The evidence of insulin’s power mounted and mounted. Doctors with impeccable credentials – Allen, Joslin, Geyelin, and others – endorsed it as one of the greatest discoveries of the century, the biggest thing of the age, the beginning of a new epoch in medicine. Reporters read the clinical papers and translated them for the layman: “Tested and retested, fairy tale of science… the seal of scientific approval on the work of the Toronto doctors.” As part of Toronto’s planned educational campaign, detailed articles were written in popular language by medical specialists. One of the most widely circulated of these, by a leading official of the American Medical Association, concluded that the clinical data on insulin
reads almost like the glowing accounts of the vendors of Snake Oil and Ready Relief, who used to shout their wares under the flaming torch at the village corner, but in this instance it is the report of the conservative, altruistic scientists who have nothing to sell and who have devoted their lives and their discoveries to the service of mankind. It is true.8
The discoverers themselves reported only to other doctors and tried to avoid the press. They continued to be upset by what Macleod called “the uncontrollable notoriety that the whole thing has had.” The high hopes raised by the publicity had put them all under tremendous pressure. Other doctors shared that view, especially during the period when their diabetic patients knew about insulin and its effects, but there was none available. (One of the first doctors to use insulin in Scotland remembered to me how his diabetic patients would hold up newspaper clippings, saying “They’ve got it in Canada; why can’t we get it here?”) The Toronto group were almost always cautious in their public statements. Interviewed in 1923 after he had given a popular lecture on alpine peaks in medicine, Macleod admitted to a reporter that perhaps insulin might be a high hill.9
II
There were still a few non-believers. The most vocal were the anti-vivisectionists, people morally outraged at the thought of humans inflicting pain on animals to further medical research. Insulin had come directly out of animal research, and seemed to tell heavily against the surprisingly effective anti-vivisectionist crusade (in Britain, for example, a doctor as inexperienced as Banting would probably not have qualified for the licence necessary to do animal research). But of course insulin wasn’t a cure, the self-proclaimed humanitarians pointed out. Not a single diabetic had recovered. All insulin was, was a lot of unproven claims, most of which had been heard before. “Why claim this age-old American-Indian superstition of giving the organs of animals for the cure of corresponding organs in human subjects as a ‘recent discovery’?” asked Dr. Walter Hadwen, one of North America’s leading anti-vivisectionists.10
And if the mistreatment of dogs in the insulin research wasn’t bad enough, look at what the drug was doing to humans. There were those poor veterans in Christie Street Hospital being literally driven up the walls by over-dosing. The anti-vivisectionists managed to get the Parkdale Branch of the Great War Veterans Association to issue a sarcastic public protest at such mistreatment:
To us, it seems only in accordance with the prevalent grateful treatment of men whose frames have been appallingly racked on the battlefield, that they should be administered extracts that throw them into convulsions or cause them to climb the walls of the experimental chamber of torture.11
The veteran in question – who had had the severe hypoglycemic reaction described in the clinical paper – responded by telling reporters that he would be willing to climb the walls of the Canadian Pacific Railway building to get the benefits he received from insulin. President Falconer of the university dismissed the anti-vivisectionists, surely some of history’s most misguided idealists, with the comment, “Why, these people simply don’t understand what the word humanity means.”12
III
So there had been a very big discovery in Toronto, another milestone in the march of modern medicine. Wonderful. But who had made it? Who discovered insulin? Who should get the laurels, honour, applause, tribute, immortality, thanks, etcetera, that grateful laymen, diabetics, doctors, and countrymen, were ready to bestow? This was a subject that the press would have something to say about through the way that the story was covered; but it was also being discussed in many other circles, most particularly in the innermost circle, the discovery group at Toronto.
Fred Banting and Charley Best had not even been present at the announcement of the discovery of insulin in Washington on May 3, 1922. They seemed to have disappeared into the background: Best the student assistant, Banting the untrained country doctor, both replaced by the real scientists, Collip and Macleod, and the expert clinicians, Campbell and Graham. By the end of the summer of 1922, however, the situation had reversed itself. Collip had left Toronto, and Best was working his way through medical school as director of Canada’s insulin production. Macleod, too, had been away from Toronto during the crucial summer months, leaving Banting as the man on the spot whom everyone turned to during the dramatic struggle to produce good insulin and save patients’ lives. To some extent Banting’s revival would have happened anyway. Once the others had agreed to give him primacy in the clinical development of insulin, he was bound to have considerable prominence during the period when clinical developments outshone the experimental physiology handled by Macleod.
