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which did not participate in this agitation of the large intestine. For quite a long time, this
exaggerated peristalsis remains limited to the colon; later, if the obstruction is complete, it
can also involve the small intestine. At this moment, the sign no longer has the same value.
However, generalized abdominal peristalsis starts and sometimes remains localized on the
right side [55, p.329]. (…) I have often found that the exaggerated peristalsis of the colon
is more painful than that of the stomach. Also, patients with transverse colon stenosis fol-
lowing perigastritis ordinarily locate the maximum of their pain in the right iliac fossa [55,
p.331].
Thus Bouveret sign of the colon refers to observed and palpable globular swelling
on the right iliac fossa and hypochondrium of the abdomen and soft, depressible
hypochondrium and left iliac fossa on the left side of the abdomen in patients with
obstruction involving the transverse colon.
4.2.13 Anschütz Sign
Alfred Wilhelm (Willy) Anschütz (1870–1954) was born in Halle (Saale), Germany,
studied medicine in Halle, Marburg, and Tübingen, and received his medical degree
from the latter in 1896 [56]. He was rst appointed assistant in medicine in Halle
from 1896 to 1897 and assistant to Johann von Mikulicz (1850–1905) and later
senior physician in surgery at the Friedrich-Wilhelms University in Breslau
(Wroclaw, Poland) from 1897 to 1902 [57, 58]. He was an associate professor in
surgery in 1902 and at Friedrich-Wilhelms University in Breslau in 1906 [56–58].
Anschütz was appointed associate professor at the Philipps University in Marburg
in 1906, followed by professor and deputy director of the surgery clinic at the
Christian-Albrechts University of Kiel in Marburg the following year [56–58]. He
was dean of medicine at the Christian-Albrechts University from 1919 to 1920 and
director of the surgical clinic from 1945 to 1946 [57].
Anschütz was a member of the German Academy of Natural Scientists Leopoldina
in Halle and president of the German Society of Surgery in 1930 [56, 57, 59]. He
was co-editor of Zentralblatt für Chirurgie (Central Journal of Surgery) and
Deutsche Zeitschrift für Chirurgie (German Journal of Surgery) [54]. Anschütz was
also appointed Geheimer Medizinalrat (Privy Medical Counselor).
He was a member of the National Socialist German Workers’ Party from 1933 to
1945 [57]. Eponymic names are honoric terms that highlight one’s contribution to
science and medicine. As such, they should not be used for individuals who support
anti-Semitism, racial, or other crimes against humanity.
Anschütz described ndings in patients with colon cancer causing intestinal
obstruction and cecal dilation in the presence of a competent ileocecal valve
(Table4.1):
(1) There is a local meteorism due to overdistension observed at the cecum in low-lying
colon obstruction. (2) The cause of this local atulence and overstretching is the increased
internal pressure in the closed colon tube with a resistant ileocecal valve. (3) The main
cause of the local atulence is found not only in differences in the resistance on the part of
the intestinal wall but especially in the different widths of the large intestine sections.
Tension at the cecum indicates the need for an operation [60, p.220].
4.2 Eponymous Signs
98
Thus, Anschütz sign refers to a closed-loop obstruction in patients with colon can-
cer in the presence of a competent ileocecal valve.
4.2.14 Nothnagel Sign
Carl Wilhelm Hermann Nothnagel (1841–1905) was born in Alt-Lietzegöricke,
Brandenburg, Germany, and received his medical degree from Friedrich-Kaiser-
Wilhelm Institute in 1863 [61–63]. He served as rst assistant under Ernst Viktor
von Leyden (1832–1910) at Königsberg from 1865 to 1868 and was an associate
professor in internal medicine in 1867 [61, 63, 64]. He lectured in medicine at the
University of Berlin from 1868 to 1870 and at the University of Breslau from 1870
to 1872 [61, 64]. Nothnagel was a professor of medicine and pharmacology in
Freiburg in 1872, chair of special pathology and therapeutics in Jena in 1874, and
professor of medicine at the University of Vienna in 1882. In Vienna, he completed
Die Specielle Pathologie und Therapie (The Special Pathology and Therapy), a
20-volume collaborative work [61, 62, 64].
