Profiles, Before and After Insulin: Charles Herbert Best (1899-1978)
By Christopher J. Rutty, Ph.D
Lead Historian, Defining Moments Canada, “Insulin 100”.
On October 26, 1923, Charles Best received a telegram from Fred Banting: “Nobel trustees have conferred prize on Macleod and me. You are with me in my share always.” Best was in Boston, invited by Harvard Medical School students to give a talk about the discovery of insulin, and to lend his name to efforts to raise $900,000 for a new dormitory. Best was introduced by Dr. Elliott P. Joslin, one of the leading diabetes specialists, based in Boston. After Best’s talk, Joslin read a telegram he received from Banting: “I assign to Best equal share discovery Insulin. Hurt that Nobel Trustees did not so acknowledge him. Will share with him. Please read this telegram at any dinner or meeting. Banting.” The Boston Globe reported on the story of Banting wanting to share the Nobel Prize with Best, who was “now the most famous medical student in the world.”
The Boston Globe report added a brief biography of the world-famous medical student: “Born in Maine, the son of a Canadian doctor who was practising there, Dr. Eliot explained, Mr. Best came to the University of Toronto as a medical student, working his way through the course there.” The full details of his life are documented in the book by his son, Henry B.M. Best, Margaret and Charley: The Personal Story of Dr. Charles Best, the Co-Discoverer of Insulin, published in 2003. Charles Herbert Best was born on February 27, 1899, in West Pembroke, Maine, to Herbert Huestis Best and Luella May Fisher, who had both grown up in Nova Scotia. Charles’ father attended Dalhousie University in Halifax and intended to complete medical school at McGill University in Montreal, but illness upset that plan and he earned his M.D. in New York City. Herbert’s sister, Anna Best Jenkins, was a nurse in New York City, and helped him with expenses; it was while there that Herbert met Luella, a second cousin, and they married in 1896. The couple soon moved to Maine, where Dr. Herbert Best began a long career as a busy country doctor along the state’s northern border, adjacent to New Brunswick. He would often take serious cases across the border to a hospital in St. Stephen, N.B.
As a young boy, Best would accompany his father on calls to help with driving the horse-drawn carriage. Indeed, he essentially grew up on horseback, driving horses at county fairs and racing horses with his father, including on winter roads and ice- covered lakes. Best and his father often discussed medical lore when he was young and his introduction to what medical practice was like began when he was 12. During emergencies, Best was sometimes called upon to administer anaesthetics when his father had little choice but to operate on kitchen tables. During the last two years of high school, Best’s father perused course catalogues from U.S. and Canadian medical schools, including Harvard, Johns Hopkins and Yale, as well as McGill, Dalhousie and the University of Toronto. Since his parents were Canadians, it made most sense to go to a Canadian university. The choice of Toronto was based on a preference for city life, and because he could stay with relatives.
There was, however, another factor that focused Best’s medical interests and channeled them towards physiology and an awareness of the problem of diabetes. His father’s sister, Anna, had trained as a nurse in Boston and developed adult-onset diabetes in 1913. She sought treatment at Elliott Joslin’s diabetes clinic; they had met during her nursing training. Joslin put Anna on a strict semi-starvation diet and she stayed with her brother’s family. Her deteriorating condition and eventual death, on May 24, 1917, left a deep impression on Best.
A year-and-a-half earlier, in the fall of 1915, Best had made his way to Toronto. He stayed with his father’s younger sister, Lillian, while he took several high school courses at Harbord Collegiate that he needed before entering the University of Toronto, including Canadian History and French. By the fall of 1916, he was ready to begin a general arts undergraduate program at the University of Toronto. It was, however, a very disturbed time for him and for much of the university community due to news of the fighting in France as World War I raged on with no end in sight. Indeed, as he wrote in an article as an alumni for his West Pembroke high schoolnewspaper on the effect of the war on a Canadian college: as he could see, and from what he was told by older students and professors, it had brought an end to invitations, dances, dinners and theatre parties, and there was a much larger proportion of women in the classes, along with an absence of faculty and a greater presence of military uniforms on campus.
As the fall, 1917, term began, Best transferred into the university’s physiology and biochemistry program. He also felt a strong call to enlist, but he ran into difficulties because of a heart murmur attributed to his having scarlet fever or measles as a child. He was thus told to wear an “A.R.” button (i.e., Applied for service, but
Rejected). Undaunted, Best soon found a recruiting officer at the Toronto armories, who, after simply looking at him, pronounced him perfectly fit.
