NOTES AND SOURCES

The two geographic hubs of our research corresponded to the two primary locations of the development of insulin: Toronto, Canada, and Indianapolis, Indiana. We went to great lengths to physically place ourselves in the rooms and on the roads in which the primary characters lived, worked, and traveled nearly ninety years ago. In Toronto, we found a rich archive at the Thomas Fisher Rare Book Library at the University of Toronto. Here we were able to see and hold many primary documents and objects related to our story, including Elizabeth’s daily dietary and insulin charts written in her own hand, Teddy Ryder’s scrapbook, newspaper clippings from around the world, and Banting’s desk diaries—not to mention the preserved pancreas of Leonard Thompson. Although Elizabeth destroyed many of the papers, photographs, and other materials that documented her illness, her letters to her mother during the pivotal years of 1921 to 1922 survive. They were essential to both the content and the mood of our narrative as far as she is concerned. We are grateful to the Hughes family for donating them to the Thomas Fisher Rare Book Library. In the University Archives, we found many documents relating to patent and royalty arrangements. We also visited the Banting House National Historic Site in London, Ontario—the house where Banting spent the sleepless night that ended in his scrawling twenty-five words in a bedside notebook.

At the Eli Lilly and Company corporate archive in Indianapolis, we found internal correspondence to and from Clowes and the Lilly family during the critical period in which he made so many trips to Toronto. The Lilly archive also yielded company newsletters, sales literature, and memoranda as well as pharmaceutical paraphernalia. Thanks to the prescience of the company leadership, which recognized the historical significance of the development of insulin even as it was happening, many important primary materials were magnificently catal ogued and preserved for history. Moreover, the company celebrated significant anniversaries of the discovery and development of insulin, and the speeches made by Banting, Clowes, and others at these commemorative events provided excellent historical information and perspective.

A third likely geographic research hub would have been Morris- town, New Jersey, but alas, the Physiatric Institute was demolished in 1937 and little evidence remains there of the great pioneering effort that Dr. Allen—”Dr. Diabetes”—so faithfully committed himself to carrying out. Information about the Physiatric Institute was drawn primarily from the Hughes papers at Columbia University, the superb collection at the New York Academy of Medicine, and the personal collection of Dr. Alfred Henderson. The property on which Otto Kahn’s resplendent mansion stood and where so many desperately ill diabetics found help is now part of a corporate campus.

We read and reread The Discovery of Insulin and Banting: A Biography, both by Michael Bliss, professor of the history of medicine at the University of Toronto. These books were instrumental in navigating the chronological framework for our narrative. Also critical to our effort were Charles Evans Hughes, Merlo Pusey’s comprehensive, two-volume biography; The Autobiographical Notes of Charles Evans Hughes, edited by David Danelski and Joseph Tulchin; Sir Frederick Banting by Dr. Lloyd Stevenson; Starvation (Allen) Treatment of Diabetes by Lewis Webb Hill, M.D., and Rena Eckman; Elliott P. Joslin, M.D.: A Centennial Portrait by Donald M. Barnett, M.D.; and the privately published commemorative volumes issued by Eli Lilly and Company on the occasion of the anniversary celebrations.

At the Library of Congress we found the Beerits memoranda, hundreds of newspaper articles, and letters and birthday cards written by Charles Evans Hughes to Antoinette Carter Hughes, often in verse, which provided insight into the nature of their relationship. At the Bentley Historical Library in Ann Arbor, Michigan, we discovered Dr. David Denning’s letter to The New England Journal of Medicine, Elizabeth’s obituaries, and biographical information about William Gossett.

We conducted meaningful research at and through the Lilly Library at Indiana University in Bloomington, Indiana; the Indiana Historical Society; the Indiana State Library; Mayo Clinic in Rochester, Minnesota; the New York State Library in Albany, New York; The American Philosophical Society in Philadelphia; the campus of The Silver Bay Association on Lake George, New York; Woodlawn Cemetery in the Bronx, New York; and Crown Hill Cemetery in Indianapolis.

Some of what we found is just plain curious, such as the fact that one of Banting’s ancestors published a book about how to lose weight by avoiding fats, starch, and sugar and thus the word “banting” still appears in the Oxford English Dictionary as a synonym for dieting. Or the coincidence that, following the 1906 San Francisco earthquake, Eli Lilly and Company sent cases of much needed medicine to California, where the recently graduated Dr. Allen was helping with the recovery effort. Or the story that in 1925 Banting was in Washington and decided to stop by the house of Charles Evans Hughes on a whim. When he gave the driver the address, the cabbie looked skeptically at his passenger and informed him that he would never be admitted to the home of the secretary of state. Banting smirked and bet the cabbie: If Banting knocked on the door and was admitted, the cab ride would be free. If he was rebuffed, Banting would return to the taxi and pay double the fare. The cabbie lost the bet.

