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THE HISTORY OF medicine "is like the night sky," says thehistorian Roy Porter in his book "The Greatest Benefit toMankind: A Medical History of Humanity." "We see a few.stars and group them into mythic constellations. What ischiefly visible is the darkness."

Diabetes doesn't come from simply eating too much sug-ar; nor is it cured, as was once thought, by a .little horsebackriding. It is not the result of a failing kidney, overactive liveror phlegmy disposition, though these were the author-itative answers for centuries. Diabetes happens when the,;blood becomes saturated :with glucose, the body's main~ienergy source, which is normally absorbed.by the cells;-which is to say that the pathology of diabetes is subtle and "-invisible, so much so that a third of the people who have itdon't even know it. Until the prohibition against autopsie~was gradually lifted (by 1482, the pope had informally sanc-

I tioned it), what we knew of human anatomy came throughhatJesEvans Hughes with his daughter; Elizabeth, two years before she developed diabetes. the tiny window of war wounds and calamitous gashes -

and even then it took centuries for doctors to decide just -E - what the long, lumpy organ called the pancreas actually did

leven-year-old Elizabeth Hughes was, in retrospect, the ideal or. in the case of diabetes. didn't do. We like to think surgically about ...

patient: bright, obedient; uncomplaining and wholly unpre- the history of medicine, that it moved purposefully from insight topared to die. Born in 1907 in the New York State governor's insight; angling closer to cure. But that is only the luxury of contem-

mansion, Elizabeth was the daughter of Charles Evans Hughes, who porary life. Looked at over time, medicine -doesn't advance as much aslater became a justice on the Supreme Court, ran against Woodrow grope forward, with remedies - like bloodletting, quicksilver oint:-Wilson in 1916 and served as secretary of state under Harding. ments and simple, unendurable hunger - that blurred the line be-

Elizabeth had a perfectly normal, aristocratic youth until she tWeen treatment and torture.seemed to become allergic to childhood. She would come home Diabetes was first diagnosed by the Greek physician Aretaeus offrom friends' birthday parties with an insatiable thirst, drinking al- - Cappadocia, who deemed it a "wonderful affection. .. being a melt-most tWo quarts of water at a sitting. By winter, she had become ing down of the flesh and limbs into urine." For the afflicted, "life isthin, constantly hungry and exhausted. Her body turned into a sieve: disgusting and painful; thirst unquenchable.. .. and one cannot stopno matter how much water she drank, she was always thirsty. them from drinking or making water." Since the classical period for-

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nsulin, a hormone that instruCts the body,0 use the sugar in the blood for energy:

Ith Type 2, the pancreas produces insu:'in (at least initially), but the tissues of the~ody stop responding appropriately. BY'f776, doctors were still just boiling the~rine of diabetics to conclusively deter~[ine that they were passing sugar,onlyto'~!~tch their pati~ntsfallinto hyperglyc~;:,~lC comas and dIe. "'TIf dangerous levels.' of glucose were

umping out of diabetics, one idea was ob-'.ous:stop it from going in. That demand-d a more sophisticated understanding ofood itself. In the long tradition of gro-esque scientific experimentation, ~ in-cight came through a lucky break: a gaping;;)tomach wound. In 1822, William Beau-

1 ont, a surgeon in the U.S. Army, went t6! he Canadian border to treat a 19-year-oldI bade dissection, Poner notes, "hidden rapper hit by a shotgun. The boy recov-

workings had to be deduced largely from red, but he was left mth a hole in his ab-,! what went in and what came out." An ear- omen. According to Poner, Beaumontl ly diagnostic test was to swill urine, and to 'took advantage of his patient's uniqueI the name diabetes, meaning "siphon," was 'ndow" and dropped food in on a string... I eventually added "mellitus," meaning e seasoned beef took the longest to di-

, i "sweetened mth honey." Healers could est. Stale bread broke down the quickest.I often diagnose diabetes without the taste e digestion process clearly worked dif-i test. Black ants were attracted to the urine erently depending on what was eaten.i Qf those wasting away, drawn by the sugar en during the 1871 siege of Paris by theI content. Generations later, doctors would ermans, a French doctor named Apolli-i make a similar deduction by spotting dried aire Bouchardat noticed that, though: white sugar spots on the shoes or pants of undreds were starving to death, hisdia-I diabetic men mth bad aim. etic patients strangely improved. This be-I For the Greeks, to separate disease me the basis for a new standard of treat-

. . . . j symptoms from individual pain while iso- ent. Mangez Ie maim possible, he advised~ Tog Shop IS proud to re-introduce two original I lating them from magical causes was itself hem. Eat as little as possible.signs by Vera Neumann whose signature ! an enormous intellectual leap. "We should -irves defined a generation of stylish elegance. I be really impr~sed with Aretaeus," says IN THE SPRING of 1919, when Elizabethese glorious silk scarves celebrate spring at two i Dr. Chris Feudtner, author of the coming Hughes came under Dr. Allen's care, sheVera's beloved Manhattan landmarks. They are a "Bittersweet: Diabetes, Insulin and the weighed 75 pounds and was nearly 5 feetleless staple for any wardrobe. Transformation of Illness." "He was able tall. For one week, he fasted her. Then he

to spot the pattern of diabetes in a dense put her on an extremely low-calorie dietEach pure silk scarf is a generous 32" square. thicket of illness and suffering." to eradicate sugar from her urine. If the

4954 Springtime in Central Park (top) Sit8 But for centuries, this increasing preci- normal caloric intake for a girl her age isi5 Tulip Time in Rockefeller Center (bottom) Sit8 sion in disease recognition was not fol- betWeen 2,200 and 2,400 calories daily,

