Health Statistics

It appears to be the impression of most physicians who have had occasion to examine large numbers of Eskimos, that the blood pressure in Eskimos is lower than in normal Whites of corresponding age (P. B. Haggland, M. D. , E. S. Rabeau, M. D. , and E. Albrecht, M. D. , personal communications). Abnormally elevated blood pressures (systolic blood pressure in the order of 170 mm or higher) are apparently quite rare. Thus, in the 213 Eskimo patients who were subject to medical examination by the author during a two-year period in Alaska, the blood pressure was measured in 1 17 cases, and only one of the patients had systolic blood pressure above 145 mm. 

In contrast to this, Saxtorph (quoted by A. Bertelsen, 1940) reported in 1926 that he had seen a considerable number of cases of hypertensio arterial is, both in old and middle-aged Greenland Eskimos. In 12 cases he measured blood pressures between 200 and 240 mm. 

Thomas ( 1927) on the other hand examined 142 Greenland Eskimos, 40-60 years of age, and found the average blood pressure to be 129/76 mm, with a single case of 170/ 1 00. He concluded that hypertension with associated complications is extremely rare among Eskimos. 

Holbeck (quoted by Bertelsen, 1940) has reported that the average systolic blood pressure in Greenland Eskimos, between 40 and 55 years uf age, was 141 in men and 131 in women. According to Bertelsen ( 1940) Svendsen examined, in 1930, the blood pressure of 106 Eskimos taken at random, some of whom had active pulmonary tuberculosis. He made the following findings: 15-30 years of age: 120/70 mm; 30-50 years ()f age: 137/77 mm; 50 years of age or over: 167/82 mm. Bertelsen (1940) concludes, on the basis of his experiences in Greenland, that the average blood pressure does not appear to deviate from that of Whites of corresponding age. 

Probably the most extensive study of Eskimo blood pressure has been reported by Hoygaard (1941). He measured the blood pressure systematically of 283 Angmagssalik Eskimos, South East Greenland, of both sexes, living on their primitive diet, using the standard technique in lying or sitting position at least one hour after exercise. He found no material difference between males and females. Twelve persons out of 283 (4%) had a systolic blood pressure of 150 or higher; only two subjects had as much as 168 mm Hg. (Table 1). He concludes that hypertonia is not common. 

According to MacMillan ( 1951) Or. E. Morse found no instance of high blood pressure among the Thule Eskimos during the Bowdoin's voyage to Greenland in 1950. 

In the case of Canadian Eskimos, Brown (1 951) states with regard to the Southampton Island and the Igloolik Eskimos: "Arterial hypertension has also been found both in the group at Southampton Island and in the group at Igloolik." However, in the 63 Eskimos living in the vicinity of Chesterfield Inlet (30 males and 33 females) examined by Crile and Quiring ( 1939) the average blood pressure in the males (average age 38 years) was: systolic pressure 1 19 mm, diastolic pressure 75. In the females (average age 31 years) the figures were 1 12 and 72 respectively. The average pulse rate was 62-69 in the males and 79-82 in the females. These authors conclude that "the blood pressure for both the males and the females is lower than that of Whites of corresponding age, the pulse rate corresponds rather closely to that of White individuals". 

Heinbecker (193 1) reports an average pulse rate of 64 in 5 Eskimos (4 females and 1 male, 15-50 years of age) from Baffin Island. Bollerud, et at. ( 1950) report an average pulse rate of 58 in their 23 male St. Lawrence Island Eskimos, 17--41 years old. 

In connection with extensive studies on the patho-physiology of Eskimos which were in progress at the Arctic Aeromedical Laboratory as part of a survey of human adaptation to cold, we had an opportunity of recording various physical and physiological measurements during a two-year period 1950-1952. In this paper we are only concerned with blood pressure. pulse rate and age. 

