The Junk Drawer

"I am lost; last night there came a phlebitis - it is that which will carry me off."

Trousseau described two different clinical signs, both bearing his name, which creates its own quiet chaos during finals. The first is carpal spasm induced by inflating a blood pressure cuff above systolic pressure for three minutes - a sign of latent hypocalcaemia. The second is migratory thrombophlebitis associated with occult malignancy, a paraneoplastic phenomenon.

The second sign became personal. Trousseau had spent years with unexplained symptoms when, in 1865, he noticed a superficial phlebitis developing on his own arm. He recognised it immediately for what it was and told a student what he had quoted above. His gastric cancer was confirmed shortly after. He died in 1867. The physician who named a sign of cancer diagnosed himself with it using that sign.

Wegener described granulomatosis with polyangiitis in papers published between 1936 and 1939. The condition bore his name for decades. In the 2000s, historians began examining his wartime records more carefully. They found evidence of Nazi party and SA membership, and raised concerns about his activities as a military pathologist during the war.

The American College of Rheumatology and the European League Against Rheumatism jointly recommended renaming the disease in 2011. It is now granulomatosis with polyangiitis, abbreviated GPA. This is the preferred term in NZ guidelines and in any documentation written after about 2012. Wegener himself lived until 1990 and always denied any wrongdoing.

Reiter described the triad of arthritis, urethritis, and conjunctivitis in a 1916 paper about a German officer on the Eastern Front. What he did not mention, or perhaps did not know, was that the same triad had been described by Benjamin Brodie in 1818 and by several others since. The eponym was not quite deserved on clinical grounds alone.

The situation became worse. Reiter was a senior Nazi party and SS member, and served as chief medical officer for the Reich Health Office during the war. He was tried by a US military tribunal at Nuremberg for his role in typhus experiments conducted on concentration camp prisoners at Buchenwald. He was convicted. The ACR officially stopped endorsing the eponym in 1999. The preferred term is reactive arthritis, which describes the condition accurately (arthritis triggered by a remote infection) without commemmorating anyone.

In 1932, Crohn, Leon Ginzburg, and Gordon Oppenheimer published a landmark paper in JAMA describing terminal ileitis. The authors were listed alphabetically. C comes before G. G comes before O. The disease took Crohn's name.

Leon Ginzburg maintained for the rest of his career that the intellectual contribution was disproportionately his. Crohn, who lived to 99, reportedly had no particular expectation that the disease would bear his name at all - he was simply listed first. It is one of medicine's more arbitrary memorials: a 98-year life attached to an eponym determined by alphabetical order and a convention about author listing.

The Baron von Münchhausen was famous during his lifetime for telling extraordinarily implausible stories about his military adventures: riding cannonballs, pulling himself out of a swamp by his own hair, travelling to the moon. He had no known involvement with medicine whatsoever.

In 1951, the British physician Richard Asher published a paper in The Lancet describing patients who fabricated or induced illness to obtain medical care. He reached for the most famous fictional liar he could think of. The resulting term - Munchausen syndrome - is arguably medicine's most creative naming decision. The baron, who had been dead for 154 years, found himself a psychiatric eponym. His name is misspelled in the condition (one 'h' dropped), which seems appropriate.

Parkinson published "An Essay on the Shaking Palsy" in 1817, based on observations of six patients, some of whom he had seen only in the street. It is a remarkably accurate clinical description. What is less often mentioned is what he was doing the rest of the time.

Under the pseudonym "Old Hubert," Parkinson wrote radical political pamphlets calling for universal male suffrage and parliamentary reform. In 1794 he was called before the Privy Council over suspected involvement in the "Pop-gun Plot" - an alleged conspiracy to assassinate King George III with a poisoned dart fired from an airgun at the theatre. He denied all knowledge and was released without charge. He was also a serious amateur palaeontologist who contributed to the understanding of fossil organisms. The man who described the most common movement disorder in older adults spent his middle years being investigated for regicide.

Down described the condition in an 1866 paper titled "Observations on an Ethnic Classification of Idiots." He was attempting a typological classification of people with intellectual disabilities, grouping them according to what he saw as racial characteristics. People with the features now recognised as trisomy 21 were classified as "Mongoloid," a term rooted in the racist evolutionary thinking of the era: the idea that disability represented a regression toward an earlier and supposedly more primitive racial type.

The chromosomal basis of the condition - trisomy 21 - was not discovered until 1959, by Jérôme Lejeune. The WHO recommended abandoning the term "mongolism" in 1965, though it persisted in some medical literature for years afterward. Down himself ran his institution, Normansfield, with relative compassion by Victorian standards, and advocated for the education and dignity of people in his care. The terminology he coined was of its time and deeply wrong. Both things are true.