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46
M.Linossier points out, in three cases, sometimes the saliva produced in excess is swal-
lowed and neutralizes the gastric contents. At other times it ows outside the mouth or, as a
consequence of a spasm of the cardia, accumulates in the lower part of the esophagus to be
rejected later in the form of aqueous pseudo-vomiting. Thus, the neutral or alkaline vomit-
ing of hyperchlorhydrics is explained [14, p.161–162].
Thus, Roger sign refers to the esophago-salivary and gastro-salivary reexes.
2.2.3 Frimaudeau Sign
There is limited historical information on Achille-Henri-Louis Anastase Frimaudeau
(1886–?). He served as a provisional intern of the Hospitals of Bordeaux and
Medical Electricity Service and was a laureate of the hospital [15, 16]. He received
his medical degree based on the thesis titled “Diagnostic et étude des rétrécisse-
ments de l’œsophage par la radioscopie” (Diagnosis and study of esophageal stric-
tures by radioscopy) in 1911 [15]. He was an ofcer in the Military Health Services
in 1911 [16].
Frimaudeau described the appearance of the esophagus in patients with esopha-
geal stricture and cancer (Table2.1):
The various stenoses are preceded by dilatations of different shapes, which aid in the under-
lying diagnosis. Thus, cancerous strictures assume a cup shape dilation of the esophagus,
which contains a regular and round bottom. Cicatricial stenoses, on the contrary, are com-
plicated by conical dilation. We explain the fact in this way: most cancerous stenoses are
due to the increase in the volume of neoplasm starting from one esophageal wall and grow-
ing towards the esophageal lumen. Neoplastic inltration never extends far upstream from
the stenosis. Above the neoplasm, the esophageal walls are exible, easily dilated, and
round in shape under the pressure of the bismuth liquid. On the contrary, cicatricial stenoses
lie between the completely sclerotic zone and normal walls and an intermediate zone of
semi-sclerosis whose dilatability decreases from top to bottom, causing this to dilate in a
funnel shape [17, p.542–543].
Thus, Frimaudeau sign refers to the “cup-shape” esophagus in patients with a stric-
ture secondary to esophageal carcinoma and “funnel-shape” in cases of esophageal
stricture caused by brosis.
2.2.4 Boyce Sign
John Welch Boyce (1871–1930) was born in Sligo, Pennsylvania, USA, and served
on the staff of West Penn and South Side Hospitals [18]. He was a consulting physi-
cian for the Eye and Ear Hospital and visiting physician for the Mayview City
Hospital, Pennsylvania. Boyce was a major in the Medical Reserve Corps at Camp
Jackson’s medical department [18, 19]. He served as president of the Allegheny
County Medical Society. He also studied law and was admitted to the Allegheny
County Bar [18].
2 Oropharynx andEsophagus Signs
47
Chevalier Jackson (1865–1958) attributed Boyce sign to Dr. John W.Boyce, a
consultant, and colleague of Jackson. In Jackson’s book Peroral Endoscopy and
Laryngeal Surgery, published in 1915, he reported a nding described by Boyce in
patients with a pharyngeal diverticulum (Table2.1):
The chief symptoms are cough, regurgitation of food, gurgling sound and subjective sensa-
tion on swallowing, a peculiar sour odor to the breath, and difculty of swallowing. Boyce’s
sign can usually be elicited immediately after swallowing. It consists in a gurgling sound
produced by pressure of the hand on the side of the neck. A fresh swallowing movement
without food or water is needed for each test. The sound is probably made by forcing out of
air and bubbles of secretion from the sac. All symptoms are valueless diagnostically, but
they are urgent indications for esophagoscopy [20, p.544–545].
Interestingly, Albert Boyce Barrow and Joseph Cunning described the case in 1905
of a 55-year-old woman who:
During the previous six months there was a marked increase in the difculty of swallowing
solid food. She volunteered the information that she had regurgitated, not vomited food
quite unchanged as long as three days after taking it. As instances, she gave a pickled onion
and portions of rabbit. She also complained that stooping caused regurgitation and that she
made a curious noise on swallowing. The patient looked so thin and half-starved that sev-
eral surgeons who saw her were tempted to say, “Oh! She looks as if she had a malignant
disease.” On examination of the neck no swelling or enlargement of the glands could be
detected, but on bilateral pressure over the oesophagus just below the level of the cricoid
cartilage, a certain amount of gas could be squeezed up into the mouth. On swallowing two-
or three-times gas could again be squeezed up. A medium sized bougie stopped eight inches
from the teeth and could be felt to the left of the trachea. A small bougie could be passed
into the stomach. As an oesophageal pouch was now suspected from the history of regurgi-
tation of unchanged food and from being able to squeeze up gas on pressure at the base of
the neck two bougies were passed together. The rst went into the pouch, the second into
the stomach [21, p.928–929].
