NINE

The Idea of the Physiatric Institute, May 1920

ON THE MORNING OF HELEN’S FUNERAL, DR. FREDERICK ALLEN squared himself at his desk at the sanitarium on Fifty-first Street. Before him on the dark green blotter was a heavy brass paperweight engraved with the words “The less food, the more life,” a gift from Belle Wishart, his loyal and capable superintendent, given to him at the opening of the sanitarium nearly one year before. Across the room stood a tower of boxes: A shipment of the latest printing of The Starvation (Allen) Treatment of Diabetes had just arrived. The Allen treatment was working. Although some patients died of starvation, many others lived past their prognoses—albeit in agony. Each day these patients remained alive was a day that a cure might be discovered. The sanitarium was regularly occupied. Elizabeth’s health had improved since Christmas, no doubt due in part to her resilient spirit and flawless adherence to the prescribed regimen.

Several unopened envelopes lay on the blotter. He opened the first one. It contained an invoice from a pharmacy for basic supplies for urine testing: copper sulphate, potassium hydroxide, sodium citrate, sodium carbonate, distilled water. The second envelope, sent by registered mail, held the news that the property in which both his practice and the sanitarium were housed had been sold. He was to vacate the premises by July 15, 1920.

His first reaction—fury—quickly dissipated. The sale of the building prompted him to make a change that he had been mulling over for a long time. Now, at last, he had a reason to make the leap. He envisioned creating an institute that would symbiotically bring together clinical work and research under one roof. However, unlike the Rockefeller Institute, it would do so in a spa-like setting, which would encourage fresh air and daily exercise. This unique combination of features would attract both established scientists and postdoctoral students, the best scientific minds from around the world to seek a cure for diabetes and other diseases. The institute would welcome patients from all walks of life, supplying the most luxurious accommodations to those who could afford to pay and allowing charity patients to pay in kind with workexchange arrangements. He had even dreamed up a name for his vision. The Physiatric Institute. Allen could hardly think of the words without grinning. The Physiatric Institute—from the Greek words physikos (physical) and iatreia (healing)—would be the nation’s first institution dedicated solely to the care and study of metabolic disorders, particularly juvenile diabetes.

Time was short. Allen’s mind raced with dozens of incremental tasks that would be needed to realize his vision. He sat down at his desk and started to make a list, his pen moving furiously over the tablet. In no time he had filled an entire page. The very first task on the list was a visit to Charles Evans Hughes.

It was now one year since Allen had walked from his office to deliver the grim news of Elizabeth’s fatal diagnosis. Although the sanitarium was on the verge of being shut down (after which he would be technically unemployed), Allen had never felt as optimistic as he did that afternoon in early May 1920 as he walked up Fifth Avenue to the corner of Sixty-fourth Street to present his master plan for the Physiatric Institute to Charles Evans Hughes. He carried the proposal in a slim portfolio in anticipation of laying it before the man whose judicial demeanor was so aloof and austere that the press had dubbed him “the Baptist Pope.” Allen could not possibly have known how keenly willing Hughes would be to help him, how precious the prospect of being able to do something, anything, to help ease the suffering of his desperately ill daughter Elizabeth.

This would be the fourth time Dr. Allen had given the presentation. The first he had confided in his most trusted colleague, Miss Wishart. Emboldened as he was by her enthusiastic support, he proceeded to share it with his fellow physicians at the sanitarium. Then he told the entire staff of the sanitarium, assembled for a compulsory meeting at which he also announced the imminent closure of the sanitarium.

Much to his amazement, and perhaps for the first time in his professional life, his idea met with unanimous support and the entire staff expressed an interest in following Dr. Allen to his new enterprise. In view of his history of difficult interpersonal relations, this response moved him deeply. He felt that he was being carried forward by a force of destiny.

A uniformed maid ushered Dr. Allen into Hughes’s study, leading him gingerly through the hushed, dimly lit house. Hughes looked up from the draft of the Wellesley commencement speech. (He would speak of vigilant adherence to democratic ideals: Unless we have in peace time, that dominant sentiment which prompts a continuous and self-sacrificing devotion to public ends, the sacrifices of patriotism in war will have been in vain.) His face was gray and drawn. Clearly, the last few months had taken their toll. With little introductory small talk Allen explained the circumstances necessitating his relocation and placed the proposal in Hughes’s hands. Hughes took the sheaf of paper and dealt four pages in the style of a croupier, laying them side by side before him on the desk. He turned his preternatural mind to the pages and, as if he were reading them simultaneously, he gathered them and replaced them with the next four pages. Allen watched in silence, pressing his damp palms together.

The proposal described the purchase of the “Cedar Court” estate owned by Mr. Otto H. Kahn, located one mile outside the city of Morristown, New Jersey, thirty-eight miles from New York City. The property sprawled over 176 lush, level acres, 136 of which had been tamed and trimmed into luxuriant gardens and grounds while the remaining 40 acres were farmland. To Hughes, it sounded like a promising location for bird-watching, in other words, an ideal environment for Elizabeth.

