Good Calories, Bad Calories

By the early twentieth century, such reports had become the norm among physicians working throughout Africa. They would typically report a few cancers in towns where the “natives mingled with Europeans” and had copied their “dietetic and other domestic practices,” but not in those areas where lifestyles and diets remained traditional. These reports, often published in the British Medical Journal, The Lancet, or local journals like the East African Medical Journal, would typically include the length of service that the author had undergone among the natives, the size of the native population served by the hospital in question, the size of the local European population, and the number of cancers diagnosed in both. F. P. Fouché, for instance, district surgeon of the Orange Free State in South Africa, reported to the BMJ in 1923 that he had spent six years at a hospital that served fourteen thousand natives. “I never saw a single case of gastric or duodenal ulcer, colitis, appendicitis, or cancer in any form in a native, although these diseases were frequently seen among the white or European population.”

In 1908, the Smithsonian Institution’s Bureau of American Ethnology published the first significant report on the health status of Native Americans. The author was the physician-turned-anthropologist Aleš Hrdlika, who served for three decades as curator of the Division of Physical Anthropology at the National Museum in Washington (now the Smithsonian’s National Museum of Natural History). In a 460-page report entitled Physiological and Medical Observations Among the Indians of Southwestern United States and Northern Mexico, Hrdlika 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.