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NLM Director’s Comments Transcript

TB and Sherlock Holmes: 11/24/2014

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff U.S. National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

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The 19th century discovery that tuberculosis (TB) is a bacteria (and the initial efforts to treat it) have surprising links to the creators of pasteurization and Sherlock Holmes, finds a new book that was recently reviewed in Science.

The book describes the pioneering work of 19th century German physician, microbiologist, and 1905 Nobel Prize recipient Robert Koch, who demonstrated TB (and anthrax) were bacteria, and tried to develop a TB remedy.

The book (and review) emphasize the importance of Koch’s scientific contributions from 1870-1910 — especially within the public health context of his lifetime. For example, TB (which as known as consumption until Koch’s bacterial discovery) was the leading cause of death in N. America and Europe in the 19th century.

At the time, sanitariums to treat TB patients flourished in the U.S., Canada, and European nations. The book notes it was Koch, a German physician, who (with impressive attention to detail and scientific evidence) debunked the existing theory that consumption was caused by miasma, a misperceived, allegedly pernicious form of air pollution. The latter misconception partially explains why sanitariums originally were located in non-urban, tree-lined neighborhoods — where the air quality was better than in inner cities.

Instead, the book (and review) explain how Koch demonstrated TB, anthrax, and some other diseases were caused by microorganisms. Koch found TB’s bacterial microorganisms were spread when an infected individual coughed, sneezed, and directly exposed others to bacterial germs (that were invisible to the human eye).

While the book explains how Koch’s germ theory and experimental methods revolutionized medicine, the text also notes two of the sources of Koch’s perseverance and drive were his contemporaries Louis Pasteur (the French microbiologist who among many scientific contributions invented milk pasteurization) and British physician-author Sir Arthur Conan Doyle, who gave us Sherlock Holmes.

The book describes how nationalistic pride, competition, and ambition drove Koch to try and outdo Pasteur. The book (and review) note the cultural differences and animosity between France and Germany influenced Koch’s eagerness to top Pasteur. On the other hand, the book notes Koch did not cut corners in a pursuit to eclipse his scientific rival. Instead, competitiveness drove Koch to provide even more meticulous evidence to demonstrate his discoveries, which he believed would overwhelm, outhustle, or embarrass his French peer.

Later in Koch’s career, the book describes his quarrels with British physician Sir Arthur Conan Doyle, who was critical of the initial TB remedies that Koch developed and advocated.

The book describes Koch and Doyle as protagonists who tried to rebut or vex each other’s medical opinions and ambitions at every turn. While the inspiration for Sherlock Holmes’ penchant for detail historically has been assumed to be Dr. Joseph Bell (a medical professor who impressed Doyle), the book argues Koch’s meticulous scientific approach presents a more likely role model. The book implies some of the less glamorous characteristics of Holmes’ character may have reflected Doyle’s reservations about Koch’s hubris and methods.

Either way, Thomas Goetz’s The Remedy: Robert Koch, Arthur Conan Doyle and the Quest to Cure Tuberculosis provides 19th century insights about the drivers of scientific competition that Dr. James Watson similarly described in The Double Helix, which covers his mid-20th century co-discovery of DNA’s structure.

Moving to the present, MedlinePlus.gov’s tuberculosis health topic page notes TB remains a 21st century public health challenge — despite well-established treatments and preventive medications. A website from National Institute of Allergy and Infectious Diseases (NIAID) explains active TB remains a leading killer of young adults worldwide. About two billion persons, or one-third of the world’s population, have a latent TB infection, which may or may not become the active disease. The NIAID website can be found in the ‘overviews’ section of MedlinePlus.gov’s TB health topic page.
More information about the differences between latent and active TB are explained in a website provided by the U.S. Centers for Disease Control and Prevention (the CDC) in the ‘specific conditions’ section of MedlinePlus.gov’s TB health topic page.

Another website from the CDC explains the treatment options for TB within the ‘treatment’ section of MedlinePlus.gov’s TB health topic page. 

MedlinePlus.gov’s TB health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about TB as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s TB health topic page type ‘TB’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Tuberculosis (National Library of Medicine).’

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