Dial M for Medicine

What makes for a really good mystery? It isn’t just an interesting question or sparring with a particularly evil villain. A good mystery is born from the tension that builds as our hero pursues the truth, often against the odds.

In many ways, that’s what happens every day in the Faculty of Medicine. Our students and faculty don’t just struggle with novel questions but pursue evidence through research and rigorous examination. They see their fair share of villains, sometimes in the form of devious pathogens, but more often revealed by a dog that doesn’t bark, like from an Arthur Conan Doyle tale. Physicians and medical researchers are frequently confronted by mysteries that demand not just strong clinical and scientific skills but also a gumshoe determination to uncover the facts. We are both Sherlock and Dr. Watson.

“The world is full of obvious things which noboby by any chance ever observes.”

— Sherlock Holmes in Sir Arthur Conan Doyle’s The Hound of the Baskervilles.

This issue of UofTMed delves into the realm of mysteries to find the inherent drama that rests behind questions and examine how we persevere to reveal the answers. The process is sometimes frustrating and at other times exhilarating, but it’s never dull.

A mystery is rarely solved by revealing what’s unknown. It’s the careful re-evaluation of what’s right in front of us that makes the truth self-evident. What I see when I look at the Faculty of Medicine is a community committed to uncovering facts — and by doing so, finding solutions to some of the most complex problems in science and medicine. And that, to anyone who observes us, is obvious.

Trevor Young 
MD, PGME (Psychiatry) ’88, MSc ’89, PhD ’95
Dean, Faculty of Medicine
Vice-Provost, Relations with Health Care Institutions

Unsolved, Unanswered, Unknown

What makes for a great medical mystery? Seven faculty members share the unsolved cases that keep them up at night — and some of the great questions still unanswered in medicine.

By Heidi Singer

Resisting Our Genetic Destiny

There are kids with autism who can cite every name, address and number in a phone book but have trouble tying their shoes. Sometimes I wonder which is the bigger medical mystery — their amazing memories and motor deficiencies, or everybody else’s memory deficiencies but adeptness at other, perhaps simpler things?

Studying the genetics of autism brings up a very fundamental mystery: Why do some people who have massive genetic irregularities never develop autism (or other disorders), but their children do? This mysterious ability that some people have to resist their genetic destiny is utterly fascinating. Scientists all over the world are now combing through the genomes of healthy people, looking for those rare ones. These miraculous genomes have learned to resist adversity, so maybe they’ll show us the way. Genetic “resiliency” is perhaps the biggest diagnostic mystery of 21st-century science — and potentially the key to solving our most complex medical questions.

—

Stephen Scherer (MSc ’91, PhD ’95) is Professor of Molecular Genetics and Director, McLaughlin Centre; Senior Scientist, The Hospital for Sick Children.

Where Cancer Doesn’t Tread

W‌hy do our muscles almost never get ‌cancer? This disease is ‌infamous ‌for becoming very invasive, travel‌ling everywhere in the body — but
‌skeletal muscle is never the place it goes. It’s just this really interesting observation that people have made, and we don’t have an explanation for it. As far as I can tell, nobody has dug down and figured out why, and there might be some important information to use in the fight against cancer. For example, there could be unique proteins in muscle that prevent tumour cells from wanting to put down roots in this type of tissue. Or it could be something fairly simple — muscle is always moving, so maybe it’s difficult for cancer cells to enter this tissue.

—

Penney Gilbert is an Assistant Professor at the Institute for Biomaterials and Biomedical Engineering.

Solving a 50-Year-Old Mystery

A few years ago, my lab discovered a cru‌cial receptor for respiratory syncytial ‌virus (RSV), which frequently causes the ‌common cold and serious lung infec‌tions like pneumonia. Researchers had known about this virus since the ’50s, but we hadn’t made much progress on a treatment because nobody had identified the molecule that allows the virus to bind to the cell. We looked at our quest as a mystery that needed solving — and I believe that mindset helped us.

First we determined the virus sticks to protein, not sugars or lipids. But which one? The cell surface contains thousands of proteins so, we had to narrow it down. We separated cell surface proteins on a gel and got a common “hit” for all the cell types and RSV strains we tested. We identified the protein we thought was responsible for these hits, and after a series of experiments using different techniques, we established the evidence that this unusual molecule was indeed an RSV receptor. The answer wasn’t intuitive, but came from a great deal of trial and error — gumshoe detective work that solved a 50-year-old mystery.

The main lessons were to keep an open mind, expect the unexpected and understand your tools. Basic scientists don’t always see their investigations as mysteries to solve, but I think it helps to look at it this way because in any good mystery the culprit is never the one you suspect at first.

—

Richard Hegele (MD ’84, PGME ’89) is Vice Dean of Research and Innovation and a Professor in the Department of Laboratory Medicine and Pathobiology.

What’s in a Name?

I marvel at the dire shortage of knowledge, both scientific and humanistic, concerning the disparate causes of, and the cures for mental disorders.

