Famine, Mortality, and Epidemic Disease

R John D. Post's article 'Famine, Mortality, and Epidemic Disease in D Process of Modernization' is a valuable addition to our limited knowledge of interaction between epidemic disease and a wide variety of environmental factors, including nutrition, housing, hygiene, and public health programmes. His article raises certain questions that perhaps can benefit from further elaboration. The following remarks are intended as comment, not as criticism, in hope that they may clarify some of points at issue in these complex environmental-medical relationships and point way for further research within this relatively new field of historical inquiry. Dr Post characterized as extreme position-which he attributes to Dr N. L. Tranter-that the decline in mortality [in later eighteenth century] resulted from an increase in natural immunity of human populations long exposed to contagion.3 Further on, Dr Post says that low case-fatality rate in typhus epidemic of I8I 7-I 8 may, indeed, be explained by growing human resistance to disease.4 He rejects, however, possibility that human beings acquired any resistance to bubonic plague bacilli, quite rightly noting that-so far as we can tell-plague in humans did not decline in virulence over time. He adds that plague is dependent on animal and insect vectors which can be controlled by quarantine, improved housing, and better hygiene.5 Let us try to separate these seemingly contradictory observations about increased human resistance to some diseases but not to others. Prof. Rene Dubos has suggested that there is a tendency towards ecological equilibrium-a search for a modus vivendi-between microbes responsible for disease and hosts on which they prey. It is not too much to say that it is in interest of microbes to reach such an equilibrium because if they are too virulent, they kill their host, which in turn means that they, too, die. Far better for them to be less virulent and keep their hosts alive. Of course, any decrease in virulence is not arrived at by conscious choice of microbes but rather by mutation to a less virulent form which has a better chance to survive than deadly form which tends to eliminate itself. The same blind process works in development of resistance in host: hosts with least resistance die, often before they have offspring, while those with resistance live to pass their resistance on to their offspring. This tendency towards accommodation-on part of both microbes and hosts-has been observed in changing patterns of disease in both animals and 1 DrJohn D. Post has indicated that he does not wish to make any reply.-Eds. 2 Economic History Review, 2nd ser. xxix (1976), I4-37. 3 Ibid. I5. 4 Ibid. 31. 5 Ibid. 34-5

Archaeology · Disease · Famine · Geography · Sociology · Demography · Global Health Care Issues · Global Public Health Policies and Epidemiology · Internal Medicine · Medicine

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