Vanderbilt Thomas and Blalock did groundbreaking research into the causes of hemorrhagic and traumatic
shock. This work later evolved into research on
crush syndrome and saved the lives of thousands of soldiers on the battlefields of World War II. In hundreds of experiments, the two disproved traditional theories which held that shock was caused by
toxins in the blood. 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. 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, defying medical taboos against operating on the heart. It was this work that laid the foundation for the revolutionary life-saving surgery they were to perform at
Johns Hopkins a decade later. Vivien Thomas spent 11 years at Vanderbilt with Blalock before moving to Johns Hopkins.
Johns Hopkins 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, he requested that Thomas accompany him. Thomas arrived in Baltimore with his family in June of that year, confronting a severe housing shortage and a level of racism worse than they had endured in Nashville. Johns 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, and he began wearing city clothes when he walked from the laboratory to Blalock's office because he received so much attention. During this time, he lived in the 1200 block of Caroline Street in the community now known as
Oliver, Baltimore.
Blue baby syndrome 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, 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, creating oxygen deprivation and a blue pallor. Having treated many such patients in her work in Johns Hopkins' Harriet Lane Home, Taussig was desperate to find a surgical cure. According to the accounts in Thomas' 1985 autobiography and in a 1967 interview with medical historian Peter Olch, Taussig suggested only that it might be possible to "reconnect the pipes" 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. 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. 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. He did demonstrate that the corrective procedure was not lethal, thus persuading Blalock that the operation could be safely attempted on a human patient. Blalock was impressed with Thomas' work; when he inspected the procedure performed on Anna, he reportedly said, "This looks like something the Lord made." 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.
Decisive surgery On November 29, 1944, the procedure was first tried on a fifteen-month-old infant named
Eileen Saxon. 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 take only 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. 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. Thomas had performed the operation hundreds of times on a dog, whereas Blalock had done so only once as Thomas' assistant. The surgery was not completely successful, though it did prolong the infant's life for several months. 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. Next, they operated on a six-year-old boy, who dramatically regained his color at the end of the surgery. 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. News of this groundbreaking story was circulated around the world by the
Associated Press.
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 Johns Hopkins old guard. Thomas' contribution remained unacknowledged, both by Blalock and by Johns Hopkins. Within a year, the operation known as the
Blalock–Thomas–Taussig shunt had been performed on more than 200 patients at Johns Hopkins, with parents bringing their suffering children from thousands of miles away.
Skills Thomas' surgical techniques included one he developed in 1946 for improving
circulation in patients whose
great vessels (the
aorta and the pulmonary artery) were transposed. 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." To the host of young surgeons Thomas trained during the 1940s, 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 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, Frank Spencer,
Rowena Spencer, 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. 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. 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 abandoned the idea only 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 Vivien Thomas felt nervous when he first met Dr. Alfred Blalock because his friend Charles Manlove made it apparent that many people had a hard time working with Blalock. However, Thomas found Blalock to be pleasant, relaxed, and informal during his interview, which provided excitement and comfort. Thomas soon learned that Blalock moved quickly and expected his technicians to be just as efficient. As Blalock performed experiments daily, Thomas observed thoroughly so that he would be able to recreate the steps when Blalock had other responsibilities to attend to. However, there were times when Blalock would lose his temper and use profanity; this often bothered Thomas and threatened their stable working relationship. During Thomas' time working at Vanderbilt in the lab, he struggled with his salary because he needed to be able to provide for himself, but he also was saving up to go back to school. After many encounters with Blalock about a pay raise and no results, Thomas was going to return to his old job as a carpenter. However, Blalock saw Thomas as a valuable asset and did everything he could to keep Thomas from leaving. Blalock's approach to the issue of Thomas' race was complicated and contradictory throughout their 34-year partnership. Thomas, a laboratory technician, was paid only a janitorial salary. However, white men performing an equivalent of Thomas' job were paid an appreciable dollar more per hour. On the one hand, Blalock defended his choice of Thomas to his superiors at Vanderbilt and to Johns 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. After Blalock's death from cancer in 1964 at the age of 65, Thomas stayed at Johns Hopkins for 15 more years. In his role as director of Surgical Research Laboratories, he mentored a number of African American 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 as of 2024 is the team doctor for the
Tampa Bay Rays.
Institutional acknowledgment 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) 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. In January 2020, Johns Hopkins Children's Center opened a center for collaboration among specialists in pediatric cardiology, pediatric cardiac surgery, and pediatric anesthesiology: the Blalock–Taussig–Thomas Pediatric and Congenital Heart Center. ==Personal life and death==