Monday, October 30, 2017

Get on the Beat

"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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