Nothnagel was a member of the German Academy of Natural Scientists,
Leopoldina, in 1879; founded and served as the rst president of the Vienna Society
of Internal Medicine; appointed by the Emperor Member of the Austrian House of
Lords in 1902; a member of the Academy of Sciences; and rst chairman of the
Society of Internal Medicine, Vienna. He cofounded with Leyden the journal
Zeitschrift für klinische Medizin (Journal of Clinical Medicine) in 1880 [62].
As a description of his character and approach to disease:
The brilliant diagnostician’s goal was to train capable and conscientious physicians. He
wanted to teach observation and examination of the patient and repeatedly reminded learn-
ers never to be blinded by symptoms, always examine the patient from head to toe, make
observations without bias, avoid neglecting even the most minor details based on careful
analysis, and derive relevant conclusions. He forgave ignorance but was intolerant of
untruthfulness, recklessness, and lack of sense of duty in patient care and swiftly intervened
with re and sword when he identied the offender [65, p.507].
Several signs of obstruction of the small and large bowel are attributed to Nothnagel.
The rst one is the ileal succession splash:
In the case of stenosis of the bowel there is frequently a feeling of uctuation on palpation,
and occasionally distinct succussion-sounds can be produced, particularly above the steno-
sis. The presence of these two signs is natural, for uctuation and succussion-sounds can
always be produced in a dilated loop of intestine lled with a mixture of gas and liquid [66,
p.372].
Early in distal colon obstruction only the large intestine is distended with dilation
occurring at the anks:
In stenosis of the sigmoid exure complicated by meteorism from stasis, the upper and
lateral aspects of the abdomen are usually distended. The distension of the lateral aspect of
the abdomen is generally called ank meteorism. When the distension of the bowel is lim-
4 Small andLarge Bowel Signs
99
ited to certain sections of the colon, ank meteorism may be unilateral. This may occur
even when stenosis is in the sigmoid exure, for only a small segment of the bowel above
the stricture may be distended [66, p.605].
Percussion sound occurring at the same site as intestinal stenosis:
In cases of stenosis of the bowel no denite and reliable information can be gained by per-
cussion. (…) It is impossible, therefore, to formulate any denite rules with regard to the
percutory phenomena observed in stenosis of the bowel. The information that can be
obtained with regard to the clinical conditions existing is too general to be of value. Only
one point is of diagnostic importance: it is that when local meteorism, strictly circum-
scribed to some one area of the bowel, can be discovered by percussion, we are justied in
assuming that the stenosis is in this region; whenever this condition is found, all our efforts
should be directed toward discovering other signs of constriction of the bowel in this par-
ticular area. Localized meteorism is of value only in the diagnosis of narrowing of the
bowel per se when combined with other symptoms that point in the same direction [66,
p.372].
Thus, Nothnagel sign refers to (1) Palpatory uctuation and auscultatory “succes-
sion splash” sound occur in the dilated bowel loop, (2) Colon dilation (meteorism)
occurs at the anks in stenosis of the sigmoid exure, (3) Localized percussion
sound identies the areas of a stenotic bowel (Table4.1).
4.2.15 Lane Sign
Sir William Arbuthnot Lane (1856–1943) was born at Fort George, Inverness,
Scotland, and studied medicine at Guy Hospital, qualifying as a member of the
Royal College of Surgeons in 1877 [67–69]. He received a Bachelor of Medicine
and a Bachelor of Science with gold medals in anatomy and medicine in 1881 from
the University of London. Lane accepted his rst appointment as a house surgeon at
the Victoria Hospital for Children, Chelsea. He returned to Guy Hospital as a dem-
onstrator in anatomy in 1882 and was elected fellow in the Royal College of
Surgeons, England, that same year. He received his Master of Surgery degree in
1883 [67–69].
Lane was appointed assistant surgeon, rising to the rank of consulting surgeon at
Great Ormond Street Hospital for Sick Children from 1883 to 1888 [67–69]. He
returned to Guy Hospital, where he was initially an assistant surgeon in 1888, a
surgeon in 1903, and consulting surgeon in 1920 [67, 68]. He served on the Royal
Army Medical Corps (RAMC) and, during World War I, was a consulting surgeon
to Aldershot Command and organized the Queen Mary’s Hospital, Sidcup, to treat
facial injuries [67, 70]. In the Royal College of Surgeons, he was an examiner in
elementary anatomy for the conjoint board (1887 to 1890) and served on the council
(1908 to 1916) [67, 68].
