The New York Historical Society’s new exhibition, “Breakthrough: The Dramatic Story of the Discovery of Insulin” is an illuminating display of historical documents and artifacts relating to the quest for a treatment of diabetes. Circling the one-room show should certainly be a moving experience for any of the millions of people whose lives are in some way indebted to the discovery of insulin. Even those who don’t have a firsthand connection to the disease, however, will appreciate the story of a breakthrough, not only for diabetics, but for science itself.
When I was young, my father told me, “If it wasn’t for science, you wouldn’t even exist.”
I had failed a Biology quiz on cellular structure, and neither of us was happy about it. The fault wasn’t mine – I was sure – but science’s. Cilia, Centriole, Cytoplasm, Chromatin. If they honestly expected me to be able to keep all these things straight, they might at least give them less-confusing names. The only cellular term I had been able to remember was The Golgi Apparatus but I had no clue what it was, or what it did. So I had simply written it in for every answer. Somehow I still got a zero.
“When I was your age,” my father explained, “I was playing outside and I got a splinter in my palm. The next day I noticed this black line heading down to my wrist. The day after that, it was halfway to my elbow. The day after that, it was up my forearm. My father took me to the hospital and they gave me a shot of penicillin and it made the line – it was an infection – disappear. But if it had happened even forty years earlier, before the discovery of penicillin? Then that infection would have gotten all the way to my heart and I’d have died. And you never would have been born!”
I tried not to take science lightly again after that. And, when one year later, my 18-month-old brother Jonathan (whose existence could also be credited to penicillin, I suppose) was diagnosed with type 1 diabetes, science would save his life as well.
Prior to the early 1920s, my brother’s type of juvenile diabetes would have been a death sentence. The finest treatments of the day included water from mineral springs, intense starvation diets, and bromides of gold and arsenic. These treatments hadn’t come far since 200 BCE, when scientists had first recorded this strange disease that seemed to make the urine smell oddly sweeter while the patient withered and died. The Breakthrough exhibit shows a 15th century book with a “urine color wheel.” To gauge the severity of the diabetes, a doctor of that day could match the hue of the patient’s urine to those in the illustration, which ranges disturbingly from grays and greens, to reds and purples. Even by the early 20th century, with the assistance of microscopes, the best minds were only able to link the disease to a strange mutation in a clump of cells in the pancreas called the “Islands of Langerhans.” A magnification of this cell structure shows diabetic islands (islets) alongside normal ones. The diabetic cells are roughly the same size as the healthy cells, but they are more angular: parallelograms instead of squares. They appear to be just slightly squished to one side, and there is something incredible in seeing this minute and yet terrible difference.
“Breakthrough” then shows how, in the early 1920s, the University of Toronto, Eli Lilly & Company, and the Joslin Diabetes Center in Boston first banded together to find a treatment for the disease. This coordination of research, pharmacy, and medicine was unprecedented at that time, and their success would mark the beginning of a new era in public health.
You can see the handwritten letters that were exchanged between Doctors Banting, Best, Macleod, and Collip as they worked on isolating and extracting insulin for the first time. “I think you will be pleased,” Banting wrote to Macleod in August of 1921, “when you see how the problem is unrolling from the one end + rolling up at the other.” These doctors seem to have worked tirelessly, though not always peacefully. Banting and Collip apparently once came to blows over the direction of the research. But none of these men could have solved the mystery alone – scary to think, when you read that Dr. Charles Best was only assigned to work with Dr. Banting after winning a coin toss, or that their research hinged on the puritanical work ethic of Elliot Proctor Joslin, who had the doctors at the Joslin Center keeping (for the first time ever) painstaking, handwritten logs of patients’ diets, weights, etc. and thus providing valuable statistics that had never before existed.
Finally, on March 22, 1922, the Toronto Star triumphantly announced, “Diabetes Sufferers Given Message of Hope” – the pink newspaper fragment hangs just beside the official citation given to Banting and Macloed by the Nobel Prize Committee in 1923.
