Tuesday 22 February 2011

More Black history Month......

I ordinarily don't write on such subjects, but rather limit my writing to humorous anecdotes and such. I viewed the articles contributed by Saffron, Camille and Kimmie with great interest. I, at this point, felt compelled to write of people that I feel have made a significant contribution to society. In this case, I write of an individual who has contributed greatly in the field of medical science.




It should be noted, that although this article satisfies the criteria of Black history month, It is not why I write this.I simply write of an extraordinary man, whose impact is incalculable, and who has advanced our understanding of medical science, by leaps and bounds, and who just happened to be a black man. I feel this the best way to honor someone whose incredible diligence, and thirst for knowledge, has benefited us all.

Vivien Thomas and others have served as a personal hero of mine as I embarked on my own studies in medicine, and as a shining example of all that is possible.

A movie was made, that chronicled the incredible life, of Vivien Thomas, called “ Something the Lord made “. The setting for this story is Johns Hopkins University



Vivien Theodore Thomas (August 29, 1910 – November 26, 1985) was an African-American surgical technician who developed the procedures used to treat blue baby syndrome in the 1940s. He was an assistant to surgeon Alfred Blalock in Blalock's experimental animal laboratory 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 of operative techniques to many of the country's most prominent surgeons. Vivien Thomas was the first African American without a doctorate degree to perform open heart surgery on a white patient in the United States

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 accounts in Thomas' 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 did not suggest how this could be accomplished.

Blalock and Thomas realized immediately that the answer lay in a procedure they had perfected for a 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 in a dog, and then correcting the condition by means of the pulmonary-to-subclavian anastomosis. Among the dogs on whom Thomas operated was one named Anna, who became the first long-term 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 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. Even though Thomas knew he was not allowed to operate on patients at that time, he still followed Blalock's rules and assisted him during 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 that 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.

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' 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' surgical techniques included one he 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 undetectable suture line, was prompted to remark, "Vivien, this looks like something the Lord made."

To the host of young surgeons Thomas trained during the 1940s, he became a figure of legend, the model of a dexterous 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 others credited Thomas with teaching them the surgical technique that 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 on 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. 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, Thomas decided to give up the idea of further education.



Blalock's approach to the issue of Thomas' race was complicated and contradictory throughout their 34-year partnership. On the one hand, he defended his choice of Thomas to his superiors at Vanderbilt and to Hopkins colleagues, 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 acknowledgment, and his social interaction outside of work.

After Blalock's death from cancer in 1964 at the age of 65, Thomas stayed 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.
Thomas' nephew, Koco Eaton, graduated from the Johns Hopkins Medical School, trained by many of the same physicians his uncle had trained. Eaton trained in orthopedics and is now the team doctor for the Tampa Bay Rays.

In 1968, the surgeons Thomas trained — who had then become chiefs of surgical departments throughout America — commissioned the painting of his portrait (by Bob Gee, oil on canvas, 1969, The Johns Hopkins Alan Mason Chesney Medical Archives) 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, but it did allow the staff and students of Johns Hopkins Hospital and Johns Hopkins Medical School to call him doctor. Thomas was also appointed to the faculty of Johns Hopkins Medical School as Instructor of Surgery.



This is a copy of the image / paintings done of both Vivien Thomas and Alfred Blalock, side by side, as they are in the foyer of Johns Hopkins University


* I would be remiss, in my responsibilities, If I did not acknowledge, the body of work, was not written by me, but rather a collection of articles gathered from the internet. I did so, because the body of work, of that of Vivien Thomas, would take up volumes. For my own part, it saddened me greatly to learn of the hardships endured by Vivien Thomas. Like many, I was left to ponder how many more advances may have been possible had Vivien been able to pursue his dreams as Medical Doctor. I am however thankful he was able to attain the level of proficiency Vivien did, despite his many setbacks. I am further thankful Johns Hopkins has honored him. *

4 comments:

kimmie coco puff said...

OMG!!! It was a rather interesting read for me Nicky being as i am medical and such. I'm researching further into this mr. Thomas as i write this. Thanks for your enlightening contribution to black history month:)

Soulstar said...

The paramount injustices present throughout his life just make me want to cry. His accomplishments and perseverance however fill me with pride and move me to give him a standing ovation at very least. This is a wonderfully crafted article about a truly gifted man who helped change history to the betterment of all humankind. I found the section on the dogs rather fascinating, as I had never known such existed. Thank you so much Nicky, for sharing such a superb educational post! :)

Saffron said...

Wow! What a story it has everything, deeply moving, inspirational and yet tainted by academic hubris by people who do not have the grace or integrity to recognise the work of others. History is littered with such stories. In Europe it tended to embody a male-female partnership, where it was the woman who was exploited.

In many ways it is an uplifting story which is still tinged by sadness. Just as an aside would such ‘maverick’ advances in medicine be possible today? I think not. ‘Medical ethics’ an interesting term at the best of times would not allow it. I think once the same attitudes were referred to in the industrial sector as a ‘closed shop.’ Interesting today that when surgeons are being trained, that most of the time is still spent on academic proficiency when the essence of the job revolves more around dexterity and psychomotor skills.

Thank you for a truly wonderful story and the time and effort you have put into sharing this Nicky. There are so many lessons we can all draw from this story.

Personally I’m rather proud that our Blog which had it’s roots in fun and saucy titillation can rise to something as moving and important as Black History Month.

Nicky said...

Thanks Kimmie,Camille,and saffron, for the Comments. I simply followed the example all of you have set with your great articles of late. This was a banner started with camille's expose' of Martin Luther King, and continued on with posts by Kimmie and Saffy and such.

The term Anastomosis is largely a generic term now, and is used very freely. A med teacher of mine told me the story of Vivien Thomas, and his incredible contributions.I knew Kimmie might appreciate this, as she has most likely seen this work performed in the operating room.

It was the work of Vivien Thomas that allowed Surgeons' to ask, " what if, ....." and " why not "
Vivien's work lives on, in the hands of other surgeon's , and he was truly a trailblazer, with a desire to help people with his talents.

Thanks Saffy, Camille, and Kimmie for your excellent work.