Down('s) syndrome

Another quick post as I desperately try to meet deadlines...

In September Virtual Linguist wrote about 'How Down's syndrome got its name' (from Dr John Langdon Down, as it happens). I responded in her comments, saying that I'd been taught that the "correct" name is Down syndrome. It turns out that this is a BrE-AmE difference that I hadn't known about. As VL replied:
In the book 'Dr John Langdon Down and Normansfield' by O Conor Ward MD, Professor Emeritus of Paediatrics at University College, Dublin [...], there is this sentence: 'From 1992 the alternative term Down syndrome was adopted in the United States'.
Actually, the date should be 1974, according to several sources, including the site Down Syndrome: Health Issues by Len Leshin, MD:
Many medical conditions and diseases have been named after a person; this type of name is called an eponym. There has been a long-standing debate in the scientific community over whether or not to add the possessive form to the names of eponyms. For quite a long time, there was no established rule as to which to use, but general usage decided which form is acceptable. So you saw both possessive and non-possessive names in use.

In 1974, a conference at the US National Institute of Health attempted to make a standard set of rules regarding the naming of diseases and conditions. This report, printed in the journal Lancet, stated: "The possessive form of an eponym should be discontinued, since the author neither had nor owned the disorder."(Lancet 1974, i:798) Since that time, the name has traditionally been called "Down syndrome" in North America (note that "syndrome" isn't capitalized). However, the change has taken longer to occur in Great Britain and other parts of Europe, for reasons that aren't quite clear to me.

One can see the adoption of Down syndrome in progress by looking at bibliographies on the topic, like this one, in which Down syndrome starts to appear in 1983. The term used in the names of conferences sponsored by National Down Syndrome Congress (US) shift from Down's to Down in 1978. (The NDSC was founded in 1973 under a different name, but their online history doesn't include the original name.)

Interestingly, though, the 'not using 's in medical eponyms' rule doesn't seem to have had as much of an impact for other conditions. Almost no one says Crohn disease and I don't recall ever hearing Alzheimer disease (although it's more frequent on the web than Crohn disease).

The "American version" of the term does appear occasionally in the UK. For example, the Portsmouth Down's Syndrome Trust morphed into Down Syndrome Educational Trust in 1997 (and changed its name to Down Syndrome Education International in 2008). But in the main, UK organi{s/z}ations use Down's. While the American medical establishment and people involved with the syndrome tend to use Down, Down's is certainly used a lot by American laypeople too.


  1. A similar difference that immediately springs to mind is that in BrE we talk about "Jane Austen's House", but in AmE it's "The Paul Revere House", and road signs and so on perpetuate this difference in writing.

  2. I suspect whether or not the possessive is used is related to whether it's a "Syndrome" (which has the initial s) or something else. It's pretty hard to hear that 's, at least in American speech. I have seen both Asperger and Asperger's Syndrome also.

    But Hodgkin's Lymphoma is another case where the possessive is always used, even in AmE, as far as I know.

  3. My little sister has Down's Syndrome, and I've always seen it written in the possessive form here. Maybe I've just always changed it to the possessive in my head though. I don't know.

    (Arizona, US)

  4. The Wkipedia list of eponymical diseases is interesting. There's a lot of variation regarding the possessive, and some "X's syndrome" to refute cathy's theory.

    There's even "non-Hodgkin's lymphoma", discovered by Dr. non-Hodgkin.

    The word "disease" is often dropped from names like "Parkinson's" and "Alzheimer's".

  5. It's interesting that the reason given for dropping the possessive is because "the author neither had nor owned the disorder." This means that it is still correct to refer to "Lou Gehrig's Disease", since the late Mr. Gehrig did suffer from it.

  6. I agree with cathy that it's most likely a phonological issue -- the voiced segment at the end of Down causes the 's morpheme to be voiced, and the dissimilation between that [z] and the following [s] results in deletion of the [z]. In Hodgkin's Lymphoma the sequence is [nzl] which is all voiced, so the [z] remains.

    Also it's silly that CNIH thinks that the 's morpheme can only refer to having or possessing, but they're medical doctors, not linguists, so I'll cut them some slack...

  7. "Interestingly, though, the 'not using 's in medical eponyms' rule doesn't seem to have had as much of an impact for other conditions."

    Indeed. I'm less familiar with AmE terms for conditions, but I'm struggling to think of a (relatively) common condition named after its diagnoser which doesn't use the possessive in BrE: Asperger's, Weil's disease, Parkinson's.

    It seems like a spurious objection to me. Tony Blair "neither owned nor had" the UK government, but we still call it Blair's government.

  8. I can see the reason for wanting to standardise but it seems pretty foolish to me not to choose the most common popular use of the term for the standard. Most laypeople won't be aware that the medical profession have made this decision (I certainly wasn't) so they'll go on saying what they've always said, leading to the situation of confusion we have today.

  9. My older brother had Down('s) syndrome, so I've followed this issue of spelling, as well as public debates on terms like "Mongoloid" and "retarded" and on what advocacy organizations should call themselves.

