The Discovery of Insulin was researched and written during a unique window of opportunity. The 1978 death of Charles Best, the last surviving member of the discovery team, happened to coincide with the release of the papers of Sir Frederick Banting. Suddenly it was possible to obtain access to complete documentation of the highly controversial events at the University of Toronto in 1921–23 that led to the isolation and emergence of insulin. At the same time, many individuals who had been witnesses to or participants in the discovery, and who were approaching the end of their lives, now felt free to speak frankly for the historical record. Working on this book, I not only uncovered many new collections of documents, but also found alive two of the original patients who had been treated with insulin in Toronto in 1922. Since publication, no significant new collections of documents have surfaced, but 66 of the 68 individuals I interviewed have died. No one can talk to them now, except through the notes of my interviews, which themselves are now part of the archival record.
My family has been untouched by diabetes, but deeply involved in medicine. As a professional historian I first became interested in the insulin story at the suggestion of a brother who had been exposed by one of J.B. Collip’s colleagues to verbal accounts of the more dramatic incidents in the discovery saga. In 1978, fresh from publishing a biography of a major Canadian philanthropist/entrepreneur (Sir Joseph Flavelle), (and having been promoted to full professor at the University of Toronto, I decided that it should finally be possible to write the full story of the discovery of insulin.
There were serious obstacles, including much skepticism about a mere historian’s qualification to write about advanced medical discoveries. Fully sharing that concern, I made a point of getting expert advice at every stage of the work, immersed myself in the history of endocrinology and diabetes, and worked and reworked my manuscript with more care and craft than I had ever applied to a project. The many people who helped me with the book have been thanked in earlier editions. Among those few who are still living, I feel particularly indebted to Richard Landon, who as head of the Thomas Fisher Rare Books Library at the University of Toronto, gave me crucial encouragement when it was most needed, and Dr. Anna Sirek, who, with her late husband Otto, gave me vital technical advice.
The archival and personal adventures generated by this project were remarkable, exciting, and life changing. They culminated in several of the most exhausting and rewarding days of my life in Cambridge, England, with the late Sir Frank Young, a grand old man of diabetes research and British science generally, as he challenged not only my conclusions, but my spelling and commas, insisting that a book that would be read around the world and for many years be as perfectly argued and polished as possible. “Bliss,” he would say, “this book will be read by Fiji Islanders and Nobel laureates. You have to get it right.”
The Discovery of Insulin received gratifyingly favourable reviews upon publication in 1982 and has remained in print since then and without need for significant revision or alteration. For this edition it has not been necessary to make any changes to the detailed narrative of the events of 1920–23. In addition to this new preface, it was, however, necessary to rewrite the final chapter, “A Continuing Epilogue,” because so much has happened in the world of diabetes in our time.
Although I moved on to other work in the history of medicine and Canadian topics, I made a point of staying in touch with this subject, and expanded upon The Discovery of Insulin with a number of publications. The most important are Banting: A Biography (Toronto, 1984; 2nd ed., University of Toronto Press, 1992), and a scholarly article, “Rewriting Medical History: Charles Best and the Banting and Best Myth,” Journal of the History of Medicine and Allied Sciences, 48 (July 1993): 253–74. Read singularly or together, these publications underline the foolishness of believing that insulin was discovered by Banting and Best. As I believe I make clear in The Discovery of Insulin, it was a collaborative process, drawing on the talents of at least four people as well as the comparatively great research capacity of the University of Toronto, where for many reasons a field of medical dreams had been built. I should have been more explicit in suggesting that J.B. Collip ought to have shared the Nobel Prize for insulin with Banting and Macleod, and in criticizing the sad attempts at historical falsification engineered by Charles Best, a troubled soul.
I also have published “Banting’s, Best’s, and Collip’s Accounts of the Discovery of Insulin,” Bulletin of the History of Medicine, 56 (Winter 1982–83): 554–68; and “J.J.R. Macleod and the Discovery of Insulin”, Quarterly Journal of Experimental Physiology, 74 (1989): 87–96, along with several condensed summaries of this book. In “Growth, Progress, and the Quest for Salvation: Confessions of a Medical Historian,” Ars Medica, I, 1 (2004): 4–14, I explain how The Discovery of Insulin relates to my 1991 study of smallpox, Plague, and to my 1999 biography, William Osier: A Life in Medicine. With the 2005 publication of Harvey Cushing: A Life in Surgery, I squared the circle, as it were, by writing about a surgeon who was both a true medical miracle worker and a great endocrinologist.
A substantial article literature, locatable through standard search engines, has developed since 1982 about the early development of insulin. Robert Tattersall’s work on insulin in the United Kingdom is particularly noteworthy, as is the writing of Chris Feudtner in the United States, especially his book Bittersweet: Diabetes, Insulin, and the Transformation of Illness (2003). There now also exist biographies of the other members of the insulin team: J. B. Collip and the Development of Medical Research in Canada, by Alison Li (2003); J.J.R. Macleod: The Co-discoverer of Insulin, by Michael J. Williams (Royal College of Physicians of Edinburgh, Supplement to Proceedings, 1993); Margaret and Charley: The Personal Story of Dr. Charles Best, by Henry Best (2003). E.C. Noble, who lost the famous coin toss to Charles Best, finally receives attention in M. Jurdjevic and C. Tillman, “E.C. Noble in June 1921, and his account of the discovery of insulin,” Bulletin of the History of Medicine, 78, 4 (2004): 864–875. With the development of the Internet the University of Toronto has been able to make more than 7,000 pages of the original documents available on its “Discovery and Early Development of Insulin” website, http://digital.library.utoronto.ca/insulin. An Oxford-based British team has done marvelous work creating an oral history of patients’ experiences with diabetes, which may be accessed at www.diabetes-stories.com.
Publication of The Discovery of Insulin dismayed and offended some of Fred Banting’s and Charles Best’s less critical admirers. Getting this history right has practical importance in Canada, for ceremonies and plaques, and in steering historical preservation priorities. Gradually, sometimes grudgingly, most devotees of Banting’s or Best’s legacies have come to accept most of my conclusions. Not so the scientific chauvinists in Romania, who have continued their noisy advocacy of Nicolas Paulesco, a campaign that substitutes repetition and agitation for scholarship. To dispute my findings without addressing them, one basic trick is to cite authorities who pronounced on credit before the evidence cited in The Discovery of Insulin became available.
The central argument of this book has now been generally accepted. In several adaptations, the story told here has educated and, to my surprise and delight, inspired people whose lives have been touched by diabetes. The Discovery of Insulin has been read by diabetic teenagers, by their parents, by insulin sales representatives, by medical students, by research scientists, by historians of science, by Nobel laureates, and possibly by Fiji Islanders. It has inspired students to go into diabetes research and at least one researcher to revisit the potential of fish islet cells. In 1988 the story was made available to tens of millions of people around the world through Gordon Hinch/Gemstone Productions’ beautifully done 1988 television adaptation, “Glory Enough for All.”
Of the books I have written, The Discovery of Insulin is my favourite. I hope it will still be read long after a cure for diabetes been found and no one needs to take insulin. I look forward to rewriting this preface on the centennial of insulin’s discovery in 2021–22, and to celebrating the occasion, once again, with my dear wife Elizabeth and our children and grandchildren.
Toronto, October 31, 2006
Michael Bliss