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Speaker 1: Welcome to Stuff You Missed in History Class, a production

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Speaker 1: of I Heart Radio. Hello, and welcome to the podcast.

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Speaker 1: I'm Tracy B. Wilson and I'm Holly Fry. Before we

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Speaker 1: start on today's episode, I wanted to update folks. We

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Speaker 1: mentioned previously a couple episodes ago that we are going

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Speaker 1: to be doing a live show on July five at

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Speaker 1: Adams National Historical Park in Quincy, Massachusetts, and I just

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Speaker 1: wanted to let folks know that the park has information

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Speaker 1: about that show up on their website now. So you

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Speaker 1: can go to NPS dot gov slash Adam, which is

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Speaker 1: the Adams National Historical Park website. You can scroll down

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Speaker 1: to the calendar we're on there, or it's also on

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Speaker 1: their Facebook at facebook dot com slash Adams and PS

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Speaker 1: and that show. If you missed the announcement previously, it's

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Speaker 1: gonna be on July five. It is a daytime, outdoor show,

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Speaker 1: two pm. It was a fun time last time we

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Speaker 1: were there, so we're expecting another fun time. Yes, fingers

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Speaker 1: crossed whether or not we have any ghosts that get

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Speaker 1: in the machine and messed with recording. I plan to

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Speaker 1: have all kinds of fun me too, And now we

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Speaker 1: will get into today's episode. We have gotten a lot

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Speaker 1: of requests over the years to talk about the discovery

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Speaker 1: of insulin, and that's something that was so immediately and

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Speaker 1: dramatically life saving that it was hailed as a miracle.

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Speaker 1: And that discovery was also deeply contentious. In the words

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Speaker 1: of John McLeod, who was one of the two men

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Speaker 1: who was awarded the Nobel Prize for discovering insulin, in quote,

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Speaker 1: if every discovery entails as much squabbling over priority, et

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Speaker 1: cetera as this one has, it will put the job

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Speaker 1: of trying to make them out of fashion. Uh. It

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Speaker 1: is a high drama story when we get to the

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Speaker 1: actual discovery of insulin part But we're going to do

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Speaker 1: this in two parts. I feel like so many of

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Speaker 1: our scientific discovery stories go that way that it makes

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Speaker 1: me chuckle that he's like, this one is the most dramatic.

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Speaker 1: I'm like, are you sure? I think we've We've definitely

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Speaker 1: talked about a lot of of of fighting among the

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Speaker 1: discoverers of things. This is the first one I personally

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Speaker 1: recall in in the modern era that involved fisticuffs. So

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Speaker 1: we won't get to that part until part two. Because

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Speaker 1: this is a story that we're telling in two parts. Today,

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Speaker 1: we have a history of diabetes and its treatment in

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Speaker 1: the centuries before insulin was developed, and that is going

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Speaker 1: to include the starvation diets that were included in the

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Speaker 1: years just before insulin was discovered. And the next time

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Speaker 1: we will be talking about insulin, including all of that

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Speaker 1: squabbling and the fisticuffs, and we'll talk about how it

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Speaker 1: became a widely available treatment for diabetes, along with some

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Speaker 1: of the developments that have happened since then. And in

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Speaker 1: both parts of this we're going to be talking about

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Speaker 1: research that involved testing on animal subjects, and in part

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Speaker 1: two we'll also be talking about the use of byproducts

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Speaker 1: from animals that were slaughtered for food. Okay, So, hormones

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Speaker 1: are substances that help coordinate all kinds of complex processes

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Speaker 1: in your body, and insulin is one of the hormones

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Speaker 1: that helps regulate the amount of sugar or glucose in

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Speaker 1: your blood. Your body has to have glucose to live.

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Speaker 1: Most of your cells and especially your brain, use it

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Speaker 1: for fuel, but it's also really important to have the

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Speaker 1: right amount of glucose circulating in your blood. Having too

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Speaker 1: much or too little can lead to several complications. Some

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Speaker 1: of which are life threatening at a very basic level, because,

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Speaker 1: like Highie just said, these are complex processes. The body's

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Speaker 1: attempts to regulate blood glucose go this way. When your

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Speaker 1: blood sugar rises, your pancreas releases insulin, and that prompts

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Speaker 1: your body to store the extra sugar. Then, if your

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Speaker 1: blood glucose dips too low, your pancreas releases another hormone

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Speaker 1: called glucagon, and that prompts your body to release some

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Speaker 1: of that storage sugar. There are other systems of the

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Speaker 1: body involved with this, and there are other hormones besides

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Speaker 1: glucagon that can help raise your blood sugar, but insulin

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Speaker 1: is the only one that can really lower it. Diabetes melodis,

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Speaker 1: which you may have heard pronounced a different way I

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Speaker 1: certainly had up to this point, but that is correct,

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Speaker 1: is a group of conditions that affect the way your

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Speaker 1: body produces or works with insulin. In type one diabetes,

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Speaker 1: the pancreas either doesn't produce any insulin or it makes

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Speaker 1: very little, which means that the body does not have

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Speaker 1: a good way to lower blood glucose levels. Although type

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Speaker 1: one diabetes can develop in people of any age, it

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Speaker 1: is usually diagnosed in children and young people, which is

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Speaker 1: why it used to be called juvenile diabetes. It has

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Speaker 1: also been called insulin dependent diabetes and type two diabetes.

