Vivien Theodore Thomas (August 29, 1910 – November 26, 1985)[1] was an AfricanAmerican laboratory supervisor who developed a procedure used to treat blue baby syndrome (now
known as cyanotic heart disease) in the 1940s.[2] He was the assistant to surgeon Alfred Blalock in
Blalock's experimental animal laboratory at Vanderbilt University in Nashville, Tennessee, and later
at the Johns Hopkins University in Baltimore, Maryland. He served as supervisor of the surgical
laboratories at Johns Hopkins for 35 years. In 1976 Hopkins awarded him an honorary doctorate and
named him an instructor of surgery for the Johns Hopkins School of Medicine.[2] Without any
education past high school, Thomas rose above poverty and racism to become a cardiac
surgery pioneer and a teacher of operative techniques to many of the country's most prominent
surgeons.
A PBS documentary Partners of the Heart,[3] was broadcast in 2003 on PBS's American
Experience. In the 2004 HBO movie, Something the Lord Made, Vivien Thomas was portrayed
by Mos Def.
Background[edit]
Thomas was born in New Iberia, Louisiana, and was the son of Mary (Eaton) and William Maceo
Thomas.[4][5] The grandson of a slave, he attended Pearl High School in Nashville in the
1920s.[6]Thomas had hoped to attend college and become a doctor, but the Great
Depression derailed his plans.[7] He worked at Vanderbilt University in the summer of 1929 doing
carpentry[8] but was laid off in the fall. In that same year, Thomas enrolled in the Tennessee
Agricultural and Industrial College , currently known as Tennessee State University, as a premedical
student.[9]
Career[edit]
In the wake of the stock market crash in October, Thomas put his educational plans on hold, and,
through a friend, in February 1930 secured a job as surgical research assistant with Dr. Alfred
Blalockat Vanderbilt University.[10] On his first day of work, Thomas assisted Blalock with a surgical
experiment on a dog.[11] At the end of Thomas's first day, Blalock told Thomas they would do another
experiment the next morning. Blalock told Thomas to "come in and put the animal to sleep and get it
set up". Within a few weeks, Thomas was starting surgery on his own.[12] Thomas was classified and
paid as a janitor,[13] despite the fact that by the mid-1930s, he was doing the work of a Postdoctoral
researcher in the lab.
When Nashville's banks failed nine months after starting his job with Blalock and Thomas' savings
were wiped out,[10] he abandoned his plans for college and medical school, relieved to have even a
low-paying job as the Great Depression deepened.
Working with Blalock[edit]
Vivien Thomas in the lab
Vanderbilt[edit]
Thomas and Blalock did groundbreaking research into the causes of hemorrhagic[14] and
traumatic shock.[15] This work later evolved into research on crush syndrome[16] and saved the lives of
thousands of soldiers on the battlefields of World War II.[16] In hundreds of experiments, the two
disproved traditional theories which held that shock was caused by toxins in the blood.[17] Blalock, a
highly original scientific thinker and something of an iconoclast, had theorized that shock resulted
from fluid loss outside the vascular bed and that the condition could be effectively treated by fluid
replacement.[17] Assisted by Thomas, he was able to provide incontrovertible proof of this theory, and
in so doing, he gained wide recognition in the medical community by the mid-1930s. At this same
time, Blalock and Thomas began experimental work in vascular and cardiac surgery,[14] defying
medical taboos against operating upon the heart. It was this work that laid the foundation for the
revolutionary lifesaving surgery they were to perform at Johns Hopkins a decade later.
Johns Hopkins[edit]
By 1940, the work Blalock had done with Thomas placed Blalock at the forefront of American
surgery, and when he was offered the position of Chief of Surgery at his alma mater Johns Hopkins
in 1941,[18] he requested that Thomas accompany him.[18] Thomas arrived in Baltimore with his family
in June of that year,[19]confronting a severe housing shortage and a level of racism worse than they
had endured in Nashville.[20] Hopkins, like the rest of Baltimore, was rigidly segregated, and the only
black employees at the institution were janitors. When Thomas walked the halls in his white lab coat,
many heads turned. He began changing into his city clothes when he walked from the laboratory to
Blalock's office because he received so much attention.[21] During this time, he lived in the 1200 block
of Caroline Street in the community now known as Oliver, Baltimore.
