In 1954 the clinical physiologist Gerald Graham, who has died aged 98, introduced to Great Ormond Street children’s hospital in London a new method of investigating congenital heart disease in children. It used cardiac catheterisation and angiocardiography as well as a safe method of maintaining circulation during open-heart surgery. Up to then, the diagnosis of cardiac defects had relied on clinical examination, a chest x-ray and an ECG. Cardiac catheterisation – which involves inserting a thin tube, or catheter, into a vein and threading it through to the chambers of the heart – allowed the measurement of oxygen saturation in the blood, and of the pressure in the four chambers of the heart and the great vessels leading to and from it.
From these measurements, deductions could be made about defects in the walls separating the chambers of the heart, and the severity of the abnormality. Angiocardiography – the x-ray imaging of the heart and great vessels following the injection of a contrast medium into the veins – delineated the anatomical defects.
Gerald was invited to join Great Ormond Street as a lecturer by the cardiac paediatrician Dr Richard Bonham Carter, who along with the surgeon David Waterston had formed a thoracic unit that combined the medical and surgical care of children with heart disease. Having gained expertise in the US in cardiac catheterisation and angiocardiography, Gerald was a valuable asset, and he also had the physiological training to establish safe cardiopulmonary bypass in the young. This combination of skills was fundamental to expanding the range of treatment available in the UK, and in 1959 Gerald was appointed consultant clinical physiologist.
The two modes of evaluation, cardiac catheterisation and angiocardiography, are now performed as a single procedure, but when Gerald began his work the catheterisation was carried out in an operating theatre, while the angiocardiograms were seven floors down in the basement. The opening of a new wing in 1964 to accommodate the growing thoracic unit included a single, fully equipped room.
As more complex conditions came within the surgeons’ realm, a safe system of cardiopulmonary bypass suitable for children was needed. There were no “off the shelf” systems available, and early attempts to devise a system based on a modified Archimedean screw were impractical. Gerald recruited a team of three technicians to build by hand a rotating pump model, utilising spinning disc oxygenators of different sizes to accommodate children, infants and newborns. These three became the highly skilled operators who ran the bypass on a daily – and, not infrequently, nightly – basis under Gerald’s watchful eye.
He was born Gerd Greiffenhagen into a Jewish family in Berlin, the son of Kurt, a dentist, and his wife, Erna (nee Rosenfeld), a kindergarten teacher. In 1936 Gerd visited Britain, where he met two sisters who taught him English grammar and helped him to develop a perfect English accent. The following year, as antisemitism continued to grow in Germany, he moved to London.
Through an introduction from an uncle who was an anti-fascist activist in the US he met the Labour politicians Aneurin Bevan and Jennie Lee, who arranged for his parents to join him in Britain, and in the spring of 1940 they emigrated to the US, anglicising their names. Gerald was awarded a Kellogg Foundation scholarship in 1941 to read chemistry at Carlton College in Bryn Mawr, Pennsylvania, as a stepping stone to studying medicine.
Before he graduated, and as he was low on funds, he became an assistant in a physiology laboratory following a chance meeting with Louis Katz, a prominent Chicago cardiologist. Although not properly qualified, he then became a lecturer in physiology under Charles Wiggers, at that time the doyen of American physiology, whose teaching staff had been depleted by wartime call-ups.
This position gave him the time and funds to read for his medical degree, which he completed in 1950 at Western Reserve University in Cleveland, Ohio. A two-year residency with Katz followed, and he then set up a cardiac unit at Northwestern University in Chicago. But by 1953, Joseph McCarthy’s anti-communist witch-hunt was at its height, and thanks in part to the activities of his anti-fascist uncle, Gerald found himself facing a day’s questioning by a tribunal.
Although he was cleared of subversion, the university was wary of keeping him on, and this – added to the experience of losing family members to the Nazis, and the disappearance of his elder brother in the Soviet Union, a victim of Stalin’s purges – persuaded him to return to Britain.
Gerald’s department of clinical physiology at Great Ormond Street was integral to the thoracic unit, but perhaps because of his quiet, retiring nature, he may not have received the recognition his achievements deserved. However, he did gain a wider reputation thanks to his editorial work. For 21 years, he edited German Medical Monthly, the English edition of the weekly journal Deutsche Medizinische Wochenschrift, translating many of the articles himself. He later became a founding editor of the journal Pediatric Cardiology.
He retired from Great Ormond Street in 1983, but continued translating articles into his 95th year.
In 1950 Gerald married Ilse Applebaum. She died in 1988, and in 1990 he married Anthea Rolle. She survives him, along with the children, Nina and Martin, of his first marriage.
• Gerald Ralph Graham, clinical physiologist, born 27 June 1918; died 21 January 2017
Gerald Graham obituary
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