Denis Burkitt

Biography

• Born on February 28, 1911 in Enniskillen, Ireland (became Northern Ireland, UK in 1921)
• 1933 – BA, Trinity College, Dublin
• 1935 – MB, Trinity College, Dublin
• 1938 – Fellowship of the Royal College of Surgeons of Edinburgh following surgical training jobs in Chester, Dublin, Preston, and Poole
• 1941 – Volunteered for the Royal Army Medical Corps but declined as he had previously lost his right eye in an accident in 1922
• 1942 – Served as surgeon with the 219 Field Ambulance near Norwich
• 1943 – Posted to a military hospital in Mombasa, Kenya. Burkitt decided his future lay in providing surgical service in the developing world, and was intent on being a missionary as well as a surgeon. He continued to work as a medical officer in Uganda after the war.
• 1946 – Returned to the UK to complete his MD. Then joined the British Colonial Service and served first as a public health officer in Lira, in the Lango District of Central Uganda. Burkitt suggested an association between the prevalence of hydrocele, its geographical distribution, and possible causation by microfilariae (Lancet 1951)
• 1948-1964 Surgeon to Mulago Hospital and lecturer in surgery at Makerere College Medical School in Kampala, Uganda. Here Burkitt identified, treated and published on the disease which would become eponymous to him (BJS 1958)
• 1964-1966 External scientific staff of the Medical Research Council (MRC)
• 1966-1976 Returned to England. Continued to work with the Medical Research Council based out of Tottenham Court Road in London studying dietary fibre and it’s health implications
• 1970 – Companion of the Order of St Michael and St George
• 1972 – Fellow of the Royal Society (FRS)
• 1976-1988 Honorary senior research fellow at St. Thomas’ Hospital Medical School; Department of Geographical pathology
• 1993 – Bower Award and Prize for Science – Benjamin Franklin Institute, USA
• Died on March 23, 1993 in Gloucester, England

Medical Eponyms

Burkitt Lymphoma (1958)

In Mulago in 1957, Burkitt examined a 5-year-old boy, named Africa, who had symmetrical jaw swellings. Burkitt audited similar cases and identified 41 children who presented with tumours in their jaws; many of whom also had involvement of their adrenals, kidneys, and liver. He began photographing young patients with similar symptoms and published preliminary observations in 1958 (A Sarcoma Involving the Jaws in African Children, BJS 1958)

Burkitt detailed the clinical features with tabulated reference to the involvement of particular jaw quadrants and the presence or absence of deposits in sites out with the jaw and devoted a section to the geographical distribution. Burkitt initially referred to the tumours as ‘sarcoma’ with histology reported by Prof Jack N.P. Davies as ‘that of a tumor of highly malignant type, the cells of which strongly resemble lymphocytes, in some cases resemble lymphosarcoma’

Burkitt was not the first to publish on the jaw tumours, but was the first to recognize that they were one presentation of a single disease that had a potential to present with a variety of apparently separate clinical manifestations.

Burkitt mailed >1,000 illustrated pamphlets and questionnaires to every government and mission hospital in Africa to track the geographical distribution of occurrences. Burkitt defined the “Lymphoma Belt” spanning central tropical Africa where tumors occurred most frequently. He set out on what he termed a “Tumor safari”, a 10,000 mile road trip, visiting 56 hospitals in Kenya, Mozambique, Nyasaland, Rhodesia, Swaziland, Tanganyika, Transvaal and Uganda to further examine the aetiology of the condition. After determining that factors such as altitude, temperature and rainfall affected tumor occurrence, Burkitt and colleagues hypothesized that an insect vector might be responsible.

The condition was eponymously termed Burkitt lymphoma for the first time in 1963 in Paris at the International Union against Cancer at the UNESCO House.

Epstein-Barr Virus

On March 22, 1961, Burkitt visited England from Uganda and presented a lecture at Middlesex Hospital detailing “The Commonest Children’s Cancer in Tropical Africa — A Hitherto Unrecognised Syndrome”. Michael Anthony Epstein (1921 – ) was in the audience.

I had been working at the Middlesex Hospital on the then seriously unfashionable cancer causing viruses of chickens (Rous sarcoma virus)…when Burkitt mentioned the peculiar temperature and rainfall determined geography of the tumour I immediately considered the possible involvement of a human cancer-causing virus spread by a climate-dependent vector and decided, even as Burkitt was talking, to stop my current work and seek for such an agent

Epstein 2012

Epstein asked Burkitt for a tissue sample and arranged for samples of tumours taken from children with Burkitt’s lymphoma to be shipped from Uganda to Epstein’s lab in London. He searched in vein for 2 years, but was not able to isolate the virus. With a US National Institute of Health grant for $45,000, Epstein recruited Yvonne Barr (1932 – 2016) for cell culture preparation, and the electron microscopy skills of Bert Geoffrey Achong (1928-1996) to help him in the search.

