Originally published in Volume 42 Issue 8 of Artificial Organs, 04 September 2018
On May the 6th, 1953 John H. Gibbon Jr., MD (Dr. Gibbon) became the first surgeon to perform an open cardiotomy during bypass under direct vision in a human, by repairing an interatrial septal defect in an 18-year-old female (Fig. 1) 1. Dr. Gibbon initially became interested in developing the heart-lung machine in 1931, after witnessing a patient with a massive pulmonary embolism 2. The patient was treated with an “off-pump” surgical embolectomy, as described by Dr. Friedrich Trendelenburg, which had a staggeringly high mortality rate, and had never been performed successfully in the USA at that time 2, 3. It is no surprise that this event profoundly affected Dr. Gibbon, as his job was to stay with the patient and take blood pressures every 15 min, for 18 h while she deteriorated. Finally, when a blood pressure was no longer obtainable, surgical treatment was initiated, and the patient ultimately died 4. In Dr. Gibbon’s own words, “During that long night, helplessly watching the patient struggle for life, the idea naturally occurred to me that if it were possible to remove continuously some of the blue blood from the patient’s distended veins, put oxygen into that blood and allow carbon dioxide to escape from it, and then inject continuously the now red blood back into the patient’s arteries, we might have been able to save her life. We would by-pass the obstructing embolus in the pulmonary artery and perform part of the work of the patient’s heart and lungs outside of the body” 2.
Figure 1
Making Dr. Gibbon’s dream a reality was no small feat. During his 23 years spent in pursuit of developing the heart-lung machine, Dr. Gibbon conducted research at three institutions, finished his residency, got married, had children, took a 4 year hiatus to serve in World War II, and rose to the rank of “Professor of Surgery” at Thomas Jefferson University Hospital 4, 5. Developing the heart-lung machine was the one constant for the majority of Dr. Gibbon’s professional life.
During this time, Dr. Gibbon’s efforts were viewed by his contemporaries as futile, and he was sometimes even described as “crazy” for pursuing such a far-fetched idea 5. When initially discussing his interest in pursuing the development of the heart-lung machine, Dr. Gibbon was dissuaded from doing so by many of his contemporaries, even Dr. Edward D. Churchill, his research supervisor at the time 5. Dr. Gibbon remembers his interactions with Dr. Walter Bauer, a prominent internist working at Massachusetts General Hospital when he first began developing the machine, “…I received a very positive discouragement to pursue the subject of the extracorporeal oxygenation from my friend the late Walter Bauer, who told me that if I wished to remain at Harvard I had better tackle easier subjects which would allow me to publish a large number of articles in the literature” 4. The closest thing to encouragement that Dr. Gibbon received was from a previous mentor, Dr. Eugene M. Landis, who said “…if you think you can do it and if this heart-lung machine would prove useful, [you] should work at it” 2. This was lukewarm encouragement at best, but to Dr. Gibbon, this was enough.
It is almost 65 years after the date of the first successful use of Dr. Gibbon’s heart-lung machine. Herein we attempt to integrate many of the recounts of Dr. Gibbon’s temperament, professional attitudes, nonmedical interests, and family legacy so that scientists, inventors and physicians can better understand the characteristics of the man behind one of the most important surgical inventions of the 21st century.
OVERVIEW OF THE DEVELOPMENT OF THE HEART-LUNG MACHINE
Dr. Gibbon began his journey to create the first heart-lung machine during his first year of fellowship at Massachusetts General Hospital. He began the fellowship in February of 1930, and after eight months of training he witnessed a patient who had died from a pulmonary embolus. Although this event is described as the primary driving force for Dr. Gibbon to pursue the development of the machine, it is clear that he was already conducting research in the area prior to this fateful event 5.
Early in his fellowship, Dr. Gibbon began conducting research to determine the physiologic changes that occur in pulmonary emboli. These experiments were conducted in a feline model and showed an inverse relationship between systemic blood pressure and pulmonary artery occlusion, and that at least 81% of the pulmonary artery must be occluded to precipitate cardiac failure 5. These experiments were concluded before Dr. Gibbon’s encounter with the patient with a fatal pulmonary embolus, but it is here where he developed the prototypes of many of the laboratory tools that would be used for animal experimentation, such as the apparatus that he used to occlude the pulmonary artery. While Dr. Gibbon had set his mind on developing the heart-lung machine during this fellowship year, he did not start directed experiments until much later.
