Richard M. Mizelle, Jr.

The University of Houston

Sugar Diabetes: Medical Entitlement and Civil Rights in America

Wake Forest University Colloquium

February 23, 2017

**Please do not reproduce without the author’s permission**

Introduction: The Pissing Evil

During the early fall of 1972, Jackie Roosevelt Robinson was visiting Miami, Florida to attend a dinner for an old friend. The fifty-three year old aging baseball great was approached for an autograph by an admirer while sitting at his table. By this time his eye-sight was in such bad shape that he needed help reading the menu, and though he had a penchant for writing lengthy autographs he told the fan that he was “glad to sign his signature but couldn’t write a personal message” because of his deteriorating vision.[1] Robinson had recently suffered a heart attack and was in excruciating pain from a pinched nerve in his leg that made walking difficult. Back home in Stamford, Connecticut several weeks later, Robinson was preparing for a trip to Washington, DC to speak at a symposium on drug abuse. Well known at the time was the son of Jackie and Rachel Robinson’s public battle with drugs. Jackie Robinson, Jr. was courageously fighting his addiction when he was killed in an automobile accident in 1971 at the age of 24. In the wake of their son’s death, Jackie and Rachel Robinson traveled the country speaking out against the dangers of drug abuse. Robinson’s health had rapidly deteriorated since the Miami trip and his physician pleaded with him to stay home and rest. He was now bleeding from the eyes and the pain in his legs had become unbearable to stand or walk.[2] Less than twenty-four hours later, on October 24, 1972, the man who broke the color line in Major League Baseball in 1947 died from heart-related complications to diabetes.

Jackie Robinson was never vocal about suffering from diabetes or his other health issues, deciding to keep those issues private. Robinson represented what seemed to many observers in the 1970s a sudden and unanticipated increase of diabetes among African Americans. The figure of Jackie Robinson as diabetic, African American and born in the South, represented an image of the disease far different from the turn of the twentieth century.

In a 1901 article printed in the Journal of the American Medical Association (JAMA), scientist James Herrick described what seemed to be a rare encounter with an African American patient: “About six years ago a colored medical student asked me to see him for a cough and great weakness. The cough I found due to tuberculosis complicating diabetes. This, by the way, is the only case of diabetes in the colored I have seen.”[3] A central figure in the history of sickle cell disease, Herrick was implying that the African American diabetic was a scientific novelty.

Three years earlier a physician writing for the Johns Hopkins Hospital Bulletin published the medical case of a person described as “Henry Roy; colored; aged 50 years; driver.”[4] After providing a litany of clinical details about the patient’s persistent cough, loss of appetite, excessive thirst, excessive urination, and loss of weight, the physician goes on to say that: “The patient is shown because diabetes in the negro is rather rare.”[5] The publication of this case is interesting for other reasons. It is rare to find early twentieth century African American diabetics recorded and documented in the patient-archive. In most cases the individual experiences of African American diabetics are refused to history. In the past scholars might have termed such records as being lost to history, but this is too imprecise a term for the racial patient-archive. Lost to the archive assumes an intention of recording the narratives of non-white groups of people. The medical-patient archive was too violent for such an assumption. African American diabetic patients were willfully absented from the patient-archive through a convergence of scientific racism, institutional exclusion, and region. We must speculate whether Henry Roy was actually his name, thoughinclusion of “colored” was a clear signal to readers not simply of this patient’s blackness but, more importantly his non-whiteness. Roy is described in the case as “a rather light-colored negro, much emaciated,” the importance of which comes in the necessity of physicians to explain black diabetics.[6] Located between the words in this physician description of Roy’s light complexion was a belief that the closer to whiteness a still non-white person was the more vulnerable to diabetes they might become.

