Frederick G. Banting

Canadian physician

• Born: November 14, 1891
• Birthplace: Alliston, Ontario, Canada
• Died: February 21, 1941
• Place of death: Near Musgrave Harbor, Newfoundland, Canada

Along with Charles Herbert Best, Banting is credited with having discovered insulin, one of the great scientific and humanitarian achievements of the twentieth century.

Early Life

Frederick G. Banting was born on his parents’ farm in Alliston, Ontario, and was of Irish-Scottish extraction. The youngest of five children, Frederick enjoyed the advantages of a boyhood in the country and developed an affection for animals and close ties to nature. At local schools he was considered to be a serious but otherwise undistinguished student, although his hardy upbringing did result in his excelling at sports and his tendency toward pugnacity was a particular asset on the athletic field. An important event in his early childhood was seeing Jane, a childhood friend, die of uncontrolled diabetes mellitus. Although, largely because of his father’s encouragement, he had considered becoming a minister, he quickly realized that medicine was his true calling, and he entered the University of Toronto Medical School in 1912.

Banting was about six feet tall and somewhat shy. He had a particularly winning smile and a twinkle in his eye, and although some would characterize his features as “horsey,” he was, when dressed up, a handsome man. Banting’s five-year medical course at Toronto was shortened because of the war, and he recalled in his writings that he had “a very deficient medical training.” Immediately after his graduation, Banting was sent to England. Before he left, he became engaged to his longtime girlfriend, Edith Roach. While serving in England he developed extensive surgical experience dealing with wounds. Six weeks before the end of the war, on learning that the medical officer of the Forty-sixth Battalion had been wounded, he went immediately to take the wounded doctor’s place. Despite receiving a shrapnel wound in his right forearm and orders to return, he went on to the front line and continued serving the wounded until he collapsed from blood loss. The wound in the arm became infected and amputation was threatened. Banting took over the care of his own wound, and with a meticulous program of dressing changes and many, many months of persistence, the wound finally healed. For his courage under fire, he received the Military Cross.

When Banting returned to Canada, he decided to enter practice in London, Ontario, because Edith was teaching in a nearby school. On July 1, 1920, Banting opened an office in the house that he bought in the residential area of London. His practice was slow at the outset; his first patient came in on July 29. One of his good friends at this time was William Tew, with whom he spent many evenings in the study of medicine. Studying was something that Banting enjoyed: It was a way to pass the time in his quiet practice. He resumed preparation for the difficult exam of Fellowship in the British Royal College of Surgeons. He also began assisting Dr. F. R. Miller of London’s Western University, who was a well-known professor of physiology.

Life’s Work

On Sunday, October 30, 1920, Banting, in preparing a lecture on the pancreas and on carbohydrate metabolism for physiology students, became aware of how little was known about the pancreas or diabetes. His copy of the November issue of the journal Surgery, Gynecology, and Obstetrics had just arrived, and he began to read an article titled “The Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis,” by Moses Barron. Barron, while performing routine autopsies, had come on cases in which the pancreatic duct had been obstructed by a stone and had found that most of the pancreas had atrophied except for the islet cells. Previous evidence, as well as this new piece of pathological evidence, seemed to suggest that the islet cells were important in secreting directly into the bloodstream something that prevented diabetes. Banting ruminated over these findings through much of the night. Finally, at two o’clock in the morning, it suddenly occurred to him that the experimental ligation of the pancreatic duct and the subsequent degeneration of those parts of the pancreas responsible for external secretion into the duodenum might then result in one’s being left with only that part of the pancreas important in the secretion of the internal factor thought to be important in diabetes. That would allow this factor to be isolated without being contaminated by the powerful enzymes, such as trypsin, that the pancreas normally secretes into the duodenum. This thought made Banting tremendously excited, and he discussed his theory with Miller, at Western University, who encouraged him to consult John J. R. Macleod, a professor of physiology at the University of Toronto. The interview with Macleod was brief and, as far as Banting was concerned, unsatisfactory. It appeared that Macleod thought him ill-trained for the task he had outlined, and Banting thought that Macleod’s scorn was thinly veiled. Macleod did not dismiss Banting outright, however, and left him the option of pursuing his hypothesis at Toronto. Banting returned to London and discussed his options at length with Miller.

At this point, Banting was considering a number of different routes he might take in his life. His practice was picking up and his income was rising, and he was constantly being encouraged by his fiancé to settle down into full-time practice. Sometime during the winter or spring, while Banting continued to debate over the wisdom of moving to Toronto, Edith apparently broke off the engagement with him. This apparently was the turning point in his decision to go to Toronto, where he again met with Macleod to plan the work. It appeared that Macleod was no more impressed than he had been earlier with Banting’s knowledge of research, but he consented to Banting’s use of the lab. Macleod assigned Charles Herbert Best, a young physiology student, to help Banting in his endeavor. Having given up his instructorship at Western University, sold his house and furnishings in London, and closed his office, Banting had burned his bridges behind him.

