By David Kudlowitz, MD
Peer Reviewed
Whether assessing for a Babinski[1] sign, listening to Korotkoff sounds, or diagnosing Wolf-Parkinson-White Syndrome, we are surrounded by names of the medical greats in day-to-day medical practice. Medical eponyms for diseases, physical exam signs, procedures, and anatomic parts are considered by many practitioners to be tributes to their physician discoverers. However, over the past several years there has been an increasing resistance to the excessive use of eponyms, especially those associated with Nazi physicians [i,ii]. A compilation of medical eponyms and their definitions found on the website whonamedit.com, currently contains around 7000 names [4] leading one commentator to coin the term eponymophilia [iii]. One quarter of these entries are from the United States and there is a bias against women, non-North Americans, and Europeans leading others to question their use [iv]. No matter where you stand on the use of eponyms, studying the history of our predecessors gives us insight into our medical culture. Here are several examples that explore the uniqueness of the eponymous nomenclature.
The Sausage Duel
Rudolf Virchow (1821-1902) is one of the many physicians whose contributions to the field of medicine led to several eponyms. Just some of the terms carrying his namesake are Virchow Syndrome (a type of amyloid degeneration), Virchow node (left sided supraclavicular lymphadenopathy), and the Virchow triad (the factors that cause thrombosis). He was the first person to describe leukemic cells, recognized that all cells come from other cells, and published over 2000 titles [v,vi].
In addition to his contributions to medicine and pathology, he also was active in politics. Virchow served in the German Reichstag for 13 years where he promoted public health and disease prevention. As a leader of the liberal party, he also opposed conservative Minister President Otto von Bismarck’s2 excessive military funding. Bismarck was so irritated with Virchow that he challenged him to a duel. Per the code duello, as the “challenged man” of the duel, Virchow picked the weapons. He chose two pork sausages: one infected with Trichinella for Bismarck to use, and one cooked for himself. Bismarck, whose nickname was the Iron Chancellor, renounced his threat [vii].
A Bellevue Murmur
Most eponyms only use the surname of the honoree, however the Austin Flint murmur is an exception to this rule. Flint (1812-1886) was a founder of Bellevue Hospital Medical College in 1861, where he taught for more than 20 years [viii, ix]. His methods concentrated on a prudent physical exam and differential diagnosis [x].
Flint is well known for the heart murmur that bears his name. The murmur is heard with aortic regurgitation, is mid-diastolic/pre-systolic, and is likely caused by the mixing of retrograde aortic flow and anterograde mitral flow on the anterior leaflet of the mitral valve. His description, published in 1862, while working at Bellevue, describes the murmur as follows:
“In some cases in which free aortic regurgitation exists, the left ventricle becoming filled before the auricles contract, the mitral curtains are floated out and the valve closed when the mitral current takes place, and, under the circumstance, the murmur may be produced by the current just named, although no mitral lesion exists.” [xi]
Interestingly enough, Flint was not a fan of eponyms. He stated, “So long as signs are determined from fancied analogies, and named from these or after the person who describes them, there cannot but be obscurity and confusion.” [xii]
Eponymous Patients
Perhaps the most famous case of a patient being named for a disease is the alternative term for Amyotrophic Lateral Sclerosis, Lou Gehrig’s disease. Lou Gehrig, also known as the Iron Horse, is listed as number 11 on ESPN’s top 100 baseball players of all-time [xiii]. Before being stricken with the disease that bears his name, this Yankee great played 2,130 games in a row – a record that persisted until Cal Ripken surpassed it in 1995. While Lou Gehrig’s plight made others aware of the plight of ALS, the disease was actually first described by Charles Bell (among others) in the early 1800s [xiv]. Bell is also eponymized for another neurologic disorder, Bell’s Palsy.
Another example of a disease named after a patient is Hemophilia B (Factor IX deficiency), or Christmas disease. Not named for the holiday, it is in honor of Stephen Christmas, the first patient to be described with the disease. Stephen Christmas died in 1993 from HIV/AIDS that he received from a blood transfusion.
An Unfortunate Coincidence
The French physician, Armand Trousseau (1801-1867), was another prolific physician of his era. His name is associated with several eponyms, including Trousseau sign (spasm in hypocalcemia) and Trousseau spot (red streak from scratching the skin in meningitis). As the “physician-in-chief” of the Hotel Dieu in Paris, he published several lecture texts. One of these texts was entitled “Phlegmasia Alba Dolens.” In this lecture about painful white inflammation caused by venous thrombosis, Trousseau is the first to describe the hypercoaguable syndrome that bears his name [xv].
