Monthly Archives: December 2022

Frederick Banting and the Isolation of Insulin

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By Paul Theerman, Director

F. G. Banting, December 27, 1922.
(All photos from the University of Toronto Libraries.)

One hundred years ago, on December 21, 1922, Frederick Grant Banting (1891–1941) addressed the New York Academy of Medicine. He had been invited to give a talk on his new therapy that used insulin to treat diabetes. Less than a year earlier, in January 1922, the first diabetes sufferer had been successfully treated for this invariably fatal condition. Less than a year later, on December 10, 1923, Banting’s name was read out at the Nobel ceremony in Stockholm, as he and John Macleod were awarded the prize in Physiology or Medicine. During this Nobel month—the annual prizes were given out last Saturday, the 10th—we take a look at this signal discovery.

The story of the isolation and therapeutic use of insulin can be told as a remarkably short and direct one. After medical and surgical training at the University of Toronto and serving in World War I, Frederick Banting set up his medical practice in London, Ontario. He also taught there, at the University of Western Ontario, and as part of preparing for his lectures, he considered a possible solution to a persistent problem in diabetes studies. For over 50 years, medical researchers had explored the role of the pancreas gland in digestion, and specifically in diabetes. This condition is characterized by high levels of sugar in the urine, leading to frequent urination, increased thirst and hunger, and dramatic weight loss. The condition can progress to the acute symptoms of nausea, vomiting, and coma, eventually leading to death. There is no cure. In Banting’s time, sufferers faced a near-starvation diet as part of a difficult and short life.

By the turn of the century, diabetes researchers had focused on the role in diabetes of the “islets of Langerhans,” microscopic glands spread throughout the pancreas. They supposed that a hormone produced by these glands—called “insulin” from the Latin word for “island,” given its source in the islets—played a crucial role in sugar metabolism. To use this insight therapeutically, though, ran up against a seemingly insurmountable challenge. One could hope to treat diabetes by administering an extract from the glands, and the usual way of preparing such extracts was to grind up the organ and then isolate and purify the hormone. But most of the pancreas produces digestive juices, and these juices promptly broke down the hormone. In 1920, Banting, reading through the medical literature, had a crucial insight: tying off the pancreatic duct could cause the rest of the pancreas to deteriorate, leaving behind only the insulin-producing islets. He took his idea to physiologist J. R. R. Macleod (1876–1935) at the University of Toronto, who provided him with a laboratory, experimental animals, and a medical student to help, Charles H. Best (1899–1978).

J. R. R. Macleod, ca 1923.
Graduation photograph of Charles Best, 1921.

By April 2021, Banting and Best had begun work, tying off the pancreatic ducts in dogs, waiting for the pancreas to deteriorate, and then isolating the insulin from the remaining pancreatic tissue.

J. B. Collip, ca. 1920.
F. G. Banting (right) and C. H. Best with a dog on the roof of the Medical Building, University of Toronto, [August 1921].

They soon turned instead to fetal calves as an insulin source—at an early stage of development, the islets of Langerhans already produced the hormone, while the pancreas’s digestive enzymes had not yet begun to be produced. In December Macleod assigned biochemist James Collip (1892–1965) to the project, to help purify the insulin and avoid allergic reactions.

After success in dogs, in January 1922 came the first successful therapeutic use in humans, at Toronto General Hospital, on 14-year-old Leonard Thompson. Then living on a 450-calorie-per-day diet and shrunk to 65 pounds, Thompson responded well to the insulin injections, and went on to live many more years. On February 7 Banting and Best announced their success at the Academy of Medicine of Toronto.

There was an immediate world-wide response. Patients flocked to Toronto for treatment. By 1923, the Eli Lilly Company was producing insulin commercially. In June 1923, John D. Rockefeller, Jr., contributed $150,000—equivalent to over $2.6M today—to 15 hospitals in the United States and Canada to support the use of insulin, including two New York hospitals, the Physiatric Institute and Presbyterian Hospital; two hospitals in Toronto; and $5,000 for the Banting-Best Fund of the University of Toronto. By December 1923, J. Sjöquist in his Nobel Presentation Speech could state: “Since [its discovery], the new remedy, the production of which does not offer any great technical difficulties, has come into use in practically all countries and with favourable results.”

Banting’s rewards were immediate and great. In 1922, he was given a Senior Demonstrator position at the University of Toronto, and the next year elected to the Banting and Best Chair of Medical Research at the University of Toronto. In August 1923 he made the cover of Time magazine. In December 1923 he and Macleod were awarded the Nobel Prize in Medicine or Physiology. Banting shared the credit and his prize money with Charles Best while Macleod did the same with James Collip. In 1925, the Banting Research Foundation was established, a private institution that supported his research, as well as that of other Canadian scientists. In 1934, he received a knighthood from King George V, and the following year was made a Fellow of the Royal Society.

