by Jim Murphy
23 “Dr. Blalock . . . conclusions”: Thomas, 27.
24 “The volume . . . being done”: Thomas, 24.
25 “I did . . . activity”: Thomas, 25.
3. Surrounded by Failure
27–29 A more visual presentation of fetal heart development can be found on the U.S. National Library of Medicine site: www.ncbi.nlm.nih.gov/pmc/articles/PMC1767109.
28 Dr. Mark Hill of the University of South Wales provided a clear description of fetal heart development. He has also created a website on the subject: embryology.med.unsw.edu.au/embryology/index.php?title=Basic_Cardiac_Embryology.
“Congenital . . . size”: G. Wayne Miller, King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery (New York: Crown, 2000), 115–16.
28–29 A technical study of congenital heart defects, with detailed illustrations, is found in Allen D. Everett and D. Scott Lim, Illustrated Field Guide to Congenital Heart Disease and Repair (Charlottesville, Va.: Scientific Software Solutions, 2010), 92–95.
29–32 A very good discussion of Helen Taussig’s family, upbringing, and early education can be found in Baldwin, 3–17.
30–31 In 1969 only 9 percent of all medical students were women. A year later, the Women’s Action Group filed a class action suit against every medical teaching facility in the United States, claiming discrimination in their admission policies. Medical schools immediately began to admit more women, and today more than 50 percent of all medical students are women. A very clear overview of this situation can be found in Walsh. Learn more about Taussig’s personal struggle to become a doctor in Baldwin, 22–28.
30 “My father . . . undertook”: Baldwin, 14.
31 “so . . . students”: Baldwin, 24.
32 Many writers have described Taussig’s loss of hearing and how she coped with it. Baldwin’s account, 37–40, is concise and detailed.
33 “Adversity . . . with her”: Baldwin, 17, 40.
33–34 Tetralogy of Fallot was described as long ago as 1672 by the Catholic bishop and scientist Niels Stensen, who did pioneering research in both anatomy and geology, and was eventually named for the French physician Étienne-Louis Arthur Fallot. The condition currently occurs in approximately 400 babies per 1 million births (or 52,000 per year worldwide). It is very treatable, especially when diagnosed and treated early. World and Olympic snowboarding champion Shaun White was operated on for the defect twice before his first birthday.
A clinical explanation of the defect is found in Beeson and McDermott, 612. Also see Stoney, 8; Thomas, 80–81; and Weisse, 40–41. Two reliable websites also provide information and illustrations. One is at the National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov/health/health-topics/topics/tof) and the other is at the Centers for Disease Control and Prevention (www.cdc.gov/ncbddd/heartdefects/TetralogyOfFallot.html).
35 “You . . . make one”: Stoney, 200.
“It seemed . . . time”: Baldwin, 52.
35-36 “When . . . chance”: Baldwin, 52.
4. Answered and Unanswered Questions
37-38 “The perception . . . cases”: Jody Bart, ed., Women Succeeding in the Sciences: Theories and Practices Across Disciplines (West Lafayette, Ind.: Purdue University Press, 2000), 4.
Taussig and Blalock had an interesting working relationship, to say the least. Both were experts in their fields; both had strong egos and were not afraid to express their opinions. And both made decisions for their desperately ill young patients that literally could mean life or death. No wonder they became tense and snappy at times. For additional details about how they worked together, see Stoney, 11–12, 68, 165–66, 246, and 261–63.
Thomas was in many ways an enigmatic person. He wrote what some people refer to as an autobiography, but most of it is about the work and people he was involved with. An interesting note is that many doctors and nurses had opinions about both Taussig and Blalock and were sometimes a bit critical. Apparently no one has, or had, a bad word to say about Thomas, which speaks highly of his skills and personality. A number of doctors discuss Thomas in Stoney, 167, 185, 191, 223, and 246–47.
38 “Dr. Taussig . . . care”: Stoney, 165.
“Dr. Taussig . . . so much”: Stoney, 115.
39 “a pleasant personality”: Thomas, 80.
40 “She expressed . . . around”: Thomas, 80–81.
