Reflections on eponyms in neuroscience terminology
Eponyms have played a very significant linguistic role in technical and scientific terminology. They are an important feature of language that have contributed for a long time to engraving in history the names of those researchers who have devoted their lives to scientific discovery. In the field of medical terminology, they are an asset, although their semantic effectiveness has constituted a long-standing debate. We will analyze how language contributes to the advance of science and technology and the current position of eponyms in the health sciences. Eponymy in neuroscience has been used for a long time as a way to identify and recognize scientific issues, such as diseases, syndromes, methods, processes, substances, organs, and parts of organs as a way to honor those who, in a certain way, contributed to the progress of science. However, sometimes those honors do not correspond to the real contributors, thus receiving a nondeserved acknowledgment. Another problem with eponymic references is the lack of information about the matter in hand, because eponyms do not provide any clear information leading to the identification of the situation under study, as they are not reasonably descriptive. The aim of this article is to encourage the use of descriptive terms instead of eponyms and to establish a system of scientific nomenclature to consolidate the use of the language as a means of conveying scientific information among experts. Anat Rec (Part B: New Anat) 289B:219–224, 2006. © 2006 Wiley-Liss, Inc.
Language is a complex heterogeneous system that comprises various interrelated subsystems, each of which can be described as the phonological (phoneme), morphological (morpheme), lexical (lexeme), syntactic (sentence), and discourse (text) levels (Cabré,1993). General language or language for general purposes (LGP) is a “set of rules, units and restrictions that form part of the knowledge of most speakers of a given language” (Cabré,1993), whereas special language or language for special/specific purposes (LSP) is a “specialized, monofunctional, subject-specific language, in which words or terms are used in a way peculiar to that domain, and also in some cases, morphologically and syntactically.” LGP is used for everyday discourse, is acquired through social communication and formal education, and differs from LSP in terms of “the lexicon, the range of the grammatical structures and their semantic determinacy” (Ahmad and Rogers,1993). On the other hand, LSP is acquired through communication with specialists and formal specialized training or experience and it is used for communication purposes among members of a certain profession.
Generally speaking, LSP conveys specific information to specific audiences for specific purposes. Their communicative function is based on concise, precise, and impersonal texts, which are characterized by a plethora of nouns and nominal groups and symbols from other semiotic systems. With reference to LGPs, they are autonomous, since any variations do not influence or are not influenced by the general language (Cabré,1993). A term is defined as “a meaningful lexical unit consisting of a word or a group of words used to univocally designate a concept in a specific subject field” (http://www.translatum.gr/journal74/behavior.htm). This definition introduces the notion of “concepts” defined as “mental constructions used to classify the individual objects in the external or internal world by means of a more or less arbitrary process of abstraction.” Among this classification of concepts and the terms that express them, we are encountered with eponymy.
The practice known as eponymy, from “eponym,” comes from the Greek word “eponumos,” meaning giving one's name to a thing or a person, from “epi” (upon) and “onoma/onyma” (name). Typically, an eponym comes from the name of a person—real, fictional, mythical, or imaginary—but it can also come from the name of a place or from a brand name. In most scientific disciplines, eponymy has long generated a lot of controversy. More than a century ago, Charles Darwin objected to eponymous terms in biology. Writing on 4 February 1849 to the English naturalist and geologist Hugh Strickland (1811–1853), composer of the first Code of Rules for Zoological Nomenclature, Darwin's objections were twofold. First, eponymy is “a direct premium to hasty work,” and using eponymous terms means “naming instead of describing.” This second objection, that eponyms merely name, or label, and do not describe, the object or idea in question, continued to be the rallying cry of those who objected to the use of eponyms as a means of coining scientific words (Henwood and Rival,1980).
An eponym can also be defined as the name(s) of one or more individuals who presumably devised or described an anatomic structure, a classification system, a disease, an injury, a syndrome, a principle, a physical sign, or an operative technique (Hunter et al.,2000). Mark Ravitch (1979), in discussing Guillaume Dupuytren's invention of the Mikulicz enterotome, said this about eponyms: “Given an eponym one may be sure (1) that the man so honored was not the first to describe the disease, the operation or the instrument, or (2) that he misunderstood the situation, or (3) that he is generally misquoted, or (4) that (1), (2) and (3) are simultaneously true…. My own feeling is that whatever their fallibility, eponyms illustrate the lineage of surgery and bring to it the color of old times, distinguished figures, ancient sieges and pestilences, and continually remind us of the international nature of science” (Hunter et al.,2000).
