Remembering a Veteran: Lt. Colonel Elliott Joslin, MD, AEF Medical Service — Groundbreaking Diabetes Researcher

 

By James Patton

A Physician and Scientist

Elliott P. Joslin, MD (1869–1962) was born into a wealthy family in Oxford, MA. Following his education at Yale and Harvard Medical School, he opened a private practice in the Boston area. From the beginning he was especially interested in the treatment of Diabetes Mellitus (DM), possibly influenced by the incidence of DM in his own family. He was the first physician in the U.S. to specialize in DM, and he kept meticulous case notes and statistics, which he called his Registry. Over seven decades he became the world’s leading voice for DM management and education.

Joslin explored the connection between DM and diet with chemist Francis G. Benedict PhD (1870–1957) and carried out trials with DM patients studying the effects of fasting and feeding on the progression of symptoms. He became convinced that DM could often be managed with glucose control. Moreover, he believed that DM patients could do this themselves, with proper instruction and supervision. This approach became known as Diabetes Self-Management Education and is still the primary treatment strategy for DM today.

Joslin was dedicated to the idea that nurses could help DM patients self-manage their illness. Starting in 1908, working with the New England Deaconess Hospital, Joslin began the first training program in DM management for nurses. 

Drawing on the findings in over 1,000 of his cases, he wrote The Treatment of Diabetes Melitus, which was the first textbook on DM published in English and remained in print through 11 editions. Two years later he published The Diabetic Manual – for the Doctor and Patient, a "how-to" book rather than an instructional text, which has run to 14 editions and is still available under the title The Joslin Guide to Diabetes.

Service in the Great War

The Massive Mesves Hospital Complex, Where Dr. Joslin Served, Under Construction

At this point in Joslin’s career, America went to war. Although 48 years old, he decided to do his bit, and on 24 January  1918 he was commissioned as a major in the Army Medical Corps at Camp Devens, MA. Before the end of February he was in France, assigned to the Mesves Hospital Center at Mesves-Bulcy-sur-Loire, which consisted of eight Base Hospitals plus an Evacuation Hospital. With a total of 20,186 patients in November 1918, Mesves was the largest American hospital complex in France. Clearly Joslin wasn’t treating DM patients during his time there. 

While still at Mesves, on 23 October 1918 Joslin was promoted to lieutenant colonel. He remained on duty there until February 1919 and upon his return was released from active duty on 1 March 1919. He was awarded the Meuse-Argonne clasp for his Victory Medal. 

Shortly thereafter, in 1921 the "Toronto Group" of medical chemists isolated and successfully extracted insulin from animals. These researchers were Frederick G. Banting, MD (1891–1941), Charles H. Best, MD (1899–1978), and James B. Collip MD, PhD (1892–1965), who were working in the laboratory of the noted biochemist J.J.R. Macleod, PhD (1876–1935). Macleod and Banting were awarded the Nobel Prize for Medicine in 1923. 

Two of these men were also war veterans. Banting was a captain in the Canadian Medical Corps and received a Military Cross; Best served with the 2nd Canadian Tank Battalion, rising to the rank of acting sergeant major. 

Dr. Joslin's Legacy

The Joslin Diabetes Center, Boston, MA

With the availability of insulin, Joslin expanded his DM practice, which attracted colleagues, eventually becoming the Joslin Clinic in 1952. Still in Boston and today called the Joslin Diabetes Center, it is the largest DM research center, DM treatment clinic and DM education center in the world. Dr. Joslin’s most quoted mantra is “The diabetic who knows the most lives the longest.”

In 1993, 30 years after Joslin’s death, a monumental ten-year study conducted by researchers at 27 sites in the U.S. and Canada concluded that Joslin’s approach to DM management showed a significant reduction in the progression of DM symptoms with no corresponding reduction in lifestyle.

Beginning in 1946, Joslin started a 20-year study that followed the incidence of DM in one Massachusetts community, which demonstrated that DM in the U.S. should be considered a public health problem and DM incidence classified as an epidemic. Statistics have borne this conclusion to be true up to the present.