Medical eponyms and their connection with Nazi crimes

In 1977, a group of doctors began a campaign to change the name of an inflammatory arthritis after discovering it was named after a Nazi doctor who planned and performed gruesome forced human experimentation that killed thousands. In one of these experiments, for example, Hans Conrad Julius Reiter inoculated Buchenwald concentration camp inmates with the microbe causing typhus, resulting in the deaths of over 250 people. The inflammatory arthritis then known as “Reiter’s syndrome,” the group of doctors suggested, should change its name to “reactive arthritis.”

That was in 1977. In 2000, Dr. Daniel J. Wallace and Dr. Michael Weisman published a paper rekindling old requests to remove Reiter’s name from the syndrome. Shortly after, the patient advocacy group Spondylitis Association of America voted to approve the name change. In 2003, a group of rheumatology journal editors decided against continued use of the eponym in their journals. The official retraction from the doctors who originally proposed the eponym came in 2009.

Sadly, the story is still not over.

The campaign to remove Reiter’s name should not actually have been morally ambiguous. Medical eponyms are meant to honor individuals who contributed to the field. Torture and murder are not things we wish to honor. After the war, a profound ethical debate sprung from the question of what to do with discoveries that came about from forced experimentation on human beings without their consent. But the question of the medical eponym does not fall into that category. Up for debate was not whether we should keep or discard useful medical information obtained through grossly immoral means. All medical information discovered would still be known. All that was asked is that the result was not named to reward a criminal. As the physicians who wrote the retraction summarized their reasoning:

Medicine is a moral enterprise. Physicians serve to promote the welfare of their patients. Hans Reiter was a Nazi war criminal responsible for heinous atrocities that violated the precepts of humanity, ethics, and professionalism. We see no acceptable rationale to preserve any professional memory of Reiter within our medical culture, except as a symbol of what our societal values obligate us to reject.

The difficult part, it turned out, was not making the moral call but implementing it. The New York Times reported on the Reiter scandal in 2000, writing: “The precise steps needed to get rid of an eponym are unclear and vary with who uses them.” A 2005 analysis found that medical journal use of the eponym without mentioning its disfavored used dropped from 57% in 1998 to 34% in 2003. One interpretation is that these figures are encouraging; use of the eponym, after all, is decreasing. But considering that the campaign to change the name began in 1977, is a less than 50% drop over the first twenty years really such tremendous progress? Moreover, the study showed that change in the US was particularly slow, with US authors more likely to use the eponym than authors in Europe.

Since then, other medical eponyms tied to Nazi crimes have surfaced. The “Clara cell,” a type of cell lining the airways to the lungs, was named after Max Clara, an “active and outspoken Nazi” who made his discovery using tissues from murdered Third Reich victims. Then there is Friedrich Wegener of the vessel disease “Wegener’s granulomatosis”: Wegener joined the brownshirts eight months before Hitler seized power, joined the Nazi party in 1933, worked in “close proximity to the genocide machinery in Lodz,” and was wanted as a war criminal.

As a medical student in 2012, here is what I have learned. I have heard “reactive arthritis,” but I have also learned about “Reiter’s syndrome.” I have learned about the Clara cell, without any qualification of its tainted name. I have learned about Wegener’s granulomatosis: this one was given with a qualification of its tainted history, but then in group discussion, the eponym was the norm. Immediately after doctors used it, it stuck with the students.

What this shows is that even an official retraction is not enough to change terminology that is deeply engrained. First impressions set the tone. Changing language takes more than official notification. It takes proactive, universal involvement. It takes a decision, and sticking to it. It takes a community, setting an example.

So, here is my humble request to doctors: please introduce these terms without their Nazi affiliations. If a tainted term has had another one substituted, please, just use the newer term. You can mention its former name and reasons for discontinued use, so that students may still recognize it if others refer to it. But from there after, make the newer term the norm. The norms of language follow from how terms are introduced.

Hans Reiter, responsible for the torture and murder of thousands of innocent people, was able to work and enjoy life until the age of 88. His crimes against humankind can never be erased. The least we can do is erase any praise of him and others like him. Saying their actions were deeply antithetical to the values of modern medicine is an understatement.

It takes a community to shape language. For the victims, and to make a statement against human rights abuses, I hope we can make it happen.

Ilana Yurkiewicz is a medical student who blogs at Unofficial Prognosis.

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  • sandra miller

    A great post. I had no idea. I’m sure most don’t.

  • John C. Key MD

    I believe the eponyms came as a result of their discoveries, not to honor them for nefarious activities. Probably many names used in medical eponyms are attached to persons who were not paragons of virtue. A campaign to ferret these out and ban their occasional use merely seems to be political correctness gone wild.

    • http://twitter.com/ilanayurkiewicz Ilana Yurkiewicz

      Thanks for reading and for commenting. I am, however, disappointed to read an accusation of political correctness by comparing Nazi murderers to scientists who simply “were not paragons of virtue.” I believe this represents a major misunderstanding of what Nazi crimes actually entailed. I am not arguing against less than perfect individuals. I am arguing against mass torturers and murderers. Surely the line has to be drawn somewhere.

