Moritz Romberg
Moritz Heinrich Romberg (1795-1873) was a German neurologist.
Moritz Heinrich Romberg is widely regarded as the founder of clinical neurology and the author of the first systematic textbook on nervous diseases: Lehrbuch der Nervenkrankheiten des Menschen (1840–1846). His work organized neurology into a coherent specialty, introducing physiological principles and structured nosology into what had been a confused branch of medicine.
Romberg is best remembered for describing Romberg’s sign, in sensory ataxia; for recognizing proprioceptive dysfunction in tabes dorsalis and obturator hernia incarceration (Howship-Romberg sign). He also provided classic accounts of progressive facial hemiatrophy (Parry-Romberg syndrome), achondroplasia (1817 thesis), and the pupillary changes of tertiary syphilis (Argyll Robertson pupils). His writings introduced rigorous clinical observation, classification, and correlation with pathology, paving the way for modern neurology.
Biographical Timeline
- Born November 11, 1795 in Meiningen, Duchy of Saxe-Meiningen, into a Jewish family
- 1812 – Entered medical studies at University of Berlin, newly founded in 1810; trained under Hufeland, Rudolphi, von Graefe, and Reil.
- 1817 – Graduated MD, University of Berlin with thesis De Rachitide Congenita (achondroplasia).
- 1818–1820 Study trip to Vienna, mentored by Johann Peter Frank (1745-1821), a pioneer in hygiene and spinal cord pathology; declared neurology his life’s focus.
- 1820 – Returned to Berlin as “Armenarzt” (physician to the poor); began autopsy-based neurological research at Charité; translated Andrew Marshall’s The Morbid Anatomy of the Brain into German.
- 1828 – Translated and annotated The Nervous System of the Human Body by Charles Bell (1774-1842), introducing British neurological concepts to Germany.
- 1830 – Qualified as Privatdozent in special pathology and therapy, University of Berlin, with a dissertation on cerebral haemorrhage.
- 1831 and 1837 – Director of the cholera hospital during the Berlin cholera epidemics.
- 1838 – Appointed extraordinary professor of pathology at the University of Berlin
- 1840–1846 Published Lehrbuch der Nervenkrankheiten des Menschen in three volumes, the first systematic neurology textbook; dedicated to Alexander von Humboldt.
- 1842–1864 Director of the Royal Outpatient Department for Internal Medicine, Charité, Berlin.
- 1845 – Appointed full professor; later awarded the title Geheime Medizinalrath (1851).
- 1853 – English translation of Lehrbuch by the Sydenham Society, titled A Manual of the Nervous Diseases of Man.
- 1864 – Retired after 44 years of medical service; celebrated widely in 1867 on the 50th anniversary of his doctorate.
- Died on June 16, 1873, Berlin aged 77, from chronic heart disease; buried in Friedrichwerder Cemetery (honorary grave)
I have selected the study of diseases of the nervous system for the object of my life and goal of my researches
Medical Eponyms
Romberg’s Sign and Sensory Ataxia
Romberg immortalised his name with a clinical manoeuvre to identify proprioceptive deficits. In patients with tabes dorsalis, he noted:
Original
English
Der Gang wird unsicher… Der Kranke setzt die Füße mit größerer Gewalt auf… Er richtet die Augen auf die Füße, um die Unsicherheit der Bewegungen nicht noch zu vermehren. Wenn man ihn auffordert, im Stehen die Augen zu schließen, so beginnt er sofort zu schwanken und von einer Seite zur anderen zu taumeln
The gait begins to be insecure… He puts down his feet with greater force. The individual keeps his eyes on his feet… If he is ordered to close his eyes while in the erect posture, he at once commences to totter and swing from side to side.
Romberg Test
This simple observation became the Romberg test, a clinical test for sensory ataxia due to impaired proprioception, typically in tabes dorsalis (syphilitic neuropathy).
