2.13 Intellectual The Intellectual
Werner Forssmann
Introduction
This article tells the story of Werner Forssmann, winner of the 1956 Nobel Prize in Physiology or Medicine.
He braved the world to experiment with his body and established cardiac catheterization; he was the founder of modern cardiology, but he was repeatedly attacked and ostracized by academia; he was a surgeon who gave up his scientific dream in order to support his family. He had joined the Nazi Party, experienced the brutality of war, been a prisoner of war, and nearly died at the hands of his own men. In the darkest hours of his life, love and hope allowed him to survive long periods of loneliness and tribulations. Thousands of words, outlining his gushing life, telling his joys and sorrows.
Written by | Gold Pans
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"He should have lived in the nineteenth century – his idealized romanticism made it difficult for him to cope with the chaos of the 20th century."
——Renate Forssmann-Falck, MD
Figure 1 Werner Forssmann (1956) | source[10]
1
Growth
Werner Forssmann was born on August 29, 1904 in Berlin, Germany. He was the only child in the family, his mother was a housewife, and his father was a lawyer. Since he was a child, his family was wealthy and he had no worries about food and clothing. But like his peers, he will enter the most turbulent era in German history. As a teenager, Forsman witnessed the promotion of cars, airplanes, and radios, witnessed the collapse of the Kingdom of Prussia, and first tasted the cruelty of war. In 1916, at the age of 12, his father, who had been conscripted two years earlier, was killed on the battlefields of World War I. Since then, his mother and grandmother have become two of the most important relatives in his life.
From the age of 6, Forsman attended one of the best schools in Berlin at the time, where he completed high school. In school, he established the Greek and Roman values of Western civilization, the idea of freedom of thought, and the attitude of lifelong learning. He also dabbled extensively in history, anthropology, theology, literature, and philosophy.
When he graduated from high school in 1922, the teacher in charge of the science club at the school asked him what he wanted to do in the future. Affected by the inflationary economic conditions at the time, Forsman said he wanted to go into business. The teacher gave him a slap in the face: "Forsman, if you go into business, you will be the only one who loses money." You should go to college, go to medical school. That's where your talent lies. ”
Following his teacher's advice, Forsmann entered the medical school of the prestigious Friedrich-Wilhelm University (now Humboldt University) in Berlin.
Forsman's uncle, Walter, was a doctor in a small town 60 miles north of Berlin. As soon as he arrived at the school holidays, Forsman stayed at his uncle's house, and often accompanied his uncle to visit patients, give his uncle a hand, and do some simple work such as bandaging and analyzing urine samples. Sometimes he could even diagnose patients in place of his uncle. Because of his medical experience with his uncle, his understanding of medicine and the skills of surgery have far surpassed those of his peers. He also learned from his uncle the professional principles of benevolence and patient supremacy.
Forsman has always been interested in scientific research. His PhD project was to study the effects of heavy consumption of liver extracts on the blood of healthy people.
Fig. 2 In 1928, Forsman was doing a doctoral project (yes, he was holding a cigar in his mouth) | source[9]
2
Intern doctor
In February 1928, Forsman passed the doctor's examination and after a one-year probationary period, he qualified to practice medicine and became a trainee doctor.
In Germany at the time, interns who had just graduated from medical school had a hard time finding paid jobs, and most of them were desperately squeezed into the most prestigious hospitals, and the first few years were completely free, similar to apprentices in other industries. Everyone wants to learn enough experience after years of slave-like hard work to find a paid position.
Forsman was lucky at this point. Richard Schneider, the chief of surgery at Auguste Viktoria Hospital, was the brother of a good friend of his mother's. The hospital is located in a small town called Eberswalde, northeast of Berlin. Schneider also became Forsman's first boss, but his relationship with Forsman was a mentor and a friend. It didn't take long for Forsman to perform minor surgeries under Schneider's guidance.
Fig. 3 Auguste Viktoria Hospital in Eberswalde, later renamed Werner Forsman Hospital| Source.[9]
The maturity of a surgeon often occurs after the first failed surgery. Once, Forsman had to operate on a 19-year-old. The patient had three typhoid perforations, severe peritonitis, and irreversible circulatory failure, and eventually died on the operating table.
The first time this happened to Forsman, he was devastated. Unable to shake off the heavy guilt, he shut himself in his room, refused to see anyone, and decided to leave the hospital the next day and abandon the operation. Schneider immediately went to Forsman's room and told him that surgery was a difficult job that required not only superhuman physical strength, but also a strong heart. His words benefited Forsman and helped him through the crisis.
At August-Victoria Hospital, forsmann's 24-hour work is commonplace. But that work experience was enjoyable for him. He worked hard and fully enjoyed life, enjoying the family atmosphere in the small hospital. This environment is also the best soil for brewing new ideas.
3
Think
During his busy internship, Forsman had a lingering idea in mind.
During his first year of medical school, he read several books by French physiologists Claude Bernard, Auguste Chauveau, and Tienne-Jules Marey. The section of the book about the animal heart catheter experiment fascinated him. He was impressed by an illustration: a man who, after making an incision in a horse's jugular vein, inserted a finger-thick catheter that went straight to the heart, with a rubber sac and a measuring device attached to the other end of the catheter to measure changes in blood pressure in the heart.
Years later, that picture is still clearly engraved in Forsman's mind. He often wondered, why not measure the indicators of the human heart or treat heart-related diseases in the same way?
