Posts Tagged ‘Helen Taussig’

The women who saved us: Abbott and Taussig

July 5, 2010

“Tonight I’ve seen someone with no legs stay standing, Dad, and someone with no voice keep shouting.”C.J. Cregg, The West Wing

From the late 1800′s until the 1950′s, the field of Pediatric Cardiology was dominated by women. In fact, women were working in Pediatric Cardiology before anyone had ever named the specialty. Because Pediatric Cardiology wasn’t really a medical specialty – it was where kids (and medical careers) went to die. And no one who had any sense wanted anything to do with it.

This was the state of medicine when Canadian Maude Abbott became a doctor in 1894. The number of female doctors at the time – in both Canada and America – could be counted on one hand. The male dominated medical profession viewed a female doctor as little more than a well-educated nurse. Even female patients were leery of a woman doctor.

Born in 1869, Abbott had decided on a medical career and graduated from Bishop’s College medical school in 1894. Abbott had gotten her undergraduate degree from McGill College and had applied to their medical school, only to find that they didn’t want her. McGill was one of the many medical schools that did not admit women.

Unable to find a job that suited her, Doctor Abbott toured Europe. She returned to Canada in 1987, opening a practice in Montreal. Before long, a fellow doctor (and her less than successful practice) had convinced her to take a research job at Royal Victoria Hospital. While at Royal Victoria, Abbott became interested in hearts and did ground breaking research on heart murmurs. The paper was good enough to be accepted by the Montreal Medical Society for presentation to the Society at their annual meeting. But Abbott would not be able to present it; the Society did not allow female membership.

If the work were to be presented, a male member of the Society would have to do it. Reluctantly, Abbott turned over her work and the paper was presented. But when the paper appeared in the Medical Society journal, it was assumed by readers that the gentleman was the author. Time passed and people forgot; it wasn’t until the early 1970′s that the M. E. Abbott, MD listed on the title sheet was recognized as the actual writer.

By late 1898 Maude Abbott was back at McGill. Stung by the fact that they had turned away someone who would eventually be recognized by the Montreal Medical Society (even if she was just a girl) McGill wanted her… but they didn’t have any job to give her. Finally they appointed Dr. Abbott as Assistant Curator of the Medical Museum with a promise to promote her when the Curator retired.

A 19th century medical museum was not what you might expect. Its primary job was to help doctors learn, and the museum was full of preserved body parts. Even with preservation, the “exhibits” would wear out and new items were constantly being sought out. A good museum also had any number of unusual or diseased specimens – things doctors might not see very often. These were very much desired as medical training of the day was more hands on, and a good museum would have plenty of normal and unusual items to study.

McGill was not a good medical museum. Things were misplaced, mislabeled, or had disappeared. There wasn’t even a catalogue and no one seemed to know where anything was. Even worse, the employees had no medical training; you could refer to something by its scientific name and no one knew what you were talking about. Obviously the first job would be the hardest – catalog and organize everything, give it some sense of order.

Abbott’s boss looked at the calender – three weeks to his retirement. No way did he want to get involved in a major project this close to leaving. But if you want to, go right ahead. So Maude got busy.

And that is when she found it.  A preserved heart in a glass jar. But was this thing really a heart – there were what looked like two Atriums, but only one Ventricle. A deeper study revealed a second Ventricle, one so small that it was barely noticable. Two of the valves drained into the larger Ventricle, and she couldn’t tell what fed the other Ventricle. The label on the container read Ulcerative Endocarditis, but that had to be the cause of death. Endocarditis could not do this to a heart.

As expected, no one knew anything about the heart. Abbott knew someone who might; Dr. William Osler was a McGill graduate and an old friend. Osler was living in the United States and building Johns Hopkins into the institution that it would become. Abbott wrote Dr. Osler, describing the heart and asking if he knew anything about it.

Osler did know – he gave details that Abbott hadn’t noticed and he called it the “Holmes Heart” – so called because it had been donated to the medical museum by Andrew Holmes, that Medical School Director in 1822. The heart was so grossly deformed that an article about it appeared in the Edinburgh Medical Journal. (Experts surmise that the Holmes Heart very well may have been a Cor Triloculare Biatriatum heart, a very rare defect indeed.)

Curious still, Abbott searched for the issue of the Edinburgh Medical Journal that contained the research paper about the heart. She was shocked to discover that the heart was removed from a 22-year-old man during his autopsy. This heart had worked for twenty-two years? HOW? With that thought in her head, Doctor Maude Abbott decided to try to find out exactly how a defective heart worked… and perhaps one day, fix them.