Romberg gave a detailed account of the pathognomonic phenomenon in his 1846 Lehrbuch
Early in the disease we find the sense of touch and muscular sense diminished… The feet feel numbed… The gait begins to be insecure… he puts down his feet with greater force… The individual keeps his eyes on his feet… If he is ordered to close his eyes while in the erect posture, he at once commences to totter and swing from side to side… It is now ten years since I pointed out this pathognomonic sign… in no case have I found it wanting.
Howship-Romberg sign (1840, 1847)
Pain and paraesthesia along along the path of the obturator nerve – the inner thigh (medial aspect) radiating to the knee with pain on internal rotation of the hip. It is caused by compression of the obturator nerve often associated with strangulated obturator hernia.
First noted by John Howship (1781–1841), the sign was further developed and given diagnostic significance by Romberg. Romberg described his findings of an obturator hernia and their clinical significance in 1847, published in 1848 as ‘Die Operation des eingeklemmten Bruches des eirunden Loches‘ emphasising the value of the nerve symptom in differential diagnosis:
Original
English
Was diesem Falle ein besonderes Interesse verleiht, ist nicht seine Seltenheit, sondern die Aufklärung der Diagnose durch ein Nervenphänomen… Druck und Zerrung des Nervus obturatorius… manifest [durch] Schmerz an der inneren Seite des Oberschenkels… und Unfähigkeit, den Schenkel anzuziehen
Für die Hernia obturatoria ist ein diagnostisches Kriterium, wie es der Verein der Schmerzen und der gestörten Beweglichkeit des Oberschenkels mit der unterbrochenen Permeabilität des Darmcanals darbietet, um so bedeutungsvoller, weil dieser Bruch nur allmälig, gleichsam chronisch entsteht, selten eine von aussen sichtbare Geschwulst bildet, und, wie kein anderer Bruch, temporären, wiederholten Incarcerationen ausgesetzt ist.
What gives this case a special interest is not that it is rare, but the elucidation of the diagnosis by a neurologic phenomenon. Pressure and distortion of the obturator nerve… will manifest [through] pain on the inner side of the thigh… and inability to adduct the thigh
Obturator hernia is associated with pain; disturbed movement of the thigh; and altered intestinal movement. Most important, because this condition is chronic it rarely forms a tumour visible from the outside, and is subjected to temporary, repeated incarceration.
Parry-Romberg syndrome (1825, 1846) (Romberg syndrome)
Parry-Romberg syndrome: rare disorder of progressive facial hemiatrophy. Slowly progressive atrophy of the soft tissues of one side of the face, associated with trigeminal neuralgia and involvement of the eyes and hair. Muscles, cartilage and the underlying bony structures may also be involved.
First described by Parry (1825) and elaborated by Romberg in 1846 as a “trophoneurosis”.
Key Medical Contributions
Lehrbuch der Nervenkrankheiten (1840–1846)
Romberg’s three-volume textbook Lehrbuch der Nervenkrankheiten des Menschen was the first systematic neurology treatise, introducing physiological principles and nosology. He divided disorders into “sensitivity neuroses” and “motility neuroses,” and integrated pathology, clinical observation, and experimental findings. Dedicated to Alexander von Humboldt, it was translated into English in 1853 and remained a reference for decades.
Romberg’s writings catalogued an astonishing range of neurological phenomena, including:
- Cranial tuberculoma, cluster headache, restless legs syndrome, and autonomic disturbances.
- Pupillary changes in tertiary syphilis (before Douglas Argyll Robertson)
- Descriptions of trigeminal neuralgia, peripheral nerve lesions, cranial nerve palsies, and reflex disorders (including the cremasteric reflex).
Tabes Dorsalis and the Role of Proprioception
Romberg’s clinical acumen allowed him to separate locomotor ataxia (tabes dorsalis) from other paralyses. He recognized the compensatory role of vision in patients who had lost position sense and noted worsening instability when eyes were closed—decades before physiology elucidated dorsal column pathways. This insight marked the birth of modern neurophysiology applied to clinical practice.
Therapeutic Principles and Medical Ethics
Romberg advocated causal therapy whenever possible, condemned charlatanism and animal magnetism, and insisted on restraint in futile cases:
If it is not possible to cure the patient, let him die peacefully, close to his loved ones.
