Berlin,
1890.
Doctors crowd the theatre's lobby,
they've come to see history made.
Tickets are impossible to get.
One British physician, a man who dabbles in writing,
and is there on behalf of a London newspaper,
begs for a seat.
When he fails to secure one,
he first tries bribery and then stealth
to make it past the ushers.
Both attempts fail.
The doors close,
and he admits defeat.
Arthur Conan Doyle will remain outside,
but inside, the great German scientist Robert Koch
begins to demonstrate his cure
for Tuberculosis.
Intro music [Birth of the People]
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The nineteenth century had
many names for Tuberculosis.
The most popular was 'Consumption',
named after patients' dramatic weight loss.
Another,
'The White Death',
because of how pale sufferers became.
And also
'The Captain of the Men of Death'
due to its prolific body count.
To live in nineteenth century Europe and America,
was to live among tubercular death.
During that century,
up to one in seven Germans died of the disease.
And, during some years,
a full quarter of London's deaths were attributed to TB.
The crowded and unclean nature of cities and factories,
both on the rise,
proved an ideal environment for transmission.
And in an era before public hygiene campaigns,
or the widespread belief in germ theory,
coughing, sneezing, and spitting in public were the norm.
Spitting was especially commonplace though,
and considered healthy,
given the amount of coal smoke that coated city dwellers' sinuses.
People freely spit on street cars,
or even the floor of the United States Congress, gross.
It came on slow,
lodging deep into the patient's lungs and lying dormant for months or years.
First, the patient would present a cough that came and went.
Then weight loss, and weakness.
One day, they might find a telltale drop of blood
in their handkerchief.
Frailness and death would follow.
There was little to do.
Cod liver oil, Opium and Quinine eased the suffering,
but didn't fight the disease.
Many patients chose to visit sanitoriums and places with
"good air":
Alpine regions or particularly dry climates,
while others subscribe to unproven regimens
of cold baths or immobility.
Some, seeking any kind of relief,
underwent surgeries
too gruesome to describe here.
Mostly though,
people found a way to live for as long as they could.
After all, it killed slowly,
and in this, it was almost considered "merciful",
providing the "good death" surrounded by friends and family
that was so desired in the Victorian Era.
The disease even became fashionable,
associated with Bohemians
and Romanticists.
After several prominent artists died from the disease,
women powdered their faces to mimic the pale look.
Novels and operas told of doomed lovers
destined to be separated by the White Plague.
Enter Doctor Robert Koch,
Hero of the German Empire.
He was *exactly* the kind of person you'd expect to cure Tuberculosis.
He'd come from humble beginnings,
serving as a surgeon during the Franco-Prussian War,
and later opening a country medical practice,
using his profits to build a home laboratory.
He kept a menagerie of test animals in his backyard,
ranging from chickens to rabbits to guinea pigs and white mice.
And it was there that he began to study a disease
that ravaged his rural community:
Anthrax.
His big break came when he developed, and demonstrated
a process for isolating and growing bacteria
in pure laboratory cultures,
techniques he used to identify the anthrax bacteria.
And, that done, Koch forged ahead with his research on microbes,
quickly gaining a reputation as a meticulous scientist.
And when he lacked the tools to prove what he needed,
he just invented new ones!
Finding novel ways to grow bacteria on gelatin and agar,
and developing a photographic microscope,
so doctors need not rely on drawings.
But these discoveries were no mere accomplishments.
By identifying a specific bacteria
as the cause of anthrax,
And proving he could use that bacteria to infect healthy animals,
he had conclusively proved the 'Germ Theory of Disease.'
Moreover,
he turned these initial experiments into his four postulates.
Criteria to demonstrate whether a specific microbe
caused a specific disease.
This country doctor had, essentially,
helped found Bacteriology.
He would go on to use these postulates
to isolate Cholera bacteria in Bombay,
and in a blockbuster 1882 announcement,
revealed that he'd found the pathogen that caused Tuberculosis.
And that last declaration
caused a sensation.
Tuberculosis was the greatest killer in Europe,
and identifying its cause
suggested that a cure might be on the way.
After all, that's what had happened when Koch first isolated Anthrax bacteria.
And five years later, Louis Pasteur had produced a vaccine.
And that, in many ways, was why
Koch was pursuing tuberculosis.
He was annoyed that Pasteur
had found a cure for Anthrax before he could.
And furious that Pasteur had
barely cited his research in doing so.
Instead of jointly celebrating the discovery,
the two entered a bitter lifetime feud,
trading barbs in scientific journals.
Koch seethed that Pasteur, who he saw as
sloppy and self-aggrandizing,
had encroached on his territory.
