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8 13 –9 295 and 11 295 Supporters 7 but quantitative quantitative but 12 [email protected] 2016; 46: 2016; Edinb Physicians Coll J R and the existence of multiple and the existence of multiple http://dx.doi.org/10.4997/JRCPE.2016.417 bemoan their lack of scientificof lack their bemoan 3 Correspondence to PBM Thomas Correspondence Department of Psychology University of Cambridge Street Downing 3EB Cambridge CB2 UK e-mail 2,9,10 © 2016 Royal College of Physicians of Edinburgh of Physicians of College Royal © 2016 It is the purpose of this paper to fill in this It is the purpose of this paper 7 The arguments on both sides are familiar and The arguments on both sides are 5,6 have recently been succinctly reviewed. been succinctly recently have quantitative blank, and give an in-depth analysis of the an in-depth analysis and give blank, quantitative the last 100 over in the usage of medical eponyms trends or so years. proof of decline (or otherwise) has largely been limited of decline (or otherwise) has largely proof atrocities. in Nazi those involved for named eponyms to argue that eponyms can be memorable, are concise, concise, are can be memorable, argue that eponyms an interest provoke and forebears, distinguished honour Critics history. medical in has not been quantified The fate of all other eponyms arise now eponyms new that evidence is there although infrequently. variants of a single eponym through grammatical through variants of a single eponym decades. spelling errors or through multiple attribution. attribution. multiple or through spelling errors been often have eponyms medical use of the in Trends their decline mourned Supporters have commented on. 1967, least at since literature the in rigour, the frequent misattribution of credit, the occasionalthe credit, of misattribution frequent the rigour, committed have who those to credit of attribution crimes against humanity,

2 and has been for for been has and 3,4 for example. Others example. for 1 No conflict of interest declared interest conflict of tion of Interests No PBM Thomas and Department of Psychology, Cambridge Addenbrooke’s Hospital, of Ophthalmology, Department Chief Resident in Ophthalmology, of Cambridge, Cambridge, UK University Paper Despite their ability to educate, medical eponyms eponyms medical educate, to their ability Despite and the debate among clinicians, feelings strong provoke polarised, is use continued their over ion Introduct a courses offer and few Medical school is a busy time, most clinicians, For in medical history. education formal often passed on in the medical history is an oral tradition, or teaching rounds during ward of anecdotes form a by often triggered are These digressions presentations. sign syndrome, disease, – an organism, medical eponym or patient, a doctor, or similar that has been named for to human context give Some eponyms party. third Baeyer’s Adolf von Nobel laureate historical figures: apocryphal) after barbiturates of naming (probably Munich, a barmaid from Barbara, Eponyms are a prominent feature of medical language. Many feel they they feel Many medical language. of feature prominent a are ABSTRACT Eponyms and education medical complicate to serveand their time had only have unmemorable concepts can make that eponyms argue Others conversation. a valuable and promote label complex concepts, can concisely memorable, in medical history. interest extinction. towards marching are eponyms that medical assumed It is frequently The fate of 8,636 tested. adequately has not been this hypothesis However, The here. contemporaryis presented from registers and historical eponyms articles 1900 is analysed since indexed in PubMed eponym each of usage annual eponyms of fate The extinction. and coinage prevalence, eponym of with metrics measured. implicated in Nazi war crimes is also those for named in their title in 2014 an eponym publications used that more shows The analysis fallen from title has eponym an using proportion the However, before. ever than overtook eponyms extinction of while annual today, peak of 3% in 1991 to 2% a are they decline, in dramatic while not that, suggests This 1980s. in the coinage is no ambiguity There scientific descriptions. more to share losing market perhaps entirely almost to Nazi war crimes which have related in the fate of eponyms decade.use in the last fallen out of Nazi linguistics, history, s eponyms, Keyword Declara Are medical eponyms really dying out? A study A study out? dying really eponyms medical Are biomedical historical in the usage of their literature demand more sober reflection, reminding us of terrible terrible of us reminding reflection, sober more demand name of our been perpetrated in the abuses that have is instance, for spider naevus, Eppinger’s profession: the a man who conducted experiments into named for subjectsas using seawater, only drinking of lethality Romani prisoners in the concentration camp at Dachau. PBM Thomas

