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Rapid Responses: Rapid Responses published:
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Tendosynovitis
- Weekitt Kittisupamongkol (31 August 2007)
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Standing by Eponyms
- A. Ross Morton (31 August 2007)
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Eponyms
- Raphael Eban (1 September 2007)
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Reiter's carmp
- Reinhard Wentz (1 September 2007)
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How to create a syndrome
- Thomas Krasemann (2 September 2007)
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The dream of your own eponym
- Thomas Krasemann (2 September 2007)
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Should the coroner use eponyms? - Aug 2007
- Phillip J Colquitt (3 September 2007)
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Wood's syndrome?
- Andy Wood (3 September 2007)
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Eponyms deserve a uniform dressing, not a total shredding
- NARAYAN JANA, SUKUMAR BARIK, NALINI ARORA (5 September 2007)
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Modernising Medicine
- Iqbal S Toor (5 September 2007)
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Abandoning Eponyms And Also
- Mark Palmer (5 September 2007)
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U.S. Health Insurance Reimbursement Issue with Eponyms
- Mark Dunham (5 September 2007)
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The Oxford English Dictionary and Eponyms.
- Yuri Zagvazdin (5 September 2007)
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The romance of medicine
- Bob Dunkley (5 September 2007)
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Should eponyms be abandoned?
- Christina Thornhill, N/A (5 September 2007)
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Save the eponyms (or some of them).
- Alexander SD Spiers (6 September 2007)
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I say tenosynovitis you say tendovaginitis...
- Grant M Dex (7 September 2007)
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To name or not to name
- Campbell J Mackenzie (13 September 2007)
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Clarification
- Eric L. Matteson, Alexander Woywodt (13 September 2007)
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Courvoisiers law
- benjamin knight (15 November 2007)
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addendum
- Eric L. Matteson, 200 1st St SW Rochester, MN 55905 USA (17 November 2007)
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Weekitt Kittisupamongkol, General Practitioner Surin Hospital ,Surin,32000,Thailand
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Dear Editor, de Quervain's disease is tendosynovitis not tendovaginitis !. Competing interests: None declared |
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A. Ross Morton, Professor of Medicine Queen's University, Kingston ON K7L 2V7 Canada
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Editor, I enjoyed the debate on the fate of eponyms. I certainly stand in favour of their retention. Indeed I stand squarely on the eponymous region that bears my surname, even though (as pointed out by Woywodt & Matteson) there are two eponymous syndromes related to this anatomic area which could easily cause confusion. One was described by Thomas George Morton and the other by Dudley Joy Morton (both late 19th / early 20th century American Orthopedic surgeons). One wonders if the eponymous name for pain in this part of the body will change with increasing common knowledge of the anatomic area (e.g. Rooney's syndrome) as suggested by Whitworth. AR Morton MD FRCP FRCPC Competing interests: None declared |
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Raphael Eban, Retired Roentgenoloist nw3 5qs
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No. To abandon "a local habitation and a name" is to ignore history and render oneself provincial in time as well as in place. reban1@blueyonder.co.uk' Retired Roentgenologist Competing interests: None declared |
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Reinhard Wentz, Retired Twickenham TW2 7PS
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Madam, one can understand why Reiter’s name should be erased from the collective eponymic memory, but e.g. the paper Hughes RA, Keat AC. Reiter’s cramp. Ann Rheum Dis. 1990 Jan;49(1):57 (which suggested a link between pen and penis), retitled as ‘Triad-of-inflammation-involving-the-eye-(CONJUNCTIVITIS)-the-bone- (POST-INFECTIOUS-ARTHRITIS)-and-the-urethra-(URETHRITIS) cramp’ would, while politically more correct, rather spoil the p/fun, would it not? Sincerely yours, Reinhard Wentz, Dipl. Bibl. Competing interests: None declared |
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Thomas Krasemann, Consultant Paediatric Cardiologist Evelina Children's Hospital, London SE1 7EH
