Why are Heberden and Bouchard’s nodes named after 2 different people?

(In osteoarthritis, enlarged DIP joints (knuckles closest to the end of your fingers) are called “Heberden’s nodes” and enlarged PIP joints (knuckles you use to knock on doors) are called “Bouchard’s nodes”.  And yes, I really am going to complain about it.)

Medicine is moving away from most eponyms, since they’re generally undeserved and were also inevitably given to some sketchy doctors who didn’t deserve to be immortalized (case in point: Wegener’s granulomatosis.  He was, it turns out, a nazi.

So that led to a 50-year-long awkward moment in medicine.  A moment which has only been extended by trying to rename the disease “granulomatosis with polyangiitis”).

To be fair, some people will try to tell you that, actually, medicine is moving away from eponyms because they’re “so difficult to memorize” – a viewpoint that’s, at best, pretty damned optimistic.  (Fun game:  Go find a physician, resident, or M4 and ask if they think organic chemistry was helpful.  Then, after they finish laughing, ask them if they’d be in favor of dropping it as a pre-med requirement.

… Yeah.  Spoiler alert: they’re not for it.  Neither am I. “Medical education” is practically synonymous with “Sure, some of it’s inefficient, but if my generation had to do it anyway, so do you.”   People who say that “medicine eats its young” aren’t kidding.)

Heberden’s and Bouchard’s nodes seem even sillier than most other eponyms.  Getting credit for seeing some weird manifestation of a disease, I understand.  Getting credit for some weird “you can only see this part of the anatomy if you cut a person open and squint at them sideways” piece of organ anatomy, I understand.

But getting credit for the fancy notion that sometimes when your knuckles are inflamed, they’re enlarged?  That’s ridiculous.  You may as well call a sore throat “Heberden’s throat”.  In either case, regardless of how fancy the pathogenesis is, I’m pretty sure people already knew the symptom was directly related to the disease.

So I looked it up.  Heberden was a fancy London physician from a good family, who wrote a chapter on arthritis in the medical book that was most in vogue at the time.  So they gave him the DIP-joint-is-inflamed eponym.  Okay, fine.

But nearly one hundred years later, the PIP -joint-is-inflamed symptom was – it appears – randomly assigned “Bouchard” as an eponym.  Bouchard was a French pathologist who studied under Charcot and doubtless did a lot of interesting things, but none of them seem to be related to arthritis.  I guess medicine felt like he was such a stand-up guy he deserved an orphan eponym?

If that’s a legitimate action to take when confronted with an awesome pathologist and an unnamed disease, Wegener’s Granulomatosis should just be renamed Goljan’s Granulomatosis.  TWO BIRDS. ONE STONE.

Goljan is a champion arm-wrestler. Hand over the eponym and no one gets hurt.

Bouchard’s nodes are less common than Heberden’s nodes, so maybe we should give Heberden a pass on not noticing that the swelling sometimes happened on the PIP joints. But I’m honestly not convinced that Heberden didn’t notice the “Bouchard’s nodes”.

You know what I think?  I think he was just like, “meh, it’s exactly the same thing in a location just centimeters away, no need to write about these nodes like they’re any different.  It’s not like they’re going to give it someone else’s name.”

Well, the joke’s on you, Heberden.

Joke’s on you.

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