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Speaker 1: Either the pancreas isn't making enough an insulin although it

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Speaker 1: is making some, or the body resists the effects of insulin,

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Speaker 1: so it's also been called insulin resistant diabetes. Type two

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Speaker 1: diabetes has generally been more preval and adults, although it's

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Speaker 1: also becoming more common in younger people and because it's

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Speaker 1: tended to develop during adulthood, Type two diabetes also used

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Speaker 1: to be known as adult onset diabetes. There is also

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Speaker 1: gestational diabetes. The hormones involved with pregnancy make the body

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Speaker 1: more resistant to insulin. In most people, the pancreas increases

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Speaker 1: insulin production enough to make up for this when a

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Speaker 1: woman is pregnant, but in others it does not. Most

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Speaker 1: of the time, this resolves after the end of the pregnancy. Today,

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Speaker 1: treating every type of diabetes meloitists generally involves diet and

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Speaker 1: lifestyle modifications, along with regular blood sugar monitoring. There are

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Speaker 1: also some oral medications that can stimulate the pancreas to

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Speaker 1: produce more insulin or kind of just how the body

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Speaker 1: responds to insulin, and sometimes these steps are enough to

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Speaker 1: manage type two or gestational diabetes, but some people with

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Speaker 1: these conditions need insulin therapy as well, and this is

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Speaker 1: especially true the longer someone lives with type two diabetes.

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Speaker 1: On the other hand, insulin therapy is always necessary in

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Speaker 1: type one diabetes. Before insulin was developed, people with type

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Speaker 1: one diabetes typically lived only a few months or years

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Speaker 1: after they started showing symptoms, as the excess glucose in

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Speaker 1: their bloodstream ultimately led to coma and death. Although insulin

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Speaker 1: therapy has existed for less than a hundred years as

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Speaker 1: of when we're recording this, people have recognized diabetes for millennia.

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Speaker 1: Ancient and medieval documents have described a group of symptoms

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Speaker 1: that we still know today, including excessive thirst, excessive urination,

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Speaker 1: unexplained weight loss, fatigue, and urine that tastes or smells sweet.

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Speaker 1: And even though these earlier medical writers haven't known what

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Speaker 1: caused all of these symptoms, they've understood that they were

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Speaker 1: all connected to one condition. I don't think I have

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Speaker 1: ever heard the taste part before, and I'm like, gross,

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Speaker 1: how do we know? Um, yeah, that's used to be

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Speaker 1: a thing in diagnostic medicine was tasting people's urine. The

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Speaker 1: earliest known mention of diabetes is often cited as Ebers Papyrus.

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Speaker 1: This papyrus was written in ancient Egypt in fifteen fifty

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Speaker 1: two BC, but named for George Ebers, who bought it

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Speaker 1: and published it in English and Latin in the eighteen seventies.

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Speaker 1: This mention is a little bit vague, though The papyrus

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Speaker 1: includes a remedy quote to eliminate urine which is too plentiful,

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Speaker 1: and that could be referencing the frequent urination that accompany's diabetes,

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Speaker 1: but it could also be about something more common and

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Speaker 1: relatively benign, such as a urinary tract infection and what's

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Speaker 1: now India, the physician Sashruda and a surgeon Chikara both

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Speaker 1: described diabetes, with Sastruda noting the difference between what we

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Speaker 1: would describe today as types one and two. We also

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Speaker 1: have a whole episode on sastrrida back in the archive.

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Speaker 1: These texts date back to the Vedic period, which is

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Speaker 1: between one thousand and six hundred BC, and they used

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Speaker 1: terms that translate to honey urine or sweet urine diseased,

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Speaker 1: and they describe aunts being attracted to the patient's urine.

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Speaker 1: In about four hundred b CE, Hippocrates described diagnostic criteria

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Speaker 1: for diabetes, although that name had not been coined yet.

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Speaker 1: The criteria or that the person had a history of

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Speaker 1: excessive hunger, thirst, and urination, and that their urine was sweet,

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Speaker 1: and he described this condition as very rare. All of

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Speaker 1: this actually predates the first written descriptions of the pancreas, which,

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Speaker 1: as we mentioned earlier, is the organ that produces insulin.

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Speaker 1: That first description came from Greek physician Horophilis around the

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Speaker 1: third century b C, from terms that meant all flesh.

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Speaker 1: Horophilis did not know about insulin at this point, though,

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Speaker 1: he just described the organ that's the pancreas. Two different

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Speaker 1: people are credited with coining the term diabetes, both of

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Speaker 1: them living in about the second century. One was Demetrius

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Speaker 1: of epam Um and the other was Alreadius of capado Cha.

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Speaker 1: The word itself is from a Greek word meaning to

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Speaker 1: run through, or describing a thing that fluid runs through,

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Speaker 1: in other words, some kind of siphon. So this all

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Speaker 1: goes back to that excessive thirst and urination that are

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Speaker 1: characteristic of diabetes. Arete has described it this way quote

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Speaker 1: the course is the common one, namely the kidneys and

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Speaker 1: the bladder. For the patients never stopped making water, but

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Speaker 1: the flow is incessant, as if from the opening of aqueducts.

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Speaker 1: The nature of the disease then is chronic, and it

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Speaker 1: takes a long period to form, but the patient is

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Speaker 1: short lived if the constitution of the disease be completely established,

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Speaker 1: For the melting is rapid, the death speedy. And then

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Speaker 1: he went on with further description from there. The physician Galen,

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Speaker 1: living in the Roman Empire in the second and third centuries,

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Speaker 1: also described diabetes. He wrote, quote, I am of the

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Speaker 1: opinion that the kidneys too are affected in the rare disease,

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Speaker 1: which some people call chamber pot dropsy, other again diabetes

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Speaker 1: ease or violent thirst. For my own part, I have

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Speaker 1: seen the disease till now only twice, when the patients

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Speaker 1: suffered from an inextinguishable thirst, which forced them to drink

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Speaker 1: enormous quantities. The fluid was urinated swiftly with a urine

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Speaker 1: resembling the drink. He called the condition diarrhea urinoma, or

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Speaker 1: diarrhea of the urine. At about the same time in

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Speaker 1: Han dynasty China, jiang jong Jing also described the classic

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Speaker 1: symptoms of thirst and excessive urination, and then later Chinese

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Speaker 1: documents also described the phenomenon of sweet urine, with the

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Speaker 1: Chinese term for diabetes translating to wasting and thirsting. Written

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Speaker 1: references continue into the medieval period, including previous podcast subject

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Speaker 1: ibn Sina also known as Avicenna writing in eleventh century Persia.

