Eskimo and Indian Field Studies In Alaska and Canada

The relationship between dental caries, physical degeneration, lowered defense for disease and facial and dental deformities has apparently not been recognized or the factors therein defined. Data will be presented in this communication which throw light on these factors and on means for their control.

In an investigation to ascertain the role of nutrition in the etiology of dental caries, modern civilization’s universal expression of degeneration, my field studies have also included the recording of data which relate to facial development, the arrangement of the teeth in the dental arches, resistance to disease and associated problems. Since many of the primitive races have had a high immunity to dental caries, in striking contrast with modern civilization, an effort has been made to study remnants of racial stocks whose isolation has preserved them from modernization. Among these have been included Eskimos in Alaska and the Indians in northern and central Canada in various stages of modernization, the study noting particularly the changing factors in the environment just at the point where the normal high immunity is lost. The data routinely studied have included the examination of each individual tooth, recording the location of dental caries when present, missing teeth, anomalies in growth, irregularities of the teeth in the arches and abnormal relationships between the dental arches. Both normal and irregular facial expression and dentition were recorded photographically. and the latter frequently also by impression taking. Samples of saliva were obtained for chemical analysis and, in special cases, samples of blood. In order to evaluate the influence of nutrition, samples of various foods were obtained for chemical analysis and data recorded as to the proportion of the various foods eaten.

Ales Hrdlicka, curator, Division of Physical Anthropology, the Smithsonian Institution, assisted me in the selection of districts for making studies in western Alaska. For reaching the less modernized Eskimos of the lower Kuskokwim, an airplane was chartered at Anchorage and used for moving from place to place through central and western Alaska to the mouth of the Kuskokwim River and northward. This gave an opportunity to make contact with some quite primitive groups who were using exceedingly little if any of the modern foods. The more modernized Eskimos as found at Bethel and some other settlements were studied for comparison. Many of these were living quite largely on modern foods, which were made available by the yearly visit of a government supply boat. At the mouth of the Kuskokwim River, a large group was examined that had gathered there for fishing. They were largely from the vicinity of Nelson Island. Fishing groups from the Tundra were studied on the island opposite Bethel.

Eskimo and Indian boys and girls were studied in the government school at Eklutna near Anchorage and at the Jesse Lee Mission Home at Seward. These children had been collected from as far north at Pt. Barrow, west through the Aleutian Islands and throughout central and southern Alaska. The native diet of western Alaska, as well as that of the Pacific coast of southern Alaska and of British Columbia, had been largely provided by the animal life of the sea. This was supplemented with some native roots, edible kelp and grasses, with practically no cereals and fruits except a few cranberries.

For comparison with the Pacific coast foods, it was very important to reach isolated groups of Indians inside the Rocky Mountain Divide. This was accomplished by using a river boat from Wrangell up the Stikine River to the end of navigation at Telegraph Creek and then across the Rocky Mountain Divide over an exceedingly difficult trail; which was accomplished by truck to the headwaters of the Dease and Liard Rivers, the latter a branch of the MacKenzie. From this point, we proceeded down stream in a powered scow to the Liard Hudson Bay Post on the Liard River. This is the last of three Hudson Bay Posts in this interior. The Indians of this district are nontreaty nomads living in tents and bark shelters in the summer and log shelters in the winter. They were sufficiently primitive that most of them had never seen a white woman before seeing Mrs. Price. Their diet consisted almost entirely of wild game, supplemented only occasionally with fish, there being no running salmon in these waters. The local fish are chiefly pike and white fish. They obtain some of the white fish in the winter by spearing through the ice. Their principal food is moose, supplemented with mountain goat, mountain sheep, caribou and small animals. Practically all of the organs and glands are eaten, as well as the marrow. By studying these people from within their isolated district outward as we returned toward civilization, we were able to note those conditions which had been modified by their first contact. They exchange furs chiefly for modern clothing, traps, firearms and ammunition. Their hunting grounds are often hundreds of miles in various directions from the posts and their trips to the posts are infrequent, usually occurring only once or twice a year. This made it impossible for them to carry back to their hunting grounds any considerable quantity of modern foods. The Indians who remain in close proximity to the posts were able to obtain imported foods throughout most of the year. These consisted of the inexpensive foods that would stand shipping and storing without spoiling, chiefly flour, sugar and various sweetened foods, dried foods, polished rice and tea.

Similarly, groups of Indians were studied at various of the coast towns, including Indian reservations on the Skeena River at Prince Rupert, also in the interior at Winnipeg Lake and between James Bay and Lake Superior. Highly modernized groups of Indians were studied in southern Ontario and in New York State.

In all, 800 persons were examined and approximately 22,000 teeth. For the most primitive groups of Eskimos, the incidence of dental caries was 0.09 per cent, or one tooth per thousand teeth examined. For the least modernized of the Indians in the northern interior, the incidence of caries was zero, for, in three groups of seventy-six persons with 2,144 teeth, not a single tooth was found to have been attacked by dental caries. In eighty-seven persons in four groups, only four teeth had been attacked by caries, or 0.16 per cent. For the Eskimos at the point of contact with modern civilization at Bethel and vicinity, the incidence of dental caries was 13 per cent of the teeth examined. For the Indians at the point of contact with modernization, the incidence of dental caries was found to be 21.5 per cent of the teeth examined. For each of these races at the point of liberal contact with modern civilization, the incidence of caries increased to an involvement of from 30 to 50 per cent of all the teeth. These figures are in accord with my data previously presented for some other races.