Figure 4 A similar illustration to the illustration that Forsman never forgot: Stephen Hales first completed intravenous intubation on a horse in 1733. | source[3]
In those days, patients with heart injuries, malfunctions, or defects had little hope of survival. At that time, the medical community held a highly reverential attitude towards the heart, believing that the heart was the center of life, the sacred temple, and that touching the heart was a crime, so almost no one dared to do heart surgery.
On the other hand, even if a few doctors dare to do it, in order to ensure the success of the operation, they need to "see" the heart in advance to know exactly what is wrong with the heart. This was difficult to do at the time. The heart of a living person is hidden in the darkness. A limited number of methods of monitoring cardiac indicators include percussion, auscultation, X-rays, and electrocardiograms, which are both inaccurate and almost entirely dependent on the doctor's personal experience.
Forsman was desperate to find a safe path to the heart—without open surgery, without general anesthesia, and to observe and measure the heart under normal physiological conditions. Let the "light" shine into the heart, let the doctor see it, and the heart catheter seems to be the best way.
Cardiac catheterization is safe to operate on horses, why can't it be done on humans?
Forsman knew that all the venous blood flowed back into the heart. The advantage of intravenous intubation is that the catheter is pushed towards the heart in the direction of blood flow and does not affect blood flow. In addition, the unidirectional nature of the venous flap also facilitates the depth of the catheter. He repeatedly considered a feasible option and felt that if it was done in humans, the jugular vein was not suitable as an insertion point. No patient wants to have the jugular vein incised just for diagnostic purposes, let alone leave a scar on the neck. Also, opening any neck vein is at risk of creating air embolism.
For cardiac catheterization to be a widely used diagnostic tool, the best option is for a catheter to enter the vein at the elbow bend. The veins here are also the preferred sites for intravenous injections. The route of the elbow vein to the heart is clear and straightforward. After the patient lifts the arm, the catheter basically goes in a straight line.
Forsman often discussed the idea with his friend at the hospital, Dr. Peter Romeis, repeatedly arguing its feasibility. But Romes warned him not to act rashly. Forsman told Schneider his thoughts. Schneider thought his idea was justified, but Forsman's attempt to put it into practice was met with strong resistance from Schneider. Schneider wouldn't allow him to do the experiment with any patient.
Forsman proposed to do it on himself.
Schneider denied: "This is absolutely not possible. If you have a three long and two short, how do I explain it to your mother? She lost her husband in the war and took her son's life in my hospital by an autologous experiment approved by me. Would you agree if it were you? ”
Schneider suggested that Forsman do animal experiments first, and then consider how to get a man when the technology is mature.
Forsman agreed on the surface, but in his heart he had secretly made up his mind. What does animal testing mean? How many times has been done before, proving the safety of cardiac catheterization in animals.
In the summer of 1929, he decided to do it behind his back—on his own.
4
Autologous experiments
But Forsman didn't have the conditions to do the experiment alone. The sterilized equipment and narcotics in the operating room were locked in cabinets and were run by a nurse named Gerda Ditzen. If he wanted to do this experiment, he first had to pass the level of Dietzen.
Forsman began to take the initiative to approach Dietzen, talk to her about things, talk about ideals and life, and most importantly, subtly educate her and make her realize the great significance of cardiac catheterization. Forsman also lent books written by several French physiologists to Dietzen. After two weeks, Dietzen began to be fascinated by Forsman's idea as well, regretting that it could not be achieved.
Forsman felt the time was ripe.
One afternoon, everyone else in the hospital was napping. Forsman went to Dietzen's desk and asked her for surgical instruments, local anesthetics and a ureter catheter. Dietzen immediately realized what Forsman wanted to do, first refusing.
Under the soft and hard bubble of Forsman, Dietzen asked: "Can you guarantee that this operation will not be dangerous?" After getting an affirmative answer, she made up her mind: "Well, do it on me." I've given myself to you. ”
The two men went to the operating room, where Dietzen opened the cabinet and took out the instruments and medicines, the most important of which was a rubber ureter catheter with a length of 65 centimeters and an outer diameter of 1.33 millimeters. Forsman put Dietzen on the operating table and coaxed her to say that in order to prevent her from reacting violently after injecting nocaine (a local anesthetic) and falling off the table, he needed to tie her hands and feet. She had no doubts. After her hands and feet were fixed to the operating table, Forsman moved the surgical instruments to the head of the operating table and quickly injected local anesthetics into the bend of her left elbow in an invisible corner of Dietzen.
Experimenting on her is actually just a pretense, he still has to do it on himself!
Forsman returned to Dietzen and pretended to be disinfected with iodine at the crook of her left elbow, and then applied a sterile gauze. He deliberately did it very slowly, actually waiting for the local anesthetics on his body to work. Time's up! Forsman returned to the head of the operating table, cut the skin of his elbow, positioned the anterior elbow vein with an aneurysm ligation needle, cut the vein, inserted the cannula, and inserted it into the catheter.
The catheter penetrates thousands of years of human awe of the heart, pushing away the dark years and moving forward smoothly. Forsman did not feel any pain, indicating that there were no nerve endings in the inner wall of the blood vessel that felt pain. The only thing he felt was a warm current extending as the catheter deepened.
When he inserted the catheter into 35 centimeters, Forsman bandaged the wound with gauze, leaving only an opening to insert the catheter.
