The declining use of the Hallervorden-Spatz eponym.

Despite efforts to the contrary, the use of eponyms remains widespread in medical practice and research. Eponyms appear to collectively function as a form of medical shorthand in communication that also serves to highlight and concretely recall a temporally far removed historical context. The actual assignation of eponyms occurs somewhat haphazardly and typically reflects the explicit recognition of a primacy of discovery and description to those deemed worthy of ‘‘eponymic glory.’’ Thus eponyms do serve as a mechanism or form of honoring medical pioneers who through astute clinical observation or scientific pursuit enabled a recognition of a particular disease entity or clinical phenomena or furthering an understanding of pathogenesis. Hallervorden-Spatz disease is but one example of a longexistent eponym within pediatric neurology. Julius Hallervorden and Hugo Spatz were indeed the first to describe a familial neurodegenerative condition characterized pathologically by progressive iron deposition in the basal ganglia. Coincidentally, these 2 individuals were also ‘‘giants’’ of neuropathology in its descriptive heyday. Their meticulous histopathologic observations, combined with thorough clinical correlation, fostered considerable progress in disease classification and pathogenesis in the first half of the 20th century. However, both of these pillars of the ivory tower of continental academic neuroscience were complicit in some of the most egregious atrocities committed by medicine in the Third Reich. While we typically consider these atrocities to be restricted to horrific experiments conducted in the charnel houses that were the concentration camps, in actuality medical abuses were more pervasively and systematically distributed in mainstream medicine. These included targeted extermination programs directed at disabled German children and chronically ill institutionalized German adults. These ‘‘euthanasia’’ programs were precursors and proving grounds for the Holocaust to come in occupied Europe. These targeted extermination programs were on occasion utilized by academic neuroscientists such as Hallervorden and Spatz to procure rare pathologic specimens that were then used to further their own research agendas. The article by Zeidman and Pandey in this issue of the Journal of Child Neurology systematically and objectively documents the effects of awareness by the neurologic community of the above roles of Hallervorden and Spatz during the Third Reich. Specifically, the authors have documented the frequency of the ‘‘unqualified’’ use of the Hallervorden-Spatz eponym in journal publications and relevant textbooks. ‘‘Unqualified’’ use refers to using the Hallervorden-Spatz disease eponym instead of an alternative nomenclature or if the eponym is used in the absence of any mention of Hallervorden’s or Spatz’s role in the atrocities of the Third Reich. The first widely distributed detailed account of their wartime activities was made directly available to the neurologic community in 1992. Reaction was immediate and subsequent letters to the editor in the publishing journal voiced a desire to remove the eponym from general use. Similar pleas occurred with future advances in the genetic understanding of the disorder—first with its chromosomal localization and subsequently with the actual identification of the pantothenate kinase gene defect. Similar pleas for eponymic reconsideration were voiced in editorials in such authoritative journals at the New England Journal of Medicine and Lancet. Zeidman and Pandey document a statistically significant decline in the unqualified use of the eponym. Indeed its use has declined by half between the intervals of 1990-1999 and 2000-2010. A similar trend was also apparent in the few textbooks they reviewed. What is intriguing about this trend is that it speaks of an unconscious collective decision by the neurologic community to ‘‘do the right thing.’’ After all, there is no central body regulating the use of eponyms. Any changes in designation or use thus must reflect a naturally occurring, emerging, and broadly based consensus. The declining trend in unqualified use of the Hallervorden-Spatz eponym documented by Zeidman and Pandey is in effect a reflection of a decision by a neurologic ‘‘court’’ of opinion. This court has weighed the evidence before it without explicitly doing so and has rendered a judgement that Hallervorden’s and Spatz’s later actions effectively negate the honor of their original discovery of a novel disease and its