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Dr. John H. Gibbon, Jr. and Jefferson’s Heart-Lung Machine

"Many are the trysts I’ve had
With the mortals here,
Their bodies offered to my trust,
To cut and sew and maybe cure.”
        John Heysham Gibbon, Jr., 1960

 

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Heart-lung machine, Model II, “the size and shape of a spinet piano,” 1951.

On May 6, 1953 at Jefferson Medical College Hospital, Dr. John Heysham Gibbon, Jr. and his staff, with the help of his latest-designed heart-lung machine “Model II,” closed a very serious septal defect between the upper chambers of the heart of eighteen-year-old Cecelia Bavolek. This was the first successful intercardiac surgery of its kind performed on a human patient. Ms. Bavolek was connected to the device for three-quarters of an hour and for 26 crucial minutes, she totally depended upon the machine’s artificial cardiac and respiratory functions.

“Jack” Gibbon did not follow this epoch-making event by holding an international press conference or by swiftly publishing his achievements in a major medical journal. In fact he later recalled that it was the first and only time that he did not write his own operative notes (which were supplied by Dr. Robert K. Finley, Jr.). According to a recent biographical review by C. Rollins Hanlon, “Therein lies a hint of the complex, unassuming personality behind the magnificent technical and surgical achievement of this patrician Philadelphia surgeon.”

After this surgery Dr. Gibbon reportedly felt “extreme exhilaration, relief, and joy that the patient had done well.” One wonders if he was also experiencing a surreal state of anticlimax, having simultaneously ended twenty-three long years of apparatus designs and experimentation leading to a new chapter in the history of medicine.

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Fourth year med student, John H. Gibbon, Jr., 1927.

The son of a Jefferson Medical College graduate (John H. Gibbon, Sr., Class of 1891), Jack was a sophomore when he announced to his father that he was quitting Jefferson for a career as a writer. Senior Gibbon gently persuaded his son to finish his medical education and turn his writing urge toward the promotion of medical research. Jack graduated in 1927 and in a brief series of events he was named Fellow at Massachusetts General Hospital.

In 1930 Dr. Gibbon found himself assisting Dr. Edward Churchill in an emergency pulmonary embolectomy. At that time the procedure was one of desperation, as no patient in the U.S. had survived the removal of blood clots in open-heart surgery. As he recorded the patient’s waning vital signs prior to the procedure he thought, “If only we could remove the blood from her body by bypassing her lungs, and oxygenate it, then return it to her heart, we could almost certainly save her life.” Despite a successful removal of large clots from her pulmonary artery, the patient never regained consciousness. This “critical event” initiated Gibbon’s determination to produce a heart-lung machine.

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Lt. Col. John H. Gibbon, Jr., ca. 1944.

Over the next two decades, most of his colleagues and superiors shared little hope in the prospect of designing a successful apparatus, but Gibbon cobbled together fellowships and employment that allowed him time for research. One of his supporter-colleagues was a researcher at Harvard, Mary “Maly” Hopkinson. They married and continued working together, mostly at the University of Pennsylvania’s research laboratories. By 1939, they published results of total body perfusion experiments on a number of laboratory cats that survived by employing the early apparatus invented by Gibbon.

World War II interrupted Gibbon’s research and separated him from his growing family for four years. He was made Chief of Surgical Services at the 364th Station Hospital in the Pacific Theater. Returning to Philadelphia after the war, his alma mater offered him the position of Professor of Surgery and Director of Surgical Research, with the understanding that he would continue his pursuit of the heart-lung device. He accepted the JMC post in January 1946.

Through JMC’s connections, IBM and its premier engineering department entered the picture and worked with Dr. Gibbon on his oxygenator to develop a larger device known as IBM “Model I.” Maly Gibbon and the JMC surgical residents were also deeply involved in the evolution of this huge apparatus (too heavy for the buildings’ elevators), which proved repeatedly successful in experiments on dogs. But limitations on the machine for human patients existed and the decision was made to cannibalize parts of Model I for Model II, which was ready for its first test in February 1952.

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Dr. Gibbon and former patient Cecelia Bavolek pose before the Plexiglas-covered “lung” ten years after the landmark operation, 1963.

Although the Model II heart-lung device was fully functional, the first patient--a 15-month old baby--died during the operation. A post-mortem revealed a much larger defect than was suspected. After the triumphant Bavolek case in May, Gibbon employed the Model II on two more patients in July 1953. Both children subsequently died, prompting Gibbon to declare a year’s moratorium on the use of the heart-lung machine, pending investigations into solving clotting problems and blood loss. A redesign of the device resulted in Model III, delivered to campus in July 1954.

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John H. Gibbon, Jr., MD, in retirement, at his family home, Lynfield Farm, Media, PA, 1972.

The Mayo Clinic, which probably had more cardiac cases than anywhere in the U.S., asked for plans for Gibbon’s oxygenator, which he shared with them in February 1953. The Mayo Clinic further developed the “Mayo Gibbon-type oxygenator” and for the next several years used this device on hundreds of patients. The mortality rate for intracardiac surgery dropped from 50% in 1955, to 20% in 1956 and to 10% in 1957. A new age for cardiac surgery was underway.

Gibbon, who received accolades and awards, continued his private practice and his teaching at JMC until his retirement in 1967 as Samuel D. Gross Professor of Surgery. Although he was criticized for “abandoning” further use of the heart-lung machine after the deaths of the two children in 1953, his friends recognized that it was very much in his character not to put humans at risk, even when faced with the prospect of losing his life-long project to others.

A daily cigarette smoker, like many of his contemporaries, Dr. John H. Gibbon, Jr., suffered a fatal heart attack at the age of 69 on February 5, 1973 while playing tennis.

Further Readings

Schumaker, Jr., Harris B., A Dream of the Heart: The Life of John H. Gibbon, Jr., Father of the Heart-Lung Machine. Santa Barbara, CA: Fithian Press, 1999.

Romaine-Davis, Ada, John Gibbon and His Heart-Lung Machine. Philadelphia, PA: University of Pennsylvania Press, 1991.



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