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A Moment in History

Dr. Thomas Dent Mütter
Dr. Thomas Dent Mütter (1811-1859)

Dr. Thomas Dent Mütter

(1811-1859)

Thomas Dent Mutter was born on March 9, 1811, in Richmond, VA. His mother died in 1813, and his father died of tuberculosis in 1817. Thomas was orphaned when he was barely 8 years old. His father left him a somewhat meager inheritance and in his early life had to do with less that others with his objectives in life. He was well educated under the tutelage of Robert Carter, his guardian, and in 1824 he started his studies at the Hampden Sidney College of Virginia. He continued with a medical apprenticeship with a Dr. Simms in VA. He was well respected and even at his early age he would do home visits for his medical benefactor with great results. He started medical studies at the University of Pennsylvania, where he earned his MD in 1831. The new young doctor, Thomas Dent Mutter, MD was only 20 years of age.

At the time, Europe was the place to go to if you wanted advanced medical studies. Dr. Mutter had no money, so he applied as a ship surgeon to be able to cross the Atlantic. Once in Europe, he spent time in Paris, where he studied under the tutelage of Dr. Guillaume Dupuytren. He later studied for a short time in England where he met Dr. Robert Liston. Following Dupuytren's teachings, Mutter was fascinated by plastic surgery.

A chance encounter with what was to become his first well-known acquisition of a medical curiosity, Mutter started thinking on how to help those people that were known at that time as “monsters”, patients who the general public did not see, because they did not appear in public. The curiosity in question was a wax reproduction of the face of a French woman who had a “horn” arising from her forehead. This piece is on exhibit at the Mütter Museum.

Back in the United States in 1832, Thomas Dent Mutter changed his last name to give it a more “European” sound and added an “umlaut”, so now he was Thomas D. Mütter, MD. It may also be that he wanted to pay homage to his Scottish-German heritage, who knows? He opened his medical office in Philadelphia and although it took time, eventually he had a thriving practice. One of his specialties was the work on “deformities” so common at the time because of facial scars born out of the use of open fires in houses, and deformities caused by burns and loss of tissue due to chemicals used in local industry. Dr. Mütter is the pioneer of what we call today “Reconstructive Surgery”.

In 1835 he was asked to join the Medical Institute of Philadelphia as an assistant professor of Surgery. He was an instant success. Dr. Mütter was adored by his students because, he would question the students and guide them to discovery instead of just lecturing and leaving. In his Discourse eulogy of Dr. Mütter by Joseph Pancoast he writes:” The power of attracting students near him by his mingled gentleness, energy, and enthusiasm; of fixing their attention by the lucid and methodical arrangements of his Subject, by his clear demonstrations, and sprightly oral elucidations, came so readily to him, and was so early displayed) as to seem almost intuitive.” In 1841 Dr Mütter was appointed Professor of Surgery at the Jefferson Medical College in Philadelphia.

Dr. Mütter had always had poor health, even in childhood, and his dedication to his passion, long hours, took its toll on his body. In 1956 he set sail for Europe and resigned his teaching duties. He was named Emeritus Professor of Surgery. Unfortunately, the trip did not help, and he returned to the US in early 1958. Fearful of another winter in cold Philadelphia, he moved to Charleston, SC, where he died on March 19, 1859.

Dr. Mütter’s story does not end here. He was an avid collector and throughout his short life he had pulled together an impressive collection of medical oddities, samples, and curiosities. Knowing that his life was at an end, he negotiated with the Philadelphia College of Physicians to have them host his collection in perpetuity as well as the creation of a trust fund that would ensure that the public and medical students would have access to this incredible collection. Through the years this collection has increased and is known today as the Mütter Museum of the Philadelphia College of Physicians. I strongly urge our readers to visit this incredible museum. For more information, click here.

Personal notes: In the late 90’s, I attended a meeting of the American Association of Clinical Anatomists.  During the meeting I met Gretchen Worden, who at the time was the Curator of the Mütter museum. Gretchen was inspirational, fun, and a great conversationalist! I had the opportunity to visit Gretchen at the Mütter museum and had the luck to be treated to a “behind the scenes” tour. What an experience! I was saddened to hear that Gretchen Worden passed on August 2, 2004. Still, in my recent visit to the Mütter Museum, I was glad to see a new section at the museum that remembers Gretchen. Her biography can be read here.

