What Stopped the Bleeding?

Short weeks before, the skinny, crew-cut teen-ager seemed beyond medical help. Fred Wallace was literally bleeding to death. And the doctors at Baylor University Medical Center seemed powerless to help. They gave heroic round-the-clock care, a record number of transfusions (932 pints of blood and plasma), and still Fred's life dripped steadily away. Then, suddenly, he got better. As he hobbled out of the hospital on his crutches last week and headed for his home in Muskogee, Okla., a team of dedicated physicians and surgeons was still wondering how an ordinary case of hemophilia had degenerated into a medical nightmare; the doctors were also trying to decide just which one of their desperate efforts had actually saved their patient.

Purple Danger. Fred Wallace had been a bleeder since birth. The absence of AHG (antihemophilic globulin) from his blood taught him early to live with danger. Every childhood spill, every bloody nose, was agonizingly slow to heal. The scrapes and scuff marks of a growing boy remained for weeks as ugly, purple discolorations under the skin. But Fred, like most hemophiliacs, survived all such crises. Then the disease caused other problems. Last spring, on a Sunday outing, Fred and his father had walked away from their parked car so that Fred might snap a picture. Inexplicably, the car started rolling downhill toward the boy. His father lunged to shove him clear. Fred was unharmed, but his father was killed. A few months later Fred was in Baylor Hospital with much more routine trouble: bleeding inside his knees. The familiar hemophilic difficulty had caused the joints to swell and stiffen; surgeons had to cut them open to clean them out. Transfusions helped Fred to recover, and, just as it does with most bleeders, the temporary supply of AHG in the transfused blood did the necessary clotting.

By fall, though, the surgical wounds had broken open and become infected. Still brooding about his father's death, Fred went back to the hospital, where his condition steadily deteriorated. After consulting with Hematologist Joseph M. Hill, Baylor surgeons decided to fight the infection with antibiotics and to reopen Fred's leg wounds to clean them out. Dr. Hill, who is also director of the Wadley Research Institute and Blood Bank in Dallas, promised to supply all the necessary blood and plasma for transfusion. It was no easy promise to fulfill. Fred got progressively sicker. The blood bank drained its supplies, sometimes at the rate of 22 pints a day. "As we began to use up our reserves," says Dr. Hill, "we had to turn to other sources. We bor rowed blood, we bought it, finally we made a public plea for donors." Volunteers turned up by the score. Prison inmates from Texas and Oklahoma bled freely for the sick boy. So did G.I.'s from nearby military camps. Home in Muskogee, the high school student council raised $5,000; with churches, civic clubs, even a barnstorming pro basketball team pitching in. And still Fred's condition deteriorated.

Death Wish. Dr. Hill and the Baylor doctors tried everything they could think of. Researchers at Wadley had read of Swedish work with a concentration of AHG known as the Blomback Fraction.

They studied the report again and prepared their own fraction--125 cc. from eight pints of blood. Fred got 35 such doses, but at first even those seemed futile. "The boy kept bleeding and bleeding," said one of his doctors. Remembering how close Fred had been to his father, the doctor decided that his patient might actually be harboring a death wish. "Bleeding can be tied in with the emotions," says the doctor. And how else to explain why someone who understood his condition as well as Fred did would spend his time in the hospital picking at his nose until he had dug a hole all the way through his septum?

A psychiatrist was called in, and Fred was even put under hypnosis. But eventually he went into convulsions. "We worked all night," one of the doctors remembers. "We gave him transfusions one right after another. So many transfusions washed out the body's calcium balance, and we gave him injections of calcium. We gave him standard treatment for shock all night." Suddenly Fred started to recover. And as consciousness returned, his first words were: "If Dad had been here, this wouldn't have happened." At home, Fred now gets two units of plasma a day. But as he continues to improve, that dose will be lowered. The doctors at Baylor plan to keep close watch over him, but now they are much more concerned with trying to figure out what saved him--the massive transfu sions, the great quantities of Blomback Fraction, or the brief dose of psychiatry. Whatever the vital treatment was, says Dr. Hill, "the first and most important thing we learned in this case is that no hemophilia is ever hopeless."

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