Owen H. Wangensteen, Owen H. Wangensteen, M.D. PhDM.D. PhD

A Legacy of Scientific and A Legacy of Scientific and Educational InnovationEducational Innovation

Innominate SocietyInnominate Society

Stanley A. Gall, M.D.Stanley A. Gall, M.D.

November 8, 2011November 8, 2011

Owen H. Wangensteen M.D., PhDOwen H. Wangensteen M.D., PhD1898-19811898-1981

Professor and HeadProfessor and Head

Department of SurgeryDepartment of Surgery

University of Minnesota Medical SchoolUniversity of Minnesota Medical School

1930-19661930-1966

Goals for PresentationGoals for Presentation

Early childhood influencesEarly childhood influences

Undergraduate and early academic Undergraduate and early academic careercareer

Process leading up to appointment of Process leading up to appointment of Department of SurgeryDepartment of Surgery

Scientific achievementsScientific achievements

Educational evaluation Educational evaluation

Early Childhood InfluencesEarly Childhood Influences

Born on a form near Lake Park Born on a form near Lake Park Minnesota – mid north part of the stateMinnesota – mid north part of the state

Father immigrated to US from Norway in Father immigrated to US from Norway in 18811881

Mother born on a farm near Lake Park Mother born on a farm near Lake Park Minnesota – Norwegian parentsMinnesota – Norwegian parents

Mother died when OHW was 7 yearsMother died when OHW was 7 years

Early Childhood InfluencesEarly Childhood Influences

OHW: prepared to make farming a careerOHW: prepared to make farming a career

Father was impressed with ability to handle Father was impressed with ability to handle sick farm animalssick farm animalsDelivered some 300 piglets from 50 sows Delivered some 300 piglets from 50 sows

who had trouble farrowingwho had trouble farrowing

OHW interested in veterinary medicine but OHW interested in veterinary medicine but father insisted on Human Medicinefather insisted on Human Medicine

Early Childhood InfluencesEarly Childhood InfluencesAn important character trait developed during which became more obvious with time. OHW developed the trait:• “with overwhelming pride not only in completion

of a task but completion with such perfection that it taxed his every ability”. Neither time nor effort was counted to achieve a goal.

II. Undergraduate and Medical School: Early II. Undergraduate and Medical School: Early Education and Early Academic CareerEducation and Early Academic Career

1915 OHW enrolled in the University of Minnesota College of Science, Literature and Arts, NOT Agriculture or Veterinary School

1918 Entered Medical School after a summer of hauling hay and manure on the family farm

OHW comment: “through the avenues of pigs and manure and a good spread of each, I finally got into medicine”.

II. OHW: Academic ProcessII. OHW: Academic Process

1919 – Bachelor of Arts

Doctor of Medicine – accelerated due to WWI.

• Finished #1 in Medical School

• Elected to AOA

II. Post-Medical School Activities II. Post-Medical School Activities

Rotating Internship at University of Minnesota. Rotating Internship at University of Minnesota. Did not get residency in Surgery.Did not get residency in Surgery.• Influenced by Dr. George E. Fahr Professor of Influenced by Dr. George E. Fahr Professor of

MedicineMedicine• Great enthusiasm for observation and Great enthusiasm for observation and

researchresearch

OHW decided he did not want private practiceOHW decided he did not want private practice

II. II. Post-Medical School ActivitiesPost-Medical School Activities1924: Spent a year at Mayo Clinic as a Surgical fellow• 6 months on diagnostic service with Henry S. Plummer• 6 months on operative service of William Mayo and Frank C.

Mann

OHW: William Mayo was a “Surgeon’s Surgeon”• Great operating surgeon• Remembers everybody

Frank Mann: Animal Farm and research laboratories frequented by OHW

II. Surgery Training ContinuedII. Surgery Training Continued

1925: 1925: OHW returned to University of OHW returned to University of Minnesota and became the chief resident in Minnesota and became the chief resident in Surgery at UMHSurgery at UMH

1926: Offer to go into private practice in 1926: Offer to go into private practice in S.D. for $15,000/yr.S.D. for $15,000/yr.• Offer to stay at University of Minnesota as Assistant Professor Offer to stay at University of Minnesota as Assistant Professor

for $3000/yr.for $3000/yr.

