McCarrison Society

Health Through Nutrition, A Birthright

Western Diseases

in ‘Non-Westernised’ Groups; Africa; Donnison Burkitt and Trowell

Civilisation and Western Disease – C.P. Donnison MD MCRP 1938

Donnison, in addition to practicising in the UK spent two and a half years as a doctor in a remote area of Kenya, and was clearly struck as were many of his contemporaries by the lack of non-communicalble diseases of ‘civilisation’ in his patients.

The first two chapters of the book gather data, and discuss it along with his own observations. He may be one of the first on record to describe these as “diseases of civilisation” and recognised that they probably had a common cause, but chose to discuss psycho-somatic rather than dietary influences.

The work is particularly interesting because of the general scarcity of this data in the public domain, and for the table of hospital visit related reported conditions in the 1930s (below).

He questions the observations that Africans were free of dental decay, but acknowledges that great detail as to their individual diets would be revealing. His comment on dental health is just that; the work of Weston Price on dental health in those on non-westernised diets, which included a visit to East Africa (Ch.9. (Isolated and Modernized African Tribes ) was both driven and rigorous. Of Muhima Tribe or Anchola, Uganda. Price observed for example “In a study of 1,040 teeth of thirty-seven individuals, not a single tooth was found with dental caries.” many groups had very low decay, although Price did observe higher decay rates in those living mainly on grain based diets.

The tables of data on disease incidence on pages 11 and 12, and blood pressure on page 16, are thought provoking. Donnison acknowledges and makes the point that the UK mortality figures do not in any way compare to the hospital presentation data, and that they were only included as no other comparator could be found.

Based on hospital data looking and between 283,000 and 831,000 hospital attendance cases in 4 African areas in the first half of the 1930’s, high blood pressure, arteriosclerosis, angina, diabetes, enlarged prostate, gall stones were in single and sometime double figures only.

Donnison makes this observation on atheromas (page 18)

“My own conclusions basal on clinical observations and a series of between twenty and thirty autopsies, without facilities for paraffin sections, are as follows. Atheroma is common, usual in later life, but is usually less in degree than is encountered at a corresponding age in the European. Medial degeneration of any marked degree I have never seen. Clinically in elderly natives it is common to encounter arteries that feel slightly thickened and tortuous, a condition closely comparable with decrescent arteriosclerosis in the European. Markedly thickened and tortuous arteries arc rarely seen. The secondary complications of arterial disease are also rarely seen.”

He includes this table on comparative blood pressure based on 1000 examinations. Two others independently got similar results. (See also Western Diseases, Burkitt and Trowel, Ch.1 page 6)

He also comments on the occurrence and progression of a number of other diseases.

The rest of the book whilst a thought provoking exploration of the connection between disease and mental health / well-being is interesting but not core to the aims of this web site, and scanning is time consuming so at the present time has not been included.

‘Western Diseases: their emergence and prevention’ Burkitt and Trowell.

There book contains a wealth of comparative disease occurrence observations and or data. So far as I am aware the book is no longer in print, and second hand copies are getting increasingly expensive. Burkitt certainly had links with and supported the McCarrison society, as likely did Trowell, and on that basis have copied very limited data from their book to make this important information more widely available.

Significant professional medical presence in East Africa in the 1920. The Kenya Medical Journal was started in 1924.

A paragraph of a chapter by Trowell taken from ‘Western Disease; their emergence and prevention’, Burkitt and Trowell Ch1, page 4.

Blood Pressure -Low -Hypertension almost non-existant

Blood pressure data page 7. ‘Kenya and Uganda lifelong low blood pressure’

Coronary Heart Disease – a competition to report the first cases.

A paragraph of a chapter by Trowell taken from ‘Western Disease; their emergence and prevention’, Burkitt and Trowell Ch1, page 26.

Uganda West Nile District

Edward Williams and Peter Williams from 1941 and 1948 respectively worked at 108 bed Kuluva Hospital on the northern Uganda border. They treated 150,000 patients over 38 years. In patient and outpatients notes were kept together so providing continuous long term records.

The hospital was quite well equipped portable x-ray, ECG, specialist opthalmological instruments etc, and had an operating theatre.

‘Western Disease; its emergence and prevention’ Ch 13 p189 Uganda West Nile District by Dr. E. Williams and Dr. P. Williams

Traditional Regional Diet

The regional diet is set out in paragraph of chapter 13, and can be seen here (Link)

Significant changes include salt, sim-sim and cotton seed oil of East African manufacture also had come onto the market, as had sugar. In the better off refined sugar intake when available and affordable rivaled that of the west at 100g a day. For salt historically (1902 report) they used burnt reeds and water plants, rich in potassium, but low in sodium. Vegetable oil consumption was also seen in Southern India, and in Indian African populations, who generally exhibited higher incidence of Western Disease, and are a potential factor.

Disease incidence

The setting out of disease incidence in this chapter (Western Disease Ch. 13 by E and P Edwards see above) is particularly concise and has been selected as mirroring in very general terms the reports of the increasing incidence of ‘Western Disease’ in populations including western refined foods into their diets. As earlier on the grounds this book is out of print and the information is of considerable public interest given the rising global individual and public health burdens of cardiovascular with related conditions, and diabetes, it is felt there is justification for positing this small section intact as representation of the wider content of the book; the words have much more power in their original form than if paraphrased.

It is clear that the information was based on the observations of highly experienced very professional dedicated doctors, and cannot be dismissed as the flights of fancy of the inexperienced working in an unsophisticated third world environments, which may be the initial reaction of some to the suggestion that western diseases likely have their roots in dietary changes, and were almost never seen in populations on traditional diets free of refined western products. Clearly infectious and other disease, hunger, and general living conditions meant that this was no Shangri-la but notwithstanding western diseases were rare as set out in these sample pages of ‘Western Disease; its emergence and prevention’ Ch 13 p189 Uganda West Nile District by Dr. E. Williams and Dr. P. Williamst.

Traditional Regional Diets

(Link to further abstracts detailing related rise in Western disease with dietary changeLink)

A paragraph of a chapter by Trowell taken from ‘Western Disease; Ch 13 p189 Uganda West Nile District by Dr. E. Williams and Dr. P. Williams indicating that diets in Africa at that time were slowly Westernising.

“Salt, sim-sim and cotton seed oil of East African manufacture also had come onto the market as had sugar. In the better off refined sugar intake when available and affordable rivaled that of the west at 100g a day. For salt historically (1902 report) they used burnt reeds and water plants, rich in potassium, but low in sodium.”

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