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On Nov. 29, 1944, Vivien Thomas assisted Dr. Alfred Blalock in performing heart surgery on an infant girl.

Because I want to focus on the work Thomas and Blalock did with heart defects, I have omitted the incredibly beautiful part of the story in which they discover what causes the body to go into shock and how to treat it. It is told at several of the sites linked at the end, including perhaps most usefully the last site, which is the story as it ought to be told. I can do only so much.

Supporting documents given at the end. Just go with me here, hmm? I will try to make the wait worth it.

OK, open-heart surgery. Kind of a big deal now, no? Lose a lung, you can survive. Lose part of your colon, you get a colostomy bag. Lose your spleen, you can survive.

You get one heart, and if it's a ticking time bomb, start saying your goodbyes in case you don't get a transplant.

In 1944, heart transplants did not exist outside of science fiction, if even there. In 1944, there were no bypass surgeries, no artificial hearts, no ... anything.

In 1944, if your heart was damaged, that was it.

Until Vivien Thomas and Drs. Alfred Blalock and Helen Taussig. Taussig, a pediatric cardiologist, was studying and trying to fix congenital heart defects. Very long story made somewhat shorter (really, Taussig deserves her own diary, so forgive me for focusing on Thomas here), she came up with the concept of what to do:

Operate on the human heart.

Which nobody was doing.

Which the medical community discouraged.

So Vivien Thomas spent two years working on dog hearts, making and fixing two of the four problems in the Tetralogy of Fallot in dog hearts.

Only two of four. But the solutions worked. And Blalock, himself a firm believer in the advancement of science through experimentation, realized that the alternative to trying a surgery for the first time and having the patient possibly die on the operating table was to have the child go on living with a fatal heart defect and very certainly dying.

Twenty-five percent within a year of birth. Seventy percent within 10 years. And in the mean time, they were ticking time bombs. They sat there getting sicker.

Really. Just sat. Because if you're not getting enough oxygen, you're not playing tag too much. Not walking too much. You're having enough trouble sitting up straight because your organs aren't getting enough oxygen, and forget about your spinal muscles. Developing those is a luxury.

But for one very sick girl, oxygen was a luxury.



Eileen Saxon, a weak infant girl (sources have her age ranging from 11 to 19 months), is wheeled into the operating room. Waiting for her are Blalock and Thomas.

Blalock has assisted on one similar heart surgery.

On a dog.

He had planned to get several instructional sessions from Thomas before attempting to do this on his own, but there is no time for little Eileen.

There is no time because this blue baby is ... not blue.

She is purple.



Thomas has operated on 200 dogs, but no humans.

Nothing this small. Nine pounds. She is like a little ... purple ... doll.

Nothing like this.

Nothing with at least one of the heart defects she has.

And while Blalock knows Thomas knows every step of what had to be done, there is the minor issue of Thomas going through the steps in the right order, including to repair one heart defect for the first time ever, while standing on a crate and not being allowed to physically assist Blalock.

For posterity, the entire operation is being filmed. The camera is pointed at the operating table.



Oh.

One more thing.

Blalock is using surgical instruments Thomas had designed himself based on his work with dogs.

The needles for stitching the girl's heart up are half an inch long.

Custom ordered.

Or ... have they, as one writer attested, actually been fashioned on the fly? Deliberately broken laboratory equipment fashioned into something Thomas and Blalock hoped would work?

Whatever they were, they would have to do. They would have to do for something nobody had ever done, and ...



No pressure. Just the difference between life and death.

Between a new era of surgery and the continued practice of the medical community to leave the heart alone.

Between fixing a defect that killed 70 percent of children before age 10 and ...

well

not.



The surgery gave the girl three more months of life before she needed a second surgery.

Days after that, she died.

But the groundwork was laid. Inasmuch as they had done the surgery correctly, they performed it on another patient, who lived.

And then another, who lived.

Six months after the first surgery, a paper based on the three cases was published.

The news went national and then international. Blalock and Taussig were famous. People traveled from far and wide to have the surgery performed on their children.

80 percent of the first 70 pediatric heart surgery patients lived. 200 were performed in the first year of the operation.

RAY HEIMBECKER M.D. OC, University of Western Ontario: The Blue Baby operation put Johns Hopkins on the map. We had people coming in from all over North America. Every day there would be license plates from Tennessee, from Quebec, from Alaska. People bringing their sickly children to us for help.

