The Troubled Healer

On the afternoon of Saturday, June 22, 1940, 10 years before my birth, a casket bearing the body of my grandfather was carried solemnly onto the stage of Convocation Hall. Hundreds of mourners, many drawn from the Canadian and international medical elite, turned to catch a glimpse of Sir Frederick Banting and Charles Best among the distinguished pallbearers. My father, Jack, then a 23-year-old University of Toronto medical student, sat silently with his sister, Molly, and mother, Edna.

Following the eulogy, the casket lid was opened. When people were invited to view the body, only a single soul – an elderly caretaker who had worked for my grandfather for years – shuffled up to the stage and gazed at his face. My grandmother suppressed a cry of anguish. No one else came forward.

I would not hear the story of my grandfather’s funeral, or the reaction to his open casket that chilled the proceedings, until well into my adulthood. In fact, as I grew up, my father, a successful medical specialist, never spoke of his father, an ambitious, driven doctor of Irish Protestant blood, known as Gerry. Given what I would later come to know – that during the ’20s and ’30s, Gerry achieved fame as the visionary architect of Canada’s modern public health system, founding the internationally renowned Connaught Laboratories and University of Toronto School of Hygiene, institutions responsible for saving countless lives – my father’s silence seemed all the more strange. Why would such a magnificent story be withheld from a man’s own grandchildren?

Many years passed before I attempted to lift the lid of my grandfather’s story, burrow through the wall of my father’s silence, and decode the secrets of my paternal bloodlines. Following a trip to my ancestral village in Northern Ireland, I delved into assorted archives, letters, photo albums, and interviews with medical historians and aging former colleagues of my grandfather. I soon realized that my private family story was inextricably bound up in an epic national drama.

The year is 1882. The grandson of tough Irish immigrants who had sailed to Canada in 1824, William FitzGerald, an austere man with sad eyes and a bushy handlebar moustache, opened a small apothecary shop on a muddy street in Drayton, Ontario, a gaslit village of 800 people several hours’ train journey northwest of Toronto. Later that year, his first of four children, Gerry, was born.

As a teenaged apprentice toiling in his father’s rural drugstore, Gerry immersed himself in medical history books, drawn to heroic figures like Louis Pasteur, who in 1881 successfully vaccinated a herd of sheep against anthrax. In 1885, Pasteur risked administering an unproven, rudimentary rabies vaccine to nine-year-old Joseph Meister, bitten 14 times by a mad dog. In saving the boy’s life, Pasteur, a pioneer of the germ theory of disease, laid the foundation of modern preventive medicine.

Tending to his invalid mother, Alice, who rarely rose from her bed, young Gerry soon realized the limits of his father’s healing powers. So it was that in September 1899, on the cusp of a hopeful new century, a precocious 16-year-old country boy wearing wire-rimmed spectacles, bow tie and stiff white collar, set off for the University of Toronto’s Faculty of Medicine, burning with an obsessive career ambition – to stamp out the terror of contagious diseases before they spread. Prevention was the key.

In January 1907, fresh from internships in neurology and psychiatry at Johns Hopkins Hospital and Sheppard and Enoch Pratt Hospital in Baltimore, 24-year-old Gerry was appointed the first pathologist and clinical director of the Toronto Asylum for the Insane at 999 Queen Street West. Working under Dr. C.K. Clarke, Gerry was swept up in the revolutionary bacteriological discoveries of the time, founding the asylum’s first laboratory and teaching courses in psychiatry at U of T. After centuries of relative ignorance, modern medical science promised, at last, to fathom the complexities of human disease.

In December 1907, Gerry’s mother died of heart failure at age 51. Nine months later, he made a fateful decision: he abandoned neurology and psychiatry in favour of a career in the related but separate fields of public health and preventive medicine.

Succeeding Gerry as pathologist and clinical director of 999 Queen Street was Dr. Ernest Jones, a Welsh colleague and eventual biographer of Sigmund Freud. Jones would remain in Toronto for the next five years, “living in sin” for a time at 407 Brunswick Avenue with his morphine-addicted mistress (later analysed by Freud), and provoking widespread alarm within the city’s medical establishment for what was seen as his unsavoury preoccupation with psychosexual issues. Gerry was taken with Jones’s intellectual dynamism, and they exchanged letters and papers. But the dedicated yet tactless Freudian proselytizer – once characterized as “Freud’s Rottweiler” – left town in 1913 following an alleged sexual harassment scandal that horrified ultra-repressed “Toronto the Good.”

