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 plain and familiar examples, is accurately demonstrated, the causes and cures of agues, or intermitting feavers, hitherto so difficult and uncertain, with sundry other things of worthy note / written by D. Reg. de Graaf ... ; and translated by Christopher Pack ...

CHAP. VII. With what Diseases the Substance of the Pancreas, and its Juice may be Mole∣sted.

CErtainly not a few, to whom the Pancrea∣tick Juice hath been unknown, have ne∣vertheless believed that the Causes of many grievous Diseases lay hid. For, Schenkius in his Exer••itatione, Anat VI. Lib. I. Sect. II. Cap. XXI. saith,

And there are the Seats (mean∣ing the Pancreas, and the Mesentery) of in∣numerable and wonderful Diseases; for the searching of which, the age of one man is not suffici∣ent. Which thing, being the Scorne of Physitians, also casteth those which are most exercised into a Blushing hue.

Fernelius also Lib. VI. Pathol. Cap. VII. speaking concerning the Diseases of the Pan∣creas and Mesentery, doth affirm and pro∣fess,

That he hath thought for the most part, these to be the Seats of Choler, Melancholy, Diar∣haea, Disenteria, Cachexia, Atrophia, of Lan∣guishing, of Light, and Erratick Feavers: Last∣ly, the Causes of hidden Diseases; by the driving a∣way of which, Health might be restored to the Afflicted.

And Riolanus, that Egregious Ornament of the University of Lovaine. V. F. Plempius, with other Famous men, also Conversant in Practise, do also think that the cause of inter∣mitting Feavers, of Hypocondriack Melan∣choly, and other Chronick Diseases, do lurk, or lye hid in the Pancreas. But this business, without all doubt, had been more successfully treated of both by these, and other men of no small Merit in Medicine, had the Pancreatick Juice, with its Generation and Nature, been known to them: Wherefore we shall endea∣vour, being excited by their Commendable Examples, to produce something to the Lear∣ned World for the Common good, by conside∣ring first, By what Diseases the Substance of the Pancreas may be infested. Secondly, By declaring the Primary Vices, which may hap∣pen to its Juice. Thirdly, By searching in∣to the Functions, which are hurt by its evil Disposition. Fourthly, By investigating the Dis∣eases which follow those Functions hurt. Fifthly, and lastly, By delivering the Reme∣dies wherewith all of them may be amended. The Diseases wherewith the Substance of the Pancreas is wont to be molested, are Ob∣structions, and those which follow them, Tu∣mours, Schirous's, Abscess's, Stones, &c. Obstructions may happen to the Pancreas two wayes: First, In the Ductus, when the Pan∣creatick Juice cannot freely pass through it, into the Intestines, even as we shall more clear∣ly Demonstrate to happen when we shall dis∣course

of Intermitting Feavers. Secondly, In the Substance of the Pancreas it self, when by any cause, either Internal or External, the Circulation of the Blood through it, is hinde∣red; from whence the Parenchyma, by the continual appulse of blood, is puffed up, and swells, unless it be indurated, or by a previous Inflamation goes into an Absees∣sus.

Which, that it may be made known to all, we will bring upon the Stage the Observations of several Phisitians, and Anatomists. Riolanus, Anthropog. Lib. 2. Cap. 10. writeth, that he had observed in many people, who were of a Melancholy Nature, and Habit of Body, that the Pancreas equalled the weight of the Liver; and also confirms the same, by the Example of the most Illustrious Augustinus Thuanus;

Who, by the Melancholy Habit of Body, did complain for four Years together of a Collick Pain, about the Region of the Colon, with a Sense of a Bur∣den, or Weight, at his Stomach, while he stood upright, or walked: But his Hypoconders did not swell: At length being taken with an un∣lookt-for Gangreen, from his right Foot sud∣dainly to the Superiour parts with Horrible and Direful Pains, in the space of Six Hours ex∣pired. His Body being opened, and the Liver taken out, was round like to a Sphare, stuffe with Fat, and trans-fixed with a certain pitui∣tous hardned Matter like to Mortar: But the Pancreas, by its Amplitude and Weight, did e∣qualize the Liver, wholly Schirhous with many

little Knobs, which were filled with the Species of a Pigeons Egg; the Spleen was so wasted that it scarce weighed an Ounce.

