Werner Forssmann

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German surgeon and urologist (1904–1979)

Forssmann was educated at the university in his native city of Berlin where he qualified as a physician in 1929. He then worked in the 1930s as a surgeon in various German hospitals. After the war he practiced as a urologist at Bad Kreuznach from 1950 until 1958 when he moved to Düsseldorf as head of surgery at the Evangelical Hospital.

In 1929 Forssmann introduced the procedure of cardiac catheterization into medicine. He was struck by the danger inherent in the direct injection of drugs into the heart frequently demanded in an emergency. The alternative that he proposed sounded no less alarming – introducing a catheter through the venous system from a vein in the elbow directly into the right atrium of the heart. Drugs could then be introduced through this.

After practice on cadavers and an unsuccessful attempt on himself made with the aid of a nervous colleague, Forssmann decided to do the whole thing himself. He consequently introduced a 65-centimeter (25.6-in) catheter for its entire length, walked up several flights of stairs to the x-ray department and calmly confirmed that the tip of the catheter had in fact reached his heart. There had been no pain or discomfort.

Unfortunately further development was inhibited by criticism from the medical profession, which assumed the method must be dangerous. Consequently it was left to André Cournand and Dickinson Richards to develop the technique into a routine clinical tool in the 1940s; for this work they shared the Nobel Prize for physiology or medicine with Forssmann in 1956.

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.)

Personal Life

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.

Books

Encyclopedia Americana International Edition, Americana Corporation, 1970.

Online

"Werner Forssmann" (1904-1979) PTCA 20th Anniversary Project: Bio of Forssmannhttp://www.ptca.org/archive/bios/forssmann.html (January 18, 2001).

"Werner Theodor Otto Forssmann" Biography of Werner Theodor Otto Forsmann from Nobel Lectures,http://www.nobel.se/medicine/laureates/1956/forssmann-bio.html(January 18, 2001).

"Forssmann, Werner" Forssmann, Werner. The Columbia Encyclopedia: Sixth Edition. 2000,http://www.bartelby.com/65/fo/Forssman.html(January 18, 2001).

"Forssmann, Werner" Electric Library Personal Edition-Document,http://wwws.elibrary.com/getdoc.cgi?id-18586849x127y39375w0(January 18, 2001).

"Werner Forssmann" Werner Forssmann Winner of the 1956 Nobel Prize in Medicine,http://www.almaz.com/nobel/medicine/1956b.html(January 18, 2001).

Werner Theodor Otto Forßmann, (August 29, 1904 – June 1, 1979) was a physician from Germany who won the Nobel Prize in Medicine for developing a procedure that allowed for the catheterization of the heart.

Werner Forssmann
A bust of Werner Forßmann
Born	August 29, 1904(1904-08-29) Berlin
Died	June 1, 1979 (aged 74)
Nationality	Germany
Fields	Medicine
Alma mater	University of Berlin
Known for	Cardiac catheterization

Contents 1 Life 2 See also 3 References 4 External links

Life

Forßmann was born in Berlin on August 29, 1904. Upon graduating from Askanische Gymnasium, he entered the University of Berlin to study medicine, passing the State Examination in 1929.^[1]

He hypothesized that a catheter could be inserted directly into the heart, for such applications as directly delivering drugs, injecting radiopaque dyes, or measuring blood pressure. The fear at the time was that such an intrusion into the heart would be fatal.^[2] In order to prove his point, he decided to try the experiment on himself.

In 1929, while working in Eberswalde, he performed the first human cardiac catheterization. He ignored his department chief and tied his assistant to an operating table.^[3] Then, he anesthetized his own lower arm and inserted a cannula into his antecubital vein, threading it 65 cm all the way to his heart.^[1] Afterwards, he walked some distance to the X-ray department to photograph the catheter which was now lying in his right atrium.

The head clinician at Eberswalde, recognizing Werner's discovery, created an unpaid position for him at the Berliner Charité Hospital, working under Ferdinand Sauerbruch. Though, once Sauerbruch saw his paper, he was thrown out of the hospital. Sauerbruch commented, "You certainly can't begin surgery in that manner".^[4] Facing such disciplinary action for self-experimentation, he was forced to quit cardiology and take up urology.^[2]

He left to work at City Hospital at Mainz. And then, went to study urology under Karl Heusch at the Rudolf Virchow Hospital in Berlin. Later, he was appointed Chief of the Surgical Clinic at both the City Hospital at Dresden-Friedrichstadt and the Robert Koch Hospital in Berlin.^[1]

In 1933, he married Dr. Elsbet Engel, a specialist in urology.

