Some medical discoveries fade as they settle into history. Others glow brightly. Here’s a little quiz for you. The poliomyelitis virus was a nasty crippler and killer that terrorized the world until the mid-1950s. Which of the following won the Nobel Prize for their work on the polio virus?
- John Enders
- Jonas Salk
- Thomas Weller
- Frederick Robbins
Most of you probably think that’s way too easy. Well, let’s see how you did. If you answered 1, 3, and 4, you’re an undisputed champion. Congratulations! You nailed it! Enders, Weller, and Robbins won the Nobel Prize in Physiology or Medicine in 1954, winning that prestigious award for developing a method to culture the polio virus in human tissues, the vital discovery that enabled production of enough virus to develop a vaccine.
I mention this bit of history not to disparage Salk, who never won a Nobel Prize but later was the first to develop a successful vaccine against polio, and thus became justifiably famous after standing on the shoulders of the above three. Albert Sabin was another vaccine developer. A few years after Salk’s contribution, Sabin came up with an effective oral vaccine.
Now let’s shift our attention to the heart with another quiz, one likely to stump most of you. Which of the following won the Nobel Prize for their work on cardiac catheterization in 1956, the time when such catheterizations were beginning to take off?
- André. Cournand
- Samuel Pepys
- Dickinson Richards
- Werner Forssmann
Okay, I rigged this one, making the same three choices correct. Yep, 1, 3, and 4 ring the correct bell. Oh, raise your hand if you smiled when you saw Samuel Pepys.
Until the 20th century, the human heart understandably was an organ doctors stayed away from. So when a man’s beating heart finally was invaded by a catheter, an event documented by x-rays, the news flew around the world.
That first catheterization wasn’t performed, as you might expect, in a major academic institution. It was done nearly a century ago in a small hospital some 30 miles from Berlin by an unsupervised 25-year-old German doctor. His name was Werner Forssmann, and the heart he catheterized was his own.
Forssmann was a surgical resident in 1929, when he calmly anesthetized the inner side of his left elbow, sliced through his skin with a scalpel, and inserted a catheter into the arm vein he had exposed. After pushing most of the catheter’s two-foot length into his body, Forssmann walked the long distance from the surgery suite to the x-ray department and even climbed a stairway with blood dripping as the catheter dangled from his arm. At last he stood in front of a fluoroscopy screen and viewed his insides through a mirror held by an obliging nurse. He could see plainly the end of the catheter twitching within his right atrium. He took x-ray films of his chest and arm to document his achievement.
Sorry, this a copy of a copy and it doesn’t show up very well. but perhaps you can at least see the dark thin line (the catheter) going up from the arm to the upper part of the chest before it turns down toward the heart.
His intent, the young German doctor wrote later that year, had been to devise a better way to administer drugs directly into the heart during certain emergencies, the prevailing method at the time being to jam a long needle through the patient’s chest wall and blindly inject substances directly into the heart, a method more likely to kill than cure.
“While sliding the catheter in I had a feeling almost of soft warmth on my vein wall,” he wrote, and when the catheter entered his chest, “an especially intense warmth behind the clavicle [collarbone].” He also noted a dry cough, presumably triggered when the catheter’s movement irritated nerves in his chest.
Other than these sensations during the episode, the young doctor reported, “I felt nothing.” Even afterward he felt nothing detrimental, “aside from a slight inflammation at the site of the venesection, which probably resulted from faulty sterilization during my self-operation.” His method, he added with justifiable youthful pride, “opens up countless vistas of new possibilities.”
Surely the young Forssmann never imagined the extraordinary advances that ultimately followed his brave solo venture with a catheter. Nor did he foresee the troubles soon to strike him, the jabs and insults whipped up by his daring experiment, woes that followed him through much of his life.
The story will continue.
