New Light Obtained by a Study of Primitive Races On Modern Physical Degenerations, Including Dental Caries

The progressive increase of many degenerative processes constitutes one of the most serious threats to modern civilizations. These degenerative diseases have not been materially curtailed by the advance in hygiene, bacteriology and surgery. Nearly all the effort of the healing professions is still being spent in ameliorating or repairing the ravages of disease. An exceedingly small proportion of the total effort is spent in prevention of the degenerative processes. This has been primarily because of lack of information as to the etiologic factors involved.

Alexis Carrel, in his recent work, Man, the Unknown, states that: “Medicine is far from having decreased human sufferings as much as it endeavors to make us believe. Indeed, the number of deaths from infectious diseases has greatly diminished. But we still must die, and we die in a much larger proportion from degenerative diseases.”

After reviewing the reduction in the epidemic infectious diseases he continues as follows: “All diseases of bacterial origin have decreased in a striking manner…Nevertheless, in spite of the triumphs of medical science, the problem of disease is far from solved. Modern man is delicate. Eleven hundred thousand persons have to attend the medical needs of 120,000,000 other persons. Every year, among this population of the United States there are about 100,000,000 illnesses, serious or slight. In the hospitals, 700,000 beds are occupied every day of the year…Medical care, under all its forms, costs about $3,500,000,000 yearly…The organism seems to have become more susceptible to degenerative diseases.”

While my studies have had as their first purpose the discovery of the cause of dental caries by an examination of primitive racial stocks having high immunity to tooth decay, the rapidly developing data have also thrown important light on many other degenerative processes.

The approach to the study of the etiology of the modern degenerative processes, including dental caries, has been almost entirely by a study of the diseased tissues. The study of the affection has not generally led directly to the cause, since the pathologic conditions found represented the accumulated effect and not the cause.

Hooton of Harvard, in discussing this problem under “An Anthropologist Looks at Medicine,”¹ advises the creation of an Institute of Clinical Anthropology, regarding which he states: “One might define such an institute as an organization devoted to the purpose of finding out what man is like biologically when he does not need a doctor, in order further to ascertain what he should be like after the doctor has finished with him. I am entirely serious when I suggest that it is a very myopic medical science which works backward from the morgue, rather than forward from the cradle.”

The problems of the dental profession have primarily to do with the health of the oral cavity. Probably in no other field of the healing sciences has the effort been more directly limited to repair and remedial procedures. Generation after generation suffers from rampant tooth decay, which in many districts is clearly on the increase. Degeneration of the supporting tissues of the teeth has continued to constitute one of the major tragedies beyond middle life. Crooked teeth and deformed faces have progressively increased in prevalence so that the national facial form is definitely changing. Each of the various degenerative diseases or processes has been looked upon as an entity quite independent of other affections.

Since many of the primitive races, past and present, have been relatively free from several of our modern degenerative processes, it has seemed very important to study the available remnants of primitive racial stocks to find, if possible, groups who are living today with high immunity to degenerative processes to which our modern civilizations are susceptible. It is common knowledge that the skulls of many primitive racial stocks have disclosed, when uncovered, that the individuals were relatively free from dental caries. Indeed, this has often been thought of as a modern disease.

Dryer,² in discussing dental caries in prehistoric South Africans, stated as follows: “In not one of a very large collection of teeth from skulls obtained in the Matjes River Shelter (Holocene) was there the slightest sign of dental caries. The indication from this area therefore bears out the experience of European anthropologists that caries is a comparatively modern disease and that no skull showing this condition can be regarded as ancient.”

In the light of our modern knowledge, since some very ancient skulls clearly demonstrate the presence of tooth decay and since several isolated groups have been found who apparently are completely free from dental caries, we can assume with confidence that the laws governing the presence or absence, of dental caries have been active whenever the conditions were favorable for their operation.

I have proceeded on the assumption that, if racial groups can be found with high immunity to dental caries and freedom from dental arch deformities while under a relatively fixed environment of long standing, that where members of their groups have lost this high perfection with a change of that environment, an adequate study of that environment will lead directly to the causative factors.

These studies have included groups in isolated high valleys in the Alps in Switzerland, where I found the incidence of dental caries to be only 4.6 per cent of the teeth studied.^3,4 This is in striking contrast with the modernized group at St. Moritz at a comparable altitude, where I found the incidence of dental caries to be 29.8 per cent of the teeth studied.⁵

In the Outer Hebrides off the west coast of Scotland, I found the people in the isolated districts in the Isle of Lewis and Harris to have only 1.2 per cent of the teeth attacked by dental caries; whereas in the modernized sections the incidence was 30 per cent of the teeth examined.⁶

Among the Eskimos in isolated districts in AlaskaI found that only two teeth out of 2138 teeth, or 0.09 per cent, had been attacked by tooth decay. At the port of Bethel, however, where a government station has been established and where the individuals secure modern foods which are shipped in, the incidence of dental caries among the local Eskimos was 13 per cent, constituting a 144-fold increase.⁷

For the Indians in the far north inside the Rocky Mountain range in northern Canada, I found that in a study of 2464 teeth in four groups of Indians there were only four teeth that had even been attacked by dental caries, or 0.16 per cent. At the point of contact with modern civilization, however, 21.5 per cent of the teeth examined had dental caries. At the coast where the contact had existed for some time, six towns were found in which the average percentage of dental caries among the Indians, living largely on the imported foods, was forty of each hundred teeth examined.^8,9,10

In the archipelagos of the Southern Pacific, for the Melanesians who were still isolated, the incidence of dental caries was 0.38 per cent of the teeth studied. For those individuals living on trade foods of modern civilization at the ports. 29.0 per cent of the teeth studied had been attacked by dental caries. For the isolated Polynesians, 0.32 per cent of the teeth had been attacked by dental caries, and for those obtaining the imported foods of modern civilization at the ports, 21.9 per cent of the teeth had been attacked by dental caries.¹¹ In the primitive Indians of Florida, from an examination of the skulls in three museums, I found practically 100 per cent immunity to dental caries. These skulls had been taken from the mounds in southern Florida and belonged to the pre-Columbian period. For the Indians living in the Cypress swamps and still endeavoring to live on the native foods, I found four teeth in each hundred teeth examined to have dental caries. In the modernized Indians of Florida, using the trade foods of modern civilization, forty teeth out of each hundred had been attacked by tooth decay.¹² In my studies last year (1935) of twenty-seven tribes in Africa, five were found in which the individuals examined had no teeth with dental caries. For thirteen groups of the twenty-seven, only twenty-six teeth out of 9564 teeth examined, or 0.2 per cent, had been attacked by tooth decay. Eight other groups partially modernized revealed that of 16,514 teeth examined, 1122, or 6.8 per cent, were involved with dental caries.^13,14

Samples of foods of all these groups were gathered and brought to my laboratories for chemical analyses. Partial reports on these have been made in the references.

