Diabetic Resurrections
As historian Michael Bliss observed in his article, “Resurrections in Toronto: The Emergence of Insulin,” published in 2005, most of the early insulin patients “experienced a reprieve from death almost without precedent in the history of medicine.” Indeed, it was “a reprieve as visually and emotionally and spiritually as spectacular as anything we can imagine.”
On December 2, 1921, when 13-year-old Leonard Thompson was admitted to Toronto General Hospital, he weighed 29.5 kg, was poorly nourished and pale. His hair was falling out and he had the smell of acetone on his breath. As there was no diabetes clinic at the Hospital for Sick Children, an arrangement was made to seek admission as a charity case to the TGH diabetic clinic, a process which involved Leonard’s father bringing him to the office of Dr. Duncan Graham, Professor of Medicine. The sight of Mr. Thompson carrying his son into Dr. Graham’s office left a vivid memory with Graham’s secretary, Stella Clutton. She was horrified. As she later recalled, “I’ve never seen a living creature as thin as he was, except pictures of victims of famine or concentration camps.” For the next five weeks, Leonard’s condition worsened. As a senior medical student helping care for him later recalled, “All of us knew that he was doomed.”
Desperate, Leonard’s father agreed to a test of Banting and Best’s pancreatic extract on January 11, 1922, with encouraging, though limited, results. However, after Collip’s more purified extract was given to Leonard on January 23rd, there was “immediate improvement,” as was reported in Banting, Best, Collip, Campbell and Fletcher’s seminal paper published in the March, 1922, issue of the Canadian Medical Association Journal. With daily injections over the next week, sugar levels in Leonard’s blood and urine fell sharply and he “became brighter, more active, looked better and said he felt stronger.”
This first medical journal report on the first human use of insulin struggled to describe its impact on both the severe diabetic patients and on physicians who witnessed what were inevitably described as resurrections. “It is difficult to put in words what is meant by clinical improvement. Those who have been treating diabetes will have recognized as early signs of improvement a certain change in the skin, the appearance of the eyes, the behaviour of the patient, his mental and psychic activity, and the physical evidences, as well as his testimony, of increased vigor and desire to use his muscles.” Six other diabetic patients at TGH received the pancreatic extract during late January and early February, one of whom, suffering from an especially severe case, “obtained complete relief from severe depressions and extreme lassitude,” it was reported.
However, the first “resurrections” were temporary as an insulin famine began in late February, when attempts to increase production of the extract at Connaught Laboratories proved problematic, as is discussed in another article. Desperate efforts led by Best finally restored a supply of insulin by mid-May, by which time Banting had established his own private practice in Toronto where he could treat diabetic patients. Banting was also able to treat diabetic patients at the Christie Street Military Hospital, including Dr. Joseph Gilchrist, who served as both physician and patient at the clinic. On May 15th, Gilchrist received his second injection of insulin as limited clinical testing resumed in Toronto, with the supply from Connaught split between Banting’s practice, Christie Street, TGH and the Hospital for Sick Children. The priority was to resume insulin treatment for the initial group of patients, including Leonard Thompson.
Shortly after Macleod delivered a seminal presentation about the Toronto work on May 3rd in Washington, D.C. attended by the leading diabetic specialists in North America, Banting began to receive letters of desperation from outside Toronto. One such desperate case was 22-year-old Jim Havens of Rochester, N.Y., who become diabetic seven years earlier, at age 15. He had done well on the Allen “starvation” diet, but in 1920, went into a sharp decline. By early 1921, Haven’s father, James Havens, Sr., a vice-president at Eastman Kodak, had all but given up hope that anyone could help his son. However, Jim somehow survived into 1922, by which time he was emaciated, weighing just 33.3 kg and living on 820 calories a day. He was unable to lift his head from a pillow, cried most of the time from pain, hunger and despair, and was ready to die.
The Havens’ proximity to Toronto and Kodak’s business and personal connections there, would help Jim receive insulin treatment. In early April, 1922, Jim’s father heard about some progress being made by Toronto doctors with a pancreatic extract. An indirect personal connection quickly set in motion a series of events that led him to Toronto. That same month, Jim’s father happened to meet with a manager of a Toronto Kodak store, George Snowball, and asked him if he’d heard anything further about diabetes treatment in Canada. Snowball happened to be a golfing partner of Dr. Macleod’s, who had mentioned to Snowball that some diabetes research work was going on at the University of Toronto, although it was premature to report successes.
