The descriptions of the term “pancreas” as well the macroscopic anatomy of the pancreas throughout Antiquity, Byzantium, Middle Ages and Renaissance are displayed. In particular, the original phrases of famous physicians of that period as regards the anatomy of the pancreas are presented: Hippocrates, Aristotle, Herophilus, Galen, Rufus of Efesus, Julius Pollux, Oribasius, Bartolomeo Eustachio, Andreas Vesalius, Gabriel Fallopius, Johann Georg Wirsung, Francis Glisson, Giovanni Domenico Santorini

Bitsis, Theodosios

Iliou, Kalliopi

Koutsouflianiotis, Konstantinos

Lazaridis, Nikolaos

Noussios, George

Paraskevas, George

Syrmos, Nikolaos

Firenze University Press: E-Journals

IJAE 
Vo l .  123,  n .  3 :  257-262 ,  2018
© 2018 Firenze University Press 
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ITALIAN JOURNAL OF ANATOMY AND EMBRYOLOGY
DOI: 10.13128/IJAE-25417
* Corresponding author. E-mail: g_paraskevas@yahoo.gr
Research Article - History of Anatomy and Embryology
Historical considerations regarding the first 
descriptions of pancreas’ anatomy
George Paraskevas*, Konstantinos Koutsouflianiotis, Nikolaos Lazaridis, Kalliopi Iliou, Theodosios 
Bitsis, George Noussios, Nikolaos Syrmos
Department of Anatomy and Surgical Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, 
Thessaloniki, Greece
Abstract
The descriptions of the term “pancreas” as well the macroscopic anatomy of the pancreas 
throughout Antiquity, Byzantium, Middle Ages and Renaissance are displayed. In particular, 
the original phrases of famous physicians of that period as regards the anatomy of the pancreas 
are presented: Hippocrates, Aristotle, Herophilus, Galen, Rufus of Efesus, Julius Pollux, Oriba-
sius, Bartolomeo Eustachio, Andreas Vesalius, Gabriel Fallopius, Johann Georg Wirsung, Francis 
Glisson, Giovanni Domenico Santorini. 
Key words
Pancreas, anatomy, history.
Hippocrates, the so-called “Father of Medicine” (about 460-375 BC) considered 
and described the lymph nodes as “glands”. A speculation has been made as regards 
the awareness of “pancreas” by Hippocrates. In his treatise “About glands” Hippo-
crates wrote: «Τά δ’ ἄλλα οκόσα ἀδένας ἓχει μούνον, οἵον έντερα, ἓχει γαρ και 
ταύτα ἀδένας ἐς το ἐπίπλουν μείζονας, τρίχας οὑκ ἐχει», which means: “There are 
other parts of body that contain only glands, such as intestines. Those parts contain 
great glands into epiploon (omentum), but they do not contain hair” (Mandilaras, 
1992). However, that statement is obscure, and it is not certain that such a gland cor-
respond to “pancreas”.
Aristotle (about 384-322 BC), the great Greek philosopher, in his famous treatise 
entitled “Historia Animalium” stated the following: «Έτι ἄλλαι ἀπό της μεγάλης 
φλεβός ἀποσχίζονται, ἠ μεν ἐπί το ἐπίπλουν ἠ δ’ ἐπί το καλούμενον πάγκρεας. 
Ἀπό δε ταύτης πολλαί φλέβες διά του μεσεντερίου τείνουσιν. Πάσαι δ’ αὐταί είς 
μίαν φλέβα μεγάλην τελευτώσιν, παρά παν το ἓντερον και την κοιλίαν μέχρι 
του στομάχου τεταμένην. Και περί ταύτα τα μόρια πολλαί ἀπ’ ἀυτών σχίζονται 
φλέβες», which means “Some veins arise from the great vein, one running onto the 
epiploon and one onto the so-called pancreas. From the great vein numerous veins 
are directed to the mesentery. All these veins end to a great vein extending from the 
intestine to the stomach (presumably that vein is the portal vein). And around these 
anatomical structures many veins are bifurcated” (Mandilaras, 1994). As it is evi-
258 George Paraskevas et alii
dent, Aristotle did not make any particular mention to the structure and function of 
the pancreas, referring only to the fact that this organ is surrounded by veins that 
presumably correspond to the superior mesenteric vein and splenic vein. Thus, it is 
apparent that prior to Herophilus from Chalcedon, Aristotle utilized the word “pan-
creas”. However, it has been stated that the word “pancreas” was popular at the time 