Forsman stood up, untied Dietzen with his right hand, and said, "That's it." Call the X-ray nurse. ”
Dietzen saw the catheter exposed on Forsman's arm, realized what was happening, and immediately screamed.
With his right hand, he raised his left arm and catheter, accompanied by Dietzen, walked through a long corridor, down a flight of stairs, and through another corridor before entering the X-ray room in the basement. X-ray nurses were waiting for them.
At this time, Romes, who was half asleep and half awake and had messy hair, heard the news and roared, "You idiot! What the hell are you doing? ”
He reached out to pull the tube out of Forsman's arm. Forsman lifted his foot and kicked him in the calf, drinking to make him back.
Forsman lay under an X-ray machine, and a nurse held up a mirror so that Forsman could see an image of his upper arm and chest on the display.
Unsurprisingly, the catheter had entered the position of the humerus. Forsman pushed the outer part of the catheter inside. The catheter encounters some resistance at the upper edge of the subclavian vein. He felt a blazing heat behind his collarbone and at the bottom of his neck. He coughed involuntarily a few times—he later analyzed it as a stimulus to the vagus nerve stem. Forsman continued to push the catheter until 65 centimeters entered his body. From the screen, the other end of the catheter has entered the right ventricle. He immediately asked the nurse to take an X-ray.
At only 25 years old, Forsman stepped into a situation that had never been reached before.
Figure 5 X-ray of Forsman. The catheter (thin black line) can be seen from the photo extending from the elbow bend to the right ventricle| source[7]
Schneider later criticized Forsman harshly. After the criticism, Schneider invited Forsman to a bar in the evening to celebrate the great achievement. Schneider encouraged him to write the autologous experiment into a paper. They expect the paper to cause an uproar in the academic world. Schneider suggested that Forsman highlight the potential application of this technique in treatment in the paper to reduce future resistance from the medical community.
Indeed, the only way to rescue a cardiac arrest at that time was to inject drugs directly into the heart. This requires open chest and pericardial puncture, which can easily damage coronary vessels, cause pericardial hematosis, or fatal pneumothorax. Cardiac catheterization avoids these risks.
With Schneider's permission, Forsman performed catheterization on a woman who was in shock and was about to die of puerperal sepsis to observe an immediate response to injecting epinephrine and digitalis preparations directly into the heart. This case, which exemplifies the medical value of cardiac catheterization, has also been included in the forthcoming paper submission.
Forsman wrote less than three pages of papers, including two x-rayed fluoroscopic photographs of his chest. The paper was submitted to Clinical Week, Germany's most prestigious journal, and was quickly accepted.
5
Cold welcome
Forsman wanted to continue his exploration in this direction of research, and Schneider encouraged him to go to a larger stage.
On Schneider's recommendation, Forsman entered The Charité-Universits tsmedizin Berlin, Germany's most famous hospital, in October 1929, under the supervision of surgeon Ferdianand Sauerbruch for the next phase of training.
For the first few weeks, Forsman was not paid, but the hospital was covered. Unlike Auguste-Victoria Hospital Hospital, The Charité Medical School is well-known but hierarchical and ruthless. Sauerbruch was the tyrant who ruled the hospitals—he stomped his feet and everyone trembled with fright. Although Forsman already has a lot of experience in surgery, he can only start from the lowest level, and it is difficult to reach patients, let alone do the operation independently.
In November 1929, Forsman's cardiac catheterization paper was published. The paper was widely reported in the media, but it also made his situation worse. Academics collectively denounced Forsman, criticizing him for his recklessness and the technology he created that had no application value. And several scholars claim that Forsman plagiarized their technique of injecting drugs through the arteries, although their previously published papers had nothing to do with the heart.
Figure 6 Forsman's 1929 German paper. The title translates into English as Probing of the Right Heart, translated Chinese as "Probing the Right Heart" | Source: Reference 7
Forsman's biggest blow came from Charite Hospital. One day, Sauerbruch summoned Forsman in his office. Furious, he slammed Forsman's heart catheterization papers on the table, saying that Forsman was only worthy of doing scientific research in the circus, and fired Forsman on the spot.
After more than a month of working for free for Charité Hospital, Forsman returned to August-Victoria Hospital.
6
Diagnostic techniques for cardiac catheterization
Forsman was not discouraged. With Schneider's support, Forsman began exploring the diagnostic application of cardiac catheterization. Forsman's month at Charité Hospital was not nothing. He became acquainted with Willi Felix, who later became the director of surgery at Neuk lln Hospital in Berlin. Felix also encouraged him to continue his cardiac catheterization studies and provided the then state-of-the-art X-fluoroscope at The New Kelln Hospital.
Forsman tried to combine cardiac catheterization with cardiovascular contrast contrast. If a high concentration of developer is transduced into the heart through a catheter, the dynamic changes of the heart and the abnormalities of blood vessels should be clearly observed on the X-ray machine. Forsman didn't know if high concentrations of developers had an effect on the heart, so he couldn't risk doing human experiments directly at first.
Animal testing became an indispensable part. The animal model he first used was a rabbit, but after doing it a few times, he found that the rabbit was not suitable: when the catheter end touched the endocardium, it would cause a temporary cardiac arrest in the rabbit. Forsman later admitted that if he had experimented with a heart catheterization in a rabbit in 1929, he would never have dared to try it on his own body.