III. Appointment of Department of Surgery III. Appointment of Department of Surgery HeadHead

1920s: UM converting faculty from part time to full time 1920s: UM converting faculty from part time to full time facultyfaculty

1925: Arthur Strachauer, Head resigned1925: Arthur Strachauer, Head resigned

1926: Search committee formed and interviewed three 1926: Search committee formed and interviewed three candidates candidates

• Frances C. Newton – HarvardFrances C. Newton – Harvard• Mont R. Reid – CincinnatiMont R. Reid – Cincinnati• Owen H. Wangensteen – MinnesotaOwen H. Wangensteen – Minnesota

Newton and Reid: commented “there is nothing worth Newton and Reid: commented “there is nothing worth while here nor will there ever be”.while here nor will there ever be”.

Medical School groomed OHWMedical School groomed OHW

II. Surgical Training II. Surgical Training

1926: Dean Lyons, arranged for a 1926: Dean Lyons, arranged for a sabbatical leave to travel and study in sabbatical leave to travel and study in EuropeEurope• Fall 1927-Fall 1928 OHW, wife and 2 yr. old daughter went to Fall 1927-Fall 1928 OHW, wife and 2 yr. old daughter went to

EuropeEurope

Primary site for research was Bern, Primary site for research was Bern, SwitzerlandSwitzerland

II. II. Europe ReflectionsEurope Reflections

OHW: Recommendation of William Mayo OHW: Recommendation of William Mayo more valuable than the President of U.S.more valuable than the President of U.S.

OHW: Treated like royalty by top echelon OHW: Treated like royalty by top echelon of well known German Professors of of well known German Professors of SurgerySurgery

II. German Professors of SurgeryII. German Professors of Surgery

Ferdinand Sauerbruch →→Ferdinand Sauerbruch →→ BerlinBerlin

Rudolf Nissen →→Rudolf Nissen →→ BerlinBerlin

Martin Kirshner →→Martin Kirshner →→TubingenTubingen

Paul Sudeck →→Paul Sudeck →→ HambergHamberg

Frederick Voelscher →→ Frederick Voelscher →→ Halle Halle

II. Work in Bern SwitzerlandII. Work in Bern Switzerland

Professor Dominique deQuerainProfessor Dominique deQuerain

Professor ArcherProfessor ArcherPublished work with deQuerain on “The Blood Supply of Published work with deQuerain on “The Blood Supply of the Normal and Diseased Thyroid Gland”.the Normal and Diseased Thyroid Gland”.

OHW: Deeply impressed with deQuerain OHW: Deeply impressed with deQuerain

Recounted: Professor deQuerain read widely over the Recounted: Professor deQuerain read widely over the entire range of Surgery and was likely to reply to a entire range of Surgery and was likely to reply to a narration of a new America practice with “ Ja, das weiss ich narration of a new America practice with “ Ja, das weiss ich schon” (that of course I already know).schon” (that of course I already know).

III. Appointments to Surgery ChairIII. Appointments to Surgery Chair

Dr. Strachauer agreed to postpone retirementDr. Strachauer agreed to postpone retirement

OHW sent to Europe for maturing and gathering OHW sent to Europe for maturing and gathering ideasideas

• Found active surgical research labs in Heidelberg Found active surgical research labs in Heidelberg and Edinburgh and Edinburgh

OHW found German professors totally engaged OHW found German professors totally engaged in clinical activities and private practicein clinical activities and private practice

III. III. Road to ChairRoad to Chair1928: Return from Europe – promoted to 1928: Return from Europe – promoted to Associate Professor of SurgeryAssociate Professor of Surgery

1930: Appointed Head Department of 1930: Appointed Head Department of SurgerySurgery

