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eponyms: Unique Female and Male Eponyms Over TimeFigureFigureFigureA tweet in the FOAMed community asked the audience to identify just three female medical pioneers who had been honored with the distinction of eponymous attribution. The results were telling. The thread of comments following the tweet managed to identify only 45 female eponyms. A mistake, surely. Of the thousands of eponymous terms in use, how could there be so few attributed to women? (June 24, 2020; https://bit.ly/3prMB4d.) Following this, we analyzed the list of eponyms hosted on the website WhoNamedIt? Their list of female eponyms boasts 131 entries, but only 80 (62%) were associated with women, and only 41 of these (31%) had a formal biography. Further research revealed a similar story. Even women associated with widely used eponymous terms had little to no recorded biographical information compared with their male counterparts. Lilly Dubowitz, for example, a pediatric neurologist who developed the Dubowitz score with her husband Victor, is deserving only of a property-based tagline, “Victor Dubowitz's wife.” It seemed an obvious hypothesis requiring investigation: Women are underrepresented in the realm of medical eponyms. Once that could be proven, a biographical database of these female pioneers would be the next goal. Testing the Hypothesis The use of eponyms in medicine has been commonplace for centuries. There is ongoing debate regarding the accuracy, effectiveness, and cultural appropriateness of these eponyms, but they remain ingrained in medical communication. The majority of eponymous terms were characterized before women were formally allowed to practice medicine. By the time they did, the period of granting eponyms had already begun to decline in favor of descriptive nomenclature. Most eponyms now have an approved and accepted modern alternative, but many clinicians still use and teach eponymous terms. They remain historically relevant, so it is important to identify and celebrate the distinguished women who characterized syndromes and other terms that bear their names the way we do their male peers. We identified 7221 eponymous terms and 3504 eponyms, an average of two terms per author, from signs, syndromes, conditions, procedures, anatomical structures, and classification systems from textbooks and online sources, including PubMed, the National Library of Medicine, HathiTrust Digital Library, Wikipedia, WhoNamedIt?, newspapers, Ancestry, and the Internet Archive. Where no biographic source could be identified, we contacted universities, research groups, and specialists. Graphical analysis was used to compare male and female eponyms over time. Results A total of 3504 eponyms were identified, 3374 (96%) male and 130 (4%) female. The 130 female eponyms shared 156 eponymous terms, an average of 1.2 terms per author. The average number of eponymous terms per male author was 2.2 (7065 shared by 3374). The average date of publication of an eponym's first eponymous term was 1972 for women and 1891 for men. Among female eponyms, 32 percent are still alive compared with five percent of male eponyms. Of those deceased, the average years of birth (1907) and death (1982) for women are more recent than those for their male counterparts, which are 1856 and 1919, respectively. Only 43 percent of female eponyms had a formal journal obituary, Wikipedia profile, or other online biography compared with 91 percent of men. Female eponyms hail from 27 different countries, but are very Americocentric, with the United States (50%), England (9%), Germany (8%), and Canada (6%) making up the majority. Male eponyms, on the other hand, were mostly European, with Germany making up 19 percent, France 16 percent, England 15 percent, and the United States 10 percent, almost certainly reflecting the power shifts among empires over time. The specialties are also unique, with female eponyms comprising geneticists, pediatricians, and pathologists. Men had a preponderance of anatomists, surgeons, neurologists, psychiatrists, physicians, and physiologists. Another relevant finding was the comparison of women in the global workforce with the rise and fall of eponyms over time. The peak of eponymous attribution was in the late 1800s and early 1900s, with eponymous terms often being used as placeholders when the exact nature of conditions was not yet understood. Eponymous attribution has seen a sharp decline with better classification systems, enhanced knowledge of pathogenesis, improved global nomenclature, and a more rigorous approach to naming systems. Female physicians made up one percent of the medical workforce in 1910. The most rapid rate of growth was seen in the past 30 years from 29 percent in 1990 to 38 percent in 2000 and 49 percent in 2020. The percentage of female physician representation within the medical workforce closely matches the rate of percentage growth of eponymous terms attributed to women. Female Representation The hypothesis that women are underrepresented in the medical realm of eponyms does not hold up, despite how it appears at first glance. The development of women achieving parity with men in the global medical workforce is relatively recent. The golden age of eponymizing was over way before this equality was reached. The peak of eponymous attribution was in the late 1800s and early 1900s, so there was reasonable representation in proportion to the number of women in medicine at the time. But women never got the chance to catch up. Where there is a staggering gender mismatch is in the biographical evidence available to us of these remarkable women, who, by their very nature, were trailblazers. Why should we care about this anachronistic slice of medicine? Well, we all still use eponyms. They bring color and history to medicine. They have hidden and often extraordinary narratives that lie underneath them: our heritage, our medical ancestry. Eponyms are given to honor such souls, the shoulders of giants upon which we practice today. We know their stories through their collective biographies. The clear proportional lack of biographical data on female eponyms, however, tarnishes this tradition. - Eponymous Representation Men Women Eponymous term per eponym 2.2 1.2 Still alive 5% (180) 32% (42) Average year of birth 1856 1907 Average year of death 1919 1982 Average year of publication 1891 1972 Journal article/obituary 59% (1976) 22% (28) WhoNamedIt profile 92% (3102) 32% (41) Wikipedia profile 90% (3020) 43% (56) One may argue that this is merely a historical issue, but we still do not have gender equity by many metrics today, even in the presence of equal (or greater) medical admission numbers. Unless we recognize the inadequacies of the past, it is difficult to progress soundly into the future. Eponyms have other shadows. The bestowal and use of eponyms were also a little random, inconsistent, idiosyncratic, and heavily influenced by local geography and culture. Sometimes there were less than truthful accounts of how diseases were discovered, evidence being less obligatory back in the day. There is also the element of ownership, particularly of body parts. Nowhere is that more evident than in the pelvis, where you can't round a corner without crashing into a body part with the name of some long-dead man and his flag planted on it. Eponyms are unlikely to be granted in any number again, so gender parity will not likely ever be reached in relation to terminology. We can, however, right a few wrongs by establishing a biographical database of the pioneering women whose names are branded on the terms that we still use in medicine today, so that they are celebrated and known in their own right, regardless of their matrimonial status. Where are all the women in the history of medical eponymization? They are present; their numbers are simply dwarfed. We can be generous and state that the reasons for the small absolute numbers merely reflect missing the boat. We might hope to see equality in the data if eponymizing were to continue today, but in the absence of this possibility, we can at least recognize the ones whose names we use, not as somebody's wife or with an epithet that is the biographical equivalent of a pauper's grave, but in their own right. This article was originally published in the blog Life in the Fast Lane (https://litfl.com), created by Mike Cadogan, FACEM, FFSEM, and Chris Nickson, FCICM, FACEM, and is reprinted with permission. Find an unabridged version with references and additional tables athttp://bit.ly/3pukuBp. Clockwise from top left:Dr. Stuart-Smithis an emergency physician at Sir Charles Gairdner Hospital in Perth, Australia, whereDr. Scott, a British emergency physician, also works. Dr. Johnstonis an emergency physician at a trauma center in Perth, Western Australia. She is the author of the novel Dustfall, available on her website, http://michellejohnston.com.au/. Follow her on Twitter@Eleytherius, and read her past columns athttp://bit.ly/EMN-WhatLiesBeneath. They all contribute regularly to the blog, Life in the Fast Lane, https://lifeinthefastlane.com.

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