Anton Nuck

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A Moment in History

Jean George Bachmann
(1877 – 1959)

French physician–physiologist whose experimental work in the early twentieth century provided the first clear functional description of a preferential interatrial conduction pathway. This structure, eponymically named “Bachmann’s bundle”, plays a central role in normal atrial activation and in the pathophysiology of interatrial block and atrial arrhythmias.

As a young man, Bachmann served as a merchant sailor, crossing the Atlantic multiple times. He emigrated to the United States in 1902 and earned his medical degree at the top of his class from Jefferson Medical College in Philadelphia in 1907. He stayed at this Medical College as a demonstrator and physiologist. In 1910, he joined Emory University in Atlanta. Between 1917 -1918 he served as a medical officer in the US Army. He retired from Emory in 1947 and continued his private medical practice until his death in 1959.

On the personal side, Bachmann was a man of many talents: a polyglot, he was fluent in German, French, Spanish and English. He was a chef in his own right and occasionally worked as a chef in international hotels. In fact, he paid his tuition at Jefferson Medical College, working both as a chef and as a language tutor.

The intrinsic cardiac conduction system was a major focus of cardiovascular research in the late nineteenth and early twentieth centuries. The atrioventricular (AV) node was discovered and described by Sunao Tawara and Karl Albert Aschoff in 1906, and the sinoatrial node by Arthur Keith and Martin Flack in 1907.

While the connections that distribute the electrical impulse from the AV node to the ventricles were known through the works of Wilhelm His Jr, in 1893 and Jan Evangelista Purkinje in 1839, the mechanism by which electrical impulses spread between the atria remained uncertain.

In 1916 Bachmann published a paper titled “The Inter-Auricular Time Interval” in the American Journal of Physiology. Bachmann measured activation times between the right and left atria and demonstrated that interruption of a distinct anterior interatrial muscular band resulted in delayed left atrial activation. He concluded that this band constituted the principal route for rapid interatrial conduction.

Subsequent anatomical and electrophysiological studies confirmed the importance of the structure described by Bachmann, which came to bear his name. Bachmann’s bundle is now recognized as a key determinant of atrial activation patterns, and its dysfunction is associated with interatrial block, atrial fibrillation, and abnormal P-wave morphology. His work remains foundational in both basic cardiac anatomy and clinical electrophysiology.

Sources and references
1. Bachmann G. “The inter-auricular time interval”. Am J Physiol. 1916;41:309–320.
2. Hurst JW. “Profiles in Cardiology: Jean George Bachmann (1877–1959)”. Clin Cardiol. 1987;10:185–187.
3. Lemery R, Guiraudon G, Veinot JP. “Anatomic description of Bachmann’s bundle and its relation to the atrial septum”. Am J Cardiol. 2003;91:148–152.
4. "Remembering the canonical discoverers of the core components of the mammalian cardiac conduction system: Keith and Flack, Aschoff and Tawara, His, and Purkinje" Icilio Cavero and Henry Holzgrefe Advances in Physiology Education 2022 46:4, 549-579.
5. Knol WG, de Vos CB, Crijns HJGM, et al. “The Bachmann bundle and interatrial conduction” Heart Rhythm. 2019;16:127–133.
6. “Iatrogenic biatrial flutter. The role of the Bachmann’s bundle” Constán E.; García F., Linde, A.. Complejo Hospitalario de Jaén, Jaén. Spain
7. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41: 172–189, 1907.

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Details: Written by: Efrain A. Miranda, Ph.D.; Published: December 19, 2024; Hits: 1086

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

Antonius Nuck

Anton Nuck (1650-1692), a Dutch surgeon and anatomist used several forms for his name such as Antonio Nuck, Anton Nuck, Antonii Nuck, and Antonius Nuck van Leyden. Born in Harderwijk, Netherlands, he moved to Leyden in South Holland, where he studied medicine at the University of Leyden. He received his doctorate in February 1677 with this thesis “De Diabete”.

In 1683 he became a reader (lecturer) of anatomy and surgery at the Collegium Anatomicum Chirurgicum, in Haag (The Hague, Netherlands). He returned to his alma mater in Leyden, where the was appointed to the chair of Medicine and Surgery.

