The use of eponyms in medical case reports: etymological, quantitative, and structural analysis

Eponym [Ancient Greek ἐπώνυμος (epṓnymos), from ἐπί (epí, “upon”) + ὄνυμα (ónyma, “name,” also referred to as “term with onomastic component”: ὀνομαστικός (onomastikós) —“belonging to naming”] is a word derived from the name of a person (real or fictitious) [1]. In particular, medical eponyms may denote diseases, structures, operations, or procedures. Medical eponyms constitute “an integral part of the language of medicine, which reflects the various stages of knowledge of reality, historical conditions, and information about those people who contributed to the development of medical science” [2]. The significance of eponyms derived from the names of doctors and scientists who discovered or described them first has been extensively studied in different medical specialties [3‐7]. There are studies devoted to ethical [8‐10], historical [2, 11], and gender [12] aspects of medical eponyms. Along with linguistic studies, eponyms are the constant focus of medical research. Indeed, professional medical discourse actively uses eponyms, which are derived from the names of prominent scientists and doctors, as is the case with “Heymann nephritis” [13], “Parkinson’s disease” [14], “Devic’s opticomyelitis” [15], “Adams–Stokes disease” [16], “Aschner–Dagnini reflex” [17], and many others. At the same time, in the context of our research, it is essential to point out that along with such “obvious” derivations, there are numerous terms with onomastic components, whose etymology might not be so transparent at first glance. For instance, the term “Bordetella avium” is derived from the name of the Belgian immunologist and microbiologist Jules Bordet (1870–1961), and “Raoultella planticola” is named after the French bacteriologist Didier Raoult (born 1952) [18]. The term “warfarin” is derived from the abbreviation “Wisconsin Alumni Research Foundation” (WARF), which is a homage to the team of chemists from the University of Wisconsin [19]. Furthermore, the term “fullerene” is derived from the name of American architect Buckminster Fuller, because of the similarity of its molecule to geodesic domes, which he designed [20]. As one can observe, the above-mentioned onomastic components require certain interpretative effort and address reference literature. Quite often, unawareness of a term’s intricate etymology can result in its incorrect spelling and use. For instance, our searches in the ResearchGate and PubMed databases yield more than ten results for each of the misspelled terms “fulerene”, “Bortedella”, and “raultella”. It is our belief that the knowledge of the etymological roots of such terms can help healthcare professionals to avoid possible mistakes when producing written professional discourse. Therefore, medical students must be appropriately instructed as to these tendencies in English medical terminology as a part of their formal education.

Eponyms are widely used in medical discourse because they “disclose the evolution of medical research and practice; provide continuity of scientific knowledge and contribute to the formation of terminological competence of medical students” [21]. Indeed, eponyms “bring colour to medicine, embed medical traditions and culture to our history” [22]. However, the features and prevalence of eponyms embedded in classical mythologies and world literature remain understudied, so far. At the same time, the paramount role of the Greek and Latin terminologies in the development of all modern European languages, and their enormous and undisputable influence on the English sublanguage of medicine, have been thoroughly substantiated in our previous studies [23‐28]. In addition, several studies have focused on the origins of specific literary eponyms [29], or their prevalence in certain medical specialties [30, 31]. Therefore, our study aims to fill this research gap and deepen doctors’ and linguists’ understanding of this terminological phenomenon, hence the interdisciplinary nature of this research. In our opinion, the study of eponyms derived from the cultural background of different peoples and nations is an indispensable element of the well-rounded education of medical specialists in general [32], and an essential prerequisite for further integration of Ukraine into the Western context. It is also a feasible tool for increasing students’ motivation, since the study of eponyms contribute to the understanding of medical terms’ appearance, and consequently promotes their better memorization [33].

Within the structure of medical writing, a special place belongs to medical case reports (MCRs), which are highly effective in the communication of scientific knowledge throughout the world, hence the importance of training medical professionals in producing written discourse in this genre [34]. Therefore, it is relevant to determine the prevalence of eponymic terms and how they are used in the modern MCRs. In such a way, this research will provide appropriate guidelines for healthcare professionals in terms of correct use and comprehension of the origins of medical eponyms, when dealing will the genre of MCRs.

