LEVINE, VICTOR E.: Schools of Medicine and Dentistry, Creighton University, Omaha, Neb. (Jan. 14, 1939).

Among Eskimos there is a profound interrelation between poor nutrition, increased physical degeneration, increased emotional stress and strain, in­creased incidence of respiratory infections, and increased mortality rate on the one hand, and decreased size and strength of jaws, increased crowding of teeth, and increased susceptibility to caries on the other. The author’s findings confirm in the main those of Price, Waugh, Hrdlieka, Collins, and others; and agree with Price’s conclusions that (a) teeth respond earlier and with greater sensitivity to nutritional changes than other parts of the body and that, (b) at points of contact with modern civilization, primitive man—dis­carding his own dietary habits and adopting White man’s forms of food having the least protective properties—loses immunity to caries. Modern Eskimos differ from the primitive in mode of life and dietary habits. Their present dietary is less balanced and sustaining, the change seeming to have increased the extent of physical degeneration, and also the incidence of mor‑bidity and mortality due to diseases of the upper and lower respiratory tract, such as laryngitis, tonsillitis, sinusitis, hypertrophic rhinitis, tracheitis, bron­chitis, the common cold, influenza, pneumonia, and tuberculosis. In contact with civilized man, the Eskimo tends to imitate him in diet, and in the use of tobacco and (sometimes) intoxicating liquors, as in Nome and in Kotzebue. The Eskimo has not adopted White man’s food in toto, but only his poorest foods—demineralized and devitaminized white flour, mineral- and vitamin- free sugar, tea and coffee—which tend to reduce the Eskimo’s intake of his own native and more protective foods. The Eskimo baby is no longer kept at the mother’s breast for several years but, as a rule, is weaned within the first year ; usually does not receive milk obtainable in evaporated form at any trading post; and no longer is exposed naked to the rays of the summer sun.

The present-day Eskimo shows under-development of the middle or lower third of the face, with consequent facial changes and deformities of the dental arch and increase in crowding of the teeth. These conditions, owing to im­paired nutrition and insufficient exercise of the masticatory apparatus, are becoming almost universal among Eskimos. The more general the adoption of White man’s diet, as in Nome and Kotzebue, the greater the incidence of caries. A mouth free from caries is more likely to show absence of crowding, and to display regularity, of the teeth than one having caries. It appears that one generation has been sufficient to produce marked divergence from the old pattern of facial form and dental arch, inducing more crowding and more caries. Loss of teeth in young Eskimos is usually due to caries. In old Es­kimos gingival disturbances may be the greatest factor in loss of teeth. Caries-free Eskimos are very likely to be in a better state of nutrition and health, but some natives who have no caries are malnourished and suffer from active tuberculosis. Eskimo females are more susceptible to caries than males.

The Eskimo’s sense of imitation has led him to discard many dietary and health habits favorable to his well-being. Liver is being eaten less frequently; liver of salmon, reindeer and walrus is now mostly used for dog food ; contents of reindeer stomach (rich in moss and other types of Arctic vegetation) and of walrus stomach (abundant in clams) are now rarely consumed. The diet of modern Eskimos, de­ficient in the regions investigated, is largely protein ; rich in iron, copper, phos­phorus, and iodine ; very poor in calcium, with reduced amounts of fats and oils —and of carbohydrate, unless added in the form of flour products and sugar ; rich in vitamins G and E; deficient in vitamin C; probably deficient in vitamins A and D, since whale, walrus, seal and oogrook blubber (and corresponding oils obtained by rendering) are derived from subcutaneous deposits, and are poor in the vitamins in liver fat (oil). Isolated Eskimos—unable to obtain white flour, sugar, tea, coffee and tobacco, and forced to subsist on their native foods—are free from caries. Eskimos living in a village having a trading post may also be free from caries. Many caries-free natives have lived in isolation most of their lives, or have only recently taken up residence in a village, or have always had a distaste for White man’s food. The greater the economic prosperity of the Eskimo, the more he tends to imitate the ways of White man, with resultant acceleration in the in­cidence of caries. Attrition in the present-day Eskimo becomes severer with age, but is less marked than in the primitive Eskimo ; attrition of the fourth degree occurs only rarely. The diet of the primitive Eskimo, mostly raw muscle and visceral meat, was rougher, tougher, and more abrasive than his present meat­white-flour-sugar-tea diet. Caries seems to occur in inverse ratio to the degree of attrition, usually in molars. Although absence of attrition is usually associated with abundant caries, attrition and caries occasionally occur in the same tooth.

The foregoing findings were obtained in a dental survey, in medical and bio­logical studies for over a year, during 1937 and 1938, under the auspices of the U. S. Public Health Service. The survey included dental conditions in 870 Es­kimos of both sexes and all ages, in the Bering Sea and Arctic sea-coasts for about 1700 miles—at Akulurak (south mouth of Yukon River), St. Michael, Nome, King Island, Little Diomede, Cape Prince of Wales, Deering, Kotzebue (and the inland river villages of Noatak, Noorvik, Kiana, and Selavik), Kivilina, Pt. Hope, Pt. Lay, Wainwright, Pt. Barrow, and points over 400 miles along the Arctic shores east of Pt. Barrow on the northern rim of the American continent (Cape Halkett, Beachy Point, mouth of Colville River, Brownlow Point, Foggy Island, Cross Island, Humphrey Point, Long Point, Martin Point, and Demarcation Point).

Reference: J. Den Res. (Proc. Int. Assoc. Den. Res.), 18, 255, 1939.

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