Richard M. Mizelle, Jr.

The University of Houston

Sugar Diabetes: Medical Entitlement and Civil Rights in America

Wake Forest University Colloquium

February 23, 2017

**Please do not reproduce without the author’s permission**

Introduction: The Pissing Evil

During the early fall of 1972, Jackie Roosevelt Robinson was visiting Miami, Florida to

attend a dinner for an old friend. The fifty-three year old aging baseball great was approached

for an autograph by an admirer while sitting at his table. By this time his eye-sight was in such

bad shape that he needed help reading the menu, and though he had a penchant for writing

lengthy autographs he told the fan that he was “glad to sign his signature but couldn’t write a

personal message” because of his deteriorating vision.1 Robinson had recently suffered a heart

attack and was in excruciating pain from a pinched nerve in his leg that made walking difficult.

Back home in Stamford, Connecticut several weeks later, Robinson was preparing for a trip to

Washington, DC to speak at a symposium on drug abuse. Well known at the time was the son of

Jackie and Rachel Robinson’s public battle with drugs. Jackie Robinson, Jr. was courageously

fighting his addiction when he was killed in an automobile accident in 1971 at the age of 24. In

the wake of their son’s death, Jackie and Rachel Robinson traveled the country speaking out

against the dangers of drug abuse. Robinson’s health had rapidly deteriorated since the Miami

trip and his physician pleaded with him to stay home and rest. He was now bleeding from the

eyes and the pain in his legs had become unbearable to stand or walk.2 Less than twenty-four

hours later, on October 24, 1972, the man who broke the color line in Major League Baseball in

1947 died from heart-related complications to diabetes.

Jackie Robinson was never vocal about suffering from diabetes or his other health issues,

deciding to keep those issues private. Robinson represented what seemed to many observers in

the 1970s a sudden and unanticipated increase of diabetes among African Americans. The figure

of Jackie Robinson as diabetic, African American and born in the South, represented an image of

the disease far different from the turn of the twentieth century.

In a 1901 article printed in the Journal of the American Medical Association (JAMA),

scientist James Herrick described what seemed to be a rare encounter with an African American

patient: “About six years ago a colored medical student asked me to see him for a cough and

great weakness. The cough I found due to tuberculosis complicating diabetes. This, by the way,

is the only case of diabetes in the colored I have seen.”3 A central figure in the history of sickle

cell disease, Herrick was implying that the African American diabetic was a scientific novelty.

Three years earlier a physician writing for the Johns Hopkins Hospital Bulletin published

the medical case of a person described as “Henry Roy; colored; aged 50 years; driver.”4 After

providing a litany of clinical details about the patient’s persistent cough, loss of appetite,

excessive thirst, excessive urination, and loss of weight, the physician goes on to say that: “The

patient is shown because diabetes in the negro is rather rare.”5 The publication of this case is

interesting for other reasons. It is rare to find early twentieth century African American diabetics

recorded and documented in the patient-archive. In most cases the individual experiences of

African American diabetics are refused to history. In the past scholars might have termed such

records as being lost to history, but this is too imprecise a term for the racial patient-archive.

Lost to the archive assumes an intention of recording the narratives of non-white groups of

people. The medical-patient archive was too violent for such an assumption. African American

diabetic patients were willfully absented from the patient-archive through a convergence of

scientific racism, institutional exclusion, and region. We must speculate whether Henry Roy was

actually his name, though inclusion of “colored” was a clear signal to readers not simply of this

patient’s blackness but, more importantly his non-whiteness. Roy is described in the case as “a

rather light-colored negro, much emaciated,” the importance of which comes in the necessity of

physicians to explain black diabetics.6 Located between the words in this physician description

of Roy’s light complexion was a belief that the closer to whiteness a still non-white person was

the more vulnerable to diabetes they might become.

Sugar Diabetes: Medical Entitlement and Civil Rights in America, 1900-2005 challenges

the assumption of the “rare” African American diabetic in the early twentieth century on

analytical grounds and answers the question of how African American diabetic patient-hood was

grudgingly acknowledged. The excellent and growing body of research on the history of

medicine and race often assumes a dearth of sources on the historical experiences of African

Americans during the early to mid-twentieth century; the result being that African Americans

often fall out of historical medical narratives and the history of disease identity. I argue this

presumed invisibility is not by accident, but instead is part of the historical un-making of

knowledge around diabetes. Historian Robert Proctor describes this phenomenon as the act of

“ignorance-making,” or information that “could have been but wasn’t, or should be but isn’t.”7

Language is used in the scientific production of doubt to silence certain kinds of information.

Gerald Markowitz and David Rosner make the case that lead industries created doubt around the

known dangers of lead toxicity from the early twentieth century, effectively frustrating efforts by

public health officials and reformers to curb the use of lead-based products in America. The

language of producing doubt revolved around calls for more research and a clear line of causality

before policy changes could be made.8 Tobacco industries would also employ language to create

doubt between cigarette smoking and lung cancer, arguing that any of a number of exposures

might lead to cancer. Writing on toxicity and what has been coined “Agnotology” or ignorance-

making, Naomi Oreskes and Eric Conway argue that the slowness of comprehending

neurological and toxic effects of pesticides inside the human body has resulted in uneven laws

that continue to expose individuals to illness while industries call for more research.9 I am not

arguing of an industry that created knowledge to frustrate information around African American

diabetics, however scientific language produced by physicians and researchers was important for

the ways in which it both created and tapped into commonly held assumptions and racial ideas

regarding African American diabetics. The circular logic meant that through written and oral

language racial characterizations of diabetes was reinforced until it provided the ring of truth.

Though evidence exists that African Americans clearly suffered from diabetes and

diabetes related complications from the late nineteenth century onward, it would take another

half a century before black diabetics were visibly recognized as a patient group. As early as the

1920s when the black diabetic was still considered rare, the Metropolitan Insurance Company

wrote in an annual report that the rate of diabetes among African Americans exceeded that of

whites. I.I. Lemann of Tulane University made a similar case in JAMA in 1927 while analyzing

admissions data at Charity Hospital in New Orleans. He argued that between 1898 and 1926

diabetes admissions increased eight-fold among blacks and four-fold among whites. In a study

conducted by the Georgia Department of Health in 1951 among women 50 years of age and

older, the study concluded that 8 percent of “colored females” had abnormal blood sugar levels

compared to 4 percent of white females, leading the researchers to make the statement that the

results were “completely unanticipated by us.” Even by mid-century, black diabetics were still

considered rare. The United States Public Health Service would eventually become concerned

by what seemed like a stark increase of diabetes morbidity among “the color groups” between

1950 and 1967. Countering William Osler’s “Principles and Practice of Medicine” which had

only recently reinforced the common narrative of black diabetic abnormality, Baltimore

physician Eugene Leopold wrote in 1932 that “It is rather common today to hear usually well

informed physicians express this belief” even while a mountain of evidence was building to

prove otherwise.10 Detailing Baltimore city wide morbidity and an outpatient diabetic clinic of

Johns Hopkins Hospital which admitted African American patients, a point which itself might

have been unusual in urban cities and unheard of in the South, Leopold quoted statistics

suggesting that by 1931, 6.4 per hundred thousand blacks suffered from diabetes in the city

compared to 10 per hundred thousand whites. Of the roughly 650 patients at the Hopkins clinic

close to 200 were African American.

