Elizabeth Hughes: Letters from Toronto

By Christopher J. Rutty, Ph.D

Lead Historian, Defining Moments Canada, “Insulin 100”.

On August 22, 1922, 15-year-old Elizabeth Hughes wrote the first of her 18 letters from Toronto.[i] “Dearest, dearest Mumsey,” she wrote. “I hope to goodness this does reach you safely for it carries in it some very interesting news I think.” “Mumsey” was Elizabeth’s mother, Antoinette Hughes, then in Washington, D.C., with Elizabeth’s father, Charles E. Hughes, U.S. Secretary of State. They were preparing for a four-week trip to Rio de Janeiro to represent the United States at the Brazilian Centennial Exposition. Antoinette had left Toronto on August 20 by train to Washington after she rushed Elizabeth and her nurse-guardian, Blanche Burgess, to Toronto to meet with Dr. Frederick Banting in hopes that Elizabeth could be treated with insulin. They met Banting on August 16. He agreed to take Elizabeth on as his patient and give her a first injection of insulin.

Elizabeth Hughes, c. 1923. The Discovery and Early Development of Insulin, University of Toronto.

She weighed just 20.4 kg (45 lbs) and had been on a strict diet of some 300 calories per day, as prescribed by Dr. Frederick M. Allen, a leading diabetes specialist who had treated Elizabeth since April, 1919. She had survived on Allen’s “starvation diet” almost four times longer than his most optimistic prognosis. But by July, 1922, Elizabeth’s condition was deteriorating. In desperation, Antoinette managed to get Elizabeth to Toronto before the Pan American was to set sail for Brazil. There were anxious letters, telegrams and phone calls from Antoinette, Dr. Allen and Charles to Banting and the president of the University of Toronto. Elizabeth was in no condition to travel to Brazil with her parents, and they had no option but to make the trip together. A deciding factor in Elizabeth going to Toronto was that she would be in the care of Blanche, who was well trained in diabetes care.

By August 22, Elizabeth had been receiving insulin produced by Connaught Laboratories, although of varying strengths and quality. Banting brought it personally and give her the injections at a rented apartment at 78 Grosvenor Street at Surrey Place, near Queen’s Park, just north of Toronto General Hospital. The “Athelma Apartments,” built in 1912, were among the largest in the city at the time. Elizabeth relied on Blanche’s nursing skills and the specialized knowledge she had learned from Dr. Elliott Joslin, another leading diabetes specialist, as well as from Dr. Allen and the staff of his diabetes sanitarium, and then at the Physiatric Institute, which opened in April 1921 in Morristown, N.J. Elizabeth and Blanche had spent some time at the older sanitarium and then at the new Institute, by which point Elizabeth had become a self-described “student of diabetes.” Indeed, she was a model patient, understanding all the precise dietary and personal testing requirements, although she never liked Dr. Allen.

As Elizabeth told her mother in her carefully typed letter dated August 22, “Dr. Banting came in as usual last night about 5:30 p.m. and said he had a good report to make. The insulin which they have been working on for so long will now be ready for use in a couple of days at the most, and it is the most powerful that has yet been made. So much so, in fact, that I will only have to take 1 c.c. at a time when I begin on my two doses, which will be very soon, I think.” She also said that Banting was getting enough insulin, “so that his three outside patients, Ruth Whitehill, Teddy Ryder, and myself will not have to change our insulin for a month or so, which is a very good thing as you know.” Ruth was eight years old and had arrived from Baltimore in mid-June. Teddy was six and came from New Jersey on July 8. Like Elizabeth, Teddy had been a patient of Dr. Allen’s. Elizabeth and Teddy got to know one another while they were at Allen’s institute in the spring of 1921.

