Vivien Thomas

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Vivien Thomas' autobiography, Partners of the Heart: Vivien Thomas and His Work With Alfred Blalock
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Vivien Thomas' autobiography, Partners of the Heart: Vivien Thomas and His Work With Alfred Blalock

Dr. Vivien Theodore Thomas (August 29, 1910November 26, 1985) was an African-American surgical technician who helped develop the procedures used to treat Blue baby syndrome in the 1940s. He was an assistant to Doctor Alfred Blalock at Vanderbilt University in Nashville, Tennessee and later at the Johns Hopkins University in Baltimore, Maryland. Without any education past high school, Thomas rose above poverty and racism to become a cardiac surgery pioneer and a teacher to many of the country's most prominent surgeons.

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[edit] Early history

Dr. Thomas was born close to Lake Providence, Louisiana. The son of a carpenter, he attended Pearl High School (now known as Pearl-Cohn Magnet High School) in Nashville in the 1920s. Even though it was part of a racially segregated system, the school provided him with a high-quality education. Thomas had hoped to go to college and study to become a doctor, but the Great Depression derailed his plans. He had worked at Fisk University in the summer of 1929 doing carpentry, but was laid off in the fall. In the wake of the stock market crash in October, Thomas felt compelled to put his educational plans on hold temporarily, and through a friend, he secured a job as a laboratory assistant in February 1930 with Dr. Alfred Blalock at Vanderbilt University. When Nashville's banks failed nine months later and Thomas' savings were wiped out, he abandoned entirely his plans for college and medical school, relieved to have even a low-paying job as the Great Depression deepened.

[edit] Meeting Alfred Blalock

From the very beginning Thomas showed an extraordinary aptitude for surgery and precise experimentation, and Blalock granted him wider and wider latitude in the execution of the protocols. Tutored in anatomy and physiology by Blalock and his young research fellow, Dr. Joseph Beard, Thomas rapidly mastered complex surgical techniques and research methodology. He and Blalock developed great respect for one another, forging such a close working relationship that they came to operate almost as a single mind. Outside the lab environment, however, they maintained the social distance dictated by the mores of the times. In an era when institutional racism was the norm, Thomas was classified, and paid, as a janitor, despite the fact that by the mid 1930s he was doing the work of a postdoctoral researcher in Blalock's lab.

Together he and Blalock did groundbreaking research into the causes of hemorrhagic and traumatic shock. This work later evolved into research on Crush syndrome and saved the lives of thousands of soldiers on the battlefields of World War II. In hundreds of flawlessly executed experiments, the two disproved traditional theories which held that shock was caused by toxins in the blood. Blalock, a highly original scientific thinker and something of an iconoclast, had theorized that shock resulted from fluid loss outside the vascular bed and that the condition could be effectively treated by fluid replacement. Assisted by Thomas, he was able to provide incontrovertible proof of this theory, and in so doing, he gained wide recognition in the medical community by the mid 1930s. At this same time, Blalock and Thomas began experimental work in vascular and cardiac surgery, defying medical taboos against operating upon the heart. It was this work that laid the foundation for the revolutionary life-saving surgery they were to perform at Johns Hopkins a decade later.

[edit] Working at Johns Hopkins

By 1940, the work Blalock had done with Thomas placed him at the forefront of American surgery, and when he was offered the position of Chief of Surgery at his alma mater, Johns Hopkins in 1941, he requested that Thomas accompany him. Thomas arrived in Baltimore with his wife, Clara, and their young child in June of that year, confronting a severe housing shortage and a level of racism worse than they had endured in Nashville. Hopkins, like the rest of the city of Baltimore, was rigidly segregated, and the only black employees at the institution were janitors. When Thomas walked the halls in his white lab coat, heads turned.

[edit] Blue baby syndrome

In 1943, while pursuing his shock research, Blalock was approached by renowned pediatric cardiologist Dr. Helen Taussig, who was seeking a surgical solution to a complex and fatal four-part heart anomaly called Tetralogy of Fallot (also known as blue baby syndrome, although other cardiac anomalies produce blueness, or cyanosis). In infants born with this defect, blood is shunted past the lungs, thus creating oxygen deprivation and a blue pallor. Having treated many such patients in her work in Hopkins' Harriet Lane Home, Taussig was desperate to find a surgical cure. According to the account provided by Thomas in his 1985 autobiography and in a 1967 interview with medical historian Peter Olch, Taussig suggested only that it might be possible to "reconnect the pipes" in some way to increase the level of blood flow to the lungs but made no suggestion whatsoever about how this could be accomplished. Blalock and Thomas realized immediately that the answer lay in a procedure they had perfected for an entirely different purpose in their Vanderbilt work, involving the anastomosis, or joining, of the subclavian to the pulmonary artery, which had the effect of increasing blood flow to the lungs.