Dr. Gibbon accepted the position of “Assistant Professor of Surgery” at the University of Pennsylvania Hospital in 1931, and while he continued research during these years, he did not pursue research related to the development of the heart-lung apparatus 5. During these years, Dr. Gibbon conducted research under the direction of Dr. Eugene H Landis and attributes his painstaking approach to conducting research to Dr. Landis 5.
In 1934, Dr. Gibbon requested an additional year of research from Dr. Churchill at Massachusetts General Hospital, with the sole purpose of developing the heart-lung machine. Dr. Churchill was not very enthusiastic about the prospects of pursuing the project, but nevertheless offered the position to Dr. Gibbon, doubting that he would ever achieve his goal. It was during this year that Dr. Gibbon developed the prototypes of many of the key components of the heart-lung machine, including the oxygenator, the venous reservoir, and the arterial pump 5.
The most essential component of the heart-lung machine that was developed at this time was the flow oxygenator. Early on, Dr. Gibbon realized that this would be the main challenge of constructing the machine, and while there were many different approaches to oxygenating blood at the time, all had their drawbacks. Settling on film oxygenation (as opposed to bubble oxygenation), Dr. Gibbon initially constructed a vertical revolving cylinder oxygenator (Fig. 2) 5 As he remembers the first prototype, “I bought an air pump in a second-hand shop in East Boston for a few dollars…Valves were made from solid rubber corks with the small end cut transversely three quarters through to form a flap 2mm thick…a cork borer was passed through the center of the stopper, thus creating a small channel for the stream of blood.” and “This assemblage of metal, glass, electric motors, water baths, electrical switches, electromagnets, ect. looked for all the world like some ridiculous Rube Goldberg apparatus.” (Rube Goldberg was a prominent cartoonist best known for his zany invention cartoons) (Fig. 3) 4. This prototype proved sufficient and was used on all of the animal research, but this design would have to be scaled to unimaginable proportions to support an animal larger than a small dog 5, 6
Figure 2
Figure 3
It was in 1935, that Dr. Gibbon demonstrated artificial circulation could maintain life in cats for up to 2 h and 51 min, and also that normal circulation could be re-established after artificial circulation was used 7. As Dr. Gibbon recounts the first time he successfully maintained oxygenation after complete occlusion of the pulmonary artery, “Although it gives me great satisfaction to know that open heart operations are being performed daily around the world nothing in my life has duplicated the joy of that dance around the laboratory…” 4. After this incredible success, in 1935, he returned to Philadelphia to continue his research.
The next few years were spent balancing clinical practice and conducting research in Philadelphia. In 1939, Dr. Gibbon published his research that had been conducted in the Harrison Research Laboratory at Pennsylvania Hospital. The major goal of these experiments was to decrease the hemodilution seen in the previous experiments, and to track long term success (previous experiments sacrificed the animals after the immediate postoperative period). In his series of 39 animals, 13 survived more than 24 h. While Dr. Gibbon continued to make advancements on the heart-lung machine, he quickly entered active service in World War II. Prior to volunteering to join the war effort, Dr. Gibbon was able to report that he had achieved indefinite survival of good condition in felines and had begun experimenting on canines. Additionally, he had completed his development of a new apparatus, which was ready for testing, but his research on the heart-lung machine was put on hold until he returned from the Medical Corps.
Dr. Gibbon returned to his clinical practice at Pennsylvania Hospital in 1945, only to be offered the position of Professor of Surgery and Director of Surgical Research from Dr. Tomas Shallow at Jefferson Medical College (now Sidney Kimmel Medical College at Thomas Jefferson University) within a few months. It was at this institution, that he would complete his goal of developing a functioning heart-lung machine.
