Ellen Davis
Chapel Hill, North Carolina, United States

Eva Saxl not only saved her own life by making insulin during World War II, but together with her husband Viktor, saved the lives of over 400 people with diabetes in war-torn Shanghai. Her life story has remained relatively obscure—I had first seen Eva’s photo in 1991 on the cover of a diabetes consumer magazine, and James S. Hirsch brought the couple back to my attention with his 2006 book Cheating Destiny: Living with Diabetes, America’s Biggest Epidemic and excellent video “Insulin and Diabetes: The Story of Eva Saxl”. As a nurse dedicated to diabetes care and education, I’ve sought to share her story with colleagues, but I’ve found very few to have heard of her beforehand.

Eva was born into a loving family in Czechoslovakia in 1921. Her parents hired tutors to teach her different languages, wanting her to have wide-ranging fluency. She eventually spoke eight languages, including English. In 1940, she married textile engineer Viktor Saxl in Prague.

After the Nazi occupation, they fled through the Suez Canal to “the port of last resort,” Shanghai, China. Eighteen thousand refugees lived in the Jewish ghetto there. However, Shanghai, which had been occupied by the Japanese since 1937, was hardly a safe place. Eva found work writing for a newspaper and as a language teacher. One day troops showed up at her school and started shooting teachers. Viktor worked as an engineer, managing a British woolen mill. But less than a year after their arrival, Eva was diagnosed with type 1 diabetes. Her diabetes was manageable at first, since she had access to medical care and insulin.

Everything changed for the Saxls with the Japanese attack on Pearl Harbor. The Japanese clamped down on their occupied territories and cut off medical supplies to Shanghai. Viktor asked them to make insulin available, but was told that death was to be expected in wartime.

People with type 1 diabetes cannot live without insulin. The beta cells that produce insulin in the pancreas are destroyed by the autoimmune condition. Insulin was first isolated and refined in 1921 after years of exhaustive research with dogs and cows by Canadian scientists Frederick Banting and Charles Best. Their work won the Nobel Prize.

Without access to insulin, Eva and others with type 1 diabetes drastically cut back on their calories. Parents of children with diabetes had done this before insulin was available. While waiting for a medical breakthrough, a “cure,” the only thing they could do to prolong their lives was watch their children waste away from starvation.

Black-market insulin was extremely expensive, of unknown quality, and sometimes poisoned. After seeing a friend die from contaminated black-market insulin, the Saxls knew that desperate measures were needed. Viktor proposed that they make their own insulin, a plan that was radical and daring. Physician friends wished them well but declined to participate lest they create a lethal batch, a not unreasonable fear. The doctors loaned them medical textbooks in six languages, which the Saxls could read—but still, the Saxls were not scientists. Nevertheless, they chose to follow Drs. Banting’s and Best’s account of how they extracted and purified insulin from the pancreases of animals.

First, they knitted stockings to raise money to buy pancreases. Eva and a friend went to a slaughterhouse each day at 5 am. As dogs and cows were unavailable, they bought pancreases of water buffalos because of their abundance in the country and large organs. Eva and her friend stuffed the pancreases into wide-mouth thermos flasks. Then, with the help of a Chinese food chemist who had access to rudimentary medical supplies, they began experimenting in a small basement laboratory. They crushed the organs with Eva’s mother’s old meat grinder and refined the mixture with alcohol, ice, and a centrifuge.

After only months, not years, they produced brown, murky insulin—a far cry from clear, pharmaceutical insulin. The risks were enormous: the organs could have been contaminated with bacteria; there was no way to test for potency; what if it induced deadly hypoglycemia? They tried it on some rabbits and moved on quickly. Finally, with only five days left of her pharmaceutical insulin, they gave it to Eva. She could soon tell that it worked by the way she felt. They had managed to reinvent insulin!

They immediately took it to two hospitalized people on the verge of death. Both of these patients recovered, and one later named his first child after Viktor. The Saxls set up a clinic where they rationed patients to sixteen units a day. People were not able to get new glass syringes for the injections, so they helped them carefully reuse what they had and painstakingly resharpen their old insulin needles. Applying his textile engineering expertise, Viktor improved the system by repurposing a sewing machine. They took no money from those they treated, and appreciated the risks that Chinese and Japanese people took who brought ice, alcohol, and other needed supplies. In the last part of the war, with Shanghai still under Japanese military control, in addition to rampant disease and inflation, there were chronic shortages of almost everything. Power plants were periodically bombed by Allied B-52 planes, cutting off the electricity needed for their endeavors.

