THE DISCOVERY of INSULIN and NICOLAE PAULESCU

1 THE DISCOVERY OF INSULIN and NICOLAE PAULESCU F. I. Dworschak 2 : I have tried not to be offensive and you may think I have been too mild, but I know that any criticism of the Toronto workers will be regarded as almost sacrilegious in certain quarters.” Ian Murray to I. Pavel, 4 April 1970 “He (Paulescu) was the first to describe the actions of what was later called insulin and demonstrated clearly that it was a hormone with actions on all aspects of metabolism”. Sir George Al berti December 2001 3 INTRODUCTION This essay will re-examine the contributions to insulin research and other areas of Medicine and Physiology by Nicolae Constantin Paulescu and account for his relative lack of recognition in English language historiography. 1 One important reason was that he wrote and published exclusively in French. He also had little access to English language medical publications, likely because he could not afford them (see his unanswered letter to Banting dated 5 February 1923). As such, he was out of touch with the rapid advances in diabetes research in the Anglo-Saxon medical literature, relying exclusively on French sources. Starting in 1922 this became fatal, he was left behind and his contributions, meager at this stage also due to financial problems, became almost irrelevant. This is in marked contrast to the previous years (1920-1921) when one could rightly say that he was the leading researcher investigating the whole range of physiological properties of the “inner secretion” of the pancreas that eventually would be known as insulin. Viewed from this angle he should be considered the discoverer of insulin as a hormone affecting practically all aspects of the metabolism. Unlike his personal life and his activities in politics and religion, where we have a certain body of information from his contemporaries, when it comes to his scientific work we are left only with what he published, and all this in French. Unfortunately, we do not have the work notes of Paulescu. They were left at his death, together with all written material in the care of Dr. V. Trifu. They disappeared because of war, earthquakes, foreign occupations and ultimately because of the installation of a repressive communist regime. We know that Dr. Trifu, who was suspected by the Communist Régime and facing imminent house search, burned all material entrusted to him by Paulescu. According to their Stalinist doctrine, Paulescu was considered an “enemy of the people” (close relations with democratic and bourgeoise France, with the Church, etc.). So we cannot study the progress of his scientific research, possible failures, how much help if any he got, not to mention the tribulations, the moments of despair or of ecstasy. Dr. Trifu had started a study on Paulescu’s life and work, but unfortunately again because of hostile political changes he only could write and publish a small introductory fragment in 1944. 2 1 His Romanian name was Nicolae Constantin Paulescu. He often used the “French spelling” of his surname, Paulesco. We shall use Paulescu, except when it is spelled differently in quoted text. 2 V. Trifu, “Profesorul Paulescu ,” in Doctorul Nicolae C. Paulescu sau Ştiin ţa M ărturisitoare, ed. Răzvan Codrescu (Bucharest: Editura Christiana, 2002), p. 31-97. Originally published in 1944 by the “Funda ţia Regal ă pentru literatur ă şi art ă”, Bucharest, România. 4 Some of the more reprehensible manifestations of Paulescu’s political anti- Semitism, expressed only in his writings but never in his deeds (on the contrary he always behaved in an exemplary fashion), will be discussed in the chapter “Criticism of Paulescu”. But they were actually very uncharacteristic of a man otherwise devoted to the principles of charity and helping humanity. Suffice to mention here that we are firmly convinced that they were based on his religious fanaticism and an erroneous conception of the Christian religion. In this essay, we shall concentrate on his important contributions to medical science, particularly in the field of the discovery of Insulin. His achievements become even more impressive when we consider how limited his resources were and how obsolete were the laboratory techniques at his disposal. He was competing against scientists in the West, where important new developments had rendered their task so much easier. The almost miraculous thing is that during the years 1920-1921 he managed to be the leading researcher in this field. Obviously, he had to utilize to the maximum his superb intellectual capacity and to make the most of simpler, even obsolete methods of investigation, like for instance simple measurements of temperature. It is not often in history that one single great mind could compete against rivals with infinitely superior armamentarium. But this could not last very long. In the end, he had to give way to the genius of a bright young researcher by the name of James Bertram Collip and this we salute wholeheartedly. We should also emphasize the infinitely superior new techniques at the disposal of the latter. But unfortunately, Paulescu also became the victim of distasteful maneuvering, due either to ignorance or to malice or to both, by Frederick Grant Banting and Charles Herbert Best as we are going to demonstrate in this essay. M. Bliss’ book “The Discovery of Insulin” is without any doubt the most important work in this field. 