I am grateful for the correction of our reference to Fox's sign and for Mr. JA Fox's receipt of due credit for noticing that limitation of inguinal bruising by the inferior insertion of Scarpa's fascia is associated with retroperitoneal hemorrhage.1,2 Even though the sign is well known the origin of the eponym is not. We could not locate it despite a search of textbooks and PubMed. We were blinkered by a reference to George Henry Fox on a website dedicated to medical eponyms into searching for a 19th century reference. George Henry Fox was a pioneer of medical photography and appeared to be a good candidate for the eponym but a search of his textbooks and of Index Medicus was negative.
Our observation of skin staining by retroperitoneal bile being limited by the insertion of Scarpa's fascia is compatible with JA Fox's report. The lower margins of Scarpa's fascia have been well documented but the upper and lateral insertions are less well known.3 The volume and distinctive color of bile permitted demonstration of all the borders of Scarpa's fascia which were photographed in our report of Icterus Marginatus. Knowledge of this anatomy is not only important to the recognition of several medical conditions but it is increasingly required in reconstructive surgery.4
This report not only described a novel clinical sign but also placed it within its historical context and suggested appropriate care.1 This was achieved within the journal's tight word and reference restrictions. Scholarship eroded or scholarship confined?
1.McAlister VC, Sener A. Demarcated truncal jaundice: a sign of retroperitoneal bile leakage. Ann Intern Med 2005;142(5):389.
2.Fox JA. A diagnostic sign of extraperitoneal haemorrhage. Br J Surg 1966;53:193-5.
3.Martin BF. The formation of abdomino-perineal sacs by the fasciae of Scarpa and Colles, and their clinical significance. J Anat 1984;138(Pt 4):603-16.
4.Worseg AP, Kuzbari R, Hubsch P et al. Scarpa's fascia flap: anatomic studies and clinical application.Plast Reconstr Surg 1997;99:1368 -80
Vivian C. McAlister. "Icterus Marginatus" Annals of Internal Medicine 13 Feb 2006. http://annals.org/content/142/5/389.short/reply