A critical study of the children at the point of contact with modern civilization revealed striking disturbances in physical development, particularly of the middle and lower third of the face. Not one single case of facial deformity or typical marked irregularity of the teeth or dental arches was found among the more primitive Eskimos or more primitive Indians; whereas, in all modernized communities, many cases revealed some phases of these disturbances. A study of the parents at the point of recent contact with modern civilization revealed that they had normal arches and normal facial development. In a single generation in contact with the foods of modern civilization, chiefly white flour and sugar products, there was marked change in the relation of the dental arches both to each other and to the remainder of the face. While these persons usually suffered from dental caries, the severity of the deformity was not in direct proportion to the caries. My investigations have revealed data that relate immunity and susceptibility to dental caries directly to nutrition. Persons who left their isolated native districts and placed themselves in contact with the foods of modern civilization for six months or more were often attacked by tooth decay, particularly during the growth period. The teeth were often badly wrecked in two years’ time. In some cases, when these people went. back to their native foods, the active caries ceased entirely and they again continued to have immunity. These persons did not have evidence of nutritional disturbance as expressed by deformity of the face or dental arches. While they were on their native foods, no overload was found to be adequate to break the normal high immunity of the isolated Eskimos and Indians, not even pregnancy and lactation or the period of rapid growth in children. When they reduced their protective native foods, these two groups had more rampant decay than other groups. We are accordingly concerned to find new facts on the etiology of dental caries and facial deformity.

In nearly all persons suffering from a lack of development in the middle third of the face, the capacity for ventilation through the nares has been physically reduced and many of them are mouth breathers. The nostrils are abnormally small and the base of the nose narrow.

By far the most frequently found facial expression of nutritional deficiency involves the lack of development of both the middle and lower thirds of the face producing deformity of both dental arches. A typical case is seen in Figure 1, in which the right lateral incisors and first bicuspids are nearly touching. The cuspids are erupting outside the arch. The lower teeth are irregular.

Fig. 1.–Case in which both the middle and the lower third of the face are underdeveloped. This is one of the most commonly seen types.

 

Not a single case of irregularity in the interrelationship of the two arches or the teeth in the arches was found among the most primitive Eskimos, except the presence, in a few cases, of supernumerary teeth. At the point of contact with modern civilization, where the mothers had displaced part of the native foods with modern foods during gestation and lactation and the children were using the modern foods in considerable part during the period of infancy and childhood, practically every case showed typical evidences of disturbed development.

Among the Indians inside the divide, living nomadic lives in northern British Columbia and the Yukon Territory and whose diet was limited almost entirely to wild game, the dental arches were normally developed in all of the adults and young people studied.

A typical case is shown in Figure 2, in which both the middle and lower thirds of the face have been retarded in development. The nostrils are small and the base of the nose is narrow.

Fig. 2.–Typical irregularity of dental arches of Indians seen after adoption of modern foods. In this case, the middle third of the face is involved.

 

In most cases, the lateral incisors develop inside the line of the arch, with the cuspids well outside. A few exceptions to this are found. A case is shown in Figure 3 in which the lateral incisors are being rotated outward by the first bicuspid. There is no room on either side for the developing cuspid, which in this class of case often is directed forward and palatally inside the arch.

Fig. 3.–Extreme deformity of dental arches involving both middle and lower third of face.

 

This developmental disturbance of the Eskimos and Indians has been found to occur when the nutritional change was from a predominance of the animal life of the sea on the part of the Eskimos and from a predominance of the animal life of the land on the part of the Indians, to the foods introduced by modern civilization, chiefly white flour and sugar products, which displaced part of the native natural foods.

A logical question is whether a similar effect would be produced when changing from other diets containing, for example, cereals. We have light on this from my field studies in Switzerland among the isolated groups in the protection of the upper valleys, and the people in the Outer Hebrides in isolated parts of the Isle of Lewis and the Isle of Harris, which I have previously reported.¹

A striking illustration is shown in two family groups of children, one from Scalpay, in the Isle of Harris, where the food was almost entirely limited to sea foods, and oat products. These children had practically complete immunity to dental caries, there being only 1 per cent of the teeth affected. The nostrils are broad and the dental arches are excellent. In contrast with this was a family of children on the Isle of Bardsey off the northwest coast of Wales. The children in both groups are Gallic and both speak the Gallic language. The latter group were living almost entirely on modern imported foods, largely white flour and sweet foods. Every one was suffering from rampant tooth decay even to the 3-year-olds. On this island, 27.6 per cent of the teeth studied showed dental caries. Every child in this group was a mouth breather, which none of the Harris group children were. The nostrils were pinched and there was lack of development of the middle and lower thirds of the face. It is of interest and deeply significant that tuberculosis was rampant on the latter island as well as on the mainland, from which this and other families had been transported by the government to repopulate the island because it had been so largely depopulated by tuberculosis.

While it is not ordinarily feasible to make experiments on human beings with various types of deficiency diets with the intention of producing deformities as we readily do with animals, we can frequently find groups of persons living on specially deficient diets some of which had been used with the expectation that they would adequately meet human demands.

At this time, many fads regarding nutrition are being generously lauded by their exponents. A characteristic type is the emphasis being placed on the relation of acid to base forming factors in the foods on the theory that much of modern illness is due to undue acidity of the system. It is accordingly not only instructive from the standpoint of science, but also a matter of great importance regarding physical welfare that data concerning such nutritional programs be studied and made available.

The following case, that of a girl aged 16, illustrates such a study. The characteristic of the nutrition as reported in detail by the mother was based upon its so-called defensive qualities in that all acid-producing foods such as cereals and meats were largely excluded and the diet was restricted to those foods that are strongly basic in chemical composition. This girl had marked underdevelopment of the middle third of the face amounting to a considerable deformity. It was for the correction and improvement of this, if possible, that she was presented for study. This included a consideration of the causative factors, such as the mother’s nutrition during gestation and lactation and the child’s food during infancy and childhood.