For which reason, some have called the Pan∣creas, the Vicar or Supply of the Spleen; not considering that this Diversity might happen to other parts also; and likewise in Doggs, after the Extirpation of the Spleen, the Substance of the Pancreas did in no wise grow into a grea∣ter weight; which, according to them, ought to happen, if the Pancreas supplyed the Office of the Spleen.

Aubertus relates a story of an Abscessus Pro∣gym. ad lib. abdit. Fernelij Exercit. 44. of a certain Merchant of Lyons, which could never sleep, and when he endeavoured to sleep, he fell into a Lipothymie, and cold sweat of the whole Body, till at length he dyed. His Body being opened there was only found a putrid Abscessus in the Pancreas; the Stomach and o∣ther principal parts being safe. Guilh. Fabric. Hildanus. Cent. 1. Observ. 71. also relates, that he, in a certain Carpenter, who for the space of two years, by Intervals, was griev∣ed with divers Diseases, laboured under Ob∣structions, and Cachexy: Found in his dead Body, among other things, a Schirhous Tu∣mour, suppurated like unto a Collection of Fat, under the skin, about the bigness of two Fists; having its rise from the Inferiour part of the Pancreas, which inclosed the Intesti∣num Duodenum; so that, being covered with the Peritonaeum, it also resembled another Ven∣tricle.

You may read of a Cancerous Ulcer of the Pancreas, most worthy of note, in the Curi∣ous Miscellanies Medico-phys, of the Germans, (which as in the year 1670. by great Dilli∣gence, they began to bring to Light: So we altogether desire that the great God, for Com∣mon benefit, may prosper their Endeavours:) Observ. 99. where Dr. J. Fera. Hert. à Tot∣tenfeld adjoyns these following things, which they found in the Cavity of the Thorax in a certain Chyrurgion after Death.

Coming to the Lower Belly, we saw that Flesh perforating the Diaphragma to be the Pancreas, which was the length of two Spans, and breadth of two Hands transverse, being putrid, and cor∣rupted; which, by its Corosive Acidity, did not only perforate the Diaphragma, but did also so corrode the Spina Dorsi, that a Cancer-like Ʋl∣cer was produced, with a light stroke the whole Spina Dorsi might easily be broken. Lastly, it corroded the very Vena Cava it self, which runs into the Spine; by which the Blood, flowing through the Diaphragma, brought Death by im∣peding the Motion of the Lungs. This Cancer of the Pancreas, by creeping further, did also cor∣rupt both the Kidneys, and caused them to be most black and putrid.

We add more-over, that which the most Fa∣mous Highmore, Corp. Hum. Disq. Anat. lib. I. part II. writeth that he observed,

In a Noble Woman, which being Antient, laboured with Convulsions, Epilepsie, and the Hysterick Passion; and at length, after Exquisite Paines

and Torments, changed Life with Death; in whose dead Body, being opened, we found the Pancreas onely evilly affected and exulcera∣ted.

They which desire more Examples of Exul∣ceration, let them read Barthol. Hist. Johan. Dan. Horstij Observ. Anatom Salmuth, Tulpi∣um, Blasij Comm. in Synt. Anat. Vesting▪ and others. That this Pancreas had obtained a stony hardness, in an Antient Roman. Wo∣man, is witnessed by Dr. Panarol; as is like∣wise to be seen in Dr. Blasius, in his Com∣mentaries, even now cited page 40. In like manner, in the Year 1667. the following Hi∣story was Communicated to us at Paris, Bona fide, by Dr. Gajen, a Chyrurgion, and Fa∣mous Anatomist, by him before observed:

A Noble Man, aged about thirty, being Melancholy, was Obnoxious to Catthars, by the intemperate use of Wine, and Fruits; con∣tinually assumed, fell into a Vomiting, and Di∣arhaea, whereby after some space, there fol∣lowed a Flux of Blood; from whence, more and more failing in Strength, the Tenth day he Changed Life with Death. His body be∣ing opened, he found in the Pancreas, about the end of the Ductus Pancreaticus going into the Intestines, seven or eight Stones, having the bigness of the largest Pease; some of which being given us by himself, we keep among our Rarities.