African American insurance companies also emerged to counter white insurance

company claims that blacks suffered primarily from contagious diseases and diseases of excess

and passion but not diabetes, heart disease, and cancer. Statistics compiled by white insurance

companies helped frame the discourse of race and health by marking African Americans and

whites as susceptible to different diseases which physicians and the public used to justify

biological explanations of race. They did so even as they refused to insure African Americans or

covered them on a limited basis. By the early twentieth century black-owned insurance

companies like the Golden State Mutual Insurance Company in Los Angeles were started to

provide health and burial insurance to Africans Americans denied the services of white insurance

companies. William Nickerson, Jr. founded Golden State in 1925 after migrating from Texas to

Los Angeles and discovering that many African Americans in the so-called “Promised Land” of

California were living from cradle to grave without basic actuarial services.

In 1938 the United Mutual Benefit Company in New York published a five-year study of

race mortality statistics in New York State confronting the narrative presented by white

insurance companies. Examining the company’s own internal files, hospital records, records of

private physicians, and city health department records, the insurance company argued that deaths

from communicable diseases were not nearly as prevalent as white insurance companies stated in

their publications.11 United Mutual’s investigation found that “In New York state, during the

five-year period beginning in 1933, the leading causes of Race deaths ranked in the following

order: heart disease, pneumonia, cancer, disease of the kidneys, diseases of the circulatory

system, tuberculosis, accidental deaths, cerebral hemorrhage, diabetes and social diseases.” The

report would go on to say that “A much larger proportion of colored people are victims of heart

ailments than is generally shown in the statistics of white companies,” the result of

environmental factors that included poor housing and economic conditions.12 Black-owned

insurance companies across the country including the Supreme Liberty Life Insurance Company

of Chicago, Atlanta Life and Mutual Aid Company, North Carolina Mutual Life Insurance

Company, Universal Life Insurance Company of Memphis, and the Afro-American Insurance

Company of Florida made it possible for African Americans to “accumulate much important

vital data concerning itself and to refute the false statistics which some white companies use as

an excuse to increase their rates on Race insurance.” Presenting a paper in front of the National

Medical Association, James T.W. Granady, a physician at Harlem Hospital said that more

detailed examinations of insurance policy applications is showing physicians and researchers

across the country that diabetes is far from uncommon among African Americans.

Sugar Diabetes does not simply argue that African Americans suffered from diabetes in

the early twentieth century, an obvious and clear point in the historical record. Instead, this book

uses diabetes as a window into racial politics and the medical language of anti-blackness during

the twentieth century. Like other diseases of the period diabetes had to be explained in racial

terms in order to fit with existing assumptions and helps do some of the work of creating

biological difference. African American diabetics proved to be a nuisance to the medical and lay

community because they consistently reminded society of the futility of race and the

precariousness of whiteness. Sugar Diabetes argues that language was used to silence black

diabetics.

In his classic text The Social System, sociologist Talcott Parsons provides the sick role as

a theoretical explanation of illness and patient-hood.13 Illness is defined in part as an inability of

a person to function as normal within society. It is an impairment which privileges the sick to be

exempted from societal obligations that the non-sick are responsible for. Defined by Parsons and

others as not the sick person’s fault, the sick role is a performance of sickness that entitles the

person to be excused from normal family and work duties. Illness is an identity that

marginalizes a person into a secondary status within society. As the twentieth century

progressed the identity of sickness was important for inclusion under insurance benefits. The

sick role is, therefore, fundamentally about who is entitled to patient-hood. Sugar Diabetes

makes the case that while disease and illness are part of the human condition, not everyone is

entitled to patient-hood. Patient hood is a separate category of entitlement experienced

differently by individuals and groups of people throughout history.14 During the era of

segregation African Americans’ ability to become patients in a hospital was mitigated by a host

of factors that included loss of valuable labor time, refusal of white employers to allow time off

for health reasons, travel, rejection at points of entry in white hospitals, lack of facilities that

would accept limited numbers of black patients, few and poorly financed black hospitals, paucity

of black doctors and refusal to be diagnosed by white doctors, and fear of being mistreated inside

white dominated medical establishments.15 It was not uncommon for southern African

Americans to never see the inside of a hospital. For some, traveling to a hospital was too far and

for others there was no expectation of being admitted as a patient.16 Integrated hospitals and

medical care struck a nerve for segregationists who believed in the scientific construction of

biological and racial difference as fundamentally immutable. Hospitals were not only places of

potential cross-pollination of ideas and flow of information but also of vulnerable open bodies.

Men and women inhabiting the same space, sick bodies and healthy bodies, blood products and

saliva, the naked bodies of patients and corpses to be examined and autopsied, all exhumed the

worst fears of integration in the white imagination.17 Added to this fear was the threat of African

American physicians who sought to practice in hospitals where whites were being served; that

they would serve only African American patients during the era of segregation was little in

question, but there presence as professionals and proximity to white vulnerability was itself

enough to stoke fear. While African Americans often existed outside the surveillance of

organized medicine and treatment, white fears of contact with black bodies often brought African

Americans under the gaze of public health reform. This book pivots on the discourse of racial

medicine, and particularly, the ways in which information networks remain invisible while

simultaneously creating racial difference.

By the early twentieth century diseases were used to define race using such terms as

civilization, nervousness, and worthiness of suffering. The advanced and more civilized internal

biology of whites that had evolved to deal with the stress of modern political and civic life made

some native-born whites susceptible to certain civilized diseases, according to this logic. African

Americans were considered incapable of suffering from civilized diseases because of their muted

biology and evolutionary inferiority; such language made African Americans and other non-

whites who suffered from these same diseases abnormal and uncommon within the medical

literature.

Like cancer, asthma, and heart disease, diabetes was racialized as a disease of whiteness

and civilization in the early twentieth century. What constituted whiteness and diabetes was

complex. Historian Arleen Tuchman makes the important point that by the late nineteenth

century it was far more common for scientists and physicians to racially frame diabetes as a

Judenkrankheit, or “Jewish disease.” W.H. Thomas, a New York physician described Jews as a

“race” with greater propensity to develop diabetes at the turn of the century. Well-known

physician William Osler wrote that “Hebrews seem especially prone to [diabetes].” Yet another

physician chimed in: “[t]he Hebrews, no doubt, are more commonly afflicted with chronic

glycosuria than natives of the nation among whom they dwell.” For their part, the United States

Public Health Service specifically connected the rise of a Jewish population in New York City

with the increase of diabetes physicians were observing. The question of immigration and

acculturation of Jews into American society collided with the disease identity of diabetes as

Americans debated their “whiteness” and ability for inclusion.

