“Lives of great men all remind us
We can make our lives
sublime,
And, departing, leave behind us
Footprints on the sands of
time……..;
“A Psalm of Life”: Henry
Wadsworth Longfellow (1807 –1882)
American poet, Harvard Professor
How do you recognise a flower? By its name! In Western
tradition, an equation in Chemistry or a geographic landmark
was named after the person who described or discovered it
first. It was their way to remember and honour the pioneer,
dedicated scientist, master clinician for his contribution,
recognise his hard work and perpetuate his memory. In an era
when nothing much was known about causation of disease, it was
logical to use Eponyms, which still retain a certain charm and
allure, an old-world poise and elegance.
Speak of ‘
Down syndrome’ and we see as in a
photograph the physical appearance, face, eyes, single palmar
crease, everything the English physician John Langdon
Down described in 1862. We know now it is caused by Trisomy
21, which is therefore its correct name. But it is interesting
to know a bit of John Down, who after graduating with honours
and gold medals from London, joined Earlswood Asylum, first as
Physician, later as Medical Superintendent. He found the
Asylum a house of horror, its inmates kept in dirty conditions
and subject to corporal punishment. With his wife Mary, he
transformed the hospital- it became a happy place, patients’
dignity was valued, punishments forbidden and replaced by
rewards and kindness; inmates were taught riding, gardening,
crafts, elocution. In his book, ‘Ethnic Classification of
Idiots’ based on his observations, he classified different
mental conditions by their striking resemblance to people of
various races: Malay, Caucasian, Ethiopian and so on. He
called some of his ‘white’ subjects the ‘
Mongolian idiots’.
The Eponym ‘
Down syndrome’ thus came to be synonymous
with ‘Mongolism’. Down argued that if disease could transform
facial features of the offspring of whites to those of another
race, there had to be universality in the genetic make-up of
the human race; this was at variance to what had been
understood hitherto. One of his grandsons had the disability.
He and his two doctor-sons converted his house into a home for
children with mental disabilities. The Langdon Down Centre,
London remains the headquarters of the Down Syndrome
Association. While it was scientifically more accurate to call
Down Syndrome as Trisomy 21, we stick to the moniker while
teaching every new generation the manifestations -physical,
mental, cardiac and haematological- of this fairly common
disorder. An Eponym is a person, real or fictional, place or
thing after which something is named [
Eponym: ~1846
from Gk “
epi”-"upon" + “
onyma”- "name"].
The earliest of all the masters, who we remember with respect
and reverence as the ‘Father of Medicine’ is Hippocrates, who
lived on the Greek island of Kos, c. 460 – c. 370 BC. This
great clinician-teacher observed carefully and recorded all
his findings meticulously. His contributions are legion:
Hippocrates described several clinical signs we
now take for granted: Clubbed fingers or ‘
Hippocratic
fingers’ which he observed in patients with
empyema, “the finger-nails become curved and the fingers
become warm, especially at the tips”; the ‘
Hippocratic
facies’, the unhealthy countenance seen in death,
prolonged illness, excessive hunger and severe cachexia
- ‘the nose sharp, the eyes sunken, the temples fallen in….’;
‘
Risus sardonicus’, the facial grimace of Tetanus and
Strychnine poisoning; the chest signs of Pneumothorax,
Pleurisy, Pneumonia; the ‘Succussion splash’ in Hydro- and
pyo- pneumothorax. He treated chest abscesses with lead pipes,
used the rectal speculum, managed haemorrhoids with ligation
and cautery, suggested lifestyle modifications and diet in
conditions like diabetes, devised the ‘
Hippocratic bench’
or ‘scamnum’ to set bones. Above all he laid out in ‘
The
Canon’ the characteristics desirable in a student of
Medicine and set up a code of conduct for physicians, in an
attempt to introduce Ethics into medical practice. All
graduating medical students start their career by taking the ‘
Hippocratic
Oath’ or its current variation. We have all this and
more in The ‘
Hippocratic Writings’ or ‘Corpus’,
available as a Penguin publication. The Corpus is a
compilation of about sixty Treatises written by several
physicians, many were his own students, over nearly a hundred
years.
Galen of Pergamon, b. 129 AD (ancient Greece, now in Turkey),
performed dissections on animals in an era when dissection on
humans was taboo; these findings were extrapolated on to
humans. He described among others, the Great Cerebral Vein,
which still bears his name. He was a renowned surgeon, in
great demand for healing gladiators’ wounds; he thus got the
opportunity to document human anatomy with precision, went on
to clarify the anatomy of the Trachea and demonstrate that
voice was produced by the Larynx.
