- Email: [email protected]
Pioneering Research in Surgical Shock and Cardiovascular Surgery. Vivien Thomas and His Work with Alfred Blalock
81 Case Report: Drummond et al: Spurious Identification of Critical Intercostals
We believe that recognition of the possibility of this phenomenon (i-e., the presence of a critical intercostal outside but immediately adjacent to the excluded segment) is important because of its potential to affect the conduct of the surgical procedure. In this instance, attempts to reimplant the two evident but very small intercostal arteries before reestablishing aortic flow could have considerably increased the total cross-clamp, and hence cord ischemia, time. The judgment to reestablish aortic flow and to secondarily reimplant these vessels (if indicated by the SSER) using only partial occlusion clamps may have been critical in determining this patient’s eventual satisfactory neurological outcome.
References 1. Cunningham JN, Laschinger JC, Merkin HA, et al: Measurement of spinal cord ischemia during operations upon the thoracic aorta. Ann Surg 196:285, 1982 2. Krieger KH, Spencer FC: Is paraplegia after repair of coarctation of the aorta due principally to distal hypotension during aortic cross-clamping? Surgery 972, 1985 3. Mizrahi EM, Crawford ES: Somatosensory evoked potentials during reversible spinal cord ischemia in man. Electroencephalogr Clin Neurophysiol 58:120, 1984 4. Szilagyi DE, Hageman JH, Smith RF, Elliott JP: Spinal cord damage in surgery of the abdominal aorta. Surgery 83:38,1978 5. Costello TG, Fisher A: Neurological complications following aortic surgery. Anaesthesia 38:230, 1983
REVIEW OF RECENT BOOKS Pioneering Research in Surgical Shock and Cardiovascular Surgery. Vivien Thomas and His Work with Alfred Blalock Vivien T. Thomas Philadelphia, University of Pennsylvania Press, 1985 245 pp, illustrated
Reviewed by Henry T. Bahnson, M . D . Vivien Thomas’s autobiography is an entertaining chronicle of events at Johns Hopkins University during the early years after World War I1 when research in cardiac surgery, or literally extracardiac surgery, was leading the way to the striking advances of the next four decades. Thomas was a bright young man who began working for Alfred Blalock in 1929 during the Depression when he was financially unable to complete his medical education. Thomas developed into a remarkable surgical technician, teacher of the art of technique, and a black leader in turbulent times in Baltimore. Talented, quick, and innovative, he worked with Blalock to take vascular surgery a step nearer the modern era beyond its turn-of-the-century origins by Alexis Carrel. In so doing, Thomas worked with several talented young surgeons who flocked to Johns Hopkins and Blalock and have subsequently become leading surgeons around the world. Most attribute to Thomas some of the skills and styles of surgical technique. He was a wizard at working without assistants. The interplay between Blalock and Thomas was interesting.
Both were raised in the traditions of the Old South. Blalock, and probably even Thomas, never fully adjusted to integration. Mutually respectful, each nonetheless felt their places were different. Blalock never appointed a black resident. Thomas was quietly effective in upgrading the status of blacks in Baltimore. He was awarded an honorary doctorate of laws from Johns Hopkins and appointed a full-time instructor in surgery on the faculty of the university, unique recognitions. The secret of Thomas’s success might be summed up in his own words: “I always worked with a minimum of supervision and had a thorough dislike for supervisors and supervision. I disliked giving orders and telling people what to do. I felt then, as I do now, that more can be gained by teaching people to do as required and expected, and then putting the responsibility of performance on them. Furthermore, no one worked for me. They all worked for the Johns Hopkins University, in the Department of Surgery, under the Professor [Blalock]. I just happened to be the person the Professor had put in charge of the laboratory and I was responsible to him. In the laboratory they would be working with me. The ’with was very important, inasmuch as there was no opposite position to take, where as if they were supposed to be working ‘for’ me they might take the opposite position and work against me.” This book is a thoroughly readable and enjoyable biography of a remarkable individual.
