The Discovery Goes Public
Throughout 1922, news of the discovery of insulin spread gradually, first beyond Toronto and across Canada. The news took even longer to reach into the United States, the United Kingdom and elsewhere. The pace of the dissemination of the story was constrained by the nature of newspaper coverage during the 1920s. Reports of new or sure-fire cures were all too common and almost always unfounded. There was thus a natural hesitance among the Toronto team, especially initially, to engage with reporters. Macleod was particularly sensitive to inadvertently adding to misleading and potentially harmful newspaper reporting about their diabetes extract work, and to seeing such reports amidst the clutter of miracle cure articles and patent medicine advertisements. Nevertheless, Macleod underestimated the persistence of some reporters and their resourcefulness in taking advantage of personal connections with members of the Toronto team.
It was the persistence of one Toronto Star reporter, Roy Greenaway, that led to the first newspaper report on January 10, 1922, about pancreatic extracts. “May Cure Diabetes,” the headline read. Somehow, Greenaway heard about “a boy of 13,” Leonard Thompson, with severe diabetes. “As a last resort,” he wrote, the boy’s family gave the Toronto research team permission to experiment on him. It may have been Leonard’s desperate father who had alerted The Star. As historian Michael Bliss noted in his Discovery of Insulin book, Greenaway found Best, who directed him to Macleod, who felt cornered. As conservatively as possible, Macleod offered an account of the first human test of the extract. A longer version of the story appeared in Toronto Star Weekly, but there was no follow-up article about the subsequent successful trial of Collip’s more purified extract on Thompson.
Indeed, there were no further articles published about the pancreatic extract until an extensive front-page story appeared in the Toronto Star of March 22. During February and most of March, there had been little good news to tell. Due to a crisis in production at Connaught Laboratories, there was little to no extract available. Collip was in charge, but he was unable to produce the extract on a larger scale, prompting a frantic effort to figure out the problem. At the same time, Banting had lapsed into despair as others on the team focused on extract production and research. With little to do and no authority to treat diabetic patients, he began drinking heavily.
In the midst of this challenging situation, a former teacher of Banting’s, Dr. G.W. “Billy” Ross, who had been impressed with Banting’s work so far, mentioned Banting’s recent research to one of his patients, who happened to be Roy Greenaway. Ross arranged for Greenaway to meet Banting, Best and Macleod. He wrote a comprehensive front-page article, “Toronto Doctors on Track of Diabetes Cure,” the publication of which was timed to coincide with the release of the Toronto team’s seminal paper in the March issue of the Canadian Medical Association Journal. Greenaway’s article featured photos of Banting, Best, Macleod and Collip, and quoted extensively from the CMAJ article.
Greenaway’s article described the discovery story from Banting’s perspective and highlighted a special moment for Banting and Best before they proceeded with the first human trial. They had to ensure the extract was not toxic. “I wouldn’t ask anybody to take something that I wouldn’t take myself,” Banting told Greenaway, who described how Best gave Banting the first “shot.” Later, Banting returned the favour. “Both lived to tell the tale,” the report noted. “Within six months,” the article predicted, “their discovery will be used on a large scale, they hope, to prolong life quite considerably at least.”
Despite the upbeat coverage, The Star article prompted only a minor flurry of attention locally, and very little attention outside of Toronto, beyond a Canadian Press version that included the photos of the four researchers posed beneath the headline, “Have They Robbed Diabetes of Its Terrors?” A version of the story published in a Belleville paper focused on the key contributions of Collip, who had been born and raised in the eastern Ontario city.
In the U.S., the story was picked up by a Buffalo newspaper, but few others. Greenaway wrote a follow-up story for the March 23rd Toronto Star, “Diabetes Work Epoch-Making Says Physician.” Although the physician wasn’t named, according to Bliss, it was evidently Dr. Ross, and ultimately the story was seen as just another miracle cure announcement.
