BMJ 2014;349:g7586 doi: 10.1136/bmj.g7586 (Published 16 December 2014)
Page 1 of 5
Feature
FEATURE
CHRISTMAS 2014: ON THE WARDS, IN THE SURGERY
Medical eponyms: taxonomies, natural history, and
the evidence
Jeffrey Aronson discovers that the golden age of the eponym was the 1950s, not the 19th century.
He provides taxonomies and a natural history
Jeffrey K Aronson honorary consultant physician
Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford OX2 6GG, UK
Eponyms have been with us ever since Adam’s apple stuck in
his throat,1 although Genesis neither specifies the fruit nor
describes the supposed dysphagia.
In Greek, ἐπωνῠμία (epōnumia) meant a name reflecting an
attribute given name as nickname. Consider the House of
Cadmus.2 Laius (“left-handed”) has his son Oedipus abandoned
on a hillside, pinned through his ankles. Later, when they meet
outside Thebes, Laius’s horses trample Oedipus’s feet. Either
way Oedipus gets an oedematous foot (pous). And because he
knows (oide) about feet, he answers the Sphinx’s riddle about
what goes on four legs in the morning, two legs in the afternoon,
and three legs in the evening.
By extension, the adjective epōnumos meant using names of
persons (eponyms) or places (toponyms), real or fictional, to
describe things. “Eponym” therefore belatedly entered English
in the mid 19th century, designating both the namer and the
named, making Laius and Oedipus even more complex.3
Some dislike eponyms. But their grasp of the relevant evidence
may be tenuous. For example, in a tetchy little piece in the BMJ,
Des Spence claimed that “eponymous medical syndromes and
signs often [have] exotic connections to central Europe; …few
[are] named after Smith, Jones, or Brown.”4 The evidence
contradicts this. All the central European countries (including
the Russian federation) listed in whonamedit.com together
muster only 146 entries, while Stedman’s Medical Eponyms
includes 111 entries containing Smith (75), Jones (18), or
Brown(e) (18) (See the annotated bibliography on bmj.com.).
Even when evidence is cited, it may be of dubious value.
Woywodt and Matteson, for instance, reported that “in a
systematic study, only 10 of 92 orthopaedic surgeons [correctly
described] Finkelstein’s test for diagnosing tendovaginitis.”5
Would they have done better if it had been called the
tendovaginitis test? Or even the tenosynovitis test (which is
what Finkelstein actually described)?
The box summarizes the debate.
Taxonomies
Most writers on medical eponyms deal largely, if not
exclusively, with diseases, syndromes, and signs. But there are
other taxonomic categories (table⇓). The examples in the table
suggest another, tripartite, taxonomy: permanent eponyms (such
as scores and units of measurement), obsolete eponyms (such
as Benedict’s test, Eaton’s agent), and eponyms in flux. Among
the last, degrees of impermanence vary. “Down’s/Down
syndrome,” for example, is well established but might be
replaced by “trisomy 21,” while “Hughes’ syndrome” is being
displaced by “antiphospholipid syndrome.”
Natural history
Eponyms progress in four overlapping phases: attribution,
elucidation, depersonalization, and substitution.
