Sixty years of haematology.

T he diamond anniversary of the Journal of Clinical Pathology (JCP) provides the opportunity to reflect of the past 60 years of haematology. It offers the chance to look back as well as forwards. This has been a time of unforeseeable advances, of which I remember only those of the past 40 years. Review of the articles published by the journal in its first decade immediately makes evident the changes that have occurred in haematology as a science and as a clinical discipline. In the late 1940s haematology was still largely a laboratory discipline. The first editor of JCP was, in fact, a haematologist, Dr Gordon Signy. In 1943, the Association of Clinical Pathologists invited him to produce a bi-annual bulletin but he soon transformed this into JCP, which he then edited with great distinction for more than 25 years. A third of the articles published in the journal in the first decade dealt with haematology. Blood cell counting, coagulation, and blood transfusion were all well represented. In the first decade, no less than five articles were published on Rhesus (now Rh) blood grouping, one of which dealt with Chown’s capillary tube method, still remembered by older haematologists forced to do out of hours laboratory work in their younger days. These were also the days of the enumeration of red cells and white cells in counting chambers, of the estimation of haemoglobin concentration by colour comparison, and of the assay of vitamin B12 assay using cultures of Euglena gracilis. Haematologists with vision were groping towards an understanding of blood coagulation with fibrinogen, prothrombin, and ‘‘tissue thromboplastin’’ having been discovered. This was a time of simple and practical technical innovations including a ‘‘blood pipette shaking machine’’, a ‘‘mechanical aid in making blood films’’, a ‘‘multiple manual register for differential leucocyte counts’’, and the rather frightening ‘‘instrument for combined sternal biopsy and aspiration’’ (fig 1). 2 Publications of this era have some attractive features. I like the hand drawn diagrams and drawings of blood and bone marrow cells (figs 2, 3) 4 and even more I liked the admirable honesty. Three authors in 1950 wrote ‘‘the sternal puncture proved to be misleading, mainly on account of the authors’ ignorance of the similar cases previously recorded’’. I would rather like to see modern authors admit their fallibility in an equally straightforward manner. This was also the time of research that would now not receive ethical committee approval—for example, that involving the transfusion of red blood cells from patients with haemolytic anaemia or polycythaemia vera into volunteers, either other patients or healthy subjects. The first decade of the journal gives little impression of the haematologist as a clinician. One of the rare clinical articles, published in 1950, dealt with a two syringe technique for exchange blood transfusion. Also striking because of its absence is any mention of leukaemia or lymphoma. These diseases might almost not have existed. The past 60 years have seen both technical progress and remarkable scientific advances in the discipline of haematology. The laboratory tests preoccupying our forefathers have become much more automated and standardised, more accurate and more precise, more speedily performed, and more clinically useful. Scientific progress has been seen particularly in our understanding of the nature of both inherited and acquired disorders of the blood and blood forming organs. The Figure 1 A combined sternal biopsy and aspiration needle, as described by Dr BA Thompson in 1952; left, outer needle and trephine with stylet in situ; right, both needles dismounted showing component parts. Figure 2 A hand drawn diagram showing a comparison of two techniques for the coagulation time as published by Dr C Merskey in 1950. Two haemophiliacs had their coagulation times measured every second day. Four readings for the Dale and Laidlaw method fell in or near the normal range, but repetition of three of them (circles) all fell outside the normal range. The broken lines illustrate the normal range of each test. EDITORIAL 789