In the spring of 1918, Best joined the 70 th Battery of the Horse Artillery and was sent to Camp Petawawa on the Ottawa River. As there were some 2,300 horses at the camp, Charles’ equestrian skills proved ideal and soon led to a promotion to sergeant. In August, 1918, Best returned home to his parents, accompanied by Clarke Noble, with whom he had made friends in the physiology and biochemistry classes. Two months later, he left for England as part of the 2 nd Canadian Tank Battalion.
Although Best was excited to finally get a chance to serve, the timing was poor. In early October, 1918, the worst wave of the influenza pandemic was sweeping across north-eastern North America. Best left Quebec City on October 3 rd on a troop carrier.He wrote home to say how much he was enjoying his trip and that there were “[l]ots of eats.” However, the next day he wrote to say that “some of the fellows have ‘grippe’ but no ‘Spanish flu.’” “Grippe” was a term for a mild type of influenza. Once the 5,000-ton transport, the Victoria, had sailed for England, carrying 1,076 Canadian soldiers, Best wrote home to say he was “Orderly Sergeant on the trip over and that means a lot of work, but I like to be busy and don’t mind having authority.” However, it soon became clear that some of those earlier cases of grippe wereindeed influenza, and there were no doctors or nurses on board for the 17-day voyage. Out of the 100 men in Best’s unit, nine died after contracting the virus and were buried at sea. In total, there were 28 deaths from influenza by the time the Victoria arrived in England. Somehow, Best managed to survive the voyage because, as he thought, he was on mast duty for several hours each day, on watch for other ships, which meant he slept on the top deck, away from others.
When he arrived at Kimmel Park Camp in North Wales, Best was kept busy with infantry drills and long marches into the foothills of Mount Snowden. Within weeks, however, the war ended and before long Best was on a boat back to Halifax. “I shall always be sorry that I did not get as far as France,” he wrote, “but I am glad to be so near.” By early December, he was back to his university courses and then returned to West Pembroke for Christmas and a joyful homecoming.
After his discharge from the army, Best had enough money to keep himself going, but he struggled to get caught up with his studies. As he told his parents in January,1919, “The work is very hard for me and I will probably have to remain for several weeks or months after convocation to complete the work.” He would soon need to earn some money, and, to appease his restless spirit, considered applying for a job as a fire ranger in Northern Ontario. However, as he began the third year of the biochemistry and physiology course, he learned that he could work as a demonstrator or a junior research assistant during the summer, or come back early in the fall term, ahead of the academic year, to do demonstrations for medical students. Amidst such considerations, Best met Margaret Mahon, a lovely 18-year- old-girl, as he described her, at a sorority party on February 28, 1919. It turned out she was born 16 kilometres away from his birthplace, “as the gull flies,” in St-Andrews-By-The-Sea, N.B. Best and Margaret soon became almost inseparable, with the Mahon household becoming a second home to him. Best also spent time with Clarke Noble, including working hard together to build a golf course, and also playing hard at baseball.
On July 12, 1920, Charles and Margaret were engaged. He proposed at the Noble farm in Georgetown, north-west of Toronto, and paid for the diamond engagement ring from money he earned playing for the Georgetown baseball team. Best was the catcher and Nobel played third base. There were lots of discussions about their future, with Best uncertain about specializing in physiology or surgery. He toyed with the idea of going to South America, where there seemed to be opportunities fora young doctor.
At about the same time, a young London, Ont., doctor was struggling to establish a new practice. Frederick Banting’s story paralleled Best’s in several ways. While still in medical school, he had tried to enlist on August 5, 1914, the day after war was declared, but was rejected because of poor eyesight. But after completing most of his medical training at the University of Toronto, Banting was able to enlist in the spring of 1915. A special curriculum was designed for Banting’s class that condensed the fifth year into a special summer and fall semester. On December 10, 1916, the morning after graduating, Banting reported for active duty. After first serving at a hospital in England, in June, 1918, Banting was sent to the front lines as a battalion medical officer. In September, 1918, he was wounded in the arm by
shrapnel and would remain in hospital recovering until December 4, 1918. The war had ended, but Banting remained in England as a medical officer, and finallyreturned to Toronto in the spring of 1919 to work at the Christie Street Hospital for Veterans while awaiting formal discharge.
