Frederick Banting

Stephen Eaton Hume

• Éditeur: Dundurn Press
• Année: 2000
• ISBN:
  9781459710849
• Sujet: Medicina
• Sous-sujet: Teoria, pratica e riferimenti medici

Frederick Banting was a surgeon and a decorated war hero when he had the idea to develop insulin in 1920, This achievement earned him the 1923 Nobel Prize for medicine, a knighthood, and the gratitude of diabetics around the world.

1

A Brilliant Idea in the Middle of the Night

The doctor couldn’t sleep. He was troubled. His medical practice in London, Ontario was going nowhere, and his girlfriend was thinking of leaving him.

It was just past midnight, on the last day of October, 1920. Because he had nothing better to do, he took out his paints and began painting a watercolour on a piece of cardboard.

The picture was of a house at night, in the snow. The house had one lighted window. He carefully painted shadows on the snow. The sound of the paintbrush was the only noise in the room.

He sat back and looked at the painting. It was a good painting. At least, he thought it was. He was pleased with the way the snow turned out. It wasn’t easy to paint snow.

He began to sing an old war song called “Pack Up Your Troubles.” He knew the words by heart. He sang under his breath, in a soft baritone. He liked the part about using a lucifer to light your fag. A lucifer was a sulphur match. He had troubles, all right. He stopped singing and lit a cigarette, a hand-rolled Piccadilly. He kept the cigarette between his lips while he painted.

The sign in front of the house where he lived at 442 Adelaide Street North said: Dr. F.G. BANTING. The front door had a shiny brass plate with his name on it. But the signs mocked him. In the last few months he had seen only a handful of patients.

He looked at his painting. It needed something else, maybe more snow. He painted some red into the window to make it look like the reflection from a fireplace.

He was engaged to Edith Roach, the daughter of a Methodist minister. She taught school a few miles away in the town of Ingersoll. It was embarrassing that she made more money than he did.

Like most women who worked, she planned to give up her job once she got married. She wanted to raise a family. No decent man in the 1920s would allow himself to be supported by his bride.

Edith wanted Fred to grow up, to settle down and earn a living. After all, he was twenty-eight. He wasn’t young anymore. Whenever they saw each other they argued. Sometimes they were not sure they were still in love. Where was the man she once knew? He drank, smoked, and cursed. He didn’t do that before the war.

It was bad enough that Banting had to pay for his house with money borrowed from his father, a hard-working farmer.

Banting had bought the house from a London shoe merchant, but the merchant still lived in the house with his wife. Banting agreed to let them stay while their new home was being built. The doctor had only two rooms: a bedroom and the front parlour. The parlour was also his office. The only furniture was a desk and wooden chair that he had borrowed from his father.

London was a community of sixty thousand people, about 150 kilometres west of Toronto. He had to remind himself that it was hard for a doctor to build up a practice in a new city. He had opened his office on July 1, four months ago. The patients were not exactly knocking down his door. To pass the time, he had started sketching and painting pictures.

His only patient in July was a man who wanted a prescription for alcohol so he could get drunk at a friend’s wedding. Ontario was a “dry” province where drinking was prohibited. Banting wrote him the prescription. His fee was four dollars, his only income for the month.

To earn extra cash, Banting had taken a part-time job as a lecturer and demonstrator in surgery and anatomy at London’s Western University. For this he received two dollars an hour.

Tonight he had to prepare for a talk he was giving his students. The subject was carbohydrate metabolism, the biochemical transformation of certain foods into energy for the body. He didn’t know much about it. So he stubbed out his cigarette, put away his paints, cleaned his brushes, and reviewed what he planned to say.

He was aware that if you talked about carbohydrate metabolism, you also had to talk about a fatal disease called diabetes mellitus, “honey-sweet diabetes.” As a physician, though, he wasn’t particularly interested in diabetes and knew little about the subject. His knowledge came mainly from a lecture he had in medical school at the University of Toronto before he went off to war.

He tried to recall the details of his medical school lecture. He knew that food was digested by powerful enzymes from the pancreas, a jelly-like gland that was connected by ducts, or tubes, to the stomach. But the pancreas did something else, too. He remembered that a mysterious internal secretion within the pancreas supposedly regulated sugar in the bloodstream.

In the nineteenth century, German scientists discovered, by accident, that a dog became diabetic if its pancreas was removed. Excess sugar built up in the dog’s urine, a condition called “glycosuria.” The dog craved water and became listless, as if all the energy had drained from its body. Then the dog went into a coma and died.