of Aristotle in the field of zoological study, and has not been authorized as an ana-
tomical term at that time, since the word had been utilized tentatively (Tsuchiya et 
al., 1997).
It is widely said that the first description of the pancreas is attributed to Herophi-
lus of Chalcedon (about 335-280 BC), the famous anatomist who is considered as the 
“Father of Anatomy” (Wain et al., 1958; Busnardo et al., 1983). Galen in his treatise 
entitled “De Semina” mentioned: “The residues pass from the stomach to the bowels; 
in addition the bile arrives from the liver and from some other glands (presumably 
the pancreas) located there comes a viscous fluid, similar to saliva. There is a consid-
erable controversy among anatomists regarding these glands, started by Herophilus 
and Eudemos, and therefore I better close here my discussion” (Kuhn, 1821; Howard, 
2002). It is certain that Herophilus and Eudemos did not name the organ and it is not 
sure whether the term “other glands” is attributed to the pancreas or the mesenteric 
lymph nodes.
Rufus of Efesus (about 100 AD), a prolific teacher, anatomist and physician, who 
had the misfortune of being cast in the shadow of Galen, in his work entitled “On 
the names of the parts of the body” writes as regards the pancreas: “Η δε παρά την 
πρώτην του εντέρου έκφυσιν κειμένη σαρξ διαπίμελος και αδενώδης, πάγκρεας” 
which means: “The first structure (flesh) adjacent to the first portion of the intestine 
is glandular and is called pancreas”. However, there is no Rufus’ mention relevant to 
the structure and potential function of the pancreas.
Galen (about 130-200 AD), the great Greek physician and surgeon, considered that 
this organ supports the blood vessels, as all lymph nodes were thought to do. More-
over, Galen missed the duct of the pancreas although he discovered both the vein 
and artery leading to this “spongy flesh” (Siegel, 1968). Galen in his work “On the 
usefulness of the parts” and in the “Fourth book” stated: “Indeed, in many animals 
something of a glandular nature is found at this point (anatomical site of pylorus), 
which increases the constriction, particularly when the stomach exercises its reten-
tive faculty and is actively engaged in digestion, gathering itself together, contracting, 
and clasping and compressing its contents”. It is not clear if the organ of “glandu-
lar nature” corresponds to pancreas or other anatomical structure. Daremberg, who 
was a famous editor and translator of the great works of Galen, considered that pre-
sumably the peculiar shape of the pylorus in the ape may be what was meant. In 
another point of the same work Galen claimed: “…the omentum is attached to the 
spleen and the part called the pancreas, as well as to the outgrowth (the duodenum) 
leading to the small intestine, the mesentery, the colon and the curve of the stomach 
itself” (May, 1968). Moreover, Galen in his work entitled “De venarum arteriarumque 
dissection” stated: «…και το πάγκρεας, ὅπερ ἓνιοι καλλίκρεας ὁνομάζουσι· ἀδήν 
δ’ ἐστίν οὓτος ὑποβεβλημένος ταις ἐνταύθα κατασχιζομέναις αρτηρίαις και 
φλεψίν», that means “…and the pancreas which some physicians call kallikreas: that 
gland is supported and surrounded by bifurcated arteries and veins”. In another text 
of the aforementioned Galen’s work, Galen claimed: «…ἰκανώς γαρ αὓτη (η φλέβα) 
259Pancreas anatomy
μικράς και πολλάς ἐν τῇ διόδῳ τριχοειδείς φλέβας εἰς το πάγκρεας εκφύει», 
that means “…that vein supply pancreas, with small and numerable capillary 
veins”(Kuhn, 1821). So, someone may conclude that Galen did not pay any particular 
attention to the structure as well the function of pancreas. He considered the pancreas 
as a glandular anatomical structure overlying arteries and veins, which supply and 
support it.
Julius Pollux, who was a lexicographer and teacher of the second century AD, in 
