Marshall Hall and “Romberg’s sign”
Marshall Hall is famous, inter alia, for his concept of the spinal reflex arc1 when he demonstrated reflex function—an “excito-motory system”2—of the spinal cord and nerves in animals after removal of the brain. This ended the misconceptions that the soul and psychic functions resided in the cord as well as in the brain. Often overlooked, in his Lectures on the nervous system and its diseases (1836)3, he predated Romberg’s account of sensory ataxia, in tabes dorsalis. Hall plainly described the loss of postural control in the dark of a patient with proprioceptive loss:
“I have this day seen a patient with a slight degree of paralysis of feeling and of voluntary motion of the lower limbs. He walks safely while his eyes are fixed upon the ground, but stumbles immediately if he attempts to walk in the dark. His own words are ‘my feet are numb; I cannot tell in the dark where they are, and I cannot poise myself.’ The voluntary motions are regulated by the sense of touch, when this is unimpaired; or by that of sight, when the touch is paralyzed.”
Hall failed to consider fully its anatomical substrate and its implications for cord physiology. Surprisingly, he did not advocate the sign in clinical practice, but the importance of his description is undeniable.
Romberg published his Lehrbuch der Nervenkrankheiten in sections between 1840 and 1846. The depiction4 of that most misspelled of all eponyms5 lies in his account of sensory ataxia in tabes dorsalis6 (Romberg’s sign, named “locomotor ataxia” by Duchenne in 1858/9). Romberg reported:
"… The feet feel numbed in standing, walking or lying down, and the patient has the sensation as if they were covered in fur; the resistance of the ground is not felt…The gait begins to be insecure… he puts down his feet with greater force…The individual keeps his eyes on his feet to prevent his movements from becoming still more unsteady. If he is ordered to close his eyes while in the erect posture, he at once commences to totter and swing from side to side; the insecurity of his gait also exhibits itself more in the dark.”
He gave a full description of the tabetic gait, urinary frequency, retention, incontinence, and the classical lightning and girdle pains.
But Marshall Hall was not alone in anticipating Romberg’s sign for in 1840 Bernardus Brach7 had given an earlier account. And Romberg’s teacher, Ernst Horn (1774–1848), had shown dorsal cord atrophy in a tabetic at autopsy.8 Moreover, five of Horn’s students wrote their doctoral theses on the same subject, published between 1817 and 1827.
Robert Bentley Todd, however, like Romberg, gave an exemplary detailed account of tabes in 18479, of which Gowers said:
“The credit of the discovery of the disease belongs, if to anyone, unquestionably to Todd.”
