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ALFRED BLALOCK April 5, 1899-September 15, 1964 BY A. McGEHEE HARVEY AEFRED BLALOCK was born in Culloden, Georgia on April 5, 1899, the first son of George Z. Blalock and Martha (Davis) B,Ialock. Blalock's father was a merchant, his mother a "remote cousin" of Jefferson Davis. George Blalock, who was almost thirteen years older than his wife, died in 1931. He exercised a firm hand as head of the house, demanding perfection of his children and laying great stress on ecluca- tion, so that "it was a sad day when anyone brought in a report card that left something to be clesirecI."* Alfred's sister Elizabeth remembers hearing Alfred say "he had rather mother use the hairbrush on him than father look at him harcI.": His mother remembered Alfred as a conscientious young boy who was unwilling to go to bed until his homework had been mastered and even cried if forced to bed before he knew every spelling worct perfectly. He was characterizes! as having an attractive smile, a soft manner of speech, a retiring gentle way, and an effective manner of saying clearly what was on his mincI. In view of his father's ill health, when Alfrec! was eleven years of age the family movecl to Jonesboro, a town about * Mark M. Ravitch, The Papers of Alfred Blalock (Baltimore: The Johns Hopkins Press, 1966), vol. 1, p. xv. tIbid. 49

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50 BIOGRAPHICAL MEMOIRS forty miles north of Culloden where medical assistance would be more readily available. By the age of fourteen Alfred had completed the ninth grade at ionesboro and was granted admission to the senior class at the Georgia Military College at Milledgeville. He entered the University of Georgia as a sophomore in the fall of 1915 anti gracluated from that insti- tution with an A.B. in l91X. Blalock dicI not consider himself to have been an exces- sively ctiligent student either in college or medical school. His academic record at the University of Georgia, however, re- vealec! a satisfactory performance with most of his grades in the 80's or 90's. The yearbook, of which he was associate editor, listed him as secretary and treasurer of the senior class and a member of the college debating society, the junior cabinet, and the Gridiron Club. Election to the Gridiron Club was considered to be the second highest honor on the cam- pus, members being chosen for overall excellence rather than specific academic achievement. He was a good tennis player and entered many of the college tournaments. Dr. John P. Campbell, Professor of Zoology at the University of Georgia, wrote to I. Whitricige Williams, the dean at the Johns Hop- kins University School of Medicine, regarding Blalock's acI- mission application: "As you will see his record is not un- usual. He went in for college activities and hacl no thought of being a 'grind.' He only cleciclecl to take up medicine in his senior year. One clay he came to me and sail! that he was going to do his very best in the hope that I might feel that I could give him a strong recommendation for Johns Hopkins. He certainly made goocl. I have no hesitation in saying that he is mature enough anti his habits of study are sufficiently well formed to be acimitted. ~ hope you will take him."* *Ibid., p. xvii.

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ALFRED BLALOCK MEDICAL EDUCATION 51 Blalock entered the Johns Hopkins University School of Medicine in the fall of 1918. His record in medical school was not outstanding. Tinsley Harrison, one of Blalock's closest friends, wrote about him as follows: While Al Blalock was in medical school he ran the student bookstore and from this earned a major fraction of his expenses at Hopkins. In addition to this he was devoted to both tennis and golf, and it was our mutual interest in these sports that first made us decide to room together and started a friendship that meant a great deal to me throughout the years. Also, he was very much the ladies' man and often had social engagements, usually at Coucher, two or three evenings a week. On the other hand, he never wasted a minute. When he was not actively working in the bookstore or following the pursuits mentioned above, he worked at his medical studies continually. I never saw him stop in the living room of the fraternity house just to sit around and gossip. I never saw him waste time as I did playing cards. Because of these several interests, Al was not an outstanding student when it came to grades. As I recall he ranked somewhere toward the bottom of the upper half of the class scholastically, but I am not certain about this. In any case he was not considered to be one of the ten or twenty top students in the class in terms of grades. I imagine it was because of the heavy (in my opinion excessive) reliance on grades that he did not get the surgical internship for which he applied. * Surgical internships at Johns Hopkins in those days were awarcled on the basis of class standing. Although Blalock failed to get the appointment in general surgery, he was accepted as "house medical officer-urology" under Hugh Hampton Young. In spite of having a nephrectomy and tem- porary facial nerve palsy during that internship year, Blalock's performance was sufficiently satisfactory to gain him an assistant residency on the general surgical service for the following year. He was turned down for a reappointment *Ibid., p. xix.

