Journal of Clinical Neuroscience 22 (2015) 642–644

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Names of infamy: Tainted eponyms F.J.E. Vajda a,⇑, S.M. Davis a, E. Byrne b a b

University of Melbourne, Department of Medicine and Neurosciences, Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3150, Australia Monash University, Clayton, VIC, Australia

a r t i c l e

i n f o

Article history: Received 11 February 2014 Accepted 7 September 2014

Keywords: Eponyms Honorific names Major discoveries Nazi crimes Unethical research

a b s t r a c t The use of eponyms is controversial. A distinction must be made between those doctors and scientists after whom disorders and syndromes are named in honour of their discoveries, and those whose discoveries were made as a result of maltreatment of defenceless prisoners, utilizing specimens from victims of Nazi extermination policies, and euthanasia victims of racial policies. The second group of scientists should have their names expunged from the historical record, and their deeds brought to the attention of their colleagues. We are not however advocating the abolition of eponyms in general, only tainted ones. Ó 2014 Elsevier Ltd. All rights reserved.

1. Personal view Eponymous names are used in medicine, particularly in neurology, in order to denote the creative activity or discovery by doctors who have provided the original or definitive description of a disease process. They have made a major contribution to medical science and should therefore be honoured for their achievements. In medical teaching and history, there is a long tradition of eponymous nomenclature, often providing a simpler and more memorable label without a detailed summary of the main features. It can be argued that the use of eponyms is controversial in any case, as there is often debate about the initial description of a syndrome, or the accuracy in naming the first person credited with the discovery. However, we consider that these issues are secondary and that eponymous names will likely retain a role in the medical literature. Our key tenet is that there is a strong argument against the retention of eponymous names when they are associated with physicians who have been convicted of being war criminals and committed infamous deeds against the ethical standards of medicine. This is particularly relevant to the activities of doctors associated with Nazism before and during the Second World War [1–8]. The British Medical Journal published two articles presenting opposing views about retaining eponyms in general or discarding them in extreme cases of criminality [9,10]. A recent article described 30 names in neurology who clearly appeared to be unworthy of the distinction of being associated with an ⇑ Corresponding author. Tel.: +61 3 9819 3056; fax: +61 3 9342 2577. E-mail address: [email protected] (F.J.E. Vajda). 0967-5868/Ó 2014 Elsevier Ltd. All rights reserved.

eponymous syndrome. In rheumatology, a winner of awards from the American College of Rheumatology has been stripped of his honours. Kondziella lists 400 Nazi doctors involved in the most sadistic and despicable activities, including crimes against children, pregnant women and many concentration camp inmates, particularly, although not exclusively, Jews. Hence, there has been a recent trend in the world literature towards the abolition of eponymous nomenclature. This tendency appears to be gaining momentum [11]. We would particularly advocate the discarding of eponymous names for convicted Nazi war criminals. We should not forget the unique historical situation in the 1930s and 1940s in Germany, when an advanced country with a modern technological infrastructure and a track record of scientific achievement was ruled by a criminal regime, the National Socialists. It is reprehensible and inexplicable that physicians associated with the Nazis, particularly those working in concentration camps, used the opportunity to perform unethical experiments on unwilling, defenceless subjects under the guise of research. No parallel exists for this confluence of medical and technological methodology and a criminal ruling ideology. The Nazi period was unique as it involved genocide without parallel and criminal complicity of some physicians in the performance of heinous medical experiments. In the period of the Armenian genocide there were no eponyms named after Turkish doctors. Similarly with genocides in Rwanda and Cambodia, there is no record of eponymous honours to medical scientists from those countries. No reports of experimentation reaching levels of

