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Early Patients

Young Lives Saved

Before the first human use of insulin in January 1922, it was exceptional for people with Type 1 diabetes to live more than a year or two. In his personal journals, Dr. Frederick Banting stated that the life expectancy of childhood diabetes before 1922 was a matter of months.^[1] In one of medicine’s more dramatized moments, the discovery of insulin has been retold as Banting, Best, and Collip going from bed to bed of the Children’s Ward at Toronto General Hospital, injecting an entire ward with the new purified extract. As the myth goes, before they had reached the last dying child, the first few were awakening from their coma to the joyous cheers of their families. Although this retelling of the events surrounding the discovery of insulin has been highly exaggerated, the impacts of this miracle drug on the lives of these children and the rest of the world is not.

Leonard Thompson was in very poor shape when he was admitted to Toronto General Hospital on December 2, 1921. The 14-year-old boy from Pickering Street (now part of the current day Beaches in Toronto, ON) was suffering the end stages of diabetes mellitus. Prior to his admission to the hospital, Thompson’s doctor was treating the disease with the standard pre-insulin method consisting of “careful dietetic regulations” and “fasting” but this regimen was unsuccessful. By the time Harry and Florence Thompson brought their son to the hospital, his state was dire.^[2]

Acording to Banting’s initial review of the boy’s case, he was “poorly nourished, pale, weight 65 pounds, hair falling out, odour of acetone on the breathe […] Previous to admission, he had been starved without evident benefit.”^[3]Leonard was dying. In an act of desperation and from fear of losing his son, Leonard’s father agreed to allow Dr. Banting, Dr. Best, and the rest of their team to inject Leonard with an experimental new drug that had not yet been tried on another human being. Surprisigly, Banting was not actually permitted to examine Leonard Thompson because he did not yet have any physician’s privileges at Toronto General Hospital. This was quite frustrating for Banting. Instead, Dr. Walter R. Campbell and Dr. Almon A. Fletcher were the doctors who worked with Leonard at Toronto General Hospital and another physician, Dr. Edward Jeffrey, was the one to actually administer the extract. On January 11, 1922 Leonard Thompson became the first person to receive an injection of the new “pancreatic extract”.

The extract within the initial injection were “not as concentrated” as was needed and Banting noted the results as “no clinical benefit was evidenced.”^[4] Unperturbed, Banting and Best continued their research while Dr. James B. Collip refined the extract to make the injections more concentrated and on January 23 Leonard was given another injection. The results were immediate. Leonard was given near daily injections of the extract from January 23 to February 4 and, according to Banting’s records, “the boy became brighter, more active, looked better and said he felt stronger.”^[5]Unfortunately, the production of insulin failed because the extract could not be purified in large quantities, therefore resulting in no potent insulin being made between March and May of 1922. It is not until October 1922 that Leonard was finally able to a steady and permanent supply insulin for his regular injections.

Leonard Thompson went on to live for thirteen more years with the aid of insulin. He died on April 20, 1935 at the age of 27 due to broncho-pneumonia and complications from diabetes.

James “Jim” Havens was 15 years old when he was diagnosed with diabetes in 1915.  The son of an American congressman from New York who eventually became vice president and secretary of the Eastman Kodak Company, Jim’s family could afford for him to receive the best medical treatment available for a diabetes patient at the time.

His physician, Dr. John R. Williams, prescribed for Jim to follow the Allen Diet. The treatment continuously limited the amount of calories one could consume over time, eventually causing most individuals to die of starvation. Despite a life expectancy of no more than a year, Jim lived on the diet for eight years. 

By the time Jim turned 20 years old, he had to eat less than 500 calories a day; at 22 years old, he weighed 74 pounds.^[6] Jim’s family and Dr. Williams felt helpless as they watched the young man slowly perish. His father, James, reached out to as many of his contacts as possible in hopes of finding other potential treatments for diabetes. Through a web of colleagues and friends, he was told about the work of Dr. Banting, Best, and Dr. Collip on insulin at the University of Toronto.

