9. The First Native Cancer Is Recognized In Northern Alaska

After forty-nine years of the search which Leavitt began in 1884, cancer in a north Alaska native was first identified at the Farthest North Hospital of the Presbyterian medical mission to Barrow in 1933.

During my own middle years, between ceasing northern field work in 1918 to becoming like everybody engrossed with World War II, my interest in the special problem of cancer on the northern Alaska-Canada frontier was mainly quiescent, though with active periods. My preoccupations during those years were study and writing, mostly in connection with the North; my base of operations was New York City, because of its great libraries. A visitor, every three to four years, was Charlie Brower who had been Leavitt's buddy at Cape Lisburne, northwestern Alaska, when his cancer search began. Brower had in 1885 moved 300 miles northeast to establish at Barrow the “station” for whaling and trading. This post became the focal point of northern Alaska for whaling ships that passed going east or west, and for revenue cutters, explorers, and natives.

Brower had many friends in New York, Connecticut, and New Jersey. He was a native New Yorker himself and his father had become mayor of a New Jersey town. It was Charlie's occasional visits to friends and relatives that kept reawakening my interest in cancer. When I saw him we kept reminiscing about Leavitt and about the various polar expeditions which had fraternized at Barrow with revenue cutters, whaling ships, missionaries, and natives.

One of these expeditions had been my own Anglo-American Polar; and Brower had been involved when the Barrow medical missionary, and the surgeon of the cutter Thetis, told our surgeon of their belief that the Eskimos of northern Alaska had suffered no cancer, at least not since they first became continuously known to the Yankee whalers following 1884. So, on his visits to New York, Brower would seldom fail to mention cancer in one connection or another, always saying its existence among natives farther south in Alaska kept being reported, but that as yet this was mere hearsay to northern Alaska.

On one of his visits, however, Brower said the time of mere hearsay knowledge had passed. A Barrow Eskimo had been struck down with cancer, a man I knew slightly through having met him several times during my visits there of 1908 to 1912.

Apart from what I heard from Brower, my interest in cancer now remained dormant until 1935 when I signed a contract with the War Department to gather, to supply from my own knowledge, and to formulate for presentation to them whatever I thought might prove useful information. To me it seemed obvious that on conditions of Alaskan health and disease the department needed information and understanding. So one thing I did was to follow up Brower's report of the eventual identification of cancer at Barrow (after such a long vain search) by seeking medical details from Dr. Henry W. Greist, who in 1921 had taken over the post Dr. Marsh had held in my time as head of the Presbyterian hospital, now known as Farthest North Hospital.

Unfortunately my 1935 letter to Dr. Greist proved to have been equivocally worded. Still more unfortunately I rushed into print the supposed facts I got in reply. My fault, which I did not realize until 1957, was that I did not ask Dr. Greist for general information about malignant disease, but instead told him Brower's story and asked for medical comment on that story specifically. The result appears in my War Department Arctic Manual, Washington, D.C.: Government Printing Office, 1940, pages 308-9:

“Cancer has not yet been reported from uncivilized Eskimos. One death from cancer has been reported at Barrow of a man who had been working for and with Mr. Charles D. Brower for nearly 40 years and living to a considerable extent on European food. However, an inquiry from Dr. Greist, medical missionary at Barrow, brings an answer which casts doubt on the diagnosis.”

Dr. Greist's reply to my letter was to the effect that the man I asked about had not died in hospital, that there had been no post mortem, and that the cause of death was unknown. Thus it was not until 1957, some twenty-two years later, that I discovered I had failed to get the information I needed, because I had asked a loaded question and the doctor had answered me literally. I had asked whether a certain specified man had died of cancer and the answer I got was that, in this specified case, the cause of death was unknown. Meantime it was known to Dr. Greist that another Eskimo had died of cancer. From the records of his hospital it is apparent that a cancer patient died there of the disease on July 27, 1933.

Because this was the first known malignancy death in northern Alaska, occurring forty-nine years after Leavitt began his search on the north coast, I shall set down all the details of which I feel sure.

