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xxiii
9.2.3 Halsted Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
9.2.4 Mayo-Robson Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
9.2.5 Löwi Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
9.2.6 Goblet Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
9.2.7 Frostberg (Inverted 3) Sign . . . . . . . . . . . . . . . . . . . . . . . . . 299
9.2.8 Mallet-Guy Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
9.2.9 Imrie Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
9.2.10 Baid Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
9.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
10 Intra-Abdominal and Diaphragm Signs . . . . . . . . . . . . . . . . . . . . . . . . 307
10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
10.2 Eponymic Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
10.2.1 Hippocratic Facies (Sign) . . . . . . . . . . . . . . . . . . . . . . . . 307
10.2.2 Stokes Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
10.2.3 Duchenne Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
10.2.4 Pfuhl–Jaffé Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
10.2.5 Federici Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
10.2.6 Thomayer (Toma) Sign . . . . . . . . . . . . . . . . . . . . . . . . . . 312
10.2.7 Clark Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
10.2.8 Fürbringer Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
10.2.9 Bolognini Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
10.2.10 Cushing Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
10.2.11 Strauss Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
10.2.12 Landau Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
10.2.13 Lennander Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
10.2.14 Bryant Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
10.2.15 Morel Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
10.2.16 Kehr Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
10.2.17 Barnard Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
10.2.18 Blumer Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
10.2.19 Brown Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
10.2.20 Chilaiditi Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
10.2.21 Oehlecker Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
10.2.22 Claybrook Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
10.2.23 Drachter Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
10.2.24 Douglas Sign (Douglas Cry) . . . . . . . . . . . . . . . . . . . . . . 331
10.2.25 Danforth Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
10.2.26 D’Amato Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
10.2.27 Chapman Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
10.2.28 Blaxland Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
10.2.29 Butler–Carlson Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
10.2.30 Leotta Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
10.2.31 Lian–Odinet Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
Contents
xxiv
10.2.32 Piteld Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
10.2.33 Rob Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
10.2.34 Robertson Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
10.2.35 Way Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
10.2.36 Dew Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
10.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
11 Abdominal Wall Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
11.2 Eponymous Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
11.2.1 Auenbrugger Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
11.2.2 Rosenbach Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358
11.2.3 Simon Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
11.2.4 Guinard Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
11.2.5 Demons Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
11.2.6 Hartmann Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
11.2.7 Sergent Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
11.2.8 Beevor Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
11.2.9 Ransohoff Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
11.2.10 Livierato Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
11.2.11 Cruveilhier–Baumgarten Sign . . . . . . . . . . . . . . . . . . . . . 367
11.2.12 Hofstätter Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
11.2.13 Wynter Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
11.2.14 Delbet Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
11.2.15 Ligat Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
11.2.16 Handley Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
11.2.17 Willan Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
11.2.18 Cullen Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
11.2.19 Grey Turner Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
11.2.20 Hellendall Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
11.2.21 Schlesinger Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
11.2.22 Barkman Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
11.2.23 Jeans Sign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
11.2.24 Carnett Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
11.2.25 Fothergill Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
11.2.26 Co Tui-Meyer Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
11.2.27 Mortola Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
11.2.28 Raw Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
11.2.29 Holman Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
11.2.30 Fox Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
11.2.31 Tixier Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
11.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Contents
xxv
12 Hernia Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
12.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
12.2 Eponymous Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
12.2.1 Laugier Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
12.2.2 Howship–Romberg Sign . . . . . . . . . . . . . . . . . . . . . . . . . 402
