Vivien Thomas
University of Pennsylvania Press, £13.95, pp 245 
ISBN 0 8122 1634 2
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Rating: ★★★
Multidisciplinary team working is the employment benchmark in the health service this decade. This applies not only in the provision of clinical services, but also in the prosecution of surgical research. However, the concept is not new. Many of the great surgical research laboratories of the past had fruitful collaboration between expert technicians and clinician scientists. In no department was this relationship better illustrated than at the Johns Hopkins Medical School. This autobiography by Vivien Thomas, who ultimately became supervisor at the Surgical Research Laboratory of the renowned Professor Alfred Blalock, essentially concerns this relationship. However, at a different level, the place of a black man’s involvement in the, until very recently, white male dominated world of surgery and surgical research is explored.
Vivien Thomas was born in 1910 in Louisville, Kentucky, the fourth of five children. His father was a carpenter, and the young Vivien was brought up in Nashville, Tennessee. He received a good basic education and had ambitions of attending university and possibly medical school. However, the economic depression of 1929 necessitated a job as a carpenter’s apprentice, and in 1930 Thomas took what he expected to be a temporary job as a technician in Blalock’s laboratory in Vanderbilt University.
During this time, Thomas was involved with large animal experimental work on shock, renal failure, and transplantation. In 1938 he developed with Blalock a subclavian-pulmonary artery anastomosis in an attempt to produce pulmonary hypertension. Although the model was not a complete success, the technique was the answer to the problem of patients with tetralogy of Fallot, when, several years later, it was found that those patients needed an operation that would bring more blood to the lungs.
In 1941 Blalock accepted the position of surgeon in chief and chairman of the Department of Surgery at Johns Hopkins Medical School and invited Thomas to join him as his technician. In the Hunterian laboratory at the medical school new techniques in cardiac surgery were developed to treat coarctation of the aorta, pulmonary A-V fistulae, atrial and ventricular septal defects, and transposition of the great vessels. A number of anecdotes give particular insight to the complex and rather insecure personality of Alfred Blalock. There are illustrations from the techniques of the pioneering experiments that Thomas largely devised.
Recognition came very belatedly: shortly before his retirement in 1976, he was awarded an honorary degree by Johns Hopkins and given faculty status. Tellingly, he received his first coauthorship only after nearly 20 years as a technician, despite his seminal contribution to many important early surgical studies, including pioneering work on paediatric cardiac surgery. How much this reflected Thomas’s status as a black non-graduate technician and how much it was due to the then practice of citing one or two authors on a paper is unclear, but it makes an interesting contrast to the now opposite problem of adhering to the Vancouver criteria.
Disappointingly, Thomas somewhat misses the opportunity to give a sociopolitical and cultural account of the changing role and position of black Americans in professional and academic roles between 1930 and 1977. This was a time of change and upheaval, and it may be that the author was too engrossed in his research and family life to feel able to make comment.
None the less, both clinical and academic surgeons and medical historians will find this a worthwhile read. This is reflected in the fact that the text has been used as the basis of a television documentary.