The objective of the research is to study the prevalence of using mythological and literary eponyms in the English language medical case reports and, in such a way, to provide academic guidelines for writing effective MCRs by medical professionals. The deeper purpose of our study is to demonstrate that eponymic terms in general, mythological, and literary eponyms, in particular, are present in doctors’ spoken and written discourse far more extensively than might seem at first glance. The material of this research is the corpus of papers from Journal of Medical Case Reports (JMCRs) [35], published within the last 15 years (2007–2022). The choice and scope of the researched material are determined by the fact that the journal was established in 2007, and it is a leading open-access peer-reviewed platform, where the major tendencies within the genre of MCRs can be effectively traced and analyzed. Our particular interest in MCRs stems from the highly important role of this genre in medical communication and education. MCRs enable the rapid exchange of essential clinical data between researchers from all over the world. This ensures the advance of global science and healthcare. We selected mythological and literary eponyms in medicine, using The Latin-Ukrainian Thesaurus of Clinical Terms [36], The Latin-Ukrainian Medical Encyclopedic Dictionary [1], and Medicine, Literature and Eponyms: An Encyclopedia of Medical Eponyms Derived from Literary Characters [37]. Further, we checked the presence and prevalence of each mythological and literary eponym in JMCRs by automatic search on the journal’s website [section “Articles”—“Search articles within this journal”—“All volumes” (2007–2022)].

The selected medical case reports were considered using the methods of quantitative examination, structural, etymological, and contextual analyses. The method of quantitative examination involves counting elements in the researched material to determine numerical trends and patterns. In the context of medical case reports, this method allows for collecting data on the frequency of eponymic terminological units. The structural method aims to describe and analyze the constituent parts and properties of a word at various levels, for example, its morphology (word-building features), syntax (the rules governing the formation of phrases), and semantics (the study of the meaning of words, phrases, and sentences in language). Structural analysis is a powerful tool for understanding the underlying patterns and regularities of language and its role in human communication. Etymological analysis reveals the origins and evolution of words and language. In medical discourse, etymological analysis involves examining the history and usage of medical terminology, and using this knowledge to better understand the meaning and significance of certain terms and terminological collocations. Contextual analysis implies examining and deeper understanding of a term within its broader historical, social, and cultural setting. For eponyms, this might involve considering factors, such as the time period in which the terms were coined for the first time, the cultural or societal beliefs that may have influenced medical practices at the time, or the broader medical context in which a term was used.

To analyze eponymic concepts quantitatively, we designed an etymological typology. We identified the most common etymological sources and recorded the number of results each detected eponym was used in JMCRs. Hence, we delineated the five most prevalent sources of these terminological units: Greek mythology, Roman mythology, other world mythologies, the Bible, and fiction. For structural consideration of the material under study, we grouped the detected eponyms into three categories: (1) one-word terms, (2) two-word phrases, and (3) three-word phrases. We used this classification due to the specificity of word-building patterns in English medical terminology, in which eponyms are generally represented by these three categories [24]. Moreover, this grouping ensures clarity and structural coherence as it enabled us to compare and contrast different types of eponyms, identify any trends that emerge across the different categories, and detect structural patterns within the researched material. Further, we organized the selected material into five semantic groups and determined their frequency in JMCRs: (1) pathological conditions, (2) anatomical descriptions, (3) physiological conditions, (4) medical instruments, diagnostic tools, and doctor’s manipulations, and (5) chemical substances and medications. These five semantic groups cover virtually all spheres of the medical profession. On the one hand, this grouping facilitates students’ memorizing of eponymic terminological material in a well-structured and meaningful manner, rather than a continuous flow of information. This will be beneficial, not only for enhancing students’ terminological competence, but also for their mastering of various clinical and theoretical subjects in medicine, for example, anatomy, physiology, pathophysiology, therapy, surgery, pharmacology, and so on, hence the interdisciplinary value of this classification. On the other hand, this approach vividly reflects which spheres of medicine have been influenced by mythological and literary eponyms most and least of all, thus contributing to a deeper analysis of terminological features and tendencies in medical discourse. By grouping the selected material into these five categories, we have achieved organizational clarity and semantic coherence for analyzing the data. By breaking the material down into smaller, more manageable units, we could more easily identify key patterns within the data. Furthermore, by categorizing the selected material into five semantic groups, we were aiming to facilitate the practical application of findings in clinical or research settings. For example, we have observed that certain types of terms were more common in certain contexts or disciplines (such as pathological conditions), while others were more prevalent in others (such as anatomical descriptions). Hence, by identifying the most common types of pathological conditions or chemical substances in the eponymic material, the study can provide valuable insights for clinicians and researchers working in these areas.