And in that moment Congenital Cardiology was born.

Fast forward in time…

The situation was almost the same for Dr. Helen Taussig. By 1930, there were still very few female doctors, and opinion of them had not improved. Taussig was about to get a job at Johns Hopkins Hospital because she had gone to medical school there – it would be a bit difficult for the Hopkins Administration to award Taussig an MD and then claim that she wasn’t good enough to do the job. Helen wasn’t doing anything to discourage that thinking, because she had a little known secret: Helen Taussig, MD was losing her hearing.

Hopkins put her in charge of the Cardiac Care Unit of the Harriet Lane Home for Invalid Children, the dreaded Pediatric Cardiology department. In the 1930′s children with heart problems fell into two categories. One group had hearts weakened by Rheumatic Fever; these children would often recover but be left weakened by the disease’s attack on the heart valves; and children with Congenital Heart Defects (CHDs). CHDs were incurable with very few treatment options. If you were lucky a heart defect let you live until you were a teenager, but it always won in the end. 100% fatality rate – with luck, you could slow it down, but that was it.

Taussig was a natural-born researcher and could see only one way to try to figure out how heart defects worked. Nearly every day she sat down with grieving parents and asked a terrible question: May I conduct an autopsy on your child? She wouldn’t leave the job to others, Taussig would do the autopsy herself, and often she would remove and preserve the heart. In a few years her office was an unofficial medical museum, made up almost exclusively of hearts. Word started getting around about what she was doing and other doctors started complaining. Taussig’s boss and former mentor in medical school, Dr. Edwards Park, had to tell her to try to be a little more discrete several times. Taussig could make a bad situation worse by wanting to slice up a child, and by now her hearing loss was obvious. But the Cardiac Clinic was also producing some results, and most of the new ideas came from Taussig. Heart Defects (“Congenital Malformations”, as Taussig always called them) still won all the battles, but they were helping the kids live longer and better. If your child has a heart problem, doctors around the country were telling parents, get them to Hopkins.

Taussig had overcome her hearing problem with a special stethoscope that worked with a hearing aid (it was huge, the amplifier case is visible IN THIS PHOTO. Look for the black box balanced on the edge of the wheelchair) and by teaching herself to feel a heartbeat with her fingertips (CLICK HERE for a close up photo of her fingertip technique). But despite all this, there was nothing she could do. Children were living a little longer, and that was it.

Taussig observed what she called the “Fallot Squat,” when children with Tetralogy of Fallot (ToF) would squat deeply, folding their knee joints as much as possible. After thinking about this activity Taussig was able to determine that the children with low blood oxygen were actually suffocating, despite breathing deeply. Further investigation and reasoning gave her an idea: Heart surgery had never been tried before, but what if the blood vessels near the heart were moved around? Rearrange them to deliver more blood to the lungs and oxygenate it better. Would that work? Taussig thought that it would – but she wasn’t a surgeon, and couldn’t convince any of the Hopkins surgeons to try it.

A new Chief of Surgery arrived in late 1942, a man named Blalock from Vanderbilt University. It wasn’t love at first sight; in fact, the two disliked each other. The new doctor… well, he was a typical surgeon, thought the entire world revolved around him. His way or the highway. She wouldn’t admit to it, but Taussig could be stubborn herself. You didn’t mess with her patients, even a little bit. Add to that the fact that her deafness robbed her of a lot of opportunities for human interaction, and Helen Taussig was a loner. Her clinic, her patients, her research, her world. And very few people were admitted to that world.

It finally came to a head in the Hopkins Cafeteria. Legend has it that Taussig barged into a conversation between Blalock and Parks and took over. Working fast because she knew she’d have only one chance, Taussig convinced Blalock that she knew what she was talking about: an operation to direct more blood to the lungs of kids with defective hearts might work.

An additional year of research was frustrating, but necessary. Blalock and his research assistant, Vivien Thomas, had considered a similar idea while at Vanderbilt but had never progressed to human testing. Meanwhile, Helen was still doing autopsies. She didn’t like it, but moving too fast could ruin the entire project.

On November 29, 1944 they still weren’t ready but they tried anyway. Eileen Saxon was near death and could not wait much longer. Entering through an incision in her side, Blalock clamped the Subclavian Artery, cut it, and sewed it into the Pulmonary Artery. When the clamps were removed the surgical team watched in amazement as her blue lips slowly turned pink.

