Organs of Digestion

‘Jo. George Wirsungus of Bavaria, is not silently to be passed by … who was very excellent in the Study of Anatomy; in the Year 1642 at Padua, first found out the Ductus Pancreaticus, which for the general good of Physicians, he caused to be Engraven in Copper, from whom we might have expected more, had he not been wickedly Pistol’d by envious persons in his own House’.

Reinier De Graaf, De Succo Pancreatico: Or, A Physical and Anatomical TREATISE Of the NATURE and OFFICE of the Pancreatick Juice; (London, 1676), p. 5.^[1]

Caspar Bauhin, Theatrum anatomicum (Frankfurt, 1621), Lib. I, Tab. XII.

As Reinier De Graaf (1641–73) notes, Johann Georg Wirsung (1589–1643), was known for two things: his depiction of the pancreatic duct, and his subsequent murder – said to have been as a result of a quarrel over who had indeed discovered the pancreatic duct! As Paraskevas et al. recount, before Wirsung, there had been no detailed description of the pancreatic duct: Hippocrates had said little about the pancreas and Aristotle, though he referred to it, had not included any discussion of its structure; Galen had missed the pancreatic duct completely and it was really only in the early modern period that sustained examination of the pancreas was undertaken.

William Cowper, The anatomy of humane bodies, with figures drawn after the life by some of the best masters in Europe, and curiously engraven in one hundred and fourteen copper plates, illustrated with large explications, containing many new anatomical discoveries, and chirurgical observations: to which   is added an introduction explaining the animal oeconomy, with a copious index (Oxford, 1698), Table 36.

Vesalius (1514–64), considered that it supported the stomach, and his pupil at Padua, Gabriel Fallopius (1523–62) noted that it was ‘placed beneath (the splenic vein) like a cushion and protects against everything that could squeeze it together’.^[2] It was not until Wirsung’s autopsy of a murderer on 2 March 1642, an autopsy attended by Thomas Bartholin (1616–80), who would later play such an important role in the teaching of anatomy at Copenhagen, and Moritz Hoffmann (1622–98), who would later claim to be the discoverer of  the pancreatic duct, that more light was shed on the pancreas in general and the pancreatic duct in particular.^[3] Despite Hoffmann’s claim to have been the true discoverer of the pancreatic duct (which joins the pancreas to the common bile duct), the pancreatic duct is known today as the duct of Wirsung, primarily because Wirsung was responsible for broadcasting the discovery to the academic world.

Reinier de Graaf, Opera omnia (Leiden, 1677), portrait of De Graaf.

Wirsung’s dissection of the pancreas had revealed its structure but as Reinier de Graaf later noted, Wirsung had said little about its function. This was a task left to De Graaf who is best known for two things: his work on female reproductive organs and his experiments on the pancreas. Initially studying at the University of Louvain, he moved to the University of Utrecht, where he was taught by Ysbrand van Diemerbroek (1609–74) and later the University of Leiden, where he was heavily influenced by the teaching on iatrochemistry of the renowned teacher, Franciscus de le Boë (1614–72). De le Boë, who also taught Jan Swammerdam (1637–80) and Nicolas Steno (Niels Stensen 1638–86), was a keen supporter of Harvey’s theory of the circulation of the blood and demonstrated it on a number of occasions. De le Boë (also known by the latinised version of his name Franciscus Sylvius), is best known for his teaching on the role of acids and alkali in digestion and is regarded as a founder of the iatrochemical school of medicine. His interest in the chemical processes taking place in the pancreas were the spur for De Graaf’s anatomical investigation of the pancreas as De Graaf acknowledged at the beginning of his preface to the work:

‘In the Year 1663, in the University of Leyden, I hearing the most Famous, and Indefatigable Man in Studies, Francis de le Boe-Sylvius, daily teaching concerning the Pancreatick Juyce, to be one of the chiefest Foundations of Physick, I endeavoured to find out that, hitherto undiscovered Juyce’.^[4]

Worth owned two texts by Dr Graaf, a 1671 edition of his famous work on the pancreas: Tractatus anatomico-medicus de succi pancreatici natura & usu (Leiden, 1671) and a 1677 Leiden edition of De Graaf’s collected works. The title page of a 1676 English edition of the former gives a flavour of the what the work encompassed: ‘De Succo Pancreatico: Or, A Physical and Anatomical TREATISE Of the NATURE and OFFICE of the Pancreatick Juice; Shewing its generation in the Body, what Diseases arise by its Vitiation; from whence in particular, by plan and familiar examples, is accurately demonstrated, the Causes and Cures of Agues, or Intermitting Feavers, hitherto so Difficult and Uncertain: with sundry other things worthy of Note (London, 1676).^[5] As De Graaf acknowledged in his preface, this was initially the result of vivisection of dogs, though he subsequently investigated the pancreatic juice of a dead sailor to confirm his discoveries.^[6]

Reinier de Graaf, Opera omnia (Leiden, 1677), Tabula prima: De Graaf’s image of the pancreas.

