Chapter 2: Banting’s Idea (Michael Bliss)

Frederick Grant Banting, always called Fred, was born on a farm near the small town of Alliston, Ontario, on November 14, 1891.He was of British descent, his grandfather having emigrated to Canada about forty years earlier.* His parents, Margaret Grant and William Banting, were hard-working farm people, devout Methodists, and reasonably prosperous, sober citizens. The youngest of five children, Fred enjoyed a normal farm boyhood in turn-of-the-century rural Ontario, growing up close to nature and with a deep affection for animals. He seems to have been happy at home and to have had a particularly close relationship with his mother. At local schools in Alliston he was a serious minded but unremarkable student. “We would not have picked him for one on whom fame should settle,” his public school principal said some years later.

Banting went on to higher education at the University of Toronto, the province’s largest and best university. Located on the shores of Lake Ontario, about forty miles south of Alliston, Toronto was the provincial metropolis and Canada’s second-largest city, a thriving community of more than five hundred thousand. Originally uncertain of his vocation―his parents had encouraged him to think of entering the Methodist ministry―Fred dropped out of an arts course towards the end of his first year and re-enrolled in medicine the next autumn, 1912. The university’s faculty of medicine was one of the largest, in terms of student enrolment, in North America, well-equipped, and apparently fairly well-staffed. Its teaching hospital, Toronto General, had recently been rebuilt and was one of the best anywhere. There was a growing emphasis at Toronto on research as a vital accompaniment to the teaching of a medical school.’
Banting was an average medical student, more serious and more studious than most, shy, best at athletics. He was tallish, almost six feet, and strong, and when dressed-up could be a handsome young man, with a particularly winning broad smile and an attractive twinkle in his eye. In a less flattering light his face had “horsey” features― it was long and narrow and his mouth seemed to stretch from one side to the other―and in his manners and conversation Fred was very much the unpolished country boy. He could seem intellectually slow; his studiousness was a kind of dogged determination to get through and never won him more than average grades. In his free time he enjoyed most of the male rituals of the university, although he apparently never learned to dance, possessing, as they said, two Methodist feet. Much of his spare time was spent with his girlfriend, Edith Roach, a languages student whose father had been the Methodist minister in Alliston.

Banting’s five-year medical course at Toronto was shortened because of the war. The class of ‘ITT’ (Toronto, 1917) took its fifth year in the summer of 1916. “I had five pages of notes on the whole lectures of the fifth year,” Banting recalled, writing that he had “a very deficient medical training.” Immediately after final results were announced in December, every able-bodied member of the class went off to war. Banting, who had been serving part-time in the Canadian Army Medical Corps for two years, was sent to England in 1917. He and Edith became engaged before he left. After a year working in hospitals in England, Captain Banting was sent to the front as a battalion medical officer. He saw a fair bit of action and received the Military Cross for his courage under fire at Cambrai, where he was wounded in the arm by shrapnel. He had a long convalescence in Britain, returned to Toronto in March of 1919, and was posted to Christie Street Military Hospital before his discharge. During his free time in the army, Banting studied to take the examinations leading to the stamp of approval of various medical bodies such as the Royal College of Physicians of London and the Royal College of Surgeons. He seems to have had a deep commitment to his profession, and was gradually developing an interest in research. Before and during his military service he worked with Clarence L. Starr, the brilliant chief surgeon at the Hospital for Sick Children in Toronto, who became something of a hero and medical father-figure to him, As soon as he was free from the army, in September1919, Banting returned to Sick Children’s as a resident in surgery, with particular interest in orthopedics. Specialization was still fairly primitive in those years, however, and it is misleading to think of Banting as a trained orthopedic surgeon. Much of his surgical experience had from treating wounded soldiers. At Sick Children he did general surgery.

It is not possible to judge Banting’s ability as a surgeon. After he became world famous, and stopped doing surgery, the natural tendency was to say that Fred was a highly skilled surgeon. Evidence of such skill is not contained unambiguously in his insulin notebooks. Banting was certainly experienced, for he had treated more wounds in the summer of 1918 than some peacetime surgeons would see in a lifetime, He was also popular with the sick children in the hospital. But he was not able to win a permanent position at the Hospital for Sick Children. “Surgeons were very plentiful in Toronto. It was my greatest ambition to obtain a place on the staff of the hospital, but this was not forthcoming.” Instead, perhaps on the advice of C.L. Starr, and knowing that Edith would be teaching high school in a nearby town, Fred decided to set up a practice in the city of London, Ontario, about 110 miles west of Toronto.