    There seems to be an acute linguistic sensitivity in this area. Each new generation of respectable terms and euphemisms is eventually deemed rude. Of course, some people use them rudely, but that produces a never-ending search for new language.

    The debate over whether to spell Down('s) syndrome with a possessive (as folks have noted, it makes no difference in the pronunciation) seems to be part of that pattern.

  10. It is Down Syndrome in Aus.

  11. In AmE you often see the term "Down's child" (usually only in headlines because it isn't the most sensitive way of putting it -- you wouldn't say "arthritis woman" or "alopecia man"). I've never read "Down child".

  12. Having had relatives with Alzheimer's, I've more and more heard it called simply "Alzheimer" (no "disease", no apostrophe-s) in discussions among those in (US) organizations promoting research about it, support for those whose relatives have it, and so forth.

  13. I thought "Down's Syndrome" was the personality quirk that keeps all those hill walkers traipsing around the Sussex countryside.

    Sorry, I couldn't resist injecting a bit of levity into this rather heavy subject. Obviously, it's "Down's" syndrome where I come from (upstate NY).

  14. "Alzheimer patient" sounds normal to me. And "Down's child", though this is not sensitive. I say (and think, as it sounds the same) Down Syndrome.

    There is a billboard I've passed recently trying to do away with "the 'R' word" as it puts it. By which I think they must mean "retarded". This seems to be a new campaign. The billboard has gone up in the last month. (Does Britain have billboards?) For some reason, there's a little voice in the back of my head that says "petarted". I wonder if this is from some SNL skit or something from back in the late 80s when I was in highschool.

  15. J.L. Bell said...
    There seems to be an acute linguistic sensitivity in this area. Each new generation of respectable terms and euphemisms is eventually deemed rude. Of course, some people use them rudely, but that produces a never-ending search for new language.

    I thought of this when watching the current BBC dramatisation of "Little Dorrit", in which Fanny Dorrit says of her admirer "He's an idiot". What she actually says in the book is "He is almost an idiot", implying that he is so slow-witted that he can almost be regarded as handicapped. Since we now use "idiot" as a mild insult, when it used to be a technical term, the modern version loses that sense.

    Kate Bunting

  16. There is actually a rule of English when it comes to medical conditions named after a person.

    If the condition is named after a doctor or researcher, it's possessive. So Down's syndrome, Asperger's syndrome, Bright's disease, Paget's fracture, etc.

    If the condition is named after a patient, then it's just the name without a possessive. So Christmas disease, Lou Gehrig disease, etc. Naming a condition after a patient is very uncommon; generally the patient is either the first person in which the disease was recognised, or else a famous person associated with it.

    There is also no possessive if the condition is named after a place: Lyme disease, Lassa fever, Bornholm pleurodynia, etc.

    The rule is generally ignored nowadays, but you can still find mention of it in some medical reference books.

  17. Robbie's rules (above) need the slight modification that when a syndrome is named after two or more doctors - the first in print to describe the characteristics defining the disorder - there is no possessive: examples include Wiskott-Aldrich, Charcot-Marie-Tooth disorders.

    Some 19-20th century doctors were so prolific with descriptive case studies that they have several syndromes or conditions/disorders named after them. More recently, it's difficult to give credit to only one or two people for identifying a new syndrome (a cluster of symptoms arising from a single change in development), because of the technical and multi-disciplinary nature of medical research.

    Hence there is now a move to give descriptive names or initials as a kind of mnemonic to recall the important components of a syndrome, and to 'clean up' any historical errors and misattributions from the old system.

    Down('s) syndrome is commonly caused by an extra copy of chromosome 21 - but not always - so we can't call it 'trisomy 21': we still need the name since the symptoms are similar, with various degrees of intensity, in all with the condition.

    I think that the early-described conditions, which must be more common and more easily recognised than the more recent discoveries, will retain their eponyms, and because of their familiarity the general public will continue to use the possessive.

  18. Just thought of Kawasaki Disease or Kawasaki Syndrome, that is named after the doctor but does not seem to be in the possessive.

  19. It's interesting to see how a group of parents of children with Down('s) syndrome refer to it on a BBC forum, here:
    Some Americans say Down's, an Essex resident is adamant it's Down, and several others have Downs, without the apostrophe.

  20. Interface said...
    It is Down Syndrome in Aus.

    ...which is true enough, but indicates that Interface may be younger than I am. When I was young it was "Down's Syndrome", which was still in the final stages of supplanting "mongolism" in the lay language. It seems to me that the move (promoted by those intimately concerned with the disease) from "Down's" to "Down" took place in the 1970s or 1980s. I believe the justification was that one about "he didn't have the disease himself".

  21. I think the American Association of Medical Transcriptionists prescribe omitting the genitive('s) in medical reporting. The fact that the speech they transcribe almost always includes the genitive must make it confusing.

  22. You can get conflict on this even within one institution - compare for example this and this. Indeed on that second one there's disagreement within the one page. This may not just be an Am/Br thing but maybe some other factor such as older vs younger, medic vs statistician ... difficult to tell.


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AmE = American English
BrE = British English
OED = Oxford English Dictionary (online)