He cofounded the Fellowship of Medicine in 1918 (the following year combined
with the Post-Graduate Medical Association), serving as its president in 1923 [71].
He resigned his membership from the British Medical Association in 1925. That
same year he founded the New Health Society and New Health journal the
4.2 Eponymous Signs
100
following year, whose purpose was to address issues of social medicine [67, 68, 72].
He was named rst baronet of Cavendish Square in 1913, The Most Honorable
Order of the Bath, Companion in 1917, and Chevalier of the Legion of Honor
[67–69].
Lane’s name is eponymously recognized in association with the technique for
applying internal splints to fracture (Lane splints, screw, or plates); the disease
(Lane disease or intestinal stasis); sign (Lane sign) found in intestinal stasis (also
recognized as Lane bands, kinks, membrane) and its operative treatment (Lane
operation or total or partial colectomy based on his theory of intestinal stasis and
autointoxication); and surgical instruments and devices (holding clamp, holding
forceps, catheter, dissector, elevator, mouth gag, needle, plates, rongeur, screw-
driver, Murphy-Lane bone skid) [69, 71].
A description of his character:
He holds a unique position among British surgeons and indeed among the surgeons of the
world, in that he is an original thinker and has carried his views into practice in the face of
opposition and prejudice. (…) Lane, however, possessed, as all men of his type possess, the
courage of his convictions, and proceeded to demonstrate the wisdom and practicality of his
opinions, without much regard to the opinions of his confreres [73, p.654].
Lane described the etiology of chronic intestinal stasis of the ileum (Table4.1):
There develops on the under surface of the mesentery of the last few inches of the small
intestines a new band, which at rst forms part of the under surface of the mesentery. Later
it forms a ligament distinct from the mesentery. The ligament contracts and deforms the
ileum, producing a kink or obstruction of this portion of the trunk, especially in the erect
posture of the trunk. In consequence of this kink the small intestines become very much
dilated and this dilation may extend up as far as the pylorus. The symptoms produced by
this obstruction are supercially very much like those of appendicitis [74, p.496].
Thus, Lane sign refers to obstruction and dilation of the ileum by a ligament particu-
larly when standing.
4.2.16 Stierlin Sign
Eduard Stierlin (1878–1919) was born in Zurich, Switzerland, studied medicine in
Zurich, Bern, Berlin, Hamburg, and Tübingen, and completed his medical degree at
the University of Zurich, passing his state examinations in 1903 [75]. He worked at
the Women’s Clinic at St. Gallen, Eppendorf, and Zurich Medical Clinic and subse-
quently was an assistant to Max Wilms (1867–1918) at the Surgical Clinic of Basel
University in 1908 [75, 76]. He was a surgeon from 1912 to 1913 during the Balkan
War (1912–1913). He was appointed rst assistant in the Ferdinand Sauerbruch
(1875–1951) Clinic in Zurich, where he habilitated in surgery, rising to the rank of
a senior physician. He followed Sauerbruch to the Surgical Clinic of the University
in Munich, where he continued his service as a senior physician at the surgical uni-
versity clinic [75, 76].
4 Small andLarge Bowel Signs
101
Stierlin reported on eight patients with radiographic and pathological correlates
of tuberculosis (four cases), cecal carcinoma (one patient), small intestinal stricture
(two cases), and ulcerative colitis (one patient) of the large intestines (Table4.1):
Surgeons and internists may welcome a new diagnostic tool found radiographically for
detecting earlier stages of ileocecal tuberculosis. In several clinically unclear cases, we
have recently been able to use this method to determine strictures in the lower ileum and
indurating and ulcerative processes in the wall of the cecum and ascending colon, thus
pointing the way to the correct diagnosis [77, p.1231].