I

On July I, 1920, Banting opened an office in a house he had bought on a corner in a residential area of London. He must have known it would take time to build up a practice in a strange city, with whose doctors he had no ties and in a profession which forbade advertising. Even so, he was not prepared for the depressing reality of his situation. Day after day in July, Doctor Banting6 kept his standard office hours, two to four in the afternoon, seven to nine in the evening, six days a week. He saw no patients at all. Not one. The first customer finally came on July 29. The patient’s “illness” was his friends’ thirst for liquor in a province where prohibition held sway. Only doctors could dole out alcohol, and then solely for medicinal purposes. “He was an honest soldier,” Banting wrote, “who had friends visiting him and he wanted to give them a drink. I gave him the prescription and considered myself rather highly trained for the barkeeping business.” Dr Banting’s July income was $4.

Patients started to dribble in during August, but business was miserably slow. Already in debt from his medical education, Banting had borrowed money from his father to buy the house in which he practised and lived. Every week of medical practice drove him deeper into debt. He tried to save money by cutting out motion pictures and often cooked his meals on the bunsen burner in his dispensary. To while away the time, Banting built a garage and started dabbling with oil paints. He also tinkered with the worthless old fourth-or fifth-hand car he had bought – having paid much more than it was worth, he discovered, the kind of realization that reinforced his sense of failure. The car soon failed, too, and had to be scrapped.

Although always a bit of a loner, Banting craved male companionship and female affection. He and a classmate, Bill Tew, who had also begun practice in London, spent “about five nights out of seven” commiserating about the practice of medicine. The camaraderie must have been marred slightly for Fred by the realization that Tew’s. practice was developing better than his. On weekends he would see Edith, but there was trouble there too. The successful female teacher was making three or four times as much money as the uncertain, insecure male doctor. Apparently they were not as sure of their love as they had been in 1916: the farmer’s son who had been to the wars and the minister’s scholarly daughter, gold medallist in her class, may have realized they had changed over the years. Edith may have been developing other interests. “I was very unhappy and worried, Banting wrote about that early period in London.8
Studying was another way to pass the time. Banting resumed preparation that he had broken off several years earlier to take the difficult exams for a fellowship in the British Royal College of Surgeons. He also got a part-time job in October as a demonstrator in surgery and anatomy at London’s Western University. Western’s faculty of medicine was small and undistinguished, but had a few good professors and a promising future based on an ambitious building program. As well, Banting could also use the $2 an hour he was paid. He soon began assisting Dr. F.R. Miller, Western’s very good professor of physiology, in occasional experiments in cerebral and cerebellar localization.

II

On Sunday, October 31, 1920, Banting spent several hours preparing a talk he had to give to physiology students on carbohydrate metabolism. Neither the topic, nor the associated disease, diabetes, were subjects in which Banting had any particular interest. Stories grew up later about diabetic school chums having had a profound influence on him, and so on, but actually Banting had never treated a diabetic patient and had no interest in the dietary treatment of diabetes. There had been one brief mention of it in his therapeutics lectures at university, an up-to-date suggestioon that physicians not be afraid to use Allen’s starvation treatment. “I remember seeing one patient only on the wards of the Toronto General Hospital,” Banting wrote years later. “I heard of people mostly well on in life dying in coma and believed there was nothing one could do….There was no such thing as a diabetic in any ward in my surgical experience….I did not even know that my friend and class-mate, Joe Gilchrist, had diabetes until I had been working on the problem for many months.

His copy of the November issue of the journal Surgery, Gynecology and Obstetrics had just arrived.11 When he had finished work in the evening he took it to bed to read himself to sleep. With carbohydrate metabolism on his mind, he was naturally interested in the leading article in the issue, an analysis of ‘The Relation of the Islets of Langerhans to Diabetes with Special Reference to Cases of Pancreatic Lithiasis,” by Moses Barron. Barron was an American pathologist who became interested in the pancreas and the islets of Langerhans when, while doing routine autopsies. he came upon a rare case of the formation of a pancreatic stone (pancreatic lithiasis). Rarer still, the stone had completely obstructed the main pancreatic duct. Studying that pancreas, Barron found that while all the acinar cells had disappeared through atrophy, most of the islet cells had apparently survived intact. A review of the literature showed that these observations were similar to those arising when pancreatic ducts were blocked experimentally by ligation. Both experimental evidence, then, and this interesting new piece of pathological evidence, seemed to reinforce the hypothesis, held by many others, that the health of the islets was the key variable in the genesis of diabetes.

