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t h e small gene pool, i n b r e e d i n g , and o p p o r t u n i t i e s for g e n e t i c d r i f t . 4/ These g e n e t i c f a c t o r s could account for c o n g e n i t a l - h e r e d i t a r y d e f o r m i t i es d e s c r i b e d below, and for the impaired immunity and p e c u l i a r h y p e r s u s c e p t i - b i l i t y t o d i s s e m i n a t e d i n f e c t i o n s t h at c h a r a c t e r i z e d the l a t e r c o n t a ct p e r i o d . The n a t i v e s ' food was mainly t a r o , sweet p o t a t o , yam, b r e a d - f r u it and banana, with f i s h , and for the maka'ainana (commoners), only i n f r e q u e n t l y pig and dog. This h i g h - f i b r e , l o w - f a t , unrefined and l i m i t e d sugar d i e t ample in vitamins and abundant in m i n e r a l s , is now c o n s i d e r e d s u p e r i o r to the usual fare of modern western s o c i e t i e s , with one i m p o r t a n t common f a u l t - - e x c e s s i ve s o d ' i r a . 5/ This is a b a s i s for i n f e r r i n g t h a t the n a t i v e s of old p r o b a b l y a l s o had some a r t e r i al h y p e r t e n s i o n and r e l a t e d d i s o r d e r s , as s h a l l be d i s c u s s ed 1 a t e r . P e r s o n a l , household, and p u b l ic c l e a n l i n e s s of the e a r l y Hawaiians a r e well documented bj and were s t r i c t l y c o n t r o l l e d by kapu ( s a c r ed law) of the kahuna ( p r i e s t s ) . !_/ P h y s i c a l a c t i v i t y in work and p l a y was vigorous and e n j o y a b l e , and yet with adequate time for s l e e p and r e s t . 8/ There were no crowding, no p u b l i c l a t r i n e s , no garbage heaps or l i t t e r , and no use of human or annucti e x c r e t a as f e r t i l i z e r. Because of clean a i r , pure water, and u n p o l l u t e d land and sea, promoted by the kapu, n a t i v es unknow^ngiy maintained c o n t r o l of p o t e n t i a l l y harmful pathogenic microorganisms. 9/ The n a t i v e s were free of the epidemic, contagious p e s t i l e n c es t h a t scourged the c o n t i n e n t s in r e c u r r i n g waves for thousanas of y e a r s . However, the i s i t i r . a e r s did have some focal, i n f e c t i o n s as evidenced in pi e - c o n t a c t s k e l e t o ns recovered fr^:r. bm i a l sand dunes. 10/ Dental c a r i e s , which r e s u l t from a c i d - p r o d u c i n g mouth b a c t e r i a acting on c a r b o h y d r a t e - c o n t a i n i n g foods, o c c u r r e d in l e s s than 7 p e r c e n t of t h o s e under age 40, to 51.5 percent in p e r s o n s over the age of 6 0 - - f r e q u e n - c i e s much lower than those obse"ved t o d a y . 11/ Some bone abscess';:, were a l s o e v i d e n t , such as ih the m a x i l la or mandible, as e x t e n s i o n s from dental p u l p i n f e c t i o n s . i 2 / "Boils" were a l s o d e s c r i b e d in Cook's j o u r n a l s . 13/ Thus, the e a r l y Hawaiians we're not e n t i r e l y free of pathogenic orcanisms, as some cave claimed. 14/ Metabolic m a l a d i e s , so prominent in n a t i v e Hawaiian^ today, were probably a l s o p r e s e n t in t h e i r ancient a n c e s t o r s . However, the evidence is l a r g e l y i n d i r e c t and t h e i r freq- e n c i es remain u n c e r t a i n . The d i r e c t ev icence i s a l s o to be found in unearthed bones, which show examples of gouty a r t h r i t i s , d e g e n e r a t i v e a r t h r i t i s , and rheumatoid a r t h r i t i s . 15/ Common soft t i s s u e d i s o r d e r s , such as coronary a t h e r o s c l e r o t i c heart d i s e a s e, a r t e r i a l h y p e r t e n s i o n , s t r o k e , chronic o b s t r u c t i v e lung d i s e a s e , d i a b e t es m e l l i t u s , and end-stage renal d i s e a s e, a r e presumed to have occurred in pre-Cook Hawaiians because h e r e d i ty appears to play some r o l e in these d i s e a s e s so p r e v a l e n t in n a t i ve Hawaiians today. _16/ However, since t h e l i f e - s t y l e f a c t o r s of the maka'- a i n a n a did not include a h i g h - f at d i e t , c i g a r e t t e smoking, pnysical i n a c t i v i t y , and appressine s t r e s s , the f r e q u e n c i e s of these " d i s e a s e s of c i v i l i z a t i o n " in the e a r l y Hawaiians were probably l e s s than today. No
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