Elizabeth wrote that Banting was happy the insulin supply was stabilizing. “He said you can tell your Mother that I can promise her that with this new extract, the next time you see me I will be on 2,240 calories the full amount that a girl of my age should be having.” It was to be delivered through 60 grams of protein, 50 grams of carbohydrates and 200 grams of fat. “Now if I don’t begin to gain weight on that I will be crazy.” Banting was also confident that the new insulin was strong enough to manage Elizabeth’s diet on two cubic centimetres (c.c.’s) per day, with one injection in the morning and the other at night. “You see what he’s so happy about, is that once he finds out my balance on that, why he has enough insulin on hand now, so that I won’t have to change for at least a month, anyway.” She hoped that once she got on a 2,240 calories diet, she could live at home with Blanche, who would administer the extract and tend to all her food. “[O]nce my diet is established like that I wouldn’t need a doctor unless something went really wrong.”

After only a week in Toronto, Elizabeth’s outlook changed dramatically. She had endured so much since starting treatment with Dr. Allen, dropping in weight from 29.5 kg in October, 1920, to 24.5 kg in March, 1921, and finally to 21.8 kg in July 1922. She lost time with her parents as she stayed in Allen’s institute periodically, and also lived in Bermuda with Blanche from January to July, 1922, in the hopes that the climate would help. “Why Mumsey when I’m on that diet next year I’m sure I will be able to do a little studying for when I get my strength and weight back I will be eating as much as I would normally anyway. That is a most thrilling thought to me, 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.”

Elizabeth with her parents, Antoinette Carter and Charles Evans Hughes. Image courtesy of Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle.

Apart from telling her mother about insulin and the details of her diet, Elizabeth told her about “other less important things,” such as spending “the whole of yesterday afternoon out in lovely Queen’s Park and had a nice reading.” However, as she wrote at the end of the letter, “Both Blanche and I can’t get used to your absence, and I can’t tell you how much I miss you but the good news that this letter brings goes a long way in helping to bear the separation, don’t you think so? For I begin to see visions of in the near future being able to live at home and lead a normal life with my dear Mother and Father once more. I really can never express my gratitude to you and Pa for giving me this wonderful chance!”

Elizabeth did not send her next letter from Toronto until September 24. Her parents were away until then, first at sea, then in Brazil, and again at sea before arriving back in Washington. Sending letters was not possible, but they did stay in contact via telegrams, and through a special radio connection the Secretary of State’s office had arranged for official government communications. It allowed her parents to keep in touch. While the radio connections were a novelty for Elizabeth, they were necessarily brief and she was happy to “bubble over with my good news to you” in long letters again.

Elizabeth was well educated in the art of letter writing. She had a passion for writing, including short stories that were published in children’s magazines. In July, shortly after returning home from Bermuda, Elizabeth used her own money ($25) to buy a small travelling typewriter. “I’m simply dying for one!” she told her mother. “It would mean so much to me now in writing all my manuscripts and letters etc. besides being lots of fun to work. Anyway authors always have one, and though I’m beginning early, I nevertheless want one, and I’d learn to manage it correctly!” However, she did make some mistakes in her typing (although relatively few), for which she apologized and did her best to correct with a pencil.

By September 24, Elizabeth weighed 27.4 kg, having gained over 4.5 kg since arriving in Toronto. She hoped her mother would be able to visit. “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, or if you didn’t I declare you’d think it was a fairly 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.”

She had just begun receiving a new batch of insulin from Dr. Banting. It was about half as potent as the previous batch, which had been the strongest yet produced, “and it certainly was simply marvelous.” Elizabeth only needed two injections per day of ¾ c.c. each, at night and in the morning. However, before getting adjusted to the stronger insulin, she had several reactions every day as she could not seem to get enough food.

