Thread by @AmbarishSatwik

How the man on the left saved the man on the right with cellophane. Thread.

This is Rudolph Nissen. When Ferdinand Sauerbruch, a pioneer in chest surgery, was named chair of surgery at the Charité in Berlin in 1927, he took along Nissen, his most eager and earnest protégé.

Nissen joined as a lecturer and incubated quite phosphorescently in that large University hospital for three years.

The young Nissen surpassed his boss Sauerbruch to become the first surgeon to successfully perform a pneumonectomy (surgical removal of a diseased lung). He reported the case in 1931, two years before Evarts Graham’s epochal operation at Barnes hospital in St. Louis.

In 1933, he was the first to describe total colectomy (removal of the entire large intestine) with an anal sphincter preserving reconstruction. This was ten years before Wangensteen reported a similar procedure in America.

At the age of 34, Nissen was elevated to the position of full professor. By 1933, his stock was high. He was offered major positions at various German surgical centres, including the chair at the Ruprecht Karl University Hospital in Heidelberg. He chose to stay on at Charité.

In 1933, Hitler was appointed Chancellor. On April 1, 1933, three months after the Nazis came to power, the Nazi boycott of Jewish businesses was announced.

There were mob attacks on Jews in the streets, and Brownshirts stationed themselves in front of Jewish stores and businesses and physically prevented people from entering them.

In a week, the Civil Service Law was passed. At the Charité, these regulations meant that all Jewish surgeons and physicians had to be fired, all Jewish inpatients immediately discharged, and Jews weren’t subsequently allowed as surgical patients.

Nissen was a Jew. Sauerbruch was well-connected with the Nazi hierarchy. He personally requested Joseph Goebbels, then head of the Nazi party in Berlin, to allow Nissen to keep his position at the Charité.

Nissen’s only option was to resign. Eerily, he knew what was coming. Within a few days, he left with his family for Bolzano, Italy, under the ruse of vacationing in the Italian Alps. From there, he posted his resignation letter to Sauerbruch.

In his memoirs, Nissen wrote: Neither my oath as a physician nor my understanding of what is right would allow me to benefit from the guiltless persecution of my colleagues, let alone from limiting surgical care to those that require it most.

Nissen found temporary moorings in Ataturk’s Turkey, where he got refuge as a German academic émigré. He was appointed as the head of the department of surgery at the University of Istanbul.

At that point, the annual number of operations performed at the University was averaging around 190. By the end of 1933, his first year as chief, though facilities were suboptimal, Nissen’s department performed 1,500 surgeries.

In May 1933, close to forty thousand Germans gathered in front of Berlin’s Opera House to burn books. To consign to flames the produce of Jewish intellectualism. This included the works of Albert Einstein.

By then, Einstein, too, had resolved to leave Berlin. He had been offered refuge at the Institute of Advanced Studies in Princeton.

As an aside, Jacoba Timerman, the Argentine Jewish journalist, has a riff on the Nazi hatred of Jewish intellectuals. And the need to burn their books: “Three main Jewish enemies: Marx, Freud and Einstein."

"Karl Marx, because he tried to destroy the Christian concept of society; Sigmund Freud, because he tried to destroy the Christian concept of the family; and Albert Einstein, because he tried to destroy the Christian concept of time and space.”

After Ataturk’s death in 1938, Turkey, led by Mustafa İnönü, tilted in favour of the Nazis. The Gestapo was allowed surveillance of German Jews living in the country. Turkey, for Jews, held the risk of becoming another moribund region. It was time for Nissen to leave again.

In the summer of 1939, Nissen sought and received permission for a speaking tour of the United States. His family accompanied him. He was in America on September 1 when Hitler invaded Poland. The Nissens never returned to Turkey.

In America with his wife and kids, and barely serviceable English language skills, and no license to practice surgery, Nissen had to search for a job at the age of 44. Nobody knew him there.

Through the Jewish expatriate network, Nissen was able to find a lowly research position at the Harvard Medical School. Once settled for a bit, he took extensive English language lessons and applied for a medical licence in New York.

