Nutrition and Physical Degradation
A Comparison of Primitive and Modern Diets
Weston A Price, MS., D.D.S., F.A.G.D.
Table of contents:
The gracious reception given to my several reports of field studies among primitive racial groups and the many requests for copies of those brief reports and for further data, together with the need for providing interpretations and applications of the data, have induced me to consolidate my investigations. There have also been many requests from my patients and from members of the medical and dental professions for concise statements as to what I have found that would be useful as preventive procedures. In addition I have been conscious of an opportunity for helpfulness to the members of the various primitive races that I have studied and who are so rapidly declining in health and numbers at their point of contact with our modern civilization. Since they have so much accumulated wisdom that is passing with them, it has seemed important that the elements in the modern contacts that are so destructive to them should be discovered and removed.
There has been a deep sense of obligation to the officials of many countries for the great kindness and assistance that they have so cheerfully given by providing the opportunity for these investigations. The list of these individuals is much too long to mention them all by name. One of the joys of my work has been the privilege of knowing the magnificent characters that are at the outposts earnestly striving to better the welfare of the natives whom they are ministering to, but who are distraught with the recognition that under the modernization program the natives decline in health and become afflicted by our modern types of degenerative diseases. It would be fortunate if each of these field workers could be provided with a copy of this report which they have helped to make possible.
In order to make this information available to as wide a group as possible, I have avoided technical language and will ask the indulgence of professional readers.
There are some individuals whose assistance I must acknowledge specifically: Reverend Father John Siegen and Doctor Alfred Gysi of Switzerland; Mrs. Lulu Herron and Doctor J. Romig of Alaska; the Indian Department at Ottawa; the Department of Indian Affairs at Washington, D. C.; the officials of the eight archipelagos studied in the Pacific; Colonel J. L. Saunders of New Zealand; the Minister of Health, New Zealand; Dr. W. Stewart Ziele of Sydney, Australia; Sir Herbert Gepp of Melbourne, Australia; Doctor William M. Hughes, Minister of Health, Canberra; Dr. Cummiston, Director-General of Health, Australian Commonwealth, Canberra; Doctor Rapael Cilento of Queensland, Australia; Mr. E. W. Saranealis, Thursday Island; the Department of Health of Kenya, Africa; the Department of Health for Belgian Congo, Brussells; the Department of National Parks, Belgian Congo; Minister of the Interior, Peru; Doctor Albert Giesecke and Esther Giesecke of Peru; the Directors of Museums in Sydney and Canberra, Australia; Auckland, New Zealand; Vancouver, and Toronto, Canada; Washington, New York and Chicago, the United States; Juneau, Alaska; Rome, Italy; and Cairo, Egypt; the publishers of the Ohio State Medical Journal, the Journal of the American Dental Association, the Dental Digest and the Dental Items of Interest; my faithful secretary, Mrs. Ruth MacMaster; Professor W. G. Garnett who so kindly provided the critical reading of the manuscript, and the publishers who furnished constructive suggestions and cooperation. To these and a host of others I am deeply indebted and profoundly grateful.
Weston A Price, Ohio, 1938
There is nothing new in the observation that savages, or peoples living under primitive conditions, have, in general, excellent teeth. This fact is a matter of record based upon casual examinations of contemporary primitives made by travellers, explorers, and scientists, and established with better documentation by the studies of teeth preserved in skeletal collections of savages recently or more remotely extinct. Nor is it news that most civilized populations possess wretched teeth which begin to decay almost before they have erupted completely, and that dental caries is likely to be accompanied by periodontal disease with further reaching complications. Indeed this has been a matter of grave concern to the dental profession for more than a generation, and rightly so. A great deal of elaborate and patient research and experimentation has been expended upon this problem of the etiology and control of dental caries, but I do not suppose that anyone would claim that it has been solved. At any rate, the dentists are still busily engaged in drilling our cavities and in plugging them. A quantity of excellent evidence has been amassed which indicates that dental caries is, to a great extent, connected with malnutrition and with deficient diets.
Since we have known for a long time that savages have excellent teeth and that civilized men have terrible teeth, it seems to me that we have been extraordinarily stupid in concentrating all of our attention upon the task of finding out why our teeth are so poor, without ever bothering to learn why savage teeth are good. Dr. Weston Price seems to be the only person who possesses the scientific horse sense to supplement his knowledge of the probable causes of dental disease with a study of the dietary regimens which are associated with dental health. In other words, Dr. Price has accomplished one of those epochal pieces of research which make every other investigator desirous of kicking himself because he never thought of doing the same thing. This is an exemplification of the fact that really gifted scientists are those who can appreciate the obvious.
So Dr. Price has found out why primitive men have good teeth and why their teeth go bad when they become “civilized.” But he has not stopped there: he has gone on to apply his knowledge acquired from savages to the problems of their less intelligent civilized brothers. For I think that we must admit that if savages know enough to eat the things which keep their teeth healthy, they are more intelligent in dietary matters than we are. So I consider that Dr. Price has written what is often called “a profoundly significant book.” The principal difference between Dr. Price’s work and many others so labelled is that in the present instance the designation happens to be correct. I salute Dr. Price with the sincerest admiration (the kind that is tinged with envy) because he has found out something which I should like to have discovered for myself.
Ernest A Hooton, Boston, 1938
This text provides a new approach to some problems of modern degeneration. Instead of the customary procedure of analyzing the expressions of degeneration, a search has been made for groups to be used as controls who are largely free from these affections.
After spending several years approaching this problem by both clinical and laboratory research methods, I interpreted the accumulating evidence as strongly indicating the absence of some essential factors from our modern program, rather than the presence of injurious factors. This immediately indicated the need for obtaining controls. To accomplish this it became necessary to locate immune groups which were found readily as isolated remnants of primitive racial stocks in different parts of the world. A critical examination of these groups revealed a high immunity to many of our serious affections so long as they were sufficiently isolated from our modern civilization and living in accordance with the nutritional programs which were directed by the accumulated wisdom of the group. In every instance where individuals of the same racial stocks who had lost this isolation and who had adopted the foods and food habits of our modern civilization were examined, there was an early loss of the high immunity characteristics of the isolated group. These studies have included a chemical analysis of foods of the isolated groups and also of the displacing foods of our modern civilization.
These investigations have been made among the following primitive racial stocks including both isolated and modernized groups: the Swiss of Switzerland, the Gaelics in the Outer and Inner Hebrides, the Eskimos of Alaska, the Indians in the far North, West and Central Canada, Western United States and Florida, the Melanesians and Polynesians on eight archipelagos of the Southern Pacific, tribes in eastern and central Africa, the Aborigines of Australia, Malay tribes on islands north of Australia, the Maori of New Zealand and the ancient civilizations and their descendants in Peru both along the coast and in the Sierras, also in the Amazon Basin. Where available the modernized whites in these communities also were studied. There have been many important unexpected developments in these investigations. While a primary quest was to find the cause of tooth decay which was established quite readily as being controlled directly by nutrition, it rapidly became apparent that a chain of disturbances developed in these various primitive racial stocks starting even in the first generation after the adoption of the modernized diet and rapidly increased in severity with expressions quite constantly like the characteristic degenerative processes of our modern civilization of America and Europe. While tooth decay has proved to be almost entirely a matter of the nutrition of the individual at the time and prior to the activity of that disease, a group of affections have expressed themselves in physical form. These have included facial and dental arch changes which, heretofore, have been accounted for as results of admixtures of different racial stocks. My investigations have revealed that these same divergencies from normal are reproduced in all these various racial stocks while the blood is still pure. Indeed, these even develop in those children of the family that are born after the parents adopted the modern nutrition.
Applying these methods of study to our American families, we find readily that a considerable percentage of our families show this same deterioration in the younger members. The percentage of individuals so affected in our American communities in which I have made studies varies through a wide range, usually between 25 per cent to 75 per cent. A certain percentage of this affected group has not only these evidences of physical injury, but also personality disturbances, the most common of which is a lower than normal mental efficiency and acuteness, chiefly observed as so-called mental backwardness which includes the group of children in the schools who are unable to keep up with their classmates. Their I.Q.’s are generally lower than normal and they readily develop inferiority complexes growing out of their handicap. From this group or parallel with it a certain percentage develop personality disturbances which have their expression largely in unsocial traits. They include the delinquents who at this time are causing so much trouble and concern because of evidence of increase in their numbers. This latter group has been accounted for largely on the basis of some conditioning experience that developed after the child had reached an impressionable age. My investigations are revealing a physical structural change and therefore, an organic factor which precedes and underlies these conditioning influences of the environment. The fact that a government survey has shown that 66 per cent of the delinquents who have been treated in the best institutions and released as cured, later have developed their unsocial or criminal tendencies, strongly emphasizes the urgent necessity that if preventive methods are to be applied these must precede and forestall the primary injuries themselves.
While it has been known that certain injuries were directly related to an inadequate nutrition of the mother during the formative period of the child, my investigations are revealing evidence that the problem goes back still further to defects in the germ plasms as contributed by the two parents. These injuries, therefore, are related directly to the physical condition of one or of both of these individuals prior to the time that conception took place.
A very important phase of my investigations has been the obtaining of information from these various primitive racial groups indicating that they were conscious that such injuries would occur if the parents were not in excellent physical condition and nourishment. Indeed, in many groups I found that the girls were not allowed to be married until after they had had a period of special feeding. In some tribes a six months period of special nutrition was required before marriage. An examination of their foods has disclosed special nutritional factors which are utilized for this purpose.
The scope of this work, accordingly, becomes of direct interest in many fields including the various branches of the healing arts, particularly medicine and dentistry, and the social organizations that are concerned with betterment of the racial stock. Similarly, the educational groups are concerned directly since, if we are to stem the tide by passing new information on to the parents of the new generation, it must be done prior to the time the emergency shall arise. This involves a system of education directed particularly to the high school age pupils.
The data that are being presented in the following chapters suggest the need for reorientation in many problems of our modern social organization. The forces involved in heredity have in general been deemed to be so powerful as to be able to resist all impacts and changes in the environment. These data will indicate that much that we have interpreted as being due to heredity is really the result of intercepted heredity. While great emphasis has been placed on the influence of the environment on the character of the individual, the body pattern has generally been supposed to require a great number of impacts of a similar nature to alter the design. The brain has been assumed to be similarly well organized in most individuals except that incidents in the life of the individual such as disappointments, fright, etc., are largely responsible for disturbed behavior. Normal brain functioning has not been thought of as being as biologic as digestion. The data provided in the succeeding chapters indicate that associated with disturbances in the development of the bones of the head, disturbances may at the same time occur in the development of the brain. Such structural defects usually are not hereditary factors even though they appear in other members of the family or parents. They are products of the environment rather than hereditary units transmitted from the ancestry.
In the light of these data important new emphasis is placed on the quality of the germ cells of the two parents as well as on the environment provided by the mother. The new evidence indicates that the paternal contribution may be an injured product and that the responsibility for defective germ cells may have to be about equally divided between the father and mother. The blending of races has been blamed for much of the distortion and defects in body form in our modern generation. It will be seen that these face changes occur in all the pure blood races studied in even the first generation, after the nutrition of the parents has been changed.
The origin of personality and character appear in the light of the newer data to be biologic products and to a much less degree than usually considered pure hereditary traits. Since these various factors are biologic, being directly related to both the nutrition of the parents and to the nutritional environment of the individuals in the formative and growth period any common contributing factor such as food deficiencies due to soil depletion will be seen to produce degeneration of the masses of people due to a common cause. Mass behavior therefore, in this new light becomes the result of natural forces, the expression of which may not be modified by propaganda but will require correction at the source. Nature has been at this process of building human cultures through many millenniums and our culture has not only its own experience to draw from but that of parallel races living today as well as those who lived in the past. This work, accordingly, includes data that have been obtained from several of Nature’s other biologic experiments to throw light on the problems of our modern white civilization.
In presenting the evidence I am utilizing photographs very liberally. A good illustration is said to be equivalent to a thousand words of text. This is in keeping too with the recent trend in journalism. The pictures are much more convincing than words can be, and since the text challenges many of the current theories, the most conclusive evidence available is essential.
Owing to the many requests received for slides or the loan of my negatives, provision is being made for supplying a limited number of slides of the illustrations in either black and white or in color. Slides of other subjects are available.
Why seek wisdom from primitive races
Some of the primitive races have avoided certain of the life problems faced by modernized groups and the methods and knowledge used by the primitive peoples are available to assist modernized individuals in solving their problems. Many primitive races have made habitual use of certain preventive measures in meeting crucial life problems.
Search for controls among remnants of primitive racial stocks has been resorted to as a result of failure to find them in our modernized groups or to find the controlling factors by applying laboratory methods to the affected clinical material. Only the primitive groups have been able to provide adequate normal controls.
In the following chapters, I have presented descriptions of certain peoples and their environments in primitive state, and, for comparative study, descriptions of members of the primitive tribes who have been in contact with modernized white races. I have recorded the effects of that contact as expressed in physical and character changes, and have given a survey of the factors in the environment which have changed. It has been necessary to study in this way a wide variety of primitive groups and physical environments. It will, accordingly, be advisable for the reader to keep in mind the comparative effects of different altitudes, latitudes, temperatures and races, and to note the similarity of the reactions of these primitive groups when contact is made with our modern civilization. The purpose is to glean data that will be applicable for use in correcting certain tragic expressions of our modern degeneration, including tooth decay, general physical degeneration, and facial and dental-arch deformities, and character changes. These data will be useful in preventing race decay and deformities, in establishing a higher resistance to infective diseases, and in reducing the number of prenatal deficiency injuries. These latter include such expressions as mental deficiencies caused by brain defects in the formative period, which result in mental disturbances ranging from moderate backwardness to character abnormalities.
The data presented show the level of susceptibility to dental caries (tooth decay) in each isolated primitive group and, contrasted with that, the level of susceptibility in the modernized natives of the same stock. A résumé of the changes in the environment that are associated with the changes in immunity and susceptibility will be presented. These data reveal an average increase in susceptibility of thirty-five fold. Similar contrasts are shown in relation to the relative incidence of facial and dental arch deformities among primitive natives and modernized natives.
It will be easy for the reader to be prejudiced since many of the applications suggested are not orthodox. I suggest that conclusions be deferred until the new approach has been used to survey the physical and mental status of the reader’s own family, of his brothers and sisters, of associated families, and finally, of the mass of people met in business and on the street. Almost everyone who studies the matter will be surprised that such clear-cut evidence of a decline in modern reproductive efficiency could be all about us and not have been previously noted and reviewed.
It is important to preface the observations by constructing a mental pattern of physical excellence from the pictures of the various primitive groups and, with this yardstick or standard of normalcy, observe our modern patterns. Certain preconceived ideas may have to be modified, as for example, that based on the belief that what we see is due to heredity or that deformity is due to mixing of races. If so, why should the last child in a large family generally suffer most, and often be different in facial form; or why should there be these changes in the later children, even in pure racial stocks, after the parents have adopted our modern types of nutrition? Although the causes of physical degeneration that can be seen easily have been hard to trace, the defects in the development of the brain, which affect the mind and character, are much more obscure, and the causes of mental degeneration are exceedingly difficult to trace. Much that formerly has been left to the psychiatrist to explain is now rapidly shifting to the realm of the anatomist and physiologist.
Those contributions of the past cultures which have blended agreeably into our modern experience have been accepted with too little questioning. Much ancient wisdom, however, has been rejected because of prejudice against the wisdom of so-called savages. Some readers may experience this reaction to the primitive wisdom recorded in these chapters.
The writer is fully aware that his message is not orthodox; but since our orthodox theories have not saved us we may have to readjust them to bring them into harmony with Nature’s laws. Nature must be obeyed, not orthodoxy. Apparently many primitive races have understood her language better than have our modernized groups. Even the primitive races share our blights when they adopt our conception of nutrition. The supporting evidence for this statement is voluminous and as much of it as space permits is included in this volume. The illustrative material used is taken from the many thousands of my negatives which are available. Photographs alone can tell much of the story, and one illustration is said to be worth as much as one thousand words.
Since the problem of applying the wisdom of the primitives to our modern needs concerns not only health workers and nutritionists, but also educators and social workers, the data are presented without technical details.
While many of the primitive races studied have continued to thrive on the same soil through thousands of years, our American human stock has declined rapidly within a few centuries, and in some localities within a few decades. In the regions in which degeneration has taken place the animal stock has also declined. A decadent individual cannot regenerate himself, although he can reduce the progressive decadence in the next generation, or can vastly improve that generation, by using the demonstrated wisdom of the primitive races. No era in the long journey of mankind reveals in the skeletal remains such a terrible degeneration of teeth and bones as this brief modern period records. Must Nature reject our vaunted culture and call back the more obedient primitives? The alternative seems to be a complete readjustment in accordance with the controlling forces of Nature.
Thinking is as biologic as is digestion, and brain embryonic defects are as biologic as are club feet. Since both are readily produced by lowered parental reproductive capacity, and since Nature in her large-scale human demonstration reveals that this is chiefly the result of inadequate nutrition of the parents and too frequent or too prolonged child bearing, the way back is indicated. Like the successful primitive racial stocks, we, too, can make, as a first requisite, provision for adequate nutrition both for generation and growth, and can make provision for the regulation of the overloads. We, like the successful primitives, can establish programs of instruction for growing youth and acquaint it with Nature s requirements long before the emergencies and stresses arise. This may require a large-scale program of home and classroom instruction, particularly for the high school girls and boys. This would be in accordance with the practice of many of the primitive races reported upon in the following chapters.
If the individuals in our modern society who are sufficiently defective to require some supervision are in part or largely the product of an injured parentage, who should be held responsible? Is it just for society to consign these unsocial individuals which it has made to a life of hard labor or confinement in depressing environments? Is it just for society to permit production of physical and mental cripples? Many primitive races apparently have prevented the distortions which find expressions in unsocial acts. If so, cannot modern society do this by studying and adopting the programs developed through centuries of experience by the primitives? Nature uses a written language which, without the keys, is made up of meaningless hieroglyphics, but which, with the proper keys, becomes a clear story of racial and individual history. The hieroglyphics indicate racial and individual disaster for modernized groups who heed not the warning story. The primitive races have some of these keys and have used them successfully in avoiding many of the disasters of our modern society. The following chapters record many of the excellent practices of the primitives and they are presented here with the hope that they will be helpful in a program designed to relieve mankind of some of the misfortunes common in the present social order and to prevent disorders for future generations of civilized peoples.