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52 BIO GRAPHICAL M E M OIRS to the surgical house staff (an event to which Blalock never reconcilecl himself), and in July 1924 he began a year as "extern in otolaryngology" uncler Samuel }. Crowe. As a medical student, Blalock was interested in research. In later years he often credited TinsIey Harrison with the awakening of his interest in this area. Of his early research experience Blalock commented: When I was a medical student, and I think the year was 1920 or 1921,1 worked for a short while in the Hunterian Laboratory with Dr. Jay McLean. My problem was on the lymphatics and no publications resulted. It was at this time that Jay McLean found a heparin-like substance in the liver, and subsequently Dr. Howell continued his work with the discovery of heparin. Two years following my graduation from medical school, that being ~uly1924,I spent a year as extern in otolaryngology on Dr. Crowe's service. One of the subjects on which I worked was that of regeneration of the recurrent laryngeal nerves of dogs. The thing that distressed me most about the Hunterian was that I was told that I could work in it on Saturday mornings from 10 to 12.1 had a good deal of free time and could have gotten along better had I been allowed to work there more. Dr. Halsted had died in 1922 else I suspect he would have given me a better opportu- nity. * During his early period at Johns Hopkins, Blalock pub- lished two papers with Harrison and C. P. Wilson. The first, "The Effects of Changes in Hydrogen Ton Concentration on the Blood Flow of MorphinizecI Dogs," appeared in the Journal of Clinical Investigation in 1925, and the second, "Par- tial Tracheal Obstruction. An Experimental Study on the Effects on the Circulation and Respiration of Morphinized Dogs," was published in the Archives of Surgery in 1926. In 1925 Blalock accepted the chief residency in surgery at the newly reorganized school of medicine at Vanclerbilt. Again Harrison was instrumental in Blalock's career. Harri- son had interned at the Peter Bent Brigham Hospital and *Ibid., p. xxi.

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ALFRED BLALOCK 53 returned to Johns Hopkins in the fall of 1924 as an assistant resident in medicine. The following year he went to Vander- bilt at the invitation of G. Canby Robinson, dean anti chair- man of the Department of Medicine. Harrison mentioned to Robinson that Blalock was available for the position of chief resident in surgery. Robinson recommencled Blalock to Bar- ney Brooks, who was moving from Washington University in St. Louis to assume the chairmanship of the Department of Surgery at Nashville, and Brooks offered Blalock the . . posltlon. When he arrived at Vanderbilt, Blalock had hoped that Brooks would allow him to be in charge of the surgical pa- thology laboratory. He was initially clisappointed that Brooks placed him in charge of the experimental laboratory, but subsequently was pleasecl that Brooks had made this choice for him. Harrison and Blalock continued work in research to- gether. Of this work Harrison wrote: During the 192~25 year at Hopkins, and the subsequent 192~26 year, when we were both chief residents at Vanderbilt, we managed to do a lot of work in the laboratory together. At that time the Van Slyke apparatus was relatively new, and the availability of a simple and accurate method for measurement of blood oxygen made it possible to, for the first time, per- form accurate determinations of cardiac output in the intact animal. Al- most nothing had been done about cardiac output before that.... There- fore Al and I became interested in studying the influence of various things on cardiac output. After a couple of years my interest was getting more and more toward the heart per se and Al s was moving more and more toward problems of cardiac output that seemed to have some direct application to the clinical problems of surgery. Therefore, we decided to split up as a team and still help each other, but that he would work on shock and I would work on cardiac output. Within a year after this decision he had completed his beautiful work on hemorrhage and trauma and its effect on the circulation of dogs. Then he came down with tuberculosis before he had been able to complete his manuscript. He went up to Saranac for a time, and I made the trip with him because we were afraid of a pulmonary