By sheer luck, one of the medical students at Jefferson had connections to Mr. Thomas Watson, chairman of the board of directors of International Business Corporation (IBM) 4. Through this student, a meeting was arranged, and a fruitful professional relationship for the next 7 years began. This association led to seemingly inexhaustible resources 6. Long gone were the days of air pumps bought from second-hand stores, or makeshift valves. All parts of the machine were constructed using the finest materials, which manifested in incredible results 6.
The list of deficiencies in the heart-lung machine were rapidly dwindling after IBM became involved in 1947. Dr. Gibbon’s blueprints were followed and a formal prototype, known as the “Model I,” was shipped to Thomas Jefferson University for testing. This machine was tested extensively in canines, and the results of this machine were published in 1950 8. The main deficits that were noted in the Model I were: (i) the oxygenator was inadequate and could not support an animal larger than a small dog, (ii) the arterial pump frequently caused air emboli, (iii) there was a large amount of hemolysis, incompatible with surgery, (iv) the amount of respiratory acidosis that developed from the thoracotomy was incompatible with surgery, and (v) foam formed within the left ventricle if a cardiac defect exposed the left ventricle to atmospheric air 6.
These problems were addressed over the following years, resulting in many inventions that were not only crucial for the development of the heart-lung machine but also useful to surgery in their own right. The flow oxygenator was optimized by introducing turbulence into the stream, which vastly increased the oxygenation. Furthermore, the cylindrical design was exchanged for a design that included six steel screens suspended from weirs 5, 6. The respiratory acidosis was corrected by the development of the first positive-negative intratracheal ventilator, known in the literature as the “Jefferson Ventilator” 5, 6. This ventilator was used in surgeries in the USA as well as abroad 6. A fluid control servo system, which made the flow of the machine completely automatic, safeguarded against embolization was an engineering feat in its own right 6. Another significant device that was produced at this phase was the left ventricle vent, which managed the buildup of foam into the left ventricle (Fig. 4) 5, 6, 9, 10.
Figure 4
NONMEDICAL INTERESTS
Some of the most fascinating aspects of Dr. Gibbon were his interests outside of medicine. Dr. Gibbon had an intense interest in many nonmedical areas prior to attending medical school. Due to the all-consuming nature of his professional aspirations, Dr. Gibbon had to suppress his interests in these areas for the vast majority of his surgical career, but he returned to these interests following retirement.
As a young boy, Dr. Gibbon wanted to be a poet and a writer 12. His mother, Marjorie Gibbon was the primary influence for him pursuing liberal arts studies 13. During his time at Penn Charter School, Dr. Gibbon was incredibly involved in nonscientific interests. He participated actively in many theater presentations, on one occasion playing a female role 4. During his time at the charter school, he was also an assistant editor on a student led magazine 4.
At the young age of 16, Dr. Gibbon enrolled in Princeton University to study philosophy and religion 5, 14. While Dr. Gibbon was incredibly well read for his age, he struggled to connect with the other students and their world views, and spent most of his time in his room reading. As he stated later in life “It was the worst year of my life, I was simply too young” 4. During a summer trip to France to visit his sister, he delved deeply into the study of philosophy and its interplay with religion, to the point where he impressed his sister and persuaded her to think critically about religion 5, 15. During this trip he also spent time studying medicine, which is the first time that he spent any time considering medicine as a field 4. It was at Princeton that Dr. Gibbon first began painting, later remarking that he was “…smitten with painting” during his collegiate experience 4. He graduated Princeton at the age of 19, and began his medical schooling at Jefferson Medical College.
Dr. Gibbon’s early years were marked by a regret in not pursuing his interests in literature and poetry 13. Even after completing his first year of medical school at Jefferson Medical College, he seriously considered quitting to pursue poetry but was talked out of this by his father 5, 13. The first year of medical school was especially difficult for Dr. Gibbon, later remarking, “The first year of medical school was, frankly, boring as hell – all needless memorization” 4. Years later, after the successful use of the heart-lung machine, Dr. Gibbon implored other medical educators, “Teaching the minutia of medical and surgical specialties to undergraduate medical students should be thrown out” 16. Dr. Gibbon confided in a close friend that he felt that his father pushed him into medical school, often stating that “[Dr. Gibbon] wouldn’t write less well for having a medical degree” 12. Although Dr. Gibbon did not pursue a career in writing, per se, his interest in the subject and natural eloquence certainly lent itself to his prolific involvement in research literature and excellent legacy as a visiting professor. One of his former colleagues noted that “Mastery of words was one of his great attributes,” and another attributed his success as the editor-in-chief of Annals of Surgery to his incredible command of the English language 12, 17.