On Friday 5 December 1963 fog caused the flight from Uganda to be diverted to Manchester and the tissue sample was delayed. The tissue sample was from the upper jaw of a 9 year old girl with Burkitt lymphoma from Kampala. On reaching Epstein’s lab in London, the usually clear sample transit fluid was found to be cloudy with huge numbers of viable, free-floating lymphoma cells shaken from the sample by the unusually long flight. Lymphoma cell lines were cultured and grew continuously, forming the immortal cell line EB-1 after Epstein and Barr.

…the free floating cells from this delayed sample were set up in suspension and the first cell line duly grew out designated EB to distinguish it from HeLa, OMK, BHK and other cells in the laboratory…This was the first time that any cells from the human lymphocytic series had ever been grown in vitro…the discovery was rapidly sent for publication with my research assistants, Bert Achong, who helped with the electron microscopy, and Yvonne Barr, who helped with the cell culture

Epstein 2012

Key Medical Contributions

America is a constipated nation…. If you pass small stools, you have to have large hospitals

Denis Burkitt

Burkitt wrote several short papers on the subject of the high-fiber diet in the 1970s. He co-authored the book, ‘Refined Carbohydrate Foods and Disease: Some Implications of Dietary Fiber,’ with Hugh Trowell (1975) and a shorter book, ‘Don’t Forget Fiber in Your Diet‘ (1979). Through these works, Burkitt is credited with simplifying the relationship between dietary fiber and disease and making it understandable for everyone.

If people are constantly falling off a cliff, you could place ambulances under the cliff or build a fence on the top of the cliff. We are placing all too many ambulances under the cliff.

Denis Burkitt

Major Publications

• Burkitt DP. Primary hydrocele and its treatment. Review of two hundred cases. Lancet. 1951;1(6669):1341-1343.
• Burkitt DP. Acute abdomens–British and Baganda compared. East Afr Med J. 1952;29(5):189-194.
• Burkitt D. A sarcoma involving the jaws in African children. Br J Surg. 1958;46(197):218-223.
• Burkitt DP. Observations on the geography of malignant lymphoma. East Afr Med J. 1961;38:511-514.
• Burkitt D. A children’s cancer dependent on climatic factors. Nature. 1962;194:232-234.
• Burkitt DP, Wilson AM, Jelliffe DB. Subcutaneous phycomycosis: A review of 31 cases seen in Uganda. Br Med J. 1964;1(5399):1669-1672.
• Burkitt DP. Epidemiology of cancer of the colon and rectum. Cancer. 1971;28(1):3-13.
• Burkitt DP. Varicose veins, deep vein thrombosis, and haemorrhoids: epidemiology and suggested aetiology. Br Med J. 1972;2(5813):556-561.
• Burkitt DP. Some diseases characteristic of modern Western civilization. Br Med J. 1973;1(5848):274-278
• Burkitt DP. Cancer of the GI tract: Colon, rectum, anus. Epidemiology and etiology. JAMA. 1975;231(5):517-518.
• Burkitt DP, Trowell HC. Refined Carbohydrate Foods and Disease: Some Implications of Dietary Fibre. 1975
• Burkitt DP. Are our commonest diseases preventable? Prev Med. 1977;6(4):556-559
• Burkitt DP. Hiatus hernia: is it preventable?. Am J Clin Nutr. 1981;34(3):428-431.
• Trowell HC, Burkitt DP. Western diseases, their emergence and prevention. 1981
• Hutt MSR, Burkitt DP. The Geography of Non-infectious Disease. 1986

References

Biography

• Kellock B. The Fibre Man: The Life-story of Dr. Denis Burkitt. 1985
• Story JA, Kritchevsky D. Denis Parsons Burkitt (1911-1993). J Nutr. 1994;124(9):1551-1554.
• Epstein MA, Eastwood MA. Denis Parsons Burkitt, 28 February 1911 – 23 March 1993. Biogr. Mems Fell. R. Soc. 1995; 41: 88–102
• Coakley D. Denis Burkitt and his contribution to haematology/oncology. Br J Haematol. 2006;135(1):17-25
• Coffin CS, Shaffer EA. The hot air and cold facts of dietary fibre. Can J Gastroenterol. 2006;20(4):255-256.
• Smith O. Denis Parsons Burkitt CMG, MD, DSc, FRS, FRCS, FTCD (1911-93) Irish by birth, Trinity by the grace of God. Br J Haematol. 2012;156(6):770-776.
• Engineer A. Denis Burkitt’s safari diaries. Wellcome Library 2016
• van den Tweel JG. Burkitt, Denis Parsons (1911–1993). Pioneers in Pathology. 2017: 94-96
• Bibliography. Burkitt, D. P. WorldCat Identities

Eponym

• Burkitt DP. Classics in oncology. A sarcoma involving the jaws in African children. CA Cancer J Clin. 1972;22(6):345-355.