These gaps in knowledge have the unfortunate effect of compounding other mysteries, and they cause fear and dread – which in turn feed superstition, and have led too often to stigma. Consequently, psychiatry has emerged as arguably the most challenging and demanding of medical specialities.

The challenges of the mind and brain and their legion of mysterious afflictions do tend to stimulate our curiosity. Our antennae of critical faculties are set tingling by unexpected notions and unusual connections. Frequently they emerge through random associations from literature and the arts – think of Shakespeare’s metaphorical references to London’s medieval “Bedlam” facility.

Novelist Timothy Findley wrote eloquently and sensitively of psychiatric patients’ experiences and, for the most part, he used the real names of Toronto area hospitals. Not so for the (now former) Clarke Institute of Psychiatry, which he called “The Parkin Institute of the University of Toronto” – after its prominent architects, rather than the sometimes-controversial Psychiatry professor and Medicine Dean C.K. Clarke. Findley’s reason for that enigmatic substitution remains a mystery.

—

John Court is an assistant professor in the Department of Psychiatry and IMS, based at CAMH, who researches and instructs on the history of psychiatry

The Mystery of the Aging, Failing Brain

A‌ging, failing brains are normal enough — ‌anyone who lives a long time will probably ‌feel this decline. Of course dementia is far ‌more tragic than “normal” memory loss, ‌but why should we lose any part of the thoughts and memories that make us human? I don’t think it’s a given that our brains should wear out like other parts of our bodies. Why should the aging process wipe out our very identities?

We’ve never solved this mystery, and as a result the medical landscape is littered with failed drugs to treat dementia. But recently, we have started to take a step back to understand the molecular basis of learning and memory. There have been great strides recently in this area. Now the challenge is to understand why and how these processes go wrong in conditions like Alzheimer’s — and then develop treatments to alleviate and perhaps even cure these awful diseases.

—

Graham Collingridge is Professor and Chair of the Department of Physiology.

Under Pressure

A ‌64-year-old woman was carried into the emergency room one night screaming from abdominal pain. To my surprise, her ‌belly was soft, ruling out most of the obvious causes. Her ‌adult daughter was worried sick, and pushing hard for action. ‌I felt the pressure to get it right. Blood tests showed elevated lactate, which meant somewhere in her body wasn’t getting oxygen. I could order a CT scan, but radiologists always say if you don’t know what you’re looking for, you won’t find it with a scan. Just when I’m trying to figure out my next move, she flips into atrial fibrillation. That’s when I smile — now I know she’s got a blood clot leading to an ischemic bowel.

I put her on blood thinners and send her off to the CT scan. Now that I know what I’m looking for, the scan confirms the diagnosis: it shows several feet of bowel that are deprived of oxygen and swelling up, causing intense pain. An interventional radiologist takes the clot out.

The things that ER physicians see are common occurrences. We solve mysteries mostly through pattern recognition. The first unusual pattern I saw in this case was pain out of proportion. But it wasn’t until her heartbeat went irregular that I thought of a blood clot in the vessels of her intestines. That heartbeat was like a gift from God: it made me realize there was turbulence in the blood stream.

Detectives solve mysteries. But I don’t imagine them becoming emotionally burdened by anxiety from their cases like doctors do with their patients. What if that woman had been close to death and I hadn’t had much time to figure out the problem? Clinicians are never dealing with a sterile medical mystery. Panic and logical thinking never go well together.

—

Brian Goldman (MD ’80, PGME ’82) is an emergency room physician at Mt. Sinai Hospital, Assistant Professor of Family and Community Medicine and host of the CBC Radio show White Coat, Black Art.

Why Do Children Get Cancer?

A‌s a medical student, I used to think cancer was ‌a disease of old people: your cells get old ‌and don’t divide as well and the DNA gets ‌jumbled. But why do children get cancer? ‌On an emotional level it’s totally unfair; however, there are lessons here that can be applied to many cancers. In children, there’s a fine balance between normal development and cancer. For example, some childhood cancers are caused by two chromosomes breaking and rejoining out of order, resulting in two normal genes being pushed together. These genes are essential for normal development, but putting them next to one another, “out of order” on the chromosome, is enough to push a very controlled process (normal development) to an uncontrolled one (cancer).

We still don’t understand what’s causing those chromosomes to break in the first place. Researchers are studying this question, and we’re hoping that genomic sequencing and high-powered bioinformatics will help us solve this mystery.

—

Gino Somers (PGME ’04) is an Associate Professor in the Department of Laboratory Medicine and Pathobiology, and the Division Head of Pathology at SickKids.

The Deep Sea of Possibility

The world’s oceans hold medical mysteries overlooked since the beginning of time — I think they hide life forms that could be the next frontier in understanding and curing disease.

The vast majority of this planet’s biological molecules, up to 95 per cent, haven’t been studied well, because we don’t know how to grow them in a lab. But they have all kinds of interesting biological activities. For example, there’s a single-cell organism that puts out a telescopic spike ten times longer than its body — a whole new life form. Scientists are only now starting to pull these fascinating creatures out of the sea, and they’re finding that any crazy thing you can dream up, some species does it. For example, some don’t make DNA transcripts — instead, they stitch together bits of RNA to form the proteins that control our genetic destiny. Who knows how this can be used for gene editing?