In 1930, Banting was appointed the inaugural departmental chair of the Banting and Best Department of Medical Research. There he developed an interest in aviation medicine. With his help, Wilbur R. Franks (1901–1986), his Toronto colleague, developed an aviation “g-suit.” This garment used water-filled bladders to counteract the g-forces that developed during rapid acceleration that pulled blood away from the brain and caused blackouts. Banting was on his way to England to assist Franks in testing the suit for wartime use when his plane crashed in Newfoundland, near the town of Musgrave Harbour. He died February 21, 1941, at the age of 49. The New York Academy of Medicine had awarded Banting honorary Fellowship in 1933; at their May 1941 meeting, the Fellows honored his memory.

The story of insulin is, of course, more complex than this quick sketch affords. Historian Michael Bliss has looked more closely at Banting’s complicated life, and various authors have considered Banting’s long line of predecessors, the tensions among the Toronto team, and how credit was granted—or not—for isolating insulin. What is sure, though, is that this advance improved the lives of millions within a dramatically short span of time—a rare feat in the history of medicine.

Bibliography

Frederick G. Banting, “Facts; Biographical; Nobel Lecture,” The Nobel Prize in Physiology or Medicine 1923, https://www.nobelprize.org/prizes/medicine/1923/banting/facts/, accessed November 30, 2022.

F. G. Banting and C. H. Best, “The Internal Secretion of the Pancreas,” The Journal of Laboratory and Clinical Medicine, 7 (5; February 1922): 256–71.

Michael Bliss, Banting: A Biography (Toronto: University of Toronto Press, 1992).

Michael Bliss, The Discovery of Insulin (Chicago: University of Chicago Press, 1982).

Alberto de Leiva, Eulàlia Brugués, and Alejandra de Leiva-Pérez, “El descubrimiento de la insulina: continúan las controversias después de noventa años/The discovery of insulin: Continued controversies after ninety years,” Endocrinología y Nutrición (English Edition) 58/9 (November 2011): 449–56. DOI: 10.1016/j.endoen.2011.10.001. https://www.elsevier.es/en-revista-endocrinologia-nutricion-english-edition–412-articulo-the-discovery-insulin-continued-controversies-S2173509311000614, accessed November 30, 2022.

“The Discovery and Early Development of Insulin,” The University of Toronto Libraries, March 2003, https://insulin.library.utoronto.ca/, accessed November 30, 2022.

Allison Piazza, “Shoot That Needle Straight (Item of the Month),” Books, Health, and History, November 18, 2016, https://nyamcenterforhistory.org/2016/11/18/shoot-that-needle-straight-item-of-the-month/, accessed November 30, 2022.

“Rockefeller Gives $150,000 for Insulin,” The New York Times, June 20, 1923.

James Ralph Scott, “In Memoriam, Frederick Grant Banting,” Bulletin of the New York Academy of Medicine 17 (5; May 1941): 400–402.; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1933643/?page=1, accessed December 13, 2022.

J. Sjöquist, “Presentation Speech [on the occasion of the award of the Nobel Prize in Physiology or Medicine to Frederick Grant Banting and John James Richard Macleod],” December 10, 1923. The Nobel Prize in Physiology or Medicine 1923, https://www.nobelprize.org/prizes/medicine/1923/ceremony-speech/, accessed November 30, 2022.

Ignazio Vecchio, Cristina Tornali, Nicola Luigi Bragazzi, and Mariano Martini, “The Discovery of Insulin: An Important Milestone in the History of Medicine,” Frontiers in Endocrinology. 9 (23 October 2018): 613. doi: 10.3389/fendo.2018.00613. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205949/, accessed November 30, 2022.

Library Luminaries: Gertrude Annan

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This post is the last in a four-part series showcasing notable figures in the history of the Academy Library as we celebrate our 175th anniversary. The first post focused on Dr. Samuel Smith Purple, the second post featured Dr. Archibald Malloch, and the third post featured Frank Place. A blog post on Janet Doe, another Library Luminary, appeared in 2021.

By Arlene Shaner, Historical Collections Librarian

In a Medical Library Association Oral History Committee interview published in 1978, Gertrude Annan (1904–1993), recounted the serendipitous turn of events that led her to the Library at the New York Academy of Medicine. Annan was born on December 4, 1904, grew up in Rhode Island, and graduated from Brown University in 1925 with a degree in English. A problem with her eyes initially prevented her from working, and during that time she decided not to pursue a teaching career, enrolling in secretarial school instead. She then accepted a job at the John Carter Brown Library, working for the librarian, Lawrence Wroth. Here she found the “most exciting, rewarding, enriching world that I never knew existed.”[1] Wroth recognized how talented she was, quickly shifted her away from her secretarial duties and took her on as his assistant, teaching her about the history of books and printing, and how to catalog rare materials.