Scientific explanations of why Jews experienced higher rates of diabetes compared to

other populations ranged from assumptions of a genetic predisposition to the wide-spread belief

that diabetes was a disease of civilization and Jews, particularly those recent immigrants into the

country, were in the seasoning process of becoming more civilized and, in a sense, more

American. Some physicians described diabetes as a “disease of the higher classes” and the price

to pay for being a member of an enlightened race. The creativeness, artistic ability, and

restrained business savvy of Jews in Germany and America created a “nervousness” of

constitution benefitting only the most civilized of peoples. Though the whiteness of Jews was

still being debated they were proving that, like non-Jewish native born whites, they were

sensitive to the pressures of modernity and civilization which, unfortunately, also made them

uniquely vulnerable to nervous-type diseases. Making the link between “diabetes, nervous

diseases, and civilization” Tuchman argues that physicians leaned on a tradition of racial science

suggesting that as groups “moved up the evolutionary ladder from ‘primitive’ to ‘civilized’ races,

the nervous system grew more complex. Such complexity permitted the development of the

‘higher faculties,’ such as aesthetics and morality.” The notion that diabetes was increasing in

the United States was often framed through the lens of surveillance; large scale immigration of

Jews from parts of Europe was the reason physicians were noticing an upswing of diabetes cases

in cities. Northern cities became an early focal point of diabetes and suffering at the same time

these cities were dealing with deadly infectious diseases.

The paradox of nervous diseases was a point of contention for Julian Hermann Lewis.

The first African American to earn a Ph.D. in medicine (1915) and teach at the University of

Chicago, Lewis earned his medical degree in 1917 from the Rush Medical School in Chicago.

Lewis accepted an appointment in 1917 in the Pathology department at the University of

Chicago where he worked until 1943. A pathologist and researcher, Lewis published his Biology

of the Negro in 1942. Contrary to nervousness as a cause of diabetes among elite whites,

nervousness was also considered a reason for hypertension among African Americans in the

early twentieth century. Some researchers argued that the migration of African Americans from

the rural South to urban cities placed considerable stress on their internal biology and caused

higher rates of hypertension.18 Lewis then compares this narrative of blacks and hypertension

with scientific research that only whites suffered from angina pectoris. Taking on researchers

making this claim Lewis argues that “It has been pointed out that individuals suffering with

angina pectoris are of the high strung, nervous type, sensitive to the stresses and strains of

modern life. Roberts says: ‘It occurs usually in the sensitive, nervous type as the Jew or in the

tense efficient American, rather than the dull, happy Negro or the calm accepting Chinaman…’

He says further that the Negro is insensitive to pain and has not the stresses and strains on his

nervous system that the whites have.”19 Lewis goes on to expose the hypocrisy in scientific

thinking in no uncertain terms by pinpointing the heart of the matter: “Exactly the same qualities

of the nervous system have been offered to explain both hypertension and angina pectoris in

whites. In Negroes emotional factors are used to explain their high rate of hypertension, a lack

of them is used to explain their low rate of angina pectoris. A theory cannot ‘blow hot and

cold.’”20

Sugar Diabetes:

Diabetes is an ancient disease, the first known reference dating back to an Egyptian

medical text known as the Papyrus Ebers written during the XVIIIth Dynasty, or roughly the

Sixteenth Century BC.21 When Egyptian physicians made recommendations to “remove the

urine which runs too often” they were likely giving an early description of diabetes. By 1875 the

Papyrus Ebers was the first Egyptian medical text to be published.22 Greek physician Aretaeus

“the Cappadocian” is credited with providing the first direct description of diabetes around the

second century A.D., explaining it as a “wonderful affection—being a melting down of the flesh

and limbs into urine.” Paying particular attention to excessive amounts of urination by the

afflicted he remarked that “Patients never stop making water, but the flow is incessant, as if from

the opening of aqueducts.” Excessive urination and thirst converged in a new disease identity

making life “disgusting and painful.”23 Though used in the past, the term diabetes enters more

common usage during this time period. Derived from the Greek word siphon, diabetes meant

that ingested water was funneled through the body and out of the bladder in the form of urine.24

In 1674 a New York English physician named Thomas Willis published the treatise, “The

Diabetes or Pissing Evil” highlighting the well-known suffering of diabetics who observers

wryly commented seemed to physically waste away into a puddle of water and urine. Upon

tasting the urine of a diabetic patient Willis remarked how the urine was “wonderfully sweet as if

it were imbued with Honey or Sugar.”25 By the beginning of the eighteenth century the word

mellitus, meaning honey or of a sweet nature was added as a secondary term to diabetes.

Diabetes is caused by a still unknown mixture of biological, environmental, and social

factors. Any combination of heredity, eating habits, poverty, and lack of exercise is known to

cause diabetes. Type I diabetes is a beta cell pancreatic disorder where the body fails to produce

insulin. Insulin resistant type II diabetes is the result of miscommunication between insulin and

the body. Produced by b cells in the pancreas, insulin is part of the body’s communication

system moving via blood throughout the body and signals to the brain and other organs that the

blood flowing past is rich with nutrients and energy to consume. When the body fails to extract,

use, or burn nutrients from the blood in the form of sugar or glucose, the body instinctively

moves into starvation mode and results in the accumulation of excess amounts of sugar in the

blood stream, known as hyperglycemia. The increase of blood sugar results in an increase of

sugar in urine products (glycosuria) that causes patients to urinate copiously and become

extremely thirsty. Polyuria (excessive urination) and polydipsia (excessive thirst) are two of the

main symptoms for the onset of diabetes. The consensus is that type I juvenile diabetes occurs in

children from birth to early adulthood while type II diabetes, or adult onset, occurs mostly

among patients age 40 and over. Type I is considered to be the more harsh form of diabetes as

the body fails to produce insulin and relies more on the supply of externally injected insulin to

adequately maintain hyperglycemia and glycosuria. During type II diabetes the body ceases to

produce insulin or the body produces insulin in sufficient amounts but organs become insulin

resistant. In other words, insulin in present and tries to inform organs of energy in the blood but

for still unknown reasons the message is not heard. The body compensates by increasing the

amount of insulin production for the hard hearing organs but over an extended period of time the

higher levels of production fail to adequately address the communication issue. Changes in diet

and exercise can help this failed communication.

Diabetes was different from other diseases in the early twentieth century because of the

ways in which measurements of control were often placed directly in the hands of sufferers.

Diabetics had to manage the disease on an individual level and managing this complicated illness

contained elements of self-actualization, self-containment, and self-discipline, in addition to

questions of access and surveillance. Before the discovery of insulin diabetes was also an

extremely deadly disease with both children and adults physically wasting away in front of

family and friends. Like cholera, tuberculosis and yellow fever diabetes was a death sentence in

nineteenth century America. On average people lived no longer than three years after being

diagnosed. By the late nineteenth century physicians began to appreciate the unique role of diet

in the lives of diabetics, even as the medical community was still searching for clues to the

biological and physiological puzzle of the disease. Some physicians argued for an elimination of

all carbohydrates from the diet while others suggested protein-free diets would help diabetics

stave off the worst aspects of the disease. Other physicians restricted just about every food and

drink imaginable, serving to starve the patient as a way of reducing hyperglycemia and weight.

One physician, Carl von Noorden advocated in 1903 for an oatmeal diet. Noorden wrote that:

“The diet consists of 250 grammes of oatmeal, 250 to 300 grammes of butter and 100 grammes

of some vegetable albumin such as roborat…This constitutes the food for one day for an adult. It

is given in from three to eight portions every two hours. Patients are occasionally permitted a

small amount of clear coffee or a few sips of sour wine with some of the meals, to relieve the

monotony.”26

One can only imagine the horror and difficulty of eating oatmeal every day for the rest of

your life. Diet was a struggle that would emerge in the historical record throughout the twentieth

century as adults and children obeyed and disobeyed physician instructions, secretly consumed

food products that were forbidden, and placed considerable demands on family members who

were held responsible for helping to control their eating habits. It was especially difficult for

children who were forbade sweets and favorite foods when their siblings and friends could

consume those products at will.

