Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle
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Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle
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Overview
It is 1919 and Elizabeth Hughes, the eleven-year-old daughter of America's most-distinguished jurist and politician, Charles Evans Hughes, has been diagnosed with juvenile diabetes. It is essentially a death sentence. The only accepted form of treatment – starvation – whittles her down to forty-five pounds skin and bones. Miles away, Canadian researchers Frederick Banting and Charles Best manage to identify and purify insulin from animal pancreases – a miracle soon marred by scientific jealousy, intense business competition and fistfights. In a race against time and a ravaging disease, Elizabeth becomes one of the first diabetics to receive insulin injections – all while its discoverers and a little known pharmaceutical company struggle to make it available to the rest of the world.
Relive the heartwarming true story of the discovery of insulin as it's never been told before. Written with authentic detail and suspense, and featuring walk-ons by William Howard Taft, Woodrow Wilson, and Eli Lilly himself, among many others.
Product Details
| ISBN-13: | 9781429965699 |
|---|---|
| Publisher: | St. Martin's Publishing Group |
| Publication date: | 09/14/2010 |
| Sold by: | Macmillan |
| Format: | eBook |
| Pages: | 320 |
| Sales rank: | 606,683 |
| File size: | 435 KB |
About the Author
THEA COOPER is an author, playwright, editor and teacher. ARTHUR AINSBERG is an author and financial industry veteran whose successful battle with Hodgkin's disease sparked his interest in medical history.
Thea Cooper is an author, playwright, editor and teacher. She is the co-author of Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle.
Arthur Ainsberg is an author and financial industry veteran whose successful battle with Hodgkin's disease sparked his interest in medical history.
Read an Excerpt
Breakthrough
Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle
By Thea Cooper, Arthur Ainsberg
St. Martin's Press
Copyright © 2010 Thea Cooper and Arthur AinsbergAll rights reserved.
ISBN: 978-1-4299-6569-9
CHAPTER 1
Christ Church Cranbrook, Bloomfield Hills, Michigan, 1981
On Tuesday, April 28, 1981, mourners began to converge on the wet streets around Christ Church Cranbrook in Bloomfield Hills, Michigan. Emerging from their late model cars, they tucked under umbrellas and made their way through the raw spring air toward the carillon bells ringing from the tower. Inside the sanctuary, organ music soared from the south wall of the nave, drawing the eye upward to the intricately carved wood, stone, and brilliant stained glass. As the mourners were ushered into pews, they nodded solemnly to one another; most everyone knew each other. They were gathered to acknowledge the passing of and pay tribute to the remarkable life of a seventy-four-year-old woman who had died three days before. Her name was Elizabeth Hughes Gossett.
Although most of the mourners would likely claim to have known Elizabeth well, only a few people in the church knew just how remarkable her life really was. Dr. Lowell Eklund, dean of continuing education at Oakland University in Rochester, Michigan, rose to the pulpit to deliver the eulogy. He mentioned Elizabeth's "intellect, wisdom, quiet yet irresistible leadership." He mentioned her distinguished service as a trustee of her alma mater, Barnard College, in New York City. He said that she, like her father, America's most famous lawyer, jurist, and politician, had been a lifelong advocate of self-directed scholarship and perpetual inquiry. It was this spirit, he said, that had led her to play an important role in the founding of Oakland University in 1957.
Did Eklund know that the circumstances of her early life had forced her to pursue her education as a self-directed and largely solitary endeavor? If he knew, he didn't say.
As heiress to the legacy of a great American statesman, she carried forth her father's ideals with "modesty, dignity and grace," he said. Dr. Eklund described her as "a champion of civil rights in speech, in document and in action." He went on to say that she had cofounded, with her friend Chief Justice Warren Burger, the Supreme Court Historical Society in 1974. But did Eklund know why this daughter was especially compelled to protect her father's legacy, of how the great man had risked everything for her sake?
Sitting in the front pew with his smooth, clean hands folded in his lap was William T. Gossett, to whom Elizabeth had been married for fifty years, a former member of the church vestry. Around him were seated their three children, Antoinette, William, and Elizabeth, and next to them were their spouses, Basil, Mary, and Fred, respectively. Also seated in front were the eight grandchildren, the eldest of whom was David Wemyss Denning, son of Antoinette and Basil. In 1981 he was a twenty-four-year-old medical student. Dappled light, steeped in the rich jewel tones of the towering east window, played over the heads of the family like the lightest touch from an invisible hand.
