Born: 2 December 1893, Jamaica
Died: 12 July 1992
Country most active: International
Also known as: NA
Jamaican physician Dr Cicely Delphine Williams, OM, CMG, FRCP was best known for her discovery of and research into kwashiorkor, a condition of advanced malnutrition, and her work against the use of sweetened condensed milk and other artificial baby milks as substitutes for human breast milk. One of the first women to graduate from Oxford University, Dr Williams was a key figure in advancing the field of maternal and child health in developing nations. In 1948, she became the first director of Mother and Child Health (MCH) at the newly created World Health Organization (WHO). She once commented that “if you learn your nutrition from a biochemist, you’re not likely to learn how essential it is to blow a baby’s nose before expecting him to suck.”
When Williams was 9 years old, her father reputedly said that she had better become a lady doctor as she was unlikely to find a husband. At 13, she left Jamaica to attend school in England, and was awarded a place at Somerville College, Oxford when she was 19. Her university training was delayed as she returned to Jamaica to help her parents following a devastating series of earthquakes and hurricanes. After the death of her father in 1916, 23-year-old Williams returned to Oxford and began studying medicine. She was one of the first females who were admitted into the course due to the lack of male students caused by World War I.
After qualifying from King’s College Hospital in 1923, she worked for two years at the Queen Elizabeth Hospital for Children in Hackney. During this period, Williams decided to specialise in paediatrics, believing that to be an effective physician she must have firsthand knowledge of a child’s home environment and background, which would come to define her medical practice.
With the end of World War I, and the return of male physicians, Williams found it difficult to secure a medical position following graduation. She worked for a term in Salonika (now known as Thessaloniki) with Turkish refugees. In 1928 and 1929, she completed a course at the London School of Hygiene and Tropical Medicine (LSHTM), applied to the Colonial Medical Service and was posted to the Gold Coast (present-day Ghana) in 1929.
Williams was employed as a “Woman Medical Officer”- a title she disagreed with, not least because it meant she was paid less than her male counterparts. Her role was to treat acutely ill infants and children, and give medical advice at a clinic level. Faced with the alarming rate of death and illness in the community, Williams trained nurses to do outreach visits, and established well-baby visits for the local community. She also started a patient information card system to help with record keeping. Though supportive of modern medicine and scientific techniques, Williams was one of the few colonial physicians who gave credence to traditional medicine and local knowledge. She noted that while child mortality was high, toddlers between two and four years were at much greater risk than infants. Dr Williams noticed they were seeing young children with swollen bellies and stick thin limbs who very often died despite treatment. This condition was often misdiagnosed as pellagra, a vitamin deficiency, but Williams disagreed, and carried out autopsies on the dead children. This presented significant risk, because there were no antibiotics in colonial Ghana, and she became severely ill with streptococcal haemolysis from a cut during one autopsy. Williams asked the local women what they called the condition, and was told kwashiorkor, which Williams translated as “disease of the deposed child”. Her findings, that the condition was due to a lack of protein in the diets of childred weaned off their mothers’ breastmilk after the arrival of a new baby, were published in the Archives of Disease in Childhood in 1933.
Her fellow colonial physicians were quick to try to discredit her research particularly H.S. Stannus, considered as an expert on African nutritional deficiency. Williams followed up her paper with another, more directly contrasting kwashiorkor and pellagra, published in The Lancet in 1935. This did little to change opinions and colonial physicians continued to avoid using the term kwashiorkor, or even acknowledge that it was a separate condition from pellagra. Thousands of childred died as a result of being treated for the wrong condition. Williams commented, “These men in Harley Street couldn’t believe you unless you wore stripy trousers.”
Williams believed that kwashiorkor was caused primarily through a lack of knowledge and information. Her attempts to combine preventive and curative medicine caused her to clash with her superiors and in 1936, after more than seven years of service on the Gold Coast, she was transferred ‘in disgrace’ to Malaya, to lecture at the University of Singapore.
In Malaya, Williams found that mortality of newborn infants was extremely high, subsequently realising this was a direct result of corporate malfeasance. She learned that companies were employing women dressed as nurses to go to tenement houses and convince new mothers that sweetened condensed milk was better for their babies for their own breastmilk. This was illegal in England and Europe, but Nestlé was exporting the milk to Malaysia and advertising it as “ideal for delicate infants”. In 1939 Williams was invited to address the Singapore Rotary Club, the chairman of which was also the president of Nestlé, and gave a speech titled “Milk and Murder,” famously saying: “Misguided propaganda on infant feeding should be punished as the most miserable form of sedition; these deaths should be regarded as murder.”
