The Nuciform Sac, an Anatomical Question

“Congratulations!” I said. Some of the juniors had just passed their examinations.

“What were the questions like?”

“They were very reasonable, clinically relevant sorts of things,” I was told.

“Nothing to far out, then?”

“Oh no, quite straightforward. Why do you ask?”

“Well,” I replied, “the examiners could be buggers when they wanted to in my day.”

“That wouldn’t be allowed now. What sort of things did they ask you?”

I thought for a moment. “I seem to remember I was asked about the nuciform sac,” I said. Of course, I was asked no such thing. There was silence.

“I didn’t know a lot about it, but I could tell them something,” I said.

There was silence in theatre, and more than a few rather puzzled faces.

“It’s one of these vestigial bits, no known function, though if diseased, removal may be helpful.”

The silence continued, the faces remained puzzled. I wasn’t very surprised, though I’d been hopeful that perhaps one of them had heard of it; or perhaps the anaesthetist. But none of them had. I had to give in and tell them.

“It’s fictional,” I said, “it's in George Bernard Shaw’s play The Doctor’s Dilemma. One of the characters makes a good living removing it, having invented an illness that can only be cured by his operation. It’s not the dilemma in the play, but a sideswipe at doctors doing unnecessary surgery — specially in private practice.”

Shaw was writing in the early 20^th century, but such practices continued for a long time afterwards — I have seen a patient who had had a nephropexy (fixation of the kidney) as a cure for her ‘droopy kidney’. As there is no such illness, the operation didn’t help her at all. I was even more surprised to learn that her private insurance had funded the procedure.