Over a billion years, evolution has figured out every way imaginable to play around with biological molecules. To fix what’s wrong in our genes, we need to uncover the mysteries that are already in front of us, or hiding under water.

—

Andy Fraser is a Professor at the Donnelly Centre for Cellular and Biomolecular Research and the Department of Molecular Genetics.

Unsolved, Unanswered, Unknown

What makes for a great medical mystery? Seven faculty members share the unsolved cases that keep them up at night — and some of the great questions still unanswered in medicine.

By Heidi Singer

Resisting Our Genetic Destiny

Stephen Scherer (MSc ’91, PhD ’95) is Professor of Molecular Genetics and Director, McLaughlin Centre; Senior Scientist, The Hospital for Sick Children.

There are kids with autism who can cite every name, address and number in a phone book but have trouble tying their shoes. Sometimes I wonder which is the bigger medical mystery — their amazing memories and motor deficiencies, or everybody else’s memory deficiencies but adeptness at other, perhaps simpler things?

Studying the genetics of autism brings up a very fundamental mystery: Why do some people who have massive genetic irregularities never develop autism (or other disorders), but their children do? This mysterious ability that some people have to resist their genetic destiny is utterly fascinating. Scientists all over the world are now combing through the genomes of healthy people, looking for those rare ones. These miraculous genomes have learned to resist adversity, so maybe they’ll show us the way. Genetic “resiliency” is perhaps the biggest diagnostic mystery of 21st-century science — and potentially the key to solving our most complex medical questions.

What’s in a Name?

John Court is an assistant professor in the Department of Psychiatry and IMS, based at CAMH, who researches and instructs on the history of psychiatry

I marvel at the dire shortage of knowledge, both scientific and humanistic, concerning the disparate causes of, and the cures for mental disorders.

These gaps in knowledge have the unfortunate effect of compounding other mysteries, and they cause fear and dread — which in turn feed superstition, and have led too often to stigma. Consequently, psychiatry has emerged as arguably the most challenging and demanding of medical specialities.

The challenges of the mind and brain and their legion of mysterious afflictions do tend to stimulate our curiosity. Our antennae of critical faculties are set tingling by unexpected notions and unusual connections. Frequently they emerge through random associations from literature and the arts — think of Shakespeare’s metaphorical references to London’s medieval “Bedlam” facility.

Novelist Timothy Findley wrote eloquently and sensitively of psychiatric patients’ experiences and, for the most part, he used the real names of Toronto area hospitals. Not so for the (now former) Clarke Institute of Psychiatry, which he called “The Parkin Institute of the University of Toronto” — after its prominent architects, rather than the sometimes-controversial Psychiatry professor and Medicine Dean C.K. Clarke. Findley’s reason for that enigmatic substitution remains a mystery.

Solving a 50-Year-Old Mystery

Richard Hegele (MD ’84, PGME ’89) is Vice Dean of Research and Innovation and a Professor in the Department of Laboratory Medicine and Pathobiology.

A few years ago, my lab discovered a cru‌cial receptor for respiratory syncytial ‌virus (RSV), which frequently causes the ‌common cold and serious lung infec‌tions like pneumonia. Researchers had known about this virus since the ’50s, but we hadn’t made much progress on a treatment because nobody had identified the molecule that allows the virus to bind to the cell. We looked at our quest as a mystery that needed solving — and I believe that mindset helped us.

First we determined the virus sticks to protein, not sugars or lipids. But which one? The cell surface contains thousands of proteins so, we had to narrow it down. We separated cell surface proteins on a gel and got a common “hit” for all the cell types and RSV strains we tested. We identified the protein we thought was responsible for these hits, and after a series of experiments using different techniques, we established the evidence that this unusual molecule was indeed an RSV receptor. The answer wasn’t intuitive, but came from a great deal of trial and error — gumshoe detective work that solved a 50-year-old mystery.

The main lessons were to keep an open mind, expect the unexpected and understand your tools. Basic scientists don’t always see their investigations as mysteries to solve, but I think it helps to look at it this way because in any good mystery the culprit is never the one you suspect at first.

Wellcome Library, London, UK

Where Cancer Doesn’t Tread

Penney Gilbert is an Assistant Professor at the Institute for Biomaterials and Biomedical Engineering.

W‌hy do our muscles almost never get ‌cancer? This disease is ‌infamous ‌for becoming very invasive, travel‌ling everywhere in the body — but skeletal muscle is never the place it goes. It’s just this really interesting observation that people have made, and we don’t have an explanation for it. As far as I can tell, nobody has dug down and figured out why, and there might be some important information to use in the fight against cancer. For example, there could be unique proteins in muscle that prevent tumour cells from wanting to put down roots in this type of tissue. Or it could be something fairly simple — muscle is always moving, so maybe it’s difficult for cancer cells to enter this tissue.

