From seeds planted in 1913, "Dr. Bob," as he was affectionately called, became the primary architect of, and was personally inseparable from, these internationally renowned institutions, particularly Connaught, and its unique public health mission: medical research, non-commercial production and distribution of essential biological products, and public service.  Under Defries’ leadership, Connaught played a key role in the international control of numerous infectious diseases, especially through its pioneering development of methods for the large-scale production of such essential products as insulin, heparin, penicillin, combined antigens and both types of polio vaccines.  Moreover, Connaught’s unique university structure and close links to the federal and provincial governments, reinforced by Defries’ professional and personal relationships, ensured that the public health benefits of Connaught’s many products were kept within the reach of everyone.

Robert D. Defries (R.D.D.) was born in Toronto, Ontario, on July 23, 1889.  His family’s Canadian roots extend back to 1829 when his great grandfather arrived from England and later began a brewery in Toronto’s east end.  R.D.D.’s grandfather expanded the family’s business, operating five of the city’s thirteen breweries in 1885.  His father, William Thomas, carried on with the business until his untimely death at age twenty-eight.  His mother, Agnes (Lumsden), who was deeply religious, was determined that her two sons stay out of the brewery business and go to university.  She was successful and both Robert and his brother William attended the University of Toronto and graduated in medicine.  R.D.D. graduated in 1911 with his M.B., followed by an M.D. in 1913 and a Diploma in Public Health (D.P.H.) in 1914.  Indeed, Defries was the first candidate and first graduate of the D.P.H. program, a situation that developed fortuitously and with some resistance, but which had enormous implications for the subsequent evolution of public health in Canada.
 

A more structured D.P.H. program with specific courses was initiated in 1912 with the appointment of Dr. John W.S. McCullough (1868-1941) as Ontario’s Provincial Health Officer, who was interested in improving local health services across the province.  However, he needed more qualified health officers and he turned to Amyot for help.  Initially, the University of Toronto was reluctant to establish a formal D.P.H. graduate course.  However, this situation changed when the young Defries, after a year of postgraduate study in biochemistry and hopeful of engaging in public health work, approached Amyot to apply for a postgraduate course at Toronto.  With a qualified and enthusiastic candidate in hand, Amyot finally convinced the faculty of medicine to establish a new D.P.H. course and Defries was the sole student for the first academic session of 1912-13.

The curriculum Defries studied was based on the British model that emphasized sanitation, quarantine, ventilation and the clinical study of fevers, supplemented by studies in geology, microbiology, meteorology and an apprentice course in bacteriology in the Provincial Board of Health laboratory.  In 1913, after graduating from this course, Defries was appointed as a demonstrator for the D.P.H. course and was joined by Dr. John G. FitzGerald (1882-1940).
 

The unique vision of an institution devoted to medical research and the non-commercial production of essential health products within an university environment originated with FitzGerald.  It emerged out of a long period of education and travel driven by a strong desire to practically develop and apply the latest methods of preventive medicine at the lowest possible cost and for the largest public benefit.  FitzGerald, though born in Ontario, came from Irish stock and graduated from the University of Toronto with a medical degree in 1903.  For the next five years FitzGerald’s studied psychiatry in the U.S. and Toronto, which proved ironic in light of his later mental illness and breakdown in the late 1930s and tragic suicide in June 1940.

A new passion for bacteriology soon emerged, leading FitzGerald back to Toronto to teach it between 1909 and 1911.  FitzGerald’s direction into preventive medicine intensified during the summers of 1910 and 1911 when he studied in Europe at the Pasteur and the Lister Institutes.  He also became aware of efforts in Boston and New York, where, under city or state auspices, laboratories for the production of public health products had been established to great public benefit.  In 1913, FitzGerald was invited back to Toronto where he hoped to practically apply the benefits of what he had seen elsewhere to Canada, but within a university environment.

FitzGerald’s first opportunity emerged in the summer of 1913 when he prepared the Pasteur Rabies Treatment in the Ontario Board of Health laboratory.  Hitherto, this product was imported from New York at a much greater cost.  Fitzgerald then presented his vision for a university-based laboratory for biologicals production and research but encountered resistance from the University governors, who were concerned that such an enterprise involved commerce more than academics.  However, FitzGerald was keenly aware of the tragic toll of diphtheria in Canada and a complete reliance on diphtheria antitoxin imported from U.S. commercial suppliers at a price that made it’s benefits available only to the well-to-do.

Undaunted by the university’s hesitancy, though confident of its ultimate support, FitzGerald, using his own money, went ahead and built a stable, and bought horses and laboratory equipment to begin production of diphtheria antitoxin.  Within a few months he had won his first contract to produce the life-saving antitoxin for the Ontario Board of Health for free provincial distribution; he produced it at one-fifth to one-tenth the cost charged by American producers.  Finally, recognizing the obvious public-service benefits, on May 1, 1914, the University of Toronto assumed full financial responsibility for FitzGerald’s work, gave him laboratory space and appointed him Director of this new Antitoxin Laboratory in the Department of Hygiene.  Despite some early opposition from commercial manufacturers and druggists, by 1920 all provinces were freely distributing Connaught’s products.
 

