Vivien Thomas: surgical technician

Published in the Journal of the IST Spring 2017

Vivien Thomas did not intend to become a technician. He was a young man from Nashville with dreams of becoming a doctor, but on 29^th October 1929 he lost his job as a carpenter, his savings, and his chance at medical school when the stock market crashed.

It took a while but a little luck came his way when a friend found Thomas a job as a technician at Vanderbilt University’s Faculty of Medicine. With characteristic hard work and dedication he developed incredible surgical skill. He also gained a surprising level of independence in the laboratory which was almost unimaginable for a technician at that time, and beyond the realms of imagination for an African-American technician in the Jim Crow state of Tennessee.

All this came about due to Thomas’s supervisor, and eventual collaborator, Alfred Blalock. Blalock was an ambitious young surgeon who was impressed by this inexperienced technicians hard work. Within a week, to Thomas’s surprise, he was assisting Blalock in complex surgical experiments on dogs to investigate the physical effects of shock. Within 5 weeks, conscientious Thomas was carrying out the bulk of the experiments with only occasional visits from the ever-busy Blalock.

The innovative research undertaken by Thomas and Blalock into shock at this time contributed to the saving of many lives on the battlefield during World War II [1]. It also led to Blalock being offered a position as chief of surgery, professor, and director of the Department of Surgery at the world famous Johns Hopkins Medical School in Baltimore in 1941.

Such was Blalock’s reliance on Thomas that he insisted a position for Thomas at Johns Hopkins as part of the package. In spite of this show of loyalty, the pair had a complex relationship. They would, on occasion, share a whiskey in the laboratory late at night –a doubly illegal act due to prohibition and the Jim Crow laws. However, outside the laboratory, Blalock did not socialize with Thomas; in fact, the doctor often hired Thomas to serve drinks in his home during social events. Nor did Blalock encourage Thomas’s education or increases in Thomas’s wages – Thomas had been classed (and paid) as a janitor until 1936.

Not that life in Baltimore was much easier. The extreme segregation, two children to support, and a low salary made life hard for Thomas. Even the hospital was segregated, with separate treatment days for African Americans and Whites. The other African Americans who worked at the hospital were all janitors or cleaners and so wore blue coats. Thomas’s white coat against his black skin, along with his soon-obvious surgical skill and his role teaching young surgeons made him an object of unwelcome curiosity for all staff members. A reserved and proud man, Thomas found this difficult, in particular the preconceptions and prejudices of visitors who would come to his office and ask to see “Mr. Thomas”. Thomas would have to simply reply “Sure, he’s sitting right here”.

Once at Johns Hopkins, an exciting new project presented itself. Paediatric cardiologist Dr Helen Taussig presented Blalock with a seemingly intractable challenge. Blue-baby syndrome was caused by a congenital heart defect that meant insufficient flow of oxygenated blood from the lungs. It caused cyanosis and other unpleasant effects, with most affected babies dying shortly after birth. The solution seemed simple: a surgeon needed to connect one of the heart’s major arteries to another feeding into the lungs to provide greater blood flow. Until then, no surgeon had thought this possible. Blalock passed the problem on to Thomas.

After two years and more than 200 experiments on dogs, Thomas found a way to carry out the difficult ‘blue-baby’ operation, later known as the ‘Blalock-Taussig shunt’. In November 1944, 15-month-old Eileen Saxon was the first child to receive the life-saving treatment. Thomas prepared the operating room but did not plan on attending the surgery – he was surprised when Blalock insisted on his presence. The sight must have been extraordinary in 1940s America: a chief surgeon at one of the world’s most renowned institutions, engaged in ground breaking surgery while his African-American technician offered advice over his shoulder while standing on a step.

Unfortunately, Eileen Saxon developed complications and died during an attempt to repeat the operation. However, hundreds of subsequent operations were successful; Blalock saved many lives and reaped prestigious awards, even being nominated for the Nobel Prize. Thomas was not acknowledged in the paper by Blalock and Taussig paper that described the technique to the surgical community, or in the subsequent papers written by Blalock that expanded on the experimental work.

It took until seven years after Blalock’s death for Thomas to receive some of the acknowledgment he deserved. Many of the young surgeons that Thomas had trained went on to become influential surgeons, becoming a part of the prestigious “Old Hands” club. Such was their respect for their former teacher that in 1971, the club insisted on commissioning Thomas’s portrait, which was then hung next to Blalock’s at Johns Hopkins. At the unveiling ceremony, one of Thomas’s former students explained: “From him I learned the valuable surgical lesson that experimental procedures which seemed nearly impossible to execute when first tried might ultimately be performed… after the separate steps had been mastered” [2].

In 1976, Thomas was proud to be awarded an honorary degree from Johns Hopkins, even if the attention made this habitually private man somewhat uncomfortable. Presenting him for the award, the eminent surgeon Dr. Norman Anderson addressed Thomas, saying: “There are people around here with all kinds of degrees that never have, and never will, accomplish anything. You’ve already made a contribution.”[3]

By Andy Connelly

References

• [1] LH. Toledo-Pereyra, Alfred Blalock. Surgeon, educator, and pioneer in shock and cardiac research, Journal of Investigative Surgery, 18(4), 161-5 (2005).
• [2] V.T. Thomas. Pioneering Research in Surgical Shock and Cardiovascular Surgery, University of Pennsylvania Press (1985)
• [3] S. Timmermans, A Black Technician and Blue Babies, Social Studies of Science, 33(2), 197-229 (2003)