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).

His theories that these disease are primarily brought on by stress, predates modern knowledge of nutrition. Stress is of course a factor but not the dominant one. The need for nutrients is determined by our biology as set out by Hugh Sinclair (Link).

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.

PDF First Chapter Civilisation and Disease

Scan First Chapter Civilisation and Disease

Western Disease: Their Emergence and Prevention. Chapter 1 ‘Hypertension, obesity, diabetes mellitus
and coronary heart disease‘

Hugh 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.”

Kenya and Uganda lifelong low blood pressure 1929-40
“Kenya, Uganda and Tanzania were among the last African countries to be westernized, for in the days of only sea communications they were more remote from Europe than North, West or South Africa. Intertribal warfare, slave-raiding and roaming nomadic warriors like the Masai had previously been barriers to trade. No railways or permanent roads ran inland from the Indian ocean until the turn of the century. Metal currency came into common use in the Kenya highlands only in the 1920s; then Africans began to open shops. Throughout the Kenya highlands and the whole of Uganda there are few surface deposits of salt (page II).

The sunny equatorial climate of Kenya, modified by altitude, encouraged thousands of British settlers to open farms in the 1920s. Scores of British doctors devotetl their lives to medicine and surgery either in government service, or in missionary hospitals, or in private practice. Never before did, and probably never again will, so many resident doctors observe three million men, women and children, as in Kenya in the 1920s, emerge from preindustrial tribal life and undergo rapid westernization. A comparable numberlived in Uganda wherein African kingdoms had welcomed some elements of westernization at least three decades earlier than occurred in Kenya. Disease patterns shifted earlier in Uganda than in Kenya. Doctors in all East African territories began to record their observations in the Kenya Medical Journal, · founded in 1924, long before comparable medical journals emerged in West _ and Central Africa. Annual conferences of doctors in Kenya reflected their number; for instance 56 doctors attended the 1926 conference in Nairobi; in 1927 the Kenya Medical Association had 100 members with British qualifications. Formal training of Kenyan hospital assistants (bush doctors) started in 1931 at Nairobi. I was responsible for their training from 1933 to 1935, then transferred to teach medicine at Mulago hospital and Makerere University in Kampala, Uganda, until 1958. It became incumbent on all teachers of medicine to collect data concerning the prevalance of the common diseases in Africans. From 1930 until 1935 doctors in Kenya were unanimous that they had never seen essential hypertension in an African and no case was reported either in Kenya and Uganda until 1941.”

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

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

PDF copy of Foreword and Chapter 1

Western Disease: Their Emergence and Prevention. Chapter 13 ‘Uganda West Nile district‘

Edward Williams and Peter Williams

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.

“Traditional Regional Diet”

The regional diet is set out in paragraph of chapter 13. 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

PDF copy of chapter 13

Western Disease: Their Emergence and Prevention. Chapter 14 ‘Zimbabwe‘

Michael Gelfand

Zimbabwe Africans’ diet and lifestyle

“The country of Rhodesia became Zimbabwe in 1980, but in this chapter the shorter terms Zimbabwe Africans ( or just Africans) and Rhodesian Europeans (or just Europeans) will be used to distinguish the two main ethnic groups before independence came to Zimbabwe. Zimbabwe Africans total at present six and a half million; two million live in the townships, four and a half million in rural areas, and one and a half million live on European farms. Comparatively few of those living in the townships are true urban dwellers, for most of them retire to their rural homes after middle-age; also during their sojourn in the urban areas there is continual movement from town to country and back again. Rhodesian Europeans number at present about half a million. Zimbabwe Africans have accepted many of the material features of Western culture, such as its dress and economic system. Western foods have come into vogue, although in both rural and urban areas traditional foods still predominate: white bread, refined sugar, jam and tea are all popular nowadays and are taken between the two main meals of lunch and dinner. These main meals consist of large portions of stiff porridge, usually made from maize
meal, and eaten with a vegetable relish and some meat or fowl occasionally. Breakfast, a modern innovation, eaten even by rural inhabitants, consists largely of tea with milk and sugar and one or two slices of white bread and jam. Salt has been in common use by Africans for a long period of time. It was commonly said that African men and women employed by Europeans, usually as cooks, were liable to indulge in rich dishes, thereby predisposing themselves to certain diseases, such as appendicitis and peptic ulcer. However, after investigating this matter closely, I am unable to prove this
association, although the figures definitely showed that urban Africans were more prone to develop both these diseases than rural Africans (Gelfand,1971).

PDF of Chapter 14