THE MAN WITH ONE EYE AND HIS DISCOVERIES – PART 1
Picture
taken from https://mccarrison.com/visionaries/burkitt/
Denis Parsons Burkitt was
born in February 1911 in Enniskillen, County
Fermanagh,
Ireland. His father, James Parsons Burkitt,
a civil engineer, was the county surveyor for Fermanagh and also a reputed
innovative ornithologist. His father used the technique of ringing or
banding to recognize individual birds and meticulously mapped their
territories. Burkitt as a child was
impressed by his father, whose techniques he used later for mapping the tumour
distribution in Africa.
Within
the family, two strong influences clearly laid the foundations for young
Burkitt future life. One was service to the British Empire, where Burkitts
three paternal uncles were working, one was a surgeon in East Africa and the
other two were in India, one became Governor of Madras and the other chief
engineer of Punjab. He was influenced by his father’s brother, Roland, who was
a surgeon working at Kenya. The second strong influence was that of religion.
Denis
and his younger brother Robin went to Portora Royal School in Enniskillen,
which was a famous school in Ireland. However, when Burkitt was 11, his right
eye was injured. Efforts to save the eye failed and hence the right eye was
removed. Denis and his brother later went to preparatory school at Tre-Arddur
Bay in Wales and to a secondary school, Dean Close, in Cheltenham. He had no
particular career ambition after finishing school. In 1929, Burkitt joined
Trinity college, Dublin to study engineering. But during his first year, he believed that he
got a divine call and so he shifted to medicine.
In
1935, he went to England to train and practice as a surgeon. He obtained
fellowship of the Royal College of Surgeons of Edinburgh in 1938. He spent 5
months as a surgeon on a cargo ship that plied between Britain and Manchuria.
After returning to England, he worked as a surgical resident at the Prince of Wales
Hospital in Plymouth. There he met a nurse by name Olive Rogers who shared his
religious convictions; they later married in July 1943.
Burkitt
wished to work with less privileged people and hence he volunteered for the
Colonial Medical Service in West Africa. Burkitt applied in Royal Army
Medical Corp in 1939 but his application was rejected as they dint need
surgeons. He again applied in early 1941, but again he was rejected because he
had only one eye. But later in May 1941, he was accepted and for the next two
years he was trained at the army hospitals in South of England. In 1943,
Burkitt was posted to East Africa. There he served with African troops in Kenya
and Somaliland. During vacations, he visited his friend in Uganda, and here he
decided to help the people of Uganda both medically and spiritually. In 1946,
Burkitt joined the colonial service and after 6 months, he went to Lira
hospital in Lango district in Uganda.
Burkitt describes himself as
a ‘simple bush surgeon’, ran a 100 bedded hospital in Lira. He increased the
number of surgeries even in the first year from 17 to over 600 though he was
assisted by just one African doctor. In 1948, he was posted to Mulago Hospital,
Makerere University teaching hospital in Kempala. He headed one of the surgical
units and made many improvements in the surgical services in the next ten
years.
One
of the improvements worth mentioning here is manufacturing plastic
limbs. Burkitt
was distressed by the frequency of amputations of lower limb he had to do due
to elephantiasis and there were no artificial limbs available in Uganda at that
time. His patients had to beg for survival or were dependant on relatives.
While attending
a postgraduate course in London, he learnt that inexpensive artificial limbs
can be made using plastic materials. After returning back to Uganda, he set up
a small workshop to manufacture plastic limbs.
This made him revolutionise the life of many disabled people.
It was in 1957, that a chance
observation changed his life from a simple bush surgeon to medical superstar.
During one of his duty days, Hugh Trowell, an eminent physician asked Burkitt
to look at a 5 year old boy with swelling of both upper and lower jaws. He knew
that single jaw tumours were common in Africa and he himself has operated many
but never followed him to know how they fared. He thought it must be some
infection or some unusual tumour, took biopsy but unfortunately it proved inconclusive.
He considered it as ‘another of the curiosities, one had to become accustomed
to seeing from time to time in Africa’.
This is where the story might
have paused if Burkitt had not visited the district hospital at Jinga, on the
shores of Lake Victoria, a few weeks later. While doing ward rounds, he glanced
out of the window and saw a small boy with a similarly grossly swollen face
sitting on the grass besides his mother. Burkitt has said, ‘My interest was
rivetted immediately. A curiosity can occur once, but two cases indicate more
than a curiosity.’
He examined the second child, but
in addition to jaw lesions, the child also had a lump in abdomen. His curiosity
increased, and his next question was, can this abdominal lump be related to jaw
lesions or not? So he started going through the hospital records and autopsy
reports which revealed that these jaw tumours were frequently associated with tumours of other
organs commonly kidneys, ovaries, adrenals glands.
Burkitt first breakthrough was
the hunch that these separately described tumours were all part of the same
disease. He wrote his first scientific paper on jaw tumours, titled “A sarcoma involving the jaws in African
children” describing 38 patients and was published in the British Journal of
Surgery in 1958. This report drew only little attention at that time, however
it became a citation classic years later. There were many new questions in
Burkitt mind now and he started hunting answers for them soon. What was the
nature of this disease? Where was the primary tumour? How common was it? Was it
a new disease or newly recognized?
Gregory O’ Conor and Jack Davis, pathologists
at Mulago hospital reexamined tumours from jaw and all different sites and
found that the tumours were all identical and classified them as lymphomas. They
described the tumour tissue as composed of malignant lymphocytes interspersed
with larger paler staining histiosytes and this pattern resembled ‘starry sky’ under the microscope. This term
is used even till now to describe the unique appearance of this tumour. Hence
forth, it was called as ‘the lymphoma syndrome’ or the ‘African lymphoma’.
He visited the Mengo mission
hospital in Kampala and saw the records and concluded that the early decription
of the disease dated back to 1902. Burkitts another highly significant
observation was, that the disease was geographically restricted. He made leaflets with typical picture of jaw
tumours and sent to some 1000 hospitals along with questionnaire. He was able
to roughly map the distribution of this
tumour and soon he travelled 10000 miles, visiting 57 hospitals in 8 countries,
to exactly define the geographic distribution which was well known as ‘the long safari’.
The long safari is mentioned in
detail in the previous post on the journey of discovery of Epstein Barr virus.
Because of tremendous
contributions of Burkitt, the African lymphoma was officially designated as Burkitt’s lymphoma in 1963 by the Union for International Cancer Control (UICC).
Such an inspiring discovery made
by a doctor, surgeon, who was only one eyed. Most of us might think luck
favoured Burkitt. Yes, luck might have,
given him the opportunity, but its because of his curiosity, when he saw
something new, his curiosity to find answers for his questions, made him a
medical superstar.
Many of us know Burkitt by his
discovery of Burkitt lymphoma, but he has made another great contribution in
the field of medicine and cancer.
See about his another important discovery in next post.
The man with one eye and his
discoveries – Part 2
References:
1.
Textbook,
The story of Epstein Barr virus. Cancer virus by Dorothy H Crawford. Alan
Rickinson, Ingolfur Johannessen.
2.
Davis Coakley. Denis Burkitt and his contribution to
haematology/oncology. British Journal of
Haematology. 2006:135; 17–25.
Written by Dr. Priyavadhana
Interesting to read. Inspiring too. Well written..
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