Eponyms are a long-standing tradition in medicine. Eponyms usually involve honoring a prominent physician scientist who played a major role in the identification of the disease. Under the right circumstances, a disease becomes well known through the name of this individual. There are no rules on eponym development. It may take an extraordinary period of time, be different in different languages and cultures, and evolve as more is known about the physician or the disease

Asher R

Clansman E

Crohn BB

Cushing HW

Friderichsen C

Graves RJ

Hans Reiter (1881-) Reiter's syndrome

Hashimoto H

Maurer K

Parkinson J

Patterson R

Waterhouse R

PubMed

Robert P. Ferguson

Deborah Thomas

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BRIEF HISTORICAL PERSPECTIVEMedical eponymsRobert P. Ferguson, MD, Editor-in-Chief*# and Deborah Thomas, MLSGreater Baltimore Medical Center (GBMC), Towson, MD, USAEponyms are a long-standing tradition in medicine. Eponyms usually involve honoring a prominent physicianscientist who played a major role in the identification of the disease. Under the right circumstances, a diseasebecomes well known through the name of this individual. There are no rules on eponym development. It maytake an extraordinary period of time, be different in different languages and cultures, and evolve as more isknown about the physician or the disease.Keywords: eponyms; medical diseases; Wegener’s; Reiter’s; munchausen syndrome*Correspondence to: Robert P. Ferguson, Greater Baltimore Medical Center (GBMC), 6701 N Charles St,Towson, MD 21204, USA, Email: rferguson@gbmc.orgReceived: 27 May 2014; Revised: 24 June 2014; Accepted: 24 June 2014; Published: 31 July 2014Eponyms are a long-standing tradition in medicine.Eponyms usually involve honoring a prominentphysician scientist who played a major role in theidentification of the disease. Under the right circum-stances, a disease becomes well known through the nameof this individual. It is often easier to remember a diseaseby its eponym than by the more scientific pathologicdescription; for example, which name is better known,Hodgkins disease or any of its five types, to wit, nodularsclerosing, mixed cellularity, lymphocyte depleted, lym-phocyte rich, and nodular lymphocyte-predominant?The naming process usually beginswhen popular atten-tion is drawn to an entity, not necessarily for the firsttime. In fact, the physician scientist whose name becomesthe eponym is often distinguishable from other parallelobservers for reasons other than being first. It may bethe individual’s reputation, standing, accuracy, detailscontained in the report or publication, or a fortuitousrediscoveryoften decades later by someone who then asso-ciates the disease with one or more of the earlier physi-cian scientists. Sometimes luck plays a major role. Thereare no rules on eponym development. It may take anextraordinary period of time, be different in differentlanguages and cultures, and evolve as more is knownabout the physician or the disease.How many medical eponyms are there? There aremedical eponyms for physical signs, tendons, reflexes,palsies, cysts, choreas, aneurisms, contractures, and manyothers. Some have estimated more than 8,000 (1). Thereare single name eponyms and multiple individual epo-nyms. There are possessive and non-possessive forms (2).When there are multiple names to the eponym, it is ofteninteresting to assess how the order was adopted. It may beindividual prestige, departmental seniority and, no doubt,could involve some bullying. Or it may be as simple asdrawing straws or the famous WatsonCrick coin flip won by Watson.Eponyms can take decades to be commonly accepted,which is not necessarily a bad thing. Many eponyms havebeen identified after the death of the eponym name-sake, when rediscovered by a secondary investigator whoposthumously connects it with the individual who ‘wroteit up’. Eponyms often reflect the dominance of scientificcultures and languages at the time. Eponyms flourishedfrom the late 19th to early 20th centuries when the lead-ing scientific languages were English and German. Agood example of the eponym process is the entity of acuteadrenal failure secondary to meningococcemia, referredto as adrenal apoplexy. Numerous case reports of thisentity were published around 1900 mostly in obscuremedical journals following autopsies that revealed adrenal(or ‘suprarenal’) fatal hemorrhage complicating sepsis(3). In 1911, British physician Rupert Waterhouse pub-lished in Lancet, the leading English language journal atthe time, a fulminant fatal case report (4). In 1917 and1918, Carl Friderichsen published two cases and a reviewof the literature in Danish and German (5). In 1933,Eduard Glanzmann, in a clinical review, gave