      • John C. Key MD

        But Wegener’s work preceded his years as a Nazi; we need not revise and sanitize all history. Just as we still honor Paul Robeson and Werner von Braun todayfor their achievements, despite their metachronous political connections.

        • http://twitter.com/ilanayurkiewicz Ilana Yurkiewicz

          I think it’s fair to debate Wegener. Reiter — not so much. And just to be clear, this has nothing to do with revising history. Let Reiter’s crimes be written in history books. Honoring him with a medical eponym is a very different story.

          • meyati

            I understand how you feel. While you feel this way, perhaps you should concentrate on the publishers. if the term was printed, then the term would die out. Also, Americans are far removed from the Nazis and the horrors. One of my father’s oncologists was imprisoned in Buchenwald when he was 14 years old. For some reason, somebody grabbed him and made him part of the hospital staff in Reiter’s typhus wards. The SS asked what good was a teen-ager? To save his life, the older doctor prisoners had him poison these poor typhus victims. The prisoner doctors tried to do it as early as they could to keep the poor prisoner from suffering so much. They taught him everything they knew, so he could have a life. When they were liberated, the Americans wanted to try this teen-ager as a war criminal for participating in Reiter’s experiments. Fortunately the Americans realized that he was a boy. He was able to go to Stanford where he was in the top of his class; then was an oncologist at one of Los Angeles County hospitals. I was 12 and my father’s main care taker, cooked dietary food, spoon fed him, sprinkled baby powder on the sheets to help keep from having bed sores, etc. The Dr. wanted to talk to me. On several visits, I went to his office and we talked how hard it is to care for a dying person. He told how he wiped the victims brows, tried to care for them. Then he had to give them poison shots and watched them die. He told me that by watching for my father and caring for him, I could open my heart to help others-and be a person that could understand others.
            The Nazis in aerospace should have been hung too. One woman went to a local AF aerospace museum. She began screaming-One of the honored scientists had come down and personally whipped her at Peenemunde.
            They removed his pictures and removed his name. No wonder it is difficult for us to understand the what went on. Thank you for the fight to expose these horrible crimes.

          • http://twitter.com/ilanayurkiewicz Ilana Yurkiewicz

            Thank you so much for sharing this valuable first hand perspective. It is very tragic that as time passes, people either don’t remember or don’t want to remember the extent of how unbelievable and unspeakably horrible these events were.

          • meyati

            At first, the prisoner doctors tried to save the lives of those that were injected..But Reiter executed the patients anyway and punished the prisoner medical staff. These experiments were not to find cures or causes, they were from the heart of an unbelievably cruel being. I cannot find myself capable of calling Nazis human, they were lower than any animal. My uncle’s squad helped liberate one of the many sub-concentration camps. They saw a bull dozer in a pit that still had it’s engine running. They went over and saw that male prisoners were being buried alive, layers and layers of living men. Then they heard the screams. The SS had set fire to the women’s barracks and they were being burnt alive. My uncle stopped men from shooting and chasing the SS. Some veteran soldiers broke down and just sit crying. Some kept running back and forth, and not helping anybody. My uncle was a large man, very large, and the sgt. of Native Americans. He got the panic stopped around him, and decided to save the women. GIs coming in would see the men in the pit, but not the women. He did this for 2 reasons. Women need to be protected first. Then my father and uncles were taken in by a Jewish family when they were teen-agers during the early part of the Depression. He knew that children are determined as Jews by having a Jewish mother. Did you know that the Navajo Tribe sent a declaration of War against Germany to the US Department of Defense and to Hitler’s government in the late 1930s? Many Navajos were praying in their own way for the Jews and gypsies.

  • http://www.facebook.com/profile.php?id=891415436 Trishul Tunga Reddy

    Didn’t know this. Good post.

  • boucains

    Dr. Key brings up a good point, although I don’t go as far as he did. The very first thing that crossed my mind was “political correctness”. I think Ms. Yurkiewicz’s thoughts have merit, but where does it stop and who gets to decide? In the case of Nazi war criminals the idea may be clear, but once the process starts who stops it?

    I would like to propose an alternate thought for those who teach medicine: Maybe using these names *with the full facts about how they were obtained* is a good thing. Maybe medical students will get the impact of medicine “gone wild” instead of political correctness. Every time that student uses a name or encounters the disease, they will remember that there is a limit to the professional practice of medicine that should not be crossed.

    God bless doctors – but doctors aren’t gods.

  • http://www.facebook.com/dylan.mann.777 Dylan Mann

    I’m in med school at UC San Diego. We were taught the new terms and why the eponyms were revoked. These eponyms should die out among the coming generation of docs.

  • StephenModesto

    …Thank you for your post. I agree with your perpsectrive…continue with your advocacy.