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Speaker 1: Medieval Persian writing uses two different terms for diabetes, one

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Speaker 1: that's derived from the word diabetes and one that translates

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Speaker 1: to water wheel. Ibn Sina also scribed leaving a patient's

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Speaker 1: urine to evaporate and it leaving a sticky sweet residue behind. Overall,

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Speaker 1: these ancient and medieval writers described diabetes as a condition

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Speaker 1: more often than they described some kind of treatment for it.

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Speaker 1: That's possibly because and what we now know as type

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Speaker 1: one diabetes patients generally did not live very long after

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Speaker 1: being diagnosed. The treatments that did exist were mostly in

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Speaker 1: line with whatever system of medicine was being practiced that

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Speaker 1: had given place and time, including abstaining from or eating

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Speaker 1: more of certain foods, various herbal preparations and plant extracts,

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Speaker 1: so Shrewda, who observed a correlation between diabetes and a

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Speaker 1: person's weight, recommended a healthy, moderate diet and exercise as

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Speaker 1: a preventative measure, although type two diabetes can develop regardless

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Speaker 1: of a person's weight, and there were also recommendations of

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Speaker 1: things like opium to try to make patients be more comfortable.

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Speaker 1: But it wasn't until later that people started to understand

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Speaker 1: that diabetes did not just cause sugar in the urine,

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Speaker 1: but also caused sugar in the blood and tried to

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Speaker 1: formulate treatments based on that discovery. And we're going to

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Speaker 1: talk more about all of that after we pause for

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Speaker 1: a sponsor break. In the sevente century, people started making

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Speaker 1: some more concrete discoveries about diabetes beyond describing its outwardly

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Speaker 1: observable signs. One was Swiss anatomist Johann Conrad Bruner, who

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Speaker 1: partially removed the pancreases of dogs and then observed afterwards

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Speaker 1: that these dogs had an increased appetite, urination, and thirst.

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Speaker 1: He didn't really connect those symptoms back to diabetes, though

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Speaker 1: by that point the idea that diabetes caused sweet urine

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Speaker 1: had been forgotten, at least in Britain. Where the practice

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Speaker 1: of physicians tasting their patient's urine had fallen out of favor.

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Speaker 1: Who boy, am I glad that happened? But in six

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Speaker 1: seventy four Thomas will did taste a patient's urine while

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Speaker 1: working at Oxford University, and afterward he coined the term

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Speaker 1: diabetes melodis, with melodis coming from a Latin term for

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Speaker 1: sweet or honeyed, and this was to set the condition

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Speaker 1: apart from diabetes incipitus, which is also associated with excessive

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Speaker 1: thirst and urination, but is related to salt rather than sugar.

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Speaker 1: Diabetes insipitus is a whole separate thing that we are

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Speaker 1: not talking about in this episode at all beyond what

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Speaker 1: we just said. In seventeen seventy six, physician Matthew Dobson

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Speaker 1: of Liverpool confirmed something that probably seems really obvious at

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Speaker 1: this point. He evaporated a patient's urine and what was

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Speaker 1: left behind was a material that was indistinguishable from sugar.

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Speaker 1: So the reason that people were having sweet urine was

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Speaker 1: because there was literally sugar in there. But he made

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Speaker 1: another discovery as well, and that's that the person's blood

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Speaker 1: serum was also sweet. So he was the one that

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Speaker 1: started making that connection that diabetes was not just about

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Speaker 1: sugar in the urine, it was also about sugar in

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Speaker 1: the blood. In seventeen seventy eight, Thomas Coullie was doing

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Speaker 1: an autopsy on someone with diabetes and he noticed stones

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Speaker 1: and signs of damage to the pancreas, and he suggested

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Speaker 1: that these two things might be related, but that connection

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Speaker 1: didn't really become clear or more widely known until later.

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Speaker 1: In eighteen fifty six, French physiologist Claude Bernard discovered that

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Speaker 1: the body stores excess glucose in the liver, and he

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Speaker 1: coined the term glycogen for this form of stored sugar.

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Speaker 1: He also discovered that the nervous system played a role

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Speaker 1: in regulating blood sugar. He made these discoveries, as many

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Speaker 1: of these other researchers did, by experimenting on dogs. This

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Speaker 1: was something that really horrified his family. His wife, Marie Fransoise,

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Speaker 1: ultimately filed for divorce, took custody of their children, and

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Speaker 1: established an anti vivisection society in response to his work.

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Speaker 1: She was one of the first of many people to

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Speaker 1: object to the use of experiments on animals that were

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Speaker 1: related to the study of diabetes or to the development

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Speaker 1: of insulin. Then, in the late eighteen sixties, while he

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Speaker 1: was still in medical school, Paul Langer Hans made a

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Speaker 1: big step in discovering the connection between diabetes and the pancreas. Today,

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Speaker 1: we know that the pancreas plays a role in both

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Speaker 1: the digestive and the endocrine systems. When it comes to digestion,

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Speaker 1: the pancreas excretes digestive enzymes that make their way through

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Speaker 1: ducts into the small intestine. As an endocrine gland, the

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Speaker 1: pancreas secretes several hormones, including insulin. But when Longer Hans

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Speaker 1: started his research, people knew very little about the microscopic

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Speaker 1: structures of the pancreas or what those structures did. His

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Speaker 1: work really started to change that. In his thesis on

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Speaker 1: the pancreas, he described nine different types of cells, and

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Speaker 1: at least two of them had not been described before.

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Speaker 1: One was a type of assent or cell which secretes

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Speaker 1: digestive enzymes, and he wasn't really sure what the other

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Speaker 1: our cells were four, but he observed that they were

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Speaker 1: clumped together in the pancreas in these little groups. Leger

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Speaker 1: Hans published his thesis in eighteen sixty nine. In eighteen

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Speaker 1: ninety three, a French history physiologist named Eduard la Guess

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Speaker 1: observed the same cells, and he named them for Leger Hans.

