Moritz Heinrich Romberg
Moritz Heinrich Romberg (1795-1873) was a German neurologist.
Leading German neurologist of the nineteenth century and the author of the first modern classification of neurological disorders – Lehrbuch der Nervenkrankheiten des Menschen, published in three volumes between 1840 and 1846. Sieveking translated into English in 1853 [A manual of the nervous diseases of man].
Romberg described the physiology of neurological function and constructed a now outdated nosology of nervous system disorders, the first real attempt to systematise neurological disease.
Remembered for the neurological sign related to involvement of the dorsal column of the spinal cord in patients with tabes dorsalis (Romberg sign); progressive facial hemiatrophy (Parry-Romberg syndrome); and obturator hernia incarceration (Howship-Romberg sign)
Biography
- Born 11th November 1795 Meiningen (Thüringen)
- 1817 – MD, University of Berlin – Thesis on ‘congenital rickets’ with comprehensive description of achondroplasia.
- 1820 – Postgraduate training in Vienna with Johann Peter Frank (1745 – 1821). Frank was a German physician and public health pioneer recognised for his contributions in spinal cord disease and was responsible for directing Romberg’s career towards neurology.
- 1821 – Physician to the poor, Berlin. He held this role for 25 years.
- 1830 – Appointed Privatdozent of special pathology and therapy at the University of Berlin.
- 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 – Appointed director of the university hospital
- 1845 – Chair of Medicine and directorship, the Royal Policlinic Institute at the Friedrich Wilhelm University, Berlin.
- Died on 16th June 1873, Berlin of heart disease.
Medical Eponyms
Howship-Romberg sign (1840, 1847)
Pain and paraesthesia along the inner (medial) aspect of the thigh, down to the knee; and pain on internal rotation of the hip along the distribution of the obturator nerve. Caused by compression of the obturator nerve most commonly associated with strangulated obturator hernia. Named with English surgeon John Howship (1781 – 1841)
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‘
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 muss bei jeder Hernia obturatoria stattfinden, und, wenn der Inhalt des Bruches eine Darmsclilinge ist, werden sich mit den Symptomen der Darmeinklemmung die Symptome der Nerveneinklemmung verbinden. Sowohl die sensibeln Fasern des N. obturatorius, welche sich als Hautnerven an der inneren Seite des Oberschenkels verbreiten, als auch die für den Muse, gracilis und die Adductoren des Schenkels bestimmten motorischen Fasern werden diese Störung kundgeben durch mehr, oder minder lebhaften Schmerz an der inneren Seite des Oberschenkels, durch Gefühl von Erstarrung und Formication, durch Unfähigkeit, den Schenkel anzuziehen. In einigen älteren Beobachtungen finden wir eme Erwähnung dieses Schmerzes als Begleiters des vorhandenen Ileus, ohne dass ihm jedoch diagnostischer Werth beigelegt wird.
Romberg 1847: 624
What gives this case a special interest is not that it is rare, but elucidating the diagnosis by its neurologic phenomenon. Pressure and distortion of the obturator nerve must be found in every obturator hernia, and if the content of the hernia is a bowel disease, symptoms of nerve entrapment will be associated with the symptoms of intestinal entrapment. Both the sensory fibers of the obturator nerve, which spread as cutaneous nerves on the inner side of the thigh, as well as the motor-fibers, destined for the muscles gracilis and adductors of the thigh, will manifest this disorder by more or less severe pain located in the inner side of the thigh, stiff with paresthesia, and the inability to adduct the thigh.. In some older observations we find a mention of this pain as a companion to the existing ileus, but without adding diagnostic value to it.
Romberg 1847: 624
Romberg summarised the diagnostic criteria for obturator hernia:
Original
English
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.
Romberg 1847: 625
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 tumor visible from the outside, and is subjected to temporary, repeated incarceration.
Romberg 1847: 625
Romberg Sign (Romberg test) 1846
Romberg gives a thorough account of the muscular weakness, tabetic gait, urinary frequency, retention and incontinence and the constricting girdle pains associated with tabes dorsalis. In particular he provides an account of sensory ataxia
Early in the disease we find the sense of touch and muscular sense diminished, while the sensibility of the skin is unaltered in reference to temperature and painful impressions. The feet feel numbed in standing, walking or lying down, and the patient has the sensation as if they were covered in fur; the resistance of the ground is not felt …The gait begins to be insecure…he puts down his feet with greater force… The individual keeps his eyes on his feet to prevent his movements from becoming still more unsteady. 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; the insecurity of his gait also exhibits itself more in the dark. It is now ten years since I pointed out this pathognomonic sign, and it is a symptom which I have not observed in other paralyses, nor in uncomplicated amaurosis…in no case have I found it wanting
Romberg 1846; 1: 794-801.
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.
Key Medical Attributions
In Lehrbuch der Nervenkrankheiten des Menschen 1840-1846 Romberg drew prevailing neurological theories together and presented a systematic and ordered approach to neurology. He combined pathophysiological features with clinical observations and treatment strategies. Of note he dichotomised disorders into ‘Neuroses of Sensibility’ (sensory or afferent disorders) and ‘Neuroses of Motility‘ (motor or efferent disorders).
Romberg gives an unmistakable description of Argyll Robertson pupils prior to the eponymous description by Douglas Argyll Robertson.
Other contributions to medicine span the areas of epilepsy and achondroplasia while further clinical descriptions include pupillary abnormalities in tertiary syphilis and the cremasteric reflex.
I have selected the study of diseases of the nervous system for the object of my life and goal of my researches
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.
- 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:
- The morbid anatomy of the brain in mania and hydrophobia by Andrew Marshall, 1814
- An exposition of the natural system of the nerves of the human body by Sir Charles Bell. [Bell’s physiologische und pathologische Untersuchungen des Nervensystems. Berlin, 1832]
References
- Bibliography. Moritz Heinrich Romberg (1795-1873). World Cat Identities
- Fresquet JL. Moritz Heinrich Romberg (1795-1873) Historia de la Medicina.
- Beighton G, Wiedemann HR. The Person Behind the Syndrome. Springer. 1997: 147
- Pearce JMS. Romberg and his sign. Eur Neurol. 2005;53(4):210-3
- 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.
- Rastogi V et al. Abdominal Physical Signs and Medical Eponyms: Movements and Compression. Clin Med Res. 2018; 16(3-4): 76-82.
Emergency Medicine Trainee based in Perth, Western Australia. Keen interest in ultrasound, rural health and water-based activities.