Eur Respir J 2010; 36: 706–708 DOI: 10.1183/09031936.00046110 CopyrightßERS 2010 EDITORIAL Tainted eponyms in medicine: the ‘‘Clara’’ cell joins the list A. Woywodt*, S. Lefrak# and E. Matteson" ponyms are a time-honoured tradition in medicine as 1939 and 1945 should have alerted our suspicions. Further well as the sciences. Some fields of medicine, such as clues that we missed were that Wegener could only find E rheumatology and neurology, are particularly fond of employment as a farm labourer immediately after the war and them and the term ‘‘eponymophilia’’ has been coined to that he never obtained the title of Professor or even lecturer. It describe their affinity [1]. Those who like their eponyms argue was, therefore, a complete surprise to us when Lancet rejected that their use adds flavour to our daily practice and that they our paper, stating that Wegener had been imprisoned after the are universally understood. They also claim that, as they are war for activities undertaken under the Nazi regime [6]. The everywhere anyway, change would be impractical [2]. next 5 yrs saw two of us (A. Woywodt and E. Matteson) trawl the archives in Germany, the USA and Poland until we were During the last decade or so, the use of eponyms has become able to shed some more light on this affair [6]. We were able to the subject of intense controversy. In 2003, PANUSH et al. [3] show that Wegener was an early member of the Nazi party reported on the biography of Hans Reiter, after whom a form well before the Nazis came to power and that he rose to the of reactive arthritis was named despite the fact that others had rank of Lt. Colonel in the SA, the Nazi party, para military described the condition well before him. Apart from being an ‘‘brown shirts’’. Furthermore, we could provide evidence that outspoken lecturer in favour of ‘‘racial hygiene’’, Reiter served Wegener had been wanted by Polish authorities and that his on the advisory board to Hitler’s physician, Karl Brandt, who case had been referred to the United Nations War Crimes headed the infamous ‘‘euthanasia’’ programme. This systema- Commission. Despite all efforts, however, we were unable to tic killing of patients with mental and other illnesses devel- discover what he had actually done to warrant being wanted, oped the killing mechanism utilised in the genocide of the Jews, and the Roma and Sinti people. Brandt was executed for not least because much of his file had been lost [6]. An this and other crimes in 1948. Moreover, Reiter, as Chief of the editorialist called the evidence ‘‘thin but tangible’’ [7]. Most Reich Health Service, approved not only the sterilisation importantly, patients with the illness expressed their belief that programmes but also the deliberate infection of concentration continued use of the eponym was offensive to them (personal communication; D.G. Shaw and J.A. Kullman, Vasculitis camp inmates with rickettsia. The report by PANUSH et al. [3] led many physicians, particularly in the USA and Germany, to Foundation, Kansas City, MO, USA). Finally, the American abandon the use of the eponym in favour of a more descriptive College of Chest Physicians, in 2007, retracted the lifetime name [4]. Panush’s work also led to the formal retraction, in ‘‘Master Clinician’’ award it had granted to Wegener [8]. 2007, of the initial publication that coined this particular In this issue of the European Respiratory Journal,WINKELMANN eponym [5]. It is probably fair to say that there is no coherent and NOACK [9], from Berlin and Dusseldorf respectively, approach to these issues within the rheumatology community. provide in-depth insight into the biography of Max Clara, Some have disdained its use, whereas others continue the use after whom a non-ciliated, secretory cell in the respiratory of the eponym. epithelium of the distal airways has been named. They More recently, the eponym controversy has reached the world document, in great detail, his political activity on behalf of of respiratory medicine. In 2001, one of us (A. Woywodt) set the National Socialist programme and provide evidence that out to write a biography of Friedrich Wegener, after whom a Clara supported and used his position to help carry out the form of vasculitis had been named. A manuscript was duly racial concepts at the heart of the Nazi regime. Undoubtedly, submitted, describing what then appeared to be the immacu- this man owed his career advancement in no small way to his late track record of a great scholar. In retrospect, the fact that membership in the Nazi party and active support of its all available accounts of Wegener’s life contained little, if any, programme. The authors show that his appointment to a information on Wegener’s time in occupied Poland between professorship in Leipzig was largely due to political support, not least from his fellow Austrian Max de Crinis, Chief