Blue baby syndrome[edit]
Heart presenting a tetralogy of Fallot. A. pulmonic stenosis B. overriding aorta C. ventricular septal
defect (VSD) D. right ventricular hypertrophy
In 1943, while pursuing his shock research, Blalock was approached by pediatric cardiologist Helen
Taussig,[22] who was seeking a surgical solution to a complex and fatal four-part heart anomaly
called tetralogy of Fallot (also known as blue baby syndrome, although other cardiac anomalies
produce blueness, or cyanosis). In infants born with this defect, blood is shunted past the lungs, thus
creating oxygen deprivation and a blue pallor.[22] Having treated many such patients in her work in
Hopkins's Harriet Lane Home, Taussig was desperate to find a surgical cure. According to the
accounts in Thomas's 1985 autobiography and in a 1967 interview with medical historian Peter Olch,
Taussig suggested only that it might be possible to "reconnect the pipes"[23] in some way to increase
the level of blood flow to the lungs but did not suggest how this could be accomplished. Blalock and
Thomas realized immediately that the answer lay in a procedure they had perfected for a different
purpose in their Vanderbilt work, involving the anastomosis (joining) of the subclavian artery to
the pulmonary artery, which had the effect of increasing blood flow to the lungs.[23]Thomas was
charged with the task of first creating a blue baby-like condition in a dog, and then correcting the
condition by means of the pulmonary-to-subclavian anastomosis.[24] Among the dogs on whom
Thomas operated was one named Anna, who became the first long-term survivor of the operation
and the only animal to have her portrait hung on the walls of Johns Hopkins. In nearly two years of
laboratory work involving 200 dogs, Thomas was able to replicate two of the four cardiac anomalies
involved in tetralogy of Fallot.[25] He did demonstrate that the corrective procedure was not lethal,
thus persuading Blalock that the operation could be safely attempted on a human patient.[26] Blalock
was impressed with Thomas's work; when he inspected the procedure performed on Anna, he
reportedly said, "This looks like something the Lord made."[27] Even though Thomas knew he was not
allowed to operate on patients at that time, he still followed Blalock's rules and assisted him during
surgery.[28]
Decisive surgery[edit]
On November 29, 1944, the procedure was first tried on an eighteen-month-old infant named Eileen
Saxon.[28] The blue baby syndrome had made her lips and fingers turn blue, with the rest of her skin
having a very faint blue tinge. She could only take a few steps before beginning to breathe heavily.
Because no instruments for cardiac surgery then existed, Thomas adapted the needles and clamps
for the procedure from those in use in the animal lab.[29] During the surgery itself, at Blalock's
request, Thomas stood on a step stool at Blalock's shoulder and coached him step by step through
the procedure.[30] Thomas performed the operation hundreds of times on a dog, whereas Blalock only
once as Thomas' assistant.[30] The surgery was not completely successful, though it did prolong the
infant's life for several months.[31] Blalock and his team operated again on an 11-year-old girl, this
time with complete success, and the patient was able to leave the hospital three weeks after the
surgery.[31] Next, they operated upon a six-year-old boy, who dramatically regained his color at the
end of the surgery.[31] The three cases formed the basis for the article that was published in the May
1945 issue of the Journal of the American Medical Association, giving credit to Blalock and Taussig
for the procedure. Thomas received no mention.[29]
Schematic representation of the Blalock-Thomas-Taussig anastomosis between the right subclavian artery and
right pulmonary artery. A / initial anastomosis - B / modified anastomosis.
News of this groundbreaking story was circulated around the world by the Associated
Press.[29] Newsreels touted the event, greatly enhancing the status of Johns Hopkins and solidifying
the reputation of Blalock, who had been regarded as a maverick up until that point by some in the
Hopkins old guard.[32] Thomas' contribution remained unacknowledged, both by Blalock and by
Hopkins. Within a year, the operation known as the Blalock-Thomas-Taussig shunt had been
performed on more than 200 patients at Hopkins, with parents bringing their suffering children from
thousands of miles away.[32]
Skills[edit]
Thomas's surgical techniques included one he developed in 1946 for improving circulation in
patients whose great vessels (the aorta and the pulmonary artery) were transposed.[33] A complex
operation called an atrial septectomy, the procedure was executed so flawlessly by Thomas that
Blalock, upon examining the nearly undetectable suture line, was prompted to remark, "Vivien, this
looks like something the Lord made".[33] To the host of young surgeons Thomas trained during the
1940s,[34] he became a figure of legend, the model of a dexterous and efficient cutting surgeon.