David knew that Eklund would not mention what to his mind was one of the most important and remarkable facts of his grandmother's life. This fact had also been omitted from his grandmother's obituaries in The New York Times, The Washington Post, The Los Angeles Times, and the leading Michigan papers. In 1922, Elizabeth Hughes was among the first children to receive an experimental pancreatic extract called insulin. By the time of her death, she had received some 42,000 insulin injections over fifty-eight years, probably more than anyone on earth at that time. And yet, through Elizabeth Gossett's own steadfast efforts only a few people knew this, and those few were sworn to secrecy.
How ironic to hear Eklund describe Elizabeth as a lover of history; it was a perfect alibi for someone who had made a lifework of obfuscating her own history. This effort had been so successful that Dr. Eklund had no knowledge of the brave, bright spirit whose childhood had been tempered in the crucible of death's daily and intimate companionship.
The last will and testament of Elizabeth Hughes Gossett arranged for the disposition of her jewelry, personal effects, and works of art. After the will was executed, there remained in her estate an odd collection of cryptic relics, like a muddle of jigsaw puzzle pieces from different puzzles:
• Thirty or so letters tied with a satin ribbon. The letters had been written by Elizabeth during 1921 and 1922, mostly to her mother ("Mumsey"), when Elizabeth was fourteen and fifteen years old. The letters had been written from New York State, Bermuda, and Toronto, marking points on her peripatetic attempt to evade the death that pursued her relentlessly.
• A small, hand-knitted sweater of fine, faded blue wool, which looked to be made for a child eight or nine years old.
• An old photograph of a modest house in Glens Falls, New York, showing a rocking chair on the front porch. On the back of the image were the words, Save one life and save the world, written in indigo ink in an elegant hand.
• A square of canvas removed from its frame, bearing a rough oil painting of a farmhouse rendered in pigments of burnt umber and cobalt.
• A small brown glass medicinal vial with an age-yellowed label on which the words had faded to illegibility.
These mute artifacts were all that remained of Elizabeth Hughes's life before her miraculous transformation into an entirely different girl. What follows is the improbable story of that Elizabeth — the Elizabeth that Elizabeth erased. This is the story of Elizabeth Hughes, who "vanished" in December of 1922 without a memorial service or a funeral, without anyone ever really even noticing.
CHAPTER 2Fifth Avenue, New York City, April 1919
Dr. Frederick M. Allen gazed around his meticulously tidy office at 5 East Fifty-first Street in Manhattan and prepared to make the trip, thirteen blocks uptown, to 32 East Sixty-fourth Street: the home of Gotham's distinguished citizen, Charles Evans Hughes. Allen was a brilliant medical investigator, the author of Glycosuria and Diabetes, the most extensive history of the search for a cure for diabetes. Known as "Dr. Diabetes," he had held research positions at both Harvard Medical School and the Rockefeller Institute. This notoriety was a mixed blessing, rather like being a very good and experienced executioner. If you must have one, you want a good one, but you hope to never need one.
Allen was self-conscious in the presence of men of great importance and wealth. He had no way of knowing that Hughes had come from a background even more humble than his own. Born in Iowa in 1879, Allen moved to California when he was eleven, where his father grew oranges. He attended the University of California as an undergraduate and continued through medical school, graduating just a year after the 1906 San Francisco earthquake. He then volunteered at an animal lab at Harvard, where he was eventually hired and earned a small stipend of $47.50 per month.
After three years and four hundred dogs at the Harvard animal lab he borrowed five thousand dollars from his father — fully one-fifth of his father's entire worth — to publish Glycosuria and Diabetes in 1913. At the time he had not published a single journal article, but he had a guileless faith that his book, written in painstaking longhand, would open the doors to a scientific career. Shortly after the book was published, the Rockefeller Institute of Medical Research offered him a position as chief physician of an investigative ward of its hospital at York Avenue and Sixty-sixth Street in Manhattan. Allen accepted the offer and relocated to New York.