As she explained, “About every night about midnight I’d wake myself up soaking with perspiration (Father would float away if he had one, I know) having a rapid pulse and looking either pale or flushed, then Blanche would give me about half a glass of Orange juice and half a glass of heavy cream, and I’d immediately recover and go right off to sleep again. Then I’d have some breakfast, but evidently not enough so about lunch time or right after I would have ‘feels’ again and have to be fed up in the same way. Then I’d get more supper too, but at night again at the same time I’d have another one, until finally we got the exact balance and I remained sugar free and reaction free. The diet we struck was this 2512 calories with 64 grams of protein, 208 of fat and best of all 97 grams of carbohydrates. I am still trying to keep on that wonderful ratio now with this weaker extract for it seems to agree with me so well and I am gaining so much on it, but in order to do it I have to take much more of this stuff per day, 4 c.c.’s or 2 c.c.’s morning and evening. I don’t mind that though, if only I can stay where I am, for you see I am getting now what a normal girl of my age should and of course gaining every hour it seems to me in weight and strength.”

Elizabeth was determined to be Dr. Banting’s “record case,” since, as he had mentioned, “none of his other patients have gained so many pounds in such a short time or have they ever reached a diet and tolerated it as high as mine is, so aren’t you proud though?” Elizabeth was excited to be able to eat 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.” She told her mother how she could fill up pages just enumerating all the dishes she could now have. “[I]t 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.”

Elizabeth found it difficult to fully express her gratitude to her parents, “for the chance I am having, in being up here to take advantage of this wonderful discovery for it is truly miraculous, and I’m so thankful that we’ve taken this apartment for the six months, for I realize more and more that until this thing is really standardized enough to be able to get it sent to us directly from the Eli Lilly Co. why the best place to be is at the fountain head up here. The stuff they’re sending Dr. Banting from the latter place is terribly weak in comparison to what the Connaught Laboratory is putting out, and the patients who use have to take it sometimes as much as 15 c.c.’s per day and don’t eat half the diet I am for instance.” She also said that Dr. Banting “brings all these eminent Doctors in from all over the world who come to Toronto to see for themselves the workings of this wonderful discovery, and I wish you could see the expression of their faces as they read my charts, they are so astounded in my unheard of progress and change in my looks.”

Concerns that Blanche may have to leave Toronto to help manage her father’s illness were an important topic in Elizabeth’s September 25 and 29 letters. Blanche’s impending absence raised the question of who else could manage Elizabeth’s diabetes and insulin treatments. Elizabeth was confident she could manage her diet “all right” and suggested to her mother that she “could learn to give injections.” In fact, Elizabeth made it clear she did not want another nurse in Toronto. Ultimately, her mother would have to learn to give injections, “for I simply can’t depend on Blanche all the time and will have to have somebody at home who knows how to.”

Fortunately, Blanche’s father’s condition stabilized and she did not have to leave, but the question of dependence lingered in Elizabeth’s mind. For now, Elizabeth and Blanche worked well together, trying to balance varying insulin strengths and doses and sugar levels with trying to maintain the rich diet Elizabeth was eager to stay on. Nevertheless, Elizabeth and Blanche went on picnics and out to see movies and concerts. “Little Lord Fauntleroy,” she wrote, was “too sweet for words.”  They also heard Alberto Salvi, “the world’s greatest harpist.” And the pair enjoyed a trip to Niagara Falls. “Suffice it to say that it was the most beautiful thing I ever saw and beyond all my hopes and expectations!”

Blanche’s attention, however, was also drawn to a Dr. McClintock, whom she apparently met in Toronto. He often accompanied Blanche and Elizabeth on various outings. Perhaps Banting introduced them, but there was no reference to a first name in the letters, or elsewhere. Elizabeth sensed a growing romantic connection. “We spend a large portion of every day out of course, and this afternoon we expect to go out canoeing on the little pond in High Park with Dr. McClintock, ‘Ahem’, who is a fine paddler and we’ve done it often. Its lots of fun and you know how at home I am in a canoe.”