The progressive decline of modern civilization
That modern man is declining in physical fitness has been emphasized by many eminent sociologists and other scientists. That the rate of degeneration is progressively accelerating constitutes a cause for great alarm, particularly since this is taking place in spite of the advance that is being made in modern science along many lines of investigation.
Dr. Alexis Carrel in his treatise “Man, the Unknown” states:
After reviewing the reduction in the epidemic infectious diseases he continues as follows:
The present health condition in the United States is reported from time to time by several agencies representing special phases of the health program. The general health problem has been thoroughly surveyed and interpreted by the Surgeon General of the United States Public Health Service, Dr. Parran. Probably no one is so well informed in all of the phases of health as is the head of this important department of the government. In his recent preliminary report (1) to state and local officers for their information and guidance, he presented data that have been gathered by a large group of government workers. The report includes a census of the health conditions of all the groups constituting the population of the United States–records of the health status and of the economic status of 2,660,000 individuals living in various sections, in various types of communities, on various economic levels. The data include records on every age-group. He makes the following interpretations based upon the assumption that the 2,660,000 offer a fair sampling of the population, and he indicates the conclusions which may be drawn regarding conditions of status for the total population of some 130,000,000 people.
Concluded Dr. Parran:
It will be seen from this report that the group expressed as oldsters, who spend on an average thirty-five days per year in bed, are sick in bed one-tenth of the time. Those of us who are well, who may have been so fortunate as to spend very little time in bed, will contemplate this fact with considerable concern since it expresses a vast amount of suffering and enforced idleness. It is clear that so great an incidence of morbidity must place a heavy load upon those who at the time are well. The problem of the progressive increase in percentage of individuals affected with heart disease and cancer is adequate cause for alarm. Statistics have been published by the Department of Public Health in New York City which show the increase in the incidence of heart disease to have progressed steadily during the years from 1907 to 1936. The figures provided in their report reveal an increase from 203.7 deaths per 100,000 in 1907 to 327.2 per 100,000 in 1936. This constitutes an increase of 60 per cent. Cancer increased 90 per cent from 1907 to 1936.
That this problem of serious degeneration of our modern civilization is not limited to the people of the United States has been commented on at length by workers in many countries. Sir Arbuthnot Lane, one of England’s distinguished surgeons, and a student of public welfare, has made this comment: (2)
The decline in white population that is taking place in many communities throughout several countries illustrates the widespread working of the forces that are responsible for this degeneration. In discussing this matter in its relation to Australia, S. R. Wolstenhole, (3) lecturer in economics at Sydney University, predicts that:
Students of our modern social problems are recognizing that these problems are not limited to health conditions which we have been accustomed to think of as bodily diseases. This is illustrated in a recent discussion by Will Durant: (4)
Dental caries or tooth decay is recognized as affecting more individuals throughout the so-called civilized world today than any other affection. In the United States, England and Europe examinations of highly modernized groups, consisting of several million individuals, reveal the fact that from 85 to 100 per cent of the individuals in various communities are suffering from this affection. As a contributing factor to absence from school among children it leads all other affections. From the standpoint of injury to health, it has been estimated by many to be the most serious contributing factor through its involvement of other organs of the body. The Honorable J. A. Young, Minister of Health of New Zealand, strongly emphasized that the insidiousness of the effect of dental disease lies in the fact that it is the forerunner of other far-reaching disturbances and he has referred to the seriousness with which it is viewed in England as follows: “Sir George Newman, Principal Medical Officer of the Ministry of Health in Great Britain, has said that ‘dental disease is one of the chief, if not the chief, cause of the ill health of the people.'”
Dr. Earnest A. Hooton, of Harvard University, has emphasized the importance of oral sepsis and the task of stopping tooth decay. In closing Chapter VII of his recent book “Apes, Men and Morons,” (5) he states the case as follows:
In discussing the strategic situation of dental science, Dr. Hooton states.
Students of history have continually commented upon the superior teeth of the so-called savages including the human types that have preceded our modernized groups. While dental caries has been found occasionally in several animal species through the recent geologic ages, the teeth of the human species have been comparatively free from dental caries. Primitive human beings have been freer from the disease than has contemporary animal life. This absence of tooth decay among primitive races has been so striking a characteristic of human kind that many commentators have referred to it as a strikingly modern disease.
Dryer, (6) in discussing dental caries in the pre-historic South Africans, makes this comment:
In connection with the studies reported in this volume, it is of particular importance that a desire to find the cause of dental caries was the primary reason for undertaking these investigations. Since it was exceedingly difficult to find in our modern social organization any large group with relatively high immunity to dental caries, a search was made for such control groups among remnants of primitive racial stocks that could also be examined at the point of contact with modern civilization in order that the changes associated with their racial loss of immunity might be noted. Probably few problems with which our modern social groups are concerned have been so inadequately understood not only by the laity, but by the members of the medical and dental professions as has this problem of the cause of dental caries.
The problem of correcting dental arch deformities and thereby improving facial form has developed a specialty in dentistry known as “orthodontia.” The literature dealing with the cause of facial deformities is now voluminous. The blending of racial stocks that differ radically in facial form has been said by many to be the chief factor contributing to the creation of deformities of the face. Crowded teeth have been said to be due to the inheritance of the large teeth of one parent and the small bone formation of the other and that such inheritances would provide dental arches that are too small for the teeth that have been made for them. A more general explanation for certain types of deformity, particularly for the protruding of the upper teeth over the lower, is that they result from thumb sucking, which tends to bring the upper arch forward and to depress the lower. Among the other contributing factors named have been faulty sleeping and breathing habits. To these has been assigned much of the blame. This problem of facial form, as well as that of bodily design, including dental arch design, is so directly a problem of growth, not only of individuals, but of races themselves, that certain laws have been very definitely worked out by physical anthropologists as laws of development. They have assumed that changes in physical type can occur only through the impact of changes in the environment which have affected a great number of generations. It is important to keep this viewpoint in mind as the succeeding chapters are read, for they contain descriptions of many changes in physical form that have occurred routinely in the various racial groups, even during the first generation after the parents have adopted the foods of modern civilization.
Many of our modern writers have recognized and have emphasized the seriousness of mental and moral degeneration. Laird has made a splendid contribution under the title “The Tail That Wags the Nation,” (7) in which he states:
In Laird’s analysis of our present situation he has stressed a very important phase. While emphasizing that the degeneration is not limited to restricted areas, he raises the question as to whether local conditions in certain areas play important roles in the rate and extent to which degeneration has taken place. He says further, (7)
The problem of lowered mentality and its place in our modern conception of bodily diseases has not been placed on a physical basis as have the better understood degenerative processes, with their direct relationship to a diseased organ, but has generally been assigned to a realm entirely outside the domain of disease or injury of a special organ or tissue. Edward Lee Thorndike, (8) of Columbia University, says that “thinking is as biological as digestion.” This implies that a disturbance in the capacity to think is directly related to a defect in the brain.
Another of the distinguished students of mental capacity, J. B. Miner, (9) states:
The origin of backwardness in a child seems to have been assigned very largely to some experience in that child’s life which becomes a conditioning factor and which thereafter strongly influences his behavior. The problem of the relation of physical defects to delinquency in its various phases, including major crime, constitutes one of the most alarming aspects of our modern problems in social degeneration. Chassell (10) has made an exhaustive study of the reports from workers in different fields in several countries and summarizes her finding as follows: “The correlation between delinquency and mental inferiority as found in the case of feeble-minded groups is clearly positive, and tends to be marked in degree.”
Burt, (11) who had made an extensive study, over an extended period, of the problems of the backward child and the delinquent child in London, states in his summary and conclusion with regard to the origin of backwardness in the child:
In discussing the relationship between general physical weakness and the mentally backward, he writes:
Among the many surveys made in the study of the forces that are responsible for producing delinquency and criminality, practically all the workers in this field have testified to the obscure nature of those forces. Burt (12) says that, “it is almost as though crime were some contagious disease, to which the constitutionally susceptible were suddenly exposed at puberty, or to which puberty left them peculiarly prone.” He emphasizes a relationship between delinquency and physical deficiency:
The assertion of the obscurity of the fundamental causative factors of delinquency constitutes one of the most striking aspects of the extensive literature that has been accumulated through the reporting of intensive studies made by workers in many countries.
Thrasher, (13) in discussing the nature and origin of gangs, expresses this very clearly:
No doubt, many cities have been provided, as has Cleveland, with a special school for delinquent boys. The institution there has been given the appropriate title, the “Thomas A. Edison School.” It usually has an enrollment of 800 to 900 boys. Dr. Watson, (14) who has been of outstanding service in the organization of this work, makes an important comment on the origin of the student population there:
It will be seen from these quotations that great emphasis has been placed upon the influence of the environment in determining factors of delinquency.
Hooton, the distinguished physical anthropologist of Harvard, has made important observations regarding our modern physical degeneration. As an approach to this larger problem of man’s progressive degeneration, he has proposed the organization and establishment of an Institute of Clinical Anthropology, (15) the purpose of which he has indicated:
Very important contributions have been made to the forces that are at work in the development of delinquents through an examination of the families in which affected individuals have appeared. Sullenger, (16) in discussing this phase, states:
As the investigations outlined in this study are reviewed, many problems not anticipated by the writer when these investigations were undertaken will be presented. These new problems were not, at first, generally thought of as related directly or indirectly to our modern racial degeneration, but have been found recently to be so related.
Since it will be seen that the size and shape of the head and sinuses, including the oral cavity and throat, are directly influenced by forces that are at work in our modern civilization, we shall consider the speaking and singing voice. In traveling among several of the primitive races, one is frequently impressed with the range and resonance of many of the voices–in fact, by almost every voice. We are quite familiar with the high premium that is placed on singing voices of exceptional quality in our modern social order. This is illustrated by the following comment: (17)
Important light will be thrown on this phase of the problem–the cause of fewer good voices in Italy today than of old–as we note the narrowing of the face and of the dental arches and as we see the change in the form of the palate of the various primitive races. These changes occur even in the first generation after the parents have adopted the foods of modern white civilizations.
As we study the primitives we will find that they have had an entirely different conception of the nature and origin of the controlling forces which have molded individuals and races.
Buckle, (18) in writing his epoch-making “History of Civilization” about the middle of the last century, summed up his years of historical studies with some very important conclusions, some of which are as follows:
This important view was not orthodox and was met by very severe criticism. The newer knowledge strongly corroborates his view.
My early studies of the relation of nutrition to dental problems were related chiefly to growth defects in the teeth produced long before the eruption of the permanent teeth, chiefly from one year of age to the time of eruption. These often appeared as lines across the teeth. I was able to trace these lines directly to the use of a few highly processed baby foods. I published an extensive report on this phase of the problem, together with illustrations, in 1913. (19) These injuries are disclosed with the x-ray long before the teeth erupt. These disturbances occur much less frequently in connection with the baby foods used today.
The problems of modern degeneration can in general be divided into two main groups, those which relate to the perfection of the physical body and those which relate to its function. The latter include character as expressed in behavior of individuals and of groups of individuals which thus relate to national character and to an entire culture.
In an enumeration of the phases in which there is a progressive decline of modern civilization, it is essential that we keep in mind that in addition to an analysis of the forces responsible for individual degeneration, the ethical standards of the whole group cannot be higher than those of the individuals that compose it. That recent mass degeneration is in progress is attested by daily events throughout the world. The current interpretation for individual character degeneration largely places the responsibility on a conditioning factor which exerts an influence during early childhood and therefore is directly related to the environment of the child. These, therefore, are postnatal conditioning factors. An important contribution to this phase comes directly from the experience of primitive races and indicates that a more fundamental conditioning factor had developed in the prenatal period. If, therefore, large groups of individuals suffer from such a prenatal conditioning influence, new light will be thrown upon the larger problems of group deterioration. History seems to provide records of such mass degeneration as, for example, those which culminated in the so-called “dark ages.” That some such mass degeneration is now in progress is suggested by leading students of human welfare. The regius professor of Greek at Oxford in his inaugural lecture in 1937 made the following observation: (20)
In commenting on this important statement Sir Alfred Zimmern in his address on the decline of international standards said that “Recent events should convince the dullest mind of the extent to which international standards have deteriorated and the anarchy which threatens the repudiation of law and order in favour of brute force.”
The problem of progressive decline in individual and group ethical standards is commanding the attention of great international organizations. In discussing this problem before the International Rotary at its meeting in San Francisco in June, 1938, one of the leaders in mass reform, Mayor Harold Burton of Cleveland, stressed very important phases. He stated that the American boys “are making irrevocable choices” between good and bad citizenship which “may make or wreck the nation. It may be on the battlefield of crime prevention that the life of democracy will be saved.” He described great industrial cities as battlefields where “the tests of democracy are the newest and sharpest.” (21) . . . “For centuries,” he said:
If the “flood waters” that must be controlled lie farther back than the cradle, in order to safeguard individual character and individual citizenship from prenatal conditioning factors which have profound influence in determining the reaction of the individuals to the environment, it is essential that programs that are to be efficient in maintaining national character reach back to those forces which are causing the degeneration of increasing numbers of the population in succeeding generations of our modern cultures.
That the problem of mass degeneration constitutes one of the most alarming problems of our modernized cultures is demonstrated by the urgency of appeals that are being made by students in national and international affairs. The discussion of “An Ethical Declaration for the Times,” (22) a declaration of faith, is accompanied by a pledge. This pledge reads:
The author emphasizes the great danger of taking for granted that the cultural progress that has been attained will continue. There is probably no phase of this whole problem of modern degeneration that is so brilliantly illuminated by the accumulated wisdom of primitive races as group degeneration. They have so organized the life of the family and the individual that the nature of the forces which established individual behavior and character are controlled.
Our problem of modern degeneration involves both individual and group destiny. Our approach to this study will, accordingly, involve first a critical examination of the forces that are responsible for individual degeneration.
In my search for the cause of degeneration of the human face and the dental organs I have been unable to find an approach to the problem through the study of affected individuals and diseased tissues. In my two volume work on “Dental Infections,” Volume I, entitled “Dental Infections, Oral and Systemic,” and Volume II, entitled “Dental Infections and the Degenerative Diseases,” (23) I reviewed at length the researches that I had conducted to throw light on this problem. The evidence seemed to indicate clearly that the forces that were at work were not to be found in the diseased tissues, but that the undesirable conditions were the result of the absence of something, rather than of the presence of something. This strongly indicated the need for finding groups of individuals so physically perfect that they could be used as controls. In order to discover them, I determined to search out primitive racial stocks that were free from the degenerative processes with which we are concerned in order to note what they have that we do not have. These field investigations have taken me to many parts of the world through a series of years. The following chapters review the studies made of primitive groups, first, when still protected by their isolation, and, second, when in contact with modern civilization.
Isolated and modernized Swiss
In order to study the possibility of greater nutritive value in foods produced at a high elevation, as indicated by a lowered incidence of morbidity, including tooth decay, I went to Switzerland and made studies in two successive years, 1931 and 1932. It was my desire to find, if possible, groups of Swiss living in a physical environment such that their isolation would compel them to live largely on locally produced foods. Officials of the Swiss Government were consulted as to the possibility of finding people in Switzerland whose physical isolation provided an adequate protection. We were told that the physical conditions that would not permit people to obtain modern foods would prevent us from reaching them without hardship. However, owing to the completion of the Loetschberg Tunnel, eleven miles long, and the building of a railroad that crosses the Loetschental Valley, at a little less than a mile above sea level, a group of about 2,000 people had been made easily accessible for study, shortly prior to 1931. Practically all the human requirements of the people in that valley, except a few items like sea salt, have been produced in the valley for centuries.
A bird’s eye view of the Loetschental Valley, looking toward the entrance, is shown in Fig. 1. The people of this valley have a history covering more than a dozen centuries. The architecture of their wooden buildings, some of them several centuries old, indicates a love for simple stability, adapted to expediency and efficiency. Artistically designed mottoes, many of them centuries old, are carved deep in the heavy supporting timbers, both within and without the buildings. They are always expressive of devotion to cultural and spiritual values rather than to material values. These people have never been conquered, although many efforts have been made to invade their valley. Except for the rugged cleft through which the river descends to the Rhone Valley, the Loetschental Valley is almost completely enclosed by three high mountain ranges which are usually snow-capped. This pass could be guarded by a small band against any attacking forces since artificial landslides could easily be released. The natural occurrence of these landslides has made passage through the gorge hazardous, if not impossible, for months of the year. According to early legends of the valley these mountains were the parapets of the universe, and the great glacier of the valley, the end of the universe. The glacier is a branch of the great ice field that stretches away to the west and south from the ice-cap of the Jungfrau and Monch. The mountains, however, are seldom approached from this direction because of the hazardous ice fields. The gateway to them with which the traveling world is familiar is from Interlaken by way of the Lauterbrunnen or Grindelwald valleys.
Fig. 1. Beautiful Loetschental Valley about a mile above sea level. About two thousand Swiss live here. In 1932 no deaths had occurred from tuberculosis in the history of the valley.
At the altitude of the Loetschental Valley the winters are long, and the summers short but beautiful, and accompanied by extraordinarily rapid and luxuriant growth. The meadows are fragrant with Alpine flowers, with violets like pansies, which bloom all summer in deepest hues.
The people of the Loetschental Valley make up a community of two thousand who have been a world unto themselves. They have neither physician nor dentist because they have so little need for them; they have neither policeman nor jail, because they have no need for them. The clothing has been the substantial homespuns made from the wool of their sheep. The valley has produced not only everything that is needed for clothing, but practically everything that is needed for food. It has been the achievement of the valley to build some of the finest physiques in all Europe. This is attested to by the fact that many of the famous Swiss guards of the Vatican at Rome, who are the admiration of the world and are the pride of Switzerland, have been selected from this and other Alpine valleys. It is every Loetschental boy’s ambition to be a Vatican guard. Notwithstanding the fact that tuberculosis is the most serious disease of Switzerland, according to a statement given me by a government official, a recent report of inspection of this valley did not reveal a single case. I was aided in my studies in Switzerland by the excellent cooperation of the Reverend John Siegen, the pastor of the one church of this beautiful valley.