He reported a method to diagnose tuberculous of the colon radiographically:
Inltrating, indurating, and ulcerative processes of the cecum and ascending colon are regu-
larly identied radiographically by the absence of the physiological shadow in this colon
section after 5–6 h in both the initial and advanced stages of the disease. Cecal tuberculosis
is, therefore, the absence of the cecum—ascending colon—shadow between the lower
ileum and transverse colon. With the help of radiography, the diagnosis is made in cases
where it cannot be determined clinically. Ulcerative and inltrates are seen in the rest of the
colon in the skiagram by a gap corresponding to the diseased section [77, p.1235].
Thus, Stierlin sign refers to the absence of a shadow in the cecum and ascending
colon detected radiographically in inltrating, indurating, and ulcerative bowel
segments.
4.2.17 Cole Sign
Lewis Gregory Cole (1874–1954) was born in Lake Mahopac, NewYork, USA, and
received his medical degree from the College of Physicians and Surgeons in 1898
[78–80]. He completed a year-long internship at Roosevelt Hospital, followed by
general medical and surgical practice and clinical work at Roosevelt Hospital in
1899 [78–80]. He served as a professor of roentgenology at Cornell University
Medical College from 1913 to 1921 [78, 80]. He advocated for the use of X-ray in
the diagnosis of pulmonary tuberculosis, the differential diagnosis of gastric ulcers
and gastric cancer, and the effects of radiation on tissue in atomic bomb casualties
[78]. He also served as director of silicotic research within the John B. Pierce
Foundation, which studied the effects of dust inhalation on the lung [78, 79].
He was a diplomate of the American Board of Radiology, a fellow of the American
College of Radiology, and president of the American Roentgen Ray Society in 1917
[80]. Cole received numerous awards, including the James Ewing Award, the rst
Gold Medal of the Radiological Society of North America, and the Julius Friedenwald
Medal from the American Gastroenterological Association [78–81].
As to a description of his character:
Dr. Cole’s brilliant, inquiring mind was devoted throughout his career to ferreting out the
facts concerning controversial subjects which might be solved by radiological means. In the
course of his studies he felt compelled to become expert in the elds of physiology, pathol-
ogy and gastroenterology. He always entered into a discussion in a ghting mood, knowing
4.2 Eponymous Signs
102
that he was going to be opposed and criticized, but in the end, he lived to see his work
acclaimed [78, p.870].
Cole applied the technique of serial radiography and roentgen-cinematography
(upper gastrointestinal series) as the method for diagnosing pre-pyloric (duodenal)
ulcers and found a (Table4.1):
[c]onstant deformity of the cap or sphincter, caused by the induration of cicatricial contrac-
tion surround the crater of an ulcer, or resulting therefrom. These ndings are of extraordi-
nary value if the radiographs of a large series are studied individually and collectively, and
matched over each other or reproduced kinematographically. (…) The induration of an
ulcer projects into the lumen of the cap, causing a displacement of bismuth as constant as
one’s nger-prints in a ball of putty. It may be so small as to present only a constant dent on
side of the cap, or it may be so extensive as to distort the lumen of the cap beyond recogni-
tion. The process may involve one-half of the cap without distorting the other half [82,
p.1242].
Thus, Cole sign refers to a deformity of the duodenal cap or sphincter identied in
an upper gastrointestinal series in patients with a duodenal ulcer.
4.2.18 Mathieu Sign
Albert Mathieu (1855–1917) was born in Thin-le-Moutier, Ardennes, France, and
studied medicine in Paris at Midi, Hôtel-Dieu, Lariboisière, and St. Louis Hospital
in 1882. He was an intern at the Pitié Salpêtrière Hospital under Ernest-Charles
Lasègue (1816–1883) in 1878 and received his medical degree with the thesis “Sur
les purpuras hémorragiques” (On hemorrhagic purpuras) in 1883 [83–85]. He
worked at St. Louis Hospital under Charles-Philippe Lailler (1822–1893) in 1882
[84, 85]. He was head of the clinic of Professor Germain Sée (1818–1896) at the
Hôtel-Dieu, Doctor of the Hospitals of Paris in 1891, head of the department of the
Tenon Hospital in 1894, a physician at St. Andral Hospital in 1897, and later head
of St. Antoine Hospital in 1907 [84, 85]. He cofounded with P.Le Gendre the French
League of the School of Hygiene in 1902 and founded the Archives des Maladies de
l’Appareil digestif (Archives of Diseases of Digestive System) in 1907 and appointed
to the rank of Knight of the Legion of Honor in 1911 [85].