If we assume that dental caries is an expression of the level of immunity of that individual at the time that active caries is in process, we have still to consider, when comparing one individual with another, the possibility that one has a higher capacity for adaptation to that environment than the other. We will accordingly be concerned to know what forces may have been at work to modify the efficiency of various individuals of the group; for example, one member of the family as compared with others living in relatively similar environmental conditions.

This leads us directly to a study of the at work during the formative period which may have controlled the general physical efficiency of that individual. In thinking of man as a biologic unit, we are concerned to know whether various individuals will react the same in varying environments, that is, with the same divergencies from normal with the same variations in environment. We are concerned when making a study of causative factors to reduce the variables to as few factors as possible.

We have, in general, the observation that the several racial stocks studied herewith changed from a high immunity to dental caries to a low immunity level, when changing their native adequate nutritions to the imported foods of modern civilization. On a chemical basis, by an analysis of these various efficient nutritional programs, I have shown them to be relatively comparable in that they have supplied a high level of body building and repairing material while providing the energy factors required from day to day. It has been shown that the displacing foods of modern civilizations have been relatively higher in energy factors in proportion to the body building and repairing factors than the effective primitive dietaries. For example, I have shown that for the Eskimos of the far north the following reductions occurred: calcium, 81.1 per cent; phosphorus, 80 per cent; iron, 30 per cent; magnesium, 86.6 per cent; copper, 46.6 per cent; iodine, 97.8 per cent. For the Indians of the far north the figures for the reductions are comparable to those of the Eskimos.

In the eight different primitive racial stocks in very different geographic locations and therefore physical environments, there has been a change in the level of immunity, ranging from 0 to 4.6 per cent for the isolated groups, to 13 to 40 per cent of the teeth of the modernized groups. In a study of the changes in facial form at the point of contact with this change in nutrition, there have developed in the next generation, irregularities in certain physical features of the body. It is important in relation to our problem that these changes have been very similar in the various racial groups studied. Among the frequent typical changes in facial pattern and dental arch form is the dropping back of the upper lateral incisors and the narrowing of the upper arch. This may or may not be associated with a similar change in the lower arch.

In Fig. 1 will be seen a group of typical illustrations taken from several of the different racial stocks referred to above. This figure, however, represents only one type of deformity frequently met with in all the various groups. These characteristic types of facial and dental arch deformities have included (1) a lack of development forward of the middle third of the face; (2) a lack of development of the lower third of the face; (3) a lack of development of both zones with narrowing and crowding of the teeth; (4) a narrowing and lengthening of the face.

Fig. 1–This typical change in the pattern of the dental arch occurred when the modern foods displaced the primitive: A, Alaska Eskimo; B, Indian of Northern Canada; C, Polynesian, South Sea Island; D, East Indian, Mombasa; E, Negro, Belgian Congo; F, Arab, Khartum.

 

It is of interest that these are the typical groups that have been constantly found in America, some of which have provided the basis for the Angle system. In that system Class I represents a relatively normal interlocking of the first permanent molars, but with a crowding of the teeth in both anterior arches corresponding with the third group I have outlined. Class II, Angle’s system, includes those cases where the lower first permanent molars occlude distally to the upper first permanent molars, which corresponds with the second group I have mentioned. Class III in the Angle system includes cases where the lower first permanent molars occlude mesially to the upper first permanent molars. This corresponds to the first group I have mentioned. That system includes subdivision within the Class II and Class III groups.

I have recently presented evidence2 indicating that, when the nutrition is adequate to meet the body’s needs in all stages of its development, various individuals of the same racial stocks reproduce the facial type or pattern so perfectly that they look like members of the same family though actually unrelated. My data reveal that this marked change in facial pattern occurs even in the first generation after the contact with the foods of modern civilizations. I have also presented evidence indicating that what might be anticipated on the basis of a strong hereditary tendency to prevent the lesion has not succeeded in doing so where the nutrition was inadequate, and also that where a father had a very marked deformity, as a narrowing of the upper arch, his children did not tend to reproduce this feature when their mother of a non-affected ancestry had an adequate nutrition. I have shown that, where both parents had the high immunity to this affection, both being of immune primitive stock, in spite of this contribution of heredity the children had a marked deformity of the upper arch, with the lateral incisors erupting entirely inside the line of the dental arch.

We are, accordingly, primarily concerned to know when this disturbance in the development and growth process occurred. That it is a nutritional deficiency seems clearly established; that it is largely prenatal has been indicated by the fact that children born to the same parents before they came in contact with foods of modern civilization were free from this affection, while those born after the contact was made frequently had these growth disturbances. My data have shown increasing severity with the younger children.

A statistical study by Petersen¹⁵ has revealed that the distribution of malformed infants in Chicago during March and April was at the rate of approximately 120 per cent of the normal expectancy, and falls to 66 per cent in August. He has related these percentages to the weather. Petersen states: “In studies made on the months of conception of infants born with malformations, it is quite clear that more are conceived in the unstable months of the year. The actual probability in a series of over 400, based on a normal conception rate, is as follows:

January February March April May June

94 106 120 120 110 119

July August September October November December

83 66 83 95 101 107

 

The malformations I have been studying among many primitive racial stocks occurred where the individuals had not changed their location, but where the contact with modern civilization was provided by the opening up of a transportation route, or as the establishment of a Hudson Bay Post for the Indians of the far north, or the calling of a ship once or twice a year on the shore of a South Sea Island when the price of copra or dried coconut was high. This could not in any sense be explained on the basis of weather change.

