The Pissing Evile

Peter Medawar

  • The Discovery of Insulin by Michael Bliss
    Paul Harris, 304 pp, £15.00, September 1983, ISBN 0 86228 056 7

The discovery of insulin may be rated the first great triumph of medical science. The first important contribution of the great pharmaceutical companies to human welfare was surely the preparation, purification, standardisation and marketing of insulin in a form suitable for self-administration by the afflicted patients.

The entire episode brought to an end, with an appropriately reverberant thunderclap, the long epoch of therapeutic nihilism described by Lewis Thomas in his most recent book.[*] The insulin story begins, of course, as other medical stories begin, at the bedside – with the taking of a history and an appraisal of the patient’s general health. The history would be loss of weight, debility and general malaise, of intractable thirst, the continual passing of urine that led to a 17th-century London surgeon’s describing diabetes as the ‘pissing evile’, and apparent susceptibility to infections. All this would raise in the physician’s mind a suspicion of diabetes mellitus – sugar diabetes – soon to be directly confirmed by testing the urine or watching house flies congregate around a drop of evaporated urine. Older physicians still recount these diagnostic exercises in order to rebuke or silence enthusiastic young medical scientists who babble incoherently about the place of nuclear magnetic resonance spectroscopy in a country practice. The discovery and marketing of insulin put it for the first time within the power of the profession to restore to something like normal life victims of juvenile diabetes who would otherwise have had before them a life of invalidism terminated by early death.

The insulin story is here recounted as a sabbatical exercise by the Professor of Canadian History in the University of Toronto. It is not now likely that there will be any further windfall of evidence relating to the matter: this, it seems, will be the definitive history. More than that, it is well-written and highly readable.

Before the story begins, physiological research had already made it clear that the pancreas had something to do with diabetes, very probably by the manufacture of an internal secretion. The extraction of such a secretion – it was later discovered to be a protein – was felt to be a chancy and difficult business because the secretion might be destroyed during extraction by the powerful digestive enzymes already known to be manufactured by the pancreas. A young surgeon, Frederick Banting, of London, Ontario, conceived the idea that extraction of a hypothetical secretion would be made easier by a ligation of the pancreatic duct to bring about atrophy of the enzyme-secreting parts of the pancreas, which could thereby be converted into a predominantly endocrine organ: that is, into an organ principally responsible for manufacturing internal secretions, which would then be liberated directly into the bloodstream instead of travelling through a duct to their place of action. The Professor of Physiology at the University of Toronto, J.J.R. Macleod, was not carried away by the notion, but he owes his place in history to having thought well enough of it to give Banting a room and the services of a medical student, Charles Best, whose principal duty would be to carry out the crucially important job of estimating the concentration of reducing sugars in blood and urine – a simple procedure now that it has been streamlined and virtually automated by the pharmaceutical companies’ diagnostic kits, but something which at the time required single-minded attention.

Although the research of Banting and Best, like all other research enterprises everywhere else, encountered some disheartening snags to begin with, they had what experimenters call a reliable ‘system’ to work with. Dogs deprived of their pancreases live no longer than a few weeks: if the pancreatic extracts were to work, they would bring the blood-sugar concentration clattering down and allow these dogs to survive for more than a couple of weeks.

You are not logged in

[*] The Youngest Science, Viking, 1983, discussed by the present reviewer in LRB, Vol. 5, No 3.

[†] Howard Florey: The Making of a Great Scientist by Gwyn Macfarlane, Oxford, 1979, also discussed by Medawar (LRB, Vol. 1, No 5).