Thus, Boyce sign refers to a gurgling sound auscultated on the side of the neck when
pressure is applied in cases of an esophageal diverticulum.
2.2.5 Clerf Sign
There is limited historical information on Louis H.Clerf. He was a fellow of the
College of Physicians of Philadelphia, USA, in December 1931 [22]. At that time,
he was an instructor in bronchoscopy and esophagoscopy and a demonstrator of
laryngology at Jefferson Medical College in Philadelphia, Pennsylvania. His other
appointments included being an assistant professor in the Department of
Bronchoscopy and Esophagoscopy at the Graduate School of Medicine at the
University of Pennsylvania. He was also a chief clinical assistant in the Department
of Bronchoscopy and Esophagoscopy at Jefferson Hospital and an assistant in
Bronchoscopy and Esophagoscopy at the University Hospital Philadelphia,
Pennsylvania [22].
2.2 Eponymic Signs
48
He and Chevalier Jackson described the method of diagnosing an esophageal
diverticulum (Table2.1):
A tentative diagnosis of diverticulum can be made from the symptoms and the Boyce and
Clerf signs. The patient is asked to swallow, which puts air in the diverticulum. Pressure
with the ngers low on the neck will force out the air and cause a gurgling sound heard at
the patient’s open mouth (Boyce sign). If, by indirect mirror laryngoscopy, the laryngeal
mirror be watched, bubbles will be seen to emerge from one or other pyriform
sinus[23, p.295–296].
Thus, Clerf sign refers to the presence of air bubbles seen on indirect laryngoscopy
in patients with pharyngeal diverticulum.
2.2.6 Heimlich Sign
Henry Judath Heimlich (1920–2016) was born in Wilmington, Delaware, USA, and
received his medical degree from Cornell Medical College, NewYork City, in 1943
[24, 25]. He served in the Navy during World War II and, upon his return, was a
thoracic surgical resident in NewYork City, including the Veterans Administration
Hospital from 1946 to 1947, Mount Sinai Hospital from 1947 to 1948, Bellevue
Hospital from 1948 to 1949, and Triboro Hospital from 1949 to 1950 [26]. He was
an attending surgeon and director at Monteore Hospital, Bronx, from 1950 to 1968
[24, 26]. Heimlich was appointed director of surgery at the Jewish Hospital,
Cincinnati, Ohio, until 1977 and professor of Advanced Clinical Sciences at Xavier
University in 1977 [24].
He received the Lasker Award in 1984 and an honorary Doctor of Science degree
from Wilmington College in Delaware in 1981; the Adelphi University, NewYork,
in 1982; the Rider College, New Jersey, in 1983; and the Alfred University,
NewYork, in 1993 [26]. Heimlich founded and served as president of the Heimlich
Institute in Cincinnati, Ohio (located at the Deaconess Hospital), from 1977 to 1989
[26]. He was the inventor of a valve named the Heimlich chest drain valve used to
remove pleural uid [24, 25]. His maneuver and other aspects of his professional
career remain controversial and contentious.
Heimlich described a sign and maneuver to recognize and prevent choking on
food. Heimlich proposed that the chocking victim use this sign as a way to notify
others that he/she is chocking (Table2.1):
It is necessary, therefore, to introduce a universal signal that the victim can use and that a
rescuer can recognize to indicate that this accident has occurred. I recommend that the
victim grasp his neck between the thumb and index nger of one hand to signal he is chok-
ing on food [27, p.398].
The abdominal infradiaphragmatic pressure maneuver was rst published in June
1974in Emergency Medicine in a paper titled “Pop goes the café coronary” as a
method for dislodging food occluding the oropharynx or trachea [28]. The
2 Oropharynx andEsophagus Signs
49
maneuver, named in honor of Heimlich, who was the rst to describe the technique,
is performed with the victim standing or sitting or if in a supine position [29]. In the
standing or sitting position:
Standing behind the victim, the rescuer puts both arms around him just above the belt line,
allowing head, arms, and upper torso to hang forward. Then, grasping his own right wrist
with his left hand, the rescuer rapidly and strongly presses into the victim’s abdomen, forc-
ing the diaphragm upward, compressing the lungs, and expelling the obstructing bolus. The
same effect can be observed with the victim lying face down on the oor, the rescuer silting
astride (the victim’s lower torso or buttocks). If, however, the victim is already lying on his
back, he needn’t be moved. The rescuer merely sits astride him and suddenly presses both
hands—one on top of the other—forcefully into the upper subdiaphragmatic abdominal
region [28, p.154].