Besides, Koch was German, and
Pasteur, French.
There was national pride on the line.
Tuberculosis, Koch decided, would be his greatest prize.
If he could find an effective treatment for the White Plague,
his legacy would be assured.
He might even get his own institute,
like his hated rival, Pasteur.
And after eight years,
he finally had a breakthrough.
A substance that,
when injected into guinea pigs,
starved the pathogen to death, by killing the infected
flesh it fed on,
allowing the dead
flesh to detach and patients to expel it via cough.
It didn't directly kill the disease, though,
but it took away the ability to spread.
He tested it on animals,
then gave doses to healthy subjects
including himself.
None had a bad reaction,
But, when he gave it to tubercular patients,
it brought on severe fever, chills, and an apparent slowing of the disease.
In patients who experienced growth in their lymph nodes,
the growths became necrotic.
It was a lucky result.
The Tenth Medical Congress was coming up,
and he was under pressure to deliver a great scientific victory for Germany.
So, in 1890,
Koch stood in a hall full of doctors
at the Tenth Medical Congress in Berlin,
and unveiled his new wonder remedy,
Tuberculin.
He stressed that his research was not complete,
and that the substance worked best in patients whose cases were not too advanced.
And, he insisted,
the precise nature of the substance must remain a secret at present.
But here at last, was a remedy
that could halt the progress of Consumption.
There would be a demonstration in a few months.
The news exploded.
Newspapers announced that Koch had found a cure.
The Kaiser presented him with Germany's highest award:
The Grand Cross of the Order of the Red Eagle.
Letters from all over the world flooded his home and laboratory,
begging for doses of tuberculin.
And sensing an end to their misery,
thousands of consumptives
flocked to Berlin,
creating a public health crisis
that necessitated police intervention to keep them away from the populace.
And Koch got his wish:
his own infectious disease institute,
with a whole section researching tuberculin.
They began producing the substance and conducting human trials.
The public demonstration was a success.
The house was so packed, that doctors without tickets,
like Conan Doyle, were turned away.
Luckily for Conan Doyle, however,
he managed to copy notes from a man who attended,
and the next day, got to visit a ward
where tuberculin was being tested on patients.
His newspaper article was saved!
But Conan Doyle was shocked at what he saw.
Patients shivering,
thrashing, burning with fever,
The term had not been invented yet,
but he was witnessing them going into shock.
This was no cure.
"The whole thing was experimental and premature,"
he warned in a piece for the London Daily Telegraph.
In a follow-up,
he said that while the injection may kill diseased tissue,
it undoubtedly left the pathogen.
Due to the swelling at the injection site, however,
in low doses, it might serve as a test to diagnose TB.
Conan Doyle was one of the few temperate voices.
And within months, the first trial doses began going out.
Not just to Berlin,
but to London, Paris, and Edinburgh,
to private practices and sanatoriums, as well as hospitals.
Newspaper reporters and crowds
gather to watch the first injections.
There were no controls about how much each patient would receive,
and over two thousand people, of all ages, received tuberculin.
But the composition
remained a secret.
Koch still wouldn't reveal what was in tuberculin.
This was unusual,
even uncomfortable.
But Koch was a genius with a world-renowned reputation.
Some patients appeared to improve,
others, die.
At first, the latter were dismissed as dire cases that would've expired anyway.
But, as tests continue,
the numbers began to tell a different story.
Though some seemed to improve,
only around two dozen (24) people were actually cured.
Thirty (30) had died.
It was a failure.
And, more than that,
news leaked that
Koch had been in talks to patent tuberculin,
using the profits to fund his new institute.
Worse,
a study revealed that killing infected tissue
didn't actually stop TB from spreading.
Under public pressure,
Koch revealed the ingredients of tuberculin:
dead tuberculosis microbes,
in glycerin extract.
...and traveled to Egypt to avoid the firestorm.
It was clear this was not the cure.
Though as Conan Doyle predicted,
the swelling around the injection area proved a very good test
to diagnose TB patients who were allergic to the substance.
Koch's mistake was one of pride and process.
In his eagerness to secure a win for self and country,
he'd abandoned the methodical practices that were his hallmark.
He'd bought into the myth of a scientist as a heroic, singular figure,
rather than as a part of a community that advances by building on each other's work.
And as we'll see next time, it would take that kind of teamwork and incremental innovations
to finally cure The White Plague.
[Postulate 5 by Sean and Dean Kiner]
Once again, thanks so much to Child and Teen Checkups programs for sponsoring this series.
Tuberculosis isn't as common as it once was,
but it does still exist.
Children should receive a health checkup every year.
And doctors can ask questions to find out if your child is at risk.
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learn more at getctc.com
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