Paul Kaznelson, Immune Thrombocytopenic Purpura, and Splenectomy: The Tragic Story of a Medical Prodigy.

In 1916 Paul Kaznelson (1892-1959), a 26-year-old medical student at German University in Prague, was the first to describe splenectomy for what would be recognized today as immune thrombocytopenic purpura (ITP). From his physical examination, microscopy of a blood smear, and what was then known about the life cycle of platelets, he concluded that his patient's bleeding diathesis and enlarged spleen were linked: she had no platelets because they were being destroyed by the organ. He convinced the chief of surgery to remove the patient's spleen, a landmark operation that succeeded beyond "the wildest expectations". He stayed on faculty, but his promising academic career was derailed by virulent antisemitism, first in his own university medical school, then his home country. Forced into exile in 1939 he found refuge in the United Kingdom, which allowed him to practice medicine but denied him formal residency. At war's end he found himself unwanted in the West by his Russian heritage and citizenship in an Iron Curtain country. Czechoslovakia's newly installed communist regime barred his repatriation due to the ambiguous circumstances of his wartime residency in England. Today treatment of ITP is directed toward controlling autoimmune reaction against platelet antigens. Splenectomy is done only after nonsurgical options have been exhausted. The operation and its history are a fading coda to the story of a medical prodigy whose career was crushed by prejudice and world events.