Barron wrote up his modest study, presenting it as another bit of evidence in the search for an explanation of diabetes. The work was perhaps of special interest because of the similarity between experimental and clinical case. He probably submitted it to Surgery, Gynecology and Obstetrics because of the interest surgeons had in stones.

Barron’s was a useful, not brilliant or trail-breaking study (his next paper, on the relationship between smoking and lung cancer, was a much important pioneering contribution). His review of the literature was particularly wide-ranging; his interpretation of his own case was questionable inasmuch as the patient had had islet cell damage and was diabetic (Barron attributed the damage to causes other than the obstruction). The sole importance of Barron’s article in the history of medicine is Fred Banting happened to read it in the evening of a day he had been thinking about carbohydrate metabolism.

Banting’s most detailed description of his reaction to the Barron article in his 1940 memoir, “The Story of Insulin”:

It was one of those nights when I was disturbed and could not sleep. I thought about the lecture and about the article and I thought about my miseries and how I would like to get out of debt and away from worry. Finally about two in the morning after the lecture and the article been chasing each other through my mind for some time, the idea occurred to me that by the experimental ligation of the duct and the subsequent degeneration of a portion of the pancreas, that one might obtain the internal secretion free from the external secretion. I got up and wrote down the idea and spent most of the night thinking about it.

This account should put an end to the story that the idea came to Banting in a dream. Beyond that, it is impossible to re-create the train of Banting’s thought as the lecture and the article chased each other through his mind. Speculation about what Banting “must” have thought is hazardous because all his accounts of his inspiration came only after his life had been changed by its consequences. As will be seen repeatedly in this history, Banting was not a precise and reliable guide to the events in which he participated.” A clear example of this is the fact that he never afterwards checked his own notebook to find out exactly what he had written at 2:00 a.m. on the morning of October 31. He quoted himself from memory, and always incorrectly. In what is taken as his most authoritative statement of the history of the discovery of insulin, the Cameron Lecture in Edinburgh in 1928, Banting recalled, “I arose and wrote in my note-book the following words-

Ligate pancreatic ducts of dogs. Wait six to eight weeks for degeneration. Remove the residue and extract.

The notebook is in the archives of the Academy of Medicine in Toronto. Banting actually wrote these words:

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”

The obvious comment that Banting didn’t know how to spell “diabetes” (and “glycosuria”), let alone treat the disease, is a bit unfair. It will cheer the modern medical student to know that Banting had never been a speller. He never became one. In any case, the spelling in a person’s private notebook ought to be his own business.

The more interesting aspects of the actual notation, as opposed to remembered one, are twofold. First, the true notation does not contain word “extract.” None of the documents written in the first six months after Banting conceived his idea contain that word. All Banting wrote was the idea of ligation, waiting for degeneration (he may not have known how long it would take), and then, “try to isolate the internal secretion.”

Second, Banting wanted to try to isolate the internal secretion “to relieve glycosurea.” He seems to have been identifying diabetes with glycosuria in the traditional way, rather than referring to the newer notion of hyperglycemia as the important condition to be relieved. The possible significance of these points will become clear shortly.

III

The morning after he wrote down his idea Banting mentioned it to Professor Miller at Western. Miller was a neurophysiologist and knew little about research in carbohydrate metabolism. It sounded like a good idea, he told Baml.ng, but surely someone had tried ii before. Banting may have asked Miller if it was possible to mount a project at Western to try out the idea. Miller apparently replied that facilities were not available for that kind of work; there were no quarters for large animals, such as dogs, in the old medical building, for example. Besides, Banting ought to consult someone who could be more helpful. Fortunately an expert was close by, in Toronto where J.J.R. Macleod had been professor of physiology since coming over from Western Reserve in 1918. Miller advised Banting to talk to Macleod.

Banting also consulted the professor of pharmacology at Western, J.W. Crane, who knew of no work on the subject. Banting remembered going to the library to look up the literature and finding nothing. This is a surprising statement, even allowing for inadequacies in Western’s medical library. I indicates either bad memory by Banting or an inability to search medical literature properly. That night Banting also had a long talk with Bill Tew. Part of his excitement came from his having seized upon the idea as a way out, something worth dropping practice for.