his famous treatise called “Onomasticon” wrote as regards the pancreas : “… ιατρός 
δε και αδένας τινάς καλούσιν… μάλιστα περί βουβώνας τε και μασχάλας και 
σιαγόνας και μεσεντέριον…” that means : “… physicians call these organs glands… 
that are located at inguinal, axillary region, jaws and mesentery” (Pollux, 1846). Pol-
lux, precisely as Hippocrates, referred to “glands” in the mesentery which corre-
spond to the lymph nodes of this anatomical region. However, someone may spec-
ulate that some of these glands, likely, represent the “pancreas”. Oribasius (about 
320-390 AD), who was personal physician to the Emperor Julian, in his excellent 
treatise termed “Collectiones Medicae” provides a well-organized anatomy based on 
Galen’s notes. In that work as regards the pancreas he wrote: “… και διά τούτο η 
φύσις αδενώδες τι σώμα δημιουργήσασα, το καλούμενο πάγκρεας, υπεσόρεσεν 
άμα τα περιέβαλεν (αγγεία και νεύρα) εν κύκλω… κι άρρηκτα διά παντός 
φυλάττεσθαι…”, which means “… and for that reason the nature created a glandular 
body, the so-called pancreas, that surrounds like circle the vessels (superior mesen-
teric) and nerves… and protects them” (Oribasius, 1556). It is apparent that Oriba-
sius paid attention only to the protective role of the pancreas with respect to the sur-
rounding superior mesenteric vessels and nerves.
Bartolomeo Eustachio (1520-1574 AD) provides us with the first known anatomical 
drawing of the pancreas demonstrating the posterior surface of a dog’s pancreas. That 
drawing was published in his work “Tabulae Anatomicae” that was edited in 1714 
by the physician Giovanni Mario Lancisi with his own explanations (Eustachio, 1728; 
Singer,1957). Andreas Vesalius (1514-1564 AD), the great reformer of the Anatomy in 
Renaissance, in his epic treatise entitled “On the fabric of the human body” published 
in Basel in 1543 provided the scientific community with a figure where the pancreas is 
shown as a U-shaped organ within the mesentery. Vesalius wrote: “…in humans it is 
rather white and reaches to the portal vein and the rami of arteries … to protect them 
and to serve as a support for the stomach” (Howard et al., 2002; Vesalius, 1453). Thus, 
Vesalius accepted the Galen’s claim that the pancreas serves as a “bed for the stomach 
to lie upon” and as a protector for the surrounding vessels. Gabriel Fallopius (1523-
1562 AD) who was pupil of Andreas Vesalius and taught anatomy at the University 
of Padua in his work entitled “Anatomical Observations” published in 1561 stated as 
regards the pancreas the following: “If there was true (that pancreas protects the stom-
ach), then this organ would be completely useless in animals which do not go about 
upright, because in them the pancreas lies above the stomach… It (pancreas) is placed 
beneath (the splenic vein) like a cushion and protects against everything that could 
squeeze it together (Fallopius,1561; Beger at al., 2008).
Johann Georg Wirsung (1589-1643 AD) as a medical student and protector to Pro-
fessor of Anatomy Vesling, on March 2nd, 1642, in Padua executed an autopsy on a 
murderer named Zuane Viaro della Badia who had been hanged the day before. The 
autopsy was witnessed by two medical students, Thomas Bartholin and Moritz Hoff-
260 George Paraskevas et alii
man (McClusky et al., 2002). The autopsy of the criminal was executed privately at 
San Francesco Hospital that was part of a monastery (Howard et al., 2002). Wirsung 
did not publish his discovery, however he engraved his discovery on a single copper 
plate and made approximately seven identical copies, sending them to famous anato-
mists in Europe expecting their opinion (Beger at al., 2008). In these letters, Wirsung 
stated that the pancreatic duct perforated the duodenum in a location just nearby to 