There were very few news reports about the pancreatic extract during April, May and into June. The next stories to appear were in papers outside of Toronto. The first was a short report on June 12th in a Battle Creek, Mich., newspaper promoting an upcoming visit by Banting, Best and Clarke Noble to give a presentation at a local physician’s clinic. The second was a prominent front-page article in the June 21st edition of the Winnipeg Tribune. “Canadian Doctor Discovers Cure for Diabetes,” was the banner headline, with the story highlighting Banting’s address to the convention of the Canadian Medical Association. “[The] discovery of a cure for diabetes by pancreatic extracts,” according to the doctors attending the Winnipeg convention, was “one of the greatest achievements in the annals of Canadian medicine.” After his report, members of the profession signified their appreciation of Banting’s work by a standing vote. This was “the first time in the history of the association, it was learned, that such an action has been taken.”
Much had happened behind the scenes between the end of March and the Winnipeg CMA conference in late June, news of which did not appear in the North American press. Banting was in a much better place in June, as was Connaught’s insulin production. Best had rallied Banting out of his poor, drinking reinforced, state of mind, and spearheaded an effort by the full Toronto team to resolve the extract production crisis. Banting also established his own practice, which finally enabled him to treat diabetic patients. Also, on May 3rd, during an especially successful presentation in Washington, D.C., at a meeting of the Association of American Physicians, Macleod called the extract “Insulin” for the first time. However, Macleod soon grew concerned that some enterprising chemist and/or drug company would figure out how to make an effective extract and apply for a patent, thus bypassing Toronto. By the end of May, this concern, and uncertainties with Connaught’s production capacity, led to a unique insulin development partnership with Eli Lilly & Co. of Indianapolis. At the same time, U of T embarked on preparations to submit formal Canadian and U.S. patent applications on behalf of Best and Collip, who were committed to giving insulin patent rights to U of T as a public trust. Though certainly agreeable to this idea, as a physician, Banting resisted attaching his name to the patent applications. Macleod also felt little need to attach his name to any insulin patents.
Despite the enthusiastic response Macleod received after his presentation in Washington, there was no mention of his talk in the press. However, a transcript of Macleod’s paper and the subsequent discussion was privately distributed among those who attended the session, during which the discovery of insulin was described as “epoch-making.” Through informal discussions and correspondence, news of the discovery increasingly spread around the U.S. among diabetes specialists, and more formally as several corresponded or met personally with the Toronto group to facilitate the set-up of the small-scale experimental production of insulin in a few labs and local clinical studies with severe diabetic cases. Such efforts attracted the attention of reporters, leading to the perspectives of the diabetic specialists involved largely shaping how the insulin story in the press would grow and evolve, especially during August.
Despite the limited press attention, the private circulation of news about insulin and its dramatic effects led to Banting being deluged with requests for the miracle extract from specialists and physicians across North America on behalf of their desperate patients. In Toronto, some diabetics even camped out at the doors of the University of Toronto Medical Building, trying to get insulin. But the supply was severely limited. In late May, however, Banting was able to provide some insulin to Jim Havens in Rochester, NY; he was the 22-year-old son of Eastman Kodak’s vice-president, and the first patient in the U.S. to receive insulin. Through his private practice, during June and July, Banting also agreed to use insulin to treat three diabetic children, all described by Banting as “living skeletons,” brought to Toronto from the U.S.; none of these cases were publicized.
In early July, Banting had received a distraught letter from the mother of 15-year-old Elizabeth Hughes, the daughter of Charles Evans Hughes, the U.S. secretary of state. Banting had to politely deny her request for insulin. The Connaught supply remained unstable, although by late July, Eli Lilly was able to provide a modest quantity that Banting himself brought back to Toronto following a trip to Indianapolis. In early August, Banting had also facilitated a $10,000 donation through a New York City diabetic specialist to enable a key upgrade of Connaught’s production equipment.
