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Anyone who has ever known someone suffering from cancer knows the ups and downs of the
disease. One day you can have so much hope yet the next day it seems hopeless.
This is a story I tell to our students. It is a story to motivate them, to let them
know that they CAN solve the biggest problems of our times.
It is also a story of hope-- a story that suggests we should never give up no matter
how hopeless it seems.
The story begins here, with Charles Evan Hughes.
This is a photo of Charles Hughes with his family in 1916, when he was running for President
of the United States. Hughes was one of the leading political figures of his time. He
had served as governor of New York and then been appointed to the United States Supreme
Court. He resigned from the court in 1916 to run for President . He ended up losing
to Woodrow Wilson in a close race.
But this story is not about Charles Hughes, it is about his youngest daughter, Elizabeth..
She was born in 1907 while her father was the governor of New York.
When Elizabeth was twelve years old, something started to go wrong. She developed a voracious
thirst, and would drink as much as half a gallon of water at a sitting. She grew weaker.
After several months it was clear that she had developed the incurable disease of diabetes
mellitus.
Her outlook was bleak. Most children would die within months of developing diabetes.
Medical research had determined that diabetes was caused by a failure in the pancreas. Early
attempts to treat the disease by grinding up animal pancreases and injecting pancreatic
extract had failed. The problem was that part of the pancreas produced external secretions
(now we call these proteases). These external secretions destroyed the internal secretions,
(now known as insulin).
No one knew how to separate the external secretions from the internal secretions.
Elizabeth's father was a powerful and influential man, who sought the advice of the leading
physicians of his time.
Based upon their advice, Elizabeth was brought to a clinic in Morristown, New Jersey run
by Dr. Frederick Allen. The doctor was famous for his advocacy of treating diabetics with
a ``starvation diet.'' Dr. Allen had shown that he could extend the life of diabetic
patients for several years by limiting their diet.
When Elizabeth first went to see Dr. Allen in the spring of 1919, she was nearly 5' tall,
but only weighed 75 pounds. Dr. Allen prescribed a carbohydrate-free diet with only about 500
calories per day. He sought to bring her weight down to the low 60's. If the disease were
left untreated Elizabeth probably would have died during the summer of 1919. The best she
could hope for under Dr. Allen's treatment would be a slow withering life, probably dying
from starvation in another three years.
In the summer of 1920, while Elizabeth was suffering through her starvation diet,
a twenty-nine year old surgeon, Frederick Banting, was struggling to start a medical
practice in London, Ontario. In his first month of business he had seen one patient
and earned $4. Dr. Banting had plenty of free time on his hands.
The free time was making him miserable. He thought he was a failure on the business side
of being a doctor. He had to take a part time job at the local university that fall to help
pay the bills (it paid $2/hour).
One night, after preparing a lecture on carbohydrate metabolism and its relationship to the pancreas,
he picked up the latest copy of a medical journal and read this article
It was October 30, 1920. Later, he described that night this way:
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 had been chasing each
other in my mind for some time, the idea occurred to me that by the experimental ligation of
the duct and 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.
A week later he went to see an expert in diabetes, J. J. R. Macleod, who was a professor of physiology
at the University of Toronto. Banting proposed a method of treating diabetes. Macleod thought
that Banting was naive. He told Banting that many scientists had devoted years of their
life to studying diabetes without significant progress. But Banting was persistent. Macleod
suggested that the approach was doomed to fail, but conceded it was original. They made
arrangements and Banting came to the University of Toronto for the summer of 1921 to perform
the experiments.
During that summer Banting worked with an Assistant, Charles Best. They experimentally
induced diabetes in dogs then tried to cure the diabetes with extract from other pancreases.
Through his persistence, Banting was wildly successful. Before the end of the summer in
1921, he had shown that he could keep alive diabetic animals with his extract.
Macleod named the extract``insulin.'' They began purifiying and bottling it.
On January 23, 1922 they performed the first human injections. and it was just in time.
. .
By August 1922, Elizabeth Hughes was close to death. Her family got her an appointment
with Dr. Banting and she first saw him on August 15, 1922---three days before her 15th
birthday.
When Dr. Banting examined her, he noted that she was "extremely emaciated. She only weighed
45 pounds. She had lost nearly half her weight in the past 3 years. Her skin was dried and
scaly, her hair brittle and thin. She was so weak, she could barely walk.
Banting immediately administered insulin and put Elizabeth on a 2,500 calories/day diet.
Elizabeth rapidly gained weight.
This was the first public evidence about the miraculous effects insulin had on diabetes.
It had taken Elizabeth from her deathbed to a normal life within a month.
This brought about a crisis. There was simply not enough insulin to meet the demand.
Banting, Macleod, and the University of Toronto worked with Eli Lilly and Company to develop
a large-scale process for the production of insulin. Eli Lilly used pig pancreases that
could be cheaply acquired from slaughter houses to develop the first commercial product.
The commercial insulin was called Iletin and sold by Lilly.
By October 1923, they had enough insulin for everyone who needed it. Banting and the Eli
Lilly company had saved the lives of thousands who were on their deathbed.
Elizabeth Hughes grew up, graduated from college, got married, had three children, started the
supreme court historical society. She lived 58 years longer than expected thanks to Frederick
Banting's relentless pursuit of a dream.
Dr. Banting and JJ R Macleod received the 1923 nobel prize for this work.
Tragically, Banting died in a plane crash while he was serving in the Royal Canadian
Air Force. He was 49.. He is considered one of the greatest canadians
to ever live.
I hope to retell this story someday soon. It will be about a metastatic cancer patient
and one of you.