Attribution
Despite frequent priority disputes, few have used their own
names eponymously. However, many eponyms fail to honour
those they should. Take Touraine-Solente-Golé syndrome,
described in 1935 by Albert Touraine, Gabriel Solente, and
Laurent Golé,7 but earlier by Nikolaus Friedreich,8 Wilhelm
Heinrich Erb,9 and Julius Arnold.10 Should we call it
Friedreich-Erb-Arnold syndrome?11 Touraine’s syndrome, skin
pigmentation and neurofibromatosis, was originally described
by Virchow12; Touraine’s syndrome, or Behçet’s disease, was
first described by Planner and Remenovsky13; and
Christ-Siemens-Touraine syndrome, X linked hypohidrotic
[email protected]
Extra material supplied by the author (see http://www.bmj.com/content/349/bmj.g7586?tab=related#datasupp)
Annotated bibliography of books and lists of epoynyms
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;349:g7586 doi: 10.1136/bmj.g7586 (Published 16 December 2014)
Page 2 of 5
FEATURE
Arguments for and against the use of medical eponyms
Arguments for
• They favour communication, being more succinct than full descriptions (for example, complicated syndromes, summary scores)
• There may not be an alternative satisfactory descriptive term
• They distinguish different forms of the same thing (such as Sydenham’s and Huntington’s chorea; different types of forceps)
• They “protect from envy the noble achievements of men who have excelled in virtue” (Galileo)
• They may commemorate a patient (Christmas disease, Hartnup disease), family (Byler’s disease/syndrome), or place (Lyme disease,
Marburg virus)
• They avoid stigma (Hansen’s disease, not leprosy), indignity (Angelman’s, not happy puppet, syndrome), and racial prejudice (Down’s
syndrome, not mongolism)
• They encourage us to read the original descriptions
• They teach about medical history and national culture
• They give junior doctors the chance to impress senior doctors
• They can be amusing (Western and Northern blots)
• Writing about them enhances your curriculum vitae
Arguments against*
• They militate against communication (for example, through ignorance or forgetfulness, or because the same condition has different
eponyms in different countries)
• They don’t reflect the contributions of uncredited others
• They reflect factors other than scientific achievement
• They sometimes glorify wicked people
• They may stigmatize a place and its inhabitants (such as “the French disease” and other ethnophaulisms)
• They focus on famous names, de-emphasizing social and cultural contexts
• Senior doctors use them to exert power over junior doctors
• They don’t reflect pathophysiology
*To which some say, “So what? They’re here to stay. Get over it.”6
ectodermal dysplasia, by Thurnam.14 These attributions obey
the law of Non-Original Malappropriate Eponymous
Nomenclature (NOMEN): “no entity is named after its
discoverer.”15 16 NOMEN has also been called Stigler’s law (by
Stigler)17; he attributed the underlying principle to RK Merton,
but it can be traced back at least to George Sarton,18 who said
that “creations absolutely de novo are very rare, if they occur
at all.” Note, however, a Touraine’s syndrome that breaks this
law, facial freckles and mental retardation, which Touraine did
describe first.19 Perhaps.
Elucidation
possessive forms; the non-possessive forms have come to
dominate in a minority of cases (fig 1⇓).
Substitution
Replacement of eponymous diseases, syndromes, or signs by
descriptive terms achieves total depersonalization. How readily
this happens depends on how accurate the description is:
“regional ileitis” is not a good substitute for “Crohn’s disease,”
which can affect any part of the gut. In extreme cases antipathy
may be instrumental, with calls to deracinate unethical
experimenters or supporters of eugenics or euthanasia.24-27
Pathophysiological elucidation yields the following sequence:
Conclusions
Other eponymic entities are clearly not so susceptible to this,
although names of microbes may swap eponyms on
reclassification.20
Eponyms persist, and new ones will emerge, albeit probably at
a slower rate today than before; invention had its heyday in the
1950s, since when it has flagged (fig 2⇓). But look in this issue
of the BMJ and discover the Campbell-Trachter syndrome,
distress in those who realize that they will never become
eponymous. For me, this self referential eponym alone, plus my
competing interest, would justify the tradition.
eponymous syndrome → eponymous disease → substitution by
a descriptive term.
Depersonalization
There are various ways of depersonalizing an eponym: (a)
derivatize it, such as adjectivally (Gauss’s distribution (actually
attributable to de Moivre16) becomes Gaussian); (b) give it a
lower case initial (Blaise Pascal’s unit of pressure becomes a
pascal); (c) drop the possessive (Henry Koplik’s spots become
Koplik spots). Jean Nicot gives us nicotine (methods a and b),
and Julius Petri’s dish becomes a petri dish (methods b and c).
Depending on the extent of the change, we may forget that the
term was ever eponymous. The examples in the table⇓ show
that no consistent rules govern this.
