Actn Medica Scnndinnvicn. Vol. CXL, fiisc. V, 1951.

Medied Studies in North Greenlmd 1948-1949.

IV.

Enlnrgeiiient of the Liver. Biliary Stone and Peptic Ulcer. Incidence and Etiology.

BY

M. CH. EHRSTROlt . ’ Helsingfors, Finland.

(Sobmitted for publication January 16, 1951.)

In 1947 The Queen’s University Arctic Expedition to Southampton Island in the northernmost part of Hudson Bay found that one-third of the Eskimos living there had enlarged livers 0). . . livers which were considerably enlarged by ordinary standards))). In 2 cases a biopsy of the liver was made which showed ))that the en- largement was due to the presence of large amounts of fat)).

There is no mention of the Eskimos’ diet being examined in the part of the Ex- pedition’s report which is so far available. But in the report of the Fifth Thule Expedition Knud Rasmussen says that the Eskimos, as early as in 1922, were liv- ing on whop foods from the Hudson Bay Company. It seems hardly probable, therefore, that in the summer of 1947 they were living solely on the original Eskimo diet that consisted mainly of protein and fat.

In Section I, General Introduction, i t is stated that the diet of the North Green- landers in the Umanak district consists mainly of food rich in protein and fat but that appreciable amounts of carbo-hydrates are also included. There seems there- fore to be no dietary pre-requisite for an enlarged liver.

The size of the liver was determined by palpation and percussion in the 1,073 persons whom I examined in North Greenland. No biopsies were made.

In 360 people (192 women and 168 men), or in 33.6 per cent, the liver (in the me- dio-clavicular line) was palpable 1 to 8 cm below the costal arch. It was remarkably firm in about 20 cases and in the remainder of normal consistency.

Mrs. Ings Ehrstrijm, Majorsgatan 15, Stockholm

MEDICAL STUDIES I N NORTU QREENLAND 1948-1940. 325

Comments.

It should be noted that in my series the liver was palpable in the same proportion of cases (i. e. in one-third of the people examined), as that in which the Americans found an enlarged liver among the population of Southampton Island.

About 25 persons with palpable liver had been living almost entirely on a Euro- pean diet and quite a few mainly on ))shop foods. In consequence, i t hardly seems probable that the palpable livers were enlarged fatty livers.

In Section I , General Introduction, it is stated that about one-third of the popu- lation of the Umanak district were almost pure Eskimos whilst the remainder often had a large admixture of European blood. The following typical charac- teristics of the pure Eskimo have been given: short stature, short thorax with gracile, ))childish)) ribs, wide epigastric angle (often almost straight) and loose ab- dominal coverings. In men, and in women who have not given birth to children the abdominal coverings are extremely loose and flabby. As mentioned in Section 111, one has the impression of ))general fragility of the mesenchymal tissue)).

Tests showed that, when the person was examined in a recumbent position, the liver did not reach below the costal arch; it was palpable in a sitting position, and hung about two finger-breadths below the costal arch in a standing position.

In people of mixed race, with European bodily structure and firm abdominal coverings the liver was not palpable, or enlarged on percussion. It is therefore very probable that the palpable livers are ptotic.

Conclusions.

In one-third of the people examined from the Umanak district in North Green- land the liver was palpable 1 to 8 cm below the costal arch. This is ascribed t o ptosis of the liver associatedl with the bodily structure of the Eskimo race.

Diseases of the Bile-Duct and Peptic Vlcer.

Bertelsen writes of gall-stone in Greenland: The common conception being that a diet consisting mainly of animal food tends to promote gall-stone owing to its cholesterol content, I should like to point out that gall-stone (cholelithiasis) is uncommon among the natives of Greenland but is frequent among the Europeans living there.

In my series there is an uncertain case of dyskinesia (No. 8) of the bile-duct and two certain cases of gall-stone. One of the patients was a 68-year-old Eskimo wom- an (No. 782) who had had typical gall-stone attacks for many years, frequently in connection with jaundice. She also had hypertension, cardio-sclerosis and psycho- somatic neurosis. The second case was an Eskimo woman (No. 940) suspected of having a turnour of the adrenal cortex. At the post mortem examination, a solitary cholesterol stone was found.

3-2 ci M. cIr. EIIRSTRSM.

Bertelsen (1940) states that peptic ulcers have not been found among the Green- landers. Dr. Mogens Holm told me, however, that he had performed an operation 011 the Polar Eskimo, Ivik, for perforated ulcer of the lesser curvature.

I found no cases of ulcer among the Greenlanders of the Umanak district. How- ever, a 49-year-old catechizer of mixed race who had recently moved from South Greenland mentioned having 10 years previously had a hematemesis, considered to be due to peptic ulcer. When I examined him he showed only symtoms of psycho-somatic neurosis (No. 1006).

Comments.

Gall-stone is rare among the native population but common among the Europeans living in Greenland. To my knowledge, peptic ulcer has only once been definite- ly found in a Greenlander.

This seems to show that dietetic factors - in gall-stone, the cholesterol content of the food and in ulcer, great quantities of meat and fat which are difficult to digest - will not alone suffice to cause these diseases. I n peptic ulcer the signif- icance of psycho-somatic disturbances has long been stressed. It is reasonable to assume that disturbances of this kind may also influence the etiology of diseasee of the bile-duct.

Referenoes.

Bertelsen, A.: Gronlands medicinsk statistik og nosografi. Meddelelser om Gronland. 117. - Holm, Mogens: Personal communication. - Rasmussen, Knud: Fra Gronland ti1 Stille- havet. Kobenhavn 1926. - The Queen’s University Expedition t o Southampton Island: Arctic, 1 (1948), Page 65. - Case reports in Swedish are deposited at the Library of the University of Helsingfors.