{"id":1431,"date":"2019-09-28T19:03:15","date_gmt":"2019-09-28T09:03:15","guid":{"rendered":"https:\/\/thejugular.org\/?p=1431"},"modified":"2026-02-06T00:18:40","modified_gmt":"2026-02-06T00:18:40","slug":"the-not-so-wonderful-world-of-medical-eponyms","status":"publish","type":"post","link":"https:\/\/jugular.org.au\/index.php\/2019\/09\/28\/the-not-so-wonderful-world-of-medical-eponyms\/","title":{"rendered":"The Not-So-Wonderful World of Medical Eponyms"},"content":{"rendered":"
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\n \t<\/i> Read Time:<\/span>10 Minute, 55 Second <\/div>\n\n <\/div>\n

written by MATT FADHIL (edited by KATERINA THEOCHAROUS)<\/p>\n\n\n\n

In my article just the other month<\/a>, I set out to explore the wonderful world of medical eponyms, talking through the fascinating and often unexpected scenarios by which diseases, signs and procedures gain their names.<\/p>\n\n\n\n

Taking off the rose-tinted glasses for a moment, though, it doesn\u2019t take long to realise that the world of medical eponyms is not always so wonderful. In fact, the tradition of naming medical terms after historical doctors or patients carries with it a whole string of potential issues, both practical and ethical. Many commentators in recent decades have labelled the use of eponyms impractical, inaccurate and outdated, some even advocating to eliminate eponyms from the medical literature altogether in favour of more standardised terminology 1<\/sup>. <\/p>\n\n\n\n

Let\u2019s take a closer look at five problems that can come up with the use of eponyms in medicine and some examples of each.<\/p>\n\n\n\n

Problem 01: Uninformative and confusing<\/strong><\/p>\n\n\n\n

One of the most common complaints levelled against medical eponyms is that they\u2019re uninformative, an arbitrarily-chosen name that gives the listener no information about the disease, sign or procedure being discussed. At least when a disease is named in ordinary med-speak, you can break it down into its constituent parts and get an idea what it refers to: translate \u201cbovine spongiform encephalopathy\u201d into \u201ccow-related spongy brain disease\u201d and you\u2019re halfway to mastering neuro. With eponyms, though, we\u2019re unable to extract from the name any hints at all about what it refers to.<\/p>\n\n\n\n

Then there\u2019s the confusion of multiple similarly-named diseases to deal with. Take Paget\u2019s disease, named after the renowned 19th<\/sup> century English surgeon Sir James Paget. If you did your MSK Anki deck that morning, you may know to interpret \u201cPaget\u2019s disease\u201d as osteitis deformans, a bone disease characterised by dysfunctional bone remodelling. However, without the qualification \u201cPaget\u2019s disease of the bone<\/em>\u201d, there\u2019s no way of distinguishing osteitis deformans from Paget\u2019s disease of the breast (a form of intraductal breast cancer) or Paget\u2019s disease of the skin (an intraepithelial cancer commonly involving the anogenital region) 2<\/sup>. And that\u2019s not even to get into Pi<\/em>aget\u2019s theory of cognitive development, probably buried deep in the recesses of your mind from BGD. It\u2019s no wonder that eponyms have been labelled \u201can impenetrable mystery to the uninitiated\u201d3<\/sup>: for med students and patients alike, eponyms can represent a small but significant barrier to communication and understanding.<\/p>\n\n\n\n

\"..\/..\/..\/..\/..\/Desktop\/Screen%20Shot%202019-09-25%20at%201.54.25%2\"\/
James Paget<\/figcaption><\/figure><\/div>\n\n\n\n
\"..\/..\/..\/..\/..\/Desktop\/Screen%20Shot%202019-09-25%20at%201.55.59%2\"\/
Paget\u2019s disease of the bone<\/figcaption><\/figure><\/div>\n\n\n\n