It happened that Banting was going to be in Toronto the next weekend for the wedding. of one of C.L. Starr’s daughters. At the reception orafterward, Banting told a number of his acquaintances from surgery about his idea. “I wished to give up practice in London immediately and commence work,” he wrote. “They all advised against such a radical move.

Banting saw Professor Macleod, whom he had not known except by reputation, in Macleod’s office the next day, Monday, November 8. Shy and inarticulate at the best of times, Banting could not have been at ease. Macleod, on the other hand, was a very senior, very articulate professor, giving up a few minutes of his valuable time as a courtesy to a University of Toronto graduate whom he had never met.

Banting told Macleod that he was interested in doing research work to search for the internal secretion of the pancreas. We do not know how much or how little he knew about previous researchers’ attempts to find it (the survey in the Barron article actually said very little). He may have known enough to mention to Macleod, and if not Macleod certainly mentioned to him (“this point immediately came up in our discussion,” Macleod wrote later) that many others had tried to prepare an extract of pancreas which contained the internal secretion. They agreed that the problem with such extracts may have been that they also contained the powerful digestive ferments of the external secretion, and that these may have acted to destroy the internal secretion.18 Banting said that perhaps the use of duct-ligated pancreases would get around that problem, because (as the Barron article showed) the effect of duct-ligation would be to destroy the cells producing the digestive ferments.

“He was tolerant at first:’ Banting wrote of Macleod at that meeting, “but apparently my subject was not well presented for he commenced to read the letters on his desk.” “I found that Dr. Banting had only a superficial text-book knowledge of the work that had been done on the effects of pancreatic extracts in diabetes,” Macleod wrote in 1922, referring to their first several meetings, “and that he had very little practical familiarity with the methods by which such a problem could be investigated in the laboratory.”
Macleod was confronted with a young surgeon who had walked in virtually off the street, had no significant experience in physiological research, and was talking, haltingly, about a topic he knew about only from standard textbooks and one article. As any conscientious professor in that situation would do, Macleod told Banting that many eminent scientists had spent years, sometimes their whole lives, in well-equipped laboratories working on the problem of the pancreas. They had not even proven conclusively that there was an internal secretion to be found, let alone found it. Research such as Banting proposed could not be undertaken lightly. Indeed it would be “useless” to attempt it without making a full-time commitment for several months.

It is not clear from the documents exactly what Banting was suggesting to Macleod. His later statements that he had asked Macleod for ten dogs, an assistant for eight weeks, and facilities for doing blood and urine tests, are not contained in his or Macleod’s 1922 accounts. Banting is maddeningly vague in 1922: “I told him carefully what I had planned… I then repeated my ideas to him.” It may have been that Banting was canvassing the idea of duct ligation as a surgical technique for isolating the internal secretion. Well, what would you do then, after the ligation had caused the pancreas to degenerate? What is the next step? How do you go about proving you have the secretion? Macleod might have asked. By making an extract of it and giving it to a diabetic animal, Banting might have answered. On the other hand, his notebooks show that some months later, when the work actually began, Banting and Macleod proposed to graft a portion of atrophied pancreas into a diabetic animal as their first experimental approach.

Grafting had been mentioned briefly in Barron’s article (extracting not been mentioned); since Hedon’s work in the early 1890s this seemed the surest way of proving that there was an internal secretion of the pancreas. In 1913 Allen had complained that “deplorably little” had been done in the way of experiments with grafts and pancreatic transplants, implying that it was a very interesting avenue for future research.23 This may have been the avenue Banting was suggesting to Macleod, or it may have appealed to Macleod as more promising than playing around with extracts. Grafting might have been discussed as a technique for isolating the internal secretion; extracting might have been discussed; both methods might have been discussed. Whatever technique they were talking about, Macleod started to become interested. Banting remembered repeating his ideas to the professor:

…he sat back in his chair with closed eyes for some time. Then he began to talk. He thought that “this might be the means of getting rid of the external secretion.” As far as he knew this had never been tried before. “It was worth trying” and “negative results would be of great physiological value.” This latter phrase he repeated at least three times.

