“It Works! Now What?” Insulin Development, Production, and Distribution at Connaught Laboratories, University of Toronto, 1922–24

Abstract

The first successful human use of a pancreatic extract on Leonard Thompson, a 13-year-old severe diabetic at Toronto General Hospital, on 23 January 1922, is generally seen as the climax of the discovery-of-insulin story. However, this seminal event in the history of medicine begs the question: “It works! Now what?” The story may well have ended abruptly if not for the foresight and leadership of Dr. John G. FitzGerald, director of the University of Toronto’s Connaught Antitoxin Laboratories, based in the basement of the same Medical Building where F.G. Banting and C.H. Best, under the direction of J.J.R. Macleod, conducted the research that led to the first tests on Thompson. Significantly, it was the addition to the team of biochemist J.B. Collip and his purification of the extract that enabled the successful 23 January test. Within a day, however, tensions within the group, especially between Banting and Collip, and Collip’s threat to leave and take out his own patent, prompted FitzGerald to act. On 25 January, FitzGerald finalized a seminal agreement between Connaught and Banting, Best, Collip, and Macleod that secured the further development of methods to prepare the extract on a larger scale to enable further clinical testing. From this point, Connaught would play a fundamental role in the insulin story, although its historical significance has been minimized and often misunderstood, overshadowed by the weight of the primary discovery, as well as by the critical contributions of Eli Lilly and Co. This article focuses on Connaught’s intimate involvement in the history of insulin from January 1922 through the summer of 1924, tracing the challenges and innovations of developing larger-scale production methods, the establishment and expansion of Canadian insulin production capacity, and the key role the labs played in spearheading the global distribution of insulin.