HISTORY.—Our knowledge of this affection dates from the description of two cases by Craigie and Bennett in the October number of the Edinburgh Medical Journal for 1845. The altered state of the blood was thought to be due to the presence of pus—a suppuration of the blood. In the November number of Froriep's Notizen for 1845, Virchow described a case in which the proportion between the red and white corpuscles seemed reversed, and the blood had in consequence a grayish-white appearance. He attributed the condition to an increase in the colorless corpuscles. A case of Rokitansky's is referred to in this article. In 1846, Fuller described a case before the Medico-Chirurgical Society of London, in which the increase in the colorless corpuscles was noted during life and after death.
In the August and September numbers of Medicinische Zeitung des Vereins für Heilkunde (1846) Virchow reviewed these four cases, and insisted upon the fact that the colorless cells in the blood were not pus, and vindicated a place in pathology for the white blood-corpuscle. In the January number (1847) of the same journal he gives further cases of white blood which he had collected in the literature—cases of Bichat (1801), Velpeau (1827), Caventon (1828), Andral (1839), Barth (1834),98 and several others—and discussed the conditions under which the colorless elements might increase and the relation of the spleen to the white cells. In the same year (1847), in the first volume of his Archiv, Virchow proposed the name leukæmia. Vogel in 1849 diagnosed a case during life.99
98 Donne (Cours de Microscope, 1844), who examined Barth's case, seems to have been the first to recognize that the colorless cells were blood- and not pus-corpuscles. See note by Gowers in Lancet, i., 1878.
99 Virchow's Archiv, Bd. iii.
Bennett in 1851 collected additional cases, and gave the name of leucocythemia to the disease, and in 1852 published a monograph entitled Leucocythemia; or, White-celled Blood, in Relation to the Physiology and Pathology of the Lymph-gland System. He claimed priority in the discovery of the condition, and for several years a lively paper war raged between the Edinburgh and the Berlin professors.
At this distance of time and place we can, now that the clouds of controversy have blown away, see the truth. Bennett certainly described cases before Virchow, but only in a manner similar to that in which Bichat, Velpeau, and others had previously done, and he distinctly stated his belief that the grayish-white color of the blood was due to pus. Virchow from the first grasped the idea that the altered state of the blood was due to an increase in the colorless cells, and he first suggested the relation between their increase and the condition of the spleen and lymph-glands, and he first gave a satisfactory name to the disease; so that, while acknowledging the great and valuable services of Bennett, we must, perforce, recognize the greater merit of Virchow, and recognize his priority in the scientific description of the disease and in giving to it a suitable name. The further investigations of Virchow enabled a splenic and a lymphatic form to be recognized, and many years later Neumann100 described the myelogenous variety.
100 Archiv der Heilkunde, Bd. xi.
FORMS OF THE DISEASE.—According as the pathological changes are located in the spleen, lymph-glands, or marrow we speak of splenic, lymphatic, and medullary or myelogenous forms; but it is very exceptional for pure unmixed varieties to occur. More commonly, the spleen and marrow, or these with the lymph-glands, are involved. The disease may begin and make great progress in one of these regions, or be confined to it for months, before appearing elsewhere. The spleen is most often affected, and with it the marrow. According to many recent writers, the myelogenous form is the most general, and certainly the marrow is rarely found unchanged. The unmixed lymphatic variety is not of frequent occurrence. An intestinal form, characterized by swelling of the solitary and agminated lymph-glands and the general adenoid tissue of the bowel, has been described by Behier.101 In a few instances the tonsillar and pharyngeal lymph-elements have been early, perhaps primarily affected, and Kaposi has recently recorded a case102 under the name lymphoderma perniciosa, in which the lymphatic elements of the skin were first involved.
101 L'Union médicale, 1869.
102 Wiener Med. Jahrbücher, 1885.