From the archives: How a medical ‘outsider’ discovered insulin

From the archives: How a medical ‘outsider’ discovered insulin thumbnail

To mark our 150th year, we’re revisiting the Popular Science stories (both hits and misses) that helped define scientific progress, understanding, and innovation–with an added hint of modern context. Explore the Notable pages and check out all our anniversary coverage here.

At the time insulin was developed into a life-saving serum, the world was still recovering from The Great War’s 40 million casualties, silent movies were the rage, Ford’s Model T topped auto sales, and 22 of 100,000 New Yorkers were dying of diabetes. The pancreas’s insulin-producing cells, known as the Islands of Langerhans, are destroyed by the disease.

Also in 1920s America, medicine–the kind taught in universities and practiced in cloistered institutions–was the almost exclusive province of wealthy white men. In September 1923, when Popular Science hailed the discovery of insulin as a modern medical miracle, it’s no surprise the magazine (already a half-century old) chose to spotlight the farm-boy pedigree of insulin’s discoverer, Frederick Grant Banting, a young Canadian doctor who was considered an outsider in research circles. Donald Harris wrote Popular Science , quoting a New York City physician. “This young doctor didn’t know much about diabetes. He discovered how to get insulin and use that as a treatment. He was able to extract insulin from animal entrails using a non-conforming lab he set up at the Toronto home of a college friend.

A century after insulin was first administered in trials, diabetes remains a killer, ranked 8th in 2020 by the CDC, taking lives at a faster clip than before its discovery. That’s because diabetes, specifically Type 2, has soared in the US, and not everyone can afford life saving treatments. Even in 1923, doctors understood that insulin was only a stopgap and that a cure would still be needed. In what now seems like an omen directed at the 21st century, Harris wrote, “the medical profession has issued a warning that [insulin] is not to be regarded as a magic or instant cure. In fact, it is not a ‘cure’ at all, since it does not destroy the causes of the disease.”

Even with artificial pancreases, coaxing other organs to grow insulin, and monoclonal antibodies, a cure remains elusive. By the efforts of another nonconforming lab–one that employs highly restricted human embryonic stem cells–a century after Banting’s insulin-treatment discovery, a diabetes cure may be closer than ever.

“Insulin–a miracle of science” (Donald Harris, September 1923)

How a young laboratory assistant won world fame by discovering serum that offers relief to millions of diabetes sufferers

A few weeks ago, six hospitals in the United States brought some shocking news to the scientific community. A serum made from the intestines of animals was given to six hospitals in the United States to be tested for its effectiveness as a treatment for diabetes. It had been so successful in administering the treatment to over 100 patients that the doctors who performed the tests declared it to be a reliable method of controlling the disease.

What “insulin” means

The new serum is insulin, a name derived from the Latin word meaning “island.” This name was applied because the particular groups of intestinal cells from which the serum is extracted are known in medicine as the “Islands of Langerhans.”

Eminent medical men have almost been a unit since the announcement of successful insulin tests. They have declared that insulin will probably be the end of diabetes, which has so far resisted all medical research. Dr. Simon Flexner, director at the Rocks feller Institute for Medical Research has stated that insulin promises to be “one of the greatest medical contributions to this world .”

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Dr. A. I. Ringer, in charge of the test of insulin at the Montefiore Hospital in New York, stated unequivocally that “insulin is undoubtedly one of the greatest discoveries of the age,” and that, now that it has been given to the world, “no person should die of diabetes.”

Dr. Nellis B. Foster, writing in the “New York Medical Journal,” declared, “I think it is safe to say that could one start with insulin before operation, one could be reasonably sure that the patient would not die of diabetes.”

Other medical authorities expressed their endorsement of the new serum with equal enthusiasm, and John D. Rockefeller, Jr., only a few weeks ago contributed $150,000 to permit 15 hospitals in the United States to introduce the use of insulin in their clinics.

The most remarkable and dramatic aspect of this amazing discovery is its discoverer’s personality. The man who gave insulin was not a well-known medical authority. He was not even a scientist. Instead, he was an obscure Canadian doctor of 31, less than six years out of medical college, a farmer’s son, who had accepted with pride a humble position as a laboratory assistant in a Canadian university when he returned wounded from war service only three years ago.

