A Male Hysteria: Diabetes and the Victorian Mind

by Edward Beasley

Overview

A history of diabetes science and the experience of diabetics in the nineteenth—century England

A Male Hysteria examines both the science of diabetes in nineteenth—century England and the testimony of Victorian diabetics. What could be known about diabetes given the science of the day? And what did new models of diabetes mean for the treatment and self—image of diabetics?

Ideas about diabetes were revolutionized in 1849 by the great French physiologist Claude Bernard. After he made rabbits diabetic by pricking their brains, diabetes in England came to be thought of as neurological, even psychological in origin. British diabetics (often men) were prevented from working or becoming excited, treated in the same manner as women who were diagnosed with hysteria. Meanwhile, discoveries in thermodynamics were applied to diabetics and menstruating women. People were assumed to be closed systems, wasting energy that couldn't be replenished. Thus, diabetics had to stay still if they wanted to live and women had to stay away from education to have the energy to produce children.

Some people resisted these hysterical views. As no brain lesion was ever found in deceased diabetics, even after decades of searching, the animal model of the disease no longer seemed to apply to humans. Some diabetic patients also resisted the hysterical picture, including medical professionals—both men and women—who refused to slow down as the new treatment regimen was mandated. Likewise, physicians at spas noted that walking long distances seemed to help diabetics.

A Male Hysteria journeys through nineteenth—century diabetes science and the lives of diabetics. It examines how science can go wrong when models from one area of inquiry are too excitedly applied to another. It also demonstrates the persistence of the psychological stereotype of diabetics as nervous and overworked in the United Kingdom—long after medical attention turned to the pancreas and the role of insulin.

Product Details

ISBN-13:	9781606189016
Publisher:	University of Pennsylvania Press, Inc.
Publication date:	07/30/2024
Series:	Transactions of the American Philosophical Society , #6
Pages:	456
Product dimensions:	6.00(w) x 9.00(h) x 0.00(d)

About the Author

Edward Beasley is Professor Emeritus of History at San Diego State University. He is the author of several books on how people thought about empire and race in nineteenth—century England, including The Victorian Reinvention of Race: New Racisms and the Problem of Grouping in the Human Sciences (2010) and The Chartist General: Charles James Napier, The Conquest of Sind, and Imperial Liberalism (2017). He lives in Baltimore, Maryland.

Andrew Scull is Professor Emeritus of Sociology at the University of California San Diego, and one of the world's foremost historians of medicine.

Read an Excerpt

Preface: Diabetes Then and Now by Andrew Scull

For millennia, diabetes mellitus was a death sentence, until the discovery of insulin in 1921 transformed it for some into a chronic disease. Yet it remains a disease that causes immense amounts of suffering—a major cause of kidney failure, of blindness, not to mention heart attacks, strokes, and amputations. It wreaks havoc on the nervous system and blood vessels, contributing to greatly reduced life expectancy. Worse still, its incidence is exploding world—wide. Cases have risen from 108 million in 1980 to 537 million by the end of 2021, a number that is expected to exceed 600 million by the end of the decade. More than 10 per cent of the American population have the disease. And all those statistics almost certainly underestimate the scale of the problem, since in the early stages of the most common form of diabetes, the disease is frequently not detected, only surfacing once its progress has already inflicted major damage on the body.

For more than a century, Western medicine has distinguished between two forms of diabetes. What used to be called juvenile diabetes (a misnomer because it can also develop in later life) is now referred to as Type 1 diabetes. It appears when the body’s immune system turns on itself, attacking the islets in the pancreas that are charged with producing insulin and destroying them. Its onset is rapid, and before the discovery of insulin and a means to administer it, 50 per cent of the afflicted died within a year, and more than 90 per cent within five years. So—called Type 2 diabetes has a different pathology. The body continues to produce insulin but proves increasingly unable to utilize it properly. Its onset is more insidious, and it often goes undetected for considerable periods of time. It is particularly common in those who are obese or overweight, and live sedentary lives, but it also appears to be partially rooted in genetics. It is this second form of diabetes that accounts for more than 80 per cent of contemporary cases, and that is the biggest contributor to the surge in the incidence of the disease.