"Even if you'd never seen surgery before, you could do it because Vivien made it look so simple," the
renowned surgeon Denton Cooley[28] told Washingtonian magazine in 1989. "There wasn't a false
move, not a wasted motion, when he operated." Surgeons like Cooley, along with Alex
Haller,[35] Frank Spencer,[36] Rowena Spencer,[37] and others credited Thomas with teaching them the
surgical technique that placed them at the forefront of medicine in the United States. Despite the
deep respect Thomas was accorded by these surgeons and by the many black lab assistants he
trained at Hopkins, he was not well paid.[38] He sometimes resorted to working as a bartender, often
at Blalock's parties. This led to the peculiar circumstance of his serving drinks to people he had been
teaching earlier in the day. Eventually, after negotiations on his behalf by Blalock, he became the
highest paid assistant at Johns Hopkins by 1946, and by far the highest paid African-American on
the institution's rolls.[39] Although Thomas never wrote or spoke publicly about his ongoing desire to
return to college and obtain a medical degree, his widow, the late Clara Flanders Thomas, revealed
in a 1987 interview with Washingtonian writer Katie McCabe that her husband had clung to the
possibility of further education throughout the blue baby period and had only abandoned the idea
with great reluctance. Mrs. Thomas stated that in 1947, Thomas had investigated the possibility of
enrolling in college and pursuing his dream of becoming a doctor, but had been deterred by the
inflexibility of Morgan State University, which refused to grant him credit for life experience and
insisted that he fulfill the standard freshman requirements. Realizing that he would be 50 years old
by the time he completed college and medical school, Thomas decided to give up the idea of further
education.
Relations with Blalock[edit]
Blalock's approach to the issue of Thomas's race was complicated and contradictory throughout
their 34-year partnership. On the one hand, he defended his choice of Thomas to his superiors at
Vanderbilt and to Hopkins colleagues, and he insisted that Thomas accompany him in the operating
room during the first series of tetralogy operations. On the other hand, there were limits to his
tolerance, especially when it came to issues of pay, academic acknowledgment, and his social
interaction outside of work. Tension with Blalock continued to build when he failed to recognize the
contributions that Thomas had made in the world-famous blue baby procedure, which led to a rift in
their relationship. Thomas was absent in official articles about the procedure, as well as in team
pictures that included all of the doctors involved in the procedure.[40]
After Blalock's death from cancer in 1964 at the age of 65,[41] Thomas stayed at Hopkins for 15 more
years. In his role as director of Surgical Research Laboratories, he mentored a number of AfricanAmerican lab assistants as well as Hopkins' first black cardiac resident, Levi Watkins, Jr., whom
Thomas assisted with his groundbreaking work in the use of the automatic implantable defibrillator.
Thomas' nephew, Koco Eaton, graduated from the Johns Hopkins School of Medicine, trained by
many of the physicians his uncle had trained. Eaton trained in orthopedics and is now the team
doctor for the Tampa Bay Rays.
Institutional acknowledgment[edit]
In 1968, the surgeons Thomas trained — who had then become chiefs of surgical departments
throughout America — commissioned the painting of his portrait (by Bob Gee, oil on canvas, 1969,
The Johns Hopkins Alan Mason Chesney Medical Archives)[42] and arranged to have it hung next to
Blalock's in the lobby of the Alfred Blalock Clinical Sciences Building.
In 1976, Johns Hopkins University presented Thomas with an honorary doctorate.[2] Because of
certain restrictions, he received an Honorary Doctor of Laws, rather than a medical doctorate, but it
did allow the staff and students of Johns Hopkins Hospital and Johns Hopkins School of Medicine to
call him doctor. After having worked there for 37 years, Thomas was also finally appointed to the
faculty of the School of Medicine as Instructor of Surgery. Due to his lack of an official medical
degree, he was never allowed to operate on a living patient.[2]
In July 2005, Johns Hopkins School of Medicine began the practice of splitting incoming first-year
students into four colleges, each named for famous Hopkins faculty members who had major
impacts on the history of medicine. Thomas was chosen as one of the four, along with Helen
Taussig, Florence Sabin, and Daniel Nathans.
Personal life and death[edit]
Before meeting Blalock, Thomas married Clara Flanders Thomas in 1933 and had two daughters.[15]
Following his retirement in 1979, Thomas began work on an autobiography.[43] He died of pancreatic
cancer on November 26, 1985, and the book was published just days later.
Legacy[edit]
Having learned about Thomas on the day of his death, Washingtonian writer Katie McCabe brought
his story to public attention in a 1989 article entitled "Like Something the Lord Made", which won the
1990 National Magazine Award for Feature Writing and inspired filmmaker Andrea Kalin to make
the PBS documentary Partners of the Heart,[44] which was broadcast in 2003 on PBS's American
Experience and won the Organization of American Historians's Erik Barnouw Award for Best History
Documentary in 2004.[45] McCabe's article, brought to Hollywood by Washington, D.C. dentist Irving
Sorkin,[46] formed the basis for the Emmy and Peabody Award-winning 2004 HBO film Something the
Lord Made.
Thomas's 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 Anesthesiology
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 Thomas's portrait commissioned by his
surgeon-trainees in 1969.[42] The Journal of Surgical Case Reports announced in January 2010 that
its annual prizes for the best case report written by a doctor and best case report written by a
medical student would be named after Thomas.[47]