Doctor George Minot was probably the most promising young physician in the United States. He was 35 years old, and had just been named the new Chief of the Medical Service at Huntington Hospital. He would oversee all of the medical practice and laboratories at Harvard Medical School’s cancer research hospital. It was 1921, at the dawn of science based medicine, and there was much work to do in medical research.
Within a month of taking over at Huntington Hospital, his life took a wild turn. He was off work one Wednesday, to serve as an usher at his brother’s wedding. He felt tired and week and the day off provided him with time to consider his own health. He thought back to the previous week and realized that he had been frequently thirsty and had drank an extraordinary amount of water. He knew what this could mean, so he went to the hospital and ordered a sugar test for his own urine. Seeing the results, Minot knew his fate immediately. He had diabetes, and he would be dead before he reached the age of 40.
For confirmation of the diagnosis, George went to see one of the leading diabetes specialists in the country, Dr Elliot P. Joslin of Boston. Both George Minot and Elliot Joslin were on the faculty of the Harvard Medical School. Joslin was 23 years older than Minot. Minot first laid eyes on Joslin when he was a medical student at Harvard, and Joslin delivered a lecture on diabetes to his class.
Joslin and Minot were already on familiar terms as professionals. In 1917, Joslin had referred a wealthy patient suffering from pernicious anemia to George. George had given the patient advice, and the patient had made a generous gift of $1000 to George to support his travel and further research in pernicious anemia.
George went to see Elliot Joslin on a Saturday, three days after his self-administered urine test. Dr. Joslin performed his own examination and carefully recorded the results in Dr Minot’s file. George stood 6 feet 1 ½ inches tall, but weighed only 135 pounds. He was very thin, even at a time when everyone was much thinner than today. His low weight was not a result of the diabetes, he had never weighed more than 147 pounds, and he was only 142 pounds one year earlier.
Joslin tested Minot’s blood sugar. It was, at 430 mg/dl, extraordinarily high. Normal range was considered to be from 70 to 120 mg/dl. This blood test confirmed the diagnosis of diabetes.
Joslin was one of the first doctors in the US to specialize in treating diabetes. He had been treating patients for about 20 years. Joslin’s philosophy is captured in his lecture that he gave to medical students. George heard it when he was back in medical school,
When they have understood the principles of the burning of sugar in the body, when they have learned to control themselves and to follow the diet without cheating, and when they have kept a daily record of food intake and sugar excrement to serve as a guide to treatment, the have come out all right.
At the time, Joslin believed that diabetes was caused by the pancreas being overworked. His treatment was focused on diet and exercise. He demanded that his patients follow the prescribed diet. When his patients fell ill, he blamed the patient for not following the diet. On that first visit with George, Dr Joslin put him on a diet of only 1250 calories per day. A week later, Dr Joslin cut his diet to 525 calories per day. It was no surprise that most patients could not follow the diet.
Joslin would have told Minot about the great progress they had made in treating diabetes over the past decade. In 1910, the average survival time for a patient diagnosed with diabetes was 30 months(1). By 1920, Joslin’s patients were surviving for an average of 45 months. Joslin’s clinic had made amazing progress, extending the lifespan of people with diabetes by 50%. Even with this progress, George Minot would surely be dead by the age of 40.