20 страница. These principles of treatment have now been applied to many hundreds of patients as indicated by the fact that over 2,800 chemical analyses of the saliva have

These principles of treatment have now been applied to many hundreds of patients as indicated by the fact that over 2,800 chemical analyses of the saliva have been made. The dietary programs that have been recommended have been determined on the basis of a study of the nutrition used by the patient, the data provided by the x-rays, from the saliva analysis and case history. The diets have been found to be deficient in minerals, chiefly phosphorus. Fat-soluble vitamins have been deficient in practically every case of active tooth decay. The foods selected for reinforcing the deficient nutritions have always included additional fatsoluble vitamins and a liberal source of minerals in the form of natural food. Human beings cannot absorb minerals satisfactorily from inorganic chemicals. Great harm is done, in my judgment, by the sale and use of substitutes for natural foods.

One of our greatest difficulties in undertaking to apply the wisdom of the primitives to our modern problems involves a character factor. The Indians of the high Andes were willing to go hundreds of miles to the sea to get kelp and fish eggs for the use of their people. Yet many of our modern people are unwilling to take sufficient trouble to obtain foods that are competent to accomplish the desired results.

Jobbers and middlemen as well as supply depot managers want butter sold in accordance with its label rather than in accordance with its vitamin content. One large distributor whom I asked to cooperate by maintaining a stock of high-vitamin butter to which I could refer people, told me frankly that he wished I would stop telling people about the difference in the vitamins in butter. He did not wish them to think of butter in terms of its vitamin content. Another large concern told me that when I had worked up a sufficiently large market they would become interested in supplying the demand. I counsel people to put in storage some of that butter which has the grassy flavor and which melts easily and is produced when the cows go onto the rapidly growing young grass. Unfortunately, cows that have been on a stable fodder low in carotene and under the stress of gestation often are so depleted in their own body vitamins that it takes them three or four weeks to replenish their own bodies when they get on good pasture. Then the vitamins will appear in liberal quantity in their milk. This has made it necessary for me to assist many patients in obtaining a supply by analyzing butter for its vitamin content and then putting this material in storage and making it available for special cases as needed.

The program that I have found most efficient has been one which includes the use of small quantities of very high vitamin butter mixed in equal parts with a very high vitamin cod liver oil. A simple method of preparing the butter is by melting it and allowing it to cool for twenty-four hours at a temperature of about 70° F., then centrifugalizing it which provides an oil that remains liquid at room temperature. When this butter oil is mixed in equal parts with a very high-vitamin cod liver oil, it produces a product that is more efficient than either alone. It should be used within a couple of weeks of the time it is mixed. It is desirable that this material be made available in various parts of the country. Even the high-vitamin butter produced on the early summer growth of grass put in storage and used during the winter will go far toward solving our great national problem of shortage of fat-soluble vitamins. The quantity of the mixture of butter oil and cod liver oil required is quite small, half a teaspoonful three times a day with meals is sufficient to control wide-spread tooth decay when used with a diet that is low in sugar and starches and high in foods providing the minerals, particularly phosphorus. A teaspoonful a day divided between two or three meals is usually adequate to prevent dental caries and maintain a high immunity; it will also maintain freedom from colds and a high level of health in general. This reinforcement of the fat-soluble vitamins to a menu that is low in starches and sugars, together with the use of bread and cereal grains freshly ground to retain the full content of the embryo or germ, and with milk for growing children and for many adults, and the liberal use of sea foods and organs of animals, produced the result described.

I have previously reported (3) seventeen cases of extensive dental caries. In these patients there were found 237 open cavities of apparently active caries. Most of the individuals were between twelve and twenty years of age and accordingly had twenty-eight permanent teeth each, or a total of 476. It will be noted that if one cavity is allowed per tooth, approximately half of the total number of teeth were affected, or precisely 49.7 per cent of all the teeth had open cavities. This group includes only persons of whom I have been making critical examination every six to twelve months over a three-year period. In practically all cases, Roentgen-ray examinations were made in addition to clinical examinations of the teeth. While these persons have been on the reinforced nutritional program during the winter and spring months of the past three years, only two new cavities have developed in the group, or 0.4 per cent. The length of time during which the cavities previously found had been developing is not known beyond the fact that all of the patients were receiving frequent and thorough dental service, most of them twice a year and many of them more frequently. It is accordingly probable that the cavities found had developed in less than a year. That dental caries was not a new problem with these persons was indicated by the very extensive and numerous dental restorations that had been made in their mouths. It is, therefore, apparent that 250 times as many cavities developed in the period preceding the starting of the nutritional program as in the three years following its adoption. If these data were reduced to a yearly basis, the comparison would show a much wider variation.