Nevertheless, this Observation to us, seem∣ed not so wonderful, who believe that Stones

are generated in all the Glandules of the Body, especially in the pineal Glandule: because in it we have more than twenty times observed Stones in men, extinguished either by a gentle Disease, or a violent Death; which thing happens more frequently in France, than in Holland; a more profitable account whereof, we do not see, than that the Anima of the French, as by Nature more Volatile, may be bound to a more firm Residence in their Bo∣dies.

We have also found in a certain Dog, in that part of the Ductus Pancreaticus, where the Ascending concurs with the Descending, and is only simple; a Cartilagineous Excres∣cency, about the Ductus and its end, which like a Nipple, did hang out into the Intestine, to the bigness of a Finger, in the middle where∣of a sufficient passage was afforded to the slid∣ing Pancreatick Juice. Riolanus l. c. found the whole Pancreas hardned like a Carti∣lage.

We might be able to inferr many Diseases of the Pancreas, were it not already sufficiently evident by what hath been said, That the Pancre∣as also may be afflicted with common Diseases; neither that its evil Constitution followeth the affections of the Liver or Spleen: For, some∣times the other Bowels being unhurt, the Pancreas alone, hath been the cause of Death, for Reasons (already) sufficiently alleadg∣ed.

For which reason, it is manifest that the Pan∣creas is necessary to Life, which is also con∣firmed by an Experiment made by us at Paris, in the Year 1667. when in the House of Dr. Bourdelot, where, every Monday, the most Curious of Physitians and Phylosophers did meet, we had for three Months together ex∣posed this little Book, in the French Tongue, to publick Examination, some being led by Spe∣culation alone, asserted that▪ Animals might live no less without the Pancreas, than the Spleen: For which cause, before all that Com∣pany, we extirpated the Spleen, and also most exactly the Pancreas, of a certain Dog: The Abdomen again being closed, Dr. Bourde∣lot commanded his Servants to keep the Dog most diligently, who, notwithstanding all their Dilligence, in a short time Dy∣ed.

Those Vices being declared, which some∣times befall the Substance of the Pancreas, we shall proceed to those things which may hap∣pen to its juice; from whence, not a few Na∣tural Functions depending upon its Natural Disposition, are wasted and hurt. First of all; The Pancreatick Juice offendeth when it is more sparingly effused into the thin Gut, which sometimes comes to pass by the more sparing Generation, or Separation thereof in the Pancreas; or when there is an Obstruction in one or more of its lateral Branches; because, for a time the Juice is therein stagnated, till at length the Obstruction is opened.

It is more sparingly generated, when the Matter thereof is more or less deficient in the blood, and not being restored with conve∣nient Aliments; or when the same is carryed off another way; or when it is more strictly conjoyned with the blood, that it cannot be suf∣ficiently separated from it. One or more of the Ducts of the Pancreas are obstructed by a pituitous, and viscid Matter, together with the Matter of the Pancreatick Juice, separated in the Pancreas, and translated into, and detained in those Ducts.

Secondly, The Pancreatick Juyce doth also offend, when it is carryed into the Intestines in greater plenty, whether it be generated more Copiously, or for a time being de∣tained by Stagnation, in one or more of the Laterall Ducts, is then more plentifully Effused, when the Obstruction is Dissol∣ved.

It is generated more plentifully by reason of the Liberal use of acid Aliments, or at least of Condited Acids; for example, soure Wine, Vinegar, Pomecitrons, &c. as also, by reason of some Vice of the Glandules, by which the Separation of that juice, from the blood is promoted; as also, sometimes perhaps, be∣cause of more larger Vessels tending into the Pancreas, and as is usual, affording a larger Matter to the juyce.