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Speaker 1: I Guess also theorized that these cells might secrete something

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Speaker 1: that removed glucose from the urine. At this point, people

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Speaker 1: hit theorized that some organs might secrete some kind of

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Speaker 1: chemicals that worked in the body somehow, but the word

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Speaker 1: hormone had not been coined yet. In between when Longer

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Speaker 1: Hans described these cells and when La Guests named them

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Speaker 1: the islets of Longer Hans, two French researchers made another discovery.

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Speaker 1: In eighteen eighty four, Louis val Yard and Charles Louis

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Speaker 1: Xavier Arnazan discovered that if you closed off the main

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Speaker 1: duct of a rabbit's pancreas, the pancreas itself would atrophy.

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Speaker 1: But it appeared that only the acid in our cells atrophied,

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Speaker 1: not the islets of longer huns, And then the rabbits

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Speaker 1: did not experience the increased appetite and urination and thirst

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Speaker 1: that Bruner had described two years before. After he partially

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Speaker 1: removed the pancreases of dogs. Five years later, in Germany,

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Speaker 1: Oscar Minkowski and Joseph vun Marrying totally removed the pancreas

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Speaker 1: of a dog, which immediately developed symptoms of severe diabetes,

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Speaker 1: including coma and death. Unlike Brunner, Minkowski and vun Marrying

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Speaker 1: were able to remove the whole pancreas, and they made

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Speaker 1: the connection between the pancreas and diabetes. So through all

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Speaker 1: of this, Western medicine had started to form a basic

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Speaker 1: understanding that diabetes caused elevated sugar, both in the blood

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Speaker 1: and in the urine, and it also seemed related to

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Speaker 1: the pancreas, specifically to these islets of longer hauns, and

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Speaker 1: it had some connections to the nervous system and to

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Speaker 1: the liver. Based on this growing knowledge, researchers speculated on

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Speaker 1: a number of potential treatments at this point. Although it

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Speaker 1: was known that diabetes caused sugar in both the blood

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Speaker 1: and the urine, it was much easier to test the urine.

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Speaker 1: Blood tests took a lot longer, and they required so

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Speaker 1: much blood that the tests themselves could be fatal for

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Speaker 1: research animals. So many of these initial studies were focused

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Speaker 1: on outward symptoms like thirst and urination as well as

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Speaker 1: how much glucose was in the urine, rather than specifically

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Speaker 1: testing blood. One idea was that diabetes root cause had

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Speaker 1: something to do with the liver's glycogen storage, and that

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Speaker 1: it might be possible to stimulate the nervous system to

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Speaker 1: activate that storage in the liver, or that maybe the

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Speaker 1: liver might be the key to the treatment for diabetes.

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Speaker 1: But a lot of researchers were focusing on the pancreas

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Speaker 1: and whether some kind of pancreatic extract could treat diabetes.

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Speaker 1: Most of these researchers followed the same basic process. They

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Speaker 1: would remove the pancreas of a dog or another animal,

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Speaker 1: which essentially caused it to develop diabetes, and then they

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Speaker 1: would try to treat that animal with an injected pancreatic extract,

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Speaker 1: sometimes from the same animals pancreas, and sometimes from the

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Speaker 1: pancreas of a different animal. This was not the first

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Speaker 1: time that people made extracts from endocrine glands and use

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Speaker 1: them as a treatment for patients who were not producing

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Speaker 1: enough of that particular hormone. The first use of thyroid

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Speaker 1: extract to treat hypothyroidism goes back to at least similar

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Speaker 1: use of adrenal extracts started in the late nineteenth century

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Speaker 1: as well, and Jocici Takaminae of Japan isolated and purified

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Speaker 1: adrenaline from cow glands in nineteen o one. The methods

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Speaker 1: for preparing this pancreatic extract varied, and for the most

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Speaker 1: part they were at least somewhat effective in reducing the

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Speaker 1: amount of sugar in a test subjects blood, as shown

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Speaker 1: by the corresponding reduction in sugar in their urine. That's

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Speaker 1: because if you make a pancreatic extract, it's very likely

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Speaker 1: to contain at least some insulin, but it's also hard

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Speaker 1: to separate the insulin from all the other tissues and

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Speaker 1: substances that are part of the pancreas. So overwhelmingly all

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Speaker 1: these experiments also caused side effects that made the work

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Speaker 1: simply too risky to try in human subjects. This included

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Speaker 1: things like abscesses and other infections and extreme fevers, and

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Speaker 1: also shock. The first person known to try this was

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Speaker 1: French physiologist Eugene Glay in the late nineteenth century. Glay

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Speaker 1: removed the pancreases of dogs and then treated them with

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Speaker 1: injections of a pancreas extract. The injections reduced the dogs

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Speaker 1: thirst and their urine output, and also lowered the amount

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Speaker 1: of sugar in the urine, but for reasons that are

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Speaker 1: not clear at all. He stopped his work on the

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Speaker 1: subject in eighteen ninety and then kept his findings sealed

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Speaker 1: until after the discovery of insulin was announced, which was

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Speaker 1: more than thirty years later. Meanwhile, in nineteen hundred, pathologists

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Speaker 1: Eugene Lindsay Opie of Johns Hopkins discovered that the islets

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Speaker 1: of Langerhans showed signs of atrophy and patients who had

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Speaker 1: died as a result of diabetes. In nineteen o five,

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Speaker 1: Ernest Henry Starling coined the word hormone, and people began

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Speaker 1: to suggest that the islets of Langerhunds were secreting some

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Speaker 1: kind of hormone that lowered blood sugar. Both of these

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Speaker 1: discoveries fed into the ongoing work on pancreatic extracts and animals.

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Speaker 1: George Ludwig Zuelzer of Berlin conducted his experiments on rabbits,

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Speaker 1: and he was successful enough that he did try to

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Speaker 1: inject his extract on a dying patient in nineteen o six,

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Speaker 1: Although this did seem to have some positive effect for

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Speaker 1: the patient, the patient's blood and urine weren't tested to

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Speaker 1: confirm it. They were really looking at outward symptoms, and

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Speaker 1: the patient died shortly after Zulzer ran out of his extract.

