On the 29th October 1944 the first cardiac operation was performed at the Johns Hopkins Hospital for the treatment of congenital heart disease. Dr Alfred Blalock, the Chief of Surgery, carried out a pioneering surgical procedure designed to palliate a condition called Tetralogy of Fallot. This complex condition is characterised by a narrowing in the outflow tract of the right ventricle, thickening of the right ventricle, a ventricular septal defect and an over-riding aorta. In essence the blood flow to the lung is severely compromised and babies born with this condition are often deeply cyanosed and therefore known as "blue-babies." In the 1930’s the management of a blue baby was to place them in an oxygen tent. Children were advised to assume a squatting position to reduce venous return to the heart, and to try and keep as quiet and calm as possible to reduce infundibular spasm. The prognosis was terrible and the paediatric cardiologist at Johns Hopkins, Dr Helen Taussig, had to simply watch babies and children die.
It was known that children with Fallot's who also had a patent ductus arteriosus were less cyanosed and this led to the idea of whether it might be possible to create a shunt between a great vessel and the pulmonary artery in order to supply blood to the lung. After painstaking laboratory work this resulted in the introduction of what is commonly called the "Blalock-Taussig shunt." In this procedure the left subclavian artery was anastomosed to the pulmonary artery. The operation was first performed at Johns Hopkins on 29th October 1944 and represented the first effective treatment for this condition and it is still used in a modified form today. It was published in JAMA in 1945.
This story would in itself be interesting but what makes it fascinating is the contribution of another member of the team. If you look at the photograph of the operating room you can see there is a man on the far left of the picture standing behind Blalock who is operating. That man was called Vivien Thomas. Nowadays we would call him an African American but in 1940’s Baltimore things were different.Thomas left school at 14 with no college education and started work as a carpenter. After losing his job he obtained a position in Dr Blalock’s laboratory as a janitor. Soon Blalock recognised his exceptional talent with his hands and he became the technician who ran Dr Blalock’s experimental surgical laboratory.
When it came to the scientific and the surgical technical aspects of the shunt his own autobiography and detailed research has demonstrated that the primary contribution was from Thomas. Most of the fundamental studies were done by him and Blalock only did one practice procedure in a dog before performing the first surgery on a 15-month-old girl. As the photograph shows Thomas stood behind Blalock during the procedure to provide advice.
At a time of racial segregation and discrimination in America, Thomas’s contribution to the development of the shunt
procedure remained relatively unknown outside Hopkins. He was ignored by the world’s press and media and the procedure became known as the Blalock-Taussig shunt. He was not even acknowledged for technical contributions in the original paper. However in time, as political and civil rights movements led to change in attitudes towards race, Thomas's exceptional contribution to the development of this pioneering heart surgery was recognised. His portrait now hands in the hallowed corridors of the Johns Hopkins Hospital alongside Dr Alfred Blalock, Sir William Osler, Dr Harvey Cushing and Dr William Halsted – legends of modern clinical medicine.
October is Black History Month. You have probably heard of Rosa Parks, Mary Seacole and Claudia Jones but the story of Vivien Thomas is not well known outside of Johns Hopkins. Thomas made a huge contribution to the birth of cardiac surgery and thus plays an important part in the history of medicine. He is a wonderful example of how despite segregation a black man fought against the odds and was key in developing a life-saving operation used to treat thousands of children worldwide. Perhaps it’s time to officially rename the Blalock-Taussig shunt the Blalock-Thomas-Taussig shunt and give him his rightful place in Black History month.
Dr Richard Bogle
The opinions expressed in this blog are strictly those of the author and should not be construed as the opinion or policy of my employers nor recommendations for your care or anyone else's. Always seek professional guidance instead.