12.2.3 Ladd Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
12.2.4 Hannington-Kiff Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
12.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
Contents
xxvii
List of Figures
Fig. 1.1 Hathcock sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Fig. 1.2 Gorlin sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Fig. 3.1 Mendel sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Fig. 4.1 Patel sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Fig. 5.1 McBurney sign (by Ryan Yale). . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Fig. 5.2 Blumberg (Shchetkin) sign (by Ryan Yale) . . . . . . . . . . . . . . . . . 134
Fig. 5.3 Illoway sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Fig. 5.4 ten Horn sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Fig. 5.5 Lanz sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Fig. 5.6 Cope (Iliopsoas) sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . 144
Fig. 5.7 Cope (Obturator) sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . 145
Fig. 5.8 Przewalsky sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Fig. 5.9 Markle sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Fig. 5.10 Sherren sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Fig. 5.11 Rovsing sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Fig. 5.12 Sloan sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Fig. 5.13 Baron sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Fig. 6.1 Lockwood sign (by Ryan Yale). . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Fig. 7.1 Naunyn sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Fig. 7.2 Murphy sign I (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Fig. 7.3 Murphy sign II (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Fig. 7.4 Abraham sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Fig. 7.5 Riesman sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Fig. 7.6 Tanyol sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Fig. 8.1 Nixon sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Fig. 8.2 Castell sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
Fig. 9.1 Mallet-Guy sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Fig. 10.1 Landau sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Fig. 10.2 Drachter sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
Fig. 11.1 Cruveilhier–Baumgarten sign (by Ryan Yale) . . . . . . . . . . . . . . . 369
Fig. 11.2 Carnett sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Fig. 12.1 Hannington- Kief sign (by Ryan Yale) . . . . . . . . . . . . . . . . . . . . . 407
xxix
List of Tables
Table 1.1 Oral cavity signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Table 2.1 Oropharynx and esophagus signs . . . . . . . . . . . . . . . . . . . . . . . . . 49
Table 3.1 Stomach signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Table 4.1 Small and large bowel signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Table 5.1 Somatic reex signs in appendicitis . . . . . . . . . . . . . . . . . . . . . . . 161
Table 5.2 Visceral reex signs in appendicitis . . . . . . . . . . . . . . . . . . . . . . . 199
Table 6.1 Miscellaneous non-reex signs in appendicitis . . . . . . . . . . . . . . 232
Table 7.1 Liver and biliary signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Table 8.1 Splenic eponyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Table 9.1 Pancreas signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Table 10.1 Intra-abdominal and diaphragm signs . . . . . . . . . . . . . . . . . . . . . 343
Table 11.1 Abdominal wall signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Table 12.1 Hernia signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
1© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
S. H. Yale et al., Gastrointestinal Eponymic Signs,
https://doi.org/10.1007/978-3-031-33673-7_1
Chapter 1
Oral Cavity Signs
1.1 Introduction
The noun “mouth” has its origins from the middle to modern English adjective ora-
lis, while the term “cavity” comes from the Latin cavitatem or hollowness [1, 2].
Thus, the oral cavity refers to the open space within the mouth. It is the initial por-
tion of the alimentary tract (digestive tube) or gastrointestinal tract. Various diseases
are found within the oral cavity and involve the soft tissues of the mucosa; tonsillar,
pharyngeal, glandular, and lymph tissues; and the rmer tissues of the teeth, tongue,
and palate, which may interfere with chewing (mastication) and swallowing
(deglutition).
The physical examination of the oral cavity requires the examiner to apply their
sense of vision, hearing, and touch through palpation and percussion, a light source,
and a wooden spatula. The oral cavity, like the skin, provides visual information
about the systemic nature of internal disease. Unfortunately, it is often neglected
and given only cursory attention during the physical examination. This may reect
that the oral examination is not thoroughly taught, studied, or emphasized during
medical education. Physicians thereby lack appropriate education, and skills,
regarding their ability to recognize abnormalities and knowledge that heavy metals
toxicity (e.g., lead) or infections (e.g., syphilis) may also occur or have their origins
within the mouth.
Since the early nineteenth century, various signs have been described in the oral
cavity. This chapter is devoted to presenting those signs by describing the persons
and signs as initially reported and their role in current clinical practice. If available,
we include tributes regarding their character and the impact that their presence had
on others’ lives. Most remarkable is that some of the oral cavity eponymic signs
include the names of Corrigan, Trélat, Mueller, Fournier, Escherich, Gorlin, and
Marfan—these eponymic names that most physicians and historians are familiar
with are not the ones attributed to the oral cavity. By learning these signs and
2
historical information about the eponym, students and physicians can begin to
appreciate the critical role that the oral cavity plays in disease diagnosis.