The most valuable part of the discovery was done in the home laboratory of a young Toronto physician, a school friend who allowed him to use his equipment and home because he was on vacation and didn’t need them.

Dr. Frederick Grant Banting is the insulin discoverer. The recent comment by Doctor Flexner

is probably the best example of the general attitude of doctors towards him and his discovery.

Where experts failed

” No one had ever heard about him. There was no reason to believe that anyone should have heard about him.

” This young doctor didn’t know anything about diabetes. He discovered how to make insulin and use it to treat diabetes by accident. He proved his treatment’s effectiveness at Toronto. We had doctors who had so much knowledge and so much scientific background that they couldn’t help us find a cure. We feel like we are kicking ourselves.

” The world is vastly better off today because of Doctor Banting’s discovery and use of insulin. I believe that humanity will never again be as afflicted by this disease as it was for so many years. Although there is still some danger, we will all one day be able to use it safely. Then all the world, every hamlet of it, will appreciate the benefits.”

Doctor Flexner did not intend to downplay the discoverer or the discovery when he spoke of “chance” in Doctor Banting’s discovery. Truth is, Doctor Banting’s achievements have been a result of chance, and no one is more willing to admit this than he.

Diabetes results from the inability of the Islands of Langerhans to properly perform their functions. These “islands” secrete insulin in the normal human body, the same insulin that is taken from animals to fight diabetes.

Carbohydrates–foods of a starchy sort –are converted into sugar, which is absorbed by the intestines. A portion of the sugar is transported to the liver where it is stored in the form of glycogen or animal starch. The blood carries the rest to the muscles and other tissues. Some of it is oxidized, while some is stored as glycogen.

Insulin secreted daily by the average man passes directly into blood. It reacts chemically with sugar substances from food to provide the body with essential elements. The insulin does not perform its chemical action against sugar substances in diabetes. They are then able to circulate in large amounts through the bloodstream and are lost in excretions. In consequence, the body is deprived of an important source for energy. The symptoms of the disease include a voracious appetite, abnormal sugar levels in the blood, and certain bodily excretions.

What causes diabetes

The medical profession knew for a long time that the removal of an animal from the Islands of Langerhans could cause symptoms of diabetes. Patients with diabetes experienced markedly destructive changes in the “islands”. It was concluded that the disease was caused by a disruption in secretions from the islands. Investigators believed that the serum could be made from extracts of secretions from the “islands”, which would supply insulin to diabetics.

Langerhans was the German physician who gave the “islands” their names. However, attempts to obtain pure insulin proved futile because it was destroyed by the powerful digestive ferments in the extracts that were made.

Dr. Banting begins research work

In November, 1920, Doctor Banting, having chanced upon Langerhans’s work on the subject of diabetes, became interested in the possibility of developing the serum, and began experimenting at the laboratories of Western University, where he had been a laboratory assistant for a few months. This work was so fascinating that he applied to take a two-month leave of absence and set up a laboratory in Toronto at Dr. F. W. Hipwell. Doctor Hipwell was a friend from school and college who was going on vacation. Doctor Banting was granted three months leave, which was extended to two months. His experiments were showing encouraging results, and he resigned from the university.

Previous experiments to extract pure insulin from animals’ intestinal tracts had shown that if the ducts were tethered, degeneration occurs much faster than in the Islands. Langerhans Islands: Doctor Banting worked for many months to develop the idea that an extract made from the remaining intestinal tissue, after the ducts were tied, should contain insulin, as there wouldn’t be enough digestive ferments to destroy the insulin.

In I921 his experiments in this line proved successful; he obtained the serum he sought in a comparatively pure state and devised methods of refining it further, in moving from it substances that rendered it unsuitable for repeated injection in man.

By this point, his experiments had reached a point that the University of Toronto authorities allowed him to continue his work at the Connaught Laboratories. After months of intensive work to determine the effects of insulin on normal and diabetic mice, the Banting serum was finally ready for clinical testing. Doctor Banting was assisted at the university by Dr. J. J. Leod and Dr. C. H. Best.

