Constructed as a problem of ignorance and backwardness, the high incidence of kwashiorkor in Uganda never earned much consternation from London. Despite reservations from Hennessey and Hall inside the Protectorate, the research undertaken in Uganda came to be considered a boon to the British Empire.
This is a distinction that deserves to be stressed. Then to consider fruits; the ignorance and indifference to fruits is astonishing. As a problem of ignorance and indifference, malnutrition here was to be remedied with the slow march of European civilisation and the slow spread of European science.
As with most pre-colonial understandings of illness in Africa, infantile deficiencies were conceptualised and prevented within social frameworks. Its subsequent medicalisation would go on to mar the prevention of malnutrition at the same time as promoting commercial salves and technical treatments for a symptom of social dislocation.
Clearly, however, the aetiology of kwashiorkor was understood by the colonised in a very different way. In , Trowell et al. If protein deficiency was indeed endemic during the early twentieth century, it may more accurately be seen as the result of relatively recent changes to African domestic economies. Using the writings of David Livingstone and other European physician-explorers, Sjoerd Rijpma has suggested that, at least in the early nineteenth century, social and sexual tradition encouraged low birth rates and long breastfeeding durations, actively protecting children from deficiency.
As a reaction to the gendered pressures of colonial government, protracted breastfeeding and sexual abstinence were increasingly untenable throughout the twentieth century, with birth spacing durations declining almost universally across the continent. Again in the Gold Coast, male ownership of extra-subsistence produce severely undermined the value of childbearing, childrearing and food production, the biologically and socially ascribed outputs of female labour.
Endemic kwashiorkor could be utilised as a tool for colonial governance partly because the medicalisation of the disease stripped it of its social and economic context. In this respect, kwashiorkor helped justify European cultural hegemony and the paternalism of imperial government.
As with other manifestations of African illness, kwashiorkor was explained in terms of deviance from metropolitan ideals. When it was, the medicalised use of the word erased much of its original meaning at the same time as adding new import. Williams had been stationed in the Gold Coast for 3 years before she heard the local name for a condition she had been seeing with some regularity.
Under European government, indigenous knowledge was progressively devalued and replaced by biomedical frameworks that exalted scientific understandings of illness and promoted technical approaches to its relief. Following the popularisation of the Ga word, both the history and the terminology of the disease have tied protein deficiency specifically to the African continent. The conceptualisation of kwashiorkor as an inherently African illness complemented an ahistorical understanding of the disease.
It also contributes to the fetishisation of an ahistorical form of African poverty entirely dissociated from the effects of colonial rule. If protein deficiency naturalised African underdevelopment, whiggish understandings of economic and technological modernisation offered a reprieve. In the s, the science of nutrition pledged an objective valuation of diet, while technological developments appeared to offer a ready reprieve from deficiency. These ideas underpinned a biopolitics of nutrition that was based on earlier histories of class and cuisine, hunger, humanitarianism and noblesse oblige.
Born from these conventions, kwashiorkor was taken to be a natural result of the deviant diets and food cultures encountered by Europeans in Africa. Made endemic both by the pressures of colonisation and the reification of nutritionist dietetics, kwashiorkor was cast as a pervasive and timeless burden of African incivility.
While this construction was not apolitical, it reflects the latent politics of European history on the later development of colonial medicine.
Working from these assumptions, and working out of atypical rainforest food economies, early-twentieth-century nutrition research could only ever offer partial insight into the aetiology and epidemiology of deficiency during this period. In spite of this, conclusions drawn from these areas were extended into savannah areas and then across the continent.
Gold Coast Nutrition and Cookery , like the infant formula which it endorsed, was one of many solutions to this construction of deficiency. Kwashiorkor had emerged and endured also because its construction covered this up. Unlike the more problematic politics of hunger and undernutrition, kwashiorkor actively bolstered the racialised hierarchies which lay at the foundations of empire. The apparent absence of kwashiorkor in European epidemiology—as well as its complex biological pathology—challenged the science of nutrition, justified European authority over African health and naturalised narratives of African exceptionalism.
He is currently writing a monograph on the long history of food and health in Ghana since the late nineteenth century. Nelson and Sons, , — Jelliffe and F. Cicely D. On the scale of nutrition mortality in contemporary contexts, see Robert E. Black et al. Piwoz and Sandra L. This paper re-treads some of this history, and at times with similar source material, although for very different ends.
See Tappan, Riddle. Phillips, , , Kenneth J. George F. Michel Foucault, The History of Sexuality. Austoker and L. Quoted in Deborah M. Philip D. Orr and J. Quoted in G. See, Edward W. Douglas M. See, for example, W. Fortes and S. Burnet and W. It should be recognised that the science of kwashiorkor is far from settled. See, for instance, M. See, for example, Charles E. Brock and M. Churchill, Czerny and A.
Vincent J. Mark R. Frisch, Lafayette B. Mendel, and John P. Colburn, , v—vi. Whittingham, , This can include tests to:. Other tests may include growth measurements, calculating body mass index BMI , measuring body water content, taking a sample of skin biopsy or hair for testing.
If kwashiorkor is found early, it can be treated with either specially formulated milk-based feeds or ready-to-use therapeutic food RUTF.
RUTF is typically made up of peanut butter, milk powder, sugar, vegetable oil, and added vitamins and minerals. More intensive treatment in hospital is needed in severe cases or where there are already complications, such as infections. How well a person recovers from kwashiorkor depends on how severe their symptoms were when treatment began. If treatment was started early, the person will usually recover well, although children may never reach their full growth potential and be shorter than their peers.
If treatment was started in the later stages of protein malnutrition, the person may be left with physical and intellectual disabilities. Marasmus is another type of malnutrition that can affect young children in regions of the world where there's an unstable food supply. Signs of marasmus include thinness and loss of fat and muscle without any tissue swelling oedema.
Like kwashiorkor, marasmus is caused by a lack of the right types of nutrients. Williams will always be remembered for her vital and ground breaking work with mothers and children around the world, and her name will be forever be synonymous with the discovery and treatment of kwashiorkor.
Spring Sections Physicians of Note. Cicely D. Clio Medica , 61, Independent , Wednesday 15 July Williams C A nutritional disease of children associated with a maize diet Arch Dis Child, 8, Lancet, ,
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