Phys.Perspect.17(2016)354–360 (cid:2)2015SpringerBasel 1422-6944/16/040354-7 DOI10.1007/s00016-015-0171-y Physics in Perspective Einstein Up in Smoke John Lisle* Albert Einstein’s biographers have not explained why he developed the abdominal aortic aneurysm that led tohis death. Early conjectures proposedthat it was caused by syphilis, without accurate evidence. The present article gives evidence to the contrary, and argues thattheprincipalcauseofEinstein’sdeathwassmoking. Key words: Albert Einstein; smoking; pipe; abdominal aortic aneurism. Many writers associate Einstein’s genius with his pipe. One night in May 1905, Einstein made a breakthrough toward the special theory of relativity. Describing thatevening,onebiographerasked,‘‘Howdidhespendit?Hesurelyindulgedin his old habit of smoking pipes and cigars while scribbling on countless scraps of paper.’’1SurelyEinsteinwassmokingwhenhehadhisbreakthrough.In1930,the New York Times ran the front-page story ‘‘Einstein Evolving Yet Another The- ory,’’ describing the man as ‘‘calculating, jotting down figures and symbols, checking equations, smoking his pipe when he has not forgotten to light it.’’2 A similar article described him pondering the nature of the universe: ‘‘Out of this thought experiment and pipe smoking new basic laws of behavior are expected, laws such as those of Euclid and Newton that lead to new systems of mathemat- ics.’’3 After Einstein’s death, his friend and doctor Ja´nos Plesch wrote some reminiscences of the man, noting, ‘‘The greatest help in his work was his pipe.’’4 Such anecdotes are exaggerations, yet the alleged link between Einstein’s genius and his pipe smoking persists, as it does with the fictional Sherlock Holmes. But strangely, nobody links Einstein’s smoking habit with his death. Not one account of Einstein’s death in thebiographiesby Jeremy Bernstein, Denis Brian, RonaldClark,AlbrechtFo¨lsing,WalterIsaacson,Ju¨rgenNeffe,orAbrahamPais mentionssmoking.5Atmost,somebiographersmentionhisdoctor’sorderstostop smoking after surgery. Even medical articles discussing Einstein’s death have neglected to connect his smoking with his chronic ailment.6 ForEinstein,smokingpipetobaccowasadailyritual.Hewrote:‘‘Diet:smoke like a chimney.’’7 His favorite brand was ‘‘Revelation’’ by House of Windsor. Whenill,Einsteinsometimesstoppedsmokingfollowinghisdoctor’sorders.After an ailment in 1915, he wrote to friends, ‘‘I am feeling quite fine … I recuperated *JohnLisleisagraduatestudentinthehistorydepartmentoftheUniversity ofTexasat Austin. 354 Vol. 17(2016) Einstein Upin Smoke 355 well,particularlyaftermakingthetoughdecisiontogiveupsmokingentirely.’’8In 1920,Einsteinhadto‘‘abstainfromsmokingduringhisseveregastricillness.’’He resumedthehabitsoonafterwards.9RelentingtohiswifeElsa’sdemands,Einstein agreedtoabstainfromsmokingonThanksgiving,1934,untiltheNewYear.‘‘You see,’’hesaid,‘‘Iamnolongeraslavetomypipe.Iamaslavetothatwoman.’’10 Right after New Year’s, he lit up again. By1947,hehadstoppedagain.Whenavisitorthenofferedhimsometobacco, Einstein passively remarked, ‘‘No, thank you. My doctor has forbidden me to smoke. Personally, I don’t think it would affect me. But my doctor is a sensitive man—and I don’t want to hurt him.’’11 Ja´nos Plesch summed up Einstein’s ‘‘de- votion to tobacco,’’ writing: ‘‘He is hardly ever to be seen without a pipe in his mouth, except when it is a cigar instead. A good