The Health Innovation Legacy
It was not until its relocation to College and University that the Toronto General Hospital (TGH) became the site of major medical discoveries. While its exceptional new facilities were essential to this transformation, they were not the primary cause. Rather, they facilitated a close collaborative relationship between the Hospital, government and the University of Toronto, which brought together a critical mass of academic and clinical expertise. As early as 1921, it became quite clear that this example of institutional collaboration was an enormous impetus for innovation.
The Toronto General was one of the first hospitals in the world to enter into a close research and teaching affiliation with a university and medical school. This initiative was set in motion in 1903, when the University of Toronto Medical School completed a massive renovation of its facilities and absorbed its former competitor, Trinity Medical College. Now boasting the largest medical school in North America, it was strongly felt that to maximize the use of its prodigious resources, the University needed free access to clinical material for educational and research purposes. For these, it turned to the TGH.
In 1906, the Ontario Provincial Government passed the “Toronto General Hospital Act,” which granted appointees from the City, Province and University joint membership on the board with Hospital trustees. More importantly, it allowed medical students from the University unrestricted access to patients and hospital resources. One year later, many of the hospitals services were put under coordinated University and Hospital governance.
It soon became clear that combining the academic expertise of university researchers with the hospital’s clinical material and its doctors’ practical experience proved to be a potent combination. Between 1913 and 1959, the College Wing of Toronto General Hospital was the scene of many significant medical discoveries and developments. (After 1959, when a new central building officially opened to consolidate the hospital's surgical and medical services and most of its other departments, the focus of the College Wing shifted more to administrative, out-patient and support services.) While these discoveries are undoubtedly the substance of the innovation legacy the Heritage building represents, the underlying institutional relationships that facilitated them are just as much a part. Indeed, it demonstrates the potential offered by a collaborative structural environment, a potential that MaRS’ principle of convergence innovation seeks to tap.
The insulin model proved to translate beautifully. By 1933-34, Best had perfected an efficient Heparin production method based on beef lung. The question of applying it clinically was assigned to Dr. Gordon Murray, a rising surgeon serving Ward C at the TGH. While Murray experimented successfully with Heparin using dogs across the street in the Banting Institute laboratory, Scott and Charles worked on purifying Heparin. They also prepared a crystalline form of the elusive substance that could be tested on patients in need of vascular surgery for the prevention of thrombosis and embolism (the formation of blood clots). On April 16, 1935, Murray first administered Heparin to patients with mixed results. Six months later, Murray resumed his clinical work, using a new purified Heparin with much improved results. By 1940, Murray had treated 400 patients with Heparin in a variety of surgical operations without thrombosis or embolism. Despite Heparin’s enormous clinical value, its discovery and implementation was not as dramatic as insulin. This in large part was because no-one could explain how Heparin worked to prevent blood from clotting; it’s still a mystery today.
Murray, ever the practical surgeon and researcher, recognized that regulating blood flow and coagulation inside and outside the body opened up many possibilities in the field of surgery, which had been severely limited by uncontrollable clotting during surgical procedures. This led to a wave of subsequent innovations. Click to learn more:
All of these developments, as well as such technologies as the kidney and heart-lung machines, depended upon the precise control of blood flow inside and outside of the body that Heparin provided. The TGH played an essential role in the development of Heparin, experimental and clinical work that was painstaking, precise and conducted almost single-handedly by Murray. However, Murray's research would not have taken place without TGH's earlier role in the insulin story, or the essential contributions of the University of Toronto and its Connaught Laboratories to the discovery and production of insulin and then the production and purification of Heparin.
The stories of these innovations highlight the importance of place, intellectual communities, and above all the catalytic roles of certain inspired individuals. The discovery of insulin made possible a wave of succeeding innovations thanks to the impetus for collaboration driven by these three factors. Techniques, skills and problem-solving approaches were transferred into new disciplines and found novel uses. The relevance to MaRS is clear. The ideal of creating an environment where diverse ideas can freely cross-fertilize—and the structures, programs and people necessary to realize it—pay homage to MaRS’ innovation legacy, and promise to bring it into the 21st Century.
The Toronto General was one of the first hospitals in the world to enter into a close research and teaching affiliation with a university and medical school. This initiative was set in motion in 1903, when the University of Toronto Medical School completed a massive renovation of its facilities and absorbed its former competitor, Trinity Medical College. Now boasting the largest medical school in North America, it was strongly felt that to maximize the use of its prodigious resources, the University needed free access to clinical material for educational and research purposes. For these, it turned to the TGH.
