Suppression of Infection by Famine and Its Activation by Refeeding—a Paradox?

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PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 20 · Number 4 · Summer 1977 SUPPRESSION OF INFECTION BY FAMINE AND ITS ACTIVATION BY REFEEDING—A PARADOX? JOHN and ANNE MURRAY* Together, famine and infection have stalked the land since earliest times. Are they inseparable twins or is their liaison dangereuse merely one ofcircumstances? Once famine is shorn ofantecedent catastrophe and its inevitable results ofpoor hygiene, inadequate sanitation, and overcrowding , what is its effect on the resistance ofthe organism to infection? At first sight the answer seems to be too obvious to consider the question further; many are familiar with the tragic picture of marasmic children dying of smallpox or measles. Historical records tell of famine and pestilence following war or natural disaster, but simultaneous disruption of civil services has too often complicated interpretation of the direct effects of starvation on infection. If the effects of starvation are to be studied separately from the effects of catastrophe, then naturally occurring famine uncomplicated by disaster and its consequences must be carefully scrutinized. Is there a useful lesson to be learned from such an exercise? We think so. If by chance famine suppressed some infections or refeeding aggravated them, the mechanism of suppression would be worth unraveling as a step toward understanding the interrelationships of diet and infections. Furthermore, our relief efforts during famine might be more vigorously directed to combating the consequences of disrupted sanitary services than to simply supplying food to starving people in overcrowded camps. If famine and infection are inevitably a conjugate pair and their effects additive, then races recurrently afflicted by natural and uncomplicated famine might be expected to die out. While some may have perished in the course of time, there are many living peoples exposed to just such conditions who continue to thrive. Some controlling system must exist in nature which prevents their extinction and which is un- ?Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455. Perspectives in Biology and Medicine · Summer 1977 | 471 likely to differ from the delicate balancing mechanisms so much a part of our terrestrial ecosystems. In times of plenty man and his animals thrive, their excess multiplication checked in part by the parallel increase of their macro- and microbiological predators. In years of famine man and his animals fail to thrive, their extinction prevented partly by a parallel decline in the fecundity of the same predators. At each end of the famine-plenty scale there seems to be a counterforce which tends to restore the equilibrium in favor of healthy survivors—a gigantic biological counterpart ofthe Le Chatelier principle ofchemical equilibrium. At least as far as animals are concerned, observations in India ofthe impact ofseasonal starvation and refeeding on the incidence of foot-and-mouth disease in cattle support this contention. During the dry season when forage was low and the animals lean, the disease dropped to its lowest ebb, only to reappear in strength as the animals fattened on new forage after the monsoon rains [1] (fig. 1). Historical Development We ought, then, to examine discriminately both the effect of natural famine or starvation and its correction by refeeding on the course of infection. Historical records of famine rarely provide the sort of information needed for critical analysis. Their monotonous theme is concurrent pestilence, but here and there a curious observer has raised provocative questions—the beginnings ofdoubt about the inevitable mutuality of starvation and infection: Why, for example, did certain epidemics appear to afflict the rich rather than the poor despite the humble circumstances of the latter? The English Sweat, a severe acute viral infection which swept recurrently through the sixteenth century, was remarked by many to select the rich man in preference to the pauper [2, p. 126]. Thomas Sydenham, a physician of the late seventeenth century and an acute observer of the natural history of disease, a quality which earned him the title of the English Hippocrates, said of smallpox, "How is it that so few of the common people die of the disease compared with the numbers that perish by it among the rich [3]?" It remained for Edwin Chadwick [4], one of the founders of the discipline of public health, to recognize in the 1830s a singular...