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Unveiling Diabetes - Historical Milestones in Diabetology


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was frugal but immaculate in dress, rising early, working long hours, and eating sparingly. According to Chris Feudtner, who studied Joslin’s long career, he had a spry body, a serene sense of discipline, and a stern New England conscience. He combined a “gentlemanly manner with a showman’s knack and a preacher’s zeal, always looking to spread his message of diabetic care” [17].

      In 1915 the well-established Joslin generously credited the younger Allen for great progress that the period 1914–1915 had seen in the treatment of diabetes mellitus:

      His clinical experience deeply impressed Joslin: “For myself, I consider the impression which I have thus obtained of far more value than any statistics which my records afford, but it is almost my duty to present these as well.” He summarized his cases in tables, but was not an adept statistician. Even his arithmetic is incorrect! (See Mazur [1] for my reanalysis of his case data.) Based on his own cases, starvation did not seriously prolong life, but it did largely eliminate coma as the proximate cause of death. Joslin was jubilant about this, concluding, “I am coming to feel that coma no longer represents the culmination of the disease, but that it is an avoidable accident” [16].

      In all his subsequent publications, Joslin praises Allen as the primary innovator in diabetic therapy. The second edition of his textbook, Treatment, opens with Joslin writing, “The advance in the treatment of diabetes, which began with the introduction of fasting by Dr. F. Allen, continues, and statistics are now available to show it. So-called acutely fatal diabetes is disappearing and the first year of diabetes is no longer, as was only too recently the case, the diabetic’s danger zone. Already I have quite a series of patients who have outlived their normal expectation of life at the age of onset of their diabetes.” And later in the text:

      Looking back upon the treatment of diabetes before Allen’s introduction of prolonged fasting, it really seems... that our patients were nursed rather than treated. Only those who have cared for many patients by the older methods can appreciate the advance which Allen has given to diabetic therapy. [16]

      Allen Back in Civilian Life

      By the war’s end, Allen was a star in the diabetes community, championed by Joslin, with imitators and critics. In 1919 Allen’s second book appeared as a Rockefeller Institute publication with his former associates at the hospital, Dr. Stillman and Dr. Fitz, as coauthors, though Allen says in his memoir that he wrote the entire text.

      Again a civilian, Allen purchased an abandoned estate with a golf course in suburban Morristown, New Jersey, converting it into a hospital and laboratory. His Physiatric Institute opened in 1920, its Greek-derived name indicating treatment through natural means. Rates varied with the quality of accommodation, whether wards or luxurious rooms. Diet therapy was individualized, requiring almost as many dieticians as nurses. Patients who were able could recreate in the grounds or the nearby town. Allen held complete control of the Institute, its medical, administrative, and fundraising aspects, and, to the extent he could, its patients.

      The Institute grew rapidly, holding 1- or 2-month-long teaching courses per year, drawing physicians from across the nation and disseminating calorie-restriction therapy. Soon young Elizabeth Hughes was brought for treatment, and her famous father became a supporter. After 1922, both Allen and Joslin were among the early adopters of insulin, but whereas Joslin’s patient-care model flourished, Allen’s operation contracted, especially after the crash of 1929. He was evicted from the Institute’s property for defaulting on the mortgage [7].