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Book Review : Bittersweet: diabetes, insulin and the transformation of illness

Medical History
Cambridge University Press
Publication Date
  • Book Reviews
  • Biology
  • Medicine


In 1923, fifteen-year-old Tracy, living at Cape Cod in the USA, contracted diabetes and was one of the first in the world to receive insulin. Twenty-seven years later she was writing to her physician, Dr Priscilla White, about her failure to get a Victory medal from her Boston clinic, despite being “sound and healthy”. In 1947, Dr Elliott Joslin had created this Victory medal to be awarded to any patients who had diabetes for twenty-five years or longer and were found—after a thorough physical examination, X-rays and an analysis of the urine—to be in perfect health. In Joslin's view lasting health with diabetes was a Scientific and Moral Victory, and this was imprinted on his other medal—the Life Span medal awarded to those who had diabetes for fifty years. Of course, the premise of this was that patients could control their disease if they followed the rules set down by the doctors; patients were responsible for their health, good or bad. A small step from this was the conclusion that patients were to blame for the long-term complications of diabetes. Tracy's exclusion was on the basis that she had minor degrees of background retinopathy. “What has got into him that he won't give me this medal?” fumed Tracy to Dr White. In Bittersweet, Chris Feudtner recounts in startling clarity the tensions and the tragedies of diabetes as seen through the correspondence of patients writing to Joslin over the sixty years of his medical career. The book describes the catastrophe of diabetes before the advent of insulin in 1921, and illustrates the unfolding medico-social tensions of the fight for prevention of complications in the following decades. For those outside the day-to-day struggle it often seems that insulin was the cure, and, of course, at one level it was. But beyond the physiological necessity for insulin to sustain life came the need for daily or multiple injections, the need to check urine many times daily (by boiling it with reagents in a small test tube), and the need to understand many aspects of

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