James wrote to Dr. Banting, pleading that he send insulin to Rochester so that he may save his son. Banting was initially hesitant at the request – the treatment was still in the initial trial phases and quantities were already limited because little to no insulin was being produced between mid-February and mid-May 1922. In addition, the doses that were available during this period were reserved for severe patients who had already begun the treatment prior to production being halted. Regardless, Banting agreed to send a small dose of insulin for Jim. On May 17, 1922, Dr. Williams administered the first injection of insulin in the United States to Jim.^[7] Receiving the lifesaving drug despite not being in Canada made Jim one of the most fortunate diabetic patients of his time, to which the social and economic status of his father is likely to thank.

After seeing no obvious signs of improvements, Dr. Williams reported back to Dr. Banting that Jim’s state had remained unchanged. Banting was unconvinced and travelled to New York to review the patient himself, this time bringing with him a large amount of the miracle drug. By the next morning, Jim was sugar-free and able to eat a full meal for lunch. Within a week he was beginning to regain his strength and soon afterwards was able to resume his passion – drawing.

Due to the still experimental status of insulin, Jim struggled to maintain access to the drug, frequently relying on his doses to be smuggled into the U.S.A. from Canada. It was not until 1923 that Eli Lilly & Company of Indianapolis began distributing an insulin extract within the United States that had a higher, less irritating potency, although the company had begun producing insulin as early as July 1922. It was later still that Jim was able to receive beef insulin rather than pork insulin, the latter to which he was extremely allergic. 

Jim’s access to insulin, both as the first recipient in America and as a patient who required the drug to be smuggled across a national border, is due in large part to the economic and social status of his father. Similar to Elizabeth Hughes, Jim was able to receive insulin as a result of his connectedness to the politically powerful echelons of society, although other factors also influenced his access to insulin, such as the proximity of Rochester to Toronto. Nevertheless, upon receiving a consistent dosages insulin, Jim went on to lead a successful career in the arts. He studied at Rochester Athenaeum and Mechanics Institute and became extremely skilled in painting, printmaking, and wood engraving. In 1927, he married Gladys Corland and had a son and daughter. In 1960, Jim died of cancer at the age of 60.

Excerpt of a letter Jim wrote to Dr. Banting reflecting on how grateful he is, particularly during the holiday season:

“Well, Thanksgiving has recently become a great institution over here; you ought to celebrate it there. It makes a fellow think a lot of great sentimental stuff about his good fortune and how lucky he is; he discounts all the little whims he’s been cussing out the past 364 days and really convinces himself the world is a fine old house of optimism after all. You can bet your last farthing a lot of people are thinking the same things, and laying it to insulin; but I’m going one step further back and laying it to Dr. Banting work at University of Toronto. Merry Christmas is coming around all of a sudden and I’m going to have a merry one all right; so are the above mentioned lot of other people. I sure hope you do; you deserve it. […] In deep appreciation, Jim D. Havens” (December 11th, 1922).

Ruth Whitehill was 8 years old when she became a private patient of Dr. Banting. Originally from Baltimore, Maryland, Ruth had been sent to Toronto for treatment by her physician, Dr. Louis Hamburger, in 1922.

Ruth had been diagnosed with diabetes at age 6 in February 1921 and was admitted to The Harriet Lane Home (John Hopkins Hospital) shortly thereafter. Weighing 47 pounds, Ruth was treated with “repeated starvation” but by Christmas of 1921 there was no improvement.^[8] At a meeting of the Association of American Physicians in Washington in Spring, 1922, Dr. Hamburger heard Dr. MacLeod’s “announcement of Dr. Banting’s epoch making discovery.” The announcement had such an impact on Dr. Hamburger, that he insisted Ruth’s father contact Dr. Banting and request to have his daughter taken on as a patient. Dr. Banting agreed.

