Rudolph Nissen

• 1. Introduction

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  Rudolph Nissen was born on the 5th of September 1896 in Neisse, Silesia, the son of a well-known surgeon named Franz Nissen. He would go on to perform the first pneumonectomy in the Western world, extend Albert Einstein's life by wrapping an aneurysm in cellophane, and give his name to a surgical technique that millions of people depend on today for relief from severe acid reflux.

  His career took him from the lecture halls of Munich to the battlefields of the First World War, then onward through Berlin, Istanbul, New York, and Basel. Along the way, he built a reputation not just as a gifted operator but as a surgeon willing to attempt what no one else had dared. How did a man trained in pathology and chest surgery come to reshape the treatment of heartburn? And what did Albert Einstein write on the back of a newspaper clipping after Nissen saved his life? Those answers are ahead.

• 2. A Surgeon's Formation

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  Ludwig Aschoff, the influential physician at the University of Freiburg, was Nissen's first great teacher. Under Aschoff, Nissen trained in pathology, learning to understand disease at the level of tissue and cell before he ever held a scalpel over a living patient.

  The First World War interrupted that formation in the most personal way possible. Nissen served in a medical corps unit and was severely injured by a gunshot wound to the lung, damage that caused him lifelong problems. He finished his medical studies only after the war ended.

  In 1921, he arrived at the Ludwig-Maximilians-Universitat Munchen as an assistant to Ferdinand Sauerbruch, one of Germany's most formidable surgeons. Sauerbruch himself had been trained by Polish-Austrian surgeon Jan Mikulicz-Radecki, who taught him to perform thoracic surgery using a pressure chamber, at a time when anesthesia through breathing tubes was not yet available. Six years after joining Sauerbruch in Munich, the two men moved together to the Charite at the Friedrich Wilhelm University of Berlin, placing Nissen at the center of German medical life.

  Then, in 1933, Hitler's rise forced Nissen out. He was initially shielded from anti-Jewish legislation because of his front-line service in World War I, but the broader Jewish boycott made the environment untenable. He accepted the chair of the surgery department at Istanbul University, crossing into a completely different world.

• 3. The First Pneumonectomy

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  In 1931, a 12-year-old girl came to Nissen with a crush injury to her chest. The damage had left her left lung producing chronic pus, and Nissen decided the only path forward was to remove the lung entirely.

  The first attempt at the operation had to be stopped. The patient experienced asystole, the complete cessation of heartbeat, what surgeons call a flatline. She was stabilized, and two weeks later Nissen returned to complete the pneumonectomy. She survived.

  No Western physician had done this before. A successful pneumonectomy was not reported in the United States until 1933, two years after Nissen's operation. The skill that made this possible traced back directly to Sauerbruch's pressure-chamber technique, which allowed surgeons to operate inside the chest without the patient's lung collapsing. Nissen had absorbed that tradition and taken it further than anyone else had gone.

• 4. Wrapping the Esophagus

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  While working in Istanbul in 1936, Nissen operated on a 28-year-old patient who had an esophageal ulcer. The procedure required him to remove a portion of the lower esophagus and reconnect what remained to the stomach.

  Facing the risk that stomach contents would flow back into the patient's esophagus, Nissen tried something improvised. He wrapped folds of the upper stomach around the lower end of the esophagus. When he followed up with the patient afterward, the heartburn had improved.

  Nissen did not immediately pursue the technique. Through the 1940s and 1950s, he treated patients with hiatal hernias using conventional methods developed by other surgeons. He even performed one of those procedures, an anterior gastropexy, on the eminent radiologist Gustav Bucky, who was very ill at the time but recovered completely and remained symptom-free for at least fifteen years. Many other patients, however, relapsed.

  By 1955, now based in Basel, Nissen returned to his Istanbul insight. He operated on two patients with reflux esophagitis, again wrapping a portion of the stomach around the lower esophagus. He published the results in 1956, and the procedure eventually became known worldwide as the Nissen fundoplication, the standard surgical treatment for gastroesophageal reflux disease.

• 5. Einstein's Aneurysm

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  In December 1948, Albert Einstein arrived at Jewish Hospital in New York, where Nissen admitted him for the removal of intestinal cysts. During the admission, Nissen discovered that Einstein was also carrying an abdominal aortic aneurysm, a dangerous ballooning of the portion of the aorta running through the abdomen.

  In the 1940s, there was no definitive surgical treatment for such an aneurysm. Beginning in 1943, surgeons had begun reinforcing the vessel wall with cellophane to induce fibrosis, reducing the risk of rupture. Nissen wrapped Einstein's aneurysm in cellophane, and Einstein recovered.

  When Einstein left the hospital, photographers crowded around him, and he stuck out his tongue at them. The image became one of the most famous photographs ever taken. He sent an autographed clipping of the newspaper photo to Nissen with the inscription: "To Nissen my tummy / The world my tongue."

  Einstein lived for several more years after the operation. When he was dying in a Princeton, New Jersey hospital in 1955, the surgeon Frank Glenn of New York Hospital proposed an operation. Einstein, then in his seventies, refused. He told his physicians, "I want to go when I want." He told his secretary Helen Dukas that it was "tasteless to prolong life artificially. I have done my share. It is time to go. I will do it elegantly." Early reports named gallbladder inflammation as the cause of death, but an autopsy performed by pathologist Thomas Harvey showed he died of a leaking abdominal aortic aneurysm, the same condition Nissen had wrapped in cellophane seven years before.

• 6. Basel and Beyond

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  Nissen left Turkey for the United States in 1939, spending two years as a surgery research fellow at Massachusetts General Hospital. He then chaired surgery programs at Jewish Hospital and Maimonides Medical Center in New York before accepting the department head position at the University of Basel in 1952, a post he held until his retirement in 1967.

  He died on the 22nd of January 1981 in Riehen. In 1969, he had published an autobiography at Deutsche Verlags-Anstalt under the title "Helle Blatter, dunkle Blatter. Erinnerungen eines Chirurgen," which was later reviewed in the Journal of the American College of Surgeons. A collection of his writings and lectures appeared posthumously in 1997 from Schattauer under the title "Funfzig Jahre erlebter Chirurgie: Ausgewahlte Vortrage und Schriften."

  The Rudolf Nissen Prize, awarded by the Deutsche Gesellschaft fur Allgemein- und Viszeralchirurgie, continues to recognize surgeons who advance gastroenterological surgery. In 1996, on the centenary of his birth, a scientific publication of the International Society for Diseases of the Esophagus was dedicated to his memory. And in 2016, the Charite, the Berlin institution where he had worked alongside Sauerbruch decades earlier, opened a new emergency admissions building named the Rudolf-Nissen-Haus.