Correspondence Address:
Dr. Arindam Choudhury
Department of Cardiac Anaesthesia, Cardio Thoracic Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India

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This was the puzzled response of a German physician, to a telephone call from Sweden, way back in October 1956. The reaction was understandable for a medical doctor who was shunned, called upon as a lunatic, with his work derided as nothing more than a circus stunt. Dr. Werner Theodor Otto Forssmann said “I felt that I had planted an apple orchard and other men who had gathered the harvest stood at the wall, laughing at me,” aptly describing his untimely scientific exile after having laid the foundation of modern cardiac catheterization.

It was for the grit of this young surgical resident, who broached a bold concept to prove that it is possible to access the heart in contrast to the general notion of leading 19th century European physicians. His inspiration emanated from the procedures performed by Chauveau and Marey, who placed a long, thin tube via the jugular vein into horse's heart.{1}

The dramatic sequence of events on November 5, 1929, was revealed by Forssmann in his autobiography Experiments on Myself.{2} To begin with, he convinced a nurse to be his first “human guinea pig.” He outplayed the nurse to perform the experiment on himself instead. With an incision in left elbow crease, he inserted a long ureteral catheter about 30 cm into a vein of his arm, toward the heart, saying “It's done.” He successfully repeated the self-experiment on five more occasions and submitted his findings to a German journal.{3}

The repercussions soon followed and reactions from the medical community were unexpected. Majority were ostensibly displeased with his rationale and approach, citing them dangerous. A Berlin tabloid newspaper sensationalized the technique as that of a medical daredevil. Subsequently, Forssmann's surgical career was severely curtailed.

In 1940, long after Forssmann's experiment, Cournand acknowledged his explorations disseminating an advanced description of cardiac catheterization. Forssmann was finally awarded the 1956 Nobel Prize in Medicine, along with Cournand and Richards. He declined an offer to head a German cardiovascular institute, citing his lack of update in the field. Forssmann, then a country doctor, told a reporter, “I feel like a village person who just learned that he had been made a bishop.”{2}

Pacemaker insertion, angioplasty, and valve repair might now be impossible without the nerve of Dr. Forssmann, whose courage to go against the medical fraternity made modern cardiac catheterization possible. The subspecialty of interventional cardiology has grown enormously, both in depth and in breadth, and cardiac interventional procedures are being performed daily in untold numbers around the world.

Forssmann's extraordinary story elucidates that even in our enlightened times, a valuable suggestion may remain unexplored on the grounds of preconceived opinions. Revisiting such exemplary, ahead of time, yet uncommonly cited stories could inspire a generation of budding physicians in the making.

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