In his new role, he succeeded in applying the knowledge gained at the Harvard animal lab to humans in a hospital setting. Unfortunately, he found that not only was working with human patients more frustrating than working with dogs, it also produced inferior results. Humans were unreliable subjects, difficult to control. They promised to comply with instructions and then failed to do so. They forgot. They cheated. They misunderstood. They succumbed to temptation with infuriating regularity. No amount of chiding seemed sufficient to persuade them of the importance of complete cooperation, and their repeated deviations and indiscretions jeopardized the integrity of his findings.
At Rockefeller Allen soon became known as an intensely dedicated worker. He was also impatient and thin-skinned. He did not mix well with his well-born colleagues and he was unpopular with the diabetic patients under his care. He was let go, and his position was turned over to another doctor, a political favorite whose background as a chemist, although vaunted, was not especially relevant to the work in which Allen had invested so much. It was a scalding professional rebuke.
By this time the United States had entered the Great War in Europe and Allen was sent to serve as an army doctor at General Hospital No. 9 in Lakewood, New Jersey. He published a second book, Total Dietary Regulation in the Treatment of Diabetes, which cited exhaustive case records of 76 of the 100 diabetes patients he had observed during his five years at Rockefeller. After his military discharge he struggled to launch a private practice in New York City. Only the most hopeless patients sought him out, and always as a last resort. He treated primarily children who were dying. One four-year-old boy, admitted to his care in the spring of 1917, had won a contest for being the most perfect baby a year or so before. As these patients survived weeks and occasionally months beyond their prognoses, more doctors referred their patients to him and he recovered from the humiliation of his Rockefeller years.
By the end of the first decade of the twentieth century, Dr. Frederick Allen and Dr. Elliott Joslin had become the two most widely recognized diabetologists in the nation. The small-boned and well-mannered Joslin had inherited significant wealth, attended Yale University, and graduated as valedictorian of his Harvard Medical School class. At Harvard, Allen and Joslin forged an unlikely friendship that would endure for decades. They contributed in different but complementary ways to the study of diabetes. Allen's expertise was in the alchemical combination of fasting, undernutrition, and exercise to stem the progression of diabetes. He was the first to see that it wasn't just carbohydrates that stressed the metabolism, but protein and fat as well. Therefore, the best approach was to find, for each patient, the minimum amount of food required to live. This proved to be a highly exacting calculus that varied from patient to patient and, for each patient, from day to day and from hour to hour. The expression "The cure is worse than the disease" may not have been coined for the Allen treatment, but it fit.
Joslin focused on improving the medical chronicle of diabetes. At the time, there was no standardized protocol for medical documentation. Joslin believed that improving the way patient data was recorded could improve the diagnostic process. He began a diabetic registry, the first such system for recording diabetic patient data outside of Europe. Throughout their careers Allen and Joslin regularly conferred with each other about patients. Both experimented with a new model of working with diabetic patients that involved educating them about diabetes and enlisting them as participants in their own treatment. This was a significant departure from the typical doctor-patient relationship at that time. Not all patients were open to such modernity and to assuming some responsibility for their own care.
On this day in April, Allen was to tell Charles and Antoinette Hughes that Elizabeth would not likely survive through the summer. Her only hope was to completely surrender to his extremely onerous therapy. While errands such as the one that occupied him on that April morning in 1919 were not unknown to Allen, clinical care could hardly be called his strong suit. Allen preferred the study of disease to the care of those unhappy individuals beset with it. He was a portly, balding, forty-year-old bachelor with thin lips and a gaze both exacting and remote; he looked like a man whose job it was to deliver bad news.
He was nervous. It was imperative that this meeting go well, which was no mean feat considering the meeting's purpose. He was building a private practice for the first time in his life. The admission of such a high profile patient as Elizabeth Hughes would be invaluable in establishing his new venture. The patient's father, Charles Evans Hughes, knew everyone. For someone as challenged in salesmanship as Allen was, the advocacy of such a highly regarded public figure would be a huge coup.
The doctor's scalp began to perspire where the smooth leather hatband fit against the thinning hair of his head. He stopped to pull a handkerchief from his jacket, his too-large hand fumbling in the narrow inside pocket. Although Allen had now established himself as a prolific author he had not written the slender, red book he was carrying, intended as a gift for the Hugheses. Starvation (Allen) Treatment of Diabetes, by Lewis Webb Hill, M.D., and Rena Eckman was a mere 134 pages and written in language that a lay practitioner or a patient could understand. It plainly stated the singular revelation, for which Dr. Allen was credited: Diabetes was a problem not just with carbohydrate metabolism, but with protein and fat as well. Instead of detailing case histories, it contained instructions for food measurement and preparation. It even contained dozens of recipes. It was this book that Allen gave to his new patients and their families. First published in August 1915, the book was now in its third printing. Unlike Allen himself, the book was a popular success.