the bile duct. Wirsung was asking the anatomists whether that canal is an artery or 
a vein: he claimed that he never noted blood within the duct, and the contained flu-
id dyed the silver probe just as the bile does (McClusky, 2002; Howard et al., 1998). 
Unfortunately, Wirsung was murdered while entering his house at night on August 
1643, presumably as a result of a quarrel over whom was the first to discover a duct. 
He was killed by a Belgian student, named Giacomo Cambier (Pai, 2002). Rumors 
existed that period that Vesling, because of jealously, had something to do with Wir-
sung’s death, rumors that have not been proved (Howard et al., 2002). Moritz Hoff-
man five years after Wirsung’s death claimed that in September 1641, prior to Wir-
sung’s discovery, he noticed such a duct during a dissection undertaken on a turkey. 
Hoffman never published his findings. Hoffmann stated that Wirsung would never 
have paid attention to such a duct, if they had not made a conversation about Hoff-
man’s discovery (McClusky et al., 2002). Albrecht von Haller claimed that Hoffman 
was honored for his discovery by most of the Germans, and every year a feast cel-
ebrated his discovery (Howard et al., 2002). It was Johan van Horne (1621-1670), Pro-
fessor of Surgery and Anatomy at Leiden, who in 1685 honored Wirsung and was the 
first who attributed Wirsung’s primacy in the duct’s discovery by applying the name 
“Wirsung’s duct” (Beger et al., 2008). Cecka et al. (2013) have suggested that Zuane 
Badia, the cadaver in whom Wirsung made his discovery, suffered from chronic pan-
creatitis, since the main pancreatic duct in healthy pancreas is frequently difficult to 
find even if we know what we are searching for. On the contrary, in chronic pancrea-
titis the duct is dilated.
Francis Glisson (1597-1677 AD) was Professor of Physics at Cambridge and one of 
the great physicians at the seventeenth century, mostly known for his work on liver 
and rickets (Persaud et al., 2014). Glisson in his famous treatise “Anatomia hepatis” 
stated for pancreas the following: “Pancreatis quidem temperies videtur humida, 
laxa, flaccid, et moderate calida; estque vapor illius necessario consimilis, nempe 
humidus et relaxans. Humor quoque, quem de se emittit, videtur ejusdem temperiei 
esse, scilicet lenis et lubricus, minimumque adstringens: ut ab illius effluviis parum 
admodum soliditatis, roboris, aut firmitudinis, partibus vicinis expectandum fit” 
which means: “Pancreas character is moist, loose, floppy and moderately warm; and 
due to its similarity (comparison with the liver) it is surely moist and loose. More-
over, the juice that it gives off (pancreatic fluid) seems to be of the same character, 
mild and fluid, minimally sticky. So that from its secretion only little strength, power 
and stability should be expected for the adjacent organs” (Glisson, 1654).
The discovery of the accessory pancreatic duct was attributed to Giovanni 
Domenico Santorini (1681-1737 AD) who was appointed Professor of Anatomy at the 
Medical College of Venice when he was 22 year old (Kleinerman et al., 2014). San-
torini executed several hundred duodenopancreatic dissections with the assistance of 
magnifying glass. Santorini utilized in his drawings a scale providing the true size of 
the anatomical structures. Santorini mentioned that the second duct was not a vari-
261Pancreas anatomy
ant, but a normal finding (Beger et al., 2008; Flati et al., 2002). That normal anatomi-
cal element was published in a Santorini’s book entitled “Observationes Anatomicae: 
quibus inventorum plurima, tabularum non modica accessio adjuncta est” that was 
edited in 1775, 38 years after Santorini’s death (Beger et al., 2008). In that treatise San-
torini named that duct “superior pancreatic duct” and wrote as regards its anatomy: 
“the duct… (that) has its small origin from the longitudinal duct… runs into the 
