Breakthrough!

by Jim Murphy

  Frank William Taussig appears stern, but his thoughtful, caring attention to his daughter’s education helped her overcome many obstacles.

  Taussig applied to Harvard Medical School and was admitted—but was allowed to take only a course or two at a time. She was the only female in her class and was made to sit apart from male students. When they studied microscope slides in the laboratory, Taussig had to sit by herself in another room “so I wouldn’t contaminate the other—male—students!”

  Fortunately, a professor in one of her Harvard classes noticed her ability and recommended that she study at Boston University, where she could take a full range of courses for credit. While she was at BU, another professor, Dr. Alexander Begg, suggested she might want to specialize in conditions of the heart, and after she demonstrated great skill in her studies, he helped her apply to Johns Hopkins Medical School to earn her medical degree.

  She must have impressed her teachers there, because when the pediatric cardiac clinic was set up in 1930, the thirty-two-year-old Taussig was asked to run it. Taussig’s professional career was definitely on the rise when she faced another serious challenge: she began to lose her hearing.

  No one would ever be able to tell her why this happened, though one doctor speculated that it might have been the result of a bout of whooping cough. Whatever the cause, impaired hearing made listening to a child’s heartbeat very difficult and put her medical career in jeopardy.

  After her initial panic subsided, Taussig did what came naturally to her—she looked for ways to solve the problem. When her first hearing aid turned out to be insufficient, she taught herself how to read lips and bought a special stethoscope that amplified sound.

  Finally, Taussig taught herself the unique skill of “listening” with her fingers when examining a young patient. She did this by gently holding the tips of her fingers against a child’s chest so she could feel the heart’s pulsations and gather other medical information. “Adversity,” medical historian Joyce Baldwin concluded, “was an excellent teacher to Helen. It deepened her compassion for others and taught her the value of persevering. . . . Gentleness was her hallmark in treating patients, who immediately sensed this quality in her and felt safe with her.”

  When hearing loss threatened her ability to diagnose her young patients, Helen Taussig developed a way to “listen” to a tiny beating heart with her fingertips.

  But perseverance and gentleness weren’t saving her patients’ lives. This was especially true of babies born with a heart defect called tetralogy of Fallot, better known as “blue baby syndrome.” A child with this condition is born with four separate and very serious malformations of the heart, all of which result in insufficient oxygen in the blood being circulated through the body. Oxygen-rich blood is bright red; deoxygenated blood is blue, and this color can be seen where blood is close to the surface of the skin (such as near the lips, toes, and fingertips).

  Even though researchers before him had studied and described tetralogy of Fallot, research conducted by the French physician Étienne-Louis Arthur Fallot in 1888 was so admired by colleagues that the condition was named for him.

  The bluish skin tone wasn’t the major problem these children faced. Twenty-five percent of children born with tetralogy of Fallot died before their first birthday; 70 percent were dead by the age of ten. Taussig felt that the lack of oxygen in the bloodstream weakened these infants and strained their heart so much that in time their heart simply failed.

  During his career, Dr. Robert Gross developed many innovative techniques to save children with congenital heart defects, but he dismissed Taussig’s idea of supplying additional oxygen to damaged hearts through surgery.

  In 1938, Taussig saw a glimmer of hope. That year Harvard surgeon Robert E. Gross successfully repaired a common birth defect of the heart called patent ductus arteriosus. Normally, the patent ductus vessel closes on its own shortly after birth so that the aorta and the pulmonary artery are separated. In patent ductus arteriosus they remain connected, allowing too much oxygen-rich blood to mix with oxygen-poor blood. The two supplies of blood create an excess of fluid that puts a great strain on the heart and can stress it until the heart fails. Operating on a seven-year-old boy, Gross tied off the connection to create the necessary separation between the aorta and pulmonary artery and relieve the potentially fatal high blood pressure.

  When Taussig read about the groundbreaking operation, her thoughts began to race as an idea took form. Babies with tetralogy of Fallot died because their hearts did not pump enough oxygenated blood throughout their bodies. But if it was possible to tie off a patent ductus arteriosus, why wouldn’t it be possible to surgically build an open one to increase the flow of oxygen-rich blood in a blue baby? It seemed so logical to Taussig, she wondered why no one had ever considered the possibility before.

  Taussig hurried up to Boston to meet with Gross and proposed that he try this sort of operation. He turned her down flat. “You know,” he told her bluntly, “I spent years trying to develop a way to divide the ductus, and now you want me to make one.” Taussig tried to laugh off the rejection, but it still stung many years later. “It seemed pretty foolish to him to have me suggest he put a ductus in again,” Taussig said. “I think he thought it was one of the craziest things he’d ever heard in a long time.”

  Dejected but not defeated, Taussig went back to Johns Hopkins and waited for the right opportunity. “When I heard that Dr. Alfred Blalock was coming to Baltimore, I thought, ‘This is my chance.’” Blalock was known as a skilled surgeon and researcher willing to tackle difficult medical problems; he also had a successful track record. But whether he would be willing to pursue a cure for blue baby syndrome remained to be seen.

