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Werner Forssmann – the Nobel winner who performed the first human cardiac catheterization… on himself

Tijana Radeska
Werner Frossmann
Werner Frossmann

“It was very painful. I felt that I had planted an apple orchard and other men who had gathered the harvest stood at the wall, laughing at me,” said Dr. Werner Forssmann before he died.

Werner Forssmann. Wikipedia/Public Domain

Werner Forssmann. Wikipedia/Public Domain

In 1929, Werner Forssmann put himself under local anesthesia and inserted a catheter into a vein in his arm. Not knowing if the catheter might pierce a vein, he put his life at risk. Forssmann was nevertheless successful; he safely passed the catheter into his heart.

In 1956, he shared the Nobel Prize in Medicine (with Andre Cournand and Dickinson Richards) for developing a procedure that allowed for cardiac catheterization. The procedure allowed doctors to diagnose and treat heart conditions with much greater accuracy then before.

1956 Nobel Prize in Medicine awarded to Werner Frossmann, Andre Cournand and Dickinson Richards. CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=609936

1956 Nobel Prize in Medicine awarded to Werner Frossmann, Andre Cournand and Dickinson Richards. Source: Wikipedia, CC BY-SA 3.0,

He went to study medicine at the University of Berlin. After passing his State Examination in 1929, he went to the University Medical Clinic for his clinical training where he worked under Professor Georg Klemperer, and he studied anatomy under Professor Rudolph Fick. For clinical instruction in surgery, he went, in 1929, to the August Victoria Home at Eberswalde near Berlin.

It was in Eberswalde where he performed the first human cardiac catheterization in 1929. Far from fantasy, Dr. Forssmann’s inspiration to perform what is now called cardiac catheterization came from a sketch in his physiology textbook depicting a long, thin tube being placed into a horse’s jugular vein and guided into the animal’s heart with balloon-assisted measurements of intracardiac pressures. Dr. Forssmann proposed to reach the heart of man — not through the jugular, but through the veins in the crease of the arm, which was more accessible.

Radiograph of cardiac catheterization by Werner Forssmann 1929. Von Werner Forßmann - Werner Forßmann Herzkatheter-Röntgenaufnahme, Über die Sondierung des rechten Herzens. In: Berliner Klinische Wochenschrift vom 5. November 1929, Gemeinfrei, https://commons.wikimedia.org/w/index.php?curid=16284561

Radiograph of cardiac catheterization by Werner Forssmann 1929. Wikipedia/Fair use

He didn’t get a permission by the clinic to do his experiment. Ignoring his department chief, Forssman persuaded the operating-room nurse in charge of the sterile supplies, Gerda Ditzen, to assist him. She agreed, but only on the promise that he would do it on her rather than on himself. However, Forssmann tricked her by strapping her to the operating table and pretending to locally anesthetize and cut her arm whilst actually doing it on himself. He anesthetized his own lower arm in the cubital region and inserted a uretic catheter into his antecubital vein, threading it partly along before releasing Ditzen (who at this point realized the catheter was not in her arm) and telling her to call the X-ray department. They walked some distance to the X-ray department on the floor below where, under the guidance of a fluoroscope, he advanced the catheter the full 60 cm into his right ventricular cavity. This was then recorded on X-Ray film showing the catheter lying in his right atrium.

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The head clinician at Eberswalde, although initially very annoyed, recognized Werner’s discovery when shown the X-rays; he allowed Forssmann to carry out another catheterization on a terminally ill woman whose condition improved after being given drugs in this way. An unpaid position was created for Forssmann at the Berliner Charité Hospital, working under Ferdinand Sauerbruch.

German Prof. Dr. Ferdinand Sauerbruch, developed the Sauerbruch chamber, a pressure chamber for operating on the open thorax, which he demonstrated in 1904. This invention was a breakthrough in thorax medicine and allowed heart and lung operations to take place at greatly reduced risk. As a battlefield surgeon during World War I, he developed several new types of limb prostheses, which for the first time enabled simple movements to be executed with the remaining muscle of the patient. By Bundesarchiv, Bild 183-R45871 / CC-BY-SA 3.0, CC BY-SA 3.0 de, https://commons.wikimedia.org/w/index.php?curid=5368423

German Prof. Dr. Ferdinand Sauerbruch, developed the Sauerbruch chamber, a pressure chamber for operating on the open thorax, which he demonstrated in 1904. This invention was a breakthrough in thorax medicine and allowed heart and lung operations to take place at greatly reduced risk. As a battlefield surgeon during World War I, he developed several new types of limb prostheses, which for the first time enabled simple movements to be executed with the remaining muscle of the patient. Source by Bundesarchiv, Bild, CC BY-SA 3.0 de,

However, after presenting his paper to Sauerbruch, Forssmann was dismissed for continuing without his approval. Sauerbruch commented, “You certainly can’t begin surgery in that manner.” His surgical skills were certainly noted, but he found it hard to find a job after being fired by several other hospitals because of not meeting scientific expectations or for not respecting hospital policies. After marrying Dr. Elsbet Engel, a specialist in urology in 1933, he quit cardiology and took up urology. He then went on 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.

Auguste Chauveau assisting Frossmann during a cardiac catheterization of a horse. Von Anonym - http://physiologie.envt.fr/spip/IMG/jpg/chauveau_et_ses_sondes.jpg, Gemeinfrei, https://commons.wikimedia.org/w/index.php?curid=24372704

Auguste Chauveau assisting Frossmann during a cardiac catheterization of a horse. By Anonimous Source

From 1932 to 1945, he was a member of the Nazi Party, and at the start of World War II he became a medical officer. In the course of his service, he rose to the rank of Major, until he was captured and put into a U.S. POW camp. Upon his release in 1945, he worked as a lumberjack and then as a country medic in the Black Forest with his wife. In 1950, he began practice as a urologist in Bad Kreuznach.

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. In 1954, he was given the Leibniz Medal of the German Academy of Sciences. In 1956, the Nobel Prize in Physiology or Medicine was awarded to Cournand, Richards, and Forssmann.

Contemporary right heart catheterization. Von J. Hupf - selbst fotografiert, Bild-frei, https://de.wikipedia.org/w/index.php?curid=2537537

Contemporary right heart catheterization. Source by J. Hupf, Bild-frei,

After winning the Nobel Prize, he was given the position of Honorary Professor of Surgery and Urology at the University of Mainz. He died in Schopfheim, Germany of heart failure in 1979.