Dr. Gibbon had a love of nature that was cultivated from a young age, and persisted his entire life. In 1912, his father bought Lynnfield Farm, a 150 acre farm in Media, on the outskirts of Philadelphia. Dr. Gibbon was expected to complete yard work and care for the animals during his summers at the farm 5. It was at the farm that he began to develop his athletic interests, such as horse riding, and a life-long love of tennis 5. Dr. Gibbon often spent time climbing various parts of the structures of the property, swimming and challenging is his younger brother, Sam, in many of these activities 4. It is clear that Dr. Gibbon had a strong connection to the farm, and after the death of his parents in 1956, he bought his brother’s and sister’s shares in the property 5. On retirement, he moved to the farm permanently 5. Even in his old age, Dr. Gibbon continued to contribute to maintaining his farm, including building a pool and doing yard work, and often entertained world renowned physicians and scientists there (Fig. 5) 12.
Retirement was an opportunity for Dr. Gibbon to return to some of his nonmedical interests. As Dr. Johnathan Rhodes noted in Dr. Gibbon’s memorial address, “With the clarity of thought which characterized him, he cut off his surgical career sharply when he retired from Jefferson and devoted himself to the hobby he had pursued for many years, that of painting and portraiture” (Fig. 6) 18. Indeed, during his retirement, Dr. Gibbon spent most of his time writing poetry, painting, and playing tennis 13, 19. He used poetry as a medium for introspection, and his last known written poem was at the age of 68, less than a year prior to his death 5. This poem, like many others, focused around the meaning of Dr. Gibbon’s life, and harkens back to the strong foundation of philosophy and religion that Dr. Gibbon attained from his studies at Princeton and in Europe 5. He wrote:
Having lived 68 years
I don’t know I am, why
I am, or where I am.
I only know that here I am
Now, this instant of time,
This no-dimensional dot
In the geometry of the universe. 5
Figure 6
PERSONALITY AND PROFESSIONAL ATTITUDE
Dr. Gibbon was an extremely complex man. Many of the recounts of Dr. Gibbon’s personality are somewhat contradictory. One of his colleagues depicted him as aloof and uncaring, but acknowledged that this was a façade that he intended to keep during his time as chief 19. To his peers and close friends, Dr. Gibbon was known to be talkative, animated, and friendly 19. Perhaps one of the most flattering comments on Dr. Gibbon’s personality is as follows, “Some men are crushed by the mantle of greatness. Some find it so heavy that they must stand tall, erect, and arrogant. Jack wore his with easy grace, with no undue pride, but with a pleasant, somewhat surprised satisfaction” 12. While Dr. Gibbon’s personality has been described as everything from sympathetic to narcissistic, there are some personality traits that were universally reported by his close colleagues 5.
One aspect of Dr. Gibbon’s personality that is not debated among any of his friends or contemporaries is his undying persistence. The most obvious example of his persistence is through the long and arduous 22-year process of developing the heart-lung machine. There are, however, other anecdotes that display his persistence. A resident once had a dispute with Dr. Gibbon about whether or not “cc” or “c.c.” was the correct abbreviation of cubic centimeters 19. This debate came at a time in which the manuscript was due the following day, after the presentation of the findings at a national conference. After calling multiple editors that Dr. Gibbon knew personally, he decided that “c.c.” was the correct abbreviation 5. After the article was retyped (prior to the advent of word processors), and submitted, the journal replied that they believed “cc” was the correct abbreviation 5. On notification of the abbreviation decision, Dr. Gibbon called another editor and the journal itself to voice his opinion that “c.c.” was the correct abbreviation. On hearing that the journal would be publishing “cc,” Dr. Gibbon seriously contemplated retracting the manuscript, much to the resident’s dismay as the research was critical to his career, but ultimately Dr. Gibbon allowed the manuscript to be printed. Dr. Gibbon did not relinquish his preference, and later claimed that “the editors are illiterate” 19.