Data collection table 1 Eponyms connected with perpetrators of Nazi crimes, and their alternative names There are many medical eponyms, both extant and extinct. To gain a comprehensive insight into their Eponyms connected with Alternative non- lifecycle and usage, a large list (8,636 in total) was the perpetrators of Nazi eponymous names compiled from www.whonamedit.com. A second list of crimes Beck–Ibrahim disease congenital cutaneous 102 medical eponyms was taken from the 1972 edition candidiasis 14 of Notable Names in Medicine and Surgery, and a third Cauchois–Eppinger–Frugoni portal vein thrombosis list was compiled of 11 eponyms connected with the syndrome 2 perpetrators of Nazi crimes and their alternative non- Clara cells club cells eponymous names (Table 1). Hallervorden–Spatz disease pantothenate kinase- associated Matlab (Mathworks, Nantick, USA) was used to create a neurodegeneration ‘webscraper’ which performed automated searches for Reiter’s syndrome reactive arthritis every eponym in the title of all indexed publications on Seitelberger disease infantile neuroaxonal PubMed. The number of uses of each eponym per year dystrophy (of publication) was logged. The total number of Spatz–Stiefler reaction paralysis agitans reaction publications listed on PubMed per year was also Van Bogaert–Scherer– cerebrotendineous Epstein syndrome xanthomatosis extracted to allow calculation of the yearly proportion Wegener’s granulomatosis granulomatosis with of all papers using each eponym. To attempt to control polyangiitis for the changing (increasingly scientific) makeup of Eppinger’s spider naevus spider naevus PubMed, searches were also made for 50 clinical Reiter’s spirochete Trepemona forans medicine terms present in publications from the early 19th century (e.g. inflammation, artery and wound) the changing content of PubMed (an increasing presence which have not become obsolete. Papers are of non-clinical science), Figure 1a also compares the retrospectively added to the PubMed database as new annual usage of all eponyms to 50 clinical medicine journals and their archives become listed. The data terms which have remained in constant use since the presented here were extracted during May 2015 and can 19th century. This ratio too has declined steadily since be considered accurate of the contents of the PubMed the early 1990s (except for 2014 which shows a small database at that point in time. Data analysis was increase), though the trend is less marked. undertaken in Microsoft Excel (Microsoft Corporation, Redmond WA, USA) and Matlab. The number of unique eponyms used per year is shown in Figure 1b. There was a rapid increase in the second Trends in eponym usage half of the 20th century, peaking in 1991 with only a small decline since. Coinage and extinction of eponyms The three datasets tell us about different aspects of were also assessed in this dataset. Coinage refers to the eponym usage. first year in which the eponym appears in a PubMed title, whereas year of extinction is here defined as the last Trends in the ‘whonamedit.com’ dataset year in which an eponym was used. Since rarely used This is by far the most comprehensive dataset available. eponyms might not appear in a given year only to It shows that throughout the 20th and 21st centuries resurface in the next, extinction is only assessed up until there has been a steady increase in the number of uses 2005 (eponyms last used in this year which have not yet of eponyms per year in titles in the PubMed database resurfaced are deemed unlikely to do so). Figure 1b also (Figure 1a). In 2014, the most recent year analysed, the shows the rates of coinage and extinction of eponyms: greatest number was seen at 21,733 (compared to during the 1980s extinction overtook coinage, and has 20,779 in 2013 and 1,995 in 1950). Since 1945, the remained ahead ever since. number of eponyms used in a given year has only failed to exceed the preceding year’s count in 1956, 1958, Trends in the ‘Bishop and Bailey’ dataset 1974, 1978, 1997 and 2007. The post-war peak prevalence of this subset of eponyms occurred in 1954. This peak pre-dates publication of the However, the number of publications referenced in third edition of Notable Names in Medicine and Surgery by PubMed per year has also grown dramatically to 18 years, and use of these eponyms was in significant 1,055,105 in 2014 (at the time the searches were decline by 1972 (the year of publication of the edition). performed) from just 85,580 in 1950: this rate has This finding is curious since the period 1954 to 1972 is outstripped eponym usage since 1991 when the a time of healthy growth among eponyms in the history prevalence of eponyms in titles peaked at 3%. By 2014 ‘whonamedit.com’ dataset. It could alert us to the this prevalence had dropped back to 2%. Figure 1a possibility that a list of eponyms is biased towards those shows the full trends. In order partially to control for eponyms that are well established at the time it is