The savior of FitzGerald’s vision was Colonel Albert E. Gooderham (1861-1935), a wealthy Toronto distiller, who served on the Canadian Red Cross Executive Committee and was a University of Toronto Governor.  Prompted by the federal government, Gooderham approached FitzGerald to prepare the tetanus antitoxin, but the capacity of the new Antitoxin Laboratory was thought insufficient to meet the growing demand for it as well as other essential health products.  Nevertheless, beginning in February 1915, tetanus antitoxin production was stepped up under Defries’ personal direction and was made available to the army at $0.34 a dose.  In total some 250,000 doses were manufactured during the war, meeting all the Canadian military needs.

Gooderham’s most important legacy came in 1915 with his gift of a 57-acre farm property that would include a modern laboratory building.  These new facilities were officially opened on October 25, 1917, and, by request of Gooderham, were christened the "Connaught Antitoxin Laboratories and University Farm," after the Duke of Connaught, Canada’s Governor-General during the war.  The Ontario government matched Gooderham’s gift with a grant of $75,000 to support medical research.  To ensure a national character for Connaught, FitzGerald set up an Advisory Committee on Scientific Work with representatives from each province.  In 1920, soon after the establishment of the Department of National Health, a more formal "Dominion Council of Health" first met and was composed of the federal and provincial deputy ministers of health and five other members, including FitzGerald, and then Defries (who served between 1940 and 1962), affording a regular national forum in which the work of Connaught was integrated into provincial and federal health programs.
 

Insulin was the most significant product to Connaught’s financial health and physical growth until the development of polio vaccines.  Moreover, "the discovery of Insulin was a stimulus of first importance" to the establishment of the School of Hygiene and its endowment by the Rockefeller Foundation (Defries, July 1957: 289).  In addition to being Associate Director of the School until 1940, Defries was also head of the Department of Epidemiology and Biometrics, and later the Department of Public Health Administration.  The new School of Hygiene building provided a centre for public health teaching, expanded facilities for Connaught and an administrative focus for both institutions.  This building also served as the heart of the Canadian Public Health Association, founded in 1910, and its journal, especially when Defries became its editor in 1928; a position he held until 1964.  Defries  was the backbone of the C.P.H.A. and is widely credited with re-energizing its journal.

World War II placed heavy demands on Connaught and resulted in a major period of expansion in staff and capacity.  In addition to supplying the military with tetanus and gas gangrene toxoids and a new typhus fever vaccine developed by Connaught, the war placed the greatest demands on Defries’ administrative skills to produce dried human blood serum to treat shock among soldiers.  This work required additional space and in 1943 Defries expedited Connaught’s acquisition of a large building on campus that became the Spadina Division.  At the same time, the new Division was also urgently required to develop methods to produce penicillin on a large scale for the federal government in time for D-Day in  June 1944.
 

The first step was Connaught’s development of the world’s first synthetic medium, known as "Medium 199," for cancer research by J.F. Morgan, H.J. Morton and R.C. Parker in 1949.  In 1951, through a close friendship between Morgan and Dr. A.E. Franklin of Rhodes’ group, Franklin discovered that "199" proved ideal for cleanly culturing the poliovirus in monkey kidney cells.  This made Salk’s vaccine safe for the first human clinical trials in 1952.  The NFIP then financed a major pilot project at Connaught to cultivate the poliovirus in larger quantities.  In 1953, this effort led to the "Toronto Method," developed by Dr. Leone N. Farrell (1904-1986), which involved culturing the poliovirus in a suspension of monkey kidney cells in "199" using large bottles incubated on special rocking machines.  Salk’s vaccine could now be produced in enough quantities to vaccinate every child.  In July 1953, as Defries took direct control of the polio work, the NFIP asked Connaught to carry out what Salk called the "herculean" task of supplying all the bulk poliovirus fluids that was inactivated in the U.S. for the 1954 field trial.  Despite some reservations within the University, over the speed of the trial and the safety of the vaccine, Defries efficiently and quietly carried out this "unusual" project.

Soon after the NFIP field trial began in April, Defries turned his attention to preparing a finished vaccine supply for Canadians and planning for its introduction in light of its still unknown value.  Gambling the vaccine was safe and at least somewhat effective, in October 1954, the Dominion Council of Health agreed to Defries’ plan for the national use of the vaccine on an experimental basis, regardless of the U.S. trial results.  The cost of the vaccine was to be shared equally between the federal and provincial governments, ensuring free vaccinations for some 500,000 children across Canada.

