Eskimo

William A. Thomas, M.D. of Chicago, finding no elevation of blood pressure and rarely any evidence of renal disease in the examination of 142 Eskimos, concluded that a carneous diet under strenuous living conditions does not produce renal or vascular disease.

​

Thomas found no rickets or scurvy among the Greenland Eskimos, but a large incidence of these diseases among the Labrador Eskimos who live mostly on preserved food including dried potatoes, flour, canned foods, and cereals.

​

"In view of the present trend of thought away from the former conception of nephritis as a purely renal disease, and bearing in mind particularly the revision of attitude toward the rôle of protein, especially of animal origin, in the production of renal and vascular disease, I considered it worth while to make a cardiovascular and renal survey of a group of people subsisting exclusively on meat. The opportunity presented itself during the MacMillan arctic expedition of 1926, where we were in close contact with the Eskimos of northern Labrador and of Greenland.

Furthermore, since the vitamins have assumed a position of such medical and economic importance, and their sources are as yet not wholly understood, evidences of scurvy and rickets were sought and an examination was made of food sources and of food composition and preparation when these conditions were found."

As early as 1927 and 1928, an influenza epidemic killed half the Inuit population of Bernard Harbour. The onset of this epidemic coincided with the arrival of the HBC supply ship Baychimo, which also brought the Reverend J. Harold Webster, who converted many of the Inuit of the Holman-Coppermine region to the Anglican faith. Other fatal epidemics occurred throughout the 1930s, 1940s, and 1950s. Tuberculosis, especially, was a chronic health problem from the early 1930s until the 1970s.

From the 1930s, tuberculosis was one of the major illnesses affecting all of the Inuit, throughout the Canadian Arctic. Systematic tuberculosis X-ray surveys, however, did not begin in the Holman-Coppermine region until the spring of 1953. After 1953, these surveys, carried out by plane throughout the Kitikmeot region, were an annual event, taking advantage of the usually good spring traveling conditions and the, by then, deploy ingrained habit of the Inuit to gather for a couple of weeks around the missions and trading posts at Easter (Dr. Otto Shaefer, personal communication). Patients found to have advanced tubercular infections were flown out immediately to TB sanatoria, first in Aklavik, and later to Sir Charles Camsell Hospital in Edmonton.

It is well known that in most human subjects ketosis appears -when the material metabolized becomes restricted to protein and fat. This condition is observed after several days of fasting, on diets deficient in carbohydrate, and in diabetes in consequence of the loss of ability to metabolize carbohydrate. These facts have led to the view that a certain minimum combustion of carbohydrate is necessary to avoid ketosis. The diet of the Eskimo has long been recognized as an apparent exception to this view. Being restricted almost wholly to animal tissues and containing therefore ,only a very small proportion of carbohydrate, such a diet might be expected to produce a ketosis. Similar diets fed to human subjects of temperate zones do so. Although the fact appears not to have been investigated, it has been assumed that Eskimos do not exhibit ketosis on their customary diets. To account for this assumed fact it has been suggested that the Eskimos must possess an adaptation to non-carbohydrate diet. In his analysis of the ketogenic and antiketogenic factors, the balance between which seems to determine the appearance or non-appearance of ketosis, Shaffer (1) has considered the Eskimo ,dietary, using the data reported by Krogh (2). According to his analysis the metabolism of the foodstuffs contained in the Eskimo dietary would not be expected to cause ketosis, because the calculated antiketogenic effect of the large protein ingestion was somewhat more than enough to offset the ketogenic effect of fat plus protein. In an effort to obtain more definite information as to the carbohydrate metabolism of the Eskimos and their liability to ketosis, the writer undertook, at Dr. Shaffer’s suggestion, the experiments here reported. The observations were made in July and August, 1927, upon Bapin Island Eskimos, the writer being a member of the Putnam Baffin Island Expedition.

The Eskimo in his natural state eats practically only flesh.

Two normal men volunteered to live solely on meat for one year, which gave us an unusual opportunity of studying the effects of this diet. The term “meat,” as used by us, included both the lean and the fat portions of animals. The subjects derived most of their calories from fat and the diet was quite different from what one, who uses the term “meat” as including chiefly lean muscle, would expect. Rubner called attention to the fact that a man cannot live on meat alone because of the physical limitation of the apparatus of mastication. He was evidently considering only lean meat as fat offers little difficulty. It is well known that the Eskimos have lived on an almost exclusive meat diet for generat.ions. Certain explorers in the North also have subsisted for long periods on meat. Dr. Vilhjalmur Stefansson in particular has demonstrated that it is feasible for travelers in the arctic region to “live off the country,” which means living on meat alone. The experiences of Stefansson and his companions have been given in his book “The Friendly Arctic”. He spent over 11 years in arctic exploration, during 9 years of which he lived almost exclusively on meat. Stimulated by this experience, Stefansson and Andersen, the latter a member of one of the expeditions, voluntarily agreed to eat nothing but meat for 1 year while they continued their usual activities in the temperate climate of New York.

