The pancreas

Pancreatic secretion was first studied at The Mount Sinai Hospital by Crohn in 1912, but measurements of pancreatic enzymes in duodenal aspirate or fe ces were found unhelpful in diagnosis. Such pancreatic tests fell into disu se because of advances in radiology of the biliary tree in the 1920s. Once extracts of secret-in and cholecystokinin-pancreozymin became available fro m Sweden in the 1930s, it became possible for the biochemist Franklin Holla nder and the surgeon David Dreiling to develop pancreatic secretion tests i nto practical procedures for the diagnosis of benign and malignant diseases of the pancreas and biliary tree, and produce physiological studies of the mechanisms of ion transport. With more purified hormones, it became possib le to measure maximum (alkaline) bicarbonate output of the pancreas analogo us to the maximal acid response of the stomach to an augmented histamine te st, and to determine whether patients with duodenal ulcer had decreased neu tralization of gastric acid in the duodenum. Clinical studies were also dir ected to the pathophysiology of acute relapsing and chronic pancreatitis an d carcinoma. However, advances in imaging and endoscopy have now shifted th e thrust of pancreatology.