The Eisenmenger Syndrome: I

Abstract

Eponymous titles are no longer in fashion, because they frequently lend themselves to controversy over historical precedence, invite criticism on the grounds of descriptive inaccuracy, and can usually be replaced with advantage by a scientific name which simultaneously identifies, defines, and classifies the disease in question.The term "Eisenmenger's syndrome," as used in these lectures, therefore requires some explanation, especially since the Editor of the British Heart Journal stated recently that it has " outlived [its] usefulness and should no longer be used in clinical medicine" (Brotmacher and Campbell, 1958).An eponymous title may be justified, however, when it has been introduced by someone singularly entitled to do so (Abbott and Dawson, 1924), when it has become familiar by customary use on an international scale over a period of 34 years, when the aetiology and precise mechanism of the syndrome are still controver- sial, and when there is no convenient alternative title likely to stand the test of time.Nothing is gained by changing customary nomenclature prematurely.To dispense with the term altogether, and to regard the Eisenmenger complex simply as a variety of ventricular septal defect, is to deny the very essence of the syn- drome, for, as will become clear later, its distinguishing feature lies not in the anatomy of the defect, but in the behaviour of the pulmonary circulation.It may help at this early stage to state precisely what Eisenmenger described.Dr. Victor Eisenmenger published his paper on "congenital defects of the ventricular septum " in 1897.He described in detail a typical example of the condi- tion that has since become known as Eisenmenger's complex.His patient was a powerfully built man of 32 who gave a history of cyanosis and moderate breath- lessness since infancy.The cyanosis increased consider- ably on effort.He managed well enough, however, and was able to lead an active life until January, 1894, when dyspnoea increased and oedema set in.Seven months later (August) he was admitted to hospital in a state of heart failure.Examination revealed marked cyanosis, clubbing of the fingers and toes, thickening of the distal joints, and *The Croonian Lectures delivered before the Royal College of Physicians of London on May 13, 1958.