The main building was an Italianate mansion of magnificent proportions. The living space in the residence, including a wing connected to it by a glorious glass-enclosed pagoda, totaled forty rooms. These would comfortably accommodate the administrative force and thirty full-pay patients, with alterations to be made as necessary to accommodate fifty or more according to the extent of the need. The other structures on the property included a superintendent’s cottage, caretaker’s cottage, two farmhouses, several greenhouses, and, best of all, a dairy designed for pasteurization and storage that could be adapted easily into an animal research laboratory to house thirty dogs.

The estate had cost Kahn over a million dollars; he would sell it for $250,000. The contract called for $10,000 in cash up front and another $20,000 in two months. Allen would need investors both now and later, for even if he were to succeed in raising enough money to purchase the property, there was the cost of operation to consider. Mr. Kahn had employed between fifteen and twenty-two men year-round just to maintain the grounds; Dr. Allen’s proposal called for five full-time groundskeep- ers. Because the property had been vacant and deteriorating for several years, there were repairs to consider, and the nine hot-air furnaces would have to be replaced with central steam heat before the first winter. It was an undertaking of enormous magnitude and complexity but it was worth the effort if it meant that Allen and his patients would never again be evicted.

The medical purposes of the Physiatric Institute would be progressive and educational, treating patients as partners in their therapy. Only those patients who would seriously commit themselves to their own improvement would be admitted, and they would be selected regardless of their ability to pay. Each case would be carefully studied to determine the proper diet to keep the disorder under control. Dietary prescriptions would be highly personalized and require dedicated and individual attention from staff members. Patients would be taught their diet so that they could continue their treatment at home, either alone or under the supervision of a local physician. Patients would keep their own detailed charts describing the preparation and circumstances of each morsel of food ingested, and the time of day and, for the first time, they would perform their own regular urine tests.

Allen had worked out the operating costs of the new enterprise in a general way, basing his figures on the per-person cost of room and board at the Fifty-first Street sanitarium. His plan was to charge thirty paying patients enough to support thirty charity patients. He was so committed to the ideal of the institute that he was prepared to forfeit any personal compensation for his work there. He did not include a personal salary in the budget. Allen believed he could depend entirely on his practice in New York City for personal income. He could not imagine how much it would cost to keep such an enormous property heated but he believed, naively, that grants and donations would materialize to make up for any operating deficit.

The first step toward the goal would involve the formation of a corporation to be run without profit to its stockholders. Allen would need the kind of investors who could attract more of the same. He thought the timing of his approach to Hughes was good. For an entire year he had overseen the care of Elizabeth, slowly earning her parents’ trust. Elizabeth was four feet eleven inches tall and weighed seventy-five pounds when he first examined her. Although her weight plummeted soon after she came under his care, he had kept it relatively stable for most of the year, gradually increasing her diet to seven hundred calories or more. For the most part he had accommodated her parents’ wish to keep her living at home. He had trained Blanche (well, really, he had Miss Wishart to thank for this) in dietetic food preparation and glucose testing. Blanche had proved to be surprisingly dedicated, keeping excellent records and developing an aptitude for timely and accurate urine testing. Elizabeth herself had proved to be perfectly reliable in honoring his dietary constraints, gram for gram, and taking regular exercise as directed. As a result, she was—quite literally—living proof of the success of the Allen treatment.

As Allen left the meeting with Hughes, he paused at the corner and looked south over the architectural marvels that crowded the narrow island of his adopted home. There was the soaring Singer Tower and the majestic Woolworth Building, the behemoth structures of Penn Station and Madison Square Garden, which somehow managed to be both graceful and gargantuan. Allen was confident that forces even more powerful than Charles Evans Hughes were working on his behalf in the universe. It seemed that new wonders were revealed daily, from aspirin to X-rays. Dirigibles transported people through the air, and subways transported them underground, and rotary dial telephones enabled them to speak directly to whomever they wished without going anywhere at all. Why wouldn’t Hughes support the Physiatric Institute? Despite all the initial misgivings about undernutrition, Allen had saved Elizabeth from certain death, at least for the time being, which was really the only time there ever was. How could Hughes refuse him?

Hughes did not refuse him. After satisfying himself by privately commissioning an investigative report on the venture, Hughes agreed to serve as honorary chairman of the Physiatric Institute. The name “The Hon. Charles E. Hughes” would top the list of fifty honorary chairmen on the letterhead, including many of the most recognizable names in New York. As chairman of the Draft Appeals Board, Hughes had been responsible for thousands of life-and-death decisions. As honorary chairman of the Physiatric Institute, he would be responsible for many more lives— including Elizabeth’s. But despite Hughes’s support and the infusion of ten thousand dollars of Allen’s own personal savings to launch the venture, the financial stability of the Physiatric Institute was tenuous. The campaign to raise money fell short and Allen was forced to invest an additional ten thousand dollars of his own money. But he remained wholly committed to the idea: The institute was to be the last resort and the best hope for diabetic children everywhere. Allen’s future was set, or so he thought.

On October 30, 1920, just six months after the Hughes family gathered at Woodlawn Cemetery and Allen proposed his grand vision to Charles Evans Hughes, and one week before the United States presidential election, a twenty-eight-year-old unknown Canadian surgeon would be awakened suddenly from a fitful sleep. He had an idea.

Frederick Allen would keep Elizabeth alive long enough to benefit from that idea.