What if you discovered a new disease and were asked to name it? Would you name it after yourself? Would you feel honored if others wanted to name it after you? Or would you prefer to name it after the person with the illness, or perhaps the place where it was discovered? There is no single way to name illnesses and, unfortunately, the best names do not always catch on; even when a logical name is chosen and endorsed by a professional organization, it may not be the name that most people use. For instance, to protect an individual's privacy, diseases are rarely if ever intentionally named after the person with the pathology. One exception is Lou Gehrig's disease. Although the official name is amyotrophic lateral sclerosis (ALS), this degenerative nerve disease continues to carry the name of Lou Gehrig, a baseball star who tragically succumbed to the disease.
There are some drawbacks to naming diseases after people or places.
One, the wrong person may be honored. Medical history has many examples of people describing a condition well before the person for whom it was named; Sir Benjamin Collins Brodie described Reiter's disease 100 years before Reiter did, and other described it at the same time that Reiter published his account.
Two, some conditions carry the names of two people and the order is often interchangeable. A good illustration of this is the Jakob-Creutzfeldt disease or Creutzfeldt-Jakob disease. Others have three or even more persons' names, for example, Charcot-Marie-Tooth Disease, a nerve and a muscle disease. “Charcot-Marie-Tooth” has nothing to do with teeth; it was named for those who wrote its classic description, included English physician Howard Henry Tooth.
Three, the name may be misleading or confusing. “Baker's cyst” has nothing to do with bakers. It is a fluid-filled cyst behind the knee that occurs in individuals with arthritis, which was named after the English surgeon William Morrant Baker.
Four, there are also some variations by country that might be misleading. “Plummer-Vinson syndrome” (iron-deficiency anemia) is the common name in the United States, while “Patterson-Kelly syndrome” is the common name in the United Kingdom for the same entity.
Five, sometimes different authors use the same label to refer to somewhat different phenomena, and, as a result, the underlying diagnosis may be confused or misunderstood. Likewise, using a similar term to describe totally different forms of a pathology also leads to chaos. A typical example is the confusion existing between the terms “Clerambault's syndrome” and “Kandinsky-Clerambault's syndrome” (Lerner et al.,2001). Egyptians had a great anatomical knowledge resulting from observation of animals, of the wounds inflicted in the battlefield, and from the embalming or mummifying process. About 220 names of anatomical parts can be differentiated, but many of these names cannot be identified in our languages and, in many cases, one name is used to refer to various parts of the body (Mejía Rivera,1999).
On the other hand, the virtue of eponyms is that they convey no preconceived notions as to the nature of an abnormality. The Hurler syndrome was, time showed (McKusick,1970), a better designation than lipochondrodystrophy, which was used in the Index Medicus long after the fundamental fault was known to concern mucopolysaccharide, not lipid.
Accuracy and consensus are sine qua non features in medical or biological communication. Nevertheless, this communication is at times unreachable because of the use of eponyms, tags, labels, and acronyms. Accordingly, throughout the biological and medical sciences, the general movement has been toward the elimination and discouragement of eponyms, particularly through the adoption of standard codes of nomenclature.
COMMUNICATION IN NEUROSCIENCE
“Science is built with facts as a house is built with bricks and stones, but the mere accumulation of facts is not science itself, as a pile of bricks and stones is not a house itself.” From this quotation of the French mathematician Jules-Henri Poincaré (1854–1912), we can extrapolate that in neuroscience, many of its elements, including the neuroanatomic structures, do not obviously stand for neuroscience or neuroanatomy. They are only abstractions that we call and use in the necessary communication among the various professionals of health with the aim to try to understand, as a minimum, the location of the basic elements, both macroscopic and microscopic, that make up the nervous system and that take part in the health or disease processes of the individual.