The people live largely in a series of villages dotting the valley floor along the river bank. The land that is tilled, chiefly for producing hay for feeding the cattle in the winter and rye for feeding the people, extends from the river and often rises steeply toward the mountains which are wooded with timber so precious for protection that little of it has been disturbed. Fortunately, there is much more on the vast area of the mountain sides than is needed for the relatively small population. The forests have been jealously guarded because they are so greatly needed to prevent slides of snow and rocks which might engulf and destroy the villages.
The valley has a fine educational system of alternate didactic and practical work. All children are required to attend school six months of the year and to spend the other six months helping with the farming and dairying industry in which young and old of both sexes must work. The school system is under the direct supervision of the Catholic Church, and the work is well done. The girls are also taught weaving, dyeing and garment making. The manufacture of wool and clothing is the chief homework for the women in the winter.
No trucks nor even horses and wagons, let alone tractors, are available to bear the burdens up and down the mountain sides. This is all done on human backs for which the hearts of the people have been made especially strong.
We are primarily concerned here with the quality of the teeth and the development of the faces that are associated with such splendid hearts and unusual physiques. I made studies of both adults and growing boys and girls, during the summer of 1931, and arranged to have samples of food, particularly dairy products, sent to me about twice a month, summer and winter. These products have been tested for their mineral and vitamin contents, particularly the fat-soluble activators. The samples were found to be high in vitamins and much higher than the average samples of commercial dairy products in America and Europe, and in the lower areas of Switzerland.
Hay is cut for winter feeding of the cattle, and this hay grows rapidly. The hay proved, on chemical analysis made at my laboratory, to be far above the average in quality for pasturage and storage grasses. Almost every household has goats or cows or both. In the summer the cattle seek the higher pasturage lands and follow the retreating snow which leaves the lower valley free for the harvesting of the hay and rye. The turning of the soil is done by hand, since there are neither plows nor draft animals to drag the plows, in preparation for the next year’s rye crop. A limited amount of garden stuff is grown, chiefly green foods for summer use. While the cows spend the warm summer on the verdant knolls and wooded slopes near the glaciers and fields of perpetual snow, they have a period of high and rich productivity of milk. The milk constitutes an important part of the summer’s harvesting. While the men and boys gather in the hay and rye, the women and children go in large numbers with the cattle to collect the milk and make and store cheese for the following winter’s use. This cheese contains the natural butter fat and minerals of the splendid milk and is a virtual storehouse of life for the coming winter.
From Dr. Siegen, I learned much about the life and customs of these people. He told me that they recognize the presence of Divinity in the life-giving qualities of the butter made in June when the cows have arrived for pasturage near the glaciers. He gathers the people together to thank the kind Father for the evidence of his Being in the life-giving qualities of butter and cheese made when the cows eat the grass near the snow line. This worshipful program includes the lighting of a wick in a bowl of the first butter made after the cows have reached the luscious summer pasturage. This wick is permitted to burn in a special sanctuary built for the purpose. The natives of the valley are able to recognize the superior quality of their June butter, and, without knowing exactly why, pay it due homage.
The nutrition of the people of the Loetschental Valley, particularly that of the growing boys and girls, consists largely of a slice of whole rye bread and a piece of the summer-made cheese (about as large as the slice of bread), which are eaten with fresh milk of goats or cows. Meat is eaten about once a week. In the light of our newer knowledge of activating substances, including vitamins, and the relative values of food for supplying minerals for body building, it is clear why they have healthy bodies and sound teeth. The average total fat-soluble activator and mineral intake of calcium and phosphorus of these children would far exceed that of the daily intake of the average American child. The sturdiness of the child life permits children to play and frolic bareheaded and barefooted even in water running down from the glacier in the late evening’s chilly breezes, in weather that made us wear our overcoats and gloves and button our collars. Of all the children in the valley still using the primitive diet of whole rye bread and dairy products the average number of cavities per person was 0.3. On an average it was necessary to examine three persons to find one defective deciduous or permanent tooth. The children examined were between seven and sixteen years of age.
If one is fortunate enough to be in the valley in early August and witness the earnestness with which the people celebrate their national holiday, he will be privileged to see a sight long to be remembered. These celebrations close with the gathering together of the mountaineers on various crags and prominences where great bonfires are lighted from fuel that has been accumulated and built into an enormous mound to make a huge torchlight. These bonfires are lighted at a given hour from end to end of the valley throughout its expanse. Every mountaineer on a distant crag seeing the lights knows that the others are signalling to him that they, too, are making their sacred consecration in song which says one for all and all for one.” This motive has been crystallized into action and has become a part of the very souls of the people. One understands why doors do not need to be bolted in the Loetschental Valley.
How different the level of life and horizon of such souls from those in many places in the so-called civilized world in which people have degraded themselves until life has no interest in values that cannot be expressed in gold or pelf, which they would obtain even though the life of the person being cheated or robbed would thereby be crippled or blotted out.
One immediately wonders if there is not something in the life-giving vitamins and minerals of the food that builds not only great physical structures within which their souls reside, but builds minds and hearts capable of a higher type of manhood in which the material values of life are made secondary to individual character. In succeeding chapters we will see evidence that this is the case.
Our quest has been for information relative to the health of the body, the perfection of the teeth, and the normality of development of faces and dental arches, in order that we might through an analysis of the foods learn the secret of such splendid body building and learn from the people of the valley how the nutrition of all groups of people may be reinforced, so that they, too, may be free from mankind’s most universal disease, tooth decay and its sequelae. These studies included not only the making of a physical examination of the teeth, the photographing of subjects, the recording of voluminous data, the obtaining of samples of food for chemical analysis, the collecting of detailed information regarding daily menus; but also the collecting of samples of saliva for chemical analysis. The chemical analysis of saliva was used to test out my newly developed procedure for estimating the level of immunity to dental caries for a given person at a given time. This procedure is outlined in following chapters. The samples of saliva were preserved by an addition of formalin equivalent in amount to one per cent of the sample of saliva.
These children will, it is hoped, be reexamined in succeeding years in order to make comparative studies of the effect of the changes in the local nutritional programs. Some of these changes are already in progress. There is now a modern bakery dispensing white bread and many white-flour products which was in full operation in 1932.
I inquired of many persons regarding the most favorable districts in which to make further studies of groups of people living in protected isolation because of their physical environment, and decided to study some special high Alpine valleys between the Rhone Valley and Italy, which I included in 1932. The Canton of Wallis is bordered by French-speaking people on the west, by Italian-speaking people on the south, and by German-speaking people on the east and north. I had as guides and interpreters in Wallis, Dr. Alfred Gysi and also Dr. Adolf Roos through part of the territory.
Our first expedition was into the valley of the Visp which is a great gorge extending southward from the Rhone River, dividing into two gorges, one going to the Saas Fee country, and the other to the vicinity of the Matterhorn with its almost spirelike pinnacle lifting itself above the surrounding snow-capped mountains and visible from eminences in all directions as one of the mightiest and most sublime spectacles in the world. It was one of the last mountains of Europe to be scaled by man. One has not seen the full majesty of the Alps if he has not seen the Matterhorn.
We left the mountain railroad, which makes many of the grades with the cog system, at the town of St. Nicholas, and climbed the mountain trail to an isolated settlement on the east bank of the Mattervisp River, called Grachen, a five-hour journey. The settlement is on a shelf high above the east side of the river where it is exposed to southern sunshine and enjoys a unique isolation because of its physical inaccessibility. An examination made of the children in this community showed that only 2.3 teeth out of every hundred had been attacked by tooth decay.
The hardihood of the people was splendidly illustrated by a woman of 62 years who carried an enormous load of rye on her back at an altitude of about 5,000 feet. We met her later and talked to her, and found that she was extraordinarily well developed and well preserved. She showed us her grandchildren who had fine physiques and facial developments.
The rye is so precious that while being carried the heads are protected by wrapping them in canvas so that not a kernel will be lost. The rye is thrashed by hand and ground in stone mills which were formerly hand-turned like the one shown in Fig. 2. Recently water turbines have been installed. Water power is abundant and the grinding is done for the people of the mountain side in these water-driven mills. Only wholerye flour is available. Each household takes turns in using the community bake-oven, which is shown in Fig. 2. A month’s supply of whole-rye bread is baked at one time for a given family.
FIG. 2. For centuries the natives ground their rye in this type of hand mill. This community bake-oven for whole rye bread is passing.
Here again the cows were away in the midsummer, pasturing up near the glaciers. Grachen has an altitude of about 5,000 feet. The church at Grachen was built several hundred years ago. We were shown an embossed certificate of honor and privilege extended to a group of about 120 people who had originally built the edifice. We were given valued assistance by the local priest, and were provided with facilities in his spacious and well-kept rooms for making our studies of the children.
From Grachen we returned to St. Nicholas and proceeded from there by train down the valley and up another steep ascent, requiring several hours, to the hamlet of Visperterminen, on the east side of the mountain above the Visp River, and below the junction of the Mattervisp and Saaservisp. This community is made up of about 1,600 people living on a sheltered shelf high above the river valley. The view from this position is indescribably beautiful. It is a little below the timber line of this and the surrounding mountains. Majestic snow-clad peaks and precipitous mountains dot the horizon and shade off into winding gorges which mark the course of wandering streams several thousand feet below our vantage point. It is a place to stop and ponder.
The gradations in climate range in the summer from a tropical temperature in protected nooks during the daytime to sub-zero weather with raging blizzards at night on the high mountains. It is a place where human stamina can be tempered to meet all the vicissitudes of life.
The village consists of a group of characteristically designed Swiss chalets clustered on the mountain side. The church stands out as a beacon visible from mountains in all directions. Visperterminen is unique in many respects. Notwithstanding its relative proximity to civilization–it is only a few hours’ journey to the thoroughfare of the Rhone Valley–it has enjoyed isolation and opportunity for maintaining its characteristic primitive social and civil life. We were greeted here by the president of the village who graciously opened the school house and sent messengers to have the children of the community promptly come to the school building in order that we might make such studies as we desired. This study included a physical examination of the teeth and of the general development of the children, particularly of the faces and dental arches, the making of photographic records, the obtaining of samples of saliva, as in other places, and also the making of a detailed study of the nutrition. In addition, we obtained samples of foods for chemical analysis.
The people of Visperterminen have the unique distinction of owning land in the lower part of the mountain on which they maintain vineyards to supply wine for this country. They have the highest vineyards of Europe. They are grown on banks that are often so steep that one wonders how the tillers of the soil or the gatherers of the fruit can maintain their hold on the precarious and shifting footing. Each terrace has a trench near its lower retaining wall to catch the soil that is washed down, and this soil must be carried back in baskets to the upper boundary of the plot. This is all done by human labor. The vineyards afforded them the additional nutrition of wine and of fruit minerals and vitamins which the two groups we studied at Loetschental and Grachen did not have.
This additional nutrition was of importance because of the opportunity for obtaining through it vitamin C. It is of particular interest in the study of the incidence of tooth decay in Visperterminen that these additional factors had not created a higher immunity to tooth decay, nor a better condition of health in gingival tissues than previously found. In each one hundred teeth examined 5.2 were found to have been attacked at some time by tooth decay. Here again the nutrition consisted of rye, used almost exclusively as the cereal; of dairy products; of meat about once a week; and also some potatoes. Limited green foods were eaten during the summer. The general custom is to have a sheep dressed and distributed to a group of families, thus providing each family with a ration of meat for one day a week, usually Sunday. The bones and scraps are utilized for making soups to be served during the week. The children have goat’s milk in the summer when the cows are away in the higher pastures near the snow line. Certain members of the families go to the higher pastures with the cows to make cheese for the coming winter’s use.
The problem of identifying goats or cattle for establishing individual ownership is a considerable one where the stock of all are pastured in common herds. It was interesting to us to observe how this problem was met. The president of the village has what is called a “tessel” which is a string of manikins in imitation of goats or cattle made of wood and leather. Every stock owner must provide a manikin to be left in the safekeeping of the president of the village with whom it is registered. It carries on it the individual markings that this member of the colony agrees to put on every member of his animal stock. The marking may be a hole punched in the left ear or a slit in the right ear, or any combination of such markings as is desired. Thereafter all animals carrying that mark are the property of the person who registered it; similarly, any animals that have not this individual symbol of identification cannot be claimed by him.
As one stands in profound admiration before the stalwart physical development and high moral character of these sturdy mountaineers, he is impressed by the superior types of manhood, womanhood, and childhood that Nature has been able to produce from a suitable diet and a suitable environment. Surely, here is evidence enough to answer the question whether cereals should be avoided because they produce acids in the system which if formed will be the cause of tooth decay and many other ills including the acidity of the blood or saliva. Surely, the ultimate control will be found in Nature’s laboratory where man has not yet been able to meddle sufficiently with Nature’s nutritional program to blight humanity with abnormal and synthetic nutrition. When one has watched for days the childlife in those high Alpine preserves of superior manhood; when one has contrasted these people with the pinched and sallow, and even deformed, faces and distorted bodies that are produced by our modern civilization and its diets; and when one has contrasted the unsurpassed beauty of the faces of these children developed on Nature’s primitive foods with the varied assortment of modern civilization’s children with their defective facial development, he finds himself filled with an earnest desire to see that this betterment is made available for modern civilization.
Again and again we had the experience of examining a young man or young woman and finding that at some period of his life tooth decay had been rampant and had suddenly ceased; but, during the stress, some teeth had been lost. When we asked such people whether they had gone out of the mountain and at what age, they generally replied that at eighteen or twenty years of age they had gone to this or that city and had stayed a year or two. They stated that they had never had a decayed tooth before they went or after they returned, but that they had lost some teeth in the short period away from home.
At this point of our studies Dr. Roos found it necessary to leave, but Dr. Gysi accompanied us to the Anniviers Valley, which is also on the south side of the Rhone. The river of the valley, the Navizenze, drains from the high Swiss and Italian boundary north to the Rhone River. Here again we had the remarkable experience of finding communities near to each other, one blessed with high immunity to tooth decay, and the other afflicted with rampant tooth decay.
The village of Ayer lies in a beautiful valley well up toward the glaciers. It is still largely primitive, although a government road has recently been developed, which, like many of the new arteries, has made it possible to dispatch military protection when and if necessary to any community. In this beautiful hamlet, until recently isolated, we found a high immunity to dental caries. Only 2.3 teeth out of each hundred examined were found to have been attacked by tooth decay. Here again the people were living on rye and dairy products. We wonder if history will repeat itself in the next few years and if there, too, this enviable immunity will be lost with the advent of the highway. Usually it is not long after tunnels and roads are built that automobiles and wagons enter with modern foods, which begin their destructive work. This fact has been tragically demonstrated in this valley since a roadway was extended as far as Vissoie several years ago. In this village modern foods have been available for some time. One could probably walk the distance from Ayer to Vissoie in an hour. The number of teeth found to be attacked with caries for each one hundred children’s teeth examined at Vissoie was 20.2 as compared with 2.3 at Ayer. We had here a splendid opportunity to study the changes that had occurred in the nutritional programs. With the coming of transportation and new markets there had been shipped in modern white flour; equipment for a bakery to make white-flour goods; highly sweetened fruit, such as jams, marmalades, jellies, sugar and syrups–all to be traded for the locally produced high-vitamin dairy products and high-mineral cheese and rye; and with the exchange there was enough money as premium to permit buying machine-made clothing and various novelties that would soon be translated into necessities.
Each valley or village has its own special feast days of which athletic contests are the principal events. The feasting in the past has been largely on dairy products. The athletes were provided with large bowls of cream as constituting one of the most popular and healthful beverages, and special cheese was always available. Practically no wine was used because no grapes grew in that valley, and for centuries the isolation of the people prevented access to much material that would provide wine. In the Visperterminen community, however, the special vineyards owned by these people on the lower level of the mountain side provided grape juice in various stages of fermentation, and their feasts in the past have been celebrated by the use of wines of rare vintage as well as by the use of cream and other dairy products. Their cream products took the place of our modern ice cream. It was a matter of deep interest to have the President of Visperterminen show us the tankards that had been in use in that community for nine or ten centuries. The care of these was one of the many responsibilities of the chief executive of the hamlet.
It is reported that practically all skulls that are exhumed in the Rhone valley, and, indeed, practically throughout all of Switzerland where graves have existed for more than a hundred years, show relatively perfect teeth; whereas the teeth of people recently buried have been riddled with caries or lost through this disease. It is of interest that each church usually has associated with it a cemetery in which the graves are kept decorated, often with beautiful designs of fresh or artificial flowers. Members of succeeding generations of families are said to be buried one above the other to a depth of many feet. Then, after a sufficient number of generations have been so honored, their bodies are exhumed to make a place for present and coming generations. These skeletons are usually preserved with honor and deference. The bones are stacked in basements of certain buildings of the church edifice with the skulls facing outward. These often constitute a solid wall of considerable extent. In Naters there is such a group said to contain 20,000 skeletons and skulls. These were studied with great interest as was also a smaller collection in connection with the cathedral at Visp. While many of the single straight-rooted teeth had been lost in the handling, many were present. It was a matter of importance to find that only a small percentage of teeth had had caries. Teeth that had been attacked with deep caries had developed apical abscesses with consequent destruction of the alveolar processes. Evidence of this bone change was readily visible. Sockets of missing teeth still had continuous walls, indicating that the teeth had been vital at death.
The reader will scarcely believe it possible that such marked differences in facial form, in the shape of the dental arches, and in the health condition of the teeth as are to be noted when passing from the highly modernized lower valleys and plains country in Switzerland to the isolated high valleys can exist. Fig. 3 shows four girls with typically broad dental arches and regular arrangement of the teeth. They have been born and raised in the Loetschental Valley or other isolated valleys of Switzerland which provide the excellent nutrition that we have been reviewing. They have been taught little regarding the use of tooth brushes. Their teeth have typical deposits of unscrubbed mouths; yet they are almost completely free from dental caries, as are the other individuals of the group they represent. In a study of 4,280 teeth of the children of these high valleys, only 3.4 per cent were found to have been attacked by tooth decay. This is in striking contrast to conditions found in the modernized sections using the modern foods.