For how Blalock and Thomas came to do the research on tetralogy of Fallot, see Stoney, 67–68; Thomas, 77 and 80–81; and Weisse, 42–43.
40-41 “sure . . . tested”: Thomas, 82.
41 “I spent . . . specimens”: Thomas, 81.
“amazed . . . at all”: Thomas, 81.
“If . . . helplessness”: Thomas, 81.
42–45 It would require many hundreds of pages to describe the use of animals in biomedical research, its history and abuses, the slowly changing attitudes about it in the medical community and the public, and how animal rights protesters, computers, and the use of cells for research have reduced the number of animals being used for experimentation. To keep my discussion concise, I focused on the state of animal research around the time when the blue baby operation was being perfected.
One of Vivien Thomas’s responsibilities was caring for the animals used in research at Johns Hopkins, and he did an especially fine job. He felt, as might be expected, that use of animal subjects was crucial to his and Dr. Blalock’s research, and he discusses this in Thomas, 152–53. He also talks about an ongoing program at Johns Hopkins that had all surgeons, from Blalock to the newest resident, set aside Friday afternoons for a veterinary clinic where local pets were treated and sometimes operated on for various conditions. See Thomas, 207–9.
The following short list of books will provide a good, solid background in the history of biomedical research and animal rights:
Cunningham, Andrew. The Laboratory Revolution in Medicine. Cambridge: Cambridge University Press, 1992.
Jasper, James, and Dorothy Nelkin. The Animal Rights Crusade: The Growth of Moral Protest. New York: The Free Press, 1992.
National Research Council. Use of Laboratory Animals in Biomedical and Behavioral Research. Washington, D.C.: National Academy Press, 1988.
Rollin, Bernard E., and M. Lynne Kesel, The Experimental Animal in Biomedical Research: A Survey of Scientific and Ethical Issues for Investigators, vol. 1. Boca Raton, Fla.: CRC Press, 1990.
Turner, James. Reckoning with the Beast: Animals, Pain and Humanity in the Victorian Mind. Baltimore: Johns Hopkins University Press, 1995.
The following websites provide general information about animal rights and the use of animals in biomedical research:
American Association for Laboratory Animal Science: www.aalas.org
American Society for the Prevention of Cruelty to Animals: www.aspca.org
The Humane Society of the United States: www.humanesociety.org
People for the Ethical Treatment of Animals: www.peta.org
44 “The dog . . . ideal”: Stoney, 93.
“Without . . . nowhere”: Miller, 67.
“I know . . . of ways”: Miller, 73.
“clinical . . . therapy”: Shumacker, 41.
45 An amazing aspect of the history of cardiac surgery is how very little history there was before the first blue baby operation in 1944. A concise look at pre–blue baby cardiac surgery can be found in Shumacker, 1–40. Also see Stoney, 1–7, 129, and 197.
5. The Search
51 “something the Lord had made”: Thomas, 122.
It was not unusual for surgeons and their laboratory assistants to create surgical tools for a particular operation. Often these new tools were improvements on existing tools, which was the case when Thomas and Longmire designed the adjustable clamp that became known as the Blalock clamp. After they had drawn up a design, Thomas took their drawings to a nearby tool-making company, where the new clamp was produced. Back when the blue baby operation was introduced, most of the designers of such tools did not receive any payment. The companie
s that made the tools would provide the inventors with free instruments and sell the instruments to other surgeons. Today everyone involved (the designers, medical schools, and manufacturers) shares in the profits. Thomas discusses the creation of the Blalock clamp in Thomas, 96.
53 “It is . . . solved”: R. B. Pond, quoted in Thomas, 89.
54 “As Dr. Taussig . . . where”: Thomas, 89.
6. “All the World Is Against It”
55 “brain power . . . projects”: Thomas, 178.
“He was . . . the time”: Stoney, 245.
Many surgeons who worked with Blalock commented on his abilities as a surgeon. Some viewed him as solid but not inspired. Others felt he was a fine surgeon who could handle even the most difficult surgical situations. For a variety of comments on Blalock’s surgical skills, see Stoney, 69–70, 115, 117, 164, 180, 186–87, 245, 258, and 260.