For more than a quarter century before Banting undertook his experiments, there was general agreement that the cause of diabetes was the failure of the pancreas to secrete enough of a certain mysterious substance necessary for the proper utilization of carbohydrates as a body fuel. As a result of this failure, the unassimilated sugar was constantly being secreted in the urine, drawing with it tremendous quantities of water and thereby leaving the victim with the triad of tremendous thirst, large volumes of urine, and increasing waste. The problem that had faced physiologists for years, and that had stumped them, was where this mysterious pancreatic secretion resided, as it apparently was not secreted into pancreatic ducts and must therefore be released into the bloodstream directly. Banting and Best began their experiments by ligating the pancreatic ducts of dogs with cat gut. They waited almost seven weeks, which must have been a very nerve-racking period, at which time they opened the dog’s abdomen, only to find, to their bitter disappointment, that the pancreas was not atrophied. The cat gut that had been used for ligatures had disintegrated, so that the gland, no longer blocked, did not degenerate. The experiment was repeated, and on July 30, Banting and Best again operated on the dogs and found the pancreases notably shriveled. They then cut the atrophied organ into small pieces, ground it up, and obtained a crude extract that they then injected into the same dog. By this time the dog had all the symptoms of diabetes, with tremendous sugar in his urine and weight loss. Within a few hours of injecting the substance into the dog, Banting and Best began to see increasing signs of returning strength in the dog, as well as a fall in the blood and urine sugar to normal levels.

This was a very solemn moment. Banting and Best, though quite thrilled with their discovery, were also worried, because it hardly seemed possible that they had achieved, in such a short time and with such crude extracts, what famous scientists had been unable to achieve. Over the next few weeks, Banting and Best refined the techniques both of producing the pancreatic lesion that would allow them to extract this new substance and of improving the method of extraction. They had read that the islets of Langerhans in the fetus were much larger than those in children after birth, and therefore they obtained fetuses from pregnant slaughtered cows and found that the fetal pancreas had oversize islets with a generous supply of this new substance that they termed isletin. When Macleod returned from a long sabbatical in Scotland and was presented with their experimental data, his initial reaction was one of caution. He seems also to have questioned the accuracy of some of the data, and engendered quite a bit of resentment and anger. The memorable part of the interview came when Banting, after relating the problems he had encountered in terms of working conditions, demanded from Macleod a salary, a room in which to work, help in looking after the dogs, and a new floor for the operating room failing which he would leave. Macleod agreed to Banting’s conditions, and Banting was to stay at Toronto. Banting and Best were eager to play the roles of the first human guinea pigs and injected ten units of insulin into each other’s arms and suffered no ill effects. The first chance to test this substance on a human patient came on January 11, 1922, on a fourteen-year-old boy, who had almost reached the end of the life expectancy of a diabetic child. He had high levels of blood sugar and was expected to go into a coma and die within a few days. He was given a small quantity of insulin, injected under the skin, and within a few hours his blood sugar had dropped about 25 percent and the sugar in his urine decreased. After ten days of receiving insulin, the boy looked and felt better. When the insulin was stopped, the boy’s condition deteriorated.

At Banting’s request, James Bertram Collip, an expert in biochemistry, was invited to join the investigation. Things progressed quickly thereafter, and Banting and Best were able to present a paper at the American Physiological Society meeting in New Haven, Connecticut, on December 28, 1921. The world had become aware of their remarkable findings, but unfortunately, as word of their discovery grew, Banting had become increasingly dissatisfied with the state of affairs in the lab and suspicious that Macleod was trying to steal his results. To compound the problem, Collip walked into the lab one day and announced to Banting and Best that he had discovered the active principal in the pancreatic islets, but declined to tell them how he had come to his discovery. The only surviving artifact of this crisis in the lab is an agreement signed by Banting, Best, Collip, and Macleod, dated January 25, 1922, in which all agreed not to take a step that would result in the process of obtaining a pancreatic extract being patented by a commercial firm. Banting became increasingly concerned that he and Best were being treated as technicians while the bulk of the work had been passed on to experts.

In April of 1922, the Toronto group prepared a paper summarizing the entire work to that point. The paper, “The Effect Produced on Diabetes by Extracts of Pancreas,” was presented by Macleod at the meeting of the Association of American Physicians. On May 22, the Toronto group agreed to collaborate with Eli Lilly and Company, which turned all of its huge resources toward the production of this compound.

