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 dfs6@cornell.edu

ONE HEALTH COMES OF AGE

By Donald F. Smith, Cornell University
Posted August 10, 2012

        The AVMA meeting in San Diego this week featured lectures and meetings on One Health, which is the branch of science that unifies human health, animal health and environmental health.
        The One Health concept was the signature initiative of Dr. Roger Mahr when he was president of the AVMA in 2006-07. He challenged the veterinary profession to assert greater involvement in what scientists and regulatory officials were warning was the growing threat of diseases like avian flu and West Nile virus. These infectious diseases, called zoonotic, were erupting with greater frequency and virulence in the U.S. and around the world.

Dr. Roger K. Mahr, CEO, One Health Commission
President of the AVMA (2006-07)
Photo courtesy of the AVMA    

        One Health or One Medicine was advocated in the 19th century by physicians like William Osler (Johns Hopkins) and veterinarians like James Law (Cornell). However, physicians became less engaged in the potential spread of diseases between animals and people in the last few decades as the development of clinical specialties has changed the focus from the health of populations of people to that of the individual. 
        A One Health Commission was established to promote the understanding, prevention and treatment of zoonotic diseases. This becomes more important as the number and virulence of pathogenic organisms is growing and as the global travel of people, food components, and the movement of animals is increasing. 
        A second component of One Health is the realization that animals get many of the diseases and conditions that affect people. This was considered so important in the early days of veterinary education that at least two veterinary colleges (those at McGill in Montreal and Columbia University in New York) were actually referred to as colleges of comparative medicine. A book called Zoobiquity that provides several interesting examples of comparative medicine has recently received attention in the mainstream media (1).
        The third element of One Health relates to the ways in which pets and other animals actually promote human health. (2) A growing body of research is documenting the improvement of the physical, social, emotional and mental health of people who share their homes and environments with pets. Whether its walking your dog in the morning, riding your horse in the afternoon, or experiencing wild animals in their natural environment, animals improve the human condition. If these benefits to human health can be measured, we have the potential to not just improve the quality of life for both people and animals, but also to reduce the cost of human health care.
        One Health is an example of Back-to-the-Future Medicine, the re-discovery of concepts of medicine from past decades, but critically important in today's world. The leadership of veterinarian Roger Mahr was pivotal to energize a movement whose time had come.

(1) Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing, by Barbara Natterson-Horowitz and Kathryn Bowers (Random House, Inc, 2012).
(2) The role of animals in promoting human health has been termed "zooeyia" by veterinarian Kate Hodgson who works with both physicians and veterinarians. 

Dr. Smith welcomes comments at dfs6@cornell.edu.

A Veterinary Student's Externship at Johns Hopkins Hospital

Guest Blog by Jennifer Morrissey, Cornell Class of 2013

Posted July 23, 2011

Ms. Morrissey scheduled her observing externship at Johns Hopkins Hospital during the summer between her second and third year veterinary college. She has a career interest in anesthesiology.

As I walked into Johns Hopkins Hospital on my first day of a two and a half week externship in anesthesia, to say I was worried is an understatement. Was externing at a human hospital a big mistake? Was I going to learn anything that would be valid in my own veterinary career? But when I reached the office of Andrea Collins, my coordinator for the externship, I was immediately relieved—her office was in the Blalock building.

Alfred Blalock was a surgeon at Johns Hopkins in the 1940s. He and his assistant, Vivien Thomas, perfected a technique colloquially called the blue baby procedure, in which the heart vessels in the affected infants were rerouted to assist oxygenation of the blood in the lungs.

Why was this story so comforting to me? Because the surgery was developed using hundreds of dogs, and finally perfected in a dog named Anna who became so famous that her portrait hands at Johns Hopkins University. A technique similar to the one developed for Anna is still used in veterinary patients today. It is also a procedure that we study in our first-year curriculum at Cornell. The simple name of the building (Blalock) reminded me that, at the end of the day, human and veterinary medicine are one medicine.

I had the pleasure of spending the next two weeks observing and learning from some of the most diligent and instructive residents I could have imagined. Every day was a learning experience with lessons ranging from how to conduct yourself in the O.R., to airway management and, my favorite subjects as an anesthesiology geek, pharmacology and physiology. The principles were all the same. Don’t touch sterile drapes! Know how to make sure your endotracheal tube is, indeed, in the trachea. Which drugs are best for sedating a patient? Beware polarizing blockers in a patient with kidney disease. Maintain fluid volume. When should we use colloids instead of crystalloids?



Veterinary student Jennifer Morrissey recently completed
an externship at Johns Hopkins Hospital in Baltimore.
Photo courtest of Ms. Morrissey.



As I rotated among a half dozen residents, I was reminded that medicine (whether human or veterinary) medicine is not just a science, it is an art. Some rules, of course, are written in stone. But I had the opportunity to discuss differing opinions among the residents. Should I start a blood transfusion now, or wait to check the hemoglobin level? Which opiate should I administer to this patient? And there were no wrong answers; it was just a difference among artists. 

