Babies Who Changed Their Colour

VIVIEN AND THE BABIES WHO CHANGED THEIR COLOR:

The human heart had never been fortunate to be treated by a surgeon’s knife until the middle of twentieth century. It was on November 29, 1944, that a team in Johns Hopkins Hospital, Baltimore, U.S.A. dared tackling the problem of ‘blue babies’. The indomitable desire to find solace to these tender babies born with a curse, brought them to together. They worked unmindful of the great depression of 1930s, the on going World War II, and the prevailing societal pressures like racial difference and hierarchical problem at the place of work.

The Tetrology of Fallot or blue baby syndrome, in a nut shell, is a congenital heart disease, characterized by generalized cyanosis or bluish discoloration all over the body due to circulating admixtured blood as a result of four congenital deffects in the heart. The interventricualr septum has a hole which allows the blood of both right and left ventricles get mixed up and then enters the aorta, the biggest artery which supplies blood to the whole body. This is because the mouth of the aorta is ‘over riding’ the defect in the septum. The pulmonary artrey arising from the right ventricle is very narrow and the right ventricle happens to be thicker. This makes the major portion of blood returning from the entire body, hence blue in color, goes into aorta and very little enters the lungs. Thus the blue discoloration of the body is due to the blood which has not gone through lungs, so is containing large amounts of carbondioxide. The babies suffer easy tiredness, difficulty in breathing and even minor exertion like suckling eating, crying, laughing and walking makes the cyanosis worse. They are unable to even play as the breathlessness which comes on playing restricts all activity. They sometimes develop ’spells’ of unconsciousness and convulsions. The babies do not grow well. They very soon succumb to infections or heart failure before they reach their teenage.

Vivien Theodore Thomas ( 1910-1985) was born in an African American carpenter’s family in New Iberia of Louisiana near the Mississippi delta. In order to realize his childhood dream of becoming a doctor he starts working in Vanderbilt Hospital, Nashville, as a janitor. As his family could not afford his education he had to work and save money for the Medical course. The great depression of 1930s threw him out of the job. With great difficulty he managed to reach the surgery chief Dr. Alfred Blalock (1899-1964) and requested for job. This young surgeon graduated from Johns Hopkins, Baltimore, was doing surgical laboratory research on trauma, circulation and transfusion related problems. He engaged Vivien in animal experiments section. With the skill and hard work of Vivien, Dr. Blalock could bring out many theories which became gospel truths. Later this helped save many soldiers who were seriously injured in the war. Johns Hopkins called back the services of Dr. Blalock offering Chief Surgeon and Head of the Department of Surgery post. The most important reason which made him occupy this chair was the fact that he could continue with the lab experiments. As he depended heavily on Vivien’s genius, he insisted that Vivien should accompany him to Baltimore. It was a tough decision for Vivien who had a small family consisting of wife and two daughters. Under the circumstances it was very difficult for him to maintain the family in a bigger city. But still he joined Blalock’s department as he knew that it is a great opportunity to work with Dr. Blalock in the animal lab. Vivien knew very well that he can contribute a lot to the animal experiments dealing with heart diseases. For Dr. Blalock, Vivien was indispensable. In order to help his partner Dr. Blalock took all the trouble to influence his friends in the administrative circle to sanction Vivien a technician’s salary. Thomas was an exceptional person to get a raise. Many people raised their eyebrows looking at this inseparable partnership. They worked like pals in the laboratory, but had decided to keep the distance out side the lab, as the circumstances demanded in those days.

Dr. Helen Brooke Taussig (1898-1986), was a pediatric cardiologist in Johns Hopkins. She became the first pediatric cardiology Professor after a long service. She was very much moved to see the children with Fallot’s tetrology getting incapacitated and dying in the very morning of their lives. Her concern for these blue babies made her approach the young scientists in the surgery department for a possible solution. In fact she came up with a suggestion of anastomosing the general circulation with the pulmonary circulation for improving the amount of blood going to the lungs. This made the Blalock-Vivien team remember one of their earlier experiments in Vanderbilt which ended with failure. They went on to develop a working model of Fallot’s anomaly in the dogs and on this model did the subclavian - pulmonary anastomosis. This time it worked. Dr. Blalock and Vivien worked together for long hours in the lab and came out successfully with a shunt which lasted for months. This took them an year of hard work with no evenings and no week ends. The heat of the world war never seemed to affect their concentration. With lot of responsibility, wisdom , patience and good will Dr. Blalock could convince the parents of an young girl to be the first ever patient to undergo this procedure which was never ever tried on any human heart. Eileen Saxon was the lucky girl to be the harbinger of cardiac surgery and it was her good fortune to be instrumental in saving many patients in the decades to come.

On the morning of Nov 29, 1944, the operation room was witnessing the maiden venture. There was an uneasy calm and tension in most of the people. But Dr. Blalock was the one who was affected most. Mid way through the operation he was compelled to call Vivien in to the OR and made him stand behind him. Under the watchful eyes of Vivien and his step by step guidance Dr. Blalock proceeded to complete the shunt procedure. The procedure was to connect the subclavian artery with the pulmonary artery. When the last clamp was released the pure blood gushed into the lungs and the baby instantaneously became pink! Dr. Blalock, Vivien the technician and all others who were present rejoiced. Dr. Taussig, who was witnessing all the events standing near the operating team felt immensely happy. After the operation he remarked with pride ” Vivien Thomas, my superb technician, and I performed many experiments with this end in view!”. Vivien himself said ” Our first attack on the problem was to try to form in the animal a ‘blue baby syndrome’ in order that we may work out a procedure for correction”.

The success of the operation made the parents of congenital heart diseases fill the out patients department of Dr. Taussig. The surgical team, went on operating on blue babies day in day out and filled almost all the wards of the Hospital. The news spread all over the world. The media covered the groundbreaking event extensively, praising the brave surgeon and the cardiologist. Dr. Blalock and Dr. Taussig were invited by the medical associations and Hospitals through out the world and were respected and honored. Many cardiologists and surgeons came to Johns Hopkins Hospital to witness the surgery. They were wonderstruck to see Dr. Blalock, the chief surgeon being guided by a technician who was not even a graduate let alone a doctor.

The dexterity with which Vivien handled the tissues of the dogs was so good that he could at times do the operation with his eyes closed! The Resident doctors who assisted Dr. Blalock later became world famous cardiac surgeons and administrators. Dr William P. Longmire and Dr. Denton Cooley fondly remember these events. They gratefully remember the expert training in the laboratory given by Vivien Thomas. Once Vivien showed the suture lines in one of his experimental surgery procedures to Dr. Blalock. He could not believe his own eyes when he took a good look at smoothly healed sutures. Such was the fineness of the sutures put by Vivien. Dr. Blalock exclaimed ” Oh! this looks like something the Lord made”. Vivien also designed and developed some fine vascular surgery instruments like needles and clamps.

When all the celebration was going on, Vivien Thomas, the technician par excel lance, never was given any recognition or publicity. He stood away from the lime light. Hurt by this attitude of Dr. Blalock and the media. Despite the requests of the repentant surgeon he decided to move away from Blalock and Johns Hopkins. He was blinded for a while by the human weakness for publicity. But soon he reconciled and saw the wisdom in rejoining the team to continue to improvise the procedure. Saving the babies gave him immense satisfaction. Despite over work and long hours he continued to work in the laboratory teaching and guiding medical students and technician trainees. Hundreds of such pupils ,including some African Americans fondly remember him for his genius in experimental surgery, his humility and self respect and self confidence. These students of Vivien , in 1969, were instrumental in placing a portrait of Vivien Thomas in the lobby of the building named after Dr. Blalock in the Department of Surgery of Johns Hopkins Hospital. Later in 1976, Johns Hopkins honored him with an honorary Doctor of Laws, thanks to the persistence of Dr. Helen Taussig. Later he was given a faculty position in the University and worked as a tutor in Surgery. He headed the surgical laboratories as its Director. After nearly 35 years of service full of trials, tribulations and triumphs, he retired in 1979. ‘Blalock-Vivien-Taussig shunt’ heralded the era of cardiac surgery.

The HBO movie of 2004, titled “Some thing the Lord made” has portrayed this effectively like a documentary. The title of the movie is likely to give any one an impression of biblical theme. It is not mythology but in a way it is an evidence of gods work. It is informative to medical students, doctors and all those interested in history of medicine.



This has been sent to me by Dr.T.K.Nagabhushan, who retired as Professor from the Bangalore Medical College, after having served the College for more than 30 years. At the moment he is staying with his daughter in America. I undestand from some of his old students that he was one of the most popular Professors in the College whose lectures were attended even by outsiders who did not belong to that class. That appears to have beeen his popularity in the Medical College

He is one of our senior members in my mailing list for my weekly articles

B.M.N.Murthy, 2nd July 2008


Vivien story
Created:Wednesday, July 2, 2008 10:13 AM