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De-eponymizing Anatomical Terminology

Buttner, Robert MBBS; Lee, Jessica MBBS, MRES; Cadogan, Mike FACEM, FFSEM

doi: 10.1097/01.EEM.0000719076.90290.60
    gender bias, anatomical terms
    gender bias, anatomical terms:
    This tweet by Kirsten Small, MBBS, PhD, a specialist obstetrician and gynecologist at Griffith University in South East Queensland, Australia, prompted this article by Drs. Buttner, Lee, and Cadogan.
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    After a recent Twitter debate, we set out to evaluate the hypothesis that there is always an alternative to a dead man's name for body parts and to create an online searchable database (https://bit.ly/Eponymictionary) to facilitate the de-eponymization of anatomic terminology.

    We reviewed 700 normal (nonpathological) anatomical and histological eponyms, and developed a searchable database modelled on the 2019 edition of Terminologia Anatomica (TA2) published by the Federative International Programme for Anatomical Terminology (FIPAT). (https://fipat.library.dal.ca/.)

    We found myriad inconsistencies, confusion, misogyny, inaccuracy, and issues pertaining to the use of anatomical eponyms in modern medical parlance. In the vast majority of cases, an internationally recognized, non-person-oriented, officially sanctioned term could be used to replace an eponym without detriment to context or education.

    The use of eponyms in medicine has been commonplace for centuries, and an ongoing debate continues about the accuracy, effectiveness, and more recently, the cultural appropriateness of their use in anatomical terminology. The majority of these eponyms have an approved and accepted modern terminology, but many clinicians continue to utilize and teach eponymous terms in their daily practice.

    Definitions and History

    We used these definitions in this review:

    • Eponym: Person after whom the anatomical entity is named, e.g., Colles.
    • Eponymous term: The anatomical entity named, e.g., Colles fascia.
    • Synonymy: Multiple alternate names for a single entity.
    • Polysemy: Multiple alternate meanings for a single term.

    Atomische Gesellschaft, the German language anatomical society, attempted in 1887 to address the problem of multiple names per anatomical structure. Wilhelm His, et al., defined the first rule of Anatomy Club, that each anatomical structure should only have one name. The first edition of Nomina Anatomica managed to break this rule more than 200 times, and consolidated the use of 165 eponymous terms. (1895; https://bit.ly/3iWnp2Z.) The number of eponymous terms and breaches of the one-name rule increased in frequency in subsequent editions.

    Each part to be named should only have one name. The names must be correct in Latin and linguistically. They are also required to be as short and simple as possible. The names are intended to be mere reminders and not to claim descriptions or speculative interpretations. Names that belong together should be composed as similarly as possible (e.g., femur, femoral artery, femoral vein, femoral nerve). (Nomina Anatomica. 1895:16.)

    The use of personal names in anatomical terms has been a contentious point of debate and delicate accommodation over the past century. Eponyms have generally been prohibited but deemed tolerable when necessary. A common compromise was to append personal names to the official Latin term: Calot's triangle as trigonum cystohepaticum (Caloti).

    The Federative International Programme for Anatomical Terminology determined in 2015 that the Latin term (official term) may have associated synonyms or related terms, and that terms in other languages should be classified as equivalent terms, synonyms, or related terms. The 2019 editions of Terminologia Anatomica (TA2; https://bit.ly/30aCjtQ), Terminologia Neuroanatomica (TNA; https://bit.ly/38UW0d2), and Terminologia Embryologica (TE2; https://bit.ly/3j12LyD) list eponyms as related terms. This moves the International Federation of Associations of Anatomists one step closer to global consensus and de-eponymization.

    Eponymous anatomical, histological, and embryological terms, their author, and their anatomical descriptor were reviewed from textbook and online sources. (Full reference list: https://bit.ly/3j0EJUw.) Only nonpathological anatomic and histologic terms with a related eponym and documented in either Nomina Anatomica, TA2, TNA, or TE2 were highlighted for review. Eponymous terms relating to signs, syndromes, topographical landmarks, and clinical anatomical areas were excluded from further evaluation.

    Results were compiled in an online database allowing review of the eponymous term, the official Latin term, synonyms, English term, and related terms. The original publication (bibliographic source), as well as the country, occupation, and date of birth/death of the author (biographic source) were recorded.

