John Brereton Barlow (24 October 1924 – 10 December 2008) was a world-renowned South African
cardiologist
Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular hear ...
. He qualified as a doctor in 1951, gained
experience
Experience refers to conscious events in general, more specifically to perceptions, or to the practical knowledge and familiarity that is produced by these conscious processes. Understood as a conscious event in the widest sense, experience involv ...
as a registrar in
Hammersmith Hospital
Hammersmith Hospital, formerly the Military Orthopaedic Hospital, and later the Special Surgical Hospital, is a major teaching hospital in White City, West London. It is part of Imperial College Healthcare NHS Trust in the London Borough of H ...
and the
Royal Postgraduate Medical School
The Royal Postgraduate Medical School (RPMS) was an independent medical school, based primarily at Hammersmith Hospital in west London. In 1988, the school merged with the Institute of Obstetrics & Gynaecology, and in 1997 became part of Imperial ...
in London. In the late 1950s he returned to
South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
to Johannesburg Hospital where he became Professor of Cardiology in the research unit and carried out significant studies on
cardiac disorder
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
s as well as discovering the cause of a well known
mitral valve disorder.
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He gives his name to
Barlow's Syndrome.
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Professional life
Barlow commenced medical studies at the
University of the Witwatersrand
The University of the Witwatersrand, Johannesburg (), is a multi-campus South African Public university, public research university situated in the northern areas of central Johannesburg. It is more commonly known as Wits University or Wits ( o ...
. However, shortly afterwards, in 1940 when South Africa became involved in World War II he enlisted in the military and spent time attached to British forces in North Africa and later the
Fifth US Army
The United States Army North (ARNORTH) is a formation of the United States Army. An Army Service Component Command (ASCC) subordinate to United States Northern Command (NORTHCOM), ARNORTH is the joint force land component of NORTHCOM. in Italy. He returned to medical school in 1946 and graduated with
MBBCh. in November 1951.
Barlow served his internship and registrar posts in the
Royal Imperial Hospital, Baragwanath Hospital and in 1955 set sail for England to sit his examination for membership of the
Royal College of Physicians
The Royal College of Physicians (RCP) is a British professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination. Founded by royal charter from King Henry VIII in 1 ...
. He worked as
SHO
Sho, Shō or SHO may refer to:
Music
* ''Shō'' (instrument) (笙), a Japanese wind instrument
* ''Kane'' (instrument) (鉦), a Japanese percussion instrument
* Sho?, a Dubai rock band
People
* Shō (given name), including ''Sho''
* Shō (su ...
to
Sheila Sherlock
Dame Sheila Patricia Violet Sherlock DBE, FRCP FRCPE FRS HFRSE FMGA FCRGA (31 March 1918 – 30 December 2001) was a British physician and medical educator who is considered the major 20th-century contributor to the field of hepatology (the ...
and medical registrar under Mr John McMichael at Hammersmith Hospital and The Royal Post Graduate Medical School in London. It was during this time that Barlow became interested in
auscultation
Auscultation (based on the Latin verb ''auscultare'' "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (hea ...
and
phonocardiography which led him to investigate
non-ejection clicks and late
systolic
Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ''sun ...
murmurs.
The non-ejection click had long been thought to have an origin outside the heart. During his time at the Royal Postgraduate Medical School Barlow attended the postmortem examination of a patient who was known to have a 'click'. Barlow noticed that the man had a single
fibrosed
Fibrosis, also known as fibrotic scarring, is a pathological wound healing in which connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodelling and the formation of perman ...
mitral valve
chord, he also noted no abnormality outside the heart to account for the click. Barlow, by further investigation, was able to demonstrate that the cause of this widely known but little understood problem was due to a pathological condition of the mitral valve. This discovery by Barlow was controversial at the time and was met with scepticism by the cardiological community. His first paper on the subject was declined on the grounds that his assertions were extreme. A friend and former colleague persuaded Barlow to submit a shorter version of the paper to the ''Maryland State Medical Journal'' (of which his friend was a sub-editor) where it was published under the title "The Significance of Late Systolic Murmurs and Mid-Late Systolic Clicks". A second and ground-breaking paper was published in the ''American Heart Journal'' in October 1963.
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So significant was this paper that it became one of the most commonly cited papers in the ''AHJ'' and in 1983 was designated by the Institute for Scientific Information as a citation classic.
In addition to his specialised work on the mitral valve he furthered research and published papers in other cardiac pathologies including the role of
tricuspid
The tricuspid valve, or right atrioventricular valve, is on the right dorsal side of the mammalian heart, at the superior portion of the right ventricle. The function of the valve is to allow blood to flow from the right atrium to the right ven ...
regurgitation after mitral valve surgery; the role of a
haemodynamic
Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously ...
valve load as the origin of refractory heart failure in patients with active
carditis
Carditis (pl. carditides) is the inflammation of the heart.
It is usually studied and treated by specifying it as:
* Pericarditis is the inflammation of the pericardium
* Myocarditis is the inflammation of the heart muscle
* Endocarditis is the in ...
; submitral
aneurysm
An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus (s ...
