TWENTY-EIGHT
The Transformation Begins, Toronto, August to November 1922
ON AUGUST 15, 1922, ANTOINETTE, ELIZABETH, AND BLANCHE arrived in Toronto and rented a large apartment in the Athelma Apartments on Grosvenor Street. The next morning, the trio left the apartment by taxi to go to Banting’s office on Bloor Street West, where he would examine her. There had been quite a bit of talk about Dr. Banting and his amazing discovery among the staff at the Physiatric Institute and, of course, Elizabeth and Blanche had read the news articles, so on this morning Elizabeth’s spirits were high. She had always harbored a special fascination with meeting people of note and she was eager to meet a bona fide scientific genius. But despite her optimism Elizabeth was so weak she could hardly walk. Still, she was determined to greet Dr. Banting on her own two feet. Supported by Blanche, she shuffled from the door of the taxi, up the stoop steps to the door of the office, a laborious process closely watched from the windows of 160 Bloor Street West by several patients in the waiting room and by Dr. Fred Hipwell, Banting’s cousin and classmate, who now shared the office with him.
Banting invited Elizabeth, Antoinette, and Blanche into the examination room. He was quite a bit younger and rougher than Antoinette expected. His hair was badly cut (she thought perhaps he’d done it himself). He was wearing a poorly made suit that appeared to have never encountered an iron in its long, adventurous life. When Banting extended his large bear paw of a hand to Antoinette, she was surprised to find it curiously rough for someone in his profession. She could not help but wonder if the whole desperate endeavor was for naught. Could this disheveled character possibly save Elizabeth’s life? Could she actually leave her daughter in his care?
Elizabeth’s first impression of Banting was entirely different from that of her mother. What Elizabeth saw and heard was the walking, talking opposite of everything that was Dr. Allen. She couldn’t have been more delighted by or more curious about him if he had had a tail and spoke in rhyme.
Banting left while Elizabeth changed into a hospital smock for the examination. Returning, he weighed and measured her. He looked into her eyes, nose, ears, and mouth. He examined her fingers and toes. He checked her reflexes by tapping on her knees and ankles with a triangular rubber hammer. He palpated the glands in her neck and armpits. He took the following notes: “Height five feet. Weight forty-five pounds. Emaciated. Skin dry. Slight edema of ankles. Hair brittle and thin. Abdomen prominent. Marked weakness.”
“Does it hurt when I press here?” he asked.
“No,” she replied.
“Here?”
“No. Do you mind if I ask you how old you are, Dr. Banting?”
“I’m thirty.”
“That’s exactly twice my age, or it will be in four days when I turn fifteen. Are you married?”
“No. Are you?”
“Oh yes,” she replied, trying to sound nonchalant. “I’ve been married several times.”
He looked at her. She looked at him. They both broke out into identical, simultaneous grins. Antoinette shook her head and Blanche tried to hide a smile by looking into her lap.
“Do you like animals?”
“Very much. I grew up on a farm.”
“Is that your farm?” Elizabeth indicated a partly finished oil painting on the desk.
“Why, yes, as a matter of fact it is.”
“Did you paint it?”
“This is the first examination I’ve ever conducted where the patient asks more questions about me than I ask about the patient!” Banting turned away to prepare a syringe. “Okay with you if I draw some blood?”
Elizabeth held out her arms, allowing him to choose. In 1922 blood sugar analysis was time consuming and inaccurate. It also required up to 20 mL of blood.
“Aren’t you going to say, ‘This might pinch a little bit’? I thought they teach you to say that in medical school.”
“Not in Canadian medical school.” Banting smirked. He was charmed.
“What’s your favorite animal?” she asked, trying to distract herself from the sight of her blood filling the syringe.
“The dog, I guess. Sometimes I think I get along better with animals than I do with people.”
“Well, I like you pretty well so far.”
“Well, I like you, too. So far.”
Banting dragged the chair from the desk over to the examination table. He turned it around and sat on it backward, resting his arms over the back. He looked seriously at Elizabeth.
“How do you feel generally?”
“Hungry.”
“Besides that.”
“Thirsty.”
“How long have you felt this way?”
“Three years and nine months.” Elizabeth turned serious for the first time during the examination.
“You look sick but you don’t act sick. Why is that?”
Elizabeth took a deep breath and leveled her gaze at the young doctor.
“Dr. Banting, have you ever known something, just known it in your bones? And even though everything may seem to point to the opposite, you still know it’s true?”
“As a matter of fact I have.”
“Really?”
“Truly.”
“Well, I know that I’m going to get better. Do you believe me?”
