Turning blue babies pink: Alfred Blalock’s shunt for Fallot’s Tetralogy

In 1946, a programme of exchanging clinical teachers was established between Guy’s Hospital in London and Johns Hopkins Hospital, Baltimore. The idea had arisen during the Second World War while Rowan Boland, who returned to be dean of the medical school at Guy’s, was serving alongside American military doctors with the allied forces’ medical services in North Africa and the Mediterranean. He wrote to Dr Alan Chesney, his counterpart at Johns Hopkins Hospital, that the ‘object of the exchange would be to maintain the friendship, cooperation and exchange of ideas which has been one of the better things which have come out of this War’. The proposal was accepted on both sides and it was decided that Dr Alfred Blalock would be the first to come to Guy’s. Blalock had by then already achieved remarkable success in dramatically improving the lives of ‘blue babies’ by operation. The most common underlying cause was Fallot’s Tetralogy. The two key components of the constellation of anatomical features are a ventricular septal defect and restriction of the outflow from the right ventricle. This obstruction forces most of the deoxygenated blood to pass through the septal defect, bypass the lungs and be pumped into the systemic circulation. This results in unremitting cyanosis. The text book edited by Conybeare, Guy’s senior physician, taught that cyanosis ‘is so characteristic that ‘‘blue baby’’ and congenital heart disease are practically synonymous’. Any exertion, crying or feeding increased the oxygen demand, and with even less oxygen being delivered to the brain, these children could sporadically lapse into unconsciousness. Furthermore, the teaching was that there was little or nothing which could be done to help. Guy’s welcome to Alfred Blalock