Sugar Diabetes: Medical Entitlement and Civil Rights in America, 1900-2005 challenges the assumption of the “rare” African American diabetic in the early twentieth century on analytical grounds and answers the question of how African American diabetic patient-hood was grudgingly acknowledged. The excellent and growing body of research on the history of medicine and race often assumes a dearth of sources on the historical experiences of African Americans during the early to mid-twentieth century; the result being that African Americans often fall out of historical medical narratives and the history of disease identity. I argue this presumed invisibility is not by accident, but instead is part of the historical un-making of knowledge around diabetes. Historian Robert Proctor describes this phenomenon as the act of “ignorance-making,” or information that “could have been but wasn’t, or should be but isn’t.”[7] Language is used in the scientific production of doubt to silence certain kinds of information. Gerald Markowitz and David Rosner make the case that lead industries created doubt around the known dangers of lead toxicity from the early twentieth century, effectively frustrating efforts by public health officials and reformers to curb the use of lead-based products in America. The language of producing doubt revolved around calls for more researchand a clear line of causality before policy changes could be made.[8] Tobacco industries would also employ language to create doubt between cigarette smoking and lung cancer, arguing that any of a number of exposures might lead to cancer. Writing on toxicity and what has been coined “Agnotology” or ignorance-making, Naomi Oreskes and Eric Conway argue that the slowness of comprehending neurological and toxic effects of pesticides inside the human body has resulted in uneven laws that continue to expose individuals to illness while industries call for more research.[9] I am not arguing of an industry that created knowledge to frustrate information around African American diabetics, however scientific language produced by physicians and researchers was important for the ways in which it both created and tapped into commonly held assumptions and racial ideas regarding African American diabetics. The circular logic meant that through written and oral language racial characterizations of diabetes was reinforced until it provided the ring of truth.

Though evidence exists that African Americans clearly suffered from diabetes and diabetes related complications from the late nineteenth century onward, it would take another half a century before black diabetics were visibly recognized as a patient group. As early as the 1920s when the black diabetic was still considered rare, the Metropolitan Insurance Company wrote in an annual report that the rate of diabetes among African Americans exceeded that of whites. I.I. Lemann of Tulane University made a similar case in JAMAin 1927 while analyzing admissions data at Charity Hospital in New Orleans. He argued that between 1898 and 1926 diabetes admissions increased eight-fold among blacks and four-fold among whites. In a study conducted by the Georgia Department of Health in 1951 among women 50 years of age and older, the study concluded that 8 percent of “colored females” had abnormal blood sugar levels compared to 4 percent of white females, leading the researchers to make the statement that the results were “completely unanticipated by us.” Even by mid-century, black diabetics were still considered rare. The United States Public Health Service would eventually become concerned by what seemed like a stark increase of diabetes morbidity among “the color groups” between 1950 and 1967. Countering William Osler’s “Principles and Practice of Medicine” which had only recently reinforced the common narrative of black diabetic abnormality, Baltimore physician Eugene Leopold wrote in 1932 that “It is rather common today to hear usually well informed physicians express this belief” even while a mountain of evidence was building to prove otherwise.[10] Detailing Baltimore city wide morbidity and an outpatient diabetic clinic of Johns Hopkins Hospital which admitted African American patients, a point which itself might have been unusual in urban cities and unheard of in the South, Leopold quoted statistics suggesting that by 1931, 6.4 per hundred thousand blacks suffered from diabetes in the city compared to 10 per hundred thousand whites. Of the roughly 650 patients at the Hopkins clinic close to 200 were African American.

African American insurance companies also emerged to counter white insurance company claims that blacks suffered primarily from contagious diseases and diseases of excess and passion but not diabetes, heart disease, and cancer. Statistics compiled by white insurance companies helped frame the discourse of race and health by marking African Americans and whites as susceptible to different diseases which physicians and the public used to justify biological explanations of race. They did so even as they refused to insure African Americans or covered them on a limited basis. By the early twentieth century black-owned insurance companies like the Golden State Mutual Insurance Company in Los Angeles were started to provide health and burial insurance to Africans Americans denied the services of white insurance companies. William Nickerson, Jr. founded Golden State in 1925 after migrating from Texas to Los Angeles and discovering that many African Americans in the so-called “Promised Land” of California were living from cradle to grave without basic actuarial services.

In 1938 the United Mutual Benefit Company in New York published a five-year study of race mortality statistics in New York State confronting the narrative presented by white insurance companies. Examining the company’s own internal files, hospital records, records of private physicians, and city health department records, the insurance company argued that deaths from communicable diseases were not nearly as prevalent as white insurance companies stated in their publications.[11] United Mutual’s investigation found that “In New York state, during the five-year period beginning in 1933, the leading causes of Race deaths ranked in the following order: heart disease, pneumonia, cancer, disease of the kidneys, diseases of the circulatory system, tuberculosis, accidental deaths, cerebral hemorrhage, diabetes and social diseases.” The report would go on to say that “A much larger proportion of colored people are victims of heart ailments than is generally shown in the statistics of white companies,” the result of environmental factors that included poor housing and economic conditions.[12] Black-owned insurance companies across the country including the Supreme Liberty Life Insurance Company of Chicago, Atlanta Life and Mutual Aid Company, North Carolina Mutual Life Insurance Company, Universal Life Insurance Company of Memphis, and the Afro-American Insurance Company of Florida made it possible for African Americans to “accumulate much important vital data concerning itself and to refute the false statistics which some white companies use as an excuse to increase their rates on Race insurance.” Presenting a paper in front of the National Medical Association, James T.W. Granady, a physician at Harlem Hospital said that more detailed examinations of insurance policy applications is showing physicians and researchers across the country that diabetes is far from uncommon among African Americans.