In an unfortunate twist of fate, a year and a half after delivering his lecture, Trousseau himself noticed swelling and erythema in his left arm, saying:
He died of gastric cancer shortly after diagnosing himself with “Trousseau Syndrome.”
Politically Incorrect Eponyms
Down syndrome is named for British physician John Langdon Down (1828-1896). The first person to describe this disease was actually Jean Etienne Dominique Esquirol in 1838. When Down gave his more detailed description in 1866, he coined the term “Mongolism” [xvii]. Although now considered derogatory, in the context of Victorian England, his description was somewhat liberal. Down placed Caucasians on the same racial spectrum and from the same progenitor as Mongols. During his time, many were using the idea that ethnicities had separate ancestors to support theories of racial superiority [xviii].
“Mongolism” was the preferred term until the 1960s, when a Mongolian delegate at the World Health Organization requested it be changed and use slowly declined [xix]. It is interesting that Down not Dominique was honored with the eponymn, since Down’s colorful description gave birth to the controversial language. The French prefer the term “Trisomie 21.” It is possible that this is an honor to the Frenchmen Dominique Esquirol and Jerome Lejeune, the cytogeneticist who discovered the extra 21st chromosome in the late 1950s [xx].
The most controversial eponyms in use are those related to Nazi physicians. The two most notorious examples are Wegener and Reiter. Hans Reiter’s crimes as a Nazi physician include approving involuntary sterilization programs and authorizing infection of concentration camp prisoners with rickettsia [xxi]. Freiderich Wegener was a Lt. Colonel in the Nazi party (and joined before Hitler rose to power). He was wanted by Polish authorities for war crimes but was never tried. Complete details of his possible wrongdoings are not clear, but the evidence was enough for the American College of Chest Physicians to take away the “Master Clinician” award granted to Wegener [xxii]. For these reasons and others, the terminology Reiter syndrome and Wegener Granulomatosis have been replaced by Reactive Arthritis and Granulomatosis with polyangitis respectively.
Eponyms are prevalent in our medical and common languages. While some medical names are clinically illustrative (like Tetralogy of Fallot3), others are nonspecific (Paget disease4). Eponyms like sandwich5, America6, and Obamacare7 add a cultural flourish to our everyday language both inside and outside the hospital. Whether you are for or against their use in clinical medicine, there is no denying that eponyms provide a lens to both explore our past and shape our future.
Editor Comments
The failed quest for immortality has led many in search of ways of at least preserving their name unto posterity. The medical lexicon is replete with the names of long-dead physicians and patients honored for their contributions to a particular disease or physical finding. The corresponding review by David Kudlowitz provides a fascinating study of the stories and controversies behind some of the most recognizable medical eponyms.
There are many paths to eponymization. A 150-word letter to the editor by a Canadian physician inquiring if somebody could investigate further his observations of the association of gastrointestinal bleeding and aortic stenosis earned EC Heyde his eponym for the subsequently identified syndrome (1). The renowned electrocardiographer Leo Schamroth became eponymized for the clubbing of his own fingers he observed during a bout of endocarditis (2). However, some physicians may regret the association of their name to a particular disease or finding, as was the case with John Homans and his linkage to the maneuver to diagnose a DVT. He went as far to deny making the original description of the sign and was quoted as saying, “if you wanted to name a sign after me, why didn’t you pick a good one.” (3,4)
1. Heyde EC. Gastrointestinal Bleeding in Aortic Stenosis. NEJM 1958
2. Shamroth l. Personal experience. South Afr Med J. 1976; 50:297-300
3. Homans J. Venous thrombosis and pulmonary embolism. NEJM 1947
4. Barker WF. To the memory of John Homan, MD. Maj Probl Clin Surg 1966.
Dr. David Kudlowitz, Internal Medicine, NYU Langone Medical Center
Peer reviewed by Michael Janjigian, MD, Medicine, NYU Langone Medical Center
Image courtesy of Wikimedia Commons (Jozef Babinski)
References:
1 Per the AMA Manual of Style, all eponyms are used in their non-possessive forms (except for the commonly used Bell’s Palsy and Lou Gehrig’s Disease).
2 Bismarck is largely credited with unifying Germany. He has several places named after him, including the city of Bismarck, the capital of North Dakota.
3 Pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. Named for Étienne-Louis Arthur Fallot.
4 Named for Sir James Paget (1814-1899): Paget disease of bone, Paget disease of the breast, Paget Schroetter disease, Extramammary Paget disease (vulva or penis).
5 John Montagu, 4th Earl of Sandwich (1718-1792)
6 Amerigo Vespucci (1454-1512)
7 The Affordable Care Act
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