18. An Ounce Of Prevention

This study of frontier cancer beliefs has reached the stage of summary and conclusion. I shall sift the testimonies and theories that have been presented by the medical missionaries I have been able to reach, and by other frontier doctors.

The witnesses are nearly unanimous in thinking that cancer is a disease of the civilized — that it remains rare, if not absent, until natives have been civilized enough for long enough, whereupon it becomes as frequent with them as with us.

Frontier doctors have consistently believed that natives might retain whatever immunity they possessed if they kept to the way of their fathers. They have believed that we who are already civilized could gain a corresponding relative immunity if we would do two things — if we discarded those European ways that will be found, upon study, to predispose to cancer; and if we acquired such native ways as are going to be found, upon like study, to have a beneficial tendency.

What this book has quoted from medical missionaries indicates that many of them believe they already have valuable clues, and that some think they possess real information about helpful details of the native way of life and the particularly harmful elements of ours. Could we, then, partially safeguard or wholly protect natives by getting them to refrain from the more carcinogenic practices of Europeans?

As for the civilized, can they be induced to adopt those native ways which seem to hold the greatest promise of relieving our communities from the steadily mounting threat of cancer?

As for getting already civilized natives to revert, past experience has made the missionaries pessimistic. We Europeans are so numerous on most frontiers, so wealthy and powerful, that our behavior patterns have become fashionable. And among primitive peoples, even more than with us, being in fashion is a controlling motive. Short of military-type regimentation, the only chance of getting natives to return to their former ways is for an influential number of whites to go native in the right way. If the aboriginal way of life were thereby shown to prevent or even materially lessen cancer among us, the adoption of certain primitive manners and customs might become fashionable enough with us to become fashionable also with civilized natives.

Medical missionaries are likely to be optimistic about the prospect of whites going native. They have known a great many Europeans to do it for what missionaries regard as unworthy motives, and they do not see why mere worthiness of motive would prove too restraining. Besides, many frontier doctors have themselves gone native in foods and other elements which they suppose to be preventive of cancer; and many of them have liked doing it. For instance, the head of the Presbyterian medical establishment at Point Barrow, Alaska, Dr. Horatio R. Marsh, whom this book has several times quoted, dressed Eskimo style, liked Eskimo food, and approved of the naked Eskimo winter living which we have described. South Sea missionaries, particularly some Mormons of long experience, have enjoyed and approved the corresponding native life of the tropical islands.

Alaskan and northern Canadian missionaries, with whom this book so largely deals, have had little to say of cures for cancer except to wish those well who seek them. Believing that their experience has proven some of the means by which death from cancer may be made less likely, or even prevented, and favoring the maxim that an ounce of prevention is worth a pound of cure, they have emphasized prevention. Some of them have felt that they had a mission, a gospel of glad tidings, with three chief commandments which they were compelled to preach.

1. Learn how men formerly lived where diligent and competent search for generations has revealed little or no cancer.

2. On the frontier, pay heed to what the changes were that took place through the several decades which preceded the first detection of cancer, and to those changes which took place thereafter during the rise of cancer toward its present dread frequency.

3. Likewise, in our cities and rural communities, observe how those groups now live who are least afflicted by cancer, and how those live that are most afflicted.

These commandments, taken together, mean recommending to others the study of a field the medical missionaries themselves have been cultivating from early times. Substantially the commandments point toward a program similar to that described in an earlier chapter from the writings of Dr. J. Clemmesen on the Danish Cancer Registries, of which he is the head — indeed similar to the studies he describes as having been carried out in Britain by Kennaway and Kennaway during the 1930's; similar also to those made by General McCarrison in northern India in the 1920's, and to those begun in northern Alaska by Captain Leavitt during the 1880's; similar also to those advocated by President Le Conte of the University of California from 1846 to 1888, and suggested by Stanislas Tanchou to the Immortals of France in 1843. This is also the program suggested by implication by the witnesses quoted in Chapter 16, “The Twentieth Century Rediscovers the Nineteenth.”

During the nineteenth century and early twentieth many frontier doctors from many countries described or indicated diets which they believed had been the means of protecting their native communities against malignant disease. Also, by implication or explicitly, they warned against those European diets which they blamed for having recently destroyed native immunities. I shall now proceed to condense, from earlier chapters, some of their outright or implied suggestions, some of their implied and explicit replies to pertinent questions.

Are there regions with little or no cancer? That there are, or have been, is the reply from all zones equally, from tropic to arctic lands. To emphasize the authoritative nature of these pronouncements it will be helpful to repeat, in abridged form, four of the replies previously given at greater length and in context. (See the Index, under the names of the witnesses, for the extended references and the documentation.)

From the tropical frontier Dr. Albert Schweitzer wrote in 1957: “On my arrival in Gabon, in 1913, I was astonished to encounter no cases of cancer ... I can not, of course say positively that there was no cancer at all; but, like other frontier doctors, I can only say that if any cases existed they must have been quite rare.”

