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Oppenheim’s name is perpetuated by his eponymous sign of pyramidal tract lesions, and by the disease bearing his name, Oppenheim’s disease.
Amyotonia congenita1 is a congenital, sometimes familial, disorder, characterised by muscular hypotonia and hypoplasia without atrophy. It results in floppy infants with excessive mobility of joints and consequent abnormal postures. Some children who survive more than 18 months from the onset may improve and are often designated benign congenital hypotonia. Oppenheim clearly described myotonia congenita, a separate condition, in his book,2 but some confusion between the disparate disorders pervades the early literature. Myotonia congenita (Thomsen’s disease) was described by Asmus Julius Thomsen (1815–1896) in 1876 in his own family, who showed episodic myotonic contractions, precipitated by cold, pressure, and percussion of enlarged muscles: later portrayed as “The Infant Hercules”. It is now doubtful if Oppenheim’s disease is a distinct entity;3 it is one of several disorders causing the “the floppy infant”. When the primary defect is in the cord, the condition is known as Werdnig-Hoffmann disease. The term amyotonia congenita should now be applied to non-progressive myopathies. Confusing causes of the floppy infant syndrome include glycogen storage diseases, the atonic-astatic syndrome of Foerster, and the congenital non-progressive myopathy (Batten and Turner), nemaline myopathy, and central core disease.
Oppenheim also drew attention to the association of spasticity with hyper-reflexia:
“Stiffness, rigidity, or spastic condition of the muscles can be recognised from exaggeration of the tendon phenomenon.”
In 1902 he reported the sign that perpetuates his name;4 observed in pyramidal tract disease in which Babinski’s sign (earlier recorded by E. Remak) was equivocal:
“If one draws the handle (or shaft) of a percussion hammer over the inner surface of the leg from the upper margin of the tibia downwards, one sees in the healthy person either no movement at all in the foot and toes or else a plantar flexion of the toes. If the irritation is made strongly enough, distinct plantar flexion of the toes is the rule, but sometimes it is necessary to divert the attention of the patient to obviate voluntary movements. Whereas in persons with the symptom complex of spastic hemiparesis, this reflex movement of the muscles is extended to the great toe and adducts or abducts the foot.”
Oppenheim made other, more important, contributions, and with Erb was considered the leading figure of German neurology.5 In 1890 he diagnosed the first brain tumour to be removed in Germany by Koehler, and he fostered the development of neurosurgery. In a controversial monograph on the traumatic neuroses,6 he contended that psychic disturbances following trauma were due to organic (molecular) changes in the brain: a theory now commonly accepted, but then vehemently opposed with much acrimony by Charcot, Mendel, and Nonne. He coined the phrase dystonia musculorum deformans7 (described by Schwalbe), describing the “dromedary gait”. Oppenheim also studied disseminated sclerosis, poliomyelitis peripheral nerve lesions, and precociously used Ehrlich’s Salvarsan in neurosyphilis.
Of enormous influence and scholastic merit was his Lehrbuch der Nervenkrankheiten. It ran to seven German editions and was translated into Russian, Spanish, Italian, and English2 (three editions). The distinguished American neurologist William Gibson Spiller (1863–1940), when challenged to write a neurology textbook, remarked, “When I can write a better book than Oppenheim’s, I’ll do so.”
Hermann Oppenheim (1858–1919) was born in Warburg, Westphalia. He was a major figure in neurology. After studying at Göttingen, Berlin, and Bonn, he trained at Berlin’s Charité under Carl Westphal. During Westphal’s protracted terminal illness, Oppenheim took charge of his clinic, but was not rewarded with his Chair, because of the official governmental anti-Semitism, which overruled the university’s nomination of Oppenheim as Professor Extraordinarius. Deprived of any official teaching post he practised in a private clinic in Berlin. Many valued scientific publications emerged so that it became the recognised international centre for neurology.