Niels Thorkild Rovsing

Biographical timeline

• Born on April 26, 1862 in Flensborg (Flensburg), then part of Denmark. Son of M. Rovsing, an army officer, and Anna C. Crone.
• 1879 – Graduated from the Metropolitan School in Copenhagen and commenced medical studies at the University of Copenhagen.
• 1885 – Graduated in medicine from the University of Copenhagen, aged 23. He subsequently undertook hospital training at the Garrison Hospital and Frederiks Hospital.
• 1887 – With Christian Heyn published Das Iodoform als Antisepticum, experimentally challenging the supposed antiseptic properties of iodoform.
• 1889 – Awarded his doctorate following his thesis Om Blærebetændelsernes Ætiologi, Pathogenese og Behandling [On the aetiology, pathogenesis and treatment of cystitis]. He challenged contemporary concepts of urinary infection and helped establish diseases of the urinary tract as a field of surgical investigation.
• 1889–1892 – Served as a reserve surgeon. He subsequently established a private surgical practice in Copenhagen with Eilert Adam Tscherning (1851–1919) and Leopold Meyer and worked at Queen Louise Children’s Hospital.
• 1890 – Married Marie Emilie Raaschou (1864–1930) on April 30. His marriage resulted in the loss of his junior hospital appointment, which had been designated for an unmarried surgeon. Following considerable protest he was subsequently reinstated.
• 1899 – Appointed Professor of Operative Surgery at the University of Copenhagen. As the appointment provided teaching responsibilities but no hospital beds, Rovsing established his own private surgical clinic, later expanding it to include an X-ray laboratory.
• 1904 – Appointed senior surgeon at Frederiks Hospital, Copenhagen.
• 1905 – Began campaigning for improved surgical facilities in Copenhagen and the development of the new Rigshospitalet.
• 1907 – Published Indirektes Hervorrufen des typischen Schmerzes an McBurney’s Punkt, describing his method of indirectly eliciting pain at McBurney point in the diagnosis of appendicitis and typhlitis, the Rovsing sign.
• 1910 – Rigshospitalet opened in Copenhagen following years of campaigning for improved surgical accommodation. Rovsing became closely associated with the development of surgery at the institution.
• 1914 – Awarded an honorary doctorate in surgery from the University of Groningen.
• 1919–1920 – Served as Rector of the University of Copenhagen. He promoted improved accommodation and welfare for university students and was instrumental in the development of Studentergården, completed in 1923.
• 1920 – Served briefly as Danish Minister of Education, from March 30 to April 5, in the government of Otto Liebe.
• 1926 – Severe cardiac disease forced Rovsing to retire from his university position. During his final illness he also underwent surgery and X-ray therapy for malignant disease of the larynx.
• Died in Copenhagen on January 14, 1927, aged 64, following progressive cardiac failure.

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Medical Eponyms

Rovsing Sign (1907)

Clinical sign originally described for appendicitis and typhlitis in which compression of the descending colon, maintained while the hands move proximally towards the left colonic flexure, reproduces pain at McBurney’s point.

1907 – Rovsing published Indirektes Hervorrufen des typischen Schmerzes an McBurney’s Punkt. Ein Beitrag zur Diagnostik der Appendicitis und Typhlitis [Indirect elicitation of the typical pain at McBurney’s point: a contribution to the diagnosis of appendicitis and typhlitis].

Rovsing placed his left hand flat over the descending colon in the left iliac fossa. The right hand compressed the fingers of the left hand against the colon and, while maintaining compression, the hands were moved proximally towards the left colonic flexure:

I press with my right hand onto the fingers of the left hand that is lying flat against the colon descendens [descending colon] and then let the hand glide up toward the splenic flexure…The entire method is based upon isolated rise of pressure within the colon.

Rovsing 1907

Rovsing proposed that the manoeuvre increased pressure within the proximal colon. With decompression into the small bowel prevented by the ileocaecal valve, he believed that the resulting distension of the caecum and appendix produced pain at McBurney’s point when either structure was inflamed.

