Vivien Thomas, Alfred Blalock, Helen Taussig, Austin Lamont, and Merel Harmel: Lessons from History
Myron Yaster MD and Mark Rockoff MD
Mark Rockoff, a former SPA President, and Senior Associate in the Department of Anesthesiology, Critical Care and Pain Medicine at the Boston Children’s Hospital and Professor of Anaesthesia at the Harvard Medical School, is one of our Society’s and the PAAD’s resident historians. He picked this recent article from JAMA Surgery on correcting the eponym Blalock-Taussig (or modified) shunt to the more appropriately named Blalock-Thomas-Taussig shunt. As many of you know, Vivien Thomas was a Black man in the Jim Crow era, who became Blalock’s lab assistant and was very much responsible for many aspects of that pioneering surgical procedure. At the time, Baltimore and the Johns Hopkins Hospital were very segregated (separate black and white wards, hospital entrances, even blood banks). Indeed, we recently commented on this in the February 25, 2022 PAAD on “Dr. Bernard Lown: Making the World a Better Place”. Nowadays Thomas would almost certainly have become a physician and an esteemed colleague, but not then. Thomas’ role in this landmark surgery was not mentioned in the original publication, even though many other collaborators of Drs. Blalock and Taussig were, including house staff, surgical assistants and anesthesiologists.1 And yet, Thomas can be seen standing directly behind Blalock’s shoulder in a photograph taken during an early shunt operation.2 Notably, he was in the operating room, where Black individuals were routinely excluded, only because Blalock insisted on his presence and relied on his intraoperative guidance. Indeed, this is a highlight moment in the 2004 film “Something the Lord Made”
In 1976, in recognition of his many achievements and accomplishments, Thomas was awarded an honorary doctoral degree by Johns Hopkins…but in law, not medicine(!) This was not unusual since Hopkins rarely awarded honorary medical degrees; in 1905 Sir William Osler received an honorary law degree from Hopkins as well. However, thereafter, Vivien Thomas was referred to by many as Dr. Thomas, and his portrait now hangs in the Blalock Building at Johns Hopkins Hospital across from Blalock’s portrait. Why should we care? This is not simply a correction of a past failure; it is very much for all of us to appreciate today. Even if you have limited time, PLEASE watch this outstanding lecture by Dr. Clyde Yancy given at the 2020 annual meeting of the Society of Thoracic Surgeons.3
https://www.sts.org/publications/videos/vivien-thomas-lecture-sts-2020
As Clancy summarizes in his lecture: “The tale of Vivien Thomas is not about discrimination, segregation and bias…it is about diversity, inclusion, sponsorship and allyship”.
We also took this opportunity to highlight the stories of Drs. Merel Harmel and Austin Lamont who were the anesthesiologists involved in the original blue baby (Tetralogy of Fallot) operations. Myron Yaster MD
Original article
Kathleen Blake, Clyde W Yancy. Change the Name of the Blalock-Taussig Shunt to Blalock-Thomas-Taussig Shunt. JAMA Surg. 2022 Apr 1;157(4):287-288. PMID: 34964811
Original article
Reves, J. G. MD; Newman, Mark F. MD. Merel Harmel: Portrait of an Anesthesiology Pioneer. Anesthesia & Analgesia: February 2016; Volume 122:(2)539-541.
Original article
A Muravchick, H Rosenberg. Austin Lamont and the evolution of modern academic American anesthesiology. Anesthesiology. 1996 Feb;84(2):436-41. PMID: 8602676
Today’s primary PAAD makes a strong case for changing the name Blalock-Taussig (B-T) shunt (or modified B-T shunt (MBTS) created using a GORE-TEX tube graft prosthesis to the Blalock-Thomas-Taussig shunt or the modified Blalock-Thomas-Taussig shunt. This is not a revisit of past history to condemn unwelcome events, but rather a revisit of celebrated history to acknowledge the pioneering work of Alfred Blalock and Helen Taussig now with the inclusion of Vivien Thomas and his pivotal contributions. What does this accomplish? Thomas’s name matters because of its power to inspire the curiosity of young scientists, engineers, and entrepreneurs to pursue their dreams and aspirations, regardless of obstacles leading to careers in medicine and research. It matters so that leaders, editors, senior physicians, and established scientists will invite and acknowledge contributions from all members of the scientific and clinical teams. And his name matters because truth matters.
The anesthesia side of the historic “blue baby” operation is not as well known. Both Drs. Lamont and Harmel were graduates of the Johns Hopkins School of Medicine. Lamont was a patrician born to great wealth.4 Harmel was one of the few Jewish men allowed to enter the Hopkins Medical School at the time.5 They both started out as surgeons and switched to anesthesiology in an era when most anesthesia services, including at Hopkins, were provided by nurses under the direction and supervision of the attending surgeon. This was not unusual then. Early in the 20th century, the first physician in Boston to be appointed “anesthetist” at any of the city’s hospitals (including Massachusetts General and Boston Children’s), Freeman Allen, was a trained as a surgeon. After his death in 1930, succeeding anesthesiologists at the Massachusetts General Hospital (Howard Bradshaw, followed by Henry Beecher) were surgeons there. Robert Smith, appointed chief of anesthesia at Boston Children’s Hospital in 1946, was also originally trained as a surgeon. At Hopkins, Lamont was the first physician anesthesiologist and Harmel was his first resident. Harmel was the physician (working alone as a resident in 1944!) who anesthestized the first baby for this shunt procedure with open drop ether. Lamont provided anesthesia for the next two patients using cyclopropane and an endotracheal tube. Though Blalock encouraged these young surgeons to develop “a more professional level of anesthesia expertise” within the Department of Surgery at Hopkins, he was not interested in having physician-delivered anesthesia and academic programs in anesthesiology at Hopkins or having anyone supersede the surgeon’s role in supervising anesthesia for their patients. Thus, Lamont and Harmel experienced severe professional disappointments and realized that they would always be “hand-maidens” to the surgeons and “scapegoats” for complications. They left Hopkins shortly thereafter. Lamont went to the University of Pennsylvania in 1947 and was one of the founders of the Association of University Anesthesiologists.4 Harmel founded and/or chaired academic departments at several universities: Albany Medical College (1948-1952), State University of New York Downstate Medical Center (1952-1968), University of Chicago (1968-1971), and Duke University (1971-1983).5
I (MY) had the good fortune of meeting and talking to Dr. Harmel on several occasions when he visited Hopkins on alumni days. He was an extraordinarily kind and warm man who made the world a better place. On more than one occasion he recounted with almost child like exuberance the awe and the feelings of wonder he experienced when that first child turned pink from a deeply cyanotic blue/purple when the Blalock-Thomas-Taussig shunt was completed.
Myron Yaster MD and Mark Rockoff MD
References
1. Blalock A, Taussig HB: Landmark article May 19, 1945: The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. By Alfred Blalock and Helen B. Taussig. Jama 1984; 251: 2123-38
2. Murphy AM, Cameron DE: The Blalock-Taussig-Thomas collaboration: a model for medical progress. Jama 2008; 300: 328-30
3. Yancy CY: 2020 Vivien T. Thomas lecture: the saga of Vivien Thomas: discrimination, segregation, and bias, 2020
4. Muravchick A, Rosenberg H: Austin Lamont and the evolution of modern academic American anesthesiology. Anesthesiology 1996; 84: 436-41
5. Reves JG, Newman MF: Merel Harmel: Portrait of an Anesthesiology Pioneer. Anesth Analg 2016; 122: 539-41