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Gowers' sign
  1. J M S PEARCE
  1. 304 Beverley Road, Anlaby, Hull HU10 7BG, York, UK

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    Sir William Richard Gowers (1845–1915) is a name hallowed in the minds of most neurologists as one of the great Victorian founders of our discipline. He is probably best remembered for the remarkable manual first published in 1886, still a continual source of reference and wisdom, remarkable for its wealth of clinical detail, experience, and understanding. Even more remarkable is it when we realise that there was virtually no neurochemistry, minimal electrophysiology, and of course only the most fundamental radiology and neuropathology available to him.

    His name is preserved in several eponymous conditions, though paradoxically he inveighed about of the use of eponyms:

    “Scientific nomenclature should be itself scientific, not founded upon accidents. However anxious we may be to honour individuals, we have no right to do so at the expense of the convenience of all future generations of learners.”

    Gowers' phenomenon, Gowers' distal myopathy, Gowers' solution in the treatment of migraine, Gowers' anterior spinocerebellar tract, are the best known eponyms. There are three Gowers' signs: Pain along the compressed sciatic nerve on passive dorsiflexion of the foot; the irregular contraction of the pupil in early tabes (cf Argyll Robertson); and the climbing up the legs signs in Duchenne dystrophy.

     It is the last which I highlight here, as a masterly example of clinical description.1 A detailed account of the progressive course and family history, pattern of weakness of muscles, the pseudohypertrophy and his experience of the pathology precede it. He gives full credit to the earlier work of Meryon2 3 and Duchenne.4

    PSEUDO-HYPERTROPHIC MUSCULAR PARALYSIS

    “The difficulty in going upstairs is especially due to the weakness of the extensors of the knee and hip. The defect of the extensors of the hip causes the gait to have a peculiar oscillating characters.

    The greatest defect, however, is in the power of rising from the floor, and the most characteristic peculiarity is the mode in which this is achieved, if it be still possible, and no objects near, by which the patient can aid himself. He commonly has not sufficient power to extend the knees when the weight of the trunk is on the upper extremity of the femur, which is then a lever in which power, applied between the fulcrum and the weight, acts at least advantage. He therefore places his hands on his knees, his arms thus bring much of the weight of the upper part of the trunk on the femur close to the fulcrum, between this and the power, which can then act at greater advantage. When the knees are extended, the power of the extensors of the hip may be sufficient to raise the body into the upright position, or the patient may aid them by an upward push with the hand as he takes it off. If, however, these extensors are weak, the hands are often moved higher and higher up the thighs, grasping alternately, and thus pushing up the trunk. To get thus the requisite support, the knees must not he quite extended, and if their extensors have no power, the device cannot be employed, and the patient is altogether unable to rise. In many cases, especially when extension of the hip is easy, the patient achieves the extension of the knees in another way; he puts the hands on the ground, stretches out the legs behind him far apart, and then, the chief weight of the trunk resting on the hands, by keeping the toes on the ground and pushing the body backwards, he manages to get the knees extended, until the trunk is supported by the hands and feet, all placed as widely apart as possible. Next the hands are moved alternately along the ground backwards, so as to bring a larger portion of the weight of the trunk over the legs. Then one hand is placed upon the knee, and a push with this, and with the other hand on the ground, is sufficient to enable the extensors of the hip to bring the trunk into the upright position.”

    This exemplary description is illustrated by several excellent drawings, from his own hand, which show the same mastery of simple precision and clear exposition that characterise all his writings.

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