Malnutrition in a Modernising Economy: The Changing Aetiology and Epidemiology of Malnutrition in an African Kingdom, Buganda c.1940-73.

The ecological fecundity of the northern shore of Lake Victoria was vital to Buganda's dominance of the interlacustrine region during the pre-colonial period. Despite this, protein-energy malnutrition was notoriously common throughout the twentieth century. This paper charts changes in nutritional illness in a relatively wealthy, food-secure area of Africa during a time of vast social, economic and medical change. In Buganda at least, it appears that both the causation and epidemiology of malnutrition moved away from the endemic societal causes described by early colonial doctors and became instead more defined by individual position within a rapidly modernising economy.

INCAP studies of kwashiorkor and marasmus.

This article summarizes thirty years of intensive clinical metabolic and therapeutic studies of the consequences of severe protein deficiency relative to calories, which results in kwashiorkor, and of a balanced deficiency of protein and calories that results in marasmus. Evidence is provided that these are two different metabolic diseases, but kwashiorkor is usually superimposed on some degree of chronic marasmus and hence most cases studied were marasmic kwashiorkor. The value of the creatinine/height index to indicate the degree of lean body cell mass with any disease is demonstrated.

Hitos conceptuales en la historia de la desnutrición proteico-energética / Conceptual landmarks in the history of protein-energy malnutrition

Aunque ancestralmente los jinetes bíblicos del hambre, la peste y la guerra han cabalgado juntos por el sendero de la historia, puede ser que las consecuencias de estas calamidades -desnutrición y muerte- hayan sido secularmente vistas de manera tan natural como la vida misma. Tal vez ésta sea la razón por la que hasta el siglo XIX -y para ser preciso, hasta 1865-, se documentó la primera descripción clínica de lo que ahora se conoce como desnutrición proteico-energética. La limitada difusión de este hallazgo dio lugar a que la enfermedad fuese redescubierta y descrita exitosamente en lengua inglesa en 1933. Un año después de creadas en 1949, la Organización Mundial de la Salud (OMS) y el Fondo para la Agricultura y la Alimentación (FOA) tomaron la decisión de unificar los criterios de diagnóstico de esta enfermedad e impulsar su investigación. En este ensayo se destacan algunos de los hitos en la historia del conocimiento científico de esta enfermedad

[Conceptual milestones in the history of protein-energy malnutrition]. / Hitos conceptuales en la historia de la desnutrición proteico-energética.

Although the biblical horsemen of hunger, plague and war have proverbially ridden together, the consequences of these adversities, i.e. malnutrition and death, may have been secularly interpreted as natural as life itself. This may be the reason why the first clinical description of what is now known as protein-energy malnutrition, did not appear until the 19th century, in 1865 to be precise. The limited dissemination of this finding, originally written in Spanish, brought about a rediscovery and successful description of the disease in English in 1933. In 1949, one year after their creation, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) decided to unify their diagnostic criteria of malnutrition, and endorse further research. The present assay describes some of the major conceptual landmarks in the history of the scientific knowledge of this disease.

The papers of Cicely Williams (1893-1992) in the Contemporary Medical Archives Centre at the Wellcome Institute.

The papers of Cicely Williams were given to the Contemporary Medical Archives Centre in 1993, and subsequently catalogued. They cover most aspects of her work in the field of maternal and child health, as practitioner, teacher and consultant, 1929-1989, especially in the developing world. The collection includes correspondence, reports, lectures, publications, photographs and sound recordings, and is of relevance to a wide range of issues related to maternal and child health and the development of appropriate local health care systems. In particular, it is of interest in relation to Williams' pioneering work on the identification of the childhood malnutrition disease kwashiorkor. The Cicely Williams papers complement many other collections held by the Contemporary Medical Archives Centre. This article focuses on two pre-war reports of her work in the Gold Coast and Singapore, which show the early development of ideas which are echoed throughout the rest of her papers.

Protein versus energy in protein energy malnutrition.

The balance of evidence indicates that protein deficiency is more constant than energy deficiency in cases of kwashiorkor. I suggest that well-conducted dietary histories with early home visits would confirm this in South African cases. In areas and groups from which kwashiorkor patients come, a pre-kwashiorkor state has to be detected by laboratory tests, e.g. plasma albumin measurement. Simple anthropometric measurements are not enough. Strategies for prevention must depend on local attitudes and resources, but throughout the world enthusiasm for protein-rich vegetable mixtures has waned. Selective provision of milk powder for sick children in clinics may be a cost-effective measure.