Snowball was persistent and eventually met with Banting, who gave some additional details, which Snowball then passed along to Jim’s father. On April 9th, Evans sent Dr. John R. Williams, who had been managing Jim’s care, to Toronto to try and secure some extract. However, none was available. But Banting assured Williams he would have some of the first extract produced once the supply was restored. Meanwhile, Jim’s condition deteriorated further, and a diabetic coma seemed imminent. Soon after Dr. Williams heard about Macleod’s presentation in Washington, Evans followed up with Macleod and Banting. On May 21st, some insulin was finally shipped to Rochester. Jim was the first diabetic patient in the U.S. to receive insulin, although in his case it would not be a simple recovery.
The first insulin injection Jim received from Dr. Williams did not seem to work, prompting a hastily arranged trip by Banting to Rochester on May 26th. He had a vial of insulin in his pocket he planned to personally administer, although in a larger dosage. This time, it worked. As Banting wrote in his notes, “The transformation has really been miraculous. [Jim] is now able to be about the house and takes a daily auto drive.” The pain in his legs also disappeared and his “mental picture has changed from one of despair to hope and tranquility.” A further supply of insulin was regularly shipped by train from Toronto to Dr. Williams, who administered it to Jim and continued to report on his progress to Banting. As Jim later wrote, “My parents arranged a dinner for Fred [Banting] with George Eastman, who was anxious to persuade Fred to come to Rochester and work at the new medical school here. When Banting told Eastman his first loyalty was to Canada, Eastman turned to my father and said, ‘here’s a young man I admire, he has backbone.’”
By early June, and through most of the summer of 1922, Banting found himself on his own and in charge of insulin in Toronto. Collip had left. Macleod was in New Brunswick on a working research holiday. And Best had gone to visit his family in Maine. Banting was free to take on a few private patients; there was no shortage of critically ill diabetics desperate for the seemingly miraculous cure. Macleod’s Washington presentation about “Banting’s epoch-making discovery” was especially impressive to Dr. Louis Hamburger of Baltimore, whose eight-year-old diabetic patient, Ruth Whitehall, was deteriorating. Hamburger immediately suggested to Ruth’s parents the idea of taking her to visit Banting in Canada. However, in light of the persistent insulin famine at the time, Banting had little choice but to deny such a visit. By early June, however, after a personal appeal by Ruth’s father and the restoration of the insulin supply, Banting “very courteously agreed to the proposal to take Ruth under his care,” as Hamburger later reported. A member of a wealthy family, Ruth arrived in Toronto on June 17th with her mother, aunt and butler. They rented an eight-room apartment and Ruth would remain under Banting’s care until the end of September.
In July, Ruth was joined in Toronto by 11-year-old Myra Blaustein, also from Baltimore. She wasn’t initially a patient of Dr. Hamburger’s, and it’s less clear how her trip to Toronto was arranged. Diagnosed in October, 1920, Myra had a more severe case of diabetes than Ruth. When she arrived in Toronto, she was so weak she had to be carried from the train station to the hotel. Once treated with insulin and given a more nutritous diet, the change in Myra was very striking. As Hamburger observed, “Instead of being pale, apathetic and subdued her color improved, she became alert and smiling and sang as in the days before her illness.” Myra remained in Toronto for three months under Banting’s care and returned to Baltimore at the same time as Ruth.
From early July through early October, Banting also treated six-year-old Teddy Ryder, who arrived in Toronto from New Jersey as a “walking skeleton,” a commonly used description of severe diabetics, weighing just under 10 kg. Teddy had developed diabetes at age four. He grew taller but did not gain weight. His diagnosis especially alarmed Teddy’s uncle, Dr. Morton Ryder, an intern at a New York hospital. Dr. Ryder spoke frankly with Teddy’s parents about their son’s likely fate: within a few weeks or months, he would be dead. Teddy’s mother took him to a series of doctors looking for hope. She finally got an appointment with Dr. Frederick Allen, who admitted Teddy to his “Physiatric Institute” in September, 1920, to undergo the starvation diet treatment, which stabilized Teddy. By Christmas 1921, he weighed 12.25 kg. However, the family’s hopes rose when Teddy’s uncle discovered the front-page Toronto Star article from March 22, 1922: “Toronto Doctors On Track of Diabetes Cure.” Dr. Ryder contacted Banting, but he was initially unable to be of help due to lack of extract. In June, Dr. Ryder visited Banting personally to ask that he take on Teddy as a patient. Banting told him to bring Teddy back in September. Dr. Ryder bluntly replied, “He won’t be alive by then.” Not ready to give up, on his way back home, Dr. Ryder wrote a detailed history of Teddy’s case that he sent to Banting, who finally agreed to accept Teddy as a private patient.