Much controversy still exists concerning who should actually receive the credit for discovering insulin. The Nobel assembly, on October 25, voted by secret ballot to award the 1923 Nobel Prize in Physiology or Medicine to Banting and Macleod. As soon as Banting heard that, he became angry at the thought of Macleod being given credit for the discovery. He immediately announced that he would share his prize with Best. Macleod, in turn, after some reflection, elected to share his portion with Collip. Numerous letters were written to the Nobel Committee by various persons, protesting the decision. Nicolas Paulesco in Bucharest had done preliminary experiments with pancreatic extract; had he proceeded more quickly, he might well have received the credit for discovering insulin.

Banting became an important public figure and was much sought-after as a speaker and teacher. The Banting and Best Department of Medical Research at the University of Toronto was separate from the rest of the university; it was Banting’s own domain, populated by colorful, reportedly hard-drinking students and cronies, some of whom were also good scientists.

Banting became more interested in things other than medicine, including the arts, and took up painting. In 1924, Canada’s most eligible bachelor was swept off his feet and was married to Marion Robertson, a doctor’s daughter from Ontario. The marriage was short-lived and produced one child. In 1934, Banting was honored with a knighthood, becoming Sir Frederick G. Banting, K.B.E. When the war resumed in 1939, Banting had just been married again, to a technician in his department, and was pressed to serve as coordinating chair of Canada’s medical research wartime effort. While in London in the winter of 1939-1940, he began to write a long account of the discovery of insulin. He returned to Canada in the spring of 1940. On February 21, 1941, he took off from Gander, Newfoundland, on board a Hudson bomber en route to England for a second time. The plane crashed in Newfoundland and Banting died in the wreck. There was much speculation as to the cause of his death and the nature of his mission.

Significance

Banting’s contribution is fundamental to the present era of medicine inasmuch as the understanding of proteins as molecules with a chemical structure that carries information between cells utilizing specific receptors all came about with the availability of insulin. The discovery of insulin has not by any means eliminated all the morbidity of diabetes, but it certainly has extended the lives of millions of diabetics, in many cases allowing them to live nearly normal lives.

Bibliography

Banting, Frederick G., and C. H. Best. “The Discovery and Preparation of Insulin.” University of Toronto Medical Journal 1 (1923): 94-98. This account is a matter-of-fact report on the sequence of experiments leading to the discovery of insulin. The report avoids controversy, and the conflicts between Banting and Macleod are not discussed.

Bayliss, W. M. “Insulin, Diabetes, and Rewards for Discoveries.” Nature 3, no. 2780 (February 10, 1923): 188-191. An excellent account of the discovery of insulin by another distinguished scientist. Bayliss did some preliminary experiments that, had he pursued them, could have led to his discovering insulin.

Bliss, Michael. The Discovery of Insulin. 3d pbk. ed. Toronto, Ont.: University of Toronto Press, 2000. A detailed account of the personalities and events leading to the discovery of insulin, with a short biography of Banting. Macleod is portrayed in a more favorable light than in other books. This book is perhaps the best researched and referenced book on the subject.

Burtness, H. I., and E. F. Cain. “A Thirty-fifth Anniversary of Insulin Therapy.” Diabetes 7 (January/February, 1958): 59-61. A general overview of the impact of insulin on the therapy of diabetes. The almost normal lifestyle and longevity of patients with diabetes in the present day and age is in striking contrast to the days before insulin.

Harris, Seale. Banting’s Miracle: The Story of the Discoverer of Insulin. Philadelphia: J. B. Lippincott, 1946. A biography of Banting that is biased in favor of Banting and against Macleod. It presents a good picture of Banting’s personal life.

Howard, John M., and Walter Hess. History of the Pancreas: Mysteries of the Hidden Organ. New York: Kluwer Academic, 2002. Written by two academic pancreatic surgeons, this history of studies of the pancreas from antiquity to contemporary times includes information about Banting and the discovery of insulin.

Macleod, John James Rickard. “History of the Researches Leading to the Discovery of Insulin.” Bulletin of the History of Medicine 52 (Fall, 1978): 295-312. This is Macleod’s own account of the events leading to the discovery of insulin. A dry, factual account that avoids the controversy between Macleod and Banting.

Pratt, Joseph H. “A Reappraisal of Researches Leading to the Discovery of Insulin.” Journal of the History of Medicine 9 (1954): 281-289. Another viewpoint on the controversy surrounding the discovery of insulin. Clearly, the researchers into the history of the discovery of insulin have all come away with different conclusions this one portrays Macleod as less of a villain than other reports.

Wrenshall, G. A., G. Hetenyi, and W. R. Feasby. The Story of Insulin: Forty Years of Success Against Diabetes. London: Bodley Head, 1962. An account of insulin, its discovery and production, that is well written and highly readable. A fair and objective review of the events at Toronto.