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54 BIOGRAPHICAL MEMOIRS hemorrhage or something like that. All the way up on the trip he was very unhappy because he had been forbidden to do any work of any kind and his data for the first paper on shock were all set and ready to be prepared for publication. I promised him faithfully that I would write the paper on shock for him and send it to him for his approval. This I did. I have derived a permanent satisfaction from the thought that I was able in this manner to help a dear friend and to play a minor role in a research problem which, looking back after 40 years, seems to have opened a lot of doors. Do not get me wrong. I had nothing whatever to do with the concep- tion or planning of the work on shock. This was entirely Al's own. I did take his data and wrote the paper for him without a true realization on my own part of the importance of the work. This was done purely to help out a friend in distress.* After spencling a year ~1927) at the Trudeau Sanatorium, Blalock went abroad for a few months where he worked in the Department of Physiology in Cambridge under G. V. Anrep and Sir Joseph Barcroft. When he returned to Van- derbilt in the latter part of 192S, he continued to work prodi- giously in the laboratory, doing essentially all his own work, making his own animal preparations and doing his own bloocl gas determinations. He had students working with him from the first ant! to be chosen by him for a summer's work was considered to be a real plum. His younger collaborators then and later remember the method of writing joint papers. When a project was completed Blalock took the experimental tiara and rough notes for a clinical paper anti, shortly, often by the next morning, wouIcl have written the entire paper, longhand, in very close to final form, frequently placing the names of his associates before his own. In January 1930 Vivien Thomas, a young black who was forced for lack of funds to leave his first year of college, came to work for Blalock in the laboratory. At that point Blalock's increasing obligations were cutting into the time he could spend in the laboratory and he neecled someone to free him *Ibid., p. xxii.

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ALFRED B LALOC K 55 from the more routine chores. A more fortunate choice could not have been macle. Vivien Thomas learned to perform the surgical operations and the chemical determinations needler] for their experiments, to calculate the results, and to keep precise records; he remained throughout Blalock's career as an invaluable associate. As time went on Blalock and Thomas worked together so closely that it was enough to suggest to Thomas the experimental preparation ant! the measure- ments to be made. Thomas often contributed his own ideas in developing the operative and manipulative techniques. RESEARCH AT VANDERBILT In 1928 Blalock began studies, with the air! of Hubert Bradburn, in which the oxygen content of blood withdrawn from veins in various parts of the body was determined dur- ing shock produced by different methods, including the in- . . ,% . . . . pectin ot . histamine in some cases anc . trauma to an extremity in others. The difference in the results led to the following statement by Blalock: These observations suggest a local accumulation of blood at the site of trauma to a large area such as the intestinal tract or an extremity, and are evidence against the action of a histamine-like substance that produces a general bodily effect. The (earlier) prevailing theory . . . was that traumatic shock was due to a toxin, possibly histamine. The strongest evidence that had been put forward in favor of the toxic theory was derived from the experiments of Cannon and Bayliss, in which they found that shock result- ing from trauma to an extremity of the cat could not be accounted for on the basis of the local loss of whole blood and plasma. In brief, they trauma- tized one posterior extremity and, when shock resulted, they amputated the two posterior extremities and determined the difference in the weight. After completing the studies on blood gases, I repeated the experiments of Cannon and Bayliss using anesthetized dogs. It was noted that the swelling extended to a higher level than the uppermost limit of the trauma and suggested that the two physiologists had not performed their amputations at a sufficiently high level. In my experiments the posterior part of the animal was bisected and the difference in the weights of the traumatized

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56 BIOGRAPHICAL MEMOIRS and non-traumatized parts was determined. A comparison of this differ- ence with the results of other experiments in which shock was produced by the slow withdrawal of blood showed that the trauma resulted in a suffi- cient loss of whole blood and plasma to explain the development of shock. In my paper published in 1930, entitled "Experimental Shock, The Cause of the Low Blood Pressure Produced by Muscle Injury to Dogs," it was stated: "The experiments which are presented in this paper offer no evi- dence that trauma to an extremity produced a toxin that caused a general dilatation of capillaries with an increase in capillary permeability and a general loss of fluid from the bloodstream."* An important paper that originated in Blalock's labora- tory describecI a method for transplanting the acirenal gland of the dog with reestablishment of its blood supply. This successful transplantation of the adrenal to the neck of the clog, apart from such early trials as Carrell and Guthrie's, was the first successful transplantation of an endocrine organ by direct anastomosis of its vascular supply. The most important aspect, however, was the success of the vascular suture tech- niques that lecT Blalock to suggest to his laboratory associates that the central ens! of the divicled subcIavian artery be con- nected to the pulmonary artery to see whether this would result in pulmonary hypertension. The results of this investi- gation were reported in the Journal of Thoracic Surgery in ~939 in a paper entitled "Experimental Observations on the Ef- fects of Connecting by Suture the Left Main Pulmonary Artery to the Systemic Circulation." Blalock was to use this operation in 1944 for the relief of the Tetralogy of Fallot. It is a measure of his breadth as a physiologist that he was interested in pulmonary hypertension, a physiological prob- lem that was not to attract the attention of other surgeons or cardiologists until almost two decades later. The studies in shock, however, were the principal occupa- tion of Blalock's laboratory in Nashville. He and his group *A. Blalock, "Reminiscence: Shock After Thirty-four Years," Review of Surgery, 2 1(1964):231.