. . lowed by any effective treatment - more Elizabeth took in 400 to 600 calories aJd $6.95 shIpping. Two or.mo.re ~arves to the same details didn't make physicians any less day for several weeks, including one day

address and shippIng IS free. helpless. At the time, they were unknow- of fasting each week. Her weight, notingly confusing tWo kinds of diabetes: surprisingly, plummeted. As Michael

,: Type 1, known until recently as "juvenile Bliss notes in his book "The Discovery ofGreat Mother's Day Gift - May 111 :;;:i~ diabetes," which is more extreme but less Insulin," the Hughes family brought in a

:;";.. common than Type 2, or "adult onset," nurse to help weigh and supen-ise every:/able only from ;~: which seems to be related to obesity and gram of food that she ate. Dessens and-fTH E ;"; overeating. With Type 1 (what Elizabeth bread were verboten. "She lived on leanOC ;; Hughes had), the pancreas stops secreting meat, eggs, lettuce, milk, a few fruits,

'::-.~ tasteless bran rusks and tasteless vegeta-"i:~;:: Austin Bu,!n ;sa ~quentcontributoTto bles (boiled three times to make t~em ~l-

SHOP ",.;" "the magazIne. ",'-"'", .' ",.cC,c "~ost totally carbohydrate-free), Bliss- DIABETES.c~NTE~

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But in August 1922, Dr. Frederick Allen had pai~e~

hocould not wait, like Elizabeth. Allen left for To'rol

0" to seCUre insuIm. While he was gone, word leake

hrough his cImic about the breakthrough. Panep1

'who had not been out of bed for weeks began to t~

eakly about, clinging to walls and furniture,"MOl

ne nurse. "Big stomachs, skiri-and:'bone necks, skUU.. e faces they looked like an old Flemish paiIit~~:

epicuonof a resurreCtion after famine. It was a resurie~

,.on, a crawImgstirririg, as ofsorne vague springtim~.'!f~~

On the night Allen returned to the clinic, he found hi

atients - "silent as the bloated ghosts they looke(

ike" - waiting in the hallway for him, wrote the nurse

hen he appeared through the open doorway, hcughtthe full beseeching ofa hundred pair of eyes. !1

topped him dead. Even now I am sure' it was minute!efore he spoke to them. ... '1 think. ' h~ said. '~ t.hjp~

h h. f, '" '"eave somet Ing or you. 'c,,;,]~'

He did, but not nearly enough. Though the resUlt!

ere striking-with the insulin, sugar vanished from the

rine of "some of the most hopelessly severe cases of dia.;

etes I have ever seen," wrote Allen - he did not have

;Walpole Woodworkers.° nough extract-to t,reat all his Patients, including EI~~

eth.So her parents got her to Toronto. When Banting

MORRJSPLAINS,NJ973-539-3555.HUNTINGTONSTATlONNY631-673-37530WAlERMILL. NY 63 1-726-2859 aw Elizabeth, she was three days away from her 15th-IGTON, CT 860-677-96900 RlDGEFIEIJ), CTW3-438-3134. WESTPOKr CT203-255-90IO. WALPOLE, MA 508-668-2800 irthday; She weighed 45 pounds. He wrote: "Pauentex-;OO-343-6948.EASTFA~10UiH,MAS08-S40-0300.NORWELL.MA781-68f-9099.WJLMINGTON.MA978-658-3373 I' . t d h " b "ttl dth . IFRAMINCHAM;"!A 508-875-6668 . MGEAN, VA 888-880-4411 . www.waipolewoodworkcrs_com erne y emacla e air n e an In ... musc es

' xtremely wasted. ... She was scarcely able to walk. "

He started her insulin treatment immediately. TheTh E aId I I rstinjections cleared the sugar from her urine, and by

e mer s e he end of the first week, she was up to 1,220 calories a

. . . y; still without sugar. By the next, she was at 2,200cal-

Shade LovIn g Hostas fi orNaturallzlng ries.B~tingadvisedhertoeatbreadandpotatoes,but

he was Incredulous. It had been three and a half years

ince she had them. That fall, she was one of several hun-

ed North American diabetics pulled back from the

dge. By November, she went home to her parents in

ashington, and by January; she weighed 105 pounds.

e same year, the 31-year-old Banting won the Nobel

rize. Meanwhile, Dr. Allen, proprietor of an expensive

linic whose patients no longer needed him, went broke.

nsulin was a miracle drug, resurreCting diabetics from'

omas and putting flesh on skeletons and, since it need..,

d to be administered at least twice daily; it was a miracle

t would be perfonned over and over. The era of

hronic medical care had begun.

That may be the most poignant part of the history of

en's clinic. The end of the famine of Elizabeth

ughes is really the start of another hunger: for the

rugs that will keep us well for the rest of our lives. Eliz-

beth went to Barnard, reared three children, drank and

moked but kept her diabetes :i secret almost her entire

fe. She died of a heart attack in 1981, more than 43,000

jections of ipsulin later. But if the discovery of insulin

ook away the terror of diabetes, it replaced themiracu-'

us with the routine. Healing lost one major ingredi-

nt: awe. "To think that I'll be leading a nonnal, healthy

Xistence is beyond all comprehension," Elizabeth

, , -, .. ote to her mother, days after her first injeCtion, in,c;"r'..,~;:.!::::f,:t: C :c;ci:": -

1922 " 1 . . I d ' rf I f, d " .'"'~i'~~i:4;"-"";':"",~:),:,;", i'r":,::"'i', . tlS simp y too won e u or wor s.' ,',",c', ,'~ ~