Successful tests in United States

The results of six insulin tests in the United States were all successful. Prior to insulin’s introduction, dietetic was the standard treatment for diabetes. This meant that you had to limit the amount of sugar and starches in your food. This treatment was not satisfactory as the poor diet caused a great loss of strength and energy. In addition, lapses from the strict diet led to recurrences of diabetic symptoms.

Doctors can now allow their patients to eat a strength-sustaining diet while they are under treatment. The serum is usually injected into the arm and restores the body’s normal ability to transform starches, sugars, and other food into the chemical constituents needed for good health.

Many of the diabetic patients who were declared cured by insulin by the clinical directors had been in a diabetic state from which only a few people had ever recovered. Five patients who were in the last stage of the disease were treated at the Montefiore Hospital and discharged.

Robert Lansing is aided by insulin

Robert Lansing is a prominent figure among those insulin has helped. Former Secretary of State, who was suffering from diabetes for many years. He recently stated that he was now well on his way to recovery after six weeks of insulin treatment.

The importance of Doctor Banting’s discovery to the nation’s health is evident in the recent mortality statistics published by the United States Census Bureau. These reveal that for 20 years the number of deaths from diabetes has been increasing steadily in the United States with a really startling increase since 1919.

In New York State the rate of mortality from diabetes is highest–22 in 100,000. New Jersey, Pennsylvania, and Ohio have very high rates of this disease, while the West and South have relatively low numbers. These variations are not due to climate differences, it has been shown, but to the known varying susceptibility of different classes to diabetes. [Editor’s note: Parts of the following phrasing have been edited for sensitivity.] As such, people older than 50 are more likely to get the disease. Whites are more vulnerable than non-whites. Women are more at risk than men. The disease is more common in white nationalities than it is among the Jewish and Irish populations. This means that the death rate from the disease is higher in states where these groups are large. Estimates as to the number of diabetics in this country vary between 500,000 and 2,000,000.

Despite the overwhelming success of insulin, doctors have warned that it should not be considered a miracle cure or instant fix. It is not a cure for the disease, as it does not remove the cause. It is a treatment, not a cure. It merely provides the body with an element that has been removed by the disease. To be successful in treatment, insulin must be injected daily for long periods of time. It is believed that stopping treatment causes the disease to reappear.

Insulin administration requires a high level of skill. The amount of insulin to be administered varies depending on the sugar level of the patient. An overdose of insulin can lead to serious complications, according to medical authorities.

While Doctor Banting has been elevated suddenly from obscurity and to worldwide fame, his close friends say that he remains the same unassuming, serious-minded young man he was after he returned from war, having been wounded, to start his professional career in Toronto. His father and mother are still living in Alliston, Ont. and his siblings and sisters take great pride in him becoming the town’s most prominent son. He still refers to Alliston as his “home .”

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Began life as a farm boy

Before leaving Alliston 12 years ago to enter the University of Toronto, Doctor Banting was a farm boy, performing chores around his father’s homestead like hundreds of other boys in the agricultural sections of Canada. His teachers said that he did not make a significant impact on his studies, but he was persistent and studious. Most people in Alliston believed that he intended to enter ministry until he left to study medicine. After graduating from medical school he joined the Canadian army as a battalion doctor with the rank captain. He was wounded at Cambrai and invalided to England, where he remained until 1920.

Referring back to the incident in his army career, his mother recently provided an interesting sidelight on his character. She recalled that “He made a promise to write to me every Sunday when I went away to college.” He never failed to keep that promise. When his right arm was useless from wounds, he learned to write with his left hand so that I’d continue to get my letters.”

The Canadian Government recently granted Doctor Banting an annuity of $7500 for life in recognition of his discovery of insulin, and the Ontario Legislature has appropriated $10,000 a year to create a department of research in the University of Toronto. This chair will be called the Banting-Best Chair for Research. and Doctor Banting has been appointed its first incumbent at a salary of $6000 a year.

Today, the scientific world is eager to see the new activities of the young doctor who has become a global figure at an age when most professional men are struggling to find a foothold.

From the archives: How a medical ‘outsider’ discovered insulin
September 1923 cover of Popular Science, featuring very fast cars… for their time.

Some text has been modified to conform to current standards and style.

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