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1.3 Conclusion
Signs of the oral cavity were discovered and named eponymously for dentists (e.g.,
Carabelli, Gorlin) and physicians, with the majority caused by infectious diseases.
Although we intended for the historical background of these persons to be brief, it was
undoubtedly difcult in many cases, given the depth and breadth of their overall
accomplishments extending far beyond their named signs. Some of these signs illus-
trate the limitations of eponyms; the names may be attributed to more than one sign
(e.g., Corrigan), or the same name may refer to different authors (e.g., Jackson). These
signs were primarily identied through observation, emphasizing the importance of
inspection, the rst step of the physical examination, when evaluating an organ or
structure. They provide additional supporting evidence for a systemic disease process
and reinforce to clinicians how a meticulously performed beside physical examination
aids in diagnosis. They are often found early in the disease process and are easily
overlooked, particularly if the oral examination is given only brief attention.
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1 Oral Cavity Signs
43
Chapter 2
Oropharynx andEsophagus Signs
2.1 Introduction
The British English “oesophagus” or American English “esophagus” terms origi-
nated from the ancient Greek word οἰσοφάγος (oisophagos), meaning gullet, which
bears or carries food to swallow [1]. The gullet refers to the tube that transports food
from the pharynx to the stomach [1]. Early eponymic signs reported in the late nine-
teen century described delayed auscultatory sounds to distinguish obstructive disor-
ders of the esophagus. With the advent of oral barium contrast, it is now possible to
visualize the esophagus and, by its appearance, the means to distinguish esophageal
stricture from esophageal carcinoma. Other ndings in the early twentieth century
involved using a palpatory technique to diagnose pharyngeal diverticulum or Zenker
diverticulum, named for Friedrich Albert von Zenker (1825–1898), who rst
described this pathological entity in 1867 [2]. The most signicant advancement in
the study of the esophagus came about with the development of the endoscope and
illumination devices which now allowed direct visualization of this organ and the
exible beroptic endoscopy by Basil Hirschowitz (1925–2013) and his student
Larry Curtiss in 1958 [3].
2.2 Eponymic Signs
2.2.1 Meltzer Sign
Samuel James Meltzer (1851–1920) was born in Ponevyeh, Curland, Russia, and
received his medical degree from the University of Berlin in 1882 [4,5]. He emi-
grated to the United States in 1883, worked as a private practitioner, and conducted
research at the Welch Laboratory at Bellevue and Curtis Laboratory at Columbia
© 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_2
44
University College of Physicians and Surgeons (currently Columbia University
Vagelos College of Physicians and Surgeons) [5]. He was appointed director of the
Department of Physiology and Pharmacology at the Rockefeller Institute for
Medical Research in 1906 [4, 6]. During World War I, he was a major in the Army
Medical Reserve Corps of the United States. His research focus involved the science
of physiology and the practical application of clinical medicine [4, 6].
He was a cofounder and served as the rst president of the American Association
for Thoracic Surgery in 1918; president of numerous societies and organizations,
including, among others, the American Physiological Society in 1888, the
Association for the Advancement of Clinical Research in 1909, the American
Society for Clinical Investigation in 1912, the Society for Experimental Biology
and Medicine, the American Gastro-Enterological Society, the Harvey Society,
Association of American Physicians, the Society for Experimental Pathology, the
American Philosophical Society, the National Academy of Sciences, and the
American Association of Pathology and Bacteriology [4–8].
As a tribute to his character by the staff of the Rockefeller Institute for Medical
Research:
His leadership and his contributions are second to the contributions of no other man in their
signicance for this generation of medical men. Dr. Meltzer’s interest in humanity tran-
scended the eld of his medical activities. In the spirit of human cooperation, he desired to
include all men, so that there might glow, across the boundaries of nations, a desire for
progress in the direction of universal ideals. These great interests were recognized, not only
in this country, but in Europe as well, and gave Dr. Meltzer a unique position as a lover of
his kind [8, p.88].