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You first need a name, short and precise. You think of some symptoms, very concise. How many patients do you need then? Do you need twenty? Do you need ten? Do you need one? Or even –none? You then need to publish, interesting stuff, In first class journals, that is enough. Everyone reads you, cites you as well. But you still need a patient, that you can tell. Let’s make an example On such a sample: The name can be Adam, to be used as an acronym. Each letter’s a symptom in this eponym. Alzheimer’s dementia, alopecia And micropenis have we got here. None to be missive, all are progressive. You tell everybody about the syndrome, Travel to meetings, give talks in Rome, Boston, Berlin and all over the world. Everyone listens. You’re the expert! But even if you chase There is no case. Then you get older and less obsessive. Think less of your syndrome (that is progressive). You look into the mirror, “he” is quite small. You look at your head, no hair at all. You cannot remember who is that bloke- You’re your first patient- that’s a good joke! Dedicated to Holger Willenbring, the inventor of ADAM’s syndrome. Competing interests: None declared |
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Thomas Krasemann, Consultant Paediatric Cardiologist Evelina Children's Hospital, London SE1 7EH
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When you enter medicine you find a lot of eponyms. Typically you think of very important doctors whose names are linked to a certain disease, and you want to be as famous at a later stage. You keep your eyes open to find an entity that has not yet been described, that is unique or almost unique, and the anatomical or pathophysiological description is much longer than your own name. You publish, and ideally everybody involved in that subject cites your article, and after a while you’re the expert. But this doesn’t mean your name is used as the eponym for this condition. You need support, others have to be instructed to use the eponym, your name. But it doesn’t work this way. An example: When I was a young consultant in Paediatric Cardiology I performed a cardiac catheterisation in a child with tetralogy of Fallot. I could not find a superior caval vein. Incidentally the head of our department and our cardiac surgeon came along, and when I told them they burst out in laughter, not believeing that the superior caval vein was absent. “If that is the case, you have to publish the case. We’ll call it Krasemann’s syndrome than…” was their comment. Well, there was no superior caval vein, and the case was published as probably the first child without superior caval veins (1). Since then a few description of such cases have been published, but nobody ever referred to this entity with my name as an eponym. But I am quite happy without, even if for a short period I shared the dream of “my own” syndrome. “Absence of the upper caval vein” is much clearer, preciser. Even if my name would have been a very sonorous eponym… But: If you use an eponym, many people will not be familiar and ask for the underlying condition anyway. Why not communicate this directly? References: 1. Krasemann T, Kehl G, Vogt J, Asfour B: Unusual systemic venous return with complete absence of the superior caval veins. Pediatr Cardiol. 2003 Jul-Aug;24(4):397-9 Competing interests: None declared |
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Phillip J Colquitt, Technician/RN Independent Comment
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Every few months or so, new or near new residents come to our ward for their term in colorectal disease/surgery. Inevitably one of them prescribes, either in writing or verbally the eponymous “Shaw’s cocktail”. A parallel group of new graduate nurses, some of whom speak English as a second language, and those nurses on practicum from university, run round asking lots of questions as to what a “Shaw’s cocktail” is. Older nurses who might elucidate usually work in management, and so aren’t available. “Shaw’s cocktail” isn’t an emergency task, but is a mixture used to “treat” severe constipation. Identifying the ingredients via the eponym often takes rather a long time, portrays the staff as inept in key areas of their work, and speaks about the interplay of accuracy and flair in medical education, since the prescribing residents usually can’t specify what’s in said cocktail. While PubMed gives no hits for “Shaw’s cocktail”, Google offers three relevant hits. One actually gives a version of the recipe[1]. Our senior pharmacist rightly rejects the eponym as outside official prescribing guidelines, though the second Google hit actually comes from the pharmacy occupation[2]. The third Google hit shows that a few months ago, the coroner for the state of Queensland-Australia used the phrase “Shaw’s cocktail” though not disparagingly of the eponym, in a published report describing a range of aperient treatments given to a bowel obstructed patient, who subsequently died of severe atherosclerosis of the coronary vessels prior to surgery.