[acb-diabetics] Miracle on Boloor Street

[armando del gobbo]

Miracle On Bloor Street: January 8th, Toronto Star

The Toronto Star
(2012-01-08)
Opinion
Miracle on Bloor Street; Ninety years ago, Toronto doctors gave the first 
insulin injection to an emaciated 14-year-old boy and delivered millions 
from
the death sentence of diabetes

Graphic: An insulin kit from the 1920s. The Hughes family in 1916, with 
Elizabeth on her father's knee. Charles Evans Hughes served as a governor, 
secretary
of state, associate justice and chief justice of the Supreme Court.

Ninety years ago this week, one of the greatest miracles in medical history 
took place. Leonard Thompson, a 14-year-old boy lying on his deathbed at 
Toronto
General Hospital, was snatched from the jaws of death with the injection of 
a brand new experimental drug.

For three years, young Leonard had starved his body in order to prolong his 
life. He was following one of the prescribed regimens for the incurable 
disease
that had, throughout history, stolen from children the opportunity to reach 
adulthood. Leonard's disease was juvenile diabetes, now commonly known as 
type
1 diabetes.

On Jan. 11, 1922, Leonard became the first human being to receive an 
experimental extract called insulin. The first injection was unsuccessful; 
an abscess
developed and additional treatment was withheld for several weeks while 
doctors struggled to refine the extract. The revised formula worked.

In those early months of 1922, only a small group of children received the 
new drug. Production issues meant the insulin was still extremely scarce. 
News
articles discussing the discovery received some attention over the next 
seven months, but it took the headline-grabbing story of a 15-year-old girl 
to
awaken the world to the miracle of insulin.

On Aug. 15, 1922, a train pulled into Union Station in Toronto, carrying an 
emaciated girl - she was five feet tall and weighed 45 pounds. Over the next
48 hours, the entire world would learn that Elizabeth Hughes, the youngest 
daughter of America's most famous politician, Charles Evans Hughes, was 
being
treated with a miraculous new drug that had the potential to end her heroic 
struggle with juvenile diabetes.

Like Leonard, Elizabeth had been diagnosed in 1919 with what was then a 
death sentence: juvenile diabetes mellitus. At the time, the average life 
span for
people with type 1 diabetes was 11 months. Defined as the body's inability 
to metabolize food, researchers speculated that a pancreatic secretion was 
key
to treating the disease, but until a group of University of Toronto Medical 
School researchers isolated that secretion, no one had been able to 
translate
theory into practice.

Elizabeth met with Dr. Frederick Banting, one of the four discoverers of 
insulin, at his Bloor Street office in downtown Toronto, a neighbourhood on 
the
edge of respectable, buzzing with the new sounds of privately owned 
automobiles, and surrounded by slums. Banting fit right in: he wore a 
wrinkled suit
- the only one he owned - and needed a haircut. "No one ever had an idea in 
a dress suit," Banting used to say.

Elizabeth was a child of privilege, born in the New York governor's mansion. 
She had lost the opportunity to live in the White House when Hughes declined
to run for president on the 1920 Republican ticket. His eldest daughter, 
Helen, had just died of pneumonia, and he believed he needed to prepare for 
Elizabeth's
imminent death. To this day her father remains the only man in American 
history to have served as a governor, secretary of state, associate justice 
and
chief justice of the Supreme Court.

Banting noted in Elizabeth's chart: "Extremely emaciated, slight edema of 
ankles, skin dry and scaly, hair brittle and thin, abdomen prominent, 
shoulders
drooped, muscles extremely wasted . . . She was scarcely able to walk on 
account of weakness."

In the years prior, Elizabeth's parents had chosen the most radical of 
treatments to prolong her survival - the Allen Starvation Diet. It called 
for a drastic
reduction in caloric intake, particularly from carbohydrates. This 
restriction allowed patients to manage their blood glucose levels, but they 
also risked
starving themselves to death.

For Elizabeth, the Allen Diet became her religion: she counted calories, 
weighed food, and kept meticulous records of her dietary intake. While most 
girls
her age averaged 2,200-2,400 calories daily, Elizabeth sometimes consumed as 
little as 400.

Despite her condition, Elizabeth's formidable spirit remained intact. "I 
spend most of my time lately from 11:00 to 6:30 out in my hammock, knitting, 
writing
and reading," she wrote her mother on May 16, 1922. "In that lazy way the 
days seem to literally fly by though and I certainly am getting stronger 
daily,
I feel it, so cheer up!!" She wasn't getting stronger.

