Topics in Public Health
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 ....is... 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 ....in quick succession
the microbial causes of ......anthrax
tuberculosis .... and cholera .
Now Professor Koch.....is 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 later....in 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 ...one 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 ..at 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 morning....in 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 ....as 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 months.....to acknowledge.
from JAMA December 2005