Named full Professor - 1931Named full Professor - 1931

III. OHW View on Operation of Department III. OHW View on Operation of Department of Surgery of Surgery

Felt his only power was the power of Felt his only power was the power of appointmentappointment

His judgments of whom to elevate to His judgments of whom to elevate to departmental responsibility decided bydepartmental responsibility decided by::

• Persons motivationPersons motivation• Persons competencePersons competence• Interest in researchInterest in research• Interest in teachingInterest in teaching• Likely contributions to the overall enterpriseLikely contributions to the overall enterprise

III. Wangensteen’s Operational III. Wangensteen’s Operational PhilosophiesPhilosophies

Professors most important role is to: Professors most important role is to: Create or help synthesize an Create or help synthesize an atmosphere in which the learning atmosphere in which the learning becomes:becomes:

• AbsorbingAbsorbing• EngagingEngaging• Interest in researchInterest in research• Fascinating adventures and Fascinating adventures and

experiencesexperiences

III. Wangensteen’s ChairmanshipIII. Wangensteen’s Chairmanship

1930 start:1930 start: 1 faculty1 faculty

2 surgical interns2 surgical interns

1 surgical fellow1 surgical fellow

130 surgical beds130 surgical beds

1966 (retirement)1966 (retirement) 18 interns18 interns

100 Surgical 100 Surgical fellowsfellows

200 surgical beds200 surgical beds

The TeamThe Team

1898-1981 Owen H. Wangensteen M.D., PhD - Surgery 1898-1981 Owen H. Wangensteen M.D., PhD - Surgery 1930-19661930-1966

Maurice Visscher PhD, M.D. 1936-1968 Maurice Visscher PhD, M.D. 1936-1968

Ray M. Amberg - Director University Hospital 1935-1964Ray M. Amberg - Director University Hospital 1935-1964

Harold S. Diehl – Dean SOM 1936-1959 Harold S. Diehl – Dean SOM 1936-1959

Minnesota LegislatureMinnesota Legislature

““The moons were in correct alignment” The moons were in correct alignment”

IV. Basis for Scientific and Educational IV. Basis for Scientific and Educational Achievements Achievements

IV. Members of the TeamIV. Members of the TeamMaurice B. Visscher PhD, M.D.Maurice B. Visscher PhD, M.D.• Early work with radioisotopesEarly work with radioisotopes• Ground breaking research on digestionGround breaking research on digestion

1936-1968: Head Dept. of Physiology1936-1968: Head Dept. of Physiology• Started weekly meetings with OHW & Dept. of SurgeryStarted weekly meetings with OHW & Dept. of Surgery• Pioneer in Interdisciplinary collaborationPioneer in Interdisciplinary collaboration

Heart Surgeons: Christiaan Barnard, C. Walton Lillehei, Heart Surgeons: Christiaan Barnard, C. Walton Lillehei, Norman Shumway, many others spent part of Surgery Norman Shumway, many others spent part of Surgery residences in Visscher’s Physiology Dept.residences in Visscher’s Physiology Dept.

IV. Members of the TeamIV. Members of the Team

Ray M. Amberg – Director UMH 1935-1964Ray M. Amberg – Director UMH 1935-1964

Hospital growth: 400 beds to 760 bedsHospital growth: 400 beds to 760 beds

additional 40 beds plannedadditional 40 beds planned

PharmacistPharmacist

Cultivated and experienced excellent working relationship Cultivated and experienced excellent working relationship with Minnesota legislaturewith Minnesota legislature

• UMH budget was a line itemUMH budget was a line item

Instituted free hospital care for members of legislatureInstituted free hospital care for members of legislature

IV. Members of the TeamIV. Members of the TeamDean Harald S. DiehlDean Harald S. Diehl• Medical School Dean 1936Medical School Dean 1936• Established MN Medical Foundation for purpose of Established MN Medical Foundation for purpose of

advancement of the Medical Schooladvancement of the Medical SchoolPublishes Bulletin of MMFPublishes Bulletin of MMFOHW was 2OHW was 2ndnd President 1949-1954 President 1949-1954

oSkilled fund-raiserSkilled fund-raiseroMMF Scholar ships to Medical studentsMMF Scholar ships to Medical students

