Shahar Madjar, MD, Journal columnist

EDITOR’S NOTE: This column originally appeared in The Mining Journal on Nov. 22, 2016.

Urologists are a curious, creative bunch. And a curious mind often stumbles upon ideas never before conceived. I will tell three short, true stories about urologists and their extraordinary ideas.

Two of these urologists won the Nobel Prize in Physiology and Medicine for their ideas. The third won the Ig Nobel prize – a parody of the Nobel prize given out for unusual or trivial scientific achievement “that first make people laugh, and then makes them think.”

Here is the first story: Werner Theodore Otto Forssmann was born in Berlin, in 1904. In 1929 he became a doctor. Forssmann wanted to be an internist but his application was rejected. He tried Gynecology but after “three miserable weeks in midwifery,” he accepted a different position in a rural hospital in the Department of Surgery.

In Surgery, the young Dr. Forssmann asked his mentor, Dr. Richard Schneider, for permission to self-experiment with cardiac catheterization: he wanted to pass a small-caliber tube (catheter) through a vein in his forearm into his heart. Forssmann believed that such a procedure, if proved possible, would allow delivery of lifesaving medications directly into the heart. To prove his point, he was willing to perform the experiment on himself.

Dr. Schneider, a logical, cautious man, swiftly rejected the very dangerous idea but the young, enthusiastic, intrepid Forssmann was not deterred. His first experiment was discontinued prematurely, for the surgical colleague who was passing the catheter through Forssmann vein suddenly lost courage and refused to pass the catheter all the way into Forssmann’s heart.

Forssmann then asked Gerda Ditzen, a nurse that was working with him, for help. She agreed to provide the necessary surgical instruments but insisted that she would be the first subject of the experiment.

Forssmann played along. He restrained the nurse to the operating table in preparation for surgery. He prepared the incision site on her arm with iodine, perhaps even gave her local anesthesia. But then, he turned away from her and while she was tied, unable to prevent him from carrying on his plan, he performed the procedure on himself, passing the catheter all the way, for a length of 65 centimeters, into his heart.

When she realized the deceit, Ditzen became angry, but then, she quickly came back to her role as a nurse, helping Forssmann walk down the corridors and downstairs – with the catheter still in his heart – to the X-ray suite where an X-ray study confirmed that the catheter was indeed in Forssmann’s heart.

The results of his experiments, published in 1929, were met with skepticism, controversy, hostility and turmoil. Professor Ferdinand Sauerbruch said: “With work like this you qualify in a circus, but not in a reputable clinic.”

Fossmann continued to experiment with cardiac catheterization, a total of nine self-experiments. He was discouraged, though, by the treatment of his peers, and so, when the opportunity arose, he accepted a position as a urologist in the only department specializing in Urology in Berlin at the time. He continued to publish scientific articles but his emphasis shifted from the heart to prostate, bladder, and kidneys. He became a urologist.

In 1956, Forssmann was awarded the Nobel Prize, along with Andre Cournard and Dickinson W. Richards, for “discoveries concerning heart catheterization and the pathologic changes in the circulatory system.”

Forssmann never returned to the field of cardiology, “… when I considered it objectively I was certain I’d never be able to catch up…” he said.

Today, cardiac catheterization is performed for both diagnostic and therapeutic reasons. A small catheter is introduced into a blood vessel that leads to the heart. The pressures and blood flow within the heart can be measured. Contrast dye can be injected through the catheter while X-rays are taken, allowing delineation of the arteries supplying the heart (coronary arteries). If a blockage in a coronary artery is identified, the blockage can be cleared, and a stent (a tiny metal tubular scaffold) can be left in the artery to keep it open. More than a million cardiac catheterizations are performed each year in the US.

Werner Theodore Otto Forssmann, a doctor, a urologist, has changed the field of cardiology.

There are two more stories about urologists that I have meant to tell you – a urologist who won the Nobel Prize and another who won the Ig Nobel prize. Can their stories be even more curious than Forssmann’s story? I promise to return with the details.

EDITOR’S NOTE: Dr. Shahar Madjar is a urologist working in several locations in the Upper Peninsula. Contact him at smadjar@yahoo.com or at DrMadjar.com.