The change in Banting’s fortunes during the summer of 1922 was nearly total. Previously he had had no connections in the scientific world outside of Toronto. Now he got to know Clowes, Allen, and Geyelin, all of whom would support him in the complex struggle for credit that lay ahead.* So would Joslin. After the May Association of American Physicians’ meeting Joslin had written enthusiastically about the achievements of Macleod “and his co-workers.” In July, however, Clowes told Joslin of the situation as he understood it, and Banting gave him offprints of his and Best’s early articles. Joslin thereafter wrote and talked about the work of Banting and Best.13
Most important, Banting regained his self-confidence. So Dr. Banting wasn’t qualified to treat diabetics, as Duncan Graham had said so many times? Well, now, let’s just step across to the Athelma apartments and see if Miss Hughes is in. Or perhaps take a look at Charlotte Clarke, the amputee, or go over to Rochester and see how Jim Havens is doing. How many diabetics were J.J.R. Macleod and J.B. Collip treating? Why were Campbell and Graham so infernally slow at organizing their own clinic?
It would not have taken anything very significant to have set off Banting that fall. After all the humiliations of the past winter and spring, Banting would have welcomed a chance to show the little son-of-a-bitch, Macleod, who had or had not done the really important things. As it happened, the casus belli was particularly offensive. On September 6, the Toronto Star, in a story on the attention insulin was getting abroad, quoted a letter Professor Sir William Bayliss of University College, London, had just published in The Times. Bayliss, co-discoverer of secretin and author of a noted text, was one of Britain’s leading physiologists and a friend of Macleod. He complained in his letter that Macleod was getting inadequate credit for the discovery, stated flatly that Macleod had devised the duct-ligation method of producing pancreatic extracts, dismissed Banting as one of the collaborators who had possibly helped in the clinical application, and concluded, “the discovery is the result of the painstaking and lengthy investigations of Prof. Macleod, which have extended over many years, and it is to him that the chief credit should be given.”
Best was the first person to go to Macleod about the article. Having reason to be upset at having been neglected himself, he asked Macleod if he thought Bayliss had been fair to Banting. Macleod had had nothing to do with Bayliss’ letter – Bayliss had stupidly written it without any real knowledge of the situation because he had been upset by a dispatch from Canada attributing the whole discovery to Banting14 – and told Best he was not going to get into a newspaper controversy by doing anything to refute it. Probably trying to explain to Best that any scientist had to learn to live with misstatements in the papers, Macle
od said, “Banting will have to get used to it.”
To Banting, hearing the conversation at second hand, Macleod seemed to have been saying that Banting had better get used to all the credit for the discovery going to Macleod. Not many hours later Banting was in Macleod’s office with Greenaway of the Star, asking for a correction of Bayliss’ statements. According to Banting’s account of the meeting, Macleod again said he had nothing to say. Banting asked Greenaway to leave the room. He told Macleod that if Macleod himself did not refute the statement there were others who would. Clark Noble came in on the pair in the middle of the discussion: years later he recalled seeing Banting, sitting in a chair opposite Macleod, with his feet on Macleod’s desk, demanding an immediate denial of the report and accusing Macleod of having engineered the situation to his own advantage. Macleod finally wrote out a statement for Greenaway.15
It was published under the heading “Gives Dr. Banting Credit for Insulin.” The article began:
The credit for complete discovery of the Insulin extract for the treatment of diabetes was given to-day to Dr. F.G. Banting by Prof. J.J.R. Macleod….This is an important statement. It once and for all authoritatively refutes the imputations in the London Times and some American papers that it was improbable that so young and comparatively inexperienced a laboratory man as Dr. Banting himself could have made this epoch-making discovery in the history of medicine.
Neither the Star reporter nor the Star’s readers understood how carefully Macleod had phrased his statement. It actually read:
With regard to the letter which recently appeared in the Times it should be pointed out that Sir Wm. Bayliss is in error in stating that the idea of preparing Insulin from pancreas sometime after ligaturing the ducts originated with me. As a matter of fact, this is particularly the part of the work that originated with Dr. Banting, who in collaboration with Mr. Best, put it to experimental test in the laboratory of Prof. Macleod. As a result of the successful demonstration of the effects on diabetic animals of extracts from this source, the problem of the physiological action of Insulin was then taken up by the physiological department of the University by a group of workers, including Dr. Banting and Mr. Best and under the direction of Prof. Macleod….16
All Macleod was doing was giving Banting credit for the duct-ligation experiment.
The Star’s headline and introduction did not satisfy Macleod. Macleod’s statement did not satisfy Banting or Best. There were more meetings. Banting insisted on Macleod giving him, in Macleod’s words, “full credit for the discovery of Insulin as it is now used in the treatment of Diabetes.” Macleod refused, and apparently made clear his belief that the Star’s treatment of his statement had been misleading.17
Best was just beginning to realize the danger of his contribution being lost sight of in the conflict between Banting and Macleod. Macleod admitted that he had not given Best due credit in his statement, and Banting issued an additional statement clarifying his “assistant’s” role:
While the idea, it is true, is mine, Mr. Best must have equal credit for the success we have attained. I never would have been able to do anything had it not been for him. We have worked side by side, sharing ideas and developing them together, and but for his unflagging devotion and enthusiasm and his patient and meticulous work we would never have made the progress we have.