By 1967 >$10,000,000 channeled to Medical SchoolBy 1967 >$10,000,000 channeled to Medical School• Established compulsory TBC and CXR for all patients and Established compulsory TBC and CXR for all patients and

personnel in hospitalpersonnel in hospital• Established School of Public Health 1944Established School of Public Health 1944

IV. Harald S. DiehlIV. Harald S. DiehlHarald S. DiehlHarald S. Diehl• Affiliation with Veterans Administration Affiliation with Veterans Administration

HospitalHospital• Established first Distinguished Award for Established first Distinguished Award for

Alumni 1951; Rules and regulations regarding Alumni 1951; Rules and regulations regarding private patients at UMHprivate patients at UMH

• Big building programBig building programPsychopathic Hospital unit 1936Psychopathic Hospital unit 1936Variety Club Heart Hospital 1951Variety Club Heart Hospital 1951Mayo Memorial Building (14 stories)Mayo Memorial Building (14 stories)Masonic Memorial Hospital 1956Masonic Memorial Hospital 1956New Biomedical Library 1958New Biomedical Library 1958

IV. Wangensteen and Funding of IV. Wangensteen and Funding of Research Research

Management of affluent patientsManagement of affluent patients• No billsNo bills• Private meeting at dischargePrivate meeting at discharge• ““whatever you would like to donate will go to research whatever you would like to donate will go to research

fundsfunds

““I am always on the prowl for sources of support, a I am always on the prowl for sources of support, a responsibility that incites insomnia and creates the responsibility that incites insomnia and creates the necessity for giving much thought during working necessity for giving much thought during working hours to this modern day problem of professors”.hours to this modern day problem of professors”.

IV. Wangensteen and Funding of IV. Wangensteen and Funding of Research Research

1966-1967: 2 fellows in General 1966-1967: 2 fellows in General Surgery departmentSurgery department

• 7 fellows state 7 fellows state fundsfunds

• 63 fellows USPHS63 fellows USPHS

• Friends of DepartmentFriends of Department

V. Scientific AccomplishmentsV. Scientific AccomplishmentsStudies in Intestinal ObstructionStudies in Intestinal Obstruction

• OHW – Referred himself as “a plumber OHW – Referred himself as “a plumber of the alimentary tract”, having worked of the alimentary tract”, having worked at both ends but mainly in the middle”.at both ends but mainly in the middle”.Wangensteen suction deviceWangensteen suction deviceRevolutionized diagnosis and Revolutionized diagnosis and

management management

Reduced mortality from 41%-5%Reduced mortality from 41%-5%

V. Scientific AccomplishmentsV. Scientific AccomplishmentsWangensteens Suction DeviceWangensteens Suction Device

Estimated by Dr. Visscher: saved 100,000 lives by Estimated by Dr. Visscher: saved 100,000 lives by 1960 & 1,000,000 by 19811960 & 1,000,000 by 1981

Device was never patentedDevice was never patented

Determined that swallowed air caused mechanical Determined that swallowed air caused mechanical distention of bowel and not “toxic factor”.distention of bowel and not “toxic factor”.

Published a textbook: The Therapeutic Problem in Published a textbook: The Therapeutic Problem in Bowel Obstructions: A Physiological and Clinical Bowel Obstructions: A Physiological and Clinical consideration 1937.consideration 1937.