Why Do Children Get Cancer?

Gino Somers (PGME ’04) is an Associate Professor in the Department of Laboratory Medicine and Pathobiology, and the Division Head of Pathology at SickKids.

A‌s a medical student, I used to think cancer was ‌a disease of old people: your cells get old ‌and don’t divide as well and the DNA gets ‌jumbled. But why do children get cancer? ‌On an emotional level it’s totally unfair; however, there are lessons here that can be applied to many cancers. In children, there’s a fine balance between normal development and cancer. For example, some childhood cancers are caused by two chromosomes breaking and rejoining out of order, resulting in two normal genes being pushed together. These genes are essential for normal development, but putting them next to one another, “out of order” on the chromosome, is enough to push a very controlled process (normal development) to an uncontrolled one (cancer).

We still don’t understand what’s causing those chromosomes to break in the first place. Researchers are studying this question, and we’re hoping that genomic sequencing and high-powered bioinformatics will help us solve this mystery.

The Mystery of the Aging, Failing Brain

Graham Collingridge is Professor and Chair of the Department of Physiology

A‌ging, failing brains are normal enough — ‌anyone who lives a long time will probably ‌feel this decline. Of course dementia is far ‌more tragic than “normal” memory loss, ‌but why should we lose any part of the thoughts and memories that make us human? I don’t think it’s a given that our brains should wear out like other parts of our bodies. Why should the aging process wipe out our very identities?

We’ve never solved this mystery, and as a result the medical landscape is littered with failed drugs to treat dementia. But recently, we have started to take a step back to understand the molecular basis of learning and memory. There have been great strides recently in this area. Now the challenge is to understand why and how these processes go wrong in conditions like Alzheimer’s — and then develop treatments to alleviate and perhaps even cure these awful diseases.

Under Pressure

Brian Goldman (MD ’80, PGME ’82) is an emergency room physician at Mt. Sinai Hospital, Assistant Professor of Family and Community Medicine and host of the CBC Radio show White Coat, Black Art.

A ‌64-year-old woman was carried into the emergency room one night screaming from abdominal pain. To my surprise, her ‌belly was soft, ruling out most of the obvious causes. Her ‌adult daughter was worried sick, and pushing hard for action. ‌I felt the pressure to get it right. Blood tests showed elevated lactate, which meant somewhere in her body wasn’t getting oxygen. I could order a CT scan, but radiologists always say if you don’t know what you’re looking for, you won’t find it with a scan. Just when I’m trying to figure out my next move, she flips into atrial fibrillation. That’s when I smile — now I know she’s got a blood clot leading to an ischemic bowel.

I put her on blood thinners and send her off to the CT scan. Now that I know what I’m looking for, the scan confirms the diagnosis: it shows several feet of bowel that are deprived of oxygen and swelling up, causing intense pain. An interventional radiologist takes the clot out.

The things that ER physicians see are common occurrences. We solve mysteries mostly through pattern recognition. The first unusual pattern I saw in this case was pain out of proportion. But it wasn’t until her heartbeat went irregular that I thought of a blood clot in the vessels of her intestines. That heartbeat was like a gift from God: it made me realize there was turbulence in the blood stream.

Detectives solve mysteries. But I don’t imagine them becoming emotionally burdened by anxiety from their cases like doctors do with their patients. What if that woman had been close to death and I hadn’t had much time to figure out the problem? Clinicians are never dealing with a sterile medical mystery. Panic and logical thinking never go well together.

The Deep Sea of Possibility

Andy Fraser is a Professor at the Donnelly Centre for Cellular and Biomolecular Research and the Department of Molecular Genetics.

The world’s oceans hold medical mysteries overlooked since the beginning of time — I think they hide life forms that could be the next frontier in understanding and curing disease.

The vast majority of this planet’s biological molecules, up to 95 per cent, haven’t been studied well, because we don’t know how to grow them in a lab. But they have all kinds of interesting biological activities. For example, there’s a single-cell organism that puts out a telescopic spike ten times longer than its body — a whole new life form. Scientists are only now starting to pull these fascinating creatures out of the sea, and they’re finding that any crazy thing you can dream up, some species does it. For example, some don’t make DNA transcripts — instead, they stitch together bits of RNA to form the proteins that control our genetic destiny. Who knows how this can be used for gene editing?

Over a billion years, evolution has figured out every way imaginable to play around with biological molecules. To fix what’s wrong in our genes, we need to uncover the mysteries that are already in front of us, or hiding under water.

The Secret Science of World War II

Deep within a mysterious North Toronto building, Faculty of Medicine researchers developed the world’s first anti-gravity suit.

By John Lorinc

In August 1941, moviegoers flocked to the latest Hollywood war flick called Dive Bomber, which hit theatres months before the bombing of Pearl Harbor. The film tells the tale of two men — a Harvard-educated doctor and a seasoned pilot — searching for solutions to the altitude sickness and blackouts that afflicted pilots on dangerous missions. The unlikely pair defied the skeptics and experimented with a “pneumatic belt” meant to keep blood flowing to the brain. The film, audiences were told, was dedicated to the cause of “aviation medicine.”