Nuck is known today for the first description of the processus vaginalis, a peritoneal evagination thar runs lateral to the gubernaculum into the inguinal canal in the fetus, both male and female, terminating in the labioscrotal fold, an area that will become the scrotum in the male or the labium majus in the female. This canal is known eponimycally today as the "Canal of Nuck"

The processus vaginalis in the male runs lateral to the vas deferens into the scrotum. The processus vaginalis in normally closed, but if it stays patent, it becomes a passageway for abdominal contents into the scrotum, setting the stage for an indirect inguinal hernia.

Title page of Adenographia & Uteri

Plate XL of Adenographia & Uteri

In the female the processus vaginalis runs lateral to the round ligament of the uterus. Since the round ligament ends in the labium majus, a patent processus vaginalis sets the stage for an indirect inguinal hernia that bulges into the labium majus (see figure 4 in Source 1- WARNING the image depicts external female genitalia)

Before Nuck, it was argued that females could not have inguinal hernias. In 1691 Nuck published his book "Adenographia Curiosa & Uteri Foeminei Anatome Nova", where he showed that indeed some females could indeed have hernias. For additional information on the canal of Nuck and the text in the book, click here.

Chapter 10 of this book is entitled “De Peritoneai Diverticulis Novis” (On a New Peritoneal Diverticulum”. Not only Nuck described the processus vaginalis, but he described a pathology today known as “Nuck’s cyst” or “Nuck’s hydrocele”, a cyst within Nucks’ canal. The images above show the title page of his book "Adenographia Curiosa & uteri foeminei anatome nova" and a composite image of plate XL and text. This book was dedicated to the mainly to the topic of lymphatic vessels. The discovery of a patent processus vaginalis was not its intent, but when he found it, he added it to his book. The text on image XL reads "diverticulum novum oculis subjiciens, ex subjecto humano" that can be freely translated as "On a new opening, seen with our eyes in a human subject"

Because of laparoscopic and robotic surgery that requires a pneumoperitoneum, an undiagnosed patent canal of Nuck can lead to a pneumatocele or pneumolabium (See Sources 6)

Besides general surgery, Anton Nuck practiced dentistry and ophthalmic surgery, being the first one to perform a paracentesis for hydrophthalmia (glaucoma) to reduce the pressure inside the eye. He also performed the first recorded vitrectomy. He studied the salivary glands and called the process sialography.

Sources:
1. “Quiste del Conducto de Nuck: una Patología Vulvar Poco Frecuente” Nuñez, JT; Virla, Ln, Delgado del Fox, MD; Gonzalez, A. Rev Obstet Ginecol Venez v.66 n.1 Caracas mar. 2006
2. “Revisiting the clinico-radiological features of an unusual inguino-labial swelling in an adult female” Vinoth, T; Lalchandani, A; Bharadwaj, S; Pandya, B. 2022. International Journal of Surgery Case Reports, 98(Complete)
3. “Early Descriptions of Vitreous Surgery” Grzybowski, A. & Kanclerz, P. (2021) Retina, 41 (7), 1364-1372.
4. The Origin of Medical Terms" Skinner 1970
5. "The cyst of the canal of Nuck: a great mimicker of groin hernia in female" Ben Ismail, I., Sghaier, M., Rebii, S., Zeznaidi, H. and Zoghlami, A. (2024) ANZ Journal of Surgery
6. "Unilateral Vulvar Pneumatocele (Pneumolabium) Diagnosed during Robotic Hysterectomy" Zoorob, D; Spalsbury, M;Slutz, T; et al. (2019) Case Reports in Obstetrics and Gynecology, 2019, 8106451
7. "A Family of Early English Oculists (1600-1751), With a Reappraisal of John Thomas Woolhouse"Leffler CT, Schwartz SG. (2017) Ophthalmol Eye Dis.
Anton Nuck's portrait in the public domain, courtesy of the Universiteit Leiden Digital Collections.
Images from "Adenographia Curiosa", public domain, courtesy of Archive.org.

Anton Nuck

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