“Yes, I do.”
“Really?”
Banting nodded solemnly.
“Then you’re the first one ever.”
“The only question I have is when would you like to start getting better,” he said.
“Of all the questions of all the doctors I’ve seen, no one has ever asked me that.”
He stood up and returned the chair to the desk. “How do you feel about shots?”
“Will they make me well?”
“Yes, I think they will.”
“Then I’m crazy about them.”
Banting pulled a string from around his neck on which there was a key. He bent to a locked cabinet in the corner of the room and opened the cabinet door. Elizabeth could see now that it was a kind of icebox and that there was nothing inside but two small brown glass vials. She watched him closely.
“Is that insulin?” she whispered.
“Yes,” he whispered back. He swabbed her thigh with alcohol.
She watched him fill the syringe.
Just before he injected her he asked, “Will you promise me one thing, Miss Elizabeth Hughes? Will you promise me that if you get well—when you get well—you will grow up to be whoever and whatever you want to be and you won’t let anyone persuade you to do or be something or someone else?”
Elizabeth must have sensed what it had cost Banting to become who he was, what it had cost him to carry the idea of insulin against seemingly impossible odds, repeated failure, and constant debt and doubt, all the way to the office in which they sat now. Or perhaps she had caught a glimpse of a profound loneliness behind his eyes. In any case, she nodded solemnly, just before the needle pierced her meager hip. She flinched but did not look away as Banting squeezed the plunger, pressing the murky beige extract into her flesh. Neither Banting nor Elizabeth spoke. Then Banting turned away to discard the empty vial.
“Wait!” Elizabeth’s voice broke the silence. “May I keep it?”
“The vial?”
“Yes.”
That, too, was a first for Banting. He placed the vial gently in her
palm. She closed her fingers around it.
* * *
That same day, Dr. Allen wrote a letter to Banting.
I take pleasure in informing you that our first results with your pancreatic extract have been marvelously good. We have cleared up both sugar and acetone in some of the most hopelessly severe cases of diabetes that I have ever seen. No bad results have been encountered either generally or locally. We have been able to increase diets, and already an effect seems evident in the form of increased strength. I am making all observations on an experimental as well as therapeutic basis, and only wish that we could have several times as much extract as is available just now. You deserve all congratulations, but as you will receive them so abundantly, I need not express myself at length now. Unless notified by you to the contrary, I shall include your name in the list of editors in the next issue of The Journal of Metabolic Research, to appear probably within two or three weeks from date.
That afternoon Banting had lunch with D. E. Robertson at the university’s faculty club. When Banting told him about the happy events of the morning, Robertson blanched and asked Banting if the suit he was wearing was the same suit he had worn to meet Mrs. Hughes.
“I only own one,” Banting replied.
“What are you doing after lunch?”
“Nothing right away,” Banting shrugged. “I have patients later this afternoon. Why?”
After lunch, Robertson took Banting to the most exclusive tailor in Toronto to be fitted for a suit and overcoat. Banting complained about the expense and protested that “no one ever had a good idea in a dress suit,” but Robertson prevailed. He could see that Banting would soon be meeting with dignitaries and representing Canada to the world. The elder man took it upon himself to provide Banting with a good suit and some basic manners.
Elizabeth responded well to the insulin; no reactions developed either at the injection site or elsewhere. Banting had assumed that Antoinette would remain in Toronto for a while, as had been the case with all of his other patients. But after just a few days, Antoinette informed him that both she and her husband would be at sea for most of the next four weeks. Antoinette left Blanche a considerable sum of money for “expenses,” which presumably might include the transportation and burial of Elizabeth’s body in the Hughes family plot at Woodlawn Cemetery.
On August 18, 1922, George B. Schley, the patent attorney for Eli Lilly and Company, happened to see a short newspaper article reporting that the daughter of the U.S. secretary of state was in Toronto taking insulin for diabetes. It described Dr. Frederick G. Banting as the original inventor of insulin. This detail alarmed Mr. Schley, who was aware that the Toronto team had drafted two patent applications: the first, a process application, by Best and Collip, and second, a product application, by Best alone. In neither of these applications did the name of Banting appear as inventor.
On August 22, 1922, Schley wrote a very stern letter to Clowes informing him that the law required that a patent application be filed by the actual inventor or inventors. If the patent is applied for by one who is not the inventor, the patent is absolutely void if that fact is found by a court. Furthermore, there was a real danger of criminal prosecution for perjury should it be shown that Best or Collip had misrepresented himself as the sole inventor(s) of the product and process when in fact both knew that Banting was the original inventor, or at least a coinventor.
