Past Issues About Edge

 

Intelligence, curiosity, and a certain solemnity show in Dr. Wilfred Gordon Bigelow's eyes. On the street he probably seems like any other octogenarian, but after a few minutes in his presence, it isn't difficult to believe that this 88-year-old is one of the great pioneers of heart surgery, responsible for advances such as open-heart surgery and the cardiac pacemaker.

Bigelow was appointed to the surgical staff of Toronto General Hospital (TGH) in 1947 and to the Department of Surgery at the University of Toronto in 1948. He retired in 1977, but has continued to have a presence in the Canadian medical community.

Bigelow was inducted into the Canadian Medical Hall of Fame in 1997 and is the recipient of over 25 major awards, including the Gairdner Award for Medical Science (1959) and the Order of Canada (1981).

Bigelow grew up in Brandon, Manitoba, where his father, Dr. Wilfred Abram Bigelow, was a general practitioner and surgeon. Bigelow may have inherited his innovative spirit from his father, who was no simple country doctor: he met the challenge of rural Manitoba's medical needs by establishing the first private medical clinic in Canada. Bigelow says that growing up around his father and the five other doctors and the nurses at the clinic, he couldn't help but be interested in medicine.

Bigelow was always interested in research. He graduated from U of T in 1938, then interned at TGH. After amputating a young man's frostbitten fingers, he was surprised to learn that little research had been done on frostbite. Encouraged by his supervisor, Dr. William Gallie, he began his own study. When he enlisted in the army soon after, he saw the opportunity to explore the topic further; historically, battles have often been won or lost by who could better handle the weather. So, in 1941, while posted in England to await the second front, he and a British engineer developed a unit that could maintain frozen extremities in a viable state and gradually re-warm them.

This experience came back to him in a surprising way when he was training as a heart surgeon at Johns Hopkins in 1946. At the time, surgeons were beginning to perform lifesaving surgeries around the heart, but they were reluctant to try to actually open the heart. Bigelow felt strongly that things would never progress unless surgeons could open a heart to operate directly with a bloodless field of vision. But how? His experience with hypothermia victims and his experience of heart surgeries combined in his consciousness. One night, he awoke with a simple solution to his conundrum. If you could carefully cool the body, thought Bigelow, you could "reduce the oxygen requirements, interrupt the circulation, and open the heart."

The idea was radical in an era when any drop in body temperature was considered extremely dangerous, but Bigelow proved to be right. In 1947, he returned to Toronto and established a hypothermia research laboratory in the Banting Institute. At the 1950 meeting of the American Surgical Association, he and colleague Dr. John Callaghan stunned the audience with their findings. The highlight was a short film demonstrating the surgical technique. They slowed a dog's heart rate by gradually cooling its body to 20°C, interrupted the circulation, and cleanly opened the heart. This inspired research into hypothermia in surgery around the world.

Bigelow continued to research and refine the hypothermia technique until 1964. Dr. John Gibbon of Philadelphia had begun to develop the heart-lung pump around the time Bigelow came up with the idea of using hypothermia. The heart-lung pump (cardiac bypass) and the technique of cooling the patient have been perfected and are used together in cardiac surgery today.

Hypothermia research also, by chance, led Bigelow to another great discovery. During a 1949 experimental operation on a dog, its heart stopped unexpectedly. Cardiac massage did nothing. The heart appeared healthy and normal. "I had this probe in my hand," says Bigelow. "Out of interest and in desperation, I gave the heart a poke.
To my surprise, it immediately contracted." Bigelow found that by stimulating the heart at a regular pace with an electric probe, a normal blood pressure resulted. The dog recovered completely.

To help turn this discovery into a device for clinical use, Bigelow and Callaghan enlisted Dr. John Hopps, an electrical engineer from the National Research Council. This collaboration is considered to be the dawn of bioengineering and Hopps the father of that field.

In 1950, the team built the world's first pacemaker for continuous clinical use. It duplicated the normal stimulation of body nerves without damaging muscles or nerves. The design of their pacemaker was not unlike that of modern ones, except that it relied on vacuum tubes and was therefore large enough to accommodate them. Technology had to catch up before it could be used practically. In 1959, after the invention of transistors, a Swedish doctor, Äke Senning, was the first to implant a pacemaker. Today, an estimated 3 million people worldwide have implanted heart pacemakers. Bigelow is one of them.

"I think his knowledge of nature allowed him to wonder about things like hypothermia and hibernation," says Dr. Tirone David, who trained under Bigelow and is now head of the Division of Cardiovascular Surgery at Toronto General Hospital, a position first held by Bigelow. However, Bigelow's rare ability to see potential in a natural phenomenon did not mean that nature's secrets were always revealed.

Bigelow sought to further the surgical usefulness of hypothermia by learning how animals achieved hibernation. After 10 years of research, Bigelow and his research team had learned many things, but had not found a means to hibernation. In fact, at one point they thought they had discovered "the hibernating chemical" but it turned out to be a contamination from plastic tubing. With grace and humour, they admitted defeat, laughing thankfully that they had not publicly announced the discovery of this chemical. To Bigelow, humility is a researcher's key asset.

"Hypothermia is his great claim to fame," says David, "but Bigelow explored every area of heart surgery." This was not limited to the operating room. With the advent of heart surgery, patient management needed a new approach. Bigelow spearheaded changes that brought many innovations common in patient care today: interdisciplinary surgical teams, a specialized environment for diagnosis, treatment and post-operative care and patient education.

Bigelow did not forget the future of the specialty either, for he was a teacher as well as a researcher and surgeon. In 1958, he set up, through U of T, the first inter-hospital postgraduate training program in cardiovascular surgery.

Bigelow felt "a real moral responsibility in introducing a new operation." He knew that better all-round care meant a better success rate for cardiac surgery, and increased confidence in the medical community and among the public.

And success was important. "In 1947, heart disease was the most common cause of illness and death. My future wife was head nurse on the ward that handled hearts and lungs. They'd have as many as six people die in one day. There was nothing you could do for them. Before we started doing surgery treatment was bed-rest, reducing salt in the diet, and giving a diuretic."

"Bigelow is a man open to the mysteries and accidents of life," says Tirone David. This spirit is evident in Bigelow's 1984 book, Cold Hearts, where he wrote; "I had never indulged in planning or promoting my career beyond the next year." He returned from the war without plans, but a "bolt from the blue" came from his supervisor at TGH, Dr. William Gallie. "How would you like to be a vascular surgeon?" asked Gallie. That was the offer that led Bigelow to Johns Hopkins, where he had his breakthrough idea to use hypothermia in heart surgery. Bigelow concedes that by not consciously planning, he may have missed some opportunities. "However, such a state has its advantages … it leaves one free to accept the wonderful chance offers such as that proposed by Dr. Gallie."

A "wonderful chance offer" helped bring us, among other things, hypothermia use in surgery, the heart pacemaker, and the team approach to surgery and surgical recovery. Not surprisingly, one of Bigelow's favourite quotations is from Louis Pasteur: "Chance favours the prepared mind."

 
     
University of Toronto Office of the Vice-President, Research and Associate Provost