The 2020 guidelines for managing a foreign body obstructing the airway recom-
mend that in children and adults, back slaps be used when the victim has an ineffec-
tive cough. When back slaps are ineffective than in adults and children (>1year), an
abdominal thrust is applied [30].
Table 2.1 Oropharynx and esophagus signs
Name Year Description of sign Signicance
Meltzer [9] 1883 When auscultating at the epigastrium or near the
xiphoid process, the rst sound (pressing sound) is
heard 6–7s after swallowing, indicating that the
swallowed mass (preferably liquid) has entered the
stomach. Sometimes, a distinct second hissing sound
is heard immediately after the rst swallowing
sound. The second sound is weak and may be absent
in esophageal insufciency
Esophageal
dysmotility
Roger [14] 1907 When a large food bolus stops within the esophagus,
a ow of saliva occurs, facilitating its progression
Esophago-
salivary reex
Frimaudeau [17] 1911 Cancerous strictures are preceded by cup shape
dilation of the esophagus—a dilation with a very
regular and round bottom. Cicatricial stenoses
assume a conical dilation
Shape of
esophagus on
barium
esophagram
Boyce [20] 1915 A gurgling sound occurs while pressing on the side
of the neck after swallowing
Pharyngeal
diverticulum
Clerf [23] 1926 The patient is asked to swallow. Pressing low on the
neck force air out, causing a gurgling sound at the
patient’s open mouth (Boyce sign). By indirect
mirror laryngoscopy, bubbles emerge from one or
other pyriform sinus
Pharyngeal
diverticulum
Heimlich [28] 1974 The victim grasps his neck between the thumb and
index nger of one hand
Chocking
2.2 Eponymic Signs
50
2.3 Conclusion
There are a few signs referable to the esophagus. Interestingly, Albert Boyce Barrow
and John Welch Boyce described a gurgling sound occurring after pressing on the
side of the neck. Included is the Heimlich sign, which, in 1975, received widespread
notoriety for the universal description of choking, which involved the victim to
grasp his neck between the thumb and index nger of one hand as a method of
informing others that he/she is choking. As widely recognized, he described the
maneuver for aiding choking victims, which has since been replaced by an alterna-
tive method.
References
1. Skinner HA.The origin of medical terms. Baltimore: Williams & Wilkins; 1949. p. 1110.
2. Zenker FA, von Ziemssen HW.Krankheiten des Oesophagus. Leipzig: F.C.Vogel; 1867.
3. Hirschowitz BI, Curtiss LE, Peters CW, Pollard HM.Demonstration of a new gastroscope, the
berscope. Gastroenterology. 1958;35:50–3.
4. [No author]. Obituary: Samuel J.Meltzer, MD.Med Rec. 1920;98:824.
5. Howell WH.Biographical memoir: Samuel James Meltzer, 1851–1920. Mem Nat Acad Sci.
1926;21:1–20.
6. Meltzer SJ.The Rockefeller University. Digital Commons. https://digitalcommons.rockefeller.
edu/faculty-members/49/. Accessed 3 Nov 2022.
7. Brainard ER.History of the American Society for Clinical Investigation, 1909–1959. J Clin
Invest. 1959;38:1784–837.
8. [No author]. Samuel J.Meltzer. Science. 1921;53:88.
9. Meltzer SJ. Schluckgeräusche im Scrobiculus cordis und ihre physiologische Bedeutung.
Centralbl med Wissensch. 1883;21:1–4.
10. Roger H.Académie royale de Médecine de Belgique. Fédération Wallonie-Bruxelles. http://
old.armb.be/index.php?id=4500. Accessed 10 Nov 2022.
11. Rouvillois H, Trémolières F, Hennet S, Wauthier A. Roger GEH.Comité des travaux his-
toriques et scientiques; 15 Dec 2020. https://cths.fr/an/savant.php?id=4637. Accessed 10
Nov 2022.
12. [No author]. Élections: Henri Roger. Bull Acad Méd. 1861–1862;27:684.