When I took up again those inquiries which led to the writing of this book, an early step was to attempt to revive my correspondence with Dr. Greist, who had resigned his medical missionary position in 1936 and retired to his Indiana home at 318 North Bluff Street, Monticello. The reply came from Mrs. Greist, for her husband had died two years before.

In a letter dated February 19, 1957, Mrs. Greist explains that she remembers nothing of a disagreement between her husband and Mr. Brower on the cause of anybody's death, and suggests that if there was such a dispute it would be outside her sphere unless the man died in hospital or unless for some reason there was s post mortem, at which, in her capacity as head nurse, she would have assisted or at least have been told about it. Then Mrs. Greist continues:

“... I do remember nursing a case of cancer of the liver of an old man who came to Barrow from far to the eastward. After a week or two he died and Dr. Greist and I held a post mortem. We were then satisfied it was cancer ...”

This was all Mrs. Greist was able to say from memory, except that northern Alaska's first identified cancer illness and death came during some year early in the 1930's. But when she learned that her testimony was intended for publication, along with other testimonies, she instituted a search and finally discovered precise dates for this case. She wrote me on August 30, 1958:

“After three days and late nights reading through three years of my diary that I kept in the North, I found what you wish to know about the cancer case. On July 27, 1933, at 7:45 A.M. Jobe passed. I have recorded the fact that Lee, Helen and I helped Dr. Greist with the autopsy. [We found] an immense cancer of the liver; we guessed the weight at 25 or 30 pounds ... Helen is dead; Lee should remember [the cancer victim's] full [Eskimo] name... Lee is head of the native store at Barrow now.”

Mrs. Greist followed up this second letter by lending me a handwritten diary dating from January 1, 1933, to December 31 of that year. Into this she has freshly written, opposite the entry for July 5: “The day Jobe came in.” The entry says: “Jobe came in with obstruction of the bowels; very bad shape.”

The diary for July 17 says: “Old Jobe much worse; going to die ... Up on duty till 4:00 A.M., did not sleep till 4:30.”

In a further recent entry Mrs. Greist indicates on the margin for July 27 that here is the crucial passage of her informal, private diary. Insofar as applicable the passage reads:

“Helen came and called me at 3:00 A.M. as she thought Jobe was passing ... but he did not die until 7:45 A.M. Both girls were very sleepy so we let them sleep ... Worked all day; cleaned some in the operating room and clinic. Helped Dr. with the autopsy on Jobe (Helen, Lee and I). An immense cancer of the liver ... it must have weighed 25 to 30 pounds. Helen and I washed and dressed Jobe for burial."

Apart from assuring me that this was the first case known to herself, or to Dr. Greist, of death from cancer by an Eskimo native from the north coast of Alaska, Mrs. Greist had little pertinent information on the case of Jobe. He was an elderly man. Whether he had worked on shipboard (thus living a good deal European style) she cannot say. In a general way it is known that all natives along this coast were eating some white man's food at most of their meals after 1913; see, for instance, the descriptions of typical meals by Dr. Diamond Jenness in his Dawn in Arctic Alaska (University of Minnesota Press, 1957). The book was compiled from the notes Dr. Jenness kept while he was anthropologist of our third expedition, the Canadian Arctic Expedition of 1913-18. See also my own writings about the coast east of Point Barrow for the years 1906-14. (In view of the idea of some, that the application of extreme heat to food is carcinogenic, it might be noted that a chief European food item around 1910-30 was fried bread — doughnuts, crullers — cooked in exceedingly hot seal oil).

Toward the end of her first letter to me, the one dated February 19, 1957, having dealt already with the case of Jobe, Mrs. Greist goes on to discuss a form of cancer that is frequent among whites in Europe and North America, breast cancer in women. The letter says:

“This I know, we never found any women with lumps in their breasts. I never knew, in all my 17 years of nursing in the hospital with Dr. Greist, of a single woman who did not breast-feed her child, and nurse it for 2, 3, and up to 4 years ... I never observed a caked breast or a sore nipple.”