Dr. Gibbon’s persistence was also demonstrated when he had suspected that he had lung carcinoma. A former resident and friend recalled, “For example he was a heavy smoker and developed a chronic dry cough. He suddenly decided to quit smoking, cold turkey. A few months later the cough remained and one day he confided in me that he had carcinoma of the lung. Of course I was shocked and asked when he had discovered this disaster. He said that he had not yet proved it but knew that he was right. My response was ‘Let’s go get a chest roentgenogram.’ He said that was not possible now because he was in the midst of editing his book ‘Surgery of the Chest’, and if his diagnosis was confirmed he would be obligated to follow through and couldn’t meet the deadline for completion of the book imposed by the publisher” 19. It is clear that when Dr. Gibbon had committed to a task, he would not let anything derail its completion, even his own health.
In somewhat of the same vein, Dr. Gibbon was known to have an incredible attention to detail. It was known among his residents that a surgical topic written with other faculty members would take half the time compared to Dr. Gibbon, although the quality of work was often higher with Dr. Gibbon 5. During his time as the editor-in-chief of Annals of Surgery, Dr. Gibbon was noted to be “fussy about statistics” and was “driven to fury” about the presentation of any statistic as a percentage that was based on less than 100 cases 17. During his presidential address to the American Surgical Association in 1955, Dr. Gibbon took time in his speech to highlight the importance of providing reference values in research, the adequate use of significant figures, and the critical evaluation of measurements as being necessary for surgeons, or “…he will be buffeted on the seas of surgical opinion” 16.
His attention to detail was paired with a natural decisiveness, and he was never hesitant to take an unpopular stand if he believed he was correct. One specific instance of this was when he alone went to the public press to gain support to continue maintaining the American College of Physicians Medical Library 21. Another example of this is when he co-authored a list of demands to the Board of Trustees of Jefferson Medical College listing grievances pertaining to the way that the surgical internship was being managed, as well as the dismissal of hospital faculty 22. Surprisingly, this article was authored a year prior to him being offered the chair of the department position in 1956. Appropriately, Dr. Gibbon was described as being “incisive in speech, in thought, and in action” 23. It is clear that this triad of persistence, attention to detail, and decisiveness were all critical to his success as a researcher and surgeon, especially in light of the fact that he had such little support from his peers when embarking on assembling the heart-lung machine.
Dr. Gibbon was noted to have an “explosive” temper at a young age, often leading to altercations with his younger brother, Sam 4. As Dr. Gibbon progressed through grade school, his temper vanished, giving way to his unshakable and peaceful persona that was noted throughout his professional career 4. Dr. Gibbon is remembered as being soft spoken, and never having to raise his voice in a professional setting to make a point.
Dr. Gibbon was also known for his humility, and while he did not actively shy away from the publicity that was brought to him for his achievements, he did not actively seek them out either. Indeed, Dr. Gibbon never received any monetary profit from his work on the heart-lung machine, nor did he ever attempt to 5, 24. One of his previous pupils and eventual colleagues remembers an event where Dr. Gibbon chastised him for bringing undue publicity to Dr. Gibbon in an instance where a radio advertisement was broadcasted asking for blood donations for a life saving cardiac case that Dr. Gibbon was about to perform 24.
Dr. Gibbon had a strong belief in applying to a position based solely on one’s merit separate from family and associated professional staff. Residents were often upset that Dr. Gibbon would not “call upon” his peers and connections to help their placements with jobs, residencies, or fellowships 5. While this was frustrating for those that worked under him, it cannot be denied that Dr. Gibbon embodied this attitude when it came to developing his own career, as he was never known to call on his father for professional opportunities, who was a prominent surgeon in the Philadelphia area 5, 19. Despite a his resistance to calling in favors for placement of surgical residents, Dr. Gibbon managed to serve as an excellent mentor to many young surgeons during his time at Jefferson University Hospital. His influence altered the lives of medical students, residents, and even faculty members at the time, and many went on to receive prestigious awards and highly sought positions 18, 19, 24.
