BLALOCK, DR. ALFRED 1899-1964

Codeveloper of the operation that saved blue babies

A Pioneering Operation

On 9 November 1944 Johns Hopkins surgeon Alfred Blalock carefully made a long incision and exposed a child's beating heart. Then, for three hours, he performed an operation no one had ever done before. The baby was slightly more than a year old but only weighed ten pounds and was not expected to live. Blalock believed that he and Dr. Helen Taussig had discovered how to increase blood flow to the lungs in "blue babies" suffering from anoxemia, or an inadequate oxygen supply. With the baby's heart exposed, Blalock could select a mediumsized artery, clamp it, cut it through, and tie off the useless upper end. He stitched the lower end into a hole he had made in the side of the pulmonary artery, thus bypassing the pulmonary artery's narrow entrance. All the time the operation was going on, one of the baby's lungs was collapsed. When he removed the clamps to let the blood flow, it flowed around and down into the pulmonary artery and to the lungs. The baby began to breathe more freely.

Blue Babies

A blue baby is an infant with cyanosis, a bluish coloration of the skin resulting from incomplete oxygenation of the blood in the arteries. Bright red, oxygenated blood gives the skin a pinkish tint. Unoxygenated blood is bluish-purple, producing the skin color which is characteristic of blue babies. Cyanosis commonly occurs as a result of a congenital heart defect. In the fetus a duct carries venous blood away from the non-functioning lungs to the aorta and eventually into the placental circulation, where a gas exchange occurs between fetal and maternal blood. After birth the shunt normally closes, allowing venous blood to be carried through the baby's pulmonary artery to the lungs for gas exchange. In some babies, however, the duct fails to close. The result is a chronic deficiency of oxygen in the blood. Cyanosis is also seen in a congenital condition when a hole in the wall between the right and left ventricles of the heart allows venous and arterial blood to mix. Without treatment, the average blue baby only lived for twelve years.

Vascular Surgery

Alfred Blalock was born in Culloden, Georgia, in 1899. He saw service in the U.S. Army in World War I and was awarded his M.D. by Johns Hopkins School of Medicine in Baltimore in 1922. He became interested in surgery during his internship at the Johns Hopkins Hospital, In 1925 the young doctor became a resident surgeon and instructor in surgery at Vanderbilt University Hospital in Nashville, Tennessee. Blalock achieved national prominence in the field of vascular surgery during his thirteen years at Vanderbilt. He became a pioneer in tracing the causes of shock, from either injury or surgery, to the loss of blood or body fluids. He was among the first to use large amounts of blood and plasma against shock, a technique which allowed new procedures in surgery in World War II.

A Medical Partnership

In 1941 Blalock became professor of surgery and chief surgeon at his alma mater, Johns Hopkins Hospital, where he met Helen B. Taussig. Dr. Taussig's interest in the physiology of the heart came during her work at the Boston University Medical School when a dean told her, "It won't do you any harm to be interested in one of the larger organs of the body." By the time Blalock arrived at Johns Hopkins, Taussig was well established as a pediatrician who believed that blue babies could be cured by an operation similar to the one she knew Blalock had performed on dogs while he was at Vanderbilt Hospital. The two physicians discussed the possibility of a surgical treatment for cyanotic heart disease. When Taussig suggested increasing the blood flow to the lungs by hooking up the subclavian artery with the pulmonary artery, Blalock said it might be possible. In order to prove cyanosis was due to the lack of oxygen in the blood caused by narrowness or closure of an artery, Blalock created artificial cyanosis in dogs and then operated, widening the artificially closed artery. After two years of experiments with two hundred procedures on dogs, he told Taussig he was ready to attempt to save a baby, and in 1944 he performed his first re oxygenation surgery on a blue baby.

The Hero of Blue Babies

Though the infant improved at first and began to gain weight, he died nine months later. But this pioneering surgery did prove that the pulmonary artery could be bypassed. In 1945, after Blalock had done sixty-five blue-baby operations, he suddenly became a hero in the press when reporters discovered he had saved 80 percent of his "doomed" patients. Patients came from all over the world; Blalock operated on suitable children after they had been thoroughly evaluated by Taussig. Before each operation the surgeons told the parents the risks were great. Fathers, they found, were the timid ones. Mothers usually said to go ahead. From 1945 to 1950 surgery was performed on more than one thousand cyanotic patients. With improvements in surgical technique and better selection of cases, operative mortality fell from 20.3 percent in 1945 to 4.7 percent in 1950. Blalock's operation was a great pioneering achievement that gave many ill children a relatively normal existence. It did not, however, cure the underlying cause of the birth defect; it relieved the cyanosis only partially and left behind the basic defects in the heart.

Sources:

"Blue Babies," Time (31 December 1945): 71;

James Bordley III and A. McGehee Harvey, Two Centuries of American Medicine (Philadelphia: Saunders, 1976), pp. 505-507;

L. Drake, "Gift of Life; Today Blue Babies Live and Thrive," Collier's (6 April 1946): 20+.

Blalock, Alfred (1899–1964), surgeon, professor, pioneer of the so‐called blue baby operation.A native of Culloden, Georgia, Blalock graduated from the University of Georgia and earned an M.D. at Johns Hopkins Medical School in 1922. He served as an intern and assistant resident at the Johns Hopkins Hospital until 1925, when he became a resident surgeon at Vanderbilt University Hospital. Blalock taught surgery at the medical schools of Vanderbilt and Johns Hopkins and held numerous appointments as a visiting lecturer at other universities. During his twenty‐two‐year career at Johns Hopkins, Blalock occupied the posts of director of surgery and surgeon in chief. He died in Baltimore, Maryland, survived by his wife, Mary Chambers O'Bryant, and their three children.

Blalock's research focused on the physiological effects of diminished blood volume. He also conducted the first successful canine transplant of a kidney. His procedure, connecting the organ's vascular supply to a cervical artery, served as a model for the surgical treatment of pulmonary stenosis, a narrowing of the pulmonary artery that causes diminished circulation and a bluish complexion among infants. In 1944, at Johns Hopkins, Blalock and Dr. Helen Taussig conducted the first “blue baby” operation by connecting one end of the left subclavian artery to the left pulmonary artery of a fifteen‐month‐old girl.
See also Medical Education; Medicine: From the 1870s to 1945; Medicine: Since 1945.

Bibliography

Alfred Blalock , Principles of Surgical Care: Shock and Other Problems, 1940.
Mark M. Ravitch , Alfred Blalock, 1899–1964, 1966.

David Cortes