The following gives the subject-matter of a letter from the author published in The Times of February 22, 1932, and written by him after the return of H. M. S. Carlisle to Simons Town and the receipt here of the preliminary reports of the dental examination which had been made on the island on the warship's visit.
Following precedent, the recent visit to Tristan da Cunha of H. M. S. Carlisle, under the command of Captain F. R. Barry, was made the occasion of inquiry into the health of the people, with the result that once again they are found to have no diseases and the only cause of death among them is accident or old age. But on this occasion their dental condition was made the subject of special examination for the first time, for the light it throws on this exceptional health of theirs, and this was undertaken by Mr. J. R. A. Moore, president of the Dental Society of the Cape Province, in co‑operation with the Surgeon Lieutenant-Commander of the Royal Naval Hospital, Simons Town, who both visited the island in the warship for the purpose, and the results are remarkable.
Islanders to the number of 156 were examined ranging in p148 age from infancy to ninety‑two years, and of these the teeth of 131 were found to be entirely free from any decay, and the general condition of them could only be described as perfect. Even the oldest man on the island, Samuel Swain, seventy-five years of age, had a complete set, none of them showing the slightest sign of decay, and he was described, not only as a dental marvel, but his physical condition was said to be extraordinary.
Mr. Moore states that such dental perfection as he found on Tristan da Cunha is entirely outside the experience of his profession in any other community, and the puzzle of it lay in the fact that the conditions under which the islanders lived are in marked conflict with those which modern scientific research lays down as desirable for dental health. "A clean tooth never decays," he said, is an accepted axiom, and yet the islanders never clean their teeth. And it is a dental maxim that "hard tack" is desirable for the life of teeth, and yet the food of the islanders is entirely soft. Well might Mr. Moore observe, as he does, that the question of any dental disease in this isolated group of people, living on a restricted diet, has been for many years a matter of marked interest to dental research workers.
Matters of diet may not be the explanation of the islanders' wonderful health, but the connection is dealt with in the present inquiry. The staple diet of the people, it was determined, was potatoes, fish, milk, and eggs. Meat is eaten only on high days and holidays. Flour, tea, and groceries, brought by visiting ships, are used as long as they last, but the Tristan housewife spends a good deal of her time in making a little go a long way. Large quantities of milk and cream, the report says, are used, but as a matter of fact there are frequent periods of shortage in these.
What, however, has special significance, we are told, in p149 the mode of diet of the people is that they never eat more than one kind of food at a time, and this, as Bishop Watts says, may be the reason for their perfect health. In living on potatoes chiefly as they do, they live on "bare" potatoes — that is, potatoes eaten without salt and unaccompanied by tea or any other food; fish they eat with nothing else, and penguin eggs — perhaps three at a time — are eaten alone.
This is a general statement of island habits of diet, but two individual instances that shed light on the subject can be given. When Captain Knud Andersen, the Danish traveller and author, called at the island in his ketch in March 1930 he brought away with him two of the islanders who wished to visit the Cape. One was Tom Rogers, an elderly man, and the other Donald Glass, a young man of twenty‑one. The latter was described by a writer in the Cape Argus as having a "superman's body," being •6 feet in height and weighing •169 lb. But in contrast to this he had a "remarkably small appetite, and in explaining it he said, "What makes you hungry is to eat one meal at four o'clock in the morning, go out fishing all day, and then eat again at night." And Tom Rogers, when justifying his decision to return home by the Carlisle after his year and more at the Cape, said that "home food's best, it keeps you tough"; and when asked what he ate, he said, " 'Taties' chiefly," and added: "In the town it's noise and rush and heavy clothes and many meals, and one can't live long like that," and he said he was going back for good. Surely there is something for our enlightenment in all this.
The letter excited interest and a correspondence ensued, and a summary of this, under the heading "The Riddle of Tristan da Cunha," was afterwards published in the Dental Magazine of the following p150 April and May. As it contains the gist of further thought on the subject, the bulk of it is now reproduced.
Mr. E. W. Fish, of the Hale Research Laboratory, Royal Dental Hospital of London, in a letter also to The Times, suggests that the explanation of the phenomena is to be found in heredity.