[3] It is known that bowel lavage can worsen abdominal distension, precipitate vomiting, and can cause death from aspiration[4]. The hospital involved made systemic changes resulting from the coronial inquiry, to eliminate delay bringing expertise to bear[3]. The inquiry is now apparently closed[3]. “Pink lady”, though not an eponym, equals, and then raises the confusion stakes of “Shaw’s cocktail”. “Pink lady” is an antacid mixture prescribed to help differentiate chest pain thought to have one of two main origins – either the heart, or the acidic burning of gastric contents in the upper digestive tract. The “Pink Lady” and the “GI cocktail” are synonymous, though GI cocktail appears more frequently in the indexes such as PubMed. Randomized trials have argued the merits of “GI cocktail’s” active ingredients[5], and speak again about the need to itemize the ingredients in that which is prescribed. “Pink lady” is also the informal name of voluntary female auxiliary workers at our hospital, who dress in pink uniforms, and who are sometimes called to the ward to help patient’s with such things as laundry. To my knowledge, there have been no instances where a resident responded to a patient’s chest pain by telling the nurse “he needs a Pink Lady”, and subsequently auxiliary workers arrived at the bedside with a laundry bag. [1]Mater Education Centre. Mater Education Centre Resident Orientation Booklet. Reviewed: 2005. Accessed online 3 September 2007 http://www.matereducation.com.au/ssl/1/haematology.pdf [2] Huxagen K. A new Look for an old Friend. In Information to Pharmacists-Your Monthly E-Magazine April 2004. http://www.computachem.com.au/i2P/emag/Issue25/Main25.shtml Accessed 3 September 2007. [3]Rinaudo O. Inquest into the death of Margaret Isabel Horsington. http://www.justice.qld.gov.au/courts/coroner/findings/HORSINGTON-Rinaudo-070501.pdf 3 September 2007 [4]de Graaf P, Slagt C, de Graaf JL, Loffeld RJ. Fatal aspiration of polyethylene glycol solution. Neth J Med. 2006 Jun;64(6):196-8. [5]Vilke GM, Jin A, Davis DP, Chan TC. Prospective randomized study of viscous lidocaine versus benzocaine in a GI cocktail for dyspepsia. J Emerg Med. 2004 Jul;27(1):7-9. Competing interests: None declared |
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Andy Wood, Senior Teaching Fellow In Anatomy University of St Andrews
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It is quite correct to state that new clinical entities are rarely named after their discoverers. Crohn’s disease was described by both Giovanni Battista Morgagni and Antoni Leœniowski, the latter in 1904. The Scottish physician T. Kennedy Dalziel described it in cattle in 1913. It was named after B B Crohn in 1932 and is known to all and sundry by that name. Should this new although commonly encountered clinical entity be called "Wood’s syndrome", not after its discoverer? Competing interests: None declared |
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NARAYAN JANA, Associate Professor of Obstetrics and Gynaecology Institute of Postgraduate Medical Education and Research, Kolkata (Calcutta) 700020, India, SUKUMAR BARIK, NALINI ARORA
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Eponyms deserve a uniform dressing, not a total shredding Editor – The critical comments on the use of eponyms1 have stimulated us to add another new dimension to the debate – “the middle path.” Naming a disease is fundamental in medicine for its identification. Unfortunately, there is no uniform guideline to follow. Although suitable descriptive terminology (e.g., trisomy 21 for Down syndrome) is generally favoured,2,3 the advantages of an agreed eponym cannot be discounted; these are useful substitutes for cumbersome, tongue-twister or offensive designations.3 Despite long-standing debate regarding legitimacy of its very existence, almost ubiquitous presence and eternal endurance of eponym over the centuries suggest that it is here to stay, whether we like or despise it. Twisting the debate, on the basis of minuscule contributors from the Nazi regimen, is unlikely to derail it.1 Eponyms are considered as labels or handles,3 and the non-possessive form is preferable as the “person behind the eponym” has no proprietary claim on it.2,3 In some situations, a possessive form is highly discouraged (after a patient's name e.g., Christmas disease) or unnecessary (e.g., Williams syndrome).3 Whilst in others, a non-possessive form is standard practice (e.g., compound eponym, Mayer-Rokitansky-Küster- Hauser syndrome).3,4 Despite all these benefits, use of eponyms alternates between the possessive and non-possessive form; the variation is arbitrary, not governed by rule.4 The problem was identified more than three decades ago when clear guidelines were suggested by an international working group.2,5 However, the recommendations were not heeded, and the problem has remained unresolved. We conducted a search in 1998 to determine the use of medical eponyms (non-possessive versus possessive) with “Down/Down’s syndrome” as an example (study unpublished). We found that American publications (40 of 50) preferred “Down syndrome” to “Down’s syndrome” when compared to their British counterpart (14 of 62, P<0.001); this was consistent both for textbooks and journals (n=116). We repeated the search several occasions over the last decade with smaller samples, and found no significant change in the trend, suggesting a standstill. Further, a Medline search using same words “Down/Down’s syndrome” reveals variation in number of the abstracts retrieved, although the medical subject heading (MeSH) “Down’s syndrome” has been replaced with “Down syndrome” in 1993. The importance of uniform use of appropriate nomenclature cannot be over emphasised.2 The aim of uniformity is to provide a flexible and practical, yet scientifically acceptable term to describe an abnormality. Our search highlights the variation of a common eponym in medical publications; this seriously hampers information retrieval from public databases and spell checking, and occasionally causes confusion. Therefore, the Council of Biology Editors has recommended complete elimination of the possessive form,3 and this has been adopted by several major references. Furthermore, the non-possessive form, which has no linguistic barrier,4 is also technically more efficient with fewer letters and no punctuation. Despite current inconsistency, there is a gradual drift towards the non-possessive form in non-medical language.4 As most medical eponyms are very resilient to survive, and a total abolition is an unpragmatic task, it would be prudent to adopt a uniform non-possessive nomenclature. Although “Down syndrome” has been taken as an example, the basic principles can be applied to thousands of eponyms. Narayan Jana, Associate Professor of Obstetrics and Gynaecology, Institute of Postgraduate Medical Education and Research, Kolkata 700020, India E-mail: njana1@vsnl.net Sukumar Barik, Consultant, Obstetrics and Gynaecology , and Academic Director Westbank Hospital, Howrah 711109, India E-mail: sukumarbarik@gmail.com Nalini Arora, Associate Professor of Obstetrics and Gynaecology, Institute of Postgraduate Medical Education and Research, Kolkata 700020, India E-mail: njarora@gmail.com Competing interests: None References 1. Woywodt A, Matteson E. Should eponyms be abandoned? BMJ 2007;335:424. (1 September.) 2. Smith DW. Classification, nomenclature, and naming of morphologic defects (editorial). J Pediatr 1975;87:162-64. 3. McKusick VA. On the naming of clinical disorders, with particular reference to eponyms (editorial). Medicine (Baltimore) 1998;77:1-2. 4. Anderson JB. The language of eponyms. J R Coll Physicians Lond 1996;30:174-77. 5. Special Article: Classification and nomenclature of malformation. Lancet 1974;1:798. Address for correspondence: Narayan Jana MD, MRCOG, Associate Professor of Obstetrics and Gynaecology, Institute of Postgraduate Medical Education and Research, 244 A.J.C. Bose Road, Kolkata 700 020, India. E- mail: njana1@vsnl.net Tel: +91(0)33-2223 2829 Fax: +91(0)33-2223 3300 Competing interests: None declared |
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Iqbal S Toor, ST1 Medicine London Chest Hospital, E2 9JX.
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In some areas of medicine eponyms appear to be hanging on despite there existing readily usable forms of nomenclature, which provide an understanding of the patho-physiology underlying a disease process. Using an example of the hypothalamus-pituitary-adrenal hormonal axis highlights the ambiguity that eponyms create. From this endocrine system there arises the less than enlightening situation of Cushing’s disease being a cause of Cushing’s syndrome. Tertiary hyperaldosteronism would be an alternative description of Cushing’s disease, which provides greater clarity and insight, as well as dispenses with the need for Cushing’s syndrome. Similarly, further down this hormonal axis the term Conn’s syndrome is an inferior description to primary hyperaldosteronism. The diminishing influence of Latin within medical terminology is an example of how medical language adapts to become more accessible for the global medical community. Medical research increasing relies on international collaboration across different cultural divides and so clarity and precision are of great importance. However, it is of course essential that descriptive nomenclature is usable and not just a reflection of scientific accuracy. In the same way I think we all prefer prescribing ramipril rather than (1S,5S,7S)-8-[(2S)-2-[[(1S)-1- ethoxycarbonyl-3-phenyl-ropyl]amino]propanoyl]-8-azabicyclo[3.3.0]octane-7 -carboxylic acid. Even within post-modern medicine there should still be a place for some eponyms if the alternative is clumsy. Guillian-Barre syndrome, as well as providing the purist a reminder of the dominance of early 20th century French neurologists, is gladly accepted as shorthand for subacute, predominantly motor, demyelinating neuropathy, despite its historical inaccuracy. I imagine we will see a continuing fall by the way side of outdated eponyms. However, medical students and their respected professors should not fear, as there will always be some remaining for those bonus marks reserved at the end of an Objective Structured Clinical Examination. Competing interests: None declared |
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Mark Palmer, General Practitioner Emscote Rd, Warwick, CV34 5QJ
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I would be in favour of abandoning Eponymous authorship of all journal/editorial articles--perhaps they would just be credited to an NHS number a GMC or UKPIN number instead! Competing interests: None declared |