For two years Annan worked on a cataloging project at the JCB, but when she expressed an interest in going to New York, Wroth provided her with letters of introduction to scholars and bookmen. The book dealer Lathrop C. Harper introduced her to Archibald Malloch, who had become the Librarian at the Academy in 1926. Malloch already had plans to enrich the Library with a Rare Book and History Room, having purchased the Edward Clark Streeter collection of rare historical medical texts in 1928. When he offered Annan a job in 1929, Wroth told her to “Give it a good try. Stay at least 6 weeks.”[2] She stayed for 41 years.

Annan took on the position of Head of the Rare Books Department shortly after her arrival in the Library, serving in that role for the next quarter century, a period of significant growth. The deep knowledge of Americana and the history of books and printing that she developed at the JCB combined with Malloch’s expertise in the history of medicine to make them ideal partners. Committed to developing the rare book holdings, they also recognized that building an extraordinary collection of reference books about the history of books and printing and the history of science and medicine was the key to making the Library even more useful. Their legacy endures: these reference works continue to be consulted by readers and library staff alike.

With her encouragement, in 1946 a group of interested Fellows formed the Friends of the Rare Book Room, and she worked closely with that group from its inception until her retirement. When the Friends decided in 1948 to launch a small periodical, The Academy Bookman, they did so because they were assured of her full collaboration. She collected content, provided editorial assistance, and documented the many gifts and purchases that arrived in the Library due to the generosity of the Friends and other donors in issue after issue over the course of the next several decades.

In 1953, Janet Doe, who stepped into the role of Librarian in 1949 after Malloch’s retirement, moved Annan into the position of Associate Librarian, and she became the Librarian herself when Doe retired in 1956. Annan and Doe already had a history of collaboration. Doe asked her to write two chapters, one on rare books and the history of medicine and the other a guide to the most useful reference works for a historical medical collection, for the first edition of the Handbook of Medical Library Practice, published in 1943. Annan later took on the role of editor herself, with Jacqueline Felter, for the third edition, which appeared in 1970.

As she shifted into her new administrative role in the Library, Annan also took on national leadership roles, as the leader or a member of the publication, finance, and nominating committees of the Medical Library Association, and then as its president in 1961, shepherding the association through the process of creating a central administrative office. She delivered the inaugural Janet Doe Lecture at the MLA annual meeting in 1967, and in 1968 was the recipient of its Marcia C. Noyes award. An advocate for collaboration among libraries, she was instrumental in the creation of the Medical Library Center of New York, which began providing services in 1961 at NYAM itself until its own headquarters opened in 1964. With others, she then worked on a model to expand the reach of the MLC into the broader New York metropolitan area and the state.

Annan’s interests in the history of medicine, the history of NYAM itself, and the development of the library profession led to a wide range of publications on many topics. She wrote short biographical articles about early Academy Fellows, including Alexander Stevens and Valentine Mott, and wrote extensively about the importance of collecting the history of medicine, and about the changing roles of medical and rare book librarians. A special tribute issue of The Academy Bookman published in 1971 provides a long (but not complete) list. A founder of the Medical Archivists of New York, after her retirement Annan spent years sorting and organizing the Academy’s own archives, and the meticulous finding aids she created are invaluable to anyone searching for information about NYAM’s history up through the early 1980s.

Joseph Tamerin began his Bookman tribute piece to Annan and her work with archives with an illustration of her with one of her acknowledged Academy heroes, Samuel Smith Purple.

To honor her years of devoted service, in 1974 NYAM awarded the Academy Plaque to its two great woman librarians, Gertrude Annan and Janet Doe. It was a well-deserved honor for them both. Annan died on December 2, 1993.

Gertrude Annan and Janet Doe (n.d.), gift of Donna Brennan.

References

Annan, Gertrude L. (Gertrude Louise), Vicki Glasgow, Myrl Ebert, and Estelle Brodman. Medical Library Association Oral History Committee Interview with Gertrude Louise Annan. Chicago, IL: Medical Library Association, 1978.

Annan, Gertrude L., Jacqueline W. Felter, Erich Meyerhoff, and Lee Ash. “Regional Plans for Medical Library Service New York State and the New York Metropolitan Area.” Bulletin of the Medical Library Association 52, no. 3 (1964): 503.

Keys, Thomas E. “Past presidents I have known.” Bulletin of the Medical Library Association 63, no. 1 (1975): 49.

Lambert Jr, S. W. “Presentation of the Academy Plaque to Miss Gertrude L. Annan.” Bulletin of the New York Academy of Medicine 50, no. 10 (1974): 1059.

Meyerhoff, E. “Gertrude Louise Annan, 1904–1993.” Bulletin of the Medical Library Association 82, no. 4 (1994): 458.

Morgenstern, S., P. Cranefield, P. Wade, J. W. Felter, M. H. Saffron, J. A. Tamerin, C. C. Morchand, and A. S. Lyons. “Tributes to Gertrude L. Annan.” The Academy Bookman 24, no. 2 (1971): 2–20.

Notes

[1] Gertrude L. (Gertrude Louise) Annan, et al. Medical Library Association Oral History Committee Interview with Gertrude Louise Annan. Medical Library Association, 1978, p. 2.

[2] Ibid.