Despite our increased understanding of the pathophysiology of diabetes, cures remain elusive and largely unobtainable. And the disease’s frequent association with indolence and obesity has added stigma to the burdens of those who contract it. Diabetics, we are frequently reminded, consume a disproportionate share of health—care resources, creating resentment in publicly funded health care systems and attempts by private insurers to evade enrolling them in their programs.

It is a bleak picture, despite our ability to prolong the lives of Type 1 diabetics with insulin and careful monitoring of their blood—sugar levels, and from the 1950s onwards, when the first oral antidiabetic drug entered the marketplace, to use medication, diet, and lifestyle changes to mitigate and delay the onset of deleterious effects of its Type 2 version. And yet by comparison with the situation before the Canadian team of Banting, MacLeod, Best, and Collip discovered insulin, it represents a marked improvement. To be sure, diabetes continues to shorten the lifespan of many of its sufferers, and their lengthened lives are all—too—often compromised by loss of sight, kidney disease, heightened susceptibility to infections, and vascular disease that eventually could require amputation of the lower limbs.

What of that world before 1921? How was diabetes understood and how was it treated? That is the task that Edward Beasley has set himself, and it is a formidable one, even though he has chosen to confine his attentions to the nineteenth century. “Diabetes” comes from Greek and Latin words meaning “to pass through” and “mellitus,” the Latin for sweet, a suitable label for what the eminent seventeenth—century neurologist Thomas Willis called “Pissing Disease.” Willis had noticed the sweet taste of diabetic urine, and that had long been a standard way to diagnose the disease. But what caused the body to excrete sugar was the subject of considerable debate. For many of those who addressed the problem in the late eighteenth and early nineteenth century, the problem was presumed to lie in the stomach, an organ that somehow turned food into unusable sugar. Others found fault with the kidneys. As for treatment, diet and tonics were usually recommended, with opium added on the grounds that it reduced the amount of urine produced.

That broad consensus was soon turned upside down, and as Beasley shows, it was the work of the great French experimental physiologist Claude Bernard that prompted the re—evaluation of the origins of diabetes, moving the field in a radically different direction, one that reverberated powerfully for decades afterwards, and pushed diabetes research down a cul—de—sac. Ironically, among Bernard’s great and controversial discoveries (for they were made via the vivisection of animals, including the family dog) were advances in the understanding of the role of the pancreas in digesting fats, and of the liver in making sugar and converting it into glycogen for storage. That work obviously trespasses on the sites that generations later would become the focus for the modern understanding of diabetes. Among Bernard’s many contributions was work on carbohydrate metabolism, and the place of the liver and the pancreas in that process. He showed that sugar was always found in the blood, indeed that its absence was incompatible with life. When blood—sugar levels exceeded a certain threshold, however—3 or 4 percent—that hyperglycemia proved too much for the body to cope with. The kidneys then acted to deal with the problem, and the excess sugar was excreted in the urine. Hence both the frequent urination and the glycosuria or sugar in the urine that had long been known to characterize diabetes. But it was to the liver rather than the kidneys that he pointed, given the role of the former in carbohydrate metabolism.

But still another experiment led Bernard and then others to shift their attention away from the liver and pancreas and toward the nervous system. In understanding what brought diabetes about. Bernard found, in Beasley’s words, “that he could create what looked like diabetes in a test animal by inflicting one and only one lesion near the base of the [vagus] nerve leading from the brain to the internal organs.” Thus was born the notion that diabetes was ultimately a disease of the nervous system. And soon enough, the deranged state of the nervous system that gave birth to heightened production of sugar in the liver was labeled a form of neurosis, an organic disturbance of the nervous system provoked by mental causes, stress, and the exhaustion of the nervous system.

