Wednesday, January 11, 2012

Dr. Banting and insulin: Canada's gift to the world


Dr. Frederick Banting

Insulin is not a cure for diabetes; it is a treatment.  It enables the diabetic to burn sufficient carbohydrates, so that proteins and fats may be added to the diet in sufficient quantities to provide energy for the economic burdens of life.

- Dr. Frederick G. Banting
'Diabetes and Insulin', Nobel Lecture, September 15, 1925, in Nobel Lectures: Physiology or Medicine 1922-1941 (1965), p. 68

Ninety years ago today, on January 11, 1922, insulin was injected into a human being for the first time during a clinical test at the University of Toronto.  Dr. Banting, a 30-year-old Canadian endocrinologist, administered bovine insulin to a 14-year-old boy named Leonard Thompson.  The boy initially suffered an allergic reaction.  Two weeks later at Toronto General Hospital, the boy was given a second injection of a more purified extract  (made by trained biochemist Dr. James Collip).  This time the result proved successful.

The scientists injected other diabetic children with their extract.  They were delighted as previously comatose children awakened from their comas.  The extract was continually improved and enough insulin was produced to meet the hospital's demand.  It wasn't until pharmaceutical maker Eli Lilly came to Banting's assistance, however, that insulin was made readily available to the public..  A deal was struck with the drug company and pure refined insulin was mass produced.

Banting  and his three colleagues agreed not to patent their discovery.  Instead, they sold the rights to the University of Toronto for $1 in order to ensure its accessibility to the greatest number of people at the lowest cost.  In so doing, the group forfeited a great deal of personal wealth but helped to save the lives of millions of diabetics.

Frederick Grant Banting was born on November 14, 1891 in a farm house in Alliston, Ontario.  He was the youngest of the five children of William Thompson Banting, a well-established farmer, and his wife, Margaret Grant Banting, who had immigrated to Canada from Ireland.  Young Fred attended the University of Toronto and graduated from medical school in 1916.  During World War I, Banting served as a medical officer in France where he was wounded and decorated for valour (he won the Military Cross for heroism under fire in 1919).  After the war, he completed his training as an orthopedic surgeon and set up a medical practice in London, Ontario.

In October of 1920, after reading a paper on diabetes in a medical journal, Banting became intrigued.  The article indicated that diabetes was caused by a the lack of a protein hormone (insulin) secreted in the pancreas (the jelly-like gland that secrets digestive fluids).  At the time, the only identified treatment for the disease's blood sugar imbalance was diet and exercise.  Diabetics faced amputation of limbs, blindness and premature death.  Banting formulated an idea for research to help fight the disease.

Banting's hypothesis involved isolating the internal secretion of the pancreas.  He recalled from his medical school lectures that this secretion regulated sugar in the bloodstream.  Isolating the secretion, he surmised, might lead to successful treatment of diabetes.

Determined to investigate his theory, Banting approached Dr. John J. Richard. McLeod, Professor of Physiology at the University of Toronto and an authority on diabetes.  In May of 1921, the University of Toronto gave Dr.Banting permission to go ahead with his experimentation under the supervision of Dr. McLeod.  McLeod provided laboratory space for Banting's research and he appointed Charles Best, a medical student, to be his assistant. 

Banting and Best began their work in the dingy little lab on the top floor of the university's medical building.  They first tested insulin on animals. The two doctors managed to isolate insulin in the pancreas of diabetic dogs and were pleased to observe that their extract had lowered the blood level of several of the dogs.  These favourable results were a boon to further research.

In December of 1921, Dr. McLeod invited biochemist James Collip to join Banting and Best's team. With Collip's assistance, the researchers conceived of a method of extracting and purifying insulin from the pancreas of cattle.  Then to determine its safety for humans, Banting and Best injected fluid into their own veins.  After experiencing no ill effects, they proceeded to administer the pancreatic extract to the diabetic Leonard Thompson.

Leonard was at death's door when he came to Banting and Best.  His ravaged body was skin and bones and he was about to slip into a coma.  After the second injection of insulin, the teenager's blood sugar returned to normal and he appeared brighter.  Thompson lived another 13 years with the help of insulin and died in 1935 at the age of 27 due to complications from diabetes.

It is interesting to note that Elizabeth Hughes, daughter of American politician Charles Evans Hughes, was one of the first persons to be treated with insulin.  She regained her health and lived to the age of 73.  Elizabeth gave birth to three children (two daughters and a son) and enjoyed time with her grandchildren before dying in 1981.

Frederick Banting and his colleagues won great acclaim for their achievement.  The 32-year-old Banting and his collaborator, Dr. J.J.R. McLeod, received the 1923 Nobel Prize in Physiology or Medicine. Believing that Charles Best should also receive credit, Banting shared his half of the prize with his assistant.  McLeod felt the same way about James Collip and rewarded the biochemist with half of his endowment.

Banting continued his medical research relentlessly and the Canadian government gifted him with a lifetime annuity for his work. He studied problems associated with silicosis (a form of respiratory disease).  He participated in cancer research and was active in devising a method to counteract the mechanism of drowning.

In 1924, Dr. Banting married Marion Robertson and they had one son, William, born in 1928.  The marriage ended in divorce in 1932 and Banting then wed Henrietta Ball in 1937.  In June of 1934, King George V bestowed knighthood on Frederick Banting.  Below is the certificate (signed by George V) granting F.G. Banting the title of Knight Commander of the Order of the British Empire.

Banting had a strong interest in aviation and developed a workable G-suit to protect pilots during high-speed flights.  During World War II, Banting worked as a liaison officer between British and North American medical services.  He became extremely involved in aviation medicine, particularly with problems associated with flying such as blackout. 

Sadly, Frederick Banting's life was cut short on February 21, 1941 when he was killed in a plane crash near Musgrave Harbour, Newfoundland.  He was on his way to England to conduct tests on a flying suit developed by a colleague named Wilbur Franks.  At the time of his death, Banting was 49 years old.  Dr. Charles Best passed away in Toronto on May 31, 1978.  He was 79 years old.

Diabetics everywhere owe a debt of thanks to Dr. Banting, Dr. Best, Dr. McLeod and Dr. Collip for their medical research, their know how and their dedication.  Insulin users are forever linked to Canada and to my hometown, Toronto.

- Joanne

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