In a group of fifty persons, including the above mentioned seventeen, who had been on the special nutritional program for from one to six years, most of them three years or more, only two new cavities developed. Allowing these persons to have an average of twenty-eight teeth per person, or a total of 1,400 teeth, this would represent an incidence of dental caries in a period of three years of 0.14 per cent. In this group of fifty, there are many instructive and striking cases.

For example, H. F. did not have a single cavity from October, 1932, to June, 1933, while taking additional vitamins and high mineral foods. From June, 1933, to May, 1934, while not taking the special vitamins, she developed ten new cavities.

S. K., prior to 1931 had rampant tooth decay with pulps nearly exposed in all first permanent molars. The remaining deciduous teeth had been reduced to shells. She was on the special nutritional program from December, 1931, to June, 1932, during which time caries was completely arrested. She discontinued taking special oil in June, 1932, and did not take it again until October, 1933, during most of which time she was taking viosterol under a physician's prescription to prevent dental caries. She came in October, 1933, with fourteen new cavities. She was immediately placed again on the special program, from October, 1933, to May, 1934. During this period, the dental caries was completely under control. During the time that she was not on the special program, there developed on many of the surfaces of the permanent teeth white patches of decalcifying enamel. Under the reinforced nutritional program, these largely disappeared, and those that did not regain their translucency turned dark.

Among the group of seventeen J. H., sent in from another city, had thirty-eight open cavities in June, 193 1. In addition to active caries, he had quite disturbing heart symptoms, which curtailed his activity, and he also had a marked sense of lassitude and weariness. He has been on the reinforced nutritional program during the fall, winter and spring of each year since that time. During this time, he has not developed a single new cavity. The density of all the teeth has progressively improved as evidenced by Roentgen-ray records. His physical condition has been greatly improved so that he is able to carry on his college activities and heavy outside work to earn money to maintain his college expenses. He is not conscious of a heart limitation. When asked what the principal change was that he had noticed, he said that in addition to not feeling tired, he was more rested with six hours' sleep than formerly with ten hours'.

A. W. had thirty-two new cavities in the two years previous to beginning the special nutritional reinforcement. She continued this regularly during the winter and spring months for three years and has not had a single new cavity since that time.

In a group of children whose mothers had the special nutritional reinforcement during gestation and lactation and who had been provided with the same dietary adjuncts during the winter and spring months of infancy and early childhood, not a single carious cavity has developed. A number of these children are now in public schools. Their physical development is distinctly above that of the average children of their age, as is also their efficiency in school work.

It is important that I emphasize here some dangers that are not usually recognized or properly emphasized in the literature. When fish oils including cod liver oils are given in too large doses to some patients they experience quite definite symptoms of depression. The available evidence indicates that fish oils that have been exposed to the air may develop toxic substances. My work and that of others with experimental animals has demonstrated that paralysis can be produced readily by over-dosing. Serious structural damage can be done to hearts and kidneys. I have reported this in considerable detail. (4) My investigations have shown that when a high vitamin natural cod liver oil is used in conjunction with a high vitamin butter oil the mixture is much more efficient than either alone.4 This makes it possible to use very small doses. Except in the late stages of pregnancy I do not prescribe more than half a teaspoonful with each of three meals a day. This procedure appears to obviate completely the undesirable effects. As stated elsewhere fish oils should be stored in small containers to avoid exposure to the air. Rancid fats and oils destroy vitamins A and E, (5) the former in the stomach. (6)

I am frequently reminded that ancient skulls are often found with extensive dental caries thus disproving that the primitive groups were more free from dental caries than the modern groups. It must be kept in mind that the fundamental laws of Nature have been in operation as long as animals and men have been on the earth. In my investigations among primitive races, I have been concerned particularly with the study of changes that have taken place both in immunity to dental caries and in the environment, including the foods used. It has been important that I find large groups with relatively high immunity to dental caries to be used as controls. There is great need, accordingly, that additional data be provided. Fortunately, this need is being met. There have just come to my desk two interesting reports; one, from Dr. Arne Hoygaard (7) and the other from Dr. P. O. Pedersen. (8) These two distinguished scientists have spent a year in East Greenland among the Eskimos in that very barren and isolated region. The percentage of teeth found attacked by dental caries among the isolated Eskimos of East Greenland is exceedingly low, less than 1 per cent. Where the Eskimos were in contact with modernized store foods at the port, tooth decay was active. The conditions which they have found were apparently not quite so favorable as in the groups I studied in Alaska. The Greenland Eskimos apparently are living in a more difficult environment. The data provided by these investigations are in accord with the data I have obtained among isolated Eskimos and other primitive racial stocks. Eastern Greenland, by international agreement, is administered by the Danish Government and no one is permitted even to visit the coast of Greenland without special permission. This permission is very difficult to obtain. Even Danish citizens are not free to travel there. We are, accordingly, very grateful to Dr. Hoygaard and Dr. Pedersen for their contribution from studies made in that protected field. We shall look forward with interest to their detailed reports.

