Moritz Heinrich Romberg: The Founder of Clinical Neurology | Guías, Proyectos, Investigaciones de Biología

PIONEERS IN NEUROLOGY

Moritz Heinrich Romberg (1795–1873)

Roland Schiffter

Received: 22 March 2010 / Accepted: 22 March 2010 / Published online: 12 May 2010

ÓSpringer-Verlag 2010

The statement ‘‘Modern neurology begins with Romberg’’

is certainly appropriate [3]. Moritz Heinrich Romberg

(1795–1873) was the founder of clinical neurology, with

his Textbook of Nervous Diseases in Humans (Lehrbuch

der Nerven-Krankheiten des Menschen; first edition 1840)

[4]. Romberg was born on 11 November 1795 in the old

town of Meiningen, located in Thuringia. His father was a

Jewish merchant; he died early. Shortly afterwards Rom-

berg’s mother moved with him and his small sister to

Berlin, where he spent the remainder of his life. He was a

good pupil, successfully completed his secondary school

called ‘‘Zum Grauen Kloster’’ and from 1812 he studied

medicine at the University of Berlin which had been

founded in 1810. He considered Carl Asmund Rudolphi

(1771–1832), Christoph Wilhelm Hufeland (1762–1836),

Karl Ferdinand von Graefe (1787–1840) and Johann

Christian Reil (1759–1813) as his academic teachers. He

attained a doctorate degree in 1817 with a thesis entitled

‘‘De Rachitide Congenita’’. Subsequently, he spent

6 months in Vienna with Johann Peter Frank (1745–1821).

After his return he opened a medical practice as a Armen-

arzt, i.e., a physician of the poor in Spandauer Vorstadt, a

suburb of old Berlin. At the same time he began conducting

research at Charite

´University clinic. With the support of

his teachers Ernst Horn (1744–1848) and Ernst Ludwig

Heim (1747–1824), he was able to conduct a large number

of autopsies of patients with diseases of the brain or spinal

cord. Romberg considered the study of diseases of the

nervous system his ‘‘task of life’’ and quickly began to

publish a number of monographs and journal articles. As

early as in 1830 he qualified as Privatdozent with a study

on brain haemorrhages. Before this, however, he had to

convert to the Christian faith since he would not have been

able to teach and work at a university as a person of Jewish

creed. During this time he married Friederike Johanna von

Halle. She bore him their only son, Ernst.

In 1838 Romberg became associate professor and in

1845 he was appointed to a full professorship. From 1842

to 1864 he was director of the Royal Outpatient Depart-

ment for Internal Medicine (Ko

¨niglich-Poliklinisches

Institut fu

¨r Innere Medizin) at the university.

In all the years between 1830 and 1864 he was a very

active, popular and successful teacher and scientist. He also

performed many animal experiments, partly with his friend

Johann Friedrich Dieffenbach (1792–1847), the founder of

plastic surgery.

He published papers on a broad range of neurological

diseases and syndromes such as trigeminal neuralgia, cranial

nerve paralyses, respiratory paralyses, cerebral tuberculo-

mas, encephalitis in children, language disorders, head-

aches, paraplegias, peripheral nerve lesions or ‘‘regeneration

R. Schiffter (&)

Wiesenerstr.53, 12101 Berlin, Germany

e-mail: [email protected]

123

J Neurol (2010) 257:1409–1410

DOI 10.1007/s00415-010-5552-1

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P I O N E E R S I N N E U R O L O G Y

Moritz Heinrich Romberg (1795–1873)

Roland Schiffter

Received: 22 March 2010 / Accepted: 22 March 2010 / Published online: 12 May 2010 Ó Springer-Verlag 2010

The statement ‘‘Modern neurology begins with Romberg’’ is certainly appropriate [3]. Moritz Heinrich Romberg (1795–1873) was the founder of clinical neurology, with his Textbook of Nervous Diseases in Humans (Lehrbuch der Nerven-Krankheiten des Menschen; first edition 1840) [4]. Romberg was born on 11 November 1795 in the old town of Meiningen, located in Thuringia. His father was a Jewish merchant; he died early. Shortly afterwards Rom- berg’s mother moved with him and his small sister to Berlin, where he spent the remainder of his life. He was a good pupil, successfully completed his secondary school called ‘‘Zum Grauen Kloster’’ and from 1812 he studied medicine at the University of Berlin which had been founded in 1810. He considered Carl Asmund Rudolphi (1771–1832), Christoph Wilhelm Hufeland (1762–1836), Karl Ferdinand von Graefe (1787–1840) and Johann

Christian Reil (1759–1813) as his academic teachers. He attained a doctorate degree in 1817 with a thesis entitled ‘‘De Rachitide Congenita’’. Subsequently, he spent 6 months in Vienna with Johann Peter Frank (1745–1821). After his return he opened a medical practice as a Armen- arzt, i.e., a physician of the poor in Spandauer Vorstadt, a suburb of old Berlin. At the same time he began conducting research at Charite´ University clinic. With the support of his teachers Ernst Horn (1744–1848) and Ernst Ludwig Heim (1747–1824), he was able to conduct a large number of autopsies of patients with diseases of the brain or spinal cord. Romberg considered the study of diseases of the nervous system his ‘‘task of life’’ and quickly began to publish a number of monographs and journal articles. As early as in 1830 he qualified as Privatdozent with a study on brain haemorrhages. Before this, however, he had to convert to the Christian faith since he would not have been able to teach and work at a university as a person of Jewish creed. During this time he married Friederike Johanna von Halle. She bore him their only son, Ernst. In 1838 Romberg became associate professor and in 1845 he was appointed to a full professorship. From 1842 to 1864 he was director of the Royal Outpatient Depart- ment for Internal Medicine (Ko¨niglich-Poliklinisches Institut fu¨r Innere Medizin) at the university. In all the years between 1830 and 1864 he was a very active, popular and successful teacher and scientist. He also performed many animal experiments, partly with his friend Johann Friedrich Dieffenbach (1792–1847), the founder of plastic surgery. He published papers on a broad range of neurological diseases and syndromes such as trigeminal neuralgia, cranial nerve paralyses, respiratory paralyses, cerebral tuberculo- mas, encephalitis in children, language disorders, head- aches, paraplegias, peripheral nerve lesions or ‘‘regeneration

