Appendix Notes on the Development of Pancreatology: Progress in Communications and Related Professional Societies Prior to the twentieth century, few patients were recognized as having a disease of the pancreas. Autopsies showed retrospectively that the pancreas had occa­ sionally been the site of the patient's problems. Diabetes was recognized; its treatment was ineffectual and it was not known with certainty if it was a disease of the pancreas - at least not until about 1882, the year of Meting and Min­ kowski's experiments with pancreatectomy. With so little knowledge, physicians, as well as the public, had little interest in the pancreas. But at the outset of the twentieth century, with general anesthesia and asepsis in the operating room, the introduction of the microscope to clinical medicine having been made, and with the recent discovery of the X-ray, new horizons were opening. There were no "societies of the pancreas" until the discovery of insulin in 1921, after which "societies of diabetes" arose - often oriented to a patient membership. As few reports on the historical developments of pancreatology have been published, the following informal observations have been based largely on communications from early leaders. The report is therefore incomplete and subject to possible errors. A.I. ORGAMZATIONS CONCERNED WITH DIABETES Although diabetes was frequently a complicating problem of surgical pa­ tients, surgeons were infrequently interested in research in diabetes in the early part of the twentieth century. This would gradually change, particularly as the 665 666 subsequent era of transplantation evolved. Nevertheless, "diabetic societies" involving patients, physicians, and other scientist-investigators were organized in Appendix many countries of the world. These were "diabetic clubs" in the broadest sense of the term. Among the leading diabetic organizations were the following: The British Diabetic Association was founded in 1938. Its founders included R. D. Lawrence and the writer H. G. Wells, himself a diabetic. The organization was essentially made up of patients, although many doctors joined, and had as its primary goal the education and care of the diabetic. During World War II it sought to obtain an adequate, fair nutritional ration of foods for the country's diabetics. A medical and scientific section of the association was organized in 1960 with F. G. Young as chairman, and it continues to meet bi-annually. The American Diabetes Association was founded in 1942, four years after the British association. The American association is composed of physicians and others who care for diabetic patknts, but diabetic patients themselves do not constitute a significant segment of the membership. It holds major annual meetings and publishes the journaJl Diabetes. Many other national associations were developed. The European Associ­ ationfor the Study of Diabetes (EASD) was founded in 1965, largely through the efforts of Albert Renold, a Swiss biochemist. Having spent years at the Joslin Clinic in Boston, Renold returned to Geneva and, together with J. F. Hoet, a Belgian pioneer in diabetes research and care, organized the European Associ­ ation along the American lines. It holds annual scientific meetings and publishes the journal Diabetologia. The International Diabetes Federation, a worldwide organization, was founded in 1952. Meeting at three-year intervals, its first was held in Leiden. S~nce then meetings have taken place on each continent. The World Health Organi­ zation, with its broad sphere of responsibility, has published a number of reports on diabetes, including the worldwide epidemiology of the disease. The Canadian Diabetes Association, organized and stimulated by the momentous discovery of insulin in its country, has been active in supporting research on the disease. The following letter, written by the late Bill Banting,(ll* the only son of Dr. Frederick Banting, depicts an aspect of their program. The letter was written following the lighting of a "a flame of hope" in London, Ontario, where the ideas leading to the discovery of insulin were born. My father asked more of himself than others. Anxious to give his first year medical students a synopsis of the latest research, he thought the material for his lecture wasn't good enough. To do a better job, he took his medical journals to bed with him. Hours later, rising from a sleep, he scribbled down a brief paragraph that would lead to the discovery of insulin. That was the night of October 30, seventy-four years ago and how my father's name was first associated with diabetes research. He conceived the idea of isolating insulin in his house in London, Ontario. Today that house is the Banting Museum and Education Centre. [ visited there this spring on the eve of my father's induction to the Canadi,m Medical Hall of Fame. For the first time I 'With permiSSion of Mr. Robert Banting. saw where the concept was first sparked that