The next animal model for Forsman picked was the dog. Neither Auguste-Victoria Hospital nor Neukorn Hospital has an animal house for dogs. Forsman can only be simple because of ugliness. He kept the dog in his mother's apartment, and on the day of the experiment he would generally anesthetize the dog, put it in a sack, and then take a taxi to The New Kelln Hospital. There he inserted a heart catheter into the dog's jugular vein, then injected a developer into the heart through the catheter, and took several X-rays in a row. After suturing the dog's wound, Forsman carried it back to his mother's apartment and placed the unawakened dog in the bathtub— a dog under the influence of anesthetics who urinated and urinated and urinated, and placed it in the bathtub for easy cleaning. After 10 days, Forsman changed to the jugular vein on the other side of the dog to repeat the same experiment, and after two experiments, Forsman returned the dog to the pet dealer and replaced the other dog for the next two rounds of experiments. The experiment had little effect on dogs, but it hurt Forsman's mother and grandmother. Weeks have allowed them to develop a relationship with the dog, and each separation is a heartbreaking moment.
After switching six or seven dogs, Forsman was ready to upgrade the experiment to a human body — he still did it himself, and did a total of 9 cardiac catheterization experiments before and after, including two development experiments. He found that rapidly perfusing high concentrations of contrast agents (sodium iodide, iodopyridone acetic acid, etc.) into the right ventricle through cardiac catheterization techniques can clearly visualize the right heart and pulmonary arteries on X-ray machines, and it is safe. But because the fast film box changer had not yet been invented, the X-perspective device they used could not take pictures quickly, the best time to capture was often not well grasped, and in the end they did not get a clear photo that satisfied him.
In 1931, he recorded and collated the results and published it as his second paper in the Munich Medical Weekly.
Before the paper was published, Forsman gave a presentation at the Surgeons' Conference to introduce this part of the work, but it was ignored and ridiculed by the audience.
His uncle, who had come to hear his report, comforted him and said, "Don't worry. These idiots simply don't understand what you're doing. You wait and see, you'll win the Nobel Prize for it. ”
Forsman didn't feel relieved for half a day, and asked in disbelief, "Uncle Walter, are you teasing me?" ”
7
Join the Nazi Party and say goodbye to your scientific dreams
In 1931, Sauerbruch changed his mind and recalled Forsman to Charité Hospital.
Forsman's situation has improved somewhat, but not much. During his year and a half at Charité Hospital, he was allowed to perform only three surgeries. Forsman did not receive any salary for the first six months. After that his salary was 30 marks per month.
The biggest takeaway from Forsman's second experience at Charité Hospital was his acquaintance with Dr. Gerhard Domagk. Dormack, who was 9 years older than Forsman, was stationed at Charité Hospital to collect tumor samples for Bayer Pharmaceuticals. Dormack had a good relationship with several young doctors, and when he talked to Forsman, he talked about sulfonamides. But Sauerbruch looked down on Domac (or any physician) and called him an idiot. (Domac is also a scientific giant with a unique destiny.) The story about him needs to be documented separately. He was awarded the Nobel Prize in Physiology or Medicine in 1939 for discovering sulfonamide antibiotics. But hitler forbade Germany to officially recognize the Nobel Prize. Domark was held in Germany, unable to attend the Awards Ceremony in Sweden, and even imprisoned for a week by the Nazis. In 1947, after the end of World War II, Domac received the Nobel Medal eight years late, but never received the bonus part. ）
It was also during this time that Forsman began to clarify his political stance.
After World War I, German society experienced the Great Depression. The growing divide between the rich and the poor and the embarrassment of ordinary people's lives created the conditions for the rise of the Nazi Party. Influenced by several senior doctors in the hospital, Forsman naively believed that only the Nazis could save and revive Germany. In 1932, a year before Hitler came to power, Forsmann voluntarily joined the Nazi Party. This was not uncommon at the time – before 1933 about a third of German doctors had joined the Nazis, and that percentage rose to one-half.
While agreeing with Nazi political claims, Forsman disagreed with nazi persecution of Jews and Nazi eugenics. In 1937, when he was deputy director of surgery at the Moabit Hospital in Berlin, he ignored the prohibition and resisted the pressure to admit Jewish patients, annoying his superiors. In his eyes, the patient is the person he needs help with, with no other additional elements. He found all kinds of excuses not to attend the training of sterilization surgery, and he also evaded the task of performing forced sterilization surgery for the "inferior person". After joining the Nazi Party, he was busy in the hospital and could not find time to participate in political activities. But Nazi party identity became an undelorable stain on his life. In the rolling torrent of history, It is difficult for Forsman, who is in the center of the whirlpool, to be alone.
Time back to 1932. That summer, Charité Hospital fired Forsman for the second time on the grounds that he had not completed his scientific mission. But in reality, Forsman had no time or opportunity to do research there.
His scientific dream ended, and his academic career did not have the opportunity to start. Since then, Forsman has embarked on a professional path of surgery and urological surgeons.
8
Love
From July 1932 to August 1933, Forsmann worked as a surgical resident at the university clinic in Mainz.