It is a matter of common knowledge [he says] that some families have good teeth, while others have bad. The experience of dental surgeons bears this out, for not only are some families almost entirely caries free, but in those with a mixed dental heredity an application of the Mendelian theory will often explain the incidence of the caries which is present.
It cannot be a coincidence that in families with a fine dental heredity all the children are immune and caries free while their diet and mode of life are just the same as those of their susceptible friends next door, with whom they live in the same school from the age of eight and a half years onwards.
Mr. Fish's suggestion is that the people of Tristan da Cunha have inherited a caries-free tendency, and that this tendency persists because "they have been a closed community for many generations, free from any outside racial admixture."
This latter statement the author controverts in a subsequent letter.
It is not a fact [he says] as Mr. Fish suggests . . . that the inhabitants have for generations formed a closed community without any outside racial admixture. Though living in isolation as they are, it is really just the contrary, for, as the p151 exhaustive report prepared on the visit of H. M. S. Odin in 1904 states, the people have come from diverse stocks. Though Scottish in origin from the nationality of William Glass, the founder of the Settlement, they have from time to time been refreshed from English, American, Dutch, and Italian sources, and it is this, the report adds, that has probably preserved the race in its present satisfactory condition. The arrival at intervals of new blood on the island has been inevitable, if only from the seventeen shipwrecks which have occurred there, and any explanation of the physical condition of the islanders in point of heredity, as Mr. Fish suggests, is on that account ruled out.
What Tristan da Cunha can tell us in the matter of the preservation of our teeth we have yet to learn, but seeing how many of us lose our natural powers of mastication while yet in the vigour of life, while the islanders retain theirs to the end, the lesson should at any rate be worth while.
On the incidence of caries in Tristan da Cunha this report1 is in agreement with that made by Dr. E. H. Marshall2 to the Medical Research Council in 1926, an abridgment of which appeared in the Dental Magazine for October of that year. On the incidence of pyorrhoea, however, the two reports are in direct conflict. Mr. J. R. A. Moore and his colleague from the Royal Naval Hospital tell us that cases of pyorrhoea are few and far between (their full report published in the British Dental Journal gives the number of cases of gingivitis and pyorrhoea as five and two respectively), whereas Dr. p152 E. H. Marshall found that "chronic general periodontitis was present in various stages in no less than 58·5 per cent of those examined between the ages of fifteen and ninety. This is probably not a disease of recent origin in the island, since histories, dating in some cases more than twenty years back, were given of teeth becoming loose and falling out without showing signs of caries. How far a shortage of sugar and jam has prevented the spread of caries, and what influence the large consumption of potatoes, on which the islanders rely almost exclusively for their carbohydrates, has had on the incidence of chronic general periodontitis are matters for discussion."
It would be interesting to know how these two reports are to be reconciled.
In continuation of the correspondence in The Times, "M. D." has a letter in which he expresses the opinion that the explanation of the perfect condition of the islanders' teeth is to be found in the fact that, as mentioned in Mr. J. R. A. Moore's report, sugar is "hardly ever used; they can get it only from ships." He says: —
. . . The view that sugar is the cause of decayed teeth has been held on and off by the medical profession during the last 200 years, but has every now and then been given up on the appearance of some new attitude of medicine towards disease. Thus there have been chemical, electrical, constitutional, and dietetic views of this disease, and the last, p153 with sugar as its main prop, was rapidly gaining ground until the Medical Research Council decided that the disease was due to lack of vitamins, and thereupon set about to investigate the point. Many thousands of pounds have so far been spent upon this investigation and, so far, in my opinion, the results show that sugar is the cause of caries and that vitamins have little or nothing to do with it. This, I may say, is not the view that the Medical Research Council hold.
There are, I feel sure, many other peoples in the world with as good teeth as these islanders. For many years I lived in Northern Rhodesia, and I can guarantee that in the bush native — that is, one far removed from European stores — there is no primary decay of the enamel of the teeth. There is decay of the dentine, that is, the tissue immediately under the enamel, but it only occurs when the enamel has been broken away by a bit of grit or some other accident. But decay of dentine is not decay of enamel, and among these natives there would be no decay at all if their enamel were not accidentally broken away. On the other hand, down in South Africa, in the Transkei, for instance, where the European stores supply the native with unlimited sugar, I have occasionally seen native children with every tooth in their mouths decayed. The decay in these natives is like that found among European people, that is to say, it is primary decay of enamel.