Antonio Maria Valsalva, Italian anatomist (1666-1723),
favourite student of Malpighi at Bologna, identified the
internal, middle, and external parts of the ear, recorded the
smallest muscles and nerves therein, described the tympanic
antrum and demonstrated an original method of inflating the
middle ear (Valsalva's manoeuvre) practiced even today. He
noted that motor paralysis occurred on the side opposite the
cerebral lesion in stroke and cranial injury and is said
to have coined the term ‘
Eustachian tube’, one of the
earliest eponyms known. He anticipated the importance of
nephrectomy, is remembered for his management of aneurysms and
the surgical instruments he invented. He considered madness to
be analogous to organic disease and was the first to implement
humanitarian treatment of the insane.
John Hunter (1728-93), one of the greatest British anatomists
and surgeons, was the founder of experimental pathology. As a
child in a suburb of Glasgow he disliked school and hated
books, but was good with his hands. When he was 20, he rode
horse-back to London to join his elder brother William, who
had his own anatomy school and was an established
Obstetrician. William spotted John’s skills, made him dissect
bodies and teach anatomy. John’s brilliant dissections soon
made him famous. He apprenticed to the surgical great, Sir
Percival Pott at St. Bartholomew's Hospital, London, qualified
as a surgeon and joined the army. He described the
Hunter’s
canal, the subsartorial canal in the thigh and the
Hunter’s
operation of ligating a popliteal aneurysm. His
interest in comparative anatomy made him build up a vast
collection of specimens and dissections; he was an advocate of
experimentation. In an attempt to decide whether gonorrhoea
and syphilis were caused by the same organism, Hunter is
reputed to have self-inoculated the pus and describe the
changes in his own body one by one: the chancre and the
complications. He suffered from angina from 1773 and from
cerebral syphilis; he died suddenly while attending a meeting
in his own hospital. The Royal College of Surgeons of England
instituted in 1813 the prestigious Hunter Oration, delivered
on Hunter’s birthday, February 14, to honour the great man for
his “improvement or extension of surgical science".
Franz Friedrich Anton Mesmer (1734-1815) was a German doctor
interested in astronomy. His Medicine doctoral thesis from the
University of Vienna was on the ‘The influence of Planets on
the Human Body’, how the tides in the human body were
controlled by the sun, moon and planets. Even in those days
this was not considered at all original: it was felt
that Mesmer had plagiarised the idea from one of Newton’s
friends! We know he was a close buddy of the composer
Mozart. But it was his theory of ‘animal magnetism’, the
natural energy which could be transferred between animate and
inanimate objects that made his ‘reputation’ and came to be
called ‘
Mesmerism’. In 1774, he “cured” a woman
of hysteria: he got her to swallow an iron preparation
and then applied magnets on her person. Mesmer remained a
controversial character: he was forced to move from Vienna to
Paris, then to Switzerland and eventually died in Meersburg,
Southwest Germany.
The islets of Langerhans were detected by Paul
Langerhans (1847-1888), a young 22-year old Berlin medical
student. In 1868 he discovered dendritic cells in the skin by
special stains. He used the same technique on the pancreas in
1869 and found there were two distinct groups of cells, the
acinar cells which secreted digestive enzymes, and others
clustered in islands or islets, which, he postulated, had
another function. The chemical from these ‘islands’ was later
isolated and named
Insulin. His mentor was Virchow -
both shared an interest in Anthropology, together they
discovered Macrophages. Paul Langerrhans died
young of tuberculosis and kidney infection.
Charles Heber McBurney (1845–1913), Professor of Surgery at
Mount Sinai - Roosevelt Hospital from 1889-1907, a gifted
teacher, is best remembered for his presentation in 1889 of
his sign in acute appendicitis - the point of maximum palpable
tenderness as determined by pressure applied by one finger -
and the anatomical landmark
McBurney’s point. His
surgical incision was presented five years later. McBurney
also described Pyloric Stenosis, introduced Sphincterotomy for
the management of stones impacted in the common bile duct,
developed techniques for the repair of inguinal herniae and
the management of fracture - dislocation of the shoulder: but
these are not widely known. A keen hunter and fisherman, he
died of myocardial infarction on one of these trips.
Named reactions in biochemistry are a nightmare to medical
students, some simple, like the test described by the American
Stanley Rossiter Benedict (1884-1936) of Yale’s Department of
Physiological Chemistry, others very complicated, like the
Henderson-Hasselbach
equation, relating pH to the bicarbonate buffer system
of blood. Two chemists developed the latter independently,
American Biological Chemist LJ Henderson and KA Hasselbach of
Sweden.