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ALFRE D B LA LO C K 57 carefully explored every facet of the problem and compiled the evidence that clearly connected shock with the loss of fluid outside the vascular bed and with the resulting decrease in blood volume. His experiments were simple and direct; his discussions and conclusions concerning the results were straightforward, forceful, and convincing. Other investiga- tors, of course, were reaching the same conclusion, particu- larly Phemister in Chicago, but the massive amount of data that Blalock accumulated on the characteristics of hemor- rhagic and traumatic shock, his carefully planned experi- ments that eliminated one possible cause after another of the then current explanations of shock, and the clarity with which he put forth his views, based on sound experimental work, led to a new understanding of this important problem. The firm recognition of the need for volume replacement was corroborated in the treatment of the wounded during World War II. Large quantities of blood, blood substitutes, and plasma expanders were used, which resulted! in the sav- ing of many lives. Blalock himself considered his best work to have been that on traumatic shock. On October 25, 1930 Blalock married Mary Chambers O'Bryan of Nashville. They tract three children: William Rice, Mary Elizabeth, and Alfred Dandy. THE BALTIMORE PERIOD In 1938 Dean DeWitt Lewis, then chairman of the Depart- ment of Surgery at Johns Hopkins, resigned because of ill- ness. The committee to select a successor recommencled several prominent surgeons in the country who turned the position down for one or another reason. One of those who declined was Evarts A. Graham, the distinguished chairman of the Department of Surgery at Washington University. Graham strongly recommended Alfred Blalock to President Bowman of Johns Hopkins. When the offer was macle to

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58 BIOGRAPHICAL MEMOIRS Blalock, he accepted without hesitation and assumed the position in ~ 94 ~ . Establishing himself in Baltimore proved somewhat diff~- CUlt for a variety of reasons, but Blalock successfully disposed of the numerous problems that arose. He began at once to operate daily anti to be actively concerned in the training of the resident staff and in the teaching of medical students. His Friday noon clinics rapidly developed into masterpieces of clinical instruction. George Duncan, an assistant resident in surgery at Vanclerbilt, was brought to Baltimore to continue the experiments on shock. At the time of Blalock's arrival in Baltimore, A. McGehee Harvey, the medical resident, ancI I. L. Lilienthal, Jr., were studying the physiology anti pharmacology of myasthenia gravis. It was their conclusion that there might be a circulat- ing substance, similar to curare, responsible for the neuro- muscular blockade and the resulting muscular weakness. The well-known changes in the thymus glancI, consisting of hyper- trophy of that organ as well as the occurrence of tumors, macle this structure the most likely source of such a substance. Harvey and Lilienthal had cliscussecI their evidence on nu- merous occasions with Frank Forct, who was the senior neu- rologist of the hospital, ancI it was clecided that a trial of total thymectomy in patients with this disease, regardless of whether there was tumor or simple hypertrophy, was indi- catecI. ForcI agreed to present this proposal to Blalock. While in Nashville Blalock had successfully removed a thymic tumor from a patient with myasthenia gravis. The decision was made to do a total thymectomy in a series of patients with myasthenia. The patients were operated on by Blalock anti their pre- and postoperative care anti study was managed by Harvey and Lilienthal. In the early cases the results were highly encouraging, and objective evidence was obtained for the first time of a function of the thymus gland in man from

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ALFRED BLALOCK 71 effects on cardiac output and blood pressure. An experimental study. Arch. Surg., 19:725-34. Oxygen content of blood in patients with varicose veins. Arch. Surg., 19:898-905. With Hubert B. Bradburn. The relationship of changes in blood- flow through an extremity to (1) changes in temperature of tissues, (2) differences in oxygen content of the arterial and venous blood, and (3) cardiac output. Am. J. Physiol., 91:115-22. 1930 With Hubert B. Bradburn. Distribution of the blood in shock. The oxygen content of the venous blood from different localities in shock produced by hemorrhage, by histamine and by trauma. Arch. Surg., 20:26-38. With P. N. Harris and Bentley Cox. Observation upon the exterior- ized appendix of the dog. Surg. Gynecol. Obstet., 50:572-77. Experimental shock. The cause of the low blood pressure produced by muscle injury to dogs. Arch. Surg., 20:959-96. With John C. Burch and Tinsley R. Harrison. A comparison of the effects of hemorrhage under ether anesthesia and under spinal anesthesia. Arch. Surg., 21:693-97. Observations upon the blood flow through skeletal muscle by the use of the hot wire anemometer. Am. J. Physiol., 95:55~60. 1931 Trauma to the intestines. The importance of the local loss of fluid in the production of low blood pressure. Arch. Surg., 22: 3 14-24. Experimental shock. IV. The probable cause for the reduction in the blood pressure following mild trauma to an extremity. Arch. Surg., 22:598-609. Experimental shock. VII. The importance of the local loss of fluid in the production of the low blood pressure after burns. Arch. Surg., 22:610-16. With l. W. Beard. Experimental shock. VIII. The composition of the fluid that escapes from the blood stream after mild trauma

