187
KNUD RASMUSSEN MEMORIAL LECTURE ETHNOLOGY, DEMOGRAPHY AND MEDICINE IN THE ARCTIC
0. Schaefer Northern Medical Research Unit, Edmonton, Canada
Two reasons persuaded me to accept the invi· Administration, he started a study into the feasi· tation to deliver the Knud Rasmussen Memorial bility of reindeer herding in Greenland. From Lecture: 1906-1909 he studied Eskimo folklore, a subject 1) Of the many explorations undertaken by which became his most consuming interest. Knud Rasmussen the longest in time and distance These studies and his travels to the isolated covered, the most fruitful one in scientific achieve Polar Eskimos led to the foundation in 1909 of ments, particularly in respect to ethnology, demo· the Mission Station of Nordstjemen in North graphy and physical anthropology was the 5th Star Bay. He added in 1910 a trading station and Thule Expedition in which Knud Rasmussen and changed the name Thule (»Ultima Thule»). Thule his colleagues travelled by dog sled all across the became the base for that famous series of scienti· Canadian Arctic and Alaska to the Bering Strait. fie expeditions, which stand out in the history of Their most important scientific achievements arctic exploration not only because vast quantities concerned the Inuit of the Barrenlands west of of data were collected in diverse fields ranging Hudson Bay and their nothern neighbours, the from the topography of land and oceanography Netchiligmiut, and we owe the first detailed in· to ethnology, material culture, mythology, demo formation on these Central Canadian Arctic graphy and physical anthropology of the various Inuit to the 5th Thule Expedition. population groups visited, but also because such 2) A more compelling personal reason for unequalled results were achieved with very accepting your invitation goes back to my pri· modest means. mary school days when I was given as a birthday Knud Rasmussen's success may be attributed present a book by Knud Rasmussen »Grtinland to: (a) His technique of travelling with, and in the ische Sagen» · in English »Greenlandic Sagas», style of, his Eskimo friends using tlieir hunting which kindled my interest in the Arctic and its methods and clothing and shelter, (b) His ability fascinating people, the Inuit. It also got me to keep strong willed characters with diverse interested in ethnology and when I was later scientific interests working and living together confronted with the medical problems of these as friendly collaborators rather than fighting people I was alert to the multiple interrelations antagonists, a fate which befell many other Arctic of Ethnology, Demography and Epidemiology, expeditions. which I have chosen as the title of my present I cannot recount here the achievements of ation. the seven Thule expeditions, all of them except I am sure that I need not review Knud the third led personally by Knud Rasmussen. He Rasmussen's history for the Danes and Green returned from the I~ one in 1933 a sick man to landers here today but for the other less fortunate die later that fall in Copenhagen (54 years old). let me briefly state that Knud Rasmussen was I shall, however, later refer to demographic data born June 7, 1879 in Jacobshaven, West Green collected 1921-24 during the Fifth Thule Ex land, the son of a Lutheran pastor and a Green pedition, which provided the most detailed early landic mother. He visited Lapland and studied account of material culture, mythology, sociology, those people after obtaining his degree from demography and physical anthropology of Cana the University of Copenhagen. In 1902 together dian Inuit, in particular those of the Central with Mylius-Erichsen he engaged in a study of Arctic. These are not only of invaluable impart· social conditions in West Greenland. Their report ance to the social scientists of these disciplines, stimulated the Danish Government to institute but are also a great interest to epidemiologists who a number of administrative reforms for Greenland. of course have to look at the demographic struc In 1905, on the request of the Greenland ture of a population when considering prevalence 188 of diseases which may be related to certain age and Demographic data published in the reports by sex groups. Birket-Smith from the 5th Thule Expedition show I want to exemplify that with the 1961 and gross deficits of young females attributed to the 1971 census figures of Inuit living in the female infanticide in the Inuit bands of the Barren N.W.T. (the 1951 census unfortunately did not se lands west of Hudson Bay, as well as their north parate Indian and Inuit). Attention should be