duodenum, about two fingers above the orifice of the main duct”. Prior to Santorini, 
Frederick Ruysch observed a second duct describing it as anatomical variation (How-
ard et al., 2002). Furthermore, it has been said that Albrecht von Haller (1708-1777) 
mentioned the presence of the minor pancreatic duct prior to Santorini’s discovery, 
however he too considered that duct as an anatomical variant (Haller, 1757).
Acknowledgments
We are grateful to Mrs. Stella Chatzi for her assistance in the translation of refer-
ences from the Latin language.
References 
Beger H., Warshaw A., Buchler M., Kozarek R., Lerch M., Neoptolemos J., Shiratori 
K., Whitcomb D. (2008) The Pancreas: An Integrated Textbook of Basic Science, 
Medicine, and Surgery. 2nd edition. Blackwell Publishing, Oxford.
Busnardo A.C., DiDio L.J., Tidrick R.T., Thomford N.R. (1983) History of the pancreas. 
Am. J. Surg. 146: 539-550.
Cecka F., Jon B., Kaska M. (2013) Was the Wirsung duct discovery facilitated by 
intemperate alcohol consumption in 17th century Italy? Pancreatology 13 suppl.: 
542.
Eustachi B. (1728) Tabulae Anatomicae. Praefatione, ac notis illustravit Joh. Maria 
Lancisius. Typis Bartholomei Locatelli, Venetiis.
Falloppius G. (1561) Observationes anatomicae. Apud Marcum Antonium Ulmum, 
Venetiis.
Flati G., Andren-Sandberg A. (2002) Wirsung and Santorini: The men behind the 
ducts. Pancreatology 2: 4-11.
Glisson F. (1654) Anatomia hepatis: cui praemittuntur quaedam ad rem anatomicam 
universe spectantia, et ad calcem operis subjiciuntur nonnulla de lymphae-ducti-
bus nuper repertis. Du-Gardianis, Londini.
Haller A. (1757) Elementa physiologiae corporis humani. Vol. VI, book XXII. Grasset, 
Bern.
Howard J.M., Hess W., Traverso W. (1998) Johann Georg Wirsung (1589-1643) and the 
pancreatic duct: the prosector of Padua, Italy. J. Am. Coll. Surg. 187(2): 201-211.
Howard J.M., Hess W. (2002) History of the Pancreas. Mystery of a Hidden Organ. 
Kluwer Academic, New York.
Kleinerman R., John A., Etienne D., Turner B., Shoja M.M., Tubbs R.S., Loukas M. 
(2014) Giovanni Domenico Santorini (1681-1737): A prominent physician and 
meticulous anatomist. Clin. Anat. 27: 545-547.
262 George Paraskevas et alii
Kuhn D.C.G. (ed). (1821) Galen, Opera Omnia. Vol.22. C. Cnobloch, Leipzig. 
May M.T. (1968) Galen on the Usefulness of the Parts of the Body. Cornell University 
Press, Ithaca. 
Mandilaras B. (Ed.) (1992) Aristotle, Opera Omnia, About Glands. Athens, Kaktos.
Mandilaras B. (Ed.) (1994) Aristotle, Opera Omnia, About the History of Animals, 
book C. Athens, Kaktos.
McClusky D.A., Skandalakis L.J., Colborn G.L., Skandalakis J.E. (2002) Harbinger or 
hermit? Pancreatic anatomy and surgery through the ages - Part 1. World J. Surg. 
26: 1175-1185.
Oribasius (1556) Collectaneorum artis medicae liber, quo totius corporis humani sec-
tio explicatur, ex Galeni commentariis. Apud Guil. Morelium, Paris.
Pai S.A. (2002) Our medical past. Death and the doctor. Can. Med. Assoc. J. (CMAJ) 
167: 1377-1378.
Persaud T.V.N., Loukas M., Tubbs R.S. (2014) A History of Human Anatomy. 2nd edn. 
Charles C. Thomas, Springfield.
Pollux J., Bekker I. (1846) Onomasticon. Prostat in Libraria Friderici Nikolai, Berolini.
Rufus of Efesus (1983 edn.) De partibus corporis humani. Duphar Hellas, Athens, 
Paris.
Siegel R.E. (1968) Galen’s System of Physiology and Medicine. S. Karger, Basel.
Singer C. (1957) A Short History of Anatomy and Physiology from the Greeks to Har-
vey. Dover Publications, New York.
Tsuchiya R., Fujisawa N. (1997) On the etymology of “pancreas”. Int. J. Pancreatol. 21: 
269-272.
Vesalius A. (1453) De humani corporis fabrica libri septem. Ex officina Ioannis 
Oporini, Basileae.
Wain H. (1958) The Story Behind the Word. Some Interesting Origins of Medical 
Terms. Charles C. Thomas, Springfield.


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