Bright leaves, dark leaves.

Abstract

The 20th century has been called the “Century of the Surgeon,” and surely it was. But who would we nominate to be the “Surgeon of the Century?” I want to place in nomination the name of a surgeon who worked in Europe and America. He developed a number of new surgical procedures, lived in four different countries during his surgical career, and studied and worked with two stalwarts in medicine. He worked in the laboratory of Ludwig Aschoff, a pioneer in pathology, and was a surgical resident and later colleague of Ernst Ferdinand Sauerbruch, an early leader in thoracic surgery. He was president of the German Surgical Society, even though he was not living in Germany at the time. He published more than 400 scientific articles in several surgical fields and in three different languages. He was editor or coeditor of 14 scientific journals, was author or coauthor of 27 books, and wrote 15 book chapters. He did pioneering research in the pathogenesis of gastric ulcer, diseases of the lungs and thorax, the origin of pulmonary emphysema, and on tuberculosis in bone and joints. In 1931, he did the first successful pneumonectomy in a human. He developed a technique for extrapleural pneumothorax for tuberculosis. Ironically, he was stricken by tuberculosis before the development of effective drug therapy, but he survived. He worked on techniques to deal with the difficult duodenal stump when partial gastrectomy was the accepted definitive therapy for intractable peptic ulcer disease. In 1937, he performed a resection of the gastric cardia and did an invaginated anastomosis. Proximal gastrectomy was well known to produce severe disabling esophagitis, but his patient did not develop it. This was to become a defining moment in his career. He left Germany, his homeland, never to live there again, and lived in Turkey, the United States, and in Switzerland. He counted among his patients Nobel Prize winners Albert Schweitzer, Albert Einstein, and pioneering radiologist Gustav Buckey. In 1955, he saw a patient with symptomatic reflux esophagitis and, recalling his 1937 patient, plicated the fundus of the stomach around the distal esophagus. This procedure not only set the stage for the best and most successful surgical treatment for reflux esophagitis—“heartburn”—but placed the surgeon’s name in the vocabulary of every general surgeon and gastroenterologist in the world. This man’s name is, of course, Rudolf Nissen. Why did a surgeon this successful entitle his biography, Helle Blatter, Dunkle Blatter—Bright Leaves, Dark Leaves (Fig. 1)? 4 Why did he leave his homeland, never to live there again? Why did he choose to live in Basel, Switzerland, for the last part of his life? How was he able to accomplish so much? What effect did his success have on his family? Rudolf Nissen was born in 1896 in Neisse, Silesia, to Dr Franz Nissen and Margarethe Borchert Nissen. Silesia was then a part of Prussia, Germany, but now is in Poland. His father, Franz Nissen, was a successful general surgeon in this quiet, tolerant city on the edge of the Carpathian Mountains. Two years after Rudolf ’s birth, his father built a clinic and hospital in Neisse. The family lived on one of the upper floors of the building, so Rudolf grew up in close contact with surgery and was inevitably drawn to it. He went to school at the katholische humanistisches Gymnasium, or Catholic high school in Neisse. The discipline of Prussia and of this school undoubtedly contributed to his strong work ethic and self-control. Perhaps, also, Immanuel Kant’s concept of “oughtness” was drilled into him at home and in school. As a young man, Rudolf thought he might like to become a painter. His father knew Fritz Erler, and sent his son to study with him at the Breslau Art Institute so that he could evaluate Rudolf ’s talent. It is likely Franz Nissen had given Erler instructions. Fritz concluded that Rudolf Nissen had enough talent to “earn his bread as a painter, but not the butter to go on it.” Rudolf began his medical studies in Breslau and then Munich, in 1913 and 1914. He volunteered for the German army to fulfill his one-year military service obligaPresented as the Presidential Address at the Texas Surgical Society, 2001.