FIG. 3. Normal design of face and dental arches when adequate nutrition is provided for both the parents and the children. Note the well developed nostrils.
In Loetschental, Grachen, Visperterminen and Ayer, we have found communities of native Swiss living almost exclusively on locally produced foods consisting of the cereal, rye, and the animal product, milk, in its various forms. At Vissoie, with its available modern nutrition, there has been a complete change in the level of immunity to dental caries. It is important that studies be made in other communities which correspond in altitude with the first four places studied in which there was a high immunity to dental caries. Modern foods should be available in the new communities selected for comparative study. To find such places one would naturally think of those that are world-famed as health resorts providing the best things that modern science and industry can assemble. Surely St. Moritz would be such a place. It is situated in the southeastern part of the Republic of Switzerland near the headwaters of the Danube in the upper Engadin. This world-famous watering place attracts people of all continents for both summer and winter health building and for the enjoyment of the mountain lakes, snow-capped peaks, forested mountain sides, and crystal clear atmosphere with abundance of sunshine.
The journey from the Canton of Wallis (Valais) to the upper Engadin takes one up the Rhone valley, climbing continually to get above cascades and beautiful waterfalls until one comes to the great Rhone glacier which blocks the end of the valley. The water gushes from beneath the mountain of ice to become the parent stream of the Rhone river which passes westward through the Rhone valley receiving tributaries from snow-fed streams from both north and south watersheds, as it rolls westward to the beautiful Lake Geneva and then onward west and south to the Mediterranean.
It is of significance that a study of the child life in the Rhone valley, as made by Swiss officials and reported by Dr. Adolf Roos and his associates, shows that practically every child had tooth decay and the majority of the children had decay in an aggravated form. People of this valley are provided with adequate railroad transportation for bringing them the luxuries of the world. As we pass eastward over the pass through Andermatt, we are reminded that the trains of the St. Gotthard tunnel go thundering through the mountain a mile below our feet en route to Italy. To reach our goal, the beautiful modern city and summer resort of St. Moritz, we enter the Engadin country famed for its beauty and crystal-clear atmosphere. We already know something of the beauty that awaits us which has attracted pleasure seekers and beauty lovers of the world to St. Moritz. One would scarcely expect to see so modern a city as St. Mortiz at an altitude of a little over a mile, with little else to attract people than its climate in winter and summer, the magnificent scenery, and the clear atmosphere. We have passed from the communities where almost everyone wears homespuns to one of English walking coats and the most elegant of feminine attire. Everyone shows the effect of contact with culture. The hotels in their appointments and design are reminiscent of Atlantic City. Immediately one sees something is different here than in the primitive localities: the children have not the splendidly developed features, and the people give no evidence of the great physical reserve that is present in the smaller communities.
Through the kindness of Dr. William Barry, a local dentist, and through that of the superintendent of the public schools, we were invited to use one of the school buildings for our studies of the children. The summer classes were dismissed with instructions that the children be retained so that we could have them for study. Several factors were immediately apparent. The teeth were shining and clean, giving eloquent testimony of the thoroughness of the instructions in the use of the modern dentifrices for efficient oral prophylaxis. The gums looked better and the teeth more beautiful for having the debris and deposits removed. Surely this superb climate, this magnificent setting, combined with the best of the findings of modern prophylactic science, should provide a 100-per-cent immunity to tooth decay. But in a study of the children from eight to fifteen years of age, 29.8 per cent of the teeth had already been attacked by dental caries. Our study of each case included careful examining of the mouth; photographing of the face and teeth; obtaining of samples of saliva for chemical analysis; and a study of the program of nutrition followed by the given case. In most cases, the diet was strikingly modern, and the only children found who did not have tooth decay proved to be children who were eating the natural foods, whole rye bread and plenty of milk.
In Chapter 15, a detailed discussion of the chemical differences in the food constituents is presented for both the districts subject to immunity, and for those subject to susceptibility.
I was told by a former resident of this upper Engadin country that in one of the isolated valleys only a few decades ago the children were still carrying their luncheons to school in the form of roasted rye carried dry in their pockets. Their ancestors had eaten cereal in this dry form for centuries.
St. Moritz is a typical Alpine community with a physical setting lar to that in the Cantons of Bern and Wallis (Valais). It is, however, provided with modern nutrition consisting of an abundance of white-flour products, marmalades, jams, canned vegetables, confections, and fruits–all of which are transported to the district. Only a limited supply of vegetables is grown locally. We studied some children here whose parents retained their primitive methods of food selection, and without exception those who were immune to dental caries were eating a distinctly different food from those with high susceptibility to dental caries.
Few countries of the world have had officials so untiring in their efforts to study and tabulate the incidence of dental caries in various geographic localities as has Switzerland. In the section lying to the north and east, and near Lake Constance, there is a considerable district where it is reported that 100 per cent of the people are suffering from dental caries. In almost all the other parts of Switzerland in which the population is large 95 to 98 per cent of the people suffer from dental caries. Of the two remaining districts, in one there is from 90 to 95 per cent and in the other from 85 to 90 per cent individual susceptibility to dental caries. Since in the district in the vicinity of Lake Constance the incidence of dental caries is so high that it is recorded as 100 per cent, it seemed especially desirable to make a similar critical study there and to obtain samples of saliva and detailed information regarding the food, and to make detailed physical examinations of growing children in this community, and through the great kindness of Dr. Hans Eggenberger, Director of Public Health for this general district, we were given an opportunity to do so.
Arrangements were made by Dr. Eggenberger so that typical groups of children, some in institutions, could be studied. He is located at Herisau in the Canton of St. Gall. We found work well organized for building up the health of these children in so far as outdoor treatment, fresh air, and sunshine were concerned. As dental caries is a major problem, and probably nutritional, it is treated by sunshine. The boys’ group and girls’ group are both given suitable athletic sports under skillfully trained directors. These groups are located in different parts of the city. Their recreation grounds are open lawns adjoining wooded knolls which give the children protection and isolation in which to play in their sunsuits and build vigorous appetites, and thus to prepare for their institutional foods which were largely from a modern menu. Critical dental examinations were made and an analysis of the data obtained revealed that one-fourth of all teeth of these growing boys and girls had already been attacked by dental caries, and that only 4 per cent of the children had escaped from the ravages of tooth decay, which disease many of them had in an aggravated form.
In the Herisau group 25.5 per cent of the 2,065 teeth examined had been attacked by dental caries and many teeth were abscessed. The upper photographs in Fig. 4 are of two girls with typically rampant tooth decay. The one to the left is sixteen years of age and several of her permanent teeth are decayed to the gum line. Her appearance is seriously marred, as is also that of the girl to the right.
Another change that is seen in passing from the isolated groups with their more nearly normal facial developments, to the groups of the lower valleys, is the marked irregularity of the teeth with narrowing of the arches and other facial features. In the lower half of Fig. 4 may be seen two such cases. While in the isolated groups not a single case of a typical mouth breather was found, many were seen among the children of the lower-plains group. The children studied were from ten to sixteen years of age.
Fig. 4. In the modernized districts of Switzerland tooth decay is rampant. The girl, upper left, is sixteen and the one to the right is younger. They use white bread and sweets liberally. The two children below have very badly formed dental arches with crowding of the teeth. this deformity is not due to heredity.
Many individuals in the modernized districts bore on their faces scars which indicated that the abscess of an infected tooth had broken through to the external surface where it had developed a fistula with resultant scar tissue, thus producing permanent deformity.
Bad as these conditions were, we were told that they were better than the average for the community. The ravages of dental caries had been strikingly evident as we came in contact with the local and traveling public. As we had at St. Moritz, we found an occasional child with much better teeth than the average. Usually the answer was not far to seek. For example, in one of the St. Moritz groups, in a class of sixteen boys, there were 158 cavities, or an average of 9.8 cavities per person (fillings are counted as cavities). In the cases of three other children in the same group, there were only three cavities, and one case was without dental caries. Two of these three had been eating dark bread or entire-grain bread, and one was eating dark bread and oatmeal porridge. All three drank milk liberally.
When looking here for the source of dairy products one is impressed by the absence of cows at pasture in the plains of Switzerland, areas in which a large percentage of the entire population resides. True, one frequently sees large laiteries or creameries, but the cows are not in sight. On asking the explanation for this, I found that a larger quantity of milk could be obtained from the cows if they were kept in the stables during the period of high production. Indeed, this was a necessity in most of these communities since there were so few fences, and during the time of the growth of the crops, including the stock feed for the winter’s use, it was necessary that the cows be kept enclosed. About the only time that cows were allowed out on pasture was in the fall after the crops had been harvested and while the stubble was being plowed.
Among the children in St. Moritz and Herisau, those groups with the lower number of cavities per person were using milk more or less liberally. Of the total number of children examined in both places only 11 per cent were using milk in their diets, whereas 100 per cent of the children in the other districts that provided immunity were using milk. Nearly every child in St. Moritz was eating white bread. In Herisau, all but one of the children examined were eating white bread in whole or in principal part.
Since so many cattle were stall-fed in the thickly populated part of Switzerland, and since so low a proportion of the children used milk even sparingly, I was concerned to know what use was made of the milk. Numerous road signs announcing the brand of sweetened milk chocolate made in the several districts suggested one use. This chocolate is one of the important products for export and as a beverage constitutes a considerable item in the nutrition of large numbers living in this and in other countries. It is recognized as a high source of energy, primarily because of the sugar and chocolate which when combined with the milk greatly reduces the ratio of the minerals to the energy factors as expressed in calories.
It was formerly thought that dental caries which was so rampant in the greater portion of Switzerland was due in part to low iodine content in the cattle feed and in other food because of iodine deficiency in the soil. Large numbers of former generations suffered from clinical goiter and various forms of thyroid disturbances. That this is not the cause seems clearly demonstrated by the fact that dental caries is apparently as extensive today as ever before, if not more so, while the iodine problem has been met through a reinforcement of the diet of growing children and others in stress periods with iodine in suitable form. Indeed the early work done in Cleveland by Crile, Marine, and Kimball was referred to by the medical authorities there as being the forerunner of the control of the thyroid disorder in these communities.
The officials of the Herisau community were so deeply concerned regarding the prevalence of dental caries that they were carrying forward institutional and community programs with the hope of checking this affliction. If dental caries were primarily the result of an inadequate amount of vitamin D, then sunning the patients should provide an adequate reinforcement. This is one of the principal purposes for getting the growing boys and girls of the community into sunsuits for tanning their bodies.
Another procedure to which my attention was called consisted of adding to the bread a product high in lime, which was being obtained in the foothills of the district. This and other types of bread were studied by chemical analyses. Clinically, tooth decay was not reduced.
I made an effort to establish a clinic in a neighboring town for the purpose of demonstrating with a group of children that dental caries can be controlled by a simple nutritional program. An interesting incident developed in connection with the selection of the children for this experimental group. When parents were asked to permit their children to have one meal a day reinforced, according to a program that has proved adequate with my clinical groups in Cleveland, the objection was made that there was no use trying to save the teeth of the girls. The girls should have all their teeth extracted and artificial teeth provided before they were married, because if they did not they would lose them then.
It is of interest that the southern part of Switzerland including the high Alpine country is largely granite. The hills in the northern part of Switzerland are largely limestone in origin. A great number of people live in the plain between these two geologic formations, a plain which is largely made of alluvial deposits which have been washed down from the upper formations. The soil is extraordinarily fertile soil and has supported a thrifty and healthy population in the past.
When I asked a government official what the principal diseases of the community were, he said that the most serious and most universal was dental caries, and the next most important, tuberculosis; and that both were largely modern diseases in that country.
When I visited the famous advocate of heliotherapy, Dr. Rollier, in his clinic in Leysin, Switzerland, I wondered at the remarkable results he was obtaining with heliotherapy in nonpulmonary tuberculosis. I asked him how many patients he had under his general supervision and he said about thirty-five hundred. I then asked him how many of them come from the isolated Alpine valleys and he said that there was not one; but that they were practically all from the Swiss plains, with some from other countries.
I inquired of several clinicians in Switzerland what their observations were with regard to the association of dental caries and tuberculosis among the people of Switzerland. I noted that the reports indicated that the two diseases were generally associated. We will find a corollary to this in many studies in other parts of the world.
These studies in Switzerland, as briefly presented here, seem to demonstrate that the isolated groups dependent on locally produced natural foods have nearly complete natural immunity to dental caries, and that the substitution of modern dietaries for these primitive natural foods destroys this immunity whether in ideally located elevated districts like St. Moritz or in the beautiful and fertile plains of lower Switzerland. The question seems to answer itself in a general way, without much laboratory data, from the results of a critical examination of the foods. The laboratory analyses, however, identify the particular factors in the foods which are primarily responsible by their presence for establishing immunity, and by their absence in inducing susceptibility to dental caries. These chemical data are discussed in Chapter 15.
High immunity to dental caries, freedom from deformity of the dental arches and face, and sturdy physiques with high immunity to disease were all found associated with physical isolation, and with forced limitation in selection of foods. This resulted in a very liberal use of dairy products and whole-rye bread, in connection with plant foods, and with meat served about once a week.
The individuals in the modernized districts were found to have widespread tooth decay. Many had facial and dental arch deformities and much susceptibility to diseases. These conditions were associated with the use of refined cereal flours, a high intake of sweets, canned goods, sweetened fruits, chocolate; and a greatly reduced use of dairy products.
Isolated and modernized Gaelics
Stories have long been told of the superb health of the people living in the Islands of the Outer Hebrides. The smoke oozing through the thatched roofs of their “black houses” has added weirdness to the description of their home life and strange environment. These stories have included a description of their wonderfully fine teeth and their stalwart physiques and strong characters. They, accordingly, provide an excellent setting for a study to throw light on the problem of the cause of dental caries and modern physical degeneration. These Islands lie off the northwest coast of Scotland, extending to a latitude nearly as far north as the southern part of Greenland. A typical view of their thatched-roof cottages may be seen in Fig. 5.
FIG. 5. A typical “black house” of the Isle of Lewis derives its name from the smoke of the peat burned for heat. The splendid physical development of the native Gaelic fisherfolk is characterized by excellent teeth and well formed faces and dental arches.
The Isle of Lewis has a population of about twenty thousand, made up almost entirely of fisher folk and crofters or sheep raisers. This island has so little lime in its soil that it is said that there are no trees in the entire island except a few which have been planted. The surface of the island is largely covered with peat, varying in thickness from a few inches to twenty feet. This is the fuel. Peat contains the rootlets of the plant life which grew many centuries ago. There is so little bacterial growth that vegetable products undergo very slow decay. The pasturage of the island is so poor that exceedingly few cattle are to be found, largely because they do not properly mature and reproduce. In a few districts some highland cattle with long shaggy hair and wide spread horns are found. Almost all of these are imported. The principal herd of cattle on the island consists of a few dozen head on the government experimental farm.
The basic foods of these islanders are fish and oat products with a little barley. Oat grain is the one cereal which develops fairly readily, and it provides the porridge and oat cakes which in many homes are eaten in some form regularly with each meal. The fishing about the Outer Hebrides is specially favorable, and small sea foods, including lobsters, crabs, oysters and clams, are abundant. An important and highly relished article of diet has been baked cod’s head stuffed with chopped cod’s liver and oatmeal. The principal port of the Isle of Lewis is Stornoway with a fixed population of about four thousand and a floating population of seamen over week-ends, of an equal or greater number. The Sunday we spent there, 450 large fishing boats were said to be in the port for the week-end. Large quantities of fish are packed here for foreign markets. These hardy fisherwomen often toil from six in the morning to ten at night. The abundance of fish makes the cost of living very low.
In Fig. 5 may be seen three of these fisher-people with teeth of unusual perfection. We saw them at the fish-cleaning benches from early morning till late at night dressed, as you see them pictured, in their oilskin suits and rubber boots. We met them again in their Sunday attire taking important parts in the leading church. It would be difficult to find examples of womanhood combining a higher degree of physical perfection and more exalted ideals than these weather-hardened toilers. Theirs is a land of frequent gales, often sleet-ridden or enshrouded in penetrating cold fogs. Life is full of meaning for characters that are developed to accept as everyday routine raging seas and piercing blizzards representing the accumulated fury of the treacherous north Atlantic. One marvels at their gentleness, refinement and sweetness of character.
The people live in these so-called black houses. These are thatched-roof dwellings containing usually two or three rooms. The walls are built of stone and dirt, ordinarily about five feet in thickness. There is usually a fireplace and chimney, one or two outside doors, and very few windows in the house. The thatch of the roofs plays a very important rôle. It is replaced each October and the old thatch is believed by the natives to have great value as a special fertilizer for their soil because of its impregnation with chemicals that have been obtained from the peat smoke which may be seen seeping through all parts of the roof at all seasons of the year. Peat fires are kept burning for this explicit purpose even when the heat is not needed. This means that enormous quantities of peat are required to maintain a continuous smudge. Some of the houses have no chimney because it is desirable that the smoke leave the building through the thatched roof. Not infrequently smoke is seen rolling out of an open door or open window. Fortunately the peat is so abundant that it can be obtained easily from the almost limitless quantities nearby. The sheep that roam the heather-covered plains are of a small black-faced breed, exhibiting great hardihood. They provide wool of specially high quality, which, incidentally, is the source of the famous Harris Tweeds which are woven in these small black houses chiefly on the Isle of Harris.
We are particularly concerned with the people of early Scotch descent who possess a physique that rivals that found in almost any place in the world. They are descendants of the original Gaelic stock which is their language today, and the only one which a large percentage of them can speak. This island has only one port which means that most of the shore line still provides primitive living conditions as does the central part of the island. It was a great surprise, and indeed a very happy one, to find such high types of manhood and womanhood as exist among the occupants of these rustic thatched-roof homes, usually located in an expanse of heather-covered treeless plains. It would be hard to visualize a more complete isolation for child life than many of these homes provide, and one marvels at the refinement, intelligence, and strength of character of these rugged people. They resent, and I think justly so, the critical and uncomplimentary references made to their homes in attaching to them the name “black-houses.” Several that we visited were artistically decorated with clean wallpaper and improvised hangings.
