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Thomas,VT
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发表时间:2008-12-24
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发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Vivien T. Thomas: a surgery master who never went to college
发信站: BBS 未名空间站 (Wed Dec 24 10:19:13 2008)

Vivien T. Thomas was born in New Iberia, Louisiana in 1910, the son of a
carpenter. His family moved to Nashville, where Vivien graduated with honors
from Pearl High School, one of the country's top high schools.

In 1929, as he was preparing for college and medical school, Thomas lost his
entire savings when a Nashville bank failed. With no financial support for
a college education, he took a job as a laboratory technician at Vanderbilt
University Medical School, working for Dr. Alfred Blalock.

Dr. Blalock, then 30, was conducting groundbreaking research into the causes
and effects of shock, the body's reaction to trauma. Because his clinical
duties required him to spend much of his time with patients in the hospital,
he wanted someone knowledgeable and independent who could carry out his
research work in the laboratory.

Although Thomas was only 19, Blalock was impressed by his confident,
business-like air, and hired him immediately. Their association was to last
until Blalock's death in 1964.

Thomas's surgical talent manifested itself almost immediately. "Within three
days," wrote Katie McCabe in Reader's Digest, "[he] was administering
anesthesia and performing arterial punctures on laboratory dogs."

"For the time being, I felt secure," Thomas wrote in his autobiography. "At
least I had a job. It seemed to be a matter of survival." He threw himself
into his work. Before long, he was spending 16 hours a day in the laboratory
, supervising experiments at night and devouring chemistry and physiology
textbooks during the day. "Within months, he was performing delicate and
complex procedures with the ease of a master, " wrote Katie McCabe.

Thomas invented a heavy spring device which they used to apply varying
degrees of pressure to the extremities of animals. He then recorded each
reaction. The information they collected enabled Blalock to construct a new
understanding of traumatic shock, showing that shock was linked to a loss of
fluid and blood volume. Blalock's landmark discovery that shock was linked
to a loss of fluid and a decrease in blood volume earned him the respect and
admiration of the international medical community, and resulted in the
widespread application of life-saving blood transfusions during World War II
.

The fruitful and enduring partnership between Blalock and Thomas was
especially remarkable considering the time and the place. "Both were steeped
in the social traditions of the Old South and knew the rigidly prescribed
codes of behavior for whites and blacks." "They understood the line in 1930
between life inside the lab, where they could drink together, and life
outside, where they could not.

In all their years together, neither would ever cross that line. But within
the insular world of the laboratory, they functioned almost as a single unit
, Thomas's deft hands turning Blalock's ideas into elegant and detailed
experiments.

They were an unbeatable combination. Blalock, the scientist, asking the
simple but profound questions. Thomas, the pragmatist, figuring the simplest
way to get the answers."

In 1941, when Blalock left Vanderbilt to become Chief of Surgery at Johns
Hopkins, he insisted that Vivien Thomas be hired to join his team there.
Although the university agreed to Blalock's terms, Thomas's arrival in June
of 1941 caused quite a stir. "On one occasion when Thomas walked across
campus, he halted traffic". "A black man in a lab coat was something unheard
of at Johns Hopkins, which had segregated restrooms and a separate entrance
for black patients. But inside the lab it was Thomas's skill, rather than
his skin color, that raised eyebrows."

Shortly after Blalock and Thomas arrived at Johns Hopkins, the hospital's
chief of pediatrics approached Blalock for help in correcting the problem of
coarctation, or narrowing, of the aorta in children. In order to
investigate the disorder--as well as many others--in laboratory animals,
Thomas devised a positive-pressure respirator that inflated the lungs of
dogs under anesthesia. At that time, no such machine was available. He and
Blalock then went on to create, and attempt to correct, specific
cardiovascular defects in dogs.

Blalock spent less and less time in the laboratory, and it was up to Thomas
to develop, monitor, and calculate the results of all of their experimental
procedures. The surgeon trusted him implicitly, and regarded him as a full
and equal partner. "It was extremely difficult to tell if Dr. Blalock had
the original idea for a particular technique or if it was Vivien Thomas," Dr
. Alan Woods, Jr., a former intern at Johns Hopkins, said. "They worked so
smoothly together, we--the medical students--didn't know...."

In 1943 Johns Hopkins cardiologist Helen Taussig met with Blalock and Thomas
to solicit their advice concerning the treatment of an infant with
deficient blood flow to the lungs. Eileen Saxon, born with multiple heart
defects that caused her to become weak and cyanotic, was only one of a
growing number of "blue babies" whom Taussig had been unable to help.

