Denis Burkitt

Epidemiology of cancer of the colon and rectum

The close relationship between bowel cancer and other non‐infective diseases of the bowel, such as benign tumor, divert ocular disease, and appendicitis, indicates that these conditions may have a common or related etiology. Their close association with the refined diet characteristic of economic development suggests that the removal of dietary fiber may be a causative factor. These diseases are all rare in every community examined which exists on a high residue diet, and common in every country where a low residue diet has been adopted. Dietary fiber has been shown to regulate the speed of transit, bulk, and consistency of stools, and together with other dietary factors is probably also responsible for the changes which have been demonstrated in the bacterial flora of feces. It seems likely that carcinogens produced by the action of an abnormal bacterial flora when held for a prolonged period in a concentrated form in contact with the bowel mucosa may account for the high incidence of these diseases in economically developed countries.

Some diseases characteristic of modern Western civilization.

A number of diseases of major importance are characteristic of modern Western civilization. These diseases are rare or un known in communities who have deviated little from their traditional way of life, and a rise in their frequency fofiows adoption of Western customs. Available evidence suggests that all these diseases were rare or uncommon even in the Western world a century ago and that they are rare or unknown in undomesticated animals. Some appear or increase in frequency within a few years of exposure to a new environmental factor, others not until several decades later. The diseases to be con sidered in this connexion are listed below, with indications of their prevalence and importance as causes of death and mor bidity in Britain and the U.S.A., countries which represent the type of civilization with which these diseases are most closely associated.

Varicose Veins, Deep Vein Thrombosis, and Haemorrhoids: Epidemiology and Suggested Aetiology

Current concepts on the aetiology of varicose veins, deep vein thrombosis, and haemorrhoids have been examined and, in the light of epidemiological evidence, found wanting. It is suggested that the fundamental cause of these disorders is faecal arrest which is the result of a low-residue diet.

Long-term remissions following one and two-dose chemotherapy for African lymphoma.

Available evidence suggests that, with African lymphoma, not only can long‐term remissions, believed to amount to cures, be obtained with no more than two administrations of chemotherapy but further dosage may reduce rather than increase the prospects of success. The possible implications of this observation are discussed.

Charles S. Mott Award. The discovery of Burkitt's lymphoma

An account is given of the steps that led to the recognition of the tumor that became known as Burkitts lymphoma. This is followed by a description of the methods employed in the subsequent epidemiologic studies, the manner in which successive hypotheses of etiology were erected and demolished, and the discovery by Epstein and his colleagues of the Epstein‐Barr virus. The impact that this tumor has had on aspects of cancer research is considered.

A “Tumour Safari” in East and Central Africa

FIVE years ago it became evident that the majority of malignant neoplasms observed in children in Uganda were but differing manifestations of a single distinctive tumour syndrome. The most frequent and characteristic presenting feature of this condition is a tumour involving one or more quadrants of the jaws. Other sites where tumours are commonly found include the kidneys, adrenals, ovaries, liver, thyroid, heart, intestine and the extra-dural space in the spinal canal.

Geographical and Tribal Distribution of the African Lymphoma in Uganda

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Geographical Distribution of Cancer in East Africa: A New Clinicopathological Approach

In most technologically advanced countries with mobile populations the majority of people live under very similar circumstances apart from specific hazards associated with special industries and individual customs. By contrast, in East Africa there are still many groups of people living in circumscribed communities in different geographical circumstances and exposed to widely varying nutritional, social, economic, and other environmental factors. These groups do not correspond to political boundaries, and from the standpoint of disease Southern Sudan can be -regarded as an extension of Northern Uganda; South-west Uganda is part of the mountainous area containing Kivu, Rwanda, and Burundi (Fig. 1);

Colonic cancer--hypotheses of causation, dietary prophylaxis, and future research.

Colonic cancer is rare in primitive populations. In western populations it was uncommon in the past, but now accounts for about 3% of all deaths. The cause almost certainly lies with dietary changes. Probably, alterations in bowelmilieu interieur, from interaction between metabolites and microbacteria, promote carcinogenesis. Changes in intakes of protein, fat, sugar, refined cereal products, and crude fiber have been advanced as predisposing or causative factors. Evidence suggests that (i) fall in fiber intake, but (ii) rise in fat intake, in their ability to increase fecal concentrations of bile acids and sterols (possible precursors of carcinogens) are most likely to be culpable. As preventive measures, a significant rise in fiber intake is practicable only from regular bran ingestion. A major reduction in fat intake is grossly unlikely. Even were rigorous dietary changes implemented, an early fall in colonic cancer incidence is highly improbable due to the long-term character of the disease. Future research must include characterization of the diet, metabolism, and disease pattern of segments of western populations who have low colonic cancer mortality rates; also, elucidation of the bearing of various intakes of different food components on the biochemistry and microbiology of the feces.Colonic cancer is rare in primitive populations. In western populations it was uncommon in the past, but now accounts for about 3% of all deaths. The cause almost certainly lies with dietary changes. Probably, alterations in bowelmilieu interieur, from interaction between metabolites and microbacteria, promote carcinogenesis. Changes in intakes of protein, fat, sugar, refined cereal products, and crude fiber have been advanced as predisposing or causative factors. Evidence suggests that (i) fall in fiber intake, but (ii) rise in fat intake, in their ability to increase fecal concentrations of bile acids and sterols (possible precursors of carcinogens) are most likely to be culpable. As preventive measures, a significant rise in fiber intake is practicable only from regular bran ingestion. A major reduction in fat intake is grossly unlikely. Even were rigorous dietary changes implemented, an early fall in colonic cancer incidence is highly improbable due to the long-term character of the disease. Future research must include characterization of the diet, metabolism, and disease pattern of segments of western populations who have low colonic cancer mortality rates; also, elucidation of the bearing of various intakes of different food components on the biochemistry and microbiology of the feces.

Burkitt's Lymphoma: Remissions following Seemingly Non-specific Therapy

Long-term remissions observed in four out of eight unselected patients with Burkitts lymphoma following seemingly non-specific treatment with Septicemine, are described. This is regarded as strong evidence of an effective immunological response.