(Author: Gwynne Schrire, Vol. 78, # 1, Summer 2023)
One finds when growing older that what is general knowledge to one person is unknown to those younger. This I discovered when I spent some time recently in Cape Town’s Chris Barnard Hospital.
Suspended from the high-ceilinged atrium, like a bunch of two-dimensional rectangular leaves, are many paintings, drawings and photographs of Chris Barnard. Opposite the lift on each floor are more photos, quotations or awards. And yet the Barnard memorabilia-filled hospital, like a museum to the Great Man, fails to acknowledge firstly that heart transplants, for which he became famous, were pioneered by Americans – he was just the first to try it on a human being – and secondly that they were all, including the Groote Schuur Hospital heart transplants, team efforts, not a one-man show.
For the first transplant on Louis Washkansky, Barnard was assisted by a team of thirty, including his brother Marius, some Jewish doctors like anaesthetists Dr Joseph Ozinsky[1] and Dr Cecil Moss[2] and the cardiologist, my uncle Velva Schrire, known as Val or Va. Dr Phil Blaiberg, the second heart recipient, wrote that the team working on him consisted of 51 members, each with an essential role to play.[3] Essential but ignored.
Actually, my uncle missed the first operation, although as the cardiologist he had selected Washkansky and cared for him before and afterwards. The team had been on standby for some days and nights waiting for a suitable donor and my aunt, believing that he needed his sleep, had pulled the phone plug out of the wall without telling him and he only heard about it on the radio next morning.
Neither the surgeon nor the physician nor any of the staff attending me during my visit to the Chris Barnard Hospital had heard of Prof Schrire, although all agreed that the heart transplants were team efforts, and that recognition should have been given to the assisting team members.
Va Schrire, using his own electrocardiographic machine that he had brought back from England, was one of the founders of modern cardiology in sub-Saharan Africa. He had to face considerable initial opposition from the Department of Medicine before he was able to establish what became the Groote Schuur Cardiac Clinic. One day in 1951 he was walking down a Groote Schuur Hospital corridor reading an ECG (electrocardiogram) when the medical superintendent Dr de Wet stopped him to ask what he was doing. After he explained, De Wet asked him for some pieces of the ECG to show at a meeting that evening. [5] Uncle Va promised to do so in return for a room to use as a Cardiac Clinic – and soon he was the proud possessor of an 8 by 10 ft room that had previously been used as a broom cupboard.
Neither the surgeon nor the physician nor any of the staff attending me during my visit to the Chris Barnard Hospital had heard of Prof Schrire, although all agreed that the heart transplants were team efforts, and that recognition should have been given to the assisting team members. According to UCT Principal Professor Stuart Sanders, Schrire was to become recognised as one of the world’s leading cardiologists. [6] His amazing ability to discern cardiac pathology only using his stethoscope resulted in the story that had someone been walking down the street with him, he would have stopped and diagnosed a heart murmur in the girl on the second floor in the right hand flat. His widow gave his stethoscope head to my brother Samuel, who offered it to the Beersheva medical museum which turned it down. [7]
The Cardiac Clinic became known as a centre of excellence in patient care, research, and training. Dr Lapa Munnik, a Member of Parliament and former executive member on the Cape Province’s Hospital and Health Affairs committee, recalled that when he visited England, Germany and Austria to look at cardiac monitoring equipment Prof Schrire’s advice saved the province vast sums of money. [8]
The success of the Cardiac Clinic led to a decision to start a division of cardiothoracic surgery which, under Schrire’s guidance, developed as a discipline. Open heart surgery started at Groote Schuur in 1958, the first such major unit in South Africa, resulting in many ground-breaking operations being introduced in the late 1960s. Cardiologists Commerford and Vogelpoel acknowledge that Schrire strove, under tremendous difficulties, to incorporate the exciting new advances that were occurring into everyday practice, including investigations and treatment of cardiac diseases. They also agree that his personal contributions and the contributions of his unit to the first human heart transplantation are, unfortunately, often forgotten. [9]
Uncle Va’s outpatients’ clinics began attracting medical registrars, including Christiaan Barnard.[10] Cupido and Ntsekhe believe that the success of the Cardiac Clinic was instrumental in persuading Barnard to pursue cardiac surgery as a discipline[11] and Barnard acknowledged that the excellent clinic “built through the labour and genius of Professor Velva ‘Val’ Schrire” was to be an invaluable help to him. [12]