Unfortunately, the public is very much at sea because of the extravagant claims that are made for many of the products advertised over the radio, in journals, and by door to door solicitation. A dependable and helpful booklet on the vitamin content of foods has been published by the United States Department of Agriculture, Miscellaneous Publications, No. 275. The fact should always be emphasized that foods as Nature makes them have much more nutritional value than after they are processed so that insect life cannot live on them. When foods cannot support insect life they cannot support human life.

A report has just appeared in the September number of the New Zealand Dental Journal by H. H. Tocker on behalf of the Hawkes Bay Branch of the New Zealand Dental Association in which he reports the results of the application of my suggestions in the Hukarere School for native Maori girls at Napier. I have reported my studies there in Chapter 12. They used only one part of my suggestions for checking the activity of dental caries. The diet of both their control group and tested group was the same except for one item, i.e., "one heaped teaspoonful twice daily of malt and cod liver oil." In a group of sixty-six native girls the thirty-three with the best teeth were used as a control group. The remaining thirty-three were given the additional fat-soluble vitamins. In six months' time ~resistance of this group was raised by 41.75 per cent" as compared with the control group. The nutrition of the test group was not adequately reinforced to obtain the best results. There was a marked inadequacy of mineral carrying foods in proportion to the energy and heat providing factors in the foods. An adequate quantity of such efficient foods should be as readily available today as before the white men came to New Zealand.

It is important to summarize at this point some of the data that I have developed in other chapters because of their direct relation to the control of dental caries and other degenerative processes. Since human life like other animal life has been developed in Nature's laboratory to fit Nature's natural foods we run a great risk when we undertake to modify seriously these foods. Bakers' so-called whole wheat bread is not comparable to Nature's foods that provide entire wheat and other cereals, because of the factors that have been removed from the wheat either mechanically or by oxidation. This is so large a problem that adequate changes in the available grain foods cannot be made until there 15 sufficient public demand to produce them through the normal channels of supply and demand. It is primarily a problem for our Federal and State governments. Packaged foods containing dry cereals can undergo important changes, even while the material is being processed or while in packages on the shelves. The determinations of the loss of vitamins in packaged foods as reported in 1938 by the Agricultural Experimental Station of Oklahoma Agricultural and Mechanical College, reveal that a material loss occurs in two weeks' time and a very serious loss in one to two months' time in certain stock rations.

An important source of misapprehension is the literature and teachings of fadists. Such, for example, as the misapprehension of many people that they must use only alkaline producing foods and that a great danger is associated with the use of acid producing foods. In the primitive races I have found practically no difference between the acid balance meat diet of the isolated Eskimos of the far north and the less acid vegetable and milk diet of other groups as efficient factors in control of caries. It is important to keep in mind that our bodies have a mechanism for maintaining proper acid and alkali balance in the blood and this varies through only a very narrow limit whether the balance of the total food eaten is acid or alkaline. It is also important to have in mind that there are certain fat-soluble vitamins provided in dairy products in adequate quantity that cannot all be supplied in fish oils. Also that overdosing with cod liver oil and other fish oils can be definitely detrimental. When packages of cod liver oil are purchased from the trade the material should be received in full containers not exposed to air and when opened should be transferred to small units so it is not progressively oxidized during the period of its use.