Georges-Fernand-Isidor Widal (1862 -1929), born in Algeria,
graduate of Paris, Professor of Internal Pathology and later
Medicine at Hospital Cochin, Paris, identified the lesions of
Erysipelas. But he is better known for his serological
test in Typhoid and its vaccine which saved innumerable lives
during the First World War. He identified salt retention as a
feature of Nephritis and of Cardiac Oedema. He also
demonstrated, with the French physician Georges Hayem, the
increased fragility of red cells in haemolytic jaundice ("
Hayem-Widal
syndrome").
Sir James Paget (1814 –1899) and his close friend Rudolph
Virchow were the founders of scientific medical pathology. As
a first year student in Bart’s, London, he noticed some white
specks in the muscle he was dissecting. Under the microscope
he recognized they were encapsulated worms; years later,
Richard Owen identified these and named them
trichinella
spiralis. Two of his famous works were
Lectures on
Tumours (1851) and Lectures on Surgical Pathology
(1853).
In 1856, a patient came to Paget for an enlarging cranial
vault. The patient’s spine was also becoming anteriorly
curved, resulting in a ‘simian stance’; dimness of vision and
deafness followed by 1872. At autopsy ‘the bone was so soft it
could be cut by a razor’ and the histology was unusual. Paget
reported his case as
osteitis deformans in 1877.
Succeeding generations identify this skeletal problem by the
eponym
Paget’s Disease of Bone. Paget, ‘a
man of small build, long face, bright eyes and sharp
intellect’, was considered a friend by the intelligentsia of
the time - John Ruskin, William Gladstone, Cardinal Newman,
Lord Tennyson, Louis Pasteur, Florence Nightingale, Thomas
Henry Huxley and Charles Darwin. As many as ten diseases are
associated with his name - including Paget’s
disease of
the Breast, a type of cancer that resembles eczema, with
skin changes involving the nipple;
Paget - von Schrötter
disease, upper limb deep vein thrombosis in the axillary
or subclavian veins;
Paget’s Abscess, an abscess
recurring at the site of a former abscess which had resolved.
Paget continued to be active professionally till he died aged
85 years.
Chorea (
Gk-‘dance’), is a quasi-purposive, non
repetitive movement, a dance, which could easily be mistaken
for Hysteria. That it could result from ingestion of
Metoclopramide, Domperidone or a phenothiazine, all of which
cross the blood-brain barrier and affect the basal ganglia,
may not be known to an unsuspecting young doctor. Chorea
occurring from the vasculitis of acute Rheumatic fever affects
the same structures and was called
St Vitus’ Dance.
St. Vitus, a Christian saint, persecuted by Roman emperors,
died a martyr in AD 303. He was considered patron saint of
dancers, actors, comedians, epileptics. In an era when hygiene
was poor and rheumatic fever common, it was a common sight to
find in mainland Europe, groups of people, thousands at a
time, afflicted by Chorea - men, women, children - gathering
in the streets and parks of various towns, dancing away till
they collapsed from exhaustion, in an attempt to propitiate
St. Vitus and rid themselves of their malady, also called
Dancing mania, Dancing plague, Choreomania and St. John's
Dance. The first major outbreak was in Aachen, Germany, in
1374, then throughout Europe, with another in Strasbourg in
1518. The first clinician to give a rational explanation, its
full description and establish the relationship with Rheumatic
Fever was Thomas Sydenham (1624 –1689), called 'The English
Hippocrates’ because of his keen clinical acumen
and the importance he gave for bedside practices. Rheumatic
Chorea is therefore popularly called Sydenham’s
Chorea and his
Observationes Medicae was standard
textbook of medicine for two centuries.
George Huntington (1850 –1916) a young 21-year old clinician
from Philadelphia, wrote in April 1872 about some families
aged 30 to 50 years who had chorea and dementia. Many of them
were mistaken to be drunk. We know more of it now - its
Autosomal dominant inheritance, that it is caused by a
cytosine-adenine-guanine (CAG) trinucleotide repeat expansion
in the huntington (HTT) gene on chromosome 4p. But we remember
the condition only as Huntington’s Chorea.
In 1768, William Heberden (1710–1801) a Cambridge physician,
gave a classic description of angina pectoris [
angere
-"to strangle",
pectus -"chest"] which is yet to be
improved. Earlier textbooks called it ‘
Heberden’s
angina’. That Heberden had also described night blindness,
differences between smallpox and chicken pox, the progress of
tongue cancer and observed that tuberculosis improved during
pregnancy but not post-partum, is not widely known. He
observed that the
Digitorum nodi of the
distal interphalangeal
joints in Osteoarthritis (
Heberden’s nodes) differed
from gouty tophi.