In a paper presented at the French Academy of Medicine on April 23, 1914,
Mathieu described the nding of clapotage, or the splashing sound heard on succus-
sion (false ascites), as a method of diagnosing intestinal stenosis (Table4.1):
Is it surprising that the ndings of intestinal uid and stasis accumulated upstream of the
stenosis can be demonstrated by the external examination. It reveals itself by extensive
clapotage and sloping dullness. It is surprising that the false ascites and abdominal clapo-
tage occurring during the intestinal occlusion are often passed unnoticed [86, p.303–304].
(…) M.Ricard made a communication on this subject to the Society of Surgery in June
1907, and the following year. I published in the Archives des maladies de l’appareil digestif
a short study on the semiological value of clapotage and sloping dullness in incomplete
occlusion of the intestine [86, p.303].
4 Small andLarge Bowel Signs
103
Furthermore, Mathieu described a method for distinguishing uid within the stom-
ach from that emanating from the intestines:
I noted that there was false ascites only in the left decubitus position. In contrast, in the right
lateral decubitus position, dullness due to uid within the stomach follows a convex line
moving inferiorly, stopping slightly below the umbilicus. Below was the intestinal sound.
Thus, it may be unclear whether there is an intestinal obstruction or gastric dilatation caused
by pyloric stenosis. In those cases, the characteristic dullness corresponds to uid within
the stomach, and radiographic examination eliminates all doubts [86, p.306].
Thus, Mathieu sign refers to dullness on percussion following a convex line from
the stomach to slightly below the umbilicus in pyloric stenosis.
4.2.19 Butters Sign
We were unable to identify any historical information on George Butters. In the
May 1915 issue of Nürnberger medizinische Gesellschaft und Poliklinik (Nuremberg
Medical Society and Polyclinic), Wilhelm Voit in Münchener medizinische
Wochenschrift used the term Butters cancer while reporting the case of a 39-year-
old man with cancer involving the hepatic exure of the colon. Initially, it was
thought that the patient had a duodenal ulcer (Table4.1). However,
[o]ccult blood remained after 14 days. With the most precise daily palpation, subtle, shift-
able resistance under the right costal arch in the parasternal line was concerning. Occult
blood persists; neither macroscopic blood nor mucus is present in the stool. (…) Since the
palpable resistance and occult blood persisted, the diagnosis of exural carcinoma was
made. Operative resection conrmed the diagnosis of a walnut-size carcinoma. (…) This
case conrms the observation that constant occult blood in the feces, despite the strictest
ulcer diet, almost always speaks for carcinoma [87, p.1119].
Thus, Butter sign refers to shiftable resistance under the right costal arch in a para-
sternal line occurring in carcinoma of the hepatic exure.
4.2.20 Kloiber Sign
Hans Kloiber (1883–1950) was born in Grüntegernbach, Landkreis Erding,
Germany, and served as an assistant at the surgical university clinic in Frankfurt am
Main [88, 89]. He was appointed assistant radiologist, followed by a senior radiolo-
gist at the radiographic institute of Baden-Baden Hospital from 1921 to 1946 [88,
89]. Kloiber described a radiographic nding in acute and chronic small bowel
obstruction (Table4.1):
A chance observation in front of the X-ray screen caused me to refrain from giving a con-
trast agent. X-ray of a patient before taking the barium meal shows a strong clearing of the
abdomen. I found several gas pockets with liquid levels to be the cause. Based on this
observation, the diagnosis of ileus was made, and the operation conrmed my assumption.
