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the small gene pool, inbreeding, and opportunities for genetic drift. 4/ These genetic factors could accoutn for gcongenital-hereditary deformities described below, and for the impaired immunity and peculiar hypersusceptibility to disseminated infections that characterized the later contact period.

The natives' food was mainly taro, sweet potato, yam, bread-fruit and banana, with fish, and for the maka'ainana (commoners), only infrequently pig and dog. This high-fibre, low-fat, unrefined and limited sugar diet ample in vitamins and abundant in minerals, is now considered superior to the usual fare of modern westeren societies, with one important common fault--excessive sodium. 5/ This is a basis for inferring that the natives of old probably also had some arterial hypertension and related disorders, as shall be discussed later.

Personal, household, and public cleanliness of the early Hawaiians are well documented 6/ and were strictly controlled by kapu (sacred law) of the kahuna (priests). 7/ Physical activity in work and play was vigorous and enjoyable, and yet with adequate time for sleep and rest. 8/

There were no crowding, no public latrines, no garbage heaps or litter, and no use of human or animal exreta as fertilizer. Because of clean air, pure water, and unpolluted land and sea, promoted by the kapu, natives unknowingly maintained control of potentially harmful pathogenic microorganisms. 9

The natives were free of the epidemic, contagious pestilences that scourged the continents in recurring waves for thousands of years. However, islanders did have some focal infections as evidenced in pre-contact skeletons recovered from burial sand dunes. 10/ Dental caries, which result from acid-producing mouth bacteria acting on carbohydrate-containing foods, occurred in less than 7 percent of those under age 40, to 51.5 percent in persons over the age of 60--frequencies much lower than those observed today. 11/ Some bones abscesses were also evident, such as in the maxilla or mandible, as extensions from dental pulp infections. 12 "Boils" were also described in Cook's journals. 13/ Thus, the early Hawaiians were not entirely free of pathogenic organisms, as some have claimed. 14/

Metabolic maladies, so prominent in native Hawaiians today, were probably also present in their ancient ancestors. However, the evidence is largely indirect and their frequencies remain uncertain. The direct evidence is also to be found in unearthed bones, which show examples of gouty arthritis, degenerative arthritis, and rheumatoid arthritis. 15/ Common soft tissue disorders, such as coronary atherosclerotic heart disease, arterial hypertension, stroke, chronic obstructive lung disease, diabetes mellitus, and end-stage renal disease, are presumed to have occurred in pre-Cook Hawaiians because heredity appears to play some role in these dieases so prevalent in native Hawaiians today. 16/ However, since th elife-style factors of the maka'ainana did not include a high-fat diet, cigarette somking, physical inactivity, and appressine stress, the frequencies of these "diseases of civilization" in the early Hawaiians were probably less than today. No


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