3 He vacillates between a few words of praise for Paulescu and many unwarranted disparaging remarks (see our last chapter). It is obvious that he has a weak spot for Banting, no matter how many blunders Banting had committed. At the same time, it is equally obvious that he is too often reluctant to grant real merits to Paulescu and is even often inclined to omit essential facts that would raise Paulescu’s standing in the world of science. This becomes quite obvious when he criticizes Paulescu’s data based on the rather imperfect Pflüger’s method for determining glucose levels in the blood especially in the upper and lower registers. The amazing thing is that in spite of being forced to work with such primitive tools, Paulescu was beyond any doubt able to achieve more than Banting was able to do prior to Collip’s arrival. Equally, when Bliss fails to quote the essential text from Macleod where the 3 Michael Bliss, The Discovery of Insulin, (Toronto: University of Toronto Press, 2000). 5 latter expresses his acceptance and recognition of Paulescu’s important contributions. Or when he fails to mention the appreciative opinions of other distinguished men of science but has no hesitation to repeat Best’s incompetent, at times even ridiculous evaluations of Paulescu’s work, etc. We have come to the conclusion that Bliss’ work, otherwise an excellent book, very rich in accumulated material and details, is unfortunately quite unfair when it comes to Paulescu’s work. We say this regretfully, but after studying Paulescu's original work and other sources, we have come to this inescapable conclusion. We should not forget that in 1993 Bliss published a stinging but very well documented critique against Best: “ Rewriting Medical History: Charles Best and the Banting and Best Myth”, 1993. His brief comments on Paulescu and Pavel will be rendered in the subchapter “Bliss and Best” near the end. They are quite positive and fair and in stark contrast to the partisan and unfair remarks in his main work “The Discovery of the Insulin”. Ian Murray among others discussed the same issues but he understood how Paulescu’s data was to be properly analyzed and interpreted. 4 Murray understood that, no matter how different Paulescu’s data was (considering the different methods used), compared to those from the West, they were conclusive. Also, Paulescu had covered a much wider field, and proved more facts than either Banting or Israel Kleiner did. Bliss’ work has the great merit that it is based on many documents hitherto unknown to the public and researchers alike. These include the previously inaccessible archives at the University of Toronto and also the Karolinska Institutet in Stockholm. We should also include Macleod’s paper found after his death in 1948 (mentioned only but not discussed or assessed by Bliss). It is known now that it had been hidden at the University of Toronto until published by Lloyd Stevenson only in 1978. Obviously, they had been kept under lock in order to protect the glorification of Banting and others. 5 Unfortunately Bliss has very little to say about some of these sources of information. It is obvious that he is at times very selective when it comes to information stressing Paulescu’s great merits. An example could be Bliss ignoring the important work by Paulescu regarding the glucogenesis in the liver or the physiology of the pituitary gland. Bliss considers Kleiner’s contributions superior to those of Paulescu. One can only have the highest respect for Kleiner, the scientist and the man. But because I 4 Ian Murray, “Paulesco and the Isolation of Insulin”, J. Hist. Med. Allied Sci. 1971, XXVI, pp. 150-157. Also: “The Search for Insulin”, 1969, in Scottish Medical Journal, 1969, 14, 286; “Insulin: Credit for its isolation”, Brit. Med. J. 1969, p.651; “No man an Island”, Brit. J., April 1971, p.119. 5 Macleod’s paper is more convincing than Banting’s version and reveals some unsavory behavior by the latter. 6 cannot agree with Bliss’ assessment, I shall have a brief chapter comparing the works of these two great scientists. Before completing this Introduction we want to express our sincere regrets that we have to be so critical of Bliss’ unjust evaluation of Paulescu, in a book that otherwise has so many merits and deserves our utmost respect.

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