The urge to memorialize is robust in medicine, particularly so on the surgical side of the house. It defies changing times and fashions. The desire to be remembered may be the instinct that drives surgeons to work harder and longer than their peers in society. Medical memorialization, the desire of society to remember a physician, on the other hand, is a mystery. It appears to be random and often inaccurate. It is quietly revered, but must not be sought.
On Apr. 23, 2015, exactly 100 years after the Second Battle of Ypres, John McCrae will be inducted into the Canadian Medical Hall of Fame. His name had been put forward on 2 previous occasions to fill the single slot reserved each year for posthumous induction. Among this year’s other inductees, who are happily still alive, is Dr. Bernard Langer. Dr. Langer, former head of surgery at the University of Toronto, is being recognized for contributions to medical education, research and patient safety.1 John McCrae, revered for his poem “In Flanders Fields,” was probably elected this time because his wartime service was placed in the context of the advanced state of his medical practice at the time of his enlistment. McCrae’s medical publications demonstrate his pioneering role in Canadian infectious disease medicine and anatomic pathology.2 He would have been remembered as a founder had he not died during the war. For John McCrae, this honour will add little to his fame. Schools and prizes have already been named for him. The Government of Canada designated him to be a “person of national historic significance” 70 years ago. Electing John McCrae to the Canadian Medical Hall of Fame is our way of reclaiming the soldier–poet for medicine. The goal of this article is to honour these physicians and to consider the role of memorialization in medicine.
The origin of memorialization can be traced from prehistorical oral sagas through the statuary of classical times to the monuments of the Victorian era. Memorialization was reserved for the ruling elite; its ultimate expression was a place in the pantheon. The hall of fame is today’s pantheon, and access to it has been democratized.
In the 19th century, advances in bacteriology resulted in the naming of many previously unknown organisms after their discoverer. This process, similar to explorers’ naming new-found landmarks, suggests that discoverers retain naming rights. This is not true in medicine. Unlike geography, claiming a name for a medical discovery or invention or bestowing it in honour of a third party, such as a sponsor or a member of a royal family, is not accepted. Universities may trade naming rights for donations, but the practice has more to do with the sponsorship of sports arenas than medicine. Neither of these forms constitute medical memorialization.
Eponyms, often considered a prized form of memorialization, may be applied for convenience of recall and communication. This is especially true of clinical signs — a cluster of observations that leads a clinician to an instantaneous diagnosis and the eternal faith of a patient. Many eponyms are inaccurate. For example, even though Thomas Cullen credited Joseph Ransohoff with the description of periumbilical staining, we remember it as Cullen’s sign.3 Eponyms applied to surgical procedures are even more inaccurate. Novel operations are built upon previous practice. Allen Whipple neither described, nor was the first to perform, the operation we call Whipple’s procedure. In spite of these inaccuracies, there are no protests, no campaigns to right these wrongs. This is because eponyms are derived from those who popularized the item rather than those who discovered or invented it. They are applied only if they facilitate communication. This explains why partial pancreatico-duodenectomy is called Whipple’s procedure but liver transplantation is not called Starzl’s procedure. Use of eponyms is therefore not an act of memorialization.
Memorialization is an inherent part of surgical education where we not only teach a procedure or an aspect of knowledge, but also how it was developed. In research it is the appropriate referencing of prior knowledge. These are preferred forms of memorialization today because they acknowledge the deed rather than remember the person. The statues, busts and portraits of medical pioneers have been removed from our hospitals. But there is a role for acknowledging the individual. There are some signs that portraiture is coming back into fashion, and 3-dimensional printing may make sculpture more popular.
The target audience of the Canadian Medical Hall of Fame is the whole of society, especially the young, because the real purpose of memorialization is to inspire. Dr. Langer’s induction will inspire students to choose a career in surgery and emulate his achievements. Dr. McCrae’s induction will remind physicians of their obligation to serve their country and the global community.
Footnotes
Competing interests: None declared.