NIHERST: Caribbean Icons in STI

The Honourable Doctor Cicely Williams CGM was one of Britain’s first female doctors and the first female doctor in Jamaica. She developed a special treatment regime for the protein malnutrition disease Kwashiorkor that saved millions of lives. During her illustrious career as a doctor, researcher, lecturer, consultant and humanitarian, Dr Williams worked in over 58 countries in Europe, Asia, Africa and the Caribbean. The methods and procedures she contributed to maternal and childcare are still practised around the world.

Cicely Williams was born in Westmoreland, Jamaica on December 2nd, 1893. When she was nine years old, her father suggested that that it was quite likely that she would never find a husband and because of this, she should go to Oxford to become a “lady doctor”! These words affected her deeply and in 1914, she took up first aid and nursing classes. Despite the onset of the First World War, she had already made up her mind to study medicine. When her father passed away in 1916, she took his advice and went to Oxford. Her timing could not have been better, since Oxford had begun admitting female students since the War had reduced the number of males enrolled.

Williams attended the Somerville College in Oxford, England and did her internship at the King’s College Hospital, graduating in 1923. At first, it was impossible for her to obtain a job because of gender prejudice, but she was eventually employed at the South London Hospital for Women and Children. There, she specialised in Paediatrics with an interest in childhood diseases. She also did further studies in Tropical Medicine in Greece. During this time, she developed the philosophy that gathering knowledge about her patients' personal backgrounds was crucial to successful diagnoses and treatments – a mindset that would influence the rest of her career.

In 1929, Williams was appointed to the Gold Coast in Ghana by the Colonial Medical Service. She was the first female medical officer in that country and although she formally specialised in children’s diseases, she also worked tirelessly to revolutionise the health care system. At the time, medical facilities were one room offices where patients waited, consulted, were examined and had drugs dispensed to them. Through her efforts, proper hospitals with clinics were established and patient information cards were issued to ensure proper record keeping. She also initiated programmes to educate mothers on nutrition and proper childcare. Through her work, Dr Williams became so renowned in Ghana that a few weeks after she opened a medical centre in the town of Koforidua, the police were sought to control the massive crowds of mothers and children that had gathered for medical care. At the Princess Marie Louise Hospital in Accra, Dr Williams introduced revolutionary ideas to combat the abnormally high child mortality rates. She proposed that mothers should begin breastfeeding their babies as early as possible, ensured that babies were kept with their mothers during their stay at the hospital and taught the mothers how to bathe and care for sick babies.

The love and compassion that Dr Williams had for children in poor and isolated districts in Africa led to her first major discovery. In 1931, she observed that children were getting sick for no apparent cause. All of the patients suffered with the same wasting disease symptoms. Over the rest of the year and into the year that followed, she recorded her observations, conducted research and performed laboratory tests with the limited equipment that she had available. When she gained the necessary instruments, she began performed post-mortem surgery on the deceased children at great personal risk, since she had no antibiotics available. At one point, she even becoming infected herself by a haemolytic streptococcus bacterium, which nearly killed her. However, when she recovered, she went back to work immediately.

Early in her investigations, Williams ruled out food poisoning and infection through insect vectors as causes for the symptoms. In her observations, she also noticed that the mystery ailment was often found among young children who had recently stopped breast-feeding, because of the birth of a sibling. She came to the conclusion that the “mystery illness” was due to a severe protein deficiency, which occurred because the children’s diets were made up almost entirely of carbohydrates. Dr Williams forsook European naming conventions and called the ailment kwashiorkor, which in the Ga language of Ghana, means “displaced child”. Hers was the first clear description of the cause of kwashiorkor, which had previously been misdiagnosed by other medical professionals as pellagra, a Vitamin B3 (niacin) deficiency.

Williams got to work immediately. She began by educating parents on proper nutrition and treating the patients with a special regimen, which began by placing them on intravenous drip treatment and then feeding them with high protein beans. The high calorie, high protein diet supplements that followed proved to be successful in ensuring the patients’ recovery. Although Williams’ pioneering work was often unjustly ignored by later researchers, it led to numerous studies in protein deficiency diseases and drew public attention to the need for improved nutrition of young children.