By this time, Blalock and his assistant had performed hundreds of intricate
cardiac procedures in the lab. In a series of experimental operations at
Vanderbilt, they had attempted to bring more blood to the lungs of
laboratory dogs by dividing a major artery and sewing it to the pulmonary
artery that supplies the lungs. They believed that a refined version of this
procedure might help Dr. Taussig's "blue babies."

Blalock and Thomas spent much of the following year developing and
performing experimental procedures in the laboratory in preparation for the
historic operation on Eileen Saxon. But it was Thomas who worked out the
final details of the surgical technique and taught them to his famous
associate. He and Blalock also collaborated on the design of surgical
equipment.

Shown here is a clamp for the temporary occlusion of the pulmonary artery,
which was devised for Blalock's use by Vivien Thomas and William Longmire,
working with the local surgical supply house.Thomas tested the procedure---a
refinement of one that they had created in laboratory dogs---to make sure
it would work.

On the day of the operation, however, Thomas was nowhere to be found.
Flanked by a surgical team that included some of the country's foremost
physicians and researchers, Blalock refused to begin the procedure without
his laboratory assistant at his side. Eventually Thomas was located in the
laboratory and summoned to the operating floor. For the next three hours,
Thomas stood quietly at Blalock's right shoulder, watching carefully as the
surgeon's scalpel and needles moved in and out, and offering helpful
suggestions. With Thomas advising Blalock, the first "blue baby" operation
was successfully performed.

Because of Thomas's surgical expertise, and his exhaustive knowledge of the
procedure, Blalock insisted that he be present for the first 100 operations.
According to McCabe, if any operating room staff member attempted to move
into the space behind Blalock's right shoulder, the surgeon would deliver
the quick admonishment, "Only Vivien is to stand there."

In addition to providing invaluable help to Dr. Blalock in the operating
room, as head of the surgical research laboratory at Johns Hopkins, Thomas
helped to train a generation of surgeons and lab technicians.

"For the residents and research fellows who worked in the Surgical Hunterian
Laboratory, Vivien's ability to teach us the newly evolving techniques in
vascular and cardiac surgery was unique," wrote Dr. David C. Sabiston in the
Journal of the American Medical Association. "He always provided willing
advice and assistance, and our respect and admiration for him were no less
than that of our professors."

Yet, despite his hard work and many talents, Thomas remained largely
invisible at Johns Hopkins and earned little more than a mediocre income.
Not until he announced his intention to leave the university to accept a
more lucrative job as a carpenter did the hospital offer to double his
salary. Thomas then agreed to stay.

By the time Dr. Blalock died in 1964, Thomas had come to terms with the fact
that he had never obtained a college degree. He continued to supervise the
surgical research laboratories at Johns Hopkins until his retirement in 1979
.

As time went on, however, he became more embroiled in teaching and
administrative responsibilities, and less involved in surgical research.

He was genuinely surprised, and deeply moved, in February of 1971, when a
large group of surgeons from around the country--members of the elite group
of residents he and Blalock had helped to train--gathered in the auditorium
at Johns Hopkins to pay tribute to his life and accomplishments.Dr. Rollins
Hanlon, former president of the American College of Surgeons, called Thomas'
impact on surgery "enormous."

In 1976, Johns Hopkins University presented Thomas with an honorary
doctorate. However, because of certain restrictions, he received an Honorary
Doctor of Laws, rather than a medical doctorate. Thomas was also appointed
to the faculty of Johns Hopkins Medical School as Instructor of Surgery.

Vivien Thomas died in Baltimore in 1985.

Vivien Thomas' legacy as an educator and scientist continued with the
institution of the Vivien Thomas Young Investigator Awards, given by the
Council on Cardiovascular Surgery and Anaesthesiology beginning in 1996. In
1993, the Congressional Black Caucus Foundation instituted the Vivien Thomas
Scholarship for Medical Science and Research sponsored by GlaxoSmithKline.
In Fall 2004, the Baltimore City Public School System opened the Vivien T.
Thomas Medical Arts Academy, and on January 29, 2008, MedStar Health
unveiled the first "Rx for Success" program at the Academy, joining the
conventional curriculum with specialized coursework geared to the health
care professions. In the halls of the school hangs a replica of the portrait
of Vivien Thomas commissioned by his surgeon-trainees in 1968.

In the early 1980s, Thomas's nephew, Koco Eaton, was admitted to Johns
Hopkins Medical School. Eaton was "trained in surgery by the men his uncle
had helped to train a generation earlier. And he turned heads in the halls
of Johns Hopkins--as his uncle had in 1941--not because he was black, but
because he was the nephew of Vivien Thomas."




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