Six weeks ago, Mr. S had fever, chills, cough, and rhinorrhea, which ultimately self-resolved. Two weeks later, he noticed right-sided neck pain that radiated towards his ear. When the pain progressively worsened, he presented to the emergency department. On physical exam, Mr. S was febrile to 100.5°F, tachycardic, diaphoretic, and in obvious pain. His right neck was swollen, erythematous, and tender to palpation. Laboratory results were significant for a white blood cell (WBC) count of 19.5 x 103/uL with 88% neutrophilic predominance, decreased thyroid stimulating hormone (TSH), and elevated thyroxine (free T4). A computed tomography (CT) scan revealed asymmetric enlargement of the right lobe of the thyroid gland with heterogeneous enhancement.
The leading diagnosis in the differential was subacute thyroiditis, also known as subacute nonsuppurative thyroiditis or subacute granulomatous thyroiditis, and sometimes called struma granulomatosa, pseudogranulomatous thyroiditis, or pseudotuberculous thyroiditis. It is even referred to by others as giant cell thyroiditis, post-viral thyroiditis, painful subacute thyroiditis, or painful thyroiditis. With this enormous mouthful of nomenclature, in a jumble of permutations, perhaps the best term for this patient’s diagnosis is the eponym “de Quervain’s thyroiditis.”
After all, for centuries eponyms have organized complex medical terminology into a form that is memorable and concise. To speak of painful, subacute, granulomatous, nonsuppurative, giant cell, post-viral thyroiditis to Mr. S would be over-saturating him with excessive medical jargon. Rather, the eponym “de Quervain’s thyroiditis” is more reasonable. Not only is this shorthand convenient for the patient community, but it is also functional within the medical profession. For example, it is cumbersome to speak of congenital cyanotic heart disease due to ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and aortic dextroposition rather than using the eponym “tetralogy of Fallot.” It is unwieldy to discuss a dorsally displaced, angulated extra-articular distal radius fracture rather than using the eponym “Colles’ fracture.” Eponyms simplify verbose phraseology by creating a distinctive, unique name to set apart clinical terms in the vast sea of information that is medical knowledge.
Eponyms add character to medicine by embedding tradition and culture into a professional language. At the turn of the 20th century, one of the leading authorities on thyroid disease described an uncommon self-limiting inflammation of the gland, often preceded by respiratory viral infections and distinct from other thyroiditides . This clinician was the accomplished surgeon Dr. Fritz de Quervain of Switzerland. In his honor, the disease became his namesake.
In consideration of these historical bases, critics argue that the etiologies of eponyms may be unfair or inaccurate. The law of Nonoriginal Malappropriate Eponymous Nomenclature (NOMEN) asserts that, “no phenomenon is named after the individual(s) who originally described it” . Admittedly, there is some truth to this facetious observation. Today we use the eponym “de Quervain’s thyroiditis” to describe Mr. S’ condition, but if history had been more just we would call it “Mygind’s thyroiditis” for Dr. Holger Mygind, the Danish physician who originally described 18 cases of the condition a decade before Dr. de Quervain’s landmark article . In defense of the victor, Dr. de Quervain never claimed to be the first expert to elucidate the condition, and his classification was a clear reiteration of Dr. Mygind’s findings. In fact, he used Dr. Mygind’s terminology in naming the disease: thyroiditis akuta simplex [2-3]. In other cases, historical eponyms may be insensitive and inappropriate. It is virtually impossible to discuss the role of eponyms in modern day language without mentioning that a few are regrettably named after Nazis, including Reiter’s syndrome, Wegener’s granulomatosis, and the Clara cell.
However, the majority of medical eponyms are not morally questionable and instead they deservedly recognize an individual or group for contributions to knowledge. Dr. de Quervain was an accomplished and respected surgeon who insisted upon the general approach to a patient, without artificial divisions of specialized care. He was one of the first clinicians to realize that post-operative pneumonias were more often, in fact, pulmonary embolisms, and he also introduced iodized table salt to prevent certain thyroid diseases . Dr. de Quervain’s aspiration to acquire knowledge in all realms of medicine was unquestionably noble; however, it is also the reason why his eponymous name is so complicated. Only knowing that Mr. S’ diagnosis of “de Quervain’s” without knowing his history of present illness may lead one to assume that he had complete testicular feminization due to androgen insensitivity, uncommonly called “de Quervain’s syndrome.” If not, then Mr. S may be mistakenly noted to have chronic tenosynovitis due to a narrowing process of the abductor pollicis longus and extensor pollicis brevis muscles, known as “de Quervain’s tendinitis.”
From the 1960s to today, interest in eponyms has grown, reflected by the steadily increasing number of scientific publications describing eponyms . The online dictionary of medical eponyms, WhoNamedIt.com, catalogued a staggering 8,531 eponyms in 4,292 entries by 2010, and it continues to expand . Nowadays, the choice to use eponyms or not is even more controversial than the eponyms themselves. But whether physicians like it or not, eponyms are here to stay. True, eponyms may not be completely descriptive and they are sometimes historically inaccurate, but these are not reasons for eliminating them from the medical lexicon altogether. Doing so would mean renaming the Fallopian tubes, Alzheimer’s disease, and the Heimlich maneuver. It would mean revamping the names of Hodgkin lymphoma, Graves’ disease, and the Achilles tendon. It would mean no pasteurization or narcissism or eosinophils. Not to mention, the medical world would have to decide exactly which alternative name to use for de Quervain’s thyroiditis. Furthermore, if arguments are valid in erasing eponyms from the medical language, they are valid in erasing them from the English language too. There would be no saxophones or sandwiches or magnolias. One could not mesmerize or boycott or wear a cardigan. And we certainly could not call this country “America.” Let us call it “the continent between Europe, Africa, and Asia.” Actually, we cannot do that either because those are eponyms too. Similar to the traditions they carry, eponyms are traditions in and of themselves. They provide color in our terminologies, history to our words, and efficiency to our semantics. They are part of our language, and that is their rightful role.
Dr. Kathy May Tran, 4th year medical student at NYU School of Medicine
Peer reviewed by Dr. Patrick Cocks, Internal Medicine, NYU Langone Medical Center
Image courtesy of the Library of the Royal College of Physicians, Pictured: Dr. Fritz de Quervain
- de Quervain F. Die acute, nicht eiterige thyreoiditis und die beteiligung der schilddruse an akuten intoxikationen und infektionen uberhaupt. Mitt Grenzgeb Med Chir, Suppl. 1904; 2:1-165.
- Aresti N, Ramachandran M. Nonoriginal Malappropriate Eponymous Nomenclature: examples relevant to paediatric orthopaedics. J Pediatr Orthop B. 2012; 21(6):606-610. http://journals.lww.com/jpo-b/Abstract/2012/11000/Nonoriginal_Malappropriate_Eponymous_Nomenclature_.24.aspx
- Mygind H. Thyroiditis akuta simplex. J Laryngol Rhinol Otol. 1895; 9:181-193.
- Enerson OD. Fritz de Quervain. WhoNamedIt? Available at: http://www.whonamedit.com/doctor.cfm/1106.html. Accessed November 1, 2013.