13. Bénard H. Éloge de Henri Roger (1860–1946). Bull Acad Méd. 1966;150:651–6.
14. Roger GH.Alimentation et digestion. Paris: Masson Cie; 1907.
15. [No author]. Frimaudeau AHLA.In: Bibliographie de la France. Paris: Cercle de la Librairie;
1911. p. 318.
16. [No author]. Annuaire Ofciel de l’Armée Française, Troupes Métropolitaines et Troupes
Coloniales pour 1913. Paris: Berger-Levrault; 1912.
17. Frimaudeau A. Étude et diagnostic des sténoses de l’œsophage par la radioscopie. Arch électr
méd. 1911;19:542–52.
18. [No author]. Dr. John W.Boyce dies in hospital. The Pittsburgh Press; 24 Nov 1930. p. 8.
19. [No author]. Medical Ofcers Reserve Corps Majors: John W.Boyce. Mil Surg. 1917;41:548.
20. Jackson C.Peroral endoscopy and laryngeal surgery. Saint Louis: Laryngoscope Co.; 1915.
21. Barrow AB, Cunning J.A case of oesophageal pouch successfully treated by excision. Lancet.
1905;1:928–9.
22. [No author]. Fellows of the College of the Physicians of Philadelphia. Tr Coll Phys Phila.
1931;53:xviii.
2 Oropharynx andEsophagus Signs
51
23. Jackson C, Clerf LH.Diseases of the oesophagus. In: Osler W.Modern medicine, its theory
and practice, vol. 3: Diseases of metabolism, diseases of the digestive system. Philadelphia:
Lea & Febiger; 1926. p. 283–302.
24. McFadden RD.Dr. Henry J.Heimlich, famous for antichocking techniques, dies at 96. New
York Times; 17 Dec 2016. https://www.nytimes.com/2016/12/17/us/dr-henry-j-heimlich-
famous-for-antichoking-technique-dies-at-96.html. Accessed 6 Nov 2022.
25. Roehr B.Henry Heimlich. Br Med J. 2017;356:j118.
26. Shampo MA, Kyle RA.Henry Heimlich: Heimlich maneuver. Mayo Clin Proc. 2000;75:474.
27. Heimlich HJ.A life-saving maneuver to prevent food-chocking. JAMA. 1975;234:398–401.
28. Heimlich HJ.Pop goes the café coronary. Emerg Med. 1974;6:154–5.
29. [No author]. Simple method relieves café coronary. JAMA. 1974;229:746–7.
30. Olasveengen TM, Mancini ME, Perkins GD, et al. Adult basic life support: international con-
sensus on cardiopulmonary resuscitation and emergency cardiovascular care science with
treatment recommendations. Resuscitation. 2020;156:A35–79.
References
53© 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_3
Chapter 3
Stomach Signs
3.1 Introduction
Ibn Sina (Avicenna) (980–1037), a Persian philosopher and physician, is credited
for being the rst to describe symptoms of gastric ulcers. Regarding tenderness of
the pylorus, he makes the following statement in his famous medical encyclopedia
titled al-Qanun al-Tibb (The Canon of Medicine): “One knows that this tender-
ness is present because pain is felt during the passage of acrid substances through
it” [1, p.502]. Giovanni Battista Morgagni (1682–1771), in 1737, was the rst to
record the pathological ndings of stomach and duodenum ulcers in a 50-year-
old female:
Its mucous coat was ulcerated in several places, and the ulcers appeared recent, and exhib-
ited a gangrenous blackness. Near the pylorus they were minute and crowed, and in the
fundus of the stomach they were larger and more dispersed; but at that part where the stom-
ach begins to expand itself from the termination of the oseophagus, they were of a greater
extent than at any other part [2, p.34].
Jean Cruveilhier (1791–1874) rst described and illustrated the clinical symptoms
and macroscopic pathological appearance of gastric ulcers in his two-volume atlas
Anatomie Pathologique du Corps Humain (Pathological Anatomy of the Human
Body), published from 1829 to 1842 [3]. Georges Maurice Debove (1845–1920), in
1866, presumably the rst eponymous sign ascribed to the stomach, assessed for the
presence of hydrochloric acid in the stomach as a method for differentiating gastric
ulcer from gastric carcinoma. With the advent of radiographic technique and con-
trast, the shift in better understanding peptic ulcers occurred in the rst quarter of
the twentieth century: Lewis G. Cole (1874–1954) in 1908, Martin Haudek
(1880–1931) in 1910, and Russell D.Carman (1875–1926) in 1921 identied spe-
cic pathologic features or signs to differentiate benign from gastric ulcers.