We found a total of 81 mythological and literary eponyms, represented by 3995 cases of use in JMCRs issues, and traced the etymology of their onomastic components. The research revealed that modern medical case reports largely rely primarily on Greek mythology (65 eponyms, 3633 results). Table 1 presents our findings: the Greek eponym, along with the reference information about it, the number of results, and some examples of its use in JMCRs as of 2022, as well as noneponymous equivalents (if available in medical terminology), also found in JMCRs.

The group of eponyms rooted in Roman mythology ranks second, and these terms are much less prevalent in modern medical case reports (6 eponyms, 113 results). Table 2 presents eponyms from this group.

Four eponyms (88 results) stem from other world mythologies (Germanic and Egyptian). Table 3 demonstrates our findings in this group.

Two terms with onomastic components come from the Bible (15 results). Table 4 present our results.

Within the corpus of analyzed MCRs, four eponyms stem from world literature (146 results) and are presented in Table 5.

The research demonstrated that most medical eponyms in modern MCRs stem from Greek mythology. Table 6 demonstrates the etymological and quantitative distribution of terms with onomastic components in JMCRs.

Tables 7 and 8 demonstrate the etymological, thematic, and structural distribution of eponyms in JMCRs.

The research revealed that medical eponyms are most frequently used to refer to pathological conditions (41 eponyms). The majority of these eponyms are one-word terms (25), rooted in Greek mythology (arthralgia, myalgia, neuralgia, fibromyalgia, cephal(al)gia, mastalgia, arachnodactyly, coma, cyclopia, echolalia, hebephrenia, hemeralopia, hermaphroditism, iridocyclitis, iritis, lethargy, labyrinthitis, nycturia, panic, proteus, psychosis, psychotic, psychopathic, priapism, and sirenomelia), 1 eponym from the Egyptian mythology (hyperammonemia), and 1 more term from Italian literature (syphilis). There are also ten two-word phrases, four of which stem from Greek mythology (caput medusa, psycho-syndrome, psycho-affective, and neuropsychological symptoms), three more from the world literature (Munchausen syndrome, Pickwickian syndrome, and Rapunzel syndrome), and one each from Roman mythology (venereal disease), Germanic mythology (Ondine curse), and the Bible (Lazarus phenomenon). This thematic category also embraces 3 three-word phrases derived from the Greek (psycho-neuro-immunomodulatory, narcissistic personality disorder, and narcissistic personality traits) and Teutonic (elf-like face) mythologies. Our study confirmed that the terminology for pathological conditions is deeply rooted in the ancient Greek tradition [21], hence the considerable number of eponyms in this group.

The second most prevalent (12 terms) thematic group of medical eponyms is the category of anatomical descriptions. Among them, Greek eponyms also prevail: six one-word terms (arachnoid, atlas, hymen, iris, labyrinth, sphincter), two two-word phrases (Achilles tendon and arachnoid mater), two three-word phrases (atlanto-occipital joint and atlanto-axial joint). There are also two two-word phrases derived from Roman mythology (Cupid’s bow and semilunar valve).

The third most prevalent group contains 11 eponyms denoting medical instruments, diagnostic tools, and doctors’ manipulations. It embraces mostly one-word Greek terms (nine eponyms): echocardiography, echocardiogram, echo, hygiene, panacea, psychotherapy, psychiatry, psychiatric, and syringe, and one two-word Greek phrase: cardiac echo. There is also one two-word phrase, derived from Roman mythology (semilunar incision).