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international recognition emerged from earlier historical times, for example in the 1241 Mongolian invasion of Europe or massacres by colonial powers in South America. Using slaves for experimentation, killing defenceless prisoners for observation of pathological processes, or aiding and abetting genocide for pseudoscientific purposes clearly indicates the need to be prosecuted fully under the criminal justice system with full exposure of the crimes, rather than being recognized by the retention of unworthy eponyms. In contradistinction, some eponyms bear the name of victims of genocide or persecution, many of whom who had to leave their countries of origin to escape racist ideologies. Those eponyms should not be discarded in our view. 2. Eponyms of victims of Nazi crimes as illustrative examples The Jarisch–Herxheimer reaction is a reaction to endotoxins released by the death of harmful organisms within the body. Karl Herxheimer died in the Nazi concentration camp at Theresienstadt. Niemann–Pick disease is an inherited condition involving lipid metabolism, which is the breakdown, transport, and use of fats and cholesterol in the body. In people with this condition, abnormal lipid metabolism causes harmful amounts of lipids to accumulate in the spleen, liver, lungs, bone marrow, and brain. Ludwig Pick was imprisoned and died in Theresienstadt. Cryptococcosis is a subacutely or chronically manifested infection caused by a yeast called Cryptococcus neoformans which may involve the skin, lungs, lymph nodes or other parts of the body but which has a decided predilection for the brain, meninges and spinal cord. The disease is also called European blastomycosis, torulosis and Busse–Buschke’s disease. Buschke, a German dermatologist, died in Theresienstadt concentration camp. Polya’s operation refers to subtotal gastrectomy with anastomosis of the transected end of the stomach to the side of the jejunum. Eugene Polya was murdered in Budapest in 1944 by Hungarian Nazi Arrow Cross vigilantes. Barraquer–Simons syndrome is partial lipodystrohy. Arthur Simons was deported from Berlin to an Estonian concentration camp, where he died [8]. The introductory remarks about war criminals are certainly a special case. The names below represent only the tip of the iceberg. These are the most prominently quoted eponyms and could be regarded as legitimizing the most despicable doctors, whose names should either be expunged or their infamy listed when the conditions which they described are mentioned. In our opinion eponyms should not be abandoned universally, but those retained should be shown by posterity to have shown exceptional merit to justify being rewarded; The National Socialist doctors, having escaped prosecution, should not be paraded in history as innovators and persons of healing and succour. It is the ‘‘tainted eponyms’’ which present the problem and we believe should now be discarded. 3. Specific examples of war criminals honoured with eponymous names


dystonia, dementia, and ultimately death. Hallervorden (1982– 1965) readily admitted that the 697 brains he had investigated during the Nazi period were from victims of euthanasia. It is alleged that he was present at the killing of more than 60 children and adolescents at the Brandenburg Psychiatric Institution on 28 October 1940. He was reported to have removed brain material himself from euthanasia victims in a nearby extermination (euthanasia) center. Hugo Spatz (2 September 1888–27 January 1969) was a German neuropathologist. In 1937, he was appointed director of the Kaiser Wilhelm Institute for Brain Research. He was a member of the Nazi Party, and admitted to knowingly performing much of his controversial research on the brains of executed prisoners. 3.2. Reactive arthritis Reactive arthritis can be associated with joint pains and inflammation of the eyes and the urinary tract, and sometimes with skin lesions. Hans Conrad Reiter first described the syndrome which was subsequently named after him. Reiter was awarded a posthumous Nazi Knight’s Cross. He was a strong proponent of eugenics. He had authorized medical experiments on prisoners in the concentration camps leading to the deaths of thousands. The syndrome has been now renamed as ‘‘reactive arthritis’’ after his connections became widely known. Transcripts from Reiter’s interrogation while he was imprisoned at Nuremberg from 1945 to 1947 reveal that as President of the Reich Health Office he acted as ‘‘quality control officer’’ for the involuntary sterilization, euthanasia, and murder of Germany’s mental hospital population. He helped design and implement a ‘‘study’’ at Buchenwald in which over 200 prisoners died after receiving an experimental typhus vaccine. The two ranking doctors at Buchenwald committed suicide before they could be captured and interrogated. Reiter was released, possibly because he provided the Allies with intelligence regarding Nazi germ warfare research [14,15]. 3.2.1. ‘‘Club cell’’ The ‘‘club cell’’ was originally eponymously named after Max Clara, who owed his career advancement in no small way to his membership in Hitler’s party and active support of its programme. In his 1937 paper, Clara acknowledges that the sample he based his work on ‘‘was obtained from a prisoner executed by the Nazi justice system’’ [16,17]. The cells in question are non-ciliated, secretory bronchiolar epithelial cells; they function as stem cells for repair in the bronchioles and can divide into ciliated or nonciliated bronchiolar cells. 3.3. Portal vein thrombosis Portal vein thrombosis has been eponymously termed the Cauchois–Eppinger–Frugoni syndrome [18]. Hans Eppinger conducted cruel experiments on Roma prisoners at the Dachau concentration camp in order to test the potability of seawater. He committed suicide with poison on 25 September 1946, 1 month before he was scheduled to testify in Nuremberg.