Speculation is in order here and is permissible because we have some idea of Macleod’s knowledge of the literature. Whether he and Banting were discussing ,grafting or extracting, what must have appealed to Macleod as never having been tried before was the idea of somebody experimenting with degenerated or atrophied pancreas. Now there was nothing new in the idea of producing degeneration or atrophy of the acinar tissues by ligating the pancreatic ducts – all sorts of researchers had done this. Their interest, however, had been almost entirely in measuring the relative amounts of degeneration that took place in the various components of the pancreas, particularly the relative changes in the acinar and islet cells. Nobody, it seemed (except, perhaps, Lydia Dewitt, with her unsatisfactory in vitro testing methods), had taken a pancreas in which the acinar tissue had been induced to atrophy and tested to see if it contained the alleged internal secretion. Nobody had either tried to prepare a graft or administer an extract using a fully degenerated pancreas. And yet, theoretically, if there was an internal secretion, and if it did come from the islets of Langerhans, and if it was the acinar cells but not the islets that degenerated after the ducts were ligated, and if two or three other conditions held good, then perhaps some interesting results would follow.

Even if the results were negative, it was the kind of experiment that ought to have been tried long ago, if only for completeness’ sake; in that sense “negative results would be of great physiological value,” probably valuable enough, for example, to write up for publication. Another possible consideration for Macleod might have been the thought that almost all experiments done in the past, with pancreatic extracts or by any other method, might show different results now that blood sugar could be tested easily and quickly. So Dr. Banting, superficial as his knowledge might have been, halting as his presentation undoubtedly was, had produced a suggestion worth thinking about.

On second thought, there was the great difficulty researchers had commonly had in getting ligation to work so that the pancreas atrophied. E.L. Scott, it will be remembered, had reasoned the same way as Banting and had wanted to try an extract made from degenerated pancreas,. but had found the technique impractical. Scott had been a student; Banting was a surgeon. Macleod may have reasoned that a surgeon would succeed where a student had failed (and, of course, Banting’s skills would be particularly important if the discussion was actually centring on transplants or grafts). They may also have discussed the possibility of failure, and/or other ways of attacking the problem of getting rid of the external secretion. Macleod wrote in 1922 that either at this meeting or at a later one, “I suggested freezing the pancreas and then extracting it at the lowest possible temperature with alcohol” – which was essentially Scott’s technique. Assuming Macleod’s memory on this point is correct (it seems to be supported by Best’s 1922 account and was never explicitly denied by Banting), the suggestion passed by as part of the general discussion. As we will see, it became important a year or so later.

Banting had explained that he could not do the work at Western and wondered about the possibility of coming to Toronto to attempt it. Having cautioned Banting about the time it would take, and about the likelihood of negative results – however interesting the idea was – Macleod said yes, if Dr. Banting wanted to come to Toronto, Macleod would take him into the lab.25
The warnings had their effect on Banting. “I was not inclined appointments in Surgery and Physiology in London to get ‘negative results of great physiological importance’.” He told Macleod he consider the whole matter carefully.26

IV

Before returning to London, Banting explained the whole situation to Dr. Starr, who functioned, Banting told Macleod, as his “father advisor.” Starr said he would think it over and write giving advice. Two weeks later Banting wrote Macleod that he was still anxious to do the work, but was still waiting to hear from Starr.”

Prodded by Banting, Starr talked with Macleod in December, telling him of Banting’s situation in London, and asking him whether there was enough likelihood of “anything real” coming out of the idea to warrant Banting giving up his position in London and coming to Toronto for several months. Macleod probably reminded Starr of the long history of failure in the search for the internal secretion and of Banting’s comparatively unimpressive qualifications. Starr apparently told Macleod that Banting was a well-trained surgeon.28 “He thinks it is very problematical,” Starr wrote Banting, “and while he is very much interested in your presentation of the case to him, yet he feels as I do, that probably it would be unwise for you, at this time to give up your work there, and come here to undertake this work. He suggested also that you might possibly come in in the summer and put in a month or two then.”

Starr advised Banting to stay in London. He probably believed that Banting was using the research idea as an excuse to get out of his discouraging situation. Surely the thing for Banting to do was to settle down and work hard at building up his practice. As well, Banting already had a useful and promising connection with a medical school. Starr urged him to “stick to your post. .. I feel you have a great future there if you stick right with it.”

Banting took Starr’s advice, and settled down to spend the winter in London. He later claimed that he had returned to London from Toronto “more determined than ever to try the experiments. I read widely on the subject of carbohydrate metabolism and even read a little about diabetes. The more I read and thought on the subject and the more subsidiary experiments which I planned, the more impatient I became.”

