17/05/2025
When Jay Freireich arrived at the National Cancer Institute in 1955, he reported to Gordon Zubrod, the head of cancer treatment. Zubrod assigned him to the children's leukemia ward, on the second floor of the main hospital building in the center of campus.
Childhood leukemia was then one of the most terrifying of all cancers. It struck without warning. A child as young as one or two would come down with a fever. The fever would persist. Then came a violent headache that would not let up, followed by infections, one after another, as the child's body lost its ability to defend itself. Then came the bleeding.
"Dr. Zubrod came around once a week to see how we were doing," Freireich remembered, "and he said to me, 'Freireich, this place is like an abattoir! There's blood all over the goddamn place. We have to clean it up!' It was true. The kids bled from everywhere - through their stool, urine - that's the worst part. They paint the ceiling. They bleed from out of their ears, from their skin. There was blood on everything. The nurses would come to work in the morning in their white uniforms and go home covered in blood."
The children would bleed internally, into their livers and spleens, putting them in extraordinary pain. They would turn over in their beds and get terrible bruises. Even a nosebleed was a potentially fatal event. You'd squeeze the child's nose and put ice on it. That wouldn't work. You'd pack gauze into the child's nostrils. That wouldn't work. You'd call in an ear, nose, and throat specialist who would go in through the mouth and pack the nasal passage from behind with gauze which then had to be pulled forward into the nose. The idea was to apply pressure on the blood vessels from inside the nasal cavity. You can imagine how painful that was for the child. Plus, it rarely worked, so you'd take out the gauze and the bleeding would start all over again. The goal of the second floor was to find a cure for leukemia. But the problem was that controlling the bleeding was so difficult that most of the children were dead before anyone could figure out how to help them.
"When they came to the hospital, ninety percent of the kids would be dead in six weeks," Freireich said. "They would bleed to death. If you're bleeding in your mouth and nose, then you can't eat. You stop eating. You try to drink. You gag. You vomit. You get diarrhea from the blood in the stools. So you starve to death. Or you get an infection and then you get pneumonia, then you get fever, and then you get convulsions, and then..." He let his voice trail off.
Doctors did not last long on the leukemia floor. It was too much. "You got there at seven in the morning," one physician who worked on the second floor in those years remembers. "You left at nine at night. You had to do everything. I would come home every day, completely destroyed psychologically. I became a stamp collector. I would sit down at ten o'clock at night with my stamps, because it was the only way to take my mind off work. The parents were afraid. Nobody would even go into the children's room. They would stand at the door. Nobody wanted to work there. I had seventy kids who died on me that year. It was a nightmare."
Not for Freireich. I was never depressed. I never sat with a parent and cried about a child dying. Freireich teamed up with another researcher at NCI named Tom Frei. Together, they became convinced that the problem was a lack of platelets - the irregularly shaped cell fragments that float around in human blood. The leukemia was destroying the children's ability to make them, and without platelets their blood couldn't clot. This was a radical idea. One of Freireich's bosses at NCI - a world expert in the field of hematology named George Brecher was skeptical. But Freireich thought Brecher wasn't counting the platelets correctly when he did his analysis. Freireich was meticulous. He used a more sophisticated methodology and zeroed in on subtle changes in the platelets at really low levels, and to him the connection was clear: the lower the platelet count, the worse the bleeding. The children needed fresh platelets over and over again, in massive doses.
The NCI blood bank wouldn't give Freireich fresh blood for his transfusions. It was against regulations. Freireich pounded on the table with his fists, shouting out, "You're gonna kill people!" "You have to be careful who you say that kind of thing to," Dick Silver, who worked at NCI with Freireich, says. "Jay didn't care."
Freireich went out and recruited blood donors. The father of one of his patients was a minister, and he brought in twenty members of his congregation. Standard procedure in blood transfusions in the mid 1950s was steel needles, rubber tubes, and glass bottles. But it turned out that platelets stuck to those surfaces. So Freireich had the idea of switching to the brand-new technology of silicon needles and plastic bags. The bags were called sausages. They were enormous. "They were this big," said Vince DeVita, who was one of Freireich's medical fellows in those years.
He held his hands far apart. "And you have this kid, who is only this big." He held his hands much closer together. "It was like watering a flowerpot with a fire hose. If you don't do it right, you put the kids into heart failure. The clinical director of NCI at the time was a guy named Berlin. He saw the [sausage] and said to Jay, 'You're insane.' He told Jay he was going to fire him if he kept doing platelet transfusions."
Freireich ignored him. "Jay being Jay," DeVita went on, "he decided if he couldn't do it, he didn't want to work there anyway." The bleeding stopped.
*Emil J. Freireich*
American hematologist, oncologist, and cancer biologist.
He was a pioneer in the treatment of cancer and use of chemotherapy and is often known as the "father of modern leukemia therapy".
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