Cardiac surgeon Professor Robert Frater, a close surgical colleague of Barnard at Groote Schuur Hospital, wrote that it was obvious that Barnard was not a natural surgeon. The technical manipulations standard to surgery did not come easily to him and when he operated there was clearly both a significant effort of will to perform maneuver’s successfully and a significant element of anxiety while doing so. To counter this Barnard had a high level of determination, tenacity and resilience. [13]
In 1960 Dr Schrire was invited to join the World Health Organisation’s Panel of Experts. He was involved in many research projects, publishing over 450 medical papers and in 1967 an internationally acclaimed textbook, Clinical Cardiology. This went into three editions during his lifetime, with a fourth published posthumously without permission. He also wrote a book with Barnard, Surgery of the Common Congenital Cardiac Malformations (Barnard and Schrire, Staples, London 1968).
Uncle Va’s cardiac technician Biller Piller described him as “indefatigable”, who “would spend one or two hours a day manually punching Hollerith cards in order to insert all the medical data of the patients he had seen that day. The cards were stacked in a file and with the aid of a knitting needle he could quite easily retrieve all data of patients according to their disease characteristics.”[14] Piller also described how each ECG was manually cut into segments and pasted onto sheets of paper.
It was only when reading Piller’s book that I understood the purpose of the vacation job my uncle found for me in his clinic when I was at university. As tools I was supplied with a knitting needle, scissors and glue and was shown a drawer filled with punched computer cards. My job was to steer the needle through selected punched holes, removing all the cards through which the needle went. My next job was to take the ECG printouts, cut up the various sections and glue them onto paper.
When Barnard was having difficulty in getting funding to go to America to learn about kidney transplantation because of the bad publicity created when he with two others had transplanted the head of one dog onto the body of another dog, he approached my uncle to support him. According to Piller, the Cardiac Clinic had to scrape the bottom of its financial barrel to help Barnard to travel to America but gained little credit from this act of generosity.[15] While in America Barnard learnt about the work of open-heart surgery pioneer Dr Walter Lilliehei and became interested in this instead, going on to assist Lilliehei in his research on heart transplantation in animals.
In the meantime, another uncle, my mom’s brother-in-law Robert, was diagnosed with a hole in the heart. Uncle Va told him to wait until Barnard returned from America, which he did later that year bringing with him a pump-oxygenator generously given to him through a grant from the US National Institutes of Health. On his return, Barnard conducted the operation and Uncle Robert lived to a ripe old age.
Piller believed it was Schrire’s support and encouragement of Barnard that led to the hospital’s success in open heart surgery.[16] Va and his Cardiac Clinic would govern the selection of heart cases and diagnose, monitor and treat their progress after the operation.[17] Peggy Jordaan, who led the operating room nursing team during the first heart transplant, wrote that if Chris had any doubts during surgery, he would send for Va who would come to the operating room. They would discuss the problem, solve it, then Va would leave, and Chris would complete the operation [18]
Some years later came the ground-breaking heart transplant on Louis Washkansky. In a book edited by David Cooper, a former associate Professor of Cardiothoracic surgery at UCT and later Director of Research and Education in the Baptist Medical Centre’s Oklahoma Transplantation Institute, Cooper acknowledges that:
…(t)he success of the heart surgery team at Groote Schuur at this time was in no small part due to the vision and support of Professor Val Schrire, the professor of cardiology, a quite outstanding clinical physician who acted as Chris’ mentor in this field for many years. Chris had immense respect for Schrire and hardly a day passed that he would not visit the cardiologist in his office to discuss a patient or some other topic of mutual interest. Schrire later supported the initiation of the transplant programme wholeheartedly, selecting suitable patients and playing a major role in their medical – rather than surgical – care. Sadly, relations between the two men subsequently became strained – in part because Schrire was not in favour of the high media profile that Chris enjoyed in the years following the first heart transplant – and never returned to their earlier closeness before Schrire’s untimely death from cancer.” [19]
To my uncle, a quiet. modest, retiring dedicated scientist, research to improve the lives of cardiac patients was important, not fame. This might be the reason why he is no longer remembered, unlike the globetrotting Barnard.
Once Barnard had decided to try a heart transplant, he said he approached his colleague, Professor Velva Schrire, “an outstanding cardiologist who had become [his] mentor and friend to discuss which patients would most benefit from heart transplantation. Professor Schrire believed that the selection of a non-white recipient or donor might be misinterpreted by the political critics of South Africa.” [20] They would say overseas that the apartheid doctors were experimenting on non-whites. Barnard wrote “Val Schrire had been right – so right. Yet this was irritating. What difference did it really make? We had struggled to save one life. It had nothing to do with colour of the skin.” [21]
Louis Washkansky’s physician, Dr Barry Kaplan, was staggered when Va told him that they were thinking of transplanting a heart into his patient. As Schrire looked rather nonchalant, however, he would look nonchalant too and immediately approached Washkansky, who agreed.[22] Washkansky told his wife, “Guess who came to see me – the big noises (Schrire and Barnard) and they’re giving me a brand-new heart.” [23] Barnard wrote that he doubted if he ever thanked Prof Schrire for giving him Washkansky.
The operation was a success and gave the media-inexperienced Groote Schuur Hospital staff the headache of dealing with the international attention of hordes of importunate journalists. Barnard was turned into a celebrity overnight and his subsequent high-profile lifestyle kept him in the public eye for a long time. [24] He reveled in his fame, and his invitations to meet film stars and aristocrats and travel in millionaire’s yachts. Not so Va, who shunned publicity and anything that took time away from his research. Thus, their relationship soured.
When Washkansky began to develop problems with rejection, Barnard called Va, who arrived immediately and gave him advice. Barnard admitted that Va had used his experience to expertly move from the known towards the unknown and envied his quick grasp and certainty.[25] Washkansky lived for 18 days, dying of pneumonia as a result of the immunosuppressive drugs he was taking to stop rejection.
The second heart transplant was performed on our family friend and dentist Phil Blaiberg. Every year my parents would hold a New Years Eve party for widowed and divorced friends. When my mother phoned Eileen Blaiberg to invite her, Eileen said she was not in the mood as Phil was in hospital again and too ill. They were waiting for a heart donor as the cardiac team had decided to try again and the family had been sworn to secrecy.
“Never mind” said my mother, “Next year, please G-d, you will both be at the party.” At the time Eileen thought it impossible.
On 2 January 1968 Phil became the second person to have a heart transplant.
At the end of the following year Eileen phoned to say they were both looking forward to coming to the New Year’s Eve party. My parents had not planned on a party that year, but with such news, they started making arrangements. Then Eileen informed us that an American film company wanted to do a film of “Blaiberg a year after” and could she bring them to the party?
There was no television in South Africa at that stage. Dr Albert Hertzog, the Minister for Posts and Telegraphs, had said that TV would come to South Africa “over [his] dead body” as television might show films of race mixing and the adverts would make Africans dissatisfied with their lot. The US TV crew visited our house and expressed dissatisfaction. No American viewers would believe they were watching a New Year’s Eve party and would my parents mind if they decorated the house to look the way Americans would expect the house to look? The crew left, returning with armfuls of streamers, garlands, lanterns, paper hats, balloons and blowers, climbed ladders and festooned the rooms to suit American tastes.