At the start of World War II, he became a medical officer. In the course of his service, he rose to the rank of Sergeant-Major, until he was captured and put into a POW camp. Upon his release, in 1945, he worked as a lumberjack and then as a country doctor in Schwarzwald with his wife. In 1950, he began practicing as urologist in Bad Kreuznach^[1][2]

During the time of his imprisonment, his paper was read by André Frédéric Cournand and Dickinson W. Richards. They developed ways of applying his technique to heart disease diagnosis and research. And, in 1956, the Nobel Prize in Physiology or Medicine was awarded to Cournand, Richards, and Forssmann.^[1]

After winning the Nobel Prize, he was given the position of Honorary Professor of Surgery and Urology at the University of Mainz.^[1]

Later, in 1954, he was given the Leibniz Medal of the German Academy of Sciences. And, in 1961, he became an Honorary Professor at the National University of Cordoba.^[1]. In 1962, he became a member of the Executive Board of the German Surgical Society. He also became a member of the American College of Chest Physicians, honorary member of the Swedish Society of Cardiology, the German Society of Urology, and the German Child Welfare Association.^[1]

He and Elsbet had six children: Klaus Forssmann in 1934, Knut Forssmann in 1936, Jörg Forssmann in 1938, Wolf Forssmann in 1939 (who was first to isolate the atrial natriuretic peptide), Bernd Forssmann in 1940 (who helped develop the first clinical lithotriptor), and Renate Forssmann in 1943.^[1][2]

He died in Schopfheim, Germany of heart failure on June 1, 1979.^[2]

See also

• André Frédéric Cournand
• Andreas Gruentzig
• Dickinson W. Richards

References

1. ^ ^{a b c d e f g h i} "Werner Forssmann - Biography". Nobel Foundation. http://nobelprize.org/nobel_prizes/medicine/laureates/1956/forssmann-bio.html. Retrieved 2008-12-22. 
2. ^ ^{a b c d e} "Werner Forssmann". NNDB. http://www.nndb.com/people/706/000129319/. Retrieved 2009-03-31. 
3. ^ Sanghavi, Darshak (2007-05-08). "Plumber's Butt? The right and wrong way to think about heart attacks". Slate. http://www.slate.com/id/2165826/. 
4. ^ "The History of Werner Forssmann". UTMB. http://www.utmb.edu/forssmann/history_of_werner_forssmann.asp. Retrieved 2008-12-22. 