It was in these artistic details that I came to grasp some of the important differences between human and veterinary medicine. The most striking difference presented itself on the second day of the externship. While chatting with a man to ease his worry over getting an epidural block, he grabbed my hand, looked me in the eye and said, “I’m not going to wake up from this, am I?”

It may seem obvious, but it is truly striking to realize that human medicine patients can talk. I was completely unprepared for this scenario! Cornell has, of course, educated me on how to talk to animal owners and trainers, and how to project serenity while working around patients. The fact that veterinary patients cannot talk is often taken as a challenge for diagnosticians. It also makes the projection of empathy a more physical practice - a petting hand, a soothing tone.

As this man looked at me, I became fully aware of how different it must be to care for other people. How do you soothe without lying? How do you emotionally separate from someone who is so much like yourself, who can understand your words? Over the weeks, I witnessed many more humbling experiences and watched as the residents dealt with each one with grace and kindness. 

I observed many other differences while at Hopkins. The precautions and monitoring of patients is taken to a whole different level in human medicine. There are also certain drug differences that exist between the two fields, ketamine being a major example. Unlike veterinarians, physicians also have to deal with the nasty 90 degree angle of the human trachea when placing an endotracheal tube―in supine position no less! 

But at the end of the day, the warm welcome and tutoring from the residents and attending anesthesiologists made me feel like I was among colleagues. I was extremely disappointed when my externship drew to a close, but I left feeling better prepared for both the art and science of one medicine.

Stephen Laudermilch, DVM 2011 Joins a Rural Practice Steeped in History

Posted May 28, 2011

By Donald F. Smith, Cornell University

CAREERS FOR VETERINARIANS Series

Stephen Laudermilch entered veterinary college in 2007 with the singular goal of returning to his home town to join his father and brother in one of the oldest and most distinguished rural veterinary practices in Pennsylvania. Dating back to 1917, what is now called Rome Veterinary Center is located about 60 miles south of Ithaca, New York, just 15 miles over the Pennsylvania border.



Dr. Stephen Laudermilch (center), with Drs. Ben (L) and Donn Laudermilch (R)



Being from a closely-knit family, the proximity of Ithaca to Rome was one of the reasons why Stephen selected Cornell over the three other northeastern colleges that offered him a seat after only three years undergraduate study.

During his time at Cornell, Stephen would make over 300 trips between Ithaca and Rome to visit family and work in the practice where he will now be a full time associate. “Being able to go back home to practice is a huge asset for me, because the establishment is family-oriented and I know right from the beginning that the level of trust and involvement will be high”.

Stephen’s father, Donn Laudermilch (U Penn ’79) agrees. “Stephen has been doing veterinary calls with me since he was two-years-old. He would sometimes join me before school, and often ride with me on calls that extended way into the night, helping treat cows with calving problems or most metabolic conditions that occur just before or after parturition.”

Stephen was one of about twelve of the 87 students in his class with an interest in food animal programs. However, because he realized that there are no guarantees that the dairy industry in upstate Pennsylvania will remain stable in the future, he took full advantage of Cornell’s excellent small animal teaching program so that he could diversify his practice as appropriate to meet future needs in the community.

The practice is currently 85% dairy cattle, with the remainder being equine and small animal medicine. For the top-producing dairies in the practice area, Stephen his brother, Ben (Virginia-Maryland ’07) and their father, all agree that new techniques they are adopting, like in vitro fertilization, could add tremendous value to the dairy industry.

The veterinary profession faces shortages of well-educated food animal veterinarians seeking to work in rural areas. The Laudermilch family provides an excellent example of how committed veterinarians continue to advance animal health in farming communities and also support the public health needs of society by assuring a safe and abundant source of animal-based protein.

Stephen Laudermilch’s interest in serving people goes beyond rural veterinary practice.  He desires to use his veterinary skills to establish relationships in foreign countries with the human medical profession--two of Stephen's siblings are medical doctors and a third is in training--to help people with both their physical health and their productivity in agriculture. With veterinary medicine as a step-stool, Stephen's goals are to reach people for Christ through veterinary medical missions.

Dr. Smith invites comments at dfs6@cornell.edu

Dr. Koji Yasuda: Connecting Veterinary Medicine in Japan and America

Donald F. Smith (Cornell University)

Posted May 30, 2011

CAREERS FOR VETERINARIANS Series

When Koji Yasuda received his DVM from Cornell last weekend, he joined his father and older brother, Junya, as a family committed to advancing veterinary medicine in both Asia and America. 

Koji (L) and Junya Yasuda relax after Koji received his DVM
 from Cornell University May 29th, 2011. Photo by author.


Koji’s father, Hidemi Yasuda, owns one of the most progressive small animal practices in Tokyo, and also manages a dermatology (IgE) diagnostic service (Spectrum Lab Japan) that employs four staff and receives over 10,000 samples per year from 4,500 veterinarians throughout the country. 

Junya (L) and his parents, Dr. Hidemi and Mrs. Sanae Yasuda.
Yasuda Veterinary Clinic, Tokyo, Japan (2010). Photo by author.



Junya, who already has a college degree in history, is in the process of finishing his veterinary education in Tokyo. Though he has been to the United States multiple times, he has decided to remain in Japan and ultimately take over the family business.