In a nearby glass case stands an enormous Abby Cady rag doll, accompanied by a small metal syringe case from 1926 – these were given by Eli Lilly & Co. to all the young girls at the Joslin Center, who each promptly named their dolls “Lilly” in gratitude.
The next display shows the first evidence of the treatment’s effects, and its title of “Resurrection” does not seem extreme in the least. You see “JL” an agonized and skeletal 3-year-old (the size of the adjacent rag doll) who weighed only 15 pounds before treatment, transformed two months later into a plump and healthy child, who, if he seems a bit sullen, is probably just unhappy about his sailor suit. You see “Teddy Ryder”, a 27 pound 6-year-old, who, a year later weighed nearly 50 pounds. His thank you note to Dr. Banting hangs on the wall – in all capital letters: “I WISH YOU COULD COME TO SEE ME. I AM A FAT BOY NOW AND I FEEL FINE. I CAN CLIMB A TREE.” And then there’s James Havens on his skis. There’s Elsie Needham, who was brought out of a diabetic coma. Elizabeth Mudge, who lived 30 years longer than anyone expected. And finally, Elizabeth Hughes, who wrote one of the first extensive diaries about being treated for diabetes and the focus of a book by Thea Cooper Arthur Ainsberg that accompanies the exhibition.
However triumphant the breakthrough was, the exhibit makes it clear that the battle was still only half-won. Insulin remained difficult and expensive to make. The injection procedures often required doctors. Banting and company were forced to treat only the sickest patients, leaving many others to suffer, due only to a lack of consistent and quality supply.
By the early 1930s, however, the Eli Lilly company – along with funding from John D. Rockefeller and a lot of animal pancreases from Chicago-area meat-packers – began to heavily invest in the mass production of insulin. Here the story becomes a bit more abstract: but the Historical Society provides a silent film, many photographs, and even a touch-screen collection of cartoons to keep the human story in this exhibit front and center.
The second half of the exhibit begins with a photograph of seven men sitting on what appears to be a bomb (not a stretch, in 1923) but in fact turns out to be the very first insulin dryer, in the very first insulin factory. It is difficult not to gawk at the photograph of the six-foot high mountain of animal pancreases that it took to derive one milk-jug full of usable insulin. You can’t help but smile at an advertisement in 1932 by Eli Lilly & Co., explaining that mass production efforts had reduced the price of insulin by 90%. A display explains how this soon allowed patients to take responsibility for their own care, instead of being tethered to a doctor. You can’t help but wince at the wallet-sized identification card that a diabetic carried in the 1940s and 50s, reading “I AM A DIABETIC. I AM NOT INTOXICATED. If I am unconscious or my behavior is peculiar, please refer to emergency instructions on the back of this card.” Back then, many workers were afraid to tell employers if they were diabetic, for fear of discrimination. You can’t help but think how different a diabetic’s life is today, thanks mainly to science.
The exhibit closes with a display of different insulin pumps, going back to 1977. One wall is covered by magazine covers featuring diabetic celebrities – from Anwar El Sadat, to Nick Jonas and Supreme Court Justice Sonia Sotomayor. A segment of a documentary film shows poor Indian children who walk 5 miles through mountains to catch a bus to find a doctor for monthly treatment. Another wall explains that, despite the incredible breakthrough of insulin, there are one million diabetics in New York alone. That’s 20,000 hospitalizations, 3,000 amputations, and 4,700 deaths each year.
Perhaps the most captivating of the final displays, however, is a glass enclosure of 360 empty insulin vials. These belonged to a single patient between 1940 and 2008. Every bottle since 1940 has been roughly the same size and shape. The caps have changed colors, over time, from green to red. The labels from the original brand name “Iletin” (after those little cellular Islands of Langerhans) becoming “Humalog” today. But my eyes jumped right to the little orange-topped vials from the early 1990s – marked clearly in types “N” and “R” – the exact bottle that kept my brother alive back then. I can see it as part of an ever-refined continuum – and I can imagine the breakthrough cure that may yet come, which would make all of these bottles relics of the past.
I may still not know a Golgi Apparatus from my elbow, but “Breakthrough” is a must for anyone interested in seeing how, in the words of my father, science has kept each and every one of us existing.