Gastroscopy allowed Norbert K.Henning (1896–1985) to directly visualize the
stomach to assist in the diagnosis of benign gastric ulcer. Other signs were attributed
54
to conditions that directly or indirectly involved the stomach. Described are the
eponymously named signs of the stomach as initially reported, listed chronically
starting from the earliest report.
3.2 Eponymous Signs
3.2.1 Chaussier Sign
François Chaussier (1746–1828) was born in Dijon, France, and served as prosector
under the aegis of Raphaël Bienvenu Sabatier (1732–1811) in Paris [4]. He was a
surgeon in the hospital and prison and a forensic scientist for the courts of Dijon [5,
6]. He lectured on anatomy and comparative anatomy beginning in 1769. The chair
of professor of anatomy was endowed in his honor by the citizens of the State of
Burgundy in 1780 [5, 6].
Chaussier was requested by the government to assist in the organization of medi-
cal education for Paris in 1874 [4, 5]. He returned to Paris and was appointed pro-
fessor of anatomy and later physician to the École Polytechnique and chief
obstetrician to the Hospices de la Maternité (Maternity Hospices) in 1804 [4, 5]. He
was professor of physiology, anatomy, and medical jurisprudence for the district at
the Faculty of Paris until 1822. He was also elected member of the National
Academy of Sciences and the Academy of Medicine [4, 6].
As to a description of his character by a colleague:
Chaussier’s reputation was immense and rightly meritorious. He touched almost all points
of science; anatomic, medicine, surgery; legal medicine, and accouchements proving that
he was a truly superior man in all areas. (…) His work in forensic medicine is stamped with
the corner of great science, great insight, and profound and sagacious attention, and bears
in many places the imprint of a great heart and a truly good man [6, p.574].
Chaussier described an early nding found in women with puerperal convulsion
(eclampsia) (Table3.1):
Considering the seizure and the subsequent development of these symptoms, it is evident
that all characterize nervous irritation and congestion of the blood in the brain. What must
be noted is that these severe cerebral symptoms, the results of a general disorder of the
circulation, are the secondary or sympathetic effect of an irritation which arises in the
abdominal viscera. Nearly almost before the seizure, the patient experience epigastric pain
followed by a heaviness in the stomach and derangements in the digestive functions, which
propagate to the uterus and extend to the brain. Sometimes we have seen women who, dur-
ing a seizure, automatically place their hands on the epigastrium, strike this region hard, and
try to tear it with their nails. However, at other times the irritation seems to begin in the
uterus and thence spread to the stomach and to the nervous system, resulting from the inti-
mate and reciprocal connection between all the parts of the body. Whatever the organ is the
primary seat of the irritation, the uterus is always in a particular state which ought to x all
the attention. If we place the hand on the abdomen and keep it there for some time, we feel
through its walls that the uterus experiences a tonic, permanent contraction, which, how-
ever, increases on the return of the convulsive attacks [7, p.344–345].
Thus, Chaussier described the clinical symptoms of the disease, later named
eclampsia.
3 Stomach Signs
55
3.2.2 Fenwick Sign
Samuel Fenwick (1821–1902) was born in Earlsdon House, Northumberland, near
Newcastle-on-Tyne, England, in 1821 and received his medical degree from St.
Andrews University, Scotland, in 1846 [8–12]. He was a general practitioner at
North Shields, followed by appointments as lecturer on pathological anatomy and
later examiner in medicine at Newcastle-on-Tyne, the University of Durham
Medical School in 1861 [13]. He received an honorary doctorate from Durham
University, England, in 1859 [11].
Fenwick served as a consulting physician at Harley Street, London, in 1862 [9–
11, 14]. He was appointed lecturer of medicine at the London Hospital Medical
College and assistant physician to the City of London (Victoria Park) Hospital for
the Diseases of the Chest and later the same staff appointment at the London
Hospital [10]. He was appointed full physician at the London Hospital in 1879 [14].
He was elected fellow of the Royal Medical and Chirurgical Society of London
in 1863; a fellow of the Royal College of Physicians, London, in 1870; and a mem-
ber of the Pathological Society [9]. His two books, The Student’s Guide to Medical
Diagnosis, rst published in 1869, and Outlines of Medical Treatment, published in
1879, have endured multiple editions [9, 10].
As to his character:
If I were asked to name the feeling with which he inspired us, I should say it was reverence.
He was our revered teacher, for these reasons: his great clinical wisdom and his unique
power of imparting his knowledge to the least of us evoked our admiration; while his cour-
teous, kindly manner to his patients and ourselves won our affection [10, p.673].