Meanwhile, Elizabeth Hughes’ condition had worsened. Her physician, Dr. Frederick Allen, asked Banting to see her in Toronto; her parents wanted to take their daughter to the source. With an improved insulin supply, Banting this time agreed to see Elizabeth on August 15th. After the first insulin shots, her condition quickly and steadily improved. Shortly after first seeing Elizabeth, Banting had lunch with a physician friend, Dr. D.E. Robertson, who told Banting that the newspapers had found out that Elizabeth was in Toronto for insulin treatment. Robertson asked Banting about the old suit he was wearing and offered to take him shopping. It seemed to be the right time for new suits and celebrations. Banting was also about to celebrate an appointment as an attending physician at Toronto General Hospital in its new diabetes clinic. Press attention would now focus as much on Banting and his discovery as it did on the captivating story of Elizabeth’s miraculous recovery.
By the fall of 1922, Elizabeth Hughes was one of several hundred diabetics receiving insulin in North America. However, as the University of Toronto Insulin Committee observed, most of the insulin production and research had shifted to the United States. This Committee had been established by the university’s Board of Governors to administer the patenting and licensing of insulin in North America; it originally consisted of three members of the Board, along Banting, Best, Collip, Macleod, and Dr. J.G. FitzGerald, director of Connaught Labs. The Insulin Committee therefore decided to support the experimental production and clinical testing of insulin elsewhere in Canada, particularly in Montreal, Winnipeg, Kingston, London and Edmonton, where Collip was producing some insulin at the University of Alberta.
By this time, the Committee was also focusing its attention on how to facilitate insulin availability in the U.K. through the Medical Research Council, which had been established to distribute medical research funds. Macleod had reached out to the MRC in June, offering to give it full U.K. patent rights. In July, FitzGerald went to the U.K. to start the process. While MRC’s scientific and medical leadership expressed interest in the discovery, some members also expressed scepticism because of the proliferation of miracle-cure stories.
In early September, Greenaway reported in the Toronto Star that the MRC was planning to send a scientific delegation to Toronto to investigate insulin production and its clinical use. The article also referred to a letter to The Times of London newspaper by one of Britain’s leading physiologists, Prof. W.M. Bayliss, that downplayed Banting’s role in the discovery of insulin while elevating Macleod’s, noting that Banting had merely served as one of Macleod’s collaborators. Macleod was a friend of Bayliss.
When Banting saw article he was, not surprisingly, upset. Best quickly interceded and got to Macleod first and asked him if he thought Bayliss had been fair to Banting. Macleod said he had nothing to do with the article and that Bayliss had written the letter with little knowledge of the situation. As noted by Michael Bliss in The Discovery of Insulin, Bayliss had been upset by a Canadian news story that attributed the whole discovery to Banting. Macleod, however, was unwilling to publicly refute the story until Banting met with him and Greenaway a few hours later in Macleod’s office. After asking the reporter to leave the room, Banting told Macleod that if he didn’t refute Bayliss’ statement, there were many others who would. Banting’s long suspicions of Macleod had once again surfaced. Macleod finally wrote out a statement for Greenaway to publish on September 7th with the headline, “Gives Dr. Banting Credit for Insulin.” However, the statement didn’t satisfy Banting or Best, prompting a further statement from Banting published on September 9th, “Declares Best Shares Honour: Dr. Banting Pays Tribute to Partner in Discovery.”
The whole Bayliss matter and exacerbation of tensions among the Toronto team affected Macleod in particular. It disrupted his research and interfered with all sorts of matters; he found the situation quite unbearable. In an effort to once and for all settle the credit question, Albert E. Gooderham, chairman of the Insulin Committee, asked Banting, Best and Macleod to each prepare written statements of their understanding of the discovery of insulin; Collip was in Alberta and wasn’t asked. Near the end of September, they submitted their statements to Gooderham, who hoped that an agreed-upon history of the work would be prepared in order to clear up misunderstandings. Unfortunately, the statements didn’t settle the tensions. A full accounting of the discovery of insulin was only published 60 years later in Michael Bliss’ The Discovery of Insulin book.