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Speaker 1: He went on to work with five other human patients,

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Speaker 1: but they all experienced high fevers, vomiting, convulsions, and other

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Speaker 1: serious side effects. As some other examples of this research,

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Speaker 1: Lydia Maria Adams DeWitt did her work with cats in

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Speaker 1: nineteen o six, legating the pancreatic ducks to try to

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Speaker 1: isolate just the islets of langerhounds when preparing her extract.

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Speaker 1: Romanian physician Nicolay Pulesque also worked with dogs in nineteen

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Speaker 1: fifteen in nineteen sixteen, developing an extract that he called

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Speaker 1: Pancrean before his work was disrupted by World War One.

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Speaker 1: Israel As Kleiner, whose parents had immigrated to the United

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Speaker 1: States from Bavaria, worked with pancreatic extracts and dogs in

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Speaker 1: nineteen nine. All of this work showed at least some promise,

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Speaker 1: but none of it was safe enough to use as

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Speaker 1: a treatment for diabetes. We'll talk about how people started

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Speaker 1: trying to manage diabetes through diet at about the same

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Speaker 1: time after a sponsor break. The idea that diabetes might

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Speaker 1: be controlled or prevented through diet goes back thousands of

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Speaker 1: years to shud azabetic medical text that we talked about earlier,

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Speaker 1: but in terms of what people were trying after the

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Speaker 1: medical community started to get a better sense of what

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Speaker 1: was happening inside of the body. One of the first

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Speaker 1: people to suggest a dietary approach was John Rolo of Scotland,

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Speaker 1: who became an English Army surgeon, and he was doing

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Speaker 1: his work in the earlier years of when people were

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Speaker 1: starting to make physiological discoveries about diabetes. Rollo concluded, incorrectly

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Speaker 1: the diabetes was a digestive problem in which some kind

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Speaker 1: of stomach issue was causing vegetable matter to break down

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Speaker 1: into excessive sugar. In s he worked with an Army

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Speaker 1: captain who had developed what we would know today as

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Speaker 1: type two diabetes. Rollo recommended a diet that was primarily meat,

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Speaker 1: along with some bread, milk, and lime water. The treatment

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00:23:39,680 --> 00:23:42,840
Speaker 1: had other components as well, including rubbing the patient's body

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Speaker 1: with lard, producing an external ulceration over each kidney, and

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Speaker 1: wine and opium at bedtime. After a couple of weeks

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Speaker 1: on this regiment, the patient was, according to Rollo, producing

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Speaker 1: less urine, and servants said that his urine was no

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Speaker 1: longer sweet, so he was really not on the right

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Speaker 1: track in terms of diabetes cause. But the diet that

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00:24:04,640 --> 00:24:09,359
Speaker 1: he was recommending was closer to correct. It was low

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Speaker 1: in sugar and other carbohydrates. But there were also physicians

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00:24:13,000 --> 00:24:16,480
Speaker 1: who drew the opposite conclusion about how diet might be

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Speaker 1: used to treat diabetes. In Paris in the eighteen fifties,

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Speaker 1: Pierre Adolphe Puri recommended a high sugar, high calorie diet,

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Speaker 1: reasoning that patients were excreting so much sugar in their

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00:24:28,400 --> 00:24:30,159
Speaker 1: urine that they would need to eat more of it

401
00:24:30,240 --> 00:24:34,800
Speaker 1: to replace it. Unfortunately, this approach was absolutely the opposite

402
00:24:34,880 --> 00:24:37,080
Speaker 1: of what needed to be done, and it contributed to

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00:24:37,119 --> 00:24:41,640
Speaker 1: at least one patient's death, who is terrifying. Apollinaire Bouchard,

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00:24:41,880 --> 00:24:43,800
Speaker 1: who was living in Paris at about the same time

405
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Speaker 1: as Puri, took a dietary approach that was closer to Ralows.

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Speaker 1: He recommended a diet that was high and fat but

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Speaker 1: low in sugar and other carbohydrates. He also recommended that

408
00:24:54,760 --> 00:24:59,600
Speaker 1: patients fast periodically and that they exercise. Did a lot

409
00:24:59,640 --> 00:25:02,440
Speaker 1: of other work in the field of diabetes research as well.

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00:25:02,480 --> 00:25:06,600
Speaker 1: He is sometimes called the father of diabetology. Moving into

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00:25:06,640 --> 00:25:11,119
Speaker 1: the twentieth century, two doctors built on Bouchardot's recommendations and

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00:25:11,240 --> 00:25:14,800
Speaker 1: formulated the most well known and widely used diets for

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Speaker 1: people with diabetes in the years just before insulin was developed.

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Speaker 1: This was Frederick Madison Allen and Elliott Proctor Jocelyn, and

415
00:25:23,400 --> 00:25:27,080
Speaker 1: they started in about nineteen fifteen. Alan came to his

416
00:25:27,119 --> 00:25:31,119
Speaker 1: conclusions about diet by working with deep pancreatized dogs, and

417
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Speaker 1: he recommended a low calorie, low carb diet that included

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Speaker 1: intermittent fasting. These and similar diets were so restrictive that

419
00:25:40,040 --> 00:25:43,920
Speaker 1: they were often described as starvation diets. I have read

420
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Speaker 1: some articles that say they were derisively called starvation diets,

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00:25:47,760 --> 00:25:49,960
Speaker 1: but no, that's literally what people called them as a

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00:25:50,000 --> 00:25:52,720
Speaker 1: matter of course. And here is how it worked. From

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Speaker 1: the Starvation Treatment of Diabetes with a series of graduated

424
00:25:56,720 --> 00:26:01,200
Speaker 1: diets used at the Massachusetts General Hospital, which was published

425
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Speaker 1: in nine and then that The text includes quote for

426
00:26:05,920 --> 00:26:08,919
Speaker 1: forty eight hours after admission to the hospital, the patient

427
00:26:09,119 --> 00:26:12,399
Speaker 1: is kept on ordinary diet to determine the severity of

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00:26:12,480 --> 00:26:16,760
Speaker 1: his diabetes. Then he is starved and no food allowed

