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The Fight to Survive: A Young Girl, Diabetes, and the Discovery of Insulin

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Caroline Cox's "The Fight to Survive" is the true story of Elizabeth Evans Hughes who, at the age of eleven, was diagnosed with what is known today as juvenile diabetes. In the twenty-first century, diabetes can be controlled with insulin and a proper diet, although there is still no cure. However, in the early nineteen hundreds, insulin was not yet available. Therefore, Elizabeth's only hope was to submit to an arduous regimen known as "starvation therapy," which was devised by Dr. Frederick Allen. Normally, a girl of Elizabeth's age would consume up to two thousand calories a day. However, for three years, she was forced to subsist on an average of eight hundred calories or less per day, in order "to prevent the sugar in her body from reaching toxic levels."

Cox admiringly depicts Elizabeth Hughes as a contented, self-disciplined, and grateful child who did as she was told. Her upbeat attitude helped her endure deprivation with relative equanimity. Although she was perpetually hungry and often physically weak, she found ways to occupy herself and take her mind off food. She read widely, socialized with friends, listened to music, enjoyed nature, wrote essays, and "tried her best in the face of enormous challenges to live well." She had self-confidence and enormous will power, and refused to be defined by her illness.

Elizabeth's father was Charles Evans Hughes, a lawyer who went on to hold important positions in the United States throughout his life: Governor of New York, Supreme Court Justice, Secretary of State, and Chief Justice of the Supreme Court. One would not blame Elizabeth if she had been somewhat spoiled, demanding of attention, and resentful of her parents' preoccupation with their social and political activities. On the contrary, she was appreciative of her devoted nurse, Blanche Burgess, and when she was separated from her mother and father, Elizabeth eagerly wrote to them and looked forward to their replies.

Cox lucidly and entertainingly recounts the tortuous path to the discovery of insulin. There was no sudden epiphany. It took years of tedious groundwork by a number of dedicated individuals to set the stage for the extraction of insulin and its production in sufficient quantity to help those who would surely die without it. In addition, doctors had to tinker with patients' diets to make sure that there was a proper balance between insulin and food intake. In 1922, Jim Havens became the first diabetic to get a shot of insulin. For him and many others, this breakthrough provided hope that diabetics could look forward to normal lives. For their role in bringing this lifesaving treatment to those in need, Frederick Banting and John Macleod were awarded the Nobel Prize in 1923. "The Fight to Survive" is an inspiring and heart-warming book about the indomitable spirit of an enthusiastic and mature young lady who, although "she never ceased to suffer... took a positive pleasure in beauty in its many forms, sights, sounds, and textures." It is also an engrossing and informative account of a medical miracle that has made a huge difference in the lives of those stricken with a potentially devastating disease.

The author, who is an associate professor of history, has done her homework. The prodigious research that went into "The Fight to Survive" is apparent from Cox's extensive list of both primary and secondary sources. A well-organized and extremely detailed index is included.

This is an extraordinarily well written story about a young girl with diabetes who survives against the odds. Her self discipline and courage comes across on every page. She is lucky that insulin became available when it did. Her prominent american family makes the historical backdrop all the more interesting.

This book is mostly set in the early 1920s, just after World War I, the influenza pandemic and a rapidly changing world. It's a time when epidemics, including polio, still broke out in communities. 10% of all children born alive died before their first birthday. And a diagnosis of diabetes was a death sentence.

Elizabeth Hughes lives a privileged life but this doesn't protect here when at 11 years old she is diagnosed with diabetes. Her parents take her to see Dr. Allen, whose treatment approach for diabetes is the Starvation Diet. Basically patients were only allowed the amount of food that wouldn't cause sugar to appear in their urine. In Elizabeth's case this means she's forced to live on a diet of no more than 750 calories a day, less when she's under stress or is sick. This is a diet that almost no-one can stick too, it's just too challenging.

But Elizabeth is a disciplined and determined young girl. Her family hires a full-time nurse to help Elizabeth live despite her diabetes. And this Elizabeth does really well, despite not being able to eat any of the food that her friends consume when she's at parties with them. She's determined to be a writer and really live in the world.

Banting and Best are two of a team of famous scientists who first isolated and produced insulin in 1922. But when Elizabeth was diagnosed, this team hadn't even been formed. This book does a masterful job of weaving the details of Elizabeth's life into the history of the early development of insulin.

As someone who is now kept alive because of insulin, I riveted by the details about those early experiments in Toronto that eventually led to insulin. They struggle with a lack of funding and lab equipment. The early experiments used dogs, and they start to run out of dogs with which to experiment. Their progress improves when they change to using pancreases taken from cattle at a local slaughterhouse.

They have to deal with toxicity and impurities. Early dosing of animals killed them, until it was realized that this was because their blood sugar was made too low by the insulin. The team had to figure out how much to give people. They also had to ration early supplies to desperate families looking for this miracle drug once word of it reached the public.

Now, less than a century later, diabetes is no longer a death sentence. People use insulin to lead long and productive lives. Reading this book brought home just how different it was before insulin was available, when you either died quickly or lived on the starvation diet and died more slowly.

Elizabeth is a compelling heroine who is forced to live away from her family because of the stresses and strains of living in Washington where her father is Secretary of State. The book shows just how much her determination and lifestyle probably contributed to her survival until she could start using insulin.

I found this book impossible to put down, the details of Elizabeth's adventures while surviving and the challenges keeping the team in Toronto working successfully to make insulin a success make for a riveting book.

I read this book in a single evening--I could not put it down. It is a compelling story, beautifully written, and meticulously researched by Caroline Cox. I loved it and will be giving copies to my friends and loved ones who have struggled with juvenile diabetes. It's also a great read for people interested in politics and law. The heroine's father was both Secretary of State and Chief Justice of the Supreme Court at various points in his career. An inspiring, wonderful book!

I got this book out of my college's medical library because I have type 1 diabetes and also am very interested in history. However, only a chapter into it, I'm very disappointed at the reading level. It might be appropriate for a high schooler or someone very new to the history of diabetes, but for someone accustomed to reading scholarly and literary historical work, it's too basic in tone, vocabulary, content, etc. I brought it along on a trip to read for fun, but I've already located a used book store near where I'm staying and am planning to go buy something else for that purpose. It's too bad, because this is an angle of the history of diabetes that hasn't received a lot of attention.