Harrison's Grooves – Edwin Harrison (1779–1847) or Edward Harrison (1766–1838)?

The physical diagnostic sign of Harrison's Groove or Sulcus refers to a groove on the anterior region of the chest at the level of the sixth and seventh costal cartilages at the anterior insertion of the diaphragm. Theories of causation include negative intrathoracic tension causing indrawing of the ribs, pulling of the diaphragm, both in the normal state and in rickets and asthma. Naish and Wallis reviewed and discussed the obscure origin of the term, pointing out that three of the standard medical dictionaries, Dorland's, Stedman's, and Gould's, attribute the eponym to Edward Harrison but they point out that an account of the deformity cannot be found in any of Harrison's works. Because of this uncertainty, Sir Frederic Still (1868–1941) was unable to include a comment on the grooves in his History of Paediatrics. Naish and Wallis were able to find and review the publications of Edwin Harrison and have attributed the name to him. However, the authors fail to discuss the association of the two Harrisons with this physical sign and the resultant confusion of ownership. ¹

Edwin Harrison was a physician to the St Marylebone Infirmary. From his few publications it seems he had an interest in chest disorders and, in particular, in the physical examination of the chest. Dr Charles JB Williams (1805–1889) was a friend of Edwin Harrison and due to the latter’s ‘peculiar repugnance to authorship’, Williams published an article on the grooves and gave the credit of this new physical finding to Edwin. ²

This brings up the question, how and why was Edward Harrison ever connected with this finding and where did the confusion arise? Edwin Harrison’s description was of a normal physiological finding used to determine the level of the diaphragm, and in turn, the abdominal organs below it. Edwin did not use it to describe a pathological groove, as is described in cases of rickets and other pathological conditions exhibiting the sign. He was using it to describe the normal retraction of the groove with each respiration.

Edward Harrison (1766–1838) practised in both Horncastle and London, his area of interest being treatment of spinal curvature and other spinal disorders.^3,4 However, Edward did describe abnormalities of the chest, ribs and chicken breast in his paper ‘Remarks upon the different Appearances of the Back, Breast, and Ribs, in persons affected with Spinal Diseases’. ⁵ He describes the distorted ribs and chest seen in patients with chicken breast and scoliosis: ‘Crookedness in the dorsal spine not only affects the back but leads to a derangement of the sternum and ribs, highly prejudicial, in many ways, to the subject of it. The ribs are firmly joined to the vertebrae, by a double articulation at one end, and to the sternum, by a single one at the other. When we examine this curious mechanism, it is discovered immediately, that the ribs, fixed and bound by ligamentous attachments, can only be moved upwards and downwards. In this direction they slide gently, at every respiration, over the thoracic viscera, neither inducing pressure, irritation, nor squeezing. The ribs become very differently affected in respect to these organs, when the vertebrae, forced from their natural places, drag them into new situations. The direction of the ribs being thus changed, the sides of the chest become flatter, or their edges are turned towards the costal pleurae. The sternum is likewise driven from its original station, in consequence of its connexion with the ribs. In this manner the thorax often gets disgustingly misshapen, and dangerously contracted within. The fore-part, instead of preserving its beautiful rotundity and capacious extension, so indispensable to the easy and uninterrupted performance of the complicated internal functions, becomes peaked, or what is called chicken-breasted’. This description of the change in the direction of the ribs and the sides of the chest becoming flatter could have been interpreted as a type of groove or sulcus in the anterior chest and thus could have been interpreted by readers as this physical sign of ‘Harrison’s Groove’. An illustration in Harrison’s article demonstrates a plaster cast of a patient with severe scoliosis and chicken breast and with resultant horizontal grooves due to the flexion compression of the chest that also could be interpreted as grooves. Chicken (Pigeon) Breast (Pectus Carinatum) appears also to be associated with Harrison grooves. Naish and Wallis’ own study found a correlation with these two physical signs particularly in patients with asthma. This adds to the confusion in the origin of the sign.

However, there may be a simpler explanation, a typographical error, a simple editorial mistake.

In the papers in the London Medical Journal, Dr Williams refers to his friend, Edwin Harrison, and his connection with this finding. Charles James Blasius Williams (1805–1889) then wrote in his 1839 book ‘The existence of this furrow, and its use a sign of limits, were first pointed out to me by my friend, Dr Edwin Harrison. Later (p. 44) he states ‘My friend, Dr Edward Harrison (p. 19), has studied these marks so successfully, that he can discover in many cases, by simple inspection, the height of the diaphragm and liver’. ⁶ Williams was referring to the same findings and was referring to Edwin on both occasions. Then, in 1845 the works of Williams were revised in another American version where he writes (p. 26) ‘These appearances have been pointed out by Dr Edward Harrison, as visible indications of the height of the diaphragm and liver.’ ⁷ There is no mention of Edwin. An obvious typing error had occurred. Anyone reading this volume would associate Edward Harrison with the grooves and not Edwin. Thus this editing mistake may have been the cause of the confusion. Edwin Harrison deserves the credit for the discovery of Harrison’s Grooves.