Blue Babies with Crossword Puzzle Hearts: The Pediatric Cardiology of Helen Taussig. (Women in Science 56)

It’s sometime in the 1930s, and you’re walking into a ward full of crouching children with blue-tinted lips.  Something is wrong with their hearts, something that is preventing their blood from getting enough oxygen, turning the red fluid a deep, thick black.  At the slightest exertion, the children can pass out and even die, their starved tissues and thickening heart unable to cope with the effort .  Next to them are the parents who have been told to expect the worst, and to expect it soon.  They are “blue babies,” victims of a congenital heart defect for which nobody holds out any hope of a cure.

At this time in the history of medicine, the heart was a surgical Forbidden Zone where none but the bravest dared tread.  Fortunately for the tens of thousands that have been since cured of the heart condition that produces blue babies, an unlikely trio of medical legends arrived on the scene to change all that: Alfred Blalock, whose research on shock and crush syndrome would deserve him the thanks of humanity even if he had never operated on a single heart, Vivien Thomas, a surgical wizard who was kept from title and decent pay most of his career by virtue of his skin color, and our subject today, pediatric cardiologist Helen Taussig (1898-1986).

Taussig’s mother, Edith Guild Taussig, was a remarkable person.  She was a graduate of Radcliffe in that institution’s experimental first years, a student of biology and botany who communicated her enthusiasms to her daughter.  For eleven years, Helen and Edith explored the outdoors and cultivated their garden, until Edith was taken away by tuberculosis and left the young Helen to be raised by her father, an economics professor who always supported her during the setbacks of her adolescent years.

And there were many.  She found reading difficult, probably because of some form of dyslexia that her era was unequipped to recognize.  When she went to college at Radcliffe, she felt that she was just the daughter of the great Professor Taussig rather than a human being in her own rite, and so she transferred to Berkeley to finish her studies.  She decided to go into public health, and went to Harvard to deepen her knowledge, where she was informed that she could take classes, but could never, as a woman, be awarded a degree.  Infuriated by the administration’s openly expressed disdain for female students, she attended classes anyway, only to find that she was made to sit apart from the rest of her classmates and, during laboratory work, was confined in a totally separate room.

Fortunately, one of her professors recommended she study instead at Boston University, where anatomy classes were open to women (which was decidedly not the case at Harvard).  While there one day, an instructor tossed a cow heart into her hands and told her to study it.  She delved into the intricacies of the heart with vigor, spending long nights studying the contractions of mammalian cardiac tissue.

She put in an application at Johns Hopkins, which as we’ll remember from Florence Sabin’s story, was financed by grants from a group of women who had attached the acceptance of women as doctoral candidates as a condition of their financing.  She was accepted in 1924 and given an internship in pediatrics to assist in the formation of the university’s pediatric cardiac clinic.  Things had been going so suddenly well that it was high time for life to send another delightful curve: in 1930, Taussig lost her hearing.  She was a pediatric cardiologist who was robbed of the ability to listen to her patients’ heartbeat, a bitter irony of Beethovenesque proportions.  Rather than giving up her hard won position, however, she taught herself how to feel heartbeats with her hands and to employ fluoroscope technology to tell her what her hands couldn’t reveal.

She began her work studying diseases that afflicted the heart like rheumatic fever, but was soon nudged in the direction of congenital heart malformations, a career path that seemed a dead end at the time.  After all, bacteria could be fought, but if a heart was malformed since birth, there was, at the time, nothing to be done.  The major vessels around the heart were just starting to be talked of as likely objects of surgery, but the heart itself?  Why study afflictions that had no possibility of remedy?

But when you’re an intern, and you’re told to study something, that’s what you do.  Taussig corresponded with Maude Abbott, a world expert on congenital heart problems, studied the patients in her ward, and soon found a link between a series of four defects called the tetralogy of Fallot and a condition known as Blue Baby Syndrome.  In tetralogy patients, the pulmonary artery is constricted, meaning that less blood makes it from the heart to the lungs for oxygenation.  As a result, the right ventricle has to pump harder than usual, thickening its walls.  At the same time, there is a hole connecting the two ventricles that really oughtn’t be there, and a displacement of the aorta both of which allow deoxygenated blood from the right ventricle to sneak over into the left ventricle for shipment throughout the body.

Children with this constellation of defects have an understandably low oxygen count in their blood, rendering it thick and nearly black, causing the tell-tale bluish complexion that gives the condition its name.  It also means that tissues wear out fast, unable to supply themselves with enough oxygen from the blood to maintain any extended exertion.  Children with the condition invariably died young.

There wasn’t much to do but keep them comfortable and relaxed until 1939 when Taussig heard about an operation performed by Robert Gross.  He had successfully performed a surgery to close off a ductus arteriosus, a blood vessel that links the pulmonary arteries to the aorta.  As fetuses, it’s a useful vessel.  We get all our oxygen from our mother, so having a duct that moves blood straight back into the aorta, bypassing the lungs, isn’t a bad idea.  After birth, this duct is supposed to close back up again, allowing blood to flow from the arteries to the lungs, and then back to the heart for distribution through the aorta.

