Cardiac catheterization, which involves inserting a cardiac catheter retrogradely through a peripheral artery into the human heart for a variety of tests and treatments, has made it possible to perform many surgical procedures that used to require an open-heart procedure in a safer and more effective way without the risk of having to open the chest. Although cardiac catheterization is now widely used in a variety of routine examinations and treatments in cardiology, 91 years ago, when a mad doctor inserted a catheter from his own blood vessel into the heart, everyone thought he was a "blasphemous" madman, and that his attempts were "fit only for the circus! to qualify as a professor in a circus". It was not until he received the Nobel Prize in Stockholm on December 10, 1956, that the forgotten "mad doctor" and "circus professor" reappeared in the limelight.
Time back to August 29, 1904, Werner Forsman was born in Berlin, Germany. He grew up under the education and influence of his father and uncle, and was firmly committed to the ideal of becoming a doctor.
At the age of 24, he passed the state examination and officially became a doctor. At the age of 25, in 1929, he secretly completed an experiment that shocked the medical world - the first human autologous heart catheterization.
At this point, although Forsman was only a trainee doctor, he discovered that he could penetrate through a tube from the human arm to the heart during one of his autopsies. By his own account, he had been interested in cardiac subjects as a student, and his later autopsy experiments were based on Claude Bernard's in vivo studies on animals, as well as the findings of the duo of Auguste Chavey and Etienne Jules Mali on animals, especially dogs and horses. Auguste Chavey developed intracardiac ventilatory tracing between 1861 and 1863 and measured intracardiac blood pressure in horses using the cardiac catheterization technique.
Based on these experiences, Forsman was confident that the technique could be applied directly to humans. His leader at the time, Richard Schneider, agreed. Schneider agreed with the idea, but thought it was too risky to experiment directly on humans, so he was advised to do more research, starting with animals. Although the hospital did not support his whimsical "idea", Forsman did not give up, but instead moved from open trials to "underground" trials.
The exact process of the first autologous cardiac catheterization is unclear, as Forsman himself published two different versions of the process:
In his autobiography, he described convincing Gerda Thiessen, a nurse in charge of the operating room. Thyssen. Thyssen prepared him with medical equipment for blood collection and a catheter. At the time, he talked to Thyssen about having him as his subject.
However, during the experiment, he simply anesthetized Thyssen, then turned around and anesthetized himself and inserted a catheter into his own veins. By the time Thyssen realized she had been duped, the experiment was already complete. She had to take Forsman to the x-ray room. The first x-ray showed that the catheter was still some distance from the heart, so he pushed the catheter in another 30 centimeters, eventually reaching the right ventricle, and took an x-ray. This version is also the most widely circulated.
Another version, written in his 1929 publication, is that Forsman's first experiment was with a colleague named Peter Romis. During this experiment, which his colleague stopped for fear of possible danger, the catheter was inserted roughly 35 centimeters before the experiment was stopped. A week later, Forsman then conducted the experiment alone. Although the exact procedure cannot be verified, Forsman did leave a valuable X-ray through the experiment.
Rumors of this madness soon spread, and Schneider, the head of surgery, was furious but aware of the far-reaching significance of the research. When it came to the question of publishing the paper, Schneider argued that it would be inappropriate to focus on the diagnostic aspects of the study in order to achieve the huge buzz that would lead to academic recognition of the trial. He therefore suggested emphasizing its possible therapeutic value. With Schneider's support, Forsman conducted a second trial in a patient who was comatose and near death due to postpartum infectious shock, for whom an intracardiac cannula was inserted and injections of two cardiac-strengthening drugs were applied directly. This proved to be more effective than peripheral intravenous injection.
In 1931, Forsman presented his report at the annual meeting of the German Surgical Society, but the response was lukewarm. Although Schneider did his best to use his influence to market Forsman and his research, his job search was not smooth. Forsman joined the Nazi Party in 1932, and when World War II broke out, he became an army doctor. And when his papers were finally taken seriously by researchers across the ocean, he was still in a U.S. Army prisoner-of-war camp, not to be released until 1945.
Both AndréFrédéric Cournand and Dickinson W. Richards read his papers during his imprisonment.
They developed ways to apply his techniques to the diagnosis and study of heart disease. In 1954, Forsman received the Leibniz Medal of the German Academy of Sciences. In 1956, the trio of Cunanan, Richards and Forsman were awarded the Nobel Prize in Physiology or Medicine together.
The story of Forsman and cardiac catheterization ends here, but human development has progressed to the present day, and the exploration and development of more uncharted territories has just begun. We have not always been as fortunate as Forsman in exploring these unknowns, and many times they have been fraught with risk. No matter how many experiments have been done in the early stage and how much data has been obtained, there is a possibility that the final result will not be realized in the actual application environment, and the most serious cost may be the researcher's life. There is a huge asymmetry in the cost of success or failure. Even in our enlightened times, a valuable discovery proposal may not be accepted by the mainstream because of old taboos. Clinical care and biomedical research, while providing richer and more effective treatments for patients, also raise a range of ethical and sociocultural dilemmas.
So, should we encourage and support these explorations, which are in the interest of humanity as a whole? What are your thoughts on this? Feel free to leave a comment, and if you're interested, you can also click to watch the video: Forsythe Mann and the Story of Cardiac Catheterization