The thematic group of physiological phenomena embraces nine eponyms, derived from Greek mythology, including four one-word terms (chimera, psyche, somatopsychic, and psychobehavioral), three two-word phrases (cofactor klotho, klotho gene, and klotho protein), one three-word phrase (Achilles tendon reflex), as well as one two-word phrase stemming from Roman mythology (Janus kinase 2).

The group of chemical substances and medications is represented by eight one-word terms, stemming from Greek mythology (antipsychotics, atropine, ether, and morphine), Roman mythology (mercury), Egyptian mythology (ammonia), and the Bible (barbiturates), as well as one two-word phrase from Greek mythology (antipsychotic drugs).

Table 8 demonstrates the structural distribution of eponyms in JMCRs: one-word terms, two-word phrases, and three-word phrases.

The majority of one-word terms (48) account for Greek mythology. Our study demonstrated considerable word-building potential of the Greek language since this etymological source is the most productive in terms of term formation, for example, “-algia” (6 terms), “echo-” (5 terms), “psyche-” (15 terms), and so on. Two-word phrases are mostly represented by the construction “eponym + syndrome/disease/phenomenon, and so on”. Three-word phrases are not numerous, but contain important details about the terms via the additional lexemes.

Our findings contribute to the understanding of the prevalence and distribution of mythological and literary eponyms in modern medical literature. By focusing on the etymology of these eponyms in MCRs, our study provides a reference for medical professionals who may encounter and use these terms in their practice and research. The awareness of the origins of medical terms with onomastic components and their alternative terms, if available, will improve communication and understanding within the medical community. Overall, our research demonstrates that a significant number of eponyms in medicine are derived from sources beyond the medical field, indicating the cultural influence on the medical profession.

One can easily observe the paramount significance of the Greek language and cultural heritage in the contemporary English sublanguage of medicine. This is due to the rich informational and metaphorical arsenal of this ancient corpus of human knowledge. It is necessary to bear in mind that “virtually all genres of medical discourse are largely based on Latin and latinized Greek terminology” [21]. Hence, our study highlights the influence of classical Greek mythology on medical language and its importance in describing medical conditions and structures. By understanding the etymology and thematic distribution of eponyms, healthcare professionals can better appreciate the cultural and historical significance of medical language.

As for Roman mythology, the analysis of Table 2 revealed a total of six eponyms with onomastic components derived from this source, namely “Cupid’s bow,” “Janus kinase 2” (JAK2), “semilunar incision,” “semilunar valve,” “Mercury,” and “venereal disease”. In the case of eponyms rooted in other world mythologies, our analysis shows that these eponyms are relatively rare in JMCRs, with only four terms identified. However, they offer an interesting insight into the influence of mythology on medical language. For example, the term “elf-like face” is derived from early Teutonic mythology, where elves were supernatural beings of dwarfish form with magical powers, well known for their capricious interference in human affairs. Similarly, the term “Ondine curse” is based on a German myth where a water nymph takes away the autonomic functions, including breathing, from her mortal husband as punishment. Among the eponyms derived from other world mythologies, the term “ammonia” was found to have the highest number of results (66). The term is derived from the name of the Egyptian god Amun (Ammon), who was the equivalent of Zeus in the perception of ancient Greeks. Eponyms rooted in the Bible are often used to describe medical conditions or treatments that have a connection to a biblical story. Eponyms rooted in world literature are based on the features of fictional characters, and they offer an interesting insight into the cultural influence on medical language. Future studies could expand the scope of the analysis to other biomedical journals and other databases to provide a more comprehensive overview of the use of eponyms rooted in Roman and other world mythologies, as well as those rooted in modern literature.

Our research sheds light on the types of medical concepts that are most commonly expressed using eponyms. In terms of thematic distribution, medical eponyms are most frequently used to refer to pathological conditions, and anatomical descriptions constitute the second most eponymized category, followed by medical instruments, diagnostic tools, doctors’ manipulations, physiological phenomena, and chemical substances and medications. Greek mythology is the primary source of eponyms in each category. Hence, our findings demonstrate that Greek mythology is the most frequently used source of eponyms in modern medical case reports, reflecting the continued relevance of ancient Greek culture in the field of medicine.