When he reached Fifth Avenue, Allen turned right and set off at a plodding pace uptown. He came to the window of an opulent haber dashery. Behind the glass was an artful composition of fine wool, polished leather, sterling silver, and starched, white linen. But Allen did not see any of this. He was scrutinizing his own reflection in the glass. He studied his girth, the length of his arms proportionate to his torso, the exact slope of his shoulder, and, most of all, his facial features, which gave the impression of stern disapproval even when he felt none. He raised his eyebrows in an attempt to soften his features and create a more sympathetic appearance, but this only made him look alarmed. His brows settled back into place and his face resumed a look of grim resolve, but this time it was authentic. He sighed. It was bad enough contending with the complications of human patients, but to have to contend with the parents of the human patients was a whole new dimension. Still gazing into the glass, he imagined himself sitting in the home of Charles Evans Hughes, facing the great man. Then he rehearsed the words he would soon have to say in earnest.
Elizabeth is suffering from severe juvenile diabetes mellitus — the inability of the body to make use of glucose. The human body needs glucose to function, much like an automobile needs gasoline. In diabetics, the pancreas does not function correctly, and the body becomes unable to metabolize glucose. There is no way to restore the pancreas. There is no cure. I'm afraid Elizabeth will be dead within a year.
Allen's daydream was abruptly interrupted as he became aware of a salesman standing inside the window, watching him. The man smiled a lubricious smile and beckoned him in. Allen turned suddenly from the window, his cheeks flushed in embarrassment.
A brand new Cadillac brougham livery cab rolled past him to the corner, its backseat empty. He did not enjoy walking but he had made a commitment to take more exercise. It was, after all, a central element of his treatment. Although he often rationalized to himself that there was no reason that a nondiabetic such as himself should adopt the treatment prescribed for diabetics, he had come to appreciate that there was something unseemly about his corpulence given that his name had become synonymous with starvation. He didn't want Mr. and Mrs. Hughes to see him arrive in a car. He checked his pocket watch and plodded on, allowing the shiny black sedan to continue its journey.
(Continues...)
Excerpted from Breakthrough by Thea Cooper, Arthur Ainsberg. Copyright © 2010 Thea Cooper and Arthur Ainsberg. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Contents
Preface,Prologue,
1 Christ Church Cranbrook, Bloomfield Hills, Michigan, 1981,
2 Fifth Avenue, New York City, April 1919,
3 The Breakfast Room of the Home of Charles Evans Hughes, New York City, April 1919,
4 The Library of the Home of Charles Evans Hughes, New York City, April 1919,
5 New York City, April 1919, Later That Afternoon,
6 Toronto, Canada, and Cambrai, France, 1917–1918,
7 War, Peace, and Politics, 1914–1918,
8 Glens Falls, New York, April 1920,
9 The Idea of the Physiatric Institute, May 1920,
10 Banting's House in London, Ontario, October 30–31, 1920,
11 Toronto or Bust, October 1920 to April 1921,
12 Presidential Politics, 1916 and 1920,
13 The Physiatric Institute, Morristown, New Jersey, 1921,
14 The University of Toronto, Summer 1921,
15 Washington, D.C., and Bolton, New York, March to September 1921,
16 The Washington Conference, November 12, 1921, to February 6, 1922,
17 The Physiatric Institute, Morristown, New Jersey, November 1921,
18 The University of Toronto, September to December 1921 111,
19 The Crossroads of America, Indianapolis, Indiana, 1919–1921,
20 The American Physiological Society Meeting, New Haven, Connecticut, December 28–30, 1921,
21 Success and Failure, The University of Toronto, January 1922,
22 Failure and Success, The University of Toronto, February to April 1922,
23 Honeymoon Cottage, Hamilton, Bermuda, January to July 1922,
24 Patents, Partnership, and Pancreases, Indianapolis and Toronto, April to August 1922,
25 Fame and Famine, Summer 1922,
26 Four Trunks, Washington, D.C., August 1922,
27 Escape from Morristown, August 1922,
28 The Transformation Begins, Toronto, August to November 1922,
29 Crossing the Line Aboard the SS ITL[Pan America,]ITL August to September 1922,
30 Fate, Fortune, and Forgetting, September to December 1922,
31 The Nobel Prize and Beyond,
32 The Emergence of Elizabeth Gossett,
Postscript: Diabetes and Insulin Today,
Notes and Sources,
Endnotes,
Bibliography,
Acknowledgments,
Index,
Reading Group Guide
1. A few months after the initial batch of newspaper stories reporting her miraculous recovery, Elizabeth Hughes chose to disappear from the public eye and keep her diabetes and treatments a secret for the rest of her life, even from her own children until they were eighteen-years-old. Why do you think she made that decision? Does looking at the context of that era and her circumstances help explain it?