• Goerig, Michael; Agarwal Kamayni (February 2008). "[Werner Forssmann: "the typical man before his time!" - self-experiment shows feasibility of cardiac catheterization]". Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS 43 (2): 162–5. doi:10.1055/s-2008-1060550. PMID 18293251. 
• Hollmann, Wildor (October 2006). "Werner Forssmann, Eberswalde, the 1956 Nobel Prize for medicine". Eur. J. Med. Res. 11 (10): 409–12. PMID 17107872. 
• Forssmann, Wolf-Georg; Hirsch Jochen R (October 2006). "50 years Nobel Prize: Werner Forssmann and the issue of commemorative stamps". Eur. J. Med. Res. 11 (10): 406–8. PMID 17107871. 
• Berry, Diana (February 2006). "History of cardiology: Werner Forssmann, MD". Circulation 113 (7): f27–8. PMID 16493783. 
• "[Werner Forssmann tested the first heart catheter on himself. For this reason he was fired by the chief physician]". MMW Fortschritte der Medizin 146 (33-34): 56. August 2004. PMID 15526639. 
• Bröer, R (October 2002). "[Legend or reality? - Werner Forssmann and heart catheterization]". Dtsch. Med. Wochenschr. 127 (41): 2151–4. doi:10.1055/s-2002-34642. PMID 12397563. 
• Raju, T N (May 1999). "The Nobel chronicles. 1956: Werner Forssmann (1904-79); André Frédéric Cournand (1895-1988); and Dickinson Woodruff Richards, Jr (1895-1973)". Lancet 353 (9167): 1891. doi:10.1016/S0140-6736(05)75106-0. PMID 10359453. 
• Siegel, D (December 1997). "Werner Forssmann and the Nazis". Am. J. Cardiol. 80 (12): 1643–4. doi:10.1016/S0002-9149(97)00944-2. PMID 9068526. 
• Hart, F D (May 1997). "Werner Forssmann (1904-1979), auto-experimenter/medical martyr. The original cardiac catheterization". Journal of medical biography 5 (2): 120–1. PMID 11619092. 
• Forssmann-Falck, R (March 1997). "Werner Forssmann: a pioneer of cardiology". Am. J. Cardiol. 79 (5): 651–60. doi:10.1016/S0002-9149(96)00833-8. PMID 9416961. 
• Heiss, H W (July 1992). "Werner Forssmann: a German problem with the Nobel Prize". Clinical cardiology 15 (7): 547–9. doi:10.1002/clc.4960150715. PMID 1499182. 
• Meyer, J A (March 1990). "Werner Forssmann and catheterization of the heart, 1929". Ann. Thorac. Surg. 49 (3): 497–9. PMID 2178572. 
• Schadewaldt, H (December 1979). "[Werner Forssmann 29.8.1904 - 1.6.1979]". Dtsch. Med. Wochenschr. 104 (52): 1856–7. PMID 391522. 
• Steckelberg, J M; Vlietstra R E, Ludwig J, Mann R J (November 1979). "Werner Forssmann (1904--1979) and his unusual success story". Mayo Clin. Proc. 54 (11): 746–8. PMID 386001. 
• Asperger, Z (August 1979). "[The life of Doctor Werner Forssmann (1904--1979) (author's transl)]". Lijecnicki vjesnik 101 (8): 509–17. PMID 396430. 
• "[Münchener Medizinische Wochenschrift/20 March 1931 Contrast representation of the cavities of the living right half of the heart by Werner Forssmann, Eberswalde]". MMW, Münchener medizinische Wochenschrift 120 (14): 489. April 1978. PMID 347275. 
• Kenéz, J (December 1969). "[Heroic self-experiment of a practicing physician (Werner Forssmann)]". Orvosi hetilap 110 (52): 3069–74. PMID 4904895. 
• Sulek, K (January 1969). "[Nobel prize for Andre F. Cournand, Werner T. O. Forssmann and Dickinson W. Richards in 1956 for the discovery related to heart catheterization and studies on pathological changes in the cardiovascular system]". Wiad. Lek. 22 (2): 203–4. PMID 4890192. 
• HEUSCH, K (1957). "[Werner Forssmann, Nobel prize winner for medicine, 1956.]". Zeitschrift für Urologie 50 (2): 57–9. PMID 13434311. 
• BOLT, W; KNIPPING H W (December 1956). "[Congratulations to Werner Forssmann on winning the 1956 Nobel prize for medicine.]". Med. Klin. (Munich) 51 (49): 2073–6. PMID 13386873. 

External links

• Biographical Sketch of Werner Forßmann with video clip
• Nobel Biography
• www.aerztezeitung.de: Der Herzkatheter-Selbstversuch: Dichtung und Wahrheit (in German)

v • d • e Nobel Laureates in Physiology or Medicine Max Theiler (1951) · Selman Waksman (1952) · Hans Krebs / Fritz Lipmann (1953) · John Enders / Thomas Weller / Frederick Robbins (1954) · Hugo Theorell (1955) · André Cournand / Werner Forssmann / Dickinson W. Richards (1956) · Daniel Bovet (1957) · George Beadle / Edward Tatum / Joshua Lederberg (1958) · Severo Ochoa / Arthur Kornberg (1959) · Frank Burnet / Peter Medawar (1960) · Georg von Békésy (1961) · Francis Crick / James D. Watson / Maurice Wilkins (1962) · John Eccles / Alan Hodgkin / Andrew Huxley (1963) · Konrad Bloch / Feodor Lynen (1964) · François Jacob / André Lwoff / Jacques Monod (1965) · Francis Rous / Charles B. Huggins (1966) · Ragnar Granit / Haldan Hartline / George Wald (1967) · Robert W. Holley / Har Khorana / Marshall Nirenberg (1968) · Max Delbrück / Alfred Hershey / Salvador Luria (1969) · Bernard Katz / Ulf von Euler / Julius Axelrod (1970) · Earl Sutherland, Jr. (1971) · Gerald Edelman / Rodney Porter (1972) · Karl von Frisch / Konrad Lorenz / Nikolaas Tinbergen (1973) · Albert Claude / Christian de Duve / George Palade (1974) · David Baltimore / Renato Dulbecco / Howard Temin (1975) Complete roster · 1901–1925 · 1926–1950 · 1951–1975 · 1976–2000 · 2001–present

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