Starting in the summer of 1919, Banting spent a year completing his internship in surgery at the Hospital for Sick Children. However, after being denied a staff position, he moved to London to start his own practise, which he opened in early July, 1920. Too few patients soon led Banting to the University of Western Ontario medical school to offer his services as a demonstrator. In late October, it was while preparing for a lecture he was asked to give on carbohydrate metabolism that Banting was struck with the compelling idea that would dramatically change the course of his life, as well as Best’s.
Meanwhile, during Best’s fourth year of his Honours Biochemistry and Physiology degree, from September, 1920, to April, 1921, he earned some money as a demonstrator in physiology for third-year medical students. Best and Noble worked together as demonstrators while also undertaking a research project involving inducing diabetes in turtles, based on Macleod’s interest in exploring the relationship of the brain and nervous system in carbohydrate metabolism. A carefully placed pin-prick in the brain of an unconscious turtle prompted the development of diabetes symptoms and Best and Noble sought to trace the pathway of the nerve impulses produced by the pin-prick to see what caused the illness.
This research introduced Best to the latest methods for estimating the amount of sugar in small blood samples. He also learned the latest in carbohydrate metabolism and diabetes research during weekly lectures given by Macleod. Best first heard about Banting in one of Macleod’s lectures and the possibility that he would come to Toronto to work on the pancreas. Best notebooks from this period include many references to diabetes research by a variety of scientists and ideas that Macleod agreed and disagreed with, particularly with respect to the role of the pancreas and an elusive internal secretion in the development and potential control of diabetes.
Macleod introduced Banting to Best and Noble in mid-May, 1921, and Banting explained his hypothesis. Macleod also showed them the small operating room i the physiology department where they would begin their work. Macleod also gave them no false hopes as to how difficult the experiments would be and the results that came of them. Macleod also left it to Best and Noble to determine who would work first with Banting. Best won a deciding coin-toss. He wrote his final exam on May 16 th and the next morning met Banting in the operating room. Their first job was to give the long-empty space a thorough cleaning. Macleod later joined them to supervise their first dog pancreatectomy.
Best initially lived in the university fraternity, Nu Sigma Nu. At the end of June, he spent two weeks fulfilling a commitment to work at a militia camp at Niagara-on- the-Lake, where he hoped to earn some money as a medical sergeant with the Governor Generals’ House Guards, riding horses that others found difficult to handle. Then, in July, 1921, he moved in with Margaret’s brother and sister while the rest of the Mahon family was on holiday. Margaret was away for most of the summer, and Best missed her a great deal. He spent most of his free time playing tennis, swimming and escaping the heat on Toronto Island. As the summer went on and the research intensified, Best often slept at the lab. By November, when it was time for Banting and Best to give their first lecture on their work, to the Journal Club of the Physiology Department, Best draft the paper. He relied on Margaret to carefully write it out by hand while he dictated.
Much has been written elsewhere on this site about Best’s work with Banting in the lab during the summer and fall of 1921 and into 1922. They were like brothers. Although seven years younger, Best was the more stable, grounded and practical of the two, and played the peacemaker when tensions between Banting and Collip boiled over in late January, 1922. He also lent Banting a hand in March, 1922, drawing him out of a drink-induced depression amidst a breakdown in Connaught Labs’ insulin production and Banting’s feelings of isolation from the work.
However, the nature of the insulin work and their different roles during 1922 and 1923 caused the two researchers to drift apart. Banting was focused mainly on clinical work with diabetic patients, while Best managed Connaught’s insulin production operations and the collaboration with Eli Lilly. Best maintained a closer working relationship with Macleod, while Banting largely avoided him. Best was also committed to completing a Master’s degree during 1922 so he could enroll in medical school in September, 1922. He spent any spare time with Margaret.
During 1922 and 1923, and indeed for much of the next decade, Best was most supported by Connaught’s director, Dr. John G. FitzGerald. In January, 1922, FitzGerald had placed Best in charge of Connaught’s insulin production, his salary helping to support his master’s research project and then medical school. In July, 1923, FitzGerald also stepped in when Banting was given a federal annuity and made the case that Best also deserved a share, although that effort was not successful. In 1924, FitzGerald appointed Best as Assistant Director of Connaught and then helped facilitate Best winning a Rockefeller Foundation fellowship to support his postgraduate studies in England and Europe after graduating from medical school in June, 1925.
Charles and Margaret, who had married on September 3, 1924, set sail for England on July 9, 1925. They spent the next year-and-a-half in England while Best, now a full medical doctor, studied with Professor Henry Dale at the National Institute for Medical Research in London. He also studied in Germany and Denmark, while consulting with insulin producers that were not getting as high a yield of insulin extraction from pancreases as Connaught was able to obtain in Toronto.