For the Temperate Zone native State of Hunza, Dr. Robert McCarrison said in 1922: “During the period of my association with these [Himalayan] peoples I never saw a case of asthenic dyspepsia, of gastric or duodenal ulcer, of appendicitis, of mucous colitis, or of cancer ... While I cannot aver that all these maladies were quite unknown, I have the strongest reason for the assertion that they were remarkably infrequent.”

For the subarctic district of Labrador, Dr. Samuel King Hutton wrote in 1925: “Some diseases common in Europe have not come under my notice during a prolonged and careful survey of the health of the Eskimos. Of these diseases the most striking is cancer.”

For primitive man throughout the world, but with special reference to the Americas, Dr. Aleš Hrdlička of the Smithsonian Institution said: “Malignant diseases, if they exist at all — that they do would be difficult to doubt — must be extremely rare.”

Are these districts permanently cancer free? Here our witnesses answer nearly unanimously in the negative. Indeed, excepting the witnesses from the State of Hunza, most of those who have proclaimed their belief in a former absence of cancer would now parallel Dr. Schweitzer when he says of his tropical district: “In the course of the years we have seen cases of cancer in growing numbers in our region.”

Does the issue of cause lie between meat eating and vegetarianism? Many frontier doctors, true, have warned against meat as probably tending to be carcinogenic, and among these is McCarrison. But many have also pointed out that during the time of alleged freedom from cancer the Eskimos were living on a predominantly flesh diet. Hutton is typical of these when he says: “I have not seen or heard of a case of malignant new growth in an Eskimo. In this connection it may be noted ... that the diet is a flesh one.” It appears that when frontier doctors could find no cancer among vegetarians they were prone to warn against meat, and that where no malignant diseases were discovered among meat eaters there was a tendency to caution against mixed or vegetarian diets. If the testimonies quoted in this book are reviewed, the conclusion will be similar to that quoted from Dr. G. T. Wrench's The Wheel of Health:

“The Hunza ... are lacto-vegetarian feeders such as Hindhode and many other nutritionists, including McCarrison, put as the healthiest diet of mankind. As a general diet it may well be so, though the polar Eskimos, with an entirely opposite diet, do not yield to the lacto-vegetarians in health and physical endurance.”

What is the frontier doctor's view on cancer prevention? The most general conclusion, from a review of the testimonies and opinions of those I have been able to reach, appears to be that relative if not complete immunity to malignant disease is a byproduct of good health. The peoples believed to be free from cancer were believed also to be long lived and to die eventually of old age, in the sense that they did not appear to die of any specific trouble but just from wearing out. The Coronation Gulf Eskimos, for instance, among whom no cancer had been reported up to 1936, are described in The Copper Eskimos by Dr. Diamond Jenness: “Amongst adults, death was nearly always due to natural causes, either old age or the perils that are inseparable from life in the Arctic.” Dr. Henry W. Greist, in his Seventeen Years with the Eskimos, speaking of the ancestors of those north Alaskans among whom he was first able to diagnose cancer in 1933, says that “the Eskimo of the far North was healthy ... He lived to a very great age.”

How may cancer-resistant health be attained? The most detailed answers to this question, of those I have seen published, come from the Hunzas, who have been alleged to be free of cancer at least from the time of McCarrison's investigations of 1904-11 to those of Banik in 1959. An abridgment and paraphrase of these explanations has been given in Chapter 18, on “The ‘Cancer Free’ People of Asia.” The general answer there is that the health of the Hunzas enables them to live, free of most diseases, till they collapse like the one hoss shay, though not at “a hundred years to the day” but more likely at around 110 or 120.

To plan for longevity, what is the most important period? As McCarrison's interpreter, Wrench, says, the crucial spell is the months before birth. “The speck that is to become a human being becomes it through food ... A healthy mother eating healthy food is then a prerequisite” for the healthy tissues and organs, including teeth and other hard parts, with which people like the Hunzas (by the testimony) live their fivescore years and ten as easily as we manage threescore and ten.

The second key to being “vigorous in age as in youth,” according to Wrench, is protracted breast feeding, while the right outside foods are being introduced to the child's diet gradually. It looks as if McCarrison himself might have placed the long breast feeding first among the keys to health, for he named it first in the sequence of prime requirements in his Mellon Lecture of November 18, 1921. He then said, speaking of the Hunzas whom he regarded as the healthiest people in the world, that “their buoyant abdominal health has, since my return to the West, provided a remarkable contrast with the dyspeptic and colonic lamentations of our highly civilized communities. Searching for an explanation of this difference in incidence of gastro-intestinal disease in the two peoples, I find it, in the main, in four circumstances [of which he discusses at length only two]: (1) Infants are reared as nature intended them to be reared — at the breast ... (2) The people live on unsophisticated foods of Nature ...” Elsewhere we learn that “The Hunza mother gives the breast for three years. She nourishes the child and protects herself from pregnancy. To become pregnant during lactation is considered unfair to the suckling child ... The breast milk of the Hunza women must unquestionably be of excellent quality.”