He had to first work as a surgical assistant in New York before starting out on his own. Slowly and painstakingly, he built a practice in Manhattan, mainly among the immigrants of the city. In 1944, he was appointed as the chief surgeon at the Brooklyn Jewish Hospital.

It was there, in 1948, that he met the other German Jew, the other bird of passage.

Einstein was now sixty-nine years old and famously sedentary. He had smoked a pipe all his life and had never had any medical complaints in the past.

But lately, Einstein had been suffering from spells of abdominal pain and vomiting that he thought were on account of a peptic ulcer or gallstones. His last attack caused him to faint in the bathroom of his house in Princeton.

For that, he consulted Nissen, who was convinced that gallstones would never precipitate a fainting spell. Einstein’s X rays had shown no evidence of stones in the right upper quadrant of the abdomen.

During the physical examination, Nissen could feel a sizeable pulsating mass in the middle of the abdomen. Btw, the medical ultrasound scanner hadn’t been invented yet.

Nissen’s diagnosis was an aneurysm of the abdominal aorta. The aorta is the largest artery in the body that starts like a spout from the heart, runs down the chest into the abdomen, and gives off branches to every organ in the body.

The average diameter of the abdominal aorta is about 2-2.5 cm. An aneurysm is a bulge or a ballooning out of the artery due to weakness in the vessel wall.

Nissen’s fear was that Einstein had experienced pain due to an impending rupture of the aneurysm. The fainting spell was possibly due to a small, contained leak. A proper rupture would mean instantaneous death. It would be the equivalent of shooting someone in the heart.

This was 1948. One could only diagnose these conditions clinically. No imaging or scanning techniques had been devised to provide images of the inside of the body.

No one had thought up an operation to tackle or repair the aneurysm. The first successful operation to replace the diseased, aneurysmal aorta would be performed in 1951 in Paris.

The only procedure that could be done was to tie off the aorta to prevent it from rupturing, but that would acutely cut off blood supply to the kidneys and the lower limbs. Kidney failure and gangrene of the legs would then be the cause of death.

You couldn't do that to the most celebrated scientist in the world. Nobody was keen on operating on Einstein.

Nissen felt that he owed something to Einstein. It was Einstein who had written to the Turkish leader, making a request for refuge and employment for fleeing German Jewish scientists.

As a direct consequence of Einstein’s intervention, Jewish invitees to Turkey totalled over “1000 saved individuals”. Nissen decided to take up the gauntlet.

During the operation on Einstein, Nissen found a normal gallbladder with no stones and an absurdly angry-looking aneurysm of the abdominal aorta about ten cm in diameter. The aneurysm hadn’t leaked.

The median survival of patients with an untreated abdominal aortic aneurysm more than seven cm is nine months. With an aneurysm of ten centimetres, Einstein would be dead possibly within a year.

Nissen did not tie off Einstein’s aorta. He wrapped it with cellophane. The idea was that the cellulose polymer, as an unwelcome “foreign body”, would induce an inflammatory reaction and the production of a rind of scar tissue around the aorta.

He hoped that it would buttress the thin wall of the weakened vessel.

The operation was uneventful. Einstein was quickly discharged. He was back at the Institute in a couple of months, exercising the old lemon to produce a theory of everything: his attempt to square the laws of gravity with the laws of quantum mechanics.

In 1952, he was offered the Presidency of the state of Israel. The formal letter stated that the offer “embodies the deepest respect that the Jewish people can repose in any of its sons”. Einstein declined the offer.

In 1955, seven years after Nissen’s intervention, Einstein suffered a severe bout of abdominal pain again. Nissen was no longer in America. He had moved to Basel as the Director of Surgery at the university there.

Frank Glenn, a vascular surgeon from New York, attended on Einstein. A proper vascular repair was now possible. Einstein refused surgery. “It is tasteless to prolong life artificially,” he said, “I have done my share; it is time to go. I will do it elegantly.”

He was admitted to Princeton hospital and given palliative morphine. He died in two days. He muttered something in German just before he died. The nurse on call couldn’t speak German, so we don’t know what his last words were.