4. Results and Discussion. 

The results from all 104 Eskimo subjects of both sexes are presented in Table 2. The average age is just over 29 years, but the ages vary widely from 3 to 75. However, of the 104 subjects, 73 were between 15 and 40 years old and only 13 were below 15 years. 

From this table it is observed that the pulse rate at rest, when considering the mean figure for all observations in each subject, is 71 beats per minute, but the figures show considerable individual variations. If only the final reading is considered, the mean value is 67 beats per minute, ranging from 44 to 120. The average systolic and diastolic blood pressures in Eskimos of both sexes, when considering the mean values of all readings in each subject, were 110 and 71 respectively. The mean values of the final blood pressure readings obtained when the lower level was established after several repeated examinations, were slightly less, the systolic pressure being 107 and the diastolic pressure 69. The range of these measurements is considerable. 

Thus the resting systolic blood pressure varies from a minimum value of 84 to a maximum value of 140; the diastolic blood pressure varies from 56 to 100. Only one subject, a 14-year old boy, showed as high an average value for the systolic blood pressure as 140. No systolic blood pressure higher than 162 mm was recorded in this series. 80.76 o/c of the recorded systolic blood pressures were below 116 mm. 

Table 3 shows the results of similar measurements in 40 normal white men examined in Alaska by the same investigator. In this material the average age is 23 years. It appears that the figures for pulse rate are very similar to the corresponding figures for Eskimos. The mean figures for blood pressure are higher than in the Eskimos, both in the case of systolic and diastolic pressure, and in the case of both the mean values of all observations as well as in the case of the final values, recorded when the lower level had been established as the result of repeated examinations. It is observed that the figures, both for pulse rate and blood pressure in these White subjects, are lower than the figures published by McKiniay and Walker (1935) for 566 normal white men with a mean age of 23.2 years. The difference is over 5 times the standard error, both in the case of pulse rate and blood pressure. 

The wide range of "normal" variations in blood pressure in Whites, has been emphasized by McKinlay and Walker (1935). According to American sources the average values for systolic pressure in healthy males, as measured in the brachial artery with the individual at rest, vary from 100 to 120 in early manhood, from 125 to 136 in the middle years of adult life, and from 145 to 150 above the age of sixty years. 

The range of individual measurements. however, may show much wider variations. Alvarez, quoted by McKinlay and Walker (1935), found that the systolic blood pressure in 6,000 University students and graduates between the ages of 16 and 40 years may be as low as 85 mm or as high as 190 mm. He concludes that 22 per cent of men have a systolic blood pressure exceeding 140 mm and that one man in every forty has Cl systolic blood pressure higher than 160 ml. According to Diehl and Sutherland (1925), nine per cent of male students, 16-40 years of age, at the University of Minnesota had blood pressures over 140 mm. None of our Eskimo men, 15-40 years old. had mean blood pressures over 140 ml. 

As a rule, the lowest blood pressure readings were obtained at the fourth examination in Whites, but ne,t until the fifth examination in Eskimos. 

McKinlay and Walker (1935) had examined the variability and interrelationship of heart rate, systolic and diastolic blood pressure, pulse pressure and age in healthy men of ages ranging from 16 to 40. They conclude that within the period of life studied, age is not of great importance in determining the level of any of these factors. They find definitely significant, positive relationship between age and both systolic and diastolic blood pressure. but in such a degree as to form anything like a reasonably accurate basis for prediction. They find positive, but not very intimate, association between heart rate and blood pressure. 

In Tables 4, 5 and 6 our data are separated into three age groups: 15-25 years, 26-40 years, and over 40 years old. 

Twenty-five of the male Eskimos were between 15 and 25 years old. the average age being slightly over 21 years in this group. The same number of male Eskimos fell in the second age group: 26-40 years, the average age in this group being 33 years. Only twelve of the male Eskimo subjects were over 40 years old. 

