Jamaican physician Cicely Williams (1893–1992) dedicated her career to advancing the health of mothers and newborns in nations around the world, beginnning her work with the “Milk and Murder” campaign to end the use of sweetened condensed milk to infants in lieu of breast milk. In her position within the World Health Organization, beginning in 1948, she focused on reducing infant mortality due to malnutrition in 58 countries, saving lives and improving public health through her research and practice.
The Williams family, originally from England, had lived in Jamaica for generations by the time Cicely Delphine Williams was born on December 2, 1893. The Williams family lived in Kew Park, in the town of Darliston, Westmoreland Parish. Williams's father, James Rowland Williams, was a landowner and the island's director of education, and her mother, Margaret Emily Caroline Farewell, operated an informal health clinic from the back verandah of their home, ministering to local mothers and their children. An energetic child, Williams helped her mother with clinic tasks from an early age, gaining an appreciation for the common ailments afflicting infants born into poverty.
In 1906, at age 13, Williams was sent to England to attend boarding school. She excelled and in 1912, at age 19, was admitted to Somerville College Oxford. News of a series of devastating earthquakes and hurricanes in Jamaica caused her to defer her Oxford education for several years. Williams returned home and helped her parents rebuild their home and community. With her father's death in 1916, she returned to Oxford, anticipating that she would train to become a nurse. Her readmission to Oxford had a contingency, however: she must study medicine because the United Kingdom needed doctors: many young men were now overseas, fighting in World War I. After slogging through pre-med science courses, she was able to focus on physician-related work, such as attending the doctors’ rounds at nearby Radcliffe Infirmary. She completed her classwork and took her residency at King's College, Oxford, graduating in 1923.
World War I ended in November 1918, and the men of Great Britain had returned to their civilian lives by the time the 31-year-old Williams completed her M.D. She took a series of temporary hospital jobs, most notably at Queen Elizabeth Hospital for Children, where she worked for two years. While there, she worked with respected Scots physician Helen Mackay (1891–1965), who ran child welfare centers in London's East End while managing a busy hospital practice. Mackay's work inspired Williams and guided her to her calling: a focus on women and children's health within a hands-on, family and community centered approach.
Williams realized that her chance to find meaningful work lay with the Colonial Medical Service. Up until World War II, the British Empire still spanned the globe and there was need for skilled doctors in many lands. Williams spent a year in Salonika, Greece, helping refugees from the Turko-Greek war and there she met Andrija Stampar, a doctor from Croatia who specialized in the field of social medicine. Stampar would become a leading authority on the subject and he taught Williams to examine the social and economic conditions of her patients and take them into account in her treatments. Returning to England, she took a year-long college course in tropical medicine before signing up with the Colonial Medical Service. Her first assignment would be in what was then called the Gold Coast of Africa, now Ghana.
With her knowledge of Ga, Williams listened carefully to what the local people called it: “kwashiorkor” more directly translated as “disease of the deposed child.” In fact, the condition happened mostly in children who had been “deposed,” weaned from breast milk when their mother birthed a new infant. Somehow, Williams reasoned, toddlers were not getting enough protein in their new non-breast-milk diet. After carefully ruling out other possible causes, she concluded that kwashiorkor was the result of the mother's lack of knowledge regarding nutrition. Putting her mind to ways to prevent as well as cure the condition, Williams shared her findings in a paper published in 1933, in the distinguished British medical journal Archives of Disease in Childhood.
The paper was poorly received and Dr. Stannus, then considered the leading expert on African nutrition, disagreed vehemently with her findings. Williams then presented a more detailed paper, comparing pellagra and kwashiorkor, and published this in the equally distinguished British medical journal The Lancet. Although opinion remained set against her analysis, further research by others proved Williams's diagnosis correct.
Williams ignored those who doubted her findings, realizing that her ideas were questioned because she was a small-time doctor practicing in the colonies, and also because she was a woman. She persisted, against the wishes of her superiors, in developing both a cure for kwashiorkor and a regimen that doctors and mothers could use to prevent it. After seven years’ work, Williams was reprimanded and transferred to a lecturer position at the University of Singapore, in what was then British Malaya (now Malaysia). It was 1939.