The character of Eddie at the Physiatric Institute is a composite of facts and anecdotes about several diabetics in different locations. The story of the birdseed is all too true. In their desperation diabetic children were driven to sneak food and to consume even nonfood items, including birdseed and toothpaste.

The phone call from Charles Evans Hughes to President Falconer at the University of Toronto is imagined, as is Antoinette’s urging him to it. It is not known for certain exactly what prompted Frederick Banting to change his mind about accepting Elizabeth as a patient in August of 1922. However, we know that President Falconer and Charles Evans Hughes had been acquainted with each other for at least a decade; that Charles had never taken an extended trip such as the sail to Brazil without Antoinette since they were married; and that just ten days before the Pan America departed for Rio de Janeiro Antoinette delivered Elizabeth into Banting’s care—and abruptly left her there.

Our depiction of Banting’s burial and retrieval of the ring represents Banting’s struggle to reach a final resolution about his engagement. We don’t know how his struggle actually manifested itself. Likewise, we don’t know that Antoinette took Elizabeth from the Physiatric Institute in the middle of the night. However, this is consistent with her dramatic efforts to save the lives of Elizabeth, Helen, and Charlie. Just as Elizabeth reinvented herself to stay true to herself, where we have invented components of our narrative we have done so to serve a greater understanding of the story and those involved.

One of the most interesting things about this story is that many of the characters who were most famous in 1922 are the most obscure now and vice versa. Charles Evans Hughes—a towering public figure in his time—is virtually unknown today. Likewise, Dr. Allen died poor and forgotten whereas the name of his colleague, Dr. Elliott Joslin, is emblazoned on diabetes centers around the world. Sadly, diabetes itself is still very much with us.

We sometimes learned as much through the pursuit of our research as we did through the research itself. For example, in our travels to Toronto we made it a habit to ask Canadians if they knew the name Frederick Banting. Most either did not recognize the name or had heard it but didn’t know who he was. One man we asked knew quite a bit about Banting, but it turned out that he was an American physician. In Glens Falls, New York, the birthplace of Charles Evans Hughes, we discovered just how forgotten Hughes really is today. When we inquired about him at the information desk of the Crandall Public Library there, we were met with the reply, “How do you spell Hughes?”

Sometimes the experience of research was emotionally arresting, as when we found Elizabeth’s name conspicuously absent among the graves of her siblings, parents, and grandparents in the Hughes family plot at Woodlawn Cemetery in the Bronx. Even in death Elizabeth abandoned the identity of Elizabeth Hughes. Elizabeth Gossett’s final resting place is marked by a modest brass plaque in the columbarium at Christ Church Cranbrook in Bloomfield Hills, where she and her husband raised their family. Having lived in daily companionship with the character of Elizabeth for years, we intuited why she had chosen to be cremated—to avoid having her pancreas (or any other part of her body) suffer the ignominious fate of Leonard Thompson’s.

Several questions remain frustratingly unanswered. One relates to Blanche Burgess and the mysterious Dr. McClintock, who, according to Elizabeth’s letters, did not seem to need to work and spent much of his time courting Blanche in Toronto. It is our conjecture that McClintock might have been a Pinkerton agent hired by Hughes to ensure Elizabeth’s safety shortly before Charles and Antoinette embarked on the Pan America to sail to Brazil. If it were to become public that Elizabeth had in effect “ jumped the line” in order to secure insulin, her life might have been threatened.

The mystery that shapes the very fulcrum of the story is: How could Charles and Antoinette leave Elizabeth in Toronto when her condition was at its most precarious, and sail for Brazil? The trip was essentially a boondoggle, a trip with no critical political agenda. Wouldn’t they want to be with Elizabeth at this decisive moment as they had been with Helen when she neared her end?

Finally, we are left to wonder at the choices Elizabeth made: How could she not keep in touch with Banting or her Toronto cohort or her devoted companion Blanche? How could she fail to dedicate herself in some way to diabetes research and to diabetics, to repay some of the luck and mercy that had spared her life? Could the answer lie in a dim awareness that at the heart of the glorious miracle through which she was saved lay the dark possibility that another child had died in her place?

This is a story punctuated with question marks. It is a story of lost diaries, censored manuscripts, and destroyed photographs. For Elizabeth, erasing was affirming; negation was preservation. This is the very kernel of Elizabeth’s story, the calligraphic stroke of her life’s work. The scant record of her four years of starvation is like the rippling rings of water that appear when something of substance has dropped beneath the water’s surface. From a research perspective, the paucity of materials documenting the critical four years of Elizabeth’s life is frustrating, but from a humanistic viewpoint it’s hard not to feel just a little bit of an empathetic victory for her. This very lack of documentation is proof of the fulfillment of Elizabeth’s impossible dream, one that so many of us take for granted: the chance to live a normal life. In our view, few people relished the extraordinary ordinariness of it as much as she did, and that makes the unanswered questions a little easier to accept.