There is no difference in the mean value of all readings in each subject for the 15-25-year-old group as compared with the 26-40- year-old group, but the mean value for the group over 40 years old is higher than the first two groups. The difference is 4 times the standard error, and is therefore probably statistically significant. 

The data for the 29 Eskimo women, divided into the three age groups: 15-25 years old (12 subjects), 26-40 years old (11 subjects), and over 40 years old (6 subjects), are given in Table 5. On the basis of this limited material it appears that the average blood pressure in Eskimo women is somewhat higher than in Eskimo men, but this difference is not statistically significant. There is also a tendency towards increased blood pressure with increasing age in Eskimo women. 

Of the 40 white men, 34 fell into the first age group (15-25 years) and 5 in the second age group (26-40 years) while only one subject was over 40 years old. If we compare these white men with Eskimo men of corresponding age, it is observed that the average blood pressure is slightly higher in Whites than in Eskimos but the difference is too small to be significant statistically (less than 3 times the standard error). The mean of the lowest measured blood pressure in each subject in the first age group is considerably lower in Eskimos than in Whites, however. The difference is about 4 times the standard error, and may be statistically significant. The number of subjects is too small, nevertheless, to allow any definite conclusion to be drawn from this material. 

It should also be noted that a larger proportion of the blood pressure measurements were recorded in the lying position in the Eskimos (70 C,c) than is the case in the Whites (25 o/c) and since the blood pressure tends to be lower in the lying position (Tables 7 and 8), this may partly account for the difference, although the difference between sitting and lying blood pressure in Whites in this material is not significant statistically. Thus, in Whites 15-25 years old, the difference between the means for sitting and lying systolic blood pressure is 5 mm, which is less than twice the standard error, as is also the case when comparing the diastolic blood pressure in the sitting and lying position. However, out of the 24 lowest measured blood pressures in Whites 15-25 years old, 76.47 per cent were measured in the lying pOSitIOn, and of the highest measured blood pressures in the same subjects, 97.06 per cent were measured in the sitting position. It may be noted however that in Eskimos the difference between sitting and lying blood pressure is about 3 times the standard error. 

In Whites 15-25 years old, the mean pulse rate is 72 measured sitting, and only 58 when measured lying. The difference is 4 times the standard error, and may therefore be considered significant in a statistical sense, although the number of observations is very small. The range of the pulse rate measured sitting is 68-86, against 51-67 measured lying.

From Table 10 it appears that the Kotzebue and Gambell Eskimos in the age group 26-40 years have a lower mean blood pressure than the corresponding age groups from Anaktuvuk Pass and Barter Island. The difference between the Gambell and the Anaktuvuk Pass groups (the groups showing the most pronounced difference), as regards the means of the lowest measured blood pressures, is 12 mm, and the standard error is 3.20. Thus, the difference is over three times the standard error. However, the material is too small to allow any conclusion. No significant difference was detected in the blood pressure in Eskimos 15 -25 years old from the 4 different settlements (Table 9). 

5. Summary and Conclusion. 

735 blood pressure and pulse rate measurements were made in a consecutive series of 104 Eskimos (75 males and 29 females) from 4 different Eskimo settlements in Alaska. Similar measurements were made in 40 normal white men for comparison. 

In Eskimos the mean resting systolic blood pressure varied from a minimum value of 84 to a maximum value of 140. No systolic blood pressure higher than 162 mm was ever recorded in our Eskimo subjects. 80 o/c of the recorded systolic blood pressures were below 1 16 mm. The mean diastolic blood pressures varied from 56 to 100. In Eskimos the mean blood pressure is somewhat higher in women than in men of corresponding age although the difference is not statistically significant, and there is a tendency towards increased blood pressure with increasing age. 

In Eskimo men the mean blood pressure was 108/69 at ages 15-40 years, and 119/77 above 40 years of age. In Eskimo women the figures were 111/71 and 122 /74 respectively. When comparing the Eskimo men with white men of corresponding age, it is observed that both the systolic and diastolic blood pressures are lower in Eskimos than in Whites. This difference appears to be statistically significant in the case of the lowest measured blood pressure in each subject in the two groups. The mean pulse rates in Eskimos at rest were not materially different from the corresponding figures for Whites.