The fact that tooth decay, which had become active during the period that imported foods were brought to a South Sea Island (consisting largely of very high energy products, chiefly white flour and sugar), completely ceased when it did not pay the trader to call at the Island, since the price of copra had gone down, gives evidence that nutrition plays a very important rôle. The rate of barter was usually 90 per cent in sugar and white flour and 10 per cent in clothing. When the trade ship did not call, this compelled the people to go back to their former dietary of sea foods, together with their land plants, the obtaining of the former often requiring much hard work.

While dental caries is most likely to appear during the stress periods of growth or reproduction, the facial and dental arch deformities are usually but little in evidence at the time of the first dentition, but become strikingly so with the development of the second dentition.

It has previously been interpreted that the forces at work for producing facial deformity were largely, if not entirely, postnatal, and had to do with the habits of the child. Irregularities, accordingly, have been ascribed to faulty breathing habits such as finger and thumb-sucking and faulty sleeping posture. Some of the primitive races studied have been found to encourage thumb and finger-sucking, and the mother was often seen putting the child’s fingers or thumb into its mouth as a comfort on which to go to sleep. In spite of this, all the dental arches were normal in form. This seems clearly to nullify this theory. When the nutrition of a child is inadequate, it is conceivable that, where the growth urge carries the scaffolding ahead of the building of the supporting structures, this may leave a pliable matrix; such a tissue might be distorted by pressure, at least temporarily.

An important phase of these studies has accordingly been the obtaining of data that would throw light upon the time at which these disturbances occur. In several of the racial groups studied it has been noted that the care of the expectant mother was unique. In the South Sea Islands she was particularly careful to obtain certain special kinds of sea foods to aid her in the process of child building. The children in the South Sea Islands were taught to follow the tide out and obtain every day oysters, clams, beche de mer, etc., and such other sea forms as were available. Among the tribes in Africa, several were found that paid particular attention to the nutrition of the mother-to-be during the earliest part of the gestation period. Among the Masai, for example, we learned that it had been their practice in their primitive state to have their girls marry at seasons of the year when the cows were on the rapidly growing young grass following the rain, in order that they would have as efficient nutrition as possible for preparing them for the important event of conception and gestation. In the Anchola tribe the girls were especially fattened to prepare them for marriage. In several tribes the brides-to-be were excused from hard work for six months or a year before their marriage, and in some tribes the girls were fed especially for several months to a year before their marriage. In some of the tribes a mother was not permitted to have a second pregnancy sooner than three years after the birth of her child. They considered that, in order to develop the most perfect babies, the mothers must have a rest period after each baby. It was also for the purpose of permitting her to nurse her baby for three years in order to tide the baby over the stress period from infancy to childhood. The principle of the adequate preparation of the mother for the problem of child bearing by beginning well in advance of the opportunity for conception has been a part of the practice of primitive tribes in quite remote parts of the earth.

Important light is thrown on this by a study of the problem of harelip and cleft palate. Petersen¹⁶ has stated that: “Children conceived during a blustery February and gestated during a stormy spring are more apt to have cleft-palates and harelips than children created while weather is more temperate.” Whether this is due to the stormy weather or to the lower level of the vitamins of those periods is a matter of great importance and interest.

In my studies of the vitamin level of dairy products for different months of the year as produced in different parts of the United States and Canada, I have found that there is a seasonal tide which does not follow the sunshine curve, but does follow the period of rapid growth of young plants. The vitamin contents of the dairy products, therefore, are high in the spring and autumn following the rains. These studies have now been in progress into the ninth year. They are not only on the butter samples retrieved from the North American Continent but from several countries throughout the world in both the Northern and Southern Hemispheres. These studies have also shown that, when the curves for mortality from each heart disease and pneumonia are related to these vitamin curves, they are practically always in opposite phase. These data are shown in graphic form in Fig. 2.

Fig. 2–Mortality curve for heart and pneumonia is in each district, in general, in opposite phase to the vitamin curves and neither follows the curve for possible hours of sunshine.

 

I have also shown¹⁷ that the vitamin curve is related to the morbidity curve for several children’s diseases. For example, in the city of Toronto, there is a marked correlation in morbidity levels for chicken-pox, measles, nephritis, scarlet fever, hemorrhage in the new-born, tetany and retropharyngeal abscesses on the one hand, and the vitamin levels on the other. When the vitamins are high, the defenses are high; when the vitamins are low, the defenses are low. Important support for this phase has recently been provided by several research reports. Hale¹8 in discussing the relation of vitamin A to eye development in the pig states: “A previous observation (see Abst. 859 4010, Vol. 3) is repeated in which three litters of pigs were born without eyeballs or with very serious eye defects when the mother had received a diet deficient in vitamin A before mating and during the first thirty days of gestation.”

Further important light on this problem of the effect of deficient nutrition of the mother-to-be prior to and at the time the conception takes place and during the early period of gestation is provided in the report of Converse and Meigs.¹⁹ They state as follows: “In 1932 we reported from Beltsville evidence that farm rations frequently fed to calves may be dangerously low in vitamin A, and that milk produced by cows fed hay which has lost its green color may be an unsafe source of vitamin A in the calf ration. This preliminary paper reported results dealing with four cows which had been fed over two years on a good grain mixture and late-cut low-color timothy hay. Of six calves born to these cows, two were dead, one was unable to stand and died shortly after birth, and three were and blind. The fact that cows so fed were unable to properly nourish their calves before birth led to the question whether the milk from these cows might not be deficient for normal growth of calves from other cows fed on rations adequate in vitamin A. This preliminary report included results on three normal calves fed milk from those cows fed low-color timothy hay. The three calves died at fifty-seven, sixty-two and seventy-one days of age, respectively…”

The importance of vitamin A for not only the development of the eye but also for its maintenance and normal function was recognized early, since when it was discovered, its first name was the antixerophthalmic vitamin. Wald²⁰ has recently shown in his work that: “Extracts of eye tissues (retina, pigment epithelium and choroid), showed the characteristic vitamin-A absorption band at 620 μ with the Sb Cl3 test, and were also potent in curing vitamin-A deficient rats. The concentration of vitamin A was very constant for different mammals, at about 20 Y per g. dry tissue. Values for frog tissues were much higher.”