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Mark Dunham, Clinical Editor-U.S. Durable Medical Goods Company 55422
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Madams and Sirs, My colleague referred me to your wonderful ongoing debate of the use of eponyms. She knew I would be interested, as I have loudly proclaimed my stand in favor of ridding the medical vocabulary of these relics. I would like to weigh in from abroad on a functional consequence of eponymic diagnoses. In my current position as Clinical Editor for a U.S. medical durable goods company specializing in an airway clearance therapy, I see daily the burden patients must endure by being assigned one of these “vanity diagnoses”. Our product is expensive and life span doubling, but still a fairly recent advance in pulmonary therapy. As a result, the list of diagnoses, which are being treated with our product, is continually expanding and evolving. Due to the labyrinthian U.S. medical insurance authorization and appeals processes, non-scientifically named diagnoses are routinely denied coverage requests, if an insurer is unfamiliar with that moniker. Our company then must attempt to provide research and assistance to the patient and their physician for their appeal process, to educate the insurer on the specifics of the diagnosis and then the basis for our therapy. Many of our patients have neuromuscular or genetic disorders and syndromes, that are rarely seen by the great majority of physicians. If the matter was as simple as looking up and forwarding along delineated lists of symptoms defined as an eponym, this would be uncomplicated. However, the reality is more blurry. Often, searching for information on an eponymic diagnosis, reveals ongoing debate or windy discussions on the “common misimpressions” of characteristic symptoms. The more references you access, frequently the foggier the diagnosis becomes. As a researcher, I’m fairly capable. I have enough formal medical education (2 years of Medical School recently) to be able to adequately understand and describe a patient’s case symptoms. Though, as soon as I see correspondence containing an non-descriptive eponym, I know that I’ll probably be seeing that patient’s name again in an appeal process. The amount of time for an appeal to process sometimes stretches beyond some patients’ lifespans, so it’s no small matter when an insurer denies a patient’s request in the first submission. Of course, our U.S. health insurance system is the first and largest culprit in this particular situation. We in the U.S. are very aware of this. Still, from my chair, practitioners not being clear in their diagnostic process have to carry a large portion of the blame. Denial of coverage or care are obvious outcomes that could be avoided without the “secret codes” of eponyms. Competing interests: None declared |
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Yuri Zagvazdin, Associate Professor Nova Southeastern University, Fort Lauderdale, Florida 33328
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Health professionals should be reminded that medical eponyms rarely honor the individuals who described syndromes and diseases for the first time. As a result, eponyms constantly generate historical misattribution in the medical literature. Just browsing the internet I found that Horner’s syndrome was first described by Johan Horner (1), Frey’s syndrome was first described by Lucja Frey (2), Bockenheimer’s syndrome was first described by Bockenheimer (3) and the list goes on. Apparently, these statements were inferred from the definition of eponym in the Oxford English Dictionary. Unfortunately, the accuracy of these statements can be disputed (4, 5, 6). Would not the medical periodicals become more accurate if we abandon the use of eponyms? With all my respect, I would rather accept a modified definition of this term in the Oxford English Dictionary that would inform readers about the precarious nature of eponymy in the medicine. We can see that eponyms stimulated to question memorializing of some individuals connected with Nazi medicine. Application of high ethical standards advances the medical community toward the more assertive use of eponyms. I can only agree that fair and truthful accounts of scientific discoveries advocated by Dr. Woywodt and Dr. Matheson can help to examine, revise and improve the medical terminology. (1). Harding JL, Sywak MS, Sidhu S, Delbridge LW. Horner’s syndrome in association with thyroid and parathyroid disease. ANZ J Surg. 2004; 74: 442-5 (2). Kreyden OP, Schmid-Grendelmeier P, Burg G. Idiopathic Localized Unilateral Hyperhydrosis. Arch. Dermatol. 2001; 137: 1622-5 (3). Van Geest AJ, Veraat JCJM, de Haan M, Neumann HAM. Bockenheimer’s syndrome. J Eur Acad Dermatol Venerol. 1999; 12: 165-8 (4). Ross I B. The role of Claude Bernard and others in the discovery of Horner’s syndrome. J Am Coll Surg. 2004; 199: 976-980 (5). Dulguerov P, Marchal F, Gysin C. Frey syndrome before Frey: the correct history. Laryngoscope 1999; 109: 1471-3 (6). Kubiena HF, Liang MG, Mulliken JB. Genuine diffuse phlebectasia of Bockenheimer: dissection of an eponym. Pediatric Dermatol. 2006; 23: 294-7 Competing interests: None declared |