took him to the dramatic 667 breakthrough at the labs of the University of Toronto. My work has taken me across five continents, but meeting the volunteers of the Canadian Diabetes Notes on the Association was a defining moment of my life. I discovered that their Development of Pancreatology dedicated energy makes the world a better place for people with diabetes. When I was born, my father was 38. He died a month before my 12th birthday. He was 49. He was raised a farm boy and the country was in his bones. He showed me how to make a whistle from a willow twig - where to look for four leaf clovers - and which unseen bird sang that song. This was valuable stuff for a young boy to get from his Dad. His biographies will tell you that he could be headstrong and stubborn and a very tough man to cross. But he was also fiercely loyal to his friends, colleagues, and war comrades. My father was also kind and gentle - especially with animals and children - who loved him. He received grateful letters from thousands of children with diabetes which he would read, late at night, with soft tears in his eyes. He knew insulin was not a cure. As World War II approached, he re-joined the army and I saw less of him. One night in early 1941 he came home and asked me to come to his study with him. Invitations to his study usually meant trouble, but this time it was different. He quietly told me he was going to Britain on war business, and that it was a secret. I was to work hard at school and help with the chores. Next morning he left for Ottawa to catch his plane. He never came back. In front of the house where my father conceived his idea for insulin - a flame bums from a cairn. It is called the flame of hope, and on the day a cure is found for diabetes, it will be extinguished. With your support harnessed to the all out efforts of dedicated researches - the lives of men, women, and children with diabetes will be made better - and eventually a cure will surely be found. If my father could be here, I know he would cheer your good work by supporting the Canadian Diabetes Association. (signed) Bill Banting Numerous other groups, varying in purpose and participants, but centered around the problems of diabetes, evolved. A.2. PANCREATIC SOCIETIES A.2.t. European Pancreatic Club Apparently, the first pancreatic society to be organized was the European Pancreatic Club; its initial meeting being held in London, December 9-10, 1965. The leading influences in its conception and initiation were gastroenterologists: Professor Rudi Ammann of Switzerland, Professor Henri Sarles of France, Profes­ sor Harry Howat of England, Dr. Helgen Woming of Denmark, Dr. Fitzgerald of Ireland, Dr. Edlund of Sweden, and Dr. Karel Herford of Czechoslovakia. It was created to foster communication between basic scientists and clini­ cians; approximately 50% of its membership and leadership representing each of those two categories. A forum for young investigators was also envisaged. Beginning as an informal group, the club became more structured in recent years when annual dues were initiated. Representing a multilinguistic European so­ ciety, presentations in English, French, and German were initially accepted, but 668 Table A.t. The European Pancreatic Club: Annual Meeting Sites and Dates Appendix Location Year 1. London, United Kingdom 1965 2. Marseille, France 1966 3. Prague, Czech Republic 1968 4. Gottingen, Germany 1969 5. Brussels, Belgium 1969 6. Goteborg, Sweden 1971 7. Dundee, United Kingdom 1974 8. Toulouse, France 1975 9. Oslo, Norway 1976 10. Dublin, Ireland 1977 11. Zurich, Switzerland 1978 12. Copenhagen, Denmark 1979 13. Krakow, Poland 1981 14. Essen, Germany 1982 15. Verona, Italy 1983 16. lisbon, Portugal 1984 17. Manchester, United Kingdom 1985 18. Nijmegen, The Netherlands 1986 19. Marseille, France 1987 20. Budapest, Hungary 1988 21. Glasgow, United Kingdom 1989 22. Basel, Switzerland 1990 23. Lund, Sweden 1991 24. Ulm, Germany 1992 25. Paris, France 1993 26. Bologna, Italy 1994 27. Barcelona, Spain 1995 28. Mannheim, Germany (combined with 1996 International Association of Pancreatology) 29. London, United Kingdom 1997 30. Thessaionia, Greece 1998 31. LOneburg, Germany 1999 32. Kiei, Germany 2000 Infonnation provided by Mr. C. W. Imrie, Glasgow, Dr. R. Ammann, Zurich, and Dr. I. Ihse, Lund. in the early 1970s English became the official language. There is a rule that 60% of scientific communications should come from basic scientists. The European Pancreatic Club rapidly involved a significant surgical compo­ nent, with leading surgeons holding major posts, including the presidency. The EPC, as it is often deSignated, was one of the original seven groups leading to the formation of the European Digestive Disease Week. Meeting annually, its third such one, in July 1968, was held in Prague during the long period of political liberalization, the "Prager Friihling," that preceded the Czechoslovakian invasion by the Soviet Union.