Even though all three of them have passed, Taussig, Blalock, and Thomas live on. The Blalock-Taussig shunt is still used today, and the entire field of Congenital Cardiac Surgery exists because of  them. “These children are my crossword puzzles,” Helen Taussig once said. “And one day I shall solve them.”

The Gross-Taussig Shunt

March 4, 2010

There was once a heart surgeon who was the acknowledged expert in Pediatric Heart Surgery. Dr. Helen Taussig once approached him asking for advice about re-routing some blood vessels to relieve a Congenital Malformation of the Heart known as Tetralogy of Fallot (ToF).

This surgeon was not Dr. Alfred Blalock.

As I mentioned yesterday, everyone is born with two heart defects: The foramen ovale and the  ductus arteriosus, which is a direct connection between the Pulmonary Artery and the Aortic Arch. It allows blood coming from the Right Ventricle to bypass the lungs, and it closes shortly after birth. If it fails to close it is refered to as a “patent ductus arteriosus” (PDA), and can lead to Congestive Heart Failure.

Robert Gross was born in 1905 and by 1938 was the Chief Resident at Children’s Hospital in Boston.  Children’s Hospital had been experimenting with closing PDAs in animals and was having success, and Gross was eager to try the repair in a human. Being a good Resident, he asked his boss, highly respected Surgeon-in-Chief  Dr. William E. Ladd. Ladd said no – we do not touch the heart.

Not long after that, Dr. Ladd went on vacation. Dr. Gross went to his substitute, Dr. Thomas Lanman, and again asked permission. Lanman gave him the OK, and on August 26, 1938, Dr. Gross closed the PDA of  a little girl named Lorraine Sweeney. Everything went perfectly.

Dr. Ladd came back from vacation, learned what had happened, and fired Dr. Gross.

Gross wasn’t out of work for long – the higher-ups at Boston Children’s thought the surgery was a great thing, and sent Dr. Ladd to rehire Dr. Gross! Rather than holding a grudge against Gross, Ladd came to realize just how good he was and the two teamed up. Working together, the two devised several new heart operations over the years and experimented with valve replacements and a heart lung machine. When Dr. Ladd retired, Dr. Gross was selected to replace him.

In the early 1940′s a young female doctor from Baltimore visited Dr. Gross. Since he was one of the leading Cardiac Surgeons of the time, she discussed with him a theory that she had: Although it was impossible (at the time) to do surgery on the heart, she felt that Tetarology of Fallot (ToF) could be relieved by redirecting some of the major blood vessels.

Gross was intrigued by the idea. When this doctor offered him the chance to actually help develop such an operation, Gross hesitated. She seem to be smart enough, and she did work at Johns Hopkins. They were as prestigious as Boston, and wouldn’t just hire anyone. But there were so few female doctors around no one would take her seriously…. and he turned her down.

So Helen Taussig, M.D., got back on the train and returned to Baltimore. A few years later Alfred Blalock was named Chief of Surgery at Johns Hopkins. Had Gross accepted Taussig’s offer, the first Congenital Heart Surgery could have been named the Gross-Taussig Shunt.

If it had worked. Without Vivian Thomas – who came to Hopkins with Dr. Balock – the operation could have failed and wrecked both of their careers.

Partners of the Heart

November 24, 2009

In honor of Red and Blue Day, what follows is a reprint of an article I wrote for the November 2009 issue of The Right Heart Times, the newsletter of the CHD support group Hypoplastic Right Hearts:

The Blalock-Taussig Shunt (Shunt means “detour”) was the brainchild of one of the most unusual people in medicine: Dr. Helen Taussig. Despite being Dyslexic and slowly losing her hearing after becoming a doctor, Taussig had overcome both disabilities to become the head of the Cardiac unit at the Harriet Lane Home for Invalid Children, located at Johns Hopkins Hospital in Baltimore, Maryland.

While at Harriet Lane she began to study Congenital Heart Defects, especially Tetralogy of Fallot (ToF). ToF children suffered from a combination of four heart defects which led to the mixing of oxygenated blood with unoxygenated blood inside their damaged hearts. This caused them to have Cyanosis (have a bluish tinge to their skin due to poor blood oxygenation), have poor stamina, difficulty feeding and usually die before they reached ten years old.  Despite the fact that these children were breathing hard and deep, they were suffocating – and there was nothing that Dr. Taussig could do about it.