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Bob Dunkley, Community Pharmacist Dewsbury WF13 2PA
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Come on folks - the use of eponyms gives a romance to medicine. They celebrate the discoverers of a specifice syndrome, and make it easier to remember what the underlying pathology is - if I mentioned Gilles de la Tourettes syndrome - everyone reading this will know what I mean. But if I said the patient had motor and phonic tics, then there would be a scratching of heads!! The eponym is the ultimate accolade for a medical scientist - your name is associated with a set of conditions that will live forever, lets not get rid of these - they prolong the romance of medicine. Competing interests: None declared |
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Christina Thornhill, medical secretary Chorley and South Ribble Hospital , Preston Road, CHORLEY Lancs PR7 1PP, N/A
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Hurray for Judith A Whitworth. As a medical secretary and linguist, I deplore the small-mindedness of those who equate the language of essential communication with 'morality'. The confusion and upheaval that would result for everyone involved in medicine, and by extension all other areas of life, if eponyms were abandoned, does not bear thinking about. Competing interests: None declared |
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Alexander SD Spiers, Professor of Medicine (retired) N/A.
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The article by Dr. Woywodt and Dr. Matteson is very thoughtful and cites many cogent reasons why eponyms should be discarded. On the other hand, the article by Dr. Whitworth (1) presents some very good reasons for retaining them. I prefer the middle ground: some eponyms should be deleted and some preserved. One must agree with Dr. Whitworth that eponyms bring colour to Medicine and reflect medical history. Serious study of a subject inevitably requires knowledge of its history, its pioneers, and its evolution, not just for cultural enrichment but for a proper understanding. Eponyms, like other parts of language, undergo evolution and some fall by the wayside while others survive. This process varies with the the medical specialty involved. In the case of anatomy, eponyms should mostly be discarded because they fail to provide essential information. For example,the term "iliofemoral ligament" is far more informative than "the y-shaped ligament of Bigelow" and "the appendiceal mesentery" tells us more than "Treeves' bloodless fold". In pathology, eponyms still serve a useful function when the aetiology of a disease is unknown, and they tend to fall out of use when knowledge advances, for example "St. Anthony's fire". In the leukaemias and other haematological disorders, improved systems of classification have virtually eliminated eponyms. Addison had two diseases named after him; his name is still applied to adrenal failure but is almost never applied to pernicious anaemia, which he also described. The term "Hodgkin's disease" persists, because there are over fifty alternative names for the condition on the international scene, and because its aetiology is still uncertain. As an example of eponymic evolution, some now call the condition "Hodgkin disease", on the grounds that Thomas Hodgkin did not suffer from the disease, nor did he own it, so the genitive,"Hodgkin's" is unjustified. In neurology and cardiology, eponyms save time and words, as in "Jacksonian epilepsy", "Huntington's chorea"and "Fallot's tetralogy" Of course eponyms may at times be unjustified: a disease is named after an individual who was not the first, or the only, person to describe it. This seeming injustice applies to all the learned disciplines and is not a reason for killing off all eponyms. The question of whether the name of a supposedly dishonourable person should be perpetuated in an eponym is an involved one and I must agree with Dr. Whitworth that the decision to reject such eponyms is a personal one. In the same vein, should we discard such useful terms as Draconian, Machiavellian, Marxist, Nazi, and Stalinism? I think not. 1. Whitworth JA. BMJ 2007; 335, 425 Competing interests: None declared |
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Grant M Dex, GP & Clinical Lecturer, Division of Primary Care, University of Nottingham. NG7 2UH
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Dear Editor Whilst some eponyms may indeed be a barrier to communication with patients and colleagues, I felt somewhat relieved this evening that I was practising in the United Kingdom, when during my evening surgery, I explained to an awkward teenager and his fretting mother that he had de Quervain's tenosynovitis. My mind raced to this Saturdays's article on eponyms in the BMJ and felt tendovaginitis of the hand might have sent the wrong message! Scientific medical terminology may be gauche to the elegance of an eponym! Grant Dex Competing interests: None declared |