I would like to thank Dr. Leslie Wolf for lending me the book by O’Keefe that lead to me writing this article. Dr. Miranda

Sources:
1. “Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine” O’Keefe, C. 2015 Penguin Random House, LLC
2. “A Discourse Commemorative of the Late Professor T.D. Mütter” Pancoast, J. 1859 J Wilson Publisher
3. “Thomas Dent Mütter: the humble narrative of a surgeon, teacher, and curious collector” Baker, J, et al. The American Surgeon, Atlanta 77:iss5 662-14
4. “Thomas Dent Mutter, MD: early reparative surgeon” Harris, ES; Morgan, RF. Ann Plast Surg 1994 33(3):333-8
5. “5 Things I Learned from Thomas Dent Mütter” O’Keefe C.


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Rudi Coninx, MD

Rudi Coninx, MD  is a physician and Chief a.i. Humanitarian policy and Guidance at the World Health Organization (WHO), based in Geneva. He obtained his MD from the University of KU Leuven Belgium, a Doctorate in Tropical Medicine from the Prins Leopold Instituut voor Tropische Geneeskunde, and an MPH from the John Hopkins University School of Medicine.

His CV shows more than twenty five years of national and international experience in policy and strategy development and analysis, policy dialogue, technical advice and program management support to countries and WHO country offices. Considerable experience in strengthening WHO country offices and in working with partners and networks at the global as well as filed level. Coordinated the WHO Country Focus Policy for more than five years and worked as a member in various strategic planning, decentralization, and global and regional partnership groups, including national and international committees, taskforces. Published several articles on policy analysis, management and health and development in regional and international journals.

He is also an Associate Faculty, Bloomberg School of Public Health, Johns Hopkins University, USA.

He has held a series of positions with the International Committee of the Red Cross, and also within the World Health Organization. His LinkedIn profile can be found here.  

Rudi Coninx

Thanks to Dr. Coninx for taking time of his busy schedule and collaborating with "Medical Terminology Daily" with the article "Did Andreas Vesalius really die from scurvy?which he co-authored with Theo Dirix. We look forward to his future writings in this blog.


Wilhelm Kiesselbach


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.To search all the articles in this series, click here.

Wilhelm Kiesselbach (1839 – 1902) German otolaryngologist born in the city of Hanau. Started his medical studies in 1859 in Göttingen. Marburg, and Tübingen. Because of an accident that affected one of his hands and legs, his doctorate was delayed until 1875.

He specialized in otolaryngology in Vienna, although he also studied and specialized in ophthalmology. He had a number of positions such as assistant professor at the Medical Polyclinic in Erlangen, assistant professor for ophthalmological examinations at the Surgical Clinic in Erlangen, and senior physician for ophthalmology.

He died of an infection he contracted while working with patients at the clinic.

His name is eponymically tied to the locus Kiesselbachii, also known as Kiesselbach’s plexus, an area of the anteroinferior nasal septum known for propensity for epistaxis or nasal bleeding. In fact, close to 90% of nose bleeds happen in this area. in this region, terminal branches of the anterior ethmoid artery, greater palatine artery, sphenopalatine artery and superior labial artery anastomose forming a plexus.

Kiesselbach


An answer regarding the death of Andreas Vesalius (3)


NOTE:  In 2014  Pavlos Plessas presented the compelling theory that Andreas Vesalius died in 1564 from scurvy on the island of Zakynthos. With his permission his original article entitled "Powerful indications that Vesalius died from scurvy" was published in this blog in 2016.

His theory was later challenged by Theo Dirix and Dr. Rudi Coninx in this same blog with the article "Did Andreas Vesalius really died from scurvy?". Pavlos Plessas' rebuttal to the latter article is published here from a letter to Theo Dirix.


...continued from: An answer regarding the death of Andreas Vesalius (2). For the initial article, click here.

16. The study’s sample is small, not representative of a general population, based on answering a questionnaire and not observation

Clinical studies of this nature face obvious limitations. If the authors are prepared to disbelieve the testimony of people who lived in a confined space with many victims of scurvy until the final fatal outcome, it is no wonder they complain about the study. Doubting is their prerogative, however, the way to discredit the study is to either find an error in the data or its interpretation, or conduct their own study and come up with different results.

17. The quoted personality changes peak on day 107. Certainly not an early symptom

Do the authors consider a symptom only when it peaks? Is pain not pain until it becomes unbearable?

