100 years of insulin: Scotland’s contribution to the history of diabetes

Marred by personal rivalries, accusations of stolen ideas and undeserved credit, Macleod has fallen into the shadow of his colleagues Frederick Banting and Charles Best. 

Scotland is not short of medical icons whose ancestry they can claim. Take, Alexander Fleming and his iconic discovery of penicillin in 1928. His name has been memorialised in postage stamps, bank notes, and statues from Ayrshire to Madrid. Yet, it was only in 2021 that a conversation was had for a statue of Noble Prize winning, co-discoverer of insulin, J.R.R Macleod, in his home city of Aberdeen. With efforts being made to return Macleod to Scotland’s memory, we can also begin to observe further contributions Scotland has made to the developments in diabetic treatments and its history.

MacLeod's early years

Born near Dunkeld in 1876, Macleod began education at the Aberdeen Grammar School. He remained in the city and studied medicine at the University of Aberdeen. He graduated in 1898 with Honours and multiple academic prizes, including a scholarship to study at the University of Leipzig.

Emigrating to the United States in 1903, Macleod began to consolidate his expertise in the field of Carbohydrate Metabolism. In 1913 his interest in diabetes was demonstrated in his seminal book, Diabetes: Its Pathological Physiology. Headhunted by the University of Toronto, he was elected to the position of Head of Physiology here in 1918. 

Two years later Macleod’s path would cross with Frederick Banting. Due to his reputation as an expert in diabetes, Banting, a newcomer to the field, was instructed to seek Macleod’s guidance. After reading one article, Banting came to Macleod, with a research idea of how to isolate the internal secretion of the pancreas. Intrigued, Macleod agreed to provide Banting with his laboratory, research animals, a research assistant, Charles Best, and his own active supervision. He later appointed James Collip to assist in the purification of the successful pancreatic extract. Macleod’s emphasis on scientific rigour and methodical guidance was integral to this monumental discovery, albeit often frustrating to Banting’s inexperienced enthusiasm.  

A landmark moment

In January 1922, this collaborative effort witnessed the first successful administering of, what would be named, ‘insulin’, on a human patient. In 1923, the Noble Prize for Medicine was jointly presented to Macleod and Banting for their ground-breaking discovery. The incompatibility of these two men was arguably present from the start, but Banting was reportedly enraged by having to share this prize. Macleod returned to Aberdeen in 1928, taking over the position of Head of Physiology at the University. Following his departure, Banting and Best were free to construct the popular narrative of insulin’s discovery in North America as they saw fit, and this did not include Macleod.

With his return to Scotland, one would imagine that Macleod’s success would have at least been recognised in his own country. Apart from several obituaries celebrating his achievements, following his untimely death in 1935, Macleod continued to be overshadowed by Banting. Even today, we celebrate World Diabetes Day on the anniversary of Banting’s birthday. M. Bliss, the leading historian on the discovery of insulin, has suggested that an element of “English Chauvinism” was responsible for Macleod’s eclipse in the UK. Noting that Science in the UK was run by London and Cambridge. If a Scottish scientist existed outside of these circles, then they were habitually excluded from the British Medical Establishment. Even if they were a Noble Prize winner whose efforts had saved the lives of millions.

The Aberdeen connection

As new books, journals and monuments begin returning Macleod to our popular memory, it is important to realise he is not Scotland’s only contributor to the history of diabetes. Even before Banting and Macleod began their research, two other Aberdonians, Rennie and Fraser, had experimented with attempting to isolate the insulin producing islets from fish pancreas, collected from Aberdeen’s fish market. Their research, published in popular medical journals of the time, was part of the ongoing discourse required for insulin’s eventual discovery. 