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72 B I OGRAPH I CAL ME MOI RS to an extremity, after trauma to the intestines, and after burns. Arch. Surg., 22:617-25. With George S. Johnson. Experimental shock. IX. A study of the effects of the loss of whole blood, of blood plasma and of red blood cells. Arch. Surg., 22:626-37. With P. N. Harris. Experimental shock. X. Observations on the water content of the tissues of the body after trauma and after hemorrhage. Arch. Surg., 22:638~8. Stab wound of heart. Ann. Surg., 93: 1278-79. With I. W. Beard and Virginia Butler. A study of the effects of division of the cervical esophagus of the dog. Surg. Gynecol. Obstet., 53: 169-75. With Virginia Butler and I. W. Beard. Experimental shock. ~I. A study of the alterations in the volume of blood and in the water content of blood and of muscle that are produced by histamine. Arch. Surg., 23:848-54. With G. S. Johnson. Experimental shock. XII. A study of the effects of hemorrhage, of trauma to muscles, of trauma to the in- testines, of burns and of histamine on the cardiac output and on blood pressure of dogs. Arch. Surg., 23:855-63. With }. W. Beard and G. S. Johnson. Experimental shock. A study of its production and treatment. I. Am. Med. Assoc., 97: 179~97. 1932 With I. W. Beard. Intravenous injections. A study of the composi- tion of the blood during continuous trauma to the intestines when no fluid is injected and when fluid is injected continu- ously. J. Clin. Invest., 11:249-65. With I. W. Beard and Charles Thuss. Intravenous injections. A study of the effects on the composition of the blood of the injection of various fluids into dogs with normal and with low blood pressures. J. Clin. Invest., 11:267-90. With J. W. Beard, Harwell Wilson, and B. M. Weinstein. A study of the effects of hemorrhage, trauma, histamine and spinal anes- thesia on the composition of the blood when no fluids are in- jected and when fluids are introduced intravenously. I. Clin. Invest., 11:291-309.

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ALFRED BLALOCK 73 With I. W. Beard. The effects on the composition of the blood of the subcutaneous injection of normal salt solution into normal dogs and into dogs subjected to intestinal trauma. Graded hemorrhages and histamine injection. T Clin. Invest., 11: 311-25. The effects of complete occlusion of the thoracic aorta. An experi- mental study. I. Thorac. Surg., 2:69-76. 1933 With l. W. Beard and Harwell Wilson. Effects on composition of blood of physiologic solution of sodium chloride when intro- duced by intraperitoneal injection and by stomach tube in the presence of low blood pressure. Arch. Surg., 26: 122-33. With Harwell Wilson, B. M. Weinstein, and J. W. Beard. Loss of protein from the blood stream. Effects of the injection of solu- tion of pituitary and of epinephrine. Arch. Surg., 26:330-34. Exposure of the heart to atmospheric pressure. Effects on the car- diac output and blood pressure. Arch. Surg., 26:516-21. With W. M. Raymond. Studies on bronchial occlusion by the method of Adams and Livingstone. Surg. Gynecol. Obstet., 56:779-81. With R. A. Daniel, fir., and S. E. Upchurch. The absorption from traumatized muscles. Surg. Gynecol. Obstet., 56:1017-20. Peritonitis. Effects on the administration of salt solution on the amount of fluid that accumulates in the peritoneal cavity. Arch. Surg., 26:1098-1102. Effects of primary shock on cardiac output and blood pressure. Proc. Soc. Exp. Biol. Med., 31:36-37. 1934 With G. V. Anrep and A. Samaan. The effect of muscular contrac- tion upon the blood flow in the skeletal muscle. Proc. R. Soc. Ser. B. 114:223~5. Shock. Further studies with particular reference to the effects of hemorrhage. Arch. Surg., 29:837-57. Influence of exposure to cold and of deprivation of food and water on the development of shock. Arch. Surg., 29: 1055-68.