Toronto audiences likely had no idea that the story was an almost eerily accurate retelling of the pioneering, super-secret aviation medicine experiments carried out by University of Toronto researchers at a Royal Canadian Air Force facility on Avenue Road north of Eglinton.

The facility was located on the grounds of the former Eglinton Hunt Club, which the RCAF bought for $50,000 to run its training programs. Inside, Professor Wilbur Franks (BA ’24, MB ’28), a U of T cancer researcher working for Sir Frederick Banting (MB ’16, MD ’22), used a human centrifuge to test the anti-gravity suit he’d designed for air force pilots prone to blacking out from intense g-force pressure created by tight turns and nose dives.

The suit, which he personally tested at Camp Borden west of Barrie, Ontario, and later at the Farnborough Airfield in England, was the first of its kind and established Franks as a pivotal figure in the history of aviation medicine. But its development exacted a heavy toll: Banting, one half of the team credited with the discovery of insulin, was killed in a crash in early 1941 in Newfoundland while heading to England to test Franks’ invention.

So what exactly does an anti-gravity suit protect the body from? When someone is sitting at ground level, not moving, the earth’s gravitational field exerts what’s called a 1-g force, equivalent to the weight of that person. But when the same individual is being whipped around on a tight curve on a roller coaster, for example, inertia causes their body and blood to move along the original trajectory, resulting in a sudden increase in centrifugal force.

Scientists say that when this increased pressure is double the g-force of a resting body, the individuals’ weight at that moment is effectively doubled. At a high g-force, the weight of blood may be several times higher than at rest. The heart, in turn, strains to pump the blood around the body, especially out of the lower extremities and into the brain. Under this g-force strain, an individual experiences reduced vision, temporary blindness and finally loss of consciousness — a condition known as static hypoxia.

According to a 2004 article in the Journal of Aviation/Aerospace Education and Research, the increasingly powerful fighter planes that were being developed during the interwar period seemed to be causing more accidents with pilots blacking out at the controls of aircraft that were flying higher and faster than ever before.

In the late 1930s, with the war in Europe looming, Banting realized that aviation medicine could play a strategic role in a conflict that would see increased use of bombers and fighter planes. His interest wasn’t incidental: Banting had served as an army surgeon in World War I and remained an officer in the reserves after the armistice of November 11, 1918.

Working with the RCAF, Banting moved to create an aviation medicine research team at U of T and tapped Franks, whom he’d met through a mutual friend of Charles Best (BA ’21, MA ’22, MD ’25). At the time, Franks was doing cancer research, which involved the use of a centrifuge for samples. He had noticed that glass test tubes tended to shatter in the device. But when he packed the tubes in water, they were fine.

Seconded to Banting’s project, Franks began thinking about the significance of this modification of a testing technique, and realized the water around the tube created sufficient hydrostatic pressure against the tube to counter the centrifugal force. Perhaps, he thought, the same principle would apply to human tissue.

After experimenting with mice at the Banting Institute, Franks in 1939 began developing a rudimentary version of an anti-gravity suit, which was lined with fluid-filled pockets and designed to fit snugly around a pilot’s legs and torso. To fund the research, Banting had approached an eccentric construction magnate named Harry F. McLean for a $5,000 grant. McLean, an aviation buff who once set out on a round-the-globe flying mission with his personal nurse, was known for wandering around in public, giving away large sums of cash or cheques.

Early in 1940, according to “The Remotest of Mistresses,” Peter Allen’s 1983 biographical essay on Franks, the researcher took a bespoke version of his invention to Camp Borden and went up with a RCAF pilot. Allen, a commercial flyer and accountant who first met Franks in the mid-1970s, writes that Franks had never even flown before, “much less endured high G aerobatic maneouvers.” But he and Banting were both fearless, and seized with a sense of mission (they had enlisted after Canada declared war and were given officer ranks). “It was their mentality,” Allen said in a recent interview. “They just did stuff that was risky.”

“In the airplane, I was sitting down,” Franks told Allen. “[W]hen the pressure hit, I thought [the suit] was going to cut me in two.” Wing Commander D’Arcy Greig, an ace Royal Air Force pilot, also tested the suit during secret flights at Malton in early June 1940. He came to similar conclusions. Allen quotes Greig’s report in his 1983 essay: “The suit in its present form is not a practical proposition.”

Interestingly, German scientists as early as 1931 had arrived at a the same impasse with their own version of an anti-gravity suit for pilots. They opted to discontinue their research program.

Realizing that they needed to refine the invention, Banting and Franks persuaded the RCAF to partner with U of T and Victory Aircraft (later Avro) and build a human centrifuge at the Hunt Club facility in 1941. Jordan Bimm, a PhD candidate at York University now completing a doctorate on the history of aerospace medicine, says the centrifuge looked like a giant stand mixer, with an air-tight gondola that could hold one person. The gondola’s temperature, air pressure and orientation could be altered, with internal sensors monitoring performance. (There are photos of Franks himself in the centrifuge, which was in operation until 1987.)