1.2 Eponymously Named Signs oftheOral Cavity
1.2.1 Burton Sign
Henry Burton (1799–1849) received his Bachelor of Medicine degree in 1826, a
medical degree from Gonville and Caius College, Cambridge, in 1831, and a fellow-
ship from the Royal College of Physicians (FRCP) in 1832 [3]. He served within the
Royal College of Physicians (RCP) as censor in 1838 and consiliarius in 1843 [3].
Burton practiced at St. Thomas’s Hospital throughout his career, rising from the
ranks of an assistant physician and lecturer on chemistry and materia medica to
senior physician [3, 4].
Burton described a nding observed on the gingiva of persons who ingested lead:
The edges of the gums attached to the neck of two or more teeth of either jaw, were dis-
tinctly bordered by a narrow leaden-blue line, about the one-twentieth part of an inch in
width, whilst the substance of the gum apparently retained its ordinary colour and condi-
tion, so far as could be determined by comparing the gums of these patients with those of
other patients of the same class in the hospital [5, p.66]. (…) For the discolouration is very
permanent; it has endured through months and until death, and having been once observed
may be afterwards easily recognize [5, p.68]. The time required to produce the blue line
varies in general with the amount of the dose, but not always, and, coeteris paribus, large
doses affect the gums sooner than small [5, p.77–78].
Thus, Burton sign refers to a narrow blue line at the gingival margin involving two
or more teeth in the maxilla or mandible caused by lead poisoning (Table1.1).
1.2.2 Carabelli Sign
Georg Carabelli (György Karabéla) (1787–1842) was born in Pest (currently
Budapest, Hungary) and received his doctorate at Josefsakad [6]. He practiced den-
tistry in Vienna from 1809 to 1813, where he also served as court dentist to Franz
Joseph I (1830–1916), the Emperor of Austria [6, 7]. At the University of Vienna, he
was a professor and cofounder of the stomatological clinic [7].
Carabelli described a supernumerary tubercule found on the lingual (median)
side to the mesial wall of the maxillary molar tooth as reported in his book
Systematisches Handbuch der Zahnheilkunde (Systematic Manual of Dentistry)
published in 1844, two years posthumously:
Sometimes on the inner wall of the molars, especially on the rst, there is an enameled
hump (tuberculus anomalous), the base of which arises from the neck of the tooth and the
tip of which stands free in the great oral cavity, somewhat remote from the crown [8,
p.107].
1 Oral Cavity Signs
3
This anomalous accessory cusp, often called Carabelli cusp or cusp of Carabelli, is
typically found in the maxillary permanent rst molar and may be identied on the
maxillary primary second molar [9] (Table1.1). Their main signicance is that the
groove in this tooth predisposes to caries and may present challenges when placing
orthodontic bands [4]. A genetic etiology has been proposed involving the PAX9
and MSX1 genes [10].
1.2.3 Corrigan Sign
Sir Dominic John Corrigan (1802–1880) was born in Dublin, Ireland, and received
his medical degree from the University of Edinburgh, Scotland, in 1825 [11–15]. He
was a physician at the Meath-Street Dispensary, Cork-Street Fever Hospital, and
later Jervis-Street Hospital in 1831, and to the House of Industry Hospitals
(Whitworth Medical, Hardwicke Fever, and Richmond Hospital—later renamed
Carmichael Hospital) in 1840 [11, 12, 15–18]. Corrigan served as a professor of
medicine at the Digges-Street School, Peter-Street School, and Richmond Hospital
College of Medicine [11]. He was a member of the Royal College of Surgeons,
England, in 1843 and received his honorary medical degree from the University of
Dublin in 1849 [11, 14]. He was appointed physician to the College of Maynooth,
an honorary physician in ordinary to Queen Victoria of Ireland in 1879, and com-
missioners of National Education in Ireland [11]. He was anointed Baronet of
Cappagh and Inniscorrig, Dublin, in 1866 [11, 12, 15, 19, 20].
