Should eponyms be abandoned? NoBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39308.380567.AD (Published 30 August 2007) Cite this as: BMJ 2007;335:425
- Judith A Whitworth, director
- John Curtin School of Medical Research, Australian National University, Canberra ACT 0200, Australia
Some years ago, filling in time between candidates in a clinical examination, I was chatting to a colleague about eponyms. His view was that eponyms were not particularly useful and he recalled an encounter with a young woman struggling in a similar examination. She couldn't find the lymph nodes and seemed unfamiliar with pulmonary auscultation. To bolster her spirits, he asked her who discovered Koch's bacillus. She became even more anxious and lost for words. My colleague helpfully asked, “Who wrote Mendelssohn's Spring Song?” and she burst into tears. Similarly, I recall a friend coming out of a fine arts examination and asking who designed the Eiffel Tower.
I understand there was a long line of people happy to argue that eponyms be abolished, and few prepared to take the contrary view. This I can only ascribe to the well known human propensity to enjoy tilting at windmills. Eponyms are here to stay.
Eponyms are everywhere and there are lots of them—7899 when I last looked at whonamedit.com.1 They are heard on the street as well as in the ward. They are in textbooks, in the mass media, on the web, palm pilots, and in the World Health Organization's latest revision of the international classification of diseases.2 They are so widely used and recognised that their eradication, even if it were desirable, would take a purge of monumental proportion and effort. Why bother? Eponyms bring colour to medicine, they provide a convenient short hand for the profession and the community alike, and they embed medical traditions and culture in our history.
The use of eponyms in medicine, as in other areas, is often random, inconsistent, idiosyncratic, confused, and heavily influenced by local geography and culture. This is part of their beauty. For example, 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.3 There are even differences within countries. For example, cholecystography was known as such in Melbourne but called the Graham test in Sydney.3
Eponyms are often practical and a form of medical shorthand. Do we really want to speak of congenital cyanotic heart disease due to ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and aortic dextroposition rather than Fallot's tetralogy? Or hereditary disorder of renal tubular function with vitamin D resistant renal rickets, glycosuria, aminoaciduria, and hyperphosphaturia for Fanconi syndrome? Or violent muscular jerks of the face, shoulders, and extremities with spasmodic grunting, explosive noises, or coprolalia instead of Tourette's syndrome?
No need for censoring
Eponyms are not simply rooted in the past. They come and go. Richard Bright, Thomas Hodgkin, and Thomas Addison, giants of 19th century medicine, were contemporaries at Guy's Hospital. Hodgkin's disease and Addison's disease are well known to practitioners and public alike. Bright's disease was widely used as an eponym for glomerulonephritis (although Stewart Cameron showed one of Bright's cases was in fact amyloid4) but with improved understanding of the diverse aetiology, pathology, and clinical courses of various forms of nephritis, it has fallen from favour. Similarly, the eponymous mongolism has disappeared from contemporary use and been replaced by Down's syndrome. As we come to understand more of the basis of diseases, current usage will change. There is no need to legislate against eponyms. They go of their own accord when they pass their use-by date.
In these (better) days of codified evidence, appeal to authority is the last resort, but here it is the best evidence we have. To learn it is necessary to understand history. Much is made of the argument that to use the name of someone who was vile is to celebrate them inappropriately. But history is what happened, not what we or the revisionists wish had happened. We remember the names of tyrants and despise them, not celebrate them. Telling people what they must or must not say or write is fraught with danger. Rather it should be left to individuals to determine if there are people whose name they “do not care to recall” (Don Quixote, Cervantes).
Simply withdrawing the eponymous term for the wicked few is not a way forward. Who would determine acceptability? Would political views or marital infidelity or tax avoidance disqualify someone? Would the heinous behaviour need to be proved in a court of law or merely rumoured? Would historicity prevail so that other times and customs become irrelevant? It is all or nothing for eponyms. Given they are now deeply embedded in our culture, abolishing them is unrealistic. Similarly, if we abolish them in medicine, can we still use them in the sciences that enable medicine? Do we get rid of Avagadro's number, Boyle's law, the joule, the kelvin, the hertz?
Eponyms are widely used in contemporary life. In many cases their use is so widespread that they are not always recognised as eponyms. Should we abolish the cardigan because he was a bully whose incompetence led to a monumental folly and over a hundred unnecessary deaths (not his own) in the charge of the Light Brigade? Should we instead speak of a front opening sweater? What will we call the sandwich, sideburns, diesel, or chauvinism?
In the words of the American philosopher Ralph Waldo Emerson, “There is properly no history, only biography.” Eponyms are here to stay.