One would expect that in their one seaport town of Stornoway things would be gay over the week-end, if not boisterous, with between four and five thousand fishermen and seamen on shore-leave from Saturday until midnight Sunday. On Saturday evening the sidewalks were crowded with happy carefree people, but no boisterousness and no drinking were to be seen. Sunday the people went in throngs to their various churches. Before the sailors went aboard their crafts on Sunday evening they met in bands on the street and on the piers for religious singing and prayers for safety on their next fishing expedition. One could not buy a postage stamp, a picture card, or a newspaper, could not hire a taxi, and could not find a place of amusement open on Sunday. Everybody has reverence for the Sabbath day on the Isle of Lewis. Every activity is made subservient to their observance of the Sabbath day. In few places in the world are moral standards so high. One wonders if the bleak winds which thrash the north Atlantic from our Labrador and Greenland coasts have not tempered the souls of these people and created in them higher levels of nobility and exalted human expression. These people are the outposts of the western fringe of the European continent.
Just as one sees in Brittany, on the west coast of France, the prehistoric druidical stone forest marking a civilization which existed so far in the past as to be without historic records except in its monuments; so, too, we find here the forest of granite slabs in which these sturdy prehistoric souls worshipped their divinities before they were crowded into the sea by the westward moving hordes. When one realizes the distance that these heavy stones had to be transported, a distance of probably twenty miles over difficult terrain, we can appreciate the task. Their size can be calculated from the depth to which they must be buried in order to stand erect even to this day.
We are concerned primarily with the physical development of the people, and particularly with their freedom from dental caries or tooth decay. One has only to see them carrying their burdens of peat or to observe the ease with which the fisherwomen on the docks carry their tubs of fish back from the cleaning table to the tiers of packing barrels to be convinced that these people have not only been trained to work, but have physiques equal to the task. These studies included the making of dental examinations, the taking of photographs, the obtaining of samples of saliva for chemical analysis, the gathering of detailed clinical records, and the collecting of samples of food for chemical analysis and detailed nutritional data.
Communication is very difficult among many of these islands. It would be difficult to find more complete isolation than some of them afford. We tried to get to the islands of Taransay and Scarpa on the west coast of the Isle of Harris, but were unable to obtain transportation since the trip can be made only in special, seaworthy crafts, which will undertake the passage only at certain phases of the tide and at certain directions of the winds. On one of these islands, we were told, the growing boys and girls had exceedingly high immunity to tooth decay. Their isolation was so great that a young woman of about twenty years of age who came to the Isle of Harris from Taransay Island had never seen milk in any larger quantity than drops. There are no dairy animals on that island. Their nutrition is provided by their oat products and fish, and by a very limited amount of vegetable foods. Lobsters and flat fish are a very important part of their foods. Fruits are practically unknown. Yet the physiques of these people are remarkably fine.
It was necessary sometimes for us to engage skilled seamen and their crafts to make a special trip to some of these isolated islands. These seamen watch critically the tide, wind and sky, and determine the length of time it will be safe to travel in a certain direction under conditions existing in the speed of the running tide and the periodic change of the wind. Some of the islands are isolated by severe weather conditions for many months of the year.
These islands have been important in the whaling industry, even up to recent years. We visited a whaling station on the Isle of Harris, not active at this time, where monsters of the sea were towed into a deep bay.
In the interior of the Isle of Lewis the teeth of the growing boys and girls had a very high degree of perfection, with only 1.3 teeth out of every hundred examined that had even been attacked by dental caries.
An important part of the study of these islands was the observations made on conditions at the fringe of civilization. A typical cross-section of the residents of the seaport town of Stornoway can be seen assembled on the docks to greet the arrival of the evening boat, the principal event of the community. The group consists largely of adult young people. In a count of one hundred individuals appearing to be between the ages of twenty and forty, twenty-five were already wearing artificial teeth, and as many more would have been more presentable had they too been so equipped. Dental caries was very extensive in the modernized section of Stornoway. Since an important part of these studies involved a determination of the kinds and quantities of foods eaten, it was necessary to visit the sources available for purchasing foods in each town studied. In Stornoway, one could purchase angel food cake, white bread, as snow white as that to be found in any community in the world, many other white-flour products; also, canned marmalades, canned vegetables, sweetened fruit juices, jams, confections of every type filled the store windows and counters. These foods probably made a great appeal both because of their variety and their high sugar content to the pallets of these primitive people. The difference in physical appearance of the child life of Stornoway from that of the interior of the Isle of Lewis was striking. We found a family on the opposite coast of the island where the two boys shown in the upper half of Fig. 6 resided. One had excellent teeth and the other had rampant caries. These boys were brothers eating at the same table. The older boy, with excellent teeth, was still enjoying primitive food of oatmeal and oatcake and sea foods with some limited dairy products. The younger boy, seen to the left, had extensive tooth decay. Many teeth were missing including two in the front. He insisted on having white bread, jam, highly sweetened coffee and also sweet chocolates. His father told me with deep concern how difficult it was for this boy to get up in the morning and go to work.
FIG. 6. Above: brothers, Isle of Harris. The younger at left uses modern food and has rampant tooth decay. Brother at right uses native food and has excellent teeth. Note narrowed face and arch of younger brother. Below: typical rampant tooth decay, modernized Gaelic. Right: typical excellent teeth of primitive Gaelic.
One of the sad stories of the Isle of Lewis has to do with the recent rapid progress of the white plague. The younger generation of the modernized part of the Isle of Lewis is not showing the same resistance to tuberculosis as their ancestors. Indeed a special hospital has been built at Stornoway for the rapidly increasing number of tubercular patients, particularly for girls between twenty and thirty years of age. The superintendent told me with deep concern of the rapidity with which this menace is growing. Apparently very little consideration was being given to the change in nutrition as a possible explanation for the failure of this generation to show the defense of previous generations against pulmonary tuberculosis. In this connection much blame had been placed upon the housing conditions, it being thought that the thatched-roof house with its smoke-laden air was an important contributing factor, notwithstanding the fact that former generations had been free from the disease. I was told that the incidence of tuberculosis was frequently the same in the modern homes as it was in the thatched-roof homes. It was of special interest to observe the mental attitude of the native with regard to the thatched-roof house. Again and again, we saw the new house built beside the old one, and the people apparently living in the new one, but still keeping the smoke smudging through the thatch of the old thatched-roof house. When I inquired regarding this I was told by one of the clearthinking residents that this thatch collected something from the smoke which when put in the soil doubled the growth of plants and yield of grain. He showed me with keen interest two patches of grain which seemed to demonstrate the soundness of his contention.
I was particularly interested in studying the growing boys and girls at a place called Scalpay in the Isle of Harris. This Island is very rocky and has only small patches of soil for available pasturage. For nutrition, the children of this community were dependent very largely on oatmeal porridge, oatcake and sea foods. An examination of the growing boys and girls disclosed the fact that only one tooth out of every hundred examined had ever been attacked by tooth decay. The general physical development of these children was excellent, as may be seen in the upper half of Fig. 7. Note their broad faces.
FIG. 7. Above: typical rugged Gaelic children, Isle of Harris, living on oats and sea food. Note the breadth of the faces and nostrils. Below: typical modernized Gaelics, Isle of Bardsey. Note narrowed faces and nostrils.
This is in striking contrast with the children of the hamlet of Tarbert which is the only shipping port on the Isle of Harris, and the place of export of most of the famous Harris tweeds which are manufactured on looms in the various crofters’ homes. These Tarbert children had an incidence of 32.4 carious teeth out of every hundred teeth examined. The distance between these two points is not over ten miles and both have equal facilities for obtaining sea foods, being on the coast. Only the latter, however, has access to modern foods, since it supports a white bread bakery store with modern jams, marmalades, and other kinds of canned foods. In studying the tragedy of the rampant tooth decay in the mouth of a young man, I asked him regarding his plans and he stated that he was expecting to go to Stornoway about sixty miles away in the near future, where there was a dentist, and have all his teeth extracted and plates made. He said that it was no use to have any teeth filled, that he would have to lose them anyway since that was everybody’s experience in Tarbert. The young women were in just as poor a condition.
Through the department of dental inspection for north Scotland, I learned of a place on the Isle of Skye, Airth of Sleat, in which only a few years ago there were thirty-six children in the school, and not one case of dental caries in the group. My examination of the children in this community disclosed two groups, one living exclusively on modern foods, and the other on primitive foods. Those living on primitive foods had only 0.7 carious teeth per hundred, while those in the group living on modern foods had 16.3, or twenty-three times as many.
This community living near the sea had recently been connected with the outside world by daily steamboat service which delivered to the people modern foods of various kinds, and within this community a modern bakery, and a supply house for purchasing the canned vegetables, jams and marmalades had been established. This district was just in the process of being modernized.
I examined teeth of several people in the seventies and eighties, and except for gingival infections with some loosening of the teeth, nearly all of the teeth were present and there was very little evidence that dental caries had ever existed. The elderly people were bemoaning the fact that the generation that was growing up had not the health of former generations. I asked what their explanation was and they pointed to two stone grinding mills which they said had ground the oats for oatcake and porridge for their families and preceding families for hundreds of years. Though they prized them highly, the plea that they would be helpful in educational work in America induced them to sell the mills to me. They told us with great concern of the recent rapid decline in health of the young people of this district.
This one-time well-populated Island, the misty Isle of Skye, still has one of the finest of the famous old castles, that belonging to the Dunvegan clan. It participated in the romantic life of Prince Charlie. The castle equipment still boasts the grandeur of a past glory. Among the relics is a horn which measured the draft to be drunk by a prospective chieftain before he could aspire to the leadership of the clan. He must drink its contents of two quarts without stopping. Again the character of that manhood is reflected in the fact that although a bounty of thirty thousand pounds was placed upon the head of Prince Charlie, none of the many who knew his place of hiding betrayed it.
On my return from the Outer Hebrides to Scotland, I was concerned to obtain information from government officials relative to the incidence of tooth decay and the degenerative diseases in various parts of north Scotland. I was advised that in the last fifty years the average height of Scotch men in some parts decreased four inches, and that this had been coincident with the general change from high immunity to dental caries to a loss of immunity in a great part of this general district. A study of the market places revealed that a large part of the nutrition was shipped into the district in the form of refined flours and canned goods and sugar. There were very few herds of dairy cattle to be seen. It was explained that even the highland cattle did not do as well as formerly on the same ranges.
As one proceeds from the north of Scotland southward to England and Wales, there is a marked increase in the percentage of individuals wearing artificial restorations or in need of them. In several communities this reached fifty per cent of adults over thirty years of age. An effort was made to find primitive people in the high country of Wales, but without success. We were advised that about the only place that we would be likely to find people living under primitive conditions would be on the Island of Bardsey off the northwest coast of Wales. This is a rock and storm-bound island with the decadent walls of an old castle and a community made up largely of recently imported colonists whom we were advised had been taken to the Island to re-populate it. There is considerable good farm land, but very limited grazing stock. Formerly the Island had produced the foods for its inhabitants with the assistance of the sea. These sources of natural foods have been largely displaced with imported white flour, marmalades, sugar, jams and canned goods. We found the physical condition of the people very poor, particularly that of the growing boys and girls. Tooth decay was so wide-spread that 27.6 out of every hundred teeth examined in the growing boys and girls had already been attacked by dental caries. It was even active in three year olds. From a conference with the director of public health of this district I learned that tuberculosis constituted a very great problem, not only for the people on this island, but for those of many districts of northern Wales. This was ascribed to the lowered defense of the people due to causes unknown. It had been noted that individuals with rampant tooth decay were more susceptible to pulmonary tuberculosis.
While on the Island of Bardsey, I inquired as to what they thought was the cause of such extensive tooth decay as we found, and was told that they were familiar with the cause and that it was due to close contact with the salt water and salt air. When I asked why many of the old people who had lived by the sea all their lives in some districts still had practically all their teeth and had never had tooth decay, no explanation was available. This they said was the reason that had been given in answer to their inquiries.
There is a very remarkable history written in the ruins of the island, and in the faces of the people who live on the Island of Bardsey. The rugged walls of ancient castles bespeak the glory and power of the people who lived proudly in past centuries. They are testified to also by the monuments in the cemeteries; but a new era has come to this island. The director of public health, of this district of Wales, including Bardsey Island, told me the story of the decline and almost complete extinction of the population due to tuberculosis. He also told how the government had re-populated the Island with fifty healthy young families, and then the sad story of how these new settlers were breaking down as rapidly as the former occupants.
The lower photograph in Fig. 7 is of a family of four children in whose faces the tragic story is deeply written. Everyone is a mouth breather and everyone has rampant tooth decay. These people are products of modernization on this island which one time produced vigorous children and stalwart men and women. It is important to compare the faces of the children of the Isle of Bardsey shown in Fig. 7 below with those shown in Fig. 7 above living in an isolated district in the Isle of Harris. As we will see later, the facial deformity does not reach its maximum severity until the eruption of the second dentition and the development of the adult face, usually at from nine to fourteen years of age. In cases of extreme injury, however, we find it appearing in the childhood face during the period of temporary or deciduous dentition. These children will, doubtless, be much more seriously deformed when their permanent dentitions and adult faces develop. It is important for us to keep this picture in mind in its relation to the high incidence of tuberculosis as we read succeeding chapters and find the part played by modernization in breaking down the defense of individuals to infective processes including tuberculosis.
In Fig. 6 (lower left) is a young girl from the Isle of Bardsey. She is about seventeen years of age. Her teeth were wrecked with dental caries, the disease involving even the front teeth. We ate a meal at the home in which she was living. It consisted of white bread, butter and jam, all imported to the island. This is in striking contrast with the picture of the girl shown in Fig. 6 (lower right) living in the Isle of Lewis, in the central area. She has splendidly formed dental arches and a high immunity to tooth decay. Her diet and that of her parents was oatmeal porridge and oatcake and fish which built stalwart people. The change in the two generations was illustrated by a little girl and her grandfather on the Isle of Skye. He was the product of the old régime, and about eighty years of age. He was carrying the harvest from the fields on his back when I stopped him to take his picture. He was typical of the stalwart product raised on the native foods. His granddaughter had pinched nostrils and narrowed face. Her dental arches were deformed and her teeth crowded. She was a mouth breather. She had the typical expression of the result of modernization after the parents had adopted the modern foods of commerce, and abandoned the oatcake, oatmeal porridge and sea foods.
FIG. 8. From left to right. These pots of soil growing oats contained decreasing amounts of smoke-thatch. Only the first produced mature grain. This is in accord with the belief and practice of the native Gaelics.
Since a fundamental part of this study involves an examination of the accumulated wisdom of the primitive racial stocks, it is important that we look further into the matter of the smoked thatch. I was advised by the old residents that a serious conflict existed between them and the health officials who came from outside to their island. The latter blamed the smoke for the sudden development of tuberculosis in acute form, and they insisted that the old procedure be entirely discontinued. For this purpose the government gave very substantial assistance in the building of new and modern homes. The experienced natives contended that the oat crop would not mature in that severe climate without being fertilized with the smoked thatch. While they were willing to move into the new house, they were not willing to give up the smoking of the oat straw used for the thatch to prepare it for fertilizing the ground. I brought some of this smoked thatch with me both for chemical analysis and for testing for the influence on plant growth. This was done by adding different quantities of the smoked thatch to a series of pots in which oat seeds were planted. In Fig. 8 will be seen the result. The pot to the right shows the result of planting the oats in a sandy soil almost like that of the Islands of the Outer Hebrides. The oats only grew to the fuzzy limited condition shown. As increasing amounts of this thatch were added to the soil, there was an increase in the ruggedness of the plants so that in the last pot to the left tall stalks were developed heavily loaded with grain which ripened by the time the growth shown in the other pots had occurred. The chemical analysis of the thatch showed that it contained a quantity of fixed nitrogen and other chemicals resulting from the peat smoke circulating through the thatch. This explains the confidence of the hardy old natives who insisted on being permitted to continue the smoking of the thatch even though they did not live in the house.
A dietary program competent to build stalwart men and women and rugged boys and girls is provided the residents of these barren Islands, with their wind and storm-swept coasts, by a diet of oats used as oatcake and oatmeal porridge; together with fish products, including some fish organs and eggs. A seriously degenerated stock followed the displacement of this diet with a typical modern diet consisting of white bread, sugar, jams, syrup, chocolate, coffee, some fish without livers, canned vegetables, and eggs.
Isolated and modernized Eskimos
During the rise and fall of historic and prehistoric cultures that have often left their monuments and arts following each other in succession in the same location, one culture, the Eskimo, living on until today, brings us a robust sample of the Stone Age people. The Maya race is gone, but has left its monuments. The Indian race is rapidly changing or disappearing in North America. The Eskimo race has remained true to ancestral type to give us a living demonstration of what Nature can do in the building of a race competent to withstand for thousands of years the rigors of an Arctic climate. Like the Indian, the Eskimo thrived as long as he was not blighted by the touch of modern civilization, but with it, like all primitives, he withers and dies.
In his primitive state he has provided an example of physical excellence and dental perfection such as has seldom been excelled by any race in the past or present. We are concerned to know the secret of this great achievement since his circumscribed life greatly reduces the factors that may enter as controlling units in molding this excellence. While we are primarily concerned in this study with the characteristics of the Eskimo dentition and facial form and the effect upon it of his contact with modern civilization, we are also deeply concerned to know the formula of his nutrition in order that we may learn from it the secrets that will not only aid the unfortunate modern or so-called civilized races, but will also, if possible, provide means for assisting in their preservation.
It is a sad commentary that with the coming of the white man the Eskimos and Indians are rapidly reduced both in numbers and physical excellence by the white man’s diseases. We have few problems more urgent or more challenging than that means shall soon be found for preventing the extermination of the primitive Americans. Many reports have been made with regard to the condition of the teeth of the Eskimos. Doubtless, all have been relatively authentic for the groups studied, which have been chiefly along the routes of commerce. Clearly those people would not represent the most primitive groups, which could only be located beyond the reach of contact with modern civilization. The problems involved strongly suggested the desirability of locating and studying Eskimos in isolated districts. While dog teams could furnish means of approach in the winter season, they would not be available for summer travel.
