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Saturday, August 25, 2012

Vivien Thomas and Canine Surgery

by Donald F. Smith, Cornell University
August 25, 2012

When I lecture on the topic of One Health, I sometimes tell the story of the first surgical repair of the blue baby syndrome to demonstrate how important dogs were in achieving major advances in human medicine. 

Through the first half of the 20th century, dogs were used extensively by physicians in medical schools to help them learn the physiologic and pathologic changes associated with disease in people. Many complex surgical procedures were tested by MDs first on dogs to see if they could be successfully performed in people. Surgical residents developed their technical skills in "dog labs" that were common in medical schools. 

Anna, the experimental dog used 
to develop the corrective surgery 
for blue baby syndrome.
Photo from Johns Hopkins U.
The blue baby story holds special interest to me not just because of its profound impact on human surgery, but also because of the special place of a dog named "Anna" in the folk lore of Johns Hopkins Hospital.  

The term blue baby refers to the bluish-purple appearance of an infant's skin caused by lack of oxygen going to the tissues. A rare but well-known cause of this problem in the early 20th century was  tetralogy of Fallot, in which heart defects during fetal development result in the inability of the heart to pump venous blood into the lungs to be properly oxygenated. Affected babies usually died during the first year of life. 

Vivien Thomas (1910-85), the surgical technician
who developed the technical procedure
for the correction of Tetralogy of Fallot.
Photo from Johns Hopkins U.
In the early 1940s, Alfred Blalock was head of surgery at Johns Hopkins Hospital, and Vivien Thomas was his laboratory technician. A cardiologist named Helen Taussig approached Blalock and Thomas one day in their surgical laboratory and appealed to them to find a way to surgically repair tetralogy of Fallot. Though Taussig did not know it, Blalock and Thomas had years earlier created an experimental model in dogs in which blood to the lungs had been rerouted. The two men devised a variation of that model (in which the left subclavian artery was anastomosed to the pulmonary artery) and developed a plan to test the idea.

Blalock went back to his busy surgical practice and his administrative duties, and Thomas worked in his laboratory to create an experimental model in dogs to mimic the birth defect. Though he had never trained with a veterinarian and had only worked in a human surgical laboratory, he devised a way to surgically produce a condition in dogs similar to the one affecting human babies. Once he could produce the blue baby-like signs in his dog model, he operated on an affected dog to make sure that the type of repair that he and Blalock had devised would correct the blood flow problem that killed the babies. He designed instruments and delicate operative techniques to ensure that the repair could be performed on a tiny child. In his autobiography, Thomas said that he used 200 experimental dogs over a several-month period to accomplish this astounding breakthrough.

Photo from the first successful operation for
correction of tetralogy of Fallot, November 29, 1944
Vivien Thomas is at back left.

Photo from Johns Hopkins U.
The procedure was first performed on a baby girl on November 29th, 1944. Blalock was the surgeon. However, looking over his shoulder and coaching him throughout the procedure, was Vivien Thomas, whose knowledge of every minute detail of the operation was critical to its success. The symbiotic relationship between Blalock and Thomas was complicated by the fact that Thomas, though perhaps the most accomplished canine surgeon of the era, had no formal training in medicine or veterinary medicine. He was a tradesman, a carpenter, whose plans to go to medical school in the late 1920s were thwarted by the Depression.

He was also African-American, working in the segregated environment of Hopkins. His story was beautifully told in "Something the Lord Made" which premiered on HBO in 2004.

In his waning years and with Blalock deceased, Thomas identified what he referred to as the "troika" who developed the procedure to correct the tetralogy of Fallot. Equal with Blalock and himself, he included the dog named Anna. It is a beautiful example of One Health and the impact that physicians had on advancing canine anesthesia and surgery 80 years ago. 

Thomas' expertise continued to be felt for decades as he used dogs to train surgical residents who later progressed to important positions at prestigious medical schools. He occasionally assisted a veterinarian in a nearby animal hospital practice where he used his skills in canine anesthesia and surgery to save lives of dogs with spontaneously-occurring surgical problems.

Dr. Smith invites comments at