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Campbell J Mackenzie, retired consultant nephrologist 2 Merchants Quay. Bristol Bs1 4RL
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HEAD TO HEAD To name or not to name Head to Head’s ‘yes’ or ‘no’ debate regarding the retention and continued use of eponyms was fascinating with Woywodt and Matteson ‘for’ and Whitworth ‘against.’ Having written a book in the eponymous series of the Royal Society of Medicine on Dr. Richard Bright1 I suppose I’d better declare an interest. The medical world would be a dull and unimaginative place without eponyms and what would examiners do when they ran out of questions to pose to struggling candidates –‘Who was Coudé?’ remains my favourite! Humour is important in medicine as in other walks of life. As a medical student eponyms stimulated further reading on the subject and also served as an ‘aide-memoire’; both to be encouraged. Perhaps it is a generation thing with younger doctors having no time for the past but to parody somebody ‘The further you can look back the further you can see forward.’ The argument about the Nazi doctors could be extended to Nobel Literature Laureates and other dignitaries and is one thing that should be left in the past. Medical history is an endangered subject and gets little if any space in the modern medical curriculum. It is unlikely that any more eponyms will be created so let us enjoy them while we can; they help to keep our heritage alive and often enrich what may be a boring tutorial or lecture. Judith Whitworth gets my vote. Campbell Mackenzie Retired consultant nephrologist. e- mail:dr.cammac@btinternet .com 1. ‘Richard Bright 1789-1858 Physician in an Age of Revolution and Reform’ Diana Berry & Campbell Mackenzie; Eponymists in Medicine – Royal Society of Medicine Ltd., London 1992 ISBN 1-85315-1882-2 Words 204 Competing interests: None declared |
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Eric L. Matteson, consultant in rheumatology Mayo Clinic College of Medicine, Rochester, MD 55905 USA, Alexander Woywodt
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We can see that our "Head to Head" regarding the use of eponyms has stirred considerable interest and resonance. There were quite a number of well-reasoned comments in the Rapid Responses as well as in the media. In addition, the article sparked discussion with colleagues and we received valuable comments personally. We respect Dr Whitworth’s point of view as well as the opinion of others who do not share our opinion and we are very pleased that our little article has contributed to this long overdue discussion. In the interest of accuracy, we wish to make a note that in our part of the article we reflected that we had been told the American College of Chest Physicians (ACCP) had decided to rescind the award it gave to Dr. Wegener. We have since learned that the ACCP has not made its final decision in this matter and that it is still under consideration. (see Rosen M. Dr. Friedrich Wegener, the ACCP, and History. Chest Physician 2: 9-10, 2007 at http://www.chestnet.org/about/publications/chestPhysician.php, accessed Sep 13, 2007). Eric Matteson MD ; Alexander Woywodt MD Competing interests: None declared |
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benjamin knight, SPR surgery North manchester General Hospital, Crumpsall, Manchester. M8 5RB
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The recent head to head article “should eponyms be abandoned? Yes/No” published in the 1st September BMJ has intrigued me for some weeks now. Until reading this article, I was certainly amongst the collective of clinicians boasting a whole plethora of preposterously named and often unpronounceable conditions. Standing aside with an inquisitive eye and accurately announcing that this is a case of Caffey’s Pseudo-Hurler Syndrome or asking a medical student to elicit Blumberg’s sign leave’s a certain cohort of physicians feeling all warm and fuzzy. I recall as a medical student listening to a consultant recite a barrage of surgical eponyms and at that time left undecided as to whether I was whole heartedly impressed by his effortless recital or left feeling that he was just a bit weird. The point is this. Medics in particular are guilty of two things. We like new scientific discoveries and we like to be recognised for our contributions to medical science. We also like patients in boxes (not the ones made of oak and useful for burying). We like them wrapped up in a nice neat bundle, which we can open from time to time without ambiguity. Eponyms do this for us. Medical professionals can also communicate with each other in a way they only no how. I also suggest that patients like them too. Their long standing ailment which has bought years of unhappiness is real and actually has a name. They even have something to type into Google. The problem is ignorance. We often use them with gay abandon without much consideration for the disease, the nomenclature of the history behind the person who named the condition or syndrome. Time forgets, names change, people are forgotten.. An example of this is Courvoisier’s law. It was recently pointed out to me that the omnipotent Oxford Textbook of Medicine consistently