TWENTY–TWO

Failure and Success, The University of Toronto, February to April 1922

AT TORONTO GENERAL HOSPITAL, DOCTORS WALTER CAMPBELL and Almon Fletcher admitted six more patients to Ward H and treated them with Collip’s extract. Every one of them improved. One of these patients was an emaciated girl, a friend of Charley Best from a Toronto suburb. Within hours of receiving insulin she became herself again—a happy, playful child. Instead of being pleased, Banting could not help but resent that it was Collip’s extract that had helped Best’s friend.

The fact that he had lost the humanity to feel happy for a little girl’s life sent him into a sickening spiral of self-recrimination. In February, Banting began to drink heavily, stealing the 95 percent pure ethyl alcohol from the lab. He plunged into an emotional vertigo that he felt he could not survive. He was like the poor chap he’d encountered in England when he was waiting for his arm to heal. Shell shock, they’d called it. Like that soldier, Banting had caught a glimpse of the indifference and injustice of the universe, and now that he had seen it, he could not unsee it. Best could do nothing to pry Banting from his crippling malaise.

Later in February, a paper authored by Banting and Best was published in the Journal of Laboratory and Clinical Medicine, and another authored by Banting, Best, Collip, Campbell, and Fletcher was submitted to the Canadian Medical Association Journal. But Banting’s participation in these efforts was minimal. His heart was no longer in it.

Just as the light of hope was dawning on the world, the original spark began to gutter and fade. Banting spent the entire month of March in an inebriated stupor, ignoring telegrams and phone calls and hardly venturing to campus. The pages of his diary suggest that he had begun to read and think about other research projects; there are several vague notes about potential cures for cancer. Reflecting on this time some years later, Banting admitted that there was not a single night during the month of March that he went to bed sober.

Banting had retreated, but others continued to work on his behalf. Billy Ross continued to talk to Roy Greenaway, and on March 22, the first major press coverage of a “diabetes cure” appeared in the Toronto Daily Star. The article spanned seven columns under a dramatic headline:

TORONTO DOCTORS ON TRACK OF

DIABETES CURE

Diabetes Sufferers Given Message of Hope

Banting Stakes His All on the Result

On the same day the Canadian Medical Association Journal published “Pancreatic Extracts in the Treatment of Diabetes Mellitus” by Banting, Best, Collip, Campbell, and Fletcher. Banting probably hardly registered either publication. Not only was he not writing the papers, he wasn’t reading them either.

Collip inexplicably lost his ability to produce the extract in March. Suddenly, there was no more insulin to give to the six patients at Toronto General Hospital. Working independently, Best and Collip strove to produce even an ounce of extract, but despite their frantic efforts Charley Best’s young friend, who had made such a heartening recovery on Ward H, slipped into a coma and died. Unless they could recover their ability to make the extract, the same fate awaited all the patients on the Ward.

On the evening of March 31, Best broke. He visited Banting’s boarding- house room and let loose his fury and frustration as he had never dare to before. He attacked Banting for allowing himself to languish in morbid self-pity when so many around him were working hard toward a solution. Banting drank stolen alcohol from a beaker and listened impassively.

“You said we’d do whatever it takes!” Charley howled.

Banting shrugged. “Changed my mind.”

“It’s too late to change your mind. You sold your house. You sold your car. We stole dogs!”

“It takes a brave man to know when to surrender.” Banting raised his glass and drank to bravery while Charley watched in disbelief. “Col- lip’s process worked. Ours didn’t. Here’s to the continued success and glory of James Bertram Collip! I salute you—you prig bastard.”

“So he won the purification round. So what. We still have to find a way to make large quantities. Aren’t you the one who’s always reminding everyone that this is about the diabetics?”

“To the diabetics!” Banting raised the beaker, drained it, and threw it across the room. It shattered against the wall.

Charley reached into his book bag and pulled out a notebook.

“I went through all of our lab books and diaries and I’ve written out a precise description of our process. If we go over it together maybe we can see how to increase quantity without losing potency.”

“I don’t care.”

“I’m going to read it anyway.” Charley opened the notebook. Banting lay back on the bed and closed his eyes.

“Finely mince beef or pork pancreas. Add 5 cc’s sulphuric acid per pound of gland. Stir this mixture for three to four hours. Add a solution of 95 percent alcohol until the overall concentration of alcohol is 60 to 70 percent. Centrifuge the mixture and filter through paper. Neutralize the filtrate with sodium hydroxide. Concentrate to one-fifteenth of original volume in vacuo and heat the concentrate to fifty degrees centigrade to separate the lipoids. Remove lipoids and other residue by further filtration. Add 37 grams of ammonium sulphate per 100 cc’s of concentrate. Skim off protein material as it floats to the top of the liquid.”

Banting interrupted. “This is pointless, you know.”

“Then what do you suggest?”

“Well, my plan has been to get drunk and stay drunk long enough for an epiphany to bubble up from the subconscious.”

“I almost think you’re serious.”

“I am. Join me?” Banting took a swig from the bottle of laboratory alcohol.

Charley looked on in disgust and continued reading.

“Mix it with hot acid alcohol until completely dissolved. Add 10 volumes of warm alcohol. Neutralize this solution with sodium hydroxide. Cool to room temperature. Store for two days at five degrees centigrade. After two days, pour off the dark-colored supernatant alcohol. Dry the precipitate to remove all traces of alcohol.”

