Gary Taubes - The Case Against Sugar

Mary Han unmarried woman, twenty-six years of age, came to the Out Patient Department of the Massachusetts General Hospital on August 2, 1893. She said her mouth was dry, that she was drinking water all the time and was compelled to rise three to four times each night to pass her urine. She felt weak and tired. Her appetite was variable; the bowels constipated and she had a dizzy headache. Belching of gas, a tight feeling in the abdomen, and a burning in the stomach followed her meals. She was short of breath.

ELLIOTT JOSLIN S diabetes case no. 1,
as recorded in the case notes of his clinic

E lliott Joslin was a medical student at Harvard in the summer of 1893, working as a clinical clerk at Massachusetts General Hospital, when he documented his first consultation with a diabetic patient. He was still a good three decades removed from becoming the most influential diabetes specialist of the twentieth century. The patient was Mary Higgins, a young immigrant who had arrived from Ireland five years previously and had been working as a domestic in a Boston suburb. She had a severe form of diabetes mellitus, Joslin noted, and her kidneys were already succumbing to the strain put upon them by the disease.

Joslins interest in diabetes dated to his undergraduate days at Yale, but it may have been Higgins who catalyzed his obsession. Over the next five years, Joslin and Reginald Fitz, a renowned Harvard pathologist, would comb through the hundreds of volumes of handwritten case notes of the Massachusetts General Hospital, looking for information that might shed light on the cause of the disease and perhaps suggest how to treat it. Joslin would travel twice to Europe, visiting medical centers in Germany and Austria, to learn from the most influential diabetes experts of the era.

In 1898, the same year Joslin established his private practice to specialize in the treatment of diabetics, he and Fitz presented their analysis of the Mass General case notes at the annual meeting of the American Medical Association in Denver. They had examined the record of every patient treated at the hospital since 1824. What they saw, although they didnt recognize it at the time, was the beginning of an epidemic.

Among the forty-eight thousand patients treated in that time period, a year shy of three-quarters of a century, a total of 172 had been diagnosed with diabetes. These patients represented only 0.3 percent of all cases at Mass General, but Joslin and Fitz detected a clear trend in the admissions: the number of patients with diabetes and the percentage of patients with diabetes had both been increasing steadily. As many diabetics were admitted to Mass General in the thirteen years after 1885 as in the sixty-one years prior. Joslin and Fitz considered several explanations, but they rejected the possibility that the disease itself was becoming more common. Instead, they attributed the increase in diabetic patients to a wholesome tendency of diabetics to place themselves under careful medical supervision. It wasnt that more Bostonians were succumbing to diabetes year to year, they said, but that a greater proportion of those who did were taking themselves off to the hospital for treatment.

By January 1921, when Joslin published an article about his clinical experience with diabetes for The Journal of the American Medical Association, his opinion had changed considerably. He was no longer talking about the wholesome tendencies of diabetics to seek medical help, but was using the word epidemic to describe what he was witnessing. On the broad street of a certain peaceful New England village there once stood three houses side by side, he wrote, apparently talking about his hometown of Oxford, Massachusetts. Into these three houses moved in succession four women and three menheads of familiesand of this number all but one subsequently succumbed to diabetes.

Joslin suggested that had these deaths been caused by an infectious diseasescarlet fever, perhaps, or typhoid, or tuberculosisthe local and state health departments would have mobilized investigative teams to establish the vectors of the disease and prevent further spread. Consider the measures, he wrote, that would have been adopted to discover the source of the outbreak and to prevent a recurrence. Because diabetes was a chronic disease, not an infectious one, and because the deaths occurred over years and not in the span of a few weeks or months, they passed unnoticed. Even the insurance companies, Joslin wrote, failed to grasp their significance.