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Elliott P. Joslin, M.D.

 

 Click here to watch
"The Story of Elliott P. Joslin."
Video courtesy of dLifeTV

   

Who was Elliott P. Joslin, M.D., and why is he so important? Dr. Joslin—most often referred to as “EPJ”—is considered the pioneer in diabetes. He was the first doctor in the U.S. to specialize in the disease, and this distinction is the first of many “firsts” associated with him. Everyone who works in the diabetes field at some point learns about EPJ. What makes him unique is both his early interest in a little known disease and his vision as to how to treat it.

Like many people, Dr. Joslin was both a product of his time and of his family background. Understanding his personal story creates a context for how he viewed diabetes and how he cared for his patients.

Early Patient Experiences

Elliott Proctor Joslin was born in 1869 in Oxford, Mass. He attended Yale University and Harvard Medical School. In the late 19th century, diabetes was considered a very obscure disease and there was little treatment, but both personal and professional experiences led EPJ to becoming one of the few doctors to pursue this area of medicine.

EPJ’s Aunt Helen was diagnosed with diabetes while he was in college. He studied up on her disease and coincidentally was assigned to a student who had diabetes during his third year in medical school. He was challenged by the outcomes of these patients and began a listing of his patients in large accounting books, complete with all the facts, progress and outcomes. This was the beginning of the first diabetes registry in the world. He then compared his data with public statistics and the field of diabetes epidemiology was launched.

 
Dr. Joslin (1899)

This enormous amount of data that Dr. Joslin collected from his patients was written in ledgers, referred to as the “black books.” He was ahead of anyone in terms of compiling diabetes statistics—so much so that the Metropolitan Life Insurance Company arranged to use Dr. Joslin’s statistics for their actuarial tables. This remains the largest collection of clinical data on diabetes in the world.

 

81 Bay State Road

 EPJ saw his first patient in 1898 at his parent’s townhouse on 517 Beacon St. He practiced at Beacon Street until late 1905 when he moved his office to 81 Bay State Road. His townhouse and building next door served his practice and staff for the next 50 years. In 1956 the office was moved to its current location at One Joslin Place. Joslin Clinic was the world’s first diabetes care facility.

All About Control

Ironically EPJ’s mother was diagnosed one year after he began his practice. Her progress and the work of a German professor shaped EPJ’s theory about how diabetes should be managed and it reflects his future thinking on the matter: diagnose diabetes early, treat the condition vigorously, which included the use of carbohydrate-restricted diets and fasting, and get regular exercise. He assembled 1,000 of his own cases into the first diabetes textbook, The Treatment of Diabetes Mellitus, in which he outlined how he reduced the death rate of his patients by 20 percent. This was the beginning of EPJ’s theory that managing tight control of one’s blood glucose through diet, exercise and constant testing could extend one’s life and prevent complications.

Two years later he published the Diabetic Manual—for the Doctor and Patient. This was the first diabetes patient handbook, and it detailed how the patient could take control of the disease. The significance of this book can’t be overemphasized—educating patients about diabetes was the first step toward people feeling empowered instead of victimized by the disease. This became the Joslin approach and to this day, the goals of JoslinCare practiced in Joslin Clinic and by Joslin Affiliates are to live a healthy and happy life while managing a chronic disease.

In addition to putting the patient front and center, Dr. Joslin expanded the role of nurses after the discovery of insulin in 1923. The “wandering nurses” would go out into the community to instruct people with diabetes about insulin management, diet and exercise. Now we know these nurses as certified diabetes educators.

EPJ also was the first to name diabetes as a serious public health issue. Just after WWII he lamented to the Surgeon General of the U.S. Public Health Service that diabetes was an epidemic and challenged the government to do a study in the town of his birthplace, Oxford, Mass. The study was started in 1946 and carried out over the next 20 years. The results confirmed EPJ’s belief that diabetes was becoming an epidemic. As a result of  this study it was the very first time diabetes was named a public health issue.

Team Approach

Dr. Joslin’s practice grew enormously after insulin was introduced. He worked with other diabetes specialists, such as Leo Krall, M.D., Howard Root, M.D., and Priscilla White, M.D., and they all followed the Joslin way of treating the patient using a team approach.

The Joslin practice reflected EPJ’s early writings and his theory of strict control of blood glucose, frequent testing and daily exercise to prevent diabetes complications. One distinctive characteristic of EPJ’s approach involves his belief in the “troika,” the Russian word meaning threesome. EPJ created a three-horse chariot to reflect his philosophy of living with diabetes—the three-horse motif symbolized insulin, diet and exercise, which are needed to achieve “victory” over diabetes. Five years later, in 1953, he incorporated the figure into the signage for the Diabetes Foundation, Inc. Horses were important to EPJ, and he drew upon them during his career.

 

Priscilla White, M.D.

This is part of The Diabetic Creed he included in the 4-8th editions of the Patient Manual and some explanation of the Troika:
 
Three horses draw the diabetic chariot and their names are diet, exercise and insulin. In fact, all of us in our life’s journey depend on the three, but seldom recognize the third although we often realize we are poor charioteers. Yet we fortunate ones have instinct to help us hold the reins, but the diabetic cannot trust his instincts as a guide, and in place of it must depend upon dieticians, nurses and doctors unless he understands his disease.

EPJ’s approach to diabetes management was debated for decades by other endocrinologists and scientists. But EPJ did not live to see his theory validated. He died in 1962, at the age of 92, at his home in Brookline, Mass. It wasn’t until 1993 that EPJ’s approach was supported by the 10-year study, “The Diabetes Control and Complications Trial Report,” published in the prestigious New England Journal of Medicine. The study demonstrated that the onset of diabetes complications was delayed by tight blood glucose control. To honor Dr. Joslin’s foresight, buttons were produced for Joslin Clinic patients and staff that read “I Told You So.”

Page last updated: September 22, 2014