As for the structural peculiarities, the majority of eponyms are one-word terms, followed by two-word phrases. This tendency indicates a strong word-building potential of medical terminology, which is designed to be concise and precise, and one-word eponyms are often more effective in achieving these goals than longer phrases. Hence, the use of one-word terms allows for more laconic narration, which is essential in medical writing.

As to the strategy of using either an eponym or an equivalent descriptive term (if available), most examined MCRs tend to use terms with onomastic components (see Tables 1–5). For instance, we found 65 results for “venereal disease” versus 29 results for “sexually transmitted disease,” 5 results for “caput medusae” versus 0 results for “palm tree sign,” 42 results for “Achilles tendon” versus 2 results for “calcaneal tendon,” and so on. An undeniable benefit of Greek-based eponyms is the fact that these terms are internationally used and immediately understood worldwide. Moreover, the Greek terms ensure the brevity and conciseness of terms as contrasted to lengthy descriptive terminological collocations, and this feature is of paramount importance for medical writing in general and MCRs in particular [34].

However, there are few exceptions to this tendency, as with the term “headache” (786 results in JMCRs), which obviously prevails over the eponymic “ceph(a)algia” (6 results). Similarly, “arthralgia” has 154 results, and is synonymous with “joint pain” (629 results in JMCRs), and “painful joints” (5 results). Another exception is the eponym “Ondine curse” (1 result) as opposed to “central hypoventilation syndrome (4 results). In this context, the scholars observe that “there has been some negative reaction to “Ondine’s curse” as a diagnostic term. One objection is that there are other versions of the Ondine myth in which she does not afflict her husband with a curse. A somewhat more cogent objection is that Ondine’s husband exhibited other effects of loss of autonomic function, such as disorders of his five senses and muscles, unlike patients with this syndrome” [37]. Thus, the knowledge of prevailing tendencies and existing debatable issues in the medical community is essential when using an eponym or its equivalent.

In the process of our search, we encountered 22 cases of “erroneous” medical eponyms, which required exclusion from the sampling. One reason for this exclusion was the authors’ mentioning proper names, fully coinciding in graphic form with some mythological denotations, for example, surnames, and the names of laboratories or devices. We found ten cases of an “erroneous” Biblical eponym with the name “Lazarus” (five articles) [39‐43], for example, “CDH was first described in 1679 by Lazarus Riverius” [39], “They were first described by Lazarus and Trombetta in 1978” [42], and “Lazarus and Chiang examined patients that had a bone marrow transplant later followed by a solid organ” [43]. There were four cases of “pseudo” Roman eponyms with the name “Hercules” (four articles) [44‐47], for example, “After incubation at room temperature for ten minutes, the absorbance was measured at 540 nm in a spectrophotometer (Bio-Rad Laboratories, Hercules, CA, USA)” [45], and one case for “Venus”: “We report the unusual case of a girl diagnosed with Neisseria gonorrhoeae after bathing in a heavily frequented hot pool at the edge of the crater lake Specchio di Venere (“Mirror of Venus”) on Pantelleria Island, Italy” [48]. As a result, we did not include the eponym “the Hercules complex” from Roman mythology [36] in our study. We also found one erroneous case for “Sphinx”: “Sphinx YAG:holmium laser stone fragmentation” [49]. Hence, the eponym “face of Sphinx” from Egyptian mythology [36] was also excluded. Another reason could be a misprint, which also distorted the search results, for example, in the term “venous”: “In cases such as a twin pregnancy, the gravid uterus increases intra-abdominal pressure significantly and decreases the epidural and subarachnoid space by the associated engorgement of the epidural venus plexus” [50]. We also detected several mistakes in the spelling of some eponyms, which can be confused with mythological or literary terms, for example, in “Adam’s forward bend testing”—three cases in two papers [51, 52] and “Adam’s solution”—two cases in one paper [53], which should be spelled “Adams’ forward bend testing” and “Adams’ solution,” as these medical phenomena were named after Dr. Adams, not Adam the first human from the Bible. It is our opinion that the awareness of an eponym’s etymology can effectively prevent and minimize the appearance of such errors in medical case reports.