it the nameof WaterhouseFriderichsen syndrome (6).In the remainder of this perspective, we will review10 eponymous medical diseases or syndromes. I believeeight are here to stay. The last name alone suffices, oftennot needing a word-like syndrome or disease to clarify.Two others are famous, if not infamous, and not only are#Robert P. Ferguson, has had no part in the review and decision process of this paper.JOURNAL OF COMMUNITY HOSPITALINTERNAL MEDICINE PERSPECTIVESJournal of Community Hospital Internal Medicine Perspectives 2014. # 2014 Robert P. Ferguson and Deborah Thomas. This is an Open Access articledistributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/),permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.1Citation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4: 25046 - http://dx.doi.org/10.3402/jchimp.v4.25046(page number not for citation purpose)fading away but there are active campaigns to erase themfrom memory, demonstrating that the slow approach maybe the wise way to go, not unlike the rule that a player isnot eligible to be elected to the Baseball Hall of Fameuntil 5 years after retirement.James Parkinson was born in Londonin 1755. His initial professional inter-ests were primarily in politics. He wasan anti-Pitt government activist andwas even questioned as part of theinvestigation of a rumored conspiracyto assassinate King George III afterAmerica was victorious in its war of independence. Afterturning to medicine, he became known for his obser-vational skills and clarity of writing style. In 1817, hepublished an ‘Essay on the Shaking Palsy’, described as‘paralysis agitans’ (7). Parkinson was 62 when he pub-lished this paper. He would die 7 years later. Approxima-tely 60 years elapsed before famous French pathologistsCharcot and Trousseu (themselves eponym namesakes)attached Parkinson’s name to the condition (8).Thomas Hodgkins was born a Quakerin England in 1798. Not surprisingly,he developed strong opinions as anadult against servitude and slavery.As a physician at Guys Hospital inLondon, he was a contemporary ofThomas Addison and Richard Bright.Guys Hospital was the epicenter of eponyms. Hodgkinswas fortunate at least twice in the development of theHodgkins eponym. His original descriptive paper was pub-lished in 1832 (9). Read and referred to by his colleague,Richard Bright, he published these reviews in 1838, butdid not become widely known. In 1856, Samuel Wilkesreported similar lymphadenopathy and splenomegaly,initially believing he had identified something new (10).Wilkes, before publishing, discovered Bright’s reference toHodgkins’ findings. The best he could say was that he re-discovered what Hodgkins had discovered 27 years before.Robert James Graves was born in 1796in Dublin. He was known as a polyglotas well as a physician. As a physician,he was considered a great teacher andcontributed to the fame of the DublinSchool of Medicine. For years physi-cians had been aware of the association between goiter,heart disease, and tachycardia. This was widely known inboth the leading German- and English-speaking medicalcommunities. Graves’ original description in 1835, when hepresented to the London Medical Society, was the first todescribe exopthalmus as part of this condition (11). Hisassociations paralleled those of Carl Basedow in Germany.Even today the eponym may vary depending on thenative language. Graves continued his skillful lectures formany years and that helped to establish the eponym.Alois Alzheimer was a Bavarian, bornin 1864. He became a pathologist anda psychiatrist. He began observing apatient at the Frankfort Asylum forLunatics and Epileptics in 1901. Whenthe patient died in 1906, Alzheimer dis-sected the brain and, augmented by the newly developedsilver stains, identified amyloid plaques and neurofibril-lary tangles. He presented his findings the same year. Thedementia became known after him when his discoverieswere written in Kraepelin’s German textbook, consideredthe standard of its time (12).Hakaru Hashimoto was born in Japanand graduated from Kyushu UniversityMedical School in 1907. As a youngman he moved to Germany to continuehis career. In 1912, he published ‘AReport on Lymphomatus Goiter’ (13).Years later the specimens were reviewed by American andBritish researchers who named the disease as Hashimoto’sdisease (14). Hashimoto returned home in 1916 becauseof World War I and became the town doctor in hishometown before succumbing to typhoid at the age of53 in 1934.Harvey Cushing was born in Cleveland in1869. He received his medical educationand training at Harvard, Johns Hopkins,and in Europe. He was a leading neuro-surgeon of his day. He was a close asso-ciate of William Osler of Hopkins. In1912, he reported a condition that hereferred to as ‘polyglandular syndrome’related to a pituitary disorder. His scientific career wasinterrupted by events in Europe. When the US becameinvolved in World War I, he served with the US Expedi-tionary Force and practiced neurosurgery near the frontlines. He treated Lt. Edward Revere Osler (Osler’s son),who died of his wounds at the third battle of Ypres. In1925, Cushing received a Pulitzer Prize for his biographyof William Osler.In 1932, he published his pituitary observations, dis-covering basophilic adenoma of the pituitary, which be-came known as Cushing’s disease (15). Despite doubters,his findings and hypothesis were vindicated over time.Burrill Crohn was born in Manhattan in1884 and became a prominent New YorkCity gastroenterologist. He was chief of gas-troenterology at Mount Sinai Hospital in1920. He and his colleagues identified acohort of patients that had similar clinicalmanifestations not previously identified. Crohn, with LeonGinzburg and Gordon Oppenheimer published ‘RegionalIleitis: a Pathological and Clinical Entity’ (16). Why Crohnwas the first of the three potential lead authors, is unclear(whether by serendipity or simply by the alphabet); andRobert P. Ferguson and Deborah Thomas2(page number not for citation purpose)Citation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4: 25046 - http://dx.doi.org/10.3402/jchimp.v4.25046even less clear, especially considering the clarity anddescriptiveness of ‘regional enteritis’, was why there wasan eponym. Moreover, Crohn reportedly was unhappywith the eponym. Or, perhaps he protested too much.Burrill Crohn practiced until the age of 90. He died in1983 at 99, half a century after his landmark paper.As noted above, I believe that these eponyms are hereto stay. The remainder are, for the reasons discussedbelow, not likely to remain in common usage.Hans Reiter was born near Leipzig in1881. He studied medicine in Berlin,Paris, and London. During World WarI, he observed non-gonococcal urethiritis/arthritis in a soldier. This and other casesdescribed by Reiter led to a syndromenamed for him (17). After World War I,he became an admirer of the rising political star, AdolfHitler, and joined the Nazi party. In World War II, hebecame a high-ranking physician staff member and parti-cipated in criminal experimentation in prisoners, suchas at the concentration camp at Buchenwald. Afterthe war, Reiter was tried at Nuremberg and interned bythe Russians and Americans. Eventually, he was released.Post-war, Reiter’s syndrome became an accepted eponymof a clinical entity. However, when Reiter’s wartime acti-vities were rediscovered a campaign was initiated to dis-associate his name from reactive arthritis (18).Friederich Wegener was born in Germanyin 1907. He developed into a brilliant phy-sician and pathologist. Working in Breslau,he first described a new type of upper air-ways granulomatous destructive airwaydisease. He published cases in the Germanliterature in 1939 (19). After World War II, a Swedishpathologist recognized it as a new disease discovered byWegener, and named it for him. Because of Wegener’saccomplishments, he was honored as a Master Clinicianby the ACCP in 1989. However, in 2000, while researchinga paper on Wegener, Matteson, and Woywoldt uncoveredWegener’s Nazi past involving medical experiments con-ducted near Lodz, Poland, as well as, his membership inthe SA and possible involvement in the genocide whichtook place in Poland during the war (20). The detailsof his involvement in Nazi atrocities were not as welldocumented as those of Reiter, but it seemed clear that hemust have at least been aware of what was happeningin Poland at that time. In 2002, a campaign was initiatedto change the name of the disease to ANCA associatedgranulomatous vasculitis, and, later to granulomatosiswith polyangitis. How successful this campaign has beenis arguable, since in many instances the use of one of thesetongue twisting terms is followed by ‘meaning Wegener’s.’It is not that easy to eliminate an eponym by a generationused to using it.Thus we see in these two cases, one of the problemswith eponyms is that subsequent information may revealpersonal issues that are inconsistent with the honorarycomponent attached to naming a clinical entity afteran individual. As Germany was one of the centers ofscience in the first half of the twentieth century, it is notsurprising that instances of brilliant discovery took placein that country. However, this was also the period ofghastly crimes committed in the treatment of individualsby representatives of that nation in Europe.Munchausen’s syndrome, or, factitious dis-order, is, without a doubt a favorite medicaleponym. While Munchausen was a histor-ical figure  Hieronymus Carl