Taussig’s frustration would continue until 1943, when Hopkins hired Dr. Alfred Blalock as the new Chief of Surgery. It wasn’t long after his arrival that Taussig and Blalock had a conversation that would change the world.

Hopkins legend states that Dr. Taussig literally broke into a conversation between Dr. Blalock and her boss, Dr. Edwards Park, and convinced him to attempt a surgical repair of the defect. Blalock reminded her that it was impossible to operate on the heart (at that time it was impossible) but Taussig contended that what she had in mind was not an operation on the heart itself, but moving the blood vessels around to send more blood to the lungs. She had the idea, but since she was not a surgeon she could not act on it.

Little did she know that he already had a partial answer. While studying the effects of shock on the human body, Blalock and his assistant Vivien Thomas had sewn a smaller artery onto the Pulmonary Artery in an attempt to increase blood pressure. Blood pressure had not been affected, but blood flow increased. The challenge now was to recreate the effects of ToF in a dog, perform the arterial connection, and evaluate the results. Swamped with his teaching duties and surgical schedule, Blalock turned the assignment almost completely over to Thomas. An African American with a high school education, Thomas had gotten a job in Blalock’s lab after dropping out of college and had become Blalock’s most able assistant.

Re-creating either the heart defect or the planned repair often proved fatal for the dog, but finally Thomas found the perfect combination and a mutt named Anna survived. The next step was to teach Blalock the procedure. The surgeon had observed the operation several times but had never done it himself; Thomas had done the procedure several hundred times – all on dogs.

On November 29, 1944, the trio tried the new surgery. They may have operated sooner than they wanted to, but young Eileen Saxon’s condition was deteriorating. Although she was 15 months of age, Eileen weighed only nine pounds and was badly cyanotic.

As they were preparing for surgery, Blalock turned to his scrub nurse and quietly asked her to summon Mr. Thomas. Although Thomas had taught him the procedure, he wanted his assistant close by in case there was a problem. Thomas entered the surgical suite and stood behind Blalock, guiding him through the operation and giving advice.

Making a five-inch incision on Eileen’s left side, Blalock clamped and cut her Left Subclavian Artery. The Left Subclavian branches off of the Aorta, travels along the shoulder blade (the Clavicle) and down the left arm. For a visual reference, the Left Subclavian Artery is located almost directly behind a police officer’s badge.
Blalock then placed clamps on the left branch of the Pulmonary Artery and made a small hole in the artery. Gently pulling the Subclavian downward, Blalock sewed the vessel onto the Pulmonary Artery, took a deep breath, and disconnected the clamps.

Eileen’s cyanosis almost instantly faded. “She’s a lovely color now!” Taussig exclaimed. Blalock’s surgical notes are a bit more understated, reporting that “the circulation in the nail beds of the left hand appeared to be fairly good at the completion of the operation.”

Originally known as a “subclavian to pulmonary anastomosis,”the operation was soon renamed the Blalock-Taussig Shunt, after the surgeon who performed it and the doctor who conceived it. Thomas received almost no credit for his part of the procedure during his lifetime.

Survivors of the Blalock-Taussig Shunt often have difficulty getting a pulse or a blood pressure reading in the arm on the shunt side (because of the disconnected Subclavian Artery) and should avoid having injections into that arm. In the late 1970′s the Modified Blalock-Taussig Shunt (MBTS) became popular. The MBTS leaves the Subclavian intact and makes the Subclavian-Pulmonary connection by inserting an artificial tube and avoids the arm problems created by the original Blalock-Taussig.
Eileen Saxon did well for a few months but again became Cyanotic as her shunt failed. She underwent another Blalock-Taussig Shunt (on her right side this time) but passed away just before her third birthday.

Blalock’s surgical team performed almost 200 Shunts in the space of a single calendar year and the operation opened the door for Congenital Cardiac Surgery. He continued to operate until just before his retirement in 1964, and died six months later.

Dr. Helen Taussig became known as “the Mother of Pediatric Cardiology” and had a part in averting the Thalidomide crisis in the early 1960′s. She retired in 1963 but often returned to Hopkins, staying current on the latest Cardiac research and contributing  much of it herself. She was killed in an automobile accident in May of 1986.

Vivien Thomas continued to stand at Blalock’s shoulder and eventually became Director of the Johns Hopkins Hospital Surgical Research Laboratories. He trained many of the surgeons who would become famous for their heart surgery accomplishments and invented many of the procedures that they would use. He received an honorary doctorate in 1976 and retired in 1979. Thomas wrote his autobiography, Partners of the Heart: Vivien Thomas and his work with Alfred Blalock and died in 1985, just before the book was published.

