Few people would go to the extreme of using their own body to prove a point, but that is exactly what Dr. Werner Forssmann (1904-1979) did when he experimented on himself to prove that a catheter could be introduced into a human heart without resulting in damage or death to the patient.
Werner Theodor Otto Forssmann was born in Berlin, Germany on August 29, 1904 to Julius and Emmy (Hindenberg) Forssmann. His father, a barrister, served as a captain in the army during World War I, where he was killed in 1916. Forssmann's education began at the Askanische Gymnasium, a secondary grammar school in Berlin. He was confirmed on March 14, 1919 at the Evangelical Church in Kaiser-Wilhelm-Gedachtniskirche in Berlin. In 1922 Forssmann continued his education at the University of Berlin where he studied medicine. He passed his medical examinations and, in 1925, began a two-year internship in Berlin, passing the state examination in January 1928. Forssmann received his MD degree in 1929 and entered the University Medical Clinic for his clinical training, where he worked under Professor Georg Klemperer while also studying anatomy under Professor Rudolph Fick. He took his surgical instruction in 1929 at the August Victoria Home in Eberswalde, near Berlin.
A Dramatic Experiment
In 1929, while in surgical residence at Eberswald Surgical Clinic, Forssmann theorized that drugs for cardiac resuscitation could be safely injected into the heart by inserting a catheter into a vein in the elbow and threading it through the body directly into the heart. He was alone in this theory as the physicians of the day believed that entry directly into the heart would be fatal. Forssmann recognized the benefit of such a procedure in measuring intracardiac pressures and injecting opaque materials for X-ray studies. However, he was unable to convince his peers and his work was initially restricted to cadavers.
Determined to prove his theory correct, Forssmann, with the assistance of a fellow resident, inserted a cannula (a long, thin tube used to administer medication) into the antecubital vein at the front of his own elbow. He pushed this catheter approximately two feet and, with the tube in place, proceeded to climb two floors to the X-ray room where he persuaded a radiologist to inject the opaque material used for X-rays into the catheter. A photograph was then taken showing the tip of the catheter in his right auricle. As a result of this successful experiment, Forssmann published a paper in which he reported his technique and discussed its benefits. Although he had proven his theory, Forssmann was fired from his position and his work was rejected. Although the press acclaimed his work, the German medical establishment scorned his efforts and ignored his work for the following decade.
A Distinguished Career
Forssmann turned to other work, becoming a pulmonary surgeon and urologist. In 1931 he began work with Ferdinand Sauerbruch, a famous German surgeon, where he remained until 1932. Forssmann worked at the Charite in Berlin and the City Hospital at Mainz before moving on to Berlin's Rudolf Virchow Hospital, where he took specialist training in urology under Karl Heusch. He later became chief of the surgical clinic of the City Hospital at Dresden-Friedrichstadt and at the Robert Koch Hospital, Berlin.
Forssmann was captured by the Allies during World War II where he served as a sanitary officer with the rank of surgeon-major. He was released from an American prisoner of war camp in 1945. After the war he moved to Schwarzwald where he entered practice with his wife. In 1950 Forssmann moved to the small town of Bad Kreuznach in the Rhine province where he practiced urology and worked as a general practitioner.
In 1954, Forssmann was awarded the Leibniz Medal of the German Academy of Sciences and was guest of honor at the National University of Cordoba, Argentina. In 1958 he became chief of the surgical division of the Evangelical Hospital at Dusseldorf. He returned to the National University of Cordoba in 1961 to be appointed honorary professor. Maintaining his belief in the benefits of heart catheterization, Forssmann published an article in 1954 in Langenbecks Archiv fur Klinische Chirurgie on the historical development and methodology of heart catheterization and its application to lung disease. He also published numerous articles on urological matters in Zeitschrift fur Urologie. In 1962 Forssmann became a member of the executive board of the German Surgical Society. He also held membership in the American College of Chest Physicians and was an honorary member of the Swedish Society of Cardiology, the German Society of Urology and the German Child Welfare Association.
The Nobel Prize
Although the German medical community considered Forssmann's theory and experiment to be nothing more than a "circus stunt," the Americans saw his work in a different light. Within three years of his experiment, two doctors at Columbia University, Andre F. Cournand and Dickinson W. Richards, Jr., studied his experiment and developed ways to use it for both research and diagnosis. They developed ways to inject contrast chemicals into the heart in order to visualize a defect on an X-ray screen. They also used cardiac catheterization to measure heart and blood vessels, determine the amount of blood an ailing heart can handle per minute, and discover abnormal communications between the pulmonary artery and the aorta.
In 1956 the Nobel Prize for Physiology or Medicine was awarded to Forssmann together with Cournand and Richards. Upon hearing of the announcement, Robert F. Loeb, executive officer of the Department of Medicine at Columbia's College of Physicians and Surgeons credited the work of the three men. "The technique of cardiac catheterization of the heart was discovered by Forssmann in Germany in 1929 and was developed and extended greatly in its application in the laboratories of Professors Cournand and Richards. By means of this and other techniques, the knowledge of the behavior of the heart and circulation in health and disease has been extended immeasurably. As a result, for example, the accuracy of diagnosis has been greatly enhanced and it has made possible the selection of those patients with heart disease who may be expected to be improved by surgery of the heart."
When he learned that he would share the Nobel Prize with Cournand and Richards, Forssmann said, "No one in West Germany has paid any attention to me. The Americans were the ones who recognized my work." He commented in reference to his own experiment in 1929, "the time was not yet ripe for this discovery." And added, "It is a very satisfying feeling to know that my research was right." (New York Times, October 19, 1956.)
In 1933 Forssmann married Dr. Elsbeth Engel, a specialist in urology. They had six children: Klaus (b. 1934), Knut (b. 1936), Jorg (b. 1938), Wolf (b. 1939), Bernd (b. 1940), and Renate (b. 1943). Forssmann's share of the Nobel Prize in 1956 was $38,633. When asked how he would use that prize he responded, "You can imagine that I can find a good use for it with six children." He added that he would start smoking 12-cent instead of 9-cent cigars. Forssmann died in Schopfheim, Germany on June 1, 1979.
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