FriedrichBaron von Munchausen  the good BaronMunchausen had nothing to do with dis-covery or description of the eponymous syndrome. Hewas born in Germany in 1720 to a prominent family inthe nobility. He became a soldier for hire and fought in anumber of military campaigns. After he retired, hebecame well known for entertaining at dinner partieson his estate. He liked to tell tall tales of his militaryadventures, often with fanciful entertaining exaggeration.Many of these tales were extensions of local folk tales,centuries old. In 1785, an anonymous publication of thetales with illustrations appeared that was unauthorized(21). The Baron was annoyed at the embarrassing use ofhis noble family name. Despite his efforts to suppress theseries, the publications continued and became popularthroughout Europe.Richard Asher published a case series of factitiousdisorders in 1951 (22). He stated: ‘Like the famous Baronvon Munchausen, the persons affected have always travel-led widely, and their stories, like those attributed tohim, are both dramatic and untrue.’ Even though it wasa century and a half after the baron’s death, the namestuck!ConclusionTypically, eponyms were established decades or evencenturies ago and were named for individuals who werecredited first with identification, description, and pub-lication. Many of the names were fortuitously connec-ted decades later as they were rediscovered by others.Although there have been instances where eponyms werelater discarded, the survivors are by and large written instone. Although the medical disease eponym is an archaicconcept and may lead to scientific confusion, we believethat eponyms are here for the foreseeable future.References1. Whonamedit? A dictionary of medical eponyms. Ole DanielEnersen; 2014. Available from: http://www.whonamedit.com/[cited 23 May 2014].Medical eponymsCitation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4: 25046 - http://dx.doi.org/10.3402/jchimp.v4.25046 3(page number not for citation purpose)2. Jana N. Current use of medical eponyms  A need for globaluniformity in scientiﬁc publications. BMC Med Res Methodol2009; 9: 18.3. Tabacco J, Suniega E, Sarabchi F, Mitsani D. Fatal meningo-coccemia. J Community Hosp Intern Med Perspect 2012; 1.Available from: http://www.jchimp.net/index.php/jchimp/article/viewFile/11584/pdf_1 [cited 23 May 2014].4. Waterhouse R. A case of supranasal apoplexy. Lancet 1911;177: 5778.5. Friderichsen C. Waterhouse-Friderichsen syndrome. ActaEndocronol 1955; 18: 48292.6. Clansman E. Beitrag zur klinik, hamatologie und pathologiedes syndroms von Waterhouse-Friderichsen. Jahrbuch furKinderheilkunde 1933; 139: 4963.7. Parkinson J. An essay on the shaking palsy. London: SherwoodNeeley-Jones; 1817.8. Jefferson M. James Parkinson 17551824. Br Med J 1973; 2:6013.9. Hodgkin T. On some morbid appearances of the absorbentglands and spleen. Med Chir Trans 1832; 17: 68114.10. Rosenfeld L. Hodgkin’s disease: Origin of an eponym and onethat got away. Bull N Y Acad Med 1989; 65(5): 61832.11. Graves RJ. Newly observed affection of the thyroid gland infemales. London Med Surg J 1985; VII: 51617.12. Maurer K, Maurer U. Alzheimer: The life of a physicianand career of a disease. New York: Columbia University Press;2003.13. Hashimoto H. Zur kenntnis der lymphomatosen verandrungder schilddruse (struma lymphomatosa). Arch Klin Chir Berlin1912; 97: 21948.14. Amino N, Tada H, Hidaka Y, Hashimoto K. Hashimoto’sdisease and Dr. Hakaru Hashimoto. Endocr J 2002; 49(4): 3937.15. Cushing HW. The basophilic adenomas of the pituitary bodyand their clinical manifestations (pituitary basophilism). BullJohns Hopkins Hosp 1932; 50: 13795.16. Crohn BB. Regional ileitis. A pathological and clinical entity.JAMA 1932; 99: 13239.17. Hans Reiter (1881-) Reiter’s syndrome. JAMA 1970; 211(5):8212.18. Panush RS, Wallace DJ, Dorff RE, Engleman EP. Retraction ofthe suggestion to use the term ‘‘Reiter’s syndrome’’ sixty-ﬁveyears later: The legacy of Reiter, a war criminal, should not beeponymic honor but rather condemnation. Arthritis Rheum2007; 56(2): 6934.19. James DG. Wegener and Wegener’s granulomatosis. Thorax1987; 42: 9201.20. Feder BJ. A Nazi past casts a pall on name of a disease.New York Times [Internet], 2008; Health. Available from: http://www.nytimes.com/2008/01/22/health/22dise.html?-r=o [cited 22January 2008]21. Patterson R. The Munchausen syndrome: Baronvon Muchausenhas taken a bum rap. CMAJ 1988; 139(6): 5689.22. Asher R. Munchausen’s syndrome. Lancet 1951; 257(6650):33941.Robert P. Ferguson and Deborah Thomas4(page number not for citation purpose)Citation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4: 25046 - http://dx.doi.org/10.3402/jchimp.v4.25046

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