Problem 02: Medically inaccurate<\/strong><\/p>\n\n\n\n

Another problem identified with eponyms is that they\u2019re imprecise, reflecting an archaic understanding of a disease, sign or procedure that doesn\u2019t take into account more recent updates in medical knowledge. After all, if you\u2019re going to get yourself an eponym, the most surefire way would be to make discoveries in an area not-so-well understood – it\u2019s often in the initial stages of a disease\u2019s description, before the full clinical and pathophysiological picture is pieced together, that the names catch on. In many cases, a single poorly-understood medical condition can accumulate a whole litany of eponymous names for its specific features before anyone figures out how to fit them together. Take aortic regurgitation, which over the years has attracted as many as 31 different eponyms for its signs and symptoms 4<\/sup>. There\u2019s actually a whole page of Talley\u2019s just devoted to listing out these eponyms, with a note at the bottom that \u201cthese signs are amusing, but not often helpful\u201d 5<\/sup>.<\/p>\n\n\n\n

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The painfully long list in Talley\u2019s of eponymous signs of aortic regurgitation<\/figcaption><\/figure>\n\n\n\n

Another result is that very different clinical situations can end up grouped together under the one imprecise name. For decades, Bright\u2019s disease (named after 19th<\/sup>-century British physician Richard Bright) was widely used as an eponym for glomerulonephritis. As our understanding of the different types of glomerulonephritis improved, with their very different causes, pathophysiologies and prognoses, the grouping term \u201cBright\u2019s disease\u201d became not at all meaningful; its use has since become obsolete 6<\/sup>. <\/p>\n\n\n\n

Overall, eponymous names can represent a convenient shorthand for incompletely-understood clinical situations. But once our understanding advances, many argue that this convenience is being purchased at the expense of accuracy and that these eponyms should all go the same way poor Bright\u2019s did. <\/p>\n\n\n\n

Problem 03: Historically inaccurate<\/strong><\/p>\n\n\n\n

You may have heard of an Arnold-Chiari malformation, a congenital downward displacement of the cerebellum and medulla through the base of the skull. So who were Arnold and Chiari? Hans Chiari was a 19th<\/sup>-century Austrian pathologist, who, over the course of decades, produced numerous anatomical and pathological descriptions of the congenital malformation that bears his name. Julius Arnold was a German pathologist (with a funky beard) and a contemporary of Chiari\u2019s, who published just one relevant case report. The term \u201cArnold-Chiari\u201d was coined a decade later by, surprise surprise, two of Arnold\u2019s very own students 7<\/sup>.<\/p>\n\n\n\n

And this is just one of many examples of historical inaccuracy in the world of medical eponyms. Whose name sticks and whose doesn\u2019t make the cut is often determined by a whole heap of factors \u2013 politics, language, culture, even sheer luck \u2013 rather than pure scientific achievement. It\u2019s no coincidence that women are grossly underrepresented in medical eponyms: the contributions of remarkable female doctors and scientists were often dismissed while their male counterparts\u2019 names were immortalised 1<\/sup>. And there are countless cases where the descriptions of the eponymous physician were very obviously not the earliest or best in the literature 3<\/sup>.<\/p>\n\n\n\n

Easy solution<\/em>, you might be thinking, Why leave anyone out? Just chuck all their names on.<\/em> Well, you idiots are the reason we talk today of Mayer-Rokitansky-Kuster-Hauser Syndrome (congenital agenesis of the vagina and uterus). Taking this idea to its extremes, authors have jokingly proposed acknowledging all those involved in the study of Beh\u00e7et\u2019s disease (a systemic autoimmune disorder named after 20th<\/sup>-century Turkish dermatologist Hul\u00fbsi Beh\u00e7et) by renaming it Hippocrates-Janin-Neumann-Reis-Bluthe-Gilbert-Planner- Remenovsky-Weve-Shigeta-Pils-Gr\u00fctz-Carol-Ruys-Samek-Fischer-Walter-Roman-Kumer-Adamantiades-Dascalopoulos-Matras-Whitwell-Nishimura-Blobner-Weekers-Reginster-Knapp-Beh\u00e7et\u2019s disease 4<\/sup>. I think I\u2019ll stick with Beh\u00e7et\u2019s, thanks.<\/p>\n\n\n\n