4.2 Eponymous Signs
104
The liquid levels are caused by uid accumulating in the intestine due to congestion and gas
formed from fermentation processes. If such a patient is placed upright, gas and liquid sepa-
rate from one another by a horizontal line. One only needs to perform a uoroscopy or, even
better, an X-ray while standing, and then it is easy to detect the liquid level with the gas
bubbles. Sometimes there are many and other times, a few gas bubbles, depending on the
location of the disease and the duration of the incarceration. From this, a tentative diagnosis
is made. A few liquid levels near the stomach indicate a high-seated intestinal obstruction,
whereas numerous uid levels in the small pelvis indicate a deep-seated intestinal obstruc-
tion [90, p.1065]. (…) Since then, I have used this symptom systematically for X-ray diag-
nosis. The usefulness of the procedure was tested on a large body of denite cases of ileus,
and the experience was made that in ileus, this sign was present in a more or less pro-
nounced manner. Then dubious cases were also examined, and it was found that it was
always possible to determine that if there were liquid levels with gas bubbles, it was actu-
ally ileus. The X-ray diagnosis was conrmed without exception by the subsequent opera-
tion. (…) Finally, I consider the uid level with gas bubbles to be a pathognomonic sign
and, therefore, a decisive sign for the diagnosis of ileus [90, p.1066].
Thus, Kloiber sign refers to air-uid levels detected in the upright X-ray in bowel
obstruction.
4.2.21 Hedri Sign
For biographic information regarding Hedri see Chap. 8—Spleen Signs. Hedri
described an intraoperative method for determining the viability of the colon
(Table4.1):
In intestinal resection, the epiploic appendices provide reliable and rapid information. It is
easy to excise an epiploic appendage of a suspected bowel and see if its stump bleeds from
the artery. If this is the case, you can leave that part of the intestine or combine the ends of
the intestine. In the opposite case, we absolutely have to remove the bowel or continue with
the resection. Ligation of the epiploic appendices is easy to perform and has no disadvan-
tages. Therefore, these are reliable indicators of the nutritional status of the large intestines.
In the most careful perusal of the literature pertaining to this, I found nothing of such an
observation, which prompted me to bring this to your attention [91, p.353].
There are several signs attributed to Hedri. The current one refers to determining the
viability of a segment of bowel by excising an epiploic appendage to see whether
the stump bleeds. The other Hedri sign is used to identify a rupture of the spleen or
liver (see Chap. 8—Spleen Signs).
4.2.22 Gold Sign
Ernst Gold (1891–1967) was born in Vienna, Austria, and received his medical
degree from the University of Vienna [92]. He served as a faculty member and asso-
ciate professor in surgery at the University of Vienna [92, 93]. Gold had his venia
4 Small andLarge Bowel Signs
105
legendi (authorization to teach) revoked and was expunged from the University of
Vienna during National Socialism, immigrating to the United States [92, 94].
Gold described a nding at the surgical clinic of the University of Vienna under
Prof. Anot Eiselsberg (1860–1939) on rectal examination in 14 of 16 patients with
small bowel obstruction (Table4.1):
The nature of our sign of ileum is seen by following the individual ndings recorded in the
case histories. In most cases of small bowel obstruction, the bowel can be palpated from the
cul-de-sac. Even though under normal conditions, the small intestine is a constant compo-
nent of the contents of the small pelvis, it is usually not accessible for direct palpation from
the pouch of Douglas. In order to palpate the small intestines during the rectal examination,
certain changes must have taken place above the areas of the narrowed intestinal lumen.
These changes involve an increase and abnormal composition of the intestinal contents that
liquefy and accumulate, leading to widening of the intestinal loops and early hypertrophy
of the muscular intestinal wall resulting from intestinal obstruction. An abnormal loop for-
mation of the prestenotic position of the small bowel is also found early [95, p.96].
Gold concluded that this phenomenon is prevented in cases of large bowel obstruc-
tion at the level of the cecum, which “lies like a lid in front of the entrance to the
small pelvis, so that later when the congestion involves the small intestines, they
can no longer sink down.” He also described, in some cases early in the disease
course, a “cushion-like protrusion” or bulge extending into the Douglas pouch [95,
p.97]. He found that unlike peritoneal effusions due to various causes, it was pos-
sible to displace the bulge with the examining nger in cases of small bowel
obstruction.
Thus, Gold sign refers to bulging, inward displacement, and reduction of the
rectal wall at the level of the pouch of Douglas in cases of small bowel obstruction.