The ease with which many of these primitive races bear their children is a matter of very great interest and significance. Dr. Romig, who had spent thirty six years among the Eskimos of Alaska, having gone there as a medical missionary, told me that in his entire period among the primitive Eskimos he had never once been able to arrive in time to see a normal childbirth for a primitive Eskimo woman, although he often reached the scene very soon after the first intimations were available. In all the primitive groups that I have visited, I have been advised that this is a relatively normal occurrence so long as they are in that excellent physical condition which is found to be present when they are on an adequate native dietary.

In contrast with this is my experience in visiting the splendid Indian reservation of the Six Nation Indians at Brampford, Ontario. When Dr. Davis, the local medical director, took me through his hospital, I asked him what its principal uses were. He stated that he had been among these people for twenty-eight years and had attended during that time three generations of mothers. He said the former generation had used the hospital chiefly for epidemics and infectious diseases, but the principal uses now for it were those associated with the difficulties of childbirth. The present generation of mothers were frequently carried into this hospital after they had been in labor for days. He reported that very morning he had been required to remove two babies by surgical operation. That these physical changes in body form are recent developments in the group was indicated by his experience that many of the grandmothers of these modern young mothers had taken a shawl and gone alone or with a daughter to the bush, and returned with the babe without medical assistance.

Important light is thrown on this phase of the problem by a recent research report by Mason.²¹ He states: “Abnormalities are described in the pregnancies of rats, maintained on diets deficient in vitamin A in varying degree: Prolongation of the gestation period up to twenty-six days in severe cases and a long and difficult labor which might last two days and often resulted in death of both mother and young were characteristic.” This latter phase of the problem has to do with disturbed function rather than a change in physical development of the mother. When the primitive races become modernized, there is much evidence that both these factors enter into the problem.

Murphy²² has presented important data relating malformations with a period of lower reproductive activity. In concluding one of his reports22 on a study of statistical data on the birth records of Philadelphia, he states:

“4. Miscarriages, still-births and premature births occurred more often than would be expected by chance in the pregnancies immediately preceding and immediately following the pregnancy which resulted in the birth of the defective child, and less often than would be expected by chance in the remaining pregnancies. Miscarriage, still-birth and premature birth occurred more often in the pregnancy immediately preceding that of the defective child.

“5. From the above observations, it is concluded that the birth of a congenitally malformed child may be only one expression of a prolonged decrease in functional reproductive activity, the other expressions being miscarriages, still-births and premature births.

“6. It is suggested that the obstetrician has unusual reason to suspect the possible existence of a congenital malformation in the pregnancy which follows immediately after a miscarriage, a still-birth, or a premature birth.”

Shute of the University of Western Ontario, London, Canada, in a personal communication, states that he has been impressed, in his studies of fetuses that have been aborted, with the large percentage of them that are malformed. This seems clearly to link the malformations with the causative factors which have resulted in decreased reproductive activity.

I have previously reported^24,25 some evidence of a direct relationship between gross deformity of the upper arch and mental deficiency. Studies were made in part to determine the possibility of modifying the mental phase by an operation to correct in part the physical phase. In cases of [mongoloids] and cretins, there is associated a marked mental deficiency with the characteristic faulty physical development which involves the middle third of the face. In these cases there is usually a marked narrowing of the upper arch and an underdevelopment of the maxillary bones, with marked restriction in the size of the nasal openings. An operation that I have made on some favorable cases has been to open the median suture in the hard palate by a slow positive pressure through attachments made rigidly to the teeth. By thus using the malar bones as a fulcrum a downward pressure is made on the base of the brain, which in these cases seems to relieve a pressure which was producing a functional disturbance, namely, nausea.

In some cases this proved to have a very marked stimulating effect probably by increasing the function of the pituitary. One boy, for example, eight years of age, had so marked a depression mentally that he could not be taught with other children, was as timid as a bird, dependent as an infant and afraid of all children for fear they might hurt him. He was very docile to his parents. After the separation of the maxillary bones with the opening of the median. suture, his condition improved so greatly that his mother could send him to the store with money to buy provisions and groceries. His attitude toward other children changed so that he became the bully of the street.

A more striking case is that of a boy sixteen years of age who was a typical [mongoloid]. By the Binet test he had a mentality of four years. He played on the floor with blocks and rattles like a small child. The left nostril was so completely occluded that a rhinologist spent half an hour trying to shrink the tissue with adrenalin and cocaine sufficiently to get air and water through, and was not able to do so. This boy was able to breathe only through his mouth. The operation made consisted of widening the upper arch and opening the median suture, which was not united at his age as it should have been. The separation was made sufficient so that there was a space of half an inch between the two upper incisors. The movement was made slowly so that the soft tissues were not broken. The artificial cleft in the hard tissues extended through the hard palate. Within three weeks’ time he breathed naturally with his mouth closed, and could maintain himself through either nostril. In twelve weeks’ time he changed physically from a child to a man. Both mustache and whiskers appeared promptly, and his mentality changed so that he would come to Cleveland from another city ninety miles away where he lived. He made two changes, paid his fare and traveled by himself. The progressive change in the hard palate, with the dates, is shown in Fig. 3. The change in the boy’s appearance is shown in Figs. 4A and 4B.

Fig. 3–Showing progressive opening of the median palatal suture, one-half inch.

Fig. 4A–Showing progressive change in the facial appearance: A, Front view before; B, in thirty days; C, in six months.

Fig. 4B–Showing progressive change in facial appearance: A, Side view before; B, in thirty days; c, in six months.

