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André Frédéric Cournand and Dickinson W. Richards developed cardiac catheterization, one of the most important achievements in cardiology. These pioneers were the first to use intracardiac catheters to measure the effects of drugs and to describe the features of many cardiac and pulmonary diseases.

Both had distinguished careers at the Columbia University College of Physicians and Surgeons. Their work has had a monumental impact. (When at Columbia, I held an endowed professorship named in honor of Richards.)

But in 1956, the was awarded not only to Cournand and Richards, but also to Werner Forssmann. Who was Werner Forssmann?

In 1929, at age 25, Forssmann received his medical degree in Berlin. That year, he discovered a picture showing a tube that had been inserted into the vein of a horse and been maneuvered into the heart. Forssmann thought this could be done in humans, but his supervisor banned him from pursuing the idea.

Forssmann ignored the directive and performed the procedure on himself. After an operating-room nurse provided sterile supplies, he restrained her to the surgical table to prevent her interference and cut into his own antecubital vein. Through it, he inserted a ureteral catheter, which he threaded into the right atrium; he walked to the radiology department to obtain x-ray confirmation of the catheter's position.

He carried out nine successful catheterizations, mostly on himself, and performed contrast studies in animals. Interestingly, if Forssmann had first carried out studies in animals, he might never have experimented on himself; cardiac catheterization of rabbits causes fatal arrhythmias.

Forssmann's discovery was ridiculed; he was censured for self-experimentation, and with his reputation ruined, he quit cardiology and became a urologist. The paper describing his work (published in November 1929) caused an outrage in the German press. His subsequent efforts to enter academic medicine failed.

Demoralized, Forssmann joined the Nazi Party in 1932. Five years later, he met Karl Gebhardt, personal physician to Heinrich Himmler, who led the campaign to exterminate six million Jews.

Gebhardt, who was later sentenced at Nuremberg for unethical medical experimentation, offered to provide human subjects for Forssmann's research in cardiac catheterization, but Forssmann declined. Had he accepted, he might have preempted some of the work of Cournand and Richards, who did not read his 1929 paper until 1940. He was reprimanded when he circumvented a decree that forbade German physicians to treat Jews.

Following enlistment in the German Army, Forssmann was captured and imprisoned. Cournand and Richards capitalized on his work while he was still a war prisoner. When released in 1945, he was shocked to learn that cardiac catheterizations were being performed throughout the world. Due to his Nazi connection, Forssmann had difficulty being employed as a physician after the war.

Am I trying to undermine Forssmann's achievement by noting his Nazi party membership? Not at all. Both my parents were Holocaust survivors, who were among only 250 Jews who survived the liquidation of the Vilna Ghetto in 1943; most of the Ghetto's 100,000 Jews were killed. The survival of my parents was made possible because Karl Plagge, a German officer and member of the Nazi party, shielded them by providing them with false work permits. (Plagge's story can be found in Wikipedia).

Both Forssmann and Plagge deeply regretted their horrific decision to join a racist political movement that offered false hope to a broken country; following the war, both were exonerated of their involvement.

Truly remarkable people can make very serious mistakes. Extremist movements can trap those who are capable doing great things.

That lesson is worth remembering these days.

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