cigar is a real pleasure for him, anditslightingupaceremony.Officiallyhiswifeallowedhimonecigaraday,and outwardlyhesubmittedtothisdiscipline,butinhisroomtherewasalwaysaboxof cigars kept replenished by good friends in the innocent conspiracy to throw dust into Frau Elsa’s anxious eyes.’’12 Tocircumventhisdoctors’orders,hisgrandsonBernhardrecalledthattheold, frumpy Einstein picked up cigarette butts off the street in Princeton.13 Plesch corroboratedthisstory,rememberingEinsteinas‘‘ashamedofhisownweakness’’: Heusedtogoeverydaytohisinstitutetakingthepathacrossthemeadow.But going that way, he never had the chance to find cigars and cigarette ends, and therefore since the ban on smoking had been imposed on him he preferred to goalongthestreet,wherehecouldfindenoughcigarandcigarettebuttstofill his pipe, so that he could smoke without being noticed. He did not want to offend his doctor by not following the prescription, but he had made up his mind that he would very soon ignore the ban quite openly.14 Pleschfeltsorryforhisoldfriendand‘‘resolvedthatthiskindofsubterfugeshould neverbenecessaryagain.FromthenonIsuppliedhimwithtobaccoandcigars.’’15 Presumably, Plesch saw himself as a good friend in the ‘‘innocent conspiracy.’’ Plesch’s son Peter recalled that his father ‘‘never realized the relation between smokingandlungdiseases,especiallylungcancer.Hehimselfwasanenthusiastic smokerandprescribedsmokingasarelaxantandsedativetonervouspatients.’’16 Einstein endured many health problems throughout his life, including a liver ailment, gastric ulcers, jaundice, congestive failure, hemolytic anemia, and a dangerous abdominal aortic aneurysm (AAA). In December, 1948, surgeon Rudolph Nissen performed life-extending surgery on Einstein by wrapping cel- lophane around the aortic aneurysm. A photograph shows Einstein leaving the hospital soon after surgery, sitting in a car—and holding his pipe (Fig. 1). Once againhetriedtoquitsmokingaftertheoperationandwastemporarily‘‘reducedto suckingonacoldpipe.’’Whenhereceivedtobaccoasagifthegaveittoafriend after first sniffing it.17 356 J.Lisle Phys.Perspect. Fig.1. EinsteinleavingtheBrooklynJewishHospitalaftersurgeryforhisaorticaneurysm,pipe inhand.Credit:JournalofSurgery,GynecologyandObstetrics(ref.6). In 1950, more than half the adult men in the US were smokers.18 That same year, when he was seventy, Einstein accepted a lifetime membership in the Montreal Pipe Smokers Club. It had been fifteen months since his surgery. He wrotetotheclub’spresident,‘‘Pipesmokingcontributestoasomewhatcalmand objective judgment in our human affairs.’’19 In April, 1955, his ‘‘grapefruit-sized’’ aneurysm finally ruptured, causing severe pain. Einstein experienced internal bleedinganddiedthenextmorning.Indeed,ofthosewhosufferarupturedAAA, ‘‘mortalityis85to90%.Ofthosepersonswhoreachthehospital,only50to70% survive.’’20 Einstein refused further medical assistance after he predicted his imminent end, saying, ‘‘I want to go when I want. It is tasteless to prolong life artificially; I have done my share, it is time to go. I will do it elegantly.’’21 Dr. Plesch tried to determine the origin of Einstein’s AAA. He conjectured thatsyphiliswastheculprit,sayingthatEinsteinwas‘‘astronglysexualperson.’’22 Knowing of the physicist’s escapades with various women, Plesch asked: ‘‘Why such a healthy and good-looking man should not have been unlucky and acquire