As to the question of pyorrhoea or periodontitis, it is clear that the islanders must suffer from some form of it or their teeth would not get loose and fall out. It is not a normal state due to old age, because even in this country it is not uncommon to see perfect teeth at the age of seventy or more showing no sign of pyorrhoea.
The islanders offer an opportunity for a gigantic experiment, an experiment which would certainly tend to settle the question. Let the Tristan da Cunha fund supply them with p154 a few tons of sweets and sugar every year, and re‑examine them at the end, say, of ten years. I should expect to find extensive decay of the teeth in those islanders who had acquired a taste for sugar, also new intestinal disorders, more rheumatism, probably adenoids, and a few other complaints it is not necessary to mention.
To the suggestion in the last paragraph of the above letter, the author replied as follows: —
Though it may not be practicable, even if it were desirable, to carry out the experiment which "M. D." suggests in your issue of yesterday of sending a few tons of sweets and sugar to Tristan da Cunha annually for a number of years for the demonstration of their effect on the island teeth, yet an experiment, in effect at least, has been made during the last few years in the consignment of sugar to the island more or less regularly. And not only has sugar been sent out but cereals also, the effect of which on the teeth has equally become open to question. A couple of tons of sugar and 3½ tons of flour, for instance, were sent by H. M. S. Dublin in 1923, and, in each consignment since, flour and sugar have been regarded as the primary requisites.
Though belief in the injurious effect of these articles of food on the teeth is too widespread for any doubts as to the soundness of the medical convictions regarding them, yet the islanders' experience serves by way of proof that neither sugar nor flour is harmful to the teeth when consumed in moderation. For, as Surgeon-Commander Sampson's report shows, the people's teeth have not suffered in consequence of them. It may be, of course, that neither flour nor sugar has been sent in quantities sufficient for any conclusive demonstration of their injurious properties in their relations with the teeth, but it is clearly shown that if dental harm follows p155 their consumption it follows only their consumption in excess. The lesson of the island, therefore, is one of moderation in the use of them, and it may be of much significance that as touching the question of flour the potato at any rate is not yet ousted from its position as the principal article of island food.a
A further contribution subsequently appeared in The Times by way of explanation of Tristan da Cunha's dental perfections and it was made by the Chief Medical Officer of Dr. Barnardo's Homes, Mr. A. H. MacDonald, and it referred to the paper written by Mr. Evelyn Sprawson of The London Hospital Dental School (University of London), entitled Preliminary Investigation of the Influences of Raw Milk on Teeth and Lymphoid Tissues, and in asserting the virtues of raw milk in this connection Mr. MacDonald said: —
Mr. Sprawson, the dental surgeon in charge of the teeth at the two largest depots of the organization from whose headquarters I write, noticed that shortly after the introduction of raw milk as part of the daily food of one of these depots there was a reduction, practically to vanishing-point, of new dental caries after admission, whereas previously such new work had been common and large in amount.
This aroused in him the curiosity to know if effects comparable to these would be found in children who had been brought up from their earliest years on raw milk, which he defines as "milk which has at no time been heated to more than a few degrees above body temperature." Children brought up in this manner are not common in this country, and when he approached me as to whether I knew of any p156 such children I was able to refer him to our "Babies' Castle" at Hawkhurst, where we had at that time (August 1931) 53 children aged up to 5½ years, and to another branch where we had 17 others similarly brought up. He examined them, and reports that 68 of them had no trace of dental caries, and that the minimum of dental caries present in the other two was present before they were admitted. These children get a considerable amount of cereal food, including oatmeal, in their dietary, and at Hawkhurst are regularly given one or two sweets after their dinner.
In so far as one may judge by the paper referred to, there seems to be a true immunity to caries, in spite of the enormous quantities of refined carbohydrates which civilized peoples now use; for, as is pointed out, freedom from caries and immunity to it are quite different things. Ante-natal care has played no part in the production of these perfect teeth.
