A Johns Hopkins study published 63 years ago in the
Journal of the American Medical
Association has made an encore appearance in the July
16 issue as part of a yearlong retrospective
celebrating JAMA's 125th anniversary by revisiting
papers that changed the course of modern-day
The now-classic "blue baby" report by pediatric
cardiologist Helen Taussig (1898-1986) and
surgeon Alfred Blalock (1899-1964) first appeared in
JAMA on May 19, 1945. In their paper, Taussig
and Blalock described for the first time the physiology of
tetralogy of Fallot, one of the most common
congenital malformations of the heart, which at the time
was poorly understood, considered inoperable
and ultimately fatal. The malformation causes inadequate
blood flow from the heart to the lungs and a
profound lack of oxygen in the blood, giving an infant's
skin its hallmark bluish hue.
In addition, the paper described the first three "blue
baby" operations in medical history
designed to alleviate the defect using a special "shunt"
technique that increased blood flow from the
heart to the lungs.
Children undergoing the surgery experienced an
immediate and dramatic improvement while still
in the operating room. When their oxygen-starved bodies
were finally flushed with oxygen-rich blood,
their bluish complexions turned a healthy pink color, an
observation that prompted Blalock to exclaim
famously after surgery number three, "The boy's a lovely
At the time, Taussig and Blalock almost certainly knew
their work would dramatically change
treatment of heart disease, and records at Johns Hopkins
show that hundreds of parents sought help
for their children in the months that followed.
The study also revolutionized pediatric cardiology, a
then nascent field, and ushered in a new
era of cardiac surgery. In hindsight, it also altered the
course of academic medicine, according to
Johns Hopkins Children's Center cardiac specialists writing
in a July 16 JAMA commentary
accompanying the reprint summary of the original paper.
Historians, filmmakers and journalists have widely
told the story of the research and eventual
surgical solution, which began with an idea from Taussig,
who took it to Blalock, who first sketched a
surgical approach to the repair. But it was Vivien Thomas
(1910-85), an African-American surgical
technician working with Blalock as a lab and office
assistant who was instrumental in developing in dogs
the necessary procedure and instrumentation.
This melange of disciplines as disparate as pediatric
cardiology, surgery and anesthesiology
working toward treatment of a single disorder became, and
to date remains, the model for progress
and innovation in medicine.
"Not only did the team's unprecedented collaboration
in effect give birth to pediatric
cardiology, and led to the first successful treatment of
this fatal heart defect, but it later became
the prototype of the bench-to-bedside approach, a staple in
academic medicine today," said Anne
Murphy, an author on the commentary and a pediatric
cardiologist at Johns Hopkins Children's Center.
In the decades that followed, the teamwork by Taussig,
Blalock and Thomas also foreshadowed
Johns Hopkins' efforts to eliminate racial and gender
inequalities in academic medicine. In the 1940s
at Johns Hopkins — the venerable citadel of medicine
— Taussig, a woman, and Thomas, an African-
American, teamed up with Blalock, a white male surgeon, to
form a diverse and brilliant crew whose
combined talent and expertise pioneered a surgery that has
saved millions of lives worldwide.
Taussig went on to achieve the status of full
professor — one of the first women at Johns
Hopkins to do so — but Thomas' role was not fully
acknowledged until much later, the JAMA
commentators point out. The original paper had not even
credited Thomas' contributions.
"The collaboration awakened everyone to the fact that
talented people like Thomas, who would
have clearly been a superb surgeon, were marginalized, and
medicine suffered for it," said commentary
co-author Duke Cameron, head of pediatric cardiac surgery
at Johns Hopkins. "It was a realization
that drove much of Hopkins' subsequent efforts toward
equality and diversity."
In 1976, Johns Hopkins gave Thomas an honorary
doctoral degree and appointed him instructor
in surgery. Today, one of the four advisory colleges for
medical students at the university is named
for him. Every entering class learns about Thomas' story
and his contributions to modern medicine.
For more information on the "blue baby" operation, go
A full text of the original paper is available online at: