Abstract
Leucosis was first described by Hughes Bennett of Edinburgh in
1845. He described the enlarged spleen and called attention to the large
number of leucocytes in the blood. He named the condition leukocythaemia.
In the same year Virchow described this disease and called it leukaemia.
He differentiated between a splenic leukaemia in which the principle
pathological change was in the spleen and a lymphatic leukaemia in which
the lymph glands were primarily involved. In 1857 Von Friedrich described
the first case of acute leucosis. In 1891 Ehrlich published his work
on differential stains for granular and non- granular leucocytes
and made it possible to separate cases where the cells are mainly granular
or myeloid from cases where the cells are chiefly non -granular or
lymphocytes. Further progress has been made since then and the differentiation
is more accurate so that we are now able to recognize what is known as
monocytic leucosis.
Knowledge of leucosis in children and infants is of relatively
recent origin. According to Adler, from the discovery of leucosis in
1545 until 1914 only seventeen cases in infants were reported and of these
ten have been accepted. Ramsay in 1927 published an analysis of one hundred
cases of leucosis in children, ninety one from the literature and nine from
hospital records in Glasgow. Two years later Warren presented a review
of the literature on acute leucosis. His conclusions were based on one
hundred and thirteen cases on which autopsied had been performed, eighty five
from the literature and twenty eight new cases. Of these one hundred and
thirteen cases twenty seven were under the age of ten years. Since that time
the literature has been increasing steadily but in the British periodicals there have been few contributions to the subject. Gittens analysis
of fourteen cases was published in 1933. All of these cases were studied
carefully both clinically and haematologically and had autopsies performed.
They form a noteworthy contribution. He remarks on the surprisingly
few papers that have been written on leucosis, in children. As recently
as 1940 Piney in his article which included two cases of myeloblastic
leucosis in children states that acute leucosis is so protean a disease
and possibly so common a one that every case should be recorded in order
to enable proper clinical pictures to be put together.
The purpose of this paper is to present the findings of cases of
leucosis observed in the Edinburgh Royal Hospital for Sick Children during
the past twenty years. This hospital cared for practically all children
requiring hospitalisation in the city of Edinburgh and district. The
population of this area is approximately half to three quarters of a million
people. Of the thirty cases included twenty had autopsies performed.
The clinical records were in varying degree of completeness. Some cases
died so rapidly that full investigations were not possible. The post mortem
examinations were all performed by the pathology department and the majority
by the same pathologist.
In addition to the above thirty cases there were seven more which
were indexed as leucosis. Two of these records were missing. The other
five cases, including two cases with post mortem, were inconclusive either
due to the difficult clinical and pathological picture or due to insufficient
clinical and haematological investigations.