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74 BIOGRAPHICAL MEMOIRS 1935 Experimental studies on the effects of the perforation of peptic ulcers. Surg. Gynecol. Obstet., 61:2~26. The effect of total pneumonectomy on the position of the esoph- agus. Proc. Soc. Exp. Biol. Med., 32:1552-55. With Sidney Burwell. Thoracic duct lymph pressure in concretio cordis. An experimental study. I. Lab. Clin. Med., 21:296-97. With Gunnar Nystrom. Contributions to the technic of pulmonary embolectomy. I. Thorac. Surg., 5:169-88. 1936 With R. S. Cunningham and C. S. Robinson. The experimental production of chylothorax by occlusion of the superior vena cave. Ann. Surg., 104: 359-64. With Morton F. Mason. Observations on the blood flow and gas- eous metabolism of the liver of unanesthetized dogs. Am. l. Physiol., 117:328-34. With Tinsley R. Harrison and Morton F. Mason. Effects on blood pressure of injection of kidney extracts of dogs with renal hypertension. Proc. Soc. Exp. Biol. Med., 35:38-40. 1937 With Sanford E. Levy. Fractionation of the output of the heart and the oxygen consumption of normal unanesthetized dogs. Am. }. Physiol., 118:368-71. With Sanford E. Levy, Morton F. Mason, and Tinsley R. Harrison. The effects of ureteral occlusion on the blood flow and oxygen consumption of the kidneys of unanesthetized dogs. Surgery, 1 :238~2. With Morton F. Mason and Tinsley R. Harrison. The direct deter- mination of the renal blood flow and renal oxygen consumption of the unanesthetized dog. Am. I. Physiol., 118: 667-76. With Sanford E. Levy. The effect of hemorrhage, intestinal trauma and histamine on the partition of the blood stream. Am. I. Physiol., 118: 734-38. With C. S. Robinson, R. S. Cunningham, and Mary E. Gray. Exper- imental studies on lymphatic blockage. Arch. Surg., 34: 1049-71.

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ALFRED BLALOCK 75 With Morton F. Mason and Ray Evers. Renal oxygen utilization of dogs with experimental hypertension. Proc. Soc. Exp. Biol. Med., 36:819-20. With Sanford E. Levy. The effects of obstruction of the common bile duct on the portal blood flow and oxygen consumption. Surgery, 2: 33-36. With C. S. Robinson, R. S. Cunningham, Mary E. Gray, and B. Carl Rogers. Chylous effusions produced by experimental ligation of the superior vena cave. Chemical and cytologic studies. Arch. Pathol., 24:3,03-14. With Tinsley R. Harrison, Morton F. Mason, and John R. Williams, fir. Relation of kidneys to blood pressure. Effects of extracts of kidneys of normal dogs and of dogs with renal hypertension on blood pressure of rats. Arch. Int. Med., 60: 1058-68. 1938 With C. Sidney Burwell. Chronic constrictive pericarditis. Physio- logic and pathologic considerations. }. Am. Med. Assoc., 110: 265-71. With Sanford E. Levy and Rudolph A. Light. The blood flow and oxygen consumption of the kidney in experimental renal hyper- tension. Am. I. Physiol., 122: 38~2. With Sanford E. Levy. The effects of unilateral nephrectomy on the renal blood flow and oxygen consumption of unanesthetized dogs. Am. I. Physiol., 122:609-13. With Sanford E. Levy. Experimental attempts to prevent or abolish the hypertension that is associated with renal ischemia. Surgery, 3:899-903. With Sanford E. Levy and Charles S. Robinson. The effect of alter- ing the renal blood pressure and blood flow on the glomerular filtration of a transplanted kidney in unanesthetized dogs. Am. J. Physiol., 123: 383-87. 1939 With Sanford E. Levy. A method for transplanting the adrenal gland of the dog with re-establishment of its blood supply. Re- port of observations. Ann. Surg., 109: 84~98. With Sanford E. Levy. Gradual complete occlusion of the coeliac

