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Einstein's Aneurysm: Of Cellophane and Rudolph Nissen

By: By Mark S. Lesney, Frontline Medical News

01/24/12

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In December 1948, Dr. Rudolph Nissen, later famed for his esophageal surgery technique called fundoplication, operated on Albert Einstein, at the Jewish Hospital in Brooklyn, New York to remove intestinal cysts. Einstein was simultaneously diagnosed with a large intact aneurysm of his abdominal aorta.

Using a then pioneering technique, Dr. Nissen wrapped cellophane around Einsteinís aneurysm in order to induce fibrosis and limit expansion. Most likely because of this timely intervention, the renowned physicist survived over 5 years before succumbing to aneurysm rupture.

At the time of Einsteinís treatment, cellophane wrapping was still a breakthrough technology for the treatment of aortic aneurysms, one of the first highly successful interventions for the disorder.

Cellophane film was invented by a Swiss textile engineer Jacques E. Brandenberger in 1908. It was produced as a polymer of cellulose. Improvements in cellophane continued, making cellophane an invaluable tool for waterproofing products, and in 1930, the first cellophane tape was developed by Dick Drew in 1930 by coating the sheets with adhesive.

The ability of cellophane to constrict blood vessels was first demonstrated by Page in 1939, who used it to induce artificial nephritis and hypertension in dogs for research use by wrapping cellophane around the kidneys. The development of polyethylene cellophane was an important breakthrough as it produced a more intense fibrotic reaction as compared to other types of the polymer.

Itís first human clinical use for aneurysms was reported in 1943 by Dr. Paul W. Harrison and Dr. Jacob A. Chandy who successfully treated two arteriovenous aneurysms of the subclavian arteries with cellophane, leading to their gradually elimination. They were inspired by the work of H.E. Pearse in 1940, who demonstrated the ability of cellophane as an improved method of gradually obliterating the lumen of blood vessels, such as the internal carotid artery, in place of clamps and banding.

It is interesting that several reports indicated that pure polyethylene cellophane was nonreactive, whereas the standard "impure" material obtained from the primary manufacturer, E.I. DuPont Nemours Company of Wilmington, Delaware, proved highly reactive, according to J.K. Poppe, who reported his excellent results with the compound in treating syphilitic aneurysms in 1947 and 1948.

In the 1950s, the real breakthrough came in the surgical repair of aneurysms. Although the surgery by Dr. Charles Dubost performed of an AAA repair using a homograft in March 29, 1951, is the most well-known, two other successful procedures were performed first. On February 26 of that year, Dr. Norman Freeman and Dr. Frank Leeds used a vein inlay autograft from the left common iliac vein and its bifurcation sutured into the abdominal aorta and iliac arteries of a 55-year-old man with a large, asymptomatic aneurysm. And on March 2, 1951, Dr. Paul Schafer and Dr. Creighton Hardin of the University of Kansas resected an aneurysm with an indwelling shunt after clamping the aorta and replacing it with a human homograft. The patient died after 29 days from a leak in the native aortic wall.

But the use of prosthetic grafts soon after would lead to a new standard of care, starting with Vorhees, who in 1952 used a Vinyon-N cloth as a plastic arterial substitute, but dramatically improved in 1954 when Dr. Michael DeBakey and Dr. Denton Cooley (see page 11) refined the design of the Dacron graft in 1954.

But this was of no avail in saving Einstein, for as he had reached his mid 70s, he resigned himself after suffering from various chronic illnesses for over 39 years, to an acceptance of what he saw as the inevitable. "The devil has put a penalty on all things we enjoy in life," he quipped. "Either we suffer in our health, or we suffer in our soul, or we get fat."

His aneurysm ruptured on April 13, 1955 and he entered Princeton hospital on April 15, but refused any further operation. He died from complications arising from the rupture on April 18, more than 5 years after he had had the offending aorta swathed in cellophane.

Surgically placed grafts remained the treatment of choice for aortic aneurysms until 1990, when Dr. Juan Parodi introduced the first successful endovascular graft in Argentina, launching the modern endovascular treatment revolution.

Selected Sources:

Kantha, S.S., (1992) Medical Hypotheses 42:340-6.

Poppe, J.K. (1948 ) American Heart Journal 36:252-6.

Yao, J. S.T. (2003) Cardiovascular Surgery 11:413-5.

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