Franks reckoned it was possible to scale down the suit, so the coverage was limited mainly to the legs and buttocks. Bimm says Franks made numerous versions of the suit, up to “Mark 7.” “They refined it many, many times.” U of T historian Michael Bliss (BA ’62, MA ’66, PhD ’72), in his biography of Banting, described him and Franks as “tinkerers.” “They tried things,” Allen says. “Sometimes it worked, and sometimes it didn’t.”

Following Banting’s tragic death in February 1941, Franks finished developing the suit sufficiently, such that the Royal Air Force was prepared to use it in combat. But the Allies regarded the discovery as so significant that they didn’t want to fly sorties over Europe, for fear of losing a plane operated by a pilot wearing the “Franks Flying Suit.” If the Germans captured the flyer, the RAF thought they could reverse engineer it.

Instead, RAF pilots wearing Franks’ invention were sent to North Africa to provide air support for US General Dwight Eisenhower’s invasion of Algeria in 1942. The results, Bimm says, were mixed:“They found it difficult to move around.” US researchers took over.

But senior American aviation medicine experts later told Franks his pioneering work was critical in the refinement of the technology. The work in Toronto, moreover, paved the way for the Canadian military’s sustained investment in aviation research at CFB Downsview, which continues to this day. “That traces right back to the decision to make this a competency in Canada,” says Bimm.

The military didn’t declassify information about the Franks Flying Suit until the 1950s, and Franks himself remained a low-key medical researcher until the 1970s, when, Peter Allen heard him lecture at U of T about the invention. He decided to make it his mission to ensure that Franks was duly recognized for an achievement that has reverberated through the post-war history of military flight. “Franks was a very understated man,” Allen reflects. “He just thought he was doing his job.”

—

Image credits: Top image: University of Toronto Archives / Jack Marshall Photography. Inset images: Canada Dept. of National Defence / Library and Archives Canada.

The Secret Science of World War II

University of Toronto Archives / Jack Marshall Photography

Deep within a mysterious North Toronto building, Faculty of Medicine researchers developed the world’s first anti-gravity suit.

By John Lorinc

In August 1941, moviegoers flocked to the latest Hollywood war flick called Dive Bomber, which hit theatres months before the bombing of Pearl Harbor. The film tells the tale of two men — a Harvard-educated doctor and a seasoned pilot — searching for solutions to the altitude sickness and blackouts that afflicted pilots on dangerous missions. The unlikely pair defied the skeptics and experimented with a “pneumatic belt” meant to keep blood flowing to the brain. The film, audiences were told, was dedicated to the cause of “aviation medicine.”

Toronto audiences likely had no idea that the story was an almost eerily accurate retelling of the pioneering, super-secret aviation medicine experiments carried out by University of Toronto researchers at a Royal Canadian Air Force facility on Avenue Road north of Eglinton.

The facility was located on the grounds of the former Eglinton Hunt Club, which the RCAF bought for $50,000 to run its training programs. Inside, Professor Wilbur Franks (BA ’24, MB ’28), a U of T cancer researcher working for Sir Frederick Banting (MB ’16, MD ’22), used a human centrifuge to test the anti-gravity suit he’d designed for air force pilots prone to blacking out from intense g-force pressure created by tight turns and nose dives.

When the pressure hit, Franks through the suit would cut him in two.

The suit, which he personally tested at Camp Borden west of Barrie, Ontario, and later at the Farnborough Airfield in England, was the first of its kind and established Franks as a pivotal figure in the history of aviation medicine. But its development exacted a heavy toll: Banting, one half of the team credited with the discovery of insulin, was killed in a crash in early 1941 in Newfoundland while heading to England to test Franks’ invention.

So what exactly does an anti-gravity suit protect the body from? When someone is sitting at ground level, not moving, the earth’s gravitational field exerts what’s called a 1-g force, equivalent to the weight of that person. But when the same individual is being whipped around on a tight curve on a roller coaster, for example, inertia causes their body and blood to move along the original trajectory, resulting in a sudden increase in centrifugal force.

Scientists say that when this increased pressure is double the g-force of a resting body, the individuals’ weight at that moment is effectively doubled. At a high g-force, the weight of blood may be several times higher than at rest. The heart, in turn, strains to pump the blood around the body, especially out of the lower extremities and into the brain. Under this g-force strain, an individual experiences reduced vision, temporary blindness and finally loss of consciousness — a condition known as static hypoxia.

The Franks Flying Suit (Canada Dept. of National Defence)

According to a 2004 article in the Journal of Aviation/Aerospace Education and Research, the increasingly powerful fighter planes that were being developed during the interwar period seemed to be causing more accidents with pilots blacking out at the controls of aircraft that were flying higher and faster than ever before.

