The Unbelievable Story Behind the Invention of Cardiac Catheterization

The discovery of X-Rays in the late 19th century by Wilhelm Rontgen had a deep impact in many areas. Over the years, scientists found many diverse ways to use X rays. Physicists, for example, use them to study the inner structure of crystals: since every crystal disperses X-rays in a slightly different way, this dispersion can be used to determine the crystal’s internal structure.

[This article is the transcript of the episode: ‘The History of X-Rays & CT’, from the Curious Minds Podcast (CMPod). Subscribe to the podcast here.]

Of course, the most common use of X rays is in medicine: X ray machines have saved countless lives by detecting and diagnosing infection and disease, as well as improving dentistry considerably.

One of the most interesting applications of X rays is in Cardiac Catheterization. This is the insertion of a thin plastic tube into the blood vessels, or even the chambers of the heart. It is one of the most important and widely used medical procedures — but the way Cardiac Catheterization came about was kind of… unusual.

Werner Forssmann

In 1929, Catheterization was already a known medical procedure — but it was used only in the Urinary tract. It was commonly believed that the insertion of a tube into the heart’s blood vessels would be extremely dangerous, and would result in almost certain death to the patient.

Urinary Catheter (Image: Wikipedia)

Werner Forssmann was a 25 year old cardiologist, working in a large hospital in Germany. Forssmann believed that Catheterization could be very useful in the diagnosis and treatment of heart disease: using a thin tube, he thought it might be possible to inject medicine directly into blocked blood vessels, or even remove the blockages entirely. He also believed that Cardiac Catheterization might be a lot less risky — if the physicians used X ray images to better guide the tube inside the heart’s blood vessels.

But Forssmann was only a young physician, and nobody would listen to him. Nevertheless, he refused to give up, and was determined to prove his hypothesis that Cardiac Catheterization wasn’t as lethal as everyone thought it was.

One day, he persuaded a nurse to unlock the medical supply room for him, and asked her to assist him with an experiment. Unaware of his plans, the nurse agreed. She laid down on a bed in the supply room — and then Forssmann surprised her, pinned her to the bed and tied her to it. Forssmann open a nearby closet, pulled out a Catheter and…inserted the tube into his own arm.

Werner Forssmann (Image: Wikipedia)

With the tube still in his veins, Forssmann rushed out from the supply room and climbed up one floor, to a room with an X ray machine. He took X ray images of himself, and used the images to guide the catheter through his veins and right up to his heart, a distance of around two feet. And he lived. He was fine.

Unexpected Consequences

With the images as proof of his success, Werner Forssmann published an article in a medical journal, describing his experiment. But in return for his brave self sacrifice for the sake of advancing science — Forssmann was fired from the hospital. His manager scolded him for his recklessness, and told him that this was not the best way to start a career as a surgeon…Disappointed, Werner left cardiology entirely, and became an urologist. At least he got to continue working with catheters.

So, 20 years passed. During World War II, Forssmann served as a medical officer in the German army, and was taken prisoner by the allied forces. Upon his release after the war, he found work as a wood cutter before going back to being a doctor in Germany.

By chance, the article Forssmann wrote back in 1929 found its way, many years later, into the hands of two American Physicians who realized the significance of his work. They improved the procedure, and turned Cardiac Catheterization into an important and life saving procedure. In 1956, Werner Forssmann, by then a totally anonymous and unknown physician — was surprised to discover that he was elected to be a recipient of the Nobel prize in Medicine, together with the two American physicians who improved upon his work. Astonished, Forssmann was quoted in the newpapers as saying —

“I feel like a village parson who has just learned that he has been made bishop”. It seems that sometimes, there is a measure of justice in our world..”

[This article is the transcript of the episode: ‘The History of X-Rays & CT’, from the Curious Minds Podcast (CMPod). Subscribe to the podcast here.]