syphilisinoneofhisadventures.InmylongmedicalpracticeIhavefoundalmost without exception that abdominal aneurysms are of syphilitic origin.’’23 He bol- stered this conjecture with the argument that Einstein suffered from ‘‘extensive secondary anaemia attacks,’’ which Plesch thought indicated an earlier syphilitic infection. But then, Plesch remarked, ‘‘It might, of course, be that Einstein was exceptionalinthatrespecttooandthathisaneurysmwasnon-specific.’’24Einstein biographerJeremyBernsteindismissedthisdiagnosis,‘‘IamnotaphysicianbutI would put this in the same category as the advice—provided in an appendix to [Plesch’s]autobiography—toexposeyoungchildrentotanningmachinesinorder to prepare them for exposure to the sun.’’25 ContrarytoPlesch’simpression,syphilisandAAAinthedescendingaortaare seldom linked. ‘‘In the prepenicillin era (1936) … only 136 [aortic aneurysms collected from the literature] were below the diaphragm, of which 1 of 10 were causedbysyphilis,demonstratingtherarity.’’26Anotherpaperfurtheranalyzesthe connection between syphilis and AAA; when late vascular manifestations of syphilis go untreated, ‘‘syphilitic aortitis is reported in 70–80%,’’ of which 10% Vol. 17(2016) Einstein Upin Smoke 357 experience ‘‘significant cardiovascular complications’’ like AAA. Out of that already narrowed field, the descending aorta is the least likely (15%) affected segment.27Summingup, justover1%(15%of10%of70–80%)ofuntreatedlate vascular manifestations of syphilis result in an AAA in the descending aorta, which is a low incidence rate. EvenfifteenyearsbeforeEinstein’sdeath,peoplewerearguingagainstastrong connection between syphilis and AAA. In 1941, the medical journal The Lancet published a note by M. H. Pappworth on ‘‘Abdominal Aneurysm and Syphilis’’ aboutamisleadingreportthatclaimedthatsyphiliscausedAAA.Thereportonly quoted one modern author, who ‘‘deduced that 39 of his 73 cases were due to syphilis.Butof38ofhiscasesinwhichpost-mortemrecordsaredescribedonly5 hadmicroscopicevidenceofaorticsyphilis.’’28Thesenumbersarenotinsignificant, but they certainly do not support the conjecture in Einstein’s case, especially becausenosignsormanifestationsofsyphilisinanypartofhisbody,includinghis dissected brain, were found.29 There is, however, an undeniably close connection between abdominal aortic aneurysmsandsmoking.Ina2014informationsheetforpatientswiththedisorder, ‘‘Albert Einstein and Aortic Aneurysm,’’ Dr. Fe´lix Ramı´rez states, ‘‘90% of the Fig.2. Einstein with his pipe—the tobacco can in front was his favorite brand, ‘‘Revela- tion.’’Credit:PermissionbyProfessionalSportsAuthenticator(PSA). 358 J.Lisle Phys.Perspect. peoplewithAAAhaveahistoryofsmoking.’’Still,Ramı´rezdoesnotmentionthat Einstein smoked.30 In an ‘‘Analysis of Risk Factors for Abdominal Aortic Aneurysm in a Cohort of more than 3 Million Individuals,’’ 80.22% of people developingAAAsmoked.31Onestudyfoundthatcurrentsmokerswere7.6times more likely to have AAA than nonsmokers.32 AnotherarticleintheNewEnglandJournalofMedicinestatesthat‘‘Smokingis thestrongestmodifiableriskfactor’’forthosewithAAA.