Whatever happened to Anderson Island?

Ship’s surgeon William Anderson died in 1778 and was buried at sea. Captain James Cook decided to name the island near the burial after Anderson. Cook, however, had made an uncharacteristic error. He failed to realise that the island had already been discovered by the explorer Bering in 1728. St. Lawrence Island, as it was named by Bering, is thought to be the first place in Alaska to have been visited by Europeans.

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Learning objectives

1. Explore how St. Lawrence Island fits into the history of medicine

2. Consider what the term ‘disease’ means to you

3. Reflect on what Anderson might have thought of more modern influences on the island which so nearly held his name

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Previously we had looked at the achievements of William Anderson during his time with James Cook on his voyages. This post will examine the fate of the island Cook wanted to name after Anderson but is instead known today as St. Lawrence Island. Not sure where it is? Well here’s a satellite image and a link to Google Earth:

St Lawrence Island
Google Earth https://earth.app.goo.gl/GVqp68

The Yupik name for St. Lawrence Island is Sivuqaq. Inhabited by the indigenous population intermittently for over two thousands years it is thought to be one of the remaining remnants of a land bridge between Asia and North America. Vitus Bering named it St. Lawrence as he visited it on August 10, 1728, the feast day of St. Lawrence.

Approximately 100 years after the death of Anderson (and 150 years after the visit by Bering), the population of St. Lawrence Island experienced a catastrophic event. Between 1878-80, the population endured a famine and a disease outbreak. It is thought that the population was reduced by more than 90% during this time. There may have been a number of contributory factors including decimation of the walrus (an important food source) by external whalers and/or migration of the native population. Spiritually, some Islanders may have considered disrespect paid to animals as responsible for the disaster.

An Inuit Medicine Man and a boy
Image from https://commons.wikimedia.org/wiki/File:Inuit_medicine_man_and_boy_1900.jpg

A report by the United States Revenue Cutter Thomas Corwin contains the following haunting entry:

On the morning of the 24th we ran down to the south side of the island and anchored off a deserted village. The sea was quite smooth, although the wind blew down off the high cliffs in terrific gusts. Owing to the strength of the gale we were unable to visit the shore and make an examination, but it is probable that this was one of the villages depopulated in the terrible famine which visited the island in the winter of 1878-79. We were informed by the natives at the Northwest Cape that at a settlement on the south side a few of the natives were still alive, and, as we saw no signs of life at this place, although the shore was constantly scanned, I concluded that there must be another settlement farther along the coast to the eastward. The wind moderating a little towards night, we got under way, and steaming slowly to the eastward, with the lead going, and keeping a sharp lookout on the shore with the glasses, we were at length rewarded by the sight of two houses, which appeared to be occupied, situated on the top of a small hill. Hauling in for them, we came to anchor near the shore in six fathoms of water. The location of these houses on top of a hill at first caused some surprise, as it was contrary to their usual custom of establishing themselves near the shore. For greater convenience in using their skiu boats, they build at the point nearest to their place of lauding, where the snow does not drift. A lauding place is selected with a view to two things, namely, a sloping bank for the convenience of launching and hauling out their boats and game, and water sufficiently deep near the shore to enable them to land without much difficulty the walrus and whales captured. Landing and making an examination, the cause of the singular location of their houses was apparent. The original settlement had been near the water, on a slightly elevated flat, protected from all winds except southeast, but during the famine all the inhabitants had died, with the exception of those now occupying the two houses on the hill, about sixteen in number, and as their blanched corpses were now lying on the ground in the immediate vicinity of their former houses, and even inside the houses, so that it was almost impossible to get around without stepping over them, the survivors had withdrawn to the hill to avoid the ghastly sight.

USRC Corwin: Departure for Alaska, 1885
Image from https://en.wikipedia.org/wiki/USRC_Thomas_Corwin_(1876)

I made a personal examination of five of the six settlements on the island. At three of them all were dead, not one left alive. At-a fourth about sixteen, two families, were still alive, and at the time of our visit had plenty of food. At the large settlement on the northwest end of the island we were informed that about two hundred had died, and that nearly four hundred yet remained alive. I have since learned that at the sixth settlement, on the southeast end of the island, the inhabitants had nearly all disappeared. In one house we counted thirty dead bodies thrown together in a heap in the corner. In every house opened by us great ghastly piles of dead bodies were exposed to view. At one deserted settlement I saw eight or nine bodies, probably an entire family, dead in a summer-house, showing that they must have survived the winter, as they would not put up the summer-house until the weather was warm enough to melt the snow and ice, thus making the winter-houses wet and uncomfortable. It appears strange that, after surviving the winter, and with strength enough remaining to put up and move into their summerhouses, they should be unable to supply themselves with food and regain their health and strength. By the time they could occupy their summer-houses the ice must have been broken so as to render seal hunting possible. It is probable that this family, having seen so many die, made no effort to save their own lives. Believing they were doomed, they submitted quietly to what to them appeared inevitable, and daily growing weaker, stretched upon the ground and covering themselves with furs, waited for the end. In this position we found them lying as if asleep, their guns, bows, arrows, spears, and traps lying strewn on the ground.

