"There is a measure of justice."
In 1879, surprising
as it may seem, doctors had yet to fully understand how the heart worked as a
pump. In that year three French physiologists conducted what was then a most peculiar
experiment. They threaded a catheter into a horse's jugular vein and then into
the animal's heart. Once there, they inflated the balloon's tip. Why? To see if
the animal's ventricle was actively contracting. It was. They published the
result of this experiment in their book Lecons
de Physiogie Operatoire.
It so
happened that 50 years later a German surgical resident Werner Forssmann, 25,
found a dusty copy of the book in his cupboard. He became obsessed with the
description of the experiment and its accompanying pictures. He tore the
drawings out of the book and carried them everywhere.
At this
time there no such thing as open-heart surgery. Doctors regarded the heart as a
type of sacred chamber, one so fragile that they rarely, if ever, performed
experiments on it, much less procedures.
Forssmann
was not like his peers. He likely asked himself, "What could doctors do if
they could see inside a beating heart? Could you insert a catheter into a
heart, inject dye, and then X-ray the organ—all without harming a patient? In what
unimaginable ways might patients' lives be saved?"
Only on rabbits
He asked a
senior physician, a Dr. Schneider, if he could explore this notion. Yes, he was
told, but you may only experiment on rabbits. When he asked his supervisor if
he could perform this experiment on humans, namely himself, his boss replied,
"Drop this suicidal idea. What could I tell your mother if one day we
should find you dead?" After all, such catheters might become tangled in patients'
hearts and kill them.
Undeterred,
Forssmann practiced on cadavers and then enlisted (or perhaps seduced) an
accomplice, an operating room nurse named Gerda Ditzen. "[I] prowl[ed]
around her like a sweet-toothed cat around the cream jug," he later wrote.
He told her that he would perform the procedure on her and that it would be
absolutely harmless.
Whether
Ditzen was seduced by the notion of furthering science or otherwise seduced,
she agreed, and the two of them went to a procedure room. Once there, she
obtained the necessary equipment, especially a uretheral catheter. (Of course,
at that time cardiac catheterization equipment had yet to be invented.)
Forssmann then strapped her arms and legs to
the exam table. This is not nearly as lurid as it sounds. Forssmann needed her
help because only she had the keys to unlock the surgical supplies he needed. As
a lowly resident, he wasn't trusted with such access.
He
pretended to ready her for the experiment. Once she was unable to stop him, he
numbed his arm and inserted the tubing deep into his body—but not quite into
his heart. Indeed, once she realized what was going on, she yelled for him to
stop.
Now
Forssmann had another problem. In his enthusiasm to perform the experiment, he realized
they were in a room that had no X-ray machine. Thus, there would be no proof he
had catheterized himself. So, the two of them walked down to the hospital's
basement with the tube stuck near his heart.
Once there,
one of Forssmann's colleagues tried to rip out the catheter. Instead, Forssmann
overcame him. He pushed the catheter into his heart, and X-rays were taken.
At first,
Dr. Schneider was furious. But then he relented and took the young doctor out
to celebrate at a "low-ceiling wine tavern" where waiters were
impeccably attired.
Forssmann
published the results of this and follow-up experiments. The resulting
publicity got him fired from a new job as a surgeon in a different hospital.
The chief of surgery resented his showboating.
And that
ended Forssmann's career as a surgeon. "The time was not yet ripe for this
discovery," he wrote, and in the early 1930s Forssmann became a urologist.
"A more critical distance"
He also
joined the Nazi Physicians League. While working in a Berlin prison in 1943, he
tried but failed to convince the warden to allow him to sedate political
prisoners before they were executed.
Perhaps
more chilling, in 1937 Forssmann met Karl Gebhardt, the personal doctor of SS
chief Heinrich Himmler. Along with Hitler, Himmler masterminded the
Holocaust. Gebhardt was convicted of crimes against humanity at the
Nuremberg Trials and executed. Gebhardt knew of Forssmann's cardiac research. He offered to supply with him with subjects for human experimentation. Forssmann
refused.
According
to Forssmann's personal correspondence during the war (and with Jewish colleagues
in the 1960s), while he was infatuated with Nazism in the early 1930s, he
"developed a more critical distance to Nazi ideology," according to a
paper in Urologia Internationalis.
Forssmann
"will be remembered as the man who saved many innocent victims from the
Nazis," according to a review of his autobiography in the British Medical
Journal.
After being
captured and put in a POW camp, Forssman became a lumberjack and then a country
doctor.
On October
11, 1956, while having a drink a pub, his wife called to tell him to rush home.
Someone with a foreign accent had called. He continued drinking and arrived
home late at night. Someone else called. He refused to take the phone.
The next
day he performed two operations. He heard that two Americans had received the
Nobel Prize for their work in the field of cardiac catheterization. Accounts
vary, but Forssmann felt either crestfallen or numb. All his life his work had
been ignored.
Then the
head of the hospital burst into the operating room. There was good news—He,
too, had won a Nobel Prize.
"I
feel like a village parson who has just learned that he has been made
bishop," Forssmann said. "It seems that sometimes there is a measure
of justice in our world."
MORAL: Get to the heart of the matter.
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