Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Jean-Louis Petit

Jean Louis Petit
(1674 – 1750)

French surgeon and anatomist, Jean Louis Petit was born in Paris in on March 13, 1674.  His family rented an apartment at his house to Alexis Littre (1658 – 1726), a French anatomist. Petit became an apprentice of Littre at seven years of age, helping him in the dissections for his lectures and at an early age became the assistant in charge of the anatomic amphitheater.

Because of Petit’s dedication to anatomy and medicine, in 1690 at the age of sixteen, became a disciple of a famous Paris surgeon, Castel.

In 1692, Petit entered the French army and performed surgery in two military campaigns. By 1693 he started delivering lectures and was accepted as a great surgeon, being invited to the most difficult operations.  In 1700 he was appointed Chief Surgeon of the Military School in Paris and in the same year he received the degree of Master of Surgery from the Faculty of Paris.

In 1715 he was made a member of the Royal Academy of Sciences and an honorary member of the Royal Society of London. He was appointed by the King as the first Director General of the Royal Academy of Surgery when it was founded in 1731.

Petit’s written works are of historical importance.  “Traite des Maladies des Os” ( A Treatise on Bone Diseases);  “Traite des Maladies Chirurgicales et des Operation” (A Treatise on Surgical Diseases and their Operations” This last book was published posthumously in 1774. He also published a monograph on hemorrhage, another on lachrymal fistula, and others.

He was one of the first to perform choIecystotomy and mastoidotomy. His original tourniquet design for amputations saved many in the battlefield and the design of the same surgical instrument today has not changed much since its invention by him.

His name is remembered in the lumbar triangle, also called the "triangle of Petit", and the abdominal hernia that can ensue through that area of weakness, the lumbar hernia or "Petit's hernia".

Sources:
1. “Jean Louis Petit – A Sketch of his Life, Character, and Writings” Hayne, AP San Fran Western Lancet 1875 4: 446-454
2. “Oeuvres compl?tes de Jean-Louis Petit” 1837 Imprimerie de F. Chapoulaud
3. Extraits de l'eloge de Jean-Louis Petit Ius dans Ia seance publique de I' Academie royale de chirurgie du 26 mai 1750” Louis A. Chirurgie 2001: 126 : 475- 81


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Canal of Nuck

The "Canal of Nuck" is the patent embryological remnant of the processus vaginalis in the female. The processus vaginalis is an extension of the peritoneum that forms to the side of the gubernaculum, a small fibrous cord that is attached to the lower pole of the gonad in the embryo. On the other end, the gubernaculum attaches to the inner aspect of the labioscrotal fold, an embryonic structure that will become the scrotum in the male and the labia majora in the female.

In the male, the processus vaginalis accompanies the gubernaculum and the testicle, on its descent towards the scrotum. In the female, the gonad (ovary) stays in the pelvis and the embryological remnants of the gubernaculum become the proper ovarian ligament (uteroovarian ligament) and the round ligament of the uterus which enters the inguinal canal, splits into multiple small fibers that disappear in the tissues of the labium majus.

In the male (and female) the walls of the processus vaginalis normally fuse, closing the communication between the scrotum (and the labia majora) and the main peritoneal cavity. If they remain open, the name is different, although the pathological consequences are similar (hernia, cysts or hydrocele). In the male, it is called a “patent processus vaginalis”, and in the female it is called the “Canal of Nuck”, which is found patent in 10-20% of the cases, although its presence does not per se imply the presence of pathology.

It was first described by Anton Nuck, a Dutch surgeon and anatomist (1650-1692) in his book "Adenographia & uteri anatome nova" published in 1722. In this book he questions why do some females present with inguinal hernias: "Haecce , praeter alias herniarium species , in utroque sexu obvias auditoribus meis anno fuperiori demonftrandi , difficile vifum fuit explicare , qui Hernia foeminarum inguinales orirentur?" Why when it is easy to see (the canal) in other species it is so difficult to explain to those listening why only some women have inguinal hernias?

In figure XL of the same book he proceeds to show the open processus vaginalis which was from then on known as the eponymic "Canal of Nuck"

The images in this article are from “Case Report: Infected Hydrocele of the Canal of Nuck” by Mandahan, P and Batthi, K. (see sources) Figure 1 shows the superficial hydrocele herniation; figure 2 shows the infected hydrocele; and figure 3 shows the excised opened hydrocele. Read the full article here. 

http://dx.doi.org/10.1155/2013/275257

My personal thanks to Dr. Sanford Osher who suggested this article. Dr. Miranda

Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. 
Click on the image for a larger depiction
 Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. 
Click on the image for a larger depiction
 Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. 
Click on the image for a larger depiction

Sources:
1. 
Adenographia curiosa et uteri foeminei anatome nova” Classic pages in Obstetrics and Gynecology Lawrence Longo, M.D. Volume 123, Issue 1, 1 September 1975, Page 66
2. Nuck, Antonio “Adenographia curiosa et uteri foeminei anatome nova” (Latin) Apud Samuellem Luchtmans   https://archive.org/details/bub_gb_tQZJYL7qyssC 
3. Poghosyanm T, et al “Hydrocele of canal of Nuck” Applied Radiology; Scotch Plains43.12 (Dec 2014): 37-38.
4. Bagley, J. “Cyst of Canal of Nuck.” Journal of Diagnostic Medical Sonography Vol 31, Issue 2, pp. 111 - 114
5. Bagu, A. et al Endometriosis in the canal of Nuck hydrocele: An unusual presentation
6. Mandham, P; Bhatti, K “Case Report: Infected Hydrocele of the Canal of Nuck” Case Reports in Urology Volume 2013  http://dx.doi.org/10.1155/2013/275257
 
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