Our study demonstrated that mythological and literary eponyms are ever-present and deeply incorporated into the modern medical discourse, which necessitates a considerable amount of encyclopedic knowledge. The adequate use of eponyms in medical case reports and understanding of their etymology are essential prerequisites for doctors’ all-round development, and successful communication of one’s clinical findings to international colleagues in research. Using these terms promotes the laconic manner, brevity, and conciseness of medical case reports, since eponyms are internationally adopted and understood. Moreover, the prevalence of mythological and literary eponyms in modern MCRs demonstrates that these terms are endowed with a powerful associative and imaginative potential—that is, they immediately express the nature of the disease, and so on, and contribute to better memorization due to their saturated metaphorical shades.

The findings contribute to our understanding of the etymology and distribution of eponyms in medical case reports and provide insights into the historical and cultural roots of medical terminology. The use of these terms contributes to better expressiveness in describing diseases and medical phenomena. At the same time, the appropriate use of eponyms requires a strong understanding of their etymology and prevailing tendencies. Medical professionals must strive to use eponyms and their equivalents in a responsible manner, recognizing the power of language in shaping medical knowledge and discourse. Therefore, we emphasize the need for medical students and practitioners to be proficient in Greek and Latin terminology to comprehend medical eponyms and better communicate with patients and colleagues. The continued relevance of ancient Greek and Latin in contemporary medical practice justifies the importance of incorporating the study of these languages in medical education.

This study highlights the need for a more interdisciplinary approach to medical education and the importance of the intersection between medicine and humanities. In particular, the results of this research will help in improving the writing proficiency among undergraduates and PhD students. Tables 1–5 present our findings in an accessible and comprehensive way, and therefore can be used in the teaching practice at a medical university for undergraduates and PhD students as part of a formal curriculum, as well as for healthcare specialists duping their continuing professional education. By providing noneponymous equivalents (if available), we not only display general tendencies in medical terminology and detect the prevalence of eponyms versus their descriptive alternatives, but also expand the terminological competence and professional vocabulary of medical students. We hope that this study will contribute to the ongoing discussion on the role of eponyms in medical writing, and encourages future research in this area. Further research is needed to explore the role of eponyms in medical communication and education.

Our study provided a comprehensive overview of the use of mythological and literary eponyms in medical case reports and highlighted their importance in modern medical discourse. The use of eponyms facilitates communication, and the transfer of medical knowledge across linguistic and cultural barriers, ultimately contributing to the global advancement of medical science. The use of eponyms promotes brevity and laconism in medical case reports, and these terms have powerful associative and imaginative potential that contributes to better memorization. Our findings confirm the significant influence of the Greek language and culture on contemporary English medical sublanguage, reflecting the rich informational and metaphorical arsenal of this ancient corpus of human knowledge.

The research emphasizes the importance of understanding the etymology and origins of medical terminology, as it can provide valuable insights into the historical and cultural context of medical practice. In this context, it is crucial for medical professionals to have adequate knowledge of these terms to facilitate effective communication and understanding of clinical findings. Therefore, it is essential to educate medical students on the most prevalent eponyms used in contemporary medicine and their origins to ensure their proper use. Medical students should not only focus on the technical aspects of their profession, but also develop a broader perspective that encompasses the humanities. We recommend that medical schools and institutions include the study of eponyms in their curricula to help medical students become familiar with these terms. This will enable them to appreciate the cultural and historical context of medicine and use eponyms appropriately, ensuring that medical knowledge is effectively communicated across linguistic and cultural barriers. We believe that incorporating the study of eponyms into medical education and continuing professional development will promote a deeper understanding of the field and contribute to the advancement of medicine. This approach will develop well-rounded healthcare professionals, who possess both professional expertise and broad background knowledge.

Overall, the integration of the humanities into medical education is crucial for the holistic development of healthcare professionals and the advancement of medical science. Future studies could explore the use of eponyms in other areas of medical literature and across different languages and cultural contexts, expanding the scope of the analysis to include other databases, to provide a more comprehensive overview of the use of medical eponyms rooted in world mythology and literature.