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MANY different types of diet have been successfully used to reduce weight in those considered obese. The principle on which most of them are constructed is to effect a reduction of calorie intake below the theoretical calorie needs of the body. Experience with these patients has suggested, however, that this conception may be too rigid. Many of them state that a very slight departure from the strict diet which can hardly affect calorie intake, results in them failing to lose weight for a time. Though it is realised that evidence from such patients is notoriously inaccurate owing to their approach to this particular condition, it is too constant a belief among them to be entirely discarded. Furthermore, most of the diets in common use not only restrict the intake of calories but also radically alter the proportions provided by protein, fat, and carbohydrate. In this country a healthy sedentary person may be supposed to consume some 2200 calories daily, made up of about 70 g. of protein, 60 g. of fat, and 350 g. of carbohydrate : protein supplies 12% of the calories, fat 24%, and carbohydrate 64%. On most reducing diets, however, the carbohydrate and fat will be restricted while the protein remains about the same ; and in a diet yielding 1000 calories protein may provide 30%, fat 37%, and carbohydrate 33%. Finally, Lyon and Dunlop (1932) observed that patients on isocaloric reducing diets lost weight more rapidly when the largest proportion of the calories was supplied by fat than when it was supplied by carbohydrate. Anderson (1944) attributed these findings to the different amounts of salt (causing water retention) in the diets used by these workers. More recently, Pennington (1951, 1954) has recommended high-fat diets in the treatment of obesity. It therefore seemed important to establish which factor has the greater effectrestriction of calories, or alteration in the proportions of MANY different types of diet have been successfully used to reduce weight in those considered obese. The principle on which most of them are constructed is to effect a reduction of calorie intake below the theoretical calorie needs of the body. Experience with these patients has suggested, however, that this conception may be too rigid. Many of them state that a very slight departure from the strict diet which can hardly affect calorie intake, results in them failing to lose weight for a time. Though it is realised that evidence from such patients is notoriously inaccurate owing to their approach to this particular condition, it is too constant a belief among them to be entirely discarded. Furthermore, most of the diets in common use not only restrict the intake of calories but also radically alter the proportions provided by protein, fat, and carbohydrate. In this country a healthy sedentary person may be supposed to consume some 2200 calories daily, made up of about 70 g. of protein, 60 g. of fat, and 350 g. of carbohydrate : protein supplies 12% of the calories, fat 24%, and carbohydrate 64%. On most reducing diets, however, the carbohydrate and fat will be restricted while the protein remains about the same ; and in a diet yielding 1000 calories protein may provide 30%, fat 37%, and carbohydrate 33%. Finally, Lyon and Dunlop (1932) observed that patients on isocaloric reducing diets lost weight more rapidly when the largest proportion of the calories was supplied by fat than when it was supplied by carbohydrate. Anderson (1944) attributed these findings to the different amounts of salt (causing water retention) in the diets used by these workers. More recently, Pennington (1951, 1954) has recommended high-fat diets in the treatment of obesity. It therefore seemed important to establish which factor has the greater effectrestriction of calories, or alteration in the proportions of protein, fat, and carbohydrate in the diet.

Discussion 

If these observations are correct, there seems to be only one reasonable explanation-namely, that the composition of the diet can alter the expenditure of calories in obese persons, increasing it when fat and protein are given, and decreasing it when carbohydrate is given. This is not surprising as regards protein, whose specific dynamic action has long been recognised. It is, however, surprising as regards fat, whose action in this respect seems to be even greater than that of protein. Direct confirmation of such altered metabolism is hard to obtain. The B.M.R., for example, is measured at a time of day and under .other conditions specifically designed to eliminate the effect of diet or reduce it to a minimum. In some patients the B.M.B. was measured at the beginning and at the end of each dietary period. Table vin shows that neither variation in calories nor variation of the composition of the diet with a constant intake of calories significantly changed the B.M.R. during these short dietary periods.