One of most well-known physicians and researchers during this period was Elliott P.

Joslin. Born in 1869 in Oxford Massachusetts Joslin completed his medical training at Yale

College and Harvard University in 1895 and three years later set up a private practice on 517

Beacon Street at his parents’ house in Boston.27 In 1905 he moved his office to 81 Bay State

Road in the Back Bay section of town where he would treat mostly diabetic patients for the next

fifty years. His interest in diabetes would come from the experiences of his aunt diagnosed

with the disease while he was in college, his mother who was diagnosed with diabetes in 1899,

and the relative obscurity of diabetes in the medical literature at the time. Joslin compiled many

of the earliest statistics on diabetes and published the first textbook on the disease, The

Treatment of Diabetes Mellitus in 1916. Based on his early research and role as physician, Joslin

firmly believed that the best course of action dealing with diabetes was early diagnosis, tight

glucose surveillance, regular exercise, a carbohydrate-reduced diet, fasting, and later frequent

insulin injection. He built his dietary approach in part on the work of Frederick Allen in

Morristown, New Jersey who was one of the early advocates of the starvation and carbohydrate-

restricted diet to reduce diabetic ketoacidosis, later understood to result from a build-up of acids

known as ketones. It is a result of the body not producing enough insulin for functioning.

Building on the work of Allen and others, Joslin argued that under-nutrition prolonged the life of

gravely ill diabetics suffering from acidosis.28 During the early years Joslin admitted and

oversaw the diet of patients at the New England Deaconess Hospital with the assistance of a

cadre of nurses. Joslin was sought out by diabetic patients and colleagues seeking advice on how

to deal with their own patients. He was known for keeping copious notes about individual

patient histories and demanded strict adherence to his guidelines. Boston would become the epi-

center of diabetes treatment because of Joslin as patients with the resources traveled from across

the country and world to visit the diabetes expert.

Joslin helped to create a discourse and universal language that would stick with the

disease throughout the twentieth century. Diabetes was a disease tied to narratives of personal

self-discipline and sacrifice because of the ways in which measurements of control and

eventually injections of insulin were placed directly in the hands of sufferers. Notions of self-

control and maintenance were closely tied with both manageable diabetes and manageable

patients. Good patients maintained strict self-control over what they consumed and stayed on

schedule with the arduous task of insulin injections. Incorrigible and poor patients were defined

as lacking self-control; failing to eat properly, manage insulin injections, and follow physician

instructions. Joslin was essentially creating a narrative of worthiness with the use of such words

as “good patients” and “incorrigible patients.” What makes a good patient versus an incorrigible

patient is a question rarely addressed by scholars writing about Elliott Joslin or diabetes. Implicit

in this kind of language is often an assumption that patients can be “good patients” or, in other

words, they have available the adequate financial, family, and friend networks to follow dietary

guidelines and complete the laborious, time-consuming, and particularly in its early days painful

process of injecting insulin several times a day. It assumes a lack of other responsibilities and

difficulties like poor African American and white sharecroppers who might not have access to a

physician who can treat diabetes, be able to follow a detailed diet, afford insulin, or allowed the

time necessary to inject insulin several times a day. Such words also do not take into

consideration the role and demands of women working in various domestic and occupational

capacities hamstrung from being “good patients.”

The intricate and fascinating details of insulin’s discovery in 1921 at the University of

Toronto by Frederick Banting, Charles Best, and J.R. MacLeod have been researched by other

scholars including Michael Bliss and Chris Feudtner, and will not be retold in my story. Insulin

does, however, play an important back-drop upon which black diabetics begin the process of

coming into medical view. The movement of large numbers of African Americans to places like

Chicago and New York during the post-World War I era Great Migration resulted in reluctant

public health recognition as migrants were more likely to receive medical care in urban cities.

Scientific and popular narratives of the unsuitability of African Americans to the cold climate of

the urban North and white fear of blacks spreading disease outside of their own neighborhoods

led to intense public health surveillance of migrants and increased scrutiny of diabetes among

urban African Americans.

Between 1915 and 1970 close to 3.5 million African Americans participated in the Great

Migration. New York City, Philadelphia, Washington, DC, Milwaukee, Boston, and Chicago

were destinations for rural African Americans looking to escape the system of sharecropping,

domestic violence, wanton murder, lynching, economic poverty, and general atmosphere of

terror that was the South for so many.29 For other migrants southern and western cities were the

destination for better opportunities. In our historical preoccupation with certain trajectories of

movement from South to North we have largely minimized other movement patterns from South

to South, and to a lesser extent, South to West.30 Sugar Diabetes focuses specifically on health

and diabetes during the Great Migration in a way few other scholars have done. More access to

obstetric care, physicians, hospitals, and treatment for specific diseases is an under-researched

aspect of the Great Migration. Similar to the ways in which immigration coincided with the

sudden awareness of diabetes among Jews in the early twentieth century the Great Migration

brought African Americans into sharper view for the medical community. Researchers in

Baltimore alluded to the idea that obesity and diabetes among African Americans in northern

cities was rare, arguing instead it was southern black diabetics with bad eating habits migrating

to urban locales that was the reason these cities were noticing an upsurge of diabetes among the

black population.31

Once word of insulin’s discovery by University of Toronto researchers began to spread

outside of its walls Toronto became the center of the diabetes world. A Canadian teenager

named Leonard Thompson was the first person in the world to receive insulin injections in 1921.

At the time emaciated and near death researchers were buoyed by his quick weight gain and

return of near normal levels of sugar in his blood. Thompson was fortunate to be in a position to

benefit from the life sustaining technology.

Insulin changed the biography of diabetes, transforming it from a deadly disease to a

chronic disease. But insulin also changed the social and cultural history of diabetes. The

promise of insulin as a cure exposed the myth of whiteness and diabetes throughout the world

and illuminated the ways in which the sick role pivoted on questions of access. One of the

earliest recipients of insulin was Elizabeth Hughes Warren, the young daughter of United States

Supreme Court Judge Charles Evans Hughes. Warren was 12 years old when diagnosed with

diabetes in the spring of 1919. For the next few years she was placed under the watchful care of

Frederick Allen in Morristown, New Jersey where like so many other diabetics she was forced to

endure a protein, fat, and carbohydrate-free diet with intermediate bouts of starvation. While

Elliott Joslin was known for his congenial and warm manner toward patients even while being

demanding, Allen was considerably more authoritarian and terse which made his patients shrink

in his presence. Frederick Banting agreed to treat Elizabeth Hughes with insulin after the request

was made by her wealthy and powerful parents. Warren was a spirited teenager who wrote

frequent letters to her parents while in New Jersey and Toronto. Most of these letters talk about

daily activities, her energy level on any particular day, and foods she recently consumed to stay

on schedule with her diet. The letters attested to her family’s wealth and status in American

society, yet one letter she wrote to her parents on October 8, 1922 told of the awareness she had

of her own particular entitlement: “We have had several poor people come here to ask about the

treatment and they were eventually all turned away. It[s] makes you feel so sorry and yet you

can’t do a thing about it. I can’t get over how fortunate I was to get in up here.”32 She was

correct in her thinking as the cost of receiving insulin in the days before it was mass produced

was about seven cents per day, an astronomical figure in 1921.