De Graaf provides the following key to the above image of a pancreas:

‘AAA, The Ductus, or Trunck, of the new Vessel stretched forth according to the Longitude of the Pancrease.

BBB, The lateral Ducts, or small branches, arising on each side from the great Trunk, and dispersed into the substance of the Pancreas.

C, The Conjunction of the new Vessel with the Ductus Biliarius, or Choler-passage.

DD, The Cholar-passage freed from the Pancreas, by which it is hid.

E, The Common Ductus of the Pancreas and Cholar-passage, ending in the Intestinum Duodenum, about four Fingers breadth under the Pylorus.

FFF, The inner part of the Pancreas, admitting the Lateral branches.

G, Part of the Pancreas separated from the Ductus Biliarius, which it did cover.

H, The inferiour part of the Ventricle.

I, The Pylorus.

K, The first of the small Gutts, which is called the Duodenum.

L, Part of the Duodenum lying under the Mesenterium.

MM, Part of the same Duodenum rising again in the left Hypocondrium.

NN, The Mesenterium greed from the Gutts.

O, The Meseraick Vein.

P, The meseraick Arterie.

Q, The Ducturs Cysticus.

R, The Ductus Hepaticus.

S, The Intestinum Duodenum opened’

 

‘The stomach is lowest and has a hidden place in the body because of its uncleanness, as though nature had spared the principal members and had relegated the stomach or bowels farther away from the site of reason and of the mind and fenced it off with the diaphragm in order not to disturb the rational part of the mind with its importunity.  These members serve the higher ones.  Some of them concoct the food into juice, others digest it into various humours, others expel the superfluity’.

– Alessandro Benedetti, 1497

The basic functions and anatomy of the digestive system were understood fairly early in the history of anatomical study. However, views around digestion were fraught with ideas of purity and uncleanliness leading anatomists and physicians to treat the digestive system not only as something to be examined and understood, but also as something to be cleansed, tamed, and balanced.

Galen had a working understanding of the anatomy and function of the digestive system, perhaps more than he is given credit for.^[8] Even though he made errors and omissions in his descriptions of the gastrointestinal tract, the terms and delineations he ascribes to different parts of it remain in use today:

‘Here, then, is the list of the instruments which, after the stomach, receive the nutriment: 1. Outgrowth; 2. Jejunum; 3. Thin intestine; 4. Caecum; 5. Colon; 6. Rectum. At the end of the rectum are the sphincter muscles that confine the residues’.^[9]

Galen’s successors elaborated on the anatomy of the colon further segmenting it into the caecum— including the appendix, and the ascending, transverse and descending colon, ending into the sigmoid colon and the rectum.

Preserved sigmoid colon. Prepared by Daniel John Cunningham, late 19^th century. Courtesy of the Old Anatomy Museum, School of Medicine, Trinity College Dublin.

Even though these terms persist into present day as well, they were challenged in the late nineteenth century in favour of more topographical delineations.

Ambrose Birmingham (1864-1905), Professor of Anatomy at the Catholic University School of Medicine in Dublin, writes in Cunningham’s Textbook of Anatomy under the heading of ‘Sigmoid flexure and Rectum:

‘It has been customary to divide the remaining portion of the large intestine into sigmoid flexure and rectum. The former was said to begin at the crest of the ilium, to lie in the iliac fossa, and to end at the brim of the pelvis. Or, in later years, the ‘sigmoid colon’ was described as ‘that part of the colon which is attached to the left iliac fossa, from the iliac crest to the brim of the true pelvis’ (Symington). Its upper part was said to be covered by peritoneum on the anterior and lateral surfaces only, its lower part to form a large loop with a complete serous coat and a long mesentery, which hung down into the pelvic cavity when the bladder and rectum were empty, and passed up out of it when these were distended. […] Treves in 1885, and Jonnesco in 1889, directed attention to the fact that no such loop as the classical sigmoid flexure, lying in the iliac fossa, was to be found in nature; and also, that the separation of the first portion of the rectum from the sigmoid flexure — so-called — was both artificial and inaccurate. They pointed out that the ‘first part of the rectum’ really belongs to the sigmoid flexure, with which it has everything in common, and that on no grounds can it be properly assigned to the rectum’.^[10]

