Neurological Eponyms. Peter J. Koehler, George W. Bruyn, John M. S. Pearce

Neurological Eponyms

Download Neurological Eponyms

Neurological Eponyms Peter J. Koehler, George W. Bruyn, John M. S. Pearce ebook pdf
Language: English
Page: 386
ISBN: 0195133668, 9780198030591

From The New England Journal of Medicine

I was never very enthusiastic about eponyms as a student, having enough problems with keeping the manifestations of the lateral medullary syndrome straight without the added burden of remembering that Adolf Wallenberg was the syndrome's original describer. My annoyance with the commemoration of some persons by appending their names to certain cells, structures, or diseases (often these physicians had actually gotten things wrong or were not even first) only grew as medical school progressed. After I recognized a patient's description of electric-shock-like sensations that occurred with neck movement as Lhermitte's sign (more accurately a symptom), I was offered an immediate residency position by the chair of the neurology department, if only I could spell ``Lhermitte.'' I failed and fortunately was doomed to another year as a student, during which I was to be burdened by a chief resident dedicated to torturing me with every eponym ever recognized.

With that disclaimer, I must admit that Koehler and colleagues have edited a beautiful book describing the origin and pathophysiology of common eponymously named phenomena in the clinical neurosciences. The book is not an exhaustive description of all such phenomena, as my former chief resident would have liked, but is instead limited to the most well known eponyms, describing the circle of Willis, Alzheimer's disease, Romberg's sign, Wernicke's aphasia, and the Purkinje cell, among others. The chapters are remarkably well balanced, discussing the historical basis of the eponymic designation in the context of present-day understanding, all within the space of 5 to 10 pages. Each chapter contains a photograph of the eponymous physician or scientist and often illustrations of how a reflex is elicited or reproductions of photomicrographs and anatomical drawings. In most cases, the information comes from secondary sources, and original historical research has not been conducted.

Any book of lists will lead to arguments regarding exclusions at the price of inclusions, and I will not pursue my personal gripes, but I can provide a few complaints for others to disagree with. American neurosurgeons will find some of the discussion of Harvey Cushing (Figure 1) quite unsettling. The author of the chapter on Cushing questions whether his achievements warrant the godlike status he is granted in this country. In fact, the subject of discussion is not Cushing's disease, but rather the Cushing reflex of increased intracranial pressure, hypertension, and bradycardia. The author cites others who questioned whether Cushing had an understanding of pituitary function. More unsettling to neurologists may be the introduction to the reflexes of Hoffman, Tromner, and Mayer, which discounts the usefulness of the clinical neurologic examination in our era of high-technology medicine, noting that in contemporary medical practice, laboratory testing and imaging are ``given greater weight in diagnostic decision making.'' Although many physicians find Babinski's sign equally valuable whether it is elicited with the shoe on or off, this attitude toward clinical examination is detrimental both from a cost-containment standpoint and from the perspective of patient care. A detailed medical history and examination -- in particular, a neurologic examination -- focuses the evaluation and confirmation of the clinical diagnosis. It is not uncommon for a blitzkrieg of testing on admission to a hospital, or for that matter at a visit to the outpatient clinic, to lead the physician back to the bedside to seek the true path to a diagnosis and appropriate treatment.

The importance of eponyms, in these days of ever increasing technology, lies in the link they establish to the past, and this book emphasizes the human nature of discovery and the evolution of knowledge in medicine. Even as I take issue with an author's questioning of the importance of Harvey Cushing and wonder why other authors waste a paragraph describing the injustice that was done to Alfons Maria Jakob when Creutzfeld-Jakob disease was not named Jakob-Creutzfeld, I reflect my own emotional response. I must agree with the editors' encouragement of the use of eponymic terms to avoid designations such as ``the clinical phenotype produced by the point mutation at Val127/Leu128 position in codon 192 of exon 6 in chromosome 39q27-ter, coding for the omega subunit of the potassium-ionophore protein.'' I suspect that even as a medical student I would have recognized that ``Koehler-Bruyn-Pearce syndrome'' was a better designation.

The editors' goal for this book was education and entertainment. They have succeeded quite admirably.

Henry J. Kaminski, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


"...a beautiful book describing the origin and clinical neurosciences...The editors' goal for this book was education and entertainment. They have succeeded quite admirably."--New England Journal of Medicine

Noted in Nature

"This book opens a valuable window on interesting people...Neurologists, neurosurgeons, neuroscientists, internists, and other generalists with an interest in the history of neurology would probably enjoy it."--JAMA2001

"The editors' goal for this book was education and entertainment. They have succeeded quite admirably."--New England Journal of MedicineAugust 2001

"...both educational and entertaining...By any account, this book is a success and can be warmly recommended."--Ian McDonald in BRAIN

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