Dr. Gibbon spent much of his time as an educator at Jefferson Medical College. As he stated in his presidential address, “As the best charity lies in helping people to help themselves, so I believe the best education lies in helping the student to educate himself…[education] is a lifelong process” 16. Dr. Gibbon thought that a medical student that did not learn to self-educate would be destined to be a poor physician 16. He thought that curiosity about the unknown was necessary for teachers and students alike, saying that at least 10 min of every hour of lecture should be set aside to acknowledge current gaps of knowledge in the subject matter 16.
Just as his interest in liberal arts was vast and varied, Dr. Gibbon displayed an incredible understanding of many areas of surgery, including urology and orthopedics 17. He held weekly grand rounds with the senior medical school class and frequently took this opportunity to educate the students on his vast understanding of the different surgical subspecialties and physiology 17. His approach to education shows that Dr. Gibbon shared the mentality of his long-time mentor, Dr. Churchill, that surgery is a single discipline, rather than multiple subspecialties 17. With respect to developing an equally broad understanding of surgery in his trainees, Dr. Gibbon was noted to strongly encourage all surgical residents to spend at least a year in the laboratory, to build their understanding of physiology and ability to review surgical literature 13. Furthermore, he stated that all surgeons should pursue a second year of surgical research in a laboratory after the conclusion of their residency, to increase proficiency in bench research 13. It is clear that these views are consistent with Dr. Gibbon’s commitment to his own broad understanding of surgery, as he himself had taken extended dedicated time spent developing the heart-lung apparatus.
Dr. Gibbon was not interested in the technical aspect of surgery as much as he was with the intellectual aspects 17. He found the technical expertise to be tedious and was much more drawn to the discussion of new surgical ideas 17. This is best exemplified by the decision to pursue other surgical areas rather than cardiac surgery, after essentially paving the way for the modern era of that field. One surgical resident recounts that Dr. Gibbon announced to the department that he was interesting himself in liver disease in the weeks following his groundbreaking surgery 17. It is clear that Dr. Gibbon quickly turned his eyes to other research endeavors after the successful surgery, as he and his associates presented an analysis of 532 consecutive cases on cancer of the lung by the end of 1953. Dr. Gibbon himself accumulated a large series of patients with carcinoma of the lung or esophagus, which formed the basis of many important publications from Jefferson in that era 21.
Dr. Gibbon was known to avoid conflict when disciplinary actions were taken. As the Samuel D. Gross Professor at Thomas Jefferson University Hospital, he often had a junior member of the staff take care of disciplinary actions 5. Dr. Gibbon’s stance was to make everyone comfortable to maximize productivity and minimize discord 5. In almost all capacities he abhorred small talk, especially during rounds, and would frequently stir up meaningful and directed conversations, be them scientific or otherwise 21.
THE GIBBON FAMILY AND PROFESSIONAL LEGACY
Dr. Gibbon was the fifth consecutive physician in his family, and the third such to graduate from Jefferson Medical College 13. John H. Gibbon Sr., MD (Dr. Gibbon Sr.) was a prominent surgeon in the Philadelphia area, holding many highly sought after positions, including the presidency of the American Surgical Association 13.
John H. Gibbon Sr., MD was the primary driving force for Dr. Gibbon to become a physician 5, 12. Dr. Gibbon Sr. may have even played a role in Dr. Gibbon’s decision to become a surgeon, but they differed in opinion of how Dr. Gibbon should spend his professional time. Dr. Gibbon Sr. felt that pursuing dedicated research time was not the most productive use of Dr. Gibbon’s time, and frequently pleaded for Dr. Gibbon to spend a larger portion of his career on clinical practice 5. Despite his father’s input, Dr. Gibbon continued to pursue research opportunities.