Mrs. Greist, who herself had ceased northern nursing in 1936, advised me to get in touch with a nurse whom the government had sent to help take over the Farthest North Hospital's work when it was transferred by the Presbyterian Church to the Department of the Interior. Mrs. Greist had been deeply impressed with Miss Mildred H. Keaton, both as to her professional training and as to her long and varied experience as a dog team and airplane nurse who was thoroughly familiar with the native situation at the western end of northern Alaska (at the Kotzebue Government hospital, just east of Bering Strait and just north of the Arctic Circle). From there eastward, Miss Keaton had again and again traversed a thousand miles of coast beyond Barrow to the Canadian border.

Miss Keaton replied to my letter on April 15, 1957, from her new post at the White Pass and Yukon Route Hospital, Skagway, Alaska:

“Regarding the absence of cancer from the pre-white Eskimos of arctic Alaska, it has ever been a source of wonder to me that during the fifteen years when I was a field nurse in the Kotzebue and Barrow districts, going east of Barrow to Demarcation Point [on the Canadian boundary], among the more primitive Eskimos, only once did I come in contact with a diagnosed case of cancer ...” (In later correspondence Miss Keaton said this lone case seen by herself was in the middle 1930's, thus two or three years after the above Greist autopsy and cancer identification at Barrow.)

“We field nurses have often wondered why the women did not have breast cancer, due to the way they carried their babies on their backs with a strong leather or reindeer skin belt fastened tightly around their chest ... the pressure on the mammary glands of the breasts must have been severe.

“The late Dr. Ray Edward Smith was hospital physician in Kotzebue for some 16 years ... [serving] a population of native people totaling about three thousand coming to Kotzebue Hospital. He once told me he had always been most pleasantly surprised at the absence of cancer of any kind among these people.”

If Miss Keaton is right about the figure 3,000 for the clients of Kotzebue Hospital, she herself must have served a total of more than 5,000 Eskimos each year during the fifteen years when she shuttled, by dog team and plane, between Kotzebue Sound and the Canadian boundary.

Miss Keaton advised us to get in touch with the widow of Dr. Smith, a trained nurse, to check her [Miss Keaton's] report on Dr. Smith's views. Mrs. Marguerite Smith answered on July 19, 1957, from 803 Fourth Avenue, Puyallup, Washington:

“It has long been my wish that Dr. Smith's observations concerning the incidence of cancer ... be made known ... I was with him after 1936, and many times he remarked that he had never encountered cancer among the natives (Eskimos) prior to that time. During the time I was in Kotzebue, 1936-41, we had only two malignancies, one in 1938, the second I believe in 1940 ... Both patients were in their late fifties ...

“Since leaving the hospital, I personally know of two women in their thirties who have died from cancer of the cervix ... Both had acquired the white man's way of living. During the time I was there I believe there were on the average one or two cases of non-native cancer pet year ...”

Dr. Thomas Marcom, formerly of northwestern Alaska, wrote from 327 Wesley Gardens, Des Moines, Washington, on January 11, 1958:

“My experience in Nome covered the years from 1936 to 1946, during which time I was privileged to see a large portion of the Eskimo population in Nome and surrounding areas, including the coast, the interior, the Diomedes, King and St. Lawrence Islands. I know of only one case of cancer ... of the penis which had been operated upon by Dr. Rex Swartz, my predecessor. I followed the case for about eight years. The man died at an age beyond 70. I diagnosed no case.”

Nome, though it was a prosperous district for a decade or two after 1900, has not shared much in recent Alaska prosperity. Consequently most natives, between the Yukon delta and Point Hope, still live mainly on fish and game which they themselves secure.

Dr. L. A. White of 642 Eugene Medical Center, Eugene, Oregon, wrote me on February 21, 1958:

“... It has been almost 17 years since I practiced in Alaska. I was at Unalaska [Aleutian Islands] 1934-48, having previously spent 17 months at Metlakatla [Alaska Panhandle], then several months in '39 at Klawock [Panhandle]; finally one and a half years at Bethel [Lower Kuskokwim]. My work led me to these conclusions: (1) hypertensive and arteriosclerotic diseases were practically nonexistent among the native peoples; (2) diabetes was extremely rare; (3) malignant disease was extremely rare — in fact, I had only one proven case (Bethel, 1940). I saw no strokes nor coronary heart disease ...”

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