It was several years later that Charles Jacques Bouchard
(1837–1915), French pathologist and student of Charcot,
described another sign of Osteoarthritis - the hard, bony
outgrowths or gelatinous cysts in the
proximal interphalangeal
joints (
Bouchard's nodes). Bouchard and Charcot
together identified the <300 micrometre miliary or micro
aneurysms in the lenticulo-striate arteries of patients
with Hypertension (
Charcot-Bouchard aneurysms).
Palmar contracture is frequent in many north European
countries where the Vikings settled hence its name, ‘
The
Viking Disease’. Wherever the Vikings went, they took
the illness - even some Egyptian mummies have the contracture!
It got to Scotland too and was handed down to successive
generations. It is common in manual labourers; we now
attribute it to repeated trauma. Bagpipe players of the Island
of Skye had been known, for centuries, to have the
contractures, called the ‘
Curse of MacCrimmons’, as it
was believed to have been the result of a widow’s curse. Baron
Guillaume Dupuytren (1777–1835), French anatomist and surgeon,
one of the richest practitioners of his time, already famous
after he treated Napoleon Bonaparte’s haemorrhoids and
his
Treatise on Artificial Anus, was the first to make
the contractures widely known. In his lectures of 1831, he
described the fascial thickening, offered corrective surgery
and published his findings in ‘The Lancet’ of 1834. He
mentioned that the condition he described in the hand could
also occur in the foot, but the first detailed reference of
the latter is in 1894, when a German doctor, Georg Ledderhose,
described fibromatosis of the plantar fascia. We see the Pope,
while blessing the congregation in Rome, uses the ‘St Peter’s
hand of benediction’. It is postulated that the curved fingers
were due to the contractures! Dupuytren was the first to drain
a brain abscess by trepanation; he claimed he discovered
melanoma, and was aggrieved that Laennec had stolen the idea
from him.
James Parkinson (1755–1824) was a GP in London. Over several
years, during his morning walks, he observed several
pedestrians, their stoop, resting tremor, propensity to bend
the trunk forwards, the abnormal gait accelerating from
walking to running pace. He noted how their physical
disability progressed over the years, but with the senses and
intellects always uninjured. He wrote all these up as a paper
in 1817 when he was 62 years old (it is never too late to
start!!), the 6 cases of ‘
paralysis agitans’, of whom
only three were his own patients. “
An Essay on the Shaking
Palsy” is a landmark article in Neurology, which can be
downloaded free as part of the Gutenberg collection. In five
chapters he described the course, pathognomonic symptoms,
confounding conditions, possible causes and suggested forms of
treatment appropriate for the period. Parkinson also
wrote about Gout and described the first case of ruptured
appendicitis. As a political activist Parkinson frequently
fell foul of the law. His interest in Paleontology led him to
important discoveries in that field. 60 years later Jean
Martin Charcot (1825-1893), "
the founder of modern
neurology”, ‘re-discovered’ the clinical condition and
named it Parkinson’s Disease.
Sir Charles Bell (1774-1842) was the first to differentiate
motor from sensory nerves. He also described
Bell’s palsy.
His artistic skills were evident even a child. He followed his
elder brother John’s footsteps into Medicine, to graduate from
Edinburgh, later compiled a
Treatise on the Hand and a
4-volume
Anatomy of the Human Body, and made wax
models of medical cases, which are still preserved in the
Surgeons’ Hall at Edinburgh. He described the Long Thoracic
Nerve;
Bell’s Palsy - Idiopathic unilateral facial
palsy;
Bell’s phenomenon - the eyes rolling up
when the eyes are closed forcibly, a defense mechanism; the
Bell-Magendie
Law which stated that the anterior roots contained only
motor fibres and the posterior roots were sensory.
However he was no relative of Joseph Bell (1837-1911), the
Scottish surgeon who taught Sir Arthur Conan Doyle at the
University of Edinburgh and provided Conan Doyle, by his
observant ways, the inspiration for the literary character
Sherlock Holmes.
