Should eponyms be abandoned? Yes
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39308.342639.AD (Published 30 August 2007) Cite this as: BMJ 2007;335:424All rapid responses
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
addendum
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
Competing interests: No competing interests