Some years ago, a great disaster in space exploration took place as the NASA Mars Climate Orbiter spaceship deviated its route because of a minute error: the flight controllers of the spaceship programmed it in British units, while another team fed data in the metric system, thus resulting in a nomenclature and unit compatibility mistake. This serious problem shows us that it is very important that the communication between collaborators in a given field of science be correct and precise, as it is the case in the multidisciplinarity of neuroscience (Duque-Parra,2001a) and neuroanatomy (Duque-Parra,2001b). It is then mandatory that a common language exists to link adequately the various contributions from different areas, and that is why neuroscience requires a common language aiming at the clear understanding among the many professionals and researchers in health and health-related areas. Accordingly, there will be a better dialogic objectivity, which will be translated, in most cases, into understanding patient neurology, a better identification of his disorders, and a more effective contribution to the recovery from or prevention of pathologies.
We should also take into account that information is a way of describing the meaning, which for some agent, is found in events. In neuroscience, information is also of great significance, as it refers to the acceptance of a collective and, consequently, of each of its individuals. Neuroanatomy, a part of neuroscience, refers to the elements that must be minimally recognized with reference to the body parts, associated to a given functional or dysfunctional aspect. It is here where the International Anatomic Nomenclature—neuroanatomic nomenclature included—provides part of these bases (Duque-Parra et al.,2002), be it for researchers in basic neuroscience or in neuroscience applied to clinical performance. It appears that we perceive objects more clearly when we have their names (Ferguson,1991) and we get their meaning if we understand as a property of our psychological state.
Basic neuroscience terminology is without doubt part of the history or neurology and related sciences (Mazzarello,2002). In fact, Herophilus of Calcedonia (335–280 B.C.), author of the first anatomical terminology (Seara Valero,1995), contributed to the ordering and nomination of various structures by differentiating the fourth ventricle and appointing it as “calamus scriptorius” (Laín Entralgo,1982) due to its resemblance to the barbs of a feather, a device used as a writing tool at that time in Alexandria, a fact that justified such a denomination. This structure is sometimes known as calamus Herophilus (Gross,1999). Terminology was also consolidated with contributions from François Magendie (1783–1855), experimental physiology pioneer (Kiernan,2000), considered the first physiologist to proclaim strongly the need to experiment with animals as a way to advance in the field of physiology (Benitez Bribiesca,2004). Magendie claimed that it would be impossible to advance without the aid of these live sciences, without the exactness of their language (Benitez Bribiesca,2004), and that our language tended to be imprecise, provisional, and ambiguous as a reflect of our ignorance (Seki,1995). Later, in the 19th century, Louis Pierre Gratiolet (1815–1865) also contributed to the advance of neuroanatomical nomenclature when he denominated many of the cerebral cortex convolutions (Aréchiga Urtuzuástegui,2004).
From ancient times, a certain arbitrariness in the use of terms in both general and scientific language had been noticed. The first serious problem resulting from this arbitrariness in scientific language was differentiation, not unification, and even more important for the development of research was the differentiation process between scientific and religious language, which appeared as a great obstacle. It is understandable that the problem of unification of scientific languages has become a very serious one, apparently more serious than the problem of unification of scientific laws. Natural sciences are day by day richer in reciprocal and in significant links with common language. Eponyms have contributed to language differentiation due to the degrees of synonymy that they display in some instances. For example, Galeazzi's fracture is also known as Dupuytren's or Piedmont fracture. Another aspect that contributes to language differentiation and, consequently, to ambiguity is the geographic variation, as it is the case of the Plummer-Vinson syndrome in the United States or the Patterson-Kelly syndrome in the United Kingdom.
In the last 4 decades, medicine has undergone a strong technological and humanistic revolution. New medication, body image scanning methods, biological tests, and surgical instruments have appeared, thus constituting advances linked to the general development of specialized language. These advances have resulted in the substitution of the classical anatomical list that uses a number of eponyms for a modern International Neuroanatomical Nomenclature. Examples of this type of substitution are those eponyms associated with the naming of vestibular nuclei described as follows: the lateral vestibular nucleus described by the German professor of anatomy and histology in Bonn, Otto Friedrich Karl Deiters (1834–1863) in 1865 (Whitmore,1998; Afifi and Bergman,1999); the medial vestibular nucleus, also known as triangular or main nucleus (Afifi and Bergman,1999), described in 1893 by the German anatomist Gustav Schwalbe (1844–1916), professor of histology in Leipzig and in Freiburg, professor of anatomy and director of the Anatomy Institute of Jena; the superior vestibular nucleus, also called angular (Ranson and Clark,1959), described in 1908 (Whitmore,1998; Afifi and Bergman,1999) by the Russian neurologist and anatomist Vladimir Mikhailovich Bechterev (1857–1927); the lower vestibular nucleus, also known as spinal or descendant (Alperts and Mancall,1961), studied by the German neurologist Christian Friedrich Wilhelm Roller (1802–1878).
