Pioneers: The Black cardiologists who shaped medical practice

In this blog we shine a light on two pioneering Black cardiologists: Daniel Hale Williams and Vivien Theodore Thomas.

Early heart surgery – Daniel Hale Williams

Nowadays, heart surgery is relatively common: more than 14,000 coronary artery bypass graft operations took place in the UK in 2018-19. But it wasn’t always that way. In the late 19th century, and even well into the 20th century, many surgeons believed that surgery on the heart was not only impractical, but also unethical. In fact, in 1881, Theodor Billroth, widely regarded as the founding father of abdominal surgery, is reported to have said “No surgeon who wished to preserve the respect of his colleagues would ever attempt to suture [stitch up] a wound of the heart.”  

But some surgeons wouldn’t take no for an answer. One of these was Daniel Hale Williams, one of only four Black physicians in Chicago at the time, and the founder of the first training hospital in the US for both Black and White staff. Dr Williams was one of the first clinicians to perform surgery to heal a wound on the heart, saving the life of 24-year-old James Cornish in 1893. Cornish had been stabbed between the ribs, injuring the protective sac surrounding his heart, called the pericardium. Dr Williams’ operation was successful - it is highly likely Cornish would have died without it.

Without early pioneers like Dr Williams venturing into the unknown, heart surgery could not have developed into the highly advanced field of medicine it is today.

Treating critically ill babies- Vivien Theodore Thomas

Half a century later, in the 1940s, Dr Helen Taussig, a cardiologist specialising in children, was searching for ways to treat children in her care living with a congenital heart condition called tetralogy of Fallot. The condition involves four abnormalities in the heart’s structure. These include a narrowed pulmonary valve, thickened muscle of the right ventricle, one of the lower heart chambers, and an overriding aorta (the largest artery in your body). Also, there is a hole between the two pumping chambers of the heart, the right and left ventricles (a ventricular septal defect). As a result, oxygen-rich and oxygen-poor blood mix, meaning not enough oxygen is pumped round the body. This can cause a bluish skin colour, leading to this condition (and others with a similar effect) previously being called “blue baby syndrome”. 

Dr Taussig challenged surgeon Alfred Blalock and his assistant Vivien Thomas to find a surgical solution for children born with tetralogy of Fallot. The pair realised the key was increasing blood flow to the lungs and around the body, by repairing some of the abnormalities. With no education beyond High School, Mr Thomas had started work for Dr Blalock as a surgical research assistant in 1930, having previously worked as a carpenter. Within years he was doing the work of a postdoctoral research assistant (despite discriminatory policies meaning he was initially paid as a janitor), and his technical skills became renowned at John Hopkins University. Throughout his 34-year partnership with Dr Blalock, Vivien Thomas frequently turned his colleague’s ground-breaking ideas into surgical reality. In the case of treating children with tetralogy of Fallot, he took the lead on developing the procedure by practicing on animals.

After two years, the pair felt ready to perform the operation. The first child to receive this type of surgery was an 18-month old baby called Eileen Saxon, who was born with tetralogy of Fallot. By this point, Vivien Thomas had practiced on dogs dozens of times while Blalock had done it just once. But Mr Thomas wasn’t allowed to carry out Eileen’s surgery as he didn’t have a university degree. He had to stand on a step, coaching Blalock through the pain-staking procedure.

Sadly, Eileen’s surgery in 1944 only prolonged her life by a few months. However, shortly afterwards the team performed the same surgery on an 11-year old girl, and then a boy of 6, both with complete success, greatly improving their bluish colour and quality of life. Within 6 years, 1,000 babies had received this pioneering surgery. This was the first stage in a long history of cutting-edge surgeries saving children born with heart conditions.

Diagram of two variations of the Blalock-Thomas-Taussig shunt: the original (left) and a modification (right)

Yet despite his crucial role, Vivien Thomas was side-lined. Due to racism and prejudice against his lack of academic background, the procedure was initially named the Blalock-Taussig shunt, and there was no mention of Thomas in academic papers. It was not until after his death in 1985 that his story began to receive significant attention, culminating in 2004 in the award-winning film about his life, Something the Lord Made, starring Mos Def and Alan Rickman. Thomas’ contribution has also now been recognised by the John Hopkins University, where he received an honorary doctorate and his portrait (top of page, right) has been hung next to that of Alfred Blalock.

 These pioneers paved the way for future generations of world-class scientists, making brave new decisions.

BRAVE CAREERS AT THE BHF