Medical Eponyms: Intrigue and Infighting Behind the Names

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Medical Eponyms Intrigue and Infighting Behind
the Names

• Daniel A. Pollyea, MD
• University of Chicago
• March 7, 2006

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What is an Eponym?
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• From the Greek eponymous
• Epi upon
• Onyma name
• Allow for shorthand method to convey specific
  information
• Particularly popular in the medical field,
  although many other every-day examples
• Rudolf Diesel
• Adolphe Sax
• Jules Léotard

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Medical Definition

• Name(s) of one or more individuals who devised
  or described an anatomic structure, a
  classification system, a disease, an injury, a
  principle, a physical sign or an operation
  technique
• BUT
• One of the following is usually true for
  eponyms The eponymized person wasnt the first
  describer the eponymized person didnt
  understand the discovery the eponyms current
  meaning is different from that which was
  described the eponym has no historical basis.
  Mark M. Ravitch, MD

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Eponyms in the Medical Literature

• 1974 US National Institutes of Health conference
  held on the naming of diseases
• JAMA published an article vowing to drop the
  possessive s (Archer J. Epitomes. JAMA 234152,
  1975) but journal editors over the years have
  been divided

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Types of Eponyms

• Named after male physicians (2,880 on
  whonamedit.com)
• Named after female physicians (101)
• First and last name
• Austin Flint
• Named after more than one person
• Charcot-Marie-Tooth-Hoffman disease
• Named after famous people with the disease
• Lou Gerhig
• Named after fictional characters
• Ulysses

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Case 1 Crohns Disease

• Subacute chronic enteritis involving the terminal
  ileum and other parts of the GI tract (lips to
  anus), characterized by patchy, deep ulcers that
  may cause fistulas, with noncaseating granulomas
• Symptoms include fever, diarrhea, cramping,
  abdominal pain and weight loss
• Distinguished from UC because inflammation is
  transmural, and presence of skip lesions

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Colonic ulceration in Crohns
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Our Story Begins at Mt. Sinai Hospital in NYC, in
1930
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Granulomas of Crohns were thought to be of an
infectious etiology
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Leon Ginzburg, MD
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Case 2 Pickwickian Syndrome

• Syndrome of hypoventilation and hypercapnia
  resulting in daytime somnolence, pulmonary
  hypertension and occasionally, polycythemia
• Cause Extreme obesity

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1837 Charles Dickens wrote The Posthumous Papers
of the Pickwick Club
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Literary Origin (and the modern-day version)

• A most violent and startling knocking was heard
  at the doorThe object that presented itself to
  the eyes of the astonished clerk was a boy- a
  wonderfully fat boy- habited as a serving lad,
  standing upright on the mat, with his eyes closed
  as if in sleep. He had never seen such a fat boy,
  in or out of a traveling caravan and this,
  coupled with the calmness and repose of his
  appearance, so very different from what was
  reasonably to have been expected in the inflictor
  of such a knock, smote him with wonder. Whats
  the matter? inquired the clerk. The
  extraordinary boy replied not a word but he
  nodded once, and seemed, to the clerks
  imagination, to snore feeblyHe breathed heavily,
  but in all other respects was motionless. The
  clerk repeated the question thrice, and receiving
  no answer, prepared to shut the door, when the
  boy suddenly opened his eyes, winked several
  times, sneezed once, and raised his hand as if to
  repeat the knocking. What the devil do you knock
  in that way for? inquired the clerk, angrily.
  Because master said, I wasnt to leave off
  knocking till they opened the door, for fear I
  should go to sleep, said the boy.

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119 Years Later

• Extreme Obesity Associated with Alveolar
  Hypoventilation A Pickwickian Syndrome by CS
  Burwell, et al., 1956
• Described a 51-year-old business executive who
  stood 55 and weighed over 260 lbs.

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Case 3 Brugada Syndrome

• Right bundle branch pattern with ST elevation
  from V1-V3
• Associated with sudden cardiac death in young
  people without structural heart disease and a
  negative stress test
• Often associated with syncope, VF/VT

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Evolution of the Syndrome

• 1953 Drs. Osher and Woff noted the
  characteristic EKG pattern, and considered it a
  normal variant
• 1980s CDC in Atlanta noted a high incidence of
  young Thai immigrants dying of sudden cardiac
  death. In Thailand, this frequent condition was
  known as Lai Thai (death during sleep). Later
  this population would be found to have high
  frequencies of the mutation associated with
  Brugada.

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• 1986 Pedro Brugada treats a male Polish child
  with syncope whose sister died of sudden cardiac
  death.
• With brother Josep, collected more cases of this
  characteristic EKG and its association with
  sudden cardiac death in young people

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• 1992 Brugada brothers, from Catalonia, Spain,
  describe the entity
• 1998 Specific gene mutations in the Na-ion
  channels found to be responsible for the
  characteristic depolarization seen on EKG and the
  incidences of sudden death with no structural
  heart disease.

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Francois Gigot de la Peyronie (1678-1747)
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Case 4 Peyronies Disease

• In a treatise on ejaculatory failure in 1743,
  Peyronie described a patient with rosary beads
  of scar tissue along the dorsum of his penis
• Resulted in a curvature in the erect penis

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• Due to a connective tissue disorder of plaque
  formation in the corpora cavernosa
• Affects .3-3 of men 40-60 years old
• Can cause penile pain
• 50 of cases spontaneously regress
• Usually initiated by penile trauma during
  intercourse, resulting in plaque formation

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Peyronie gets the eponym, but

• First described in 1587 by Giulio Casare Aranzi,
  a Bolognese anatomist
• Thought to be punishment for incest, since the
  Byzantinian Emperor Heracles, who took his niece
  for his wife, was said to have developed a penile
  deformity that caused him to urinate into his
  face

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• 1942 review article speculated when a youth is
  addicted regularly to sessions of prolonged
  ungratified sexual desires, his prostate, being
  in a constant state of engorgement, will develop
  prostatic hypertrophy and result in Peyronies
  disease
• Also cited frigid female partners, giving as
  evidence one man whose condition resolved after
  his wife became more amorous.

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Treatment

• If treatment of the plaque with iodides is
  unsuccessfulor if the condition progressesthen
  the whole penis must promptly be amputated
• William J. Walsham, MD
• London surgeon, 1903
• Vitamin E, various surgical techniques,
  straightening braces

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Case 5 Barretts Oesophagus

• Change of the esophageal lining from squamous to
  columnar (which is found in the stomach)
• Thought to be a complication of severe GERD
• Risk factor for esophageal cancer (metaplasia)

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• Norman Barrett, an Australian surgeon, was the
  first to recognize these changes
• However, he believed they occurred because these
  patients had a congenitally short esophagus, and
  the stomach had intruded into the chest to
  compensate
• Dr. Jean-Louis Lortat-Jacob, a French surgeon,
  discovered the abnormalities around the same time
  as Barrett, and he correctly hypothesized that it
  was an acquired lesion
• However, his paper was written in French.
  Barrett wrote his in English. The rest is
  history.

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Eponyms Etiquette

• It is poor form to name something after yourself
• Follow the lead of Fred Askin Make a long name
• Described a Small round blue cell tumor of the
  thoraco-pulmonary region.
• The next paper referred to small round blue cell
  tumor of the thoraco-pulmonary region (Askins
  disease)
• Now simply known as Askins disease

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Tashimas Syndrome

• CK Tashima (JAMA 1942081965) identified
  Tashimas Syndrome
• A physicians search for a new sign, disease or
  syndrome to attach his name to.