3.1. Pantothenate kinase associated neurodegeneration Pantothenate kinase associated neurodegeneration, also known as neurodegeneration with brain iron accumulation, has formerly been called Hallervorden–Spatz syndrome. The use of this eponym is discouraged due to Julius Hallervorden’s and Hugo Spatz’s affiliation with the Nazi regime and the ethically unacceptable manner in which they obtained 110,000 autopsy specimens from 2800 psychiatric patients who were gassed [12,13]. The condition is a degenerative disease of the brain that can lead to parkinsonism,

3.4. Anti-neutrophil cytoplasmic autoantibody-associated granulomatous vasculitis The anti-neutrophil cytoplasmic autoantibody (ANCA)-associated granulomatous vasculitis had been eponymously named Wegener’s granulomatosis until his past was discovered. Wegener was a German pathologist and although this disease was known before his description, the eponym was used since the 1950s. Wegener joined the Nazi Party in 1932. As a relatively high-ranking


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military doctor, he spent some of the Second World War in a medical office three blocks from the Lodz Ghetto, in close proximity to the genocide machinery. There is speculation that he participated in experiments on concentration camp inmates. Lodz had a Jewish population of several hundred thousand, almost all of whom were murdered. The evidence suggests that Wegener was, at least at some point of his career, a follower of the regime. His mentor, Martin Staemmler, was an ardent supporter of racial hygiene. Data indicate that the Polish authorities wanted Wegener and that his files were forwarded to the United Nations War Crimes Commission. The American College of Chest Physicians (ACCP) awarded Wegener a ‘‘master clinician’’ prize in 1989. After his past was discovered in 2000, the ACCP rescinded the prize and, separately, a campaign was begun to rename the condition as ANCA-associated granulomatous vasculitis [1]. More recently, the name ‘‘granulomatosis with polyangiitis’’ has been proposed [19–21]. Working as military doctor close to the Nazi murder machinery, being wanted by the Polish government for investigation and being stripped of his honours after investigation by a highly reputable medical college all indicate there is sufficient incriminating evidence to remove his eponym. 3.5. Infantile neuroaxonal dystrophy Infantile neuroaxonal dystrophy is a rare pervasive developmental disorder that primarily affects the nervous system. Individuals with infantile neuroaxonal dystrophy typically do not have any symptoms at birth, but begin to experience delays in acquiring new motor and intellectual skills, such as crawling or beginning to speak, between the ages of about 6 and 18 months. Eventually they lose previously acquired skills. This condition was named after F. Seitelberger from Vienna. Seitelberger, a Viennese neurologist, was a former member of the Schutzstaffel (SS). Examining the brains of three ‘‘euthanasia’’ victims from the Landesanstalt Görden in Brandenburg, Seitelberger earned his PhD in 1954 under the supervision of Hallervorden [22]. Membership of the SS alone was defined at Nuremberg as belonging to a criminal organisation. 3.6. Cerebrotendineous xanthomatosis Cerebrotendineous xanthomatosis or Van Bogaert–Scherer– Epstein syndrome is an inherited disorder associated with the deposition of a form of cholesterol (cholestanol) in the brain and other tissues, with elevated levels of cholesterol in plasma. It is characterized by progressive cerebellar ataxia beginning after puberty, juvenile cataracts, juvenile or infantile onset of chronic diarrhoea, childhood neurological deficit, and tendinous or tuberous xanthomas. During the Second World War Scherer worked at the Neurology Institute in Breslau, Silesia. He was directly involved in neuropathological brain analyses of over 300 Polish and German children euthanized in the nearby Loben Psychiatric Clinic for Youth [23]. To quote form Jindal [1]: ‘‘There are strong arguments put forward by those who do not like to see the blots on the face of medicine. The medical history of the Nazi era of unspeakable crimes committed cannot be written off, will not be written off, nor forgotten. The eponyms

not only glorify the persons associated with these names and the stories of their horrendous experiments and inhuman practices. They rub the salt on the wounds of the affected communities and nations. They are, therefore better buried in oblivion. . ..’’ We cannot put it better.