paid ern neighbours, the Netchiligmiut, around Boothia to the peculiar age and sex distribution seen in Peninsula and King William Island. Franz Boas these two census tabulations and then refer to reported similar findings from Baffin Island and demographic data collected by Knud Rasmussen Diamond Jenness from the Copper Eskimos to the and Kaj Birket-Smith in Central Arctic Inuit and West. The female deficit varied from 50 % for similar but less numerous data collected by others the tribes in the harshest and most often famine· in neighbouring regions. I will then discuss the plagued areas of the Central Arctic to around 20 % significance of the very unusual sex ratio seen for in the more fortunate populations to the East and certain age groups in the 1961 & 1971 Census in West (9). the light of demographic data collected by Knud But, at the time of birth of the youngest Rasmussen and other explorers and epidemio cohort showing a very significant sex ratio devia logical factors observed by us in the past 30 years. tion, i.e., in the years 1926-31, after the 5th Thule Fig. 1 depicts the N.W.T. Inuit population Expedition, missions, trading posts and police pyramid: For 1961 with hatched bars, for 1971 detachments were well established in all regions of with empty white bars, and for comparison, the the Canadian Arctic, and even in the remote and structure of the total Canadian population in 1971 harsh Central Arctic female infanticide became is depicted in solid black bars. There are striking exceedingly rare, and births of boys and girls differences: The total Canadian population show registered by the police appeared from then on a shrinking base while becoming top heavy. This is fairly evenly matched. We must therefore look for the typcial picture of an ageing birth-rontrolled other factors still operative after the mid 1920's modem society. In comparison the Inuit popu to explain most, if not all, of this very marked lation structure resembles more the very wide deficit of middle aged females apparent in the bottom population pyramids with slim tops ty 1961 & 1971 Census charts. pical for the young exploding populations of the Two epidemiological observations come to Third World. But if vve look more closely at the mind: details and the changes seen betvveen 1961 and 1) I was struck by certain facts relating to 1971 in the Inuit highly interesting things come tuberculosis found during several community to light. health surveys which I conducted in the last 15 Looking at the male/female sex ratio (Fig. 2) years as well as in a review of the records of our we notice that sexes were fairly vvell balanced in Chronic Disease Control computer records. the 1961 Census up to age 30 years and in the Although practically all adult Inuit had been 1971 census up to age 40 years, but that women found to react positive to tuberwlin testing, and aged from 30-54 years in the 1961 census, and although there were no significant sex differences women aged 40-54 years in the 1971 census, in the prevalence of hilar calcifications found on number 20-35 % less than men in each of the X-ray surveys both the hospitalization for tuber specified age groups. culosis and the diagnosis of advanced pulmonary Differences of such magnitude which persist tuberculosis vvere found to be almost twice as high and increase over an age span of 25 years must be for adult females as for adult males. I also found highly significant, even if we are dealing in each that evacuation rates for tuberculosis between the of these adult 5 year age groups, with hundreds ages of 15 and 30 years were more than three rather than thousands of people. What could be times higher for female than for male Inuit. We the cause for this remarkable deficit of middle know, therefore, that while almost all Inuit of aged Inuit women, obvious in 1961 from age the Canadian Arctic, in the late 1940's and early 30 years on, and in 1971 from age 40 years on, 1950's, were exposed to tuberculosis infection, it and then disappearing above age 55 in both was the young women of childbearing age who census tabulations? were most vulnerable to develop advanced disease 189
MALES FEMALES 75 YRS •
7[}-74 ESKIMOS NWT ESKIMOS NWT 65-69 1961 1971 h l 1%1 I 1971 >60 L 69fo 1.51~ = >60.1 LW.. I L~ 6[}-64 4(}-59 6.
25-29 v ·n 21>-24 r//. '//////. ////, /////. .,... 15-19 " .,, 7,7,>?I UH4 .,, 5-9 '/, f}-4
loYo SS 6'11 4" ~ 0 ~ 4" 6'11 8"' 100. Fig. 1. Population structure of Inuit living in the Northwest Territories in 1961 (Hatched bars) and 1971 (empty bars) vs. 1971 total Canadian population according to official C81JSIJS figures.