Teddy and his mother travelled on a sleeper train to Toronto, arriving on Saturday, July 8th. They drove straight to Banting’s office, but there was no insulin. The last batch had not passed its quality tests, and they would have to wait until Monday. In the meantime, Banting found Teddy and his mother a small rented room near his office. On Monday morning, he came by to give Teddy his first insulin injections. The boy responded nicely, but often needed three to four injections per day. He soon gained weight and started acting like a healthy little boy. After three months in Toronto, Teddy and his mother went home. His cheeks had filled out and he was able to run and play. According to a February 20, 1983, Toronto Star interview with 67-year-old Teddy and his 92-year-old mother, he was “a child as if resurrected from the grave.”
The first reported almost literal “resurrection” of a diabetic after administering insulin — a resurrection from what otherwise would have been a fatal diabetic coma — involved 11-year-old Elsie Needham of Galt, Ont. In early October 1922, Elsie had been diagnosed with diabetes for six months when, after a likely fit of diabetic hunger, she lapsed into a coma after gorging herself on grapes and olives. While her family doctor had little hope for recovery, Elsie’s parents took her to the Hospital for Sick Children, where she was seen by Dr. Gladys Boyd, who was in charge of the hospital’s endocrine service. Dr. Boyd consulted with Banting and together they gave Elsie insulin. But the injection drove her blood sugar to a dangerously low level. In an attempt to stabilize Elsie, Banting took a chance and gave her some sugar.
Banting stayed with Elsie around the clock to closely monitor her symptoms as the coma persisted. As Banting later wrote, “I lived at the hospital day and night for three days and there every few hours for a week.” After further treatment, during which she experienced fever, delirium and many fluctuations in her condition, Elsie finally regained consciousness. “It is a wonderful recovery all right,” the Hospital for Sick Children’s superintendent told The Toronto Star on Nov 1st. “By all the medical laws and expectations, she ought to have been dead.” The article concluded by saying Elsie had “proceeded so far on the road to recovery that she was able to write a letter to her father and tell him that she expected soon to be back in Galt.”
The restoration of another young, severely diabetic girl who was treated in Toronto by Banting became the most publicized insulin account across North America during 1922. Indeed, the story of 14-year-old Elizabeth Hughes’ recovery was the first such narrative to be reported in newspapers; previous cases mentioned in the press were left anonymous.
Elizabeth was the daughter of the U.S. secretary of state and she spent four months in Toronto. In addition to newspaper reports, Elizabeth’s experience was well documented in letters she wrote from Toronto to her parents. Unlike Teddy Ryder, Elizabeth did not stay in Toronto with her mother or father, but rather with a governess/nurse. She was first diagnosed with diabetes when she was 11. From a family of means, Elizabeth had access to the best treatment available, which at the time meant admission to Dr. Allen’s Physiatric Institute to undergo his strict starvation-based treatment.
During the winter of 1921-22, Elizabeth clung to life, starving and weighing little more than 22.7 kg. After a trip to Bermuda with her nurse to hopefully benefit from the warm climate, her condition deteriorated further. As Michael Bliss wrote, “As indomitable a girl as ever existed, a kind of real-life duplicate of the heroines of girl’s literature, Elizabeth fought off the lassitude and despair that overtook most diabetics in the final stages of their sickness.” After Elizabeth’s mother heard about the diabetes discovery in Toronto through Dr. Allen and other doctors, on July 3rd she wrote to Banting. His initial answer was the standard one of discouragement due to limited supplies of insulin. Elizabeth’s condition continued to decline.