Elizabeth started on a new batch of insulin on September 29 and hoped it would be stronger than the last one, particularly as she had to take 4 c.c.’s twice a day, but the syringe only held 2 c.c.’s. “I had to have two injections you see, two c.c.’s in each hip, also twice a day, until I got so sore I could hardly sit comfortably, but I’d do anything to be able to maintain this glorious diet of 2512 calories.” Banting, however, thought that “2 c.c.’s will be enough to take on this new batch and that remains to be found out today. We have twenty-four bottles of this stuff on hand and if it only does not go ‘soupy’ on us we’ll have a nice long supply of it. We had the other day fifteen perfectly good bottles go bad on us. Wasn’t that maddening though?”

Soon, Elizabeth no longer had to share the local insulin supply with Ruth Whitehill and Teddy Ryder, who left Toronto on September 29. “I know we shall miss them dreadfully. We have all had such a common interest and living so near together we became quite fast friends.” They would be getting “the stuff from the Lilly Co. called ‘Iletin’ which is much weaker that what we are getting up here and I wouldn’t like to use it unless there was nothing else as I couldn’t take care of such a big diet on it I know.” As Elizabeth told her mother, “Nobody 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. Its our great big secret!”

By October 1, as Elizabeth wrote, “everything is going beautifully with us just now.” She was not only gaining weight. “I know you will be surprised when I tell you that I’m actually growing up as well as out, and I’m about five feet one inch now, that is I’ve grown over half an inch since I came, besides weighing thirteen pounds more. Isn’t that some record though? Dr. Banting is pleased to death over it, and as I once said, I’m his best patient so far.” She was able to strike a precise balance between her diet and her insulin with each dose. “I haven’t showed a trace of green in any single specimen or have I had a reaction since I began taking it. Isn’t that wonderful?” She was so pleased with the latest insulin. “Oh, it is simply too wonderful for words this stuff and you just wait and see how its changed me. Well you see I’ve been on a diet of over 2,000 calories since August 25th, so no wonder! Both Dr. Allen and Dr. Joslin are coming up here again in a [month’s] time they think, and so I hope they strike the time you are here. Wouldn’t Dr. Allen have ten fits if he knew what I was on now though.”

News about Elizabeth’s residence in Toronto was spreading, at least among the nurses at Toronto General Hospital. As she reported in her October 6th letter, “The other morning I went over to the hospital to get weighed being the first time we had been there since you were here last, and the nurses said they would hardly have known me I looked so different. They had evidently heard lots about my progress through Dr. Banting who I guess talks about his prize case quite a lot and although they expected marvels I know they didn’t expect to see such progress as I’ve made. I can really hardly hold my horses for you to see me.” She officially weighed 27.7 kg and had gained 7.26 kg since the first week in July. She was now taking a somewhat larger dose of insulin, 3 c.c.’s at a time, for a total of 6 c.c.’s per day, “but I don’t mind a bit as long as it carries me on this wonderful diet which it is doing.”

Article from the Fort Worth Star-Telegram titled “Little daughter of Hughes seemingly cured of diabetes by serum taken from fish” dated December 16, 1922. The Discovery and Early Development of Insulin, University of Toronto.

The American press had also reported on Elizabeth’s remarkable insulin experience, prompting phone calls to her apartment, and also visits, such as by “this lovely lady, Mrs. Ferris,” as Elizabeth told her mother in a letter dated October 8. Mrs. Ferris (no first name was given) “had Diabetes and wanted to know about the effect of the treatment on me, and something about it, as she couldn’t find Dr. Banting and had read of my case in the New York papers.” She was with a group touring the U.S. and happened to be visiting Toronto. Mrs. Ferris was a patient of Dr. Allen’s and had suffered from mild diabetes since 1914. But, as Elizabeth observed after her visit, “through great carelessness in handling her diet she has now become quite a severe case I guess. She has no idea at all of 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 as she had two diabetic carbuncles on her hands.” Elizabeth and Blanche “did what we could for the poor ignorant lady and she left hoping to come in touch with Dr. Banting sometime during the day.” Interestingly, Banting happened to drop by their apartment shortly after Mrs. Ferris left, “bringing with him another Doctor Howard from Iowa. Wasn’t that the perversity of fate though. We told Dr. Banting about her and he was going to try and reach her.”