Anna the Dog served as the mascot of the Johns Hopkins Surgical Labs until her death in 1957.

The Dirty Little Secret of HLHS

October 1, 2009

She didn’t even have a name for it.

When Dr. Helen Taussig wrote Congenital Malformations of the Heart in 1947, she described one malformation as “Atresia or marked hypoplasia of the aortic orifice prevents the expulsion of blood from the left ventricle in the normal manner.” Taussig described several variations of the defect – actually different defects, later grouped together under the same deadly name – but could offer no treatment suggestions. Her Tetralogy of Fallot (ToF) patients could at least squat and get some temporary relief; children cursed with this malady died in less than one week. The left side of the heart wasn’t damaged as much as it just wasn’t there.

It wasn’t until 1958 that Dr. Jacqueline Noonan and Dr. Alexander Nadas named the group of defects Hypoplastic Left Heart Syndrome (HLHS). Hypoplastic comes from the root word hypoplasia, which means “small”.

But having a name for it didn’t make it any less deadly as HLHS continued to claim 100% of its victims. This sad story continued until 1985, when the first successful infant heart transplant took place.

At about the same time the Norwood Procedure was developed. Originally designed as one operation (which consistently failed) the procedure was soon split into two heart operations – and eventually three – which seemed to work. HLHS children now had a chance. Obviously long term survival rates aren’t known yet, but approximately 70% survive the three surgery protocol.

And thats when the dirty little secret of HLHS showed itself: While survival rates for the three operation procedure may be in the 70% range, getting from Stage I to Stage II is the hardest step.

The goal of the Stage I operation is to make the Right Ventricle do the job of the defective Left Ventricle – getting the blood to the body. With all of the blood flowing through the right side of the heart, that side is subject to higher flow pressures than it usually receives. A lot higher. In a defect in which the entire left side of the heart is damaged, a successful outcome usually depends on the Tricuspid Valve – located on the right side of the heart.

The inital results were confusing. The Norwood worked – then it didn’t. There didn’t seem to be any rhyme or reason to it, no way to predict outcomes. The surgery itself worked, but too often the results  seemed to be as random as a roll of the dice. The answer was the Sano Shunt, invented by Japanese surgeon Shunji Sano – a direct connection from the Right Ventricle to the Pulmonary Artery through a Gortex conduit. (this sounds redundant, but the Pulmonary Artery is normally disconnected from the ventricle in the Stage I operation). Studies showed that survival chances with the Modified Norwood was 11 times greater than with the Classic Norwood.

And now it is time to turn the tables – we’ve got a nasty little trick of our own. Heart defects have to start somewhere… at some point in fetal development, there must be one isolated problem that seems to “snowball” into something bigger as time passes. If we could find that one little problem and repair it then, maybe we can stop the snowball before it gets too big. A pretty cool idea, and maybe one day…

Someday…

A study released Monday (September 28, 2009) revealed that for seven years, doctors at several hospitals in Boston and Harvard Medical School have been detecting Aortic Stenosis in fetuses. Fetal Aortic Stenosis is a snowball; it usually becomes HLHS as the fetus develops.

70 future HLHS patients underwent surgery while still in the womb – a needle was inserted into the mother’s abdomen, passed into the fetus, and into the heart of the unborn child. A small balloon was used to enlarge the abnormally small Aortic Valve. 51 of the procedures were considered successful… and 30% (17 children of the 51) were born with two functional ventricles. That’s 17 children who won’t have HLHS.

Mark September 28  on your calendar… that was the day that the CHD world changed forever.

Present at the Creation

April 22, 2009

“In late November 1944 Dr. Blalock did the first Blue Baby operation on Eileen Saxon. I believe Denton Cooley was the Intern. The operation was done in late November just before changing services, and I rotated onto the service as Denton rotated off.

My job was to take care of Eileen. A lot of people, mainly Dr. Blalock and Dr. Taussig, were hovering over her. She didn’t seem to be less blue than she had been before the operation, but Eileen got better over the next few days.