‘‘Theprevalenceandsize of aneurysms are strongly associated with both the amount and duration of smoking; cessation of smoking can reverse this risk and is associated with a reduced rate of aneurysmal growth.’’33 In the book Aortic Aneurysms: Pathogen- esis and Treatment, Dr. B. Timothy Baxter writes that, ‘‘AAA is more closely associated with cigarette smoking than any other tobacco-related disease except lung cancer.’’34 Although several studies focused mainly on cigarette smoke, another study found no association between AAA and the type of tobacco used, whether pipe, cigar, or cigarette.35 Though non-modifiable risk factors for AAA include older age, male sex, and a family history, the US Preventive Services Task Force now ‘‘recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men ages 65 to 75 years who have ever smoked.’’36 Einsteindiedattheageof76.Oneofhispipeshasbecome‘‘themostpopular object in the Modern Physics collection’’ at the National Museum of American History.37 Einstein compulsively gnawed a hole through its bit. With high prob- ability,wecannowsaythatthesamepipethatgaveEinsteinaniconicimageand brought him comfort also ensured his demise. Regardless, Einstein lived as he wished—irreverently. He once wrote: ‘‘You may believe that smoking is bad for your health and nevertheless be a smoker. And this holds true for all the evil impulses that poison life’’38 (Fig. 2). Acknowledgments IthankProf.AlbertoA.Martı´nezandProf.AbenaDoveOsseo-Asareforhelpful suggestions and encouragement in writing this article. References 1Ju¨rgenNeffe,Einstein:ABiography(Baltimore:JohnsHopkinsUniversityPress,2007),126. 2ClarenceStreit,‘‘EinsteinEvolvingYetAnotherTheory,’’TheNewYorkTimes,July27,1930. 3‘‘Dr.EinsteinConsultsCaliforniaPhysicists,’’TheNewYorkTimes,January4,1931. 4PeterPleschandJa´nosPlesch,‘‘SomeReminiscencesofAlbertEinstein,’’NotesandRecordsof theRoyalSocietyofLondon49(1995),320. 5Jeremy Bernstein,Albert Einstein and the Frontier of Physics(New York: Oxford University Press,1996);DenisBrian,Einstein:ALife(NewYork:J.Wiley,1996);RonaldClark,Einstein: The Life and Times(New York: World Publishing Company, 1971); Albrecht Fo¨lsing, Albert Vol. 17(2016) Einstein Upin Smoke 359 Einstein:ABiography(NewYork:PenguinPress,1997);WalterIsaacson,Einstein:HisLifeand Universe(NewYork:SimonandSchuster,2007);Ju¨rgenNeffe,Einstein:ABiography;Abraham Pais,SubtleIStheLord(NewYork:OxfordUniversityPress,2005). 6JorgeCervantes-Castro,‘‘AlbertEinsteinandHisAbdominalAorticAneurysm,’’GacetaMe´dica de Me´xico174 (2011), 74–76; J. Chandler, ‘‘The Einstein Sign: The Clinical Picture of Acute Cholecystitis Caused by Ruptured Abdominal Aortic Aneurysm,’’The New England Journal of Medicine310 (1984), 1538; J. R. Cohen and L. M. Graver, ‘‘The Ruptured Abdominal Aortic AneurysmofAlbertEinstein,’’Surgery,GynecologyandObstetrics170(1990),455–58;S.Kantha, ‘‘AnAppraisalofAlbertEinstein’sChronicIllness,’’MedicalHypotheses42(1994),340–46. 7AlbertEinstein,TheCollectedPapersofAlbertEinstein,vol.5,trans.AnnaBeck(Princeton: PrincetonUniversityPress,1995),348. 8AlbertEinstein,TheCollectedPapersofAlbertEinstein,vol.8,trans.AnnHentschel(Prince- ton:PrincetonUniversityPress,1998),122. 9Albert Einstein,The Collected Papers of Albert Einstein, vol. 10, trans. Ann Hentschel (Princeton:PrincetonUniversityPress,2006),445n4. 10Brian,Einstein:ALife(ref.5),265. 11Quoted in Leonard Lyons, ‘‘Einstein Has Pipes, but Won’t Smoke,’’The Austin Statesman, September9,1947,4. 12Ja´nosPlesch,Ja´nos,theStoryofaDoctor,trans.EdwardFitzgerald(London:VictorGollancz, 1947),213. 