Meltzer describes the movement of food into the esophagus during the act of swal-
lowing (Table2.1):
When auscultating at the epigastrium or near the xiphoid process, a sound is heard in almost
all cases during swallowing, indicating that the swallowed mass (preferably liquid) has
entered the stomach. A study of more than 100 persons on this subject produced the follow-
ing results: In most cases examined, a long noise was heard 6–7seconds after swallowing
began, as if air or liquid was being pushed through a previously closed sphincter. I call this
sound a Durchpreßgeräusch [pressing noise]. In a minority of cases, a distinct hissing sound
is heard immediately after the rst moment of swallowing, often as if the swallowed liquid
was running into the stethoscope. One has the impression that the swallowed liquid is
immediately squirted into the stomach without hindrance. Where this noise was present,
there was no pressing sound. In some cases, the former was present only more or less sug-
gestively, and afterward, the latter was heard but weak; only in a few cases was the sound
absent [9,p.2]. (…) In most cases, one hears in the epigastrium a constant pressing noise
occurring 6–7seconds after the start of swallowing. From this, we conclude that the cardia
is normally closed and that the mass for the individual swallowing arrives 6–7seconds
above the cardia. A distinct squeezing sound is heard immediately after swallowing when
the cardia is quiet. I bear no hesitation in pointing out that the distinct presence of the sound
is a sure symptom of esophageal insufciency [9, p.4].
Thus, Meltzer found that the second sound is either delayed or absent in cases of
esophageal obstruction.
2 Oropharynx andEsophagus Signs
45
2.2.2 Roger Sign
Georges Eugène Henri Roger (1860–1946) was born in Paris, France, and served as
an extern in 1881 and intern at the Hospitals of Paris in 1883 [10, 11]. He was a
physician at Concours du Bureau Central Hospital and earned his agrégé in 1892
[12]. He was appointed physician to the Contagious Hospital at Porte d’Aubervilliers
and head of the laboratory from 1895 to 1903 and the Charité Hospital in 1903, fol-
lowed by the Hôtel-Dieu Hospital [10–12]. He was appointed professor of the
Department of Experimental and Comparative Pathology of the Faculty of Medicine,
the University of Paris in 1904, professor at the Institute of Colonial Medicine in
1905, and dean of the Faculty of Medicine from 1917 to 1930 [10–12].
Roger co-founded the journal La Presse Médicale and received honorary doctor-
ates from Edinburgh, England; Cluj, Romania; and Vilnius, Lithuania [11]. He was
president of the Association of General Medicine in 1890 and the National Academy
of Medicine in 1910 [11, 12]. He was knighted in 1908 and elected member of the
Academy of Medicine of Paris for the section of pathological anatomy in 1910, as
well as the Academies of Milan, Warsaw, Turin, Madrid, and Buenos Aires [10–12].
He was Commander of the Legion of Honor in 1923 and was crowned from Italy,
Romania, and Poland. He was appointed a foreign correspondence in 1924 and
Foreign Honorary Member in 1926 [10].
As to a description of his character by Bénard:
He was one of the greatest intellects of his time, with a mind open to all knowledge. A man
of science and a ne scholar in love with art, history, and philosophy—in a word, with the
most varied culture. Such is the memory left behind by the distinguished personality of
Henri Roger [13, p.651].
Roger was the rst to describe the esophago-salivary reex (Ta ble2.1):
The signicance of the esophago-salivary reex is obvious. When a large food bolus stops
within the esophagus, the ow of saliva facilitates its progression. M.Carnot has observed
that in humans, catheterization of the esophagus causes a ow of saliva, sometimes so
abundant that the liquid ows freely out of the mouth. It is important, says this author quite
rightly, when carrying out this gastric chemistry test, tilts the subject’s head forward to
avoid swallowing saliva and diluting the gastric juice [14, p.150–151]. (…) In summary,
the excitations of the esophagus depends on the function of the salivary and glands within
the mouth. They provoke an abundant secretion, and the liquid produced by them stimulates
the pharynx and, consequently, promotes esophageal contractions. It is by a circuitous
mechanism that the esophagus responds to excitations. Incapable of contracting effectively,
the esophagus facilitates the pharynx’s excitability by stimulating the buccal secretions.
This set of reexes stimulates esophageal movement resetting the reex to its starting point
[14, p.156].
Roger also recognized the presence of a gastro-salivary reex caused by increased
acid within the stomach due to hyperacidity:
The meaning of this ow of saliva seems obvious to me. Saliva is an alkaline liquid. In cases
of gastric hyperacidity, it neutralizes the contents of the stomach and prevents both the
action of fermentation acids and the action of hydrochloric acid. All physicians who have
observed hyperchlorhydrics know how frequently sialorrhea occurs in these patients. As
2.2 Eponymic Signs