SHIFTS OF SEX RATIO Ch,Fl WITH Ni., ;i.w, T. lllUIT AtCDRDl:IG TO TH£G>WG> llllD~'ll.1~ CENSUS
YEAR.i
181•
55-59
45-49 H,f RATIO FOR 30-511 YR. OLD I IT l!lfil· I W C!!21-7]5)
25-29 5.765 IMLES
~.GllO FEIW.ES
15-1!! ll:f. ~.l.JIZZ 10-14 • , I :i-!! 41) ~. . I (l-4 2.245 •1.580 0.6 0.7 a.a 0.9 1.0 J.! 1.2 J.3 1.4 1.5 Fig. 2. Sex ratio Northwest Territories Inuit. 190
and die of it. cases of Sheehan's Syndrome (hypopituitarism) Recalling that the death rate due to tuber· associated with severe post-partum hemorrhage in culosis at the end of the 1940's was more than 1% Inuit. While a few of these cases could have been per year for the total native population of the related to inherited conditions such as placenta N.W.T (Fig. 3) ·and was at that time higher for accreta, as reported by me in 1960 in a kinship Inuit than Indians · we must presume that deaths from Cumberland Sound (4), and also found later due to tuberculosis in this most susceptible group in two groups of Arctic Quebec Inuit, the majority of young women was a substantial factor for the of cases of excessive post-partum bleeding in Inuit deficit of females first seen in the cohort born may be better explained by the mechanism eluci· between 1926 to 1931, i.e., women who were be· dated by the outstanding work of Bang & Dyer· tween 15 and 25 years of age in the worst years of berg in Greenland. the tuberculosis epidemic in the Canadian Arctic. Loss of life or loss of pituitary function due to exsanguinating hemorrhages have become rare in the Canadian Arctic since the mid· 1960's, partly due to faster evacuation services, better local facilities and a tendency to deliver most women in hospitals. But perhaps this decrease is also to some degree due to marked changes in I dietary habits. Post-partum hemorrhage, although ' I I1,,,-. not causing maternal deaths, was nevertheless \/ \ (\ \/I listed as a serious complication in 9.3 % of Inuit >I I deliveries in a twelve month period 1973/74, i.e., I I \ more than twice the rate found in White women \ /' delivered during the same study period (7). \/ \. .... , .... ____ ..._ If we look again at the M:F sex ratio (Fig. 2) in regard to start and end of the remarkable de· a • ~ • M P • ~ • • u • n n YEAR ficit of middle-aged women as depicted by the Fig. 3. Tuberculosis mortality Northwest Terri· solid curves for 1961 and broken curves for 1971 tories 1947-1973. there appears a very clear separation of the curves by 10 years at the beginning of a significant M:F shift, i.e., age groups 20-24 in 1961 correspond 2) There is a second epidemiological observation in their sex ratio position quite closely to those concerning post-partum hemorrhage which may 30-34 year olds in 1971, and a similar parallelism have contributed to the deficint of women aged is shown by the next two 5 year age groups, indi· 30-54 seen in the 1961 Census, and also seen in eating that these cohorts remain at the same M:F females aged 40-54 in the 1971 Census, althoug position between 1961 and 1971 . This suggests this accounted certainly for less excess mortality that whatever caused the deficit of middle-aged of women than did tuberculosis. H.O. Bang and Inuit women was no longer operative. This fits his group from the Aalborg Hospital here in Den· indeed the epidemiological history of the two mark ( 1 I, demonstrated that food eaten by Coastal factors we suggested as main causes of this de· Eskimos is rich in omega-3 polyunsaturated fatty ficit: During the 1950's deaths due to tuber acids, such as eicosapentaenoic acid (20:5) which culosis were pretty well eradicated even for the beoomes incorporated into platelets and has an previously very much affected young women, anti-aggregatory effect. Although this may convey with the introduction of intesified surveys, hos· some protection against thrombosis and therfore pitalization and effective chemotherapy. At prevent coronary infarcts, it may contribute to an about the same time or slightly later faster help inaeased bleeding tendency which has been re· became available for severe post-partum haemorr· ported from Greenland (2) and which is also hages, and concomitant diet changes may have evident, particularly in the post-partum period, deaeased incidence and severity of these. in Canadian Inuit. We have observed an excessive Looking now at the upper limitation of the number of deaths as well as an apparent excess of M:F sex shift note that both in 1971and1961 the 191 the curves return to near the midline (around 1.0) of their respiratory function to less than 50 % of not 10 years apart but beginning with exactly norms in the 5th decade and associated or conse the same age group, namely those between 55-59 quent pulmonary hypertension and right heart years old. hypertorphy, followed often by he;irt failure Could