Vision of the Future

In the scant hundred years since Pasteur developed the germ theory of disease, medical scientists have concentrated on helping the patient by attacking the germs, first with preventive vaccines, latterly with antibiotics that arrest or alter the course of full-blown disease. Last week, before a packed audience at the New York Academy of Medicine, Dr. Rene Jules Dubos, most imaginative of Pasteur's scientific heirs, suggested a radically new approach: work not on the microbes but on the patient, so that the microbe-invaders will never have a chance to cause disease.

What started the Rockefeller Institute's Dr. Dubos on the new tack was a common and persistent question: Why is it that a man can carry around for years a throatful of disease-causing bacteria without getting sick, and then suddenly come down with a roaring infection caused by one of the bacteria he has harbored?

Clues to a Puzzle. The answer, Dubos concluded, lies in the physicochemical balance of the host. Somehow, his system becomes a more favorable medium for germs to multiply. It is not simply a question of a loss of the host's immunity or an increase in microbial virulence. Dubos suggests that receptivity to infection in the first place may depend on bodily mechanisms entirely different from those which regulate other aspects of physical wellbeing, such as growth. So far, Dubos can only hint at what these mechanisms may be. One clue lies in acute starvation, as distinguished from long-range underfeeding. If Dubos takes well-fed mice, but omits their feedings for 30 hours (not long enough to cause obvious physical distress), they become suddenly susceptible to artificial infections, which prove rapidly fatal. Some chemicals also have this effect--notably sodium citrate. (By contrast chronically undernourished mice can maintain a normal level of resistance.)

Acute starvation produces similar susceptibility in humans. So does diabetes. But most victims of diseases contracted under these malign spells recover their resistance to infection when their diet or metabolism is corrected. It may be that even among well-fed and generally healthy individuals, Dr. Dubos suggests, the ability to ward off attack by infectious agents will vary greatly from day to day. If so, it may explain why a nurse or attendant in a leprosarium may be exposed to infection for years and then, mysteriously, fall victim to the disease. As Dubos puts it: "Contact and receptivity may be rarely coincidental."

No More Treatment? An immense amount of research must be done to find out what changes in the human body make it prone to infection--and, probably, more years of work to find out how to prevent or reverse these changes. But Dr. Dubos permitted himself a vision of the future: a world in which antibiotics and elaborate medical treatment will not be needed, because the power to resist infectious disease will be built into, and maintained in, man himself.

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