Fenwick rst reported and described the case in a 45-year-old male whom he diag-
nosed with atrophy of the stomach (Table3.1). He wrote:
I am, however, not aware that any cases have been published in which the whole of the
secreting structures of the stomach was found after death to be in a state of atrophy, and in
which the symptoms were sufciently well marked to admit of an accurate diagnosis being
made during the life of the patient [15, p.78].
Histological examination found:
The whole of the glandular structure of the organ was in a state of atrophy; in no part could
I succeed in procuring a section of normal tissue. In the pyloric and middle regions the
secreting tubes seemed to be converted into a mass of connective tissue, (…) and it was only
near the cardiac end that a trace of gland structure could be observed [15, p.79].
It is now well-recognized that chronic atrophic gastritis is associated with vitamin
B12 and iron deciency anemia. Interestingly, Fenwick noted the resemblance of
symptoms found in his patients to idiopathic anemia described by Dr. Thomas
Addison (1793–1860). Based on these ndings, he recommended histologic exami-
nation of the stomach and intestines in patients with Addison disease [15, p.80].
3.2 Eponymous Signs
56
3.2.3 Trousseau Sign
Armand Trousseau (1801–1867) was born in Tours, France, and received his medi-
cal degree from School of Medicine in Paris in 1825. He was appointed physician
to the Bureau Central in 1831, was an assistant at Récamier Clinic, Hôtel-Dieu, and
physician to Saint-Antoine Hospital, Sainte-Marguerite Hospital, and eventually
Necker Hospital [16]. He was appointed chair of therapeutics and materia medica of
the Paris Faculty of Medicine in 1839 and professor and chair of clinical medicine
at Hôtel-Dieu in 1852 [17–19].
Trousseau published his three-volume books, Traité de Thérapeutique et de
Matière Médicale (Treatise on Therapeutics and Materia Medica) from 1836 to
1839. He was recognized by the French Academy of Medicine in 1837, being the
recipient of the grand prize for his work titled “Traité pratique de la phthisic laryn-
gée, de la laryngite chronique et des maladies de la voix” (Practical treatise on
laryngeal phthisis, chronic laryngitis and diseases of the voice) and elected member
of the National Academy of Medicine in 1856. His other signicant accomplish-
ments include tracheotomy in croup and thoracentesis in pleural effusions [17, 19].
It should be noted that Armand Trousseau (1856–1919), chief of the clinic of
Hôpital des Quinze-Vingts (Hospital of the Three Hundred [Beds]) and the
Rothschild Eye Institute, was the grandson of Armand Trousseau (1801–1867) [20].
As to a description of his character:
Mr. Trousseau remains as one of the grand medical gures of our time. If he had not genius
to discover, he had it to apply. The fortunate chances of his medical education were happily
joined to his natural disposition. A rare quickness of impression, a greater delicacy of per-
ception, perfected by study, the gift of seeing everything and foreseeing everything, ren-
dered him quick to seize and to x that which was difcult of attainment, and even more
quick to deduce therefrom practical percepts. He lived penetrated with this thought, that in
an epoch of transition such as ours, the physician has nothing better to do than to take ref-
uge, as well as possible, in the unnished edice of medicine. Full off work of the day, men
like Mr. Trousseau are in their lives more useful perhaps than others, but in their death we
have a double loss [21, p.552].
Trousseau sign is one of the few “signs” for which it is appropriate to use the posses-
sive form (Trousseau’s) since he described the physical nding or disease which he
had acquired in association with a gastric tumor: “[i]t is all up with me, the appear-
ance of a patch of phlebitis last night leaves no loophole for doubt as to the nature of
my illness” [22, p.836]. In patients with thrombosis and advanced tuberculosis,
uterine and visceral cancer, Trousseau described the occurrence of spontaneous
coagulation and phlegmasia alba dolens or painful white inammation (Tab le3.1):
I have long been struck with the frequency with which cancerous patients are affected with
painful edema in the superior or inferior extremities, whether one or other was the seat of
cancer. This frequent concurrence of phlegmasia alba dolens with an appreciable cancerous
tumor, led me to the inquiry whether a relationship of cause and effect did not exist between
the two, and whether the phlegmasia was not the consequence of the cancerous cachexia.
(…) I have thus been led to the conclusion, that when there is a cachectic state not attribut-
able to the tuberculous diathesis nor to the puerperal state, there is most probably a cancer-
ous tumor in some organ [23, p.287].
3 Stomach Signs