Denis Burkitt: Burkitt's lymphoma.
Abstract: It is unusual for a medical investigator to have his name attached to a disease or syndrome during his lifetime. An exception to this rule was Denis Burkitt.

KEYWORDS Denis Burkitt / Burkitt 's lymphoma / Sarcoma / Tumour
Article Type: Report
Subject: Burkitt's lymphoma (Identification and classification)
Burkitt's lymphoma (History)
Surgeons (History)
Surgeons (Appreciation)
Author: Ellis, Harold
Pub Date: 07/01/2012
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: July, 2012 Source Volume: 22 Source Issue: 7
Persons: Named Person: Burkitt, Denis Parsos; Burkitt, Denis Parsos
Accession Number: 300545554
Full Text: In 1958 a short article, just five and a half pages in length, appeared in the British Journal of Surgery. It was nicely written and well illustrated with dramatic clinical photographs and was entitled 'A sarcoma involving the jaws in African children'. It originated from the Department of Surgery of the Makerere Medical School in Kampala, Uganda and its sole author was a medical officer in the Colonial Medical Service, Denis Parkins Burkitt. At the time, the paper aroused only passing interest. Nowadays it is one of the most quoted articles on the epidemiology of malignant disease and is held up as an example to follow for students in this field of research. Burkitt gave an account of 38 patients that he had studied over a period of seven years; 32 at Mulago and six at various district hospitals. A further eight children were not included because of lack of histological material from their tumours. The children's ages ranged from two to 14 years. The mandible, maxilla, or, in eight cases, both, sometimes involving all four quadrants, were involved. The tumour underwent rapid growth, with early invasion of the eye socket in the maxillary tumours. The lymph nodes were not involved unless there was secondary infection of the tumour. The tumour was rapidly progressive, (radiotherapy was unavailable in Uganda at that time and cytotoxic drugs remained to be developed), and at autopsy there were widespread deposits of the tumour, especially in the kidneys, liver and suprarenal glands The spleen was not involved. Burkitt could only trace reports of three similar cases in previous publications.

Microscopic examination of the tumour revealed a highly malignant tumour, with cells of variable size containing a large nucleus and with scanty cytoplasm. (Later studies described a typical 'starry sky' pattern produced by infiltrating benign macrophages which were ingesting dying tumour cells). Burkitt stated that 'so far no common factor has been recognised which might have a bearing on the aetiology'.

However, Burkitt then went on to make ground-breaking epidemiological studies as he travelled widely through central Africa, driving 10,000 miles in his old stationwagon. He was proud of the fact that his research cost but a few hundred pounds-a grant from the Medical Research Council for his travels. A number of important facts emerged; there was no apparent genetic factor in the distribution of the tumour, different tribes were affected, as were the children of Europeans and Asians in the endemic zone, so that it could be stated that the disease was 'not a tumour of African children but of children living in Africa'. A careful geographical survey enabled Burkitt to show concurrence of the tumour with that of malaria and with the anopheles mosquito, the insect carrier of this disease, and to suggest that the tumour was related to failure of immune surveillance.

This led to a search for a tumour-producing virus and other workers demonstrated the association with the Epstein-Barr virus (EBV), which is the causal virus of glandular fever in non immuno-suppressed subjects. The EBV genome was shown to be present in most of the African patients. With the spread of HIV infection, cases of Burkitt's lymphoma were soon to be reported in AIDS patients throughout the world, and in these patients the EBV genome was demonstrated in between 25 and 40% of the patients. Interestingly, these AIDS related patients demonstrate a different distribution of the disease to the African children, with particular involvement of the lower small intestine, the caecum, kidneys and, in the female, the ovaries. It should be noted that rare sporadic cases of the tumour have been reported throughout the world in non-tropical, non-AIDS patients.Nowadays, treatment with modern cytotoxic drugs can achieve rapid regression of these tumour masses, with long term survival in a proportion of cases. However, such sophisticated and expensive treatment is rarely available to children in tropical and sub-tropical Africa.

Denis Burkitt was born in Enniskillen, Northern Ireland, in 1911. He qualified in medicine at Dublin University in 1936, and obtained his Edinburgh FRCS two years later. He served as a surgeon in World War II then joined the Colonial Medical Service in 1946 as Government surgeon and lecturer in surgery at Makerere Medical School.

He was promoted to the rank of senior consultant surgeon to the Ministry of Health in Uganda in 1961 until returning to England in 1964 to work for the Medical Research Council. Here he pursued his epidemiological studies in other fields.

Burkitt pointed out the frequency of diverticulosis in the Western World in contrast to its rarity in Africa. He noted that the rise of this condition occurred at around the beginning of the 20th century, which could be correlated with the introduction of refined grain in the manufacture of bread.He demonstrated the extraordinary difference in the vast amount of stool passed daily by the African villager compared with the feeble quantity produced in the West. He also postulated a relationship between a low roughage diet and the high incidence of large bowel cancer, third in the list of cancer deaths in the UK and the comparative rarity of this tumour in less sophisticated communities. His books, articles and lectures did much to popularise a high fibre diet and supplements in this country.

Burkitt was appointed a Companion of St.Michael and St. George (CMG) in 1970 and elected a Fellow of the Royal Society (FRS) two years later. He was a charming, diffident and deeply religious man and both a brilliant and amusing lecturer. He died in 1993.

Members can search all issues of the BJPN/JPP published since 1998 and download articles free of charge at www.afpp.org.uk.

Access is also available to non-members who pay a small fee for each article download.

by Professor Harold Ellis Correspondence address: Department of Anatomy, University of London, Guy's Campus, London, SE1 1UL.

About the author

Professor Harold Ellis

CBE, FRCS

Emeritus Professor of Surgery, University of London; Department of Anatomy, Guy's Hospital, London

No competing interests declared
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.