Dr. Wilfred Bigelow (Class of 3T8) and his research team discovered that lowering the body’s core temperature before surgery reduced the amount of oxygen the body needed, slowed tissue metabolism, and protected the heart and brain. This breakthrough research on hypothermia led to the first successful open heart surgery in 1953.
Incidental to the hypothermia research was the team’s discovery that electrical impulses to a motionless heart could stimulate it to beat again, laying the groundwork for cardiac pacemakers.
Together, these two discoveries revolutionized cardiac care, swinging open the door for further advances.
A fragmented education
Soon after graduating, Bigelow enrolled in surgery at Toronto General Hospital. Three years later, the Second World War interrupted his training. From 1941 to ’45, Bigelow served as a Canadian Army surgeon in casualty clearing stations in England, Normandy, and Northwestern Europe. There, he developed an interest in frostbite and how hypothermia affects the body; he tucked away his observations for the day when he could explore them through scientific research.
During the war, Bigelow also developed an interest in chest surgery, but there was no subspecialty training in Canada. However, after the war, he was awarded a clinical and research fellowship in vascular and cardiac surgery at Johns Hopkins University Hospital in Baltimore, which he completed in 1947. There, he observed Dr. Alfred Blalock perform the first “blue baby” operations and learned about cardiac catheterization for measuring intracardiac pressures.
On returning to Toronto, Bigelow was appointed an associate professor at U of T and to the Toronto General surgical staff. He also became the Director of the cardiovascular surgical experimental laboratory in the basement of U of T’s Banting Institute on College Street. Dr. John Carter Callaghan, who had just graduated with the Class of 4T6, was at his side in the dingy lab known as “Room 64.”
In 1961, Dr. Bernard Goldman (Class of 6T0) was a fellow in the lab, furthering Bigelow’s search for a substance, perhaps a hormone, that Bigelow thought allowed groundhogs to hibernate underground through the winter at two degrees above freezing. “I hated those groundhogs,” says Goldman. “They could bite.”
After 10 years, the research hit a dead end, but Goldman says Bigelow “responded with his usual grace.” Later, Bigelow wrote about the experience in an essay titled “Intellectual Humility in Surgical Research.”
Between 1947 and ’65, the lab performed multiple canine experiments to establish the physiological effects and medical benefits of hypothermia, and a safe technique for inducing and reversing it. Trouble was, the heart stopped beating when the body was cooled.
During an experimental surgery in 1949, again the dog’s heart stopped when they lowered its temperature. In frustration, Bigelow gave the left ventricle a good poke. To his surprise, the heart contracted, and with repeated pokes began to beat.
That night, over many cups of coffee, Bigelow and Callaghan proposed that electrical impulses could keep the heart beating during open heart surgery. Bigelow approached the National Research Council for help.
The genesis of bioengineering
In 1949, the Council recommended John Hopps, an electrical engineer in Ottawa, for Bigelow’s project. But Hopps was busy figuring out how to use radio frequencies to pasteurize beer. He described his summoning to Toronto “as an annoying interruption to this vital task.” But Hopps soon arrived in Room 64 to work with Callaghan on how best to deliver an electrical stimulus to the heart.
In 1950, Hopps returned to Ottawa to design the pacemaker. His invention looked like a small table radio. It was 12 inches long, used vacuum tubes to generate pulses, and needed to be plugged into an electrical outlet. Its catheter electrode could be passed through the jugular vein and into the right atrium.
That same year, Bigelow and Callaghan performed a landmark open heart operation on a dog using Hopps’ pacemaker. When the heart stopped during the cooling process, the pacemaker took over, making the heart beat once again.
Later that year, Bigelow, Callaghan, and Hopps developed the first pacemaker for continual use in humans. And in 1953, Callaghan presented their research findings at the American College of Surgeons conference in Boston, stimulating much public interest and professional competition.
In 1958, a Swedish physician implanted the first battery-powered pacemaker with heart electrodes sewn onto the myocardium through a small chest incision. Then in 1969, Toronto General became the first hospital in Canada to implant pacemakers connected to the heart by a transvenous intracardiac electrode.
From 1956 until retiring in ’77, Bigelow was Head of both U of T’s and Toronto General’s Cardiac Surgery Division. At the hospital, he created Canada’s first Cardiovascular Investigation Unit to unify cardiology, cardiac surgery, and related investigations. It was known affectionately as “Bigelow’s Bungalow.”
“In the OR, there was never any question about who was in charge. It was Bill Bigelow,” recalls Dr. Hugh Scully, who trained in general surgery and cardiovascular and thoracic surgery at Toronto General. “In an emergency, Bigelow was the calmest person and the most supportive leader I’ve ever seen. When I was a senior resident, I remember that he would put his hand on mine and say, ‘Scully, just settle down.’ I tried to emulate his calmness.
“He was the most wonderful mentor,” recalls Goldman, who left Toronto General in 1990 to became Head of the new Cardiac Surgery Division at Sunnybrook Health Sciences Centre. “He was like a father figure to us. We used to call him Uncle Bill, but not to his face.”
“Some of Bigelow’s surgeries were so revolutionary that Toronto General wouldn’t allow him to perform them there, so he operated at the Wellesley and Sunnybrook,” says Scully, who was a staff cardiac surgeon at Toronto General from 1974 until retiring from active surgery in 2008. “Bigelow performed his first closed heart operation on the mitral valve at Sunnybrook because the Toronto General cardiologists were reluctant to refer sick patients for surgery. Bigelow was incredibly courageous, especially since the mortality rate for cardiac surgery at the time was as high as 50 per cent.
“He invented the heart team,” Scully adds. “On the Friday morning weekly teaching rounds, Bigelow would include all of the staff cardiac surgeons and trainees, pathologists, anesthesiologists, nurses, and even attendants. He would never embarrass people. He would ask participants a question and then thank them for their answers.”
Bigelow also created the first Canadian inter-hospital cardiac surgery training program by involving the Hospital for Sick Children and St. Michael’s Hospital. In Bigelow’s tenure, more than 70 physicians passed through the postgraduate cardiovascular surgery program.
Worldwide, Bigelow’s insights improved, if not saved, the lives of millions of people with cardiac conditions. Honorary bodies – from the Order of Canada to the Canadian Medical Hall of Fame – seemingly tripped over each other to recognize his achievements. Before his death on March 27, 2005, Bigelow humbly accepted more than 25 major awards.
Want to know more about Dr. Wilfred Bigelow? Drs Scully and Goldman worked with U of T history professor Edward Shorter to write The Heartbeat of Innovation: A history of cardiac surgery at the Toronto General Hospital. U of T Press has just released it.
Credit for drawing: Canadian Medical Hall of Fame, Irma Coucill
Credit for photo: Courtesy Bigelow Fonds, History of Medicine Program, Temerty Faculty of Medicine