NARRATOR: Not every child could be saved. Eileen Saxon, the first Blue Baby, died from complications within a year after her operation. The new surgery, still experimental, was used only on children with no other hope for survival. Cookie Belkov was now four years old, her condition much worse.

SYLVIA BELKOV: Cookie had 4 spells in one day. I called my doctor. He says we're not putting it off. I'm calling Johns Hopkins. Next thing I knew, he says, pack up, you're getting on a train. You and Cookie.

NARRATOR: Cookie was rushed to Hopkins, her condition so serious that Blalock cancelled a trip to Europe to operate immediately. Her operation lasted two hours, but it would be nine hours before Sylvia Belkov knew the results.

SYLVIA BELKOV: I did not see Dr. Blalock until they brought her into her room. And he says, you want to see your daughter, go ahead. She looked like a little rosebud. She was beautiful when they brought her down, just beautiful. I'll tell you the color pink is prettier than the color blue.

NARRATOR: Cookie Belkov was one of the early success stories. Today, she lives in San Francisco.

The Hopkins Heart room had captured world attention. Michelle Rannou flew from Paris clutching her life-sized doll. One mother hitchhiked with her two year old from Appalachia. American GIs stationed in Germany, raised over $2000 to send a 5 year old from Frankfurt. Under the intense spotlight of the O.R., Blalock and Thomas perfected their procedure. During the first year alone, the team performed over 200 operations.

The procedure was named after the doctors who had developed it: Blalock and Taussig.

Thomas, who had been working tirelessly as Blalock's assistant for 14 years, was not included in the celebration.

He had helped develop the technique.

He had developed the instruments used.

He had guided Blalock through the procedure.

But ... technically, he was a lab janitor. He was paid as one despite the level of work he was doing.

Why?

Because Vivien Thomas not only did not have a medical degree, he did not even have a college degree.

He was doing work on the level of a cutting-edge heart surgeon, but he was a college dropout. And he was paid like one.



In 1929, Vivien Thomas was 19 and an aspiring medical student.

In 1929, Vivien Thomas was 19 and a former aspiring medical student now looking for work because his savings had been wiped out when the bank storing the money had collapsed.

In 1930, Blalock hired Thomas as his lab assistant. Together they changed the medical community's knowledge and understanding of blood pressure and traumatic shock.

In 1940, Blalock went to work at Johns Hopkins University. Thomas went with him. That was all there was to it. To have one was to have the other. Nothing else made sense -- separate Blalock and Thomas? Why? They fed off each other. Blalock had the daring and natural ability to match Thomas' meticulous scientific approach.

Thomas would do more than just be the one person to direct Blalock in performing life-saving heart surgeries on children.

He would also train surgical residents.

You may have heard of Dr. Denton Cooley, who is to heart surgery what heart surgery is to heart surgery. (That's not an editing mistake. See the links at the end.)

You probably have not heard of Dr. Levi Watkins Jr. He was the first black chief cardiac surgery resident at Hopkins.

And so it was that Watkins, Hopkins' first black chief cardiac resident, worked with Thomas, Hopkins' first black surgical technician.



While he was busily helping Blalock save lives, two great problems vexed Thomas.

He wanted to be a doctor, and he wanted to be paid enough to support his family.

Not long after the surgery to repair the Tetralogy of Fallot took off and he was advising in surgeries nearly two days out of three, Thomas got a raise. As one account puts it:

[Thomas] was careful but firm when he approached Blalock on the issue. "I told Dr. Blalock ... that for the type of work I was doing, I felt I should be ... put on the pay scale of a technician, which I was pretty sure was higher than janitor pay."

Blalock promised to investigate. After that, "nothing more was ever said about the matter," Thomas recalled. When several paydays later Thomas and his coworker received salary increases, neither knew whether he had been reclassified or just been given more money because Blalock demanded it.

He grew to be the highest-paid black man at Hopkins.

His other wish would not be fulfilled so easily. The historical record seems incomplete on this point, but the story is that Thomas tried to enroll at Morgan State University, but they would not credit him for life experience.

He would have to enter as a freshman. Imagine being his biology teacher.