Pittsburgh, PA
We believe that recognition of the possibility of this phenomenon (i-e., the presence of a critical intercostal outside but immediately adjacent to the excluded segment) is important because of its potential to affect the conduct of the surgical procedure. In this instance, attempts to reimplant the two evident but very small intercostal arteries before reestablishing aortic flow could have considerably increased the total cross-clamp, and hence cord ischemia, time. The judgment to reestablish aortic flow and to secondarily reimplant these vessels (if indicated by the SSER) using only partial occlusion clamps may have been critical in determining this patient’s eventual satisfactory neurological outcome.
References 1. Cunningham JN, Laschinger JC, Merkin HA, et al: Measurement of spinal cord ischemia during operations upon the thoracic aorta. Ann Surg 196:285, 1982 2. Krieger KH, Spencer FC: Is paraplegia after repair of coarctation of the aorta due principally to distal hypotension during aortic cross-clamping? Surgery 972, 1985 3. Mizrahi EM, Crawford ES: Somatosensory evoked potentials during reversible spinal cord ischemia in man. Electroencephalogr Clin Neurophysiol 58:120, 1984 4. Szilagyi DE, Hageman JH, Smith RF, Elliott JP: Spinal cord damage in surgery of the abdominal aorta. Surgery 83:38,1978 5. Costello TG, Fisher A: Neurological complications following aortic surgery. Anaesthesia 38:230, 1983
REVIEW OF RECENT BOOKS Pioneering Research in Surgical Shock and Cardiovascular Surgery. Vivien Thomas and His Work with Alfred Blalock Vivien T. Thomas Philadelphia, University of Pennsylvania Press, 1985 245 pp, illustrated
Reviewed by Henry T. Bahnson, M . D . Vivien Thomas’s autobiography is an entertaining chronicle of events at Johns Hopkins University during the early years after World War I1 when research in cardiac surgery, or literally extracardiac surgery, was leading the way to the striking advances of the next four decades. Thomas was a bright young man who began working for Alfred Blalock in 1929 during the Depression when he was financially unable to complete his medical education. Thomas developed into a remarkable surgical technician, teacher of the art of technique, and a black leader in turbulent times in Baltimore. Talented, quick, and innovative, he worked with Blalock to take vascular surgery a step nearer the modern era beyond its turn-of-the-century origins by Alexis Carrel. In so doing, Thomas worked with several talented young surgeons who flocked to Johns Hopkins and Blalock and have subsequently become leading surgeons around the world. Most attribute to Thomas some of the skills and styles of surgical technique. He was a wizard at working without assistants. The interplay between Blalock and Thomas was interesting.
Both were raised in the traditions of the Old South. Blalock, and probably even Thomas, never fully adjusted to integration. Mutually respectful, each nonetheless felt their places were different. Blalock never appointed a black resident. Thomas was quietly effective in upgrading the status of blacks in Baltimore. He was awarded an honorary doctorate of laws from Johns Hopkins and appointed a full-time instructor in surgery on the faculty of the university, unique recognitions. The secret of Thomas’s success might be summed up in his own words: “I always worked with a minimum of supervision and had a thorough dislike for supervisors and supervision. I disliked giving orders and telling people what to do. I felt then, as I do now, that more can be gained by teaching people to do as required and expected, and then putting the responsibility of performance on them. Furthermore, no one worked for me. They all worked for the Johns Hopkins University, in the Department of Surgery, under the Professor [Blalock]. I just happened to be the person the Professor had put in charge of the laboratory and I was responsible to him. In the laboratory they would be working with me. The ’with was very important, inasmuch as there was no opposite position to take, where as if they were supposed to be working ‘for’ me they might take the opposite position and work against me.” This book is a thoroughly readable and enjoyable biography of a remarkable individual.
Pittsburgh, PA