Among his other appointments and accomplishments, he was the founder of the
Dublin Pathological Society in 1838, later serving as president; a member of the
Senate of the Queen’s University in Ireland in 1841; fellow of the Royal College of
Physicians, Ireland, in 1856; and representative on the Medical Council in 1859.
Notably, he was elected president of the Royal College of Physicians, Ireland, in
1859; president of the Royal Zoological Society; and president of the Pharmaceutical
Society of Ireland [13]. He served as vice-chancellor of the Queen’s University,
Ireland, in 1871 and president of the King and Queen’s College of Physicians [11,
20]. He held a seat as a member of the House of Parliament at Westminster for the
city of Dublin from 1870 to 1874 [11, 12, 21, 22].
As to his character:
As a practitioner, he exhibited in a striking manner the distinguishing traits of his character,
decision and boldness; tempered, however, with kindness and tenderness towards the sick,
and guided by the most scrupulous honour in his professional relationship. (…) In debate
he was at his best. Always uent and impressive, and capable of marshalling his facts with
a skill possessed by few public men, he was occasionally eloquent. To these qualities,
enhanced in no small degree by his easy and dignied action, his ne erect gure and intel-
lectual countenance, which, when he rose to the full height of the occasion, glowed with
enthusiasm and conscious power, lent considerable force [11, p.227].
These represent a glimpse of the plethora of his honorary achievements. Despite his
enduring accomplishments, his name is undoubtedly best recognized and entrenched
in the medical literature in the association of the sign related to aortic insufciency,
1.2 Eponymously Named Signs oftheOral Cavity
4
eponymously named the “Corrigan pulse” or “Corrigan sign.” He published this
nding in 1832in the Edinburgh Medical and Surgical Journal and was titled “On
permanent patency of the mouth of the aorta, or inadequacy of the aortic valves,”
where he stated:
Visible pulsation of the arteries of the head and superior extremities: (…) When a patient
affected by the disease is stripped, the arterial trunks of the head, neck, and superior extrem-
ities immediately catch the eye of their singular pulsation. At each diastole the subclavian,
carotid, temporal, brachial, and in some cases even the palmar arteries, are suddenly thrown
from their bed, bounding up under the skin. The pulsations of these arteries may be observed
in a healthy person through a considerable portion of their tract, and become still more
marked after exercise or exertion but in the disease now under consideration, the degree to
which the vessels are thrown out is excessive. Though a moment before unmarked, they are
at each pulsation thrown out on the surface in the strongest relief. From its singular and
striking appearance, the name of visible pulsation is given to the beating of the arteries [23,
p.227].
Thus, one eponymous sign ascribed to Corrigan refers to the visible pulsation
observed in the head, neck, and upper extremities. Corrigan also described a nding
found in patients with chronic exposure to copper:
In all cases of copper-poisoning which have come under my notice there was exhibited a
very peculiar feature, which does not appear to have been previously noticed, viz., an edg-
ing of rich purple on the margin of the gums of the incisor, canine, and bicuspid teeth of
both jaws. (…) In many of the cases of copper-poisoning, the effects have been produced
by handling old or dirty copper, on which the carbonate has accidentally formed [24,
p.229].
Thus, Corrigan sign also refers to the purple-colored line occurring at the junction
or margins between the teeth (incisor, canine, and bicuspid) and gingiva (Table1.1).
1.2.4 Trélat Sign
Ulysse Trélat (1828–1890) was born in Paris, France, served as a hospital intern in
Paris in 1849, and received his medical degree based on the thesis titled Des frac-
tures de l’extrémité inférieure du fémur (Fractures of the distal femur) in 1854 [25].
He was an associate of anatomy at the École Pratique from 1853 to 1857, agrégé of
the Faculty of Medicine in Paris, based on the thesis titled De la nécrose causée par
le phosphore (Necrosis caused by phosphorous) in 1857, and lectured on congenital
surgical diseases and surgery from 1859 to 1861 [25–27]. He was appointed sur-
geon at the Central Bureau in 1860, rose to the rank of chief of Maternité surgeon in
1864, followed by appointments at Saint-Antoine Hospital in 1867, Saint-Louis
Hospital in 1868, Pitié Hospital in 1869, and Charité Hospital in 1872; the later as
professor of external surgical pathology [25, 27].
During the Franco-Prussian War of 1870, he was chief surgeon of the fth ambu-
lance of the Society for the Relief of the Military Wounded [25, 28]. After the war,
he was appointed surgeon and professor of pathology at Charité in Paris, followed
1 Oral Cavity Signs
5
by professor and chair of the surgical clinics at Hôpital Necker in 1880, and subse-
quently professor of clinical surgery at Charité in 1884. Trélat was passionately
involved in issues involving public and occupational health and assistance [25, 27].
He was a member of the Society of Surgery in 1864 (president in 1872), the
Academy of Medicine in 1874 (president in 1886), the Society of Public Medicine
(chairman in 1885), the Superior Council of Public Assistance, the Council for
Hygiene and Sanitation of Seine in 1874, and decorated as Commander of the
Legion of Honor in 1889 [25]. His lectures were posthumously published by his
former student Pierre Delbet (1861–1957) in 1891in the two-volume book titled
Clinique Chirurgicale (Surgical Clinic) [28, 29].
In the words of Professor Tarnier as to a description of his character:
Throughout his life, he hated banality, loving only beauty and authenticity. His efforts were
directed toward specic goals and relentlessly advanced toward achieving those goals. His
intelligence was so keen and his power of assimilation so great that his knowledge seemed
vast. We often admired the insight and marvelous intuition with which he approached the
most difcult problems of surgery, hygiene, and administration [25, p.14].
One of his former students, Dr. Paul Segond, described Trélat as:
Incomparable teacher, marvelous worker, and clinician who was as judicious as wise. He
possessed all of the great qualities of common sense, righteousness, and balance that have
made French surgery famous. In short, you were the master for us, the one we listen to,
admired, respected and loved—But that’s not all. Those who would only remember your
operative dexterity, your penetrating eloquence, your profound knowledge, the wary care
you always took to pursue progress as the truth, your marvelous abilities to synthesize,
clarify or summarize the most obscure scientic questions would still know you imper-
fectly. They would be unaware that you were not only a great surgeon and that you pos-
sessed within you many other qualities of the heart and mind [25, p.23–24].
Trélat presented at the French Academy on 27 November 1869 an observed nding
in the oral cavity in patients with tuberculosis (Tab le1.1):
It now remains for me to reveal a nding that I regard as pathognomonic. It occurs early, but
as these ulcers progress, they are almost always persistent ndings that enable us to recog-
nize them since they are invasive. Tuberculosis ulcers of the mouth develop in the following
way: one nds on the mucous membrane a spot, a barely protruding plate, round, 1 to 3 or
4 millimeters in width, with its surface covered with epithelium, and one or more follicular
orices. This spot is light yellow, similar to that of phlegmonous pus. After a few days, the
epithelium is destroyed and soon leaves behind an ulcerated surface. Instead of one spot, we
observe several of them at different stages of evolution. The patient whose history I have
related had, the rst time I saw him, new ulceration for a long time until towards the end of
his life, the whole tongue was ulcerated [30, p.44–45].
Thus, Trélat sign refers to tiny supercial light-yellow spots (abscesses) on the sur-
face of a tuberculous lesion in the mouth progressing to form a large tuberculous
ulcer (Table1.1).
His name is undoubtedly best recognized in regard to the sign he described in
1883 and independently by Edmund Lesser (1852–1918) in 1901 (Lesser-Trélat
sign). Lesser’s description and reporting of cherry angiomas associated with various
internal malignancies were similar to the ndings discussed in Trélat lectures as
1.2 Eponymously Named Signs oftheOral Cavity