Taussig realized that the ductus aretriosus was the answer to her problem.  If a duct could be safely closed surgically, why couldn’t one be added?  That would provide a second pathway for blood to get to the lungs, bypassing the narrowed pulmonary arteries.  If it could be done, it could provide a way for blood to obtain a normal amount of oxygen, and cure the children in her ward.  She brought the idea to Gross, who couldn’t understand why you would want to insert the very duct he had just become famous for sewing up.

He was not helpful.  But the next people she brought the idea to were.  There are conflicting accounts about just how Vivien Thomas, Alfred Blalock, and Helen Taussig developed the operation that cured blue babies, but it seems to be a case of marvelous serendipity.  Blalock and Thomas had been working on techniques to join blood vessels onto each other, and Taussig had an idea for relieving the blue baby symptoms through joining the aorta and the pulmonary artery.  The actual surgery was performed in 1944 on a fifteen month old child named Eileen Saxon.  Everything was set up to go wrong.  All the experiments on dogs to refine the procedure had been performed by Vivien Thomas, but it was Blalock who was performing the first human surgery.  The dog vessels they had been working with were twice the size of tiny Eileen’s.  All that everybody in the room knew was that, without the surgery, Eileen would die, and soon.

Blalock performed the surgery with Thomas standing behind him and Taussig watching nervously on.  It was a success, as was the next surgery.  The pink color returned to Eileen’s lips while she was still on the table.  Taussig and Blalock were vaulted to celebrity while Thomas, the African American technician who had perfected the procedure, was pushed to the shadows of obscurity.  John Hopkins was suddenly swamped with children from all over the world, their parents desperate for the emergency procedure.  Blalock himself performed the surgery over a thousand times, while Taussig was responsible for diagnosing the patients and overseeing their treatment and recovery.

Through her research and persistence, Taussig had saved the lives of thousands of children.  That’s sufficient laurels for just about anybody, but Taussig wasn’t done yet.  She had one more service to offer us.

In the late 1950s and early 1960s, a wave of children were being born throughout Europe with phocomelia, popularly known as Seal Limbs.  These children had their hands and feet growing directly out of their torso, a developmental problem coming from seemingly nowhere.  She talked with Widukind Lenz, a German physician who was investigating the matter.  His conclusion was that the defects were being caused by Contergan, the brand name of thalidomide, a sleeping medication that was considered so harmless it was sold over the counter.  Taking the results, she returned to America, where thalidomide was being distributed to doctors even though it hadn’t yet received FDA approval.

In this era before tightened federal regulation, it was a regular occurrence for pharmaceutical companies to offer medication directly to doctors in spite of that medication not being cleared by the government.  Sixteen thousand people, and two hundred pregnant mothers, had taken it under these loose conditions, a recipe for disaster that Taussig met head-on by publishing her findings in every scientific journal that would listen, and in speeches at the American College of Physicians and Johns Hopkins.   Thalidomide was pulled from production and every hospital that had received samples was tracked down and their supplies recovered.  As a result, while Europe and Africa witnessed 10,000 seal baby births, the United States only had 17.  Not only that, but the scrutiny Taussig had shone upon the practices of the pharmaceutical industry caused President Kennedy to enact new legislation to tighten the FDA process.

Not bad, Dr. Taussig.

Taussig continued working with children and their “crossword problem” hearts, writing a third of her scientific papers after having supposedly retired.  She lived to see one of the blue babies her surgery had saved give a virtuoso piano recital in her honor, to win the Kober Medal, and serve as the first woman president of the American Heart Association.

Helen Taussig died in 1986 in an automobile crash.

She saved children, a lot.

FURTHER READING:  Well, good luck on this one, folks.  In spite of the importance of her work, there is no full length adult biographical treatment of her life.  Lisa Yount’s Mending Children’s Hearts: Alfred Blalock, Helen Taussig & Vivien Thomas is a middle to high school level book that is about your best bet.  Vivien Thomas also wrote a memoir, but it is not for the weak of stomach.  He describes the often grizzly surgical procedures of Blalock’s research lab in minute detail and, if you’re squeamish like me, that makes it a hard book to get through, though fascinating.  There is also a movie about the events surrounding the blue baby surgery starring none other than the recently passed Alan Rickman and the still alive Mos Def, Something the Lord Made.  It’s a good film, but Taussig’s role in suggesting the basic mechanism of the surgery is transferred entirely to Blalock and Thomas, reducing Taussig to basically That Female Doctor That Works With Kids And Has A Problem It’s Up to Us Brilliant Men To Fix.  Still, Mos Def is astounding in it, so it’s worth watching.

A NOTE ON THE COMIC: Johns Hopkins was actually entirely supportive of Taussig throughout her career and generally fine with Blalock’s attempting this radical new procedure of replumbing the heart, though they did take For-Ever to give Thomas a title and salary commensurate with the magnitude of his work.  Still, there were at least a few figures on campus whose reaction to this team-up was entirely in line with the comic.