The Press and Journal (Aberdeen and Aberdeenshire)
City doc’s vital role in fight against diabetes
There was a time when the diagnosis of diabetes, particularly at a younger age, inevitably meant a death sentence.
But millions of lives have been saved since the discovery of insulin almost 100 years ago – and an Aberdeen doctor was one of the first to benefit.
In 1920, at the age of 28, Robert Daniel (RD) Lawrence was diagnosed with the condition and the hormone saved his life.
Today, retired consultant Ken McHardy, who worked at ARI for more than 30 years, has told how the pioneering doctor went on to become a champion for diabetes patients across the world.
Lawrence studied medicine at Aberdeen University and was working at King’s College Hospital in London as an assistant surgeon in the ear, nose and throat department when tests revealed he had diabetes.
Ken said: “He used to go to the mortuary to practise his skills on skulls and a chip of bone flew into his eye. He got a nasty infection and had to be admitted to his own hospital.
“It was during that admission they tested his urine and found it was full of sugar. He had diabetes. At that time there was no medication for what came to be known as type 1 diabetes.
“The treatment was a very stringent diet – that helped people live a few months longer, but at the expense of weakness and wasting.”
Lawrence abandoned his dreams of becoming a surgeon and moved into the department of clinical biochemistry. But he left the UK soon afterwards as his condition deteriorated.
Ken said: “He decided he would go to the milder climate in Florence, do some private practice among expatriates and in due course wither away and die, out of sight of friends and family.”
Within months, he was barely able to walk.
Luckily, Lawrence’s illness came at a time when insulin had just been discovered and supplies started arriving in the UK.
And when he received a telegram from Geoffrey Harrison, his friend and colleague at King’s which read: “I’ve got insulin. Come quick. It works”, he loaded up his car and enlisted a chauffeur to drive him home.
Ken added: “When they got back he was admitted to King’s College Hospital and he was admitted there. At 10am on the 31st of May 1923 – when he would surely have been just weeks from death – he was given his first injection of insulin.
“He went on to become a major champion for diabetes patients, founding the diabetic clinic at King’s College Hospital, publishing lots of research on the effects of diet, exercise, and other factors alongside insulin, often with himself as the main subject.”
Lawrence embarked on a new career as a diabetes specialist; his 1925 book called ‘The Diabetic Life’ was written for patients and doctors and ran to 17 editions over 40 years.
And in 1934 with the help of his patient, science fiction writer HG Wells, he started the Diabetic Association to help improve the lives of those with diabetes.
It is now known as the charity Diabetes UK.
The charity organises Diabetes Week every year from June 14-20.
Ken said: “This was an organisation to foster education and peer support for people with diabetes and promote research in the subject. It was a pioneering idea.
“He championed things such as normalising the condition so that people with diabetes could live normal, active, working lives free from discrimination.”
RD Lawrence died on August 27, 1968 – his life prolonged by more than 40 years due to insulin.
Douglas Twenefour, Deputy Head of Care at Diabetes UK, said insulin continues to play an important role in the care of patients.
He said: “Insulin is a vital part of managing diabetes for all people with type 1 diabetes and some people with type 2 diabetes.
“Without insulin, blood sugar levels can become dangerously high, and can lead to diabetic ketoacidosis (DKA), which if left untreated can be life-threatening.
“With the right support, up to half of type 2 diabetes cases – and the accompanying risk of developing life-threatening complications – can be delayed or prevented.”
Throughout my career in diabetes research, insulin was always available and for those with type 1 diabetes it is a truly life-saving treatment. But for too long the major contribution of Aberdeen-educated John JR Macleod to the discovery of insulin has been largely unknown. A headstone in Allenvale Cemetery proclaims him as “Co-Discoverer of Insulin”, while a commemorative plaque in Cairn Road, Cults, announces him as the “co-discover of insulin and Nobel prize winner” who once lived there. Yet few have heard his name.
Celebration of the man and his work has been muted – perhaps in part due to the natural reticence of the “north-east condition” – but more likely resulting from the popular myth of the insulin discovery and attendant claims that Macleod’s recognition by the Nobel Prize Committee was undeserved.
In 2021, the world is celebrating the centenary of the discovery of insulin somewhat prematurely, following the traditional narrative that plaudits are owed only to two inexperienced Canadian researchers, Frederick Banting and Charles Best. As is apparent on examination of the facts, the true centenary of the magnificent Toronto breakthrough comes next January and Macleod was undoubtedly a central figure. It is time for all Aberdonians to know his name and understand his greatness.
Born near Dunkeld, Macleod moved to Aberdeen when his clergyman father was appointed to a city church. A prize-winning grammar school pupil, he similarly excelled in medicine at the University of Aberdeen.
On graduation he won a travelling scholarship to Leipzig where he embarked on a career in physiology. After time in London, he became a professor of physiology in Cleveland, Ohio, aged only 27. Fifteen years later, this successful researcher and teacher was recruited by the ambitious University of Toronto.
When young Canadian doctor Frederick Banting, with no experience of diabetes or research, came up with an idea to find a treatment for the condition, he was directed to Macleod – a famous authority on carbohydrate metabolism. Macleod generously offered laboratory space and guidance to the inexperienced Banting, plus a student assistant, Charles Best.
Macleod was quiet, methodical and rigorous in his work. Banting was driven, impatient and not well read. This disparity led to clashes which would damage their professional relationship and Macleod’s historical legacy.
Banting’s and Best’s early experiments were mostly conducted while Macleod was back in Scotland. When they wrote to tell him of promising results, he urged caution. Banting’s fury at what he perceived as rejection of his findings fuelled irreversible growing resentment. Having prepared a pancreatic extract that variably lowered blood sugar in diabetic dogs, Banting and Best had got about as far as several earlier groups. While Banting was permanently convinced he had already discovered the “cure”, this view was never tenable as his “big idea” proved unnecessarily complicated and was completely abandoned. Furthermore, nobody thus far had made extract sufficiently pure for continuing human usage.
Macleod’s experience guided the research to completion in both producing usable insulin and characterising its physiological properties. The definitive progress came when visiting biochemistry professor, James Bertram Collip, joined the team in December to apply his expertise on extracts of whole bovine pancreas.
Banting, threatened by Collip’s progress, saw a human trial of his own extract fail in early January. However, by January 23 1922, Collip’s purer extract had spectacular, life-saving effects on young Leonard Thompson. This was the Toronto breakthrough.
The confusion around the centenary date symbolises a steady erosion of Macleod’s place in the great discovery. In 1923, Macleod and Banting shared a Nobel Prize, but Banting and his allies told anyone who would listen that Macleod had no right to any credit, having simply stolen Banting’s (abandoned) idea.
Not until 1982 – when Toronto historian Professor Michael Bliss returned to original laboratory notes and files to produce his definitive work, The Discovery of Insulin – was there serious recognition of the burning need to restore Macleod’s unfairly diminished reputation.
Local attempts thus far include the 1993 biography published by Aberdeen diabetologist, Dr Michael Williams, and the opening of the JJR Macleod Diabetes Centre at Foresterhill in Aberdeen by Professor Bliss in 2013.
As we approach the (real) 100th anniversary of this remarkable breakthrough, it is now time that Macleod’s deserved glory is appreciated more widely. • Retired diabetologist Ken McHardy is an honorary senior lecturer at the University of Aberdeen who spent more than 30 years working in diabetes with NHS Grampian.
It is now time that his deserved glory is widely appreciated