While Best was away, FitzGerald led a major effort to increase Connaught’s insulin production capacity in the same new building that accommodated Connaught’s expanded research and vaccine production facilities, as well as the new School of Hygiene’s public health teaching and research programs. This project was made possible through funding from the Rockefeller Foundation. In May, 1926, Banting wrote to Best to say that he had recently met with his parents when they visited Toronto and showed them Connaught’s insulin facility in the old Y.M.C.A. building that Connaught had taken over in 1923. He told Best the School of Hygiene Building looked great and was almost ready for roofing. Banting added that FitzGerald was “pleased as ‘Punch’ and wears a smile not unlike the historic gentleman.” He even enclosed a sketch of the smiling director of the Labs and the new School.
In December, 1926, Best returned to Toronto to resume direction of Connaught’s Insulin Division. With the official opening of the School of Hygiene Building in June, 1927, he became head of the new Department of Physiological Hygiene. The next year, Best added to his responsibilities by succeeding Macleod as head of the medical school’s Department of Physiology. The administrative demands of this appointment meant Best had to resign as Assistant Director at Connaught. FitzGerald had hoped Best would succeed him as Director of Connaught and the School of Hygiene, but that now seemed impossible.
Nevertheless, Best and FitzGerald remained close during the 1930s, with Best finding some respite from his busy schedule by visiting the Connaught “farm” site where he could ride his favourite horse. FitzGerald also hosted official events at the farm, including a garden party during the meetings of the Royal Society of Canada in May, 1931. A panoramic photograph taken at the garden party shows FitzGerald along with Banting and his first wife Marion next to Best and Margaret, who had just had their first child, Alexander. As discussed by Henry Best in his Margaret and Charley book, Alexander, or Sandy, as he would be known, inherited his father’s intellect, as well as a similar depressive temperament that affected many in the Best family. Through the Depression of the 1930s, Charles Best’s mother struggled with clinical depression. And in 1940, after Charles’ paternal grandmother died, his father also experienced bouts of depression. During the late 1930s, Charles spent quite a bit of time at the Connaught Farm riding his horse, and also with FitzGerald, who increasingly suffered from severe episodes of depression that finally forced him to take an extended medical leave. But in June, 1940, FitzGerald’s psychological decline was such that he took his own life. Best later said of his mentor, “There would have been no insulin without FitzGerald.”
Eight months later, in February 1941, after Banting’s tragic death, Best succeeded him as Chair of the Banting and Best Department of Medical Research. The increasing pace of war-related research work, followed by the establishment of the Best Institute, and a relentless schedule of travelling, took a toll on Best. Through the 1950s and 1960s, he and Margaret also were deeply dismayed as their son Sandy struggled with depression amidst personal and financial challenges. And Charles himself showed disturbing signs of depression as he approached retirement.
In early August, 1963, Margaret grew especially worried about Charles. “He had a frightful depression,” she wrote in her diary, “— most unusual for him.” Soon after his 65 th birthday, exhausted from travel and worried about his son, Charles was admitted to St. Michael’s Hospital after an apparent suicide attempt. Margaret had found him in bed with a box of potentially harmful pharmaceutical samples lined up on his bedside table. He was given a series of electric shock treatments, but there was not much else that could be done.
Charles slowly recovered, but it was clear to Margaret he must never work so hard again. He also recognized there was a family predisposition to depression, which he alled the “Woodsworth strain”; both his parents suffered from it, as did his two grandmothers (who were first cousins). His condition was exacerbated by Sandy’s financial and marital problems and, as Henry Best suggested in Margaret and Charley, Charles bottled up his anxieties to spare Margaret. There were also worries about the future of his departments and his approaching retirement.
In November, 1964, Best’s condition had deteriorated further and concerns were raised among his friends and within the family about his prognosis. Professor Aldwyn Stokes, head of psychiatry at the University of Toronto, who had been in charge of Best’s treatment, gave an assessment of Best, in letter marked “very private and confidential,” to the Dean of Medicine, Dr. John Hamilton. Stokes identified a profound despondency in Best associated with “self-blaming, self-
doubting and indecisive immobility.” The source of the mistakes and failures seemed to be within his own family. According to Stokes, Best had been “confronted with a situation in which his good name seemed in jeopardy and his financial resources in danger. With the weight of these events pressing hard upon him, he found himself less able to live up to his professional role and in fact the depression started when on an important lecture tour, he found himself unable to match the standards he had set for himself and the standards which other people expected of him. That was not a case of burned-out effort but of a threat to himself which he had never previously experienced.” The assessment concluded by recommending that the university provide Best with a very good pension.
