The Joslin Diabetes Center

Annabelle S. Slingerland
Leiden University Medical Center, Leiden, the Netherlands

Matthew Brown
Joslin Diabetes Center, Boston, MA (Fall 2017)

 

Bay State Road- cca. 1920

Of the many hospitals that have risen to fame because of the accomplishments of their staff, the Joslin Diabetes Center is one of the most iconic. Founded at a time when diabetes was largely untreatable and often a death sentence, it was named after Elliott Proctor Joslin (1869-1962), a pioneer in the fight against a disease that even today remains one of the cruelest harbingers of death.

 

Doctor Joslin

Known as EPJ to his friends, Elliott Joslin took on a post-doctoral fellowship at the then German University of Strasbourg in order to translate Mering and Minkovski’s (1889) ideas on the role of the pancreas in diabetes. After a period of training with Bernhard Naunym, then regarded as the Nestor of diabetes, he spent time in Professor Chittenden’s lab at Yale University’s Sheffield School of Science before entering Harvard Medical School and Massachusetts General Hospital. In his third year of study, in 1894, he studied the chemical and epidemiological aspects of diabetes. Joslin published his first paper, “The Pathology of Diabetes Mellitus,” and graduated as valedictorian in 1895.

After graduation, Dr. Joslin opened a private practice and saw patients in his parents’ townhouse at what today is the busy corner of Massachusetts Avenue and Beacon Street. He diagnosed diabetes in his mother, Sarah, and a fifteen-year-old boy named Alton, but he had essentially no treatment to offer them.  Encouraged to pursue studies and undertake foreign travel by the Proctor Fund, which had been left to Harvard in his aunt’s will (1901), he lived modestly and worked hard, staying true to his upbringing and to the principles of his distant relative, John Proctor of Salem.

 

81 Bay State Road       

By 1906 a residence was partially set up as a clinic in fashionable Back Bay, facing the Charles River and resembling London’s Harley Street practices. Joslin, who was by now a Harvard faculty member, would see patients “earmarked for his consultation,” sending them to 108 Bay State Road to Dr. Beetham for eye consultation. The clinic, in McKim Classic Revival Style, was of “sober monumentality, symmetry, monotone color, stone material, and decorative features copied from Roman monuments.” There on the second floor Dr. Joslin held office six-and-a-half days a week, surrounded by Osler’s textbook, medical reprints, and articles in progress (seventeen papers had already been published). At the back of the brownstone, with a view of the Massachusetts Institute of Technology across the Charles River, he entertained friends, foreign visitors, and members of professional societies in the same dining room where nurses instructed patients and compiled publications. He lectured physicians, nurses, and patients, and worked in the laboratory of the physiologist Dr. Benedict, as well as the Carnegie laboratories, studying metabolism, strict diets, and exercise.

Plaque at the Baker Clinic of first insulin injection

In 1916 Dr. Joslin published The Treatment of Diabetes Mellitus – for physicians – and in 1918 the Diabetic Manual for Doctor and Patient, both still in use today! His military discipline, even more so after serving in World War I, made him walk his talk, “not gaining nor losing a pound.” Well-trained patients would claim, “I had no doctor except the Joslin manual.” In his 1921 publication The Prevention of Diabetes he wrote: “Although six of the seven persons …living in adjoining houses… succumbed to diabetes…no one spoke of an epidemic….Because the Disease was diabetes, and because the deaths occurred over a considerable interval of time, the fatalities passed unnoticed.

A plaque commemorating the first injection of insulin in New England on 7 August 1922 can be found near Deaconess Hospital. Dr. Howard Root, Joslin’s chief associate, gave the injection to Elizabeth Mudge while supervised by Dr. Joslin. Insulin was still relatively unheard of and only available in small batches following its discovery in Toronto by Best, Banting, and McLeod in 1922. Biochemical correction and access remained incomplete until the Eli Lily company’s commercial production of insulin, making it available for babies, children, adults, and the elderly.

In 1924 Joslin hired Dr. Priscilla White, who worked miracles in the treatment of diabetes in pregnancy. On the principle that “teaching is cheaper than nursing,” patients themselves became teachers, training each other, providing meal plans, giving general advice, and supplying files to be taken home. People of all ages were now living longer with diabetes. In 1926 a surgeon, physician, podiatrist, and specialty nurses started the “beauty parlor” or “foot room.” In 1931 patients who were seen as outstanding achievers in managing their condition received medals as “Explorers in an Uncharted Sea.”  Oxford, Massachusetts, where Dr. Joslin was born, became the home of the Clara Barton Camp for girls with diabetes. In the years following World War II, Joslin also established the Joslin Camp for Boys.

 

Baker Clinic (Research Laboratory)/ New England Deaconess Hospital

An architect’s rendering of the Baker Clinic before construction commenced in the early 1930s

In 1934 Dr. Joslin’s team established a central location for their research, the Baker Clinic Research Laboratory, at the New England Deaconess Hospital. This newly built research facility was designed to “catch fatal diseases (diabetes) in their early stages,” for as the mortality of the diabetes had decreased from 60% to 5% since the use of insulin, its complications had become more frequent. To make the research laboratory possible, the banker and philanthropist George Baker generously donated the required funds.

The first floor of the new facility had staff offices, a foot and dental clinic, and a modern classroom. On the second floor was research and clinical laboratory space and an area dedicated to acidotic patients, as emergency rooms did not exist at that time. The third floor had special plumbing and pediatrics. The fourth was for adult and ambulatory patients, and the fifth was devoted to eye surgery and obstetrics. The sixth became the Baker Roof for recreation and exercise. Joslin himself purchased the Leatherbee and Lewis cottages across from the Deaconess in the mid-1930’s for patients to stay and eat their meals, but he was envisioning an even greater plan to expand his clinic.