Banting had seen diabetics before. The most severe form of diabetes, diabetes mellitus, struck children and young people. It was sometimes known as juvenile diabetes. The first symptoms were often an insatiable hunger and thirst. As the disease progressed, children lost almost all their body weight. Eating didn’t help. They began to look like living skeletons. Death usually occurred within a year or two, but sometimes a child was gone in a week. There were one million people with diabetes in North America in 1920, and countless more around the world. The disease had never been conquered.

A condition that was probably diabetes mellitus appeared in the ancient writings of China and India. The description was the same one the Greeks and Romans reported – the patient urinates frequently, and the urine is sweet. The Greeks tested for diabetes by tasting the urine, or placing it next to an anthill to see if it attracted ants. The word “mellitus,” honey-sweet, was coined to describe the disease.

Banting knew that “diabetes” came from the Greek word for “siphon.” When people had diabetes, it was as if their lives were being siphoned away. The glucose from food was not absorbed into the cells and instead stayed in the blood. The sugar overload was so great, it spilled into the urine. That’s why a diabetic’s urine was sweet. The kidneys produced more urine than usual in an attempt to dilute the high levels of sugar. When the body lost this extra liquid, a terrible thirst was created. The craving for energy led to a hunger which no amount of eating could satisfy. Unable to obtain energy from food, the body tried to consume itself. Diabetic children were always so tired and hungry. They looked like victims of famine, and they were very quiet as death approached.

Life for diabetics was a constant struggle to ward off illness. Their skin became dry as paper. Their hair became brittle. They could go blind, or develop cataracts, a clouding of the lense of the eye. They tended to get lower-leg infections that formed gangrene, creating a horrible stench that permeated hospital wards. It often became necessary to amputate, but amputations were usually fatal because the wounds didn’t heal. It was easy to see why diabetics were desperate for a cure. They grasped at anything. Hundreds of worthless patent medicines and fad diets, from potato cures to oatmeal cures, were on the market. But nothing could stop the disease.

Banting looked out the window at the deserted street. His reflection stared back at him. He was tall and big-boned, with a horsey face and wire-rimmed glasses. He had blue eyes and light-red hair. Edith said he had a good smile. But he wasn’t smiling much these days.

He took a dog-eared anatomy book from the shelf. It was the same book he had in Europe when he was a medical officer in the Great War. He used to read it in the trenches while German shells whistled and exploded around him. Major L.C. Palmer, his superior officer, used to kid him about the way he studied. The other men had never seen anything like it. That Banting was something. He had guts. Not even the German guns could shake him. He was wounded in the right arm near Cambrai, France and received the Military Cross. That was two years ago. Now he was a doctor without any patients. A man who couldn’t hold on to his girlfriend, a man with no future.

He opened the book. On the flyleaf was a date and the word “Cambrai.” For a moment, he thought about the war. His Methodist parents brought him up to have a relationship with God, but the brutality of the conflict destroyed almost everything he had believed in. He didn’t go to church anymore. Life in Canada had changed. There were more cars. Food was expensive. Women wanted to vote and have the same rights that men had.

He put the book back on the shelf and looked out the window. He remembered the farm where he grew up, near Alliston, Ontario. He loved the farm. He thought again about his lecture. Pancreas. What a strange word. His family used to eat animal pancreases. They were called sweetbreads and were fried or mixed into poultry stuffing.

In medical school, Banting was taught about the “undernutrition” therapy of Dr. Frederick Allen, an American who kept diabetic patients in a state of starvation as a way of holding down their blood sugar. Allen was lengthening their lives a little by reducing the impact of the disease. However, the patients eventually starved to death or succumbed to diabetes.

Allen did not believe that a pancreatic extract would ever be able to regulate blood sugar in a diabetic. No one did. It had been tried, and it didn’t work. But that didn’t bother Banting. He was blissfully ignorant. He didn’t know anything about the background of Allen’s method, or about diabetes research.

All Banting could think about were his problems with Edith and his lousy medical practice. He wished he could sleep. He began reading an article in a November 1920 medical journal he had just received in the mail, Surgery, Gynecology and Obstetrics.

The article was called, “The Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis,” by Dr. Moses Barron, an American pathologist who had become interested in the pancreas, and its relation to diabetes, while performing autopsies.