It is difficult to understand why a people who have lived and nourished for so many generations should be so suddenly and almost entirely swept away in one winter. I can only account for it by supposing that no such severe winter as that of 1878-79 has occurred for many years, and that during those years the habits of the people have changed; they have become less provident than before. They have acquired a taste for liquor, for which they will barter anything they possess, and when obtained, remain drunk until the last drop is gone. Hunting, of course, is entirely neglected at such times, and hunger and starvation are the results. Unless something is done for these people their total extinction is a question of a few years.

The report suggests alcohol consumption may have been a factor although I can’t find any evidence or other reports to substantiate this claim. It is interesting, however, that alcohol which was presumably imported to the island following European contact was even considered a factor. Compare the feelings that Anderson articulated on the possible European introduction of syphilis to Pacific Islands.

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Questions

Is the classification of alcoholism as a disease given equal parity by doctors and society when compared to a disease like syphilis?

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Fast forward another 100 years and we’re in the latter part of the Cold War. During this time, St, Lawrence Island has become strategically important and a number of military installations litter the Alaskan region. As tensions ease, many of these sites are abandoned, however St. Lawrence Island is said to host some of the most polluted military sites.

Northeast Cape Air Force Station, St. Lawrence Island
Closed in the 1970s, 2003 image prior to the site remediation
Image taken from https://commons.wikimedia.org/wiki/File:Northeast_Cape_Air_Force_Station_-_2003.jpg

Of particular concern and an issue of considerable controversy is the contamination of the area with polychlorinated biphenyls (PCBs). These were used in electrical appliances/insulation as they are highly inert. Unfortunately they can also enter the food chain. PCBs can eventually enter the waterways into the ocean where they biomagnify in marine life. This marine life forms an important food source for Islanders. Humans can bioaccumulate PCBs by eating contaminated food, through intrauterine exposure and postnatal exposure via breast milk.

Polychlorinated biphenyl (PCB) structure
Image from https://commons.wikimedia.org/wiki/Category:Polychlorinated_biphenyls#/media/File:PCB_general_structure.svg

Besides the numerous known effects on animal species, there is also data on the effect on the human population. By entering the human diet, PCBs may cause illness and disease. Although there are a number of potential confounders (e.g wealth/poverty, obesity, diet, contamination of marine life from other sources), PCBs have been associated with cancer (melanoma and non-Hodgkin lymphoma, breast, prostate and ovarian, subfertility and behavioural changes. I think it’s important to stress that this is a highly debated issue.

Another potential factor in health outcomes may be healthcare access. In an apt demonstration of the inverse care law, the residents of St. Lawrence Island who require the most medical input have had to take a plane journey to the mainland to receive it. New clinics have been recently opened on the Island and for a further insight about life as a doctor in Nome (near St. Lawrence Island) there’s a blog that I recommend as an interesting read called Nome Muckin’ Around.

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Questions

Is exposure to environmental pollution considered as much of a ‘disease’ compared to alcoholism or syphilis?

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Cook’s voyages heralded the dawn of globalisation. The impact on health (good and bad) is still being realised and includes the consequences of communicable disease, dietary changes, environmental pollution, migration and cultural/identity change. The effect on different populations is also different; there may well be a rich-poor divide similar to other disease processes such as modern obesity. Understanding and appreciating this as a distinct and important healthcare phenomenon remains in its infancy. You’re unlikely to encounter a chapter on globalisation in a standard undergraduate medical text-book yet it will be something that clinicians will face on a daily basis whether they are conscious of it or not. Some of our patients however will be all too aware:

“…hard choices will have to be faced, sooner or later. If cancer-causing toxic chemicals are indeed coming in from the sea… then the natural diet that has sustained people here for thousands of years is no longer viable. Our traditional foods are killing our people. But without our traditional foods, we die as a culture.”

Vi Waghiyi, resident of St. Lawrence Island

(Quote taken from https://www.nytimes.com/2015/08/04/us/native-alaskans-study-and-clean-up-a-legacy-of-pollution.html)

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Questions

Is globalisation good for the health of your patient population?

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Although St. Lawrence Island doesn’t bear his name, geographically, Anderson is still honored by Anderson point in Nootka Sound:

Image from Mapcarta https://mapcarta.com/24115608

Image from Google Earth https://earth.google.com/web/@49.64244624,-126.46317183,77.52706473a,20043.51324909d,35y,0h,0t,0r

What a great picture for the waiting room.

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Summary

It’s ironic that the population of an island so nearly named after a someone concerned with health and the introduction of disease subsequently went on to suffer problems of famine possibly related to the introduction alcohol and cancer allegedly related to the introduction of pollution. It is now being said that in the developing world, pollution is killing more than disease. The health impact of globalisation is complex and interdisciplinary but that doesn’t mean that doctors should be afraid or excluded from asking challenging questions about it.

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Further resources