The excess of calories over body building minerals is exceedingly high in sweets of various kinds regardless of their special branding and the methods of manufacture and storage. There is very little of the body building minerals in maple syrup, cane syrup from sugar or honey. They can all defeat an otherwise efficient dietary. The problem is not so simple as merely cutting down or eliminating sugars and white flour though this is exceedingly important. It is also necessary that adequate mineral and vitamin carrying foods be made available. It is also necessary to realize that many of our important foods for providing vitamins are very low in body building material. For example, one would have to eat nearly a bushel of apples a day or half a bushel of oranges to obtain a liberal factor of safety for providing phosphorus; similarly one would be required to eat nine and one half pounds of carrots or eleven pounds of beets each day to get enough phosphorus for a liberal factor of safety, while this quantity would be provided in one pound of lentils or beans, wheat or oats. I have discussed elsewhere the availability of phosphorus depending upon its chemical form. Since the calories largely determine the satisfying of the appetite and since under ordinary circumstances we stop when we have obtained about two thousand to twenty-five hundred very little of the highly sweetened fruits defeats our nutritional program. We would have to consume daily the contents of thirty-two one pound jars of marmalade, jellies or jams to provide a two gram intake of phosphorus. This quantity would provide 32,500 calories; an amount impossible for the system to take care of.

Milk is one of the best foods for providing minerals but it may be inadequate in several vitamins. Of all of the primitive groups studied those using sea foods abundantly appear to obtain an adequate quantity of minerals particularly phosphorus with the greatest ease, in part because the fat-soluble vitamins provided in the sea foods (by which I mean animal life of the sea) are usually high. This enables a more efficient utilization of the minerals, calcium and phosphorus.

As I study routinely the sample dietaries being used by people suffering from dental caries, usually associated with other disturbances, I find large numbers who are not getting in their food even half the minimum requirements of calcium, phosphorus and magnesium and iron and usually only a fraction of the minimum requirements of the fat-soluble vitamins. These latter have a role which in many respects is like the battery of an automobile which provides the spark for igniting the fuel. Even though the tank is filled with gasoline there is no power without the igniting spark.

There are two programs now available for meeting the dental caries problem. One is to know first in detail all the physical and chemical factors involved and then proceed. The other is to know how to prevent the disease as the primitives have shown and then proceed. The former is largely the practice of the moderns. The latter is the program suggested by these investigations. Available data indicate that the blood and saliva normally carry defensive factors which when present control the growth of the acid producing organisms and the local reactions at tooth surfaces. When these defensive factors are not present the acid producing organisms multiply and produce an acid which dissolves tooth structure. The origin of this protective factor is provided in nutrition and is directly related to the mineral content of the foods and to known and unknown vitamins particularly the fat-soluble. Clinical data demonstrate that by following the program outlined dental caries can be prevented or controlled when active in practically all individuals. This does not require either permission or prescription but it is the inherent right of every individual. A properly balanced diet is good for the entire body.

REFERENCES

1. TISDALL, F. F. and KRAMER, B. Methods for the direct quantitative determination of sodium, potassium, calcium, and magnesium. J. Biol. Chem., 48:1, 1921.

2. KUTTNER, T. and COHEN, H. Micro colorimetric studies. I. A molybdic acid, stannous chloride reagent. J. Biol. Chem., 75: 517, 1927.

3. PRICE, W. A. Eskimo and Indian field studies in Alaska and Canada. J. Am. Dent. A., 23:417, 1936.

4. PRICE, W. A. Control of dental caries and some associated degenerative processes through reinforcement of the diet with special activators. J. Am. Dent. A., 19:1339, 1932.

5. MATTILL, H. A. The oxidative destruction of vitamins A and E. J.A.M.A., 89:1505, 1927.

6. LEASE, E. J., et al. Destruction of vitamin A by rancid fats. J. Nutrition, 16:571, 1938.

7. HOYGAARD, A. Some investigations into the physiology and nasology of Eskimos from Angmagsslik in Greenland. Oslo, Dybwad, 1937.

8. PEDERSEN, P. O. Investigations into dental conditions of about 3000 ancient and modern Greenlanders. Dent. Rec., 58:191, 1938.

TABLE OF CONTENTS

Chapter 17

ONE ORIGIN OF PHYSICAL DEFORMITIES

FACES are classified on the basis of physical characteristics and appearances which identify them as having a common ancestry. The constant reproduction of ancestral patterns constitutes one of the fundamental laws of heredity. We are concerned here with the divergences from the normal course of reproduction.

The precision with which Nature reproduces widely distributed racial stocks demonstrates how deeply seated and controlling are the Mendelian laws. In Fig. 98 may be seen four young men of the Melanesian race born on four different islands. They have never seen each other, yet they look like brothers. Similarly, in Fig. 99 are shown four Polynesian girls. Here again they look so much alike that they might readily be taken for sisters. Yet, they live in four different groups of Polynesian islands; the Hawaiian, the Samoan, the Tahitian, and the Rarotongan.