On the first day of arriving in Mainz, Forsman met the love of his life. He went to the hospital cafeteria for dinner. The cafeteria was empty and there were few people. Suddenly the door opened and a female doctor walked in. Forsman was about to go up to say hello when the phone at the door rang. She turned to answer the phone. This gave him enough time to observe her. Her voice was warm and deep, and she had large gray-blue eyes. During the call, she kept leaning against the wall, her left hand crossed around the waist under the open white coat, revealing a long silk dress with wide stripes of white and green. She is like a lotus flower blooming in the middle of summer, soft and delicate. He knew at that moment that she would be his wife.
His sweetheart was Elsbet Engel, a trainee intern physician at the hospital.
But turning a colleague into a wife is a big project, especially when there is not much time left for Forsman. Elsbet has six weeks to leave Mainz to take up a job at a hospital abroad. Forsman therefore developed a rigorous plan and implemented it carefully.
He repeatedly went to Ellsbet for discussions in the name of scientific collaboration. Prior to this, in this hospital, there were strict barriers between surgeons and internists, and there was little communication. They started from academia and gradually talked about everything. They went from chatting to walking, watching movies, and tasting wine.
Forsman was waiting for the right opportunity to confess.
At an academic conference in the field, Forsman met Domac again. Domac was delighted to see Forsman and invited him to dinner. He observed forsman's unusual relationship with Elsbeth. At the invitation, he smiled and said, "Bring your beautiful colleague with you tonight." ”
The three of them had a pleasant dinner that night. In his farewell, Domac whispered to Forsman, "You two are so radiant together." I wish you happiness. ”
On the way back, Forsman plucked up the courage to say to Elsbeth, "I have a way to keep you from Mainz." Marry me, right? Elsbeth was stunned and protested, "So fast! Are you crazy?"
Over the next two days, when Forsman dined in the cafeteria, he often caught Elsbeth Bate's dodgy glances from the corner of the house.
On the third day after returning from a meeting, the two were secretly engaged. Elsbeth changed his plans, gave up his field job and took a job in the pathology department of the Mainz Hospital.
9
Family and career
In August 1933, Forsman returned to Berlin accompanied by Ellesbet and soon married. For the next three years, Forsman served as deputy director of the Department of Urology at the Rudolf Virchow Hospital in Berlin. Director Dr. Karl Heusch became another of his mentors.
Forsman and Elsbeth found an empty house upstairs in the hospital and moved in. They began to have their own home. Over the next 10 years, Elsbeth and Forsman had six children, the first five of whom were boys, the youngest being a daughter.
It was also at this hospital, with Hersch's help, that Forsman conducted another autologous experiment. Unfortunately, this time it didn't go well. They wanted to explore the safety of aortic imaging as a diagnostic method. Hirsch prepares to inject the aorta between Forsman's scapula and spine. When the tip of the needle reaches the wall of the aorta, Hirsch can feel it beating. Forsman suddenly felt a sharp pain coming from his body like an electric shock. This may be because the plexus that surrounds the blood vessels has been touched.
After three unsuccessful attempts, they abandoned the experiment. Forsman was exhausted and had to go to bed. Half an hour later, he began to have a severe headache and a stiff neck.
This phenomenon lasted for three days. Elsbeth's expression was mixed with worry and anger. When Forsman muttered, "It could be a vegetative reflex!" When she finally broke out, "You won't have such crazy experiments anymore." You now have a family, and you don't have the right to joke with your life anymore! ”
This was Forsman's last autologous experiment.
With the birth of his second child, Forsman needed to earn more money to support his family. In October 1936, Forsman became deputy director of surgery at the Dresden City Hospital. Director Albert Fromme, when giving him an offer letter, made it clear that he could only concentrate on surgery in this position.
The pressures of life made him put aside his scientific dreams. Elsbeth had rented the apartment in Dresden in advance, settled in and took the two children over. They have lived here for almost two years. Forsman had hardly any free time for those two years—he and Elsbeth had only gone out to see the opera once, and he only needed to be in the hospital on Sunday afternoons every week.
In August 1938, Forsman was forcibly transferred by the government to Moabit Hospital, the second largest academic hospital in Berlin at the time (after the Charité Medical School), as deputy director of surgery. Forsman's year here was also the only year of his career in an academic institution after completing his medical school and residency training. Moabit Hospital once enjoyed a high academic reputation, but it is no longer what it used to be. Kurt Strauss, a senior SS officer, was the chief of surgery at the time. Before 1933, 70 percent of the hospital's doctors were Jewish, and by the time Forsman took office, there were no more Jewish doctors there.
Military doctor
On 11 August 1939, Forsmann enlisted as a surgeon in the Wehrmacht and served until the end of World War II. His main purpose in joining the Wehrmacht was to escape harassment or persecution by the SS, which was self-contained. But the idea is still too naïve.
On the platform of the train waiting to go to the front line, Forsman and Ellsbet embraced again. She broke the silence, stared into his eyes and asked, "You look so serious!" Is it that hard to leave me? ”
"It could take a long time this time."
"No, it won't! You'll go home for Christmas. ”
"If we can still be safe together in two years, we're lucky."
As it turns out, Forsman's estimates are also overly optimistic.
Forsmann followed the Germans on the European front, first in Norway, Poland, and finally to Russia. As an Army surgeon he treated countless wounded. But he felt loneliness that he had never felt before. He had no Hesch or Fromm to consult, no friends to talk to, and no wife or family to comfort him.
