Lives of the fellows

Cicely Delphine Williams

b.2 December 1893 d.13 July 1992
CMC(1968) 0M Jamaica(1975) BA BM ChB Oxon(1923) DTM&H(1929) MRCP(1935) DM(1935) FRCP(1949)

Cicely Williams was one of the founding figures of tropical paediatrics and the originator of the discipline of Mother and Child Health as it has come to be taught and practised in the Commonwealth countries. A great deal has been written about her work, including two biographies. Awards and honours have been bestowed upon her by scientific bodies, international agencies and governments. She was one of the first women to be made a Commander of the Most Distinguished Order of St Michael and St George and to receive the Order of Merit of the government of Jamaica.

Cicely’s ancestors had migrated to Jamaica from Glamorgan, Wales, in the 17th century and there had already been 14 generations of the Williams family as plantation owners by the time she was born. Her father Rowland read classics at Trinity College, Oxford, and was director of education in Jamaica from 1909-1916. At a time when education for women was not considered important he felt sure that Cicely would go to Oxford and frequently expressed a wish for ‘a lady doctor in the family’. On the plantation Cicely and her sisters learnt the rudiments of first aid through helping their mother with medical emergencies on the estate. This often took her into the worker’s homes where young Cicely saw the living conditions at first hand. Her mother, Margaret, and a group of friends started a health clinic for young mothers when Cicely was 19 years old. This may well have influenced her young mind but medical studies were not even remotely on the horizon. On finishing school, Cicely applied to Oxford to read history and was offered a place. But times were bad and the offer had to be declined so that the family could afford the education of her brother. Instead, Cicely took up Montessori teaching in Kingston and her interest in children stemmed from this experience.

The first world war was a major factor in determining Cicely’s future. She had moved to the United States and was working in a pathology laboratory at Harvard. Universities on both sides of the Atlantic would not accept women medical students at that time but so many British doctors had been lost in the early years of the war that Oxford began to open its doors to women - the faculty of medicine having passed a resolution allowing women to take the BA (pre-clinical) examination. At Oxford, the greatest influence was Sir William Osier [Munk’s Roll, Vol.IV, p.295] whose three precepts of service, teaching and research epitomized everything that Cicely’s early education and ambitions meant. She was for ever scathing about ‘ . . . those who do nothing but investigate and never see the human outcome.’

Her clinical studies were at King’s College Hospital, London, in the days of Kinnier Wilson [Munk’s Roll, Vol.IV, p.540] and Sir George Frederic Still [Munk’s Roll, Vol.IV, p.432]. After qualification, women doctors found jobs difficult to find. A period of locum work at the Queen’s Hospital for Children, now Queen Elizabeth Hospital for Children at Hackney, was a turning point for Cicely. There she found her vocation, under the influence of Helen Mackay [Munk’s Roll, Vol.V, p.253] and Donald Winnicott [Munk’s Roll, Vol.VI, p.471]. The foundations of her own philosophy of integrating preventive and curative medicine and looking after the entire family, particularly the emotional climate of the home, were laid during this period.

At 34, having failed the membership examination and tired of job hunting, Cicely accepted the offer of work with refugees in Salonika. On her way she stopped in Belgrade to look at the work being done by Andrija Stampar. What she saw was the practical working of her own evolving philosophy of child care. His influence was lasting and they were to meet again some 20 years or so later as colleagues within WHO.

After Salonika and a brief period of study for the DTM&H, Cicely was posted to the Gold Coast (now Ghana) in the Colonial Medical Service. There several of Stampar’s ideas were adapted for the African situation. She started tiny clinics in borrowed garages, school rooms and shop fronts. Questioning the established wisdom, breaking the barriers between curative and preventive medicine and providing equitable distribution of basic services; these were to become the hallmark of her work. Medical dogma came under scrutiny. It was in Ghana that she wrote the first clinical description of kwashiorkor, in 1931. Established authorities everywhere disagreed with her about its causation and a great deal of debate ensued in learned journals. It was not until 1952 that kwashiorkor as a nutritional deficiency disease, distinct from pellagra, was accepted by WHO and the medical world at large. After five years of medical work on the Gold Coast and several papers on kwashiorkor, as well as other paediatric problems, Cicely received the membership of the College on the basis of her publications, which she later expanded for her DM.

Cicely was transferred to Malaya, now Malaysia, and once again set up a system of MCH centres in Trengganu villages scattered in the rubber plantations. The centres were staffed by local midwives assisted by visiting nurses. It was in Malaya that she again threw down the gauntlet in a lecture to the Rotary Club of Singapore, entitled ‘Milk and murder’. She took the gathered captains of commerce and industry to task on the question of infant feeding: ‘... seeing day after day this massacre of the innocents, you would feel as I do that misguided propaganda on infant feeding should be punished as the most criminal form of sedition.’ The controversy continues to this day and, later, in the same vein the medical profession were reminded in a paper entitled ‘Whither welfare’, published in the BMJ, that ‘To take a child to hospital and cure his disease only to send him back to precisely those conditions which produced the disease is a form of hypocrisy.’ She was drawing attention to the fact that a great deal of paediatric pathology often stems from social pathology and ignorance. Cicely was now moving into head-on confrontation but destiny intervened m the form of the second world war.

When Singapore fell in 1942, Cicely was 49 years old. Her great contribution to the health and morale of fellow prisoners of war is well documented but even at that time of hardship and deprivation she continued to make observations and write them down. The resulting paper ‘Nutritional conditions among women and children in internment in the civilian camp at Singapore’ was published in 1946. Two observations will be remembered by generations of paediatricians: all the women who gave birth during internment were able to breast feed successfully and all the infants survived.

After the war the World Health Organization was established and Cicely Williams was appointed head of the division of maternal and child health. She grasped the opportunity to change the approach to the care of mothers and children worldwide. Instead of large curative centres the focus shifted to care through medical auxiliaries and non-medical lay health workers operating from small community clinics, regular supervision of families through home visits, the empowerment of mother and families in the care of their children and, above all, recognition of the need to listen to the people if service programmes were to be effective. They resulted from lessons learnt in the Gold Coast and Trengganu. At one of her postings with WHO, Andrija Stampar was a close colleague and according to Cicely ‘the father of all my ideas’.

Cicely Williams was indeed a remarkable woman. When young she had striking flaming red hair. Her intrepid nature, combined with a clarity of vision and reforming zeal, affected the lives of millions. MCH is now an established discipline taught in institutions ranging from schools of medical and nursing auxiliaries to leading universities. The concept of equity in health care is enshrined in the Alma-Ata declaration on primary health care and expressed in programmes of immunization, oral rehydration and breastfeeding.

In her personal struggle to establish herself professionally, Cicely Williams drew the world’s attention to the important contribution women can make in the home, the community and the wider society. It received recognition in the United Nations ‘Decade of the woman’, culminating in a global programme for safe motherhood.

G J Ebrahim

[Brit.med.J., 1992,305,307; The Lancet, 1992,340,421; The Times, 18 July 1992;The Independent, 16,24 & 27 July 1992;The Guardian, 21 July 1992;The Daily Telegraph, 30 July 1992; Somerville Coll., Report...1992;The Lancet, Dec 1973; Pulse,6 Dec 1969; World Medicine, 6 June 1967]

(Volume IX, page 584)

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