By 1923 the world had been made aware of insulin to the point that the University of

Toronto created an Insulin Committee to handle requests for insulin and deal with the issue of

mass production which would be given to the Eli Lilly Manufacturing Company of

Indianapolis.33 One can feel the angst, sincerity, and hope in letters to Toronto, as well as

anticipate the devastation of the form letter many received telling them that insulin was not yet

available to them. Letters arrived to Toronto from all over the U.S. and World. Doctors wrote

on behalf of patients, family members, and themselves. Patients read or heard about insulin

before their physicians, forcing them to write to Toronto for information. People wrote directly

to Toronto using typescript and hand-written letters. Some of the typed letters were on plain

pieces of paper while others arrived on business letter head, no doubt an attempt to come across

as more official. Individuals wrote on behalf of themselves, for their children, parents, nieces

and nephews, for friends and family in another country. Physicians and patients asked for free

samples of insulin, entire doses of insulin, more reading literature on insulin, information on

dose requirements and how to administer insulin, how to alter diet, and price. Physicians and

patients sent money to ensure a return letter, sample, and offered to travel to Toronto for

treatment or information. More desperate patients offered to be used for trials and

experimentation in exchange for insulin treatment (or serum as many called it). Toronto was like

a physical and mental place of pilgrimage for diabetics.

War on Diabetes and a “Pampered Favored Class”

In the twenty years after the Toronto researchers disclosed to the world their wonderful

discovery the scientific community realized that for all of its life saving potential insulin was no

magic bullet. Though it certainly afforded longer lives—Leonard Thompson and Elizabeth

Hughes lived considerably longer lives then they likely would have without insulin—insulin

transformed diabetes from a deadly disease into a chronic illness. A host of additional factors

came with its new chronic status that included heart, leg, kidney, and eye complications, the

continuation of restricted diets, demands on family and friends that might now last for fifty years

or more, and what many patients described as the oppressive clock of bending their lives to

insulin injections every day. As the United States contemplated entrance into World War II it

was clear to many physicians and researchers that the growing number of visible diabetics

needed a voice to address their needs.

On December 7, 1940, exactly one year before the bombing of Pearl Harbor which

brought the United States into the Second World War officers of the newly minted American

Diabetes Association (ADA) met to plan the first annual meeting. After some negotiating it was

agreed the first meeting would take place, with the unofficial blessing of the American Medical

Association (AMA), on June 1, 1941 in Cleveland, Ohio.34 Yet the ADA had significant

detractors during its infancy stages in 1939 and beyond from physicians and organizations that

did not believe a new organization was necessary. Specialized organizations like the National

Tuberculosis Association (NTA) founded in 1904 and American Heart Association founded in

1924 (AHA) represented medical culture wars of the Progressive-era where resources for

patients and prestige for physicians were always at stake. Cecil Striker was the first president of

the ADA from 1940 to 1941 and wrote in an unpublished manuscript on the history of the

organization that “Stumbling blocks arise with almost all attempts to create a new organization.

Existing agencies foresee an intrusion into an area of their labors, and more vital, a diminution of

financial support, if new associations seek support among a common base of lay or professional

interest. In the case of the realm of diabetes, it was the existing National Tuberculosis

Association that found the new movement encroaching upon common ground at a crucial era in

its own history.”35 The AHA and to a lesser extent the AMA were also less than thrilled about

the new organization. One member of the NTA opposed to the ADA wrote that perhaps their

organization should stave off this encroachment by expanding more into the arena of diabetes

themselves, particularly since tuberculosis was on a down-swing.36 Surprisingly Elliott Joslin

was also initially opposed to creation of the ADA, though he would support the organization

from the beginning. In a strongly worded letter to Kendall Emerson, managing director of the

NTA at the end of 1939 Joslin wrote: “I totally disapprove of a National Diabetes Association,

and whenever it is possible I have discouraged local Diabetes Associations unless they are

already started.” Joslin’s rationale was that the NTA was already established and doing work that

could easily be extended to diabetes. In his mind, “It would be a waste of effort to have two

similar societies.”37 The ADA would survive with a mission to provide more uniform guidance

on diet, continue unlocking the physiological puzzle of diabetes, educate the public on the

disease, develop more physician training and post-graduate research opportunities, assist in the

formation of local diabetes societies, and key to all of these goals, raise money during a time

when the country was at war.38

As the U.S. entered World War II the fitness of the diabetic soldier mirrored broader

conversations of medicine during the war. Herman Mosenthal opened the second annual ADA

conference as president by saying “While the clouds of war are hanging over us.”39 Mosenthal

was addressing the question of the diabetic’s role during the war effort as both civilian and

soldier. The battlefront of science and medicine was framed as an important tenet of winning the

war. Healthy soldiers made for better prepared soldiers and healthy citizens played their part by

sacrificing labor and working in civil sectors on the home front. Shifting the organization’s

overall mission to the war effort Mosenthal suggested the ADA was doing a service to the

country “by bettering and simplifying the treatment of diabetes and by defining and promoting

the employability of diabetics,” in the process “rendering a distinct service to diabetics, to our

country, and to humanity.”40

The average age range of soldiers and urine testing at induction stations might have

lowered the percentage of diabetic soldiers enlisted during the war, yet it is clear that known and

unknown diabetic soldiers were of concern to the United States military and ADA.41 Army

regulations and mobilization boards defined diabetes as a cause for rejection at military entry

points. While some physicians disagreed with this position—arguing diabetics could be used in

restricted and non-combat situations—others like Elliott Joslin said it was too risky: “The

hazards which both the diabetic and the Government would undergo if they were inducted are so

great and the need for their services in civilian occupations, where they would be less exposed to

complications, so apparent, that the present rule to omit them from the draft appears proper.”42

In Britain and the United States diabetic soldiers were sometimes referred to as the “pampered

favored class” of the war because of extra food rations they might receive. The ADA and

military officials discussed the threat of insulin-shock on the battlefield, the need to transport

insulin into war zones, and ability of diabetic soldiers to perform combat.43 During the early

years of the war the ADA took note from the older British Diabetes Association on the

emergency allocation of insulin for soldiers, proper food rations, and the handling of diabetics

during a blitzkrieg. Importantly the ADA provided guidelines for military officials to tell the

difference between diabetic coma from hyperglycemia and unconsciousness from a war related

injury. Diabetic soldiers were also given special identification tags so they could be easily

identifiable for their special needs.44 The emergency supply of insulin between allies shows how

diabetes was very much part of the war effort. When Cecil Striker received an emergency

message in November 1942 from a medical agency in Puerto Rico stating they were suffering an

insulin shortage because of a German submarine blockade, he reached out to United States

Surgeon General Thomas Parran for assistance. Parran contacted an official of the U.S. Navy

who ordered a Navy bomber to the territory of Puerto Rico with insulin supplies.45