Whatever reading he did; Banting made no entries about carbohydrate metabolism in the little notebook he used to record ideas and research proposals. When Macleod saw him later he was no more impressed with Banting’s knowledge than at the first meeting. And in fact Macleod did not hear from Banting again for almost four months. It was not until March 8, 21,that Banting wrote Macleod saying he would like to spend the second half of May, plus June and July, in Macleod’s lab, “if your offer for
facilities to do the research still holds good.”

Banting was actually considering a number of different things to do with the rest of his life. His practice was picking up, and his income rising, well beyond the break-even point by February. Edith, by all accounts, was encouraging him to settle down with his practice. His work as a demonstrator at Western and assisting Professor Miller had apparently gone well.32 That, plus his interest in research, may have encouraged him to consider the possibility of full-time university work. He may have gone so far as discussing the possibility with the dean of medicine at Western either before or after his conversations with the people at Toronto; if so, the dean held out no hope of Banting getting the salary he wanted to support himself in a research job.” In March Banting was working on several experiments in Miller’s lab, none of them relating to carbohydrate metabolism. On the same day that he wrote Macleod about summer plans, he also wrote to G.S. Sherrington, the distinguished professor of physiology at Oxford, asking his advice on an idea he had to study reflex action in the hind-limbs of kittens and dogs.34

In his letter to Macleod, Banting suggested that he might start a bit early, coming to ‘I’oronto during the Easter holidays “to do” half a dozen dogs so they would be ready for investigation in May. Macleod replied promptly that he would “be glad to have you come up here on May 15, as you suggest, to see what you can do with the problem of Pancreatic Diabetes,” but explained that it would not be advisable to do operations over the Easter holidays. Between the end of holidays and mid-May everyone was so busy with exams and winding up the term that no one at the lab would have free time to supervise the animals, “and this supervision. as you know, is of extreme importance in all researches of this character.”35

Even then, however, Banting had apparently not made up his mind whether he wanted to work in Macleod’s or any other lab. His moods undoubtedly varied with the state of his practice and, above all, his romance. Some time during the winter or spring Edith apparently broke off the engagement, returning the ring.36 At a time like that, Banting wanted nothing more than to get a long way away from his problems. He and Bill Tew talked that winter about joining the medical service of the Indian army and even wrote for details. A bit closer to home, Banting heard of an expedition going to the Mackenzie River valley in Canada’s Northwest Territories to drill for oil. They were apparently considering taking a medical officer with them. The head of the expedition lived in St. Thomas, just a few miles from London. About the middle of March, Banting recalled (which would be after he had written Macleod proposing to come to Toronto for the summer), he decided to stake his future on the toss of a coin. “Heads I was to do the research, tails I was to go to the Arctic to search for oil.” Three out of five tosses came up tails. The Arctic won.

So Banting took the next train to St. Thomas to see the oil man. “He explained that he was not sure of taking a medical officer, but that if they took one, I could have the job.” During March and April, 1921, when Banting is popularly thought to have been waiting with “gnawing impatience and mounting eagerness” to start searching for the internal secretion of the pancreas in Toronto,37 he was actually waiting for a letter offering him a job as doctor to an oil expedition. A letter finally came saying the
group had decided not to take a doctor.38

V

“Since nothing presented itself,” Banting wrote of his schemes for escaping from London, “I turned the key in my office on the morning of April 26, 1921, parked my suitcase at the station on the way to my last class at the medical college and took the noon train for Toronto.” He was committed to the work now, even though Dr. Starr was still advising against it.40 With no idea how the research would turn out, Banting paid enough attention to Starr that he did not, as some have thought, immediately close affairs in London. He kept his house and could have gone back again if experiments failed.

Banting met again with Macleod to plan the work. Macleod was no more impressed now than earlier with Banting’s knowledge of previous research on the problem or of the techniques he might use in the lab. But the work was to go forward. Again, there is no authoritative record of what was said at the meeting, or meetings. “I worked out with Dr. Banting a plan of investigation,” Macleod wrote sixteen months later, “the first step of which was to render one or two dogs diabetic by extirpation of the pancreas so that he might make himself familiar with the cause of this condition in animals….At the same time I advised him to tie the ducts in several of the animals so that the gland might be suitably degenerated….”