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Speaker 1: save whiskey and black coffee. The whiskey is given in

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00:26:20,720 --> 00:26:24,360
Speaker 1: the coffee one ounce of whiskey every two hours from

431
00:26:24,400 --> 00:26:28,919
Speaker 1: seven am until seven pm. This furnishes roughly about eight

432
00:26:29,040 --> 00:26:32,800
Speaker 1: hundred calories. The whiskey is not an essential part of

433
00:26:32,840 --> 00:26:36,200
Speaker 1: the treatment. It merely furnishes a few calories and keeps

434
00:26:36,200 --> 00:26:40,040
Speaker 1: the patient more comfortable while he is being starved. As

435
00:26:40,080 --> 00:26:44,440
Speaker 1: manual recommends bullion or a clear soup if whiskey isn't desirable,

436
00:26:44,880 --> 00:26:47,520
Speaker 1: and recommends that the patient be given by carbonate of

437
00:26:47,560 --> 00:26:50,840
Speaker 1: soda if they show signs of acidosis, and that's one

438
00:26:50,880 --> 00:26:54,200
Speaker 1: of the potential complications of diabetes in which acids start

439
00:26:54,240 --> 00:26:57,639
Speaker 1: to build up in the body. The starvation process continued

440
00:26:57,800 --> 00:27:00,960
Speaker 1: until the patient's yurine had no sugar in it. Then

441
00:27:01,080 --> 00:27:05,159
Speaker 1: food would be slowly reintroduced quote to the limit of tolerance.

442
00:27:05,800 --> 00:27:09,120
Speaker 1: In other words, doctors would gradually give patients more calories

443
00:27:09,160 --> 00:27:13,040
Speaker 1: and carbohydrates each day until sugar reappeared in the urine,

444
00:27:13,119 --> 00:27:15,320
Speaker 1: and then they would reduce that amount until it went

445
00:27:15,359 --> 00:27:19,960
Speaker 1: away again. This particular publication includes case studies for several

446
00:27:20,040 --> 00:27:23,320
Speaker 1: adults whose diets were adjusted over a period of roughly

447
00:27:23,440 --> 00:27:26,520
Speaker 1: one to two weeks as doctors figured out how many

448
00:27:26,560 --> 00:27:29,840
Speaker 1: grams of carbohydrates they could consume every day while still

449
00:27:29,880 --> 00:27:33,199
Speaker 1: not having any sugar in their urine. Most of the

450
00:27:33,200 --> 00:27:36,719
Speaker 1: patients wound up with diets that included between fifteen and

451
00:27:36,800 --> 00:27:40,479
Speaker 1: fifty grams of carbohydrates per day, between twenty five and

452
00:27:40,520 --> 00:27:43,720
Speaker 1: sixty grams of protein, and between a hundred and fifty

453
00:27:43,760 --> 00:27:46,159
Speaker 1: and two hundred grams of fat, and that added up

454
00:27:46,200 --> 00:27:50,200
Speaker 1: to a roughly two thousand calorie diet on average among

455
00:27:50,240 --> 00:27:54,840
Speaker 1: these adult patients. Type two diabetes is also associated with weight,

456
00:27:55,040 --> 00:27:57,359
Speaker 1: although as we said earlier, it can develop in people

457
00:27:57,440 --> 00:28:01,240
Speaker 1: regardless of their weight, and in general, with manual recommends

458
00:28:01,280 --> 00:28:04,760
Speaker 1: that adult patients lose weight. The approach in children was

459
00:28:04,800 --> 00:28:08,280
Speaker 1: a little different, though, reading from the same book quote,

460
00:28:08,600 --> 00:28:11,120
Speaker 1: Diabetes and Children is likely to be a good deal

461
00:28:11,200 --> 00:28:14,520
Speaker 1: more severe than it is in adults. Still, in a

462
00:28:14,520 --> 00:28:17,280
Speaker 1: few cases that have been treated with the starvation treatment

463
00:28:17,320 --> 00:28:20,880
Speaker 1: at the children's hospital, the results have been very satisfactory

464
00:28:21,000 --> 00:28:23,800
Speaker 1: as far as rendering the patients sugar free. Is concerned.

465
00:28:24,680 --> 00:28:28,120
Speaker 1: Most diabetic children, however, are thin and frail, and they

466
00:28:28,160 --> 00:28:31,040
Speaker 1: have no extra weight to lose, so it does not

467
00:28:31,160 --> 00:28:34,160
Speaker 1: seem so desirable to bring about any very great loss

468
00:28:34,200 --> 00:28:36,520
Speaker 1: of weight, which is quite an essential part of the

469
00:28:36,560 --> 00:28:40,080
Speaker 1: treatment for most adults. The few children that have been

470
00:28:40,080 --> 00:28:44,120
Speaker 1: treated have borne starvation remarkably well. It is too early,

471
00:28:44,240 --> 00:28:46,480
Speaker 1: and we have seen two few children treated by this

472
00:28:46,560 --> 00:28:49,320
Speaker 1: method to say what influence it may have on the

473
00:28:49,320 --> 00:28:52,000
Speaker 1: course of the disease, but it can certainly be said

474
00:28:52,040 --> 00:28:55,080
Speaker 1: that it is very efficacious in rendering them sugar free.

475
00:28:55,720 --> 00:28:58,280
Speaker 1: So here's the daily food intake of a twelve year

476
00:28:58,320 --> 00:29:00,400
Speaker 1: old girl who was admitted to the High Spittle in

477
00:29:00,520 --> 00:29:03,840
Speaker 1: nine after she went through this starvation process and then

478
00:29:03,920 --> 00:29:08,840
Speaker 1: was discharged with a new diet. Bacon four slices oatmeal,

479
00:29:09,080 --> 00:29:15,640
Speaker 1: four tablespoonfuls bread, one slice meat, one ounce, cabbage, five

480
00:29:15,720 --> 00:29:24,400
Speaker 1: tablespoonfuls spinach, five tablespoonfuls string beans, five tablespoonfuls butter two ounces.