this still reflect the balancing of sexes in the 6th decade at age 55-65 years. The same (or even moderate excess of females) described by occupational hazards and history as hunters Birket-Smith, Franz Boas, Diamond Jenness and applied to Inuit men (older than 55 years) in 1971 others for adults (9), which they ascribed to an as it did in 1961, as a majority of Eskimo men excess male loss of life, suffered in particular by then living had been active hunters and trappers, young hunters? That the loss of hunters starved including mid-winter, up to the mid-1950's and in to death when caught in severe prolonged storms rnany areas until the mid-1960's with the notable or marooned on icefloes drifting into the open sea exception of people of the Mackenzie Delta. The was quite real I learned when delving into family most active hunting years used to extend from age histories while travelling to hunting camps on 15 to 40 years and as a general rule very little Davies Strait and around Cumberland Sound in the rnid-winter hunting was practiced by men older mid-1950's. Systematic attempts to rescue such than 45 years. lost hunting parties were only possible when radio We have seen then that, for a full explanation and aircraft becatne available. When taking excess of the peculiar demographic picture found in loss of young hunters into account, which no Canadian Inuit, we have to take into account doubt was greater at the time of the 5th Thule ethnological research on the one hand, which we Expedition, and up to the late 1940's much owe in our case most eminently to Knud Ras greater than in recent decades, the loss of young rnussen and his colleagues, and on the other hand women may actually have been even greater than local medical history as well as general medical apparent in the depicted M :F ratio curves derived research as exemplified by the quite recent work from the 1961 and 1971 Census figures. It would, by Bang and his associates. however, be difficult to explain the return to a Systematic health surveys, conducted in the M:F sex balance beginning at age 55 and in parti rnid-1960's in the Canadian Central and Eastern cular the lack of a 10 year delay in the 1971 curve Arctic, showed that the population structure of at the upper end of the female deficit bulge by each population group examined reflected very excess loss of young hunters. Obviously what Well their local epidemiological history. Fig. 4 ever caused the excess mortality of elderly Inuit shows population pyramids of Coppermine/ men was still going on between 1961 and 1971 . Holman Island and Pangnirtung I Cumberland Since excess mortality of middle age and elderly Sound in the mid-1960's. The Coppermine men due to coronary heart disease is even in Holman Island Inuit material compiled 1963 (8) Western societies not of an order of magnitude to demonstrate a sharp incision in the age group explain such large M:F sex shifts as evident in the 35-39 years who number less than half of the N.W.T. Inuit in their 6th decade of life in the 1961 40-44 year olds. What happened same 40 years and 1971 Census., and as deaths due to coronary before this survey in the Holman Island and heart disease were practically unheard of before Coppermine area? The early 1920's saw the first age 70 in Inuit prior to 1961 and is even now establishment of trading posts in that area and the extremely rare, we must look for another cause for first massive contact with the outside. and larger this phenomenon. Severe obstructive lung disease congregation around trading posts followed by a in males traced back to »freezing their lungs• on Series of deadly epidemics killing a fair proportion one or more occasions must be considered (5). of adults and wiping out the majority of infants Such men usually die around 60 years of age. De bom during those years as well as causing fetal tailed data presented at the IVth Circumpolar wastage and lowered fertility of wornen during Health Symposium in Novosibirsk in 1978, indi these epidemics. cated that Central and Eastern Arctic hunters, who The most remarkable incision in the Pangnir had engaged in extensive mid-winter hunting and tung-Cumberland Sound population pyramid (6), travelling activities in younger years, showed was in 1965 in the 20-24 year age group: There marked obstructive lung disease with a decline was a typhoid fever epidemic raging in the camps 192
Cat.t'OSIT10N OF ll£ POPUlA T10N BY AC:E. & SEX
Panorwtmo Coppennile I lolr11an Reolon 1965 1963 M F M F 298 270 249 269
70+ 65+ 65~9 o-64 80-64 5-59
-1919ACW fht ,,...... Conlil -1924 Wave of •' nk:a
10 8 6 4 2 " 2 4 6 8 10 10 8 8 4 2 " 2 4 8 8 10 12 Fig. 4. Composition by age and sex of the Inuit population of an eastern arctic (left) and a westem-amtral arctic fright) trading district in the mid-60's.
