Diabetes

From ancient Egyptian medical papyruses, like the Edwin Smith Papyrus, above, we know that the symptoms of diabetes were known in 1552 BC, including the understanding that ants were attracted to people with this disease. Source: Wikipedia

 

 

Diabetes mellitus is one of the oldest known human diseases.

 

The first known mention of diabetes symptoms was in 1552 BCE, when Hesy-Ra, an Egyptian physician, documented, in an Egyptian papyrus, frequent urination as a symptom of a mysterious disease that also caused emaciation. Also around this time, ancient healers noted that ants seemed to be attracted to the urine of people who had this disease. Type 1 and type 2 diabetes were also identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400-500 CE with type 1 associated with youth and type 2 with being overweight. The term “mellitus“ or “from honey“ was added by the Briton John Rolle in the late 1700’s to separate the condition from diabetes insipidus which is also associated with frequent urination. The term “diabetes“ or “to pass through“ was first used in 230 BCE by the Greek Apollonius of Memphis. The disease was rare during the time of the Roman empire with Galen commenting that he had only seen two cases during his career. In 150 CE, the Greek physician Arateus described what we now call diabetes as “the melting down of flesh and limbs into urine.“ From then on, physicians began to gain a better understanding of diabetes.

 

Centuries later, people known as “water tasters“ diagnosed diabetes by tasting the urine of people suspected to have it. If urine tasted sweet, diabetes was diagnosed. To acknowledge this feature, in 1675 the word “mellitus,“ meaning honey, was added to the name “diabetes,“ meaning siphon. It wasn’t until the 1800’s that scientists developed chemical tests to detect the presence of sugar in the urine. As physicians learned more about diabetes, they began to understand how it could be managed. The first diabetes treatment involved prescribed exercise, often horseback riding, which was thought to relieve excessive urination. In the 1700’s and 1800’s, physicians began to realize that dietary changes could help manage diabetes, and they advised their patients to do things like eat only the fat and meat of animals or not consume large amounts of sugar. During the Franco-Prussian War of the early 1870’s, the French physician Apollinaire Bouchardat noted that his diabetic patients’ symptoms improved due to war-related food rationing, and he developed individualized diets as diabetes treatments. This led to the fad diets of the early 1900s, which included the “oat-cure,“ “potato therapy,“ and the “starvation diet.“

 

In 1916, Boston scientist Elliott Joslin established himself as one of the world’s leading diabetes experts by creating the textbook “The Treatment of Diabetes Mellitus,“ which reported that a fasting diet combined with regular exercise could significantly reduce the risk of death in diabetes patients. Today, doctors and diabetes educators still use these principles when teaching their patients about lifestyle changes for the management of diabetes. Despite these advances, before the discovery of insulin, diabetes inevitably led to premature death. The first big breakthrough that eventually led to the use of insulin to treat diabetes was in 1889, when Oskar Minkowski and Joseph von Mering, researchers at the University of Strasbourg in France, showed that the removal of a dog’s pancreas could induce diabetes. In the early 1900s, Georg Zuelzer, a German scientist, found that injecting pancreatic extract into patients could help control diabetes. Frederick Banting, a physician in Ontario, Canada, first had the idea to use insulin to treat diabetes in 1920, and he and his colleagues began trying out his theory in animal experiments. Banting and his team finally used insulin to successfully treat a diabetic patient in 1922 and were awarded the Nobel Prize in Medicine the following year.

 

Frederick Banting in 1938: Photo credit: Arthur Goss – Library and Archives of Canada – PA-123481, Public Domain, https://commons.wikimedia.org/w/index.php?curid=468141

 

A “Flame of Hope” was lit by Her Majesty Queen Elizabeth the Queen Mother in 1989 as a tribute to Dr. Frederick Banting and all the people that have lost their lives to diabetes. The flame will remain lit until there is a cure for diabetes. When a cure is found, the flame will be extinguished by the researchers who discover the cure. The flame is located at Sir Frederick Banting Square in London, Ontario, Canada beside the Banting House National Historic Site of Canada.