\"..\/..\/..\/..\/..\/Desktop\/Screen%20Shot%202019-09-25%20at%206.22.12%2\"\/
Hul\u00fbsi Beh\u00e7et, pictured on a Turkish banknote.<\/figcaption><\/figure><\/div>\n\n\n\n

Problem 04: Historically inappropriate<\/strong><\/p>\n\n\n\n

Reactive arthritis, formerly known as Reiter\u2019s syndrome, is a form of arthritis triggered by infection elsewhere in the body, most commonly the gut or urogenital tract. Hans Reiter was a German physician who published early descriptions of reactive arthritis in the early 20th<\/sup> century. He was also, unfortunately, a Nazi war criminal. Specifically, Reiter is known to have been complicit in Nazi sterilisation and euthanasia programs and to have committed horrific medical experiments at the Buchenwald concentration camp. The term \u201cReiter\u2019s syndrome\u201d was proposed in 1942 by Dr Ephraim Engelman, a Jewish rheumatologist, before the extent of Reiter\u2019s complicity was revealed. In an unbelievable twist of fate, it was Dr Engelman himself who issued the callout to rename the term half a century later 8<\/sup>. <\/p>\n\n\n\n

Nor is Reiter the only case of a historically tainted eponym: unfortunately, the names of widely-condemned historical figures have infiltrated the catalogue of medical eponyms and are only recently being weeded out. It\u2019s fair to say that having your name taken as an eponym, to be spoken and written day-to-day by doctors and patients, is an honour. Only those who model the ethical and professional responsibilities of being a doctor should be honoured in this way; commemorating those who don\u2019t meet that standard becomes very, very problematic.<\/p>\n\n\n\n

A quick final note. The only thing more uncomfortable than a Nazi eponym? A double-barrelled Nazi eponym. That\u2019s right, both Julius Hallevorden and Hugo Spatz, the two men who gave their names to the rare neurodegenerative disorder formerly known as Hallevorden-Spatz syndrome, were fully-fledged members of the Nazi party. Pantothenate kinase-associated neurodegeneration is a bit of a mouthful, but honestly, we\u2019ll take it. <\/p>\n\n\n\n

\"..\/..\/..\/..\/..\/Desktop\/Screen%20Shot%202019-09-25%20at%202.27.38%2\"\/
Hans Reiter<\/figcaption><\/figure><\/div>\n\n\n\n

Problem 05: Difficult to use<\/strong><\/p>\n\n\n\n

Last, but very much not least, eponyms can just be difficult. Difficult to say, to write, and to use consistently. There\u2019s the weird and wacky foreign eponyms that you need to be fluent in 17 European languages to pronounce correctly (think Chvostek, Sjogren, Ziehl-Neilsen). There are the dramatic variations in eponyms across countries: sideropenic dysphagia goes by the name Plummer-Vinson syndrome in Australia and the not-so-similar name Waldenstrom-Kjellberg syndrome in Scandinavia6<\/sup>. And there\u2019s the question over whether or not to add the possessive –\u2018s<\/em> to an eponym (is it Down syndrome? or Down\u2019s syndrome?), a source of inconsistency that\u2019s inspired countless angry responses to the editor and caused some medical journals to issue flat bans on the use of the possessive 9<\/sup>.<\/p>\n\n\n\n

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Okay Matt<\/em>, you\u2019re thinking, I\u2019m convinced. Eponyms are a problem, what\u2019s all the fuss about it, let\u2019s just scrap them.<\/em> Well, just hold your horses for a second. The core idea of my previous article still holds true: behind every medical eponym is a story, a story about the namesake themselves or about the journey each eponym has taken to end up with that namesake. In this way, eponyms in medicine allow us to stay deeply rooted within medical history, celebrating past discoveries and their discoverers (who, in the vast majority of cases, are NOT Nazis). Even if they just inspire a quick Google search by a patient in the waiting room or a med student after rounds, eponyms spark opportunities to bring the colour and excitement of each individual story to the day-to-day. <\/p>\n\n\n\n

