Who really discovered aplastic anemia?

Andrea Bacigalupo has recently published very useful guidelines for the treatment of severe aplastic anemia. As in the most recent and authoritative monograph on this condition, «the empty bone marrow and its devastating consequences for the patient have rightly fascinated hematologists for a century». The term itself is somewhat of a misnomer since the disease consists of a hypo-aplastic pancytopenia rather than a monophyletic marrow failure such as pure red cell aplasia (PRCA). Paul Ehrlich is often credited with the first desciption of aplastic anemia, but I believe that we should now accept the idea of a stepwise historical identification of the disease. In 1888 Ehrlich, then a young physician, described the case of a young woman with extremely severe and ultimately fatal pancytopenia, in whom an autopsy performed by Dr. Israel disclosed a yellow femoral marrow, in contrast with the reddish appearance that one was used to seeing in most anemias. The anemia was considered pernicious, since that term was originally employed to describe fatal evolution. Probably at my instigation, Young and Alter credit Chauffard with introducing the term aplastic; however, Chauffard’s patient had hepatosplenomegaly, with a spleen 14 cm in diameter, and the author himself utilizes the term aplastic as a quotation from a former paper, a masterful publication by Vaquez. The patient died after a progressive loss of red cells from 0.85310 /L (on the day of admittance) to 0.3310/L. Histologic examination revealed that the bone marrow was fatty throughout, with a few lymphocytes. The marrow was «as stricken by sterility» (frappée de stérilité). The term aplastic was utilized to define this condition. Thus one can reasonably state that Paul Ehrlich described perhaps the first case of this condition, and that Vaquez and Aubertin were the first to analyze it in depth and confer on it the name which we still use today.