 

Best and Banting in 1924.  Photo credit: University of Toronto, Public Domain, https://commons.wikimedia.org/w/index.php?curid=5956010

 

A time capsule was buried in the Sir Frederick Banting Square in 1991 to honor the 100th anniversary of Sir Frederick Banting’s birth. It was buried by the International Diabetes Federation Youth Representatives and Governor General of Canada Ray Hnatyshyn. It will be exhumed if a cure for diabetes is found. Prior to the award of the Nobel Prize in Physiology or Medicine for 1923, which Banting shared with Macleod, he received the Reeve Prize of the University of Toronto (1922). In 1928 Banting gave the Cameron Lecture in Edinburgh. He was a member of numerous medical academies and societies in Canada and abroad, including the British and American Physiological Societies, and the American Pharmacological Society. In 1934 he was knighted as a Knight Commander of the Order of the British Empire (KBE) and became an active Vice-President of the Diabetic Association (now Diabetes UK). In May, 1935 he was elected a Fellow of the Royal Society. In 2004, Banting was inducted into the National Inventors Hall of Fame.

 

Sir Frederick Grant Banting

 

Sir Frederick Grant Banting, KBE MC FRS FRSC (November 14, 1891 – February 21, 1941) was a Canadian medical scientist, physician, painter, and Nobel laureate noted as the co-discoverer of insulin and its therapeutic potential. In 1923 Banting and John James Rickard Macleod received the Nobel Prize in Medicine. Banting shared the award money with his colleague, Dr. Charles Best. As of November 2016, Banting, who received the Nobel Prize at age 32, remains the youngest Nobel laureate in the area of Physiology/Medicine. In 1923 the Government of Canada granted Banting a lifetime annuity to continue his work. In 1934 he was knighted by King George V.

 

Frederick Banting was born on November 14, 1891, in a farm house near Alliston, Ontario. The youngest of five children of William Thompson Banting and Margaret Grant, Banting attended public high schools in Alliston. In 1910, he started at Victoria College, part of the University of Toronto, in the General Arts program. After failing his first year, he petitioned to join the medical program in 1912 and was accepted. He began medical school in September 1912. In 1914, he attempted to enter the army on August 5, and then again in October, but was refused due to poor eyesight. Banting successfully joined the army in 1915, and spent the summer training before returning to school. His class was fast-tracked to get more doctors into the war and so he graduated in December 1916 and reported for military duty the next day. He was wounded at the Battle of Cambrai in 1918. Despite his injuries, he helped other wounded men for sixteen hours, until another doctor told him to stop. He was awarded the Military Cross in 1919, for heroism.

 

Banting returned to Canada after the war and went to Toronto to complete his surgical training. He studied orthopedic medicine and, in 1919-1920, was Resident Surgeon at The Hospital for Sick Children. Banting was unable to gain a place on the hospital staff and so he decided to move to London, Ontario to set up a medical practice. From July 1920 to May 1921, he continued his general practice, while teaching orthopedics and anthropology part-time at the University of Western Ontario in London because his medical practice had not been particularly successful. From 1921 to 1922 he lectured in pharmacology at the University of Toronto. He received his M.D. degree in 1922, and was also awarded a gold medal. An article he read about the pancreas piqued Banting’s interest in diabetes. Banting had to give a talk on the pancreas to one of his classes at the University of Western Ontario on November 1, 1920, and as a result, read reports that other scientists had written. Research by German pathologist Bernhard Naunyn, Oskar Minkowski, American physician and pathologist Eugene Lindsay Opie, English physiologist Edward Albert Sharpey-Schafer, and others suggested that diabetes resulted from a lack of a protein hormone secreted by the islets of Langerhans in the pancreas. Schafer had named this putative hormone “insulin“. Insulin was thought to control the metabolism of sugar; its lack led to an increase of sugar in the blood which was then excreted in urine. Attempts to extract insulin from ground-up pancreas cells were unsuccessful, likely because of the destruction of the insulin by the proteolysis enzyme of the pancreas. The challenge was to find a way to extract insulin from the pancreas prior to it being destroyed.