From the very beginning it has been a case of Banting and Best, and if our hopes are realized I desire to see Mr. Best given all the honour that would be his due.18
No detailed accounts of the September quarrelling have been found. Macleod’s letters, with their passing references to “this fresh outbreak of Banting’s”… “an extremely uncomfortable position here”… “unbelievable trouble”, show clearly enough how unpleasant the situation had become. The modus vivendi worked out that spring had broken down entirely. All the old suspicions and misunderstandings had come back to the surface. The discovery of insulin was sitting there on the table to be fought over.19
Macleod found the tension almost unbearable. It disrupted his research and impinged on all sorts of matters. He was being put forward for Fellowship in the Royal Society of London that year, for example. To a suggestion that he submit his paper on insulin in fish for publication by the Royal Society, he replied:
Banting has also criticized my placement of papers for publication, stating that his work should appear in an English journal. I have defended my policy on the ground that immediate publication was desirable. In view of all this I believe that it would only serve to fan the fires still more – and they are almost unbearably hot at present – if I were to publish my recent researches in the Transactions of the Royal Society, dearly though I should love to do so. I find that Banting has succeeded so well in sowing the seeds of distrust in me that it will be necessary for me not to take any step that could possibly be misinterpreted. If I sent this to the Royal Society he would immediately say – “I told you so, Macleod all along was endeavouring to minimize the importance of my work by its publication in ordinary journals whilst he placed his work in the most conspicuous ones he could think of”, and if I should be elected to the Society after this article appeared he would claim that I sailed in under false colours.20
Colonel Albert Gooderham, the prominent member of the Board of Governors and patron of the Connaught Laboratories who was also chairman of the Insulin Committee, decided to intervene. Upset at the squabbling, Gooderham determined to settle the matter of credit once and for all. He asked Banting, Best, and Macleod each to prepare a typewritten statement of their understanding of the discovery of insulin. Each was asked to outline Collip’s contribution (Gooderham did not bother to write Collip in far-off Alberta and ask for his views). Gooderham planned to compare the statements and then meet with the trio to harmonize them. He hoped it would be possible to clear up all misunderstandings and prepare one agreed-upon history of the work.21
In the third week of September 1922, Banting, Best, and Macleod sat down and wrote their accounts of the discovery of insulin. Almost sixty years later, these were invaluable sources in the writing of this book. At the time, they settled nothing. When he received them, Gooderham must have realized the impossibility of ever reconciling the conflicting claims of the three men. The same events were being described, that was clear enough, but by different personalities, with different perspectives, different emphases, and, in some cases, different memories of events.
Macleod, who wrote the longest account, was quite certain that he had always given Banting and Best appropriate support, encouragement, and advice. If he had been critical of Banting’s early proposals, it was because Banting had come to him with such superficial knowledge. If he had criticized the early results and demanded better ones, it was to strengthen the credibility of the work. He at first resisted clinical testing because there was altogether too much premature clinical work in medicine. He jumped into the New Haven discussion to protect the reputation of his lab. And so on. At every step, Macleod felt he had given Banting and Best proper assistance, valuable suggestions, and adequate support. To make crystal-clear his belief that the young men should get full credit for their experiments, he had explicitly declined Banting and Best’s offer to add his name to their first paper, published in the February 1922 Journal of Laboratory and Clinical Medicine. If anything, he had bent over backward not to claim as much as other research directors might have:
In many, if not most, laboratories it is the custom for the “chief” to have his name on the papers when the investigation is in a subject related to that in which he is engaged and if he stands responsible for the conclusions and has participated to the extent that I did in the planning of the research. By this step I made it perfectly evident that I considered the full credit for this investigation to be Banting and Best’s. This is surely what counts in questions of priority.
Macleod was concerned that Collip be given full credit for the purification of the extract: “it is unfair and unjust for Banting and Best to rob hi
m of any of the credit by saying that they told him of the percentages of alcohol at which the active principle was soluble. Collip denies that they gave him any information that was of use in this connection and they never communicated any such to me.”* Generally, Macleod stressed the large amount of research – the investigation of rabbits, of glycogen formation, of acetone excretion, of respiratory quotients – that had been done by members of a team working under his direction.
Macleod’s position has not been understood or appreciated. All of the stories of an evil Macleod conspiring to steal credit are silly. The notion of an innocent physiology professor who never tried to claim any credit is also untrue. Macleod was proud of his achievement and wanted credit for it. He also wanted to make sure that other members of the team, notably Collip, were not deprived of due credit, and that the collaborative nature of this, like most scientific investigation, be properly understood. J.J.R. Macleod believed that the discovery of insulin as used in the treatment of diabetes, “has depended on the conjoint efforts of several investigators working under my direction, of which Dr. Banting was one.” He saw the insulin work as a whole package, one that Banting and Best had put on the table perhaps, but that he had, with help, wrapped up, tied up, and given to the world. “Through concentrated effort, for the co-ordination of which I have been responsible, we have given to Science in little more than one year a practically completed piece of research work.” That was no mean feat, Macleod realized.
The Discovery of Insulin Page 27
