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The Many Faces of Diabetes: Complications and Debility in Late 20th Century America

Richard M. Mizelle, Jr., PhD, will give the 14th annual James H. Cassedy Memorial Lecture in the History of Medicine on Thursday, February 2, 2023 at 2:00 PM ET. This talk will be live-streamed globally, and archived, by NIH VideoCasting. Dr. Mizelle is Associate Professor of History at the University of Houston. Circulating Now interviewed him about his research and upcoming talk.

Circulating Now: Please tell us a little about yourself. Where are you from? What do you do? What is your typical workday like?

Richard M. Mizelle, Jr.: I am from Raleigh, the capital city of North Carolina.  Including my parents, I come from a long line of teachers and educators.  My interest in higher education stemmed from my parents and mentors at North Carolina Central University in Durham, NC.  I am currently an Associate Professor of History at the University of Houston.  My research focuses on the historical intersections of race, medicine, environmentalism, and technology in the United States.  A typical workday for me includes checking and responding to emails first thing in the morning.  If teaching that day, I will make last minute revisions to lectures.  I spend a few hours, either in the morning or afternoon, juggling my multiple writing projects.  I am currently writing a history of race and diabetes in the twentieth century, but also have several other smaller writing projects.  Some days are spent actually writing a section of an article or book while other days are spent conceptualizing ideas.  Like many of us, I have meetings with students and colleagues throughout the day.  But the best part of my day is returning home and relaxing with my wife.

CN: What initially sparked your interest in the History of Medicine? What inspires you in your work?

RM: My interest in the history of medicine evolved over time.  I entered my MA program at American University interested in rebel maroon communities in the United States (particularly the Great Dismal Swamp) and Brazil.  During coursework, I took a course with immigration and medical historian Alan Kraut.  Prior to the course, I had never heard of the history of medicine and thought it strange at first.  However, I was soon fascinated by the idea and began transforming my research interests.

A Black physician is examining an older Black man.
A routine check-up for a diabetes sufferer, 1971
World Health Organization, Photograph by A.S. Kochar
National Library of Medicine #101437097

As a 20th century historian of race and medicine, I am inspired by the opportunity for my work to impact the lives of people living today.  Disease and illness are a universal experience, but my work highlights how racism and anti-blackness during the late 19th, 20th, and continuing into the 21st century makes Black people and minorities more vulnerable to sickness.  I am particularly inspired to help explain the deleterious impact that racism can have on chronic disease, access to life-sustaining medical resources, and quality of life.  Everyone deserves not just a right to life, but the right to a good and healthy life.  The unique role of the historian is to help explain how stigma, racism, and harmful policies continue to influence healthcare, healing, and public health.  The work historians of medicine do is such an important part of American history that it cannot be ignored.  There is no part of 20th century US history that cannot be understood in part through the window of disease and illness.

CN: Tell us a little about your upcoming talk, “The Many Faces of Diabetes: Complications and Debility in Late 20th Century America,” what drew your attention specifically to Diabetes?

Poster reading Diabetes favors minorities with portraits of a Native American woman, a Black woman and a Latino man.
“Diabetes Favors Minorities” poster by the American Diabetes Association, ca. 1980
National Library of Medicine #101438542

RM: This talk is a slice of my broader book on the history of race and diabetes.  Part of what distinguishes my work on diabetes from other scholars is the focus on diabetes related complications.  The complications of diabetes are worthy of more individual exploration by scholars.  Amputations, chronic kidney failure, cardiovascular disease, retinopathy, and headaches are just a few.  My work has dealt quite a bit with amputations as an epidemic within an epidemic.  Minority groups and the socio-economic poor are significantly more likely to suffer from diabetes-related amputations, the result of a confluence of factors that include poverty, living in medical and food deserts, and a health system that reinforces surgeries over life-style changes and non-invasive procedures that might prevent amputations.  This talk will also delve into the complicated typologies of diabetes and long-standing misconceptions about the disease that continue to render some groups historically invisible.