No article on Eponyms would be complete without mention of
Jean-Marie Charcot (1853-1940), “the founder of modern
neurology” who worked and taught at the famous Salpetriere
Hospital of Paris for 33 years and made it the Mecca of
Neurology. Even as a young boy Charcot was interested in
painting and drawing, which taught him the importance of
making careful observations: this gift helped him throughout
his career as a charismatic teacher and an outstanding
scientist. He qualified at the age of 23 and was appointed to
his hospital position after he presented an outstanding
doctoral thesis on gout and its difference with chronic
rheumatism. He underlined the importance of
anatomical-clinical correlation of symptoms with the findings
at autopsy. He discovered that the dorsal horn of the spinal
cord carried trophic properties while studying the cells of
patients with infantile paralysis, and demonstrated that the
neuropathic (
Charcot’s) joint, a complication of Tabes
dorsalis, was the result of loss of proprioception. He was the
first to diagnose Multiple Sclerosis and its
Triad of
nystagmus, intention tremor and dysarthria. He researched the
functions of different parts of the brain, the role of
arteries in cerebral haemorrhage and to describe ankle clonus.
There is a famous painting by Andre Brouillet of Charcot
demonstrating Hypnosis to cure the Hysteria of his patient
“Blanche” Wittman with many of his students gathered around
him: these included Joseph Babinski, Henri Parinaud and
Georges Gilles de la Tourette. Charcot gave his name to
at least 15 conditions, including Amyotrophic Lateral
Sclerosis, Intermittent Hepatic Fever (pain, fever, jaundice,
loss of weight-indicative of biliary colic), the
Triad in
Cholangitis - right upper quadrant pain, fever,
jaundice. Charcot, Pierre Marie, his resident, and Howard
Henry Tooth of Queen Square, London together announced the
discovery of a new hereditary sensori-motor neuropathy which
came to be called
CMT disease. He worked
uninterruptedly, his sole relaxation being the music of
Beethoven, till he died nearly 90, literally burning the
midnight oil.
Joseph Babinski (1857-1932), son of a Polish engineer,
was one of Charcot’s distinguished students. Unfortunately he
was sidelined from academic positions, so he concentrated on
clinical observations. In a 26-line presentation, "
phenomene
des orteil" at a meeting of the
Societe de Biologie
in 1896, he gave the first report on his observation that
stimulation of the sole of the foot normally caused plantar
flexion of the toes, but injury to the pyramidal tract
resulted in an isolated dorsal flexion of the great toe, later
called the “
Babinski sign”. Babinski was the first to
localize spinal tumours and send them for surgery. His
greatest contribution was to persuade his mentor Charcot to
separate the young and suggestible female sufferers of
Hysteria on the ward from those with epilepsy, as the two were
separate entities. A year before Alfred Frohlich, Babinski
described the Adiposo-genital syndrome in a patient with a
pituitary tumour; it is still termed
Babinski-Frohlich
syndrome. Robert Wartenberg and Samuel Alexander Kinnier
Wilson sought out Babinski for training. Perhaps his most
distinguished student was the Portuguese Egas Moniz who was
awarded the Nobel Prize for his discovery of Prefrontal
Lobotomy in Schizophrenia and for introducing
contrast-enhanced cerebral angiography. Babinski who had
started having symptoms of Parkinsonism, wrote the preface for
Moniz’s monograph.
A contemporary of Charcot was Guillaume Benjamin Armand
Duchenne (1806-75) of Boulogne, who was so fascinated by
science that he went against his father’s wishes and decided
against a career in the Navy. Duchenne’s wife died of
puerperal fever; his wife’s family blamed him for this tragedy
and separated him from his son. He became a loner because of
his country accent and unsophisticated ways, was mocked by
interns, shunned by his peers, never applied for regular
posts, wandered ‘mariner-like’, haunting different
hospitals to study difficult cases. Charcot became his friend
and called him “The Master”. It was Duchenne, the
diligent observer, who first established the meticulous and
elaborate neurological examination, introduced surface
electrodes into neurophysiology and introduced biopsy as a
tool for diagnosis. He was a keen photographer, introduced
medical photography into clinical practice, studied the
mechanisms of facial expressions in emotion and documented in
his Atlas the progress of his patients with Muscle diseases.
Addison’s Disease (Hypoadrenalism) was first described
by Thomas Addison (1793-1860) of Guy’s Hospital, London.
Addison’s schooling was in Newcastle-on-Tyne. He was fluent in
Latin, always ‘correct’ with his notes and diction. His father
wanted him to become a lawyer but he entered Edinburgh
University Medical School to graduate in 1815, aged 22. He
moved to London, joined Guy’s Hospital, developed a lifelong
interest in Skin diseases, described the skin changes of the
disease that bears his name, and became a popular teacher. His
findings were much debated and became accepted only after
Armand Trousseau (1801-1867) of Paris recognised adrenal
failure as an entity and gave it the eponym Addison's disease.
