Peering back in time from the safety of 2014, it can be difficult to grasp just how powerfully tuberculosis affected everyday life in the second half of the 19th century. Although TB was the number-one cause of death in the United States at the time, not only was there no effective treatment, but its very cause was a mystery to scientists and physicians alike. In “The Remedy,” Thomas Goetz describes TB’s impact on individuals and whole societies, and how science was harnessed to find a cure, upending many paradigms and careers in the process.
The most prominent character in “The Remedy” is Dr. Robert Koch, a small-town German doctor, whose determination and scientific rigor made him the first to identify the bacteria that causes TB in 1882. Although a necessary first step on the pathway to a cure, it would be more than six decades until the first effective treatment was discovered. Many other 19th-century physicians and scientists, such as Louis Pasteur and Paul Ehrlich, make appearances in the book as well, reminding the reader of the importance and continued relevance of their wide-ranging discoveries, separate and apart from the struggle with TB. Pasteur’s development of the rabies vaccine in 1885 is but one example of this.
Arthur Conan Doyle — the physician, author, and journalist who created Sherlock Holmes — also features prominently in “The Remedy.” Conan Doyle was sent by a London newspaper to cover a presentation given by Koch in 1890 in which Koch revealed what he believed to be a cure for TB. Conan Doyle’s thoughtful and skeptical report for the Review of Reviews about Koch’s purported cure was highly influential. The two never seem to have actually met, however, and beyond being physically present in Berlin at the same time there is very little else to link them. Nonetheless, Goetz strives to do just this, proceeding to tell the story of Conan Doyle’s abandonment of medicine in favor of a full-time literary career.
And this is the book’s weakness: its tendency to veer rapidly from topic to tangentially related topic, leaving the reader not entirely clear as to what, exactly, it’s all about. Goetz shifts from describing the lives of many of the medical luminaries of second half of the 19th century (and their professional and personal rivalries), to such topics as the use of pesticides in Iowa in the 1950s; public backlash against vivisection in the mid-19th century; and present-day resistance to childhood vaccines.
Still, “The Remedy” provides fascinating insight into the ways in which science, both medical and general, evolved over the course of the 19th century. The rapid pace at which this happened left behind many who were unable to adapt, and whose egos prevented them from recognizing the discoveries of others. For example, Goetz describes the interaction between Koch and Rudolph Virchow, one of the giants of 19th-century medicine in Germany, who had long been skeptical of bacteria’s role in causing disease. After Koch presented proof, Virchow simply turned away and walked out of the room. Afterward, Virchow would deny Koch’s role in discovering the germ that causes TB. Koch himself would in later years display similar inflexibility in accepting the findings of others, stubbornly refusing to acknowledge that TB could be transmitted from cows to humans via untreated milk, despite proof that this was indeed the case. This led to unnecessary delays in universal pasteurization, and greater infection rates.
“The Remedy” is a highly entertaining, interesting, and thought-provoking book, leaving the reader with a much deeper appreciation of how much safer — and in many ways, predictable — our lives are today thanks to the toil and efforts of men such as Robert Koch and his contemporaries.
Dennis Rosen is a pediatric pulmonologist who practices in Boston. His book “Vital Conversations: Improving Communication Between Doctors And Patients” will be published by Columbia University Press in the summer.