I may also mention that the ratios of increase in growth and weight and resistance to infection are so much more favourable in children brought up in this manner that, in so far as our finances allow it, we are making a daily raw milk ration as universal as we can to all the children under our care.
In Tristan da Cunha, and we have it on the authority of Mrs. Rose Rogers who spent three years there, the custom is to milk a cow and while the milk is still warm from the cow to give it to the infant. It is never warmed and hardly ever is water added. There are no infant foods at Tristan, and the mothers nurse the babies themselves, very often until sixteen months or over. And the islanders are very good to the young, and their supply of milk comes first.
From the foregoing it would appear that if any p157 lesson is to be learnt from Tristan da Cunha for the preservation of the teeth, it is to be found in one or other of the following expedients: —
1. The elimination from the diet in part or whole of cereals or sugar or both.
2. The use of raw milk, that is milk unboiled, and neither sterilized nor pasteurized; and it may be added —
3. Moderation in diet whatever it be.
Whether or not defective teeth come from the consumption of cereals as a staple article of diet, there is a general suspicion amongst research workers that they do, and on that account the record of Tristan da Cunha's almost entire elimination of them from their food products admits of a fuller statement. The ascendancy there of the potato in place of wheat has prevailed throughout, and whether or not this accounts for the sound constitutional health of its people — health which has now received additional recognition in the proof of the dental perfections which accompany it — the two at least exist as contemporaneous facts.
The first mention to be found of island produce strangely enough has reference to the cultivation of wheat, and it is contained in the report Captain Cloete, who went to the island in 1816 in command of the troops then sent there. It is stated that he had •twenty acres of ground broken up for the purpose of sowing wheat, expecting an ample p158 yield owing to "the extraordinary fertility of the soil." Whether or not the ground was sown and the wheat produced does not appear, but eight years later we find it on record that bread was practically unknown on the island. Augustus Earle, the young artist who was marooned there in 1824 for nearly a year, tells us this in the published account of his life there, and he says the potatoes were the finest he ever tasted, and they formed the chief article of food as well as traffic.
With the passing of another thirteen years the same impression remains, for the Australian pioneer, Thomas Sutcliffe Mort, who spent a couple of days on the island in 1837 on his way out, and whose diary has already been quoted, leaves it on record, when referring to the island produce, that the islanders grew potatoes in large quantities — 80 or 100 tons a year — but he makes no mention of any growing of corn.º And similar testimony is found in the account of the mission of the Rev. W. F. Taylor, who remained on the island for six years, from 1851 to 1857. He says that the crops consisted almost entirely of potatoes, and what flour they had was obtained mostly from whale ships in exchange for potatoes. And he adds that nothing but potatoes had ever succeeded, or were likely to succeed. The islanders ate them, as now, without salt, of which very little was eaten at all.
p159 In 1882 the Henry B. Paul was wrecked on the island, and rats invaded it, and afterwards became a pest that rendered the growing of corn impracticable, even if it were attempted. But apparently corn was not an island produce at the time, for information reaches me to this effect from the American lady who was wrecked on the island as a girl of ten in the Mabel Clark, and this was in 1878, four years before the arrival of the rats. In referring to the people's food she makes no mention of bread, but she says that potatoes thrived there, and when they became scarce the islanders went over to Inaccessible Island for a boat-load. It seems that the pest of rats only followed a pest of mice which had long existed, and these equally prevented the growing of corn, even if the soil had proved suitable, as they ate the seed.
Thus it is seen that the island's adoption of the potato in place of flour as its staple article of food does not find its commencement in the wreck of the Henry B. Paul in 1882, when rats for the first time came ashore. Though the subsequent increase of them until they became a plague made the growing of corn impossible, it did not account for the people's preference for the potato, for that had prevailed throughout their occupation.