By early August, much had changed in the insulin supply, allowing Dr. Allen to start giving it to his most critically ill patients, although not yet to Elizabeth. She did not like Dr. Allen and her parents were more interested in being treated at “the fountainhead” in Toronto. Allen had been in Toronto in early August, just before he began his use of insulin, and reminded Banting of Elizabeth’s case. Indeed, Allen characterized Elizabeth as a model patient for insulin treatment. On August 15th, Elizabeth, with her mother and nurse, made the train trip to Toronto and saw Banting the next day. He was surprised Elizabeth was still alive. She was extremely emaciated with thin, brittle hair and dry, scaly skin. She could barely walk due to her weakness. Banting began the insulin treatment immediately and very quickly the sugar was cleared from her urine. Banting also began increasing her diet. Within two weeks, she was consuming what a normal girl her age would eat.
Once Elizabeth stabilized, her mother left her in the care of the family nurse and Elizabeth kept her informed in regular letters. She turned 15 shortly after her insulin treatment began. Though an especially fluent writer, she had trouble finding the right words to describe what experience of her dramatic restoration meant. “To think that I’ll be leading a normal, healthy existence is beyond all comprehension,” she told her mother in her first letter from Toronto. A few weeks later, in another letter, she exclaimed, “Oh, it is simply too wonderful for words this stuff.” She carefully charted her diet, noting in another letter that after five weeks in Toronto, that she’d gained over 4.5 kg. “I declare you’d think it was a fairly tale.”
During the fall of 1922, Elizabeth was one of several hundred North American diabetics receiving insulin, among whom were many restoration stories not unlike her “fairy tale.” There were also a few of the more dramatic resurrection-like accounts, like Elsie Needham’s. To their astonished families, these comatose patients seemed to be rising from the dead. Indeed, a few days after Elizabeth left Toronto for home and American Thanksgiving with her family, reports surfaced about two almost simultaneous recoveries not unlike resurrections. The first involved an eight-year-old girl from Vulcan, Alberta, who had been brought to the university hospital in Edmonton two weeks earlier in a diabetic coma. “As far as has been known,” one news report stated, “there had never been a recovery.” Though unaware of Elsie Needham’s experience, the girl from Vulcan was “brought back to life,” as was reported in the December 6th edition of the Edmonton Journal, thanks to use of insulin prepared at the University of Alberta by Dr. J. Bertram Collip. He had returned from Toronto in June and was able to prepare a small supply that saved this young girl’s life. The second such case of a striking recovery from a diabetic coma took place in New York City and involved a 16-year-old boy.
It was later revealed that several even more sensational cases had taken place at Toronto General Hospital. As was reported in a January, 1923, British Medical Journal article by Banting, W.R. Campbell and A.A. Fletcher, by the end of December 1922, 50 diabetic cases had been successfully treated with insulin at TGH, with ten patients revived from complete comas. The authors did note that four patients later died due to a lack of insulin supply or from other causes.
Not unlike Elizabeth Hughes, physicians, especially diabetic specialists, also found themselves at a loss for words when trying to describe what they witnessed when severe diabetic patients were seemingly resurrected by insulin. Dr. Elliot Joslin wrote, “It still remains a wonder that this limpid liquid injected under the skin twice a day can metamorphose a frail baby, child, adult, or old man or woman to their nearly normal counterparts.” When Dr. Allen saw Elizabeth Hughes in Toronto in November, 1922, just before she returned home, he didn’t recognize her. As she wrote in a letter home when he saw her, “Allen said with his mouth open – Oh! – and that’s all he did. He just kept saying over and over again that he had never seen such a great change in anyone and he actually cracked a joke as he was leaving saying he was glad to have been introduced to me or he wouldn’t have known who it was.”
Allen was certainly one of the sternest, strictest and least emotional of the diabetes doctors, but even his accounts included reference to the transcendent nature of insulin treatment. “Though the patient was an extremely poor and uneducated tenement dweller, she followed treatment with religious scrupulousness… although she lived the life of an emaciated invalid and death from inanition seemed to be the ultimate prospect, this treatment was the only possible means whereby a patient with diabetes of this severity could have been kept alive to receive salvation through insulin… The child has become the picture of health, and pictures of her condition before and after insulin would show a miraculous contrast.” As Dr. J.R. Williams said of Jim Havens, “The restoration of this patient to his present state of health is an achievement difficult to record in temperate language. Certainly, few recoveries from impending death more dramatic than this have ever been witnessed by a physician.”