Through the kindness of Dr. Alexis Hrdlicka, who has made anthropological studies of the Eskimos in many of the districts of Alaska, I learned that the most primitive groups were located south of the Yukon in the country between it and Bristol Bay including the Delta and mouth of the Kuskokwim River. A government station has been established on the Kuskokwim River for which a government boat enters the mouth of the Kuskokwim to deliver supplies. It carries officials, but not passengers. This contact with civilization has made available modern foods for a limited district, chiefly at the point at which the boat lands, namely, Bethel. A portion of these supplies is transported by a stern-wheel river boat to settlements farther up the river. A great number, however, of Eskimos live between the mouth of the Kuskokwim and the mouth of the Yukon River, on the mainland and islands, a distance of several hundred miles, and have little or no contact with this food.
Accordingly, our program for making these field studies among the Eskimos in 1933 required transportation over long distances and into districts where travelling facilities were practically non-existent by other means than by modern aeroplane. Mrs. Price accompanies and assists me with my records. Our itinerary included steamship service to Seward in western Alaska and railway to Anchorage, where an aeroplane was chartered which carried us to various districts in western and central Alaska. This plane carried our field equipment, and travelled to the points selected. The great Alaska mountain range, culminating in the magnificent Mt. McKinley, stretches across Alaska from the Aleutian Peninsula at the southwest far into the heart of this vast territory. The highest mountain in the United States proper is Mt. Whitney, 14,502 feet. The highest mountain in Canada is Mt. Logan, 19,539 feet. Alaska, however, boasts many mountains that are higher than any of these, many of which are in this range. Mt. McKinley is 20,300 feet. It was necessary for us to surmount this magnificent range to reach the territory in which our investigations were to be made. The special aeroplane selected was equipped with radio for both sending and receiving, and was in touch, or could be in touch at all times, with the Signal Service Corps, as well as with the headquarters and branches of the Company. Owing to clouds in the selected pass, the pilot found it necessary to go one hundred fifty miles out of his course to find one that was clear enough to fly through. Beyond these mountains were vast areas of bare wilderness with no signs of human life. Moose were frequently seen.
Our first objective was to find, if possible, a band of Indians reported to live on Stony River. They had been described as being very primitive. Our pilot, who was well informed about this region, said this was the first time he had even landed in this district. All the people were busy catching and storing the running salmon. After drying the fish they are smoked for a few hours and then stored for winter use. These thrifty people have physical features quite unlike the Indians of central, southern and eastern Alaska. Of the twelve individuals studied here, ten had lived entirely on the native foods or practically so. In their 288 teeth only one tooth was found that had ever been attacked by tooth decay, or 0.3 per cent. Two had come up from the Kuskokwim River, of which the Stony River is a branch. There, they had received a considerable quantity of the “store grub” that had been shipped up the Kuskokwim from Bethel. Twenty-seven per cent of the teeth of these two had been attacked by dental caries.
We then proceeded to Sleet Mute, on the Kuskokwim River, where three individuals were found who had lived entirely on native foods. None of them had ever had a tooth attacked by tooth decay. Seven others had lived partly on native foods and partly on “store grub,” and they had dental caries in 12.2 per cent of their teeth.
At Crooked Creek, the next settlement, eight individuals were examined and of their 216 teeth forty-one, or 18.9 per cent, had caries. All but one of these were living in considerable part on “store grub,” and this individual had no dental caries.
At Napimute, 16 per cent of the teeth had been attacked by dental caries, but no individuals studied here were living entirely on native foods.
Bethel is the largest settlement on the Kuskokwim, and contains in addition to the white residents many visiting Eskimos from the nearby Tundra country surrounding it. Eighty-eight individuals studied here were largely Eskimos and mixed bloods. Of their 2,490 teeth, 11.6 per cent, or 281 teeth, had been attacked by tooth decay. Of these eighty-eight individuals twenty-seven with 796 teeth had lived almost exclusively on natural foods, and in this group only one tooth was found with dental caries, or 0.1 per cent. Forty individuals were living almost exclusively on modern foods as shipped in by the government supply boat. Of their 1,094 teeth, 252, or 21.1 per cent, had been attacked by tooth decay. Twenty-one individuals were living partly on native foods and partly on “store grub,” and of their 600 teeth thirty-eight, or 6.3 per cent, had been attacked by tooth decay.
At Kokamute, on the Bering Sea at the mouth of the Kuskokwim River, a large band of very primitive Eskimos was studied. They had come from the vicinity of Nelson Island, a district which has had exceedingly little contact with modern civilization. In this group twenty-eight individuals with 820 teeth showed only one tooth, or 0.1 per cent, that had ever been attacked by dental caries.
Bethel Island is situated in the Kuskokwim River. It is visited in the summer by Eskimos from the Tundra Country for laying in their store of fish for winter use. Of fifteen individuals here, thirteen, with 410 teeth, had lived exclusively on native foods, and not a single tooth had been attacked by dental caries. Two had come from Bethel, and of their sixty teeth twenty-one or 35 per cent had been attacked by tooth decay.
In the various groups in the lower Kuskokwim seventy-two individuals who were living exclusively on native foods had in their 2,138 teeth only two teeth or 0.09 per cent that had ever been attacked by tooth decay. In this district eighty-one individuals were studied who had been living in part or in considerable part on modern foods, and of their 2,254 teeth 394 or 13 per cent had been attacked by dental caries. This represents an increase in dental caries of 144 fold.
It next became desirable to study a district that had been in contact with the foods of modern commerce for many years, and for this Holy Cross was selected. This community is located on the Yukon River above the Arctic Circle. It has been in contact with the summer commerce of the Yukon for several decades. It has one of the oldest and best organized Catholic Missions of Alaska. The individuals studied were all in the school connected with the Mission. The students had come from as far north as Point Barrow on the Arctic Ocean and west to the Bering Straits. All but one had been in contact with and had used modern foods before coming to the Mission, and were using them while there. This one individual had lived exclusively on native foods before coming to the Mission and he had no carious teeth. In eight individuals with 224 teeth, who had lived very largely on modern foods, forty-two teeth or 18.7 per cent had been attacked by tooth decay. Four individuals had lived partly on native foods and partly on modern foods, and of their 112 teeth four, or 3.5 per cent, had been attacked by tooth decay.
It is of interest that while the Eskimos and Indians have lived in accord, they have not intermarried. The Eskimos occupy the lower section of the Yukon and Kuskokwim Rivers, and the Bering Sea frontier. The Indians have occupied the Upper waterways of both these rivers. The next place selected for study was McGrath, which is on the Upper Kuskokwim not far distant from the McKinley Mountain Range. It is the upper terminus of navigation on the Kuskokwim River for the stern-wheel river boats. Its chief importance lies in the fact that it is the division point on the Cross Alaska Aeroplane Routes from Anchorage or Fairbanks to Nome and other western points. Its population consists of several white prospectors and miners who have stayed in the country following the gold rush. Some of them have married Indian and Eskimo women. Of twenty-one individuals only one had lived almost exclusively on native foods and she had no dental caries. Twenty had lived chiefly on imported foods, and of their 527 teeth 175, or 33.2 per cent, had been attacked by tooth decay.
Among the residents of McGrath there is a remarkable family. The father is an American mining engineer who has spent much of his life in that country. His wife is a charming Eskimo woman of splendid intelligence and fine personality. She had come originally from the lower Kuskokwim and was one of the primitive Eskimo stock. While mining interests had provided food supplies for the family, shipped from the United States, she followed her early training and insisted on catching and storing salmon in season as an important part of her own dietary. The salmon were dried and smoked as was the custom of her people. She is the mother of at least twenty children, for she could give the names of that many. Only eleven were living, however, several having died from tuberculosis. Notwithstanding her many overloads, not a single tooth had ever been attacked by tooth decay. A lower anterior tooth had been broken. A picture of this woman is shown in Fig. 9 (upper, left). There has been extensive wear of the teeth, as is characteristic of the teeth of many of the Eskimos, a matter which we will presently discuss. It is of interest to note the splendid symmetry of her dental arches. Her children and husband and son-in-law had lived very largely on modern foods and in these eight individuals with 212 teeth eighty-seven, or 41 per cent, had been attacked by tooth decay. Her oldest living daughter is twenty-two years of age. She has a narrowing of the upper arch and extensive tooth decay. Another daughter, sixteen, is a beautiful girl except for her narrow dental arches. She was reported by our pilot to have become so deeply interested in the engines of the aircrafts as they stopped at this point for servicing and fuel that she had become expert in tuning up and conditioning aeroplane motors. She, doubtless, inherited some of the genius of her father, who is a mining engineer. Twelve of her teeth had been attacked by dental caries.
FIG. 9. Typical native Alaskan Eskimos. Note the broad faces and broad arches and no dental caries (tooth decay). Upper left, woman has a broken lower tooth. She has had twenty-six children with no tooth decay.
One does not get a conception of the magnificent dental development of the more primitive Eskimos simply by learning that they have freedom from dental caries. The size and strength of the mandible, the breadth of the face and the strength of the muscles of mastication all reach a degree of excellence that is seldom seen in other races. This is typically illustrated in Fig. 9. I was told that an average adult Eskimo man can carry one hundred pounds in each hand and one hundred pounds in his teeth with ease for a considerable distance. This illustrates the physical development of other parts of the body as well as the jaws, and suggests that the exercising of the jaws is not the sole reason for their very fine teeth, since the superb development of the musculature includes all parts of the body. It has also been suggested that chewing of tough foods, by building teeth of exceptionally fine quality, has been an important factor in the establishment of immunity to caries. As will be shown presently, the teeth of these individuals with their excellent physical development and fine tooth structure develop caries when they depart from their native foods and adopt our modern foods.
Much has been reported in the literature of the excessive wear of the Eskimos’ teeth, which in the case of the women has been ascribed to the chewing of the leather in the process of tanning. It is of interest that while many of the teeth studied gave evidence of excessive wear involving the crowns to a depth that in many individuals would have exposed the pulps, there was in no case an open pulp chamber. They were always filled with secondary dentin. This is important since our newer knowledge indicates that with the chemical characteristics of their food we might expect that secondary dentin would be readily formed within the pulp chambers by a process similar to that which occurs in many individuals under a diet reinforced with mineral and activator-providing foods. One old Eskimo had a scar on his lower lip, which was the result of perforations for carrying a decoration as practiced by his tribe. I have found primitive tribes in several parts of the world with this marking.
The principal outer garment worn by the Eskimo for the more primitive groups consists of a parka carrying a hood which is pulled over the head and closed around the neck with a shirr string, while another shirr string controls the size of the face opening in the hood when it is up. In the summer this is made of cloth or of skin without the fur. A typical case is shown in Fig. 9. It will again be noted that the teeth are excessively worn.
FIG. 10. These primitive Alaskan mothers rear strong, rugged babies. The mothers do not suffer from dental caries.
Owing to the bleakness of the winds off the Bering Sea, even in the summer many of the women wear furs. A typical mother and child dressed in their warm clothing are shown in Fig. 10. The Eskimo women are both artistic and skillful in needle work. They use fur of different colors for decorating their garments. These women make artistic decorations by carving ivory from walrus teeth and from the buried tusks of the hairy mammoth that wandered over the Tundra tens of thousands of years ago. The ear decoration of this Eskimo woman is a typical design. This mother’s teeth are literally “two rows of pearls.” It is important to note the width of the arches. One is continually impressed with the magnificent health of the child life which is illustrated in Fig. 10. In our various contacts with them we never heard an Eskimo child crying except when hungry, or frightened by the presence of strangers. The women are characterized by the abundance of breastfood which almost always develops normally and is maintained without difficulty for a year. The mothers were completely free of dental caries, and I was told that the children of the Eskimos have no difficulties with the cutting of their teeth.
FIG. 11. When the primitive Alaskan Eskimos obtain the white man’s foods, dental caries become active. Pyorrhea also often becomes severe. In many districts dental service cannot be obtained and suffering is acute and prolonged.
The excellence of dentitions among the Eskimos has been a characteristic also of the skulls that have been excavated in various parts of Alaska.
It might be expected that such wonderfully formed teeth would maintain so high an immunity to dental caries that their proud possessors would never be troubled with tooth decay. This, unfortunately, is not the case, a fact of great significance in evaluating our modern theories of the causes of dental caries. When these adult Eskimos exchange their foods for our modern foods, which we will discuss in Chapter 15, they often have very extensive tooth decay and suffer severely. This is clearly illustrated in Fig. 11, for these Eskimos’ teeth had been seriously wrecked by tooth decay. They had been living on modern foods and were typical of a large number who are in contact with the Bering Sea ports. Their plight often becomes tragic since there are no dentists in these districts.
A typical effect of modernization on a growing girl was shown in a case in which the central incisors and 16 other teeth were attacked by dental caries. Sixty-four per cent of her teeth had tooth decay.
There are no dentists in western Alaska, north or west of Anchorage, which is near the southern coast, except at Fairbanks which, like Anchorage, is many hundreds of miles from these Eskimos. It would take months for them to make the journey in winter by dog team, and it would be practically impossible to make it in the summer season by any means of travel except by aeroplane, which clearly these people could not afford. Their dilemma is, accordingly, most tragic when they suddenly become victims of diseases which require hospitalization or skilled medical or dental service. One mining engineer in the interior told me that he had spent two thousand dollars to have a dentist brought in by aeroplane to render dental service. On my examination of his mouth I found twenty-nine of his thirty-two teeth had been attacked by dental caries.
One important phase of modern degeneration, namely, change in facial and dental arch form and other physical expressions, is of interest. It is a matter of great significance that the Eskimos who are living in isolated districts and on native foods have produced uniformly broad dental arches and typical Eskimo facial patterns. Even the first generation forsaking that diet and using the modern diet, presents large numbers of individuals with marked changes in facial and dental arch form. In Fig. 12 will be seen four Eskimo girls who are of the first generation following the adoption of modernized foods by their parents. All have deformed dental arches. It is important to note the pattern of the settling inward of the lateral incisors and the crowding outward of the cuspids. This facial design is currently assigned to a mixing of racial bloods. These girls are pure-blooded Eskimos whose parents have normally formed dental arches.
FIG. 12. While dental arch deformities or crowded teeth are practically unknown among many of the primitive groups of Eskimos, they occur frequently in the first generation of children born after the parents have adopted the white man’s foods. Note the narrow nostrils and changed facial form of these children. This is not due to thumb sucking.
We are particularly concerned with the foods used by these primitive Eskimos. They almost always have their homes on or near deep water. Their skill in handling their kayaks is most remarkable. During the salmon running season they store large quantities of dried salmon. They spear many of these fish from their kayaks; even young boys are very skillful. They land salmon so large that they can hardly lift them. They are expert in spearing seals from these light crafts. Seal oil provides a very important part of their nutrition. As each piece of fish is broken off, it is dipped in seal oil. I obtained some seal oil from them and brought it to my laboratory for analyzing for its vitamin content. It proved to be one of the richest foods in vitamin A that I have found.
The fish are hung on racks in the wind for drying. Fish eggs are also spread out to dry, as shown in Fig. 13. These foods constitute a very important part of the nutrition of the small children after they are weaned. Naturally, the drifting sands of the bleak Bering Straits lodge upon and cling to the moist surfaces of the fish that are hung up to dry. This constitutes the principal cause for the excessive wear of the Eskimos’ teeth in both men and women.
FIG. 13. The eggs of the salmon are dried and stored as an important item of nutrition for both children and adults. They are also used to increase the fertility of the women. From a chemical standpoint they are one of the most nutritious foods I have found anywhere.
The food of these Eskimos in their native state includes caribou, ground nuts which are gathered by mice and stored in caches, kelp which is gathered in season and stored for winter use, berries including cranberries which are preserved by freezing, blossoms of flowers preserved in seal oil, sorrel grass preserved in seal oil, and quantities of frozen fish. Another important food factor consists of the organs of the large animals of the sea, including certain layers of the skin of one of the species of whale, which has been found to be very high in vitamin C.
Since contact with our modern civilization, the Eskimo population for Alaska is very rapidly declining. One authority has quoted the reduction of 50 per cent in population in seventy-five years.
An important observation has been made relative to the rapid shortening of the average life by Dr. V. E. Levine and Professor C. W. Bauer, of Creighton University, Nebraska, who reported:
Unless a very radical change is made in the interference with the native supply of game and sea foods, the Eskimo population seems destined to have a rapid decline and an early extinction. Their primitive fish foods have been largely curtailed by the encroachment on their salmon streams made by modern canneries.
It is of interest to discuss in connection with the Alaskan Eskimo two white boys (one is shown in Fig. 14), who were sons of a mining engineer. They had been born and raised in a mining camp in Alaska, where their foods had been almost entirely shipped in. I travelled with the mother of these two boys who was bringing them to the United States for operations on their noses, because they were mouth-breathers. It is important to observe the marked underdevelopment of both the middle third and lower third of the face of the boy shown in Fig. 14. The nutrition of the family during their development and growth had been largely provided in package form shipped in from the United States. Their disfiguration is typical of that of large numbers that are developing in our highly modernized communities, and is similar, in general, to the deformities which develop in the primitive races after they adopt the modernized nutrition.
FIG. 14. This white boy was born and raised in Alaska on imported foods. His facial deformity includes a lack of development of the air passages, so that he breathes through his mouth. Lack of bone development creates the crowded condition of the teeth. Note his narrow nostrils.
Notwithstanding the very inhospitable part of the world in which they reside, with nine or ten months of winter and only two or three of summer, and in spite of the absence for long periods of plant foods and dairy products and eggs, the Eskimos were able to provide their bodies with all the mineral and vitamin requirements from sea foods, stored greens and berries and plants from the sea.