Summary 

1. Loss of weight can be successfully achieved in obese patients by numerous diets, most of which restrict calorie intake. At the same time almost all such diets alter the proportion of protein, carbohydrate, and fat as compared with the normal, restricting carbohydrate and fat in particular. It seemed desirable to investigate which factor was of the greatest importance in weight reduction-calorie restriction or alteration in the composition of the diet. 

2. The rate of weight-loss has been shown to be proportional to the deficiency in calorie intake when the proportions of fat, carbohydrate, and protein in the diet are kept constant at each level of calorie restriction. 

3. When calorie intake was constant at 1000 per day, however, the rate of weight-loss varied greatly on diets of different composition. It was most rapid with high-fat diets ; it was less rapid with high-protein diets ; and weight could be maintained for short periods on diets of 1000-calorie value given chiefly in the form of carbohydrate. 

4. At a level of intake of 2000 calories per day, weight was maintained or increased in four out of five obese patients. In these same subjects significant weight-loss occurred when calorie intake was raised to 2600 per day, provided this intake was given mainly in the form of fat and protein. 

5. No defect in absorption of these experimental diets occurred to account for the weight-loss. There was neither loss of body-protein stores nor of carbohydrate stores to a degree which significantly contributed to the reduction in weight. 

6. The weight lost on these diets appeared to be partly derived from the total body-water (30-50%) and the remainder from body-fat (50-70%). 

7. As the rate of weight-loss varied so markedly with the composition of the diets on a constant calorie intake, it is suggested that obese patients must alter their metabolism in response to the contents of the diet. The rate of insensible loss of water has been shown to rise with high-fat and high-protein diets and to fall with highcarbohydrate diets. This supports the suggestion that an alteration in metabolism takes place.

The aboriginal diet of the Arctic Eskimo, which consisted mainly of land and sea mammals and fish, is analyzed with respect to its capacity to provide the nutrients now regarded as essential for nutritional health. It is concluded that, despite its remarkably restricted composition, the native diet is capable of furnishing all the essential nutritional elements when prepared and consumed according to traditional customs. However, its low carbohydrate and high protein content necessitated major metabolic adaptations in energy and nitrogen metabolism. Erosion of the traditional diet culture and life style has been accompanied by a decline in nutritional status. [Eskimo, diet, nutrition]

A natural association between the “B complex” vitamins and proteins in the enzyme systems of animal tissues provides strong assurance against a deficiency of these vitamins in a diet high in animal protein. There is no history among Eskimos of the epidemic vitamin deficiency diseases which afflicted some cereal-based food cultures. The oils of fish and marine mammals are rich in the fat-soluble vitamin A and D. A high meat diet also provides adequate amounts of vitamin K. The vitamin E nutriture of Eskimos is of particular interest, since this vitamin is ordinarily derived mainly from cereal oils. A recent investigation of the vitamin E status of Alaskan Eskimos revealed that their blood levels are fully comparable to those of populations consuming a mixed diet (Wo and Draper 1975). This finding is attributable to the fact that nearly all of the vitamin E in animal tissues is present in its most active form (a-tocopherol), whereas in cereals it is present primarily as a less active isomer (7-tocopherol).

Stefansson’s appraisal of the ascorbic acid nutriture of the Eskimo has successfully withstood 40 years of critical evaluation, namely “. . . that if you have some fresh meat in your diet every day, and don’t overcook it, there will be enough C from that source alone to prevent scurvy” (Stefansson 1935-36). The Eskimo practice of eating their food in the raw, frozen, or lightly cooked state was a critical factor in preserving the small amounts of vitamin C necessary to prevent scurvy (less than 10 milligrams per day).

