Moritz Romberg

 

Like many other pioneers in the medical sciences, Moritz Romberg would hardly be remembered today were it not for his description of a test that just as Joseph Babinksi’s is still part of the routine neurologic examination.

The Romberg test is deemed to be positive when the patient becomes unsteady on standing with feet together and eyes closed. It once almost meant neurosyphilis (tabes dorsalis), easily picked up in an abridged physical examination boiled down to looking at the pupils, getting the patient to tell which way his  toe was being moved, testing for loss of pain on squeezing the Achilles tendon, and (often mentioned in the books but not recommended) loss of pain on squeezing the testicles. Nowadays a positive the Romberg sign is more likely to be found in other conditions, notably diabetes.

The man behind the sign was born in 1795, in Meiningen, then capital of the duchy of Saxe-Meiningen in eastern Germany.  His father, a Jewish merchant, died when he was still a child (family records destroyed by the Nazis). His mother  then moved with him and his little sister to Berlin. In school he was a promising pupil who by age five was already learning Latin and Greek. After school he enrolled in the faculty of medicine of the Friedrich-Wilhelm University in Berlin, graduating in 1817 as one of the sixty-eight non-Prussian foreigners from other German states among a total 117 graduating students. His graduating thesis was on achondroplasia, which he called congenital rickets.

To further his education Romberg went to Vienna to study for one and a half years under Johann Peter Frank, a pioneer in public health and spinal cord diseases, with whom he had a father-son relationship, and who first stimulated his interest in neurology. Returning to Berlin in 1820, he was appointed medical officer for the indigent, and also began to devote himself to studies of the nervous system. Much appointed in 1830 as private docent in special pathology and therapy at the Charité University Hospital, in effect the first ever position in neurology, he was able to carry out many autopsies on patients with brain and spinal cord diseases. He was promoted in 1830 on account of his studies on cerebral hemorrhage, and  had by then, like Heine and Mendelsohn, found it necessary to further his career by converting to Christianity.  During the 1831 and 1837 epidemics he worked assiduously in cholera hospitals to contain the disease. In 1838 he was appointed external professor of neurology. In 1842 he was put in charge of the university outpatient department of polyclinic, becoming its director and full professor of special pathology and therapy in 1845. He then abandoned his position as physician to the poor in order to devote himself to teaching and research, remaining in that position until 1865.influenced by English authors, he translated into German the Morbid Anatomy of the Brain (1815) by London anatomist Andrew Marshal, a pupil of William Hunter, brother of John Hunter who was also lecturing on anatomy. This book described the gross anatomy of the brain in patients who had died of mental diseases at Bethlem Hospital. It would later lead him to the 1830 the Nervous System of the Human Body by Sir Charles Bell, which greatly influenced him and which he translated into German in 1832, first using the term neurologist.

Stimulated early on by the work of Sir Charles Bell, Romberg wrote his comprehensive textbook of neurology, the first ever of its kind. It appeared in three parts between 1840 and 1846, with a second edition in 1851; was for many years the standard textbook in German-speaking countries; and was translated into English, Dutch, and Russian in 1853. It contained classical descriptions of diseases such as tabes dorsalis, motor neuron disease, carpal tunnel syndrome, cluster headache – some described earlier by others but organized in a systematic way.

Romberg is also remembered eponymously for the Parry-Romberg syndrome of facial hemiatrophy, for obturator neuralgia, and for the cremasteric reflex. Like many other observations in medicine, his primacy of describing the Romberg sign has been disputed, the test having been reported earlier but not necessarily having its full significance emphasized. Yet it has survived under that designation to the present day, and without an examination of the nervous system would be deemed incomplete. Romberg retired in 1865, dying from chronic heart disease in 1873, and is regarded as one of the founders of clinical neurology.In his introduction to his compendium Romberg displayed his humanist side by writing it was his ardent hope was that students of medicine would find his book not only a source of instruction but also stimulate them to further inquiry “in order that stress forces may be brought on the great aim which we must to achieve, the emancipation of medical science from the trammels of mere mechanical technicalities”.

Further reading

Editorial. Moritz Heinrich Romberg. JAMA, 1965,193:137

Pearce, JMS. Romberg and his sign.  European Neurology, 2015, 53:210,

Romberg MH. Diseases of the nervous diseases of man, Berlin 1846 (Dunker)and London 1853 (Sydenham Society).

Schiffer.   Moritz Heinrich Romberg, Early founder of neurology, Akt Neurologie, 1996,23:13 and J of Neurology,2010,257:1409. (in German).


George Dunea, M.D., Editor-in-Chief

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