EPONYMS IN MEDICINE REVISITED

The Oxford Concise Medical Dictionary defines an eponym as “…a disease, structure, or species named after a particular person, usually the person who first discovered or described it”. [7, p.248] The word “eponym” is derived from the Greek “epi” which means “upon” or “in addition”, and “onyma” which implies “name”. Eponyms are widely applied in contemporary life. In many cases their use is so pervasive that they are not always acknowledged as eponyms. In the web site “whonamedit.com” an effort is being made to catalogue more than 15 000 medical eponyms and more than 6000 persons.

Eponyms are particularly abundant in medicine as well as in all branches of science. In medicine since ancient times proper names have been applied to anatomic structures, syndromes, diseases, medications, procedures, operations, instruments. Eponyms usually commemorate actual persons, but some derive from literature or mythology. For example, Munchausen syndrome (a mental disorder in which the patient persistently tries to obtain invasive hospital treatment for an illness that is nonexistent), Lazarus complex (spontaneous return of circulation after attempts to resuscitate fail), Oedipus complex (repressed sexual feelings of a child for its opposite-sexed parent, combined with rivalry towards the same-sexed parent).

Some medical fields, such as rheumatology and neurology, are particularly fond of eponyms, and the term “eponymophilia” has been coined to describe their affinity. [5]

Nevertheless, during the last decade the use of eponyms has become the subject of intense debate. The supporters of medical eponyms claim that they “…bring colour to medicine, provide a convenient short hand for the profession and the community alike, and they embed medical traditions and culture in the history.” [10, p.425] Certainly, it may be more convenient for physicians to speak about Fallot’s tetralogy rather than about congenital cyanotic heart disease due to ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and aortic dextroposition. Similarly, medical professionals are likely to apply a term Fanconi syndrome instead of hereditary disorder of renal tubular function with vitamin D resistant renal rickets. As a rule, eponyms are shorter than their non-eponymous counterparts. It takes significantly less time to define a neoplasm as Evans tumour as opposed to low-grade fibromyxoid sarcoma. While it is considered a standard to include both names in published papers, in everyday practice using just the eponym would be sufficient to convey the necessary information. Secondly, there is a group of common conditions whose eponymous names are so deeply rooted in both medical practice and everyday life that it is hard to imagine them abandoned (e.g., Crohn disease, Alzheimer disease, Down syndrome). Furthermore, eponyms often provide a historical context to the description of the syndrome and a link to the development of medical science.

According to Wright V. “…the aetiology of the use of eponyms is multifactorial, and not all the reasons for their use are despicable.” [12, p.1600] This scientist provides the following rationales for eponymous terms usage: hiding distressing aspects of a disease (e.g., Hurler’s syndrome is preferable to gargoylism); crediting the origin of a new understanding; directing attention to the original article; a basis for argument about precedence.

Opponents of eponymous terms state that “…this system of nomenclature which simply commemorates a person is inconvenient, poses difficulties to students and leads to frequent mistakes in scientific writings”. [9, p.1] However, they agree that eponyms can be useful in describing multi-symptomatic medical conditions or complex surgical procedures whose specific descriptions are difficult to remember and describe.

In addition, the opponents of eponymous terms assert that they may lead to confusion owing to their inconsistent application between countries and medical specialties, since national pride results in some names prevailing over foreign terminology, resulting in overlapping descriptions. For example, Reiter syndrom is known as Fiessinger-Leroy syndrome in France, after French physicians who described some cases shortly after Reiter.[6, p.1499] Alkylosing spondylitis is known variably as Bekhterev’s syndrome, Bekhterev-Strumpell-Marie disease, Marie’s disease, Marie-Strumpell arthritis, Pierre- Marie’s syndrome and so on. In addition, different ways of spelling add another level of complexity.[5, p.1328] Similarly, Plummer-Vinson syndrome in the United States (and Australia), Paterson-Kelly’s syndrome in the United Kingdom, and Waldenstrom-Kjellberg syndrome in Scandinavia all describe sideropenic dysphagia. Besides, there are differences even within countries. For instance, cholecystography was known as such in Melburn but called the Graham test in Sydney.[10, p.425]

Scientists who disparage eponyms and discourage their use point to the observation that attribution can be inaccurate in fact or priority. For example, the eponymous distinction of Takayasu arteritis for the inflammatory large vessel disease was awarded to physicians who failed to recognize important features of “their” disease.[6 ] Moreover, this disease had been recognized by numerous physicians well before Takayasu.