Koji, on the other hand and with his family’s full support, decided to make his career in the United States. He left home at age 15, attended a boarding school in New Hampshire. After receiving his BS and MS from Cornell, he became one of the relatively few international students to receive a DVM from Cornell.

Koji recently received his green card (signifying permanent resident) from the United States Citizenship and Immigration Services, and now embarks on a comparative pathology residency at the New England Primate Research Center at Harvard Medical School in June. With his commitment to the concept of the “One Health” advancing both human and animal medicine, he plans to establish a career in comparative pathology at either a veterinary or medical school setting.

Dr. Smith invites comments at dfs6@cornell.edu.

When Washington, D.C. had Two Veterinary Colleges

By Donald F. Smith, DVM, Cornell University
Posted February 12, 2011



This historical blog is in recognition of the 150th anniversary 
of the American Veterinary Medical Association (1863-2013).



After 33 years of operation and educating almost 500 veterinarians, the United States College of Veterinary Surgeons in Washington, D.C. shut its doors forever in 1927.

“The passing of the horse sounded the death knell of the veterinary profession”, was the opening line of the June 16^th 1927 article as The Washington Post announced the closure.

The other institution was the National Veterinary College, established in 1892 by Cornell University graduate, Dr. Daniel Salmon (the man credited with discovering the Salmonella organism). The college later became part of Columbian University, which was renamed George Washington University in 1904.

Cornell's DVM Class of 2015 (150th Anniversary)

Blog by Donald F. Smith, Cornell University, 01.26.11

This a special welcome to the students who comprise the Veterinary Class of 2015 at Cornell University. You are on track to complete your DVM degree during the 150^th anniversary of the university.

Our founder, Ezra Cornell, was an entrepreneur who built a vast telegraph network for Samuel Morse. After amassing his fortune in Western Union stock, Cornell returned to his first love, farming. He acquired an expansive land tract on the top of the hill overlooking Cayuga Lake and then set to work fulfilling his dream of providing an educational institution where any person could find instruction in any study.

Why is there no Veterinary College in New York City?

By Dr. Donald F. Smith, Cornell University
Posted January 7, 2011 (reposted July 9, 2012).

This historical blog is in recognition of the 150th anniversary 

of the American Veterinary Medical Association (1863-2013).

Veterinary medicine is filled with strange anecdotes and quirks of history. For example:

• What happened to the four veterinary colleges that once existed in New York City – and the ones in Chicago, Washington, San Francisco and many other cities?

• When and why did veterinary colleges separate from medical schools and move to the country?
• Why did the veterinary profession almost collapse between 1920 and 1925, when much of the rest of the country was experiencing the “Roaring Twenties”?
• Why did Cornell’s veterinary college―that had a written policy of favoring farm boys over city boys―admit a larger proportion of urban-raised Jews during the 1930s than the medical college at Cornell and the most prominent undergraduate colleges of the period?
• Why did the veterinary colleges at Harvard University and New York University (which had state funding) both close?

         These and many other questions are answered in an article on the history of veterinary medicine just published in the Journal of Veterinary Medical Education. [J Vet Med Educ 37 (4) p 317-327]. Based in large part from first person interviews with veterinarians (or close family members) who graduated in the 1920s and 1930s, this article provides answers to many questions that have never even previously been asked.
         This is the first in a series that summarizes the content of a course in veterinary history that I teach for veterinary students at Cornell. Three more articles have since been published and they describe the progress in veterinary education to the present. 

An abstract of the first article can be located at  http://jvmeonline.metapress.com/content/t17226626n444666/?p=b1ad61e374e64b89ae5363f40fc6dc84&pi=1
A full copy can be obtained from the publisher, library access, or by contacting me at the address below.

Dr. Smith invites comments at dfs6@cornell.edu

The Beginning of Organ Transplants

December 29, 2010:
Today’s Boston Globe contains a long obituary following the death Monday of the first human kidney transplant donor. It recalls the story of a remarkable event 56 years ago that ushered in the age of human organ transplantation. http://www.legacy.com/obituaries/bostonglobe/obituary.aspx?n=ronald-lee-herrick&pid=147481890

But the Globe’s obituary of 79-year-old Ronald Lee Herrick, and related stories in hundreds of other newspapers (and NPR), fail to recall an important element of that achievement.

Dogs Are Good Medicine

What do some child psychologists, neurologists and family therapists have in common? They use dogs as adjuncts in their medical practices.

A two-page spread is yesterday’s Wall Street Journal features numerous photographs of health care professionals accompanied by the dogs they use in their clinical practices. (URL below) There is even a flashback to Sigmund Freud and his Chou named Jofi.

Veterinarians and physicians use the term “One Health” to describe the growing awareness that animals and people share many health problems. Diseases like Salmonella or influenza are well known examples, but even some environmental-induced cancers are similar in animals and people.

However, "One Health" also refers to contributions that animals make to human health. Whether controlling obesity through encouraging exercise, lowering blood pressure, managing stress or providing companionship to senior citizens, dogs and other pets often part of a holistic human health strategy.