He developed the manoeuvre in the autumn of 1904 after examining two patients with similar right iliac inflammatory masses in whom direct examination was limited by pain and défense musculaire. He subsequently used the test for approximately two years and reported experience in more than 100 cases.

1908 – Criticism followed rapidly. Arthur Hofmann published Zu dem Rovsing’schen Symptom. He found the sign in only three of 18 patients with appendicitis/perityphlitis and also demonstrated positive responses in pelvic inflammatory disease. Hofmann challenged Rovsing’s intracolonic-pressure mechanism and proposed that displacement of abdominal contents transmitted pressure or traction to inflamed parietal peritoneum.

Rovsing responded with his Erwiderung an Dr. A. Hofmann. He emphasised that brief pressure over the left lower abdomen was not his manoeuvre. The descending colon had to be isolated and compressed against the posterior abdominal wall while maintained pressure was moved proximally towards the left colonic flexure.

1911 – Emil Perman published Uber die Bedeutung des indirekten Druckschmerzes bei Appendizitis. He reiterated his earlier 1904 description of ileocaecal pain elicited by simple pressure on the left abdomen. Perman’s manoeuvre and proposed mechanism differed from Rovsing’s, although the two signs subsequently became closely associated.

2014 – Prosenz and Hirtler published Rovsing sign revisited-effects of an erroneous translation on medical teaching and research. They reviewed contemporary descriptions of Rovsing sign and found marked divergence from the original technique. None of the publications that described how the manoeuvre was performed reproduced Rovsing’s original method correctly. English-language surgical textbooks generally described the modern simplified manoeuvre, whereas the German texts examined retained the original technique.

Consequently, published estimates of sensitivity, specificity and likelihood ratios for “Rovsing sign” cannot confidently be attributed to the original manoeuvre described by Rovsing in 1907.

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Rovsing operation I (1910)

Rovsing published Behandling af det multilokulare Nyrekystom med multiple Punkturer. He described an operation with multiple puncture and decompression of renal cysts for multilocular renal cystoma (congenital cystic kidney; broadly corresponding to polycystic kidney disease). Rovsing presented the technique to the Danish Surgical Society on October 29, 1910 and published three cases in 1911.

In 1912, Rovsing published his English language account The treatment of multilocular kidney cystoma (Congenital cystic kidney) by means of multiple punctures in the American Journal of Urology.

Rovsing syndrome (1911)

1911 – Rovsing published Beitrag zur Symptomatologie, Diagnose und Behandlung der Hufeisenniere, on the symptomatology, diagnosis and treatment of horseshoe kidney in Zeitschrift für Urologie.

Based on four cases, Rovsing described a characteristic syndrome of pressing or dragging pain across the lumbar and abdominal regions associated with uncomplicated horseshoe kidney. The pain disappeared with recumbency and rest, was provoked by strenuous physical activity, and was characteristically exacerbated by hyperextension of the spine.

Rovsing proposed that hyperextension stretched the horseshoe kidney across the vertebral column, producing tension within the kidney and compression of the great vessels and nerves lying between the kidney and vertebral bodies.

Rovsing operation II (1910/1911)

In the same paper, Rovsing described operative division of the renal isthmus to separate the two renal moieties and restore a more normal anatomical position.

On June 17, 1910, Rovsing performed the operation transperitoneally in a 23-year-old man with disabling symptoms. He divided the broad renal isthmus using a Roux angiotribe, divided the remaining tissue between clamps, and sutured the cut renal surfaces. Following division, the left kidney immediately retracted towards its normal anatomical position. Rovsing reported complete relief of the patient’s symptoms.