 

The improvement in his physical condition included much change in the development of the sexual organs. This created a new and serious problem such that, with his subnormal mentality, he became a community problem and had to be put in an institution. At the time he went there he was both physically and mentally capable of supporting himself under adequate supervision. I later called on him in the institution and had great difficulty to locate him, since I did not know his number. Finally, through the card system, his history was obtained and his number located so that he was easily found. I had not seen him for a year or two, but he recognized me and greeted me affectionately. From my conversation with the attendant I found he was now only one of a large group and received no personal supervision, consequently was drifting aimlessly from day to day. He was just one of several hundred feeble-minded individuals, several of them of the typical [mongoloid] type.

We are concerned in his case, particularly with the circumstances attending his early development and growth. He had two sisters that were much older than he. His mother was a partial invalid when he was born late in her life. We do not have data relative to the details of the children who may have been lost. His father was living and well except for a railroad injury. These cases throw important light on the role of the natural nursing process on both facial development and the stimulation of the pituitary by depressing the sella turcica.

Important light has been thrown on this problem of mongolism in its relation to racial incidence by Gesell.²⁶ He has studied the incidence of mongolism in colored races for comparison with white races. He interprets his data as suggesting “that clinical mongolism occurs with almost equal frequency in black and white populations.”

Among the disturbances which result in facial deformity are those related to harelip and cleft-palate. These lesions are definitely related to an interruption in the developmental process in early embryonic life. Many theories have been provided to account for them. The recent rapid development of our knowledge regarding the influence of an inadequate amount of certain body building materials in the foods, particularly the minerals and vitamins, has thrown important light on the etiology of these lessons. Macomber has reported deformities in the tails of rats resulting from faulty nutrition of the mother. Slonaker²⁷ has recently shown that the reduction of adequate vitamin B content tends to result in an interference with the development of the fetuses such that they are born with deformities of tails and eyes. He states:

“Diet. An accurately prepared synthetic diet was used throughout the experiment. A careful study was made in the selection of the ingredients in order that all the known amino-acids and vitamins were present. After a short time it was found that the diet was deficient in vitamin B. This was especially noted in the offspring of the animals on low protein, group I, and was manifested by greatly retarded growth of the young and often by malformations. Such conditions were not observed in the other groups. The most common deformities consisted of blindness or of a loss of from one fourth to three-fourths of the tail. Those which were blind remained so throughout life. The lids remained closed and their sunken condition indicated a lack of development of the eyeball.”

In my animal experimental work in which I was testing the value of different diets as applied to the problems of the rat, we have frequently had deformities develop on highly deficient diets. For example, in a diet consisting of white flour, 69 parts; gluten, 20 parts; powdered whole milk, 5 parts; Crisco, 5 parts; and salt, one part, with high vitamin butter unlimited, marked changes occurred in the tails, with the loss in some of more than half the total length of the tail. I have published²⁸ in detail data on the chemical contents of both the food and the blood of the rats, together with photographs of marked structural changes in the animals, where white flour was used as the cereal content in comparison with the entire wheat and the bran and middlings mixture, the other parts of the diet being the same. In this diet using white flour, the minerals and vitamin B were greatly reduced. Phosphorus was decreased about 80 per cent. These rats did not reproduce.

In my field studies of primitive racial stocks I have never seen among the isolated groups a single case of harelip or cleft-palate nor have I learned of the history of such from the missionaries and government workers in contact with the primitives. I was interested, however, to find and photograph a typical case in the modernized colony at Mombasa on the east coast of Africa.

We are frequently concerned to observe other characteristics of a large group of individuals in our modernized civilization who have suffered a disturbance in the developmental period such that the dental arches are abnormally formed.

In my local clinical investigations as to the effect of reinforcing the nutrition, I have used several groups assembled in districts of the city where the industrial depression has been quite severe. For one of these groups I asked the officials connected with the Board of Education and having charge of the dental phase to select for me about twenty-four children suffering severely from dental caries and who were backward in their school work. In this group of twenty-four there were seven who proved to have marked deficiency in the development of the dental arches. The treatment given consisted in providing them with additional fat-soluble vitamins obtained from very high vitamin butter, mixed with equal parts of a high vitamin cod-liver oil, together with the addition to their dietary of sufficient milk to make a total of a quart a day.

Detailed x-ray records were made before and after the reinforcement of the nutrition. Clinical records were kept in detail as to the size and location of cavities. 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 being 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. The caries was shown by the x-ray pictures to have apparently ceased. The chemical analysis of the saliva showed a marked improvement, as previously reported in detail.²⁹

The progressive increase in the rate of several degenerative processes in the United States constitutes one of the alarming warnings for the future. Even more striking than this is the rapid deterioration of primitive racial stocks when they come in contact with our modern civilization. This applies not only to their dental caries and facial and dental arch deformities, but very strikingly to their resistance to some of the infective processes. If it shall be that we may find evidence indicating these factors are related in the same individuals, namely, a lowered resistance to infective processes and evidence of nutritional injury in the formative period, it will suggest the direction in which further studies should be made.

Among the Indians of the far north and the Eskimos of Alaska, one of the most serious causes of death is tuberculosis. A late survey shows the present average length of life of the Eskimos to be reduced twenty years, due largely to tuberculosis. I was particularly concerned to observe whether this was attacking the people in the isolated groups who are still primitive and who had their body development and growth while in their isolated environment or in the modernized groups. In the government hospital at Juneau, Alaska, there were twenty boys and girls bedridden with pulmonary tuberculosis. It is a matter of great interest and evident significance that every one of these individuals had marked disturbance in the development of the dental arches, strongly suggesting that the same injury disturbed the mechanisms of defense. In the South Sea Islands the individuals in two hospitals were studied, one in Hilo and the other in Honolulu in the Hawaiian Islands. Again, with eighteen individuals studied in the Hilo hospital and nineteen in the Honolulu hospital, I found all to have had interference in the growth period as expressed in a deformity of the dental arches.