The Islets of Langerhans were a cluster of cells that floated within the pancreas like little islands. Scientists thought the islets had something to do with controlling blood sugar. Barron’s article fascinated Banting. During the routine autopsy of a diabetic, Barron discovered that a pancreatic stone (lithiasis) had obstructed the main pancreatic duct to the stomach. What is more, he saw that the cells of the patient’s pancreas had atrophied, or wasted away, while most of the cells in the Islets of Langerhans, within the pancreas, had remained healthy and intact.

Banting finished the article and dropped the medical journal to the floor. He took off his glasses. No matter how hard he tried, he couldn’t get to sleep. He thought about the article, and the lecture he had to give, and rubbed his eyes. He put his face in his hands and cursed. The mantel clock ticked on.

At around 2:00 a.m., Banting sat straight up in his chair. He scribbled twenty-five words in his notebook: “Diabetus. Ligate pancreatic ducts of dog. Keep dogs alive till acini degenerate leaving Islets. Try to isolate the internal secretion of these to relieve glycosurea.”

He misspelled diabetes and glycosuria. The spelling didn’t matter. He’d always had trouble spelling. The important thing was the idea. Tie off the ducts that connect the pancreas to the stomach. Keep the dog alive until acini (pancreatic cells) degenerate, leaving behind the all-important Islets of Langerhans. Try to isolate the internal secretion of these cells. Perhaps it could be used to relieve glycosuria, glucose in the urine, and the symptoms of diabetes.

Banting stayed up most of the night wondering if this mysterious secretion could be turned into an extract. If only it could be used to save diabetics.

In the morning he looked over his note. Maybe the idea was worth pursuing. He decided to try out his experiment. But the animal quarters at Western’s medical building weren’t big enough. Besides, there was a diabetes expert who was nearby, at the University of Toronto. His name was Professor J.J.R. Macleod, a Scotsman and respected researcher in the field of carbohydrate metabolism.

A week later, in November, while Banting was in Toronto for a wedding, he went to see Macleod. It was good to be back on the campus. He had gone to medical school here. But he had also failed his first year of university. He couldn’t forget that.

Banting found Macleod’s office and knocked on the door. “Enter, if you please,” Macleod said in a thick Scottish accent.

The professor looked up from his desk and noticed Banting’s scuffed shoes and threadbare jacket.

“How may I help you?”

“I am a physician and I have a research idea,” Banting said.

“And what is your idea, Doctor…”

“Banting. Doctor Banting.”

When Banting had finished describing his project, the professor said: “What is your research experience?”

“None, to speak of.”

“Your published articles?”

“None.”

“Other than this one article in the gynecology journal, your reading in the extensive diabetes literature of the past thirty years?”

“I’m afraid the answer is none.”

Macleod sighed, looked down, and began reading from his pile of papers and correspondence.

Banting’s face flushed with anger.

“Dammit,” he said. “All I want are a few dogs for research. Maybe my idea is cockeyed. Maybe it’s not. I’d like to find out.”

Macleod stared at Banting. He didn’t like the way this unruly Canadian talked, and he didn’t expect him to succeed. For one thing, Macleod did not believe that an internal secretion of the pancreas could ever be isolated. In 1913, he had published a book on diabetes stating that very fact. Yet, he was intrigued by the idea that Banting wanted to work with atrophied or degenerated pancreases. No one had ever tried to develop an extract from a fully atrophied pancreas. The way Macleod saw it, Banting might as well follow the trail he was on, and besides, a failure in the laboratory might prove useful to diabetes researchers because it could eliminate one more step in the fruitless search for a treatment. He told Banting to wait and try the experiment the next summer.

A defeated Banting took the train home. He wondered if he should give up his medical practice, small as it was, and his part-time teaching job, for a questionable research project. When he mentioned the project to Edith, she told him to grow up and pay attention to his practice. He forgot about diabetes, and continued working in London as a physician.

The next spring, in March of 1921, Banting contacted Macleod to see if he remembered their interview. He did, and invited Banting to Toronto. ...

Table des matières

• Cover
• Title
• Copyright
• Contents
• 1 A Brilliant Idea in the Middle of the Night
• 2 Discovering Insulin
• 3 The Luckiest Boy in the World
• 4 Bringing the Bones to Life
• 5 The Nobel Prize
• 6 Waiting for Another Great Idea
• 7 The Great Utopia and the Ministry of Love
• 8 Painting Till His Fingers Froze
• 9 Fighting Like a Man
• 10 A Man Who Saved Lives
• Chronology of Frederick Banting (1891-1941)
• Sources consulted
• Index