Rapid weight loss in children.

Much new information, necropsy, radiological, and clinical, is presented shortly concerning the great rarity of diverticular disease in many countries in Africa and Asia.

Abstract

Fibre and Irritable Bowels SIR,-I read with interest your leading article (1 June, p. 457) which referred to recent work on this disorder.I had just completed a survey of most of the medical journals of Africa south of the Sahara from 1960 to 1974 and had found no mention of this disease in Africans.In 1960 I had suggested as a tentative hypothesis that the rarity of non-infective colonic diseases in Africans was due to diets which contained large amounts of fibre-rich starchy carbo- hydrate.This may be called the "fibre hypothesis," those words being employed at that time.There appeared to be rarity of constipation, irritable bowel disease, diverti- cular disease, appendicitis, ulcerative colitis, haemorrhoids, polyps, and carcinoma of the large bowel and rectum.1The position does not seem to have changed much in the intervening 14 years.My clinical obsetrvations, based on some 30 years' medical ex- perience in East Africa, have been considerably amplified by my Uganda colleague, Mr. Denis Burkitt, and the studies of Mr. Neil Painter.There is a possibility that irritable bowel disease often precedes diverticular disease.It is therefore of interest that we are presenting shortly much new information, necropsy, radiological, and clinical, concern- ing the great rarity of diverticular disease in many countries in Africa and Asia.2At medical 'boards I had frequently retired European government officials for incurable irritable bowel disease, having satisfied my- self that no significant and detectable tropical infection was present.In 1960 I could not remember ever having diagnosed an African as having suffered from irritable bowel disease so I suggested that a placid tempera- ment and high-carbohydrate diets rich in dietary fibre protected them against oonsti-