The predominant feature of the Eskimo native diet from an adaptational standpoint is its remarkably low carbohydrate content. The all-meat diet typically provides about 10 grams of glucose in the form of glycogen per 2,500 calories.

A subject of frequent speculation concerning the energy metabolism of Eskimos is whether they relied on ketone bodies as a significant source of metabolic fuel. It is difficult to estimate how frequently conditions conducive to ketogenesis prevailed in Eskimo dietary experience, but it seems likely that there were times when the supply of protein was inadequate to meet the amino acid requirements for glucose synthesis as well as for protein synthesis. Further, it has been estimated that the capacity of the liver to convert amino acids to glucose is limited to about half the total energy requirement. Four of the 20 amino acids supplied by dietary protein are ketogenic as well as glycogenic and anQther (leucine) is specifically ketogenic. An abrupt change from a mixed diet to a meat diet leads to asymptomatic ketafis and ketonuria, but these conditions gradually diminish as a result of biochemical adaptation to the use of ketone bodies for energy. Whether Eskimos have unusual adaptational capabilities in this regard is unknown.

Their high-protein diet imposed on Eskimos a need to dispose of an unusually large metabolic load of urea, a potentially toxic nitrogenous compound formed during the conversion of amino acids to glucose. Animals fed high-protein diets exhibit diuresis and an increase in water consumption, and it is of interest that early explorers commented on the high water intake of Eskimos. A feedback mechanism acts to prevent uremia under conditions of high protein intake by stimulating water consumption and thereby enhancing the dilution and excretion of urea. The need for efficient urea clearance implies that renal disease in Eskimos consuming the native diet has unusually serious clinical implications. The all-meat diet is also distinctive with respect to its lack of “fiber,” a composite of plant materials which is resistant to digestion and therefore passes relatively unchanged into the feces. Such materials normally exert several physiological effects, including an enhancement of food transit through the gut, an increase in fecal bulk, alterations in bacterial activity, and a sequestering of cholesterol and bile salts. The decline in the fiber content of the general U.S. dietary in recent decades has been implicated as a factor in the incidence of a number of intestinal diseases (constipation, diverticulosis, colonic cancer) which may be increased by food stasis and putrefaction in the lower intestine. Medical records are too fragmentary to indicate whether these diseases are unusually prevalent in Eskimos habituated to the native diet.

The modem Eskimo has for the first time the opportunity to make significant food choices. Presented with an array of exotic new foods which he is not equipped by personal experience or education to evaluate, he tends to choose badly. In general, the items he selects are below the average quality of the U.S. mixed diet and of the foods they replace in his native diet. His nutritional status is deteriorating, in terms of both undernutrition and overnutrition, in direct relation to the proportion of processed foods in his total diet. In the subarctic, where dietary acculturation is extensive, the Eskimo has the full complement of diet-related diseases that are characteristic of other segments of the U.S. population of low socioeconomic status: obesity, cardiovascular disease, hypertension, and tooth decay.

Acknowledgment. This paper was presented at a symposium on Human Adaptability in Relation to Regional Ecosystems held under the auspices of the International Biological Program at the 141st annual meeting of the American Association for the Advancement of Science, New York City, 26-31 January 1974. The author gratefully acknowledges the collaboration of the following: R. Raines Bell, J. G. Bergan, Catherine C. K. Wei Wo, G. V. Mann, L. M. Hursh, M. J. Colbert, and Christine A. Heller.

I flew to Anchorage, Alaska, in the spring of 1990 and the news was bad. Hunting for ivory had fallen into ill repute. To save Africa's elephants a world-wide ban on ivory trade was now in effect. There had been reports in magazines and in Alaskas press of Inuit "headhunting, of killing walruses only for their tusks, leaving the headless carcasses upon the ice. The more lurid reports spoke of "chainsaw gangs" that lopped off walrus heads. The Diomeders, I guessed, would be very touchy. A Japanese TV crew, I was told, had offered the Diomeders big money to film the walrus hunt and had been curtly advised that they and their money were not wanted. "I wouldn't be surprised," a biologist friend in Anchorage told me, "if they put you back on the helicopter and tell you to fly off." 