US President John F. Kennedy was on lifelong steroids for
Addison’s. Addison also described
Addisonian Pernicious
anemia from failure to absorb Vitamin B12. He was a
contemporary of two other ‘
all time greats of Guy’s’,
Richard Bright (1789-1858), Father of Nephrology, who
described
‘Bright’s Disease’, and Thomas Hodgkin
(1798–1866) who gave the first account of the Lymphoma which
bears his name. Another contemporary, Benjamin Guy Babington
(1794-1866) invented the laryngoscope: he had called it a ‘
glottiscope’
and was the first to introduce indirect laryngoscopy
into routine practice.
In 1896, French Paediatrician, Antoine Bernard-Jean Marfan
presented a clinical syndrome at the
Societe Medicale des
Hopitaux de Paris. Gabrielle, a 5-year old girl,
had asthenia from birth, disproportionately long
limbs, unusually slender fingers and toes- Marfan called
them ‘spider-like’, "
pattes d'araignee", ‘spider’s
legs’ and the condition “
dolicostenomely” (
Gk:
stenos = narrow, slender; melos = limb). It was only in
1931 that Henricus Jacobus Marie Weve (1888–1962) of Utrecht
called it “
Marfan syndrome”: this name became so
popular it has stayed. Abraham Lincoln, 16th President of the
US, tall, lean, with slender fingers, was known to have “
Marfan’s”.
Perhaps if Booth had not shot him, Lincoln might have died of
an aortic bleed, a known complication. This habitus with span
greater than height, gothic palate and the like, well
described by McKusick, occurs in other hereditary disorders of
Connective Tissue. But Lincoln was no fool! If the person had
in addition to the habitus, mental subnormality and congenital
cardiac defects like ASD or VSD, the more likely diagnosis was
Homocystinuria, easily identified by a simple urine
test. Ehlers-Danlos syndrome is a similar clinical condition.
All have hyper-motile joints and orthopaedic problems. But it
is easier for a medical student to link Lincoln to Marfan’s
rather than remember its complicated Greek name!
Antoine Bernard-Jean Marfan made another major contribution:
Marfan’s
Law. He noticed the rarity of pulmonary tuberculosis
after local tuberculous lesions had healed, “One rarely
records pulmonary tuberculosis in people who, during their
childhood, had been attacked by the disease and in whom
lesions had healed before the age of 15 years”. This led to a
better understanding of immunity and the development of the
BCG vaccine.
Johann Friedrich Horner (1831 –1886), Zurich Ophthalmologist,
described in 1869 the syndrome caused by a disorder of the
sympathetic nervous system. He also described the “
Horner's
muscle", “tensor tarsi muscle”, the Lacrimal portion of
the Orbicularis oculi, and “
Horner-Trantas spots", the
small whitish-yellow chalky concretions of the conjunctiva
around the corneal limbus. He was the first to introduce ‘Z’-
plasty for Ectropion correction. Many add the name of French
physiologist Claude Bernard (1813- 1878) to Horner syndrome.
Claude started off as a playwright, then moved to Medicine. He
was the first to use blinded experiments to establish the
accuracy of scientific experiments and originate the terms
Le
milieu interieur (internal environment) and
homeostasis.
His contributions on the function of the Pancreas and
Glycogenic action of the liver were followed by his discovery
of the vasomotor nerves.
It is always a source of merriment for the teacher and
confusion to the medical student who is asked whether the
signs of the ‘
ARP’ were described by one person or by
two! Scottish ophthalmologist Douglas Moray Cooper Lamb Argyll
Robertson (1837–909) was the first to identify the pupillary
changes. He followed his father’s footsteps to become
President of the Royal College of Surgeons of Edinburgh. He
was a keen archer and golfer - his wife’s favourite item of
jewellery being a necklace fashioned from her husband's
golfing medals.
Charles Edward Beevor (1854–1908), President of the
Neurological Society, Consultant in Queen Square,
London, described the sign of selective weakness of the lower
abdominal muscles causing movement of the navel towards the
head on flexing the neck; the umbilicus moves up because the
upper part of Rectus abdominis is intact, localising Spinal
cord injury to T9-T10 levels. It is also found in ALS and
Facio-scapulo-humeral dystrophy. That Beevor also localised
the Jaw reflex to the area of brain supplied by anterior
choroidal artery is not widely known.