The imbalance between the insulin supply and the mounting demand generated by the press attention was difficult for Elizabeth. “We have had several poor people come here to ask about the treatment and they were eventually turned away,” she wrote. “It 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 up here.” But all she could do was focus on her own case. “Dr. Banting told me yesterday that he’d try and get me a good lot of extract that would do me for two or three weeks and let me come home for Christmas,” she told her mother. “Wouldn’t that be simply wonderful though I’d eat you out of house and home though, so you had better beware.”

Press attention towards Elizabeth’s remarkable insulin treatment in Toronto intensified during October as Elizabeth’s father become involved in campaigning during U.S. mid-term elections. In her October 14th letter, she wrote, “I know I shouldn’t suggest it, but I was wondering whether Pa couldn’t go and do his campaigning in Ohio via way of Toronto and stop and see me, if only it was the time between trains. Just to be able to see and talk with wonderful Dr. Banting and see the marvelous change that’s come over his daughter. I don’t dare hope anything about it but will you just please ask him?”

To her disappointment, he didn’t visit. Elizabeth was also concerned a few days later to learn that her father had fallen, although it was not serious. “I have just written him a little letter in which I said I thought I could sympathize with him better than anyone else, as I think I can appreciate how his poor hips must have felt. I have had so many injections now you see, that my hips are swollen and literally all little lumps all over them now, but cheer up its all in a good cause, and I would put up with absolutely anything to keep on this wonderful diet I’m on now.”

The press attention became increasingly unsettling. In her October 21st letter, after updating her mother on her steady weight gain of almost 1 kg per week (she was now 29.7 kg, or 9.3 kg heavier since arriving in Toronto), Elizabeth added, “please don’t let on to a newspaper reporter! Haven’t they been horrible enough. I hate to be written up like that all over the country and I think its cheapening 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?” And a few weeks later, after going to a concert, Elizabeth told her mother, “We saw our friend the Star reporter there in front of us and I’m sure if she had seen us she would have written me up.”

As access to potent insulin stabilized her diabetes, Elizabeth’s reactions became much less frequent during early October. She now felt increasingly constrained and restless. As much as she liked the excursions and time to read and write, Elizabeth was a 15-year-old-girl with a new lease on life and needed to be doing more with her time. While Banting was visiting Elizabeth one day, he offered an interesting suggestion. As she excitedly put it in her October 17 letter, “Dr. Banting actually suggested himself that afternoon that I go to school up here, or if I didn’t do that to take some course of study that would interest me so as to help pass the time, and also to bring me in contact with some girls my own age. He says as far as my health is concerned now it wouldn’t do me a bit of harm, in fact it would do me good he thought, for I am so much stronger now than I think you or Father have any idea of. I really feel like my own self again and better than I used to sometimes.” She was particularly interested in going to the Technical School nearby, which “is supposed to be perfectly marvelous.” Her parents were quick to approve of the idea.

Banting surprised Elizabeth again by dropping by for an evening visit to ask her to go out for a drive. Blanche could not make it as she had plans to go out with Dr. McClintock. So, as Elizabeth related in her October 17 letter, “I went with him alone. Gracious I felt so grown up going out with a man alone at night!” They had “the loveliest time!” Banting first took Elizabeth to his office and showed her “no end of interesting things about his work, clippings etc. and then he took me up to his room to see his favorite books and paintings.” As she observed, “It seems that his hobby is books and painting in his spare time and I just wish you could have seen those oil paintings he does. They are simply beautiful showing great talent, and if he hadn’t already gained distinction for being a famous doctor, he certainly would to my thinking, gain distinction as an artist of some note.” They next drove about town and ended up at the Connaught Laboratories, “which is in the basement of the Medical Building over at the university, and seeing extract made from the very first stages to the last. It was the most interesting thing I’ve seen in a long time and you must prevail on him to let you see it done when you come up. They are putting out such large quantities now that enormous plant is running night and day with the men working in relays. Oh it certainly was one glorious evening and I shall never forget it.”