While the credit controversy played out in the Toronto press, the focus of insulin coverage in the U.K. and the U.S. became more focused on Banting, to the exclusion of Macleod and Best. Collip was rarely, if ever, mentioned. A frequently reprinted September 13th article in British newspaper, The Manchester Guardian, proved particularly influential in promoting an especially distorted story of Banting’s discovery, overly boosting his role and being unfairly critical of the university and of Connaught’s work preparing insulin. “Although conservative and inclined to be sceptical,” the story noted, “the authorities at the University of Toronto were so impressed with young Banting’s sincerity and theory and capacity that they did, with perhaps some resistance, place at his disposal certain facilities for carrying out his experiments. Thereupon followed a year or two of intense work on the part of Banting and one or two associates.” The article also highlighted that “nine men are employed in the production of this fluid, working in the Connaught Laboratories, of the University, which are already famous for their quantity production of vaccine, anti-typhoid, and other serums.” Yet, the writer pointed to anonymous “critics of the University who say that the provisions so far made for the development of Dr. Banting’s treatment are entirely inadequate. They say that instead of nine men there should be hundreds at work on the production of the serum, and that no expense should be spared in giving to the world every facility for employing the remedy.”
By October, U.S. press attention to Banting’s discovery had intensified, fuelled by the compelling Elizabeth Hughes story, as well as insulin success stories from Santa Barbara, CA, where the Potter Metabolic Laboratory and Clinic had been preparing and using insulin on an experimental basis with nine severe cases. The increased U.S. and European press attention prompted a Toronto Star article on October 14th, likely by Greenaway, that focused on the heightened media coverage, much of which had emphasized how insulin was a “certain cure.” But, as the article also observed, “While the University of Toronto remains officially silent, distorted reports in some of the papers of the United States give wrong impressions regarding where the credit is due.” It appeared that “American physicians who have obtained some of the serum very circuitously are made to appear to be the real experimenters. Since most of these are usually famous diabetes physicians with many years of distinguished service in connection with their names, weight is added to these mistakes of reporters who are not acquainted with all the facts.”
The balance of the October 14th Star article focused on questions asked of Banting about whether or not insulin was actually a “cure” for diabetes. Banting didn’t regard insulin as a cure but rather a means of managing the illness, since diabetics had to keep taking it indefinitely to control their blood sugar. But to many physicians, the press and the public, they are content to “use the term in its ordinary sense” to say, “For all intents and purposes, Insulin is a cure.” The more important question for the people was “when can they have it? They want to have some definite statement that will give them hope for its widespread use. On this point, Dr. Banting would say nothing definite. ‘We are doing all we can to increase the production — everything in our power.’ That was all he could say.”
Starting with a Toronto Star report on October 20th, U of T’s Insulin Committee assumed a more direct role in controlling the insulin story in the press, beginning with an official statement detailing the university’s formal application for patents. “The originators of the method of preparation of Insulin have applied for patents in Canada and other countries, and have offered to assign these, when granted, to the University of Toronto, to administer in whatever way it deems best, so as to prevent commercial exploitation of the product and to safeguard the production of a standardized product.” Through its Board of Governors, U of T “has accepted the trust.” The statement went on to highlight the work of Connaught Laboratories and its limits in developing large scale production methods, necessitating a collaboration with a large U.S. firm “experienced in the preparation of extract from slaughterhouse material, so that enough Insulin could be produced in the country to supply it to a selected group of physicians, so as to test its therapeutic value in diabetes, its proper dosage, and so forth, before it was placed on the market.”
The Insulin Committee’s more proactive role led to the preparation of a widely syndicated article from the New York World that told the insulin discovery story in more accurate detail. The New York World article also named Eli Lilly as the one U.S. firm partnering with the Toronto group, which is “understood to be expending a large sum in preparation for mass production.”
U of T’s patent application, as well as its offer allowing Britain’s Medical Research Council to apply for a British patent, proved controversial to some, especially to physicians, as news reports published later that fall noted. In response, the Toronto Star published an extensive article on December 7th, which featured comments from both U of T president, Sir Robert Falconer, and Macleod, both of them reaffirming the rationale behind the insulin patent applications. As Falconer stressed, “Insulin is patented for one reason – and for one reason only. That is for the protection of the public. It was done to make sure that the extract will be always at exactly the proper strength for its effective use.” Macleod, nevertheless, added another key factor: “The reason the university patented Insulin is quite obvious. If the university had not done so, some commercial company would have done it, and so would have obtained a monopoly.”