Andre Alfred Lemierre (1878-1956), French bacteriologist
reported in The Lancet of 1936, 20 cases of anaerobic
oro-pharyngeal infection causing septic thrombophlebitis
of internal jugular vein, often complicated by septic
pulmonary emboli and distant metastatic infections. The
organism responsible is now known to be Fusobacterium
necrophorum. Lemierre's syndrome, not infrequent in the
pre-antibiotic era, occurs today uncommonly and is
therefore under-recognised.
Sir William Osler (1849-1919), ‘Father of Modern
Medicine’ was the first to bring medical students out of the
lecture hall for bedside clinical training and create the
first residency program for specialty training of physicians.
William Osler’s father was an Anglican missionary who went to
Canada. William excelled in studies and sports. Though it was
supposed he would become a priest, his fascination for natural
history made him opt out of becoming a person of the cloth. He
joined Toronto, transferred to McGill, Montreal, graduated in
1872. He started teaching at McGill after spending several
years in England and Europe, and joined the new Johns Hopkins
University, Baltimore, as Professor of Medicine. With
William Henry Welch (1850-1934), chief of pathology, Howard
Atwood Kelly (1858-1943), chief of gynaecology and William
Steward Halsted (1852-1922), chief of surgery, Osler
transformed the organization and curriculum of clinical
teaching to make Johns Hopkins a famous medical school.
Osler’s textbook of Medicine, which first came out in 1892
became popular for lucidity in style, readability and for
being exhaustive. The system of clinical teaching now extant
in medical schools was first introduced by Osler. His
best-known saying was "Listen to your patient, he is telling
you the diagnosis", emphasising the importance of a good
history. In 1904, Osler was invited to Oxford as Regius
Professor of Medicine, a signal honour. He was largely
responsible for setting up the Association of Physicians of
England and Ireland and the Quarterly Journal of Medicine. He
was a great clinician who lent his name to a number of
diseases, signs and symptoms: systolic hypertension secondary
to atherosclerotic arteries; the tender nodules in
infective endocarditis due to vasculitis of the finger tips
and toes; hereditary haemorrhagic telangiectasia; Polycythemia
Rubra Vera; atypical, verrucous, nonbacterial, valvular and
mural endocarditis in terminal SLE; recurrent episodes of
colic, with typical radiation to back, intermittent rigors,
chills and fever due to a free-moving gallstone in Vater’s
diverticulum larger than the orifice.
Osler's triad is
the association of pneumonia, endocarditis and meningitis.
There are two important biographies on Osler: the
Pulitzer-prize winning biography written by his own student,
Harvey Cushing (1869-1939), Father of Neurosurgery and another
by historian and author Michael Bliss.
It was Harvey Cushing who popularised the sphygmomanometer,
already invented in 1896 by Riva-Rocci and insisted that every
patient should have a blood pressure recording on the case
sheet. In 1912, he reported an endocrinological syndrome
caused by malfunction of the pituitary gland which he termed "
polyglandular
syndrome" and published the findings in 1932 as "
The
Basophil Adenomas of the Pituitary Body and Their Clinical
Manifestations: pituitary Basophilism". He
differentiated the ‘
disease’ from the ‘
syndrome’,
caused by cortisol excess from non-pituitary causes, invented
the
Cushing forceps to grasp the thick tissues of the
scalp during cranial surgery, the
Cushing ventricular
cannula to enter the brain ventricles for CSF drainage
and a surgical magnet to extract shrapnel from the heads of
wounded soldiers. Not surprisingly, he was nominated for the
Nobel Prize 38 times!
The first reports on what we know now as inflammatory bowel
disease were by Giovanni Batista Morgagni (1682–1771). As
early as 1904 Polish surgeon Antoni Lesniowski (1867-1940)
described several cases of inflammation in the wall of the gut
and one with a fistula to the colon - they could not be
distinguished from intestinal tuberculosis. In
1913 Glasgow surgeon Thomas Kennedy Dalziel (1861-1924)
presented 9 cases of
Ileitis terminalis. But it
was Burrill Bernard Crohn (1884-1983), Professor of
Gastroenterology at Mount Sinai Hospital and Columbia
University who, with his surgical colleagues, identified
14 cases whose symptoms were common, but would not
fit in with any previous description of disease, as a paper in
the JAMA of October 1932. This was the first description of
Crohn’s
disease. In Poland, it is still called
Lesniowski-Crohn's
disease. Crohn’s was a multi-faceted personality: he
enjoyed studying the history of the American Civil war, and
painting - many of his water-colours were on display in New
York galleries.
There are two household names among the great psychiatrists:
Sigmund Freud (1856-1939) and Alois Alzheimer (1864-1915).