Elizabeth’s parents finally came to Toronto in early November to see their daughter’s progress in person. It was a short visit and they left with Elizabeth “eagerly counting the days until we come to see you at Xmas.” While the Toronto weather in November was often miserable, Elizabeth’s spirits steadily rose with several pieces of good news. As she noted in her November 11 letter, Dr. Banting visited the day before and “told us something very wonderful about the production of insulin which is being kept in the utmost secrecy as yet and which I’ll tell you as soon as I come home, but I’m afraid this letter would be miles long if I attempted to tell you now. It is very encouraging though, and its very new.” She also said that, “all the eminent doctors were supposed to arrive yesterday and today and Dr. Banting says they were delayed and wouldn’t get here until the twenty-forth of this month instead. So it’s a good thing you didn’t wait for them. I’m rather glad, for now, it will give me more time to screw up my courage to meet Dr. Allen face to face again, and have him see my ‘roundness’ as you call it, which he hadn’t put on.”

Blanche also had some good news of her own as she and Dr. McClintock had become engaged, but they would be moving to California. As Elizabeth wrote in her November 14 letter, “It seems that the Doctor has been called suddenly out there and wants her to go with him, which of course she wants to do, and I don’t blame her. It is rather a sudden call both for us and her, but it was entirely unforeseen. Thank goodness you know how to give the extract, for then you can tend to me that way at Xmas time and I can attend to my diet.” The question then became, should Elizabeth get a new nurse to replace Blanche? Elizabeth made it clear she was not interested in having another nurse taking care of her, especially someone she did not know.

The plan was for her to remain on Connaught’s insulin as Eli Lilly’s version was still too weak. Thus, after going home for Christmas, she would come back to Toronto, but her parents insisted on sending along a new nurse. She hoped, however, that Lilly’s insulin would improve by Christmas so she could remain at home.

A few days later, those plans changed. As Elizabeth wrote in her November 19 letter, she would go home on November 30, which was Thanksgiving Day in the U.S., and not return to Toronto. She had passed a tolerance test for Banting. It involved scaling back her diet and then measuring blood sugar at regular intervals after insulin injections in order to assess pituitary and adrenal function and insulin sensitivity. As Elizabeth explained, “Well this proves the marvel of insulin all right, for it shows that’s its that stuff alone that is carrying all of my extra calories. Isn’t it wonderful to think that just that liquid stuff does all that work for my poor old tired out pancreas. Dr. Banting thinks that on newly-developed cases their tolerance would be much more likely to be raised under this treatment, but for an old case like mine where the pancreas has had so much strain and where my tolerance has been much lowered by various setbacks he thinks the pancreas is just about done its duty, and can’t take care of even a gram more. Thank goodness for insulin!”

In her next letter, sent on November 21, Elizabeth wrote, “Now I know I am going to shock you by what I am going to say next, but I seem to be always giving you surprises nowadays, and I think you will agree with me that this last is a thing that I will benefit by knowing what to do. I will try to camouflage it in terms that I don’t usually use, for they you will get it more gradually and I’m sure you’ll be able to fathom it.” She was pleased to report she was now “Captain of my own ship” and could now self-administer insulin injections. Banting visited the day before and said that he had received a letter from Mrs. Whitehill, who “said that wonder of all wonders, little eight-year-old Ruth was giving herself her own injections.”

