November 26th marks the 100th anniversary of a splendid dinner held at the University of Toronto to recognize perhaps the greatest Canadian achievement in science. A few weeks earlier, the Nobel committee had announced the awarding of the 1923 Nobel Prize in Physiology and Medicine to Drs. Frederick Banting and John Macleod of the University of Toronto for their discovery of insulin.
The story of the discovery of insulin is a fascinating one and well told in the 1989 television movie, “Glory Enough for All,” produced by the CBC. It seems appropriate to mark the centennial of the Nobel Prize for the discovery of insulin that forever changed the lives of diabetics with a review of that film.
“Glory Enough for All” introduces us to Dr. Frederick Banting as he is administering to wounded soldiers on the front in 1918. After the war, unable to secure a hospital position, he sets up a private practice in London, Ontario. With patients being scarce, Banting somewhat reluctantly accepts a part-time teaching post at the University of Western Ontario where in one of his classes he has to discuss the pancreas. As he researches the subject, his interest is piqued by papers describing the role of pancreatic secretions in preventing diabetes and the failed attempts to extract the active ingredient, putatively having been named “insulin” by the British physiologist Edward Sharpey-Schafer.
The film erroneously attributes the coining of the term insulin to J.R. Macleod, Professor of Physiology at the University of Toronto whom Banting approaches with an idea about tying off the pancreatic duct in a dog. He believes this will force the organ to produce more insulin for extraction. While the movie does acknowledge that Banting was aware of previous research, it fails to divulge just how extensive that research was. More than 400 scientists had already investigated pancreatic secretions in the treatment of diabetes, and while in some cases sugar levels dropped, the work was stymied by the serious side effects. Romanian physician Nicolae Paulescu in particular had published a paper five months before Banting’s landmark publication in which he described the isolation of what he called “pancreine” and its effective use in diabetic dogs. However, Paulescu was unable to scale up his production and did not publish any use of pancreine in humans. Paulescu later argued that he should have been awarded the Nobel Prize for insulin, but he did not get much support from the scientific community, partly because he was an ultranationalist and flagrant anti-Semite who claimed that Jews are degenerate because their brains weigh much less than "Arian" brains.
Dr. Macleod is skeptical about Banting’s proposal to ligate the pancreatic duct, but is intrigued enough to offer a small laboratory and a bright medical student, Charles Best, to assist with the research. The film accurately portrays the pair’s work in the stifling heat of the summer 1921 and the unfortunate deaths of a number of dogs before, with the help of young biochemist James Collip, they manage to purify the pancreatic extract. The key here, seemingly too complicated for the film, is the elimination of trypsinogen produced by the pancreas. This is the precursor to trypsin, an enzyme that breaks down proteins such as insulin.
Banting, Best and Collip do not always see eye to eye, and their arguments, sometimes close to fisticuffs, are accurately portrayed, as is Banting’s failed romantic relationship. The most significant conflict is between Banting and Macleod, with the former being irritated with what he sees as Macleod taking credit for work in which he was not involved. That is also historically accurate, as Macleod was actually not in Toronto the summer of 1921 and was not a great supporter of the research until a pure form of insulin was successfully used to treat Leonard Thompson, a 14-year-old diabetic. Curiously, the film does not highlight this epic moment, but rather focuses on Banting’s compassionate use of insulin on Elizabeth Hughes, daughter of U.S. Secretary of State Charles Evans Hughes. Perhaps this makes for a more compelling storyline. In any case, Elizabeth’s story allows for an accurate description of the severe restriction of calories that she had to endure, the common treatment for diabetes at the time.
All in all, “Glory Enough for All” is a first-rate production and correctly portrays the trials and tribulations leading up to the awarding of the 1923 Nobel Prize to Banting and Macleod and does leave the viewer with an appreciation of the criticism that has been leveled at the Nobel committee for not recognizing the contribution of Best. The film can be seen on the CBC’s GEM channel.
On November 27, 2-5 PM, the Toronto Medical Historical Club will present a symposium to celebrate the 100th anniversary of the Nobel prize for insulin with a series of talks on the history and current status of the treatment of diabetes. It will be available on Zoom for free but registration is required. Details at http://www.torontomedicalhistoricalclub.ca