University of Minnesota

“If It Isn’t Fun.” – Letter from a Missionary Friend

This letter is from Dr. William Hughlett, missionary in the Belgian Congo and long-term family friend. Coupled with his stay in New Orleans during my senior year, this may have been the implantation of ideas about the social origins of common diseases, which became the lines of my career with Ancel Keys and later. Dr. Hughlett not only had interesting ideas about the causes of diseases, or of their absence, among native Africans, but he had very clear ideas of how to go about studying lifestyle-disease associations in contrasting populations and their trends over time. Even then, great minds seemed to be running in the same channels, that is, Keys, Burkitt, and Hughlett!

February 5, 1947

Dear Doctor Henry:

Accept my congratulations on the progress to your present stage of medical education. You certainly have a wealth of clinical material at ol’ Charity Hospital, or does it still suffer under Huey Long’s influence, open only to LSU staff and students?

Out here we still need concentrated, skilled doctors. For example, in 1931 we had four. One has died, one has retired. Both of us left are due furloughs.

As to research, I’ve just finished writing the South African Institute for Medical Research at Johannesburg asking if they might explore some of the issues I ponder. Library research, like old Sherlock Holmes did, might resolve these questions.

First, the etiology of appendicitis.

Why have I operated only two cases of acute appendicitis and one of peritonitis presumably from a ruptured appendix, in 18 years of service here? Even these three cases were “mission natives;” not a single case occurring among the thousands we serve who live under primitive conditions. What is it that the white man, particularly the American, does or eats that the semi-civilized native Congolese does or eats little and that the primitive native does or eats not at all?

Might not the answer be found through comparing statistics on the incidence of appendicitis in populations with varying dietary habits and opportunities? For example, might not the incidence be compared in occupied countries before and during occupation, checking on consumption of sugar, meats, potatoes, canned goods, etc. available during those times? Wouldn’t it be revealing to note the sudden rise of rates just as, for example, sugar came back on the market? Sugar is only one lead but possibly an important one.

If we can’t immediately see why, let us first see what the statistics show and then concentrate on the explanation.

How about tonsillitis?

I think there is some evidence that tonsils tend to be less healthy or more easily invaded in people eating a high carbohydrate diet. How about similar susceptibility of lymphoid tissue in the appendix? Pure sugar is not a natural product like honey. Again, sugar is not the only possibility by long shot. But what is the answer?

Mostly our work here is general, and I mean general. Gynecology takes quite a bit of our time. These people consider life lost if they can’t bear children and yet in our sector venereal disease is sealing them up. We seem to have been able to unseal a few and they are terribly grateful.

Our biggest public health problem is hookworm disease; simply awful! For several years we used blood transfusions (subcutaneously!) to save some of the more extreme cases. The old standby is the hematinics, arsenic and iron, given with anti-helminthics. Of course, we actively put out propaganda about toilets and wearing wooden shoes.

Goodbye for this time, Henry. I hope to see you later this year.

Very sincerely yours, William Hughlett, M.D..

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