Elizabeth went on to say, “Well that was too much altogether for me. I was not going to be in anyway outdone by a mere girl of eight, whereupon I made the bold resolve to give it to myself for the first time ‘doing absolutely everything’ last night. So I did and thus you know the result. I can do it perfectly beautifully and it doesn’t hurt me as much anyone else giving it to me for I know, just when it hurts and just when to give more and stop and so on. It really is a wonderful thing to be able to do, and I fell so absolutely independent because I can do that. I can cook my food, and I can weigh and figure, and so I don’t see why I’d be perfectly able to live alone (that is if I wanted to) and be well able to do everything for myself. Blanche is elated and so am I, and now things seem to be working out better than ever. I thought they would.”

Elizabeth also insisted that when she got home, there would be no need for a nurse, or anyone else to take care of her. Her parents could confidently leave her alone at home when they went out to dinner or an event. “Listen Mother, I always know when I am having a reaction now because I’ve had them so much and all I have to do is to reach on my table for a kiss and then in five minutes time I am all right and ready to turn over and go to sleep again, and if one candy didn’t seem to be enough for that time why all I’d do would be to eat another one and keep on until I recovered. That’s all there is to it, and there’s nothing anybody can do to help me but myself.” Dr. Banting and Blanche were fully confident in Elizabeth’s ability to manage her injections and diet. “[I]n fact,” she noted, “Dr. Banting said that he’d rather I would do everything than relie (sic) on somebody who wasn’t quite as well trained as I am. You see I’ve lived with this thing from the beginning, and I know every little ins and outs to it and I know just as well as Blanche just what dose to give when I’ve showed sugar or when I’ve had a reaction, in fact I’ve helped B. lots of times in deciding.” As she emphasized, “I’m not a bit sick or weak any more and I don’t want to have to have somebody watching and hanging around me all the time waiting for a reaction to come on when they couldn’t do the least thing for me in that event anyway.”

Confident in Elizabeth’s ability to take of herself, but still wishing to ensure her continued use of Connaught’s insulin, Banting arranged to send insulin to her father, via the U.S. State Department, at regular intervals. “On every Thursday or so on,” she explained, “coming through Father it probably won’t have to go through customs and I can get it very easily. You see being under his care I won’t have to have it go through another doctor in Washington like Dr. Ruffin, for I’m like a doctor myself in knowing how to administer it and Dr. Banting takes full responsibility my being his patient.”

In her November 23 letter, Elizabeth described experiencing another reaction the previous night which she managed smoothly. However, she focused mostly on the details about how Banting would be sending insulin to Washington by parcel post, including how often to send it and how long shipments would take. “Of course things will happen, such as it going bad sometimes, but that is very unusual and we’d just have to take the consequences that’s all. It’s very unlikely now though that anything like that will happen for he says their getting it more and more so that it will keep indefinitely.”

She had met with Banting at the hospital for a weight check, and he shared some additional good news, which she relayed to her mother: “They had just made an excellent batch which was the strongest in ages and he had saved 100 c.c.’s for me to take down with me this time. Isn’t that perfectly wonderful, though? He says this particular batch has proved that it will keep also, so I will be beautifully fixed for a nice long time then, especially being stronger I won’t have to use so much anyway.” Elizabeth also had some good news for him. “I also told Dr. Banting over there how I began giving myself the injections the very night he told me Ruth was giving herself hers, and was simply tickled to death. He said it was a wonderful thing to be so independent and that it was fine I should manage everything when I went home and not bother you at all.”

November 25 was a snow day in Toronto, and it began with Elizabeth receiving a letter from her parents. “Your wee note came this morning and it made be very happy to think that I had won my case. I did try so hard to explain it so that you would really see that it wasn’t necessary and, I guess I succeeded, although I did not think it was at all clear. I think what must have clapped the climax was my giving myself the insulin!” She said she was hoping to be able to go out in the snow, but she had to stay inside and wait for the “old doctors” to arrive. “[W]e don’t know at just what time they’ll be able to break away from all their meetings and come over here to see me. Wouldn’t you know that it would be the very day I wanted to go out in a long time?” Elizabeth was anxious about seeing Dr. Allen again. “You can imagine sometime today this little apartment filled with about six big men with two poor little females. I hope to goodness they won’t stay long and will come soon as I do want to get out this lovely day. The sun has just come out and is shining so prettily on the newly fallen snow.”