Where was I during all this excitement – a real live television team in our house? I was living in Johannesburg, most upset to be missing all the excitement. And excitement there was – the director decided that Americans needed to see the Blaibergs dancing so my father put on some records. This resulted in a worried call from Mrs. X’s relatives in America asking if she had got divorced because that was definitely not her dancing with Dr X. The film company had attached the wrong names.
I was due to come to Cape Town at the end of February to have my first child and the Blaibergs promised to borrow the film and screen it for me. Unfortunately, my son chose to arrive the very evening of the screening. An angry Eileen phoned my mother: Where was Gwynne? The projector was set up, everyone was waiting, what was keeping the Schrires?
” Oh, it is so exciting!” gasped my mother, “My grandson has just arrived.”
“Oh, have you just fetched him from the airport? Has he come on holiday?”
Once all was explained, all was forgiven. When I was out of the nursing home, another showing was arranged just for me.
What precipitated this article was that, bored because of the lockdown, I decided to re-read an inscribed copy of Dr Philip Blaiberg’s book Looking at my heart and found, tucked into the back, a letter my mother had written to us in Johannesburg on 9 June 1969. It read:
Personality changes are not a side effect of heart transplants usually mentioned. Phil Blaiberg, mourned by all who knew him, died of chronic organ rejection two months later on 17 August 1969. He had survived for 19 months. Later Eileen went to visit her daughter in Israel and remarried there.
“We popped in on Saturday to visit the Blaibergs… He had been very ill again a couple of days ago. Eileen said Va told her it was all up – something wrong with the ventricle and when that happens normally it is the end. As Phil said, he is abnormal – and rallied. Eileen said she got the impression that Va etc. were waiting for Phil to be legally dead – they were dying to re-examine that heart. He looked quite fine – has the ruddy cortisone face but can hardly walk, keeps himself very busy with his mountain of correspondence [26] and definitely, personality wise, is a changed man now, irritable, rude I believe to some – and that you know is quite out of character because he was always a mild-mannered person. In the hour we were there he yelled for Eileen at least 30 times, and for some trivial causes. She is amazingly patient with him. I suppose with all these drugs, his metabolism must have been affected. Anyway, he just reached 60 so he has had some innings.” [27]
That was not the last connection we had with the Cardiac Clinic. Next it was the turn of my brother Samuel, a medical student. In his fifth year of study, he was found by pure chance and a general practitioner’s discerning ear to have a congenital heart lesion, a “hole-in-the-heart” and had to spend his mid-year vacation as a patient in the cardiac ward. Uncle Va asked Barnard to operate on his nephew. Samuel was very anxious, as a medical student having read all the books explaining everything that could go wrong and wanting reassurance. It was not to be. He had two visits from Dr Barnard. The day before the operation, Barnard stopped and said “Ah! You are the ASD – we are operating on you on Monday” and walked on. Registrars cut him open, Barnard went in, made a few stitches, left Samuel to the registrars to close up and phoned Va to say that he had operated on his nephew. The next day on his ward round he stopped at Samuel’s bed and told him, “You had a hole. We closed it up” [28] Then off he went to fuss over the overseas patients in the ward. Who Samuel was, what he felt, what he studied, what concerns he may or may not have had, were of no importance.
Some years later Samuel was back in the cardiac surgery ward, this time as a newly qualified doctor. He made it his duty to be an ear for the patients, enabling them to vent their anxieties as he was able to tell them, in the first person, what to expect and what one would feel. Indeed, he was walking proof of the wonders of modern surgery and that one could survive open heart surgery. Until Barnard announced in the clipped, terrifying tones in which he conducted his ward rounds: “I am told that the houseman talks to the patients. The job of the intern is to take blood from the patients in the morning and see that the results are back from the various laboratories in time for the evening ward rounds”. Samuel was forbidden from then on to talk to patients. Sometime later he realised that Dr Barnard was totally unaware that this intern had been his patient a mere 15 months before. When Samuel told him, Barnard remarked to the ward round that he could not recall receiving any personal gift from our father.