Forsman found that operations in the Mobile Unit Surgical Hospital (MASH) were very different from those in civilian hospitals. Frontline hospitals are unable to achieve a completely sterile environment and lack the necessary supplies. Therefore, military doctors need good creativity and emergency response capabilities. Disposable sterile gloves, for example, are neither in stock nor practical. He wore elbow-flush rubber gloves all day and could only be simply washed with disinfectant soap between surgeries.
In frontline healthcare, speed is critical and efficiency reigns supreme. A frontline surgeon needs to deal with hundreds of wounded in a short period of time, and he can't take care of each patient as carefully as he did in the rear hospital. Wartime emergency medical care must be batched and must help the most people in the shortest possible time. In the face of an injured person, the doctor needs to make a decision within a few minutes: whether to amputate the limb? Is there a condition for a long period of rest if there is no amputation surgery? Is it simple to bandage and then send it to the rear hospital for treatment?
He had removed countless shrapnel from the wounded and stitched up tens of thousands of wounds; he had produced false evidence for self-injurious soldiers to escape military execution; he had treated Russian civilians, cut their appendixes, tumors, and even had a caesarean section. He witnessed the beautiful autumn of Russia: dense forests, labyrinthine streams, hidden lakes and vast swamps. He also experienced the coldest winter in Russia, shivering and almost freezing in his single clothes in the snow and ice. Witnessing too much blood and severed limbs and arms numbed him. The scientific dreams and cardiac catheterization experiments he had had become out of reach. His only dream is to live and be reunited with his family.
In October 1942, Forsmann was transferred back to the military hospital in Berlin. This is thanks to a new German policy: fathers with more than 5 children are no longer sent to the front. His family saved him for the time being. But as the war progresses, the lines between the front and the rear will become increasingly blurred.
11
Escape
In early 1945, at a military hospital 80 kilometers northwest of Berlin, Forsman realized that the war was coming to an end. The German army collapsed in an all-round way on the east-west front, and the Allied air raids became more and more frequent, and Germany's defeat was a foregone conclusion.
If he had survived, he would have had only two personal fates, either to become a prisoner of the Red Army or a prisoner of the American Army. As the Soviets approached Berlin, he decided to flee west to avoid falling into Soviet hands. He came out day and night, crossing the mountains, and after a few days he finally came to the edge of the Elbe. On the other side of the river was occupied by the American army, and this end of the river was also guarded by German troops, both to prevent the enemy and to prevent their own defections.
When it was dark, Forsman waded along the breakwater to chest-deep and began to swim to the opposite shore. He tried not to make a sound, but after swimming 150 feet, he was spotted by a German soldier.
A string of submachine gun bullets hit the water 10 feet to his left. He plunged into the water and swam toward the point where the bullet had just landed. In his experience, it was very difficult to hit the same position twice in a row with a submachine gun. The second string of bullets hit him 5 feet ahead to his right. He swam in that direction again. The third string hit the spot he had just left. Fortunately, no more bullets came. He continued to swim to the opposite bank in the icy waters.
About an hour later, he climbed ashore exhausted and lay on the ground on all fours, panting heavily, with a Red Cross armband on his arm and feet still soaked in the river. Then two American soldiers carrying submachine guns approached, and one of them crouched down and patted Forsman on the shoulder, smiled and said, "Nice job, Doctor!" ”
12
Go home
In this way, Forsman became a prisoner of the American army. The soldiers found from him his family portrait and two pamphlets of Goethe's Faust, studied them for half a day, dried them and returned them to him.
He was transferred from one camp to another, but his treatment became worse with each transfer. The worst-case scenario was that 50,000 prisoners of war, including Forsman, were herded into a football stadium. All could only stand, huddled shoulder to shoulder, with no water to drink and no food. It started to rain in the evening. Soon after everyone's ankles were flooded with sludge, and the mud was mixed with more and more feces and urine. Several prisoners of war wanted to escape. They were shot as they climbed the barbed wire and hung on it, their moans getting weaker and weaker until they went silent.
Six months later, Forsman was finally released. Once alive and well, he was already skinny, weak and haggard. In October 1945, he changed trains several times and traveled to Uncle Elsbeth's house in Ladenburg. To escape Allied bombing, Forsman's family had moved to the Black Forest mountains of southwestern Germany in 1943. Forsman and Elsbeth had agreed that if they lost contact in the war, they would send messages to her uncle and use her uncle as a messenger.
Boundless tiredness made him fall asleep on his head. The next morning, his uncle gently woke him up: "Someone has come to see you." Forsman struggled to open his eyes. Elsbeth stood in front of his bed. Sunlight poured in from the window behind her, casting a warm glow all over her body. She said softly, "Let's go home." ”
13
Seclusion
In the post-war years, the Forsman family continued to live in the picturesque, isolated Black Forest region. Since he was previously a Nazi Party, he was banned from practicing medicine for three years. Elsbeth became a local village doctor, supporting the family. The local population is poor and cannot afford to pay too much for medical care. They were also very simple, often sending bacon, milk, eggs, or corn to Ellesbet for additional medical expenses.
The Black Forest belongs to the French occupation zone, and everyone who has joined the Nazis needs to go through the process of "going to the Nazis", explaining history, and defending themselves. In the process, Forsman received help from many colleagues and friends. Fromm and others testified that Forsman had committed no evil deeds in the past, and even that in World War II there were acts of protecting prisoners of war and the words and deeds of opposition SS and Hitler.
