Frederick Grant Banting (1891-1941), was the driving force behind the discovery of insulin and in 2004 was voted the 4th greatest Canadian ever.
In 1912 he started in the faculty of divinity at the University of Toronto but soon switched to medicine. After a course shortened because of the war, was sent to Europe in 1917 as a member of the Canadian Army Medical Corps. He was wounded at the battle of Cambrai and awarded the Military Cross. He hoped to become a surgeon at the Toronto Hospital for Sick Children but, after failing to be appointed to this prestigious position, set up practice in London, Ontario. This was not a financial success and to make ends meet he got a part time job as a demonstrator at the Western University in London, Ontario.
At the end of October 1920, he had to lecture to the students on carbohydrate metabolism, a subject of which he knew little. While preparing for it, he read an article in the journal Surgery, Gynecology and Obstetrics by Moses Barron (1884-1975), professor of pathology at the University of Minnesota, reporting a case in which stone had blocked the pancreatic duct leading to atrophy of the acinar tissue but leaving the islets intact. This was not particularly startling since it had been known for some time, at least to physiologists, that this was what happened when the duct was ligated in experimental animals. Banting decided that if he ligated the pancreatic ducts of dogs to cause the acinar tissue to degenerate, he might be able to isolate the internal secretion from the islets. Banting did not know but there had been many fruitless attempts to do this over the previous 30 years.
Banting mentioned his idea to a colleague, who suggested he consult John Macleod, the professor of physiology in Toronto and an internationally recognized authority on carbohydrate metabolism. The meeting between took place on November 7th 1920. Macleod later wrote, ‘I found that Dr Banting had only a superficial textbook knowledge of the work that had been done on the effects of pancreatic extracts in diabetes and that he had very little practical familiarity with the methods by which such a problem could be investigated in the laboratory’. For his part, Banting wrote, ‘Macleod put me off by saying that many men had worked for years in well-equipped laboratories and had not proved that there was even an internal secretion of the pancreas.’ Finally Macleod said that negative results would be of great physiological value. According to Banting, he repeated this three times. Nevertheless, he offered to help.
Banting contacted Macleod again in April 1921 and was was given a small disused dirty room in the physiology department. Macleod’s research students Charles Best (1899-1978) and Clark Noble (1900-1978) were given the chance to make pocket money by helping Banting and tossed a coin to decide who should do the first month. It was originally agreed that they should do a month each but when Best’s month was up, they agreed that there was no reason to change horses in mid stream.
Banting needed an assistant because he did not know how to measure blood sugar and Macleod had wisely insisted on this as the end point of the experiment. Another stumbling block was Banting had never done a pancreatectomy, an operation used only in animal research. On May 14th Macleod showed Banting how to do Hédon’s two stage pancreatectomy and during the rest of the month Banting and Best did several more operations. In the middle of June Macleod went on holiday to Scotland although he could be (and was) contacted by letter.
In August they depancreatized two dogs and treated one with pancreatic extract leaving the other as a control. The untreated dog died in 4 days while the treated one remained in good health. When Macleod returned to Toronto at the end of September, Banting presented a list of demands including a salary and improved facilities. At first Macleod refused saying that Banting’s research was no more important than any other in the department. Eventually he did produce better facilities and Banting was given a salaried job. At a journal club on November 14th 1921 Banting and Best gave a preliminary presentation of their work to colleagues and students. This caused further resentment because, according to Banting, in his introduction Macleod said everything Banting was going to say as well as using the pronoun ‘we’ throughout.
One important suggestion at this meeting was that the best way of showing that the extract worked would be if regular administration could prolong the life of diabetic dogs. This was a major problem because the duct ligation method of obtaining extract was slow, cumbersome, and expensive. Banting’s solution was to use foetal calf pancreas which he sent Best to get from the local abattoir. The rationale was that calf pancreas contained a high proportion of islets in relation to acinar tissue. An important breakthrough came on December 6th 1921 when Banting decided to use alcohol in making their extract (an idea Macleod had suggested some months before). It worked well and led them to wonder whether they could get a similar result with fresh adult beef pancreas. That they did must have been a considerable surprise because the original rationale for duct ligation was that the internal secretion would be destroyed by proteolytic enzymes from the exocrine pancreas.
Around this time they were joined by Bert Collip who improved the extraction process. The results on the first seven patients treated with the new extract in early 1922 were a resounding success. The aftermath of this epoch making discovery was scarred by years of bitter wrangling between the main proponents. The award of the Nobel Prize for Medicine or Physiology to himself and Macleod infuriated Banting and he shared his part with Best.
Banting’s position was invidious. He had now become famous and was revered as the lone genius who, using primitive facilities grudgingly given to him by a remote professor,had made the discovery of the century. In the eyes of many, he would be able to solve all medical mysteries if given the money. Yet, with the benefit of hindsight, the true situation was there for all to see; his previous training had been as an orthopaedic surgeon but he was now regarded by much of the world as an expert on diabetes. He did set up a small diabetic clinic in Toronto in 1923 but wound it up within a year or two.
He had decided that his future was going to be in research in anything but diabetes with the hope that he would make another discovery as momentous as that of insulin. His first project was on the adrenal cortex, an extract of which he thought might overcome the effect of diphtheria and other toxins. He then worked for a time on the transmissible Rous sarcoma in the hope of finding the clue to cancer. Neither produced anything useful. According to Michael Bliss, he only published two papers between 1926 and 1934. Later he was given his own Banting research institution and was able to recruit properly trained researchers who turned out reasonable quality work. Banting never allowed his name to appear on any of these papers, presumably as some sort of protest against Macleod who he always believed had stolen his insulin results. In 1938 he described his daily life as follows:
When I go in I find that it is not a lab but an office. There are a pile of letters to answer, phone numbers to call up, people waiting to have an interview, routine work that must be done. Some person wants me to give him some money, someone wants a signature, someone wants to know what to do about a friend of a great aunt’s cousin who has a cancer, or who has gone insane. Someone has a cure for diarrhoea, cancer or anterior polyio myelitis [sic]. Some antivivisectionist damns…Some visitor from China, the USA, England has arrived and “cannot visit Canada without seeing the distinguished discoverer of Insulin!”
Among the many honours Banting received were a lifetime annuity of $7,500 from the Canadian government and in 1934 a knighthood from King George V. He was killed in a plane crash in Newfoundland in 1941.
^ Robert Tattersall. Pancreatic Organotherapy for Diabetes, 1889-1921. Medical History 1995;39:288-316.
^ Banting FG, Best CH, Collip JB, Campbell WR, Fletcher.A.A. Pancreatic Extracts in the Treatment of Diabetes Mellitus: Preliminary Report. Canad Med Assoc J 1922;12:141-146.
^ The best biography of Banting is by Michael Bliss. Banting: a Biography. Toronto, McClelland and Stewart, 1984. I have drawn on it extensively.