    Results

    We identified 700 nonpathological anatomical eponymous terms attributed to 432 different eponyms.

    • A total of 424 eponyms were male physicians.
    • The eight non-male physician eponyms included five gods, a king, a hero, and one woman.
    • Thirty nationalities were represented, but 57 percent of eponyms originated from just three countries: Germany (194 eponymous terms, 114 eponyms), France (105/67), and Italy (104/41).
    • The average date of eponymous term attribution was 1847, with 51 percent of eponymous physicians being born between 1800 and 1875.
    • A total of 117 authors were associated with more than one eponymous term. The most attributed authors accounted for seven percent of eponymous terms: Morgagni (15), Santori (10), Haller (9), Golgi (8), and Jacobson (8).

    Misogyny and Myths

    Eponyms are dead; long live the eponym! There are reasons we are probably unable to say that there is always an alternative to a dead man's name for body parts. Eponymic misogyny, for one. One woman did make the list. The only human woman eponymously affiliated with a macroscopic anatomical structure was Raissa Nitabuch (Nitabuch fibrinoid or Stria fibrinoidea interna, the internal fibrinoid layer of the maturing placenta).

    The first woman to graduate from medical school was Elizabeth Blackwell (1821-1910) in 1849. (Life in the Fast Lane; July 13, 2020; https://bit.ly/2DAMmRn.) Given that the lead time to eponymic attribution was 28.5 years and the average date of attribution was 1847, it is not unsurprising that more than 90 percent of the anatomical eponyms had already been designated by the time women graduates were eligible for attribution.

    A number of anatomical terms relate to historical and mythical figures. Some have entered the vernacular more as metaphors and mythonyms than true anatomical eponyms. Examples include:

    • Ancient Greece: Iris, Atlas, Achilles, Hymenios (hymen)
    • Ancient Egypt: Amun (Ammon's horn)
    • Ancient Rome: Venus (mons veneris)
    • Biblical: King David (David's lyre), Adam (Adam's apple)

    At the risk of causing more controversy, the mythological (now anatomically and histologically defined) Gräfenberg spot has been included in the database in its shortened colloquial version, the G-spot. (BJOG. 2014;121[11]:1333; https://bit.ly/2CAvDgo.) The eponym is there; you just can't see it any more.

    Latin, Latin, and More Latin

    When is an eponym not an eponym? When it is written in Latin, of course.

    Where a suitable structural term is not available, an adjectival eponym may be used if a personal name has been internationally accepted, despite the desirability of avoiding eponyms.—Nomina Histologica. 1977.

    Golgi (golgiensis), Paneth (panethensis), and Purkinje (purkinjense) are included in Terminologia Histologica (TH) as adjectives. Examples include:

    • Camillo Golgi (1843-1926): Apparatus golgiensis (Golgi apparatus)
    • Joseph Paneth (1857-1890): Cellula panethensis (Paneth cell)
    • Johannes Purkinje (1787-1869): Stratum purkinjense (Purkinje cell layer)
    • Theodor Schwann (1810-1882): Schwannocytus (Schwann cell). Schwannocytus was added as a compound word in 2008. The term Schwann cell is now almost universally ascribed to the PNS ensheathing cell. Terms including the stem neurolemma are now rarely used.

    Eponymic Polysemy

    Despite this minor semantic diversion, we believe that eponyms relating to anatomical nomenclature should be abolished. Eponyms often enter the medical vocabulary in a haphazard and chaotic manner. It is not uncommon for them to break Neuman's eighth rule of anatomical nomenclature that each name must be unique. (Clin Anat. 2017 Apr;30[3]:300.) Multiple anatomical terms may be referred to by a single eponym (polysemy), such as Müller's muscle. Related terms in TA2 include the fibrae circulares (ciliary circular fibers), the musculus orbitalis (orbitalis muscle), and the musculus tarsalis superior (superior tarsal muscle).

    Eponyms as Synonyms

    The medical literature is filled with a dissonant array of eponyms scattered throughout the timeline of descriptive terminology. Unsurprisingly, this has resulted in multiple separate eponyms being promoted to describe the same anatomical structure. For example, the ileal orifice (ileocecal valve) is most commonly termed Bauhin's valve, but also the valve of Tulp, Macalister, Falloppio, Morgagni, or Varolio. Nodules of the semilunar leaflets of the aortic valve have the eponymic synonyms of the bodies of Arantius, nodules of Morgagni, and the nodules of Valsalva.