Thomas was charged with the task of first creating a blue baby-like condition (cyanosis) in a dog, then correcting the condition by means of the pulmonary-to-subclavian anastomosis. Among the dogs upon whom Thomas operated was one named Anna, who became the first long-term canine survivor of the operation and the only animal to have her portrait hung on the walls of Johns Hopkins. In nearly two years of laboratory work, involving some 200 dogs, Thomas was ultimately able to replicate in the canine model only two of the four cardiac anomalies involved in Tetralogy of Fallot. He did demonstrate that the corrective procedure was not lethal, thus persuading Blalock that the operation could be safely attempted on a human patient.

[edit] Decisive surgery

On November 29, 1944, the procedure was first tried on an eighteen-month-old infant named Eileen Saxon. The blue baby syndrome had made her lips and fingers turn blue, with the rest of her skin having a very faint blue tinge. She could only take a few steps before beginning to breathe heavily. Because no instruments for cardiac surgery then existed, Thomas adapted the needles and clamps for the procedure from those in use in the animal lab. During the surgery itself, at Blalock's request, Thomas stood on a step stool at Blalock's shoulder and coached him step by step through the procedure, Thomas having performed the operation hundreds of times on a dog, Blalock only once, as Thomas' assistant. The surgery was not completely successful, though it did prolong the infant's life for several more months. Blalock and his team operated again on an 11-year-old girl, this time with complete success, and the patient was able to leave the hospital three weeks after the surgery. Next, they operated upon a six-year-old boy, who dramatically regained his color at the end of the surgery. The three cases formed the basis for the article which was published in the May 1945 issue of the Journal of the American Medical Association, giving credit to Blalock and Taussig for the procedure. Thomas received no mention.

[edit] Unrecognized accomplishments

News of this groundbreaking story circulated around the world via the Associated Press. Newsreels touted the event, greatly enhancing the status of Johns Hopkins and solidifying the reputation of Blalock, who had been regarded as a maverick up until that point by some in the Hopkins old guard. Thomas's contribution remained unacknowledged, both by Blalock and by Hopkins. Within a year, the operation known as the Blalock-Taussig shunt had been performed on more than 200 patients at Hopkins, with parents bringing their suffering children from thousands of miles away.

Thomas soon began to train others in the Blue Baby procedure, as well as in a number of other cardiac techniques, including one he himself developed in 1946 for improving circulation in patients whose great vessels (the aorta and the pulmonary artery) were transposed. A complex operation called an atrial septectomy, the procedure was executed so flawlessly by Thomas that Blalock, upon examining the nearly indetectable suture line, was prompted to remark, "Vivien, this looks like something the Lord made."

[edit] Late recognition

To the host of young surgeons Thomas trained during the 1940's, he became a figure of legend, the model of the dextrous and efficient cutting surgeon. "Even if you'd never seen surgery before, you could do it because Vivien made it look so simple," the renowned surgeon Denton Cooley told Washingtonian magazine in 1989. "There wasn't a false move, not a wasted motion, when he operated." Surgeons like Cooley, along with Alex Haller, Frank Spencer, Rowena Spencer, and the late Mark Ravitch, William Longmire, David Sabiston and Henry Bahnson credited Thomas with teaching them the surgical technique which placed them at the forefront of medicine in the United States. Despite the deep respect Thomas was accorded by these surgeons and by the many black lab technicians he trained at Hopkins, he was not well paid. He sometimes resorted to working as a bartender, often at Blalock's parties. This led to the peculiar circumstance of his serving drinks to people he had been teaching earlier in the day. Eventually, after negotiations in his behalf by Blalock, he became the highest paid technician at Johns Hopkins by 1946, and by far the highest paid African-American on the institution's rolls. (From 1943 to 1947, hospital records show that Blalock earned roughly ten times as much as Thomas.).