around Cumberland Sound 1941and1942, killing 12 % of the total population and so weakening sur viving women to cause abortions and loss of breast AO milk, and thus death of their babies, and to be infertile fof the next year. Thu~ about half of the BIRTH f .. TO 30 t !! normal baby crop was lost from 1940-43 as this + graph clearly shows. NEXT ~ CONCEPTION 1 The population structure is naturally also in 20 .+ 1 + . fluenced by other factors than epidemics of such t . ! t INTERVAL .; . acute or chronic infections as discussed above. 10 + t-' t• J . There is little doubt in my mind that the popu (MONTHS) •AGE fl-79 lation explosion evident in the 1961 N.W.T. Inuit +AGE 30-50 Census and similarly in the Third World, and in 0 10 20 30 AO many European countries 50-100 years ago, was less due to medical advances than to shortening of LACTATION {MONlHS) lactation and consequent rises in fecundity rates Fig. 5. Lactation and fertility in lgloolik women (Fig. 5). age 17-50 (3). As it appears ft-om the 1961 Census (Fig. 1' the youngest age group, children aged 0-4 years. had exploded into comprising almost 20 % of the cohorts born 1956-1966. Th&reafter a small, population, the largest increase between age but more recently a very marked, drop in birth· groups in this pyramid. This is still evident in the rates was seen. This was probably brought about 1971 Census. Obviously the largest widening of the widely available birth control pills and intra the population pyramids must be attributed to uterine devices. 193
Why the sharp rise of birth rates starting with Communities, 1965. the cohort born 1956-61? 1955-57 saw the const 7. Spady, D.W., Covill, F.J., Hobart, C.W., ruction of the DEW-line across the Canadian Schaefer, 0. and Tasker, R.S. (eds.): The North Arctic which attracted lots of Inuit females. This west Territories Perinatal and Infant Mortality and brought cash income, baby bottles and milk Morbidity Study. A Report to the Government of powder or condensed milk. Also the movies which Canada, Edmonton 1979. In Press Boreal Institute, became available then introduced the concept of Univ. of Alberta (1981). the female breast as a sex organ, and this inhibited 8. Usher, P.J.: Economic Basis and Rewurce Use its public use as a nutritional organ for the infant. of the Coppermine - Holman Region, N.W.T. Thus traditional modes of infant nutrition and the Report prepared for the Dept. of Northern Affairs beautiful interaction of mother and child, bio and National Resources, NCRC-65·2, Ottawa, logical as well as emotional, were disrupted. The 1965. traditionally small Inuit family, which was de 9. Weyer, E.M_, Jr.: The Eskimos - Their En scribed by Knud Rasmussen and his colleagues, vironment and Folkways. Archon Books Hamden, and all older explorers, exploded. Connecticutt 1962 - original 1932 by Yale Univ. I started out today with the promise to relate Press, p. 134 ff., Fig. 13. Knud Rasmussen and his own work as well as that of his explorer colleagues to our Circum General Bibliography: polar Health interest. I have tried to do this with Reports of the 5th Thule Expedition 1921-24, examples taken from recent demographic data published 1928-40 by Gyldendalske Boghandel available for the Canadian Inuit. I hope I justi Nordisk Forlag, Copenhagen, Denmark. Especially fied the inclusion of this Giant of scientific ex contributions by Knud Rasmussen and Kaj Birket ploration and research, born in Greenland of Sroith in Volumes V - IX (Ethnology of Central mixed Danish-Gteenlandish parentage in this, Eskimos). the 5th CircumPolar Health Symposium, taking Birket-Smith, Kaj: Eskimos. English Edition, place here in Copenhagen, the city where he Crown Publisher Inc. New York 1971. studied and died prematurely, exhausted by the hardship of his expeditions. 0. Schaefer, M.D., FRCP (C) Northern Medical Research Unit REFERENCES Medical Services c/o Camsell Hospital 1. Bang, H.O., Dyerberg, J. and Hjtbrne, N.: The Edmonton T5M 3A4 composition of food consumed by Greenland Canada Eskimos. Acta Med. Scand. 200: 69-73, 1976. 2. Dyerberg, J. and Bang, H.0.: Hemostatic function and platelet polyunsaturated fatty acids in Eskimos. Lancet ii: 433-435, 1979. 3. Hildes, J.A. and Schaefer, 0.: Health of lgloolik Eskimos and changes with urbanization. J. Hum. Evol. 2: 241-46, 1973. 4. Schaefer, 0.: Familial occurrence of ab normal placentation and fetal malformations ob served in Baffin Island Eskimos. CMAJ 83: 437- 438. 5. Schaefer, 0., Eaton, R.D.P., Timmermans, F.J.W. and Hildes, J.A.: Respiratory function impairment and cardiopulmonary consequences in long-time residents of the Canadian Arctic. Can. Med. Assoc. J. 123: 997-1004, 1980. 6. Schaefer, 0.: Intradepartmental report on Health and Nutrition Surveys in Four Arctic