Biochemical Determinants of Microbial Disease

This is a very stimulating book, since in it the author discusses infectious processes in biochemical terms. He emphasizes not only what can be done to develop our understanding of microbial disease and host resistance mechanisms, but also shows how meagre our knowledge in this field really is. Early in the book Dubos points out that current infectious disease literature has "a quaint mid-nineteenth century flavor. It describes disease as a conflict between two opponents, one endowed with 'aggressive' weapons, and guilty of 'invasion,' the other 'mobilizing' various defense weapons.... After pointing out our ignorance of host-parasite relationships, Dubos demonstrates how inadequate our thinking is when we use the archaic terms of warfare. He does this by describing some of the advances the biochemical approach has produced in our knowledge of infectious diseases. Among other things, he discusses the metabolic changes produced in tissues by inflammation, and the effects of these changes on bacteria growing in the host. He also explains some of the reasons for decreased resistance in metabolic diseases such as diabetes. In the third chapter, the author discusses biochemical disturbances produced in the host by infections. Here, for example, Pappenheimer's hypothesis that diphtheria toxin acts by inhibiting host synthesis of cytochrome b is taken up in some detail. The lecithinase action of Cl. welchii toxin is also discussed and the relation of this enzyme to the disease picture. The Schwartzman reaction is also partially explained from the metabolic point of view. The last two chapters dealing with tuberculosis and immunity I did not find as stimulating as the rest of the book, although here again there is much useful information expressed in biochemical terms. The book is not a complete review of our biochemical knowledge of infectious disease, nor does it pretend to be. For instance, Racker's work showing that mouse poliomyelitis virus inhibits glycolysis in brain is not mentioned, nor it there any discussion of the observation that diphtheria toxin lowers host reserves of energy-rich phosphorus compounds, presumably by inhibiting oxidative phosphorylation. Dubos' book seems to me a very valuable one, since it cannot help but stimulate interest in the biochemical mechanisms of infectious diseases and host resistance. It should be of interest to clinicians, medical students, and of course to anyone primarily interested in medical microbiology, since it takes up in readily readable terms this aspect of infection so frequently ignored in textbooks of infectious disease. GIFFORD B. PINCHOT