Further light is thrown on the problem of lowered defense for tuberculosis by the condition that I found at Telegraph Creek in northern British Columbia, at the point of contact of the foods of modern civilization with the Indians of the interior of northern Canada. The Stikine River has its source in the backbone of the continent, draining the western watershed of the Rocky Mountains of that northern area to the Pacific. It has cut a great gorge through the Cascades and Coast ranges, through which it flows as a large turbulent stream. Special high-powered boats have been constructed for the purpose of going up these rapids for a considerable distance to Telegraph Creek. This has made possible the carrying in of modern foods, particularly white flour and sugar products and canned foods during the summer, for exchange for the furs of the Indians, which have been carried over the mountains from the interior. Many of the Indians have brought their families to this district, where they reside throughout the year, while the men go back to their trap lines for collecting the furs in the winter. The new generation of Indians that is growing up at this point of contact is showing a very greatly reduced resistance to tuberculosis. Many families were found in which several of the children had died, and many children were seen who were either bedridden or coughing. Another disease that was conspicuous there was arthritis. In the interior beyond the mountain range, where we studied the primitive Indians, we did not see a single case of arthritis. At this point of contact, however, at Telegraph Creek we found ten bedridden, or nearly so, cripples with arthritis; several of the individuals were under twenty-five years of age.

In order further to observe whether an injury in the prenatal period due to faulty nutrition constituted a contributing factor to susceptibility to tuberculosis, I made an examination in one of our municipal tubercular sanitariums in Cleveland and found forty out of forty three individuals to be showing evidence of nutritional injury in the formative period. This was expressed as a change in the form of the dental arches. It probably is needless to emphasize that I do not consider that the form of the dental arch contributed directly, but that both the lowered defense and this physical injury were expressions of the defective development. In those cases, however, where the normal ventilation of the lungs was seriously impaired because of the small nares, that impairment should be expected to add to the difficulty of functioning of the lung tissues.

In the United States the heart disease problem has been very carefully studied by various organizations, including the American Heart Association. In their booklet published in 1934, entitled Heart Disease Mortality Statistics, they show that deaths from disease of the heart have increased from 159.1 per 100,000 to 213.5 per 100,000 for the years 1920 to 1930. In 1925, they published a map indicating those states in deep color in which the increase is most rapid and where the total number of deaths per hundred thousand exceeds 180. In this map the states that were chiefly involved included the New England district states and two states on the Pacific coast. In their later map of 1932, this area of most rapid increase is shown to have extended along the Great Lakes. In other words, the increase seems to have occurred in those districts where the soil has been cultivated for the longest period and where depletion has accordingly been the greatest.

It is of particular interest that Petersen,15,16 in arranging his data for various affections, found in the United States Draft, according to prevalence in states, has shown that the following were the highest in the New England States: defective teeth, defective hearing, myopia and defective vision, atrophy of the muscles of the extremities, underweight, underheight and myocarditis. The figures provided by the United States Census for 1931 reveal a marked reduction in the number of farms occupied in some states in New England during the years 1911 to 1931.

It is of interest that in my studies of the vitamin levels of various districts as shown in Fig. 2, the levels found in the dairy products of the New England States were lower than in any other part of the United States and Canada. I have corresponded with the Departments of Agriculture of each of the United States inquiring if data were available as to whether the soil of that state was capable of carrying as many cattle at this time as in years past and on what basis comparisons could be made. I was advised that in practically all states the efficiency of the soil had gone down in amounts ranging from 25 to 90 per cent, and further that the element that was most frequently being exhausted was phosphorus.

Bullock had made a study of the phosphorus level of the blood of individuals in various periods of life. From an examination of 200 individuals of various ages he has shown that after birth the inorganic phosphorus level of the blood, which at birth is a little over 4 milligrams, tends to rise until about five years of age, when it reaches 5 or 6 milligrams per 100 cc. of blood. Then it progressively declines, passing the average line of 4 milligrams at about eighteen to twenty years of age and then it slowly becomes lower through the remaining years of life.

I have correlated data relating to this phase as obtained from 500 successive blood chemical analyses. I have used as the factor of measurement the product of serum calcium and serum inorganic phosphorus. Forty is used as a base line, based on an average of 10 milligrams of calcium and 4 milligrams of inorganic phosphorus per 100 cc. of serum. These data are shown graphically in Fig. 5, in which the average product, the solid line, is shown to run above the base of the middle teens, and then declines to a level below the base line and progressively declines through the balance of life. When, however, the 10 per cent best individuals are carried through they are found, as shown by the broken line, to run well above the base line throughout life. When the 10 per cent poorest in the age groups are used as shown in the dotted line below, they are seen to fall early below the base line and carry along at a very low level throughout life.

Fig. 5–Individuals readily divide into three groups on the basis of the product of blood calcium and inorganic phosphorus.

 

When twenty of these individuals of the lower group were given a diet reinforced by the selection of foods higher in minerals and vitamins, the latter being reinforced by an oil centrifuged from a very high vitamin butter produced while cows are eating young wheat, oats, rye or barley, preferably wheat or rye, which is mixed in equal parts with a high vitamin natural cod-liver oil, the average change in this group was to bring them up from 27.1 to 37.5 nearly to the base line. This is shown in Fig. 6.

Fig. 6–The response to treatment with activators is shown as an increase for (Ca x P) from 27.1 to 37.5 as an average for 20 cases. Physical improvement accompanies this change.

 

Coincidentally with this change in the blood picture there was a very marked improvement in the physical condition of the individuals. Active tooth decay, when present, was completely arrested. The individuals who were physically languid and were carrying their work with difficulty, experienced an increase in efficiency. A very marked and general experience was a sense of being more rested from sleep.

