PROLOGUE

IN 1918 AN ELEVEN-YEAR-OLD GIRL STANDS IN THE KITCHEN OF HER family’s elegant townhouse gulping water from a glass with such ferocity that it runs down the sides of her face. It is her sixth glass. Elizabeth Hughes is the daughter of Charles Evans Hughes, one of New York City’s most highly respected and familiar citizens. In a few months her diagnosis will be confirmed, and what had been a happy, active childhood will be devoured by the mounting symptoms of ravenous hunger and insatiable thirst. She has diabetes mellitus, also known as type 1 or juvenile diabetes.* It carries a prognosis of eleven months of suffering followed by death.

Most of the food a person eats is turned into glucose, or sugar, for his or her body to use for energy. A healthy pancreas makes the hormone insulin, which helps glucose get into the body’s cells. A diabetic either doesn’t make enough insulin or can’t use it well.

Symptoms of diabetes were described on Egyptian papyrus as early as 1550 b.c. The recommended Egyptian treatment was to eat a boiled assortment of bones, wheat, grain, and earth for four days, a diet perhaps no more satisfying than that prescribed for the disease in 1918. Progress toward understanding and treating diabetes has been slow and halting. It wouldn’t be given its current name until the second century a.d.—thousands of years after its appearance on papyrus. Aretaeus of Cappadocia, a celebrated Greek physician, coined the term “diabetes” after the Greek word for “sieve” because the symptomatic incessant thirst and urination made the body act as a sieve. Three centuries later, Indian physicians noted that the urine of their diabetic patients tasted sweet, like honey, but they did not know why. For the next thirteen centuries, little more was learned.

In the eighteenth century an Englishman named Matthew Dobson determined that the sweet, sticky substance found in diabetic urine was sugar. His important contribution ushered in a series of advances during the nineteenth century. In 1856, Claude Bernard, the French physician known as “the Father of Physiology,” postulated that the pancreas was the probable source of the disease. In 1889, Germany’s Oskar Minkowski and Josef von Mering definitively confirmed the central role of the pancreas. After removing the organ from a dog, the animal exhibited all the classic symptoms of diabetes. This monumental discovery launched a decades-long search for a mysterious substance in the pancreas. Germany’s Paul Langerhans described a cluster of cells that he separated from the pancreas in 1869, but he did not investigate its purpose. In 1889, France’s Edouard Laguesse named these cells the islets of Langerhans after their discoverer and suggested these cells lower blood glucose levels. As the twentieth century dawned, Belgium’s Jean de Meyer named the mysterious pancreatic substance “insulin”—from the Latin word for island—yet its existence was only a scientific speculation.

Around the world, the search for insulin continued. Germany’s Georg Zuelzer claimed to have isolated the pancreatic substance in 1906, going as far as obtaining a patent in 1912. Unfortunately, he was unable to produce enough consistently effective extract to prove it. America’s Ernest L. Scott made similar claims and met similar failure in 1912. And so medical science continued to struggle with how to use insulin to alleviate diabetes. For type 1 diabetics, this struggle was a matter of life and death, Elizabeth Hughes included.

In 1918, despite thousands of years of medical scrutiny, physicians could only watch helplessly as diabetic children like Elizabeth died. They yearned for a cure or at least a treatment that would prolong their patients’ lives until the cure that had eluded medicine for centuries could be found. That was exactly what Dr. Frederick M. Allen accomplished with his “starvation treatment,” a drastic diet that usually succeeded in keeping diabetics alive, albeit as living skeletons, for months beyond their prognoses. To be sure, some patients starved to death under his care, but Allen reasoned that they would have died anyway. In 1918 this desperate course was the only hope that diabetics had. The years 1914 to 1922 were known as the Allen era of diabetes research. Elizabeth Hughes would become one of Allen’s most tragic and successful patients.

Ironically, a cure for diabetes couldn’t have been farther from the mind of the man who would be at the very center of its discovery. In 1918 Frederick Banting was too busy tending to wounded soldiers in the fetid trenches of Cambrai, France, to think about medicine’s next marvel. When the war allowed him a rare quiet moment, he likely thought about his fiancee, Edith, walking to church on the dirt roads of Alliston, Canada, or the family farm where he had grown up. His aspirations were to marry and find a job as an orthopedic surgeon. In these goals he would be thwarted. Instead, he would find himself bound for a destiny of international fame and fortune that he was ill equipped to manage. This trajectory would be launched, in no small measure, by Elizabeth Hughes.

Elizabeth Hughes could not have foreseen how these very different men would figure prominently in her life. In 1918, she was a healthy, adventurous American girl, destined for all the promise and privilege that her famous parentage afforded her. Everything would change in 1919.

* There are two major types of diabetes: Type 1 diabetes is defined by the body’s failure to produce insulin; type 2 diabetes is defined by the body’s resistance to or insufficient production of insulin. Type 1 diabetes is also called insulin-dependent diabetes, or juvenile diabetes, because it affects mostly children, teenagers, and young adults.