Among the important problems involved is the question as to whether a disturbed development of the bones of the face represents a latent process and one which can be resumed at a later date than that in which the growth should normally have taken place. The problem of deformity of the dental arch is so common and serious that an entire division of the dental profession has been built up for the purpose of correcting as far as possible by physical means these physical deformities and disturbances of the function of mastication. This procedure has had limited applicability to the correction of gross facial deformity such as an incomplete development of either the middle or lower third of the face or both. It has, in other words, been limited largely to correction of the position of the teeth in the arches and in part to correction of the relationship of one dental arch to the other. Little effort has been made to achieve the completion of the normal development, nor has this been deemed possible. In connection with these investigations, studies have been made to ascertain whether and to what extent this might be accomplished by a reinforcement of the nutrition. After the young woman had been on a special nutritional program for the purpose of stimulating growth for one year, there was evident a very marked building forward of the middle and lower thirds of the face, which strongly suggests that the condition was largely one of retarded development due to lack of available materials. As in the case of lowered resistance to infection and reduced function of special tissues and organs, there was greatly increased efficiency of the total human mechanism, both in the process of normal functioning and in the building and repair of all tissues. This growth was directly related to the available quantity of activating and tissue building materials in proportion to the heat and energy providing factors in the food.

In many of the groups studied, an early effect of a moderate nutritional deficiency was a tendency to an end-to-end bite of the upper lateral incisors on the lower with a reduced overlap of the central incisors. Along the Canadian and Alaskan coasts, several cases were found in which this particular divergence from normal occurred in both the parents and the children, probably indicating not an inheritance factor, but a similar exposure to stress in the two generations. The question as to how many generations would have to be involved to make this an “inherited character” probably can not be stated very definitely. It is an interesting problem for the geneticists.

Simultaneously, another major problem has been studied. While it has been known that primitive Eskimos and Indians when modernized succumb rapidly to tuberculosis and suffer severely from arthritis, this has generally been explained on the basis of a lack of an inherited immunity because of the ancestry not having built up an immunity through both exposure and successful combat. In my study of the Eskimos and Indians who were suffering from tuberculosis, I have found those making a poor fight to be living largely at present or in the past on the foods of our modern civilization. When persons were studied from the standpoint of the presence or absence of evidence of a nutritional deficiency in infancy and early childhood, the data obtained revealed a very great increase in the percentage of persons who were breaking with tuberculosis among those who had been injured in infancy by nutritional stress as indicated by facial deformity. For example, in the study of twenty persons under 21 years of age, who constituted all the patients in the government hospital at Juneau, suffering from pulmonary tuberculosis, 100 per cent were found to have deformity of the dental arches, indicating an injury not only to the mechanisms of physical growth but also to the development of the chemical laboratory for providing the defensive weapons for combating infection.

These are not problems which chiefly concern particular cases. My examinations made in a municipal tuberculosis sanitarium of Cleveland revealed that, in forty-three successive cases of tuberculosis at various ages, forty gave evidence of nutritional injury in the early growth period.

I was informed by an Indian reputed to be a high authority on the Indian languages of northwestern America that none of the Indian languages had a word for rheumatism or arthritis and that his people did not suffer much from these diseases until they were touched by modern civilization. That this affection is on the increase in modern civilization seems clearly established by the data being developed in many states. Massachusetts alone is now reported by its health department to have 150,000 cases of arthritis. Similarly, appendicitis, heart disease and a number of other degenerative processes are clearly on the increase. It is of interest that these increases are occurring in spite of the best efforts of modern clinical science, hospitalization and prenatal care. These affections are largely accepted as being incurable diseases and not subject to more than palliative treatment.

In the light of newer knowledge, we are concerned to know to what extent these so-called diseases just referred to may be symptoms rather than unit diseases. On the basis of the foregoing and other findings, I have established nutritional programs that provide the chemical characteristics found to obtain in the protective nutrition of the Eskimos and Indians and of other isolated groups. Diets are provided which furnish at least 2 gm. each of phosphorus and calcium per day in suitable form, together with an adequate quantity of the other minerals, and these all suitably reinforced with the fat soluble activators such as are provided for the Indians and Eskimos and other physically efficient groups in their native foods. By these means, we are now able, as previously reported, to control dental caries regardless of its being very rampant.

The chemical analysis of the foods of a typical menu as used by the Eskimos is shown in Table 1 and as used by primitive Indians in Table 2. The analysis of a typical displacing diet for these two groups is shown in Table 3. It will be seen from the summary shown in Table 4 that the minerals in this displacing diet were from 30 to 97 per cent lower than in the native diets. The Eskimos and Indians suddenly placed in contact with modern civilization were particularly unfortunate in that the two new foods that were most readily provided, namely, white flour products and sugar products, are two of the least nutritious from both a mineral and a vitamin standpoint of all the foods of modern civilization. It is of particular interest that the demineralized flours from which also wheat embryo has been largely removed are not adequate to maintain life in either larger animals or in the small flour grubs which tend to infest the ground entire wheat products.

 

Table 1.–Distribution of Activators and Minerals in Typical Menu of Primitive Eskimos

Table 2.–Distribution of Activators and Minerals in Typical Menu of Primitive Indians

 

Table 3.–Mineral Distribution in Typical Menu of Modernized Indians and Eskimos

 

Table 4.–Comparison of Diets of Caries Immune and Susceptible

Investigation of physical anthropologists have revealed physical degeneration coincident with national decadence. The investigations of Hooton and his associates at the Pecos Pueblo have revealed an increase in arthritic processes and skeletal degeneration associated with the decline of that group. It has been noted by many observers that the skeletons of children and invalids disintegrate much more rapidly than those with the more perfect physical development. It is appropriate to note in this connection the progressively accelerating rate of many of the degenerative processes in current civilization. It is also significant that these increasing rates are not uniformly distributed throughout a continent. In the United States, heart disease is increasing most rapidly in the eastern maritime states and along the Great Lakes. Similarly, arthritis makes progressive advances, reaching one in twenty-five of the population.