R. Schiffter (&) Wiesenerstr.53, 12101 Berlin, Germany e-mail: [email protected]

J Neurol (2010) 257:1409– DOI 10.1007/s00415-010-5552-

of the nerve substance’’. From Paris Romberg introduced methods of auscultation and percussion, which were new in Berlin at that time. He highly regarded French and English neurological research and translated and annotated many important works of foreign scientists, such as Francois Bichat, Francois Magendie, Charles Bell and Marshall Hall. Romberg’s most important and trailblazing work was his Textbook of Nervous Diseases in Humans (Lehrbuch der Nerven-Krankheiten des Menschen) which appeared in three parts, between 1840 and 1846 [4], dedicated to Alexander von Humboldt; a second edition was completed in 1851. For decades it was considered the standard work in German-speaking countries, and in 1853 the book was translated into English, Dutch and Russian. It was the first systematic textbook of neurological disorders in the history of medicine [1, 2, 5, 6]. Romberg stressed that he had conceived the book ‘‘according to the physiological principle’’. It included a careful description of disease patterns and syndromes and the correlation of these with the pathological-anatomical findings as well as his own results in animal experiments, all this in the context of the international literature. He categorized nervous diseases into ‘sensitivity neuroses’ and ‘motility neuroses’. The umbrella term ‘neuroses’ was merely a designation for organic neurological disease. The two groups of neuroses were further divided into ‘‘hyper- aesthesia/anaesthesia’’ and ‘‘hyperkinesia/akinesia.’’ The pains (neuralgias) and hallucinations were classified under hyperaesthesia syndromes, to anaesthesias belonged blindness and deafness, to the hyperkinesias cramps as well as epilepsy and to the akinesias, paralyses. Under the additional term ‘logoneurosis’ he classified psychological symptoms, under ‘trophoneurosis’ the autonomous distur- bances that on their own constituted nearly half of the text (heart attacks, respiratory disorders, stomach and intestinal disturbances among other symptoms). Topographically, he differentiated between brain and spinal cord syndromes, disturbances of the peripheral nervous system and the vegetative (autonomous) system. As causes of diseases he named hereditary disorders, traumas, haemorrhages, inflammations, tumours, poisoning, under- and malnutri- tion, a poor lifestyle (‘‘excesses in Baccho et Venere’’), psychosocial factors and ‘‘poverty, need and misery.’’ Beside the classical diseases he, for the first time, described the phenomenon now known as the ‘Romberg sign’ in tabes dorsalis, the syndrome of amyotrophic lateral sclerosis, the carpal tunnel syndrome, cluster headache, hemiatrophia faciei (Parry-Romberg syndrome), neuralgia

obturatoria (with pain in the inner thigh, the Howship- Romberg sign), neuralgia nasociliaris, the restless legs syndrome, the ‘pusher syndrome’ and the cremasteric reflex. For therapy Romberg always demanded ‘causal indication’, i.e., a search for the cause and, if possible, its treatment. He was against charlatanism and blind activism and adamantly rejected the notion of animal magnetism, which was propagated by Mesmer at that time, or Hahne- mann’s homeopathy. Opportunities for causal treatment were of course very limited at the time. Romberg had to use spasmolytics (Belladonna), opiates, digitalis, camphor, mercury and iodine potash (against syphilis), herbs and also bleeding, emetics and enemas - the whole spectrum from humoral theory. He recommended diets, bath cures, relaxation exercises, gymnastics and sport. If it was not possible to cure the patients he recommended not to tor- ment them with interventionism but to let them die a peaceful death, ‘‘close to their loved ones.’’ Romberg was awarded many German and international distinctions. Romberg ended his career in 1864 at the age of 69. In 1867 the 50th anniversary of his doctorate was celebrated in Berlin as an all-German celebration, attended not only by representatives of Berlin university but also by the King, government officials and delegates from nearly all German universities. He was praised for his achievements in ‘‘the reorganization of medicine.’’ Du Bois-Reymond called him ‘‘the creator of modern nerve pathology.’’ Romberg died on 16 June 1873 of heart disease and was buried in the Friedrichwerder cemetery in Berlin-Kreuzberg (honorary grave, designated by the Senate of Berlin). The author of this essay organized the mounting of a commemorative plaque at Romberg’s home in Berlin at Am Zeughaus 2.

References

Jacobi E (1965) Der Neurologe Moritz Heinrich Romberg 1795–
1. Inauguraldissertation medicine. Faculty University, Zurich
Karenberg A (1990) ‘‘Lehrbuch der Nervenkrankheiten des Menschen’’ von Moritz Heinrich Romberg (1840). Therapiewoche 40:3407–
Klawans HL (1982) The medicine of history. From Paracelsus to Freud. Raven press, New York
Romberg MH (1840–1846) Lehrbuch der Nerven-Krankheiten des Menschen. Duncker, Berlin
Schiffter R (2007) Lebensbilder von Romberg. Fortschr Neurol Psychiatr 75:160–
Schiffter R (1998) Moritz Heinrich Romberg. In: Schliack H, Hippius H (eds) Nervena¨rzte Biografien, Stuttgart, Thieme

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