Ultimately, Eva and Viktor made enough insulin for everyone in the ghetto and later for others in Shanghai. They kept about 420 people alive between 1942 and 1945. No one died from lack of insulin or contaminated insulin. A 1951 newspaper article revealed that Eva was the test case or “guinea pig” for every batch before they released it to others.

The story of the Saxls is a testament to ingenuity, resilience, and the will to survive. What makes it even more extraordinary is that they had no formal medical training. Driven by necessity and love for life, they succeeded in creating something that many would think impossible.

During the 1945 liberation of Shanghai, the American military heard of their outstanding achievement. A U.S. Marine medical officer brought them pharmaceutical insulin. Eva and Viktor cried when they saw the vials of clear, pure liquid. The Saxls left China for New York in 1947. Did they slide into a quiet life? No, they had more to accomplish.

Their efforts had made them well-known. The Saxls were celebrities. President Eisenhower invited them to the White House, and Eva became a spokesperson for the American Diabetes Association, a first. With her strong, melodic voice, she gave speeches and television appearances, including one with Edward R. Murrow. She met Dr. Best. With her celebrity status she worked tirelessly to erase misinformation and decrease the stigma surrounding diabetes. Eva also spent two years studying with the renowned diabetes physician Dr. Elliott Joslin in Boston, and they became close friends. He admired her intellect and her optimistic spirit and asked her to give lectures to professional and lay groups.

In 1968, Viktor, who had been working for a textile firm in New York, accepted a position with the United Nations to provide technical support in less developed countries. Accompanied by Eva, he went to South America on a three-week assignment. While visiting Eva’s brother in Santiago, Chile, Viktor died suddenly of a heart attack at age fifty-eight. Eva was devastated and had to decide what to do with the rest of her life. She chose to stay in Santiago to be with her only living relative. He had emigrated there during the war; the rest of their family had been killed during the Holocaust.

Eva decided to bring diabetes education to Chile, teaching at the Diabetes Association of Chile and other institutions. She worked diligently to supply underprivileged children with medicine. She created educational materials and published a paper in the journal of the Association of Diabetes Care and Education Specialists. Her travels took her across the Americas and around the world. One of her most meaningful experiences was speaking in Düsseldorf at the German Diabetes Association.

Eva Saxl exemplified characteristics that people with diabetes need: resilience, resourcefulness, and courage. She received many awards for her work, including the Charles H. Best Medal for “Distinguished Service in the Cause of Diabetes” in 1991.

Eva died in Santiago in 2002 at the age of eighty-one. She was relatively healthy until the end of her life. Her finest trait was her commitment to her community, wherever she may have been. She spent her life advocating for others.

References

• Hirsch, JS. Cheating Destiny: Living with Diabetes, America’s Biggest Epidemic. Boston: Houghton Mifflin Co, 2006.
• Hirsch, JS in “Insulin and Diabetes: The Story of Eva Saxl.” Nov 19, 2007. dLife. YouTube, 7:43. https://youtu.be/xlOBl_nEits?si=Kwi6wKjA5fhcyw3i. Accessed November 23, 2024.
• Jen. “The Incredible Eva Saxl: Homemade Insulin.” Connected in Motion. Experiential Diabetes Education Group February 17, 2021. https://www.connectedinmotion.ca/blog/insulin-centennial-eva-saxl-homemade-insulin/. Accessed November 25, 2024.
• Miller, C. Viktor and Eva Saxl. The Engines of our Ingenuity. University of Houston Cullen College of Engineering. https://engines.egr.uh.edu/episode/3065. Accessed November 25, 2024.
• Edward R. Morrow. “I Never Stopped Believing: Eva Saxl—Jackson Heights, New York.” This I Believe. https://thisibelieve.org/essay/16957/. Accessed November 14, 2024.
• Savage, JW. “Wife stricken in war-torn China, husband develops own insulin lab.” Kentucky New Era November 6, 1951, 14. Google News Archive. https://news.google.com/newspapers?nid=266&dat=19511106&id=zOErAAAAIBAJ&sjid=12UFAAAAIBAJ&pg=1629,3743614&hl=en. Accessed November 25, 2024.
• Milo, J. “Savvy legends: Eva Saxl, T1 made her own insulin during WWII.” The Savvy Diabetic. January 22, 2017. https://thesavvydiabetic.com/savvy-legends-eva-saxl-t1-made-her-insulin-during-wwii/. Accessed November 25, 2024.
• Saxl, ER. “Diabetes Education in Chile.” The Diabetes Educator, 1985;11(1):60, 71.