Conflicts of Interest/Disclosures The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication. References [1] Hans-Walter Schmuhl added Forschungsprogramm ‘‘Geschichte der KaiserWilhelm-Gesellschaft im Nationalsozialismus’’ Research Program ‘‘History of the Kaiser Wilhelm Society in the National Socialist Era’’. Hirnforschung and Krankenmord Das Kaiser-Wilhelm-Institut fuer Hirnforschung 1937–1945. [2] Jindal SK. Nazi Eponyms in Medicine. J Postgrad Med Ed Res 2012;46:i–Vi. [3] Shorvon S, Weiss G. International League Against Epilepsy- the first period 1090–1952. In: Shorvon A, Avanzini G, Meinardi H, et al., editors. International League Against Epilepsy: 1909–2009 A Centenary History. Oxford: Blackwell Science; 2009. [4] Lindert J, Stein Y, Guggenheim H, et al. How ethics failed – the role of psychiatrists and physicians in Nazi programs from exclusion to extermination, 1933–1945. Public Health Rev 2012;34:1–25. [5] Schmuhl HW. Brain research and the murder of the sick: The Kaiser Wilhen Institute for Brain Research 1937–1945. In: Heim S, Sachse C, Walker M, editors. The Kaiser Wilhelm Society under National Socialism. Cambridge: Cambridge University Press; 2009. [6] Bernadac C. Devil’s doctors. Geneva: Ferni Publishing House; 1978. [7] Hillberg R. The destruction of the European Jews. New York: Holmes and Meier; 1985. [8] Strous RD, Edelman MC. Eponyms and the Nazi era: time to remember and time for change. Israel Med Assoc J 2007;9:207–14. [9] Woywodt A, Matteson E. Should eponyms be abandoned? Yes. BMJ 2007;335:424. [10] Whitworth JA. Should eponyms be abandoned? No. BMJ 2007;335:425. [11] Kondziella D. Thirty neurological eponyms associated with the Nazi era. Eur Neurol 2009;62:56–64. [12] Harper PS. Naming of syndromes and unethical activities: the case of Hallervorden and Spatz. Lancet 1996;348:1224–5. [13] Shevell MI, Peiffer J. Julius Hallervorden’s wartime activities: implications for science under dictatorship. Pediatr Neurol 2001;25:162–5. [14] Panush RS, Paraschiv D, Dorff RE. The tainted legacy of Hans Reiter. Semin Arthritis Rheum 2003;32:231–6. [15] Panush RS, Wallace DJ, Dorff RE, et al. Retraction of the suggestion to use the term ‘‘Reiter’s syndrome’’ sixty-five years later: the legacy of Reiter, a war criminal, should not be eponymic honor but rather condemnation. Arthritis Rheum 2007;56:693–4. [16] Woywodt A, Lefrak S, Matteson E. Tainted eponyms in medicine: the ‘‘Clara’’ cell joins the list. Eur Resp J 2010;36:706–8. [17] The Clara cell. Saunders Comprehensive Veterinary Dictionary, 3rd ed. Elsevier: 2007. [18] Levine C. What’s in a name? The Eppinger prize and Nazi experiments. Hastings Cent Rep 1984;14:3–4. [19] Woywodt A, Matteson EL. Wegener’s granulomatosis—probing the untold past of the man behind the eponym. Rheumatology (Oxford) 2006;45:1303–6. [20] Rosen MJ. Dr. Friedrich Wegener and the ACCP, Revisited. Chest 2007;132:1723–4 [discussion 1723-4]. [21] Falk RJ, Gross WL, Guillevin L, et al. Granulomatosis with polyangiitis (Wegener’s): an alternative name for Wegener’s granulomatosis. J Am Soc Nephrol 2011;22:587–8. [22] Weindling PJ. The Nazi Medical Experiments. In: Emmanuel JE, Grady C, Crouch RA, et al., editors. The Oxford textbook of clinical research ethics. New York: Oxford University Press; 2008. [23] Pfeiffer J, Kleihues P. Hans-Joachim Scherer (1906–1945), pioneer in glioma research. Brain Pathol 1999;9:241–5.

Names of infamy: tainted eponyms.

The use of eponyms is controversial. A distinction must be made between those doctors and scientists after whom disorders and syndromes are named in h...
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