In 1906, the Ontario Provincial Government passed the “Toronto General Hospital Act,” which granted appointees from the City, Province and University joint membership on the board with Hospital trustees. More importantly, it allowed medical students from the University unrestricted access to patients and hospital resources. One year later, many of the hospitals services were put under coordinated University and Hospital governance.
It soon became clear that combining the academic expertise of university researchers with the hospital’s clinical material and its doctors’ practical experience proved to be a potent combination. Between 1913 and 1959, the College Wing of Toronto General Hospital was the scene of many significant medical discoveries and developments. (After 1959, when a new central building officially opened to consolidate the hospital's surgical and medical services and most of its other departments, the focus of the College Wing shifted more to administrative, out-patient and support services.) While these discoveries are undoubtedly the substance of the innovation legacy the Heritage building represents, the underlying institutional relationships that facilitated them are just as much a part. Indeed, it demonstrates the potential offered by a collaborative structural environment, a potential that MaRS’ principle of convergence innovation seeks to tap.
MEDICAL BREAKTHROUGHS AT THE TGH
The most spectacular innovation to arise from the University-Hospital collaboration was the discovery of Insulin in 1921-1922 by Frederick Banting, Charles Best, J.B. Collip and J.J.R. Macleod, for which Banting and Macleod received the 1923 Nobel Prize in Medicine. This story deserves special mention and is the subject of the next section. But by no means were the succeeding forty years a denouement to this brilliant feat. Such success with developing a tissue extract to control a chronic disease like diabetes also generated new opportunities for doctors and researchers struggling to control or cure other diseases and conditions that had hitherto seemed impossible. A classic example is the development of Heparin, an immensely useful blood anti-coagulant which in turn enabled a host of corresponding innovations in the field of surgery.
Best in his lab, 1948
HEPARIN AND ITS SURGICAL APPLICATIONS
Following his team’s success in isolating insulin from the pancreas, Dr. Charles Best sought to tackle other diseases using the tissue extract approach. In particular he became interested in the dilemma posed by Heparin. Discovered in 1917 at Johns Hopkins University, Heparin was a blood anti-coagulant with immense clinical potential, including the prevention of blood clots during surgery. However, all attempts to isolate Heparin from liver tissue, its source, had yielded highly impure, toxic extracts. Best thought that a process similar to the one used to make insulin could be applied to produce a purified supply of Heparin, after which it might be clinically tested at TGH. In 1929, Best first assigned the problem of developing Heparin production and purification methods to Drs. D.A. Scott and A.F. Charles of Connaught Laboratories at the University of Toronto.The insulin model proved to translate beautifully. By 1933-34, Best had perfected an efficient Heparin production method based on beef lung. The question of applying it clinically was assigned to Dr. Gordon Murray, a rising surgeon serving Ward C at the TGH. While Murray experimented successfully with Heparin using dogs across the street in the Banting Institute laboratory, Scott and Charles worked on purifying Heparin. They also prepared a crystalline form of the elusive substance that could be tested on patients in need of vascular surgery for the prevention of thrombosis and embolism (the formation of blood clots). On April 16, 1935, Murray first administered Heparin to patients with mixed results. Six months later, Murray resumed his clinical work, using a new purified Heparin with much improved results. By 1940, Murray had treated 400 patients with Heparin in a variety of surgical operations without thrombosis or embolism. Despite Heparin’s enormous clinical value, its discovery and implementation was not as dramatic as insulin. This in large part was because no-one could explain how Heparin worked to prevent blood from clotting; it’s still a mystery today.
Murray, ever the practical surgeon and researcher, recognized that regulating blood flow and coagulation inside and outside the body opened up many possibilities in the field of surgery, which had been severely limited by uncontrollable clotting during surgical procedures. This led to a wave of subsequent innovations. Click to learn more:
The stories of these innovations highlight the importance of place, intellectual communities, and above all the catalytic roles of certain inspired individuals. The discovery of insulin made possible a wave of succeeding innovations thanks to the impetus for collaboration driven by these three factors. Techniques, skills and problem-solving approaches were transferred into new disciplines and found novel uses. The relevance to MaRS is clear. The ideal of creating an environment where diverse ideas can freely cross-fertilize—and the structures, programs and people necessary to realize it—pay homage to MaRS’ innovation legacy, and promise to bring it into the 21st Century.