Fatal Thirst: Diabetes in Britain until Insulin (review)

Elizabeth Lane Furdell has written a thorough overview of the history of diabetes before 1922 and the breakthrough of insulin treatment. Her focus is Britain (predominantly England) and the debates that swirled around a condition that caused misery for patients and confusion for healers.

The early chapters focus on the long global history of diabetes from the identification of frequent thirst and urination as the cardinal signs of the disease by Hindu authors in the sixteenth century BCE to the English Renaissance. Although this is necessarily rapid, Furdell manages to weave together an interesting narrative of great healers who influenced the treatment of diabetes. Galen was influential in prescribing diet and vigorous horseback riding despite the fact that he saw only two cases of diabetes in his lifetime. Galenists favored bleedings and purgings to balance the humoral makeup of the patient, while Paracelsians promoted new chemical remedies and the old art of uroscopy, or examining flasks of urine.

True to her pledge in the introduction to discuss patients as well as healers, Furdell identifies Cardinal Wolsey and Sir Christopher Hatton as probable diabetics and speculates on what treatments a contemporary physician, Dr. Linacre, would have recommended. Similarly she discusses the case histories of Theodore Turquet de Mayerne and shows how sixteenth-century physicians were attempting to add new treatments to Galenic medicine and prescribing individual treatments for diabetes. Furdell includes an interesting chapter on the ways in which ideas about the disease circulated in print that addresses the immense medico-astrological influence of Nicholas Culpeper. He recommended eating dried animal bladders especially from goats as a beneficial diet, goats being associated with Saturn and Saturn with diabetes. Such vernacular remedies circulated widely among healers and patients in early modern England. In the later seventeenth century Thomas Willis and Thomas Sydenham battled over the cause of diabetes and potential dietary cures. Furdell ably shows how differences both political (their families were on opposing sides in the English Civil War) and philosophical (Willis dissected and experimented while Sydenham practiced trial and error medicine at the bedside) influenced the care of patients.

The resistance of many patients to treatment in the eighteenth and nineteenth centuries exasperated doctors, particularly as hospitals became the places where clinical research was carried out on diets. Richard Bright (of Bright's disease) at Guys in London had his patients keep a log of how much they drank and urinated. At least, unlike other physicians, Furdell explains, Bright did not prescribe sugary foods to replace the sugar found in the urine of diabetics.

The final chapters of the book discuss diabetic specialists and the flooding of the market with self-help literature before the discovery of insulin in 1922. Sufferers from diabetes were stigmatized as lazy and uncooperative—an image that lingered on even after insulin became available in Britain. Furdell has produced an impressive and compassionate history of an old disease that continues to affect many new lives today. It would be a useful text to assign in an upper-division or graduate-level history of medicine course.