At first, Banting dismissed the matter, but when he heard about the possibility of criminal charges against Best, he changed his mind. The name Banting was added to the two U.S. patent applications and to those for the United Kingdom, Europe, and the rest of the world.
On August 21, 1922, the diabetic clinic at Toronto General Hospital finally opened. Through the summer and fall of 1922 its patients were sustained largely with Lilly’s help because of Connaught’s sporadic output. The insulin directed to Banting’s patients in Toronto, including those at Toronto General Hospital under Banting’s care, was provided at no cost to patients.
Elizabeth took insulin twice daily, fifteen to thirty minutes before her morning and evening meals. Each specimen of her urine was tested, and when sugar appeared, her dosage was slightly increased. Banting visited her at the Athelma Apartments each day at 5:30 in the afternoon, bringing with him her evening dose of insulin. During this period of dose testing and regulation, her caloric intake was also steadily increased, and so there ensued a precarious simultaneous balancing of an increased insulin dose to match the increased calories. A failure to balance these produced two risks, either potentially fatal.
Before 1922, hyperglycemic coma, induced by total lack of or insufficient insulin, accounted for 86 percent of the mortality of diabetic children; after insulin, from 1922 to 1936 the mortality rate of diabetic children from hyperglycemic coma declined, but was still 56 percent. The first diabetic “resurrected” from a hyperglycemic coma by the injection of insulin was eleven-year-old Elsie Needham, at the Hospital for Sick Children in Toronto in October 1922.
The introduction of insulin saved diabetics from hyperglycemic coma, but it also introduced a second type of coma—hypoglycemic coma. Diabetic children were more susceptible than diabetic adults to hypoglycemic coma. Soon after the discovery of insulin, the need to control the dosage became apparent.
Too much insulin drives the blood sugar down to dangerous levels; hypoglycemia occurs when it falls below 60 milligrams of sugar per deciliter. (An average person’s blood sugar is 80 to 120 milligrams of sugar per deciliter of blood.) The symptoms of too little sugar in the blood, which involve the autonomic and central nervous systems, include numbness and tingling, rapid heartbeat, trembling, weakness, sweating, pallor, and nausea. These symptoms are often accompanied by confusion or stupor, which can prevent the diabetic from taking the simple steps necessary to save himself—most important, a quick dose of sugar. If not treated, hypoglycemia can lead to seizures and coma.
Elizabeth called these hypoglycemic episodes “the feels,” and she often had them, sometimes three episodes a day. To prevent Elizabeth from lapsing into shock during the night while she was asleep, Blanche and Elizabeth shared a bed in hope that Blanche could better detect and respond to a nighttime attack of “the feels.” In those early months of experimental insulin, Blanche saved Elizabeth’s life dozens of times by reviving her with orange juice or a molasses kiss during the night.
And there arose other problems with the miracle cure. Protein impurities caused abscesses in many patients and salts in the solution made injections painful. Elizabeth’s hips and thighs were soon upholstered with egg-shaped welts. The new ones were purple, the older ones were green fading to yellow. Banting had taught Blanche to administer the injections using this color-coded pattern of wounds to guide where to place the next injection. When the insulin was weak, the injections were necessarily large. In October the only insulin available was so weak that Elizabeth had to take 5 cc at a time. Her syringe held only 2 cc. So Blanche filled the syringe and injected 2 cc, then unscrewed the glass barrel from the needle, which she left sticking into Elizabeth’s hip, filled the syringe again and screwed it to the needle, and injected the insulin into Elizabeth, and then unscrewed the syringe one final time and repeated the process for the final cc. The whole procedure required about twenty minutes, and in this time Elizabeth’s hip swelled and her whole leg became numb. It took about an hour of careful walking on it for the sensation to return, but it was worth the trouble if it allowed her to eat real food again.
Both Elizabeth and Blanche were compelled to acquire a thorough understanding of sterile injection and urinalysis procedure. For the rest of her life Elizabeth would need to have with her certain necessary equipment. For injection of insulin she would need two syringes, two rustless 3/8-inch, 25-gauge hypodermic needles, a supply of insulin, a small covered pan for sterilization, clean cotton and rubbing alcohol, and a sponge and cleanser for cleaning her needles. For urinalysis she would need a supply of Benedict’s solution, two test tubes, one eyedropper, a teaspoon, an open-mouth bottle for urine, and an aluminum cup. All of this was in addition to the meticulous charts that detailed her caloric intake, exercise, insulin reactions, and urine readings, which she was still required to keep. As Frederick Allen said, insulin improved but did not simplify the treatment of diabetes.