On this element of baby rearing, in the period when cancer was found among whites but not yet among Eskimos, Hutton says that “European mothers resident on the Labrador coast find themselves unable to suckle their babies — the breasts are full of milk for a few days after birth, and then the supply ceases — the result, no doubt, of the preponderance of tinned and dried foods in the dietary of a European resident. The Eskimo mothers suckle their babies, often for two years: the milk supply is plentiful and the babies grow fat and strong ...”

The third key to Hunza disease resistance and longevity, in the McCarrison-Wrench view, is the preponderant use of fresh and raw foods, with the minimum of processing. These two authorities speak in general terms; Banik is specific in pointing out that raw food constitutes 80 per cent of the dietary. Wrench emphasizes the special value to the Hunzas of “young life,” the eating of this priceless commodity in uncooked germinating seeds and the drinking of it in the form of the bacteria that produce fermentation.

In relation to Eskimos of the old dispensation, Hutton suggests special anticarcinogenic values in raw flesh foods, as I should like to emphasize here by again quoting: “I have not seen or heard of a case of malignant new growth in an Eskimo. In this connection it may be noted that ... most of the food is eaten raw.”

Negative anticarcinogenic values are attained by not doing what are considered the wrong things. Cooking was at a minimum among the Eskimos, formerly; and among the Hunzas less than 20 per cent of the food is cooked today, according to Banik's testimony for 1959. Formerly the Eskimos avoided salt scrupulously; the Hunzas go easy on it still. As to the stewing of meat by the Hunzas, McCarrison and Wrench indicated that cooked foods are so small a part of the whole diet that scurvy never appears. Many frontier doctors considered that whatever was antiscorbutic was also anticarcinogenic.

Maladies said to be rare when cancer is difficult to find have been mentioned in quantity and with remarkable unanimity by those familiar with frontier conditions.

1. Appendicitis was reported never found among unmodernized Athapaskans or Eskimos of southwestern Alaska during the first four decades following Romig's arrival there in 1896. Hutton reported similarly from the Labrador Eskimos for the years 1903-13. As to the Gabon section of tropical Africa following 1913 Schweitzer says: “... I vividly recall the 27th of April, 1954. That day we performed our first surgical operation on a black native.”

2. Constipation was formerly so rare on the northern coast of North America that it was looked upon as not occurring except when some accident or a famine made fat meat unavailable. Its rarity is still being reported from the Hunza section of the Himalayas.

3. Corpulence was not observed on the northern coast of Alaska, even among middle-aged women who were eating constantly through the largely house-confined idle period of winter, as reported by Simpson in the 1850's, by Murdoch in the 1880's, and by me between 1903 and 1914. It is, however, as common there now as among resident whites. The rarity or absence of corpulence is still being reported from the Hunza region.

Among the other difficulties said to have been rare or absent in the time of Eskimo primitive living these troubles have been mentioned frequently: arthritis, asthma, beriberi, caries (dental), colitis (mucous), diabetes, duodenal ulcers, epilepsy, gall stones, gastric ulcers, hypertension, night blindness, pellagra, rickets, scurvy.

How acceptable are frontier suggestions for cancer prevention? The first suggestion of Wrench, that couples start out in marriage to eat the foods he recommends may go a bit against the grain; and so may McCarrison's first, that children should be breast fed for three years. But the third suggestion is already popular, that something like 80 per cent of our food should be raw or underdone. Salads composed largely of fresh and raw vegetables and fruits are widely enjoyed, and many are already particular at breakfast that their orange juice shall have been squeezed no more than a few minutes before, discovering that it tastes better that way and having been told by the doctor that it has a higher vitamin C potency in that condition. Many would rather have their breakfast eggs soft-boiled than hard, and at no meal is it much of a hardship to have oranges served instead of orange marmalade or fresh strawberries in place of strawberry jam.

By the frontier doctor prescription, at lunch and dinner you would have your oysters and clams more often in a cocktail or on the shell than baked or in a soup or stew; your roasts and sirloins would be on the rare side, or medium, and your desserts would tend toward fresh fruits and things like yogurt. To be avoided might be New England boiled dinner, corned beef and cabbage, ham, sausage, and too lean bacon, and anything cooked to death, preserved by any chemical, canned, or preserved in jars. And even with these you could satisfy a hankering now and then, on the principle that the Hunzas have avoided cancer, and such diseases as rickets and scurvy, on a diet that has included 20 per cent of cooked foods and a moderate use of salt. So there appears to be a good deal of freedom through diluting the suspect dishes with those which are given a carcinogenically clean bill of health.

The typical frontier doctor would think of these preventive regimens as merely something to start with and to improve upon through any and all the techniques of research in public health, medicine, and nutrition. And of course, as heretofore, he would continue to wish well those who in the meantime seek a cure for cancer.

The End