Because of Williams’ research, she was elected as a Member of the Royal College of Physicians in London in 1935, without having to sit the entrance examination- a distinct honour. In the same year, her alma mater Oxford University also conferred an honorary Doctorate in Medicine upon her. Amidst growing recognition, Dr Williams did not lose her enthusiasm or focus. She continued to travel between Africa, Asia and Europe, treating victims of kwashiorkor wherever it had been identified as a widespread issue.

In 1936, Dr Williams went to the Federation of Malaya (now Malaysia and Singapore), where she lectured at the College of Medicine and worked as Acting State Medical Officer in Trenggamu. In the latter capacity, she was in charge of 23 doctors responsible for serving a community of 300 000 people. At the time, milk manufacturers were encouraging people to use condensed milk instead of breast milk to feed their newborn babies and the doctor became a strong critic of this initiative, launching a widespread campaign against it. Williams published a treatise titled "Milk and Murder," encouraged mothers to feed their children with buffalo’s milk when breast milk was unavailable and ensured that the hospitals themselves followed this policy. Her counter-campaign was widely successful: mothers became aware that they should not feed nursing children with condensed milk and they no longer viewed the consumption of buffalo’s milk as taboo.

In December 1941, during World War II, the Japanese invaded Malaya. Although Dr Williams hated to leave her patients, all Europeans were ordered to make the treacherous journey to Singapore where it was assumed they would be safe. However, that portion of Malaya fell soon afterward and she was captured and interned in a prison camp. In the camp’s unsanitary conditions, she came down with a nearly fatal bout of dysentery and soon after she recovered, she was moved to an even worse camp where she spent two years in near starvation. Even under these circumstances, she continued her service to the people in the camps and her dietary and medical expertise lowered the death rate considerably, also helping to preserve the lives of 20 babies born in prison. After four months of imprisonment and a rigorous period of torture and interrogation in Kempe Tai headquarters, Williams was returned to the camps. She spent V Day in the hospital, close to death but her Malayan friends helped to nurse her back to health.

After the Allies’ victory, she was chosen by the British Government to serve as part of an honour guard composed solely of females who had been prisoners of the Japanese, which accompanied Lord Francis Mountbatten when he received the official surrender of General Seishiro Itagaki and the Japanese invaders in Singapore. After this ceremony, she left for England in 1946, having spent 10 years in Asia. As soon as she regained her health, Dr. Williams returned to Malaya, where she was the first woman to be put in charge of all maternity and child welfare services. However, she would not remain there.

After spending three years in Malaya, Dr Williams returned to England to lecture at Oxford, beginning a phase of her career that would take her around the globe. Between 1948 and 1951, she worked as the first advisor in maternal and child health to the World Health Organisation (WHO). In 1951, she did collaborative research at the New University College Hospital in Jamaica to find the cure for the “vomiting sickness” attributed to ackee poisoning. The poisoning was identified as being due to hypoglycin, which led to a dramatic fall in blood sugar levels. The simple sweet drink treatment that was developed in response saved thousands of lives. In 1953, she went to London University, where she taught for two years as a Senior Lecturer in Nutrition. In 1960, she became a professor of Maternal and Child Health at the American University in Beirut. In 1964, at the age of 70, she became an adviser in the training programme of the Family Planning Association, a position she retained for three years. In her nineties, she remained an active speaker, giving talks in countries such as Nepal, Pakistan and Israel.

Dr Cicely Williams’ work has saved millions and has inspired many. She lectured at many universities in Europe, Beirut and USA including Oxford and the University of the West Indies in Mona, where she had the privilege of seeing many of her female students graduate as qualified professionals and find acceptance and recognition in an increasingly tolerant Caribbean. She remained active even in her nineties, giving talks in Nepal, Pakistan and Israel.

Cicely Williams - Paediatrician

Cicely Williams
- Paediatrician