My investigations on the monthly variations in milk fat vitamins as received twice a month from many districts throughout the world are now being carried into the seventh successive year. When these data are arranged on a monthly basis for succeeding years, the annual curves harmonize in a general way. All communities show a seasonal cycle which is not in accord with the sunshine cycle but is in accord with the plant growth cycle. When these curves are associated with curves for heart disease and pneumonia for various districts, as, for example, when the United States and Canada are divided into sixteen districts of many thousand square miles each, the mortality and activator curves are, as previously reported,2 always in opposite phase. When the fat soluble activators of the dairy products are high, the deaths from heart disease and pneumonia are low, and vice versa. In those districts with the highest mean levels for the fat soluble activators, there is disclosed the lowest mean levels for heart disease, and vice versa. It is also of significance that the government statistics for abandoned farms show an important relationship to low vitamin foods and high mortality levels. The common cause for the abandonment of the farms is that they have “run out.” Since there is only provided enough phosphorus in most of the surface soils for about 100 crops of wheat, rye or corn, and in much of the land less than this, it will be understood why this element should readily become exhausted or depleted. Many other minerals required by the body, and some of them in very small quantities, may also be involved in this depletion, particularly copper and iodine.

I have shown how greatly the minerals were found to be reduced in the menus of the Eskimos and Indians when they displaced a considerable portion of their native foods with those of modern civilization. This displacement seems to be based upon one of the most fundamental of animal instincts, namely, the sense of need for foods, being expressed as hunger. With the native foods of the earth, animal life, including man, has had usually only to eat those foods near at hand to obtain a sufficiently well-balanced ration with regard to both energy products and building materials adequate for both growth and repair. This has been completely changed by modern civilization, since man has learned how to modify the natural foods or has obtained greater latitude in food selection. Appetite still determines the quantity of food eaten; but since appetite applies almost entirely to energy producing foods, it has not been a safe guide. This probably has been a leading factor in the decadence of various races. This was brought out in my conversation with the Eskimos and Indians at the point of contact with modern civilization. When I asked them why they like our modern foods better than theirs, they said because they did not need to eat so much to keep themselves warm or to do their work. These people break faster than people of modern civilization and more sharply, in large part because they do not have so large a variety of such good substitutes, for their native foods. They do not get our whole grains, dairy products, fruits and vegetables. We cannot live on what we send them, and both we and they can be saved by better foods than our modern civilizations use.

We have, therefore, two inherent forces at work in modern civilizations: one, a natural limitation of the soil and its progressive exhaustion, and man’s habit of depending on his sense of hunger as his chief guide in both the kind and quantity of food that will be eaten. It has been abundantly demonstrated that poor soils produce poorer foods, not only in the minerals, which are deficient in the soil, but lower in activating substances, the creation of which is dependent on the chemical content of plants. These two forces combine to establish a nutritional deficiency, which produces varying effects in different periods of life according to the needs of the body. During the prenatal and postnatal growth periods, the needs of the body are very great, not only for minerals, but also for the special activating substances which are essential for the differentiations of tissues and for organ development. The efficiency of the animal mechanism, physical and chemical, will be largely determined by the availability of the building material. While Nature will make the best of the available material, the ancestral order, as provided through inheritance, may have to be curtailed, not only for a single generation, but also continuously through many succeeding generations, thus introducing modifications which may become inheritance factors. Accordingly, progressive physical and, of necessity, moral degeneration ensues.

I have arranged these forces and their resultants in graphic form in Table 5 as my interpretation of some of the influences and their effects. For the two main roots of the tree, I would use, as indicated, modern civilization and mineral deficient soils. The former through its demands for high calory foods is very likely to choose those of low mineral and low activator content. The mineral deficient soils will inevitably produce foods of lower mineral and lower vitamin content. These provide a nutrition that is of necessity deficient in the elements essential for development and for the maintenance of maximum physical protection and efficiency. The influence of starvation for minerals and activator during the growth period will of necessity produce stresses in mineral metabolism during the period of most rapid growth of the long bones. This will appear as shown in Group I as rickets, and at any age when the daily mineral requirements are not provided by the nutrition, a stress will be established, with the result that Nature’s safety device, namely, a capacity for borrowing from the stored minerals of the skeleton, will come into play. This produces a stress in body fluids, first in the blood and then in other serums, such that the saliva can no longer maintain an environment adequate to provide immunity to dental caries, which accordingly becomes active or even rampant in proportion to the stress. If these stresses are long continued and the body is not able to replenish the borrowed material and provide for adequate growth, the structure is stunted. The deficiency expresses itself at those points where growth would normally have been accomplished had building material been adequate. These effects will have their expression as in Group II, namely, as skeletal deformity, facial deformity and irregularities of the dental arches and the teeth. When the stresses for the body building material occur in embryonic and prenatal life, many handicaps develop for both the mother and child, which have expression as in Group III, namely, as abnormally high infant and motherhood mortality. These are conditions which exist strikingly in many in modern civilization in spite of the development of prenatal and postnatal care of mother and child. An important phase of these deficiencies would have its expression in the incomplete development of the chemical laboratories of the body with the result that defense against acute and chronic infections is lowered. These have their expression as shown in Group IV, apparently accounting in large part for the high toll of tuberculosis among the aborigines after they adopt modern foods, also the development of rheumatism and arthritis. Similarly, heart disease, appendicitis and rheumatism and a host of other affections develop which, in the light of newer knowledge, should largely be termed as symptoms rather than as unit diseases. When the deficiencies result in an incomplete development of the nervous system or fail to provide adequate nutriment for maintaining the brain and nervous mechanism, the end-results will express themselves in many ways as included in Group V, nerve instability and moral weakness providing a rapid increase in institutional population.