I was initially drawn to diabetes as an outgrowth of my interests surrounding environmental disasters My first book, Backwater Blues: The Mississippi Flood of 1927 in the African American Imagination provided some framework for understanding Hurricane Katrina in 2005.  Following Katrina, I began to think more about the special needs population in New Orleans and the Gulf Coast, particularly elderly groups in nursing homes and dialysis patients whose ability to evacuate was dependent upon having transportation provided for them and a place where they could receive treatment.  People with debilitating chronic diseases like asthma and cardiovascular disease suffered tremendously in evacuation shelters and other places after being displaced from their homes.  The vulnerability of dialysis patients, in particular, led me to begin thinking about the historical and long-standing vulnerability of both dialysis patients and people with diabetes.  It might seem like my first and second projects are completely different, but for me it was a natural outgrowth.

CN: What kinds of primary sources have you found most useful in your research and where do you find them?

RM: This is a needle in a haystack project to be sure.  The sources I have culled are wide-ranging and varied.  Sources that upend traditional narratives and move us to rethink ways of knowing are important.  I pay close attention to sources that other scholars have ignored when it comes to the history of medicine.  As one example, Black insurance company records can be a window into health during the early 20th century.  The Atlanta Life Insurance Company and other Black insurance companies were at the forefront of highlighting the dangers of diabetes for Black people in cities during the early to mid-20th century, particularly during the years of the Great Migration.  Because these were social institutions, you will also find valuable information about the communities in which they served, all valuable context for writing about diabetes and other illnesses.  The Atlanta Life Insurance records can be found at the Auburn Avenue Research Library.  While larger archives and repositories are important, I think there is much value that can be found in the smaller archives as well.  Sometimes it takes just one primary source after days of searching to change your whole way of thinking.

CN: In researching this subject, were you drawn to any particular document or individual’s story?

A round printed item decorated like a baseball.
“I’m Helping to Strikeout Diabetes” by the American Diabetes Association
National Library of Medicine #101453356

RM: There are so many stories and I hope to tell many of them.  The story that I come back to frequently is that of Jackie Robinson who died of diabetes-related complications in 1972.  His story is fascinating to me because his death from diabetes remains obscure.  We know of Robinson’s breaking the color line with the Brooklyn Dodgers in 1947 and his civil rights activism, yet the symbolism of his brief disability becomes a powerful metaphor of the insidiousness of diabetes.  Robinson was not vocal about his disease, but his life nonetheless provides a window into the 1970s and the scientific changes that were slowly taking shape.

CN: You’ve also done work here at NLM on environmental health, curating the NLM exhibition This Lead is Killing Us, do you see parallels in your work on lead poisoning and Diabetes?

RM: Absolutely.  Both lead poisoning and diabetes are influenced by broader questions of medical citizenship, racialized exclusion, and poverty.  In particular, environmental racism plays a large role in which groups of people are systematically exposed to lead poisoning.  The ongoing crisis in Jackson, Mississippi is one example of how neglected and poorly maintained water translates to exposure.  At the same time, people living in food and medical deserts find it more difficult to access the fruits and vegetables that lead to healthy lifestyles.  Public pronouncements of making healthy lifestyle choices must also consider historically degraded geographical spaces that make such choices difficult.  From a historical perspective there are other correlations as well in the form of social justice and civil rights organizations that mobilized around both lead poisoning and diabetes during the 1960s and 1970s.  The Medical Civil Rights Movement was in part a movement around the diseases and illnesses that disproportionately impacted Blacks, Latinas/os and other minority groups, as well as pushing for inclusion from the federal government and public health agencies.  Lead poisoning, diabetes, as well as cancer, sickle-cell disease, asthma, and other diseases were part of the era’s activism around health.

Logo graphic for This Lead is Killing Us

Richard M. Mizelle, Jr.’s presentation is part of our NLM History Talks, which promote awareness and use of the National Library of Medicine and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All talks are live-streamed globally, and subsequently archived, by NIH VideoCasting. Stay informed about the lecture series on Twitter at #NLMHistTalk.

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