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For the surgery, please book an appointment online , or contact reception on Florence Road Surgery or Bramley Road Surgery to make an appointment. This is a private service as ear syringing is no longer available at this Surgery. Also please check the following information on NHS Choices. For a GP, please book an appointment online , or contact reception on Florence Road Surgery or Bramley Road Surgery to make an appointment.
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Such diagnoses likely combined a number of bone-deforming illnesses of infancy, including wasting, scurvy and kwashiorkor. This may explain the emphasis laid by other writers on the occurrence of hepatomegaly—or the enlarged liver later seen as typical in kwashiorkor patients—in cases categorised as rickets.
Under similar social and economic pressures to those seen in colonial Africa a century later, localised food economies and the domestic economy of childrearing changed enormously throughout during the Industrial Revolution.
By the s, accounts of oedematous malnutrition were commonly listed in paediatric textbooks and, from the nineteenth century, medical attention began to explicitly address food, feeding and deficiency in the modernising economy. By this time, however, low-protein diets were becoming less common, at least in Western Europe.
Although not often consumed by the majority of the population, animal produce was central to European perceptions of dietary value, something at least in part related to the history of class stratification. The same being true for sheep and mutton, cows and beef, calves and veal, meat had long been an aspirational expenditure. As average income increased, the consumption of animal produce grew in tandem. In the years following the First World War, protein deficiencies became increasingly interesting to a medical community recently exposed to the destitution of the poor in the ghettos of Europe and in the dustbowls of North America.
Early European administrators and physicians stationed in Africa highlighted the lack of meat as a chief cause of European ill-health on the continent. An African, who has been feasted with every delicacy which an European table can afford, yet if rice has not constituted a part of his entertainment, will say, he has had no meat for so long a time, and on his return home will recur to his beloved food with redoubled ardour.
Linguistics clearly offers insight into the culturally specific value of food. In this often food-insecure savannah economy, Meyer Fortes, writing in the s, found that meat was shared widely while arable produce was commonly secreted away. The advent of tropical medicine facilitated the spread of nutrition research into the fertile ground of the Global South, where oedematous malnutrition was found to be particularly prevalent.
In Latin America, symptoms later defined as kwashiorkor were described in a number of articles from Despite its global incidence, her construction would spark decades of debate and research into primarily African presentations of the illness. In earlier years, however, European doctors in Africa had been relatively dismissive of such symptoms, even though they were readily apparent. In the absence of effective medical communication, it was not until later in the twentieth century that the numerous descriptions of kwashiorkor began to be brought together.
This, Trowell and Davis would go on to explain, suggested that patients were unable to digest their food due to a shortage of pancreatic secretions; it also explained why supplements failed to relieve patients in advanced cases. By it was suggested that a lack of protein could severely harm the tissues and organs of the body because it restricted the ability to create new tissue.
The functioning of the liver and the pancreas were gradually undermined, leading to a decline in enzyme production and the restriction of nutrient absorption. The subsequent failure to digest led to diarrhoea and, because of excessive fat, an enlarged liver.
In Uganda, R. Hennessey, a politically minded pathologist, who would later become Principle Medical Officer of the Uganda Protectorate, took little interest in kwashiorkor. Prior to his promotion, Hennessey would perform a number of autopsies in the space of an hour, mainly on vital organs extracted by students and medical assistants. Jack Davies, taking 50 sections of one cadaver, found the critical pancreatic degenerations on his first attempt. Trowell describes Hennessey as saying;.
There is no new complaint here. It is, however, important to realise that the concerns of the administrations inside individual colonies were not necessarily the same as those in Whitehall. While in-country administrators were understandably reluctant to draw attention to a high incidence of kwashiorkor, protein deficiencies were still more palatable than a fundamental lack of food, especially if they could be presented as an endemic problem of the African environment.
This was not necessarily a problem for the government of the day. In , under Apartheid, the South African minister of health spoke in parliament in order to explain that there was no famine or undernutrition in the country but, because of custom, ignorance and immorality, kwashiorkor was still present.
Unlike kwashiorkor, hunger presented a more difficult conceptual problem for imperial administrations. As a fundamental lack of nutrients, undernutrition is a much more substantive failure, one which exists beyond the nutritionist paradigm.
The construction of kwashiorkor as the clinical manifestation of a continental protein deficit offered valuable distance from any upturn in undernutrition. The history of kwashiorkor, therefore, has just as much to do with an absence of food as it does with an absence of high-protein foods. There was a year between the receipt of replies to the Thomas circular and the final publication of Nutrition in the Colonial Empire.
It was, in fact, sent to London, although nearly 2 years after its completion. On receipt of the report, S. Starvation was a difficult problem for governments to contend with. Humanitarianism had come of age and absolute failures of subsistence were widely seen as a governmental responsibility, if not a direct failure of imperial government. 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. Edema can mask how little body weight a child has. The child may appear to be a typical weight or even plump, but this appearance is swelling due to fluid, not the presence of fat or muscle. When diagnosing kwashiorkor in a child, doctors begin by taking a medical history and performing a physical examination.
They will look for the characteristic skin lesions or rash, as well as edema on the legs, feet, and, sometimes, the face and arms. In some cases, the doctor may order blood testing for electrolyte levels, creatinine, total protein, and prealbumin. Children with kwashiorkor tend to have low blood sugar levels, as well as low levels of protein, sodium, zinc, and magnesium.
According to the worldwide relief organization Unicef , marasmus is the most common form of acute malnutrition in food shortage emergencies. This condition affects both children and adults. Although kwashiorkor is a condition that relates to malnutrition, merely feeding a child or adult will not correct all of the deficiencies and effects of the condition. If a child has been living without sufficient protein and nutrients for a long time, they can find it difficult to take in food.
It is, therefore, essential to reintroduce food carefully to avoid refeeding syndrome. Refeeding syndrome involves life threatening electrolyte and fluid shifts that occur with rapid refeeding of malnourished individuals. Many children with kwashiorkor will also develop lactose intolerance. As a result, they may need to avoid milk products or take enzymes so that their body can handle milk.
Doctors treating the condition will first give carbohydrates , then add in proteins, vitamins , and minerals. The reintroduction of food may take a week or more to accomplish safely. Children with kwashiorkor may not grow to an expected height due to malnutrition at an early age. The condition also makes a person more vulnerable to infection, which, alongside a weakened immune system, can lead to life threatening complications.
Kwashiorkor is a type of severe malnutrition that is most common in children. It occurs due to a lack of protein in the diet, which affects the balance and distribution of fluids in the body and often leads to a swollen belly. Effective treatment can usually reverse many of the signs and symptoms of kwashiorkor. It is important to reintroduce foods slowly and carefully to avoid refeeding syndrome.
A look at anasarca, a condition that causes a general swelling of the body.
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