Dr. Gibbon Sr. was most likely the source of Dr. Gibbon’s competitive nature 14. One resident remarked, “Doctor Gibbon also was very competitive. I believe that he unconsciously had a rivalry with his father, John H. Gibbon, Sr, M.D., a prominent Philadelphian and national surgeon who had been professor of surgery at Jefferson Medical College and president of the American Surgical Association” 19. Certainly, competitiveness permeated the entire Gibbon household, whether it was puzzles and word games with his mother or athletic challenges between siblings, although the competition between Dr. Gibbon and Dr. Gibbon Sr. was the most intense 4.
One of the best examples of the intense competition between Dr. Gibbon and Dr. Gibbon Sr. is shown through their chess matches. At an early age, Dr. Gibbon was exposed to chess by his father, and he quickly learned the rules of the game 5, 14. Dr. Gibbon would frequently play against his father through meals and would often irritate his father by the painstakingly careful nature in which he approached his moves 5. Dr. Gibbon’s competitiveness with his father in chess developed him into an excellent player, and a colleague who served with Dr. Gibbon in World War II recounts, “The story was that he had been the champion of a certain region of the South Pacific during the war and that from time to time flights were taken to nearby islands for the express purpose of extending the area over which he reigned” 17.
While Dr. Gibbon was extremely competitive with his father, he felt an intense desire to avoid professional comparisons to him. It is clear that Dr. Gibbon believed that a man should stand on his own merits, and not take advantage of connections to attain positions that they were not qualified for 5. In 1954, when Dr. Gibbon was elected to the presidency of the American Surgical Association, a colleague had made an offhand comment to Dr. Gibbon, noting that it was an incredible feat to occupy the same position as Dr. Gibbon Sr. had held many years prior 5. Dr. Gibbon later remarked to a close friend that he hoped that the previous doctor did not believe that his presidency was affected by the achievements of his father.
Once Dr. Gibbon had established himself as a separate entity from his father (mainly after the first use of the heart-lung machine), their relationship became more of one of mutual respect rather than competitive. Dr. Gibbon is noted to have become a particularly well-known lung surgeon during this time, and even consulted with his father on some of the nonmedical aspects of managing his clinical practice 5. This change in attitude is summed up by a resident’s account that Dr. Gibbon was pleased that his portrait, painted at the tenth anniversary of his historic surgery, was hung in the same place that his father’s once had 12. As one former resident, who grew rather close to Dr. Gibbon, remarked, “In the long run, Gibbon Jr. surpassed his father’s achievements but I never heard him say so” 19.
Dr. Gibbon often felt that his wife’s, Mary Hopkinson (Maly), contributions to his scientific achievements were vastly undervalued. After meeting Maly in Dr. Churchill’s lab in early 1930, and after working closely in the lab, they became engaged in early 1932 4, 25. In retrospect, their relationship was almost unavoidable. Both Dr. Gibbon and Maly were about the same age, were intensely interested in medicine and scientific research, and both had spent significant time engaging in artistic endeavors. Both had even spent extended time in France prior to meeting in Dr. Churchill’s lab 4. Maly, the daughter of a painter, spent years playing the piano, which was certainly a skill that was respected by Dr. Gibbon. By all accounts, Maly and Dr. Gibbon had intense respect for each other, and attributed much of the happiness in their lives to each other 4, 25.
It is clear that Dr. Gibbon’s pursuit of his medical interests permeated his entire life, and to some extent affected his family life. After all, Dr. Gibbon met his future wife Maly in Dr. Churchill’s lab, where he began conducting his first experiments for the development of the heart-lung machine on felines 25. While their relationship was incredibly fulfilling for both Maly and Dr. Gibbon, it is clear that his professional responsibilities took a toll on his family life. This was most evident when Dr. Gibbon voluntarily entered into the army for World War II, and was absent for some of the formative years of his children 5, 14. This decision was somewhat perplexing to his family and his peers, as Dr. Gibbon was 38-years old and had a family with four children 4. Shortly after returning from war, Dr. Gibbon had another extended period of absence in which he visited Europe to attend an international research meeting and to meet with a colleague, Dr. Clarence Crafoord, who had developed an interest in Gibbon’s research on the development of the heart-lung apparatus 5, 12. While this was an inopportune time for visiting Dr. Crafoord, it is clear that this was an important relationship to Dr. Gibbon. Dr. Crafoord was a frequent visitor to the lab, and after the first successful use of the machine, Dr. Gibbon called Dr. Crafoord first. Furthermore, Dr. Gibbon’s professional relationship with his brother revolved around selling some of the technology that was developed to create the heart-lung machine. Sam Gibbon was a businessman at Air-Shields, and profited from the Haupt/Jefferson ventilator and other medical supplies that were developed in the Gibbon lab 5, 6 Additionally, Dr. Gibbon frequently contacted his brother about managing the finances and purchasing decisions of the Jefferson surgical department, especially once Dr. Gibbon had assumed the Samuel D. Gross chair of the Surgery Department.