Gerry gradually lost contact with Jones while deepening his connection with Dr. C.B. Farrar, whom he had first befriended while interning in Baltimore. An orthodox psychiatrist who would become editor of the American Journal of Psychiatry and the founding director of the Toronto Psychiatric Hospital (the forerunner of the Clarke Institute of Psychiatry) in 1925, Farrar once condemned communism, Catholicism, unionism and psychoanalysis as “The Four Horsemen of the Apocalypse.” With the departure of Jones, the radical new psychoanalytical ideas about dreams, repression and “the talking cure” did not take root in Toronto for another 40 years.

Why did Gerry abandon psychiatry? Perhaps he was disturbed by what he had witnessed at 999 Queen Street – a snakepit in desperate need of reform – and realized that his therapeutic impact on psychotics would be limited. Or perhaps he realized he could accomplish far more in the emerging field of public health – easier to rub out diphtheria, for example, than schizophrenia. Whatever his motives, the decision would change the course of Canadian medical history.

At the turn of the last century, Canada’s primitive public health system was in crisis, overwhelmed by the rapid industrialization and immigration of the Laurier boom years. Conditions in urban areas were appalling: overcrowded immigrant worker slums, an estimated five to 15 per cent of the population infected with venereal diseases, periodic typhoid epidemics in Toronto caused by polluted water and unpasteurized milk, and shocking infant mortality rates. From 1880 to 1929, more than 36,000 Ontario children perished from diphtheria, a leading cause of death among children ages two to 14, which slowly asphyxiated its young victims. The efforts of understaffed, under-trained municipal and provincial boards of health were often reactive and unco-ordinated; a federal department of health would not be formed until after the First World War.

In the first decade of the century, public health reformers struggled against popular and political resistance to stricter sanitation laws, including compulsory smallpox vaccination. Anti-vaccinationists charged that, in addition to infringing on civil rights, compulsory immunization was a class weapon used against common working men, who often lost many days wages suffering from severely ulcerated arms, the vicious side-effect of the crude vaccine. Gerry saw an opportunity to make a difference on a grand scale.

In April 1910, following a year on a research fellowship in bacteriology at Harvard University, Gerry married Edna Leonard of London, Ont., a former Havergal College student and an heiress to a family foundry fortune. As part of a working honeymoon, they travelled to Europe. Gerry studied at the Pasteur Institute in Paris and Brussels, learning how to make rabies, diphtheria and smallpox vaccines and antitoxins under the mantle of Dr. Emile Roux, Louis Pasteur’s right-hand man and a co-creator of the world’s first diphtheria antitoxin. During Gerry’s first week in France, the German bacteriologist Paul Ehrlich announced the momentous discovery of Salvarsan for the treatment of syphilis.

Over the next three years, Gerry set a blistering pace, establishing a network of international contacts while working with leading experts in pathology and bacteriology at the University of Freiburg in Germany, the Lister Institute in London, the New York City Department of Health and the University of California at Berkeley. In 1913, armed with his international training, he returned to Toronto ready to execute the first step of his master plan. Now an associate professor of hygiene at U of T, he prepared the first Pasteur anti-rabies vaccine in Canada at a small provincial Board of Health lab at 5 Queen’s Park Crescent.

Encouraged by this success, he boldly proposed to the University of Toronto that he manufacture a safe, effective Canadian-made antitoxin for diphtheria, and distribute it free or at cost to doctors, pharmacists and boards of health across Canada. Treatment with imported American antitoxin cost as much as $25 – the equivalent of two weeks’ wages for most working families. One Toronto doctor recorded a story of a family who could afford to treat only one of their two children. Tragically, one child lived and one died.

The university’s board of governors initially deferred Gerry’s proposal – the idea of uniting an academic institution with the commercial production of biomedical products was unprecedented anywhere in the world. Impatient with their inertia, Gerry, with $3,000 borrowed from his wife’s inheritance, built a rudimentary stable at 145 Barton Avenue, near Bloor and Bathurst streets, in December 1913 and stocked it with lab equipment. He bought five horses bound for the glue factory for about $3 each, and hired a technician.

The dangerous, painstaking process of making diphtheria antitoxin involved injecting a horse with small, incremental amounts of poisonous diphtheria toxin – lethal enough to kill several men but not a horse – which would mix with the animal’s blood and build up immunity over time. The human antitoxin would then be obtained from white blood cells in blood drawn from the horse.

Following the diphtheria success, the U of T board of governors approved Gerry’s idea – an enlightened decision, as it would turn out – and the University of Toronto Antitoxin Laboratories were formed on May 1, 1914. The idea was that a full range of preventive medicines should be available free to all Canadians, regardless of class or income.