56 “was very . . . technician”: Stoney, 260.
60–61 It appears that after the success of the first blue baby operation, Dr. Austin Lamont did administer anesthesia to very young patients. A very nice tribute to Lamont, “Austin Lamont and the Evolution of Modern Academic American Anesthesiology,” by Stanley Mursvchick, M.D., and Henry Rosenberg, M.D., appeared in the Journal of the American Society of Anesthesiologists 84, no. 2 (February 1996): 436–91.
61 “When suffering . . . burden”: Peter Safer, “Tribute to Dr. Austin Lamont,” Anesthesiology 87, no. 2 (August 1997): 461.
“Surgery . . . of the heart”: Stephen Paget, Surgery of the Chest (London: John Wright, 1896), 121.
61-62 “The heart . . . techniques”: Mike Field, “I Remember . . . Thinking It Was Impossible,” The Gazette: The Newspaper of Johns Hopkins University, May 30, 1995, 8.
64 “This was . . . available”: Stoney, 12.
“Many of us . . . disaster”: Stoney, 245.
65 “You know . . . right”: Weisse, 77.
7. “Vivien, You’d Better Come Down Here”
66 “had said . . . nervous”: Thomas, 92.
67 “Miss Puryear . . . down here”: Thomas, 92.
68 “The patient . . . drapes”: Thomas, 92.
68–70 There have been numerous descriptions of the first blue baby operation, with Blalock’s own postoperative notes the most direct. Thomas describes it in detail in Thomas, 91–95. Several other descriptions appear in Stoney, 8–14, 68–70, 115–66, and 244–45.
69-70 “less than . . . procedure”: Thomas, 93.
70 “Dr. Blalock . . . to him”: Stoney, 244.
70-71 “I watched . . . direction”: Thomas, 95.
71 “was . . . there”: Stoney, 69.
“disturbed . . . thrill”: Blalock’s surgical notes, from the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions.
“The color is improving” and “Take a look”: Stoney, 70.
When Eileen Saxon’s operation was complete, Merel Harmel noted that her blue skin was “improving”—that is, becoming less blue—and that her change in color was “quite dramatic.” Neither Blalock, Thomas, nor Taussig ever contradicted these descriptions, though it is interesting that these three were always very matter-of-fact about Eileen’s skin color change. Blalock always said the immediate color change was evident but never described it as dramatic, and Thomas never mentioned it at all. Harmel is quoted in Stoney, 70. It is my opinion that some of the more dramatic descriptions that have appeared over the years in articles and movies were actually describing later operations on older children, where increased oxygen had an instant and obvious effect on skin color.
72–73 “leaned over . . . dramatic”: Stoney, 70.
8. Then What Happened?
75-76 “because . . . monitoring”: Stoney, 143.
Surgery and postoperative care were both in their infancy in the mid-1940s. Operating rooms were not completely sterile areas. It was not unusual, for instance, for a doctor to come in from the street and go directly into the room where an operation was in progress to chat with a fellow surgeon. Pieces of equipment such as lamps and chairs were often brought into were operating rooms without being sterilized.
Postoperative care was primitive, to say the least. A doctor or nurse would simply look in on patients to make sure they were doing okay; there were no electronic monitors to check heart rate, for instance. A discussion of what surgery and aftercare were like can be found in Stoney, xi–xii, 12–13, 69, 101, 197–98, 245–46, and 514. Also see Shumacker, 42–43.
76 “Eileen’s . . . pink”: Thomas, 95–96.
Almost nothing is known about Eileen Saxon or her family. All written sources about her sound identical and seem to have been drawn from information gathered when she was admitted to Johns Hopkins in 1944. It appears that the family was poor and that her operation and stay in the hospital were free, which means no information (such as her parents’ names and address) was gathered for billing purposes.
We know that the first blue baby operation improved her health and that she was discharged after a lengthy stay at Johns Hopkins. Then, several months later, she began suffering blue baby symptoms again and had a second operation, this time on the opposite side of her chest. She survived the operation, but died several days later, just short of her third birthday.
77 “Some . . . patients”: Thomas, 97.
78 “To these . . . praying for”: Thomas, 97.