On the home-front the stigma of diabetes demanded that both men and women hide their

diagnosis from potential suitors and employers for fear they might be considered unsuitable for

marriage or labor. For some diabetes was a hereditary defect that families wanted to prevent

from entering into their gene pool. The pre-insulin era images of emaciated and starving diabetic

adults and children were not too far removed for people living in the 1940s; marrying and

conceiving a child with a known diabetic was cause for alarm. Employers worried about

productivity levels of diabetics and feared employees going into diabetic comas while on the

clock. Because they were considered to be such a liability diabetics asked their physicians, if

they had a physician, to write a letter on their behalf testifying to their ability to work in certain

industries, particularly if the job was physically demanding. Cecil Striker assuaged the fears of

an employer by saying “I am very happy to tell you that Alfred has been doing very nicely. He

has been under my medical care for a good many years and is extremely cooperative and has not

run into any difficulties, and in my judgment I feel that he should be able to fulfill all of the

obligations that go with his job and would recommend that he be given a permanent

appointment.”46 In another letter Striker is even more specific: “In reference to Frederick, I feel

that I can tell you that his diabetes is very nicely controlled and that he does not present any

unusual hazard in driving an automobile. He, similar to all insulin-taking diabetics, may

occasionally have a little upset [?] but I believe that the incidence of this is no greater than the

upsets that may occur in a non-diabetic. In view of this, I do not believe that he presents any

significant hazard both as far as your company is concerned and as far as the general public is

concerned.”47 This patient worked for an insurance company where driving an automobile was a

necessary part of the job and the employer wanted some type of assurance that hiring this person

would not become a liability. This was the kind of stigma faced by many diabetics during the

middle of the twentieth century.

Common perceptions of race also dot the military language of war time diabetics. A

general consensus was that the rate of black diabetic soldiers was lower than white diabetic

soldiers though this idea was in part predicated on more generalized assumptions of diabetes

morbidity and mortality. During the war years black diabetics were still considered abnormal

even though this stereotype was increasingly at odds with what military officials were observing

at induction stations and among active ranks. One report disputed the idea that diabetes was

uncommon in the military: “In view of the frequently expressed opinion that diabetes is less

common in Negroes than in white people, the data…are of interest. It is evident that diabetes

was at least as common among Negro as among white enlisted men, taking into account the

much smaller numbers of Negro soldiers.”48 Sugar Diabetes deals with the idea and reality of

black diabetic soldiers during World War II.

Civil Rights and Black Power

Scholars of the Civil Rights Movement, Black Power, and health have recently begun to

understand the ways in which the 1960s and 1970s shifted federal attention onto long-neglected

diseases among African Americans, Latinos, and Asians including sickle-cell disease, cancer,

and asthma. John Dittmer’s The Good Doctors: The Medical Committee for Human Rights and

the Struggle for Social Justice in Health Care re-discovers the important role of physicians in

pushing to desegregate health care organizations and facilities during the Civil Rights

Movement. Alondra Nelson’s Body and Soul: The Black Panther Party and the Fight Against

Medical Discrimination uses the Black Panther Party’s Sickle Cell Disease program to highlight

a federal funding infrastructure that produced fewer resources for Sickle Cell Disease versus the

genetic disorders that seemed to disproportionately impact other ethnic groups. My study enters

this newly emerging scholarship by showing how physicians, nurses, and Civil Rights

organizations demanded increased awareness for black diabetic patients during the Civil

Rights/Black Power era.

The Medical Committee for Human Rights (MCHR), an interracial coalition of health

professionals formed in 1964 understood what was at stake and served many roles during the

movement, including providing medical attention to Civil Rights protesters injured during non-

violent marches and lobbying and picketing the AMA to discontinue the exclusion of black

physicians and dentists in public hospitals, residencies and internships.49 The MCHR also

developed educational programs, rural clinics, and health surveys dealing with a number of

health issues in southern communities that included diabetes, heart disease, nutrition, pre- and

post-natal care, arthritis, cancer, dental care, sanitation, stroke, immunization against child-hood

diseases, and dangers of smoking.50 This health work in rural southern communities would build

on a much longer history of black organizational work in the Deep South earlier in the century.

The Alpha Kappa Alpha Sorority, a historically black sorority founded at Howard University in

1908 initiated a social program called the AKA Mississippi Health Project in 1935 with the goal

of bringing much needed medical attention to African Americans in rural Mississippi Delta

counties who did not have access to care. Arguably one of the first mobile health clinics in the

country the sorority sisters formed make-shift clinics under the shade of big trees, in churches,

schools, and private homes. The program lasted for six consecutive summers between 1935 and

1941 and is credited with helping to treat smallpox, diphtheria, dental care, and the nutritional

needs of poor African Americans.

The Civil Rights era of the 1960s pushed the country’s climate toward significant social

and political change. Though the patient experiences of African Americans long suffering from

diabetes, cancer, sickle cell disease and others slowly emerged out of the superstition of willful

ignorance medicine, like other avenues in society, adapted its discourse to reflect these changes.

The protest of African Americans to end segregation in public spaces and within medical care

and scientific funding for diseases prompted a response from the medical and scientific

community, who in turn explained the anger of African Americans using long-standing

frameworks of scientific racism. Jonathan Metzl argues in The Protest Psychosis: How

Schizophrenia Became a Black Disease that psychiatrists sometimes framed black civil rights

activism as a mental illness requiring medication.51 This was clearly a regurgitation of the

antebellum medical diagnosis of draptomania, defined by nineteenth century physicians as a

mental illness that caused a normally content slave to run away. In this case medicine was

employed to create a disease that satisfied the needs of the plantation economy and render

illogical any type of resistance to bondage.52 Historian Gregg Mittman makes a similar point

regarding the evolution of asthma; allergists in the 1960s explaining what they defined as a

sudden explosion of asthma among African Americans as the result of internalized

psychosomatic reactions to participation in civil rights protests and rioting.53 Building on much

older racist ideologies, African Americans had to be mentally ill or crazy to fight for Civil

Rights. In her book How Race is Made in America: Immigration, Citizenship, and the Historical

Power of Racial Scripts, Natalia Molina talks about knowledge production and stigma.54 Racial

scripts are ways that stereotypes and stigmas are uncritically reproduced across time and space as

a way of reinforcing practices of racism, exclusion, otherness, and un-Americanness.

By the 1960s and 1970s kidney failure had emerged as one of the more recognizable and

deadly complications of diabetes. Kidney failure, dialysis technology, and Civil Rights reflected

the politics of the era that would in turn help shape lasting and significant policy during the Great

Society. In the late 1940s Boston emerged as the first place in the United States where the new

technology of dialysis was being used. The emergence of nephrology as a specialized field in

the 1960s shaped an ethics of access to dialysis technology that would become a medical civil

rights issue.55 “They Decide Who Lives: Medical Miracle Puts Moral Burden on a Small

Committee” was the title of a 1962 Life Magazine article on the decisions made by medical and

lay committees regarding entitlement to the earliest dialysis treatment. Although it is unclear

how common they were, these so-called “God Committees” did exist and were made up mostly

of local businessmen, clergy, and physicians who made recommendations about worthiness and

who should receive the life-saving technology. From the limited sources it seems clear that the

“committee” favored Protestant, middle-class white men for the technology. In October 1972

the Federal Government entered the conversation when Medicare expanded its coverage to

include dialysis patients. Known as the “dialysis entitlement,” Public Law 92-603 moved

Medicare, not Medicaid, into the realm of treating patients suffering from kidney failure.56 Sugar

Diabetes focuses on this important moment in the history of diabetes identity by arguing how the

technology of dialysis, similar to insulin technology earlier in the century, was far from neutral

and instead reified important questions of racism, class, gender, and medical citizenship.