Another historical example of lax usage of eponymous terms is the use of the term Down syndrome. The 19^th-century physician John Langdon Down did not discover the famed genetic disorder, but he did assign it the name “mongolism”. In the 1960s, to purge medical journals of embarrassingly racist term (Down believed sufferers bore some resemblance to Mongols), researchers instead opted for an eponym and falsely gave credit to Down. [1] Nevertheless, due to Wright V., the term “Down syndrome” sounds “…much more humane.” Besides, it avoids “…suggestions of racial prejudice.” [12, p.1600]

Recently scientists have begun the campaign of stripping eponym-status from physicians with Nazi links. The most cited example is Hans Reiter, the namesake of Reiter’s syndrome, a type of arthritis that can cause painful inflammation in the joints, skin, genitals and eyes. In 2003, Panush R., Paraschiv D., Dorff R. reported on biography of Hans Reiter, after whom a form of reactive arthritis was named despite the fact that others had described the condition before him. Apart from being an outspoken lecturer in favour of “racial hygiene”, Reiter served on the advisory board to Hitler’s physician, Karl Brandt, who headed the infamous “euthanasia” programme. This systematic killing of patients with mental and other illnesses developed the killing mechanism utilized in the genocide of the Jews, the Roma, and Sinti people. Moreover, Reiter approved not only the sterilization programmes but also the deliberate infection of concentration camp inmates with rickettsia.[8] The above-mentioned report by Panush et al. led many physicians, particularly in the USA and Germany, to abandon the use of the eponym in favour of a more descriptive name. However, there is no consistent approach to these issues within rheumatology community. Some physicians have disdained its use, whereas others continue to use of the eponym.[11, p.706]

For all these reasons there is a tendency to dispose of the usage of eponyms. Most of the greatest medical discoveries of the 20^th century are markedly non-eponymous. Dr Michael Gottlieb’s landmark 1981 discovery of a mysterious condition that attacks the immune system was given the name “acquired immune deficiency syndrome – AIDS” instead of Gottlieb’s syndrome. Italian physician Carlo Urbani described a highly contagious lung syndrome in 2003. Nonetheless, we know his discovery by the name “severe acute respiratory syndrome, or SARS”.[1]

Nevertheless, despite the questionable nature of some eponyms, one cannot deny their functional convenience. When a new discovery is made, an eponym becomes the simplest way for medical professionals to reference this discovery. Many years may pass before scientists provide accurate explanation of the true mechanism of findings. Most scientists agree that whatever their fallibility, eponyms illuminate the lineage of scientific endeavours, bring the colour of old time, and continually remind of the international nature of science. Selection of an apt eponym attests to a physician’s range of knowledge, stimulates a reader’s curiosity, and prompts a search for the original source. Even though eponyms may seem old-fashioned, they remain a valuable tradition and form a bridge across the generations of physicians.

References:

1. Death of the eponym: naming diseases after doctors is a practice in decline. – National Post. – Dec.2. – 2011

2. Haubrich W. In defense of eponyms. – British Medical Journal. – 2002 – vol.25 – No 1– p. 31

3. Jana N., Barik S., Arora N. Current use of medical eponyms – a need for global uniformity in scientific publications. – BMC Medical Research Methodology. – 2009 – No 9 – p.18

4. Linda B., Kevin C.Chung. In defense of eponyms. Plastic and Reconstructive surgery. – 2012 – vol.129 – No 5 – pp. 896-898

5. Matteson E., Woywodt. Eponymophylia in rheumatology. Rheumatology. – 2006 – No 45. – pp. 1328-1330

6. Mora B., Bosch X. Medical eponyms: time for a name change. – Archives of Internal medicine.- 2010 – vol.170 – No 16 – pp.1499-1500

7. Oxford Concise Medical Dictionary. Oxford University Press. – 2007 – 807 p.

8. Panush R., Paraschiv D., Dorff R. The tainted legacy of Hans Reiter. – Seminars in Arthritis and Rheumatism – 2003 – No 32 – pp. 231-236

9. Waseem M., Khan M., Hussian N., Giannoudis P., Fisher J., Smith R. Eponyms: Errors in clinical practice and scientific writing. – Acta Orthopedica Belgica. – vol. 71 – No 1 – 2005

10. Whitworth J. Should eponyms be abandoned? No – British Medical Journal. – 2007 – vol. 335 – p. 425

11. Woywodt A., Lefrak S., Matteson E. Tainted eponyms in medicine: the “Clara” cell joints the list. – European Respiratory Journal. – 2010 – vol.36 – No 4 – pp. 706-708

12. Wright V. In defense of eponyms. – British Medical Journal. – 1991 – vol. 303 – No 6817 – pp.1600-1602

 

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