4.2.23 Fleischner Sign
Felix George Fleischner (1893–1969) was born in Vienna, Austria, and received his
medical degree from the University of Vienna Medical School in 1919 [96, 97]. He
was an intern at Karolinen Children’s Hospital and First Medical Clinic of the
University and a resident and assistant at Wilhelminen Hospital from 1921 to 1929
[96]. He served under the auspices of Guido Holzknecht (1872–1931) at the Central
Roentgen Institute from 1929 to 1930 and was an associate professor in radiology
at the University of Vienna in 1931 [96]. He was chief of the roentgen department
of the Vienna C.S.Child’s Hospital [96, 97].
His venia legendi (authorization to teach) was revoked from the University of
Vienna during National Socialism in 1938. He emigrated to the United States, where
he was appointed to the radiology department at the Massachusetts Hospital and
was a private practitioner in Greeneld, Massachusetts, from 1940 to 1942 [96–98].
Fleischner was appointed radiologist and eventually chief of the radiology depart-
ment at Beth Israel Hospital from 1942 to 1960, with faculty appointments at
Harvard (ascending to the rank of clinical professor of radiology in 1952) and Tufts
4.2 Eponymous Signs
106
College of Medicine (assistant professor in 1945) [96–98]. He was appointed con-
sultant in radiology at Peter Bent Brigham Hospital, Massachusetts General Hospital
and Veterans Affairs Hospital in Boston, and Wet Roxbury, Massachusetts [96].
The Fleischner Society was named in his honor and founded in 1969, dedicated
“to the development of roentgenology of the chest as a discipline in its own right”
[99]. His name is eponymously associated with the dense horizontal line of atelec-
tasis and healed infarction, located in the lower lobes 1–3cm above the dome of the
diaphragm (Fleischner lines) and a pulmonary sign (Fleischner sign) involving a
prominence of the central pulmonary artery, caused by pulmonary embolism or
thrombosis of this vessel [97].
Fleischner reported the results of over a hundred cases and described a novel
radiographic nding in patients with ileocecal tuberculosis (Table4.1):
The diagnosis of ileocecal tuberculosis has not been emphasized. Upon reviewing the lit-
erature, insufciency of the valve is understood and discussed as the consequence of a liq-
uid enema in the lower loop of the small intestines. The recently described ndings of rigid
walls of the ileum suggest that insufciency occurs even with oral contrast. I observed this
in all such cases. The mouth of the ileocecal valve is seen as being patent. One has to rotate
the patient or apply pressure to bring the area into view to avoid the overlying cecal shadow.
Therefore, I am providing evidence for the insufciency of the ileocecal valve by attaching
great diagnostic importance to the detection of the openness of the valve as conrmed by its
gross anatomical changes [100, p.385–386].
Thus, incompetence of the ileocecal valve is caused by an ulcerative and brotic
process that transforms the bowel into a rigid thick-walled tube with a narrowed
lumen at the distal ileum.
4.2.24 Hintze Sign
There is limited historical information on Arthur Hintze (1881–1946). Hintze served
as director of the Roentgen and Radium Institute of the Surgical University Clinic
in Berlin from 1917 to 1935 [101, 102]. During this time, he was an associate pro-
fessor in surgery and radiology [102, 103]. He was appointed deputy director at the
General Institute against Tumorous Diseases beginning in 1935 [101, 102].
Hintze described the radiographic feature rst mentioned by von Wahl on physi-
cal examination at the Roentgen Congress in 1919 (Tab le4.1):
[I]t consists in the detection of a severely distended, immobile bowel loop xed in the abdo-
men. (…) [t]he gas-inated loop is specic for obstruction of an intestinal loop and its cir-
culation. The small intestinal loop is abundantly lled with gas and liquid. This von Wahl’s
symptom, which I made visible on X-ray, fullls its task, in the most perfect way, of clarify-
ing the diagnosis of ileum. It is immediately clear whether it is a small-intestinal loop with
the typical Kerckring folds or a large-intestinal loop, which at most shows haustral marking.
(…) The strength of the gas lling and the narrowness of the wall contour allow a conclu-
sion to be drawn as to the nearness of the risk of perforation. If the wall contour is wide
despite the abundant gas lling as has only been observed in sigmoid volvulus, this suggests
that the disease is intermittent and is preceded by a series of attacks of bowel torsion with
4 Small andLarge Bowel Signs