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Preventive medecine: heart disease and appendicitis PREVENTIVE MEDECINE: HEART DISEASE AND APPENDICITIS
Heart disease
Now the biggest single killer in the western world, cardio-vascular disease emerges last of all the western diseases as a population becomes westernized. Even today rural peoples around the world have very little coronary heart disease. Among the rural Bantu in southern Africa coronary heart disease occurs at a level of only 1 or 2 per cent of that seen in white South Africans of similar age and sex. As obesity rises in a community, usually along with blood pressure, death rates from heart disease also rise.
Appendicitis
Most of us think of appendicitis - the emergency operation most often performed in the western world-as inevitable but this again is a relatively recent western disease. In fact it is the first of these diseases to appear once a population changes its eating habits and lifestyle.
Studies of appendicitis in pre-1920 Africa show that it was a rare disease among the indigenous population but relatively common in the Europeans and Indians. It is still possible to find hospitals in Africa where the surgeons have not seen a case of appendicitis for ten years. In contrast, British hospitals remove 56,000 appendixes every year. During the past twenty-five years the number of people with acute appendicitis admitted annually to large western hospitals throughout sub-Saharan Africa has risen from less than 5 to over 50 per year. When appendicitis emerges in a community it appears first in the adults. Two dramatic examples of a western diet as the cause of appendicitis come from China and Africa. In China a flour mill was installed in a town in which appendicitis was almost unknown. Within a few months of the mill opening cases of appendicitis began to appear in the wealthier middle class, who had taken to eating white flour. During the 1939-45 War appendicitis appeared for the first time amongst African troops when they were supplied with British army rations during their attachment to British regiments.
It is not known for certain what causes appendicitis but the initial problem, is likely to be an obstruction to the hollow cavity within the appendix; pressure builds up and deprives the lining of the appendix of its blood supply. This paves the way for infection to enter and the organ becomes inflamed. The original obstruction probably comes about as a result of the passage of sluggish, thick, tarry stools along the large bowel off which the appendix branches. It is known that low-fibre diets, high in refined carbohydrates, are the biggest culprits in this story.
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