18. Elevation of this triad is also found in prolonged semi starvation, and deficiencies of B-complex vitamins

Pavlos Plessas
Pavlos Plessas
Click on the image for author information

The study at this point refers to Brozek and indirectly to the Minnesota Starvation Experiment of 1944-45, meaning semi-starvation over many months. It is clearly not relevant here as Vesalius did not face food shortages for more than a few weeks. As for vitamins of the B complex if the authors are ready to suggest that Vesalius may have died from beriberi or pellagra I am ready and happy to argue. 

19. These changes are characteristic of individuals who are physically ill, as the subjects were

Yes, but in the beginning they did not know that they were ill (no clinical signs). Besides, there is another study which indicates that “behavioural change in human scurvy patients has a physiological rather than a solely psychological basis” (6). And there is a suggested biological explanation. “Vitamin C is a cofactor in the biosynthesis of catecholamines, most notably in the conversion of dopamine to norepinephrine, which may explain the behavior and mood disorders associated with vitamin C deficiency” (7). “Acutely hospitalized patients experience emotional distress for many reasons; therefore, it may seem unexpected that simple correction of their vitamin C deficiency could account for such rapid and dramatic improvements in psychological well-being. There are several reasons why this possibility merits serious consideration. First, the result is biologically plausible. Psychological dysfunction is known to occur in vitamin C deficiency, presumably because of the involvement of ascorbate in neuronal transmission and in brain neurotransmitter and fuel metabolism.” (8)

20. Vesalius’ reaction was normal in the view of many passengers getting sick, dying and being thrown overboard

Did all the passengers start begging the crew not to throw their dead bodies overboard? Did Boucherus do it? Why did he then only report Vesalius doing it? Was it normal behaviour for a distressed 16th century aristocrat to beg lowly-born sailors?

21. The only known symptoms of Vesalius are consistent with many other diseases

I think the best way for someone to debunk the scurvy theory is to make a list of diseases that could have killed Vesalius. It appears that the authors do not consider it too great a challenge. But these diseases have to be compatible with the circumstances and the authors will have to do considerably better than the suggestion of food poisoning.

22. Vesalius died from exhaustion combined by illness

All sources agree that Vesalius died from an illness. He had gone through an ordeal, he was probably malnourished and dehydrated to some extent but there is no evidence of exhaustion. He was sick, not tired. He was a passenger on a ship, not a galley slave. The crew, who worked around the clock, were fine. The only exhaustion was that of his reserves of Vitamin C.

23. In order to have a definite diagnosis, it will be important to locate the grave of Andreas Vesalius

Amen. I have one more reason to wish it than most of the many people who wish Theo and Pascale good luck in the search for the grave. I expect to be vindicated. And I hope that maybe my work will contribute in the beyond doubt identification of Vesalius’ remains..


PERSONAL NOTE: My thanks to all the authors who are part of this ongoing discussion and who are also friends and contributors to this blog. Everybody is correct in the fact that the only way to find the truth of the cause of death of Andreas Vesalius is to find his grave. The quest is ongoing and hopefully we are closer every day to this objective. Dr. Miranda


Sources:

1. "Voyages and Travels in the Levant in the Years 1749, 50, 51, 52" London 1766, p. 147
2. "Medicina Nautica: an Essay on the Diseases of Seamen" Volume III, London 1803, p. 387
3. "De magnis Hippocratis" Lienibus Libellus, Antwerp 1564, pp. 26a – 31b
4. A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101.
5. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
6. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
7. Olivier Fain, Musculoskeletal manifestations of scurvy, Joint Bone Spine 72, 2005.
8. Wang et al, Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients, the American Journal of Clinical Nutrition, 2013.


An answer regarding the death of Andreas Vesalius (2)


NOTE:  In 2014  Pavlos Plessas presented the compelling theory that Andreas Vesalius died in 1564 from scurvy on the island of Zakynthos. With his permission his original article entitled "Powerful indications that Vesalius died from scurvy" was published in this blog in 2016.

His theory was later challenged by Theo Dirix and Dr. Rudi Coninx in this same blog with the article "Did Andreas Vesalius really died from scurvy?". Pavlos Plessas' rebuttal to the latter article is published here from a letter to Theo Dirix.


...continued from: An answer regarding the death of Andreas Vesalius (1)...