On June 17, 1922 Ruth received her first injection of insulin. She was also treated to a diet of over 1,400 calories a day  and “as a rule, took several hundred calories more than this allowance.”^[9] From June to September, Ruth remained in the care of Banting in Toronto as her health and strength continued to improve. By October, Ruth was well enough to return to Baltimore and continue her treatments with the help of Dr. Hamburger and the distribution of insulin through Eli Lilly & Co. Ruth went on to marry John J. Leidy of Baltimore, cofounder and president of the Leidy Chemical Corporation.^[10]

The sudden and drastic recovery of Ruth in the early days of her treatment had such an impact on Dr. Hamburger that he wanted to continue working with Banting. Dr. Banting therefore referred to him another diabetic child patient to treat; Myra Blaustein. Myra, also from Baltimore, had been admitted to the Hebrew Hospital in October 1920 and, according to Dr. Hamburger, “showed a more marked pancreatic deficiency than Ruth.”^[11]

Myra had already been suffering from diabetes for the past two years and weighed only 54 pounds at the age of 8. In July 1922, she was accepted as a private patient of Dr. Banting’s and went to Toronto. Once she began receiving insulin injections, her recovery was also swift. By the Fall of 1922, “instead of being pale, apathetic and subdued her colour improved, she became alert and smiling and sang as in the days before her illness.”^[12] Myra was able to return to Baltimore at the same time as Ruth.

As an adult, Myra devoted herself to charitable work, including coordinating volunteer activities at the only hospital in Maryland for people of colour who suffered from mental illnesses.

Ruth and Myra died three years apart (February, 1957 and December, 1954 respectively), both at the age of forty-two.^[13]

Theodore (Teddy) Ryder was born in Keyport, New Jersey in 1916. At the age of 4, he was diagnosed with Type 1 diabetes and later recalled that by the age of 5, he was “twenty-six or seven pounds” and could only walk up three or four steps before needing help.^[14] In an effort to treat his diabetes, Teddy was put on the Allen Diet in order to maintain healthy levels of blood sugar. Often referred to as the “starvation diet,” the Allen diet required diabetic patients to limit how many calories they could intake, often no more than 500-600 calories a day.^[15] Under this treatment, most individuals with diabetes lived six to twelve months.

When the Ryder family heard of Dr. Banting and his work with insulin, Teddy’s uncle, Dr. Morton Ryder, personally reached out to Banting. Dr. Ryder asked for Teddy to be included in his trials but Banting initially denied the request, stating that he did not have enough insulin to treat Teddy. Dr. Banting suggested to bring the young boy to be treated later, perhaps in September. Teddy’s uncle knew that his nephew’s condition was worsening and responded to Banting that he did not believe Teddy would survive until September.^[16]

Banting agreed to treat Teddy and, on July 10, 1922, Teddy became one of the first people to receive insulin to treat his diabetes. Within two weeks of starting the treatment, Teddy began to gain weight. By September 1922, Teddy and his family celebrated his sixth birthday, a milestone that seemed unlikely only three months earlier. A party was thrown by the family of Ruth Whitehill and Banting attended.

Teddy returned home to New Jersey in October 1922 and continued his treatment. He remained in contact with Dr. Banting, writing each other letters until Banting’s death in 1941. In one such letter, Teddy wrote “I wish you could come see me. I am a fat boy now and I feel fine. I can climb a tree. […] Lots of love from Teddy Ryder”.^[17] Teddy went on to become a librarian in Hartford, Connecticut and, in 1990, attended an unveiling of an exhibit at the University of Toronto honouring the discovery of insulin. Teddy had no serious complications from diabetes for the remainder of his life but died of heart failure at the age of 76 in 1993. At the time, he’d received insulin treatments longer than anyone else in the world and had “obviously responded well to the over 45,000 injections he had taken since 1922”.^[18]

