Werner Forßmann (1904-1979) was a German surgeon. At the young age of 24, he secured a surgical internship at the Auguste Victoria Home in Eberswalde, close to Berlin. In the same year he carried out the reckless self-experiment that should earn him a share of the 1956 Nobel Prize for Physiology or Medicine. Fascinated by similar experiments done on horses, Forßmann inserted a caoutchouc catheter into a vein of his upper arm and pushed it 65cm towards his heart. He then walked to the hospital’s X-Ray facility and, with the aid of the x-ray images, pushed the catheter even further until it reached his right heart chamber. At the time, Forßmann believed that his catheter technique could help to dose medication to the heart directly, for example. However, the immediate resonance in the scientific and medical communities was poor. It took the work of others, first and foremost Forßmann’s Nobel Prize co-recipients André Cournand and Dickinson Richards, to develop heart catheterization to a generally accepted medical procedure.

All in all, Forßmann pursued his profession for more than forty years, including a six-year period as a military surgeon during World War II. This allowed him to witness some of the major medical revolutions of the 20th century first hand. Building on his extensive experience, Forßmann uses the present talk to give a review of the development of surgery. Surgeons in particular might be pleased when listening to the first minutes of the speech, which could well be called an outright ode to surgery. Forßmann describes surgery as the most noble and primordial of medical methods and characterizes surgeons as having an incorruptible and relentless sense for responsibility.

He then runs through the major surgical revolutions, seasoned by experiences from his own medical practice. They include the invention of laughing gas anaesthesia in the 1840s, the idea of asepsis (disinfection of clothes and tools) during surgical procedures and the invention of first antibiotics able to treat internal infections by Gerhard Domagk (1939 Nobel Prize in Physiology or Medicine) and Alexander Fleming (1945 Nobel Prize in Physiology and Medicine).

Furthermore, Forßmann discusses a topic which is currently resurfacing as a major threat to modern medicine: the emergence of germs resistant to antibiotics. Today, the WHO describes this issue rather graphically: “Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.” [1] Almost half a century before this statement was issued, Forßmann, who had experienced a medicine without antibiotics, acknowledges that in many hospitals antibiotic-resistant germs are bred because asepsis is neglected and antibiotics are often used unnecessarily. He also identifies air conditioning systems as major problems due to their ability to distribute resistant germs rapidly in an entire building. Still, he expresses belief in the ability of science to come up with new, more powerful antibiotics. The next decades will have to show whether this is in fact the case and whether mankind can get bacteria under tight control once more.

David Siegel

[1] http://www.who.int/mediacentre/factsheets/fs194/en/