2. Elizabeth strives for "normalcy." How do you define normalcy? Is there such a thing?
3. When Charles Evans Hughes ponders whether he should call President Harding on Elizabeth's behalf, he wonders "[w]as his responsibility to the principles he had sworn to abide by greater than his responsibility to his daughter? One was broad, the other deep. Which was the greater good?" (186) What is your opinion?
4. When Banting attempts to secure research funding and a lab, he is rebuffed because his theories have been tested and failed before. His response is, "I'm not trying to be original. I'm trying to find something that works!" (67) What lessons can we learn from his ultimate success?
5. Discuss the nature of the rivalry between Banting and Macleod. Are such professional rivalries ultimately productive or counterproductive?
6. Consider these reflections about Charles Evans Hughes: "Living is by necessity a process of continuous loss. As we live we lose time, we lose innocence, we lose family and friends, we lose memories and the longer we live the more we lose. Ultimately, we lose the process of losing itself, which is what living is to begin with." (212) Do you agree? How are we defined by our losses?
7. Banting once told an audience, "We do not know whence ideas come, but the importance of the idea in medical research cannot be overestimated. From the nature of things ideas do not come from prosperity, affluence and contentment, but rather from the blackness of despair, not in the bright light of day, ...but rather in the quiet, undisturbed hours of midnight...when one can be alone to think...." (229) Do you agree with Banting's view of the nature of ideas? If so, what does this mean for modern scientific breakthroughs?
8. Frederick Allen, like Banting, appeared to place financial compensation second to the goal of patient treatment. For example, when writing the budget for the Physiatric Institute, Allen did not include a personal salary in the budget. The New York Times reported that "patients in all degrees of financial circumstances" could find help at the Institute. Yet Allen often felt conflicted with his job as a doctor caring for patients, and raising the funds to keep the Institute open. It says in the book that "he resented the need to split his time and energy between what he considered to be his real work and that greedy ancillary endeavor which was the work of supporting the work." (109) Are these roles necessarily at odds with one another? Do you think this conflict remains in modern medicine?
9. Throughout the book, Antoinette and Charles Evans Hughes are portrayed as sympathetic parents who dearly love their daughter. Yet, after bringing her to Toronto to be treated by Dr. Banting—with what was then an experimental treatment that could save her life or hasten her death—Charles and Antoinette sail for Brazil. It is with Dr. Banting and her nurse, Blanche, that Elizabeth spends the most crucial and precarious time of her young life. Were you surprised that her parents would leave her in Toronto? What does this say about the familial relationships of the time period, and how might that relationship have affected Elizabeth's perception of her disease? Why do you think she didn't stay in contact with Blanche or Dr. Banting after she recovered her health?
10. Ultimately the intervention of Eli Lilly enables the mass production of insulin in the book. Considered a radical idea at the time, Lilly believed the future of pharmaceutical manufacturing lay in fundamental biological research, saying "Ideas don't cure people. Drugs cure people . . . That's why we must bring the research scientists and the drug manufacturers together." Do you think this statement still holds true today? Would greater cooperation mean further advancements?
11. We get an extensive overview of the world in BREAKTHROUGH, including the political and social circumstances, and the myriad of conditions that led to, and at times hindered, the scientific advancement. What are some of the events that inadvertently affected this medical breakthrough? How precarious was the discovery? At what point can it be said that fate intervened?
12. How did reading this book affect, if at all, your view of what it's like to live with a chronic condition? Did it change your view of the research or pharmaceutical production side of the equation?
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