Teacher: "And in 1944, the first surgery was performed by Dr. Walter Blalock, who --"
Thomas: "Alfred Blalock."
Teacher: "Excuse me?"
Thomas: "Alfred Blalock. Friend of mine."
Teacher: "Very funny. But you're right, his name is Alfred Blalock."
Thomas: "Wasn't joking. We work together."
Teacher: "Oh, is that right?"
Thomas: "It is right. I guided him through the first blue baby surgery at Hopkins in November 1944. He used instruments I designed. He wouldn't start the surgery without me there behind him, standing on a crate and guiding him through it step by step."
Teacher: " ... then what in the bloody blue baby hell are you doing in an intro biology class?"
Thomas: "School wouldn't credit me for time served."
Teacher: "That's the dumbest thing I've heard since a flat earther took my class."

More than 20 years after Thomas had given up on going back to school, he was teaching surgery at Hopkins. He had been teaching surgery at Hopkins for years. And in 1968, some of those surgical students, having become surgical chiefs at various hospitals in the U.S., decided that anyone who entered the building named after the doctor who first corrected the Tetralogy of Fallot should see Blalock's portrait and Thomas' portrait.

Together, just as in surgery.

But this was not enough.

Several years later, Johns Hopkins University had Thomas change his name to better reflect his life experience.

And so on a spring day in 1976, at the university he had worked at for 36 years, saving and changing lives daily, the man who was born Vivien Theodore Thomas changed his name.

He became

Dr. Vivien Theodore Thomas.





Pictures of Dr. Thomas, plus a story similar to the one you read here.
A great source for more information and personal enrichment.
The Vivien Thomas Fund.
Performthe surgery (no pressure).
Dr. Levi Watkins
A picture of a young Dr. Thomas and a story similar to the one you read here.
A medical accounting of the surgery and the day's events.
Page 1 of Dr. Blalock's notes from the surgery, and page 2 of same.
More pictures, more story.
Sometimes you can't get enough pictures and stories.
This is where I got that giant blockquote of tear-inducing doom.
Dr. Denton Cooley.
The best story about Thomas by someone who was not there.

Originally posted to iampunha on Thu Jun 23, 2011 at 06:39 AM PDT.

Also republished by History for Kossacks and Community Spotlight.

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Comment Preferences

  •  Tips for (32+ / 0-)

    one of the best people we've ever had as a doctor and one of the best minds we've ever had as a human.

    Vivien Thomas could have been a lot of things.

    He ended up being a lifesaver.

    "Homeless veteran" should be an oxymoron.
    "Please know that I accept you and yours with no need for explanation of [any] kind." -Translator

    by iampunha on Thu Jun 23, 2011 at 06:06:21 AM PDT

  •  Wow (5+ / 0-)

    What a great story.  Thanks for this.

    Over the past 30-odd years, the Democrats have moved to the right, and the Republicans have moved into a mental hospital. --Bill Maher

    by Youffraita on Thu Jun 23, 2011 at 07:07:19 AM PDT

  •  Slight correction, and question (and thanks) (8+ / 0-)

    This is a great story, and there was a terrific HBO film about it called "Something the Lord Made" with Mos Def playing Dr. Thomas -- a performance that made me completely admire the talent of this former rapper.

    My question is why more people don't credit Dr. Daniel Hale Williams as a cardiac surgery pioneer -- a doctor who is said to have performed the first successful cardiac surgery in the US in which the patient didn't die, and who also happened to be African American?  I suppose it's because Dr. Williams operated only on the pericardium.

    Thanks for the diary.

    •  News to me. (8+ / 0-)

      Dr. Vivien Thomas didn't touch a human patient's heart for ages. Wasn't qualified to. He oversaw many hundreds, if not thousands, of surgeries, though, in addition to the follow-up work for the surgeries. And he was Dr. Blalock's supervisor, in effect.

      Dr. Williams operated on the cellular matter around the heart, as you indicate. I would guess that part of the reason for the discrepancy of coverage is that less is known about Williams, who was operating in the late 19th century as opposed to the 1940s for Thomas -- who still was obscure outside of Hopkins until the late 1970s.

      The movie you mention is embedded in the diary. I started watching it this morning -- really good subtle hints at the time period. It seems the sort of thing where the viewer is invited to mournfully remember where we were, be glad of where we are and look to where we will be on civil rights.