Key to Location of Indian and Eskimo Groups Examined in Canada
Primitive and modernized North American Indians
Nature seems to have made one of her large scale demonstrations in the Americas of the power of adaptation of a single racial stock to the scale of climates ranging from torrid jungles of the tropics to the Arctics. The various members of the American Indian race seem clearly to have come from a common origin. The route by which they reached America from Asia as suggested by anthropologists was by way of the Bering Strait. Within a decade a Russian engineer has crossed from Asia to America on the pack ice of the Bering sea, a distance of ninety miles. If this is possible now, how much more likely is it that it has been possible in earlier periods of the world’s history, as, for example, during or following the last ice age, or at the time of an earlier ice age. The American Indian, therefore, provides a very remarkable opportunity to study both the capacity for adaptability to different environments and the variations that different environments can produce in a single racial stock. That the Indian of today is not in general a counterpart of the native resident at the time of the discovery of America by Columbus is clearly demonstrated both by the skeletal material and by the early records.
Our problem involved the location and study of groups of the original stock, if such were to be found, who were living in accordance with the tradition of their race and as little affected as might be possible by the influence of the white man. At first thought it might seem impossible that such groups can exist, but as a matter of fact there are still great areas of the American continent inhabited by the original stock living in areas still unexplored. In order to find Indians as little changed as possible by reason of their contact with the white man, particularly with the white man’s foods, I went to northern Canada to the region inside the Rocky Mountain range to study the Indians of Northern British Columbia and the Yukon territory. Since an aeroplane could not be used, owing to the lack of a base of supplies for fuel for the return trip; and since the MacKenzie water route was impracticable (an expedition could not go up the waterways through Canada on the MacKenzie River and its branches and return the same season), the route selected was that which enters that territory from Alaska on the large waterway of the Stikine River. This river has cut its channel through the Coast and Cascade Ranges of mountains and has its origin in the high western watershed of the Rockies. It was particularly desirable to reach a group of Indians who could not obtain the animal life of the sea, not even the running salmon. These fish do not enter the waterways draining to the Arctic. We used a high-powered river transport specially designed for going up rapids on the Stikine River to the end of navigation at Telegraph Creek. At this point large quantities of modern foods are stored during the short open navigation season of the summer to be exchanged for furs during the long winter. A Hudson Bay Post has been established at this point. Here a truck was chartered which took us over a trail across the Rocky Mountain Divide to the headwaters of the rivers flowing north to the Arctic. At this outpost two guides were engaged and a high powered scow chartered to make the trip down the waterways toward the Arctic on the Diese and Liard Rivers. This made it possible, in the summer of 1933, to make contact with large bands of Indians who had come out of the Pelly mountain country to exchange their catch of furs at the last outpost of the Hudson Bay Company. Most of the Indians of Canada are under treaty with the Canadian Government whereby that government gives them an annual per capita bounty. This arrangement induces the Indians in the interior to come out to the designated centers to obtain the bounty. Since it is based on the number in the family, all of the children are brought. This treaty, however, was never signed by the Indians of the British Columbia and Yukon Territory. And, accordingly, they have remained as nomadic wandering tribes following the moose and caribou herds in the necessary search to obtain their foods.
The rigorous winters reach seventy degrees below zero. This precludes the possibility of maintaining dairy animals or growing seed cereals or fruits. The diet of these Indians is almost entirely limited to the wild animals of the chase. This made a study of them exceedingly important. The wisdom of these people regarding Nature’s laws, and their skill in adapting themselves to the rigorous climate and very limited variety of foods, and these often very hard to obtain, have developed a skill in the art of living comfortably with rugged Nature that has been approached by few other tribes in the world. The sense of honor among these tribes is so strong that practically all cabins, temporarily unoccupied due to the absence of the Indians on their hunting trip, were entirely unprotected by locks; and the valuables belonging to the Indians were left in plain sight. The people were remarkably hospitable, and where they had not been taken advantage of were very kind. Many of the women had never seen a white woman until they saw Mrs. Price. Their knowledge of woodcraft as expressed in skill in building their cabins so that they would be kept comfortably warm and protected from the sub-zero weather was remarkable. Their planning ahead for storing provisions and firewood strongly emphasized their community spirit. When an Indian and his family moved to a camp site on a lake or river, they always girdled a few more trees than they would use for firewood so that there would be a plentiful supply of dry standing timber for future visitors to the camp.
They lived in a country in which grizzly bears were common. Their pelts were highly prized and they captured many of them with baited pitfalls. Their knowledge of the use of different organs and tissues of the animals for providing a defense against certain of the affections of the body which we speak of as degenerative diseases was surprising. When I asked an old Indian, through an interpreter, why the Indians did not get scurvy he replied promptly that that was a white man’s disease. I asked whether it was possible for the Indians to get scurvy. He replied that it was, but said that the Indians know how to prevent it and the white man does not. When asked why he did not tell the white man how, his reply was that the white man knew too much to ask the Indian anything. I then asked him if he would tell me. He said he would if the chief said he might. He went to see the chief and returned in about an hour, saying that the chief said he could tell me because I was a friend of the Indians and had come to tell the Indians not to eat the food in the white man’s store. He took me by the hand and led me to a log where we both sat down. He then described how when the Indian kills a moose he opens it up and at the back of the moose just above the kidney there are what he described as two small balls in the fat. These he said the Indian would take and cut up into as many pieces as there were little and big Indians in the family and each one would eat his piece. They would eat also the walls of the second stomach. By eating these parts of the animal the Indians would keep free from scurvy, which is due to the lack of vitamin C. The Indians were getting vitamin C from the adrenal glands and organs. Modern science has very recently discovered that the adrenal glands are the richest sources of vitamin C in all animal or plant tissues. We found these Indians most cooperative in aiding us. We, of course, had taken presents that we thought would be appreciated by them, and we had no difficulty in making measurements and photographs, nor, indeed, in making a detailed study of the condition of each tooth in the dental arches. I obtained samples of saliva, and of their foods for chemical analysis. A typical Indian family in the big timber forests in shown in Fig. 15.
FIG. 15. This typical family of forest Indians of Northern Canada presents a picture of superb health. They live amidst an abundance of food in the form of wild animal life in the shelter of the big timber.
The condition of the teeth, and the shape of the dental arches and the facial form, were superb. Indeed, in several groups examined not a single tooth was found that had ever been attacked by tooth decay. In an examination of eighty-seven individuals having 2,464 teeth only four teeth were found that had ever been attacked by dental caries. This is equivalent to 0.16 per cent. As we came back to civilization and studied, successively, different groups with increasing amounts of contact with modern civilization, we found dental caries increased progressively, reaching 25.5 per cent of all of the teeth examined at Telegraph Creek, the point of contact with the white man’s foods. As we came down the Stikine River to the Alaskan frontier towns, the dental caries problem increased to 40 per cent of all of the teeth.
Careful inquiry regarding the presence of arthritis was made in the more isolated groups. We neither saw nor heard of a case in the isolated groups. However, at the point of contact with the foods of modern civilization many cases were found including ten bed-ridden cripples in a series of about twenty Indian homes. Some other affections made their appearance here, particularly tuberculosis which was taking a very severe toll of the children who had been born at this center. In Fig. 16 are seen two typical cases of tubercular involvement of glands of the neck. The suffering from tooth decay was tragic. There were no dentists, no doctors available within hundreds of miles to relieve suffering.
FIG. 16. At the point of modernization including the use of the foods of modern commerce, the health problem of the Indians is very different. These modernized Indian children are dying of tuberculosis which seldom kills the primitives.
The physiques of the Indians of the far north who are still living in their isolated locations and in accordance with their accumulated wisdom were superb. There were practically no irregular teeth, including no impacted third molars, as evidenced by the fact that all individuals old enough to have the molars erupted had them standing in position and functioning normally for mastication. The excellence of the dental arches is shown in Fig. 17. Where the Indians were using the white man’s food tooth decay was very severe, as shown in Fig. 18. In the new generation, after meeting the white civilization and using his foods, many developed crooked teeth, so-called, with deformed dental arches, as seen in Fig. 19.
FIG. 17. Wherever the Indians were living on their native foods, chiefly moose and caribou meat, their physical development including facial and dental arch form was superb with nearly complete immunity to dental caries. These two women and two girls are typical.
FIG. 18. Wherever the Indians had access to the modern foods of commerce the dental conditions were extremely bad. These four individuals are typical.
FIG. 19. The blight of the white man’s commerce is seen everywhere in the distorted countenances of even the first generation after the adoption by the parents of the foods of modern commerce. These young people with their deformed dental arches are typical. Note the faulty development of the facial bones as evidenced by the narrow nostrils and crowded teeth.
Contact was also made with representatives of relatively isolated primitive Indian stocks in the district south of Hudson Bay. These groups were reached by a newly projected railroad extending eastward and northward from Winnipeg, Manitoba, and we were thus brought into contact with the Indians that had come out of the waterways draining the Hudson Bay and from as far north as James Bay. They had come down to dispose of their furs in exchange for ammunition, blankets, etc. Since this contact was made only once or twice a year, it was quite impossible for the Indians to carry back a sufficient quantity of the foods of the white man to have great influence on their total diet for the year. They still lived on the wild animal game of the land. As in the northern country just reviewed, their principal large animal was the moose. These are treaty Indians, and many of them come out to this frontier to obtain the government bounty and, accordingly, were obliged to bring their families. The bounty here amounted to five dollars per head, a considerable income in exchange for blankets and other equipment. Some of these contact points were at the height of the land dividing the waters running north and east to James Bay and Hudson Bay, or south to Lake Superior. This was historic country that had been the meeting ground of the tribes of the northern waters with the tribes of the Great Lakes district. Many battles had been fought there. For comparison with these more primitive groups from the Hudson and James Bay watershed, I had the opportunity here of studying families that had taken up residence along the railroad or in its vicinity in order that they might have the advantage of exchanging furs for the modern white man’s foods. This gave us an excellent opportunity to study the effects of the modern dietary, of which an example is shown in Fig. 20. This Indian and his wife had built their bodies before the contact with the white man. He is about six feet tall. Both the parents had splendid dental arches and well formed faces. His teeth are shown in Fig. 20 (upper, left). Their two children shown in the photograph were born after the adoption of the white man’s foods brought in by the railroad. Both are mouth-breathers and both have narrow dental arches and marked underdevelopment of the middle third of the face. The older girl has tuberculosis. Another adult man is shown in Fig. 20 (upper, right). He, like the generation he represents, has exceptionally fine dental arches and well developed face.
FIG. 20. These primitive Indians are in central Canada. The three parents were developed before their district was reached by modern civilization. Note their good physical and facial form in contrast with the pinched nostrils of the two children. The oldest girl has tuberculosis. They are the product of civilization’s contact with their primitive parents.
At this point we again found many of the younger generation ill with tuberculosis or crippled with arthritis. Two of these are shown in Fig. 21
FIG. 21. These are typical cripples met at the point of contact of our modern civilization with the primitive Indians. The boy at the left has arthritis in nearly all of his joints. He has several abscessed teeth. The boy at the right has tubercul sis of the spine.
For further comparison of the more isolated and more highly modernized groups a study was made of the Indians in the largest single Indian Reservation in Canada, which is located at Brantford, Ontario. In this group there are about 4,700 Indians living under highly modernized conditions provided by the Canadian Government. They live on very fertile land and in close proximity to a modern Canadian city. Each head of a family is provided with a tract of land from which he usually has an income sufficient to permit him to have an automobile. They were able to buy not only necessities and comforts according to the modern standards of the white man, but many of the luxuries as well. The government provides a well administered hospital and staff. When I asked the Director of this hospital, Dr. Davis, what the principal use of the hospital was at that time (1933), he said that the demand for beds had completely changed in the twenty-eight years he had been there. The principal services requested at the hospital in 1933 related to the problems of maternity. He stated that in his period of contact he had seen three generations of mothers. The grandmothers of the present generation would take a shawl and either alone or accompanied by one member of their family retire to the bush and give birth to the baby and return with it to the cabin. A problem of little difficulty or concern, it seemed. He stated that today the young mothers of this last generation are brought to his hospital sometimes after they have been in labor for days. They are entirely different from their grandmothers or even mothers in their capacity and efficiency in the matter of reproduction. He stated that that morning he had had two cases in which surgical interference was necessary in order to make birth possible.
We had an opportunity here to study the effects of modernization. Indians are great lovers of sports, particularly of their own national game which is lacrosse. We were able to witness one of these contests with a team from another reservation. Indian families came in modern automobiles dressed in modern clothes and purchased pop and candy and modern confections at typical confection stands. These were highly modernized Indians.
The group on this reservation, comprising approximately four thousand seven hundred Indians, belong to the following tribes: Mohawks, Onondagas, Cayugas, Senecas, Oneidas and Delawares making up the Six Nation or Iroquois group. A later addition to this group has been the Tuscaroras from the Carolinas. While there were many mixed bloods, there were also a goodly number of full-blooded Indian families, so that there was an opportunity to study comparatively the effects of intermingling of the Indians with the whites. As in previous investigations, a special effort was made to study the children from eight to sixteen years of age. Typical cases were selected from different environments. For example, boys and girls selected from a training school called Mohawk Institute, which was near the city of Brantford, represented one type of environment. There are approximately one hundred and sixty students under training here, and we were informed that they study half a day and work half a day. The boys are taught craftsmanship and farming, the girls, home economics and garment making, and such practical training as would prepare them for later home building. While most of the boys and girls come from that reservation, a few are accepted from other reservations. It is of interest that 77 per cent of the children in this Institution had suffered from earlier dental caries and that 17 per cent of all the teeth examined had already been attacked by dental caries. But this had occurred apparently before their entrance to the Institute, for we did not find a single case of active caries among those examined, and this is particularly important in connection with their excellent nutrition. The Institute maintained a fine dairy herd and provided fresh vegetables, whole wheat bread, and limited the sugar and white flour.
The children of this group were compared with children of approximately the same age in a public school of the reservation where it was found that 90 per cent had had dental caries, and that at present in 70 per cent of the cases the caries was apparently active. It is important to note that in this group 28.5 per cent of all the teeth examined had already been attacked by tooth decay.
A study was made of patients at the reservation hospital where free service of all kinds is provided. We found that 83 per cent had suffered from dental caries, and that 23.2 per cent of all teeth had already been attacked by caries.
We were particularly interested in the conditions obtaining in the homes, especially with the mothers. A typical young mother had approximately half her teeth attacked by dental caries, as had also her son, aged seven. The middle third of his face was underdeveloped and all of his upper anterior teeth were decayed to the gum line.
A study was made of an Indian reservation in New York State for comparison and for making an estimate of typical modern American Indian life with regard to dental caries and nutrition. For this study a band of 450 in the Tuscarora Reservation northeast of Niagara Falls was visited. Here again we were fortunate to see the people in holiday mood since the study was made on Decoration Day and events of the year had been scheduled, a lacrosse match and a baseball game, between the Indians’ teams and white teams from adjacent towns. Several hundred Indians were congregated to exhibit their best in wearing apparel, transportation equipment, and physical prowess. There was evidence of a similarity of features in the older Indians who had not been highly modernized, and a striking deficiency in the facial development of many of the moderns.
A typical mother was studied at her home. She had four children. Her teeth were ravaged by dental caries. She was strictly modern, for she had gold inlays in some of her teeth. The roots of the missing teeth had not been extracted. Twenty of her teeth had active dental caries. Her little girl, aged four, already had twelve very badly carious teeth. Another daughter aged eight had sixteen carious teeth, and her son aged ten had six. The husband was in bed from an acute lung involvement, doubtless tuberculosis. The children were eating their noon day meal when we arrived, which consisted of a white bread and some stewed vegetables. Milk was available for only the small baby in arms. In this Tuscarora group 83 per cent of those examined had dental caries and 38 per cent of all teeth had already been attacked by dental caries. Every one studied in this reservation was using white-flour products, none were using milk liberally, and only a few in even limited amounts. I was told that in both reservations a few years ago the Indians grew wheat and kept cows to provide a liberal supply of natural cereal and milk for their families, but of late this practice had been discontinued. They were now buying their wheat in the form of white flour and their vegetables largely put up in cans. In both reservations they were using commercial vegetable fats, jams and marmalades, sweetened goods, syrups and confections very liberally. It is remarkable how early the child life adopts modern civilization’s confections.
In order to provide a further cross section of the modernized Indians of North America, I made a study in a reservation on Winnipeg Lake in Manitoba. This reservation lies north and east of Winnipeg and is quite highly modernized.
These people were reached with much difficulty because of the natural protection provided by the location of their reservation at the mouth of Brokenhead River. They had been provided with fertile lands and taught modern methods of farming. Their proximity to a great body of water fairly well-stocked with fish gave them an opportunity to secure fish, if they were disposed to make the effort to do so, as their ancestors had done through previous centuries. Their homes were found to be in a dilapidated condition, and while their lands were stocked with cattle and horses, such as we found were in poor condition, and limited in number. The people had been provided with a government school and a government agent to assist in providing for their needs and in giving material assistance when needed. They were within fairly easy distance of hospitals, and had available modern medical service. Notwithstanding all these advantages, their physical condition was very poor. Dental caries was so wide-spread that 39.1 per cent of all teeth studied were found to be affected. They were living almost entirely on modern foods, imported white flours, jams, canned vegetables and liberal quantities of sugar. Over 90 per cent of the individuals had rampant dental caries. Their physical condition and their supply of necessities was very much lower than was that of either of the two preceding groups. Distress was evident even in late summer.
The Indians so far reported were living inland with access to inland foods only. The Pacific Coast Indians were examined to determine the effect of sea foods. To find evidence relating to the physical, and particularly to the dental condition of the Indians who inhabited the Pacific slope a thousand or more years ago, a visit was made to the Vancouver Museum at Vancouver which fortunately possesses splendidly preserved specimens of prehistoric periods. Some of these skulls were uncovered while cutting through a hill for a street extension in the city of Vancouver. Above was a virgin forest of large size green firs and underneath them in the soil there were preserved fallen trunks of other large trees. Several feet below these, burials were uncovered containing skeletons of an early Indian race. This collection contains also skulls from several places and from prehistoric periods. The teeth are all splendidly formed and free from dental caries. The arches are very symmetrical and the teeth in normal and regular position.
It was important to study the conditions of their successors living in the same general community. Accordingly, we examined the teeth and general physical condition of the Indians in a reservation in North Vancouver, so situated that they have the modern conveniences and modern foods. In this group of children between eight and fifteen years of age, 36.9 per cent of all the teeth examined had already been attacked by dental caries. No people were found in this group who were living largely on native foods.