Practically speaking, physicians had concluded by the late eighteenth century that, regardless of what caused diabetes, it was excess sugar that created problems for the patient. Hence an ongoing attempt to address that issue by regulating the patient’s diet. By doing so, doctors hoped to prevent the formation of sugar. Carbohydrates and “vegetable matter” were the usual enemies whose ingestion had to be sharply limited in favor of protein and fat. Once methods were developed in the middle of the nineteenth century to measure the amounts of sugar in the urine, the efficacy of different diets might be “scientifically” compared—a process that helped to spawn a host of different approaches to the management of the disease: Donkin’s skim—milk diet, Mosse’s potato, and von Noorden’s oatmeal cure (which was nothing of the sort) to name but a few that were tried. More drastically, some began to recommend a drastic reduction of caloric intake. The French physician Apollinaire Bouchardat told his patients “mangez le moins possible,” and such advice was often taken to extraordinary lengths. Patients often cheated or rebelled entirely, though near—starvation did indeed eliminate sugar from their urine. Those who embraced the regimen might indeed extend their lives, though they were at constant risk of ketoacidosis, which manifested itself by breath that smelled of acetone and quickly progressed to irreversible coma and death. As Beasley notes, not for the last time, medical theories and interventions brought new iatrogenic risks.

Pragmatically, diet might retain its primary influence in managing the disease, but the underlying problem, the source of the disorder, was for most physicians essentially mental. Diabetes came from worry, and since men had the more important things to worry about, the theory that diabetes had a nervous origin implied that it would be more commonly found among men. Too much work, too much stress could lead on the one hand to the disease of neurasthenia (a nervous disorder first propounded by the American neurologist George Miller Beard in the late 1860s), but on the other hand it could instead provoke diabetes. From that stemmed a further set of prescriptions about the management of the latter: an urgent need to avoid undue excitement of the nervous system and to live a quiet and uneventful life. As Beasley puts it, “diabetics, like the hysterics, should not be operating out in the grown—up masculine world. They had to be protected from the physical assault of train travel, and protected from anything else that might worsen their condition and trigger the catastrophe of a diabetic coma. They had an energy—and—brain disease, and they needed to be overruled in their desires and kept under control.” The misanthropic Henry Maudsley, who dominated late nineteenth—century British psychiatry, was at one with many of his alienist colleagues in believing that diabetics were close cousins of the insane, both examples of degeneration, along with epilepsy, asthma, hysteria, and alcoholism.

The reorientation of medicine that had begun in Paris in the early nineteenth century had at its core the correlation of clinical symptoms in life with post—mortem discovery of lesions on autopsy. But the clinic—pathological method faced an impasse when it came to diabetes. Excessive urination pointed toward the kidneys but they looked normal, as did other organs on inspection. Even at the end of the nineteenth century, the absence of obvious lesions led many to classify diabetes as a “general disease” with no ascertained pathology. That inability to discover morbid appearances extended to the nervous system and the brain, without having much notable effect on the widespread assumption that diabetes had a “nervous” origin. That was particularly the case with older, fatter people, whose nervous systems, in the words of the American neurologist Silas Weir Mitchell, had been subjected to excess “wear and tear.”

Nor did a critical discovery made in 1889 immediately lead to the abandonment of this now long—standing consensus. Working in a laboratory in Strasbourg, Oskar Minkowski had been involved in discussions about the functions of the pancreas. Having decided that the best way of uncovering what it did was to remove it, and having an experimental dog to hand, he performed the necessary operation. Bereft of its pancreas, the dog began to urinate uncontrollably, and on testing its urine, Minkowski found it was full of sugar. Further experiments where a portion of the pancreas was removed and implanted elsewhere in the body before the rest of the organ was removed showed that diabetes did not appear, though it did once the implant was extracted in a subsequent surgery.

Despite these findings, suspicions that diabetes ultimately had a nervous origin persisted in many quarters. This is most clearly illustrated in the views of William Osler, first physician at the Johns Hopkins School of Medicine, a man revered in the profession and often dubbed the Father of Modern Medicine. Osler saw what we now call Type 1 diabetes as hopeless, as it then was, and concentrated his attention on diabète gras, the disorder mostly found among the overweight. As late as 1909 in his famous textbook The Principles and Practice of Medicine—the bible for generations in most medical schools—alongside an emphasis on a low—carbohydrate diet, he insisted that “Sources of worry should be avoided and [the diabetic] should lead an even quiet life, if possible in an equable climate.”

