That the basic aspects of medicine—its chemistry, immunology, and genetics—should be becoming ever more complex is not difficult to understand. But that even relatively simple clinical decisions should have become matters for controversy is at first blush surprising. This has happened in the management of idiopathic thrombocytopenic purpura (ITP). Why it has happened, what are the controversial points, and how they can be resolved —these are the subjects of the present discussion.
When in 1916 Kaznelson1 of Prague, cognizant of the rather dramatic effects of splenectomy in some cases of hemolytic anemia as described by Banti and Micheli in 1913-1915, suggested that the operation might be beneficial in Werlhof's disease, it was fortunate that in the first cases the operation was successful; in others, the results were far from encouraging. Nevertheless, news of this new mode of therapy for a previously intractable and at times serious disease spread rapidly,