Macleod also advised Banting to use Hedon’s method of pancreatectomy and gave him references to Hedon’s work in the Iiterature.41
At one of their meetings, apparently the one in which Macleod gave Banting complete directions for the work, Banting met ].B. Collip, a professor at the University of Alberta who had an interest and some expertise in the study of glandular secretions and the making of tissue extracts. Collip, who had a Ph.D. in biochemistry from Toronto, was passing through on his way for a summer’s study in Massachusetts, and was consulting with Macleod about coming to work at Toronto for part of his sabbatical the following year. He planned to work on a very different problem from the one Banting and Macleod were discussing, but would have found the talk interesting. Several years earlier he had published a good summary article on internal secretions and he had recently been giving animals injections of different kinds of tissue extracts, measuring their impact, along with adrenalin, on blood pressure.42
Whatever experimental techniques Banting and Macleod planned to use, the results would be measured by tests on urine and blood. Banting had no practical knowledge of how to do this kind of chemical testing – in fact, as his original October 31 note seems to indicate, he may not have been aware of the sophisticated methods of blood testing available to researchers – and would obviously need help. Banting later remembered that he had asked Macleod for an assistant from the beginning, but although one would expect to find it, there is no reference to an assistant in any of the letters they exchanged about the work.43 Perhaps the matter did not come up until May. Or it might have come up earlier and Macleod, knowing he had student fellows on hand, had assured Banting it would not be a problem.

One day in May, Macleod introduced Banting to the two student assistants he had employed through that winter, Charles Best and Clark Noble. They were fourth year students in the Honour Physiology and Biochemistry course, picking up extra money as demonstrators and research assistants for Macleod. Both were planning to do a Master of Arts degree with him the next year. .Macleod had mentioned Banting in his lectures that winter, Best remembered, saying that he might be coming to Toronto to work on the pancreas. Now Banting explained his hypothesis to Best and Noble.44 They were going to assist him. It was probably on that same day that Macleod also showed Banting the little room in the physiology department once used for surgical research. Nobody had operated in it for more than a decade, though. As Banting remembered it, the room “contained the truck and dirt of the years.”

Macleod held out no false hopes when he talked to Noble and Best about assisting Banting. This kind of research, going after the internal secretion, had been tried many times before and had always failed. “There is always a chance,” Noble remembered him adding. Banting later heard, apparently from Best, that Macleod told the two students that the project would probably go up in smoke, but they would at least learn something about surgery from the work; also, as good scientists, “we must leave no sod unturned.” Macleod apparently left it to Best and Noble to decide how they would divide the time to be spent with Banting.

The practical problem of arranging the assistance was that in its normal rhythm the University of Toronto went on holidays in July and August. Term appointments and salaries, such as Best and Noble enjoyed, ended on June 30. But Banting intended to work in July, and presumably would need help then. So one of the two students would have to split his summer holidays, taking some time off in May or June and then working in July while the other was on holidays. The contemporary evidence suggests that Best and Noble flipped a coin to see who would go first, and therefore not have to work in July. There is no evidence for the legend in Toronto that the prospect of working with Banting on his wild idea was so unattractive that Best went first because he lost the toss. Actually it was the prospect of having a broken summer holiday that was unattractive. Research with a surgeon like Banting would be interesting no matter what the results. So the winner of the toss would work first with Banting. Best won.47

VI

Banting was in London for most of the first half of May. On the morning of Saturday, May 14, he presided at an exam for Western’s fourth-year medical students. After the exam they gave their demonstrator a box of cigars. Banting “escaped” from London on the next train. Best wrote his last exam on Monday, May 16. Either that day or early the next,49 Banting and Best cleaned up the physiology department’s filthy operating room. They washed the walls and the ceiling. Just as they were about to mop the floor, someone from the floor below complained that water was leaking through. So they cleaned the wood floor of the little room on their hands and knees.

Banting had brought his instruments with him. Towels for the operation had to be borrowed. When everything was ready, on Tuesday May 17, Macleod joined them to begin the first experiment.50\

Discussion questions:
1. Did this historical account provide you a new lens through which to discover the complexities behind the discovery of insulin? What types of new perspectives did this piece provide in order to help the reader achieve a better understanding of a major medical breakthrough?
2. How did this work go about challenging presuppositions and myths about Banting’s life and his early work? Did any aspects of this chapter cause you to pause and reconsider how accounts of discoveries may become distorted over time?

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