481
00:29:25,280 --> 00:29:28,840
Speaker 1: This child's description of her diet ends with the note

482
00:29:28,920 --> 00:29:32,560
Speaker 1: quote a rather mild case which responded readily to treatment.

483
00:29:32,680 --> 00:29:35,280
Speaker 1: The question is can she grow and develop on a

484
00:29:35,360 --> 00:29:38,320
Speaker 1: diet which will keep her sugar free. A six year

485
00:29:38,320 --> 00:29:42,560
Speaker 1: old boy was also discharged on this diet string beans

486
00:29:42,600 --> 00:29:50,640
Speaker 1: three tablespoonfuls, spinach four tablespoonfuls, bacon, four slices, butter two ounces,

487
00:29:50,840 --> 00:29:57,840
Speaker 1: eggs three bread, one half slice cereal, two tablespoonfuls, meat

488
00:29:58,120 --> 00:30:02,440
Speaker 1: three ounces. This particular book was written about patients who

489
00:30:02,480 --> 00:30:05,200
Speaker 1: came to the hospital in nineteen fifteen, and the book

490
00:30:05,240 --> 00:30:08,160
Speaker 1: came out in nineteen sixteen, so it doesn't really include

491
00:30:08,560 --> 00:30:12,840
Speaker 1: anyone's long term results or prognosis in terms of the children,

492
00:30:12,880 --> 00:30:15,960
Speaker 1: though it does report one patient whose condition was critical

493
00:30:16,000 --> 00:30:18,680
Speaker 1: when they arrived at the hospital and who died during

494
00:30:18,720 --> 00:30:21,720
Speaker 1: the starvation period, as well as one who seemed to

495
00:30:21,760 --> 00:30:24,200
Speaker 1: be doing well but died suddenly a few months after

496
00:30:24,280 --> 00:30:27,960
Speaker 1: being discharged. These two children's diets that we just gave

497
00:30:28,000 --> 00:30:31,840
Speaker 1: as examples totaled one thousand, five hundred ten calories for

498
00:30:31,840 --> 00:30:35,000
Speaker 1: the first and one thousand, four hundred two calories for

499
00:30:35,040 --> 00:30:36,840
Speaker 1: the second. But as we said at the top of

500
00:30:36,880 --> 00:30:40,200
Speaker 1: the show, diet alone is not enough to control glucose

501
00:30:40,320 --> 00:30:44,200
Speaker 1: levels and type one diabetes. These children's bodies needed insulin

502
00:30:44,320 --> 00:30:47,160
Speaker 1: but could not make it so. Over time, a lot

503
00:30:47,200 --> 00:30:49,960
Speaker 1: of children who were on one of Alan's or Joscelyn's

504
00:30:50,000 --> 00:30:54,000
Speaker 1: diets were given fewer and fewer calories every day as

505
00:30:54,040 --> 00:30:57,680
Speaker 1: they inevitably showed signs of sugar in their urine. Sometimes

506
00:30:57,720 --> 00:30:59,640
Speaker 1: they would have like a full day of fasting to

507
00:30:59,680 --> 00:31:03,720
Speaker 1: try to reset their bodies. Patients were routinely on diets

508
00:31:03,720 --> 00:31:06,600
Speaker 1: of eight hundred calories a day or less, with a

509
00:31:06,680 --> 00:31:09,960
Speaker 1: day of total or near total fasting if any glucose

510
00:31:10,000 --> 00:31:12,760
Speaker 1: appeared in their urine. This breaks my heart seeing all

511
00:31:12,760 --> 00:31:15,760
Speaker 1: of this limited calorie diet for kids who need all

512
00:31:15,800 --> 00:31:18,760
Speaker 1: of the nutrients that they can possibly get to grow

513
00:31:18,800 --> 00:31:23,640
Speaker 1: and finish their bodies forming um. Because these were so restrictive,

514
00:31:23,680 --> 00:31:27,240
Speaker 1: these diets were very hard for patients to maintain, even

515
00:31:27,240 --> 00:31:29,959
Speaker 1: if they could and their urine stay free of glucose.

516
00:31:30,360 --> 00:31:34,120
Speaker 1: The children's bodies in particular were experiencing other negative effects

517
00:31:34,160 --> 00:31:38,200
Speaker 1: as a result of just not having enough nourishment. Basically,

518
00:31:38,320 --> 00:31:41,400
Speaker 1: children were described as wasting away on these diets, which

519
00:31:41,520 --> 00:31:44,640
Speaker 1: may have at best prolonged their lives by a few

520
00:31:44,680 --> 00:31:48,040
Speaker 1: months to a couple of years. They were often emaciated

521
00:31:48,120 --> 00:31:51,040
Speaker 1: and weak and prone to infections, while their growth was

522
00:31:51,080 --> 00:31:54,760
Speaker 1: delayed because they just weren't getting enough nourishment to simply survive,

523
00:31:55,600 --> 00:31:59,680
Speaker 1: and whether these diets actually did prolong their lives is

524
00:31:59,720 --> 00:32:03,640
Speaker 1: not entirely clear. There are just so many variables involved

525
00:32:03,680 --> 00:32:06,280
Speaker 1: in type one diabetes it's hard to say whether this

526
00:32:06,480 --> 00:32:10,480
Speaker 1: worked or not, and many doctors views these diets were

527
00:32:10,520 --> 00:32:14,040
Speaker 1: a desperate effort to prolong children's lives just a little

528
00:32:14,040 --> 00:32:16,280
Speaker 1: bit longer, with the hope that they would hang on

529
00:32:16,520 --> 00:32:19,360
Speaker 1: long enough to see and benefit from the discovery of

530
00:32:19,360 --> 00:32:23,840
Speaker 1: a more effective treatment. And Joscelyn's words quote, we literally

531
00:32:24,000 --> 00:32:27,000
Speaker 1: starved the child an adult with the faint hope that

532
00:32:27,160 --> 00:32:30,480
Speaker 1: something new in treatment would appear. It was no fun

533
00:32:30,600 --> 00:32:34,480
Speaker 1: to starve a child to let him live. That better treatment, though,

534
00:32:34,600 --> 00:32:37,200
Speaker 1: was finally found in nine two, and we're going to

535
00:32:37,280 --> 00:32:41,760
Speaker 1: talk about that on the next episode. So that is

536
00:32:41,800 --> 00:32:45,440
Speaker 1: sort of a cliffhanger, but also that means it's time

537
00:32:45,480 --> 00:32:48,280
Speaker 1: for listener mail. It is time for listener mail. This

538
00:32:48,360 --> 00:32:51,280
Speaker 1: is from Dan, and Dan wrote in to say I

539
00:32:51,360 --> 00:32:55,160
Speaker 1: love the recent six Impossible Episodes podcast on civil actions.

