Dr. Denis Gill

Dublin, Ireland

I must confess to liking medical eponyms. As a medical student in 1960s Dublin, we were taught the names of famous Irish physicians of the Georgian period (1780-1840), a time when Dublin was famed for its bedside teaching. Their names evoked an interest in the history of medicine and in clinical signs. Since then, Corrigan’s waterhammer pulse of aortic incompetence has irrevocably collapsed. Grave’s disease or thyrotoxicosis is still partially alive. Stokes-Adams attacks and Cheyne-Stokes breathing still incite physiological discussion.

For us, as raw and raucous medical students, Murphy’s law meant one of two things:

  1. If things can go wrong, they will.
  2. In the adult male with an acute abdomen, the penis usually points to the side of the lesion. (I doubt if this gem has ever been subjected to an evidence-based analysis, though I suspect that the Christmas edition of the British Medical Journal would welcome an analytical annotated submission.)

We also greatly liked the doggerel and anatomic poetry of Oliver St. John Gogarty, a Dublin Ear-Nose-Throat surgeon from the early 1900s. In particular, we relished his lines on the lingual nerve:

The lingual nerve took a swerve
Around the hyoglossus.
Well I’ll be fucked,
Said Wharton’s duct,
The fucker’s double-crossed us.

This would sound far less poetic and emphatic if Wharton’s duct had to be called the submandibular duct, its actual name.

My interest in eponyms was further whetted by being a pediatrician, since eponyms abound in pediatrics: from the rare Hurler’s syndrome, to the Germanic Henoch-Schönlein syndrome, to those cited within terrific texts such as Smith’s Recognizable Patterns of Human Malformation, wherein all is expounded.

Eponymic syndromes might be defined as baptized collections of signs and symptoms awaiting confirmation. The poet Matthew Arnold, however, was not impressed:

Nor bring, to see me cease to live,
Some doctor full of phrase and fame,
To shake his sapient head, and give
The ill he can not cure a name.

We pediatricians revel in Koplik’s spots, Dennie-Morgan folds, Potter’s facies, Sprengel’s deformity, Wilm’s tumor, Barr bodies, Barlow’s maneuver, Epstein’s pearls, Erb’s palsy, Fallot’s tetralogy, Meckel’s diverticulum, and a host of other diseases and syndromes named rightly or wrongly (of which more later) by our predecessors. While Smith’s text is, in my opinion, the bible of dysmorphology, lots can be got from Goodman and Gorlin’s Malformed Infant and Child, from the London-based Winter and Baraitser dysmorphology and neurogenetic databases, and from McKusick’s OMIM (Online Mendelian Inheritance in Man).

My interest was later reactivated by an adult nephrology trainee, Judith Whitford, after our paths crossed in Guy’s Hospital in London. Judy returned to Australia, where she co-edited with Barry Firkin the reference text Dictionary of Medical Eponyms (Informal Healthcare, 2002). Recently, she staunchly defended eponyms in the BMJ’s Head to Head series of articles (August, 2007). According to Judy, there are about 8000 medical eponyms out there. She acknowledges that the use of eponyms is often random, inconsistent, idiosyncratic, and confused by local history, geography and culture. Eponyms do come and go. Take, for example, the eponyms of three 18th century English contemporaries of Guy’s Hospital:

Hodgkin’s Disease (1798-1866) remains current,
Addison’s Disease (1795-1860) survives—John F. Kennedy suffered from it—whereas

Bright’s Disease (1789-1858) has died.

But I beg the question: What would a doctor’s life be without eponyms?

How about a quick multiple-choice quiz?

Which of the following medical terms is derived from the name of a doctor?

1.

A. Adam’s apple
B. Pap smear
C. Coxsackie virus
D. Christmas disease.

Only 3% of eponyms are named after women. Which of the following were women?

2.

A. Wasserman test
B. Lyme disease
C. Potter syndrome
D. Apgar score.

Finally, of the four features of Henoch-Schönlein syndrome, who described what?

3.

A. Purpuric rash (vasculitis)
B. Arthritis
C. Nephritis
D. Abdominal pain.

Answers are at the end of this article.