In the late 1930s, with the war in Europe looming, Banting realized that aviation medicine could play a strategic role in a conflict that would see increased use of bombers and fighter planes. His interest wasn’t incidental: Banting had served as an army surgeon in World War I and remained an officer in the reserves after the armistice of November 11, 1918.

Working with the RCAF, Banting moved to create an aviation medicine research team at U of T and tapped Franks, whom he’d met through a mutual friend of Charles Best (BA ’21, MA ’22, MD ’25). At the time, Franks was doing cancer research, which involved the use of a centrifuge for samples. He had noticed that glass test tubes tended to shatter in the device. But when he packed the tubes in water, they were fine.

Franks and Banting were both fearless, and seized with a sense of mission

Seconded to Banting’s project, Franks began thinking about the significance of this modification of a testing technique, and realized the water around the tube created sufficient hydrostatic pressure against the tube to counter the centrifugal force. Perhaps, he thought, the same principle would apply to human tissue.

After experimenting with mice at the Banting Institute, Franks in 1939 began developing a rudimentary version of an anti-gravity suit, which was lined with fluid-filled pockets and designed to fit snugly around a pilot’s legs and torso. To fund the research, Banting had approached an eccentric construction magnate named Harry F. McLean for a $5,000 grant. McLean, an aviation buff who once set out on a round-the-globe flying mission with his personal nurse, was known for wandering around in public, giving away large sums of cash or cheques.

Early in 1940, according to “The Remotest of Mistresses,” Peter Allen’s 1983 biographical essay on Franks, the researcher took a bespoke version of his invention to Camp Borden and went up with a RCAF pilot. Allen, a commercial flyer and accountant who first met Franks in the mid-1970s, writes that Franks had never even flown before, “much less endured high G aerobatic maneouvers.” But he and Banting were both fearless, and seized with a sense of mission (they had enlisted after Canada declared war and were given officer ranks). “It was their mentality,” Allen said in a recent interview. “They just did stuff that was risky.”

“In the airplane, I was sitting down,” Franks told Allen. “[W]hen the pressure hit, I thought [the suit] was going to cut me in two.” Wing Commander D’Arcy Greig, an ace Royal Air Force pilot, also tested the suit during secret flights at Malton in early June 1940. He came to similar conclusions. Allen quotes Greig’s report in his 1983 essay: “The suit in its present form is not a practical proposition.”

Interestingly, German scientists as early as 1931 had arrived at a the same impasse with their own version of an anti-gravity suit for pilots. They opted to discontinue their research program.

The human centrifuge machine invented by Franks. Built in 1942 and used to test the Franks Flying Suit (Library and Archives Canada).

Realizing that they needed to refine the invention, Banting and Franks persuaded the RCAF to partner with U of T and Victory Aircraft (later Avro) and build a human centrifuge at the Hunt Club facility in 1941. Jordan Bimm, a PhD candidate at York University now completing a doctorate on the history of aerospace medicine, says the centrifuge looked like a giant stand mixer, with an air-tight gondola that could hold one person. The gondola’s temperature, air pressure and orientation could be altered, with internal sensors monitoring performance. (There are photos of Franks himself in the centrifuge, which was in operation until 1987.)

Franks reckoned it was possible to scale down the suit, so the coverage was limited mainly to the legs and buttocks. Bimm says Franks made numerous versions of the suit, up to “Mark 7.” “They refined it many, many times.” U of T historian Michael Bliss (BA ’62, MA ’66, PhD ’72), in his biography of Banting, described him and Franks as “tinkerers.” “They tried things,” Allen says. “Sometimes it worked, and sometimes it didn’t.”

Following Banting’s tragic death in February 1941, Franks finished developing the suit sufficiently, such that the Royal Air Force was prepared to use it in combat. But the Allies regarded the discovery as so significant that they didn’t want to fly sorties over Europe, for fear of losing a plane operated by a pilot wearing the “Franks Flying Suit.” If the Germans captured the flyer, the RAF thought they could reverse engineer it.

Instead, RAF pilots wearing Franks’ invention were sent to North Africa to provide air support for US General Dwight Eisenhower’s invasion of Algeria in 1942. The results, Bimm says, were mixed:“They found it difficult to move around.” US researchers took over.

But senior American aviation medicine experts later told Franks his pioneering work was critical in the refinement of the technology. The work in Toronto, moreover, paved the way for the Canadian military’s sustained investment in aviation research at CFB Downsview, which continues to this day. “That traces right back to the decision to make this a competency in Canada,” says Bimm.

The military didn’t declassify information about the Franks Flying Suit until the 1950s, and Franks himself remained a low-key medical researcher until the 1970s, when, Peter Allen heard him lecture at U of T about the invention. He decided to make it his mission to ensure that Franks was duly recognized for an achievement that has reverberated through the post-war history of military flight. “Franks was a very understated man,” Allen reflects. “He just thought he was doing his job.”

Dancing in the Dark

With no explanation for her symptoms, Rachel became a mystery to her doctors — one of the ‘medically unexplained.’