Excerpt of a letter written by Dr. Banting to Teddy Ryder expressing how strong of a patient Teddy was:

“I shall always follow your career with interest and, you will forgive me if I add, a little pride, because I shall always remember the difficult times we had in the early days of insulin. The outstanding thing I remember was your strength and fortitude in observing your diet and the manly way in which you stood up to the punishment of hypodermic injections. I am sure that you will be a success in life if you maintain the same spirit in meeting the rebuffs of the world.” (Dec. 27, 1938)

Elsie Needham was admitted to Hospital for Sick Children in Toronto in October, 1922. The 11 year old girl from Galt, Ontario was in a diabetic coma and on the edge of death.^[19] Prior to her parents deciding to send her to Toronto, medical professionals who had examined the young girl declared her condition hopeless.

Within a few days of her arrival to the Hospital for Sick Children, Elsie was still in a coma and began receiving insulin treatments by Dr. Banting and Dr. Gladys Boyd, the head of the Hospital’s new diabetic clinic. Banting worked tirelessly to save her life, monitoring her symptoms and evaluating her response to treatment. Banting is quoted as saying, “I lived at the hospital day and night for three days and was there every few hours for a week.”^[20] In the most spectacular effect, Elsie returned to consciousness as if she had risen from the dead. Within a few days, under the watchful eye of astonished medical attendees, Elsie started to regain her strength, so much so that she was able to write to her father with the hopes of returning home soon. 

Elsie is the first child to recover from a diabetic coma as a result of insulin. With the help of the miracle treatment, Elsie returned to Galt and was able to resume her schooling in January, 1923. Little more is known about Elsie Needham, with her last sighting recorded as being “alive as late as 1946.”^[21]

Elizabeth Hughes was another child patient whose case rose to prominence because it was the first personal story of diabetes treated with insulin to be reported publicly in newspapers. She was thus the most famous of the early insulin patients. Elizabeth was the daughter of Charles Evans Hughes, an American politician who would serve throughout his career as the 36^th Governor of New York, a Republican nominee for the 1916 presidential election, and the 11^th Chief Justice of the United States Supreme Court. But, in the Spring of 1919, he and his family were concerned with the health of their youngest child, Elizabeth.

At 11 years old, Elizabeth was 4 feet 11.5 inches (1.511 m) and weighed merely 75 pounds (34 kg). Being the daughter of such a famous man, Elizabeth had access to the best treatments possible and was brought to Dr. Frederick M. Allen, a specialist at the Physiatric Institute in Morristown, New Jersey. Elizabeth was diagnosed with diabetes and put on a strict diet of 800 calories per day. Due to his prominence in the field, Dr. Allen’s dietary restrictions on Elizabeth became the common course of medical treatment for diabetic patients, later being referred to as the “Allen Diet”. Dr. Allen continued to monitor her condition over the next three years but, by August 1922, her weight had fallen to 45 pounds (20 kg).^[22]

Elizabeth’s mother, Antoinette, grew increasingly worried for her sickly daughter. Upon hearing about the work of Canadian doctor Frederick Banting, she decided to make contact. Dr. Banting agreed to take Elizabeth as a private patient and on August 15, 1922 Elizabeth and her mother arrived in Toronto. 

Elizabeth, now age 14, was examined by Dr. Banting, who recorded that her “skin was scaling and hair brittle and falling out due to starvation.” Dr. Banting immediately began administering the insulin treatment to Elizabeth, in combination with a high caloric diet (2200–2400 calories a day), which included heavy creams and butter. Elizabeth, just a few days shy of her 15^th birthday, responded to the treatment triumphantly. Her blood sugar is recorded to have stabilized quickly and she began gaining 2 pounds a week and even growing taller. In a letter to her mother, dated August 22, 1922, Elizabet writes “[…] and to think too, that I’ll be leading a normal, healthy existence is beyond all comprehension. I haven’t shown sugar at any time, since the last time when you were here and consider myself a very good child. You ought to see the cream I’m taking too – it’s 32%”^[23] Later, on September 24, 1992, Elizabeth again writes to her mother, exclaiming “As you know I am simply bursting to see you and can hardly wait for you to actually see with your own eyes what I’m eating nowadats, for if you didn’t I declare you’d think it was a fairy tale. I know you will hardly know me as your weak, thin daughter, for I look entirely different everybody says, and I can even see it myself. By now I have gained a little over ten pounds.”^[24] Elizabeth’s previous doctor, Dr. Allen, came to see her progress for himself and, in astonishment, wrote “insulin is performing miracles.”^[25]