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76 BIOGRAPHICAL MEMOIRS axis, the superior and inferior mesenteric arteries with survival of animals: Effects of ischemia on blood pressure. Surgery, 5: 175-78. With Ralph D. Cressman. Experimental traumatic shock. Further studies with particular reference to the role of the nervous system. Surg. Gynecol. Obstet., 68:278-87. With Ralph D. Cressman. Experimental hypertension. Effects of kieselguhr injection and of splanchnic stimulation. Proc. Soc. Exp. Biol. Med., 40:258-60. With Sanford E. Levy and Ralph D. Cressman. Experimental hypertension. The effects of unilateral renal ischemia combined with intestinal ischemia on the arterial blood pressure. I. Exp. Med., 69:833-46. With Sanford E. Levy. Experimental observations on the effects of connecting by suture the left main pulmonary artery to the systemic circulation. I. Thorac. Surg., 8:525-30. With Morton F. Mason, Hugh I. Morgan, and S. S. Riven. Myasthe- nia gravis and tumors of the thymic region. Ann. Surg., 110: 554-61. 1940 With George O. Wood and Morton F. Mason. Studies on the effects of the inhalation of a high concentration of oxygen in experi- mental shock. Surgery, 8:247-56. With Morton F. Mason and C. Sidney Robinson. Studies on the renal arterial blood pressure and the metabolism of kidney tis- sue in experimental hypertension. J. Exp. Med., 72:289-99. With A. S. Minot. Plasma loss in severe dehydration, shock and other conditions as affected by therapy. Ann. Surg., 112: 557-67. 1941 With James R. Dawson and Ralph D. Cressman. Experimental hypertension and pregnancy in dogs. Am. J. Pathol., 17:31-38. With Morton F. Mason. Blood and blood substitutes in the preven- tion and treatment of shock: With particular reference to their uses in warfare. Ann. Surg., 133:657-76. With George O. Wood. Effects of uncomplicated hemoconcentra- tion (erythrocytosis) with particular reference to shock. Arch. Surg., 42:1019-25.

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ALFRED BLALOCK 77 With Morton F. Mason. A comparison of the effects of heat and those of cold in the prevention and treatment of shock. Arch. Surg., 42: 1054-59. Tumors of the thymic region and myasthenia gravis. Am. I. Surg., 54: 149-50. With Sidney Burwell. Chronic pericardial disease. Report of twenty-eight cases of constrictive pericarditis. Surg. Gynecol. Obstet., 73:433-61. With A. McGehee Harvey, Frank R. Ford, and Joseph L. Lilienthal. The treatment of myasthenia gravis by removal of the thymus gland. Preliminary report. I. Am. Med. Assoc., 117:1529-33. 1942 With Mark M. Ravitch. An evaluation of blood and blood sub- stitutes. Surg. Gynecol. Obstet., 74:348-52. A comparison of the effects of local application of heat and cold in the prevention and treatment of experimental traumatic shock. Surgery, 11:356-59. With George Duncan. The uniform production of experimental shock by crush injury. Possible relationship to clinical crush syndrome. Ann. Surg., 115:684-97. With George W. Duncan. Shock produced by crush injury. Effects of the administration of plasma and the local application of cold. Arch. Surg., 45: 183-94. 1943 Effects of lowering temperature of an injured extremity to which a tourniquet has been applied. Arch. Surg., 46: 167-70. Effects of morphine in experimental shock due to hemorrhage. Arch. Surg., 47 :326-28. 1944 With Edwards A. Park. The surgical treatment of experimental coarctation (atresia) of the aorta. Ann. Surg., 119:445-56. A comparison of the effects of continuous and of intermittent ap- plication of a tourniquet to a traumatized extremity. Arch. Surg., 48:489-90. Thymectomy in the treatment of myasthenia gravis. Report of twenty cases. I. Thorac. Surg., 13:316-39.

