Westphal, Carl

Abstract

German neuropsychiatrist Carl Westphal (1833–90) and German neurologist Wilhelm Erb (1840–1921) independently described the knee jerk in 1875. Although Westphal concluded erroneously that the knee jerk was due to a local excitation and contraction of muscle, rather than a neutrally mediated reflex response, he nevertheless began the important work of establishing its clinical significance when either hyper- or hypoactive. He noted the co-occurrence of hyperactive knee jerks, ankle clonus, and hypertonicity on the side of hemiparesis or in both legs in patients with paraparesis. He also noted that the knee jerk and ankle clonus “were invariably absent in all examined cases of established tabes dorsalis” – a phenomenon later referred to as Westphal’s sign. Westphal’s many other contributions included his description of agoraphobia in 1871; his description of a patient with choreoathetosis and rigidity in 1883, later considered as an early description of hepatolenticular degeneration; and his demonstration of the accessory nucleus of the oculomotor nerve (the Edinger–Westphal nucleus) in the adult in 1887, 2 years after Ludwig Edinger’s description of the nucleus in the fetus.