• Dedication to     Ancel Keys  • Introduction  • Overview  • Yugoslavia  • Italy  • Greece  • Finland     - Fit Finns     - Sequel  • Netherlands  • ;U.S.A.  • Japan  • Addendum

The East Finn survey participants make long travels by boat, bus, truck, car, and often by bicycle to come to our examinations at the border station. One of the remarkable things about them is that they are quite fit, yet their arteries are heavily involved with atherosclerosis. Finally, the disease becomes manifest by angina or cardiac infarction.

These men have a lifetime high level of fitness as a result of their vigorous occupations. It seems incongruous, but is highly significant, that a population with one of the highest rates of vascular disease recorded should have, perhaps, the highest level of fitness and live in rural calm and order.

The Finnish men we examine have lined, open faces. Though not as gregarious as our Mediterranean subjects, they move through the survey stations with good humor, quick to smile and to respond to greetings. The Finnish language is distinctive, with a staccato sound, clear and bell-like, full of vowels. It is pleasing off the tongue of the young women technicians, clipped and semi-swallowed by our medical colleagues, and a deep, bearish growl from the mouths of our hardy participants. These voices together create a soothing harmony throughout the busy survey stations.

I suspect there are different degrees of culturally determined motivation and competitiveness under stress. The Finnish men, for example, appear genuinely challenged by our exercise tolerance test, giving it "their all." Alan Barry's scale of perceived exertion is graded consistently lower here than in other Seven Countries areas. On a scale of one to fifteen, the same level of activity might be perceived as an eight by the Finns and a thirteen by the Italians, though these comparisons have not yet been made systematically.

Similarly, with pulmonary function tests, the Finn technicians are vigorous and the participants highly responsive, making all-out expiratory efforts. It is also likely, as our London colleague, Geoffrey Rose, has found and we confirm with his chest pain questionnaire, that there are sizable cultural, as well as biologic differences in responses among men of our Seven Countries regions. Comparative population studies do not resolve all the fundamental issues about "nature versus nurture."

The New High-Tech Cardiovascular Disease Survey

The second round examinations in Finland are the more technologically advanced of all surveys up to now, 1964. Rautaharju and Wolf have developed solid and reliable systems for the recording simultaneously of multiple-lead electrocardiograms, phonocardiograms, chest displacement curves, pulse wave velocities, and pulmonary function curves.

As an interested collaborator and long-term sponsor of such technical undertakings, I observe that the instrumentation seems to be forever obsolescent, new instruments taking precedence over the old, new ideas and questions consistently displacing the old questions or recording modes, before the last are thoroughly exploited.

The epidemiological need for consistency, comparability and stability of measurement, and the academic need for published results, are superseded by the new idea and the new recording system and all its technology, or so it seems to me.

When I undertook these collaborations I had expected that we would soon have inexpensive and efficient "black boxes" to tie on to people to record and integrate respiration with heart beats, electrocardiograms, and pulse waves, giving continuous read-outs and even predictions, all in reliable, rugged systems.

It would be fortunate if such systems existed so that we could finally move into the modern electronic era of physiologic data collection, processing, classification, and prediction in population studies. But clearly, this was sanguine.

A Renaissance Man in the Forest

The field team of the Seven Countries Study, in Karelia in the Fall of 1964, was pleased, after three long weeks of survey work, to learn of an invitation to dinner at the home of the local pharmacist, who I'll call Pentti Saarinen.

His pharmacy, which served a large area of Eastern Finland, was based in Ilomantsi, a small logging and farming village of 1,200 inhabitants. Former mayor and still leading citizen, it was not unusual that he would honor our crew. Our survey was surely the town's major social event of the year.

The Finnish survey team was particularly serious, hard-working, and effective. In three weeks they saw some 800 men, ages 45 to 64, first examined in 1959. After many days of a grueling schedule, with little social life on evenings in our simple country inn, the team was ripe for "R and R," and we were quite lively as we walked through woods to the home of our host.

We found ourselves welcome and comfortable in the Saarinen's bourgeois home, sipping sherry before the evening meal. At dinner, all twelve members of the survey team were accommodated around a large oval table in the formal dining room, cheerily served by Mrs. Saarinen with her best china and silver.

The conversation was animated as we worked through several courses, starting with hors d'oeuvres of smoked reindeer tongue. There was considerable speculation about the radioactive Cesium content in the meat of reindeer, which graze on Lapland pastures contaminated by Russian nuclear test fall-out.

At the close of the meal, our host offered tea selections from five large tins. In a personal, practiced tea ceremony, Saarinen steeped the type of tea appropriate to our requests, or, if no preference was expressed, he decided for us. All the while he explained the gustatory and pharmacological properties of each brew. It was a thorough, learned, and pleasant formality.

After tea and mints, we were offered a profusion of home-made liqueurs, accompanied again by a colorful lecture on each. He first explained his legal access to neutral spirits in the pharmacy, combined with a hobby of collecting herbs and berries. This seemed to us a reasonable avocation for a pharmacist, particularly one living in an isolated village fifty miles from the nearest state-run liquor store.

Our host first held up each handsome container, with its colorful herb or berry displayed, then described the preparation and unique qualities of each brandy. Then, charmingly, he served each of us our choice concoction, catering to our curiosity and taste, making this, too, a rich experience.

The men team members were invited to carry their snifters to an anteroom, while the women, in the custom of those days, cleared the table and chatted. The gentlemen were offered choice imported Havanas from a musty wood humidor. The conversation by now had largely lapsed into Finnish and I occupied myself by strolling around the library and inspecting myriad photographs mounted on the wall.

In each was our host's beaming countenance, usually holding an impressive string of Lapland salmon.

Stupefying, however, was the identity of his fishing companions in the photographs. In one was President Kekkonen of Finland, in another, Chairman Bulganin of the Soviet Union, in another, Prime Minister Churchill, and in another, could it be -- President Roosevelt?

All bore delighted smiles, with cigarettes or cigars at jaunty angles in their faces, holding one end of a string of champion fishes, our host holding the other!

When I reopened the conversation in English, I suggested quietly that our host was either a master of all master spies in history, or the most sought-after fishing guide on earth. Saarinen modestly admitted to the latter, and instantly rose several more rungs up the ladder of his visitors' esteem!

Cigars and brandies finished, our host rose and invited us to another salon, where we were joined by the women-folk, distributing ourselves in clusters of stand-up conversation. Again, I undertook my lone inspection of displays around the walls. Framed, under glass, were dozens of mounted specimens of colorful trout and salmon flies, clearly assembled by an expert fly-tier - our host. It all seemed to fit. Long, winters' nights brewing exotic liqueurs and tying flies to send as gifts around the world to his prestigious summer fishing companions.

We were then all invited to a rich, mahogany-paneled library, to examine bookcases filled with stamp albums. We were no longer intimidated, just amazed and curious about the next marvel. Harking back to my adolescent experience in stamp collecting, and minor specialization in United States postage issues, I focused on his American album, turning the elegant pages in wonderment. Every issue was there, complete, in mint and canceled form, missing only the rarest Upside-down Airmail and misprinted Pony Express issues.

This collection, far in the Finnish woods, was one of the top collections of United States stamps in the world, in impeccable condition and beautifully displayed. One could only assume that the rest of his international stamp collection was equally choice and cared for. This was another example of the perfectionist and scholarly qualities of our host, and of his broad curiosity, collector's skills, and passion.

The female members of our team were beginning to yawn and talk about how long a day it had been. A very long day, indeed, and a lovely evening. Mrs. Saarinen was quick to take the cue, and suggested that she accompany the women the short distance back to the inn.

As our colleagues and hostess filed out, Saarinen offered us men glasses of French cognac, inviting us with a twinkle in his eye to what he called the "piece de resistance." He led us down the hall to still another library. There, we found an exhibit far beyond the experience of any of our team. In fact, it was quite beyond our ken. We were presented with immense, handsome, leather-bound volumes with onion-skin paper protecting priceless lithographs of classical erotica, dating back centuries. As we turned the enchanting pages, we were also offered objects d'art: amber in voluptuous shapes, ivory tusks carved with gracefully entwined bodies of men and women engaged in erotic activities. Nothing was offensive to the eye or touch. The difference was sharply defined between pornography, which I have always found repulsive, and classic erotica, which portrays the art and the central meaning of love-making in human activity throughout history.

Finally, excusing ourselves with our charming host, we walked the short trail back to the inn, shaking our heads and clucking our tongues in wonderment over this quiet, rotund, balding, kind, small-town pharmacist. Bon vivant, gourmet, companion of world leaders, expert fisherman and fly-tier, philatelist non-pareil, and finally, connoisseur and collector of erotic art!