The first studies initiated at the Baker Clinic included diabetes and exercise; blood cholesterol, lipids and atrophy of subcutaneous fat; comparative studies of diverse preparations; inheritance; pernicious anemia; and thyroid disease. The fifth edition of Dr. Joslin’s famous textbook was now co-authored by the strong team of Drs. White, Root, and Marble. Dr. White’s paper on the classification of diabetes in pregnancy was also developed from obstetric research at the Baker Clinic and remains the reference text on this topic today.

In 1940 “excellent control” was an international cause celebre for patients and physicians alike. Joslin saw world-famous colleagues such as Hagedorn (Copenhagen, protamine insulin) and Houssay (Argentina, pituitary-pancreatic axis) at the twenty-fifth anniversary of the discovery of insulin. Working with architect Henry Shepley, he envisaged a unit that would serve the whole range of diabetes patients in general hospitals. In 1947 he asked the Surgeon General of the United States to support an epidemiological study on diabetes, also launching the “Victory Medal” for those free from any detectable form of tissue abnormality. In 1953 he founded the Joslin Diabetes Foundation, Inc. in order to bring all his fundraising activities under one roof.

 

Joslin Diabetes Center and Diabetes Foundation at Joslin Road

Joslin Diabetes Center, cca. 1956  

The day after Christmas 1956, eighty-seven-year-old Joslin moved his clinic of fifty employees to the state-of-the-art diabetes-focused hospital at 15 Joslin Road (currently One Joslin Place). A wide ramp for wheelchairs was built to enable non-ambulatory patients to come to a teaching room. Offices, a twenty-four bed unit on the second floor, and research space filled out the clinic. To educate  passersby, patients, and curious minds, Malvina Hoffmann, trained by the great Auguste Rodin and sculptor of several renowned works, sculpted the Evolution of Medicine bas-relief on the front façade of the Joslin Clinic.

In 1976 the National Diabetes Research and Education Act was passed with Joslin’s clinic and laboratory in mind.  In 1982 the Diabetes Treatment Unit (DTU) grew to a seventy-bed capacity, with two new physicians to accommodate the sharp rise in patient referrals. Drs. Aiello and Beetham, and later Dr. Rand, had already been working exclusively with laser photocoagulated diabetic retinopathy since 1969—a major turning point in therapy. Many seeing-eye dogs for blind persons with diabetes were transitioned into accompanying dogs.

Joslin Diabetes Center was seen as a haven, but not always appreciated by non-referring doctors. Patients often asked Joslin not to tell their primary doctors, who had threatened not to see them again if they also attended Joslin’s clinic. But in time, growing insight would attract more patients and garner increased appreciation.

 

Longwood Towers

At the age of ninety-two, one week before his death, Dr. Joslin took part in the filming of a segment called “Diabetes in Youth.” Until then he had been seeing fifteen patients and dictating no less than twenty letters every day. On the morning of his death he had been to church, refusing private drivers as usual and using public transportation. The “Dean of Diabetes” passed away silently at home, having survived his family as well as his associates.

Dr. Joslin’s legacy remains as vivid as ever in the world-renowned institute that bears his name. The Joslin Diabetes Center and its staff continue to occupy a leading role in the struggle to contain the worldwide epidemic of diabetes.

 

Bio and Acknowledgements

The authors are grateful for Drs Younger and Barnett’s inspiration, survivors from Dr. Joslin’s era and exemplary for their dedication; to Professor Amenta for his generosity and philanthropic pursuits; to Mr. Brown’s diligent archival work and Dr. Barnett’s strenuous efforts to preserve to keep history of the Joslin Diabetes Center.

 

Literature

  • The History of Medicine Especially as Related to Diabetes Sculptured for Diabetes Foundation Inc by Malvian Hoffman/ Evolution of Medicine, especially as related to diabetes by Elliott P. Joslin and Anna C. Holt, Boston Diabetes Foundation, Inc 1960.
  • Harvard Health Talks, by Eliott P. Joslin
  • Legends/ descriptions on the paintings in Joslin Diabetes Center Matthew Brown/ Donald M. Barnett
  • A brief history of diabetes from 1891 to 1988 through the publications of the Joslin Diabetes Center. Donald M. Barnett
  • Dr Joslin’s Magnificent Obsession, Dr Ellitott Proctor Joslin, A memoir 1869-1962, Anna C Holt, ASA Bartlett Press Worcester, Massachusetts 1969
  • Elliott P. Joslin, MD A Centennial Portrait by Donad M. Barnett, MD
  • 1982, The discovery of Insulin, Michael Bliss
  • Joslin and Marble Library
  • Boston University
  • https://www.bu.edu/housing/residences/floor-plans/baystate/dorms/
  • https://www.bu.edu/housing/residences/floor-plans/baystate/81-83/
  • http://realestate.boston.com/news/2015/02/12/historic-district-along-charles-river-is-a-calm-amongst-the-urban-sprawl/
  • And the Boston University archives they referred to: http://archives.bu.edu

 


 

ANNABELLE S. SLINGERLAND, MD, DSc, MPH, MScHSR co-authored scientific international articles on physiology, public health and cost-effectiveness. On her USA journey through rehabilitation centers, she was impressed by veterans and both their medical and military history as in similar articles at Hektoen International portraying Alcatraz, Craighlockheart, and Westerbork.

MATTHEW BROWN is a historian and archivist at the Joslin Diabetes Center.

 

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