Monday, December 13, 2021

Fred & Marjorie: A doctor, a dog and the discovery of insulin by Deborah Kerbel

Dr. Frederick Banting had just finished a long surgery at the Hospital for Sick Children. On his break he walked by a room where the parents of a young girl are just being told their daughter has diabetes. As there is no cure, she has a few months, maybe a year before she will die. As Fred and another doctor try to relax on the steps of the hospital, a stray street dog begs for food and Fred gives it a bun.

At a hospital some of the sickest patients were those with juvenile diabetes. In 1920 doctors knew that diabetes was somehow connected to problems with the pancreas. But the connection was not understood. What was known was that the only treatment was starvation.

Meanwhile the stray dog continued to wander the streets of Toronto, even hanging around the hospital.

After his residency at Sick Kids ends, Fred left Toronto for London, Ontario where he set up a small medical practice. But business was slow, so Fred decided to visit the University of Western Ontario to see if he could obtain a teaching position. He was able to work as a part time instructor in anatomy and surgery.


A few weeks into his teaching job, Fred had to prepare a lesson on the pancreas. It was something he knew nothing about, so he spent time reading and researching. And then he had idea as to how to determine the pancreas's involvement in diabetes.

On the advice of Professor Miller from the University of Western, Fred sought out Professor J.J.R. Macleod at the University of Toronto. Macleod, a professor of physiology listened as Fred described his idea. It was to remove the pancreas from a dog making it diabetic, after which they would tie of the external ducts in the pancreas of a second dog to isolate whatever substance the pancreas is making. This substance would then be injected into one group of diabetic dogs to see if they regained their health. 

Professor Macleod was skeptical because Fred was an orthopedic surgeon with no research experience. Nevertheless, Fred begged Macleod for a lab to conduct his experiment and a team of dogs. Macleod agreed but told Fred he had to wait until the end of the school year for a lab to be free. The stage was now set for the unbelievable discovery that would save the lives of millions of people from a slow death due to diabetes.

Discussion

Frederick Banting and Charles Best's work to isolate what would become known as insulin, was one of the most significant medical discoveries of the the twentieth century. Until their groundbreaking work, insulin which is the hormone produced by the pancreas to allow the body to process sugar, was unknown at the time. Extracting, identifying and developing a way to purify it so it could be given to diabetics, saved hundreds of millions of children from death. It was so monumental, that the 1923 Nobel Prize in Medicine was awarded to Banting and Macleod.

Frederick Banting was born on a farm near Alliston, Ontario in 1891. Initially Banting enrolled in a general arts course at the University of Toronto in 1910 but he did not complete his first year. He then enrolled into the medicine program in 1912, with a specialty in surgery. With the onset of World War I, Banting attempted to enroll in the Canadian Army but was rejected due to poor eyesight. He was accepted into the Canadian Army Medical Service. Banting graduated with a bachelor's degree in medicine in December, 1916. 

Banting was eventually sent to England where he first worked at the Granville Hospital. Banting was sent over to the front lines and was wounded in the Battle of Chambrai. After spending some time healing in hospital, Banting eventually returned home where he worked at the Christie Street Hospital for Veterans in Toronto. After he was demobilized, Banting completed his internship in surgery at the Hospital for Sick Children. 

The graphic novel Fred & Marjorie picks up Banting's story at this point. His idea for a possible treatment of diabetes came to him, October 31, 1920 while takes notes from Moses Barron's in preparation for a lecture. Initially he presented his idea to Dr. F.G. Miller at the University of Western Ontario who referred him to Prof. J.J.R. Macleod at the University of Toronto. Although Macleod was skeptical of Banting's idea, he made arrangements for Banting to carry out his experiments at Toronto in the spring. With the help of his assistant, Charles Best, a recent graduate of physiology and biochemistry, the two men worked diligently, overcoming many problems. By the end of July they were able to inject one of the diabetic dogs with the extract from the pancreas which resulted in lowering the animal's blood sugar level. They knew they were on the right track.

In Fred & Marjorie, Kerbel focuses on Frederick Banting's contributions, and his relationship with a stray dog he named Marjorie. In her retelling of this remarkable event, Kerbel notes that it is "based mainly on firsthand accounts as they were recorded at the time and remembered years later, although some parts of the timeline were condensed in the interest of pacing." As a result, this graphic novel is short, and to the point, focusing on the most important events in the time line it covers, and limiting the telling to just the two major characters, Banting and research as well as his relationship with one of the research dogs, Marjorie.

Marjorie was also known as Dog 33. Her life before she became one of the laboratory dogs was imagined by the author, but her contributions to the experiment were real: she survived very long on the insulin treatments, proving that there was a way to treat diabetes.

In her note titled, An Ethical Dilemma, Kerbel  discusses the use of animals, and in this case, dogs in medical experiments. She mentions that Banting experienced conflicting emotions about the use of dogs in the experiments. He was after all, taking healthy dogs and making them diabetic in order to test his theory that something produced by the pancreas controlled the level of sugar in the blood. Kerbel captures some of Banting's conflict in her story. She portrays Banting developing a friendship with many of the dogs, despite Charles Best telling him researchers should never allow themselves to become emotionally attached to the animals. However Banting, who grew up on a farm and who loved animals, couldn't help himself. There are panels showing Banting concerned for the dogs, making sure they get out of the stuffy, hot rooms for some air during the summer heat, and even having their pictures taken because he considers the dogs to be heroes. 

Eventually the stray whom Banting names Marjorie becomes part of the research and is eventually chosen for the most important step of their work, a longevity experiment. Kerbel portrays Banting's intense emotions when he knows that Marjorie, surviving seventy days on the pancreatic extract, must be put down.The panels show Banting in tears, devastated at her death.

Fred & Marjorie is illustrated by Canadian artist, Angela Poon.

Fred & Marjorie will appeal to fans of graphic novels, to those interested in science and Canadian scientists. Short and sweet, beautifully illustrated, this graphic novel is engaging and informative.

You can read more about the discovery of insulin from the University of Toronto's website, The  Discovery  and Early Development of Insulin: https://insulin.library.utoronto.ca/

Book Details:

Fred & Marjorie: A doctor, a dog and the discovery of insulin by Deborah Kerbel
Toronto: Owlkids Books     2021
55pp.

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