While Dr. Gibbon’s relationship with his children was somewhat tumultuous due to his absence during the war as well as his professional responsibilities, he and Maly managed to raise three successful children, and cultivated a love for the arts in his children, just as his parents had done for him. As one friend recounts, “At Christmas parties, one child would read a poem, while another might do a dance. One could sense the creativity within the household” 17. Another contemporary and friend of Dr. Gibbon, Dr. Harris B. Shumacker, fondly remembers Maly playing the piano while Dr. Gibbon’s children sang and danced 12. Dr. Gibbon’s children received degrees and specialized in diverse areas, such as sociology and animal behavior, however none of them decided to pursuit medicine 5. Even though Dr. Gibbon and Maly raised incredibly successful children, it is noted that his family understood that Dr. Gibbon’s professional responsibilities and patients came first.
CONCLUSIONS
On February 5th, 1973 Dr. Gibbon suffered his second heart attack on the tennis court, and passed away almost instantly 5. He had been avoiding evaluations for angina for years prior, and his friends and family agree that he passed the way that he would have wanted to, quickly and with his wits and devices still his own 5, 18. Dr. Gibbon passed as one of the most influential surgeons of the 20th Century. He left an incredible mark on the field of surgery, and his invention of the heart-lung machine gave rise to a completely new era of cardiac surgery. Dr. Gibbon’s accomplishments do not end there, as he achieved many other excellent feats, including serving as an army surgeon, with the rank of Lieutenant Colonel during World War II, being the editor-in-chief of Annals of Surgery, and positively affecting the careers of many of the medical students, residents, and faculty members at Jefferson Medical College. There is no doubt that his unique attitude and personality played an extensive role in achieving these goals.
One personality trait that is uniformly corroborated is Dr. Gibbon’s persistence. Dr. Gibbon embodied persistence in his arduous and tedious path in creating the heart-lung machine, as well as his other professional endeavors. Taking the anecdotal accounts of Dr. Gibbon’s interactions with his residents, especially in the context of research, it seems that Dr. Gibbon toed a fine line between persistence and being stubborn.
Furthermore, Dr. Gibbon was man of many interests. This is evident not only in his extensive understanding of physiology and surgical subspecialties that were outside of his area of expertise, but also in nonmedical fields as well. Based on achievements alone, we may say that Dr. Gibbon’s calling in life was to be a researcher and surgeon; however, his proficiency in the arts has been noted by many of his colleagues. His strong interest in literature helped him excel in writing research papers, as well as the editor-in-chief of Annals of Surgery. His interest in philosophy, painting, nature, and sport helped give his life meaning both prior to medicine, and certainly in his retirement.
Dr. Gibbon’s achievements are staggering and awe inspiring. Future and budding inventors, medical doctors, and scientists have much to take away from studying the career choices that led to his incredibly prolific career, but this only tells a portion of the story. To truly put any great person’s achievements in perspective, one must examine their temperament and interests.
Conflict of Interest
The authors have declared no conflicts of interest for this article.
Financial Remuneration to Authors
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
BIOSKETCHES
Tyler M. Bauer, BS is a medical student at Sidney Kimmel Medical College at Thomas Jefferson University Hospital. He is an aspiring cardiothoracic surgeon. Mr. Bauer attended Muhlenberg College, where he studied biology and music performance.
Vakhtang Tchantchaleishvili, MD is a cardiac surgeon at Thomas Jefferson University and Editorial Board member of Artificial Organs, with clinical and research focus in assisted circulation and organ replacement therapy.