The Romberg Sign and Early Instruments for Measuring Postural Sway

ABSTRACT

In the first half of the 19th century, European physicians-including Marshall Hall, Moritz Romberg, and Bernardus Brach-described loss of postural control in darkness of patients with severely compromised proprioception. Romberg and Brach emphasized the relationship between this sign and tabes dorsalis. Later, other neurologists evaluated the phenomenon, which is now known as Romberg's sign, in a broader range of neurologic disorders using a variety of simple but increasingly precise and sensitive clinical tests. In the late 19th century, neurologists also developed instruments to measure and record postural sway in patients with neurologic disease. Principal contributors included Philadelphia neurologist Silas Weir Mitchell and his trainees Morris Lewis and Guy Hinsdale. The efforts of these neurologists anticipated later physiologic studies and ultimately the development of computerized dynamic platform posturography.

KEYWORD

Romberg sign - postural sway - tabes dorsalis (locomotor ataxia) - proprioception - medical history-19th century - posturography

REFERENCES

• 1 Lanska D J, Goetz C G. Romberg's sign: description, adoption, and adaptation in the 19th century.  Neurology . 2000;  55 1201-1206
• 2 Hall M. Lectures on the Nervous System and Its Diseases.  London: Sherwood, Gilbert, and Pyer 1836: 27
• 3 McHenry L C. The Emerging Clinical Neurologist and his Manual of the Nervous Diseases of Man.  Birmingham: Gryphon Editions 1983
• 4 Romberg M. Lehrbuch der Nervenkrankheiten des Menschen.  Berlin: Duncker 1851
• 5 Romberg M H. In: Sieveking EH ed., trans. A Manual of the Nervous Diseases of Man London: Sydenham Society; 1853: 226-227, 395-401
• 6 Brach B. Einige Worte über einen nicht hinlänglich beachteten Punkt aus der Physiologie der Nerven und eine eigenthümliche Art von Lähmung.  Medicinische Zeitung . 1840;  9 215-217
• 7 Peterson F. Locomotor ataxia. In: Dercum FX, ed. A Text-Book on Nervous Diseases by American Authors Philadelphia: Lea Brothers & Co. 1895: 633-645
• 8 Osler W. Locomotor ataxia (tabes dorsalis; posterior spinal sclerosis). In: The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine New York: D. Appleton and Company 1892: 840-848
• 9 Mitchell S W, Dercum F X. Nervous diseases and their treatment: general considerations. In: Dercum FX, ed. A Text-Book on Nervous Diseases by American Authors Philadelphia: Lea Brothers & Co. 1895: 2-50
• 10 Charcot J-M. Leçons du Mardi: Policlinique 1887-1888.  Paris: Bureaux du Progrès Médical 1888
• 11 Mills C K. Station and sway. In: The Nervous System and Its Diseases: A Practical Treatise on Neurology for the Use of Physicians and Students Philadelphia: J.B. Lippincott 1898: 170-171
• 12 Dana C L. Diagnosis and methods of examination. In: Dana CL, ed. Text-Book of Nervous Diseases: Being a Compendium for the Use of Students and Practitioners of Medicine 5th ed. New York: William Wood and Co. 1901: 39-59
• 13 Duchenne de Boulogne [GBA]. De l'ataxie locomotrice progressive: recherches sur une maladie caractérisée spécialement par des troubles généreaux de la coordination des mouvements.  Arch Gén Méd . 1859;  13 36-451
• 14 Duchenne de Boulogne [GBA]. De l'ataxie locomotrice progressive: recherches sur une maladie caractérisée spécialement par des troubles généraux de la coordination des movements.  Arch Gén Méd . 1858;  12 641-652
• 15 Radcliffe C B. Locomotor ataxy. In: Reynolds JR, ed. A System of Medicine Vol. 2. London: MacMillan and Co. 1868: 336-353
• 16 Hammond W A. Sclerosis of the posterior columns of the spinal cord (locomotor ataxia). In: A Treatise on Diseases of the Nervous System New York: D. Appleton & Co. 1871: 484-516
• 17 Osler W. Locomotor ataxia (tabes dorsalis; posterior spinal sclerosis). In: The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine New York: D. Appleton and Company 1892: 840-848
• 18 Gowers W R. Locomotor ataxy (tabes dorsalis: posterior sclerosis). In: A Manual of Diseases of the Nervous System Am ed. Philadelphia: P. Blakiston, Son & Co. 1888: 285-323
• 19 Lanska D J. The role of technology in neurologic specialization in America.  Neurology . 1997;  48 1722-1727
• 20 Lanska D J. 19th-century contributions to the clinical assessment and mechanical recording of postural sway.  Arch Neurol . 2000;  58 1147-1150
• 21 Mitchell S W, Lewis M J. The tendon-jerk and muscle-jerk in disease, and especially in posterior sclerosis.  Am J Med Sci . 1886;  92 363-372
• 22 Mitchell S W, Dercum F X. Nervous diseases and their treatment: general considerations. In: Dercum FX, ed. A Text-Book on Nervous Diseases by American Authors Philadelphia: Lea Brothers & Co. 1895: 2-39
• 23 Hinsdale G. The station of man, considered physiologically and clinically.  Am J Med Sci . 1887;  93 478-485
• 24 Hinsdale G. Observations on station with reference to respiration.  N Y Med J . 1890;  51 292-294
• 25 Tilney F, Jellife S E. Dr Guy Hinsdale. In: Tilney F, Jellife SE, eds. Semi-Centennial Anniversary Volume of the American Neurological Association: 1875-1924 Albany, NY: American Neurological Association 1924: 185-186