  Taussig, 1940.

  CHAPTER FOUR

  Answered and Unanswered Questions

  EARLY one morning in 1943, the phone in Vivien Thomas’s office rang. Thomas was surprised when he answered it and heard the Professor’s voice. Blalock never phoned Thomas unless it was an emergency or he had an unusual request. It turned out to be the latter: Dr. Taussig wanted to discuss something related to infant heart defects, and Blalock had arranged for a meeting in the lab.

  Thomas had never met Taussig, who headed the pediatric cardiac unit over at the hospital and rarely visited the labs. But he had heard about her from Blalock and the other doctors. Taussig and the female pediatricians on her staff often ruffled the feathers of the male doctors, especially the surgeons. Some of the younger doctors believed that Taussig’s clinic was admitting many more young patients than it had in the past. “The perception,” reported Laura Malloy, a professor of biology, “was that her clinic was ‘robbing’ the medical residents in other departments of the opportunity to learn from these cases.”

  Even when these tensions eased, problems remained. “Dr. Taussig and the other pediatricians would sometimes change the [post-surgery] medication orders [without consulting the surgeon in charge of the case],” Dr. C. Rollins Hanlon observed, “and we would complain to the Professor, and the Professor would speak to Dr. Taussig. It wasn’t violent, but there was the usual question of turf when it came to who was running the postoperative care.”

  “Dr. Taussig could be difficult,” Dr. Denton Cooley remembered, “and Dr. Blalock had some friction with her.” As Blalock described it to Cooley, “You know, Denton, Dr. Taussig [and her entire staff] come around here and worry me so much.”

  Taussig “worried” Blalock because she didn’t want her ideas (or those of her staff) about the treatment of their patients to be dismissed out of hand. She even “worried” Blalock about how he and his residents treated the parents of her young patients. At the time, most surgeons maintained an authoritarian distance between themselves and their patients. They tended to announce what medical steps would be taken and did not bother to explain the situation to patients or relatives. Taussig insisted that doctors who treated her patients take the extra time and care to explain what was wrong with a child and h
ow they planned to help, be it with medicine or surgery.

  Taussig talks with a young patient.

  So on that morning in 1943, Thomas was expecting to meet an intense, possibly brusque Dr. Taussig; instead, he found that she had “a pleasant personality.” After introductions, Taussig told Blalock and Thomas about her meeting with Dr. Gross and how she had suggested he reverse his innovative operation to increase the flow of oxygen-rich blood. As Thomas recalled, “She expressed her belief that it should be possible to do something to get more oxygenated blood to the lungs, as a plumber changes pipes around.”

  This was a remarkable meeting of genius. Taussig was the worldwide expert on congenital heart problems. Blalock, though not a heart specialist, had very good surgical skills and an open mind eager to tackle complex medical problems. He had actually done some research on hypertension (high blood pressure) in the past that involved redirecting the flow of blood to the heart. And finally, there was Vivien Thomas, as determined and brilliant a researcher as anyone at any medical facility.

  After Taussig left, Blalock and Thomas continued to discuss the blue baby problem. Because of the war, Blalock’s research on shock was still a major national priority; he made this clear to Thomas and instructed him to keep the research on shock as his main focus. But Blalock had promised Taussig that he would look into how to get more oxygen circulating in the bloodstream, so he turned this line of research over to his assistant as well. Thomas would plan and carry out the research, consulting regularly with the Professor and reporting on his results.

  Oddly enough, neither man remembered discussing the past hypertension research project as a possible solution to the blue baby problem. Thomas remembered leaving the meeting “sure both of us were aware of what operative procedure was to be tested.”

  Thomas’s first move was to give himself an intensive course in congenital heart problems. He visited the pathology museum to study the many defective hearts that Taussig had collected. “I spent hours and days poring over, examining and studying these preserved specimens,” he recalled.

  Almost immediately, he perceived just how badly deformed many of the tiny hearts were. He was “amazed that some of these patients had survived as long as they had, or had survived at all.” This awareness led to a deeper understanding of Dr. Taussig’s intense concern. “If [she] had witnessed the autopsy and examined these numerous hearts, each representing a former patient, one could well appreciate her feeling of utter helplessness.”

  Taussig had a strong emotional connection to her patients and the pressing sense that time was rapidly running out for them. This bond was what drove her to seek out a solution and “worry” other doctors about treatment and care. Like most surgeons and researchers, Blalock and Thomas chose to remain emotionally separate from the patients, not wanting their feelings to distract them and possibly have a negative effect on their work. Standing in the pathology museum, Thomas understood why Taussig could sometimes be so insistent.

  Once Thomas had a clear idea of what the heart of a blue baby was like, he could move ahead with his research. Before he could think about a cure, he had to figure out how to re-create the condition in a laboratory animal so that he could test various operative procedures on a living creature.

  Like many medical researchers at the time, Thomas had done experimental surgery on hundreds and hundreds of dogs in his years with Blalock. With every experiment he conducted using an animal, he entered a world of intense controversy.

