DIABETES

A history of diabetes over the past 150 years, less as a disease than a mark of racial stereotyping.

Vanderbilt professor Tuchman, a specialist in the history of medicine in the U.S. and Europe, begins in the late 19th century, when scientists had learned enough about germs, hygiene, nutrition, and physiology to give doctors confidence that they understood disease. Using diabetes as her example, the author delivers a well-researched, lucidly written, and often unnerving account of how doctors have explained it down to the present day, often ignoring the science in favor of the prejudices and anxieties of their time. Readers may be surprised to learn that until well into the 20th century, doctors considered diabetes a Jewish disease, supposedly caused by what some physicians called “Jewish nervousness.” During this same period, doctors recorded so few cases of diabetes in Black patients that many regarded them as immune, following the racist belief circulating at the time that “immunity signified a race’s primitive nature.” In a theme she repeats throughout, Tuchman points out that statistics during this period refuted both claims, but few paid attention. As the 20th century progressed, these theories faded, replaced by the idea that diabetes was the result of overindulgence. Most victims were obese, and women fell victim more often than men. Tuchman stresses that racial stereotyping did not disappear but merely switched gears. Flawed notions of poverty, obesity, and race all contributed to prejudice and discrimination, though the word “race” was rarely mentioned. Even today, writes Tuchman, there is not enough “recognition that racism and poverty are themselves fundamental causes for ill health, potentially exacerbating diabetes by raising stress and glucose levels, and certainly placing an additional burden on individuals who may already be struggling to make ends meet.” Labeling patients as “responsible for their disease,” she writes, “masks the structural inequalities that produce poor health.”

Unsettling but insightful social history.