In 1948, Forsman received a certificate to go to the Nazis. He is classified as a fourth category of people – followers (after "felonies", "sins", "misdemeanors", before "innocence"). He was therefore required to pay 15 per cent of his salary as punishment for the next three years.
In 1950, Forsman found a job in Bad Kreuznach, a small town on the northern edge of the Black Forest, and became the director of urology at the hospital there. The family moved in with him, and life has improved ever since. In 1954, Elsbeth was also accredited as one of the first female doctors in urology in Germany. She became Forsman's helper in the hospital. When Forsman was on a business trip, Ellsbett would take care of the patient in his place.
14
The outside world
First caught in the chaos of war, and then living in seclusion in the dark forest far from the hustle and bustle of the news, Forsman did not know that the outside world had changed dramatically.
In the winter of 1948, a friend of Forsman's pediatricians told him, "You don't know how famous you are now!" Swiss doctors call you the father of cardiac catheterization! ”
It turns out that in recent years outside of Germany, cardiac catheterization technology has taken root and become mainstream. Among them, André Cournand and Dickinson Richards of Columbia University in the United States have contributed the most to their development. After resisting the initial inevitable resistance, cardiac catheterization technology has become a conventional technology that has shown its safety and convenience in diagnostic applications. Combined with cardiovascular angiography, it provides surgeons with a precise way to diagnose that heart surgery is no longer an adventure full of chance. Cardiac catheterization technology has become the cornerstone of modern cardiology.
Kurnan cited Forsman's 1929 paper in his 1941 paper and made it clear that it was Forsman who first practiced cardiac catheterization techniques in humans.
Figure 7 Kurnan's 1941 paper. The first sentence of the article and the first two articles of the cited literature determine forsman's authorial priority| source[2]
Through the paediatric friend, the Children's Hospital basel in Switzerland invited the Forsmanns to visit. It was for the first time for Forsman and Elsbeth to go abroad after World War II, although Basel was only 20 miles away. In Switzerland, for the first time since 1940, they saw a city without ruins, neat streets, beautiful buildings and clean glass windows. In the hospital, they were warmly welcomed. Having just arrived from post-war West Germany, which was desperately impoverished, they had a hearty breakfast of eggs, ham and bread. They also drank real coffee that had been missing for a long time.
They were even more shocked by what they saw in the modern, bright hospital. Cardiac catheterization technology, high-resolution rapid X-ray technology and electrocardiographs are perfectly combined to be used in one child after another to diagnose the health of their hearts and measure cardiac physiological indicators. The diagnosed child is full of curiosity about everything on the body, as if he is playing a game.
Leaving shiny Switzerland, Forsman and Elsbeth boarded a German train, as if stepping from heaven to hell. The trunk was cold, dirty, and tattered, and although it leaked everywhere, the air was still muddy. They sat side by side, without a word. Elsbeth suddenly rested his head on Forsman's shoulder. Forsman thought Elsbeth was cold and quickly put his arms around her.
She gently took his hand and said, "I owe you an apology." I used to always put up with your crazy theory. I just think that loving you should accept everything about you, including this fetish, no matter how crazy and dangerous it is. But I never imagined that would be the case. ”
The two snuggled up to each other and did not speak again along the way. In the rhythm of the train, the sparse light spilled into the corner of his dusty memory, and the sometimes clear and sometimes blurred image flashed in front of his eyes, making him tearful.
When the two arrived home in the evening, Elsbeth walked ahead. At the moment when she pushed open the door of the house, she turned back to him and smiled: "Today is a really happy day." ”
15
Nobel Prize
On the evening of October 12, 1956, Forsman was drinking with his friends in a bar when he suddenly received a call from Elsbeth: "A lady with a foreign accent has just called you, as if there is an emergency. She'll call again at 10 o'clock. ”
Forsman returned home. At 10 o'clock the phone rang as promised. The other party is a reporter from the Swedish daily newspaper, and he wants to meet with Forsman for an interview, hoping that the sooner the better. She also confided that Forsman would likely receive this year's Nobel Prize in Medicine.
Forsman asked, "Didn't the committee keep the winner's information confidential until the Nobel Prize was announced?" The female reporter said: "Yes. In recent years, however, the Committee has generally disclosed it to the media in advance to facilitate the scheduling of interviews. She also explained that it will be officially announced on October 18, but no one can be 100 percent sure of the winners before that day, and the probability of Forsman winning is at least 25%. Forsman declined the interview, saying he would be interviewed when the probability rose to 51 percent.
Ellsbeth listened to the conversation between the two on another line. When Forsman put down the phone, the two looked at each other and saw the shock in each other's eyes.
On October 18, Forsman and Elsbeth arrived at the hospital early in the morning — as scheduled, he had three kidney surgeries to be performed, with Elsbeth batting him. By the time they came out of the operating room it was already afternoon. Outside the operating room stood the medical director of the long-awaited hospital. He said with a solemn expression, "Mr. Forsman, let me be the first to congratulate you and your wife." You won this year's Nobel Prize in Medicine with two Americans. Forsman broke out in a cold sweat and his mind went blank. By this time Elsbeth had embraced him with open arms.
Figure 8 Kurnan, Forsman, and Richards were awarded the 1956 Nobel Prize in Physiology or Medicine for their work on cardiac catheterization| Source[10]
The two rushed home, and several children couldn't believe it was true. From 4 p.m. Forsman began receiving congratulatory telegrams. Then a large, heavy and comfortable armchair was delivered to the door. The armchair he saw in the shop window had been in his heart for a long time. Elsbeth called and ordered it as a special gift to help him "take on the pressure of glory".
