Dr. Alfred Blalock and His Team

On April 29, 1953, Dr. Alfred Blalock, the Chief of Surgery at The Johns Hopkins Hospital, accepted the presidency of the American Surgical Association at the Hotel Warwick in Philadelphia. This was almost 13 months after he performed my open heart surgery at Hopkins that saved my life.

Dr. Blalock had a fascinating medical career and led the team that eventually developed the techniques for successful congenital cardiac surgery. He was born on April 5, 1899, in Culloden, GA, the oldest of five siblings. Dr. Blalock was always a perfectionist—completing his homework before bedtime, being an accomplished tennis player and golfer as a teen, and being admitted directly to the senior class at the Georgia Military Academy at age 15. Dr. Blalock then attended the University of Georgia, where he was a below average student but had an active campus social life. He was elected as secretary and treasurer of his senior class, served as associate editor of the yearbook, and was admitted as a member of the Gridiron Club, the highest honor at the school. But also during his senior year, he decided to enter the field of medicine.

Dr. Blalock was admitted to The Johns Hopkins Medical School in 1918. He worked at the student bookstore to earn pocket money, continued to play tennis and golf, and was a frequent visitor to Goucher College, a women's college in nearby suburban Baltimore. None of this improved his study habits. He graduated in the middle of his class and was rejected by Hopkins for a surgical internship.

Dr. Blalock moved to Nashville in 1925 and started his surgical residency at Vanderbilt University Hospital. He became interested in the measurement of the oxygen level in blood and began to focus his medical study on pulmonary hypertension. In 1930, Dr. Blalock interviewed Vivien Thomas, a 19-year-old African American who had to drop out of Tennessee State College because of the stock market crash, to be his laboratory assistant. Dr. Blalock was impressed by Thomas’s inquisitiveness and energy and offered him the job at $12 per week. Thomas’s Vanderbilt employment record listed his job as janitor. Dr. Blalock’s decision to hire Thomas would be the beginning of a professional relationship that lasted 26 years.

Dr. Blalock’s reputation as a cardiac surgeon grew rapidly at Vanderbilt. He devoted more time to the study of cardiorespiratory issues and the problem of hypertension. He kept meticulous surgical notes and authored numerous papers in longhand, all of which were reviewed by Thomas. Dr. Blalock and Thomas worked seamlessly as a team in operation technique and surgical room partnership.

In 1938, Johns Hopkins invited Dr. Blalock to return to Baltimore as Professor of Surgery at the medical school and soon thereafter as the Chairman of the Surgical Department. He was particular about how to run the department—paying attention to student teaching, keeping careful hospital records, and developing sound operating room protocols. He would occasionally surprise fellow surgeons by scrubbing and showing up in the operating room to watch them perform their surgeries.

Dr. Blalock developed a routine at Hopkins by starting his surgical days at 8 a.m. and would perform two or three surgeries on any one day. He would return to his office to draft his notes, then meet his colleagues at a circular table in the Doctor’s Dining Room; soon doctors would arrive early for lunch to have the honor of sitting at his table. He would finish the day making rounds. The only exception to this routine was Friday, when he would teach a clinic at the medical school, using the Socratic method famous for law schools to encourage discussion. One student called the lectures “masterful, polished clinical performances.”

Dr. Blalock and Vivien Thomas first met Dr. Helen Taussig, a pediatric cardiologist at Hopkins, in 1945. Born one year before Dr. Blalock, she had a serious hearing defect, but that did not prevent her from graduating as a member of Phi Beta Kappa from the University of California at Berkeley before receiving her medical degree from Johns Hopkins in 1927. She wanted to go into the field of internal medicine, but eventually ended up working in pediatric cardiology. Dr. Taussig went on to become the first woman president of the American Heart Association and later was awarded the Medal of Freedom in 1964.

Dr. Taussig soon met with Dr. Blalock and Vivien Thomas to suggest a procedure for patients with tetralogy of Fallot to increase pulmonary circulation of blood. She had discussed the idea with numerous surgeons, all of whom of course were male and did not want to risk their reputation on a procedure suggested by a woman pediatrician. Dr. Blalock and Thomas thought her idea had merit, and the three of then teamed up to develop the “Blue Baby” operation, which they first performed on a human in 1944. The procedure became famously known as the Blalock-Thomas-Taussig shunt.

In the spring of 1952, Dr. Taussig urged Dr. Blalock to operate on me, one of her patients at Hopkins with all the symptoms of being a blue baby—blue lips and fingernails and little stamina. At first, Dr. Blalock resisted, saying that three-year olds did not survive the anesthesia. Dr. Taussig responded by saying, “Well, otherwise he is going to die anyway.” Dr. Blalock agreed to operate, and on April 5, 1952—his 53rd birthday—with Dr. Taussig and Vivien Thomas present, the open heart procedure to repair my pulmonary valve was successful. I was told that eventually I would need a pulmonary valve replacement, but so far, after 74 years, that has not been necessary. Yes, team, a job well done!

Dr. Blalock died on September 15, 1964, at the age of 65 from metastatic urothelial carcinoma of the ureter. He was scheduled to retire from Johns Hopkins 75 days later.