It is important that we apply the data obtained from a study of the primitive races directly to the problems of our modern civilization, as well as to the new problems of the primitive groups when they come in contact with our modern civilization. A splendid illustration of the latter is shown in Fig. 7, in which will be seen a Wakamba man and his son. This man is employed, and has been for several years, by the Kenya and Uganda railroad. He has been obtaining modern foods, which have largely displaced his former native foods. This boy has been born since this change took place. You will see at a glance that the middle third of the face has not developed completely, constituting a marked change in the tribal pattern. The upper dental arch has not developed forward, producing a crowding of the teeth. The nostrils are narrow and, like many of the modern individuals so affected, he is a mouth-breather. In the light of our newer information this injury occurred very early in the formative period, and may have been increased in severity by his deficient nutrition during the growth period.

Fig. 7–Note the marked change in the first generation after adopting modernized diet.

 

In general, any deformity pattern that is found in individuals in our modern civilization seems to be duplicated, in even the first generation, among the primitives where they have replaced their more efficient native foods with modernized dietaries. A striking illustration will be seen in Fig. 8, which shows a boy from southern Uganda, first generation on the changed dietary, and in comparison a boy in Cleveland of approximately the same age. The Cleveland boy was born and raised in a well-to-do family. His parents were of good physique. His birth rank in the family was the sixth child. His birth was preceded by two premature births, which were preceded by twins, who were preceded by the first child by only one year. This is of special interest in connection with the observation previously quoted from Dr. Murphy²³ in which he stated:

“…(6) It is suggested that the obstetrician has unusual reason to suspect the possible existence of a congenital malformation in the pregnancy which follows immediately after a miscarriage, a stillbirth or a premature birth.”

 

Fig. 8–Similar pattern changes in facial form occur in central Africa, shown to the right, as occur in America, when the mother’s nutrition is deficient.

 

His analysis of the statistical data points strongly to the earliest period of the formative stage and to a decrease in functional reproductive efficiency. When this decreased reproductive activity extends over a considerable period, the succeeding children may show the same general injury but with different severity. Usually, however, it is most severe in the youngest.

This is illustrated in Fig. 9 which shows a father and mother and their three children. Note the marked lack of development of the middle third of the face in each of the children, shown in greatest severity in the youngest. The mother’s teeth have been very badly injured by dental caries. The restorations indicate that she had been in contact with excellent modern dental service. The dental caries was probably active during her periods of gestation and lactation. The parents were born and reared where they had a liberal supply of sea foods. The children had their formative and growth periods while living in a modernized business community. This is precisely the condition I have found among the primitive people at the point of contact with modern civilization, as splendidly illustrated in the Indian family in Fig. 10. The father and mother were born and reared in northern central Canada at Point Lookout, before the approach of civilization. Then the Canadian Northern Railway passed through their primitive country and made modern refined foods available for use during the development and growth of the children. Note the marked narrowing of the nostrils and lack of development of the children’s faces. The girl was coughing. Many of the young generation of this district had developed tuberculosis.

Fig. 9–Typical progressive change in facial pattern in succeeding children. Note the lack of development of the middle third of the face.

Fig. 10–This Indian and his wife were developed on primitive foods, their children on modern foods. Note the narrowing of the nostrils of the children. Both are mouth breathers.

 

A very important opportunity for study is hereby provided by an examination of American-born families in comparison with the European-born parents. An examination of family groups in almost any gathering discloses at once, to a trained eye, that a radical change is taking place and expressing itself in the change of facial pattern. When I called the attention of a young lady who came to me for advice relative to her facial deformity to this, she told me that it was a common topic of conversation among her generation and nationality that the children were not so good-looking as their parents.

In an examination of fifty-seven family groups where the children were American born and the parents European born, I found that twenty-four, or 42.1 per cent, showed distinct evidence of a change in the facial pattern. This was characterized by the narrowing of the nostrils and an increase in the height of the face in proportion to its width. Further it was revealed that this tendency was progressive in these families. Because of limited space a discussion of this phase will be made in a separate communication.

The evidence from these various sources points directly to the primary cells whose elements determine the architectural pattern of the new unit, as though the perfection of the genes of the chromosomes were dependent upon an adequate nutrition of both parents prior to and at the time that the fertilization of the ovum takes place.

That the relatively high immunity of several of these primitive racial stocks to our modern degenerative processes, including dental caries, is not due to their living in a specially favorable environment, is clearly demonstrated by the fact that in each case they have broken down while remaining in that environment, and the only change that was found to have occurred was in their nutrition. Indeed, their environment has usually been very unfavorable, otherwise they would have long since been reached by modern commerce. Medical missionaries and physicians working among several of these primitive groups have reported to me that many of the degenerative diseases that are so common in our modern civilization have seldom been met with in their contact with these primitive stocks. A detailed study of their nutritional programs reveals clearly that they have accumulated wisdom relative to living in harmony with Nature through obeying her laws. It is exceedingly important that, before these rapidly declining remnants have been exterminated by having come in contact with our modern civilization, an effort be made to learn from them the secrets by which they have built up their fine physiques. This is one of the fundamental purposes of these field investigations which are being continued this season (1936) among the aborigines of Australia and the Maoris of New Zealand.

Summary

(1) Modern civilizations are progressively breaking down in many districts through the increase in both the incidence and the severity of several degenerative diseases, among them dental caries.

(2) Many primitive racial stocks have been studied and found to be relatively free from dental caries in comparison with our modern civilized groups, and, further, that they lose high immunity to tooth decay when they displace part of their native foods with modernized foods.

(3) A chemical analysis of the foods of the two groups reveals that the primitives with high immunity have selected dietaries that are relatively high in the minerals and vitamins required for body building and repairing, in comparison to the calories or energy content; whereas the foods of modern civilizations tend to be higher in calories and energy and lower in activating substances and minerals.

(4) A study of morbidity and mortality levels has revealed a direct relationship of these factors to the vitamin levels of the foods in certain districts.

(5) The accumulated wisdom of several of the primitive races studied has been found to provide a special nutrition for women prior to conception and also during both the gestation and lactation periods. This has been shown to be directly related to the high physical perfection of their child life.

(6) Experimental data have been presented which directly relate a deficiency of vitamins in the nutrition of the mother-to-be and the presence or absence of deformities in the offspring.

(7) The extreme facial deformity which accompanies mongolism, with its associated mental deficiency, appears, from the data, to have more than a coincidental parallelism with deformed dental arches and disturbed facial development.

