It was with the encouragement of the late Dr. John F. Fulton, professor at Yale University School of Medicine, that Dr. Stefansson undertook to organize in the form of a book his anthropological observations on cancer. Professor Fulton had intended to write the preface for this book, but unfortunately did not live long enough to do it. In taking his place, I cannot do better than try to state the reasons that probably enlisted his interest in this study.

Professor Fulton was a historian of medicine, and his knowledge of the past had made clear to him that the pattern of disease in different places has greatly changed in the course of time. History shows that each type of civilization, like each social group and each way of life, has diseases which are peculiar to it. While this fact is well recognized by medical historians, its explanation is a matter of controversy. Is the reason for the variability in incidence of disease to be sought in peculiarities of human constitution, in genetic traits that condition susceptibility and resistance? Or are environmental conditions and living habits the more important factors in determining the types of pathological disorders most common in a given community? The very statement of these questions suggests the almost insuperable difficulties that stand in the way of a decision between the alternatives on the basis of historical records.

Fortunately, the past still survives today in the form of a few populations which have remained almost completely isolated so far, and whose mode of life for this reason differs profoundly from that of modern man. In other words, these primitive peoples constitute control groups for the study of what modern civilization has done to man. However, the time for studying the surviving primitive populations is getting short because everywhere ancient social structures are disappearing or are being grossly altered.

The Eskimos have probably been isolated as long as any primitive people. Indeed, they still had a Stone Age culture a few decades ago, and they therefore provide excellent material for anthropological studies. As everyone knows, Dr. Stefansson lived among them, practically as one of them, before their ways of life had been modified by other human contacts. He thus had the opportunity to observe at first hand what human beings can be like, biologically and socially, when not conditioned by modern technology. In several fascinating books he has described some aspects of life among Stone Age Eskimos. In the present study, he has selected from his broad knowledge the facts that pertain to the occurrence among them of various forms of disease and particularly of cancer.

Not only does Dr. Stefansson give in the present book a detailed account of what he has seen and heard in the Arctic; he also compares his own observations with those reported by anthropologists, physicians, and travelers who have been in contact with primitive people in other parts of the World. From this broad survey there emerges the impression that certain diseases such as dental caries, arteriosclerosis, and cancers are so uncommon among certain primitive people as to remain unnoticed — at least as long as nothing is changed in the ancestral ways of life. Admittedly, the evidence adduced on these points does not satisfy exacting statistical requirements. It would be desirable, for example, to know more exactly the numbers of people that have been observed and the age distribution of the populations; one would wish also that the statements were based on sophisticated medical examinations rather than on casual observations and hearsay. Circumstances did not permit, of course, such quantitative studies. But incomplete as they are, the findings raise intriguing questions as to the effect of environment and customs on the incidence of disease.

It has long been known that there exist enormous differences in the frequency of different types of cancer in various populations and various places. Recent studies have revealed, for example, a very high incidence of liver and pancreatic tumors among the Bantus in Rhodesia. The dramatic increase in lung tumors in industrialized countries constitutes further evidence of a profound effect of environmental factors on this disease. The findings reported by Dr. Stefansson are therefore compatible with modern knowledge in showing that under certain conditions various types of cancers are extremely rare. These findings will acquire even greater significance if they can be supplemented in two different directions suggested by the present book — on the one hand by more thorough medical surveys to determine whether forms of cancer not readily detectable have been overlooked; on the other hand by follow-up studies to see whether the pattern of disease becomes different as living conditions change.

Dr. Stefansson had the good fortune to observe the Eskimos while they were still in a Stone Age culture, and he has made a most exciting use of this opportunity. He presents an entrancing picture of their life, and of the techniques which have permitted them to function successfully and live happily in their difficult environment. In addition to its sheer interest, this account of primitive life carries a lesson of enormous importance for mankind. It demonstrates that through biological and social adaptations human beings can achieve some sort of fitness to even the most stressful conditions. The Stone Age Eskimos had successfully met the challenges of the Arctic by empirical procedures developed slowly and progressively. In contrast, modern man cannot depend on slow empiricism to achieve fitness to his rapidly changing environment. It is the responsibility of social and medical sciences to analyze the natural and artificial forces which affect his health and happiness, in order to help him develop a rational way of life fitted to the new world he is creating.

René Dubos,
Professor and Member,
Rockefeller Institute

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