Dr Williams managed the development and running of a primary health care center in the province of Trengganu, and was responsible for 23 other doctors and 300,000 patients. When the Japanese invaded in 1941, Williams was forced to trek to Singapore to safety. But soon after she arrived, Singapore fell to the Japanese as well. She was interned first at the Sime Road camp, and was later taken to Changi Prison with 6,000 other prisoners. She was jailed for 3.5 years at Changi, and became one of the camp leaders, which led to her being moved for six months to the Kempe Tai headquarters where she was tortured, starved and kept in cages with dying men. Williams suffered dysentery and beriberi (vitamin B1 deficiency, which left her feet numb for the rest of her life) and when the war ended in 1945, she was in the hospital, near death.
In 1948, Williams was named director of the new Maternal and Child Health (MCH) division of the World Health Organization, and later transferred back to Malaya to lead all maternal and child welfare services in South-East Asia. In 1950, she led the commission of an international survey into kwashiorkor across 10 countries in sub-Saharan Africa. The study found that the condition represented “the most serious and widespread nutritional disorder known to medical or nutritional science.” In her years with the WHO, she lectured and advised on maternal and child health in more that 70 countries and promoted the advantages of local knowledge and resources as key to achieving health and wellness in local communities.
In 1951, following an outbreak of “vomiting sickness” in Jamaica, the government ordered an investigation “to improve child care and investigate the causes of food poisoning”. From 1951 to 1953 Dr. Williams coordinated this research and the results were published, leading to the identification of the hypoglycaemic effects of unripe ackee.
From 1953 to 1955 she was a senior lecturer in Nutrition at the London School of Hygiene & Tropical Medicine, where she had studied in the 1920s. In 1960 Williams became a Professor of Maternal and Child Services at the American University of Beirut. In her four years there, she worked with the United Nations Relief and Works Agency (UNRWA) helping Palestinian refugees in the Gaza Strip. She also worked with at-risk communities in Yugoslavia, Tanzania, Cyprus, Ethiopia and Uganda.
In 1965, Williams was awarded the James Spence Gold Medal of the Royal College of Paediatrics and Child Health for the discovery of kwashiorkor and for recognising malnutrition was more likely to be caused by lack of nutritional knowledge, as opposed to poverty.
In 1986 Dr Williams was awarded an honorary Doctorate of Science from the University of Ghana, for her “love, care and devotion to sick children” and her citation noted that during her time as a colonial physician “it became necessary to have the police keep order among the surging patients.” The same year, she was made a Companion of the Order of St. Michael and St. George (CMG), and met Queen Elizabeth II at a ceremony at Buckingham Palace.
In 2005, Ghanaian physician Felix Konotey-Ahulu wrote to The Lancet praising Dr Williams’ ability to identify and acknowledge the social context of diseases such as kwashiorkor. He states that her translation of the concept had yet to be improved almost 70 years later, and commended her for her respect for local traditions, as evidenced by her referring to kwashiorkor by its local name.
However, it should be noted that, although very progressive for a white woman of her time and open to valuing local practices, Dr Williams wrote about Africans of the Gold Coast in an incredibly racist, colonialist manner in her 1938 dissertation: “compared to the white races, he seems to lack initiative and constructive ideas, although he may be shrewd to judge the attainment of others… he is almost invariably dishonest. He wishes to attain wealth without expending too much energy. He does not consider that there is any obligation to honesty beyond the members of his own family… Some of the intellectual qualities of the African that delay his progress, lack of initiative, the servile acceptance of superstitions and customs, many of them fantastic and damaging, his propensity to prevaricate and to defraud may be ascribed in part to some dietetic imbalance, and some to imbalance of upbringing. Although the mothers are fond of their children, they’re quite incredibly careless with them. Like all primitive people, they are lacking in imagination. I have seen enough of the excellent qualities of the Africans, their good nature and cheerfulness, their astuteness, their uncomplaining fidelity, their patience in very great trials, to know that they are worth educating.”
She has also been recognised for pioneering the field of maternal and child-focused medicine, as during her early days in Ghana, such works was devalued as ‘women’s work’ and outside the purview of standard modern medicine. She took many photographs and notes cataloguing her time in Ghana, and admired the mothering skills of the local women, remarking that “[The baby] is carried about on the mother’s back, a position it loves, it sleeps close beside her, it is nourished whenever it cries, and on the whole it does remarkably well on this treatment”, where traditional British parenting recommended the separation of mothers from their infants whenever possible.
Dr Williams continued travelling and speaking into the early 1990s.