It is interesting how little treatment we had to give back then. There wasn’t really much you could do except put a child in an oxygen tent, which increased the oxygen from 20 percent to 28 percent, obviously not much help. We did not have chest tubes, no intubation during general anesthesia, and none of the other things that are commonly done at the present time. Her operation had been done without an endotracheal tube, only with a mask. Miss Berger, the nurse-anesthetist, did the procedure.” – Dr. Henry T. Bahnson; interview appearing in Pioneers of Cardiac Surgery by William S. Stoney, M.D. Copyright 2008 Vanderbilt University Press, Nashville, Tennessee

We’ve come so far…

April 10, 2009

Here’s an article from a 2001 issue of the medical journal Circulation: Researchers studied Centers for Disease Control (CDC) records from 1979 to 1997, searching for deaths in which a Congenital Heart Defect was a factor. After identifying over 124,000 deaths that met the criteria, they discovered a few amazing facts:

* From 1979 to 1997, Congenital Heart Defect (CHD) deaths declined 39.4%.

* During the same time period, deaths associated with a CHD – in other words, a death in which the defect was a contributing factor but not the direct cause – dropped from an average of 7169 to an average of 5822. That is a decline of 5.32%.

* The number of infant deaths dropped by 50% over the study period.

So the big question is why? What are we doing right? The answer is “Nearly everything.” We’ve got better technology. Better methods of putting the patient under for surgery. For example, the “correct” formula for rendering a patient unconscious used to be X milligrams of Ether per Kilogram of body weight. Ether hasn’t been used since the 1960′s, and hardly anyone remembers the correct ratio anymore.

We’ve got a better, standardized heart-lung machine. In the early days of cardiac surgery there was no open heart surgery because no one could figure out how to operate on a beating heart. There were experiments with using another human being as a heart-lung;  running cross- circulation tubes and then stopping the heart while the other person’s heart and lungs took over for them. This left the chance that two people could perish during a surgery gone wrong – but surprisingly, the first person to undergo the procedure survived. She’s still alive today, but is a very private person and only a few select people know where she lives.

There were experiments with putting the patient in a tub full of ice and stopping the heart that way. The idea was interesting, but it never really worked. And then there was the first heart-lung machines – everyone who had an idea built one, it seemed, and in the mid 1950s there were several different versions available. Most of them used tubing from the same beer company – the same type of plastic tubes that deliver the beer into your glass when the bartender pulls the handle! But that was the best tubing that could be found, so that’s what they used. But now we have an even better, standardized Heart-Lung machine. A surgeon who worked last week in Chicago can step into an operating room in Sacramento and feel comfortable with his equipment.

The level of care has improved. Post surgical procedure used to involve sending the patient to “Cardiac Care” which was really just a spiffy ward. Only over time did the highly specialized Heart Units develop, along with the skills of the people who work there. Take the best nurse at Johns Hopkins in the 1940′s – better yet, take Helen Taussig herself – and drop her into a 2009 Cardiac Intensive Care Unit. She wouldn’t have the skills needed to work there.

And it is improving even more, all the time.

Making History

January 6, 2009

Doctor Blalock!

What are you doing out here? Doctor Taussig is beside herself, wondering where you are! Please get in there and get scrubbed up, or she’ll have my hide!

No I don’t know where Mr. Thomas is. Find him? Send him down to the OR? I don’t know about this… Yes, sir, you’re the doctor and I’m just an orderly. I’ll find Mr. Thomas myself! But right now, you need to be in the Scrub Room!

It is November 29, 1944, and YOU are Dr. Alfred Blalock. Eileen Saxon has just been brought into Room 706 for heart surgery… the first such operation ever attempted. If you think you are up to the challenge, CLICK THIS LINK.

What good is a deaf cardiologist?

November 30, 2008

Not much.

I’ve written about Vivien Thomas and Alfred Blaock; so it is time to write a few lines about the third person involved in the Blalock-Taussig Shunt: Pediatric Cardiologist Helen Brooke Taussig.

For those of you who may not know, Taussig’s my personal hero. When I was a patient at Johns Hopkins in 1967, Taussig herself examined me. From what my parents tell me, she was officially retired, but still lived in the Baltimore area and “stopped by the office” occasionally. I was five months old at the time, so I don’t remember it.

Her father was Frank Taussig, a prominent economist who taught at Harvard. Imagine his frustration when his daughter tried her best in school but still seemed to just not get it. I think every parent has shared that frustration at one time or another. It wasn’t her fault – it turns out that Helen Taussig had Dyslexia. Finally after a lot of patient work with her father everything just “clicked” and she was able to graduate. She went to the University of California at Berkley and then applied to Harvard Medical School.