Elizabeth returned to school in 1923 and, in 1930, she married a lawyer named William T. Gossett. They settled in Bloomfield, Michigan, and had a son and two daughters. Elizabeth became a significant figure on the boards and committees of higher education institutions, holding positions of note at Barnard College, Oakland University, the Merrill-Palmer Institute, and Michigan State University. She also beame a member of the Detroit Urban League and founded the Supreme Court Historical Society in 1972. On April 21, 1981, Elizabeth died at the age of 73. By the time of her death, she had received approximately 42,000 insulin injections over 58 years.^[26]

Excerpt from a letter written by Elizabeth to her mother about how Insulin has impacted her:

“I am simply bursting to see you and can hardly wait for you to actually see with your own eyes what I’m eating nowadays, for if you didn’t I declare you’d think it was a fairytale. I know you will hardly know me as your weak, thin daughter, for I look entirely different everybody says, and I can even see it myself … you see I am getting now what a normal girl of my age should and am of course gaining every hour it seems to me in weight and strength [.…] The best part of all my diet now is that I am eating absolutely anything, including candy. Now don’t be shocked by that statement, for it is only on reactions when I have that privilege, but you see it gets my blood sugar up to normal again as quickly as anything will, so Dr. Banting thought that as long as I was out a great deal candy would be much easier to carry and to take also. So now my pockets are full of these little molasses kisses, you know, and when I have a reaction I take just one and I recover immediately [….] I could use up pages just in numerating all the dishes I have nowadays and it seems to me that I eat something every day 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. I can’t express my gratitude for the chance I am having, in being up here to take advantage of this wonderful discovery, for it is truly miraculous…” (September 24, 1922) 

^[1] University of Toronto, Fisher Library Digital Collections, F. G. Banting (Frederick Grant, Sir) Papers. Banting Scrapbooks, Scrapbook 1, pp. 34, 35. https://resource.library.utoronto.ca/insulin/scrapbooks.cfm.

^[2] Bernie Fletcher, “Canada’s 150th: The Miracle Boy from the Beach” in Beach Metro (Toronto: January 10, 2017), https://www.beachmetro.com/2017/01/10/canadas-150th-miracle-boy-beach/.

^[3] Frederick Banting, “Pancreatic extracts in the treatment of diabetes mellitus” in Canadian Medical Association Journal (March, 1922). University of Toronto, Fisher Library Digital Collections, F. G. Banting (Frederick Grant, Sir) Papers, COLL. 76 (Bnting), Box 61, Folder 12, pp. 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1524425/.

^[4] Ibid.

^[5] Ibid.

^[6] Rachel Delle Palme “Banting’s First American House Call” on the Banting House Museum website, (January, 2019), https://bantinghousenhsc.wordpress.com/2019/01/24/bantings-first-american-house-call/.

^[7] Ibid.

^[8] Louis P. Hamburger, “Discussion of Dr. Bantings paper on the insulin treatment of diabetes read before the Baltimore city medical society,” University of Toronto, Fisher Library Digital Collections, F. G. Banting (Frederick Grant, Sir), MS. COLL. 76 (Banting), Box 8B, Folder 21. Accessed July 9, 2020. https://insulin.library.utoronto.ca/islandora/object/insulin%3AW10008

^[9] Ibid.