By early 1965, Best’s health had slowly improved. A few weeks before his 65 th birthday, he was re-appointed as professor of physiology and director of the Banting and Best Department of Medical Research (BBDMR). He decided to retire from physiology as of May 1 st , but still continued to lead the BBDMR for another two years. In the meantime, life gradually returned to normal, although Best never regained his sparkle. His limited energy prevented him from attending the funeral for J.B. Collip in June, 1965. Collip had been dean of medicine at the University of Western Ontario in London since 1947. Best was invited to attend, but he did not feel up to it and instead wrote a letter to Collip’s widow.
There had been a personal estrangement between Best and Collip that began in 1922, with Best never quite forgiving Collip for threatening to take out his own patent for insulin purification. He had thus been reluctant to talk about the
discovery of insulin when Collip was present, and the same discomfort would apply if Best attended Collip’s funeral. The two men had, nevertheless, worked well together on a professional level while involved in wartime research for the National Research Council. Their relationship remained cordial, but they were never friends. Best was later surprised to learn through an interview for a BBC documentary about the discovery of insulin that Banting and Collip had become friendly during the period just before Banting’s tragic death in February 1941. During the BBC interview, Best was asked if he held on to any bitterness about the Nobel prize. He said that he did harbour some bitterness early on, but after his struggles with depression, he no longer dwelt on it.
As the last surviving member of the insulin discovery team, Best faced some challenges as 50 th anniversary celebrations geared up in 1970 and 1971. He was the sole focus of attention and did not have to worry about talking about the discovery with any of the other three men present. Best was invited to a seemingly endless list of Insulin 50 th events that took him and Margaret to many parts of the world. Fortunately, their health remained good. Among the many Insulin 50 th events, the official opening of the new Medical Sciences Building at the University of Toronto, on October 7, 1970, held particular significance. The new facility replaced the original Medical Building, in which insulin had been discovered, developed and first produced. There was a special convocation held that day and Best received an honorary LLD. Similarly significant was the official opening of the Robert D. Defries Building at Connaught Laboratories’ Dufferin Division site on November 20, 1970, which had been specially designed for insulin production. Best was a featured guest at the opening. A year later, Best and Banting’s widow, Henrietta, unveiled an Ontario Heritage Foundation plaque on the new Medical Sciences Building wall, marking the site of the old Medical Building. The original wording on the plaque only mentioned Banting and Best. However, following the publication of Michael Bliss’ Discovery of Insulin book, the wording was revised to include Macleod and Collip’s vital contributions.
Following the hectic pace of the Insulin 50 th celebrations, Charles and Margaret enjoyed a quieter period at home and some more leisure travel, although Margaret’s health sometimes faltered. However, on March 25, 1978, their quiet life was suddenly shattered by news that their eldest son, Sandy, suffered a massive heart attack and died at age 46. While struggling to write a tribute to his son, Charles collapsed suddenly. In the early morning of March 31 st , he died in hospital. The cause of death was an aneurysm of the aorta.
Margaret Best endured the dual shocks of losing her son and husband within days of each other. During most of the next decade, she struggled with managing Charles Best’s legacy and preserving his papers on behalf of the family and for the benefit of historians, such as Michael Bliss. However, Bliss’ initial interest was to interview Margaret, although many advised her against talking to him. But her younger son, Henry, who later wrote Margaret and Charley, suggested that she should be as helpful as possible. Margaret thus agreed to an interview in May, 1980, and another in November, 1980.
Margaret met Bliss again after the publication of The Discovery of Insulin, at the opening of the Toronto General Hospital Diabetes Clinic. She said to him, “I understand you are now writing a biography of Fred Banting,” then added, “Don’t be too hard on Fred.” Whether or not she was pleased with Bliss’ Banting: A Biography, published in 1984, is unclear. But she was quite pleased with the CBC mini-series, Glory Enough for All, which was based on Bliss’ books, especially the performance of R.H. Thompson as Banting. However, she was disappointed in the portrayal of Charles. Margaret was not given the opportunity to meet with Leah Pinsent, who played her, as the series’ director did not tell the actress that Margaret was still alive. Margaret Best saw a preview of the mini-series, but she did not live to watch its premier in October 1988. She passed away in peacefully in her home on January