 

Moses Barron published an article in 1920 which described experimental closure of the pancreatic duct by ligature; this further influenced Banting’s thinking. The procedure caused deterioration of the cells of the pancreas that secrete trypsin which breaks down insulin, but it left the islets of Langerhans intact. Banting realized that this procedure would destroy the trypsin-secreting cells but not the insulin. Once the trypsin-secreting cells had died, insulin could be extracted from the islets of Langerhans. Banting discussed this approach with J. J. R. Macleod, Professor of Physiology at the University of Toronto. Macleod provided experimental facilities and the assistance of one of his students, Dr. Charles Best. Banting and Best, with the assistance of biochemist James Collip, began the production of insulin by this means. As the experiments proceeded, the required quantities could no longer be obtained by performing surgery on living dogs. On November 16, 1921, Banting hit upon the idea of obtaining insulin from the fetal pancreas. He removed the pancreases from fetal calves at a William Davies slaughterhouse and found the extracts to be just as potent as those extracted from the dog pancreases. Pork and beef would remain the primary commercial sources of insulin until they were replaced by genetically-engineered bacteria in the late 20th century. In spring of 1922, Banting established a private practice in Toronto and began to treat diabetic patients, including Elizabeth Hughes Gossett, daughter of then U.S. Secretary of State Charles Evans Hughes.

 

Banting and Macleod were jointly awarded the 1923 Nobel Prize in Physiology or Medicine. Banting split his half of the Prize money with Best, and Macleod split the other half of the Prize money with James Collip. Banting was appointed Senior Demonstrator in Medicine at the University of Toronto in 1922. The following year he was elected to the new Banting and Best Chair of Medical Research, endowed by the Legislature of the Province of Ontario. He also served as Honorary Consulting Physician to the Toronto General, the Hospital for Sick Children, and the Toronto Western Hospital. At the Banting and Best Institute, he focused his research on silicosis, cancer, and the mechanisms of drowning. In 1938, Banting’s interest in aviation medicine resulted in his participation with the Royal Canadian Air Force (RCAF) in research concerning the physiological problems encountered by pilots operating high-altitude combat aircraft. Banting headed the RCAF’s Number 1 Clinical Investigation Unit (CIU), which was housed in a secret facility on the grounds of the former Eglington Hunt Club in Toronto. During the Second World War he investigated the problems of aviators, such as “blackout“ (syncope). He also helped Wilbur Franks with the invention of the G-suit to stop pilots from blacking out when they were subjected to g-forces while turning or diving. Another of Banting’s projects during the Second World War involved using and treating mustard gas burns. Banting even tested the gas and antidotes on himself to see if they were effective.

 

Banting developed an interest in painting beginning around 1921 while he was in London, Ontario. Some of his first pieces were done on the back of the cardboard in which his shirts were packed by the dry-cleaners. He became friends with The Group of Seven artists A. Y. Jackson and Lawren Harris, sharing their love of the rugged Canadian landscape. In 1927 he made a sketching trip with Jackson to the St. Lawrence River in Quebec. Later that year they traveled to RCMP outposts in the Arctic on the Canadian Government supply ship Beothic. The sketches, done both in oils on birch panels and in pen and ink, were named after the places he visited: Craig Harbor, Ellesmere Island; Pond Inlet, Baylot Island; Eskimo tents at Etach; others were untitled. Jackson and Banting also made painting expeditions to Great Slave Lake, Walsh Lake (Northwest Territories), Georgian Bay, French River and the Sudbury District.

 

Banting married twice. His first marriage was to Marion Robertson in 1924; they had one child, William (born 1928). They divorced in 1932 and Banting married Henrietta Ball in 1937. Four years later, In February 1941, Banting died of wounds and exposure following the crash of a Lockheed L-14 Super Electra/Hudson in which he was a passenger, in Musgrave Harbor, Newfoundland. After departing from Gander, Newfoundland, both of the plane’s engines failed. The navigator and co-pilot died instantly, but Banting and the pilot, Captain Joseph Mackey, survived the initial impact. According to Mackey, the sole survivor, Banting died from his injuries the next day. Banting was en route to England to conduct operational tests on the Franks flying suit developed by his colleague Wilbur Franks. Banting and his wife are buried at Mount Pleasant Cemetery in Toronto.