540
00:32:55,600 --> 00:32:59,080
Speaker 1: I actually gassed when you mentioned Julius Is. I'm a

541
00:32:59,160 --> 00:33:03,400
Speaker 1: journalist and frequently right about LGBTQ history. Stonewall was a

542
00:33:03,400 --> 00:33:06,280
Speaker 1: pivotal moment but it's so important to understand how much

543
00:33:06,320 --> 00:33:08,920
Speaker 1: work was done before then, and the sip in is

544
00:33:08,960 --> 00:33:11,360
Speaker 1: one of those key moments leading to the removal of

545
00:33:11,400 --> 00:33:14,880
Speaker 1: the New York liquor Boards ban on serving alcohol to homosexuals.

546
00:33:14,880 --> 00:33:17,320
Speaker 1: But I'm writing because I wanted your readers to know

547
00:33:17,800 --> 00:33:20,640
Speaker 1: that not only is Julius is still open, but it's

548
00:33:20,640 --> 00:33:23,200
Speaker 1: a wonderful bar that welcomes everyone. It opened in the

549
00:33:23,240 --> 00:33:26,200
Speaker 1: eighteen sixties, and by the nineteen fifties it was widely

550
00:33:26,240 --> 00:33:29,520
Speaker 1: known as a gay hangout, popular with Truman Capote, Tennessee

551
00:33:29,520 --> 00:33:33,280
Speaker 1: Williams and Rudolph Neriev. There's a press clipping from Walter

552
00:33:33,400 --> 00:33:36,360
Speaker 1: Winchell on the wall. It's largely the same as it

553
00:33:36,480 --> 00:33:39,400
Speaker 1: was when the Sippin happened, with photos and memorabilia from

554
00:33:39,440 --> 00:33:43,000
Speaker 1: that era. They have a monthly party machine named after

555
00:33:43,000 --> 00:33:46,840
Speaker 1: the Historic Machine Society. Unlike the Woolworth lunch counters and

556
00:33:46,920 --> 00:33:50,120
Speaker 1: other venues, Julius is one of the few places involved

557
00:33:50,120 --> 00:33:53,080
Speaker 1: in America's civil rights struggle that still exists in its

558
00:33:53,080 --> 00:33:55,920
Speaker 1: original form, not as a museum or a monument, but

559
00:33:55,960 --> 00:33:59,960
Speaker 1: as a living, breathing space for community celebration and joy.

560
00:34:00,040 --> 00:34:02,200
Speaker 1: I urge anyone coming to New York to hop down

561
00:34:02,240 --> 00:34:04,080
Speaker 1: to the village to visit this one of a kind

562
00:34:04,160 --> 00:34:07,000
Speaker 1: watering hole. Their burgers are to die for. Thanks for

563
00:34:07,040 --> 00:34:09,879
Speaker 1: all you do, sincerely, Dan. Thank you so much Dan

564
00:34:09,960 --> 00:34:12,560
Speaker 1: for writing I of course did not have all of

565
00:34:12,560 --> 00:34:16,160
Speaker 1: this detail in the outline ever, um but I did

566
00:34:16,200 --> 00:34:18,959
Speaker 1: at one point half that like the Julius is still

567
00:34:18,960 --> 00:34:22,160
Speaker 1: open and it welcomes everyone now um as opposed to

568
00:34:22,200 --> 00:34:24,400
Speaker 1: sort of what happened on the day with the manaching

569
00:34:24,480 --> 00:34:28,640
Speaker 1: Society sippen. But that six impossible episodes felt like it

570
00:34:28,680 --> 00:34:31,160
Speaker 1: was getting quite long, and I made some cuts for length,

571
00:34:31,200 --> 00:34:33,640
Speaker 1: and that was one of the details that was sadly

572
00:34:33,680 --> 00:34:36,080
Speaker 1: cut out. So thank you so much Dan for writing

573
00:34:36,080 --> 00:34:38,480
Speaker 1: in and giving me the chance to add that Today.

574
00:34:39,239 --> 00:34:40,880
Speaker 1: If you would like to write to us about this

575
00:34:41,000 --> 00:34:43,680
Speaker 1: or any other podcast, we're at History podcast that I

576
00:34:43,760 --> 00:34:46,239
Speaker 1: Heart radio dot com. And then you'll also find us

577
00:34:46,239 --> 00:34:48,560
Speaker 1: all over social media at miss in History. That's where

578
00:34:48,560 --> 00:34:52,879
Speaker 1: you will find our Facebook, Twitter, Pinterest, and Instagram. You

579
00:34:52,960 --> 00:34:55,840
Speaker 1: can subscribe to our show on Apple podcast, the I

580
00:34:55,880 --> 00:35:01,000
Speaker 1: Heart Radio app, and anywhere else to get your podcasts. MMMM.

581
00:35:04,040 --> 00:35:06,200
Speaker 1: Stuff you Missed in History Class is a production of

582
00:35:06,280 --> 00:35:09,480
Speaker 1: I Heart Radio. For more podcasts from I heart Radio,

583
00:35:09,680 --> 00:35:12,680
Speaker 1: visit the I heart Radio app, Apple podcasts, or wherever

584
00:35:12,760 --> 00:35:17,640
Speaker 1: you listen to your favorite shows. H