Diabetes mellitus and pernicious anemia: interrelated therapeutic triumphs discovered shortly after William Osler’s death

Abstract

William Osler died on December 29, 1919, at the age of 70. Less than 1 year later, Frederick Grant Banting began a research project at the University of Toronto to find a treatment for diabetes mellitus. John James Rickard Macleod, director of physiology, gave him space, funding, and supplies. Charles Herbert Best, an undergraduate medical student, joined Banting. In 1921, Banting and Best isolated and purified insulin from pancreatic extracts of dogs. James Bertram Collip, a biochemist, helped in the purification process. The first American patient was treated with Toronto insulin in May 1922. Banting and Macleod were awarded the Nobel Prize in 1923 “for the discovery of insulin.” George Richards Minot, a young hematologist in Boston, had an obsessive interest in the effect of diet on anemia. In October 1921, Minot developed weight loss and was diagnosed with severe diabetes mellitus. By January 1923, the pioneering diabetologist, Elliott Proctor Joslin, began to treat Minot with insulin. Minot’s condition improved and he returned to work. In 1926, Minot and William Parry Murphy amazed the medical world when they eradicated anemia in 45 pernicious anemia patients by feeding them a half-pound of beef liver daily. Minot shared the 1934 Nobel Prize with Murphy and George Hoyt Whipple “for their discoveries concerning liver therapy in cases of anemia.” Minot remained on insulin the rest of his life. Osler described the clinical findings and blood picture of pernicious anemia nearly a half century before Minot but his observations were largely ignored. Osler had an intriguing connection to Banting. Had he lived, Osler would have been ecstatic over these two monumental therapeutic breakthroughs.

Keywords:

• Anemia
• pernicious
• Banting
• Frederick Grant
• Best
• Charles Herbert
• Collip
• James Bertram
• diabetes mellitus
• history of medicine
• insulin
• Joslin
• Elliott Proctor
• Macleod
• John James Rickard
• Minot
• George Richards
• Murphy
• William Parry
• Nobel Prize in Physiology or Medicine
• Whipple
• George Hoyt

ACKNOWLEDGMENTS

Supported in part by the Edward and Ruth Wilkof Foundation. The author thanks Kathleen Shannon Stone for expert help with manuscript preparation.