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Major Publications

• Heyn C, Rovsing T. Das Iodoform als Antisepticum. Fortschritte der Medizin 1887; 5: 33
• Rovsing T. Nyrens og ureters chirurgiske sygdomme, efter forelæsninger holdte ved Kjøbenhavns universitet. Ugeskr Laeger 1895
• Rovsing T. Klinische und experimentelle Untersuchungen über die infektiösen Krankheiten der Harnorgane. 1898
• Rovsing T. Blærens chirurgiske sygdomme. Ugeskr Laeger 1899
• Rovsing T. Galdestenssygdommen og dens behandling. Tre prøveforelæ sninger holdte ved konkurrencen om et Professorat i kirurgi ved Københavns universitet. [Gallstone disease and its treatment] 1900.
• Rovsing T. Urinrørets og prostatas chirurgiske sygdomme. Ugeskr Laeger 1903
• Rovsing T. Die sogenannte enteroptosis und ihre chirurgische behandlung. Sammlung klinisher Vorträge, No. 431 (Chirurgie No. 120). 1906.
• Rovsing T. Indirektes Hervorrufen des typischen Schmerzes an McBurney’s Punkt. Ein Beitrag zur diagnostik der Appendicitis und Typhlitis. [Indirect cause of typical pain at McBurney’s point. A contribution to diagnosis of Appendicitis and Typhylitis] Zentralblatt für Chirurgie, 1907; 34: 1257-1259. [Rovsing sign]
• Rovsing T. Zu dem Rovsing’schen Symptom. Erwiderung an Dr. A. Hofmann. Zentralblatt für Chirurgie 1908; 35: 537–8.
• Rovsing T. Beitrag zur Symptomatologie, Diagnose und Behandlung der Hufeisenniere [Symptomatology, diagnosis and treatment of horseshoe kidney]. Zeitschrift für Urologie 1911; 5: 586-601.
• Rovsing T. Behandling af det multilokulare Nyrekystom med multiple Punkturer. [Treatment of multilocular renal cyst with multiple punctures]. Hospitalstidende 1911: 105–16.
• Rovsing T. Tuberculosis of the kidney. Annals of Surgery 1912; 56: 521-43.
• Rovsing T. The treatment of multilocular kidney cystoma (Congenital cystic kidney) by means of multiple punctures. American Journal of Urology 1912;VIII:120-124
• Rovsing T. Abdominal surgery-clinical lectures for students and physicians. 1914
• Rovsing T. Galdestenssygdommens aarsagsforhold og disses betydning for valget af behandlingen belyst ved experimentelle undersøgelser og tredive aars kliniske erfaringer. 1922

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References

Biography

• Professor Thorkild Rovsing and the Rigshospital at Copenhagen. Br J Surg 1924; 11(43): 571–82.
• Obituary: Niels Thorkild Rovsing. Br Med J. 1927 Feb 5; 1(3448): 265.
• Rovsing C. Thorkild Rovsing, co-founder of the Danish Surgical Society. Bibliotek for Læger 1958; 150: 407–19
• Hognason K, Swan KG. Niels Thorkild Rovsing: the Surgeon Behind the Sign. Am Surg 2014 12;80(12):1201-1206
• Permin H, Secher NH. Juleartikel: Professorerne indtager kandidatgangen på Rigshospitalet. Ugeskr Laeger. 2024 Dec 9;186(50):V20244
• Aagaard OC. Thorkild Rovsing. Dansk Biografisk Leksikon on lex.dk
• Krak O. Thorkild Rovsing Biografi
• Bibliography. Rovsing, Thorkild. WorldCat Identities

Eponymous terms

• Hoffmann A. Zu dem Rovsing’schen Symptom. Zentralblatt für Chirurgie 1908; 35: 537–8.
• Räf L. Skandinaviska kirurger först med beskrivning av tecken på appendicit [The men behind the syndrome: Emil Perman and Nils Thorkild Rovsing. Scandinavian surgeons were the first to describe signs of appendicitis] Läkartidningen 1984; 81(32-33): 2829-30
• Prosenz J, Hirtler L. Rovsing sign revisited-effects of an erroneous translation on medical teaching and research. J Surg Educ. 2014 Sep-Oct;71(5):738-42
• Hognason K, Swan KG. Niels thorkild Rovsing: the surgeon behind the sign. Am Surg. 2014 Dec;80(12):1201-6.
• Cadogan M. Appendicitis eponymous signs. LITFL