 Obviously, from the testimony presented so far, the frontier doctors of Alaska and northern Canada would have expected that statistics, if and when published, would confirm their view that the most civilized parts of northern territories would show the highest cancer incidence.

The chance to test this theory against the facts of statistically adequate population, and for a large and culturally differentiated area, did not come until the U.S. Treasury's Public Health Reports for March 2, 1934, carried “Mortality in the Native Races of the Territory of Alaska, with Special Reference to Tuberculosis," by F. S. Fellows, Passed Assistant Surgeon, United States Public Health Service, and Director, Alaska Medical Service.

The discussion by Dr. Fellows does have “special reference to tuberculosis.” But “malignancy" receives a column in the statistical tables, from which we can readily derive the information we need. The time covered is the five years 1926-30; the population, by the 1930 census, was around 60,000, about evenly divided between natives and whites, thus about 30,000 of each. As to causes of death, Dr. Fellows compares natives with whites and each of the four judicial divisions of Alaska with the other three. For my analysis of his cancer results I shall arrange the divisions in descending order of Europeanization. With an eye on the map (p. 91) and bearing history in mind, we may characterize the judicial divisions as follows:

Most intensively and longest civilized is the First Judicial Division, the Panhandle that stretches southeasterly along British Columbia. Its first European contacts were probably with Spain through Mexico in the 1500's. After Bering's voyage in 1741 the capital of Russian America was established at Sitka, where it remained even for some decades after the over-all name was changed to Alaska through purchase by the United States in 1867. Both before and after 1776 Yankee influence was considerable, as was British. After the purchase the influence of San Francisco was at first dominant, until Seattle and Vancouver took over.

Since the forest Indians of the Panhandle have been civilized the longest and most intensively of native Alaskans, the First Judicial Division ought to show the heaviest cancer incidence, according to the views of the frontier doctors whom we have quoted. That is the theory. Let us turn to statistics and seek the facts.

Table 2 of the Fellows paper is entitled “Actual and relative mortality from important causes among the native Indians and Eskimos and among the white population of Alaska during the five years 1926-30.” In the first third of this table, under “Average annual death rate per 100,000,” we find in the column marked “Malignancy” that in the First Judicial Division the white deaths from cancer are 92, the native 70. In the middle third of the table, under “Percent of all deaths due to indicated cause,” we learn that the white percentage from cancer was 7.8, the native 2.8. In the lowest third of the table, under “Number of deaths,” we learn that the whites who died of cancer were 59, the natives 21.

Map showing judicial divisions of Alaska

Historically the Third Judicial Division of Alaska ranks second among the divisions in Europeanization. It consists of the Aleutian island chain and of the southwestern corner of the mainland. Russian influence in the islands dates as far back as in the Panhandle, but the mainland part of the division was never intensively Europeanized. By the Tanchou-Le Conte principle, the native cancer rate should be fairly high but not as high as that of the Panhandle. According to Fellows' Table 2, the cancer figure per 100,000 is 75 for whites and 22 for natives; in percentages the whites rate 6.0 and the natives 1.4; in actual cancer deaths the whites have 33 and the natives 8.

The Second Judicial Division, from its history, should be in native cancer deaths the next to the lowest of the judicial districts, by the frontier theory. According to the tables of Dr. Fellows the per hundred thousand rate is white 126 to native 14; in percentages it is white 10.8 to native 0.8; in actual deaths the white are 9 to the native 6.

The Fourth Judicial Division should be lowest of the four in native cancer deaths. Here the population consists mainly of Athapaskan forest Indians who, except in becoming Christian, have resisted Europeanization much more successfully than either Eskimos or Aleuts, and far more successfully than the natives of the Panhandle.

According to Dr. Fellows the per hundred thousand rate is white 98, native 3; in percentage it is white 8.4, native 0.1; in actual number of cancer deaths the Fourth Judicial has white 27 and native 1.

The medical missionary theorists, those who favor the Tanchou-Le Conte principle, will think that the percentage table (the middle division of Dr. Fellows' Table 2) confirms their belief in most satisfactory fashion. In percentages of all deaths during the five years 1926-30, the cancer rate drops from the highest to the lowest of the districts on the scale as 7.8 to 2.8; 6.0 to 1.4; 10.8 to 0.8; and 8.4 to 0.1.