Birmingham supported the findings of Romanian anatomist and surgeon Thomas Jonnesco (Toma Ionescu) who described the anatomy of the sigmoid colon in detail for the first time. Ionescu (1860–1926) is also credited with being the first to describe the duodeno–jejunal fossae, the sigmoid fossae, the rectal sheath, and the rectal wings (lateral sacral ligaments). He is celebrated as the founder of the Romanian school of modern surgery.^[11]

Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, and Ms Evi Numen, Curator of the Old Anatomy Museum, Trinity College Dublin.

Sources

Balalykin, Dmitry, ‘Galen’s Understanding of the Digestive System in the Context of the Commensurability of Medical Knowledge in Different Periods’, History of Medicine, 6, no. 2 (2019), 98–110.

Busnardo, Antonio C. et al, ‘History of the Pancreas’, The American Journal of Surgery, 146 (1983), 539-50.

De Graaf, Reinier, De Succo Pancreatico: Or, A Physical and Anatomical TREATISE Of the NATURE and OFFICE of the Pancreatick Juice; Shewing its generation in the Body, what Diseases arise by its Vitiation; from whence in particular, by plan and familiar examples, is accurately demonstrated, the Causes and Cures of Agues, or Intermitting Feavers, hitherto so Difficult and Uncertain: with sundry other things worthy of Note (London, 1676).

Cunningham, Daniel J. (ed). Text-book of Anatomy (Edinburgh, 1902).

Jonnesco, T., ‘Appareil digestif’ in Poirier P. and A. Charpy (eds), Traité D’Anatomie Humaine (Paris, 1901, 2^nd edition), iv, pp 372–3.

Paraskevas, George, et al., ‘Historical considerations regarding the first descriptions of pancreas’ anatomy’, Italian Journal of Anatomy and Embryology, 123, no. 3 (2018), 257–62.

Popa, Florian et al., ‘Professor Thoma Ionescu (1860-1926) founder of the modern Romanian school of surgery’, Journal of medicine and life, 3, no. 1 (2010), 1-2.

Thiery, M., ‘Reinier De Graaf (1641–1673) and the Graafian follicle’, Gynaecol. Surg., 6 (2009), 189–91.

^[1] Worth owned a 1671 Leiden Latin edition of this work.

^[2] Paraskevas, George, et al., ‘Historical considerations regarding the first descriptions of pancreas’ anatomy’, Italian Journal of Anatomy and Embryology, 123, no. 3 (2018), 259.

^[3] Busnardo et al, note, however, that Herophilus of Chalcedon (circa 300 BS), provided the earliest description of the pancreas: Busnardo, Antonio C. et al, ‘History of the Pancreas’, The American Journal of Surgery, 146 (1983), 539.

^[4] De Graaf, Reinier, De Succo Pancreatico: Or, A Physical and Anatomical TREATISE Of the NATURE and OFFICE of the Pancreatick Juice; Shewing its generation in the Body, what Diseases arise by its Vitiation; from whence in particular, by plan and familiar examples, is accurately demonstrated, the Causes and Cures of Agues, or Intermitting Feavers, hitherto so Difficult and Uncertain: with sundry other things worthy of Note (London, 1676), Sig. A3r.

^[5] This English translation is not in the Worth Library.

^[6] Busnardo et al., ‘History of the pancreas’, 540.

^[7] De Graaf, De Succo Pancreatico: Or, A Physical and Anatomical TREATISE Of the NATURE and OFFICE of the Pancreatick Juice, pp 10–11.

^[8] On this see Balalykin, Dmitry, ‘Galen’s Understanding of the Digestive System in the Context of the Commensurability of Medical Knowledge in Different Periods’, History of Medicine, 6, no. 2 (2019), 98–110.

^[9] Ibid., 105.

^[10] Cunningham, Daniel J. (ed). Text-book of Anatomy (Edinburgh, 1902), p. 1034.

^[11] Popa, Florian et al., ‘Professor Thoma Ionescu (1860-1926) founder of the modern Romanian school of surgery’, Journal of medicine and life, 3, no. 1 (2010), 1-2.