The problem was, Harvard didn’t accept women into its medical program, so Helen tried Johns Hopkins Medical School instead. After she graduated, she took the job as head of the Cardiac Clinic at Hopkins’ children’s hospital, the Harriet Lane Home for Invalid Children.

Ironically, after becoming a doctor, Helen Taussig began to lose her hearing. And what good is a doctor – especially a cardiologist – who loses their hearing?

Thankfully, it wasn’t a sudden event. Helen Taussig lost her hearing slowly, and was able to compensate. Obviously a hearing aid would help, and she took full advantage of them. The movie Something the Lord Made is inaccurate in one respect: Mary Stuart Masterson (the actress who played the role of Helen Taussig) chose to use a more advanced hearing aid than was available at the time. The earpiece available in the early 1940′s was the size of an earmuff, and Masterson thought that such a large, bulky prop would distract from the character. (Look at this 1940′s era photo of Dr. Taussig examining a child in a wheelchair. The black box balanced on the edge of the chair is not Taussig’s medical bag, it is the amplifier for her hearing aid.)

As her hearing faded, she lost the ability to hear some of the chest sounds that a Cardiologist needs to hear to make a diagnosis. So she taught herself how to feel heartbeats by placing her fingertips lightly on the patient’s chest, and for years her hands were her “second stethoscope.” (Click here for a close-up photo of Taussig’s fingertip examination.)

Known mainly for her work in Pediatric Cardiology, few remember that Helen Taussig also played a critical role in averting the Thalidomide crisis in the United States. While Frances Kelsey receives credit (deservedly so) for not authorizing the drug for sale here, Taussig got involved when one of her German students commented that there had been a marked increase in the occurrence of Phocomelia in her home country. Taussig began to study the problem, and before long had determined that the morning sickness drug Thalidomide was causing birth defects. Because of Kelsey’s and Taussig’s actions, only 17 American children were affected by the drug.

So, what good is a deaf cardiologist? It all depends on who that deaf cardiologist is!

NOVEMBER 29, 1944: THE BLALOCK-TAUSSIG SHUNT

November 29, 2008

“I had never seen or examined a defective heart, and what I actually saw defies verbal description except in highly technical terms. I was amazed that some of these patients had survived as long as they had.”  — Vivien Thomas, Partners of the Heart: Vivien Thomas and his Work with Alfred Blalock, p. 81

“Like Something the Lord Made”, the original magazine article written by Katie McCabe that appeared in the August 1989 issue of The Washingtonian. (.pdf file)

“I remember… thinking it was impossible.”

The Vivien Thomas Fund

The History of Heart Medicine at Johns Hopkins

Hopkins Reading Room ( LOTS of information about the heart from Johns Hopkins Hospital)

“This operation is new and our knowledge is advancing rapidly; consequently, much of the following discussion may be subject to radical revision.”  — Dr. Helen Taussig, Congenital Malformations of the Heart, volume 1, p. 553.

Teamwork

November 28, 2008

blalock-thomas1

These two men did pioneer work on blood loss and shock. They developed heart surgery procedures that are still in use. Odds are, you have only heard of one of them.

Vivien Theodore Thomas was born on August 29, 1910 in Lake Providence, Louisiana. After graduating high school in 1929, he planned to attend Tennessee Agricultural and Industrial State Normal School, (Now known as Tennessee State University) with hopes of becoming a doctor.

He had been in school two months when the stock market crashed, causing him to lose his part-time carpentry job. Forced to drop out of college, Thomas still found work as a Lab Assistant at Vanderbilt University Medical School, working for surgeon Dr. Alfred Blalock. Although hired to sweep floors and clean out cages, Vivien Thomas impressed Dr. Blalock with his intelligence. Blalock was so impressed that he trained Thomas to be his Surgical Technician.

Thomas began assisting Blalock in the study of shock during surgery. Shock is caused by a sudden drop in blood flow through the body, and can be fatal. Working together, Blalock and Thomas developed ways to prevent shock from occurring during an operation. By World War II most of their theories were in use, saving the lives of countless injured soldiers.

In 1941, Dr. Blalock was hired by Johns Hopkins Hospital in Baltimore, Maryland, to serve as the hospital’s Chief Surgeon and as a Surgical Professor in the Hopkins Medical School. The doctor asked his trusted assistant to go with him, and Thomas agreed. But while Blalock was responsible for training every surgeon in the school, Thomas had to enter the building through the service entrance. He was also listed on the hospital payroll as a handyman.

