Medicine: City of Hope

As Toni frolicked in the playroom at the City of Hope, 20 miles from downtown Los Angeles, she looked like an average, happy two-year-old. Usually treated as an outpatient, she had been kept in the hospital a few days because of a cold and swelling in her lymph nodes. She was much better after a blood transfusion, and would probably be home before New Year's Day. Toni has acute leukemia, commonest of the cancers and related disorders that annually kill more U.S. children than any other group of diseases.

If she had been stricken a scant five years' earlier, Toni (a twin with a normal, healthy brother) would not have lived more than four to six months. As it is, she has been kept going since March by regular blood transfusions and a variety of drugs. Doctors can now point to youngsters with acute leukemia who are living happily and almost normally three years or more after the disease struck. A diagnosis of acute leukemia is still a sentence of death, but each discovery prolongs the reprieves that medicine can grant. Doctors hope that they may soon find a way to prolong the victims' lives indefinitely.

Hope for Middle Incomes. The City of Hope is one of the newest and most active centers for leukemia research. It began 40 years ago as a couple of tents on the edge of the desert for tuberculosis patients from nearby Los Angeles. Now a 75-acre complex of low, rambling buildings in well-landscaped grounds, the hospital community lives up to its name. The beds are reserved for TB, heart and cancer cases, but they must be those to whom medicine and surgery can still offer a prolonged and more comfortable life.

Financed mainly by a nationwide chain of clubs and labor unions, the City of Hope accepts neither the indigent nor the wealthy—only middle-income patients, who do not go to charity wards and for whom a severe, long-term illness is a financial disaster.

The City of Hope's leukemia unit comprises 32 beds, an outpatient department and scattered laboratories, where its chief, Dr. Howard Richard Bierman, and a team of a dozen assistants carry on treatment and research. New Jersey-born, St. Louis-trained Dr. Bierman is already a veteran (at 39) of investigation into blood cells, and something of a maverick among leukemia specialists.

Hope for Control? For almost a century after Berlin's Dr. Rudolf Virchow named leukemia ("white blood") and de scribed it as a proliferation of the white cells, little more was learned about it. Most researchers have tried to find out where the white cells come from, and why. Dr. Bierman thinks this is only one part of the picture, and probably not the most important, because in some forms of leukemia, it is now known, there is no excess of white cells.

Treatment, Dr. Bierman insists, must take into account not only the apparent overproduction of white cells, but the whole cycle of production, delivery, removal and destruction. White cells normally live only two to four days. But in some leukemia victims, he has found, the cells may live as long as 100 days. This, in what Bierman calls his "balance hypothesis," means principally that removal and destruction are slowing down somewhere. The phenomenon of overproduction of the white cells may often be an illusion (some normal people manufacture many more white cells than leukemics without suffering ill effects).