Northern Mexico, Hrdli
ka described his observations from six expeditions he had undertaken. “Malignant diseases,” he said, “if they exist at all—that they do would be difficult to doubt—must be extremely rare.” He had not encountered “unequivocal signs of a malignant growth on an Indian bone.” Hrdlika also noted that he saw only three cases of “organic heart trouble” among more than two thousand Native Americans he examined, and “not one pronounced instance of advanced arterial sclerosis.” Varicose veins were rare, and hemorrhoids infrequent. “No case of appendicitis, peritonitis, ulcer of the stomach, or of any grave disease of the liver was observed,” he wrote.
Hrdlika considered the possibility, which Keys would raise fifty years later, that these Native Americans were unaffected by chronic disease because their life expectancy was relatively short; he rejected it because the evidence suggested that they lived as long as or longer than the local whites.
In 1910, Hrdlika’s field observations on cancer were confirmed by Isaac Levin, a Columbia University pathologist, who surveyed physicians working for the Indian Affairs Bureau on reservations throughout the Midwestern and Western states. Levin’s report, entitled “Cancer Among the North American Indians and Its Bearing upon the Ethnological Distribution of the Disease,” discussed the observations of 107 physicians who had responded to his survey, with their names, locations, size of practice, duration of practice, and number of cancers diagnosed: Chas. M. Buchannan, for instance, practiced fifteen years among two thousand Indians with an average life expectancy of fifty-five to sixty years and saw only one case of cancer; Henry E. Goodrich, practicing for thirteen years among thirty-five hundred Indians, saw not a single case. Levin’s survey covered over 115,000 Native Americans treated by agency doctors for anywhere from a few months to two decades and produced a total of twenty-nine documented cases of malignant tumors.
The two most comprehensive attempts to deal with the question of cancer in isolated populations were in The Natural History of Cancer, with Special Reference to Its Causation and Prevention, published in 1908 by W. Roger Williams, a fellow of the British Royal College of Surgeons, and The Mortality from Cancer Throughout the World, published in 1915 by the American statistician Fredrick Hoffman. In The Natural History of Cancer, Williams marched from continent to continent, region to region. In Fiji, for instance, in 1900, among 120,000 aborigines, Melanesians, Polynesians, and “Indian coolies,” there were only two recorded deaths from malignant tumors. In Borneo, a Dr. Pagel wrote that he had been in practice for ten years and had never seen a case. Williams also documented the rising mortality from cancer that Tanchou had reported in the developed nations. In the United States, the proportional number of cancer deaths rose dramatically in the latter part of the nineteenth century: in New York, from thirty-two per thousand deaths in 1864 to sixty-seven in 1900; in Philadelphia, from thirty-one in 1861 to seventy in 1904.
Hoffman dedicated the better part of his career to making sense of these observations. He began his cancer studies as chief statistician of the Prudential Insurance Company and continued them as part of an investigation of the Committee on Statistics of the American Society for the Control of Cancer (a predecessor of the American Cancer Society, of which Hoffman was a founder). In The Mortality from Cancer Throughout the World and then again in Cancer and Diet, his 1937, seven-hundred-plus- page update of the evidence, Hoffman concluded that cancer mortality was increasing “at a more or less alarming rate throughout the entire world,” and this could only partially be explained by new diagnostic practices and the aging of the population.
Hoffman could not explain away the observations that physicians like Schweitzer and Hutton had made around the world and that both he and Williams had documented so comprehensively. In 1914, Hoffman himself had surveyed physicians working for the Bureau of Indian Affairs. “Among some 63,000 Indians of all tribes,” he reported, “there occurred only 2 deaths from cancer as medically observed during the year 1914.”
“There are no known reasons why cancer should not occasionally occur among any race or people, even though it be of the lowest degree of savagery or barbarism,” Hoffman wrote.
Granting the practical difficulties of determining with accuracy the causes of death among non-civilized races, it is nevertheless a safe assumption that the large number of medical missionaries and other trained medical observers, living for years among native races throughout the world, would long ago have provided a more substantial basis of fact regarding the frequency of occurrence of malignant disease among the so-called “uncivilized” races, if cancer were met with among them to anything like the degree common to practically all civilized countries. Quite to the contrary, the negative evidence is convincing that in the opinion of qualified medical observers cancer is exceptionally rare among primitive peoples.
Through the 1930s, this evidence continued to accumulate, virtually without counterargument. By the 1950s, malignancies among the Inuit were still considered sufficiently uncommon that local physicians, as in Africa earlier in the century, would publish single-case reports when they did appear. One 1952 article, written by three physicians from Queen’s University in Ontario, begins with the comment “It is commonly stated that cancer does not occur in the Eskimos, and to our knowledge no case has so far been reported.” In 1975, a team of Canadian physicians published an analysis of a quarter-century of cancer incidence among Inuit in the western and central Arctic. Though lung and cervical cancer had “dramatically increased” since 1949, they reported, the incidence of breast cancer was still “surprisingly low.” They could not find a single case in an Inuit patient before 1966; they could find only two cases between 1967 and 1974.
These missionary and colonial physicians did often diagnose tumors and other diseases of civilization in local whites, and among natives who were working for European households and industries. In August 1923, for instance, A. J. Orenstein reported in the British Medical Journal on his experience as a superintendent of sanitation for the Rand mines in South Africa: “In a series of one hundred consecutive necropsies on native mine laborers conducted by myself in the latter part of 1922 and the first two months of 1923, two cases of carcinoma were observed—one was carcinoma of the pancreas and glands of the neck in a native male of the Shangaan race, age about 40, the other was a case of carcinoma involving practically the whole of the liver, in a native male of the same race, age about 25.” The reports from these physicians were a reminder of how dramatic the course of the disease could be, and evidence against the argument that sophisticated diagnostic technology, unavailable in these outposts, was required to diagnose cancer. In 1923, George Prentice, who worked in Nyasaland, in southern central Africa, described one native patient with an inoperable breast tumor in the British Medical Journal: “It ran an uninterrupted course,” Prentice wrote, “completely destroyed the breast, then the soft structure of the chest wall, and then ate through the ribs; when I last saw the negress in her village, I could see the heart pulsating. That was just before her death.”
The absence of malignant cancer in isolated populations prompted questions about why cancer did develop elsewhere. One early hypothesis was that meat-eating was the problem, and that primitive populations were protected from cancer by eating mostly vegetarian diets. But this failed to explain why malignancies were prevalent among Hindus in India—“to whom the fleshpot is an abomination”—and rare to absent in the Inuit, Masai, and other decidedly carnivorous populations. (This hypothesis “hardly holds good in regard to the [American] Indians,” as Isaac Levin wrote in 1910. “They consume a great deal of food [rich in nitrogen—i.e., meat], frequently to excess.”)
By the late 1920s, the meat-eating hypothesis had given way to the notion that it was overnutrition in general, in conjunction with modern processed foods, lacking the vital elements necessary for health, that were to blame. These were those foods, as Hoffman put it, “demanding conservation or refrigeration, artificial preservation and coloring, or processing otherwise to an astonishing degree.” As a result of these modern processed foods, noted Hoffman, “far-reaching changes in bodily functioning and metabolism are introduced which, extending over many years, are the causes or conditions predisposing to the development of malignant new growths, and in part at least explain the observed increase in the cancer death rate of practically all civilized and highly urbanized countries.”
