Part III – Blalock, Taussig and Vivian Thomas – Standing On Tall Shoulders The History of Cardiac Surgery – by Thomas N Muziani PA-C, CP

“Knowledge comes, but wisdom lingers”- Alfred Blalock, 1944

Synergy- “The interaction of elements that, when combined, produce a total effect that is greater than the sum of the individual elements”.

There are times throughout history that we can bear witness to a team or group of individuals that, due to their collective collaboration, achieve excellence. Sometimes, it has been music, sometimes science. Very rarely medicine. Hubris and vainglory thrive deep inside surgeons.

However, with Drs. Alfred Blalock, Helen B. Taussig and Vivian Thomas, something magical happened. They recognized an acute need for a corrective operation, performed copious experiments and enlightened the world at a time when the world needed a ray of hope.

Alfred Blalock grew up a true Southerner in Culloden, Georgia. He attended the University of Georgia as a sophomore undergraduate, skipping his freshman year. After he graduated from Georgia he enrolled at Johns Hopkins School of Medicine, where his record was not considered “outstanding”, graduating near the middle of the class, earning his medical degree in 1922. He was denied a surgical residency due to his average grades, so he decided to take an internship in urology.

In September 1925, Blalock decided to complete his surgical residency at Vanderbilt University. He discovered  that he thrived in the surgical research laboratory, which he found both exciting and challenging. While conducting research on surgical shock, he realized that severe loss of blood was the main culprit leading to shock. His advocacy of using blood or blood products to mitigate shock resulted in saving many lives on the battlefield during World War II.

In 1930, while working at Vanderbilt, Blalock found that his many obligations necessitated his presence away from his research lab. As a result of this, he began a search for an assistant that could work alone, complete his myriad of assignments and somehow provide the necessary data that he demanded for his publications.

Vivian Thomas was a carpenter by trade. He was hired by the university to complete odd jobs, but it became obvious very early on that he was a quick study, meticulous in detail, borderline ambidextrous and forever curious. He displayed an uncanny knack for holding surgical instruments, not an easy thing to do. Blalock was duly impressed and enjoyed his quiet nature and incessant good humor. So, he hired him as his lab assistant…although, officially his title was janitor. Mr. Thomas was African-American.

As they became comfortable with each other, Blalock provided Thomas with more and more freedom in the lab. Blalock would describe the concept and goal and Thomas would formulate how best to carry out the experiment. When Blalock would return to the lab., he was presented with all the data necessary to produce a paper. Blalock and Thomas became joined at the hip…albeit, if that hip was fused by a very Southern gentleman and his African-American worker.

Helen Brooke Taussig was a truly remarkable woman. She was born 24 May 1898 in Cambridge, Massachusetts. Her father was an economist at Harvard University and her mother was one of the first students at Radcliffe College, a women’s university. When Helen was 11 years old, her mother succumbed to tuberculosis, which Helen also contracted, severely affecting her ability to do schoolwork and eventually leading to deafness. She also had to endure the difficulties of dyslexia.

The path for women to advance during this time in history was fraught with roadblocks. Discrimination, prejudice and myopia were pervasive, from politicians, college professors to street sweepers. And they came down hard on women. Helen attended both Harvard Medical School and Boston College, studying histology, bacteriology and anatomy. But, they denied her a degree.

When she applied to Johns Hopkins University School of Medicine, she was granted a full-degree candidacy. She completed her MD degree in 1927 remaining for another year to study cardiology. After residency in cardiology she was hired by the pediatric department of Johns Hopkins, the Harriet Lane Home, as its chief, where she served from 1930 to 1963. It was here that she become engrossed in the study of anoxemia, the blue baby syndrome.

In 1951, my older brother, Dennis, contracted leukemia. The treatment of choice for leukemia at that time was for my mother to take Dennis to the City of Hope Hospital in Los Angeles once a week for a blood transfusion. The theory being that fresh blood would wash out the leukemia. However, with constant transfusions comes hepatitis…and the attending jaundice.

To this day, I can still remember my mother describing to me how adults and children treated my brother as an alien species due to his discoloration of skin. It literally rattled her to the core. My brother passed away in 1953. This is precisely how people treated blue babies. They were pariahs, mandated to be segregated away from the rest of the hospital population…in the same area as the tuberculosis wards.

Because of this “oddity” Helen Taussig gravitated to these little ones. Discrimination, by its odious nature, bears a common fruit. Helen discovered its root cause as a partial blockage of the pulmonary artery either alone or combined with a hole between the ventricles of the infant’s heart.

In 1941, Alfred Blalock was asked to return to Johns Hopkins as Chief of Surgery, Professor and Director, Department of Surgery and the School of Medicine. Upon accepting the position he made it contingent that he bring his lab assistant, Vivian Thomas along with him. Once at Hopkins, Blalock and Thomas, through extensive animal experimentation, developed a shunt technique to bypass the coarctation of the aorta…and Johns Hopkins was on the map.

During extensive discussions, first with Dr. Blalock and then with Blalock and Vivian Thomas, Dr. Taussig convinced them this anomaly, known as Tetralogy of Fallot, was repairable. The rest of the world considered invading the inner heart sacrosanct…it was fraught with peril. Blalock and Thomas knew, through their previous experiments, they could find a successful repair.

In 1944, with Vivian Thomas by his side, Dr. Blalock performed the first “blue baby” operation on Eileen Saxon, a 15-month-old baby. Once again, the operation was successful, although the baby died a few months later. However, the operation, Dr. Alfred Blalock and Johns Hopkins became royalty around the world. They were featured on the cover of Life magazine. Mothers and babies from around the world flocked to Johns Hopkins for their magical cure. The world was going through its third year of a horrible war and everyone needed something to smile about.

Only one person was relegated back bleacher status and conveniently forgotten. Vivian Thomas. Throughout history there has always been a caste system. We can always find someone or something to demean, even if you are a shining star.

In one giant swing with a huge scalpel, Alfred Blalock, Helen Taussig and Vivian Thomas catapulted cardiac surgery into the world’s imagination. It became the top of the pyramid for surgeons and institutions everywhere. Cardiac surgery achieved movie star status and we never looked back.

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Perfusion Theory is an educational platform for the Oxygen Pressure Field Theory (OPFT). August Krogh’s theoretical concept of the oxygen pressure field is explained and then applied to clinical applications in perfusion practice.