Post-Civil Rights Landscapes of Health

Despite changes in the scientific and popular imagination of diabetes over the past

century, notions of self-discipline and personal choice around food remain as defining today as

they were in the early twentieth-century. Sugar Diabetes links the increasing reliance on

processed food with the evolution of post-civil rights era segregated neighborhoods and food

deserts in the making of an obesity epidemic. Linking the past to the present, and an uncertain

future, eating our way out of diabetes has never been simple for Americans of the late twentieth

century living in harsh environmental landscapes. There has been a recent explosion in food

studies research linking the biological necessity of eating with the political, social, and cultural

meaning of food consumption from indigenous populations to the present.

This book connects the history of medicine and environmental history, focusing on the

ways in which environments play a part in diabetes-related disparities.57 Where people live and

how they interact with the environment is important. Historical fiction is an important source for

thinking about diabetes and the environment, foreshadowing important foundations for other

scholarship. Novelist Walter Mosley’s Always Outnumbered Always Outgunned, for example,

highlights important historical, sociological, and empirical questions of poverty, urban planning,

transportation, and access to supermarkets.58

The main character is Socrates Fortlow, an ex-convict originally from Kansas who lives

in the modern day Watts section of Los Angeles. In search of a job, Fortlow decides to apply for

a job at the Bounty Supermarket. The nearest Bounty supermarket is over ten miles away on

public transportation from his Watts residence. Mosley describes a landscape of Watts that has

only small convenience stores and bodega like markets where local residents can shop, but no

larger food-chains in the immediate area. When Fortlow enters Bounty supermarket he is

immediately confronted with unwanted stares and hostile side glances from the mostly white

shoppers, employees and supervisors. For the people in this particular environment Fortlow

seems out of place. Once he is finally able to get the ear of a manager and ask for an application,

Mosley presents a key element of how space and the environment become stressful and must be

negotiated. The manager inquires where Fortlow lives and he replies with, Watts.59 At this point

the manager seems confused and asks how he plans to travel to work every day when living so

far away from the store. Fortlow responds that he would come to work the same way he arrived

to ask for an application: public transportation. When the manager finds out that Fortlow does

not have a home telephone number he attempts to dismiss him by saying that it is impossible for

the store to hire someone who does not own a telephone. The reality is, of course, that it might

be difficult for Fortlow to get a telephone without first securing a job. Mosley is brilliantly

constructing a picture of environmental stress for poor African Americans. Mosley’s character is

not immobile (though he must rely on public transportation), but his ethnicity, class status,

address, and lack of resources all converge to stigmatize him. Mosley creates a narrative where

Watts residents must find ways to cope with the disadvantages of their environment that can take

its toll on their ability to eat and live.60

Mosley’s fictionalized account is suggestive of a broader historical and sociological

inquiry that poor neighborhoods suffer disproportionately from a lack of accessible supermarkets

or stores with a comparable variety of fresh fruits and vegetables to more wealthy communities

—forcing residents to travel farther by automobile or public transportation to shop or maintain

employment. Automobile ownership and urban planning remain important for understanding

what social scientists have very recently described as a “Supermarket Gap” in American cities.

The presence of accessible large-scale retail stores is not a unilateral process and certain

neighborhoods in cities have been forced to fight for large food chains to build in their

communities. In essence, this has become a vital civil rights issue. In places like Los Angeles,

Baltimore, St. Louis, New York City and Houston, sociologists and public health experts have

described the inverse relationship between racial segregation of neighborhoods and fewer large-

scale food chains. Residents of these areas also have lower rates of automobile ownership and

must travel considerable distances by public transportation to reach a large supermarket chain.

The smaller convenience stores often located in these neighborhoods have less options of

everything, including fresh meats and vegetables and prices are significantly higher.61 Sugar

Diabetes concludes with a forward looking chapter on Hurricane Katrina, race, and diabetes that

deals with the long-standing vulnerability of diabetics in the Gulf Coast temporarily exposed to

the nation by the storm.

A Note on Sources

This is a national study of diabetes (mostly type II), not limited to a particular region.

While I am not writing a story of diabetes in Memphis or New York City, for example, I

anticipate most of the narrative will center heavily upon urban centers as the place where many

of these conversations were being held. In addition to published and unpublished manuscripts,

archival holdings, public health records, and forms of expressive culture (poems, films,

literature, etc.), this project also involves the use of patient and physician records. More recently

medical historians have approached patient records as a literary discourse where disease and

illness is imagined and created by physicians as opposed to neutral and objective fact. The

clinical, social, and cultural worldviews of physicians served to both create categories of illness

around certain groups of people while systematically silencing the experiences of others.62 To be

sure the clinical patient archive on diabetes is overwhelmingly white during the early part of the

twentieth century. This reflected issues that are central to Sugar Diabetes’ argument including

assumptions of race at the initial clinical encounter that shaped the course of the disease and

exclusion of African Americans from the entitlement of patient-hood.

1 Jackie Robinson Papers, Library of Congress2

Dean Lewis, Commentary, WHN Storer Radio, Inc., New York, Jackie Robinson Papers, Miscellaneous File, Manuscript Division, Library of Congress, Washington, DC.3

James Herrick, “The Diagnosis of Diabetes Mellitus,” Journal of the American Medical Association, January 26, 1901, James Herrick Papers, Box 16 Folder 1, University of Chicago Special Collections.4

“Diabetes in the Negro,” Johns Hopkins Hospital Bulletin no. 83, February 1898: 405

Ibid, 416

Ibid, 417

Robert Proctor and Londa Schiebinger ed., Agnotology: The Making and Unmaking of Ignorance (Stanford: Stanford University Press, 2008): vii.8

Gerald Markowitz and David Rosner, Lead Wars: The Politics of Science and the Fate of America’s Children (Berkeley: University of California Press, 2014). 9

Naomi Oreskes and Eric Conway in Robert Proctor and Londa Schiebinger ed., Agnotology: The Making and Unmaking of Ignorance (Stanford: Stanford University Press, 2008): 68.10 Eugene J. Leopold, “Diabetes in the Negro Race,” Annals of Internal Medicine, Vol. 3, September 1931.11 “Charge Race Mortality is Misrepresented: N.Y. Risk Firm Figures Show Fewer Deaths: 5-Year Study Indicates Statistics of White Companies Untrue.” The Chicago Defender, October 8, 1938. 12 Ibid.13

Talcot Parsons, The Social System (Oxford: Routledge Press, 1951). 14

Edward Beardsley, A History of Neglect: Health Care for Black and Mill Workers in the Twentieth Century South (Knoxville: University of Tennessee Press, 1987).15

Susan Reverby, Examining Tuskegee: The Infamous Syphilis Study and Its Legacy (Chapel Hill: University of North Carolina Press, 2009); Spencie Love, One Blood: The Death and Resurrection of Charles R. Drew (Chapel Hill: University of North Carolina Press, 1996; Thomas J. Ward, Jr., Black Physicians in the Jim Crow South (Fayetteville: University of Arkansas Press, 2003). 16

Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York: Oxford University Press, 1995); Edward Beardsley, A History of Neglect: Health Care for Black and Mill Workers in the Twentieth Century South (Knoxville: University of Tennessee Press, 1987).17

George M. Fredrickson, The Black Image in the White Mind: The Debate on Afro-American Character and Destiny, 1817-1914 (New York: Harper and Row Press, 1972). 18

Biology of the Negro: 293-294.19

Ibid, 298-299.20

Ibid.21

Henry Sigerist, A History of Medicine Volume I: Primitive and Archaic Medicine (New York: Oxford University Press, 1951): 311.22

Cecil Striker, Famous Faces in Diabetes; Sigerist, A History of Medicine.23

Aretaeus (c. 81-138 A.D.), “On Diabetes,” and “Cure of Diabetes”; Striker, Famous Faces24

Ibid.25 Thomas Willis, “The Diabetes or the Pissing Evil”; Willis, Pharmaceutic Rationalis, 79.