“Charley?”

“Yes?”

Now Banting spoke with a chilling calm.

“There is nothing you can say to make me stay in this. I’m through.”

Charley took a cold, hard look at his friend and colleague. There was one thing that he could have said to make Banting change his mind, and somehow he said it.

“If you get out, I get out,” Charley said.

“Don’t be stupid!” Banting spat. “Your future is secure. Macleod will take care of you.”

“He won’t have to. I quit.”

They glared at each other, but Banting was too drunk to sustain it and his eyes slid shut. After a few moments, Banting’s breathing became deep and slow. Partly to see if he was asleep, Charley asked quietly, “What will you do now?” Without opening his eyes, Banting smiled.

“Paint, I think.”

“Paint? Paint what?”

“Landscapes. Nature. Canada. I know a guy by the name of Jackson, a real artist, who wants to take a painting trip to the Canadian Rockies.”

“So you’ll give up research altogether?” Banting didn’t answer. “I’ve never heard you mention painting. Are you any good?”

“Nope. But I’m no good at medical research either.”

Charley looked down at the notebook still open on his lap. He scanned the remaining pages of notes that he had meticulously copied into the pages. Banting began to snore. Charley closed the notebook and placed it on the small table beside the bed. He stood up.

“Goodbye, Fred. I hope painting makes you happy.” Charley left.

* * *

The next day Banting awoke to find Charley’s notebook on his bedside table and slowly the events of the previous night came back to him. He cared little for his own future, but he could not allow Charley to scuttle his. He rebounded with a vengeance from his dark night of the soul. It was April 1: the beginning of a new month, the beginning of a new start.

Banting saw now that his retreat into depression and drink only helped prove that Macleod and Graham were right about him all along. In his wallow of misery he had not seen how his behavior had played directly into the hands of his detractors. But Charley had seen it. Many times over the past months Charley had tried to tell him, beginning with the train ride back from New Haven in December. Banting thought of the desperate times they had endured together the previous summer. And he thought of Marjorie and of her sacrifice, and of the promise he had made to her. He must repay loyalty with loyalty.

For months his friends and advisors had suggested that he establish a clinical practice. The fact that he was not a practicing physician and had never treated diabetics was Graham’s primary justification for denying him a role in the human trials at Toronto General Hospital. But having been rejected by both Toronto General Hospital and the Hospital for Sick Children, how was he to acquire such clinical experience? Banting suddenly saw a simple solution to what had so recently seemed an intractable problem. He opened a private practice at 160 Bloor Street West to treat diabetics. His cousin and fellow doctor, Fred Hipwell, joined him in the practice.

In April, a representative of the Canadian government’s Department of Soldiers Civil Re-Establishment came to Toronto to discuss how the department might be helpful in further developing insulin. It was decided that a diabetic clinic would be established at Toronto’s Christie Street Military Hospital. The soldiers who had fought the Germans would now enlist to fight diabetes. Banting was to be in charge of the program. Banting’s old friend and classmate Joe Gilchrist would have a role too.

By this time Charley Best had taken over as lead chemist on the team because Collip’s appointment at the University of Toronto was to expire on May 31. While there had been some discussion about Collip’s being invited to stay on, the enmity among the discoverers—and particularly the threat of physical violence from Banting—dampened his interest.

Banting’s luck had changed abruptly. He now found that he had better facilities and potentially more access to insulin than anyone—except that there was no insulin. For several weeks, no one had been able to produce a single drop of effective extract. After weeks of frustration and failure, Toronto’s resolve to keep the Americans out was weakening.

On April 3, Macleod wrote to Clowes:

We have not as yet succeeded in working out to our satisfaction all the steps necessary to prepare a non-toxic potent extract. . . . We are working intensively on this problem in the hope that in a month or two we may be able to publish our method in sufficient detail so that the extract can be prepared satisfactorily elsewhere.

Banting’s friends urged him to patent the insulin formulation and method of purification. Banting refused to have anything to do with the idea, feeling that it was in conflict with the Hippocratic oath, but he recognized the need to protect the discovery from unscrupulous opportunists. In April, Banting, Best, Collip, Macleod, and FitzGerald composed a joint letter to Falconer. The letter proposed that a patent be sought by Best and Collip, neither of whom had taken the Hippocratic oath, and that the rights then be assigned immediately to the board of governors of the University of Toronto in return for the sum of one dollar.

Even as insulin production faltered in Toronto and the enmity among the discovery team intensified, reports of extraordinary success in Toronto appeared in American newspapers. Many read like fairy tales. One story began: “So impressed with the feasibility of Dr. Banting’s hypothesis was Professor J. J. R. Macleod, an investigator himself in this field of research for over 15 years, that every opportunity was given to the young doctor from London to push on [with] his experiments.” Another described diabetic children frolicking in hospital wards, eating dates, and sipping tea with milk and sugar.

Dr. Frederick Allen read these articles with great interest. Here at last was the fulfillment of a promise that he had been making to his patients for years, entreating them to believe that a cure would come. Although he was originally cautious about trying insulin on his starvation-depleted patients, he would ultimately provide insulin to more patients than anyone during the first year of human trial. In 1922 a total of 161 patients would receive insulin through Dr. Frederick Allen.

Elizabeth Hughes would not be among them.