16 mm film is run from one reel to another through a machine that displays the image on a screen.

What is That?!? Heart Surgery on Film

By Rachel James ~

I’ve spent the last year watching heart surgery in a library.

I’ve been working as an intern with Sarah Eilers, who manages the Historical Audiovisuals (HAV) collection at the National Library of Medicine. My task has been viewing and describing unprocessed films in the collection, with the goal of making these “hidden” titles discoverable through a finding aid. I had no prior experience watching historical films for library or archival research, let alone medical films, so this was an adventure and a challenge.

A woman in a lab coat works with plastic objects, thread, and patterns.
Dr. Nina Braunwald working with surgical materials, ca. 1965 Courtesy Eugene Braunwald, M.D.

I was able to work through a collection of films featuring the research of three NIH investigators. I started with Dr. Nina Starr Braunwald. She was one of the first female heart surgeons to work in the National Heart Institute (now the National Heart, Lung, and Blood Institute), and was featured in an NLM exhibition, Changing the Face of Medicine. Her research involved experimenting with artificial heart valves, and several of the films reflected that, showcasing innovative use of materials, such as a Teflon prosthesis. Braunwald also conducted valvulotomies in the mitral and aortic valves, tested pacemakers, and used a number of surgical adhesives. Andrew “Glenn” Morrow, the second investigator I worked on, mentored Braunwald (and her husband Eugene Braunwald), in cardiac surgery. In addition to valve replacements, he repaired aneurysms, mitral stenosis, and septal defects. The third investigator whose films I worked with, James F. Bosma, was in a different field. He studied the physical and biological aspects of swallowing while also examining how people with cleft palates and other dental anomalies speak and pronounce words.

One of the most challenging aspects of the project was reconciling content—the titles written on the canisters and reels vs. the titles and descriptions that were on accompanying notecards. Sometimes the cans mentioned other doctors’ names, and it wasn’t clear what they had to do with the films. There were also instances of multiple copies and versions of the same film, so I had to weave together a story from all of these pieces.

A man and a woman in scrubs talk in front of an x-ray lightboard.
Dr. Nina Braunwald and Dr. Glenn Morrow, ca. 1965
Courtesy Eugene Braunwald, M.D.

Because of my general interest in history and learning about the lives of different kinds of people, I liked looking up information about the investigators themselves. I learned about the processes they pioneered and the people they inspired and mentored.  I was able to use a lot of the same reference material for Nina Starr Braunwald and Andrew Morrow since they worked together and were at NIH during the same era. There was not a lot of biographical information about Morrow, so I had to really dig to find out more about him, sometimes using NLM historical collections as resource: for example, I watched a videorecording from the 1980s of the dedication of a surgical suite in his honor, after he passed away. His colleagues shared many personal stories about him and I learned a lot about his personality and working style from that recording.

Researching the content of the films was interesting, but I also enjoyed exploring the film vault and learning about its properties and arrangement and the procedures specific to this type of archival work. My guide in all this was Jason Anderson, a Pathways intern in the HAV program.  Jason views and writes descriptions of films in the collection, and transcribes dialogue as well. He has a substantial amount of experience watching medical movies and had seen other heart surgery films, so his insight was invaluable to my process as I learned to write descriptions. I often was unsure what I was seeing on the screen, as many of the films did not show the opening of the chest cavity, but just began with a close-up view of a heart valve, for example. When I was confused, Jason would gave me a refresher on anatomy and biology including the number of chambers in the heart and the process of how the oxygenated blood pumps in and out of the heart. I also used resources such as PubMed and MedlinePlus  to figure out which tools the investigators were using and which parts of the body they worked on. It was like trying to translate these concepts I recognized visually into another language.

16 mm film is run from one reel to another through a machine that displays the image on a screen.
A Moviola film-editing machine, 2017

When I had to view the 16mm films, Jason assisted me. I did not realize the time it takes to locate a title, set it up properly so that the “leader” (beginning part of the reel) is in the correct place, and repair tears—these are all things I observed Jason do. He also showed me how to arrange the reels on the Moviola film-editing machine in order to view them.

The films themselves varied in format. The heart surgery films from Braunwald and Morrow were all silent, in color and generally bloody, but the close-up views of valves and chambers allowed me not to think too hard about what was going on. I am not squeamish about blood, and perhaps because there was no audio for most of them, I was not put off by it. There were some films that exhibited new technologies as well as a new surgery suite, which were a relief after days watching films showing a valve being sewn into someone’s heart. On the other hand, nearly all of the James F. Bosma films had an audio component; he listened to people speak and gave detailed descriptions of what he was having the people do and say and why. Watching and listening to the Bosma films was more challenging, because there were many close-up shots of people’s mouths, and I discovered that I’m more sensitive when it comes to mouth sounds and drool than to heart surgery. His films were also the most unusual to me because he simulated sounds such as a cat’s meow and a baby’s cry as part of his research, which I found grating to listen to for an extended period of time.

I really enjoyed my time with HAV program. It was very interesting to view and describe the films and learn about the three investigators. Sarah and Jason were a lot of fun to work with as well. There were some challenging aspects, but I learned a lot from the project and the staff. Once the finding aids become available online, I sincerely hope that the people who want to view these films and learn about the work of the investigators will find them based on the descriptions that I wrote.

A formal portrait of Rachel James.Rachel James is a recent library school graduate and currently the digital access librarian for the federal Office of Minority Health Resource Center. Ms. James came to the U.S. National Library of Medicine in January 2016 through the Association of Research Libraries (ARL) Career Enhancement Program Fellowship. After the fellowship ended in May 2016, she continued to work at NLM as a volunteer for almost a year.

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