      "Homeless veteran" should be an oxymoron.
      "Please know that I accept you and yours with no need for explanation of [any] kind." -Translator

      by iampunha on Thu Jun 23, 2011 at 07:42:49 AM PDT

      [ Parent ]

  •  Lovely story! Reminds me of one close to my (5+ / 0-)

    childhood home at Lamont Geological. Gusta Wolin was a janitor who would stop by one of the oceanographers and ask questions at night. Bit by bit Gusta started helping out and collecting data, and ended up as a full collaborator - all without a high school diploma!

    Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

    by Wee Mama on Thu Jun 23, 2011 at 10:12:12 AM PDT

  •  This was great (4+ / 0-)
    Recommended by:
    worldlotus, ybruti, Matt Z, trashablanca

    Indirectly (because it was many years later) those men saved my nephew's life.

    He was born with a hole in his heart. He had surgery to fix it when he was about 18 mos old.

    Today he's a senior at Rutgers, a budding entrepreneur, and a marathon runner.

    Now I know who to thank.

  •  iampunha, thank you for this! Dr. V. Thomas (3+ / 0-)
    Recommended by:
    ybruti, Matt Z, trashablanca

    has always been one of my (& my son's) heroes.

    In an aside, my mother lost her first & only biological child
    when he was about age 3.  She watched him bleed from his eyes, nose-every oriface-as he died.  From a hole in his heart...so easily repairable today...but not in the 1930s...

    It is truly amazing to realize the advances in cardiac surgery-just in my own lifetime-can be traced back to this team.

  •  I really enjoyed reading this, and the link at the (3+ / 0-)
    Recommended by:
    ybruti, Matt Z, trashablanca

    end was indeed excellent.  Thank you for doing the research to educate us to these "lost" heroes.

  •  Thank you for this diary on one of the world's... (2+ / 0-)
    Recommended by:
    Matt Z, SoCalSal

    ...most interesting and powerful scientific stories.

    Many of us knew this case, but I am pleased that you have reminded us of it.

    Michael Faraday began his career in a similar fashion, although Faraday was recognized much more quickly by his peers and students.

  •  I'm particularly indebted to Thomas and Blalock (1+ / 0-)
    Recommended by:
    trashablanca

    because my daughter was born with a congenital heart defect and had successful corrective surgery at age 2, in 1970.

    •  That is about as young (0+ / 0-)

      as it could be done, no?

      The more medically inclined of the sources I read for this diary indicated that part of the trouble with treating Eileen Saxon is that her vascular system was just not very well developed. Arteries etc. were not very thick, so the system was generally compromised, so to speak, and that was the case for most very young patients.

      The practice once this was understood (I don't have a year on this) was to perform a sort of compromise surgery in the mean time and then do the full-on job once the heart could take it. At one point, the age at which they would do the surgery was 3 years old.

      I don't know if any advances have allowed that age to be pushed up -- I know fetal heart surgery has been an option (though generally not ideal) for some years, but that might be a different situation, so to speak.

      "Homeless veteran" should be an oxymoron.
      "Please know that I accept you and yours with no need for explanation of [any] kind." -Translator

      by iampunha on Fri Jun 24, 2011 at 12:22:48 AM PDT

      [ Parent ]

      •  Two years was the age (0+ / 0-)

        that was deemed safe 40 years ago, where we lived. Specialists said that surgery was not desirable at an earlier age, and doctors didn't suggest a compromise surgery.

        My daughter was in better shape than some of the babies having surgery back then. She was smaller than average but verbal and active (active until she suddenly needed another nap in the day). Some of the babies having surgery had more severe heart problems, were much smaller, lethargic, and lagged developmentally. Seeing them in hospital about broke my heart and made me realize that I could have had more worries about my own child. But all of them had recently passed their second birthdays. I don't recall that any had previous heart surgeries, but that doesn't mean that some compromise surgeries weren't done.

        •  Surgery was not desirable earlier (1+ / 0-)
          Recommended by:
          SoCalSal

          it was not really practical, from what I've read. Science and advancements and putting your surgical tools where your mouth is can take you only so far -- if a body can't handle something, that's the ballgame.

          But forgive me -- in my academic zeal (research gives me a sort of high), I forgot to say something sort of important:

          Glad you and your daughter are here:)

          "Homeless veteran" should be an oxymoron.
          "Please know that I accept you and yours with no need for explanation of [any] kind." -Translator

          by iampunha on Fri Jun 24, 2011 at 06:45:44 AM PDT

          [ Parent ]

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