;
hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM, or HOCM when obstructive) is a condition in which the heart becomes thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This r ...
and the time course of "false positive
stress ECGs"
In the late 1950s, Barlow had returned to South Africa to work at Johannesburg Hospital as a registrar. In 1960, he became a consultant physician in the cardiac research unit, in 1971 he was appointed director of the cardiology unit and named his newly commissioned cardiac
catheter
In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cath ...
ization unit the McMichael Unit in honour of his erstwhile mentor.
In 1972, together with Margaret McClaren and others, he carried out a study on 12,000 schoolchildren of
Soweto
Soweto () is a township of the City of Johannesburg Metropolitan Municipality in Gauteng, South Africa, bordering the city's mining belt in the south. Its name is an English syllabic abbreviation for ''South Western Townships''. Formerly a s ...
which demonstrated very high levels of
rheumatic heart disease
Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and brain. The disease typically develops two to four weeks after a streptococcal throat infection. Signs and symptoms include fever, multiple painful jo ...
. When the paper was published in the
''British Medical Journal'' the international publicity highlighted the poor socio-economic conditions of the children living under the laws of
apartheid
Apartheid (, especially South African English: , ; , "aparthood") was a system of institutionalised racial segregation that existed in South Africa and South West Africa (now Namibia) from 1948 to the early 1990s. Apartheid was ...
, the South African government was critical of the study. In 1980 he was awarded a Professorship of Cardiology,(Ad Hominem) and continued in this post for a further 10 years to his retirement.
Barlow was widely acknowledged by his peers as an excellent clinician who put great store in taking a careful medical history and a thorough physical examination. He tended not to trust medical tests and questioned medical orthodoxy in general. He treated people from all walks of life, from poor children from Soweto to President
Nelson Mandela
Nelson Rolihlahla Mandela (; ; 18 July 1918 – 5 December 2013) was a South African Internal resistance to apartheid, anti-apartheid activist who served as the President of South Africa, first president of South Africa from 1994 to 1 ...
.
Later in his career he found maintaining standards more difficult as other consultants either emigrated or moved to the private medicine sector, but even after his retirement he continued to support, advise, consult and supervise until a few months before his death.
Barlow had a deserved international reputation for his knowledge of cardiac problems, specifically those associated with murmurs of the
mitral valve
The mitral valve (), also known as the bicuspid valve or left atrioventricular valve, is one of the four heart valves. It has two cusps or flaps and lies between the left atrium and the left ventricle of the heart. The heart valves are all one-w ...
. He described the development and mechanism of the 'click' and murmur and showed that they were caused by
prolapse
In medicine, prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes call ...
or billowing of the valve and
mitral regurgitation
Mitral regurgitation (MR), also known as mitral insufficiency or mitral incompetence, is a form of valvular heart disease in which the mitral valve is insufficient and does not close properly when the heart pumps out blood. respectively.
He also described other pathological conditions of the mitral valve including associated regurgitation, abnormal changes of rhythms and associated abnormal electrocardiograph readings. In 1968 Barlow and Wendy Pocock co-authored a paper published by the
''British Heart Journal''
Bibliography
''Perspectives on the Mitral Valve'' F.A. Davis Company, Philadelphia, 1986. .
The dedication reads —
"To all the students who listen, look, touch and reflect: may they hear, see, feel and comprehend"
Personal life
John Barlow was the son of Lancelot White Barlow, a South African who studied medicine in England and returned to South Africa to work as a medical pathologist. His mother was Madeline Dicks who Lancelot met while studying medicine. Educated at
, where he excelled as a sportsman - especially rugby. He had a reputation for flouting the rules.
As a medical student he was fond of referring to rare or bizarre medical conditions, this earned him the nickname 'Canary' alluding to the fact that
canaries are rare in South Africa, Later Barlow, in a tribute to this name (and his eccentricity) kept canaries outside his office.
Barlow married Shelagh Cox in 1949 and they had two sons, Richard John and Clifford William who are medical consultants in dermatology and cardio-thoracic surgery respectively and working in the United Kingdom.
Awards
Among many local and international awards made to John Barlow are the following:
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* Walter Bleifield Award for Distinguished Contribution in the Field of Clinical Research in Clinical Cardiology from the International Society of Heart Failure.
* Louis and Artur Lucian Award for Outstanding Research in the Field of Diseases of the Circulation from McGill University in Montreal.
* First Recipient of Award for Distinguished Contributions to National and International Cardiology from the South African Cardiac Society in Johannesburg.
* Percy Fox Foundation National Award for Outstanding Work as an Internationally Recognized Authority in Cardiology.
* Annual Laennec Society Lectureship from the American Heart Association.
* Annual St Cyres Lectureship, National Heart Hospital in London and British Cardiac Society.
* André Allard Medal for Distinguished Service to Medicine from the International Academy of Aviation and Space Medicine.
* The Seymour Lectureship and Medal for Distinguished Service to International Medicine from
Wesley Medical Center, Wichita, Kansas.
* President's Medal for Distinguished Contributions to International Cardiology from the National Council of the South Africa Cardiac Society.
* Honorary Research Fellowship from the University of Witwatersrand, Johannesburg.
References
{{DEFAULTSORT:Barlow, John Brereton
South African people of British descent
People from Johannesburg
South African cardiologists
1924 births
2008 deaths
Alumni of St John's College (Johannesburg)
Physicians of Hammersmith Hospital