of Psychiatry at Charite´ Hospital in Berlin, Germany. Dr de Crinis *Dept of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK. was a high-ranking member of the SS, and perhaps the most #Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, outspoken and influential Nazi within the German psychiatric St. Louis, MO, and "Division of Rheumatology, Mayo College of Medicine, Rochester, MN, establishment who assumed a leading role in the T4 ‘‘eutha- USA. nasia’’ programme. The weight of this evidence alone should CORRESPONDENCE: A. Woywodt, Renal Unit, Lancashire Teaching Hospitals NHS Trust, Royal be sufficient to cast very serious doubt on the use of this Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, UK. E-mail: [email protected] particular eponym. 706 VOLUME 36 NUMBER 4 EUROPEAN RESPIRATORY JOURNAL A.WOYWODT ET AL. EDITORIAL However, WINKELMANN and NOACK [9] also focus attention on What can be learnt from this latest addition to the list of provenance of the tissue used for the original description of the ‘‘tainted’’ eponyms? First, recognition is due to WINKELMANN ‘‘Clara cell’’. It was obtained from a prisoner executed by the and NOACK [9] for this contribution to medical history and Nazi ‘‘justice system’’. Clara states this in his original paper of society. We have previously called for more doctors to more 1937. We do not know whether this was an ‘‘ordinary’’ criminal closely examine the males and females behind medical or a victim of prosecution and torture. However, we are forced eponyms. WINKELMANN and NOACK [9] have done just that, to conclude that Clara’s discovery is, at the very least, closely when they asked: Who was Max Clara? linked to the Nazi system of systematic injustice. As the Nazi Empire grew and capital punishment increased for lesser and Their work also shows, again, how difficult it is to assess these lesser ‘‘crimes’’, the bodies available to Clara and his Leipzig issues more than 70 yrs on. It raises difficult questions, as all group increased just as they did for all anatomists working in good research does. How intimate an involvement in the Nazi atrocities, or other inhuman activities in which physicians have the Third Reich. WINKELMANN and NOACK [9] demonstrate that Clara and his colleagues not only made good use of this increase engaged, do we require before we consider someone’s in ‘‘anatomical material’’ by publishing at least 20 scientific behaviour inappropriate? Is it enough to have benefited papers utilising it, but that Clara actively sought to increase his directly in one’s career? Or will only direct involvement be cadaver supply by soliciting the justice administration. Clara sufficient? Clara apparently supported a ‘‘half-Jewish’’ doc- requested that specimens for anatomical research be obtained toral candidate: does that make things any better? from the executed without the knowledge of their families. This We should also appreciate a fact that is often overlooked, fact is important: in doing so, Clara not only crossed another namely that some eponyms honour victims and survivors of moral boundary but also violated legal procedure at the time. the Nazi regime, and not the perpetrators [14, 15]. Neurology, There is also reason to believe that, at least on one occasion, another field with considerable eponymophilia, provides some Clara and his co-workers experimented on such prisoners prior evidence in this regard: Tinel’s test, for example, honours a to execution, although this did not involve torture. WINKELMANN physician who fought in the French resistance movement and NOACK [9] emphasise that, although these deeds were during the Second World War, whereas Joannes Cassianus neither illegal at the time nor unique, Clara can be accused of Pompe, after whom a glycogen storage disease is named, was ‘‘moral complicity’’ with the system and personally benefited executed for his participation in the Dutch resistance move- hugely from the crimes committed by the Nazi regime [10]. We ment [15]. Should we perhaps keep those eponyms, as they fully agree with the authors’ assessment. clearly honour brave and upright people? A similar case that comes to mind is that of Berlin anatomist Two of us (A. Woywodt and E. Matteson) have previously Hermann Stieve, who conducted his research on reproductive argued in favour of a more descriptive nomenclature in anatomy on the corpses of female camp inmates [11]. In an medicine and suggested that eponyms be abandoned for a earlier paper, WINKELMANN and SCHAGEN [11] examined his variety of reasons [16]. This new example provides impetus for research and found no evidence of murder or torture although arguing that medicine should abandon bestowing names of they diagnosed ‘‘moral complicity’’ with the system; the scientists on diseases or other critical areas of interest to assessment of Stieve’s work was controversial [12].