 

In 1994 Banting was inducted into the Canadian Medical Hall of Fame. In 2004, he was nominated as one of the top 10 “Greatest Canadians“ by viewers of the Canadian Broadcasting Corporation. When the final votes were counted, Banting finished fourth behind Tommy Douglas, Terry Fox and Pierre Trudeau.

 

Banting’s namesake, the Banting Research Foundation, was created in 1925 and provides funding to support health and biomedical research in Canada. Banting’s name is immortalized in the yearly Banting Lectures, given by an expert in diabetes, and by the creation of the Banting and Best Department of Medical Research of the University of Toronto; Sir Frederick G Banting Research Centre located on Sir Frederick Banting Driveway in the Tunney’s Pasture complex, Ottawa, ON; Banting Memorial High School in Alliston, ON; Sir Frederick Banting Secondary School in London, ON; Sir Frederick Banting Alternative Program Site in Ottawa, ON; Frederick Banting Elementary School in Montr?al-Nord QC and ?cole Banting Middle School in Coquitlam, BC. The “Major Sir Frederick Banting, MC, RCAMC Award for Military Health Research“, sponsored by the True Patriot Love Foundation, is awarded annually by the Surgeon General to the researcher whose work presented at the annual Military and Veterans Health Research Forum is deemed to contribute most to military health. It was first awarded in 2011 in the presence of several Banting descendants. The “Canadian Forces Major Sir Frederick Banting Term Chair in Military Trauma Research“ at Sunnybrook Health Sciences Centre was established in 2012. The first Chair holder is Colonel Homer Tien, Medical Director of Sunnybrook’s Tory Regional Trauma Centre and Senior Specialist and Trauma Adviser to the Surgeon General. The Banting Postdoctoral Fellowship Program is administered by the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research Council of Canada. The fellowship provided up to two years of funding at $70,000 per year to researchers in health, natural sciences, engineering, social sciences and humanities.

 

Banting House, his former home located in London, Ontario, was declared a National Historic Site of Canada in 1997. The Banting Interpretation Centre in Musgrave Harbor, Newfoundland and Labrador is a museum named after him which focuses on the circumstances surrounding the 1941 plane crash which claimed his life. The crater Banting on the Moon is also named after him for his contributions to medicine. During the voting for “Greatest Canadians“ in late 2003, controversy arose over the future use of the Banting family farm in New Tecumseth which had been left to the Ontario Historical Society by Banting’s late nephew, Edward, in 1998. The dispute centered on the future use of the 40 ha (100 acre) property and its buildings. In a year-long negotiation, assisted by a provincially appointed facilitator, the Town of New Tecumseth offered $1 million to the Ontario Historical Society (OHS). The town intended to turn the property over to the Sir Frederick Banting Legacy Foundation for preservation of the property and buildings, and the Legacy Foundation planned to erect a Camp for Diabetic Youths. The day after the November 22, 2006, deadline for the OHS to sign the agreement, the OHS announced that it had sold the property for housing development to Solmar Development for more than $2 million. The Town of New Tecumseth announced it would designate the property under the Ontario Heritage Act. This would prevent its commercial development and obligate the owner to maintain it properly. OHS objected. The Ontario Conservation Review Board heard arguments for and against designation in September 2007 and recommended designation of the entire property in October. The Town officially passed the designation by-law on November 12, 2007.

 

Banting’s artwork has gained attention in the art community; A painting of his called “St. T?te des Cap“ sold for $30,000 including buyer’s premium at a Canadian art auction in Toronto.

 

He and his insulin discovery have also been depicted in various media formats, including comic books, the biography by Michael Bliss, and on television. The National Film Board of Canada produced a short film in 1958, The Quest, about his initial insulin experiments on dogs. The 1988 television movie Glory Enough for All depicted the search for insulin by Banting and Best, with R. H. Thomson starring as Banting. Banting is also portrayed by Jason Priestley boarding his fatal flight in the 2006 historical drama Above and Beyond.

 

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