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78 BIOGRAPHICAL MEMOIRS With William P. Longmire, fir., and George W. Duncan. The use of venous tourniquets as an aid to the diagnosis of incipient trau- matic shock. Surg. Gynecol. Obstet., 79:434-37. The utilization of oxygen by the brain in traumatic shock. Arch. Surg., 49:167-69. 1945 With Helen B. Taussig. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. }. Am. Med. Assoc., 128:189-202. 1946 Operative closure of the patent ductus arteriosus. Surg. Gynecol. Obstet., 82:113-14. Effects of an artificial ductus arteriosus on experimental cyanosis and anoxemia. Arch. Surg., 52:247-52. The surgical treatment of congenital pulmonic stenosis. Ann. Surg., 124: 879-87. 1947 The use of shunt or bypass operations in the treatment of certain circulatory disorders including portal hypertension and pul- monic stenosis (Churchill Lecture). Ann. Surg., 125:129~1. With Helen B. Taussig. Observations on the volume of the pulmo- nary circulation and its importance in the production of cya- nosis and polycythemia. Am. Heart J., 33:413-19. The technique of the creation of an artificial ductus arteriosus in the treatment of pulmonic stenosis. J. Thorac. Surg., 16: 244-54. 1948 With C. Rollins Hanlon. Complete transposition of the aorta and the pulmonary artery. Experimental observations on venous shunts as corrective procedures. Ann. Surg., 127: 385-97. With C. Rollins Hanlon. Interatrial septal defect. Its experimental production under direct vision without interruption of the cir- culation. Surg. Gynecol. Obstet., 87:183-87. With R. l. Bing, }. C. Handelsman, I. Campbell, and H. Griswold. The surgical treatment and the physiopathology of coarctation of the aorta. Ann. Surg., 128: 803-24.

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ALFRED BLALOCK 1949 79 With Mark M. Ravitch. Aspiration of blood from pericardium in treatment of acute cardiac tamponade after injury. Further ex- perience, with report of cases. Arch. Surg., 58:463-77. 1950 With C. Rollins Hanlon. The surgical treatment of complete trans- position of the aorta and the pulmonary artery. Surg. Gynecol. Obstet., 90:1-15. With Henry T. Bahnson. Aortic vascular rings encountered in the surgical treatment of congenital pulmonic stenosis. Ann. Surg., 133:356-62. With Richard C. Clay. Congenital arteriovenous fistulas in the man- dible. Surg. Gynecol. Obstet., 90:543~6. With Richard F. Kieffer, {r. Valvulotomy for the relief of congen- ital valvular pulmonic stenosis with intact ventricular septum. Report of nineteen operations by the Brock method. Ann. Surg., 132: 496-516. With Ray Heimbecker and Vivien Thomas. Experimental reversal of capillary blood flow. Circulation, 4: 116-19. 1953 With Henry T. Bahnson and Robert D. Sloan. Splenic-portal ve- nography. A technique utilizing percutaneous injection of radiopaque material into the spleen. Johns Hopkins Hosp. Bull., 92:331-45. With {erome Harold Kay and Vivien Thomas. The experimental production of high interventricular sentry clefectc. Ally (~.vne- col. Obstet., 96:529-35. 1954 ~ A, With Thomas N. P. Johns. Mitral insufficiency: The experimental use of a mobile polyvinyl sponge prosthesis. Ann. Surg., 140:335~1. 1955 Our obligations and opportunities (Presidential address, American College of Surgeons, November 19, 1954~. Bull. Am. Coll. Surg., 40:83-86.

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80 BIOGRAPHICAL MEMOIRS 1956 The nature of discovery (Presidential address, American Surgical Association). Ann. Surg., 144:289-303. With Robert A. Gaertner. Experimental coarctation of the ascend- ing aorta. Surgery, 40: 712- 17. 1957 With David C. Sabiston, Jr., and Jean P. Fauteux. An experimental study of the fate of arterial implants in the left ventricular myo- cardium. Ann. Surg., 145: 927-38. 1958 With David C. Sabiston, Jr. Experimental ligation of the internal mammary artery and its effect on coronary occlusion. Surgery, 43:906-12. With David C. Sabiston, Jr. Physiologic and anatomic determinants of coronary blood flow and their relationship to myocardial revascularization. Surgery, 44:406-23. 1959 With David C. Sabiston, Jr., J. L. Talbert, and L. H. Riley. Mainte- nance of the heart beat by perfusion of the coronary circulation with gaseous oxygen. Ann. Surg., 150:361-70. 1961 With James L. Talbert, Lee H. Riley, Jr., and David C. Sabiston, Jr. An evaluation of gaseous oxygen perfusion as a method for maintaining renal viability during periods of complete ischemia. Surg. Gynecol. Obstet., 112: 593-99. With David C. Sabiston, fir. Coronary thromboendarterectomy for angina pectoris. Postgrad. Med., 29:439-50. 1963 With David C. Sabiston, Jr., and Gary W. Archer. Fate of cells in passage through lymphatics and lymph nodes. Ann. Surg., 158:570-80.

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ALFRED BLALOCK 1964 81 With Lazar I. Greenfield. Effect of low molecular weight dextran on survival following hemorrhagic shock. Surgery, 55:684-86. Reminiscence: Shock after thirty-four years. Rev. Surg., 21 :231-34.