‘Bed rotting’ once went by a different name.
Eponymous syndromes, diseases or symptoms (hereafter ES) are names derived from the person who first identified the condition, less frequently a literary character and, even more rarely, the first patient.
ES, however, are a threatened species; ever searching for purity, the trend has been to replace them with more anonymous but “scientific” terms. This has led to a debate: are we losing the historical features that shape our discipline, or is it a progressive development that can remove anachronistic, offensive or inappropriate titles?
What no one in the debate will disagree on is the importance of names of conditions; their social, cultural, practical and clinical importance cannot be understated.
Conditions named after doctors are intended to reflect their primacy but, as so often happens in science, this can be strongly disputed. The story of encephalitis lethargica (EL) is illustrative.
After the first description by Constantin Von Economo in 1917, people referred to it as Von Economo’s disease. To his credit Von Economo refused this encomium and it was EL after that (but many still refer to it as sleepy sickness). At the same time, the French maintained that Jean-René Cruchet deserved the title but the matter was left with the historians.
The Klüver-Bucy syndrome (KBS) was described in 1937 by neuropsychologist Heinrich Klüver and neurosurgeon Paul Bucy showing the changes that occurred in chimps after removal of the temporal lobes. This revealed the important role of the temporal lobes (and later the limbic system), in behaviour. However, there was a report of KBS by Sanger Brown and Edward Schäfer in 1888 of which they were unaware.
This is an example of what occurs all too often in science when primacy is given to those who get to publish first, rather than make the discovery.
In a reversal of the usual trend the name of mongolism (trisomy 21) was changed to Down syndrome, named after the doctor who first described the condition in 1866, to avoid causing offence to people from Mongolia.
The pattern of eponyms started with naming symptoms and syndromes, there being no means at the time to determine cause or treatment. Some terms were intriguing – consider the Sister Mary Joseph nodule (secondary cancer of the umbilicus). Sister Mary Joseph was a catholic nurse at the Mayo Clinic and the term was first used in Hamilton Bailey’s textbook in 1949.
Some eponyms, through longevity and widespread use, have resisted defenestration, of which well-known examples are Alzheimer’s, Parkinson’s and Huntington’s disease.
It is regarded as bad form to attempt to name eponyms after oneself (auto-eponym), but this did not stop Howard Ricketts, Asmus Thomsen or Daniel Carrion.
Removal of eponyms associated with appalling medical abuses has been important and necessary.
Hallervorden–Spatz disease, Wegener’s Granulomatosis and Reiter’s Syndrome, all named after German doctors who experimented on Holocaust victims, represented medicine at its lowest point and have since been renamed.
Recently there has been discussion about Hans Asperger’s Nazi links, although it’s not clear if this played a part in the decision to submerge the condition into Autism Spectrum Disorder in the DSM update.
Fregoli delusion, Capgras syndrome, Münchausen’s syndrome and Pickwick syndrome are just a few named from fictional characters; the list is extensive.
Conditions named after patients are quite rare.
Lou Gehrig’s disease (ALS), named after the famous baseballer, is mostly used in the USA where there is a greater focus on fame and celebrity. Machado-Joseph disease, an incurable neurological disorder, was named after the two Portuguese Azorean Machado and Joseph families in whom it was first described.
Some examples do not last; for example, there was a move to use the term Rock Hudson’s disease after the film actor who died of AIDS, but perhaps this was trumped by the universal use of the abbreviations HIV-AIDS (perhaps showing that acronyms can trump eponyms).
Related
An intriguing example of an enduring eponymous name turned to political use is Oblomov syndrome. Ilya Ilyich Oblomov, the central character in Ivan Goncharov’s 1859 novel Oblomov, was intended to show the decadent nature of the Russian upper class. After an indulged childhood, Oblomov fails to leave his bed and rarely leaves his room or bed. These limitations notwithstanding, he manages to get engaged to Olga. However, she calls off the relationship after he endlessly delays the wedding.
Oblomov’s lifestyle was dominated by his sloth and avoidance; he would conduct whatever business he could not avoid from his bed. He has a child with his landlady, but they never marry and for the rest of his life he is taken care of by Agafia Pshenitsina. After many sad events, Oblomov dies of cerebral haemorrhage. Ever-rueful, Oblomov blamed “Oblomovitis” as the cause of his demise.
Literate doctors paid attention and Polish physician Wladyslaw Wermut gets the credit for naming Oblomov syndrome in 1975 for the refusal to get out of bed. Was this a Polish joke, or is there some validity in describing such a pattern of behaviour?
“Oblomovism” was added to the Russian lexicon, a byword for someone who withdrew from the world due to inertia, apathy, sloth or indecision, representing a sort of fatalistic laziness as an integral part of Russian character. Vladimir Lenin, despairing of the problems in the public, said (with characteristic restraint) in 1922: “Russia has made three revolutions, and still the Oblomovs have remained . . . and he must be washed, cleaned, pulled about and flogged.”
The debate on eponyms will continue and one suspects that despite the best efforts of the scientific rigorists they will keep bouncing back. This is by no means a bad thing and Oblomov would certainly approve.
Robert M Kaplan is a forensic psychiatrist, writer and historian. His latest book The King who Strangled his Psychiatrist and Other Dark Tales is in press.