 

Table 5.–Physical and Moral Degeneration With Civilization

It is of particular importance that we consider some of the available evidence as to the chemical factors that are involved in these processes. Since animal life cannot exist except as it obtains, directly and indirectly, products of plant life, we are concerned with advances in knowledge regarding the unit factors that the plant contributes. It is frequently said that all life can be traced directly to chlorophyll, which synthesizes the products of the air and plant juices through the medium of the radiant energy from the sun and thereby provides the nutrition of all animal life of the sea and land. Among the products so created are the precursors of the various groups of organic catalysts or enzymes, which enable the animal to build its special tissues of the elements that are provided through the plant tissues and the atmosphere. Some of these organic catalysts have their residence in the embryo or germ of the plant seed and in other plant tissues. The modern milling process apparently needs to eliminate these and much of the minerals from grains in order to prevent the growth of minute animal life that would feed on the ground cereals. Some of these activating substances are fat soluble, others are water soluble. These are stored in the organs of the animals of both land and sea and in special tissues of which they are an essential part. They apparently are transferred from animal to animal as one preys on another.

Among the precursors of the organic catalysts, certain products have recently been identified in the plant pigments. These include both fat soluble and water soluble groups. The carotenoids are fat soluble and accordingly are classed as lipochromes. The water soluble pigments, called flavines, are now found to be the precursors of the water soluble vitamin B2. This group of pigments are the lyochromes. In the dairy products, the fat soluble factors are removed from whole milk with the butter fat. The water soluble activating substances go with the whey. These have now been concentrated by Kuhn and others3 and have proved to be the most active stimulators of growth yet discovered. They have also been found to be capable of transition direct to chemical forms in which they act as organic catalysts and participate in intracellular metabolism.

Data have now been developed indicating that there are six provitamins A, three of which are different forms of carotene. Two molecules of vitamin A are formed in the animal body from one molecule of a carotene. Certain of the activating substances have been isolated and identified by their effects or chemical content or both. Doubtless, many other activators are still to be so identified. The role of these activators seems now clearly to be that of organic catalysts. When, for example, pigeons are not provided with an adequate quantity of vitamin B1, the antineuritic factor, they develop symptoms of derangement of the nervous system. When the brain of such a pigeon is removed and placed in an atmosphere of oxygen, the quantity of oxygen being taken up is greatly enhanced when there is injected into the brain tissue a small quantity of vitamin B1. Similarly, when such an injection is made into the brain of a live pigeon suffering from violent reactions in the nervous system, the symptoms disappear. This has been demonstrated by Gavrilescu and Peters.4 Similarly, when vitamin B2, the antipellagric factor, is insufficient in the nutrition, there is a very marked decrease in the rate of growth, and it has been shown by Kuhn that this vitamin behaves as a catalyst. Among the roles that are played by these vitamins as organic catalysts, one is related to the formation or development of phosphorus in inorganic form apparently by an action of vitamin D on an organically combined phosphorus. My investigations5 have shown that the inorganic phosphorus of the blood of normal persons tends readily to be adsorbed onto finely powdered bone and that in persons with disturbed bone growth and also in some pathologic states, this characteristic of the inorganic phosphorus of the blood is reduced. The quantity adsorbed may even be reduced to zero or may go into the opposite phase, in which inorganic phosphorus is taken from the powdered bone chips to the blood serum. Further, I have shown that this characteristic can be changed to normal by the administration of the fat soluble activators A and D, together with foods amply rich in minerals, the blood thus being apparently restored to normal in this regard. I have also shown that the saliva of persons who have an adequately high immunity to tooth decay is characterized by inorganic phosphorus factors which tend readily to be adsorbed on finely powdered bone. In the presence of active dental caries, a lesser amount is adsorbed, or the inorganic phosphorus may be increased in the saliva in the presence of powdered bone. I have also shown that this factor can readily be changed by the administration of the fat soluble activators and adequate mineral carrying foods as provided by Nature, with the result of controlling the dental caries. I have further shown that this abnormal characteristic of the saliva with regard to the behavior of inorganic phosphorus can be modified in the test tube by simply shaking the saliva with a foodstuff which is rich in the fat soluble activators. The clinical conditions of practically all patients who are suffering from rampant tooth decay can rapidly be changed to complete control of the caries process through this modification of the saliva even without mechanical or physical operation on the tooth, such as the placing of fillings. Similarly, dental caries can be completely prevented by this simple procedure. It is of interest that this is accomplished by restoring to the foods the chemical characteristics that are found to obtain in the foods of the primitive Eskimos and Indians and other races who had normally a very high immunity to tooth decay.

The application to the problems of the Eskimos and Indians of these new chemical seriologic methods for evaluating physical vitality levels has developed very instructive data. Some samples of blood were obtained from Eskimos who were living on their native diets. These were sent to my laboratory for chemical analysis for comparison with the blood of modern civilized persons. When tested by the foregoing procedure, these blood specimens showed a very high factor of safety. Similarly, 200 samples of saliva were collected and preserved and sent to my laboratory for chemical analysis and, on the basis of the type of nutrition, they showed a much lower factor of safety for the Eskimos and Indians who were living on “store grub” than for those living on the native foods. These data will be published in connection with similar studies. among other racial groups.

As regards the origin of physical deformities, particularly those of the face and dental arches, we understand, in the light of this newer knowledge, why, in our previous efforts to change by mechanical force the configuration of the dental arches and facial features, we have been only partially successful and have often soon lost what we have gained. By the application of this newer knowledge, we are now able to do team work with Nature, and as teeth are moved and the arches enlarged, we may aid Nature in building the new hard structures and indeed stimulate her in her local growth processes. This reinforcement of Nature’s effort is well illustrated in the changes that are produced in pulp chambers. In normal growth, there is a normal diminution in the size of the pulp tissues through the laying down of a normal dentin. In cases of nutritional stress, the pulps are abnormally large. This characteristic may be carried through life and be found as a deficiency in growth and at any time later when this tooth may be studied either during life, when it may be examined with roentgen rays or later by sectioning or roentgen rays. In the process of tooth decay, the dentin is demineralized often to the pulp chamber, while the organic matrix remains in situ. In such a tooth, the complete removal of the decalcified dentin would expose the pulp. If these patients are placed on a sufficiently nutritive diet, adequately reinforced with fat soluble activators, characteristic of the foods of the primitives, that were found to produce and maintain high immunity, there is established a remineralization of the dentin (not a revitalization) to such an extent that the leathery dentin may become stone hard and such that silver nitrate cannot penetrate it. This has been illustrated in previous reports.