Based in Singapore, Williams both lectured students and became Acting State Medical Officer. In this capacity, she established a women and children's health service in the poor area of the city. There, she discovered that the Swiss food company Nestlé was hiring young women in white coats to sell canned, sweetened condensed milk to young mothers, touting it as a healthful alternative to breast milk. Although this practice was illegal throughout Europe and the United Kingdom, it was permitted in British Malaya, and infants were dying as a result. Incensed, Williams delivered a speech to the Singapore Rotary Club, provocatively titling it “Milk and Murder.” It was the first shot in a long campaign against Nestlé that would produce a global boycott in decades to come.
Meanwhile, Williams's health service expanded its reach through new clinics, extending out from Singapore and into Malayan villages. The clinics were well organized and run by indigenous nurses trained in the social aspects of medicine and local midwives trained in safe delivery practices.
By 1940, World War II had swept most of the world into conflict, expanding from the initial confrontation between Germany, France, and the United Kingdom. The Japanese Empire was invading country after country in a terrible bid for dominance of Asia, and they arrived in British Malaya in 1941, part of the attack strategy that included the bombing of U.S. Naval forced at Pearl Harbor, Hawai'i. Williams was working in a remote village at the time, and she knew that she was at risk. Although she treked from the jungle to Singapore, where Australian-led Allied Forces offered safety, on February 8, 1942, the Japanese started a barrage of fire that, 15 hours later, had cut communications and led to the loss of Allied control. When Japanese planes began strafing the city with bullets and dropping bombs, Williams moved sick children from the city's hospitals into makeshift shelters, then moved them again as Japanese ground troops advanced. Pleading with Malay families to take these children and keep them safe, she was able to protect her vulnerable patients from becoming an inconvenience to the city's Japanese overseers.
As a British subject, Williams was captured when the Japanese took control of Singapore, and she was held in a prison camp in the city. Determined to inspire hope in others, she busied herself caring for injured female prisoners, 20 of whom gave birth over the next two years. Every baby born was breast-fed and survived, in spite of prevalent disease and unsanitary conditions. Williams was much appreciated by her fellow captives, although this made her the target of scrutiny from her Japanese captors. When the Kempaitai, or secret police, noticed her leadership position in camp, they arrested her and placed her in a cell with seven men. Although Williams was not tortured, her cellmates were, and she treated them as best she could. During her time in prison, Williams suffering malnourishment and dysentery so severe that she lost a third of her body weight. She also suffered from beri-beri (thiamine deficiency), which would make her feet numb for the rest of her life. She eventually became so sick that she was returned to the women's camp. Leaving the camp bent and grey following Japan's surrender of the City in September of 1945, Williams was taken straight to a hospital.
In 1948, now mostly recovered from her wartime imprisonment, Williams was appointed head of the newly created office of Mother and Child Health (MCH), within the recently organized World Health Organization. From there, she became head of MCH in Southeast Asia. Williams continued to promote her vision of locally sourced, socially sensitive medical care for the poor, in contrast to the larger trend toward first-world high-tech medical care. As Jennifer Stanton wrote in reflecting on Williams's career in the London Independent, the outspoken physician was wont to comment: “If you learn your nutrition from a biochemist, you're not likely to learn how essential it is to blow a baby's nose before expecting him to suck.”
In 1978, at age 85, Williams gave up extensive travel, with the proviso “except on demand.” She received many awards and honors later in life, her favorite of which was an honorary doctorate from the University of Ghana, land of her first African assignment. Her 90th birthday was honored with a symposium held at Somerville College Oxford that was attended by colleagues and friends from the MCH field from around the world. She continued lecturing well into her 90s, and encouraged young doctors to enter general medicine, where they could look after people, and not just diseases. Settling at last at her home in Oxford, England, Williams died there on July 13, 1992, at age 98.
Craddock, Sally, Retired Except on Demand: The Life of Cicely Williams, Green College Press, 1983.
Dally, Ann, Cicely: The Life of a Doctor, Gollancz, 1968.
Independent online (London, England), July 15, 1992, Jennifer Stanton, “Dr Cicely Williams.”
Jamaica Gleaner website, http://old.jamaica-gleaner.com/ (January 9, 2017), Dr. Rebecca Tortello, “A Pioneer, a Survivor: Dr. Cicely Williams: Jamaica's Gift to the Field for Maternal and Child Health Care, 1893–1992.” ❑