Epagogic eponyms Gerald Stern University College Hospitals, London, UK

Be not the first by whom the new are tried, nor yet the last to lay the old aside

Correspondence to Dr Gerald Stern, 10 Cottesmore Court, Stanford Road, London W85QL, UK; [email protected] Published Online First 24 January 2014

To cite: Stern G. Pract Neurol 2014;14:280–282.


An essay on criticism. Alexander Pope (1688–1744).

At times, the use of eponyms has been controversial. Much has been written about their limitations, but it cannot be denied that many have usefully withstood the test of time. In Western culture, pedants may have differed over the first eponym. Assyrians in the second millennium named each year after a high official; since the 8th century BC, Homer’s Odyssey has been called after Odysseus; in ancient Greece, the name of the highest magistrate was given to the year of his office and at least five of the months in the revised Roman Justinian–Gregorian calendar are named after gods or emperors. Koehler, Bryn and Pearce, editors of a scholarly and fascinating book on ‘Neurological Eponyms’,1 commented, “Medical eponyms are again in vogue after a period of 50–60 years when would-be-scientific doctors disdainfully rejected eponyms as obsolete … liberated from its inferiority complex … it now transpired that physic, chemistry astronomy … and the like, command a plethora of many hundreds of eponyms. Many terms chosen in place of eponyms are unwieldy and awkward”. The reasons for this renaissance may be complex but essentially indicate a practical need for succinct, useful terms, which are acceptable to patients and their families as well as to doctors and neuroscientists. When I was a medical student, both in general medicine and clinical neurology, textbooks were replete with polysyllabic lists of deceased often Teutonic clinicians whose priority gave rise to much polemical debate. Some of these eponyms have survived and a few now have global i

Kindly reader forgive a little pedantry: Epagogue (Greek), the bringing forward of particular instances to lead to a general conclusion.

recognition to both lay as well as medical audiences. Alzheimer’s disease is the commonest of the neurodegenerative diseases, but as he was a neuropathologist— although of great distinction—his name may be respectfully withdrawn from a list of ‘The world’s best known neurologist’. It has been proposed that this accolade might be awarded to James Parkinson.2 The path to eponymity may be capricious and long delayed. During his life, Parkinson was a prolific writer and polymath contributing to politics, social welfare, palaeontology and many aspects of medicine, yet his death was largely unnoticed (figure 1) save for a brief notice in the Gentleman’s Magazine (figure 2). We have no portrait,3 but there is a brief account given by a fellow scientist, “Mr Parkinson was rather below middle stature, with an energetic and pleasing countenance, and of mild and courteous manner; readily imparting information either on his favourite science, or on professional subjects”. When his first biographer, Rowntree,4 discovered much of what we know about Parkinson, he began his article, “English born and bred, an English physician and scientist, forgotten by the English and by the world at large—such is the fate of James Parkinson”. Rowntree was able to photograph the now derelict house number 1 Hoxton Square, where Parkinson lived and practised (figure 3). Contemporary physicians warmly received Parkinson’s now famous ‘An Essay on the shaking Palsy’, published in 1817. The Medico-Chirurgical Journal and Review of that year noted: The reader will now perceive that this little pamphlet is highly worthy of perusal, and deserves the attention of the medical public.

Thereafter, during the 19th century in England, there were some generous testaments. Several influential teachers recognised the originality of Parkinson’s contribution but, curiously, there was no eponymous attribution. Perhaps the

Stern G. Pract Neurol 2014;14:280–282. doi:10.1136/practneurol-2013-000772


Figure 1

James Parkinson’s death certificate.

surgeon–apothecary and former writer of radical political pamphlets was not considered sufficiently important by the medical establishment. ▸ John Elliotson, in a lecture at St. Thomas’s Hospital in 1830, said: “The best account of this disease which I have seen is one given by a general practitioner, now deceased, of the name of Parkinson…”. ▸ Marshall Hall, in a lecture on paralysis agitans in 1837: “…I must now draw your attention to another disease… the paralysis agitans. Its symptoms have been well described by Mr Parkinson…” ▸ Sir Thomas Watson in a lecture at King’s College in 1841: “I refer to the shaking palsy—paralysis agitans… Allusions to this disease are to be found in many of the

older writers on physic; but it never was much attended in this country until Mr Parkinson published an essay… and a very interesting little pamphlet it is”. ▸ David Maclachlan in his book Diseases and Infirmities of Advanced Life (1863) wrote: “Mr Parkinson’s essay… gives a faithful account of the symptoms from beginning to end, and is still the best work on the subject”. ▸ Thomas Buzzard in his clinical lecture on Diseases of the Nervous System (1882) wrote: “The disease ‘shaking palsy’ or ‘paralysis agitans’… was first regularly described by our countryman Parkinson in 1817… presents so graphic and admirable a description of the disease that comparatively little has left for subsequent observers to add to its account”.

Figure 2

Figure 3 Number 1, Hoxton Square, in London’s East End.

A note in the Gentleman’s Magazine.

Stern G. Pract Neurol 2014;14:280–282. doi:10.1136/practneurol-2013-000772


FROM THE RETIRED In Europe, however, recognition came earlier. Having obtained with difficulty a copy of the only publication of the essay, Jean-Martin Charcot first gave eponymous priority when describing the ‘Maladie de Parkinson’. In a lecture (1887), Charcot described an illustrative case “…attacked by Parkinson’s disease”. William Gowers, in his classical Manual of Diseases of the Nervous System (1888), wrote: “From the fact that it was first fully described by Parkinson in 1817, it has been called Parkinson’s disease, but the name which he has given to it of ‘shaking palsy is both apt and adequate’” and in a footnote he added: “To the name ‘paralysis agitans’, it has been objected by Charcot that either the weakness or tremor is sometimes slight and occurs late, but this does not lessen the applicability of the name, since in the majority of cases both symptoms are conspicuous”. Gowers was not keen on eponyms and, perhaps because of his considerable authority in England, the illness continued to be called paralysis agitans until the 1930s. It would appear that presently ‘Parkinson’s disease’ is under threat of dissolution, modification or replacement. Advancing knowledge—putative causes, identification of multiple genetic ‘susceptibility’ factors, possible epigenomic hazards, increasing recognition of early phases of the disease process ( preclinical,


prodromal or premotor)—are some of the currently proposed additional subdivisions. A prestigious subcommittee has now been set up to review the need for modification or even replacement of the eponym. It would be sad if Parkinson’s name no longer continued to receive the universal medical and public recognition it so richly deserves. Present aspirants for eponymous fame may recall that the Bible’s warning (Mathew, 57), “A prophet is not without honour, save in his own country”, but might be slightly encouraged that recognition may eventually be posthumous. Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Christopher Gardner-Thorpe, Exeter, UK.

REFERENCES 1 Koehler PJ, Bruyn GW, Pearce JMS. Neurological eponyms. New York: Oxford University Press, 2000. 2 Stern G. The world’s best known neurologist? Pract Neurol 2011;11:312–15. 3 Lawden M. Parkinson’s facies. Pract Neurol 2011;11:316. 4 Rowntree LG. James Parkinson. Bull Johns Hopkins Hospital 1912;XXIII:33–45.

Stern G. Pract Neurol 2014;14:280–282. doi:10.1136/practneurol-2013-000772

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