Biography of Alfred Blalock
Alfred Blalock graduated from the University of Georgia in 1918, and that year entered the study of medicine at Johns Hopkins University School of Medicine. He earned his M.D. from Johns Hopkins in 1922. From 1923 to 1925 he was hospital physician and assistant resident surgeon at Hopkins. Unable to obtain a residency at Hopkins, 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. Years later Dr. Blalock was to return to the idea. This early work on shock is credited with saving the lives of many casualties during World War II. In 1938 he conducted one experiment in which the left subclavian artery was joined to the left pulmonary artery in an effort to produce pulmonary hypertension. The experiment failed and was put aside. He was professor at Vanderbilt from 1938 to 1941, when he became professor and director of Department of Surgery, Johns Hopkins, positions he was to hold until his retirement in 1964.
The operation for blue babies
Blalock had developed great expertise in vascular anastomosis in animal surgery and invited Taussig to work in his laboratory following discussions she had with him on her patients with Fallot’s tetralogy. After many animal experiments, on November 29, 1944, Blalock and Taussig decided to proceed, and Blalock, with his surgical team and his invaluable assistant, Vivien T. Thomas, performed the first Blalock-Taussig operation on a patient with Fallot's tetralogy – joining the subclavian artery to the pulmonary artery in a cyanotic child. The tiny child who had been at such great risk survived the operation and slowly improved.
- "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 Dr. 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 instruments 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 Dr. Blalock and offered a number of helpful suggestions in regard to the actual technique of the procedure."
William P. Longmire, Resident Surgeon and first assistant in the operation. 1965.
Word of the successful operation spread quickly, bringing a steady flow of patients and visitors to the hospital. By the third time the procedure was performed, the success of the operation had become dramatically apparent. Dr. Taussig described the third patient to receive the landmark operation "as an utterly miserable, small six-year old boy who was no longer able to walk." His skin was intensely blue, his lips deep purple. Just after the final stitches were tied and the clamps released, the anaesthesiologist called out,
"The boy's a lovely colour now!"
In the years that followed thousands of cyanotic children were helped by the operation. Doctors from all over the world travelled to The Johns Hopkins Hospital to learn from Taussig how to make the diagnosis and from Blalock how to perform the anastomosis.
The third man
(Music by Anton Karas)
While Helen Brooke Taussig and Alfred Blalock both won deserved fame for their efforts, another key player is still unknown to most people: Blalock's assistant. In January 1930, Vivien Thomas, a young African-American, came to work for Blalock in his laboratory. At that point Blalock's increasing obligations were cutting into the time he could spend in the laboratory and he needed a surgical assistant. A more fortunate choice could not have been made. Vivien Thomas learned to perform the surgical operations and chemical determinations needed for their experiments, to calculate the results, and to keep precise records.
Blalock and Thomas worked closely in the surgical laboratories. Thomas was a major contributor in the development of operative techniques. Thomas supervised the surgical laboratories at Hopkins for over 35 years, and in 1976 he was appointed instructor in surgery at the Johns Hopkins University School of Medicine. In 1979, upon his retirement, he became instructor emeritus of surgery. Vivien Thomas's achievements were widely recognized by his colleagues. In 1976, he was awarded the honorary degree Doctor of Laws, by the Johns Hopkins University.
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.
In his last year Blalock devoted much of his time to the establishment of a centre for child medicine and child surgery in Baltimore.
- «It usually requires a considerable time to determine with certainty the virtues of a new method of treatment and usually still longer to ascertain the harmful effects.»
- Mechanism and treatment of experimental shock. I. Shock following hemorrhage.
Archives of Surgery, Chicago, 1927, 15: 762-798.
- Experimental shock. The cause of the low blood pressure produced by muscle injury.
Archives of Surgery, Chicago, 1930, 20: 959-996.
Blalock demonstrated that surgical shock is not due to the elaboration of toxins nor to reflex neurologic mechanisms, but to decrease in circulating the blood volume.
- Allen, J. Garrott:
Alfred Blalock and Our Heritage.
Archives of Surgery, Chicago, 1964, 89 (November): 929-931.
- A. Blalock, M. F. Mason, H. J. Morgan, S. S. Riven:
Myasthenia gravis and tumors of the thymic region.
Annals of Surgery, Philadelphia, 1939, 110: 544-561.
Report of a case in which the tumor was removed.
First deliberate treatment of myasthenia gravis by thymectomy.
- A. Blalock:
The Papers of Alfred Blalock.
2 volumes. Edited by Mark M. Ravitch. Baltimore: The Johns Hopkins Press, 1966.
- A. Blalock:
Reminiscence: Shock after Thirty-Four Years.
Review of Surgery, Philadelphia, 1964, 21: 231-234.