• Dedication to     Ancel Keys  • Introduction  • Overview  • Yugoslavia  • Italy     - Montegiorgio  • Greece  • Finland  • Netherlands  • U.S.A.  • Japan  • Addendum

Montegiorgio, Second Round, 1966

Anche Uno Disastro! (Another disaster!)

In the spring of 1966, the Seven Countries Study was in the midst of the second round survey in the villages of Montegiorgio and Porto San Giorgio on the central Adriatic coast of Italy. There, we met Pentti Rautaharju and his engineer colleague, Herman Wolf, as well as members of the Yugoslavian and Italian Seven Countries field teams. It was a big year for our recording of electrocardiograms by new methods, on magnetic tape, at rest and in exercise.

I was met at Rome's Fumicino Airport by an Italian colleague in a Fiat 500 like that involved in the earlier adventure near Crevalcore. We took off toward the Apennines, our car loaded with survey equipment. A rosy Alpenglow gleamed off the snow-covered peaks as we climbed eastward over the spine of Italy. Just as night fell, starless and moonless, we arrived at the divide, the Adriatic far below. My colleague paused a moment at the pass.

Then down the mountain we went, freewheeling, in top gear. On the straightaways, at top speed, the clutch went in "per conserve di benzina," and as we wildly approached the turns, the brakes were slammed hard. We teetered and screeched around each curve, turn after hairpin turn, and then again hurtled down the straightaways. There was no idea of driving in gear, no idea about shifting down for powered turns.

Black became the night. Suddenly, on an inside curve, the little Fiat's over-heated brakes locked. We skidded wildly and hurtled off the highway into the blackness!

At the turn just above, there was a 1,000-foot drop into a ravine. At the turn just below, a 500-foot plunge into a dark stream. But at our turn, we left the road, sailed over a greensward, tumbled over and over, and came to rest gently against a soft hillock.

Silence.

Then came the now-familiar cry, "Uno disastro, Enrico! Accidente! Misericordia!"

My door was jammed, but I was able to extract myself through the cleanly broken window. Then, as an obstetrician might do with forceps over the head of a plump baby, I inserted first left hand, then right, helping deliver inch by inch the ample flesh of my colleague through the tiny Fiat window. Delivered, he knelt in the green field, shivering.

Abruptly, out of the silence and darkness, loomed a band of peasants in silhouette. After commiserations with the good "professore dottore," and assurances that we were intact, they together picked up the little Fiat and carried it the hundred meters back to the road. There, setting it down like a clothes basket, they stood by patiently as we surveyed the damage. Unbelievably, only a dozen test tubes were broken among some $30,000 worth of equipment. And we were fine.

Our helpers then pulled out fenders gouging the tires, and we proceeded down the mountain, limping, scraping, veering crab-like at a few miles an hour until we reached the next village. Companions hailed, our equipment transferred, the remainder of the trip to our hotel in Porto San Giorgio was uneventful.

Grateful to be alive, I silently swore that I would never, ever again ride as passenger in a private automobile in Italy.

Conclusions
	The Italian Seven Countries Study experience confirmed the salubrious nature of the Mediterranean lifestyle and eating pattern. It highlighted the effects of different lifestyles within the varied geography of Italy. The Italian collaboration, particularly that of Fidanza and Puddu, was centrally involved in the initial concepts, hypotheses, and methods of the Seven Countries Study, as well as in the selection of Italian and Mediterranean survey areas. A major field pre-test of the Seven Countries Study protocol, instruments, and methods was carried out by Fidanza and an international team with Keys and White in the fall of 1957, in Nicotera, Calabria. Most of the later Seven Countries principal investigators met there. The added Italian surveys and two-year follow-up, plus the Italian Rail Study, contributed significantly to the precision of data and the development of methods for the long run. Menotti has been centrally responsible for the coordination and analytical team that so effectively held the study together following the end of the National Institutes of Health support in the late 1960s. His analyses and collaboration with Keys and the other Seven Countries investigators have revealed the remarkable findings of multivariate prediction of coronary heart disease risk, regional differences in prediction of absolute risk, and comparable findings in the magnitude of risk (coefficients) for long-term compared to short-term coronary heart disease experience. In recent years, the Italian center's contribution has been in understanding the effects of changes in distribution of risk characteristics during the first ten years of Seven Countries surveys in regard to subsequent cardiovascular disease experience. This has established unequivocally and for the first time - using standardized, comparable methods - that the shift in risk characteristics in either direction, favorable or unfavorable, is associated with parallel shifts in population rates of disease, after a certain lag time. In addition to these major contributions, the Italian studies were clearly the first epidemiological enterprise of any sort on population-based samples in that country, and the first to show the independent significant predictive power of conventional risk factors within the Italian culture in regard to death from coronary disease, cerebral vascular disease, other causes of death than cardiovascular, and all causes of death. As much as any other study, the coordination of the dietary and medical surveys in the Italian component of the Seven Countries Study resulted in a universal understanding of the healthy nature of the so-called "Mediterranean Diet." It also revealed the importance of dietary patterns, over and above single foods or nutrients, in determining the population-wide causes of disease and death.