Problems with the potency of the extract threatened her recovery. One shipment of insulin from Lilly had proved to be very unsatisfactory, and Banting had given doses as high as 15 cc a day to Joe Gilchrist with very little effect. If no effective insulin could be obtained Elizabeth and the other diabetics would be forced to return to fasting and the Allen diet. On August 21, Dr. Banting visited at his usual time of 5:30 p.m. to tell Elizabeth that Connaught was about to produce its first substantial batch of truly potent insulin. It was so potent that she would only have to take one cc at a time. He said that she would soon be on a diet of 2,240 calories, like a normal girl.
Banting was not nearly as cautious about the process of increasing the caloric intake of his patients as was Allen, and Elizabeth was soon experimenting with previously forbidden foodstuffs such as cereal, bread, potatoes, and rice. In this once forbidden domain of food, revelation followed revelation on a near daily basis. Elizabeth described it as “unspeakably wonderful.”
On August 25, she ate a piece of white bread for the first time in three and a half years.
On August 29, she ate corn for the first time in three and a half years.
On September 7, she ate macaroni and cheese for the first time in three and a half years.
On September 13, she ate grapes for the first time in three and a half years.
On September 21, she ate bananas.
On September 22, she ate plums.
In Rochester, New York, James Havens had a similarly ecstatic reaction. He wrote to Banting: “A week ago last Thursday . . . marked an historical event as I then tasted my first egg on toast. Egg on toast is my idea of the only food necessary in heaven. Moreover if they don’t pass out at least that much rations up there I guess I prefer the other place.”
Banting encouraged Elizabeth to eat unreservedly. For breakfast she ate peaches, three-quarters of a shredded wheat biscuit with cream, an omelet with an ounce of butter, some bacon, some cream cheese, and a big slice of toast. For lunch she ate meat, a hot vegetable, celery or tomatoes, and a large serving of custard for dessert. For supper she might have cold roast beef and potato salad and eggplant, celery with lots of butter, cocoa, saltines with cream cheese, junket pudding with fruit, and a big bunch of grapes.
Although Elizabeth could not send letters to her mother in Brazil, she had promised Colonel Swalm that she would maintain the exercise of writing every day and so she continued to write to her mother and to her sister, Catherine, and brother, Charlie, too.
No body up here except Dr. Banting of course knows what a big diet I’m on and the foods I’m eating on it either, and I know if they did know they’d nearly roll off their seats. It’s our great big secret! [Her diet consisted of 2512 calories.] I could use up pages just in innummerating [sic] all the dishes I have nowadays and it seems to me that I eat something everyday that I haven’t tasted for over three years, and you don’t know how good it seems and how I appreciate every morsel I eat.
At this time there was happy, if slightly mysterious, news for Blanche too. As Elizabeth wrote to her mother:
I suppose you’ve heard either from Catherine or Charlie of Dr. Mc- Clintock’s appearance and how he accompanys [sic] us on all our picnics and comes up to see Blanche every night. . . . I’m simply positive they must be engaged for they call each other “dear” and do other very significant things, but Blanche won’t vouchsafe anything to me as yet. Isn’t it queer? I’m glad I know him as well as I do though, for he really is worthy of her in my opinion now, although what he does is beyond me. He seems to have plenty of money so as not to have to work, yet if he has why don’t they get married. Well it’s a mystery as I say, and yet it strikes me very funny too, doesn’t it you?
As Elizabeth gained strength, she and Blanche often spent afternoons in Queen’s Park reading and walking the lovely footpaths of the campus and the city, always accompanied by the enigmatic Dr. McClintock. In October, she wrote:
Yesterday afternoon I had an awfully good time going over to the library here on College St. and reading while Blanche and the Dr. took a walk. I love to do that and in that way I can almost read in one afternoon one of the short books that really wouldn’t be worthwhile to take out on my card. Yesterday I read and almost finished Hudson’s charming book of tales of the Pampas land and it was great, the way all his books are. . . . It certainly is one of the best librarys [sic] I’ve ever been to, and they have the nicest, cleanest books as well as almost all the latest ones. I was astounded the other day in looking up, to gaze on a book called, “Charles E. Hughes.” Jurist and Statesman [sic], which I had never seen or heard of before, and which I immediately took down and perused. It’s very interesting being of his law cases and how he handled them on the Supreme Court. I suppose you know all about it but it was news to me.