Some claim that displacement of possessive forms of [single
name] diseases and syndromes by attributive ones (such as
“Down” instead of “Down’s”) is increasingly common21 or will
become so.22 The evidence does not support this.23 Although
non-possessive forms have increased with time, so too have
For personal use only: See rights and reprints http://www.bmj.com/permissions
Competing interests: I have read and understood the BMJ Group policy
on declaration of interests and declare the following interests: I have
had a mathematical sequence named after me (http://en.wikipedia.org/
wiki/Aronson’s_sequence).
1
2
3
4
5
6
7
8
Jacobs NJ. Naming-day in Eden: the creation and re-creation of language . Victor Gollancz,
1958.
Aronson JK. Unity from diversity: the evidential use of anecdotal reports of adverse drug
reactions and interactions. J Eval Clin Pract 2005;11:195-208.
Ross JM. Oedipus revisited. Laius and the “Laius complex.” Psychoanal Study Child
1982;37:169-200.
Spence D. Medical heresy: ditch the eponyms. BMJ 2012;344:e2503.
Woywodt A, Matteson E. Should eponyms be abandoned? Yes. BMJ 2007;335:424.
Whitworth JA. Should eponyms be abandoned? No. BMJ 2007;335:425. [Erratum
2007;335:0-b.]
Touraine A, Solente G, Golé L. Un syndrome ostéodermopathique: la pachydermie
plicaturée avec pachypériostose des extrémités. Presse Med 1935;43:1820-4.
Friedreich N. Hyperostose des gesammten Skelettes. Arch Pathol Anat 1868;43:83-7.
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;349:g7586 doi: 10.1136/bmj.g7586 (Published 16 December 2014)
Page 3 of 5
FEATURE
9
10
11
12
13
14
15
16
17
18
19
Erb W. Über Akromegalie (krankhaften Riesenwuchs). Dtsch Arch Klin Med
1887-88;42:295-338.
Arnold J. Acromegalie, Pachyacrie oder Ostitis? Ein anatomischer Bericht über den Fall
Hagner. Beiträge Pathol Anat Allg Pathol 1891;10:1.
Jansen T, Brandl G, Bandmann M, Meurer M. Pachydermoperiostose. Hautarzt
1995;46:429-35.
Virchow R. Pigment und diffuse Mélanose der Arachnoides. Virchow’s Arch Pathol Anat
Physiol Klin Med 1859;16:180-7.
Planner H, Remenovsky F. Beiträge zur Kenntnis der Ulzerationen am äußeren weiblichen
Genitale. Arch Dermatol Syph (Berl) 1922;140:162-88.
Thurnam J. Two cases in which the skin, hair and teeth were imperfectly developed.
Medico-Chirurg Trans 1848;31:71-82.
Aronson JK. Rabid responses. BMJ 2005;331:383.
Aresti N, Ramachandran M. Nonoriginal malappropriate eponymous nomenclature:
examples relevant to paediatric orthopaedics. J Pediatr Orthop B 2012;21:606-10.
Stigler SM. Stigler’s law of eponymy. In: Gieryn TF, ed. Science and social structure: a
festschrift for Robert K Merton. Trans NY Acad Sci 1980;39:147-57.
Sarton G. The study of the history of science . Harvard University Press, 1936:36.
Touraine A. Une nouvelle neuro-ectodermose congénitale: la lentiginose centro-faciale
et ses dysplasies associées. Ann Dermatol Syphiligr 1941;8:453-73.
For personal use only: See rights and reprints http://www.bmj.com/permissions
20
21
22
23
24
25
26
27
Collins FM. Pasteurella, Yersinia, and Francisella. In: Baron S, ed. Medical microbiology
. 4th ed. University of Texas Medical Branch at Galveston, 1996: chapter 29.
Anderson JB. The language of eponyms. J R Coll Physicians Lond 1996;30:174-7.
Ritter RM, ed. The Oxford style manual . Oxford University Press, 2003:373.
Macaskill MR, Anderson TJ. Whose name is it anyway? Varying patterns of possessive
usage in eponymous neurodegenerative diseases. Peer J 2013;1:e67.