If we used the eponyms for these nuclei such as Deiters, Schwalbe, Bechterev, and Roller, those who would interpret them must first establish an association between last names and anatomical places, thus taking into consideration that the last name itself gives no idea of anatomical location to study, for example, their physiology. In other words, when identifying the anatomical location that is defining where to find a structure, the name of the discoverer does not imply a relationship of location or function. Maybe friendship or the sense of gratefulness has resulted in maintaining an affective bind, as it is the case of Costero Tudanca Isaac, a histopathologist who worked for 14 years with Pio del Rio Hortega. In his work on microglia cells, Isaac insisted in naming these cells Hortega cells (Fernandez Guardiola,1997). Who could recognize without any additional information that the Hortega cells are glial cells or where they are located? Alternatively, Santiago Felipe Ramón y Cajal named new cell types that saturated the brain nomenclature with images of the daily Spanish life, for example, the mitral cells in the olfactory bulb that resembled the bishop miters, or the allusions to the Hispanic American landscape with the climbing fibers of the cerebellum (Aréchiga Urtuzuástegui,2001).
Another example associated with neural science is the Golgi apparatus. In 1898, Camillo Golgi described the intracellular way to the medical-surgical society of Pavia and named it the internal reticular apparatus. After 1910, it came to be known as the Golgi apparatus (Mazzarello,2002). Equal consideration was given to the tendineous muscles, transductor elements of muscular tension, as well as to the Golgi-Mazzoni corpuscles, which indicate pressure stimuli. In all cases, the eponym does not represent any place in the body for the student or for the novice reader.
From the multiplicity of terms, it is also concluded that so much similarity of names is perceived as a particular interpretation trend. Thus, the frontal lobe precentral convolution is also referred to as the primary motor cortex (functional quality), area 4 (cytoarchitecture), motor band (morphofunctional quality), motor homunculus (physiological quality), Jackson's band (eponym), pyramidal area (neuronal type quality), and pre-Rolandic gyrus (neuroanatomical and eponymous quality). It might be easier for the reader or the interlocutor to establish a rapid reference if, instead of the eponym, a descriptive term is used. For example, the term “primary adrenocortical deficiency” might be of greater help than “Addison's disease,” and “herniation of the cerebellar tonsils” might be more useful than “Arnold-Chiari malformation.”
Attempts to modify the eponyms used in clinics are also noteworthy, as it is the case of the names of some etiologies concerning brainstem lesions, where some authors considered the use of eponyms is not adequate as most of the syndromes refer to tumors and other nonvascular disorders (Infante-Velásquez et al.,2002). Besides, the diagnosis of disorders in this region of the encephalon is not favored because of the knowledge of eponyms, but because of the reference to the anatomy of the corresponding structure (Adams,1997). From the comparison with elements of nature, some neuroanatomical names have appeared, such as amigdala = almond or nucleus = nut (Palacios Sánchez,1993). Also, “geniculated” derives from “genu,” the Latin word for “knee,” which refers to the form of the nucleus (Allman,2000).
ENGLISH LANGUAGE AND INTERNATIONAL STANDARDS
The English language has several ways of forming eponyms. Some of these are illustrated by Bell's palsy, the organ of Corti, the Krebs cycle, and Addisonian anemia. Until recently, eponyms containing genitives (proper noun + apostrophe + s) were very numerous in medical English. Present-day English (PDE) is undergoing a change in which eponyms of the possessive type are being replaced by variants containing proper nouns in uninflected form (Bell palsy) (Dirckx,2001).
Accordingly, there has been a long-standing controversy in the scientific community over whether or not to use the genitive form in the formation of eponyms. In 1974, a conference at the U.S. National Institutes of Health attempted to make a standard set of rules regarding the naming of diseases and conditions. They stated that the possessive form of an eponym should be discontinued, since the author neither had nor owned the disorder. Effective that time, the condition has traditionally been called “Down syndrome” in the United States. However, the change has taken long to occur in Great Britain and in other parts of Europe.