296 J R Coll Physicians Edinb 2016; 46: 295–9 © 2016 RCPE history 297 This assumption is questionable, is questionable, This assumption 15 Are medical eponyms really dying out? out? dying really eponyms medical Are since more established scientific disciplines than ours ours scientific disciplines than established since more most basic language: in their most enshrine eponyms recently many and constants, and units physical a reductionist Taking example. for elements, discovered two for exist eponyms that argue could one view, and remembered; be to desire human a first, reasons: of better way a sometimes isn’t there because second, and cumbersome to without resorting concept a naming in arguments Theoretical unmemorable descriptions. of little chance stand scientific nomenclature a of favour discussion Amid much altering either of these realities. has a decline of medical eponyms cons, and of their pros has evidence hard no However, presumed. been often trend. a such existence of confirm the to been presented that conclude can we here, presented analysis the From point in the than at any more used now are eponyms been have they that evidence is there However, past. the past scientific terms for to more share losing market but eponym, passed peak might have We decades. two exaggerated. greatly are their death of reports Although one can make theoretical arguments for and and for arguments theoretical make can one Although of medical language practicalities usage, eponym against to were If we them. to preserve will strongly act Daniel Salmonella (named for the eponym abandon example, a veterinary for pathologist) Elmer Salmon, gain? we what would and with, it replace we what would can we scientific way succinct and alternative an there Is effortthe worth it is and and genus, this describe as such Other eponyms, confusion of a rebranding? a Alzheimer, Aloysius disease (named for Alzheimer’s in entrenched well so are neuropathologist) German cause would rebranding that understanding public taxonomy scientific more a that the confusion precisely existing eponyms, many Therefore aims to avoid. be practically cannot ones, prevalent the most especially or entrenched too well are because they replaced of describing them way is no concise there because eponyms obscure The popularity of more scientifically. but the change, will fluctuate as fashions doubtless (Escherichiaubiquity of the most used eponyms , disease, Parkinson’s Salmonella, disease, Alzheimer’s a etc.) virus Epstein-Barr provides disease, Crohn’s a significant short against buffer or medium term strong usage. eponym in the incidence of reduction its continues It has been suggested that as medicine eponyms phenomenology science, to from evolution die out. slowly should 295–9 2016; 46: 2016; a) Total annual post-war eponym usage (black line, right axis) in Pubmed, annual eponym prevalence prevalence eponym annual right axis) in Pubmed, (black line, usage eponym post-war annual Total ) a) (overleaf 1 Figure left axis); (black squares, 50 clinical terms of one using papers among prevalence eponym annual and left axis), (black circles, of the number and right axis), 2005 (black line, 1900 and between year in each used unique eponyms of The total number b) of The prevalence c) year; left axis) in each (black circles, extinct becoming left axis) and (black diamonds, coined eponyms 1945–2014. (open black circles), their scientific alternatives and circles) (filled black atrocities Nazi to related eponyms © 2016 RCPE J R Coll Physicians Edinb Coll Physicians J R Synthesis some internal shows above presented The analysis in are eponyms that suggest numbers The raw conflict. in use since 1945. increasing relentlessly rude health, A decline. a slow suggests however, Their prevalence, in 2014 used eponyms papers of smaller proportion whether this is an say to It is hard than at the 1991 peak. The within PubMed. focus artefactresearch changing of eponym when present, still but weaker, is trend containing papers those among is measured prevalence loss of eponym also see a slow We clinical terms. clearly use in 2014 (704) in active eponyms with fewer diversity, in medical explosion an in 1991 (720) despite than of rate increased The period. same the publication over might we though clear, extinction is eponym annual disease’ ‘Alzheimer’s the next coinage: underestimate sub-specialty been coined in a small, have might recently use to widespread through broken and not yet journal, lists. eponym of curators of the attention attracted and those when considering The story clearer is much in implicated are who individuals for named eponyms has been a dramatic decline in There Nazi atrocities. Only years. five past the particularly over usage, their in the regularly still occurred granulomatosis Wegener’s outnumbered though its use is now in 2014, literature polyangiitis. with granulomatosis term the by fourfold ‘Wegener’s 2015 suggests that use of Preliminary data for would It 2014. to compared halved granulomatosis’ of on the verge finally are seem these eponyms complete extinction. compiled, and might not include those that have recently recently have that those include not might and compiled, use. widespread to on but will been coined go dataset ‘Nazi’ in Trends to related of eponyms in usage trends 1c shows Figure the of usage as well as crimes Nazi of the perpetrators conditions. same the to refer that names scientific disease and in 1993 occurred eponyms Nazi of prevalence Peak Only decline. precipitous been a has since then there renamed largely now granulomatosis, Wegener’s in common remains with polyangiitis, granulomatosis this among uses the of 77% for accounts and usage is most dramatic since 2010 The decline in 2014. dataset of in the usage increase a marked which coincides with conditions. to the same the scientific names which refer PBM Thomas history

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