Portrait of Alfred Blalock by Yousuf Karsh, ©Karsh
Alfred Blalock earned his M.D. from Johns Hopkins in 1922. Three years
later he left Baltimore, considering himself something of a failure at age 26, for he had
not achieved a residency in surgery. He headed to Nashville to become the first resident
in surgery in the new Vanderbilt University Hospital. While at Vanderbilt he did
pioneering work on the nature and treatment of hemorrhagic and traumatic shock. He
demonstrated that surgical shock resulted primarily from the loss of blood, and he
encouraged the use of plasma or whole-blood transfusions as treatment following the onset
of shock. This early work on shock is credited with saving the lives of many casualties
during World War II.
Blalock and his team who were working on shock at Vanderbilt,
labored to create different physical conditions in dogs. In 1938, he
conducted one experiment in
which the left subclavian artery was joined (anastomosed) to the left pulmonary
artery in an effort to produce pulmonary hypertension. The experiment
failed and was put aside.
Years later Blalock was to return to the idea.
In 1941 Alfred Blalock returned to Hopkins to assume dual appointments as
surgeon-in-chief of the hospital, and professor and director of the department of surgery
of the medical school, positions he was to hold until his retirement in 1964.
Alfred Blalock lecturing at The Johns Hopkins
University School of Medicine,
from the Olive Berger papers of The Alan Mason Chesney Medical Archives
Blalock arrived well prepared for the surgical work that was to
challenge him. He brought with him one of his most valued colleagues, his surgical
research technician Vivien Thomas.
Together they formed a close partnership that was to last more than 30 years. Thomas was
known for his eager intelligence and his superb surgical skill.
Over the next few years, the shunt technique was developed further at
Hopkins. It was used as a means of bypassing an obstruction (coarctation) of the aorta.
It was while Blalock was discussing his work on coarctation that Helen
Taussig presented to him the problem of the blue-baby in relation to some sort of
arterial shunt that would furnish more blood to the lungs.
Later Blalock wrote, "Vivien Thomas, my superb technician, and
I performed many experiments with this end in view." Vivien Thomas said, "Our
first attack on the problem was to try to form in an animal a 'blue-baby syndrome' in
order that we could work out a procedure for correction."
The 'syndrome' is the tetralogy of Fallot, which consists of a hole in the
wall between the heart's two major chambers (ventricles), an elarged right ventricle, a
defective pulmonary valve that prevents full flow of blood to the lung, and cyanosis.
Cyanosis is indicated outwardly by blueness and caused by the lung's inability to
oxygenate sufficient blood for the system.
The first operation on a patient occurred on November 29, 1944. First
assistant in that operation was William P. Longmire, Resident Surgeon. In 1965 he
recalled,
I must say my enthusiasm for the idea completely disintegrated when I
saw the frail cyanotic infant in the oxygen tent on the east ward of Harriet Lane 4. At
that time Blalock spoke briefly with the parents (and indicated again the serious
nature of the operation). It seemed to me from the way he greeted them that they had
discussed the operation prior to the child's admission to the hospital....At the time of
the first operation we lacked all of the modern vascular intstruments and really had
little but the Professor's determination to carry us through the procedure. The child had
extensive collateral vessels full of thick dark blood which I of course, had never seen
before. The pulmonary artery was identified with some difficulty and was isolated back
into the mediastinum. It was amazing to see the Professor gently but blindly insert a
right angle clamp into the mediastinum and after dissecting over his index finger, pull
out the innominate artery...Vivien Thomas stood in back of Blalock and offered a
number of helpful suggestions in regard to the actual technique of the procedure.
An illustration by Leon Schlossberg of the
procedure.
By permission of Surgery, Gynecology & Obstetrics, now known
as the
Journal of The American College of Surgeons.
The operation was successful, and word spread quickly, bringing a steady
flow of patients and visitors to the hospital.
Blalock's contributions to surgery were recognized nationally and
internationally. He was elected to membership in the National Academy of Sciences and
the American Philosophical Society.
A detail of a presentation letter given to Blalock
following the
Moynihan Lecture, which he gave in 1954, in Leeds, England.
Among the prestigious honors which Alfred Blalock received were the Chevalier
de la Legion d'Honneur, the Passano
Award, the Matas Award, and the Albert Lasker Medical Research Award.
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