V. Scientific AccomplishmentsV. Scientific AccomplishmentsRevised techniques of radical resection of stomach Revised techniques of radical resection of stomach and colonand colon

Initiated 2Initiated 2ndnd “look” for exploring the abdomen at “look” for exploring the abdomen at intervalsintervals

Introduced concepts of gastric cooling for control of Introduced concepts of gastric cooling for control of massive hemorrhage massive hemorrhage

Proposed development of a surgical forum for young Proposed development of a surgical forum for young residents to publish research results-1941residents to publish research results-1941

Developed UM Cancer Detection Center 1948Developed UM Cancer Detection Center 1948

VI. Education Innovation VI. Education Innovation Affiliation between the medical and Graduate Affiliation between the medical and Graduate schools at UMschools at UM• Effected in 1914 with 839 fellows registered Effected in 1914 with 839 fellows registered

(1960)(1960)35% from UMH35% from UMH15% from VAH15% from VAH12% from MGH12% from MGH5% from AH5% from AH33% from other hospitals33% from other hospitals

OHW felt registration in Graduate School signifies: OHW felt registration in Graduate School signifies: Intent to pursue a graduate degree: monthly stipendIntent to pursue a graduate degree: monthly stipend

VI. Shift from Part-Time to Full-Time VI. Shift from Part-Time to Full-Time FacultyFaculty

Took salaries from part-time faculty to hire more Took salaries from part-time faculty to hire more surgical fellows.surgical fellows.• Created backlash with Dean of Graduate SchoolCreated backlash with Dean of Graduate School

Enlisted friends = Dean Lyon Med SchoolEnlisted friends = Dean Lyon Med School

Lotus Coffman President UMLotus Coffman President UM

William J. MayoWilliam J. Mayo

Harsh words for Dean Graduate school “Richard Harsh words for Dean Graduate school “Richard Scammon was a great teacher in my days as a student Scammon was a great teacher in my days as a student but it takes other qualities to be a great Dean. but it takes other qualities to be a great Dean.

VI. Further ConsiderationsVI. Further Considerations

OHW Episode “Kindergarten Cabal” OHW Episode “Kindergarten Cabal”

A shift of emphasis to more active participation A shift of emphasis to more active participation by young full-time staff for patient care in by young full-time staff for patient care in hospitalhospital

If shift had failed it would have been decades to If shift had failed it would have been decades to make the transactionmake the transaction

VIVI. Departmental Budgets & . Departmental Budgets & PersonnelPersonnel

1930: $30,000 1930: $30,000 2 fellows2 fellows

1940:1940: 9 fellows9 fellows

1941-19451941-1945 Significant IncreaseSignificant Increase

19601960 85 fellows85 fellows

Legislative Budget Inc. 500%Legislative Budget Inc. 500%

VI. Growth of Department of SurgeryVI. Growth of Department of Surgery1930-1940 Depression1930-1940 Depression

1940-1945 Contraction, dissipation, diversion of 1940-1945 Contraction, dissipation, diversion of interest because of war effortinterest because of war effort

1930-1945 real spirit of the department formed1930-1945 real spirit of the department formed

Part-time and full-time associates came to Part-time and full-time associates came to accept OHW and his general plan for accept OHW and his general plan for development of the departmentdevelopment of the department

VI. OHW Philosophy on VI. OHW Philosophy on DepartmentalDepartmental Operation Operation

Decentralized mannerDecentralized manner

Each faculty afforded staff status and is autonomous Each faculty afforded staff status and is autonomous

• Does not need to consult OHWDoes not need to consult OHW

Rarely offers gratuitous adviseRarely offers gratuitous advise

Each full-time professor controls 15 beds in hospitalEach full-time professor controls 15 beds in hospital

Residents comment on going on Rounds with OHW: Residents comment on going on Rounds with OHW: “If you follow him with a pencil and paper, you can “If you follow him with a pencil and paper, you can write down 20 original ideas each daywrite down 20 original ideas each day”.”.

