Obituary: Denis Burkitt
Saturday 03 April 1993
DENIS BURKITT is a household name in the medical profession. He had two claims to fame - as the discoverer of the first cancer to be caused by a virus and as the man who forced the world to take dietary fibre seriously. These achievements are made more extraordinary by the fact that he had no training in scientific research, in nutrition or in communication. He was the archetype of the unselfconscious, gifted amateur.
His great gifts were intellectual curiosity, enormous energy, perseverance and the ability to see the connections between things. All this was harnessed to an old-fashioned but very real desire to ease the sufferings of humanity, based on a deep Christian faith. His faith really was his mainspring. It kept him humble to a fault, even when he had received the highest scientific honours in Britain (FRS, 1972), France (member of the Academie de Sciences, 1990), the US (Bower Prize, 1993), and his own native Ireland (honorary fellow of Trinity College, Dublin, where he had his medical training, 1979), plus a string of medals, prizes and honorary degrees. He did not pretend to be a scholar or scientist and, when asked for his autograph, would write, 'Attitudes are more important than abilities, motives than methods and character than cleverness; and the heart takes precedence over the head.'
The common thread in Burkitt's scientific work was a fascination with geography. His father - James Burkitt, a surveyor in County Fermanagh and a naturalist - was the first person to use the ringing of birds to map out their territories and movements. His son's great discovery was a five- million-square-mile band across equatorial Africa in which occurred a strange cancer of children, now known universally as Burkitt's lymphoma.
As a government surgeon in Kampala in the post-war years he had been intrigued and, doubtless, horrified by the occasional child - typically a five-year-old boy - brought to him with a rapidly growing tumour of the face. Reviewing the hospital records of such cases, he noticed that all the children came from the north and east of Uganda. He decided to find out exactly where the disease did and did not occur in Africa, in the hope that it would point to a possible cause. To this end he sent pictures of his patients to hundreds of hospitals around Africa asking if they ever had similar cases. The answers pointed to a lymphoma belt. Excited, Burkitt published his findings in 1958 with gruesome photographs and a masterly account of 38 cases. The paper fell flat. Undaunted, he gathered more data and published again, in 1961. Now people took notice. He was invited to lecture in London and in the audience was a virologist named Tony Epstein. Epstein was researching possible links between viruses and cancer and, as he listened, he wondered if the geography of Burkitt's lymphoma meant that it was caused by a virus. So it proved. Burkitt sent frozen specimens from tumours to London, Epstein looked at them down his electron microscope and there indeed was evidence of a virus.
This discovery galvanised the world of cancer research. It took several more years and a 10,000-mile safari to explain the geography of Burkitt's lymphoma. Eventually it was realised that it occurs in the hot, wet parts of Africa where mosquitoes thrive and where, as a consequence, many children have chronic malaria. In some children this leads to suppression of the body's defences, the immune response. This lack of defences allows a virus, now called Epstein-Barr virus and recognised as causing glandular fever in normally immune people, to provoke lymphoid cells into turning malignant.
Knowing that his surgical skills availed little with this highly malignant tumour Burkitt made a bold experiment and tried chemotherapy. To his amazement the tumours melted away with just a single course of cytotoxic drugs. To find both the cause and cure for cancer was melodramatic stuff and Burkitt became a hero.
By 1964 ordinary clinical work had lost its appeal and Burkitt dropped his scalpel in favour of full-time research, first in Uganda then in the offices of the Medical Research Council in London. Almost at once he hit gold again. It had an unlikely source. An eccentric but highly original naval physician, TL Cleave, published a book in 1966 blaming many diseases of modern civilisation on the modern habit of eating carbohydrate (sugars and starches) in refined form, stripped of their bulky, chewy coverings. Cleave emphasised the dangers of refined products, chiefly sugar and white flour. Burkitt saw the logic of the hypothesis but, turning it round, found himself looking at the positive virtues of the matter removed in producing refined foods, especially the bran which is removed in flour- milling. He knew that, in rural Africa, food was eaten in unprocessed or lightly milled form and reasoned that the higher fibre-content of such food could explain why, in his surgical practice in Uganda, he had seldom seen diseases like gall-stones, appendicitis, varicose veins and haemorrhoids.
It was time to make some new maps, but this time on a worldwide scale. Burkitt sent out questionnaires to hundreds of hospitals in rural areas of the Third World and proved Cleave right in most respects. Where sugar and white flour were rare, so were the diseases of Western civilisation. This led to several classic papers and endless lecture tours emphasising the virtues of fibre. We now know the links are much more complex than that, but Burkitt's vivid advocacy of the fibre hypothesis, together with his great prestige, forced scientists and especially nutritionists to think in a new way. The sciences of nutrition, gastroenterology and epidemiology were revolutionised.
Burkitt's lectures were always packed. His slides were telling, his one-liners memorable. Purists were offended by his simple approach, his sweeping statements. But he was a pioneer and, like Columbus, he could not always know exactly where he was.
Denis Burkitt left a widow, Olive, and three daughters, two of whom are married to doctors. For them and his friends a light has gone out of their lives. For the world, his legacy is a richer science of medicine and a better way of eating.
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