With the outbreak of the First World War only three months later, the fledgling lab, in a cramped basement space in the U of T medical building, was soon overwhelmed by the demand for preventive medicines to inoculate thousands of Canadian soldiers. Fortuitously, philanthropist Albert Gooderham, chairman of the Ontario division of the Canadian Red Cross and a member of the Gooderham & Worts distillery empire, came to the rescue, donating 58 acres of farmland at Dufferin and Steeles, 12 miles north of U of T, and money for more extensive lab buildings.

The labs quickly grew into a dynamic wartime factory, pumping out enormous quantities of tetanus antitoxin, anti-typhoid vaccine, diphtheria antitoxin, anti-meningitis serum and smallpox vaccine, dramatically reducing the numbers of soldiers dying of disease in the trenches. During the latter stages of the war, Gerry served in France as a major commanding a mobile pathology lab attached to the British Fifth Army.

In October 1917, at Albert Gooderham’s request, the U of T Antitoxin Labs were renamed the Connaught Laboratories, after the outgoing Governor General of Canada, Prince Arthur (who was also the Duke of Connaught and Queen Victoria’s youngest son).

In 1919, in the wake of the post-war influenza pandemic that killed more than 20 million people worldwide, the Canadian government established our first national Department of Health. To ensure a national character for Connaught, Gerry set up a scientific advisory committee that soon became the Ottawa-based Dominion Council of Health, comprising himself and four other members, as well as the federal and provincial deputy ministers of health. Despite early opposition from commercial drug manufacturers and druggists, by 1920 all provinces were distributing Connaught’s products to the public for free.

Thus, within a decade of the building of a primitive horse stable on Barton Avenue, two historical events – the Great War and the discovery of insulin by Frederick Banting and Charles Best (with Collip and Macleod) in a U of T lab in 1921-22 – vaulted Canadian medicine into a world leadership position. In the early 1920s, before eventually cutting a deal with the Canadian arm of American pharmaceutical house Eli Lilly, the Connaught Laboratories were manufacturing almost 100 per cent of the Canadian supply of insulin, and its production capacity for its full range of preventive medicines was now comparable to that of the Pasteur Institute in Paris and the Lister Institute in London.

Now a full professor of hygiene at U of T, Gerry began restructuring and staffing the department of hygiene within the Faculty of Medicine. He wrote a textbook on preventive medicine and overhauled undergraduate medical education, introducing mandatory field courses in public health. It proved a tough sell – most med students preferred studying curative, clinical medicine to tramping through noxious sewage treatment plants on steamy summer afternoons.

By the early 1920s, the Connaught’s work caught the attention of the New York-based Rockefeller Foundation. Impressed with Gerry’s dedication to medical research and education, the Rockefellers donated $1.25 million for the establishment of a School of Hygiene – only the third in North America, after Johns Hopkins and Harvard – to be erected at 150 College Street. This generous endowment brought enormous international prestige to the university, the city and the country.

As director of both the Connaught Laboratories and the new, four-storey School of Hygiene, opened in 1927, Gerry was now realizing his dream of transforming Canada’s health conditions. For the school’s faculty, he helped assemble a multidisciplinary team of men and women that would come to include leading experts in the emerg-ing medical sciences of immunology, microbiology, biometrics, parasitology, virology, epidemiology, environmental health, nutritional science and sanitary engineering. Each year, the school trained post-medical graduates who went on to direct public health services in municipal, provincial and federal departments of health. During this period, Gerry also lobbied the federal government to develop a national health insurance program.

The Connaught philosophy, mens sana in corpore sano (a sound mind in a sound body), became a way of life. Practising what he preached, Gerry required the Connaught doctors to eat nutritionally balanced cafeteria meals, follow exercise regimens and regularly compete in tennis tournaments at the School of Hygiene to promote team spirit.

For decades, the sprawling Connaught Labs Farm in Downsview, together with its academic arm, the Georgian red-brick School of Hygiene on College Street, formed an independent, self-sustaining division of the University of Toronto. Laying the foundation of provincial and federal health programs across Canada, its triad of research, teaching and manufacturing of biomedical products in the name of public service was unique in the world. Within a generation, the Canadian public health system had transformed itself from a colonial backwater to set a new international standard of excellence.

Former colleagues of my grandfather remember the Connaught as a seamlessly efficient organization demanding selfless service to a collective, missionary ideal. Gerry himself was seen as a study in contrasts. On the surface, he was calm, courteous, even mild-mannered, giving direction by means of subtle suggestion; yet under the controlled, genteel demeanour, he was a fireball of energy. “Play to win or don’t play at all,” he urged. June Callwood, in a 1955 Maclean’s article on the Connaught Laboratories, says my grandmother used to complain, “I’m married to an idea, not a man.”

