Pancreatic organotherapy for diabetes, 1889-1921.

The isolation of insulin by Banting and Best in 1921 and its rapid commercial exploitation revolutionized the treatment of diabetes. The story, frequently told as a romance of medicine, is that a young orthopaedic surgeon, Frederick Banting, went to the local Professor of Physiology, J J R Macleod, asking for facilities to try to isolate the internal secretion of the pancreas. Macleod was sceptical but provided a lab, dogs and a student assistant to measure blood sugar. After only three months, Banting and Charles Best isolated a potent anti-diabetic substance which was first used on a human diabetic in January 1922. Controversy followed when Banting and Macleod, not Banting and Best, were awarded the 1923 Nobel Prize. Much has been written about the events in Toronto in 1921-1922l as well as about the priority disputes which followed.2 Two editorials in the Lancet in 1923 questioned why this discovery had taken so long.3 The seductively simple critique ran as follows: in 1869, Paul Langerhans described his eponymous islands, in 1889 Oskar Minkowski produced severe diabetes in dogs by pancreatectomy, in 1891 George Murray cured myxoedema by injections of thyroid extract and in 1893 Gustave-Edouard Laguesse suggested that the islands of Langerhans produced "an endocrine secretion" which controlled carbohydrate metabolism. How could it have taken thirty years for therapeutics to exploit the physiological suggestion? The origins of the hormone concept and the history of organotherapy in general have been explored in detail by Merriley Borell.4 Her work focuses on the role of physiologists,