Strous RD, Edelman MC. Eponyms and the Nazi era: time to remember and time for
change. Isr Med Assoc J 2007;9:207-14.
Kondziella D. Thirty neurological eponyms associated with the Nazi era. Eur Neurol
2009;62:56-64.
Sweet F, Csapó-Sweet RM. Clauberg’s eponym and crimes against humanity. Isr Med
Assoc J 2012;14:719-23.
Zeidman LA, Pandey DK. Declining use of the Hallervorden-Spatz disease eponym in
the last two decades. J Child Neurol 2012;27:1310-5.
Accepted: 01 December 2014
Cite this as: BMJ 2014;349:g7586
© BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;349:g7586 doi: 10.1136/bmj.g7586 (Published 16 December 2014)
Page 4 of 5
FEATURE
Table
Table 1| Taxonomy of medically relevant eponyms, according to the types of entities described
Types of entity
Examples
Diseases, disorders, syndromes
Hodgkin’s disease, Mendelian disorders, Zollinger-Ellison syndrome
Signs or features of diseases
Duroziez’s sign, Heberden’s nodes, Koplik spots
Adverse drug reactions
Hoigné syndrome, Jarisch-Herxheimer reaction
Scores and staging systems
Apgar score, Barthell score, Ann Arbor staging
Laboratory tests and reactions
Benedict’s test, Weil-Felix reaction
Laboratory equipment, reagents, and procedures
Petri dish, Krebs-Ringer solution, gadolinium, Southern blot, Ziehl-Neelsen stain
Anatomical and pathological structures
atlas, bundle of His, Meckel’s diverticulum, Lewy bodies
Biochemical, physiological, and pharmacological phenomena Krebs tricarboxylic acid cycle, Frank-Starling curve, Langmuir adsorption isotherm, Schild plot*
Medications
atropine, barbiturates, galenics, morphine, nicotine
Surgical operations, equipment, and procedures
Bankart operation, McBurney retractor, Pfannenstiel incision
Types of personality
bombastic, epicurean, Jekyll and Hyde, machiavellian, quixotic
Units of measurement
ampere, gray, newton, Hounsfield number
Classifications, laws, rules
Gell and Coombs classification, Guldberg-Waage law, M’Naghten rule
Microbes
Brucella, Klebs-Loeffler bacillus, Eaton’s agent
Places
Bedlam, John Radcliffe Hospital
Textbooks and journals
Meyler (Meyler’s Side Effects of Drugs), Naunyn-Schmiedeberg’s Archives of Pharmacology
Ideas and theoretical constructs
Gaussian distribution, Hippocratic oath, Koch’s postulates
Quasi-eponyms
fuller’s (not Fuller’s) earth, red man (not Redman) syndrome, stiff man (not Stiffman) syndrome,
forest (not Forest) plot, tako-tsubo (not Takotsubo) syndrome
*The British Pharmacological Society calls its premises the Schild plot.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;349:g7586 doi: 10.1136/bmj.g7586 (Published 16 December 2014)
Page 5 of 5
FEATURE
Figures
Fig 1 Possessive and non-possessive forms of 14 eponymous diseases and syndromes, as cited in the titles of 161 399
papers listed in Pubmed 1945-2014. Top panel: combined data; two broad patterns emerge. Middle panel: possessive form
comes to dominate, exemplified by Parkinson’s disease (similar patterns for Alzheimer’s disease, Behçet’s disease, Bowen’s
disease, Crohn’s disease, Cushing’s syndrome, Darier’s disease, Graves’ disease, Hashimoto’s disease/thyroiditis, Paget’s
disease (of bone)). Bottom panel: possessive form is overtaken by non-possessive form, exemplified by Down’s syndrome
(similar patterns for Chagas’ disease, Hodgkin’s disease/lymphoma, and Munchausen’s syndrome)
Fig 2 Frequency distribution of a random sample of 392 eponymous syndromes and diseases listed in
Stedman’s Medical Eponyms, according to the year in which the eponym was first mentioned in a paper listed in Pubmed
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe