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Vivien Thomas

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Dr. Vivien Theodore Thomas (August 29, 1910–November 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 Dr. Alfred Blalock at Vanderbilt University in Nashville, Tennessee and later at Johns Hopkins University in Baltimore, Maryland. Without any education past high school, Thomas rose above poverty and racism to became a cardiac surgery pioneer and a teacher to many of the country's most prominent surgeons.

Dr. Thomas was born near 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 education system, the school provided him with a high-quality education.

Blalock hired Thomas as a laboratory assistant in 1930 at age 19. 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. Without financial back-up, Thomas felt compelled to put his educational plans on hold, and through a friend, he secured a job as a laboratory assistant with Dr. Alfred Blalock at Vanderbilt University. When the stock market crashed later that year, Thomas abandoned plans for college and medical school, relieved to have even a low-paying job as financial conditions deteriorated in Nashville and across the country.

Over time, Thomas took on a greater role as Blalock saw Thomas's talents emerge. Thomas helped fabricate some of the surgical tools that Blalock required while Blalock educated him about proper scientific procedures. The two grew to have a great respect for one another, forging a remarkable working partnership inside the laboratory. Outside the lab environment, however, they maintained the social distance dictated by the mores of the times.

Together they did groundbreaking research into the causes of surgical 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. Working together, the two disproved traditional theories which held that shock was caused by toxins in the blood. They demonstrated instead that fluid loss outside the vascular bed was the cause of shock and that the condition could be effectively treated by fluid replacement. This discovery brought Blalock wide recognition in the medical community by the mid 1930's. 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.

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.

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 four-part heart anomaly called Tetralogy of Fallot (colloquially known as blue baby syndrome). According to the account provided by Thomas in his 1985 autobiography, Taussig suggested 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 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.

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, a procedure that would increase blood flow to the lungs. Two years and 200 dogs later, a satisfactory operative technique was developed. Among the dogs upon whom Thomas operated was one named Anna, who became the only animal to have her portrait hung on the walls of Johns Hopkins. Thomas was ultimately able to replicate in the laboratory dogs 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.

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 two 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.

Almost immediately after the article was published, a medical reporter picked up the story and circulated it 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 a number of other cardiac techniques, including one he himself developed with Dr. C. Rollins Hanlon for correction of a cardiac malformation known as an Interatrial Septal Defect (IASD). Dr. Hanlon and a host of other young surgeons trained by Thomas during the 1940's went on to become some of the most renowned cardiac specialists in America. Such surgeons as Denton Cooley, 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 surgical 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.).

In 1947, Thomas tried again to gain admission to college to pursue his dream of becoming a doctor. He enrolled as a freshman at Morgan State University, but soon realized that by the time he completed college and medical school, he would be 50 years old before he entered practice. He reluctantly decided to give up the idea.

Blalock's dealings with the issue of Thomas's race were complicated. 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 the event is conspicuously absent from Thomas' autobiography, a letter submitted to the Hopkins Archives by 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.

Blalock died in 1964 at the age of 65, having worked with Thomas for 34 years. Following Blalock's death, 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.

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 had already earned a higher encomium, when he was admitted to the faculty of Johns Hopkins without a degree. In addition, the surgeons he trained arranged in 1973 to have his portrait painted and to hang it next to Blalock's in the lobby of the Alfred Blalock Clinical Sciences Building at Johns Hopkins.

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 (originally published under the title Pioneering Research in Surgical Shock and Cardiovascular Surgery). 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, Washington writer Katie McCabe brought his story to public attention for the first time in an article entitled "Like Something the Lord Made." The piece was published in August, 1989 in the Washingtonian and won the National Magazine Award for Feature Writing. The article was optioned in 1996 by producer Robert Cort and became the basis for the Emmy and Peabody Award-winning 2004 HBO film Something the Lord Made, directed by Joseph Sargent, scripted by Peter Silverman, and starring Mos Def as Thomas and Alan Rickman as Blalock.

Vivien Thomas' legacy continues today through the Vivien Thomas Scholarship Fund for Medical Science and Research, founded in 2003 as part of the outreach efforts associated with the public television documentary on Blalock and Thomas, "Partners of the Heart." Funded by GlaxoSmithKline and administered by the Congressional Black Caucus, the Fund provides scholarships to students pursuing graduate education in medicine and science.

References

  • (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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