^[10] Thea Cooper, Arthur Ainsberg. Breakthrough: Banting, Best, And The Race To Save Millions Of Diabetics. (Toronto: Penguin Group, Viking Canada, 2010).

^[11] Louis P. Hamburger, “Discussion of Dr. Bantings paper on the insulin treatment of diabetes read before the Baltimore city medical society,” University of Toronto, Fisher Library Digital Collections, F. G. Banting (Frederick Grant, Sir), MS. COLL. 76 (Banting), Box 8B, Folder 21. Accessed July 9, 2020. https://insulin.library.utoronto.ca/islandora/object/insulin%3AW10008

^[12] Ibid.

^[13] Cooper & Ainsberg. Breakthrough.

^[14] Rachel Delle Palme, “The Long Life of One of Banting’s First Patients” on the Banting House Museum website (September 2018), https://bantinghousenhsc.wordpress.com/2018/09/27/the-long-life-of-one-of-bantings-first-patients/.

^[15] Ibid.

^[16] Ibid.

^[17] Ibid.

^[18] Michael Bliss, “Who Discovered Insulin?” in American Physiological Society. Volume 1, (February, 1986), pp. 31-36. Accessed July 5, 2020, https://journals.physiology.org/doi/pdf/10.1152/physiologyonline.1986.1.1.31

^[19] Michael Bliss, “Resurrections in Toronto: Fact and Myth in the Discovery of Insulin” in Bulletin of the American Academy of Arts and Sciences. Vol. 38, No. 3 (Dec., 1984), pp. 15-36. Accessed July 7, 2020. https://www.jstor.org/stable/20171755.

^[20] University of Toronto, Fisher Library Digital Collections, F. G. Banting (Frederick Grant, Sir) Papers. Banting Scrapbooks, Scrapbook 1, pp. 34, 35. https://resource.library.utoronto.ca/insulin/scrapbooks.cfm. And Sarah Riedlinger, Dean Giustini, & Brenden Hursh, “Part II: The impact of insulin on children with diabetes at Toronto Sick Kids in the 1920s” in Hektoen International Journal, (Vancouver: Spring, 2018), https://hekint.org/2018/05/15/part-ii-the-impact-of-insulin-on-children-with-diabetes-at-toronto-sick-kids-in-the-1920s/.

^[21] Bliss, “Resurrections in Toronto” in Bulletin of the American Academy of Arts and Sciences, https://www.jstor.org/stable/20171755.

^[22] Rachel Delle Palme, “Banting’s ‘Star’ Patient” on the Banting House Museum website (April, 2019), https://bantinghousenhsc.wordpress.com/2019/04/12/bantings-star-patient/. And Michael Bliss, The Discovery of Insulin, (Chicago: University of Chicago Press, 1982).

^[23] Elizabeth Hughes, “Letter to Mother 22/08/1922” (scanned copy) held at the University of Toronto, Thomas Fischer Rare Book Library Collection (MS. COLL 334 (Hughes) Box 1, Folder 35A), https://insulin.library.utoronto.ca/islandora/object/insulin%3AL10006.

^[24] Elizabeth Hughes, “Letter to Mother and Father 24/09/1922” (scanned copy) held at the University of Toronto, Thomas Fischer Rare Book Library Collection (MS. COLL 334 (Hughes) Box 1, Folder 36), https://insulin.library.utoronto.ca/islandora/object/insulin%3AL10007.

^[25] Rachel Delle Palme, “Banting’s ‘Star’ Patient” on the Banting House Museum website (April, 2019), https://bantinghousenhsc.wordpress.com/2019/04/12/bantings-star-patient/.  

^[26] Joseph S. Alpert, “An Amazing Story: The Discovery of Insulin” in The American Journal of Medicine, (Vol 129, No 3, March 2016), https://www.amjmed.com/article/S0002-9343(16)30001-8/pdf.