There are plenty of other benefits to eponyms too. Sometimes, they\u2019re actually easier to remember than the long convoluted med-speak equivalents: \u201ccongenital cyanotic heart disease due to ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and aortic dextroposition\u201d is much more taxing on the memory than Tetralogy of Fallot 6<\/sup>. The non-specificity of eponymous names for syndromes, while contributing to imprecision, also allows for their flexibility: provisional labelling is a convenient way for doctors to communicate specific situations to one another and to patients while we improve our knowledge. Last, but definitely not least, eponyms are absolutely everywhere in medicine: you\u2019ll find them in every field in every part of the world, across textbooks, medical school curricula and medical practice. In ENT alone, there are 106 eponymously-named types of forceps 3<\/sup>. Some medical eponyms have become so common and indispensable that we\u2019ve almost forgotten they\u2019re eponyms at all: the Gram stain (G capitalised) is named after 19th<\/sup>-century Danish bacteriologist Hans Christian Gram, who was celebrated in this funky Google logo just the other month.<\/p>\n\n\n\n

\"..\/..\/..\/..\/..\/Desktop\/Screen%20Shot%202019-09-25%20at%202.30.27%2\"\/
Google logo commemorating Hans Christian Gram<\/figcaption><\/figure><\/div>\n\n\n\n

So what\u2019s the verdict? Should we eradicate eponyms completely? I, for one, believe eponyms are worth keeping. It\u2019s vital that efforts to improve their use continue, like weeding out eponyms that are grossly inaccurate or inappropriate and standardising their grammar and spelling. A little change that has been adopted in the past to much success is to replace the generic noun (\u201cdisease\u201d, \u201csyndrome\u201d, etc.) with a more precise term: rather than Albright\u2019s syndrome, why not go with Albright\u2019s hereditary osteodystrophy 3<\/sup>. Regardless, one thing\u2019s for sure: for generations of doctors and students, eponyms are here to stay.<\/p>\n\n\n\n

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1\tFargen, K. M. & Hoh, B. L. The debate over eponyms. Clinical Anatomy<\/em> 27<\/strong>, 1137-1140, doi:10.1002\/ca.22409 (2014).<\/p>\n\n\n\n

2\tBuchanan, W. W. Sir James Paget (1814\u20131894). Rheumatology<\/em> 42<\/strong>, 1107-1108, doi:10.1093\/rheumatology\/keg004 (2003).<\/p>\n\n\n\n

3\tBrunt, R. Medical eponyms revisited. English Today<\/em> 14<\/strong>, 51-56, doi:10.1017\/s0266078400010208 (1998).<\/p>\n\n\n\n

4\tWoywodt, A. & Matteson, E. Should eponyms be abandoned? Yes. BMJ<\/em> 335<\/strong>, 424-424, doi:10.1136\/bmj.39308.342639.AD (2007).<\/p>\n\n\n\n

5\tTalley, N. & O\u2019Connor, S. Clinical examination: a systematic guide to physical diagnosis. 7th ed. Elsevier Health Sciences (2014).<\/p>\n\n\n\n

6\tWhitworth, J. A. Should eponyms be abandoned? No. BMJ<\/em> 335<\/strong>, 425-425, doi:10.1136\/bmj.39308.380567.AD (2007).<\/p>\n\n\n\n

7\tSolt, I. Chiari malformation eponym- time for historical justice. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology<\/em> 37<\/strong>, 250-251, doi:10.1002\/uog.8876 (2011).<\/p>\n\n\n\n

8\tPanush, R. S., Wallace, D. J., Dorff, R. E. N. & Engleman, E. P. Retraction of the suggestion to use the term \u201cReiter’s syndrome\u201d sixty-five years later: The legacy of Reiter, a war criminal, should not be eponymic honor but rather condemnation. Arthritis & Rheumatism<\/em> 56<\/strong>, 693-694, doi:10.1002\/art.22374 (2007).<\/p>\n\n\n\n

9\tJana, N., Barik, S. & Arora, N. Current use of medical eponyms–a need for global uniformity in scientific publications. BMC Med Res Methodol<\/em> 9<\/strong>, 18-18, doi:10.1186\/1471-2288-9-18 (2009).
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