That was another change: a heliport at Diomede and weekly helicopter service from Nome. It all looked so familiar: the fields of ice in Bering Strait; the soaring cliffs of Diomede; the weather-gray houses glued to the mountainside; the umiaks on their racks; the great rust-red tanks for oil and gas. I stared down and worried about my welcome. The helicopter landed on a new metal pad on the beach. There was the familiar smell of sea and wrack and walrus oil. And there stood Tom Menadelook and Mary. He recognized me instantly and was as brief and decisive as ever. "Good to see you back," he said. "Mary and I are going to Portland [Oregon] for Etta's graduation. You can stay at our house." Junior," he called, and from the crowd around the helicopter came a heavyset, sturdy young man: Tom, Jr., now twenty-six, father of three lovely children, a fine hunter, and the village policeman. "This is Fred," his father said. "He'll stay at our place. Get him the keys. And he'll go out again with our boat." All my worries vanished. 

Young men carried the bags up to "my" house. I followed slowly, up the steep, familiar cobbled path. Annie Iyahuk sat on the steps of her house. "Come in," she said. "Albert will be glad to see you." Albert, with whom long ago I had collected greens on the slopes of Diomede, now in his seventies, was thin and frail but still an excellent carver. He grasped my hand in both of his. "Ah," he said. "You came back to us." I was given tea and bread, and hard-boiled eggs with seal oil. After fifteen years, it was like coming home. 

There had been many changes in these years: a large new school had been built, a new store, some new houses, a "washateria" owned, like the store, by the islanders and paid for, in large part, with money made from ivory carving. It was kept spotlessly clean and for three dollars one could shower, wash a load of clothing, and dry it. The washateria brought in $100,000 in its first year of operation. 

There was one drastic change: Diomede was dry. All alcohol was forbidden. The planes with booze, the wild parties, the fights, the smashed windows, the drunken threats, the bilious hangovers were now only memories of a violent past. "It sure is quiet, kidded George Milligrock, once one of the wild young men of Diomede and now approaching portly middle age. "Yes," he agreed with a touch of regret, "we're getting to be quite civilized." Young Inuit who had tried city life in Nome, Anchorage, or Seattle and were nearly crushed by drink and other problems, had returned to Diomede, to their roots, to an older, simpler way of life. The population of Ignaluk, after shrinking for many years to a low of 84 in 1970, had increased to 121 in 1975, and to 171 in 1990. 

Life on Diomede was peaceful, pleasant, quiet. It certainly was a nicer, gentler place than on my first visit - and yet, some of the panache, the verve, that devil-may-care daring was gone, and at times I felt a certain perverse nostalgia for the wildness of the bad old days. 

"Civilization" also seemed to have exacted a bitter price. Once Diomeders had been famous for their daring and their vigorous health. The Smithsonian Institution anthropologist Ales Hrdlicka visited Little Diomede in 1926. "The natives look sturdy, " he noted. "None other could survive here." Shortly after I arrived, I met John Iyapana who, on my previous visit, had taken me by umiak back to the mainland. I remembered him as a weather-beaten, bluff bear of a man, violent when drunk, affable when sober, with an immense fund of stories about Diomede. Now he was a broken hulk, wan and weak. He pulled a notebook from his pocket and wrote: "Welcome back, Fred! Cancer had destroyed his throat and vocal cords; he could no longer speak. He would never tell stories again. 

"Long ago, when I was young, said Albert Iyahuk, "people were never sick." Now cancer and heart disease were common; one of the causes may be a partial change to Western food. Recent studies by scientists from the Emory University Medical School have shown "that the incidence of cancer [among Inuit] has increased significantly following westernization."