publishes Courvoisier’s law incorrectly year after year. It states, “if malignant obstruction is below the level of the cystic duct, the gallbladder is distended and may be palpable . Ludwig Courvoisier was born in Switzerland in 1843. In his book “The pathology and surgery of the gall bladder” published in Liepzig in 1890 he stated, “with obstruction of the common duct by a stone, dilatation is rare. The organ is usually well shrunken. With obstruction from other kinds, on the contrary, distension is the rule. Shrinking occurs in only one twelfth of cases”. Almost all definitions without exception are subject to slight changes in wording and grammar from time to time. This is accepted as long as these changes do not in anyway redefine the definition. At no point did Courvoisier mention malignancy, nor was he ever specific regarding the site of the biliary obstruction. Naturally this got me thinking. I wonder how many other textbooks have also got this wrong? I considered eight core undergraduate textbooks, which were easily accessible at my local hospital library. Worryingly these are all books I have used with unquestionable trust over the years. Of note, there were many more but you will see my oint in a minute. Only one textbook correctly quoted Courvoisier’s law, well done Bailey and Love . Ok, there were some slight alterations to the wording but the definition was true to the original words written in 1890. Without exception, the remaining textbook insisted on relating his law to malignancy of the pancreas and I located his eponym under the subheadings of pancreatic malignancy Overtime, we have inferred that he was talking about pancreatic malignancy causing a distended palpable gallbladder but this is a long way from what he actually stated. What hope do we have? A major drawback with eponyms is that the nomenclature often does not relate to the disease process or condition leading to a high rate of inaccurate factual recall. However, if we are misremembering information that is factually incorrect in the first instance then eponyms probably do deserve to rest in peace. The original article highlights that eponyms connected to the work of Nazi medicine are inappropriate. I agree that much of the medicine conducted in this era involved human experimentation and was holy inappropriate and should never be repeated. I do not believe it something that should be forgotten. Eponyms help us remember how diseases or conditions were discovered, who discovered them and where? Atrocities or not, they enable us to reflect on the history, the history of medicine. I also agree with the authors that scientific discoveries are rarely a solo venture and are often the work of several contributors spanned over a length of time. I also agree that the nomenclature rarely relates to the disease process. To rectify this, Dercum’s syndrome would be come either Anders-Vitaut-Dercum disease or “the syndrome of multiple painful lipomatas often confined to the trunk and limbs”. A Hartmanns procedure would be come “ an exploratory laparotomy with resection of a left sided colonic lesion and formation of an end stoma” (I prefer to write Hartmanns at the top of my operation notes). Takayasu’s arteritis should be correctly known as Morgagni–Takayasu-Onishi-Martorell-Raeder-Harbitz- Tersol-Danaraj arteritis. All of these flaws are not the fault of the eponym. They have merely been subjected to human error and misinterpretation. I believe eponyms must stay. They aid learning, improve communication, help patient understanding and preserve some of the history of medicine. However, they need to be used with understanding to ensure factual clarity and scientific accuracy is preserved. The original article against eponyms has encouraged me to discover more about the person behind the eponym and the history associated with it and to me, this only further supports their existence. Oxford Textbook of Medicine. Warrell D, Cox T, Firth J, Benz E. 4th Edition. 2004 Courvoisier LJ. Casaustisch-statistische beitrage zur patholgie und chirurgie der gallenweger. Leipzig; Vogel 1890 Bailey and Love’s Short Practive of Surgery. 23rd Edition. Arnold Publishers. P 982 Clinical Medicine. Kumar and Clark. 5th Edition. W A Saunders. p 403 Andreoli and Carpenters Essentials of Medicine. 7th Edition. W A Saunders. p 429 Textbook of Medicine. Souhami R, Moxham J. $th Edition. Chirchill Livingstone. p 832 Essential Surgery. Burkitt H G, Quick C R. 3rd Edition. Churchill Livingstone. p 163 A companion to specialist surgical practice. Hepatobiliary and Pancreatic surgery. 3rd Edition. Elsevier Saunders. p 314 Master of Medicine. Surgery 1. 2nd Edition. Churchill Livingstone p 38 Competing interests: None declared |
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Eric L. Matteson, physician Mayo Clinic, 200 1st St SW Rochester, MN 55905 USA
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During its October 2007 national meeting, The regents of the American College of Chest Physicians did vote unnanimously to withdraw the award "Master Clinicaan" given to Friedrich Wegener in 1989. Competing interests: None declared |
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