(8) Evidence has been presented which strongly indicates a relationship between the level of individual defense for infection and an injury resulting from a nutritional deficiency in the formative period.

(9) The progressive increase in the incidence of degenerative diseases in certain districts has been shown to be associated with a lowering of the minerals in the soil of that district, resulting in a lowering of the mineral and vitamin content of the foods.

(10) Data have been presented which suggest a relationship between the level of vitality throughout life and the level of phosphate in the blood. It has also been shown that this factor is readily influenced by an intake of fat-soluble activators and high mineral, natural foods.

(11) Malformations, including irregular teeth and change in facial pattern, have been shown to have a direct relationship to reproductive capacity of the mother, which in turn has been shown to be directly related to her nutrition and overloads.

(12) Progressive physical degeneration has been shown to be taking place in some of our modern communities similar to that which occurs in primitives at their point of contact with our modern civilizations. This is evidenced by a change in facial pattern.

(13) These various data indicate the means whereby not only dental caries and irregular teeth and change in facial form may be greatly lessened, but also means for checking the increase in susceptibility to the degenerative diseases and means for a substantial betterment of our modern civilization. Means are also indicated for checking the degeneration of the primitive races where they come in contact with our modern civilizations.

 

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, and physical/developmental disabilities has evolved, and some readers may be offended by references to “primitive” people, “mongoloids” 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 individuals or groups is intended.

 

References Cited:

1. Hooton, E. A.: Science, March 1936.
2. Dryer, T. F.: “Dental Caries in Prehistoric South Africa.” Nature, 136:302-303, 1935.
3. Price, Weston A.: “Why Dental Caries with Modern Civilization? (1) Field Studies in Primitive Loetschental Valley, Switzerland.” Dental Digest, March 1933.
4. Idem: “(2) Field Studies in Primitive, Valais (Wallis) Districts, Switzerland.” Dental Digest, April 1933.
5. Idem: “(3) Field Studies in Modernized St. Moritz, Herisau, Switzerland.” Dental Digest, May 1933.
6. Idem: “(4) Field Studies in Primitive and in Modern Outer Hebrides, Scotland.” Dental Digest, June 1933.
7. Idem: “(10) Field Studies among Primitive and Modernized Eskimos of Alaska.” Dental Digest, 40:120, June 1934.
8. Idem: “(9) Field Studies among Primitive Indians in Northern Canada.” Dental Digest, 40:130, April 1934.
9. Idem: “(8) Field Studies of Modernized Indians in Twenty Communities of the Canadian and Alaskan Pacific Coast.” Dental Digest, 40:81, March 1934.
10. Idem: “(7) Field Studies of Modernized American Indians in Ontario, Manitoba and New York.” Dental Digest, 40:52, February 1934.
11. Idem: “(12) and (13) Field Studies among the Polynesians and Melanesians of the South Sea Islands.” Dental Digest, 41:161, 191, May and June 1935.
12. Idem: “Studies of Relationships between Nutritional Deficiencies and (a) Facial and Dental Arch Deformities and (b) Loss of Immunity to Dental Caries among South Sea Islanders and Florida Indians.” Dental Cosmos, 77:1033, November 1935.
13. Idem: “(14) and (15) Field Studies in Kenya, Uganda, Belgian Congo, Sudan and Egypt.” Dental Digest, 42:52, 89, February and March 1936.
14. Idem: “Field Studies among Some African Tribes on the Relation of Their Nutrition to the Incidence of Dental Caries and Dental Arch Deformities.” Journ. A. D. A., 23:876, May 1936.
15. Petersen, William F.: The Patient and the Weather. Vol. I, Part 1–published by Edwards Brothers, Inc., Ann Arbor, Michigan, 1935.
16. Idem: Time, January 20, 1936.
17. Price, Weston A.: “Some Contributing Factors to the Degenerative Diseases, with Special Consideration of the Role of Dental Focal Infections and Seasonal Tides in Defensive Vitamins.” Dental Cosmos, 72:1049, 1119, October and November 1930.
18. Hale, F.: “The Relation of Vitamin A to the Eye Development in the Pig.” Proc. Amer. Soc. Animal Prod., pp. 126-128. (Texas Exp. Station), January 1935.
19. Converse, H. T., and Meigs, Edward B.: “Carotene and Vitamin A in the Nutrition of Dairy Calves.” Bureau of Dairy Industry, U. S. Dept. of Agriculture (BDIM-645).
20. Wald, G.: “Vitamin A in Eye Tissues.” Journ. Gen. Physiol., 18:905-915, July 1935.
21. Mason, K. E.: “Foetal Death, Prolonged Gestation, and Difficult Parturition in Rat as Result of Vitamin A Deficiency.” Amer. Journ. Anat., 57:303-349, September 1935.
22. Murphy, D. P., and Mazer, M.: “The Birth Order of 582 Malformed Individuals.” Journ. A. M. A., 105:849-851, September 14, 1935.
23. Idem: “Reproductive Efficiency before and after the Birth of Malformed Children.” Surgery, Gynecology and Obstetrics, 62:585-589, March 1936.
24. Price, Weston A.: “Some Contributions to Dental and Medical Science. A Report of Personal Research.” Dental Summary, 34:253, April 1914.
25. Idem: Dental Infections, Oral and Systemic. Vol. I, p. 433, Penton Publishing Co., Cleveland, Ohio, 1923.
26. Gesell, A.: “Clinical Mongolism in Colored Races.” Journ. A. M. A., 106:1146, April 4, 1936.
27. Slonaker, J. R.: “The Effect of Different per cents of Protein in the Diet.” American Journal of Physiology, 96:547, March 1931.
28. Price, Weston A.: “Additional Light on the Etiology and Nutritional Control of Dental Caries, with Its Application to Each District Showing Immunity and Susceptibility.” Journ. A. D. A., September 1933.
29. Idem: “Eskimo and Indian Field Studies in Alaska and Canada.” Journ. A. D. A., 23: 417, March 1936.