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.
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).
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.
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
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."
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.
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.
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.
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.
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.
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.
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.
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
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
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
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
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
"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."
"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."