8. Echtius’ treatise was only published after his death in 1556

This is incorrect. Echtius was alive almost a decade after that and heard Boucherus describe Vesalius’ death with his own ears. The treatise was first published in 1564, the year of Vesalius’ death, albeit was wrongly attributed to Wierus.

9. Echtius believed scurvy was caused by a blocked spleen, leading to an excess of black bile

Echtius believed that an excess of black bile (melancholic humour) caused scurvy. He wrote that in addition to eating preserved foods and mouldy biscuit, and drinking foul water, the following conditions led to an excess of black bile: warm air, lack of sleep, hard manual work, anxiety and fevers. Each one individually could cause scurvy even if the diet was good . The reasons for Vesalius’ illness as indicated by the sources are: eating rotten biscuit, drinking corrupt water, hot weather and extreme worrying. Please compare with the list of causes given by Echtius in his treatise.

10. It is claimed that extreme fear and irrational behaviour … are well known early symptoms [Plessas]. This is not the case

Pavlos Plessas
Pavlos Plessas
Click on the image for author information

I quote Rev. Richard Walter of the Anson expedition, who saw many of his shipmates die from scurvy: This disease is likewise usually attended with a strange dejection of spirits; and with shiverings, tremblings, and a disposition to be seized with the most dreadful terrors on the slightest accident (4). 


11. This (absence of extreme fear and irrational behaviour) is also the observation of one of the authors (RC) having observed scurvy patients in Ethiopian prisons

Did any of Dr. Coninx’s patients see other inmates die from scurvy? Did he ever observe one of his patients witness an accident? Were his patients evaluated by a psychiatrist? I would hazard the guess that the answer to all the questions is no. I choose to believe Rev. Richard Walter.

12. The Italian Pietro Bizzari based his account on what he had been told by an anonymous Venetian goldsmith

Bizzari’s account is not credible. It clashes with the accounts of three different people, who saw Vesalius’ grave in Santa Maria delle Grazie.

13. Metellus describes the symptoms of Vesalius’ illness

No, he does no such thing.

14. The possibility of rotten food as a cause of death on the ship is plausible

I hope this is not a suggestion that a great physician like Vesalius could not recognise the symptoms of food poisoning in others. If he did, it would have been possible to identify the particular source and he would not have fallen ill himself. Even if that was not possible they could have resorted to sharing the supplies of the crew, who had suffered no cases of illness. Surely it is best to be malnourished than risk death from food poisoning. In addition, had the cause of death been food poisoning, the sources would not have blamed Vesalius’ worrying for his illness. Finally, since the authors seem to agree that Metellus’ version of events is the most reliable, how is it possible for a man on the verge of death from food poisoning to be walking on the seashore of Zakynthos? Food poisoning as a cause of death is not plausible even though the sources claim the disease was somehow related to food and water shortage.

15. A 1971 study by Kinsman and Hood which allegedly claims that personality changes are amongst the first symptoms of scurvy

Why allegedly? I quote from the study: The personality changes occurred at an earlier stage of depletion than the psychomotor changes, which did not appear until obvious clinical scurvy was present (5). So the study does claim that personality changes are amongst the first symptoms of scurvy, the very first as a matter of fact. According to figure 3 of the study the MMPI T-scores started increasing when the level of Vitamin C in the body was at the equivalent of 761 mg. Clinical signs of scurvy became apparent only when the level went down to 300 mg. 

Article continued here: An answer regarding the death of Andreas Vesalius (3)

Sources:

1. "Voyages and Travels in the Levant in the Years 1749, 50, 51, 52" London 1766, p. 147
2. "Medicina Nautica: an Essay on the Diseases of Seamen" Volume III, London 1803, p. 387
3. "De magnis Hippocratis" Lienibus Libellus, Antwerp 1564, pp. 26a – 31b
4. A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101.
5. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
6. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
7. Olivier Fain, Musculoskeletal manifestations of scurvy, Joint Bone Spine 72, 2005.
8. Wang et al, Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients, the American Journal of Clinical Nutrition, 2013.


An answer regarding the death of Andreas Vesalius (1)


NOTE:  In 2014  Pavlos Plessas presented the compelling theory that Andreas Vesalius died in 1564 from scurvy on the island of Zakynthos. With his permission his original article entitled "Powerful indications that Vesalius died from scurvy" was published in this blog in 2016.