During the 1930s, Gerry took on yet more work. Delegating much of the day-to-day running of the Connaught to his colleague, Dr. Robert Defries, in 1931 Gerry became scientific director of the Rockefeller Foundation’s international health division, the first Canadian appointed to that position. Following a four-year term as dean of medicine at U of T, and now a world authority in his field, he spent a full year in 1936-37, travelling to 24 countries in Europe and North America, assessing dozens of medical schools and hospitals for the Geneva-based League of Nations.

The fall, when it came, was precipitous. By 1938, ravaged by insomnia, migraine headaches, a bleeding ulcer and decades of overwork, a man obsessed with attacking disease had effectively ruined his personal health.

In February 1939, Gerry swallowed a fistful of Nembutal tablets at his home in Toronto, fell into a coma and recovered. Within weeks, his old friend and psychiatric colleague, Dr. C.B. Farrar, now director of the Toronto Psychiatric Hospital, arranged for his admission to the Hartford Retreat, a private sanatorium in Connecticut.

During a harrowing year there, Gerry suffered 57 insulin shock treatments, often falling into a cycle of profuse sweating, painful convulsions and sometimes a deep coma. Gerry’s letters to Farrar are rife with self-laceration: “I am a disgrace to my family. I should be taken out and shot.” Not a religious man, he asks to see a Catholic priest. Repeatedly, he accuses himself of having committed an unpardonable sin – for which “the penalty is death.”

Farrar, a virulent anti-Freudian, together with the Hartford psychiatrists, doubtless gave Gerry no opportunity to talk his problems out. Upon his release, Gerry received a letter from the Hartford Retreat psychiatrist-in-chief that ended: “I am glad all your difficulties are now permanently behind you.”

In April 1940, two days before his 30th wedding anniversary, Gerry returned to Toronto and tried to resume his work. But on June 16, 1940, in a state of paranoia he told his wife that the University of Toronto was out to get him. Again he took an overdose of Nembutal; again he was rushed to Toronto General Hospital; again he recovered.

My grandfather’s death certificate states that he died of a duodenal ulcer four days later. It was only in 1996, interviewing a former U of T dean of medicine, that I learned the true details of his death, details suppressed for over half a century, and withheld – perhaps rightly so – from my own father.

On June 20, 1940, as my grandfather lay recovering from the toxic drug overdose at Toronto General Hospital, a nurse placed a tray of food on his lap. When she withdrew, he grasped the knife and, marshalling the stoic willpower of his Irish Protestant forefathers, he felt for the femoral artery in his thigh, and stabbed his flesh again and again. In less than five minutes, John Gerald FitzGerald was dead. A life of self-sacrifice was over. He was 57.

Despite the exorbitant cost in private suffering, a civilizing public legacy survived. In addition to insulin, one of the Connaught Laboratories’ major global achievements includes the control of diphtheria (by 1940, the year of Gerry’s death, Toronto and Hamilton had become the world’s first diphtheria-free cities). The lab also contributed to the mass production and worldwide distribution of penicillin in the 1940s and the Jonas Salk polio vaccine in the 1950s. In the 1970s, together with the World Health Organization, it played a leading role in the conquest of smallpox, the first disease erased from the face of the earth.

In 1972, the University of Toronto sold the Connaught Labs and it was later privatized; the multiple disciplines within the School of Hygiene were eventually integrated into various departments of the Faculty of Medicine. Without a single, forceful personality to sustain it, Dr. FitzGerald’s unique institutional vision had run its course – 58 years – almost exactly the length of his own life.

Following a series of contentious corporate takeovers and mergers in the ’80s and ’90s, the labs today serve as a division within the German- and French-owned, multibillion-dollar Aventis Pasteur pharmaceutical empire.

In the age of AIDS and increasingly frequent public health scandals such as the contaminated water crisis in Walkerton, Ont. – near my grandfather’s birthplace – the thrust of his life’s work stands as timeless as ever. As the re-emergence of virulent, drug-resistant infectious diseases threatens humanity in new and unforeseen ways – not to mention the unthinkable spectre of global bioterrorism – contemporary public health workers face what seems like a Sisyphean task.

As for my grandfather’s unpardonable sin, it remains an enigma – an enigma that drives my own ongoing need to understand him, my father and myself. From the stranger I never knew, the healer who still lives inside me, I am learning a simple truth: that the truth itself, like an invisible microbe, remains perpetually elusive quarry, no more or less meaningful than a dream.

James FitzGerald is the author of Old Boys: The Powerful Legacy of Upper Canada College (Macfarlane, Walter & Ross, 1994). He is currently working on a biography of Dr. J.G. FitzGerald.