EPONYM ETHICS: NAMING INHUMANE MEDICINE

As one of the most studied, popularly represented, and morally contemptuous regimes in modern times, to publicly adopt any aspect of Nazi or fascist language in contemporary society would quickly draw widespread revulsion and reprehension. Yet, the legacies of Nazi experimentation and medicinal breakthroughs found in the nomenclature of science and medicine still produce uncomfortable spectres of inhuman barbarism in a field based upon ethics and human good. Set this within a period where COVID-19 has renewed public attention to the centrality of medicine and science; and in the UK where the toppling of slave trader Edward Colston’s statue in Bristol, June 2020, still generates political discord, becoming conscious of and confronting these legacies has become increasingly salient.

Whilst hardly renowned names of the Nazi state, two medicinal eponyms allow a perspective into the utility and consequences of names as commemoration: Asperger’s Syndrome, a type of autism increasingly defined as Autism Spectrum Disorder (ASD); and Wegener’s Granulomatosis, a type of the rare but chronic autoimmune disease Vasculitis, now named Granulomatosis with Polyangiitis (GPA). However, despite their alternate names, often the eponym coexists or remains in use despite their fascist origins. Whilst initially explained by their novelty, such eponyms prove extremely resilient: from the ambiguities or recent discovery of biographical information, or proponents of medical eponyms (much like statues and building names) pointing to them preserving the past, and thus language, as it happened.

Friedrich Wegener, for example, despite membership of the Sturmabteilungs (SA) paramilitary group offers no definitive proof of his participation in unethical experimentation - only his proximity to the Lodz Ghetto, Poland, and implication in expected knowledge of human research on Holocaust victims there. Meanwhile, Hans Asperger’s name was only given to ASD in the 1980s, taking until 2018 to evidence him sending disabled children to be experimented on and ultimately euthanised in the Austrian ‘Aktion T4’ programme. Neither of these men were ever brought to trial for their actions and lived comfortable post-war lives.

Such biographies of terror and inhumanity, and as vestiges of the most morally base and contemptible acts to have been carried out in human history - never mind the last century - using eponyms are still present in the landscape of medicinal language. Especially so in the linguistic technicalities of science, eponymic terminology not only provides a mnemonic for the layperson and scientist alike to memorise these diseases, but to distinguish them. Remembering Wegener’s as a decontextualised term is more suited to memory and conversation, especially as an already rare disease, than granulomatosis with polyangiitis. Meanwhile, the specificity of the Asperger’s eponym relates its signs and diagnostics away from the range of behavioural and neurological conditions of general ASD, which quotidian discussion may be averse to distinguish. Sometimes occluding history in language can simply be efficient.

Further to these issues are the placement of these histories in a scientific context of medicine, which prides itself on ethics and studies to save and improve human life. Understanding the inhuman actions of these doctors can expose uncomfortable contradictions in a discipline predicated on its humanity - particularly in the epistemology of these scientific breakthroughs achieved via inherently abhorrent means, facilitating the ends of contemporary medicinal diagnostics or treatment predicated on improved patient quality of life. By continuing to conceptualise diseases after these individuals as commemoration or reward both recognizes their immoral means to achieve discovery whilst presenting a dissonance between the proposed morality of medicine in the present to past doctors who explicitly disregarded those considerations. It can also threaten to obfuscate the timeline of scientific knowledge and collective efforts to realise such developments, reducing medicinal advancement to the acclaim of one person and diminishing the historical precedent and palimpsest of knowledge many people formulated in their own contributions.

Lastly, and often neglected in considerations of eponymic diseases, are how the patients of these diseases have to confront the history and names of their illness. Especially upon diagnosis of ASD or GPA, utilising the eponym or even having to come across popular knowledge of it (especially the case for Asperger’s), can be a conflicting experience. Aside from having to face the realities of their malady, from being diagnosed the eponym can require an engagement, association, or even acceptance of that name and thus past actions patients have no agency over. Whilst arguments may be raised about the distinction of naming diseases from actual commemoration, or the use of terminology mainly by doctors or specialists as a trivial usage, patients often have no choice but to traverse or re-engage with these awful histories in communicating their medical experiences. Continuing eponym use threatens to undermine this tact regarding present patients, whilst continuing remembrance and commemoration of evil doctors instead of the horrific experiences of their past victims.

Unlike Colston, these eponyms cannot be pulled down overnight. However, language and names traverse similar issues to scandals surrounding memorial commemoration: of remembrance good and bad, cultural and social significance, and specious accusations of “rewriting history”. Yet it is not revisionist, overly sensitive, sanitised, or even ahistorical to contest and confront these names and people, but itself becomes a part of the historical process of memory, empathy, and the diachronic progression of language and ethical human history. Avoiding this change and confrontation with uncomfortable histories threatens to mould both language and history into monoliths. Rejecting inhumane eponyms to respect victims becomes history in and of itself.