The two men respected and trusted each other, but were hardly equal. At one time, Blalock was paid ten times more than Thomas. Often the doctor hired Thomas to serve drinks in his home during a social event. And never was Thomas allowed in the Operating Room.

It was at Johns Hopkins that the two men met Dr. Helen Taussig. Taussig had been hired in 1930 to oversee the Cardiac Clinic of the Harriet Lane Home, (Hopkins’ children’s hospital) and quickly grew interested in “Blue-Baby” diseases.

Usually, blood coming into the heart is routed first to the lungs, where it absorbs oxygen. The oxygen rich blood then goes back to the heart, where it is pumped throughout the body. Blue Babies are born with a badly formed heart or blood vessels that cannot provide enough oxygen to the blood. Their skin has a distinctive blueish tinge, especially in the fingertips. At that time Blue Baby diseases were incurable, and almost all of the patients died very young.

Dr. Taussig approached Dr. Blalock with an idea: if a Blue Baby’s heart couldn’t provide  oxygen to the blood naturally , then why couldn’t a surgeon re-route the major blood vessels? Taussig’s plan was interesting but extremely dangerous. The operation would have to take place near the heart, and heart surgery was so risky it was almost never recommended. Any accidental damage to the heart would have to be repaired within 4 minutes, or the patient died.

Busy with his teaching duties, Blalock asked Vivien Thomas to work out the details of how such an operation could be done. Thomas began by studying medical textbooks, drawings and diagrams of hearts, and even real hearts taken from dead bodies. Then he operated on dogs, intentionally creating Blue Baby hearts in them. Later he would operate again, repairing the heart and making careful notes of everything he did. It was a slow process, learning exactly what had to be done.  Many dogs died, and several of the surgical tools he needed didn’t even exist. Quite often, Thomas would invent them.

X-rays of the patient were another problem. X-ray films provide a good still photograph of the workings of the body. But Taussig preferred to use a fluoroscope. A fluoroscope image is best described as “X-ray TV”– It provided moving images of the interior of the body. If the patient accidentally moved, so did the picture. There was no way to record the fluoroscope image, so the three doctors would have to study their patient’s fluoroscope scans carefully and commit them to memory.

At last they felt they were ready, and Taussig began to search for a proper patient. On November 29, 1944, they operated on a little girl named Eileen. Although fifteen months old, Eileen only weighed nine pounds.

Thomas had planned to be in the observation room, watching the operation. Blalock said no – he felt more comfortable with Thomas close enough to give him advice. In preparation for the operation, Thomas had performed the procedure over 100 times on animals. Blalock had been taught the procedure by Thomas, but had actually done it only once. Breaking all the rules of the time, Thomas entered the operating room and guided  Blalock through the operation.

Eileen’s heart never stopped beating and her blood vessels were only as thick as a  matchstick. After about 90 minutes, Blalock was finished. Everyone held their breath as he removed the last clamp from a blood vessel. After a long pause, Helen Taussig said “Al, the baby’s lips are a glorious pink color.”

Proven to be a success, Blalock’s team performed nearly 300 operations in less than a year. Surgeons came from around the world to study Blalock’s new surgical procedures, only to learn that Thomas was the expert, not Blalock or Taussig. Still, the operation was known as the “Blalock-Taussig Shunt,” named for the surgeon who performed it and the doctor who suggested it.

Blalock retired in 1964 and died four months later. For six years, Thomas continued to teach but took on no major project – almost as if  he were in mourning. But as the 1970′s began, more and more African-Americans were entering the Hopkins Medical School. To them, Vivien Thomas was not just one of their teachers, he became their mentor. And just as he had guided Blalock so many years before, Thomas’ advice and support guided a new generation of doctors through medical school.

Thomas died in 1985, just a few days before his autobiography was published.* Today, Vivien Thomas is almost unknown to the general public. But Dr. Alfred Blalock never forgot him. If someone stood too close to his right shoulder during an operation, Blalock would tell them to back away. “Only Vivien may stand there.”**

* Thomas’ autobiography has been reissued with a new title: Partners of the Heart: Vivien Thomas and his work with Alfred Blalock. A hardback copy of the original title, Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and his work with Alfred Blalock is usually valued at over $100.

** This photo has been identified by Johns Hopkins archivists as being a photo of the third Blalock-Taussig Shunt taken in early 1945. Dr. Helen Taussig normally would have been in the operating room but is not identifable in this photograph.


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