The initial patent application named Best and Collip, the lay members of the discovery team. As a physician, Banting initially resisted including his name, concerned about violating the Hippocratic oath he took as a physician to not engage in the profiting from a discovery normally implied in patenting. However, it soon became clear that an insulin patent, especially in the U.S., would not be valid without Banting’s name. Thus, on December 11th, Banting finally agreed to add his name to the official patent applications and the three men were formally recognized by the patent offices as the discoverers of insulin. For a symbolic fee of $1 each, they promptly assigned their patent rights to the Board of Governors of the University of Toronto.
As the year drew to a close, press attention shifted away from the patent issue towards dramatic accounts of how insulin had revived patients in diabetic comas. “Child at Death’s Door Brought Back to Life: Edmonton Cure of Diabetic Coma Predates That in New York,” a Toronto Star headline exclaimed on December 7th. The story referred to two almost simultaneous cases in which insulin injections resurrected diabetics on “death’s door” in Edmonton and New York City. In Edmonton, Collip’s insulin revived an eight-year-old girl, while a 16-year-old New York City boy emerged from a coma following treatment.
News reports had said the Edmonton girl was the first patient to be revived from a diabetic coma, although the Toronto Star had reported a month earlier that 11-year-old Elsie Needham was similarly revived from an unconscious state with insulin administered by Banting at Toronto’s Hospital for Sick Children. A follow-up story in the Toronto Star revealed that “Toronto was hiding the results of cases even more sensational,” including six recoveries from diabetic comas at Toronto General Hospital. At about the same time, the most famous insulin patient, Elizabeth Hughes, finally returned home to Washington, “seemingly cured.”
Newspaper coverage of Hughes’ homecoming was soon followed by reports on the annual conference of the Federation of American Societies for Experimental Biology held at the University of Toronto at the end of December. It was a major gathering of some 250 Canadian and American scientists who were members of one or more of the affiliated groups: the Physiological Society, the Society of Biological Chemists, the Society of Pharmacology and Experimental Therapeutics, and the Society for Experimental Pathology. While part of the meeting was to celebrate the 100th anniversary of Louis Pasteur’s birth, most attendees were drawn to the sessions on insulin treatment, as well as the presentation of nine papers by members of the extended Toronto insulin team. Collip couldn’t make the trip from Edmonton, but he submitted a paper through the conference secretary.
During the conference’s final joint session, speakers paid tribute to the work of Banting, and to the whole Toronto group. “This insulin treatment has come practically out of a clear sky,” Dr. Frederick Allen told the crowd. “Dr. Banting is to be congratulated. Whatever may have been done before by other scientists, his work did not grow out of their work. It was purely and simply his discovery, and a discovery of this nature is a rare thing.” When Banting finally spoke, he didn’t dwell on his own discovery, but rather paid tribute to his collaborators, especially Macleod, who, he said, had played a “guiding” role.
At the close of the session, Banting received a three-minute ovation and later told reporters, “To listen to these papers this afternoon, papers telling of further work along lines on which I worked along till last year, has been the most gratifying and satisfying moment of my life. Next to that I appreciate most the gratitude of the patients we have treated. There have been cases of diabetic coma where recovery has been sufficient to enable those suffering to recommence living useful lives.”
The U of T conference took place exactly one year after Banting had hesitantly — and, in his mind, disastrously — presented an early paper on the pancreatic extract in New Haven, Conn. On that occasion, Macleod had had to step in to rescue Banting. There were no reporters at the New Haven meeting, and there would be no substantive press attention to pancreatic extract story for another three months. Much of what happened during the subsequent months ultimately brought Banting to a place of triumph at the end of the year. Much of this story was told in newspapers, albeit with varying degrees of accuracy, but much more was not told. Indeed, there was still much more to be revealed about the insulin story as the new year began.