Vancouver Island with its salubrious climate is one of the most favored places of residence on the Pacific Coast. It was of particular interest to study the Indians near Victoria on this island in the Craigflower Indian Reservation. Indeed, the city of Victoria has been partly built on the original Craigflower Indian Reservation. As the need became acute for the territory reserved for them, an arrangement was consummated whereby the Indians were induced to exchange that land for new land in an adjoining district in which a new house was built free for each family. Besides a house, an allotment of land and a sum of money, reported to be ten thousand dollars, was given to each family. This allowed them to become very modern, and, accordingly, many of them owned automobiles and other modern luxuries. The physical effects of the use of food luxuries, resulting from ample funds for purchasing any foods that they might desire, was marked. They were in close proximity to skilled dental service and had practical training in oral prophylaxis. Notwithstanding this, 48.5 per cent of all teeth examined had already been attacked by dental caries. Every individual examined was suffering from tooth decay. The original diet of the Indians of the Pacific Coast was, as we shall see, very largely sea foods, which are probably as abundant today as ever before. It would require a real urge to go to catch the fish since they can now be purchased canned in the open market. Like most modern people, they were living on white-flour products, sweet foods and pastries.
Probably few cities of the Pacific Coast have had a greater abundance and variety of edible sea foods, particularly the various kinds of salmon, than Ketchikan. It is beautifully located on an island, and is the most southerly city in Alaska. Among the many fish that are abundant along this part of the Pacific Coast is the oolachan or candle fish. It is a small fish, but very rich in oil; so much so that it gets its name from being burned as a candle for light. This oil is collected in large quantities and used as a dressing for many of their sea foods. It is also traded with the Indians of the interior for furs and other products. An Indian settlement in this city was studied and it was found that 46.6 per cent of all teeth examined had already been attacked by tooth decay. In many of the homes individuals were ill with tuberculosis or arthritis. Tuberculosis had robbed many of the homes of one or more of its children.
At Juneau, the capital of Alaska, two groups were studied; one in the government hospital, and the other in an Indian settlement. In the hospital were both Indians and Eskimos, chiefly the former. Seventy-five per cent of the patients were reported to have been brought because they had tuberculosis, and some who had come because of accident and other conditions were reported to have tuberculosis also. Approximately 50 per cent of the total hospital enrollment was under 21 years of age. The dental conditions were bad, for 39.1 per cent of all the teeth examined had been attacked by tooth decay.
In the Indian settlement, a group of elderly primitives was found, every one of whom had complete dentitions in normal arrangement of the arches and without dental caries. In a settlement of modern Indians living principally on modern foods 40 per cent of all teeth had been attacked by tooth decay.
At Sitka, the former capital, two important groups were studied. Located here is the Sheldon Jackson School for Eskimos and Indian boys and girls, chiefly Indians. They have come from widely scatterd territory throughout Alaska, and represent the finest physical specimens that can readily be secured for giving the advantages of an education. Of necessity they came very largely from the modernized districts. In this group 53.7 per cent of all the teeth examined had already been attacked by tooth decay. This gives an indication of the dental conditions in the large number of modernized districts which they represented.
In a settlement at Sitka, a group of Indians of various ages were studied, and it was found that 35.6 per cent of all their teeth had already been attacked by dental caries. A well preserved native Indian, seventy years of age, was found who had come into town from another district. He stated that his diet had consisted chiefly of fish, fish eggs, seaweed and deer. His teeth were of very high excellence and were entirely free from past or present dental caries. He is a splendid example of the product of the native dietary provided for the Pacific Coast people of any period or stage of civilization.
The local physician at Sitka kindly gave very valuable information relative to the attitude of the native Indians in the matter of obtaining fresh sea foods when foods that were very satisfying could be so easily obtained in concentrated form at the various stores. They could go to one of the piers at almost any time of the year and catch fish or secure them as they had been accustomed to do before the arrival of modern foods, but there is a constant striving to be like and live like the white people. They seem to think it is a mark of distinction to purchase their foods and that it is degrading to have to forage for one’s foods. They very readily come to depend on white flour and sugar, jams and canned vegetables; and much prefer to have the government or charitable organization supply these when they cannot purchase them, rather than go out and secure their own nutrition. This physician stated that there were about 800 whites living in the town and about 400 Indians, and that notwithstanding this difference in numbers there were twice as many Indian children born as white children, but that by the time these children reached six years of age there were more white children living than Indian and half-breed children. This he stated was largely due to the very high child mortality rate, of which the most frequent cause is tuberculosis. While it does not take many decades to record a distinct physical deterioration, a deteriorating parenthood greatly speeds up this process. While physical defects acquired by the parent will not be transmitted as such, prenatal deficiencies may be established because of the physical defects of the mother resulting from her faulty nutrition, and these deficiencies, together with disturbed nutrition of infancy and early childhood will go far in determining whether there will be for the child a physical breakdown or whether the normal defense of the body will be adequate to protect it from various infections to which it may later be exposed.
Sitka has furnished the longest history of contact with white men of almost any community on the Pacific Coast. Indeed, it was a famous seaport long before any United States Pacific Coast communities had been established. It is of much interest that it was a shipbuilding center for vessels in the Russian trade. Its foundries were developed so efficiently that the bells of the early monasteries of California were cast in this town by the Russians. It contains some of the best examples of the early Russian architecture, particularly in its cathedral.
Anchorage is the principal city of western Alaska, since it is not only a base for the railroad running north to Fairbanks, but a base for aeroplane companies operating throughout various parts of Alaska. It is accordingly a combination of a coast city with its retail activities and a wholesale base for outfitters for the interior. It has an excellent government hospital which probably has been built around the life of one man whom many people told us was the most beloved man in all Alaska. He is Dr. Josef Romig, a surgeon of great skill and with an experience among the Eskimos and Indians, both the primitives and modernized, extending over thirty-six years. I am deeply indebted to him for much information and for assistance in making contacts. He took me, for example, to several typically modernized Indian homes in the city. In one, the grandmother, who had come from the northern shore of Cook Inlet to visit her daughter, was sixty-three years of age, and was entirely free from tooth decay and had lost only one of her teeth. Her son, who had accompanied her, was twenty-four years of age. He had only one tooth that had ever been attacked by tooth decay. Their diet had been principally moose and deer meat, fresh and dried fish, a few vegetables and at time some cranberries. Recently the son had been obtaining some modern foods. Her daughter, twenty-nine years of age, had married a white man and had had eight children. She and they were living on modern foods entirely. Twenty-one of her thirty-two teeth had been wrecked by dental caries. Their diet consisted largely of white bread, syrup and potatoes. Her children whom we examined ranged from five to twelve years of age, and in that family 37 per cent of all the teeth have already been attacked by dental caries, notwithstanding the young age of the children. The mother of this family is shown in Fig. 18 (upper, left). It is of great importance that not only was dental caries rampant, but that there were marked deformity of the dental arches and irregularity of teeth in the cases of the children.
Among the many items of information of great interest furnished by Dr. Romig were facts that fitted well into the modern picture of association of modern degenerative processes with modernization. He stated that in his thirty-six years of contact with these people he had never seen a case of malignant disease among the truly primitive Eskimos and Indians, although it frequently occurs when they become modernized. He found similarly that the acute surgical problems requiring operation on internal organs such as the gall bladder, kidney, stomach, and appendix do not tend to occur among the primitive, but are very common problems among the modernized Eskimos and Indians. Growing out of his experience, in which he had seen large numbers of the modernized Eskimos and Indians attacked with tuberculosis, which tended to be progressive and ultimately fatal as long as the patients stayed under modernized living conditions, he now sends them back when possible to primitive conditions and to a primitive diet, under which the death rate is very much lower than under modernized conditions. Indeed, he reported that a great majority of the afflicted recover under the primitive type of living and nutrition.
The institutions that have been organized for the care of orphans and for the education of Eskimo and Indian boys and girls provide an opportunity to study conditions. A particularly favorable institution is located at Eklutna on the railroad north of Anchorage. Many of the individuals in the school had come from districts so remote from transportation facilities that their isolation had compelled them to live mostly on native foods, at least during their early childhood. They had come from districts very widely distributed throughout the Alaskan peninsula. Credit is due to the management of this institution for preparing and storing dried salmon for use throughout the winter. The beneficial effects of their good nutritional program were evident. The percentage of teeth attacked by dental caries was 14.6. A large percentage of these pupils were of mixed blood of native Eskimos or Indians with whites. The white parent had probably been largely responsible for their attendance at this training school. There were several full-blooded Eskimos and Indians from modernized communities where they had been living on modern foods throughout their entire lifetime. This gave an opportunity to study the rôle of nutritional deficiencies in the development of deformities and irregularities in the facial features, in the arrangement of the teeth, and in the inter-relationship between the dental arches. The typical irregularities and divergencies from normal were present in the full-blooded Eskimo and Indian boys and girls in as high percentage as in the mixed bloods. Some of the young people with parentage of mixed blood have beautiful features.
Another important institutional group was studied at Seward in the Jesse Lee Home which had first been established at Nome and had been moved to Seward to avoid the extreme isolation of that district. This institution is located at Resurrection Bay which is one of the most beautiful harbors in the world. It gives shelter and educational opportunities to Eskimos and Indians, chiefly of mixed blood, from a large area of Alaska, and particularly from the Aleutian Peninsula, the Aleutian Islands and the Bering Sea. These individuals, whether of mixed or pure blood, had come chiefly from homes that were in large part modernized. The incidence of dental caries found here was 27.5 per cent for all teeth examined. Here again all individuals were affected. Notwithstanding the unusually fine hygienic conditions and highly trained dietitians of this institution, a medical ward and trained nurses, tuberculosis was reaping a heavy toll. I was told that 60 per cent of all those students who had moved with the school from Nome to this location were already dead from tuberculosis. It is common knowledge that tuberculosis has played a very important rôle in decimating the Indian and Eskimo population in the Pacific Coast towns and villages. A very important phase of these investigations is the development of new light on the rôle of nutrition in lowering the defense of these individuals so that with their low inheritance of defensive factors they rapidly become susceptible to tuberculosis.
The problem of evaluating the influence of a particular environment on racial and tribal development is relatively simple when studying contemporary remnants of primitive racial stocks. However, groups that have lived and disappeared in the past do not permit of so simple a procedure for making physical estimates. Fortunately, we have in the burial grounds not only the skeletons, but also many of the implements used in daily life. Sometimes these contain samples of the foods. We may find also their art ware and hunting equipment. While the period may not be definitely recorded, the knowledge of the history of the pottery of the tribe often gives an important clue to the dates as will also the method of burial. Burials made before the advent of the Christian era will in many groups show the bodies in a flexed position with the arms in the lap, whereas in the Christian burials the bodies have been laid prone and the arms crossed on the chest. By this sign the pre-Columbian burials can readily be separated from the post-Columbian.
Using these guides, a study of the Indians of Florida, past and present, permits of comparing the pre-Columbians with those living today in that same territory. We will, accordingly, consider the dental caries problem and that of facial and dental arch form in the Florida Indians by comparing three groups: namely, the pre-Columbian, as evidenced from a study of the skull material in the museums; the tribes of Indians living in as much isolation as is possible in the Everglades and Cypress Swamps; and the Indians of the same stock that are living in contact with the foods of modern civilization. This latter group lives along the Tamiami trail and near Miami. In a study of several hundred skulls taken from the burial mounds of southern Florida, the incidence of tooth decay was so low as to constitute an immunity of apparently one hundred per cent, since in several hundred skulls not a single tooth was found to have been attacked by tooth decay. Dental arch deformity and the typical change in facial form due to an inadequate nutrition were also completely absent, all dental arches having a form and interdental relationship such as to bring them into the classification of normal. These are illustrated in Figs. 22 and 23. The problem of reaching the isolated groups living in the depth of the Cypress Swamps was complicated by the fact that these people had a dread of all whites growing out of their belief that they had been grossly taken advantage of in some of their early efforts to make a treaty with the whites. With the assistance of three guides, one, an Indian of their own group, another, a white man whom they trusted, and the third, a government nurse who had been very helpful in case of sickness, we were able to take the desired measurements and records and photographs. A group of these more primitive representatives is shown in Fig. 24. While their hunting territory had been grossly encroached upon by the white hunters, they were still able to maintain a very high degree of physical excellence and high immunity to dental caries. Only four teeth in each hundred examined were found to have been attacked by tooth decay.
FIG. 22. Skulls of primitive Indians showing superb dental arches typical of Nature’s normal plan. Note the splendid position of the third molars which are so frequently defective in position and quality in our modern white civilization. In many districts where I have made studies among primitive Indians and in many collections of their skulls close to a hundred per cent of the teeth have been free from dental caries or faulty position.
FIG. 23. The Indian skulls that have been uncovered in many parts of the United States and Canada show a degree of excellence comparable to those seen in this Figure. These levels of excellence were the rule with them, not the exception as with us. The parents of these individuals knew what they and their children should eat!
FIG. 24. The Seminole Indians living today in southern Florida largely beyond contact with the white civilization still produce magnificent teeth and dental arches of which these are typical. They live in the Everglade forest and still obtain the native foods.
Practically all of the dental arches were normal in contour with freedom from facial distortion. In contrast with this, the Indians of Florida who are living today in contact with modern civilization present a pathetic picture. Forty out of every hundred teeth examined were found to have been attacked by tooth decay, typically illustrated in Fig. 25. In the latest generation, many dental arches showed a typical deformation with crowding of the teeth and narrowing of the face, conditions that have been found in all human stocks when on an inadequate nutrition during the formative and early growth period. A group of these is typically illustrated in Fig. 26.
FIG. 25. The Seminole Indians of Florida who are living in contact with our modern civilization and its foods suffer from rampant dental caries.
FIG. 26. Seminole Indians. Note the change in facial and dental arch form in the children of this modernized group. They have a marked lack of development of the facial bones with a narrowing of the nostrils and dental arches with crowding of the teeth. Their faces are stamped with the blight which so many often think of as normal because it is so common with us.
It is of interest that the quality of the skeletal material that is taken from the mounds showed unusually fine physical development and freedom from joint involvements. In contrast with this, many of the individuals of the modernized group were suffering from advanced deformities of the skeleton due to arthritic processes.
The effects of the excellent nutrition of the pre-Columbian Indians is indicated in the comparative thickness of the skulls. In Fig. 27 are shown two pieces of a pre-Columbian skull in contrast with a modern skull. The specimen of a trephined lower jaw, shown in Fig. 27 (right) indicates a knowledge of surgery that is very remarkable. The margins show new bone growth. The operation opened a cyst.
FIG. 27. Left: Example of greater thickness of pre-Columbian Indian skulls in Florida than modern skulls. Right: Illustration of bone surgery of ancient Florida Indians. Note healing of margins of trephined opening into a cyst, of the lower jaw. This is typical of the advanced surgery of the Peruvian Indians.
For the study of a group of Indians now living in a high western state, Albuquerque, New Mexico, was visited.
Several other Indian studies have been made including studies of living groups, recently opened burials and museum collections, all of which support the findings recorded here. I am indebted to the directors and to the staffs of these institutions for their assistance.
Notwithstanding the wide range of physical and climatic conditions under which primitive Indians had been living, their incidence of tooth decay while on their native foods was always near zero; whereas, the modernized Indians of these groups showed very high incidence of dental caries. A summary of percentages follows: Primitive Indians: Pelly Mountain, 0.16 per cent; Juneau, 0.00 per cent; Florida Pre-Columbian, 0.00 per cent; Florida Seminoles, 4.0 per cent. Modernized Indians: Telegraph Creek, 25.5 per cent; Alaska Frontier, 40.0 per cent; Mohawk Institute, 17 per cent; Brantford Reservation Public School, 28.5 per cent; Brantford Reservation Hospital, 23.2 per cent, Tuscarora Reservation, 38.0 per cent; Winnipeg Lake Reservation, 39.1 per cent; North Vancouver Reservation, 36.9 per cent; Craigflower Indian Reservation, 48.5 per cent; Ketchikan, 46.6 per cent; Juneau Hospital, 39.1 per cent; Sheldon Jackson School, 53.7 per cent; Sitka, 35.6 per cent; Eklutna, 14.6 per cent; Jessie Lee Home, Seward, 27.6 per cent, and Florida Seminoles, 40.0 per cent.
The foods used by the primitives varies according to location and climate. The foods of the modernized groups in all cases were the typical white man’s foods of commerce.
While the primitive groups constantly presented well-formed faces and dental arches reproducing the tribal pattern, the new generation, after the adoption of white man’s foods, showed marked changes in facial and dental arch form.
The Indians like several primitive races I have studied are aware of the fact that their degeneration is in some way brought about by their contact with the white man. The dislike of the American Indian for the modern white civilization has been emphasized by many writers. In my studies among the Seminole Indians of Florida I found great difficulty in communicating with or making examination of the isolated Seminoles living deep in the Everglades and Cypress Swamp. Fortunately, I had the able assistance of one of their own tribe, a government nurse who had been very helpful to them and also a white man who had befriended them and whom they trusted. With their assistance I was able to carry out very detailed studies. It was of interest, however, that when we arrived at a settlement in the bush we practically always found it uninhabited. Our Indian guide would go into the surrounding scrub and call to the people assuring them it was to their advantage to come out, which they finally did. I was told that this attitude had grown out of the belief on their part that their treaties had been violated. These isolated Seminole Indian women had the reputation of turning their backs on all white men.
A United States Press report (1) provides an article with the heading “Tribes ‘Fed Up’ Seek Solitude, Indians Dislike Civilization, Ask Land Barred to White Men.” The article continues:
It will be most fortunate if in the interest of science and human betterment such a program as this will be carried out in order to permit these Indians to live in accordance with the accumulated wisdom of their various tribes. Their preservation in isolation would preserve their culture. The greatest heritage of the white man today is the accumulated wisdom of the human race.
(to be completed, see also here)
(I had not realised when I uploaded this that it is not complete as per the link above the whole book is available at Project Gutenberg. I will find time to get a copy from them for inclusion here in due course.)