PEOPLE WHO INSTILLED FIBRE HYPOTHESIS IN BURKITTS MIND- PART 5 HUBERT (HUGH) CAREY TROWELL OBE, MD, FRCP (1904–1989)
I
have already introduced this eminent physician in my previous post,
The
man with one eye and his discoveries- Part 1.
Hugh
Trowell was born on July 1904. He did
his schooling at Reigate Grammar School. He qualified medicine at St Thomas’s
Hospital in London in 1928. He got married the same year to Margaret Sifton. In 1929, he joined the Colonial Medical
Service, Kenya. He then moved to Uganda. He worked as a senior physician and paediatrician
at the Mulago Hospital, Kampala from
1935 to 1958. Burkitt joined the same hospital in 1948. This is where Trowell
and Burkitt met.
Where
and how did Trowell come in the fibre story?
Was
it when they worked together in Mulago hospital?
Read
further to know the answers for this…
From
1930 to 1958, he studied and worked on kwashiorkor in Uganda. He was one of the first who recognized the concept
non-communicable diseases. Though he was late in the fibre story, but he made
significant contributions to the fibre hypothesis by bringing a physician’s
view, defined
dietary fibre
and together with Burkitt wrote a series of books and papers between 1972 and
1985 which explained in detail the hypothesis and evidence for it. He was an
enthusiast, always wanted to understand what was going on around him and was a
born letter-writer and editor.
Picture
taken from John H. Cummings and Amanda Engineer.
Denis Burkitt and the origins of the dietary fibre hypothesis. Nutrition
Research Reviews (2018), 31, 1–15
During
his first posting in Kenya in 1929, Trowell had seen a form of severe malnutrition
in young children but thought it was pellagra. There was a paper published by
Cicely Williams’in the Lancet
in 1933 and she also described a similar
problem in young children in the Gold Coast but she was sure it was not due to
vitamin B deficiency. By 1935, Williams took the name ‘kwashiorkor’ from
local people, which meant ‘…the disease the deposed baby gets when the
next one is born…’.
Trowell,
after reading the paper by Williams, realized that it was probably kwashiorkor what
he had seen in Kenyan children, which he had called it as ‘malignant
malnutrition’. He
worked extensively on kwashiorkor and particularly was successful in using powdered
milk to treat kwashiorkar. Trowell was internationally
acknowledged for his work on Kwashiorkor. He was the first to show that serum albumin
concentration was below normal in Kwashiorkar children. This supported the
hypothesis that a protein deficient diet was responsible.
Burkitt
and Trowell had many similarities. He was also a keen observer of diseases in
Africa and in 1939 he published a book on the ‘Diagnosis and Treatment of Diseases in
the Tropics’. In this book, in the section on
constipation, he remarks that the Africans ‘…eat foods that contain many skins and fibres,
such as beans and maize meal, and pass a bulky stool two or three times a day’.
It
was Trowell who asked Burkitt to see a 5-year-old boy with swellings on his upper
and lower jaws in 1957. Trowell is thus credited with introducing Burkitt to
his first
case of the lymphoma. Both of them never considered fibre
or diet as a major factor in any disease other than malnutrition when they were
in Africa.
After
retiring, Trowell returned to England and completed a book ‘Non-Infective
Disease in Africa’, which he was
working on, for many years. It was written in the inside cover as ‘the
incidence, diagnosis and treatment of medical non-infective diseases in the indigenous
inhabitants of Africa south of the Sahara’. He has described CHD, diabetes, peptic
ulcer, hypertension, and bowel and urinary tract disorders. There was no significant
discussion of diet or fibre in these conditions.
But
he has described about bulky stools of the Africans in large bowel discussion
and he notes that the African’s natural diet is high in fibre
in the section on constipation.
Trowell
was wondering why these ‘non-infective’
conditions were rare in Africa but they
were the major problems in Europe and North America. Fibre was not in Trowells thinking in 1960. However,
the concept of ‘non-infective diseases’ is
original, which later evolved into diseases of civilisation, then ‘Western
diseases’
and now currently it’s the ‘non-communicable
diseases’
which is more prevalent.
After
completing the book, he continued to work on another ambition of his life, to become ordained. In 1960, he was ordained into Anglican Church. He undertook a
year-long course in 1959 at Wells Theological College. In 1961, he became vicar
of Stratford-sub-Castle in Wiltshire and Chaplain to Salisbury Hospital. He was
the first Chairman of London Medical Group for Study of Medical Ethics and was
in that position from 1960 to 1964. He
was the Study secretary of the newly formed Institute of Religion and Medicine from
1960 to 1966. He was also Chair of British Medical Association, working party
on the ethical aspects of Euthanasia. He relinquished his clerical appointment
in August 1969.
After
few weeks, he received an invitation to return to Uganda to the Centenary Celebrations in honour of Sir Albert Cook, who was a British medical missionary in Uganda, and the founder of Mulago Hospital and Mengo Hospital. There
he met his former colleague Burkitt , and now he heard him lecture not on
lymphoma as everyone expected but on his views of fibre and
bowel diseases. Their reunion made many
significant contributions to the development
of the fibre
story.
Picture taken from Amazon books.
Now
he started his study on ‘dietary fibre’. In 1972, he introduced the term
dietary fibre. In 1975, Trowell along with Denis Burkitt wrote a book on ‘Refined Carbohydrates Foods and Disease’.
In 1977, he became the Co-Chairman of the Pritkin Centers, USA and also Witness
at Senate Committee on Nutrition, Washington. In 1979, he became President of
Institute of Religion and Medicine. He has written so many books. In 1981, he
wrote Western disease: Emergence and Prevention, with Dennis Burkitt. In 1985, another book along with Burkitt was
Dietary Fibre, Fibre Depleted Foods and Disease.
Perhaps his proudest moment was at an international conference on
dietary fibre in Washington, in 1988, when, together with Denis Burkitt
and the South African fibre pioneer Alec Walker, he was presented with a scroll
of honour signed by all the delegates. In
his long and varied life Hugh Trowell saw much and wrote much; he wrote ten
books.
His prime interests were Christianity and nutrition and he wrote
on both. Such an inspiration his life story is…. With lots of dedication
and hardwork.. and most importantly it’s the passion for what he wanted…..
He died in July 1989.
References:
1 John H. Cummings and Amanda Engineer. Denis Burkitt and the origins of the
dietary fibre
hypothesis. Nutrition Research Reviews (2018), 31, 1–15
Written by Dr.Priyavadhana
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