A few months ago, a former CMR from Sunnybrook Hospital challenged #medtwitter to identify 3 eponyms named after women without googling it first. I have to admit, I was stumped. And even with a month of searching, the examples are few and far between. So this week, instead of discussing a case, let’s chat a bit about the issue.
In medicine, we use eponyms for medical syndromes (collections of symptoms that group together, pointing to a common cause) or physical exam findings. To have an eponym in your name was considered an honour and was a way of memorializing your contribution to medicine. This practice continued until the 1970s, when a publication in the Lancet¹ proposed limiting the use of eponyms to conditions where the pathophysiology was not yet known, and then only temporarily until further discovery was made that would allow for more specific nomenclature.
So why are so few eponyms named after women?
In the late 1800s-early 1900s, particularly in Europe, women were allowed into medical school and were contributing to medical science as researchers. In the 1870s in particular, enrollment of women in colleges across Europe and the United States started exponentially rising. In this era we see the rise of researchers like Dr. Dorothy Andersen, and there were 19 women’s medical schools and 9 women’s hospitals in the US. By the end of the 1800s, 5% of the physician workforce was female. During this time period, our own Women’s Medical College here in Toronto was formed in 1883.
Even though women made incredible discoveries during this time, many of them did not end up becoming eponyms. The diseases they discovered may have been named instead after the pathology, such as in cystic fibrosis. Or, they may have been named after a male scientist who co-discovered them, as is the case of Dr. Kristine Bonnevie who published a case series of patients with 45X chromosomal abnormalities. Today, we refer to this condition as Turner syndrome after Henry Turner, or occasionally Ullrich-Turner after her lab-mate and co author Otto Ullrich. Note that somehow Bonnevie’s name was the first to be dropped.
Other women researchers, like Dr. Mary Putnam Jacobi, were not as focused on understanding the pathophysiology of diseases they saw in practice. Instead, they had to prove a bigger goal: that women were not physiologically inferior to men and therefore deserved to train to be physicians. Dr. Jacobi compiled exhaustive data including blood pressure, pulse and strength measurements from her co-residents to demonstrate that the menstrual cycle did not impact a women’s health. She published her findings in an award winning book entitled “The Question of Rest for Women during Menstruation”. Despite awarding this piece the prestigious Boylston Award, Harvard Medical School still did not accept women for another 50 years after it was published.
Even though times were tough, women persevered and continued to make waves in the fields of research and clinical medicine until the beginning of the 20th century. Until another set back changed the face of medicine for over 50 years.
What happened in the early 1900s?
In 1910, a dramatic shift in medical education occurred due to an educator named Abraham Flexner. The Flexner Report was transformative, focusing on improving standardization and rigor in medical education. As a result, many medical schools in the United States and Canada without the resources to re-create their curriculums and training environments were closed. Unsurprisingly, those focused on treatment of women and minorities were the hardest hit. By 1930 only a single women’s medical school existed in the US.
In Canada, fortunately Women’s Medical College had amalgamated with the University of Toronto just 5 years before the Flexner Report in 1906. Had this not been the case, our institution may have been shut down just like the many in the United States.
It wasn’t until 1975, the Public Health Services Act banned discrimination against women on the basis of gender! After this point, the amount of women enrolling in medical schools increased exponentially yet again. Around 1995, women reached 50% of medical school acceptances.
However despite these huge gains, we still have a long way to come.
Despite having gender parity in medical school admissions for 20 years, we still see less women in leadership and academic positions. In Japan, a university was recently caught adjusting exam scores to make sure men made up a larger portion of entrance classes. Women are given less consistent feedback and mentorship than their male colleagues. Every day I go to work humbled by the women who paved the way, and inspired to make the road a little easier for those coming after me.
If you want to be inspired, check out the NIH website Changing the Face of Medicine to read about Dr. Putnam Jacobi and many other trailblazers in medicine.
- Classification and nomenclature of morphological defects. The Lancet. March 1975 Volume 305 Page513