Although Thomas never wrote or spoke publicly about his ongoing desire to return to college and obtain a medical degree, his widow, the late Clara Flanders Thomas, revealed in a 1987 interview with Washingtonian writer Katie McCabe that her husband had clung to the possibility of further education throughout the Blue Baby period and had only abandoned the idea with great reluctance. Mrs. Thomas stated that in 1947, Thomas had investigated the possibility of enrolling in college and pursuing his dream of becoming a doctor, but had been deterred by the inflexibility of Morgan State University, which refused to grant him credit for life experience and insisted that he fulfill the standard freshman requirements. Realizing that he would be 50 years old by the time he completed college and medical school, he decided to give up the idea of further education.

[edit] Relations with Blalock

Throughout Thomas' 34-year partnership with Blalock, the white surgeon's approach to the issue of Thomas's race was complicated and contradictory. On one hand, he defended his choice of Thomas to his superiors at Vanderbilt and to Hopkins colleagues as well, and he insisted that Thomas accompany him in the operating room during the first series of tetralogy operations. On the other hand, there were limits to his tolerance, especially when it came to issues of pay, academic acknowledgement, and social interaction outside of work. When Blalock celebrated his 60th birthday at the Southern Hotel in Baltimore in April 1960, Thomas was not invited, apparently at Blalock's request. While any mention of the event is conspicuously absent from Thomas' autobiography, a letter submitted to the Hopkins Archives by the late Dr. Mark Ravitch, one of the party's organizers, indicates that he and others arranged for Thomas to watch the proceedings from a screened corner of the ballroom rather than have him entirely excluded. No record of Thomas' reaction exists.

After Blalock's death in 1964 at the age of 65, Thomas remained at Hopkins for 15 more years. In his role as Director of Surgical Research Laboratories, he mentored a number of African American lab technicians as well as Hopkins' first black cardiac resident, Dr. Levi Watkins, Jr., whom Thomas assisted with his groundbreaking work in the use of the Automatic Implantable Defibrillator.

[edit] Institutional acknowledgment

In 1971, the surgeons Thomas trained—all by this time chiefs of surgical departments around the country—commissioned the painting of his portrait and arranged to have it hung next to Blalock's in the lobby of the Alfred Blalock Clinical Sciences Building. In 1976, Johns Hopkins University presented Thomas with an honorary doctorate. However, because of certain restrictions, he received an Honorary Doctor of Laws, rather than a medical doctorate. Thomas was also appointed to the faculty of Johns Hopkins Medical School as Instructor of Surgery.

Following his retirement in 1979, Thomas began work on an autobiography, Partners of the Heart: Vivien Thomas and his Work with Alfred Blalock, ISBN 0-8122-1634-2. He died in November 1985, at age 75, and the book was published just days later. Having learned of Thomas on the day of his death, Washingtonian writer Katie McCabe brought his story to public attention for the first time in a 1989 article entitled "Like Something the Lord Made," which became the basis for the Emmy and Peabody Award-winning 2004 HBO film Something the Lord Made.

[edit] Legacy

Vivien Thomas' legacy as an educator and scientist continues today through the Vivien Thomas Fund for Diversity, established in 2004 by the Johns Hopkins School of Medicine for the purpose of increasing minority enrollment at the institution, and the Vivien Thomas Young Investigator Awards, given by the Council on Cardiovascular Surgery and Anaesthesiology beginning in 1996. The Vivien Thomas Scholarship Fund for Medical Science and Research, funded in 2003 by GlaxoSmithKline and administered by the Congressional Black Caucus, provides scholarships to students pursuing graduate education in medicine and science. In 2005, the Johns Hopkins School of Medicine honored Vivien Thomas by naming one of its four colleges after him.

[edit] References

  • (1985) Partners of the Heart: Vivien Thomas and His Work with Alfred Blalock (originally published as Pioneering Research in Surgical Shock and Cadiovascular Surgery: Vivien Thomas and His Work with Alfred Blalock), U. Penn. Press.
  • (1989) "Like Something the Lord Made," by Katie McCabe. The Washingtonian Magazine, August 1989. Reprinted in Feature Writing for Newspapers and Magazines: The Pursuit of Excellence, ed. by Jay Friedlander and John Lee. May also be accessed by going to the film's web site, below.
  • (2003). Partners of the Heart. American Experience.
  • (2003) Stefan Timmermans, "A Black Technician and Blue Babies" in Social Studies of Science 33:2 (April 2003), 197–229.

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