26 Feudtner27 Joslin cite28 Joslin29 Grossman, ect.30 Earl Lewis, In Their Own Interest: Race, Class, and Power in Twentieth-Century Norfolk, Virginia (Berkeley: University of California Press, 1991), 29-66: 167-199; Shirley Anne Wilson-Moore, To Place Our Deeds: The African American Community in Richmond, California, 1910-1963 (Berkeley: University of California Press, 2000). 31 Leopold.32 Letter from Elizabeth Hughes to Parents, dated October 8, 1922. MS Coll. 334, Elizabeth Hughes Papers. Box 1, Folder 41. Thomas Fisher Library, University of Toronto Special Collections.

33 Board of Governors, Insulin Committee Records , MS Coll. A82-0001. Thomas Fisher Library, University of Toronto Special Collections.

34 The Journey and the Dream: A History of the American Diabetes Association (New York: American Diabetes Association, 1990: 9.35 Cecil Striker, MD, The History of the ADA – Undated Manuscript: Ch. 1 – The Formative Years: American Diabetes Association – 1940 to 1979, 1959-1975. Box 18, Folder 7, Cecil Striker Papers, Henry Winkler Medical Center Archives, University of Cincinnati.

36 Ibid.37

Letter from Elliott Joslin to Kendall Emergson, National Tuberculosis Association, 50 W. 50 th Street, New York City, Dated December 20, 1939. The History of the ADA, Writings, Project Research, 1939-1940, Box 18 Folder 25. Cecil Striker Papers, Henry Winkler Medical Library, University of Cincinnati Medical Center.38

Ibid.39

Cecil Striker, “The History of the ADA—Undated Manuscript: 1942-1944,” p. 6. Dr. Herman O. Mosenthal, New York, Presiding over ADA. Box 18, Folder 7, Cecil Striker Papers, Henry Winkler Medical Center Archives, University of Cincinnati.

40 Ibid.41

Alexander Marble, M.D. U.S. Army Medical Department Office of Medical History, Chapter XI, Diabetes Mellitus, Year42

Ibid.43

Proceedings of the American Diabetes Association, Third Annual Meeting, Volume 3, June 26, 1943, p. 81. Cecil Striker Papers, Henry Winkler Medical Library, University of Cincinnati Medical Center. 44

Cecil Striker, MD, The History of the ADA – Undated Manuscript: Ch. 1 – The Formative Years: American Diabetes Association – 1940 to 1979, 1959-1975. Box 18, Folder 7, Cecil Striker Papers, Henry Winkler Medical Center Archives, University of Cincinnati.45

Ibid.46

Letter From Cecil Striker to Employer, Dated June 13, 1953, Box 37. Cecil Striker Papers, Henry Winkler Medical Center Archives, University of Cincinnati. When using restricted patient records it is customary to make patients anonymous. Therefore the names and ages of patients have been changed to maintain anonymity. Unless absolutely necessary to a particular story the city, town, and region will also be changed in the historical narrative.

47 Letter From Cecil Striker to Insurance Company Employer of patient, Dated May 7, 1955, Box 37. Cecil Striker Papers, Henry Winkler Medical Center Archives, University of Cincinnati.

48 Alexander Marble, M.D. U.S. Army Medical Department Office of Medical History, Chapter XI, Diabetes Mellitus, Year

49

John Ditmer, The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care (New York: Bloomsbury Press, 2009).

50 Ms. Coll, 641Collection on the Medical Committee for Human Rights, 1963-2004, Program Work, Southern Programs (A), General Box 29, Folder 317, Kislak Center for Special Collections, Rare Books, and Manuscripts, Van Pelt-Dietrich Library, University of Pennsylvania, Philadelphia, PA.

51 John Ditmer, The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care (New York: Bloomsbury Press, 2009); Jonathan Metzl, The Protest Psychosis: How Schizophrenia Became a Black Disease (New York: Beacon Press, 2011).

52 Natalia Molina, How Race is Made in America: Immigration, Citizenship, and the Historical Power of Racial Scripts (Berkeley: University of California Press, 2014); Jonathan Metzl, The Protest Psychosis: How Schizophrenia Became a Black Disease (New York: Beacon Press, 2011).53

Gregg Mitman, Breathing Space: How Allergies Shape Our Lives and Landscapes (New Haven: Yale University Press, 2007). 54

Natalia Molina, How Race is Made in America: Immigration, Citizenship, and the Historical Power of Racial Scripts (Berkeley: University of California Press, 2014).55Peitzman, Dropsy, Dialysis, Transplant, 2007, pp. 92-96.56

Keith Wailoo, “A Slow and Toxic Decline,” in Keith Wailoo, Karen O’Neill, Jeffrey Dowd, and Roland Anglin ed. Katrina’s Imprint: Race and Vulnerability in America (New Brunswick: Rutgers University Press, 2010), 38.57

See David R. Williams and Chiquita Collins, “Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health,” Public Health Reports 116 (September-October 2001): 404-416.58

Walter Mosley, Always Outnumbered Always Outgunned (New York: Washington Square Press, 1998).59

Ibid.60

Ibid.61

“REACH Coalition: African American Legacy Health Project,” Sloane, DC, et al (USDA, Center for Nutrition and Policy Promotion), 2002; See also Robert D. Bullard, “Dumping on Houston’s Black Neighborhoods,” pgs. 207-223 in Martin V. Melosi and Joseph A. Pratt ed., Energy Metropolis: An Environmental History of Houston and the Gulf Coast (Pittsburg: University of Pittsburg Press, 2007)62 Steven Noll, “Patient Records as Historical Stories: The Case of Caswell Training School,” Bulletin of the History of Medicine 68 (Fall 1994): 413; John Harley Warner, “The Uses of Patient Records by Historians—Patterns, Possibilities and Perplexities,” Health and History (1999): 101-11; Guenter B. Risse and John Harley Warner, “Reconstructing Clinical Activities: Patient Records in Medical History,” Social History of Medicine 5 (August 1992): 183-205; Warwick Anderson, “The Case of the Archive,” Critical Inquiry 39 (Spring 2013): 532-47; Thomas Laqueur, “Bodies, Details, and the Humanitarian Narrative,” in The New Cultural History, ed. Lynn Hunt (Berkeley: University of California Press, 1989), 176-204.