Another factor that is particularly important is the fact that, in such a tooth as we have just described, wherein Nature has remineralized the decalcified dentin in contact with a normal saliva, the pulp tissue is also readily induced to lay down a new layer of normal dentin in such a position in the pulp chamber as to completely wall off the original decalcified area and thus restore the pulp to a relatively normal condition in its encasement as far as its immediate surrounding hard tissues are concerned. This has been accomplished in a large number of cases by selecting children in districts of the city where the stress of the industrial depression has greatly reduced the quantity of nutritious foods. These children were placed on one reinforced meal a day for six days a week, without changing directly the other meals. This is now being done in an equivalent way in the fourth group.. The children are given the additional fat soluble activators that are provided from a high vitamin butter produced by cows eating rapidly growing green wheat, which is the best fodder found for accomplishing this. This butter oil is mixed with equal quantities of a specially high vitamin natural cod liver oil. The quantity given is a teaspoonful of this mixture at the time of eating the special meal, which consists of natural foods for providing minerals in liberal quantity and in suitable chemical form. Physical measurements and photographs are made of the children, together with roentgenograms of the teeth. It is of interest that the physical expressions of nutritional deficiency are apparently the same in these children under this modern stress as were found among the primitive Eskimos and Indians.

The data that are being developed from field investigations among Eskimos and Indians have not only supported my previous interpretations, but also provide a basis for enlarging the scope of preventive programs, They also throw light on the reason for the success of the nutritional program that I have been developing for the past fifteen years and have had in use in practical clinical cases for twelve years, with progressive increase in efficiency with the increase of knowledge.

The correctness of any theory which relates to the control of dental caries must stand the final test of not only preventing it from developing, but also checking it when it is even rampantly active. This phase of the problem has accordingly received diligent and continuous checking by the application of the principle, not only to average cases but also to the most extreme cases of dental caries that I have been able to find. Since referred cases are usually of the severe type, they have been given especially careful study with the recording of data.

In seventeen persons, many of them referred from other cities with more or less rampant dental caries, there were found 237 open cavities of apparently active caries. Most of these persons were in the teens and accordingly have twenty-eight permanent teeth. On this basis, seventeen persons would have 476 teeth. It will be noted accordingly, if one cavity is allowed per tooth, that approximately half of the total number of teeth were being attacked, or precisely 49.7 per cent of all the teeth had open cavities. This group includes only persons of whom I have been making critical examination every six to twelve months over a three year period. In practically all cases, roentgen-ray examinations were made in addition to clinical examinations of the teeth. While these persons have been on the reinforced nutritional program which have directed during the winter and spring months of the past three years, only two new cavities have developed in the entire seventeen persons, or 0.4 per cent. It is not known just what length of time had occurred during which the cavities previously found had been developing except that all were receiving frequent and thorough dental service, most of them twice a year and many of them more frequently. It is accordingly probable that the cavities found had developed most of them in less than a year. That dental caries was not a new problem with these persons was clearly indicated by the very extensive and numerous dental restorations that had been made in these mouths. It is, therefore, apparent that there were 250 times as many cavities developed in the period preceding the starting of the nutritional program as in the three years following its adoption. If these data were reduced to a yearly basis, the comparison would show a much wider variation than even this large difference.

In a group of fifty persons, including the above-mentioned seventeen, who had been on this special nutritional program for from one to six years, most of them three years or more, there were only these two new cavities developed in the entire group. Allowing these persons to have an average of twenty-eight teeth per person, or a total of 1,400 teeth, this would represent an incidence of dental caries in a period of three years of 0.14 per cent. In this group of fifty, there are many instructive and striking cases.

For example, H. F., now aged 17, did not have a single cavity from October, 1932, to June, 1933, while taking the capsules. From June, 1933, to May, 1934, while not taking the special vitamin capsules, she developed ten new cavities.

S.K., now aged 14, prior to 1931 had rampant tooth decay with pulps nearly exposed in all first permanent molars. The remaining deciduous teeth had been reduced to shells. She was on the special nutritional program from December, 1931, to June, 1932, during which time caries was completely arrested. She discontinued the capsules in June, 1932, and did not take any until October, 1933, during most of which time she was taking viosterol under a physician’s prescription to prevent dental caries. She came in in October, 1933, with fourteen new cavities. She was immediately placed again on the special program, taking the special butter and cod liver oil capsules from October, 1933, to May, 1934. During this period, the dental caries was completely under control. During the time that she was not on the special program, there developed on many of the surfaces of the permanent teeth white patches of decalcifying enamel. Under the reinforced nutritional program, these largely disappeared, and those that did not regain their translucency turned dark.

In the group of seventeen above referred to, some should have special attention. J. H., now aged 20, sent in from another city, had thirty-eight open cavities in June, 1931. In addition to active caries, he had quite disturbing heart symptoms, which curtailed his activity, and he also had a marked sense of lassitude and weariness. He has been on the reinforced nutritional program during the fall, winter and spring since that time, except the summer of the first year. During this time, he has not developed a single new cavity. The density of all the teeth has progressively improved as evidenced by roentgen-ray records. His physical condition has been greatly improved so that he was able to carry on his college activities and heavy outside work in earning money to maintain his college expense. He is not conscious of a heart limitation, as he does not now get short of breath from ordinary exercise. When asked what the principal change was that he had noticed, he said that in addition to not feeling tired, he was more rested with six hours’ sleep than formerly with ten hours’. A letter from him today states, “At present, I am feeling in the best of condition.”