13JustinStares,‘‘Einstein,EccentricGenius,SmokedButtsPickedupoffStreet,’’TheTelegraph, accessed October 4, 2015, http://www.telegraph.co.uk/news/worldnews/europe/belgium/1502358/ Einstein-eccentric-genius-smoked-butts-picked-up-off-street.html. 14PleschandPlesch,‘‘ReminiscencesofAlbertEinstein’’(ref.4),320. 15Ibid. 16Ibid.,328n15. 17JamieSayen,EinsteininAmerica(NewYork:Crown,1985),222. 18‘‘AchievementsinPublicHealth,1900-1999:TobaccoUse—UnitedStates,1900–1999,’’Centers for Disease Control Morbidity and Mortality Weekly Report, accessed October 4, 2015, http:// www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a2.htm. 19‘‘EinsteinJoinsPipeClub,’’TheNewYorkTimes,March12,1950. 20K. Craig Kent, ‘‘Abdominal Aortic Aneurysms,’’The New England Journal of Medicine371 (2014),2101–8. 21QuotedinPais,SubtleistheLord(ref.5),477. 22PleschandPlesch,‘‘ReminiscencesofAlbertEinstein’’(ref.4)309. 23Ibid.,310. 24Ibid. 25JeremyBernstein,‘‘JanosPlesch,’’HarvardMagazine,January-February2004,accessedOcto- ber4,2015,http://harvardmagazine.com/2004/01/janos-plesch.html. 26Jeyakumar Williams, Gopi Krishnan, and Hema Devarajan, ‘‘Syphilitic Abdominal Aortic Aneurysm,’’AIDSPatientCareandSTDs16(2002),468. 27Nelson Paulo, Jose´ Cascarejo, and Lu´ıs Vouga, ‘‘Syphilitic Aneurysm of the Ascending Aorta,’’InteractiveCardiovascularandThoracicJournal14(2012),4450–71. 28M.H.Pappworth,‘‘AbdominalAneurysmandSyphilis,’’TheLancet237(1941),804. 360 J.Lisle Phys.Perspect. 29DianaKormosBuchwald,directoroftheEinsteinPapersProject,informsmethat,asfarasshe isaware,theprojectdoesnotcontainEinstein’smedicalrecordsorautopsyreport. 30Fe´lix Ram´ırez, ‘‘Albert Einstein and Aortic Aneurysm,’’ Argentine Journal of Cardiology 83 (2014):250,http://doi.org/10.7775/rac.v82.i3.4089. 31K.CraigKentetal.,‘‘AnalysisofRiskFactorsforAbdominalAorticAneurysminaCohortof morethan3MillionIndividuals,’’JournalofVascularSurgery52(2010),539–48. 32TeunWilmink,CliveQuick,andNicholasDay,‘‘TheAssociationbetweenCigaretteSmoking andAbdominalAorticAneurysms,’’JournalofVascularSurgery30(1999),1099–105. 33Kent,‘‘AbdominalAorticAneurysms’’(ref.20). 34B. Timothy Baxter, ‘‘Medical Management of Small Aortic Abdominal Aortic Aneurysms,’’ inAortic Aneurysms: Pathogenesis and Treatment, ed. Gilbert R. Upchurch, Jr., and Enrique Criado(NewYork:HumanaPress,2009),62. 35J.T.Powell,P.Worrell,S.T.MacSweeney,P.J.Franks,andR.M.Greenhaigh,‘‘Smokingasa RiskFactorforAbdominalAorticAneurysm,’’AnnalsoftheNewYorkAcademyofSciences800 (1996),246–8,on247. 36‘‘FinalRecommendationStatementAbdominalAorticAneurysm:Screening,’’U.S.Preventa- tiveServicesTaskForce,accessedOctober4,2015,http://www.uspreventiveservicestaskforce.org/ Page/Document/RecommendationStatementFinal/abdominal-aortic-aneurysm-screening. It is unclearwhetheranyapparentdelayinthewidespreadpublicgraspofthelinkbetweenAAAand smoking was influenced by the tobacco industry’s strategy to obfuscate recognition of tobacco healthhazards.ThisstrategyiswellchronicledinRobertN.Proctor,GoldenHolocaust:Originsof the Cigarette Catastrophe and the Case for Abolition (Berkeley: University of California Press, 2011). 37‘‘Einstein’sBrierPipe,’’TheNationalMuseumofAmericanHistory,accessedOctober4,2015, http://americanhistory.si.edu/collections/search/object/nmah_334905. 38AlbertEinstein,lettertoJohnCranston,May16,1951,reprintedinAlbertEinstein,Einsteinon Peace,ed.OttoNathanandHeinzNorden(NewYork:SimonandSchuster,1960),556. DepartmentofHistory,UniversityofTexasatAustin 128InnerCampusDr.,B7000 Austin,TX78712,USA e-mail:[email protected]