In December, eight of Forsman's family traveled to Sweden to attend the award ceremony. They did a lot of preparatory work before that. At first Elsbeth didn't want to go because "there were no clothes." The family put a lot of thought into preparing the evening dress, and suddenly trained the children how to behave properly, so as not to show timidity in front of high society and the Swedish royal family. The six children also taught each other how to be generous, although none of them had ever attended such a formal occasion.
In Stockholm, the family experienced the highlights of their lives. They chatted and laughed with other Nobel laureates, were received by the royal family, and attended a lavish dinner. Wolf Georg Forssmann, 17, even went on a love offensive against Kurnan's beautiful daughter.
Figure 9 Group photo of the Forsman family before the award ceremony in Stockholm| Source[9]
The morning after the dinner, three Nobel laureates in medicine — Forsman, Kurnan and Richards — gave their presentations. The three had been summed up in advance, with Forsman talking about the historical development of cardiac catheterization, Kurnan's report focusing on its theoretical aspects, and Richards focusing on clinical applications.
At the luncheon after the lecture, Forsman looked very tired and worried. Kurnan and Richards' report made him aware of the rapid development of the field of cardiac catheterization, which he had been away from for too long. The small saplings he planted with his own hands 27 years ago have grown into towering trees, and now he can only look up at the untouchable fruits under the trees.
16
The song ends with no one dispersing
Previously, Forsman had always wanted to enter academia, but was rejected several times by many German universities. After winning the Nobel Prize, he was finally hired as an honorary professor at the University of Mainz.
In 1958, Forsman was appointed Director of Surgery at the Evangelical Hospital in Düsseldorf. He worked there until 1969. After retirement, Forsman and his wife moved back to the Black Forest.
On June 1, 1979, Forsman died of a myocardial infarction at the age of 75.
Two of Forsman's greatest fortunes to the world were cardiac catheterization techniques and his six children. Today, in addition to its diagnostic applications, cardiac catheterization has been widely used in treatments, including balloon dilation, stent mounting, and thrombotic aspiration. And Forsman's belief that the essence of life is to learn took root in the hearts of six children. Each child later earned a doctorate and achieved extraordinary success in their respective careers. Wolff became an expert in the study of polypeptides and was the first person in the world to purify the heart natriuretic peptide; Bernd Forssmann was one of the inventors of the in vitro lithotripter (a medical device that can break stones in the body without surgery).
Forsman was a tragic figure: he was a pioneer, but he was repeatedly ostracized, constantly troubled by academic disputes, politics, and wars; he established new disciplines but could not continue to pursue his scientific research dreams; he spent his life trying to enter the ivory tower of academia but could not enter. He was out of step with the times—his ideas were ahead of his time, his morality was back to antiquity. The traditional Prussian virtues he was proud of—honesty, law-abiding, sense of responsibility, self-sacrifice for the common good—often left him scratching his head in the face of reality. He was a contradictory man. He has been painfully reconciling noble moral standards with a passionate personality, rebellious and unconventional character. To sum up his life in the words of his daughter Renate Forssmann-Falck, Forsman was "a fearless man who struggled with his passions, an adventurer who pursued pure reason, a man of tragic character who recklessly insisted on doing what he thought was right, a desperate man who could not reconcile the contradictory forces in his character."
But Forsman was lucky: his family of eight survived World War II intact; because of the attention of American scientists, the world reacquainted him and gave him the highest honors; he always had a strong sense of family, friendship and love in his life. Love is the inexhaustible source of strength in his life.
After Elsbeth's death in 1993, he and Forsman were buried together in a country cemetery in Wies.
References and notes in the text:
[1] Forssmann W. Experiments on myself: memoirs of a surgeon in Germany: Saint Martin's Press; 1974.
[2] Cournand A, Ranges HA. Catheterization of the Right Auricle in Man. Proceedings of the Society for Experimental Biology and Medicine. 1941;46(3):462-6.
[3] Sette P, Dorizzi RM, Azzini AM. Vascular access: an historical perspective from Sir William Harvey to the 1956 Nobel prize to Andre F. Cournand, Werner Forssmann, and Dickinson W. Richards. J Vasc Access. 2012;13(2):137-44.
[4] Packy LM, Krischel M, Gross D. Werner Forssmann - A Nobel Prize Winner and His Political Attitude before and after 1945. Urol Int. 2016;96(4):379-85.
[5] Schott M, Khan ZH. Werner Forssmann, the Man Behind the Self-experiment, and the Nobel Laureate: A Historical Note. 2021.
[6] Meyer JA. Werner Forssmann and catheterization of the heart, 1929. Ann Thorac Surg. 1990;49(3):497-9.
[7] Forssmann W. The Exploration of the Right Heart. Klinische Wochenschrift. 1929;8( 45):2085-7.
[8] Siegel D. Werner Forssmann and the Nazis. Am J Cardiol. 1997;80(12):1643-4.
[9] Forssmann-Falck R. Werner Forssmann: a pioneer of cardiology. Am J Cardiol. 1997;79(5):651-60.
[10] https://www.nobelprize.org/prizes/medicine/1956/summary/
Plate editor| Lucas