Blalock became one of the world’s first superstar surgeons after the blue baby operation. His fame embarrassed him, since it was generally considered unethical for surgeons to promote themselves in newspapers and magazine articles. For more information on the importance of the operation and Blalock’s international fame, see Stoney, 14–18, 70–71, 186, 237, 247–48, and 264. Also see Shumacker, 66 and 69–70.
“literally . . . start”: Stoney, 16.
79 “a forceful and impressive presentation”: Stoney, 15.
79-80 “A long . . . earlier”: Stoney, 15–16.
80 “There was . . . breakthrough”: Stoney, 264.
80–81 Alfred Blalock had one of the most successful research and teaching careers in the history of medicine. He became internationally famous for his studies and publications on shock, then became even more famous with his blue baby operation. Both of these innovations saved hundreds of thousands of lives and changed medical history. He would eventually write more than two hundred articles plus a book (Principles of Surgery, Shock and Other Problems), receive nine honorary degrees from research universities, be a member of forty-three medical societies, and be given numerous awards for his medical research, including the Passano Award, the Matas Award, and the Albert Lasker Medical Research Award, as well as France’s highest award for public service, Chevalier de la Légion d’Honneur. He died of cancer in 1964, shortly after he retired from Johns Hopkins.
81 “more than . . . era”: Stoney, 18.
84 Jamie Wyeth was just seventeen years old when he painted Taussig’s portrait. The painting was considered so offensive that Taussig wrapped it in a bath towel and stored it away in a spare room in her house for years. After her death, it was donated to Johns Hopkins, but it never hung in the hall where Blalock’s and Thomas’s portraits are displayed. It ended up in a little-used room, but was later removed when doctors who knew and had worked with Taussig complained. It now hangs in a private office at Johns Hopkins. In his defense, Wyeth said he was struck by Taussig’s intensity and wanted to capture that on canvas. “I felt I had caught something, not that it was something cruel, not that it was something ugly, but I had really caught the personality of this person as I saw her” (quoted in Patricia Mersal, “The Changing Face of a Strong Woman,” www.newyorktimes.com/2013/08/18/arts/design/a-showing-for-3). Two paintings of Taussig were commissioned later; they are pleasant, accurate portrayals, but both are bland and lifeless. Wyeth created a genuine work of art that did not reflect what Taussig’s friends and colleagues saw in her.
84–85 “Physician . . . heart”: Baldwin, 111.
8
5–86 The exact nature of Taussig’s role in developing the original blue baby procedure has been argued for years. A few say that during the first meeting with Blalock and Thomas, she suggested the specific procedure that could bring more oxygenated blood to a patient’s heart; according to others, she simply wondered if this might be possible surgically. It’s important to remember that Taussig never claimed to have suggested the research path that should be taken; nor did Blalock, who gave his colleague great credit for the operation. Thomas says she explained genetic cardiac defects in great detail and wondered if it might be possible to “redo the plumbing” of a child’s body to allow more oxygenated blood to circulate. I assume she mentioned Dr. Gross’s procedure because that is what took her up to Boston to talk with him. For a variety of opinions on this, see Stoney, 9, 12, 14, 70, 115, 159, 166, 186, and 245–46. Also see Weisse, 43 and 380–81; Baldwin, 52; and Thomas, 80–81.
86 “led to . . . paper”: Blalock and Taussig, 189–202.
89 “to . . . his own”: Thomas, 10–11.
90 “Dr. Blalock . . . Blalock”: Stoney, 191.
91 “Vivien was not . . . imagination”: Dr. Levi Watkins Jr., quoted in Partners of the Heart, Act III.
“I think the gentlemen . . . time”: Dr. Levi Watkins Jr., quoted in Partners of the Heart, Act III.
92 “The race issue . . . earlier”: Stoney, 191.
93 “the most . . . world”: Dr. Levi Watkins Jr., quoted in Partners of the Heart, Act I.
94 “Heimbecker thought . . . Alfred Blalock”: Thomas, 152.
95 “Even if you’d never seen . . . operated”: Washingtonian magazine, August 1989, 110.
96-97 “Well, we . . . surgeons”: Stoney, 265.