“I remember operating on a young girl whose father gave me free petrol for a year – you I don’t remember.”
Va was very concerned about the effect of cholesterol on the heart. He and my aunt hosted a party each year for the Clinic staff and its friends, with platters of food displaying flags saying, “saturated fats” and “unsaturated fats”,[29] and when the two of them attended parties my parents hosted, my parents would do the same. While Va was at the buffet table, everyone would self-consciously help themselves to food from the unsaturated fats platter, making a dive for the saturated fats platter the moment he left the room.
My uncle died, too young, at the age of 52, not from a heart condition but from pancreatic cancer. Until shortly before his death he continued working and writing articles with his usual drive. A few weeks before his passing he was promoted to full professor – the family believed the delay was because of the reluctance of the university to appoint Jewish people to professorships.
Although his contribution appears to have been forgotten today, it was certainly recognised by his contemporaries. Describing his passing as “a tremendous loss” to UCT and to world medicine Professor Jannie Louw, head of the Department of Surgery, wrote that:
“This modest man was without doubt one of their most brilliant graduates and one of the most outstanding staff members of their medical school”, [30] … a cardiologist of international repute … considered by many to be one of the best in the world. He contributed greatly to Professor Barnard’s success in cardiac surgery and played a major role in their historic heart transplant.” [31]
Wrote Professor W P U Jackson, [32] “No one is irreplaceable, but Val Schrire comes very close. Luckily for us one of his great achievements lay in the training of others to carry on work in the vast field which he has sown…while quietly building a service for his fellowmen that is second to none.”
Drs Commerford and Vogelpoel summed up Dr Velva Schrire in these words:
“He strove, under tremendous difficulties, to incorporate the exciting new advances that were occurring into everyday practice. Major developments in investigations and treatment of cardiac diseases were instituted…His personal contributions and the contributions of his unit to the first human heart transplantation are, unfortunately, often forgotten. He can, however, be considered to be one of the founders of modern cardiology in South Africa. Exacting, firm, strong, and at times inflexible, Velva Schrire was courteous, well mannered, generous, and disarmingly charming. He was a skilled physician and cardiologist with a prodigious memory for what he had observed and read. He always made time for teaching, and any problem, however simple, asked by a junior in the middle of a rushed clinic would receive his undivided attention. His publications largely reflected his clinical experience and personal observations, which were meticulously recorded in a database that he established.” [33]
Unlike Chris Barnard, Va Schrire was very modest and shunned publicity. His role both in the heart transplants and as one of the founders of modern cardiology in South Africa has been undeservedly forgotten. My uncle would not have approved of this article in which he is the focus and would never have allowed a hospital to be named after him, but modest people also deserve recognition, and it is a pity that their contributions tend to be forgotten.
Gwynne Schrire, a veteran contributor to Jewish Affairs and a long-serving member of its editorial board, is a former Deputy Director of the SA Jewish Board of Deputies – Cape Council. She has authored, co-written and edited over twenty books on aspects of South African Jewish and Western Cape history.
