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Sunday, November 22, 2015

To practice medicine is to appreciate the richness of its history, especially when it comes to the physician names that are sprinkled liberally in the language of the profession. While some names originate in ancient Greek times, think Achilles, a hero of the Trojan War whose tendon is routinely injured in NFL wars, many terms have their origins in the last couple centuries. New England Patriot’s receiver, Julian Edelman broke the proximal fifth metatarsal in his foot but every medical student has to learn that it is a Jones Fracture, named after Sir Robert Jones, who in 1902 described 11 patients with similar fractures of the foot, including his own.

Medical speak is littered with eponyms that honor the people who first discovered their piece of medical knowledge. Some names are almost never heard while others have become part of the language.

  • In 1953 Dr. Virginia Apgar, an obstetrical anesthesiologist developed a scoring system, the APGAR score, to help determine how well newborn babies were coping with the world outside the uterus just after their birth. She used scores for the baby’s Appearance (color), Pulse rate, Grimace (irritability), Activity and Respirations to predict whether they needed emergent care in the delivery suite. It was fortuitous that her name and the scoring system where the same.
  • In 1963, two pediatric orthopedic doctors, devised the Salter-Harris system to classify children’s fractures based upon the involvement of a bone’s growth plates. Medical students routinely have to Google the classification system but it’s important to know because in orthopedics, it’s all about understanding where the bones are in relationship to each other; plus bones tend to break in similar ways, so the first doctor to describe the injury pattern gets to name it…or at least publish the scientific article and have colleagues bestow the eponym.
  • Sometimes there is sadness about how a disease is named. In 1872, George Huntington wrote of the genetic disease that bears his name. He described the symptoms of the degenerative brain disease that led to the gradual decline in the physical and mental function of both his father and grandfather. He would also develop Huntington’s Disease, but continued to document the progression of his symptoms.
  • Englishman, Thomas Addison wrote about adrenal insufficiency in 1855. The general public learned about Addison’s Disease only after President Kennedy was elected in 1960. His family and advisors were able to hide this disease from the electorate, as well as his hypothyroidism, even though he had collapsed at an election rally and his opponents tried to use his Addison’s diagnosis as a political weapon.

No matter how hard doctors try to speak regular English, even to each other, the eponyms have a way of creeping into the conversation. From surgeons who talk about McBirnie’s point, where abdominal tenderness in appendicitis is often located, to cardiologists and their Beck’s triad, whose symptoms often make the diagnosis of cardiac tamponade, the names become medical shorthand.

While there is nothing special about using an eponym, there is a certain satisfaction in knowing that learning and practicing medicine is based on one doctor caring for one patients only to recognize enough similarities with others to describe a physical symptom or an illness or injury, and be lucky enough to have their name memorialized. It’s also a reminder that when a doctor gets lucky enough to find an interesting patient, perhaps that patient isn’t so lucky to have that injury or disease.

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