Sitting in Banting's office, Elizabeth was putting her faith in another 
radical treatment. Banting understood the enormity of her risk. He had 
abandoned
his own newly established medical practice and fiancée three years earlier 
to research the drug. He filled a 3/8-inch, 25-gauge hypodermic needle and 
plunged
it into Elizabeth's hip.

Insulin had been the missing link in diabetes treatment. By isolating this 
pancreatic secretion in healthy animals, Banting and a team of researchers 
had
figured out how to literally bottle the very extract that people with 
diabetes cannot produce on their own.

At the time of Elizabeth's first injection, insulin supply was low, and any 
manufactured batches were either unusable or unpredictable. Banting was 
thrust
into the unenviable position of deciding who would receive insulin - and who 
would not. He wrote of the almost mythical perception of the drug: 
"Diabetics
swarm around from all over and think that we can conjure the extract from 
the ground." Consequently, he was forced to turn away hundreds who arrived 
at
his clinic and hundreds more who wrote him. Elizabeth's position as Charles 
Evans Hughes' daughter afforded her the luck to be one of the chosen. And 
her
body responded well to her good fortune.

Despite its experimental nature, Elizabeth's reaction to insulin was 
remarkable. She did not experience any of the severe side effects seen in 
other early
patients, such as hypoglycemic shock. Every day she added foods to her diet 
that she hadn't tasted in years - white bread, bananas, corn, plums. She 
grew
taller and gained two pounds a week.

"I can't express my gratitude for the chance I am having in being up here to 
take advantage of this wonderful discovery," Elizabeth wrote in a letter on
Sept. 24, 1922. "We have several poor people come here to ask about the 
treatment and they were eventually all turned away," she later wrote. "[It] 
makes
you feel so sorry and yet you can't do a thing about it."

Elizabeth was reminded of her privileged position whenever she opened a 
newspaper. She became, too, the unwilling poster child for insulin, with 
headlines
proclaiming: "New Treatment Aids Miss Hughes"; "Little Daughter of Hughes 
Seemingly Cured of Diabetes"; "Science's New Cure Leads Hughes's Child to 
Health."

For Banting, the attention bestowed on Elizabeth was validation that his 
discovery worked. He was not a distinguished endocrinologist. He was an 
ex-WWI
medic more comfortable amputating limbs on the battlefield than conducting 
formal research. Yet within a year he had proven his skeptics wrong.

Insulin saved lives. But it was not a cure, as many touted. Many who 
received insulin stopped regulating their diets, and others did not take the 
drug as
scheduled, suffering fatal consequences. Elizabeth had swollen, painful 
lumps on her hips from repeated injections and she continued to take great 
care
with her diet - facts the public was not privy to. They read only of her 
miraculous recovery.

In December 1922, Elizabeth returned home to Washington D.C. Besides the 
daily insulin injections that she administered to herself, her life regained 
a
sense of normalcy. She attended school, played sports, and summered in 
Europe. And as the press coverage faded into distant memory, she hid her 
condition
from anyone outside her close family circle. She destroyed all pictures of 
herself while in the ravages of the starvation diet. Even her father's 
biographer
wasn't permitted to write of Elizabeth's condition.

After Elizabeth left Toronto, Banting's prominence grew. For his discovery 
of insulin, he was the co-recipient - with Dr. J.J.R. Macleod - of the 1923 
Nobel
Prize in Medicine; an award they shared with the two other discoverers, 
Charles Best and Bertram Collip. Banting was knighted by the King in 1934 
and given
a lifetime annuity by the Canadian government. In the annals of medical 
history, his discovery had - according to the New York Times in May 1923 - 
put
the "feather in the cap of science."

Elizabeth chose to follow her moment of fame with a lifetime of silence. She 
married, had three children, took two insulin injections a day, and 
successfully
hid her disease. When she died in 1981 at the age of 73, no obituaries noted 
her illness or her being, for a snapshot in time, the most famous girl in
America.

Insulin cost $1,400 to discover at the University of Toronto Medical School 
in 1922 and through the extraordinary efforts of the Eli Lilly and Company,
became available to people around the world just two years later. Insulin is 
today the most widely prescribed drug in medical science. The world now has,
according to the International Diabetes Federation, 366 million diabetics - 
and the IDF announced in November that this number will swell to 552 million
by 2030. The "Miracle Drug," once only granted to a select few, will 
continue to transform millions of lives.

Arthur Ainsberg is the co-author, with Thea Cooper, of Breakthrough: 
Banting, Best, and the Race to Save Millions of Diabetics.

Arthur Ainsberg
-

Every job is a self-portrait of the person who did it.
Autograph your work with excellence.
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