LETTERS Seventy-Five Years after the Birth of an Idea: A Tribute to John H Gibbon Jr Jaswinder Singh, MS Rajinder Singh Dhaliwal, MCh Suvitesh Luthra, MCH Debasis Das, MCh Sudhir Mehta, MS Pgimer, Chandigarh, India It was on October 3, 1930; a patient lay dying at Massachusetts General Hospital in Boston. She had undergone cholecystectomy 2 weeks earlier and devel- oped massive pulmonary embolism. The treating sur- geon, Dr Edward Churchill, moved her to the operat- ing room, where a pulmonary embolectomy would be performed as soon as a decision to operate was made. John H Gibbon Jr, a surgical resident, was assigned the task of watching the patient and monitoring her vital signs. Her condition deteriorated during the night, and, finally, at 8 AM the next day, respiration ceased and blood pressure became unrecordable. Within 6 minutes and 30 seconds, Dr Edward Churchill opened the chest, incised the pulmonary artery, extracted a large pulmonary em- bolus, and closed the incised wound in the pulmonary artery with a lateral clamp. 1 It was to no avail. The pa- tient could not be revived. The events of October 3, 1930, marked a turning point in the history of surgery, not because of the way in which the patient was managed—it was standard prac- tice at that time—and not because of the fatal result of the pulmonary embolism—that was the usual result— but because it gave birth to an idea that led to develop- ment of the heart-lung machine and made contempo- rary cardiopulmonary bypass (CPB) and open heart operation possible. Birth of an idea During that long night, helplessly watching the patient struggle for life as she became cyanotic and her veins dis- tended, an idea occurred to John Gibbon. He thought that if some of the blue blood could be removed from the pa- tient’s distended veins, oxygen could be added, and carbon dioxide allowed to escape, then the new oxygenated blood could be injected continuously back into the patient’s ar- teries, saving her life. 2 Instead of building an apparatus that could take over some of the cardiopulmonary functions and make pul- monary embolectomy a safe procedure, he attempted to build one that could perform the functions of the heart and lungs for a period of time, a heart-lung machine, which made operations on the heart itself possible, even inside its chambers. It took him 23 years to bring his idea to fruition. Working on the idea When he returned to Philadelphia from Boston after working as a fellow in Churchill’s laboratory, he not only brought along his idea of a CPB machine, but also his technical assistant and new wife, Maly Hopkinson, who for years worked with him as a partner in his investiga- tive efforts. He practiced surgery in the mornings and in the afternoons worked in the Harrison Experimental Surgical Laboratories at the University of Pennsylvania, where he obtained a staff appointment. This time in Philadelphia provided no opportunity for research on the heart-lung machine. When he discussed the idea of a heart-lung machine and CPB with his colleagues, he met with little or no encouragement. He was not dissuaded by the opinion of the majority and when he was offered another fellowship year in Boston, he gladly accepted it. John and Maly saved money by walking about the Bos- ton streets at night, securing cats without expense. As he recalled once, “I can recall prowling at Beacon Hill at night with some tuna fish as bait and a gunny bag to catch any of those stray cats which swarmed over Boston in those days.” 1 When the year in Boston ended in 1934, the Gibbons returned to Philadelphia. They experi- mented endlessly and, in 1939, Gibbon brought CPB over a high hurdle. Describing the event in 1967 he said, “I will never forget the day when we were able to screw the clamp all the way, completely occluding the pulmo- nary artery, with the extracorporeal blood circuit in op- eration with no change in the animal’s blood pressure! My wife and I threw arms around each other and danced around the laboratory.” 3 CPB had come a long way, but application in human operations was still some years away. 384 © 2006 by the American College of Surgeons ISSN 1072-7515/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jamcollsurg.2005.10.004