This year I was in a little town on the shore of Lake Maggiore in Italy. On a plaque near the town hall, the town honors Monteggia, chirurgo e scrittore, who described an arm fracture. We in Dublin are proud of Robert Colles, surgeon and author, whose name is attached to a forearm fracture. Many doctors (and parents) know of Colles’ fracture, whereas most of us have forgotten Monteggia.

Did you know that Tim Howard, the goalkeeper for the USA national and English Everton teams, has Tourette’s syndrome? That’s much less of a mouthful to say than to explain that he suffers from tics, jerks, explosive reactions, and insulting coprolalia, is it not? Fallot’s Tetrad or Tetralogy is much easier to say than its four component parts. Fanconi syndrome, or multiple proximal tubular leaks, is simpler than glycosuria, aminoaciduria, and hyperphosphaturia with rickets.

Which readily leads on to some of the problems of eponyms: Swiss doctor Guido Fanconi was either a smart bloke or a successful plagiarizer who managed to be remembered for a syndrome previously described by Abderhalden, Lignac, De Toni, and Debré—resulting in understandable Franco-German distrust of that Swiss upstart.

Fanconi was not the first to steal someone else’s eponymic thunder. Other pediatric syndromes whose time-honored eponymic name is not the first author’s include:

Patau syndrome (1960). First described by Bartholin (presumably by identifying the characteristic cyst) in 1657.

Turner syndrome (1938). Described by Rossle in 1922.

Cornelia de Lange syndrome (1933). Described by Brachmann in 1916. I have often wondered if this was the original description of fetal alcohol syndrome.

Treacher-Collins syndrome (1900). Described by Thomson in 1946.

Ehlers-Danlos syndrome [Ehlers (1901) and Danlos (1918)]. Originally described by Van Meekeren in 1682.

Von Recklinghausen syndrome (1882). Described by Smith of Dublin in 1849. This syndrome is now more commonly known as neurofibromatosis (NFI).

And there are at least 20 more.

 

Judy’s opposition in the BMJ suggested that the continued use of eponyms is inappropriate and will not be accepted by patients, relatives, and the public. I doubt that. Many parents of dysmorphic or differently-abled children do not stop till they find the pediatrician who knows the name of their child’s condition, be it Janksy-Bielschowsky syndrome or whatever.

Those who oppose the use of eponyms also cite the example of Behçets disease (which I, in my ignorance used to call Bechets, thinking the Turk was a Frenchman). To acknowledge everyone who discovered facets of this disorder, they maintain that we would have to name it: Hippocrates, Janin, Neumann, Reid, Bluthe, Gilbert, Planner, Remenovsky, Weve, Shigeta, Grutz, Carol, Ruys, Samek, Fischer, Walter, Roman, Kumer, Adamandtiades, Dascalopoulos, Matras, Whitwell, Nuschimura, Blobner, Weekers, Reginster, Knapp, Behçets Disease. I never knew it had so many bits. But that is beside the point.

For myself, I love the history behind each eponym. I have in my library a delightful book called The Man behind the Syndrome (Beighton and Beighton, Springer-Verlag: 1986), which I browse through from time to time. It provides pen pictures, photos, and brief biographies of a selection of eponymic medical syndromes. The best site is undoubtedly whonamedit.com. Thus far they have listed 8,360 eponyms linked to 3,326 persons, 3,198 male, 128 female. They plan to include 15,000 eponyms and 6,000 persons. Now is your chance to make your name—though you will certainly be considered a bad sport should you nominate yourself.

Eponym is, I think, is an acronym for Every Pediatrician Of Note Yearns Memorability. Many pediatricians fantasize of securing an eponym, and with it, assured historical recognition. Eponymity, not anonymity, remains the vainglorious goal of innovative practitioners.

I would certainly raise my glass and toast Batten, Donohue, Down, Noonan, Still, and Duchenne, to name but a few of the names that add color, history, curiosity, querulousity, and personality to the study of medicine.

 

ANSWERS:

1. B      Papanicolau smear
2. C,D   Potter and Apgar
3. A,B   Henoch      C,D = Schonlein

 


DR. DENIS GILL is a retired Professor of Pediatrics at the Royal College of Surgeons in Ireland Dublin and a pediatric nephrologist at Children’s University Hospital in Dublin. He is also the author of Pediatric Clinical Examination (5th ed.) and the former President of the Confederation of European Specialists in Pediatrics. Denis Gill resides in Dublin, Ireland.