A. W., now aged 24, had thirty-two new cavities in the two years previous to beginning the special nutritional reinforcement. She continued this regularly winter and spring months for three years and has not had a single new cavity since that time.

In a group of children whose mothers had the special nutritional reinforcement during gestation and lactation and who had been provided with the same dietary adjuncts during the winter and spring months of infancy and early childhood, not a single carious cavity has developed. A number of these children are now in public schools. Their physical development is distinctly above that of the average children of their age, as is also their efficiency in school work.

A considerable number of heart cases should have special mention. A typical one is that of N. F., now aged 52. She was referred by a physician in January, 1930 with a heart involvement so severe that she had to be carried up steps and could remain on her feet only a few minutes. The physician reported that her condition was very grave. After reinforcement of the diet, some infected teeth were extracted. She has been receiving reinforcement of her nutritional program regularly since January, 1930, to this date (June, 1934). Her general health is so greatly improved that she goes about on street cars alone and without serious physical limitation. About three years after she started this reinforced nutritional program and after the removal of the infected teeth, her physician made the comment that, according to all the rules regarding hearts, she should have been dead two and a half years ago.

Another phase of these cases is directly related to the forces that are at work in the maintenance of immunity to dental caries, which indicate that the controlling factors are in large part resident in the saliva. I have previously presented data5 indicating the presence in the saliva of chemical factors which vary directly with immunity and susceptibility to tooth decay. The rapidly increasing volume of data dealing with this phase is continually supporting previously made interpretations.

An important phase, therefore, of these studies has been involved in the collecting of samples of saliva and chemical analysis. This principle involves, as I have reported, the behavior of the inorganic phosphorus of the saliva and blood serum in the presence of finely powdered bone, which acts as an adsorbant. In cases with high immunity to dental caries, there is practically without exception a distinct reduction in the level of the inorganic phosphorus of the saliva when shaken with finely powdered bone. This change is expressed in percentage of indicated quantity found in the duplicate sample as tested without the presence of finely powdered bone. In normal persons, the percentage change, which appears to be the best way to express this factor, is from 20 to 30 per cent decrease. In persons with active dental caries, this reduction is practically always lessened and may be reduced even to zero. In cases of rampant tooth decay, this factor is found to be increased. Instead of inorganic phosphorus moving from saliva to powdered bone, it moves in the opposite direction. In practically every case wherein the activity of the dental caries is controlled, this factor changes to, or nearly to, normal. For eighty-two persons with active caries who had reinforcement of the nutritional program which was associated with complete control of dental caries, this phase of the saliva changed from an increase in the reading of inorganic phosphorus of plus 8.4, which is characteristic of a state of low immunity, to minus 11.2, which is characteristic of immunity to dental caries.

Clearly, the most exacting test for the control of dental caries will be provided by the most extreme cases, which are fortunately not available in large numbers in an average community.

I have, accordingly, been assisting groups of children in districts of the city where the industrial depression has critically reduced the food supply. From one to three of such groups have been under investigation each year for winter and spring periods during the last three years. I have previously reported some of these groups.5

Through the assistance of Harris R. C. Wilson, supervisor of dental health in the public schools, and his assistants, Dr. Pyle and Miss Herman, I have had sent to me twenty-four severe cases of dental caries. These were selected from a parochial school of 3,000 pupils. These children are of foreign parentage, mostly Polish. In each case, the following data have been recorded: roentgenographic examination of the teeth, a direct physical examination of the teeth, photographic record of the face when facial deformities were involved and the chemical analysis of the saliva. Detailed daily menus were recorded by Miss Herman on forms provided by me. I also have a report of their grades at school before beginning of the treatment and after being on the treatment for one month. The nutritional program consisted of providing each pupil with special reinforcement as obtained from high vitamin butter and high vitamin natural cod liver oil in equal parts, furnished in bulk form instead of in capsules and taken from a teaspoon. Most of these pupils had not only very extensive destruction of the crowns of the molars and bicuspids, but also serious injury to the incisors above and below. The requirement for the parents before beginning the test was that the children must have one glass of milk for each of the three meals a day. A request was also made that as far as possible, entire grain breads be purchased instead of white flour breads. No requirement was made regarding this phase of the dietary.

This nutritional program was of necessity less effective than that usually provided the regular patients or special groups, such as the Broadway Mission and the West Side Community House groups, previously reported.

The average of the chemical analyses of the saliva for the group of twenty-four indicated a loss of immunity to dental caries amounting to a plus 0.8 per cent. After only six weeks of nutritional reinforcement, there occurred a change toward normal in the chemical analysis of the saliva from plus 0.8 to minus 5.7 per cent. Roentgenographic records revealed an increase, already perceptible to the eye, in the density of the tooth structure, with a building in of the pulp chambers beneath deeply carious areas. There was almost complete relief from pulpitis in the carious teeth. In one month, after beginning of the treatment, the average school grades increased 3.1 per cent. Only one pupil showed a lowered grade. A number of the teachers reported voluntarily to the school nurse that there was a marked improvement in the learning ability of the boys and girls. In one pupil, it was so marked that the teacher reported his condition to have changed from a very serious problem, since he apparently did not have the ability to concentrate mentally, to a marked increase in capacity for concentration and efficiency. This has been a frequent experience in the children of both my private groups and these special groups.

Approximately 200 specimens of saliva were collected from Eskimos and Indians in the various groups, including both those isolated and so living virtually on the native foods entirely and of other groups in contact with foods of modern civilization. It is accordingly important that these data be considered in connection with the direct applicability to the problems of modern civilization of lessons that are learned from these primitive people.

Since the examination of the Indians and their families was made at the time when they came out of the wilderness on their annual trek to the point of exchange of their wares, namely, the furs of the wild animals, for ammunition, rifles and such other products as they considered most important, they were of necessity examined at the one time in the year when they are in contact with the trading post and the imported foods. This sojourn lasted two weeks and was a time of merrymaking and feasting on the foods of the white man as found at the post. Even though they do not carry enough of this food back to their hunting grounds to constitute any important modification of the total year’s nutrition, they were under the influence of the high calory and low mineral foods for this short period. Although this period of lowered immunity to dental caries might extend over two weeks, it would not, in that time, express itself in the development of caries, even though there would be expressed a lowered level of the immunity factors in the saliva, which would be of temporary existence. The data, accordingly, must be viewed in the light of these facts.

When the persons from whom specimens of saliva were obtained for chemical analysis were placed in two groups, those living on native foods and those on “store grub” or imported modern foods, consisting chiefly of white flour, sugar, sweetened goods, etc., the data indicated for forty-three persons receiving highly modernized diets a movement of the inorganic phosphorus from the powdered bone to the saliva amounting to a plus 9 per cent. For sixty-seven persons living for most of the year on native foods, although for a week or two preceding the obtaining of the samples they had been on modernized foods, the change of inorganic phosphorus in the presence of powdered bone showed a decrease of 2.7 per cent. This is in accordance with my data obtained for several other relatively primitive groups, as well as for immune persons of our modern civilization.

If, as seems indicated by these studies, physical form of an individual group or tribe is in large part an expression of nutrition, a study of skulls of persons or groups who have lived in an earlier period should record conditions which might be studied in relation to the known nutrition of the groups. With this in mind, I have been studying skulls in various collections to note such relationships. These studies will be reported in another communication. It is important to note here that a relationship between skull characteristics and nutrition is clearly evident.

The influence of heredity and environment on physical form has been the subject of extended investigations. A report to the Congressional Immigration Commission and at the sixty-first Congress, Dec. 5, 1910 on the “Changes in Bodily Form of Descendants of Immigrants” was prepared by Franz Boas, professor of anthropology, Columbia University. In this investigation, Dr. Boas compared factors as found in the American born and foreign born persons of the same races at various ages. His data indicated a marked tendency for the characteristic head forms for certain European races to change toward a common type. Thus, the cephalic index, “the width of the head expressed in per cent of the length of the head,” which was for the Sicilians born in Sicily 78 per cent, increased for the Sicilians born in America to 80 per cent; while for the Hebrews born in Eastern Europe with a cephalic index of about 83 per cent, this factor in those born in America was reduced to 81 per cent.

In the light of the field studies herewith reported, it seems probable that these changes are largely the result of changes in nutrition. It is also suggested that racial stocks of any given place should be considered as an expression of that stock, with its given ancestry, while living in that particular food environment. Accordingly, neither the Hebrews of Eastern Europe or the Sicilians of the Isle of Sicily necessarily represent an exact racial type, but rather its expression in that particular environment.

We seem justified in anticipating that a new and higher type of physical development may be accomplished which will be the product of an optimum nutritional reinforcement based upon the most perfectly balanced nutritional program that may ultimately be developed. Indeed, this offers a challenge for the motherhood of tomorrow and is far from being a visionary suggestion, since indeed it is already in progress. The time is not far distant when it will be a matter of keen humiliation for parents to have dental caries develop in their growing children, or to have irregular teeth or facial deformity mar their beauty and masticating efficiency.

Summary

These data are interpreted to indicate that

1. Dental caries has not occurred among the Eskimo and Indian groups studied when they are living on a diet adequately reinforced with minerals and activators.
2. Nutritional deficiencies can produce in a single generation marked changes in physical development and skeletal form.
3. The principal factors in these changes are associated with a reduction of the minerals and activators in proportion to the calory or energy producing factors in the foods ingested.
4. Adequate diets appear to have been provided by a proper selection of the organs and tissues of either the animal life of the sea or the wild animal life of the land, and apparently both are as effective as more elaborate menus.
5. Lowered resistance to disease has been found to be related to disturbed physical development during infancy and childhood due to deficient nutrition.
6. The pigments of plants are found to be essential for life in animals. They can now be traced from the plants to storage depots in organs of animals and apparently are the precursors of many activators including vitamins and organic catalysts or enzymes, which control intracellular metabolism.
7. A basis has been suggested to account for progressive individual and group degeneration.
8. The application of these new principles in clinical practice has been found to be competent to prevent dental caries or control it when it is active.
9. The application of these data indicates a basis for individual and racial betterment.

 

Editor’s note: Since the era in which this article was written, society’s understanding of respectful terminology when referring to ethnic and cultural groups has evolved, and some readers may be offended by references to “primitive” people and other out-of-date terminology. However, this article has been archived as a historical document, and so we have chosen to use Price’s exact words in the interest of authenticity.  No disrespect to any cultural or ethnic group is intended.

 

References Cited:

1. Price, W. A.: “Why Dental Caries with Modern Civilizations?“ D. Digest, 39:94 (March), 147 (April), 205 (May), 225 (June), 266 (July), 299 (Aug.) 1933.
2. Price, W. A.: “Some Means of Improving Human Life by Increasing the Vitamin Content of Milk and Its Product,“ Internat. Milk Dealers Ass’n Bull., Jan. 19, 1931.
3. Kuhn, R.; Gyorgy, P., and Wagner-Jauregg, T.: Klin. Wchnschr., 12:124 (Aug. 12) 1933.
4. Gavrilescu, N., and Peters, R. A.: “Function of Torulin. In Vitro Efficient of Antineuritic Vitamin Concentrates,“ Biochem. J., 30:2150, 1931.
5. Price, W. A.: “Experimental Basis for New Theory of Dental Caries with Chemical Procedures for Determining Immunity and Susceptibility, D. Cosmos, 74:1139 (Dec.) 1932. Additional Light on Etiology and Nutritional Control of Dental Caries with Application to Each District Showing Immunity and Susceptibility,” J.A.D.A., 22:1648 (Sept.) 1933.