VI. Surgical TrainingVI. Surgical Training

50% of fellows in General Surgery 50% of fellows in General Surgery spend time in experimental spend time in experimental laboratorieslaboratories

Training 7-8 yearsTraining 7-8 years• Earn PhD in basic scienceEarn PhD in basic science

• Instructor at 5 or 6Instructor at 5 or 6thth year year

VI. OHW View of Role of ProfessorVI. OHW View of Role of Professor

TeacherTeacher

SurgeonSurgeon

InvestigatorInvestigator

Side-line cheerleaderSide-line cheerleader

Regimental water carrierRegimental water carrier

Create an atmosphere friendly to learningCreate an atmosphere friendly to learning

Ability to recognize every type of talentAbility to recognize every type of talent

VI. Lessons for Time In Europe VI. Lessons for Time In Europe 1927-19281927-1928

Only two laboratories actually doing Only two laboratories actually doing experimental work:experimental work:

• Eugene Enderlen – HeidlebergEugene Enderlen – Heidleberg• David Wilke – EdinburghDavid Wilke – Edinburgh

Feels no department head can Feels no department head can neglect the experimental laboratoryneglect the experimental laboratory

VI. Philosophy of OHWVI. Philosophy of OHW

The University offers the perspective The University offers the perspective full-time clinician who professes to full-time clinician who professes to follow the academic line the follow the academic line the opportunity of making something opportunity of making something ofof himself.himself. He must take care not to He must take care not to become to absorbed in making become to absorbed in making something something forfor himself.himself.

VI. OHW: Student InvolvementVI. OHW: Student Involvement

Creation of the James E. Moore SocietyCreation of the James E. Moore Society• For Scholarship in Medical StudentsFor Scholarship in Medical Students• 12 Senior students12 Senior students• 12 junior students12 junior students

Monthly meeting at Professor homesMonthly meeting at Professor homes

Seniors present research papersSeniors present research papers

11stst meeting @ Dr. Wangensteen’s home meeting @ Dr. Wangensteen’s home

VII.VII. Summary SummaryFarm boy from rural MinnesotaFarm boy from rural Minnesota

Inspiration from fatherInspiration from father

George E. Fahr M.D. – excitement for learningGeorge E. Fahr M.D. – excitement for learning

European trip – research needEuropean trip – research need

Organization of departmentOrganization of department

Multiple Scientific AdvancementsMultiple Scientific Advancements

Educational innovationsEducational innovations

Bibliography Bibliography Wangensteen OH: Impressions from A Surgical Study Trip Aboard. Wangensteen OH: Impressions from A Surgical Study Trip Aboard. Minnesota Medicine 1929; 12:129-136Minnesota Medicine 1929; 12:129-136

Wangensteen OH: Education of a Surgeon. J. Med. Educ.Wangensteen OH: Education of a Surgeon. J. Med. Educ.

1960; 35: 964-9751960; 35: 964-975

Wangensteen OH: The Minnesota Experience in Surgical Graduate Wangensteen OH: The Minnesota Experience in Surgical Graduate Education Surgery 1960; 48: 984-996Education Surgery 1960; 48: 984-996

Wangensteen OH: The Fascination of Scholarship and Research: Wangensteen OH: The Fascination of Scholarship and Research: Their Importance in the Education of Surgeons. J. Surg Res. Their Importance in the Education of Surgeons. J. Surg Res.

1961; 1: 5-71961; 1: 5-7

Wangensteen OH: The Therapeutic Problem in Bowel ObstructionsWangensteen OH: The Therapeutic Problem in Bowel Obstructions

Charles C. Thomas 1937 Springfield, ILCharles C. Thomas 1937 Springfield, IL

Wangensteen OH: Glimpses of the University of Minnesota Surgery Wangensteen OH: Glimpses of the University of Minnesota Surgery Department. Journal-Lancet 1963; 83: 161-176Department. Journal-Lancet 1963; 83: 161-176

Wangensteen OH: Then and Now – The Surgical Arena Three Wangensteen OH: Then and Now – The Surgical Arena Three Decades Ago. Journal- Lancet 1957; 77: 391-402Decades Ago. Journal- Lancet 1957; 77: 391-402

Dietzman R: James Edward Moore: Educator and Surgeon.Dietzman R: James Edward Moore: Educator and Surgeon.

The Journal Lancet April 1963: 157-160The Journal Lancet April 1963: 157-160