Freud was an Austrian Jew who died in exile in Britain. He
founded the science of psychoanalysis, redefined sexuality and
interpreted dreams. The poet WH Auden wrote a poetic tribute
to Freud in 1940. Alzheimer was born in Bavaria, Germany.
While just out of school, as a member of his fencing group, he
was fined for disturbing the peace. After graduating from
Wurszburg, he started working in the Frankfurt mental asylum
with Frank Nissl, who was to develop special stains to study
brain tissue leading to the identification of ‘
Nissl
granules’ and popularise the lumbar puncture for CSF
study: the two collaborated for seven years and established
the relation between mental illnesses and structural disease.
Alzheimer studied his most famous patient Frau Auguste Deter
from 1901 till she died in 1906, identified post mortem the
amyloid plaques and neurofibrillary tangles which
characterised the dementia he described. He was only 51 years
old when he died.
Sometimes a disease takes the name of a fictional
character. In their 1956 article in the
Am J Med,
Burwell and others called Obstructive Sleep Apnoea the ‘
Pickwickian
Syndrome’ after Joe, the fat boy in Charles
Dickens’ ‘
Pickwick Papers’, who always fell asleep.
Baron Munchausen, a German nobleman, enjoyed telling tall
tales of his imaginary exploits. In ‘
Baron Münchausen and
his exploits’, Richard Asher described patients who went
from doctor to doctor seeking a remedy for symptoms; the
patients were so convincing that the doctor would
perform one or more operations. The patient would then
go to the next doctor, show him all the scars and complain he
had had no cure.
Munchausen syndrome is a psychiatric
factitious disorder manifest in those affected who feign
disease, illness, or psychological trauma to draw attention,
sympathy, or reassurance.
Patients have given their names to diseases:
Lou Gehrig,
American baseball player, was not the first to have
amyotrophic lateral sclerosis but he had celebrity status by
the time he fell ill. In 1952, British doctors Rosemary Biggs
and Robert Gwyn Macfarlane at the Radcliffe Infirmary, Oxford,
discovered that
Stephen Christmas (1947–1993), the
first patient to have Haemophilia B was not deficient of
Factor VIII, but of Factor IX.
Many eponyms have single, others multiple names. Who decided
which one was first? Sometimes it depended on individual
prestige, rank, seniority, or whoever described it first. Was
there some bullying in some instances? Perhaps! Sometimes the
decision was taken by drawing lots, or as in the case of
Watson-Crick, a coin-flip! A few never got full credit:
in the case of GBS syndrome, Jean Baptiste Octave Landry de
Thezillat (1826-1865) had already reported ten similar cases
in 1859, but credit for identifying the clinical
characteristics and cerebrospinal fluid changes is given to
Georges Guillain (1876 –1961), Jean Alexandre Barre
(1880–1967) and Andre Strohl (1887-1977) on their two
cases with a self-limiting paralysis they reported in 1916.
Genius certainly runs in certain families! Herman David Weber
(1823-1918), German- born physician who settled in England,
who had come to work in the German Hospital, London then
joined Guy’s, was the first to identify ipsilateral third
nerve palsy with contralateral hemiplegia as the result of
Midbrain infarction - the Weber syndrome. His son, Frederick
Parkes Weber (1863-1962) became even more famous, having
described several conditions: Sturge-Weber syndrome;
Osler-Weber-Rendu disease (telangiectasia of skin and mucous
membranes); Klippel–Trenaunay–Weber syndrome (‘port-wine’
stain, which Gorbachev famously had, varicosities, soft
tissue and skeletal anomalies); Weber-Christian disease
(panniculitis among others). Father and son were dedicated
coin collectors and Alpine campers.
There are several thousand Eponyms in Medicine. Many fell by
the wayside and were forgotten. With each Eponym, we salute
the man behind - many of them were geniuses, giants in their
respective fields, flamboyant personalities with interests
outside Medicine, from politics to palaeontology. Our
admiration quadruples when we realise that these observations
were made entirely on clinical grounds, against overwhelming
odds, often after a lifetime of meticulous observation and
scrupulously honest documentation, with no sophisticated
gadgets to help them. Even today, where Biochemistry or
Genetics remain elusive, the Eponym holds its place.
As we commemorate the person we honour with the eponym, the
veil of mist lifts from the past. We get a glimpse of
the period, the circumstances, trials, tribulations that he
had to endure. A bit of history unfolds, we understand the man
and the era in which he lived. We see farther now because we
stand on the shoulders of giants. Eponyms are dead, long live
Eponyms!