

for this purpose.....was a very odd thing for him to do.


Conan Doyle took the train to Berlin

....where he arrived on November 16.

Dr. Koch's colleague.... Dr. Ernst von Bergmann,

was scheduled to demonstrate ..the miraculous TB remedy

the following the medical auditorium.

However Doyle was dismayed to find

that there were no tickets left to the demonstration.

It was all sold out......Doyle was very disappointed.

However a TB specialist from Detroit

named Henry J. Hartz ... kindly volunteered to share his notes

on the demonstration with Doyle,

and then, even better...... the following morning,

Hartz quietly escorted Conan Doyle

into Dr. von Bergmann's clinical wards

so that Doyle could examine

the patients who had been treated with Koch's lymph.

Well, within one day ....of analyzing the mass of clinical data

Conan Doyle came to a startling conclusion.

He concluded.....that Koch's treatment was experimental

And that his conclusions ...were premature.


Then after he returned to England

Doyle published his opinion.... in the London Daily Telegraph

and then subsequently in a British magazine ...called Review of Reviews.

So while the rest of the world rejoiced

over the reported conquest of tuberculosis,

Conan Doyle argued that while Koch's lymph

was valuable a test for the presence of TB in a patient

but that in treating the disease..... it was useless.

It was quite a spectacle.....

Here was an unknown English country GP

Criticizing the work...

Of one of the world's leading medical scientists.


However ...Conan Doyle was ultimately proven to be correct.

By early 1891,

After there had been several.... highly publicized treatment failures,

Including some deaths

Professor Koch publicly retracted his announcement

of his "remedy" for tuberculosis

The professor then announced that ,

just as Doyle had claimed,

although Koch's lymph .....

was an excellent means of diagnosing tuberculosis,

that the actual cure ....was nowhere in sight.


So the young Conan Doyle,

Who was the creator... of the greatest detective in English literature,

deduced .... In short order

what took Professor Koch,

who was one of the most famous medical detectives in history,

many more acknowledge.

M. Chairman



from JAMA December 2005