Aberdeen continued to produce key figures in the history of diabetic care. Born in Aberdeen in 1892, Robert Daniel Lawrence followed a similar early trajectory as Macleod. Educated at Aberdeen Grammar School before moving on to study medicine at the University of Aberdeen. Unlike Macleod however, Lawrence himself was diagnosed with diabetes in the early 1920s. By utilising his medical knowledge, he slowed his deterioration through strict dieting, however, like all diabetic diagnosis of the time, a death sentence seemed inevitable. Fortunately, his diagnosis coincided with the discovery of insulin and supplies reached the UK in 1923, just in time to save Lawrence’s life. 

Returning to a position at Kings College Hospital London, Lawrence dedicated his career to improving the clinical treatment of diabetes. His patient manual, The Diabetic Life, which saw 16 editions and multiple translations, was influential in handing over medical knowledge and control of one’s treatment to the patient. Recognising the importance of patient education and engagement, Lawrence went onto establish the Diabetic Association, Britain’s first patient-organisation, in 1934. This organisation continues to flourish today under the name Diabetes UK.

Yet Scotland’s contributions to the history of diabetes are not just confined to Aberdeen. The Edinburgh Royal Infirmary is significantly associated with the treatment of diabetes and its clinical developments. Its Head of Therapeutics, Jonathon Campbell Meakins, and his team, consisting of David Murray Lyons and Charles George Lambie, expressed great interest in diabetes even before the arrival of insulin. As word began to grow of the monumental discovery, Meakins wrote to Macleod in 1922, asking for a supply of insulin. Macleod’s refusal was due to early insulin’s inability to survive transit, but he did send detailed instructions of how to produce it. Meakins also sent his colleague Lambie to Toronto to observe insulin’s production. Historian R.L. Lyon has credited Lambie as being the first to bring a supply of insulin to the UK. Using these instructions, the Edinburgh team successfully administered their insulin to their diabetic colleague, Norman Walker, in August 1922. This is now thought to be the first insulin injection given in Europe.

The Edinburgh team’s interest in diabetes expanded beyond the innovation of insulin. The introduction of insulin therapy altered the dietic treatment. Traditionally the Allen method or ‘starvation diet’ was used, which severely limited the diabetics consumption, to the point in which death by undernutrition seemed just as likely as a diabetic coma. Whilst many in London’s medical circles were unenthused by the thought of stepping away from traditional treatment methods, the Edinburgh team jumped at the chance to innovate treatment. Dr Murray Lyons declared in 1923 that “the Allen diet had been eclipsed by the discovery of insulin”.

Dr Murray Lyon, in collaboration with Sister Pybus, went onto make significant steps in the dietic treatment of diabetes. They wrote up detailed diet sheets for different levels of treatment that were to be used by physicians across the country. It’s important to realise that with diabetes dramatically changing over these decades, many physicians were sometimes just as knowledgeable as their patients. Making these diets sheets were incredibly useful. In 1938, after Dr Murray Lyon stood down, Professor Dunlop continued this dietary innovation with a focus on increasing the carbohydrate and calorie content to allow the diabetic to live as normal life as possible. Such diet sheets were used in collaboration with the patient at Edinburgh Royal Infirmary’s Specialist Diabetic Outpatient Clinic, set up under Sister Pybus in 1924 as the first of its kind in Britain.

With 100 years of insulin being celebrated in 2021 and the next few years marking several other significant milestones, it’s important that Scotland is aware of its place in this history. Hopefully as J.R.R Macleod takes his place in our nation’s popular memory, we can begin to appreciate the other prominent Scottish figures and their actions that influenced the way we view and treat diabetes today. Looking forward, research into diabetes continues to flourish. With NHS Lothian, this year rolling out a new diabetic test which could transform the lives of many Type-1 diabetics, Scotland continues to play an influential role in the history of this condition.

About the author

A type 1 diabetic himself, Luke Whittle recently graduated from the University of Dundee in MLitt History with Distinction and the Charles McKean History Prize. His research dissertation concerned early influences of insulin upon patient agency and consumerism in Scotland. A prospective PhD candidate, he intends to extend his research to consider the significance of the Highland and Islands Medical Service and Scotland's NHS upon the 20th century diabetic experiences.