    Table
    Table:
    Eponyms from the Eponymictionary

    Vernacular Duality

    Eponyms can differ from country to country. The ligamentum iliofemorale (iliofemoral ligament) is known as Bertin's ligament in French and Bigelow's ligament in English. Similarly, the nodus inguinalis profundus proximalis (proximal deep inguinal lymph node) is referred to as Cloquet's ganglion/node in French and English and the Rosenmüller-Lymphknoten in German.

    Mireille Cavalerie introduced the term éponymes confusionnants in 1990 to describe the eponymic confusion relating to symmetrical organs sharing a common function. Stensen's and Wharton's ducts, for example, are both devoid of clues to indicate which belongs to the parotid gland and which to the submandibular gland.

    Tainted Eponyms

    Concerns were raised about using eponyms following World War II when it was revealed that some anatomical eponyms and their discovery were directly connected with active members of the Nazi party. The bronchiolar exocrine cell (exocrinocytus bronchiolaris or club cell) was originally named the Clara cell after Max Clara (1899-1965), an active supporter of Hitler's party. Clara acknowledged in his 1937 paper that the sample he based his work on was obtained from a prisoner executed by the Nazis.

    Eduard Pernkopf (1888-1955) published his amazingly detailed, and “beautifully” illustrated Pernkopf Atlas of Human Anatomy in 1964, and it possibly included research and prosections conducted on executed civilians. (https://bit.ly/2Opak44.) After Hitler invaded Austria in 1938, Pernkopf was appointed dean of the medical school at the University of Vienna and was a major instigator in purging Jewish staff from the medical school (153 of its 197 members). He voiced support for euthanasia and the Holocaust that was yet to come in several public speeches. The illustrators of the atlas were active Nazi party members who incorporated small swastikas and SS insignia into their signatures (airbrushed out in later editions).

    Namesakes and Dynasties

    Eponymous terms usually relate to the surname of the attributed physician. Confusion arises when two eponyms have the same surname, more still when the namesakes are related and share the same given names.

    Wilhelm His Sr. (1831-1904) described the angle of His (cardiac notch) in 1868, and his son Wilhelm His Jr. (1863-1934) described the bundle of His (atrioventricular bundle) in 1893.

    Johann Friedrich Meckel (1724-1774) described Meckel's ganglion (ganglion pterygopalatinum) in 1749, and his grandson Johann Friedrich Meckel (the younger) (1781-1833) described the Meckel diverticulum (diverticulum ilei) in 1809.

    Ghost Eponyms

    Orly coined the term bibliographical ghosts in 2014 in reference to eponymous publications which, though mentioned by historians, appear to have never existed. Some eponymous terms refer to prominent physicians with no recorded evidence of description or discovery. The dorsal tubercle of radius, for example, is eponymously remembered as Lister's tubercle after British surgeon Sir Joseph Lister (1827-1912), though no evidence exists that he ever described it.

    Others list little or no biographical information about the author, such as Johann Ehrenritter for the ganglion of Ehrenritter (1790); Karl Friedrich Ludwig Gantzer for Gantzer's muscle (1813), Onésime Lecomte for Lecomte's pronator of ulna (1863); Raissa Nitabuch for the Nitabuch membrane (1877); Christian Friedrich Wilhelm Roller (1802-1878 or 1844-1884) for Roller's nucleus (1881); Hugo Schütz for the fasciculus of Schütz (1891), and V Bernasconi for the artery of Bernasconi and Cassinari (1957).

    This article was originally published in the blog Life in the Fast Lane (https://litfl.com), created by Mike Cadogan, FACEM, FFSEM, and Chris Nickson, FCICM, FACEM, and is reprinted with permission.

    Dr. Buttneris an emergency medicine trainee at Sir Charles Gairdner Hospital in Perth, Western Australia, and an author for the blog Life in the Fast Lane. Follow him on Twitter@ButtnerRob. Dr. Leeis a UK-trained physician currently working in emergency medicine in Perth, Western Australia, and an author for Life in the Fast Lane. Dr. Cadoganis an emergency physician at Sir Charles Gairdner Hospital in Perth, Western Australia, and a founder of the Life in the Fast Lane blog. Follow him on Twitter@sandnsurf.

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