The start of this Canadian program coincided with the much anticipated April 12, 1955 announcement of the NFIP field trial results in Ann Arbor, Michigan, which revealed that the vaccine was safe and 60-90% effective.  However, high public expectations and unprecedented media coverage generated the popular perception that the vaccine was completely successful and that the long war against polio was finally over.  This attitude was particularly strong in the American press and it worried Defries.  Dr. G.D.W. Cameron (1899-1983), Deputy Minister of National Health, who, with Defries, sat well toward the back of the room at the Ann Arbor event, was more concerned that "throughout the performance there was no recognition of what the Connaught had done."  He later remembered "being furious but Bob, of course, was philosophical" (Rutty, 1995: 345).

Canada’s foresight in planning early for the vaccine’s orderly introduction, orchestrated largely through Defries’ leadership, was prominently vindicated in the wake of the infamous "Cutter Incident."  By early May 1955, some 80 cases of paralytic polio in the U.S. were directly associated with vaccine prepared by Cutter Laboratories of California, touching off a national crisis that resulted in the cancellation of the entire U.S. vaccination program.  In Ottawa, Paul Martin, the Minister of National Health and Welfare, faced one of his most difficult political decisions: what should Canada do?  The Prime Minister was reluctant to let the Canadian trial continue, but based on Defries’ convincing counsel and the experience of Connaught with the development of the vaccine, Martin maintained his confidence.  The vaccine had not yet caused any problems in Canada and so the immunization program continued without incident.  Martin’s confidence was also based on a stricter Canadian testing procedure in which Connaught and the federal Laboratory of Hygiene tested each vaccine lot; something which lapsed in the U.S. when commercial manufacturers expedited the release of the vaccine immediately after its licensing.  This unusual Canadian success story generated significant American media attention and political debate, sharply highlighting the differing levels of government interest in controlling the vaccine.  The prominence of the Canadian Salk vaccine program also played a major role in ensuring its future international use in the control of polio.
 

After his retirement, Defries remained as Director Emeritus and Consultant for Connaught, actively supporting his successor, Dr. J.K.W. Ferguson (1907-1999), expand production of the Salk vaccine, prepare combined antigens containing polio vaccine in 1958-59, and develop the first trivalent Sabin oral polio vaccine between 1959 and 1962.  Defries also worked closely with his successor at the School, A.J. Rhodes, who faced perhaps the greater challenge of maintaining the public health mission of the School in the shadow of a rapidly expanding Faculty of Medicine.  

In recognition of his enormous legacy, in 1965 the Canadian Public Health Association established the "R.D. Defries Award" to honour outstanding individual contributions to public health.  In his retirement years Defries received many other honours, including the Companion of the Order of Canada in 1970, which as Ferguson recalls, he was characteristically reluctant to accept.  As noted earlier, Defries’ personal life was inseparable from his work.  He never married and in his spare moments, in addition to a passion for flowers and photography, he paid close attention to helping others, particularly employees, to find worthwhile tasks that suited their talents.  Defries was also the first official historian of Connaught and he spent much of his retirement preparing a history of the laboratories, published in 1968.

Robert D. Defries, "Canada’s Mr. Public Health," died quietly at his home on October 25, 1975, leaving an indelible impact on Canadian public health through his writings and which continues today through the institution he largely created, Connaught Laboratories.  Connaught was sold by the University of Toronto in 1972 and has since been transformed into the North American component of the world’s largest fully integrated biologicals company, Pasteur Mérieux-Connaught of France.  Defries’ medical missionary spirit still resides in Connaught’s essential public health research and production work that continues into the twenty-first century much as it did under Defries’ direction during much of the twentieth, quietly protecting the public from the tragedy of infectious disease.
 

Information pertaining to Defries is held in the Archives of Sanofi Pasteur Limited (Connaught Campus), 1755 Steeles Ave. W, North York, Ontario.  The collection contains numerous medical journal and newspaper articles correspondence and reprints of Defries’ articles and a personal papers file.  Also important are Defries’ Connaught and School of Hygiene Annual Reports of the Director (formally published after 1948).  The Archives of the University of Toronto and the National Archives of Canada in Ottawa (RG29) also contain some of Defries’ correspondence.   Dr. J.K.W. Ferguson, Defries’ successor as Director of Connaught (1955-1972), was another important source of information on Defries’ life.  I thank Dr. Ferguson  for his kind assistance.  Very little secondary material has been written on the life and work of Dr. Defries.  The most significant sources are Bator (1990, 1995) and Rutty (1995).

Abbreviations:

 CPHJ = Canadian Public Health Journal
 CJPH = Canadian Journal of Public Health
 CMAJ = Canadian Medical Association Journal

Writings by Defries:
 

Writings about Defries: