Fatal Thirst: Diabetes in Britain until Insulin (review)

Elizabeth Lane Furdell offers a concise and informative history in Fatal Thirst: Diabetes in Britain until Insulin. Although her focus is Britain, her early chapters offer a transnational history of the impact of diabetes on populations. For a millennium or more, medical texts throughout the world have identified diabetes. Three theories have been fairly constant: diabetes is most often characterized by the frequent and sweet urine, there is more than one type of the ailment, and it is linked to food and drink. In short, the disease is as old as recorded text and until the twentieth century there was no pattern of effective treatment in Britain or elsewhere.

The early chapters of Fatal Thirst offer encyclopedic information about great healers’ responses to diabetes. Galenic treatment proved influential, especially its emphasis on balance and diet. Healers in the classical world relied on Galen’s theories to prescribe dietary changes for restoration of health. When these prescriptions included a reduction of carbohydrates and sugar, they offered a positive impact on the disease. Furdell traces case records of notable physicians including court physicians Thomas Linacre, Girolamo Cardano, and Theodore Turquet de Mayerne. Furdell’s research reveals that by the seventeenth century many physicians mediated Galenic approaches with new medicine, and diabetes treatment varied from person to person.

Renaissance healers, most notably Paracelsus, synthesized Galen’s treatment with contemporary ideas about science and disease triggers. This synthesis arrived in Britain with an emphasis on nutritional intake combined with a critical perspective on external influences including herbal remedies, astrological medicine, and advice about exercise. Renaissance-era healers tended to support theories that dovetailed classic and folk remedies, often challenging strict adherence to humoral theory. The narrative is rich in detail and evidence, and reveals a tension emerging in the mid-sixteenth century over a standard for diabetes care. In addition to the narrative description of diabetic treatment, Furdell explores how these ideas of disease circulated in the early modern period. She demonstrates that health manuals and almanacs, widely shared, offered patients ideas about remedies. Some physicians bemoaned sharing medical information with lay populations, but enough healers published in such venues that vernacular descriptions of diabetic treatment circulated widely.

As Furdell traces trends in diabetic care, she reveals two distinct schools of thought in Britain. Many physicians added more scientific rigor to their care, testing urine for sugar content, and adjusting treatment accordingly. Organizational affiliation seems central to this story as well. As a case in point, physicians working in Guy’s hospital ramped up clinical efforts, while others maintained allegiance to standard ideas about restoring balance in the body. By the eighteenth century authoritative instruction on diabetes care could be found in a wide range of Victorian self-care texts throughout Britain.

The final chapter offers an exciting glimpse of the dramatic changes ushered in with the discovery of insulin in Canada in the early 1920s. It also demonstrates the potential of transnational studies in diabetes. As one example, Furdell writes about the impact of the Canadian discovery, insulin’s production in the USA, and the Medical Research Council’s decision to prioritize the distribution of insulin throughout the UK. Although this chapter serves as a conclusion to the text, it also speaks to the continued debates that surround diabetic care, even in the post-insulin era.

Diabetes has long puzzled healers. Drawing upon published and archival cases, Furdell has mapped a story that summarizes various diabetic theories that circulated in the pre-insulin era. Her story traces certain continuities. For example, conventional wisdom about humoral theory often translated into useful dietary recommendations. By the seventeenth century, diagnosis became more systematic and even clinical as popular “piss prophets” could quickly recognize diabetic urine. Urinalysis inspired discussions about the internal ailments that might result in sweet urine, with much attention directed to the kidneys. In addition, Furdell offers a thoughtful epilogue that succinctly summarizes the main points of her work. As she writes, “There is no progressive...