  Various groups had been actively trying for many years to stop the use of animals in medical research. One of the most powerful organizations was the National Anti-Vivisection Society, founded in 1929. It opposed the use of animals in research experiments for a number of reasons, claiming the practice was immoral (the animals did not volunteer for the experiments and were therefore captives against their will), often caused incredible pain, and almost always ended with the animal either maimed for life or put to death. It also questioned the validity of the experiments because animal bodies did not exactly duplicate human bodies, suggesting that the results were questionable and certainly did not justify the pain and sacrifice of so many animals.

  Thomas was well aware of the protests and understood the arguments against the use of animals. He even felt that in some respects the anti-vivisectionists were right. In order to induce shock in one dog, he’d had to crush its leg with a hammer. But he felt strongly that animal testing was a vital part of their research—that, in fact, medical advances could not be made without it.

  An early-twentieth-century anti-vivisectionist protest in London. There were few crusaders for the cause at first, but their passion helped build the movement into a worldwide force.

  Back in the 1940s many, if not most, surgeons at Johns Hopkins and at other medical research facilities agreed. Dr. C. Walton (Walt) Lillehei at the University of Minnesota gained worldwide fame in the 1950s by performing the first successful open-heart surgery and helping to develop the first battery-operated pacemaker. When asked about the use of dogs in his research, he was characteristically blunt. “The dog was ideal,” he stated, adding, “Without live animals, you got nowhere.” Another internationally recognized researcher at the University of Minnesota and chairman of the American Association for Accreditation of Laboratory Animal Care, Dr. Maurice Visscher, minced few words when he said, “I know of no persons of sound mind who doubt that medical research involving surgery of animals has greatly benefited mankind in thousands of ways.”

  Heart surgery was still in its infancy in 1943. It was such a new branch of medicine that no doctors were listed officially as cardiac surgeons. They were still called thoracic—chest—surgeons, surgeons who could open the chest of a patient to perform various types of procedures, such as draining a lung abscess or removing a tumor. But aside from a few daring individuals, such as Robert Gross, not many surgeons ever attempted any sort of procedure on a living human heart. As the pioneering cardiac surgeon Dr. Harris B. Shumacker points out, very few “clinical efforts in cardiac surgery were undertaken.” To be frank, he continues, as late as 1940, “cardiac surgery hardly seemed a viable method of therapy.”

  In effect, just about everything Thomas and Blalock would do relating to the human heart would be new and groundbreaking. Even the tools they would eventually use in their procedures would have to be invented and refined as they went along. Back then there were no computers available to create simulated models of the heart or of possible surgical procedures. Adding to the difficulty of devising an operative cure was the fact that no hospital would allow a researcher to use an untested technique on a human subject, even if that human agreed to the procedure. So Thomas had no alternative: experimenting on animals was the only way to find out whether his and Blalock’s theories and proposed procedures might actually work on a human.

  The debate about the use of animals in medical research projects never faded away as some doctors hoped it would. It has continued through the years right up to the present day. And as computer models and cell testing have become more sophisticated, the demands to end animal testing have intensified. Though fewer animals are involved in medical research today, they are still considered vital for many tests. Even though Thomas was aware of the controversy and sympathized with the protesters to a degree, he could see no other option for creating a new surgical procedure than to test it on animals.

  Thomas was embarking on a complicated and uncharted journey. Studying Taussig’s preserved hearts had shown him the precise nature of the malformation; he was also able to read about the procedure Gross had performed. These were the only guides available to him. Many more unanswered questions remained to be resolved.

  Thomas (center, wearing surgical mask) with two assistants, about to perform an experimental procedure on a research dog.

  CHAPTER FIVE

  The Search

  VIVIEN Thomas was a realist. He wanted to find answers to the blue baby problem as quickly as possible without slowing down the
shock research. On his own, Thomas came to a decisive conclusion early on. Blalock had made it clear that he didn’t want to spend years and years on research that might not lead to a meaningful result; he wanted this part of Thomas’s research to be done efficiently and as quickly as possible. Thomas was skilled enough to realize that it could take anywhere from one to two years to reproduce all four tetralogy of Fallot problems in an animal. Instead, Thomas suggested they concentrate solely on reducing the flow of oxygenated blood throughout the animal’s body. He had to make a healthy animal unhealthy.

  Blalock was not happy about this. It meant that they would not be working for a total cure to the problem, only a partial fix. But Thomas was certain that in time he could replicate the most serious defect that Taussig had identified, that of limiting the flow of oxygen to the dog’s body. With this as his focus, Thomas plunged forward with his experiments.

  Simply restricting the flow of oxygen-rich blood wouldn’t be enough. Thomas had to lower the amount of blood oxygen to a precise level, as close as possible to the low level of oxygen in blue babies. He had data on what this level was from Taussig’s research, and he analyzed the blood of a number of blue babies to verify past results. In addition to re-creating the exact level of oxygen depletion, the experimental animals would have to survive with this lower oxygen level for many days before any sort of corrective procedure could be attempted. Thomas and Blalock wanted the animals to recover from the initial surgery and duplicate as nearly as possible what a blue baby experienced.