By Erin Howe

Tests and doctors’ visits gave no insight into Rachel’s chronic pain, muscle spasms and neurological symptoms. The 16-year-old had been a healthy, vibrant ballet dancer. The first signs of trouble came after Rachel fell and hit her back during an audition for a professional dance school a few hours from her home in central Ontario.

“Afterward, I started to have paralysis in my legs,” Rachel recalls. “The longer I was sick, the worse I felt. But it seemed like most of the doctors just kept saying, ‘I don’t know.’”

Medical tests came back negative, revealing no clues. Specialists, chiropractor, osteopath and physiotherapist couldn’t help. Nothing brought Rachel closer to a diagnosis or lasting relief.

“As time passed, it was scary,” says Rachel’s mother, Debbie. “As parents, we depend on the medical system and when the specialists couldn’t figure it out, we thought somebody should have been able to.”

‘The symptoms are real’
When faced with enigmatic illnesses that appear to have no clear biological explanation, doctors may describe the unexplained, using expressions like “psychosomatic complaints,” “functional” or “non-organic symptoms.” But Claire De Souza (BSc ’93, MD ’97, PGME ’02), an Assistant Professor in the Department of Psychiatry, says such language can be confusing for patients and their families because the terms are not diagnostic, and they can’t be looked up and better understood.

“Framing an illness as a medical mystery isn’t satisfying for young people or their families,” says De Souza, who is also a Staff Psychiatrist and the Medical Director of the Consultation-Liaison Psychiatry Program at The Hospital for Sick Children (SickKids). “As healthcare providers, we need to convey to this population that we believe what they tell us and that we know they’re not faking an illness or looking for attention. Their symptoms are real and have had significant impacts, and we can help.”

As Rachel and her mother’s search for answers continued, they began to feel the stigma and hopelessness that can accompany a medically unexplained illness.

“There was one specialist who said, ‘This is not my department,’” recalls Rachel’s mother. “He had my daughter stand on her paralyzed leg and fall repeatedly. We asked him for a referral and with his arms crossed, he said, ‘Nope, that’s not my job — I would see a neurologist or a psychologist.’ But he wouldn’t recommend anyone.”

When answers remain elusive, De Souza advocates for a new way of approaching the patient assessment: the biopsychosocial model. Using this framework, biological factors like infections or injuries, psychological factors like perfectionism or a traumatic experience, and social factors like academic challenges, difficult peer relationships and family circumstances are all taken into consideration to understand a person’s symptoms.

“There’s still a tendency to think of assessing distressing and impairing symptoms using a biomedical approach,” says De Souza. “When the tests don’t reveal anything, these young people are moved through to psychiatry, creating a bit of a mind-body split. But children and teenagers can’t be divided that way.”

There’s a growing recognition that medical mysteries can flourish in the gap between treating the mind and the body. A recent SickKids survey showed a widespread desire by physicians to do better at helping young people with both physical symptoms and mental health issues. And a town hall meeting at the hospital aimed at bridging the gap drew attendance from nearly every department.

Like De Souza, Antonio Pignatiello (MD ’87, PGME ’93), an Associate Professor in the Department of Psychiatry, is working to change the way medical professionals see children and youth with medical and mental health conditions.

In his role as Director of the Medical Psychiatry Alliance’s Child and Youth Health and Family Services, Pignatiello is helping build a collaborative care model. The idea is to better equip physicians across specialties like emergency medicine and family medicine to treat physical and mental illnesses — including medically unexplained symptoms — simultaneously. At SickKids, these efforts include a somatic symptom consultation group to allow caregivers from various disciplines to share their expertise with each other. Teens and parents are also making suggestions for improvement.

“We want to provide better, quicker access to the most appropriate service in the most appropriate place at the most appropriate time,” says Pignatiello. “Ultimately, we want people to be able to feel that no door is the wrong door for accessing the care they need.”

Nearly a year after she fell ill, Rachel’s symptoms grew worse. She had less control over her arms, slurred speech and a loss of vision. Again, her family took her to their community hospital, where she was admitted.

Within a few days, the doctor overseeing Rachel’s case called the family together with a potential diagnosis: conversion disorder, a psychological condition that causes neurological symptoms.

Rachel’s doctor had seen a case of conversion disorder before, which had left another young patient confined to a wheelchair for years. He wanted to help Rachel do better. In collaboration with De Souza and a team of local healthcare providers, Rachel was able to recover at her community hospital. Debbie credits the combination of help from De Souza, a physiotherapist and the family doctor with helping Rachel make a quick recovery.

From hope to recovery

After her diagnosis, Rachel’s doctor told her she would make progress quickly. Before she left the hospital, the teen took her first steps.

“It was pretty awesome to start walking without the parallel walking bars,” remembers Rachel. “I hadn’t been able to walk in eight months. Even before that, my leg would spasm or give out. So I was really happy to start walking again.”

Today, Rachel says she feels “100 per cent better” and is dancing once more.

With greater integration between specialties, De Souza and Pignatiello hope to create more happy endings for people whose mysterious illnesses might otherwise be considered “medically unexplained.”