NOTES
[1] Barnard said Dr Ozinsky was to become a major figure in all future heart operations. Barnard, Christiaan and Curtis Bill Pepper, Christaan Barnard: One Life, Howard Timmins, Cape Town, 1969, 210 Peggy Jordaan said that Barnard “relied on his chief anaesthetist, Dr Ozinsky… and expected him to be there always when he was operating, and he was, day or night.” Jordaan, Peggy, “The Chris Barnard I came to Know” in Cooper, David, Chris Barnard by those who knew him’, Vlaeberg, South Africa, 1992
[2] Lissoos, Irving, ‘The First Heart Transplant: The Jewish Connection’, Jewish Affairs, Winter 2001, 56:2,37-9
[3] Blaiberg, Dr Philip, Looking at my Heart, Heinemann, London, 1969, 57
[4] Cooper, David, ‘Christiaan Barnard — The surgeon who dared: The story of the first human-to-human heart transplant” In Glob Cardiol Sci Pract. 2018 Jun 30; 2018(2): Published online 2018 Jun 30
[5] Piller, Laurence William, The Cardiac Clinic Groote Schuur Hospital 1951-1972; The Schrire Years, Groote Schuur
Hospital, Compress, Cape Town, 2000, 9
[6] Sanders, Stuart, “Barnard as a Patient” in Cooper. op cit, 318
[7] E-mail from Dr Samuel Schrire dated 4 January 2021. He adds “Today 50 years later most cardiologists no longer possess stethoscopes and certainly do not use them with Va’s skill and knowledge.”
[8] Munnik, Lapa, “Chris Barnard – a most remarkable personality“, in Cooper, op cit 1992, 258
[9] Commerford P and L. Vogelpoel: “Velva Schrire”, Clin. Cardiol. 26, 300–301 (2003)
[10] Piller, op cit, 20
[11] Cupido Blanche, MBChB FCP (SA) Cert Cardio (SA) and Mpiko Ntsekhe, MD PhD FCP (SA) FACC, Clinical cardiology: founders of modern cardiology, in European Heart Journal, Volume 40, Issue 5, 1 February
2019, Pages 406–408, https://doi.org/10.1093/eurheartj/ehy864
[12] Barnard, and Pepper, op cit, 211
[13] Frater, Robert, “Christiaan- the early years”, in Cooper, op cit 1992. 163
[14] Piller, op cit, 23 and 12
[15] Ibid., op cit, 62
[16] Piller, op cit, 39
[17] Barnard and Pepper, op cit, 229
[18] Peggy Jordaan, “The Chris Barnard I know”, in Cooper, op cit, 1992, p199
[19] Cooper, David, op cit, 1992, p44
[20] Cooper, David, “Barnard as told to David Cooper – Reflections on the First Heart Transplant”, in Cooper, op cit 1992, 83-84
[21] Barnard, and Pepper, op cit 232, 305
[22] Barnard and Pepper, op cit 237, 239
[23] Hawthorne, Peter, The Transplanted Heart, Hugh Keartland, Johannesburg, 1968, p26
[24] David Cooper, op cit, 1992, p5
[25] Barnard and Pepper, op cit, 316
[26] This is confirmed by Dr Blaiberg in his autobiography where he writes” My daily postbag has for months been a fascinating surprise packet. I have been deluged by thousands of letters from every land outside Red China…. It takes me hours to reply to them all, mostly in brief autographed acknowledgements, others more fully when I am asked for comment of a personal nature or encouragement for good causes. At first, I gave (philatelists) the
stamps… now they are sent to the Israeli wounded of the Six Day War for occupational therapy purposes.” Blaiberg, Philip, op cit, p119
[27] Letter dated 9.6.1969 in possession of the author
[28] Schrire, Samuel, “Personal View”, British Medical Journal, 31.10 1978
[29] Piller, op cit, p76
[30] The top Matric student in the Union of South Africa, he graduated at UCT with MB ChB (with honors) and PhD, and gained a MRCP, MRCPE, FRCP Edinburgh and FRCP London. He was Director of the Cardiac Clinic in Groote Schuur Hospital, Director of the Council for Scientific and Industrial Research, University of Cape Town, principle physician and cardiologist, Groote Schuur Hospital, and principle physician at Red Cross Memorial Childrens’ Hospital.
[31] Piller, op cit., p77
[32] Jackson, WPU, Schrire obituary, South African Medical Journal, 11.3.1972
[33] Commerford, P and L. Vogelpoel: Velva Schrire, Clin. Cardiol. 26, 300–301 (2003)