Still, the genie was out of the bottle. Long neglected, the pancreas now became the focus of much research. Knowledge of the role of secretions from various glands had been growing in recent decades. In 1869, the Parisian Brown—Séquard had used research on the adrenal glands to suggest that they produced profound physiological effects. More sensationally, some twenty years later when in his seventies, he prepared a testicular extract from monkeys, injected it into himself and pronounced himself rejuvenated: Viagra avant la letter. Patent medicine quacks were quick to jump on the endocrine bandwagon, promoting a variety of therapeutic substances of dubious efficacy. But serious research on internal secretions was also under way. As early as 1891, a thyroid extract from a sheep was successfully used to treat a woman with a severely underactive thyroid, and soon it became clear that the extract could successfully be given orally. Ironically, that would prove a problem for those working on diabetes, because insulin cannot be delivered in this fashion.

The pathway to discovering what exactly it was that the pancreas produced that regulated sugar in the blood was anything but straightforward, and more than three decades would pass between the discovery that the absence of a pancreas would automatically induce diabetes and the discovery of insulin. That discovery when it arrived had a dramatic effect on the fate of young sufferers from Type 1 diabetes. Their disease, from being virtually uniformly and rapidly fatal was transformed into a condition that could be managed for years, even decades. It would be much longer before the different pathology of Type 2 diabetes was unraveled. (Here the pancreas continues to produce insulin but it is increasingly ineffectual in performing its normal function). And longer still until the first effective drugs to manage that disease first appeared on the scene—in the late 1950s.

Nor did the stigma that had long clung to those afflicted with the disease disappear with the arrival of novel treatments that greatly mitigated its pathological effects. Type 2 diabetes, linked in the nineteenth century to overstrain and overwork was now recast as a disease of the slothful and the overweight, whose life choices and weakness of will provoked and explained the disorder that afflicted them. In the 1930s and 1940s, as Beasley shows, a diagnosis of diabetes brought discrimination in employment and an inability to secure life insurance. Though the former problem has abated, diabetes remains a source of shame for many of those who suffer from it. As I’ve already indicated, publicly funded medical systems express resentment over the costs diabetics impose on their budgets, and the American system of private insurance funded health care actively attempts to avoid covering them. Regrettably, we remain a long way from being able to cure either Type 1 or Type 2 diabetes, and its rapidly increasing incidence is a major public health problem worldwide. Edward Beasley’s book is a stimulating and provocative guide to the history of our attempts to grapple with the disorder over the past two centuries and more.

Table of Contents

Contents
Abbreviations
Preface Diabetes Then and Now by Andrew Scull
Chapter 1. Introduction
Chapter 2. Diabetes Before Bernard
Chapter 3. Bernard’s Revolution and the Diabetes of the Brain
Chapter 4. Diabetes and Medical Science after Bernard
Chapter 5. Robert Saundby’s Statistical and Clinical Response
Chapter 6. Hysteria and Henry Maudsley
Chapter 7. The Cultural Context
Chapter 8. The Lives Affected: Diabetes in the DNB
Chapter 9. Diabetes at the Spa
Chapter 10. From the Brain to the Pancreas
Chapter 11. Insulin and After
Chapter 12. Conclusion

Editorial Reviews

"Beasley…does an incredible job capturing the history of medical treatments (which were sometimes, but not always, based in science) as well as the evolving human story of what it has meant in different eras to live with [diabetes]. To derive this multifaceted understanding, he draws from diverse sources that include not only expert medical texts but also personal correspondence and other forms of writing that document the experiences of diabetic patients themselves. Beasley's prose and engaging storytelling make this book appropriate for a wide audience of readers, including historians of medicine but also physicians, other health care providers, scholars in adjacent disciplines, and diabetic patients themselves."

Journal of the History of the Behavioral Sciences - Amy Koerber

"Beasley’s work painstakingly explores the social construction of diabetes and convincingly argues that the association of diabetes with the nervous system and especially its framing as a mental disorder were the products of 'a male hysteria' ... [This] is an excellent and riveting read that will be of interest to scholars of the history of science and medicine and their students."

Choice - John Rankin