FIG. 98. These four Melanesian boys born on different islands look like brothers but are not blood relations. They illustrate the role of heredity in reproducing racial type. Heredity, however, can only operate normally when the germ cells have not been injured.

99. These four Polynesian girls live on different islands and are not related though they look like sisters. They record their racial type by undisturbed heredity.

The blending of different racial stocks produces typical characteristics of either or both ancestral patterns. When, however, marked divergences appear without mixing of racial stocks, the result is not due to heredity, but occurs in spite of heredity. In the previous chapters, I have shown that in the modernized groups of various primitive racial stocks, ccrtain individuals developed marked changes in facial and dental arch form from the racial pattern. We are interested to know the nature of the forces responsible for this distortion of the ancestral pattern. In a study of 1,276 skulls of the ancient civilizations of Peru, I did not find one with a typical divergence from normal such as we find in modern whites or in children of primitive racial stocks after the parents have adopted the foods of our modern civilization. It is important that we study this phase in further detail.

In Fig. 100 are shown two Indian fathers and their sons, whom we studied in Peru. The father and son shown above lived at Talara, in a highly modernized Indian colony. The father worked in the oil fields on the coast. This district is an arid desert into which practically all food has to be shipped for the large colony engaged in the oil industry. The father was born while his parents were using the native foods of the coast, including an abundance of sea foods. The son was born to his parents after they had adopted the foods of modern civilization. The father and son shown below, lived in the high Sierras. The father is an Indian descendant of the Incas and was born while his parents were living on the native dietary of the high plateau country, near Cuzco. After the adoption of the modern foods by the parents, the son shown to the right was born. It is important to keep in mind that the marked change in these fathers and sons has occurred in the first generation after the parents have adopted the white man's foods, and has occurred in spite of heredity.

FIG. 100. Disturbed heredity. Above, father a primitive coastal Indian of Peru with normal facial and dental arch development. Son at right presents distortions of both facial and dental arch form. Below, father a primitive Andean Indian with excellent facial and dental arch form. His son at right has not reproduced the racial pattern. Both sons are full blood.

In Fig. 101 above is shown a Wakamba father in central Africa, a man who is working for the railroad company which contributed largely to the food supply for the laborers. The boy shown at the right was born after the parents had adopted the imported foods. In the lower picture, in Fig. 101, is seen a Fiji Islander and his son. The father was born to parents living on the native foods, and his son was born after the adoption of the white man's foods. All these are typical cases of the inhibition of Nature's normal procedure. We have additional data which indicate that our problem is associated with a progressive lowering of reproductive capacity on the part of one or both of the parents.

FIG. 101. Disturbed heredity. Above, the father is a primitive Wakamba of Central Africa. His son at right has not reproduced the tribal pattern. Below, the father presents the typical Fijian primitive facial and dental arch form. His son at right has a narrowed arch and change in facial form. Both sons are full blood.

In photographing the members of modernized families, regardless of racial stocks, we frequently find that changes in facial expression appear in the younger members of the family. This change in facial contour within a family does not occur in the primitive races, while on their native dietary.

In contrast with this we see, in Fig. 102, two sisters and two brothers. In each pair there is a marked change in the facial form of the younger. The arches and the nostrils of the younger child are narrower and there is a marked lack of development in both the middle and lower thirds of the face.

FIG. 102. Disturbed heredity. Quichua Indians. Note the marked change in shape of the face and dental arches of the younger sister at the right. Also of the younger brother at the right. These families demonstrate a lowering of reproductive capacity of the parents with the later born children.

Very striking illustrations of this progressive degeneration in the children of a given family were found among the modernized aborigines of Australia. Two views of brothers are shown in Fig. 103 (upper). The father and mother of these two boys were born in the Bush. They were living, when photographed, in one of the reservations, on the imported modern foods which were provided by the government. This is also illustrated in the lower photograph. Note the marked underdevelopment of the middle third of the face of the girl.

FIG. 103. Disturbed heredity. These children are Australian Aborigines. Note the marked change in facial and dental arch form in the younger child at the right in both families. This is depressed reproductive capacity of the parents.

Striking instances were frequently seen among the modernized Maori of New Zealand. Two sisters presenting two extremes of facial form are shown in the upper section of Fig. 104. The girl to the left is the older. She has the typical tribal pattern which has been completely lost in her younger sister to the right.

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