Sugar Diabetes does not simply argue that African Americans suffered from diabetes in the early twentieth century, an obvious and clear point in the historical record. Instead, this book uses diabetes as a window into racial politics and the medical language of anti-blackness during the twentieth century. Like other diseases of the period diabetes had to be explained in racial terms in order to fit with existing assumptions and helps do some of the work of creating biological difference. African American diabetics proved to be a nuisance to the medical and lay community because they consistently reminded society of the futility of race and the precariousness of whiteness. Sugar Diabetes argues that language was used to silence black diabetics.

In his classic text The Social System, sociologist Talcott Parsons provides the sick role as a theoretical explanation of illness and patient-hood.[13] Illness is defined in part as an inability of a person to function as normal within society. It is an impairment which privileges the sick to be exempted from societal obligations that the non-sick are responsible for. Defined by Parsons and others as not the sick person’s fault, the sick role is a performance of sickness that entitles the person to be excused from normal family and work duties. Illness is an identity that marginalizes a person into a secondary status within society. As the twentieth century progressed the identity of sickness was important for inclusion under insurance benefits. The sick role is, therefore, fundamentally about who is entitled to patient-hood. Sugar Diabetes makes the case that while disease and illness are part of the human condition, not everyone is entitled to patient-hood. Patient hoodis a separate category of entitlement experienced differently by individuals and groups of people throughout history.[14] During the era of segregation African Americans’ ability to become patients in a hospital was mitigated by a host of factors that included loss of valuable labor time, refusal of white employers to allow time off for health reasons, travel, rejection at points of entry in white hospitals, lack of facilities that would accept limited numbers of black patients, few and poorly financed black hospitals, paucity of black doctors and refusal to be diagnosed by white doctors, and fear of being mistreated inside white dominated medical establishments.[15] It was not uncommon for southern African Americans to never see the inside of a hospital. For some, traveling to a hospital was too far and for others there was no expectation of being admitted as a patient.[16] Integrated hospitals and medical care struck a nerve for segregationists who believed in the scientific construction of biological and racial difference as fundamentally immutable. Hospitals were not only places of potential cross-pollination of ideas and flow of information but also of vulnerable open bodies. Men and women inhabiting the same space, sick bodies and healthy bodies, blood products and saliva, the naked bodies of patients and corpses to be examined and autopsied, all exhumed the worst fears of integration in the white imagination.[17] Added to this fear was the threat of African American physicians who sought to practice in hospitals where whites were being served; that they would serve only African American patients during the era of segregation was little in question, but there presence as professionals and proximity to white vulnerability was itself enough to stoke fear. While African Americans often existed outside the surveillance of organized medicine and treatment, white fears of contact with black bodies often brought African Americans under the gaze of public health reform. This book pivots on the discourse of racial medicine, and particularly, the ways in which information networks remain invisible while simultaneously creating racial difference.

By the early twentieth century diseases were used to define race using such terms as civilization, nervousness, and worthiness of suffering. The advanced and more civilized internal biology of whites that had evolved to deal with the stress of modern political and civic life made some native-born whites susceptible to certain civilized diseases, according to this logic. African Americans were considered incapable of suffering from civilized diseases because of their muted biology and evolutionary inferiority; such language made African Americans and other non-whites who suffered from these same diseases abnormal and uncommon within the medical literature.

Like cancer, asthma, and heart disease, diabetes was racialized as a disease of whiteness and civilization in the early twentieth century. What constituted whiteness and diabetes was complex. Historian Arleen Tuchman makes the important point that by the late nineteenth century it was far more common for scientists and physicians to racially frame diabetes as a Judenkrankheit, or “Jewish disease.” W.H. Thomas, a New York physician described Jews as a “race” with greater propensity to develop diabetes at the turn of the century. Well-known physician William Osler wrote that “Hebrews seem especially prone to [diabetes].” Yet another physician chimed in: “[t]he Hebrews, no doubt, are more commonly afflicted with chronic glycosuria than natives of the nation among whom they dwell.” For their part, the United States Public Health Service specifically connected the rise of a Jewish population in New York City with the increase of diabetes physicians were observing. The question of immigration and acculturation of Jews into American society collided with the disease identity of diabetes as Americans debated their “whiteness” and ability for inclusion.