Elizabeth looked forward to sending her last letter from Toronto on November 28. Indeed, she hoped it would be the last letter she would have to write to her mother in a long time. “It seems to me for about the last two years I have been doing nothing but writing letters to you which is all right but I’d much prefer using my tongue, wouldn’t you?” She was very anxious to get home and described the travel plans and managing insulin injections and what and when to eat, including making sure her mother was prepared. “Probably you will have everything that’s necessary, but I will enumerate some few things. Can you have half a pint of forty per cent cream, bacon, cream cheese, fruit and some kind of meat, then I’ll be all right. The cream is of course the most important and if you want to you can add that extra amount to your order for every day from now on for we’ve figured out I will use about that much of the heavy whipping cream daily and if I should sometime need a little extra I could help out with the light cream, but I’m sure that will hardly ever be necessary.”

In addition to outlining her travel plans, as well as noting how much she had grown to hate Sundays in Toronto — “[y]ou have no idea how awfully lonely Sundays have been up here. Nearly always it is horrid so you can’t go out and all you have to do is sit in here and read your head off” — Elizabeth described the visit of the eminent doctors. They finally arrived on November 25, “just as we were about to sit down to lunch the way I just had a feeling they would. However, they only stayed about ten minutes so it didn’t matter much and we had the table set in the kitchen as we had a lunch they’d arrive at that hour.”

It was a delegation of six: Drs Joslin, Allen, Banting, Fletcher and Woodchat, along with Charles Best. “[They all] stood in the doorway and just stared at me until I got so nervous I didn’t know what to do. It seems to me that every time I looked up I met the eye of one of theirs fixed on me. It was terrible.” However, “Dr. Allen acted nicer that I’ve ever seen him and Dr. Joslin was simply adorable. No wonder everybody is crazy over him. Of course these two were ushered in first and Dr. Allen said with his mouth wide 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. Now I think that’s very good for him.”

On the evening before Elizabeth left Toronto, Banting paid a short visit to drop off 100 c.c.’s of “this wonderful extract.” He told her the visiting doctors “had had the honor of hearing Dr. Joslin say at one of their meetings up here after he had seen me that I was the most wonderful case of Diabetes he had ever seen treated. Now think of that coming from a man like that and think of Dr. Allan probably sitting there and hearing him say it.” She asked Banting if Allen had said anything and he said no. “Dr. Allen had only spoken a few words during the whole time he was here. A man of few words is the word. It’s a joke among the doctors though that what Dr. Allen misses in saying he always takes out in writing. It seems he writes and writes on this thing in every medical journal he can get hold of including of course an awful amount in his own paper published out a Morristown and called ‘The Metabolic Research.’”

Elizabeth ended her last letter by telling her mother it was still snowing, but that she had gone outside to enjoy her first snowstorm in two years. It was “very pretty.” Elizabeth wrote that she wandered “all over the campus and Queen’s Park until I didn’t have any place else to go and seeing I had been out an hour I came in.” While she certainly enjoyed her time in Toronto, it was the medical attention and the insulin injections that defined her stay. During the 15 weeks she had lived in the Athelma Apartments, Elizabeth was transformed from a severe diabetic and dependent girl living on borrowed time into a robust, independent and energetic young woman. She was now ready head home and get on with her new lease on life.

[i] Elizabeth Hughes’ 18 letters from Toronto, as well as letters she wrote earlier, were donated to the University of Toronto’s Fisher Rare Books Library. Most of this collection, and all of Elizabeth’s letters written while she was in Toronto, are available at: