Toronto, Canada (Spring 2015)
|Walter Ruggles Campbell|
When the teenager Leonard Thompson was admitted to the Toronto General in 1922 he was struggling with diabetes. His doctor had referred him to a wartime friend, a local expert in diabetes. The young expert, Walter Ruggles Campbell, became the first doctor to administer insulin to a patient.
The genesis and aftermath of this landmark event have been meticulously described. As the time approached for insulin to be used clinically, Campbell was in a difficult position. His physician-in-chief, Duncan Graham, had absolutely no confidence in the clinical skills of the impulsive co-discoverer of insulin, Frederick Banting.1
When Graham, something of a martinet, was appointed to the Toronto General Hospital in 1919, he undertook a vigorous reorganization of the Department of Medicine. An endowment of $25,000 from a wealthy Canadian family allowed him to hire Campbell as full-time member of the staff. Graham’s policy then was to steer public patients to the clinicians whose interest matched their diagnoses.2, 3
Campbell and his colleague Almon Fletcher were both assigned to a ward where diabetics were admitted. As treatment they used a modified Allen starvation diet. With no dietitian but especially gifted in mathematics, the head nurse Rosabel Coutts developed a formula that allowed her to work out appropriate diets in her head.4
Over the next two years, Campbell absorbed experience in treating diabetic patients. By January 1922, when insulin was ready for a trial, Graham had positioned Campbell and his colleague Fletcher where they would be in charge of insulin administration.
Campbell was born on a farm in Ontario in 1891. His grandfather came to Canada to work on the Welland Canal as a carpenter, then took up farming. The farm stayed in the family but Campbell’s father Bruce struggled to maintain it under the tight economic conditions in Ontario in the late nineteenth century. When asthma made him unable to continue, he took his family to California and joined two older brothers in the building business. In 1906 he died unexpectedly, which led Campbell’s mother to return to Ontario to enable him to attend medical school in Toronto.5, 6
When Campbell completed high school, he was too young to start medical school and entered a biochemistry and physiology course, graduating in 1911. He was then appointed to the junior staff in a biochemistry department that was just beginning. Here he met and worked alongside James Collip, who later shared Macleod’s Nobel Prize.
He eventually entered medical school and graduated in 1915. Shortly after, with the help of a senior clinician, he started a diabetic clinic at the Toronto General Hospital that may have been the first in Canada. He was said to have established a chemistry laboratory at the hospital and worked as demonstrator in chemical pathology.2
In 1917, he enlisted in wartime service and by 1918 was overseas, where his path took him to the No. 4 Canadian General Hospital at Basingstoke, England, to treat nephritic casualties.
When insulin was ready to be tried, young Thomson was chosen. He had been a diabetic for about a year. Campbell had gained the consent of the father to try the new pancreatic extract. When Banting brought over the brownish grey liquid, 7.5 ml of McLeod’s serum (which is what it was called in the orders) was injected into each buttock.1, 6
As often in hospital care, the “hands on” work fell to someone lower in the hierarchy and it was the senior intern, Jeffrey, who actually gave the injection. The seminal paper was published in March 1922, leading to a steady stream of diabetes experts like Joslin from Boston, Wilder from the Mayo Clinic, and Woodyat from Chicago to visit Toronto.4,8
By the summer of 1922 the Toronto group, with enough purified insulin on hand, had studied its effects on many diabetic patients. The two young clinicians had sweated out the new hormone’s side effects. In particular, they wrestled with hypoglycemia, predicted by Collip from his work with rabbits. Nobody really knew how tight sugar control should be as patients gained miraculous relief from their symptoms while still pouring out sugar in the urine. A high fat diet meant using less insulin and nutrition improved but there were doubts about the wisdom of this course. Adherence to a strict diet was still felt to be the best action.
Campbell’s career thrived in the spotlight of insulin discovery, but his interest in endocrinology also led to a reputation in calcium physiology. He retired from clinical work in 1952 but remained active in his laboratory until 1971. He lived a further ten years until the age of 90. In 1953 he was awarded the Banting medal by the American Diabetes Association along with his friend Fletcher.9 In the insulin story he was more than a footnote.
- Bliss Michael. The Discovery of Insulin. McClelland and Stewart. Toronto. 1982.
- Cosbie WG. The Toronto General Hospital 1819-1965: A Chronicle. The Macmillan Company of Canada. Toronto 1975.
- Kerr RB and Waugh D. Duncan Graham: Medical Reformer and Educator. Dundurn Press. Toronto 1989.
- Campbell WR. Anabasis. Can Med Assoc J. 1962 87:1055-61 5.
- Notes from Ann Campbell Ward family history of Walter Campbell received November 29, 2011.
- Taped interview of Walter Campbell by Dr RB Kerr 1979 University of Toronto archives.
- Partial chart of Leonard Thompson available at the Toronto General Hospital archives on request.
- Banting FG, Best CH, Collip JB, Campbell WR, Fletcher, AA. Pancreatic Extracts in the Treatment of Diabetes Mellitus: a preliminary report. Can Med Assoc J 1922 22:141-6.
- American Diabetes Association website accessed November 30, 2013.
- Campbell, WR. Hypoglycemia and Hyperinsulinism Can Med Assoc. J. 1958 79:760-67.
- Banting FG, Campbell WR, Fletcher AA. Further Clinical Experience with Insulin (Pancreatic Extracts) in the Treatment of Diabetes Mellitus Br Med J 1923:1:8-12.
- Campbell WR. Andrew Almon Fletcher: An Appreciation. Obituary Can Med Assoc J. 1965 92: 145-46.
- Torontonensis 1915 and information from Thompson’s chart TGH Archives.
JAMES GOODWIN, MD, is a 1955 graduate of the Faculty of Medicine at the University of Toronto. He went on to complete graduate training in obstetrics and gynecology at Harvard. His career included academic stops in Toronto Ontario, Edmonton, Alberta, Tehran, Iran, and St. John’s, Newfoundland. He was the co-editor of Perinatal Medicine published in 1977. In 2007, he published Our Gallant Doctor, a biography of a young obstetrician killed in action during the Second World War. He is currently retired but is working on a third book. As well, he holds membership in the Toronto Medical Historical Club. He was the nephew of Walter Campbell.
PETER KOPPLIN, MD, is a 1963 medical graduate of the University of Toronto. He trained in general internal medicine in Montreal, Quebec, and Toronto, Ontario, with some additional public health training in New Haven, Connecticut. His career has been practicing and teaching general internal medicine at St. Michael’s Hospital in Toronto. He is the secretary of the Toronto Medical Historical Club and has written a small historical sketch on residency life entitled On Call in the Heart of the City.
Highlighted in Frontispiece Spring 2015 – Volume 7, Issue 2