His theory was later challenged by Theo Dirix and Dr. Rudi Coninx in this same blog with the article "Did Andreas Vesalius really died from scurvy?". Pavlos Plessas' rebuttal to the latter article is published here from a letter to Theo Dirix.


An answer to Theo (and Rudi) regarding the death of Vesalius

Three years after my 2014 speech at the Vesalius Continuum meeting, where I suggested that scurvy appeared as the only possible explanation to Vesalius’ death, Dr. Rudi Coninx and Theo Dirix published a refutation. Theo is a dear friend and Dr. Coninx has dealt with scorbutic patients in Ethiopia. In addition, Theo is – along with another good friend, Pascale Pollier – the driving force behind the search for Vesalius’ remains. Arguments are always welcome, since they bring us closer to the truth, and are particularly important amongst people with common goals. Here is my reaction.

Quotes have been altered or truncated for brevity.

1. Vesalius must have eaten well in the Holy Land because he was a nobleman

The point I made was that at that time of year there was extreme scarcity of foods containing Vitamin C in that area, not that Vesalius was devoid of means or that he was not well looked after by the monks who hosted him.

2. Vesalius ate the food that protected monks from scurvy

Pavlos Plessas
Pavlos Plessas
Click on the image for author information

It did not protect them. There is at least one recorded outbreak of scurvy in a Holy Land monastery (1). The circumstances were not unusual so scurvy in those monasteries was probably not uncommon.

3. Scurvy was not uncommon in the area but people were not dying in large numbers

If they had been suddenly forced to migrate en masse, through desert and sea for three months in Vesalius’ footsteps, there would have been a very large number of deaths.

4. Liver and kidneys are also sources of Vitamin C

True, but they are not prime cuts. How many times a month would a nobleman be offered offal? I would say probably none.

5. Forty days at sea is not long enough to develop scurvy. Symptoms appear after 3 months at least

This is true for a previously healthy-eating subject of a study. An 18th century British warship could easily have a dozen dead and another 50 sick in less than 2 months (2) . There are many factors such as activity, infections, temperature, stress, smoking and possibly others, like age, gender, weight and genetic make-up. The most important though is the amount of Vitamin C in the body when the period of deprivation starts. Some historians seem to believe that West European aristocrats would not have fared very well in this field because of their diet. There is an intriguing study by Susan Maclean Kybett that suggests Henry VIII of England, a contemporary of Vesalius, died from scurvy. And he was neither in the Middle East nor at sea. Vesalius had been travelling for seven months prior to his death. Of those, more than two he spent at sea and more than three in arid conditions during the summer. This is how and where he spent the last five months of his life. He could have been affected by scurvy and died even earlier than he did.

6. “Clinical description is typical for scurvy”. This is simply not true

What is not true is that I ever made the above statement. I am not a doctor and I did not make a diagnosis. I presented a theory based on historical research. What I said is that every single thing we know about this case, not only the few symptoms known to us, either points to scurvy or is compatible with scurvy. At the same time no other illness fits the picture. I also made two more observations. First that the sources, which do not name the disease – scurvy had no universally accepted name yet – and do not consciously describe its symptoms, do give a number of causes for it, all of which feature in a list of causes of scurvy in the treatise of Johannes Echtius. Second that the fact Echtius took the trouble to meet Georgius Boucherus – the man who travelled with Vesalius and paid for his burial – and hear for himself the details of what happened is probably not coincidental.

7. Vesalius would have recognized the symptoms of scurvy and described them

We have no description of the disease or its symptoms by Vesalius. There is no reason to believe that Vesalius would have described symptoms of scurvy but not of the plague or of cholera for example. All sources are unfortunately silent on the symptoms. His mental state and his sudden death were only mentioned because they were unusual and impressive events, and in the case of the former also as a factor that contributed to his illness. I am the one who considers them as symptoms of an illness.

Article continued here: An answer regarding the death of Andreas Vesalius (2)

Sources:

1. "Voyages and Travels in the Levant in the Years 1749, 50, 51, 52" London 1766, p. 147
2. "Medicina Nautica: an Essay on the Diseases of Seamen" Volume III, London 1803, p. 387
3. "De magnis Hippocratis" Lienibus Libellus, Antwerp 1564, pp. 26a – 31b
4. A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101.
5. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
6. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
7. Olivier Fain, Musculoskeletal manifestations of scurvy, Joint Bone Spine 72, 2005.
8. Wang et al, Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients, the American Journal of Clinical Nutrition, 2013.


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