If this ascendancy of the potato in the island diet has been subject to any qualification it has come about through the current movement for p160 helping the people, for that has given rise to the consignment of flour to the island, and the consignment of it in considerable quantities. What is the result? In earlier times the people's dependence on cereals and no less on sugar had been limited to what visiting ships — most of them whalers — could spare from their own ship's stores — usually a few bags at the most. Now the supply of flour and sugar is more or less organized, as already stated, and the consumption of them, as it now obtains, constitutes a new factor in the island dietary, and it cannot be disregarded in any conclusions concerning their admirable dental conditions. Mrs. Mellanby and Dr. Pattison, we are told, experimented on children of six years and under, and they found that the initiation and spread of dental caries in each were almost eliminated with the exclusion of cereals from their diet. Does the addition of cereals and sugar now made to the Tristan diet affect the island children in an opposite way, and produce caries, or the symptoms of it? Apparently not, for Surgeon-Commander Sampson is conclusive in the tables of his report that no islander under twenty‑one years of age has any carious teeth, and yet the younger among them have been born and reared since the supply of flour and sugar became more or less regular and more plentiful.
As already stated, it may, of course, be said that p161 the supplies of flour and sugar, even as now sent, are still inadequate to taint the system. But this is only tantamount to saying that cereals and sugar in moderation are not injurious, and this is the point which the lesson of Tristan da Cunha seems to establish with regard to our teeth. The principle of fasting was introduced on hygienic grounds and, through recognition of the importance of it, it became a religious observance. It operated either as a total abstinence or as one confined to specific articles of food, and the benefits of it are now more or less disregarded. In the spirit of it, cannot the "experiment" in diet, which has been made in Tristan da Cunha with success, of giving a qualified preference to the potato, now be tried here, and results noted for our edification?
That moderation in diet may be at the root of the good health that prevails on the island receives the most convincing proof perhaps in a passage in Augustus Earle's book, in which he describes the effect of residence on the island on himself; and for what it implies, and more particularly for what he attributes it to, the following extract from the passage is worth perusal. As already suggested, the prevailing health on Tristan da Cunha may not be due so much to what the island diet contains as the moderation which now, as in the early days, marks the island's consumption of it, and it may well be that in this connection Mr. Earle's allusions to the p162 benefits of abstemious living will carry weight. He says: —
Exercise and temperance we all believe to be greatly conducive to health. Five months' residence on this island has convinced me of their wonderful effects on the constitution.
Here our food is of the coarsest description: bread we never see; milk and potatoes are our standing dishes: fish we have when we chance to catch them; and flesh when we can bring down a goat. In order to furnish materials to furnish forth a dinner,º I go early in the morning to the mountains; and the exertions I go through make me ready to retire to bed by eight o'clock in the evening, when I enjoy the soundest sleep; and though certainly I have nothing here to exhilarate my spirits, on the contrary, much to depress them — anxiety for absent friends who are ignorant of my fate and my irksome situation thus shut out from the world — yet in spite of every disagreeable, I have never enjoyed so calm and even a flow of spirits, which is doubtless caused by my abstemious living and the exercise I am obliged to take. These last few months' experience has done more to convince me of the "beauty of temperance" than all the books that have ever been written could have done.
Well might Mr. J. Menzies Campbell, the author of Those Teeth of Yours, say, as he does in a recent article3 of his, that as illness would appear to have increased step by step with the advance of civilization, it would surely repay us to review the general outlines of primitive man's diet and endeavour to determine which, if any, of his customs could, with advantage, be adapted to suit modern requirements. p163 And this appeal he enforces when he reminds us that while, in reality, the primitive man had need of more food than the modern man because he lived a strenuous, open‑air life, yet he did not eat as much as the modern man, and from this we may judge how much the modern man consumes in excess of his physical requirements.
1 The report of H. M. S. Carlisle.
2 Of the Royal Research Ship Discovery.
3 "Random Thoughts on Diet," Western Dental Bulletin, May 1932.
a Derrick Miles Booy, on p192 of his book Rock of Exile (1958), reports that currency having been introduced on the island, "It enables the people to buy clothing and hardware and to vary their fish and potato diet with potted food-stuffs; it may also widen the gulfs between families, making sharper divisions between rich and poor. Already the change of diet has introduced decay to the islanders' teeth, once almost perfect." [my italics]
In fact, though, well before the introduction of important amounts of sugar to the Tristanian diet, there were dental problems: see Rev. Augustus Partridge, chaplain on the island in 1929‑1931, quoted in Margaret Mackay, Angry Island, p203.
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