Insulin is a hormone produced in the body by the pancreas; its main role is to cause cells to take up glucose from the blood thus regulating its level. The history of the discovery of insulin is an interesting one, albeit involving the death of a pack dogs.
In 1889, the physicians Oscar Minowski and Joseph von Mering removed the pancreas from a dog to test its assumed role in digestion. Several days after the dog’s pancreas was removed, it was noticed that there was a swarm of flies feeding on the dog’s urine. On testing the urine they found that there was an unusually high sugar content, establishing for the first time a relationship between the pancreas and diabetes mellitus. In 1901, it was established that the diabetes was caused by the destruction of a part of the pancreas called the Islets of Langerhans. These islets had been identified by Paul Langerhans whilst a medical student in 1869.
We now know that what the islets were producing was insulin, but this proved difficult to isolate. Nicolae Paulescu a professor of physiology in
Efforts continued by Banting and Best to purify the extracted insulin enough to allow administration to humans, which was underway by late 1921; commercial quantities were available by 1923. Banting received the Nobel Prize for his work, although controversially Paulescu was not recognised.
In the sadly now departed spirit of have-a-go experimentalism, the newly discovered insulin was then tried out on patients suffering with illnesses for which no treatment was known. In
Noting these results, Sakel moved to
The German name for the treatment was ‘Insulin-shock-behandlung’. Translated into English, the phrase became ‘insulin-shock-treatment’. Sakel interpolated the word ‘shock’ to emphasize his belief that the essential element of ICT was the lowered blood pressure, sweating, increased heart rate, and increased breathing rate that resulted from the stresses produced. It was later understood that, that the medical shock aspects were not important to the treatment results, and any benefit was mostly likely due to the insulin induced coma. Insulin coma therapy was regarded as a specific treatment for schizophrenia, and was probably the first in this regard.
Essentially the treatment involved a large dose of insulin which lowered the patient’s blood glucose enough to produce a coma. This would be maintained for one to three hours and terminated by either tube feeding or intravenous glucose. A course of treatment could include up to 60 comas. Serious side effects were common, and a mortality of at 1-10% could be expected depending on the standard of the clinic and physical state of the patient. Epileptic seizures could occur during the beginning stages of treatment, roughly 45–100 minutes into the procedure, but before the onset of the comatose state. Seizures occurring during the coma were more dangerous, requiring immediate interruption of the procedure and coma termination, and were often followed by delayed recovery or severe hypotension. Complications would also occur from the unconsciousness reaching excessive depths and that the coma would not end despite the administration of feeding or glucose. Administrators would monitor the patient’s vital signs, to determine the level of danger.
Despite these risks, insulin coma treatment was rapidly taken up throughout
There were always some doctors who doubted the efficacy of insulin coma treatment. Their doubts were reinforced by a controlled trial by Acker and
The Acker and Oldham study was published about the same time that chlorpromazine was introduced and both factors lead to a rapid decline in the use of insulin coma treatment. It should be said though that some controlled studies did not exclude the efficacy of insulin treatment in certain circumstances and a number of workers continued to maintain that it was effective**. Recent experimental studies have shown that insulin administration causes changes in the release of monoamine neurotransmitters, suggesting a possible mechanism of action**.
The Insulin Treatment of Schizophrenia From An Introduction to Physical Methods of Treatment in Psychiatry (First Edition) by William Sargant and Eliot Slater (1944, Edinburgh, E & S Livingstone).
A History of Shock Therapy in Psychiatry by Renato M.E. Sabbatini, director of the Center for Biomedical Informatics and Chairman of Medical Informatics of the Medical School of the State University of Campinas Brazil
Drug Treatments in Modern Psychiatry: A History of Delusion Dr Joanna Moncrieff Senior lecturer UCL UK
A Brilliant Madness PBS minisite about Nobel Prize winning schizophrenia sufferer John Nash. In the same site Dr. Max Fink, the head of the insulin coma unit at the Hillside Hospital in Glen Oaks, Queens, New York from 1952 to 1958 writes about the treatment
Wikipedia on insulin shock therapy
* I haven’t read this, Joanna Moncrieff, Senior Lecturer in Social and Community Psychiatry UCL and chair of the Critical Psychiatry Network cites it in the above presentation. He’s a journalist though, so I can’t shake the suspicion that he’s making it up.
**Source Shorter Oxford Textbook of Psychiatry by Michael Gelder, Richard Mayou and Philip Cohen Oxford 2001 pg 648. They don’t cite a source.