Thirdly, When it flows inequally into the thin Gut, that is, at one time more abundantly, at another more sparingly: Which, first of all,

pens by an Obstruction of one or more of the Lateral Ducts, which continuing, nothing floweth out from them; and therefore a more sparing juyce is then effused into the whole:

By the said Obstruction, any way removed, presently that which was stagnant in the middle Duct, together with the rest of the juice, is effused into the thin Gut; from whence, on the contrary, the Excretion of the Pancreatick juice is then more plentiful.

That such an Obstruction may sometimes hap∣pen in the Lateral Ducts of the Pancreas, Rea∣son doth perswade, and Experience it self con∣firmeth, even as we shall more clearly evince in the following Discourse of Intermitting Fea∣vours.

Fourthly, It offendeth when it is more Fluid and Liquid, than Natural: which happeneth by reason of such blood, or animal Spirits, more Copiously mixed there-with.

Fifthly, It offendeth, when on the contrary it is more Viscid; by reason of the Blood, likewise Viscid, and abounding with much pi∣tuity.

Sixthly, The said Pancreatick juyce of∣fends; when the Natural Relish thereof is changed:

Whence it is one while less acid, another while more acid; one while salt, another while austere; sometimes of a simple Tast, or else Compounded of those before-named.

The Nominated Juice is less acid, either be∣beause of the animal Spirits, more plentifully carried to the Pancreas, or for want of acidity in the Blood; whether it may come to pass, by reason of assuming things unfit to repair the a∣cidity taken away, or by the use of such things as infringe, concentrate, obtund, or extinguish acidity.

The acidity of the Pancreatick Juice aug∣mented, for the most part, is to be ascribed to the Redundancy of acid Humours in the Body; sometimes to the Impedited Afflux of the Animal Spirits to the Pancreas; at least-wise, to that part of the Juyce which is stagnant in the Lateral Ducts; or other-wise, perhaps, by reason of the Animal Spirits, be∣ing Exhausted. An acid Humour is wont to abound in the Body, for the most part, from assumed Aliments, Sauces, or Medicaments, which are sharp, with sharp Wines, such as for the most part is Renish, Mosellanous, &c. as also, because of a more Cold Air, and North Wind, Sorrow of Mind though not over much, &c. The motion of the Animal Spirits, to the Pancreas, is impedited, when the Animal Spirits are defective; or being more dull or slow throughout the whole Body; also, when the Nerves are obstructed, dissecated, or com∣pressed.

The Succus Pancreaticus is made Salt by a Marine, or Fossile Salsitude, in like manner, because of the Serosity of the Blood likewise Salt; perhaps by a like Fault of the Glandules

concurring; for which reason, the Secretion of the Saline parts from the Acid, cannot be absolved: For, our common Salt consisteth of two parts, to wit, a Lixivious Salt, and an A∣cid Spirit joyned together. The austerity of the Pancreatick Juice seemeth to us, to be de∣duced from the more gross, or Terrene Par∣ticles, with which its acid Particles are invol∣ved; which appeareth, not only in Fruits, be∣ing first soure, afterwards, when by the gentle Heat of the Sun, they are Ripened, they are made a little more acid; and at length, when the more gross Particles thereof, by the Agita∣tion of Heat, are more exalted, they become Sweet.

But moreover it is manifest, that those things which are sower, it is by their Syncrisis and Diacrisis: So D. Paisenus hath noted in Thesi. XXI. C. that the juyce of Ribes, being powred to Coral of a grateful acid, becomes austere. Vitriol and Allum distilled, yield an acid Spirit: Likewise an acid Spirit may be di∣stilled from sealed Earths, Bole Armeniack, and the like; but how Bole Armen. may by the help of Nitre and other things, be made more astrin∣gent, is to be seen in Le Febre, in his French Edi∣tion. Page 649.