It has also been argued that eponyms alter history, as it is the case of Vater-Pacini corpuscles, which, although identified by the German anatomist Abraham Vater and by the Italian anatomist Filippo Pacini, were actually described by Lehman for the first time, and even Shekleton dissected them 10 years before Pacini. The use of this term is due mainly to Henle and Kolliker in the 19th century (Afifi and Bergman,1999). The use of Terminologia Anatomica (TA) favors at least the neuroanatomical comprehension, as it is closer to a concept (structure-function), thus highlighting functional neuroanatomy. As neuroanatomy has been enriched with a lot of knowledge from other related sciences for many years, eponyms should be avoided regardless of their frequent use (O'Rahilly,1989), because they introduce a lot of disorder, they do not clearly define the structure they refer to, and they frequently alter history, as in many cases the person they refer to was not the first to describe the corresponding structure.
Robert Schmerling, an associate physician at Beth Israel Deaconess Medical Center and teacher in the Internal Medicine Residence Program, pointed out: “Let's not be put off by eponyms. Even though they may seem to lend an air of legitimacy, they are no more than a convention, supported by history and by the fact that many health care professionals, like most people, resist change.” Accordingly, a very important reason to avoid eponymy lies in Darwin's distinction between naming and describing eponyms are in themselves meaningless, for they have no descriptive content. They never describe, they often obscure. What, for instance, do the terms “Bruton's disease,” “Conn's syndrome,” or “Crigler-Najjar syndrome” reveal about the nature of the disease or syndrome? The corresponding noneponymous or descriptive terms such as “X-linked agammaglobinemia,” “primary hyperaldosteronism,” and “congenital neonatal jaundice,” on the other hand, are in themselves suggestive and indicative of the entities under consideration and thus possess both heuristic and mnemonic value.
If eponymy is to be avoided, alternate methods of naming should be used. Obviously, the most common alternative is to coin new terms with Latin and Greek elements. As long as the scientific community were endowed with even a rudimentary knowledge of these classical languages, such a method would work effectively.
A valuable guide to nomenclature is provided by the International Federation of Associations of Anatomists (IFAA), which is the only international corporate representative of all anatomical aspects and who oversees medical terminology all over the world by urging physicians and scientists to use the same name for every structure (Whitmore,1998). Although it is pitiful that modern schools have eliminated the study of Greek etyma or their Latin equivalents, our lexicon is full of Greek and Latin terminology, a fact that facilitates the morphofunctional connection in our minds, something that does not happen with morphoeponymous associations. The diverse nomenclature systems existing in neuroscience nowadays reflect not only the heterogeneity of traditions but also the main problems resulting from the emphasis on functional aspects. It is perhaps simpler that the brain structures be named according to the color (e.g., red nucleus, substantia nigra), the chemical content (noradrenalin or acetylcholine ways), electrophysiological characteristics (3-8-cycle-per-second theta rhythm), morphological similarity with a natural object (hippocampus), and, even more rarely, a direct reference to an established function even if it is not perfectly understood (visual cortex, vestibular cortex) (Warwick,1986).
Ironically, although the identification of brain neurochemical constituents takes place frequently in terms of their function, this refers invariably to the context in which the substance was originally discovered, for example, the stimulation of the contraction of the biliary vesicle by cholecystoquinine, a fact that is doubtlessly irrelevant to the unknown function of this substance in the cerebral cortex. However, we are forced to name phenomena even if after research the intuitions seem to be frequently wrong (Warwick,1986).
The use of the International Neuroanatomical Nomenclature, in contrast to the traditional neuroanatomical nomenclature that emphasizes the use of eponyms, presents a number of advantages from the perspective of the various topics dealt with in the study and analysis of the structure of the nervous system in neuroscience. Among these advantages are aspects that include the description of the constitution of various elements of the central nervous system and the peripheral nervous system, descriptions of their tissues, and description of the location and physiological relationships among their different components. Accordingly, the thinking process must be oriented initially to the morphofunctional, neuromorphophysiological meaning, not to the use of eponyms that do not clearly and precisely express their structure, function, or disease. However, eponyms can be useful for a multisymptomatic medical condition or complex surgical procedure that cannot be neatly condensed in a reasonably convenient term or phrase.
The authors thank the reviewers and editors of the journal for revising the text to make it more readable and its meaning clearer.