His pharmacological tools were limited to opiates, belladonna, mercury, iodine, and bleeding, but his rational approach prefigured modern medical ethics.
Influences and International Connections
Romberg was profoundly shaped by British and French medicine. He translated works by Andrew Marshall, Charles Bell, and François Magendie, and brought French techniques of auscultation and percussion to Berlin. This cosmopolitan outlook gave German neurology its first structured foundation.
Controversies
Romberg was one of many physicians who incorrectly attributed the discovery of the function of the anterior and posterior roots of the spinal cord to Charles Bell, when in fact the finding was of François Magendie. Not backwards in coming forwards…
Romberg takes a swipe at his erstwhile colleagues in neurology…
The blame lies in a measure with the distinguished members of our profession who have been deterred by a fear that pathological investigations would fail to cope with the advanced state of physiological inquiry; in others, the fault is to be attributed to that mental indolence, which gives the preference to the easy path of tradition, and with foolish scepticism rejects everything that is new.
Romberg MH, 1840
Major Publications
- Romberg MH. Thesis. De rachitide congenital. [Congenital Rickets] Karl August Platen, Berlin. 1817
- Romberg MH. Commentationes quaedam de cerebri haemorrhagia: quibus ad praelectiones suas de morbis nervorum. Berolini 1830
- Romberg MH. Lehrbuch der Nervenkrankheiten des Menschen. Berlin: Hirschwald. 1840-1846. [Vol I, Vol II, Vol III]
- Romberg MH. Tabes Dorsualis. In: Lehrbuch der Nervenkrankheiten des Menschen. Berlin. 1840; 1: 794-801.
- Romberg MH. Trophoneurosen. In: Klinische Ergebnisse. Forstner, Berlin, 1846: 75-81
- Romberg MH. Die Operation des eingeklemmten Bruches des eirunden Loches. Operatio hernia foraminis ovales incarceratae. In: Die operative Chirurgie. Dieffenbach JF 1848: 619-626
- Romberg MH. A manual of the nervous diseases of man. Volume I. Translation Sieveking EH 1853. Sydenham Society [Volume II]
- Romberg MH. Tabes Dorsalis. In: A Manual of the Nervous Diseases of Man. 1853; 2: 395–401.
Romberg translated two seminal neurology texts into German:
- Marshall A. The morbid anatomy of the brain in mania and hydrophobia 1814
- Bell C. An exposition of the natural system of the nerves of the human body [Bell’s physiologische und pathologische Untersuchungen des Nervensystems. Berlin, 1832]
References
Biography
- Moritz Heinrich Romberg (1795-1873). JAMA. 1965;193(13):1119–1120.
- Schiffter R. Moritz Heinrich Romberg (1795-1873). J Neurol. 2010 Aug;257(8):1409-10.
- Housman B, Bellary SS, Walters A, Mirzayan N, Tubbs RS, Loukas M. Moritz Heinrich Romberg (1795-1873): Early founder of neurology. Clin Anat. 2014 Mar;27(2):147-9.
- Fresquet JL. Moritz Heinrich Romberg (1795-1873) Historia de la Medicina.
- Bibliography. Moritz Heinrich Romberg (1795-1873). World Cat Identities
Eponymous terms
- Lanska DJ, Goetz CG. Romberg’s sign: development, adoption, and adaptation in the 19th century. Neurology. 2000 Oct 24;55(8):1201-6.
- Yamashita K, Hayashi J, Tsunoda T. Howship-Romberg sign caused by an obturator granuloma. Am J Surg. 2004 Jun;187(6):775-6.
- Pearce JM. Romberg and his sign. Eur Neurol. 2005;53(4):210-3.
- Rastogi V et al. Abdominal Physical Signs and Medical Eponyms: Movements and Compression. Clin Med Res. 2018; 16(3-4): 76-82.
- Beighton G, Wiedemann HR. The Person Behind the Syndrome. Springer. 1997: 147
Eponym
the person behind the name
Emergency Medicine Trainee based in Perth, Western Australia. Keen interest in ultrasound, rural health and water-based activities.