Blanche is going to let me tell just you and Catherine the exciting news she told me the other day in the most casual manner ever, which I have been expecting and waiting for, for months now, and that is that she really is engaged to Dr. McClintock. She is most secretive about it as usual, and all I can get out of her is that they will be married sometime in the near future and are going to live way out in California. I am so glad for her, for she will be simply adorable as a wife and mother, and I am sure now that he is worthy of her, after having seen him everyday for two months. Upon first meeting him I know you would not think it at all, but upon knowing him well and after drawing him out he’s perfectly adorable and so full offun. He has a great sense of humor just like us, and the games he thinks up for us to play evenings here are lots offun. I really have enjoyed his being here every day a lot, and accompanying us on all our picnics, etc. He is leaving Monday evening on the seven P.M. train. I know you’ll be very much interested in all this, and that’s why I wanted to prepare you for it before you came up. I was positive of it all the time. She couldn’t have had all the various symtons [sic] of it and not have the malady.
Newspapers reported on Elizabeth’s miraculous recovery, and not always entirely accurately:
NEW TREATMENT AIDS MISS HUGHES
Daughter of Secretary of State Improves Under
Canadian Specialist’s Discovery
Gains Sixteen Pounds
After Transfusions Diabetic Sufferer is Now Permitted
Nearly Normal Diet
PERMANENTLY CURED BY INSULIN TREATMENT
Mr. Hughes’ Daughter Treated Here a Year Ago—Fear
No Return of Diabetes
NEW YORK EXCITED OVER NEW CURE
FOR DIABETES
Discovery of Dr. Banting of Toronto is
Discussed in American Press
Public Interested
Treatment of Miss Hughes Focuses Attention of America
on Toronto Experiments
LITTLE DAUGHTER OF HUGHES SEEMINGLY
CURED OF DIABETES BY
SERUM TAKEN FROM FISH
Banting said that Elizabeth was his “record case.” She was gaining roughly two pounds per week. “You’d think it was a fairy tale,” she said. She could hardly wait for her parents to see the transformation in her appearance. But she was irritated at the publicity. “I hate to be written up like that all over the country and I think it’s cheapening to the discovery. Poor Dr. Banting’s even gotten to the place where doctors are beginning to kid him about advertising his discovery through me. Isn’t that perfectly horrid, though?”
Elizabeth had begun to receive letters from desperate diabetics who had read about her. At first she tried to reply to them all, but she soon felt burdened by them. “With your letter this morning came two more letters from poor diabetics which I suppose I’ve got to answer. The poor things. I feel so sorry for them.”
She had no interest whatsoever in becoming a poster child for insulin: In fact, she had already begun to think of herself as a nondiabetic.
Yesterday morning we were called on the telephone by this lovely lady, Mrs. Ferris who had Diabetes and wanted to know about the effect of the treatment on me and something about it and she couldn’t find Dr. Banting and had read of my case in the New York papers. She said she was only going to be here until the late afternoon as she was with a party who were leaving then. They had been touring the US and the other member of this party were Sir Charles and Lady Wakefield and Sir Arthur and Lady Halmsworth . . . she came up to see us for a while and we told her all we could for she seemed very nice. It seems that she’s had this since 1914 very mildly, but through great carelessness in han- dling her diet she has now become quite a severe case I guess. She has no idea at all how to take care of her diet not knowing even what calories and carbohydrates meant so I don’t see how she can be getting along very well. And I don’t see how she could manage this treatment at all. She must be showing sugar all the time and has two diabetic carbuncles on her hands. Now you only get those you know from showing sugar constantly so that’s the reason why she had them. Well we did all we could for the poor ignorant lady and she left hoping to come in touch with Dr. Banting sometime during the day. Well the poor thing must’ve passed him going down in the elevator and not known it, for immediately after she left, Dr. Banting appeared. . . . Wasn’t that the perversity of fate though. . . . We have had several poor people come here to ask about the treatment and they were eventually all turned away. Its [sic] makes you feel so sorry and yet you can’t do a thing about it. I can’t get over how fortunate I was to get in up here.
This was not at all her idea of what life would be after Toronto. Instead, she imagined herself returning to Washington and to school and leading a completely normal life, which she hoped would commence before the end of the year. She intended to put the past forty months so completely out of her consciousness that it would be as if they had never happened at all. The only thing that was stopping her was that she had promised Dr. Banting that she would not leave Toronto until a meeting of clinicians could be arranged. At this meeting, she would be the main attraction. The meeting was scheduled for November 25. Elizabeth and Blanche planned to leave Toronto on December 1—each to begin a new life. Blanche was to marry Dr. McClintock and move to California and Elizabeth would begin an ostensibly nondiabetic life in Washington. Only one of these scenarios would come to pass.