3 Owen H. Wangensteen M.D., PhD 1898-1981 Professor and HeadDepartment of SurgeryUniversity of Minnesota Medical School
4 Goals for Presentation Early childhood influencesUndergraduate and early academic careerProcess leading up to appointment of Department of SurgeryScientific achievementsEducational evaluation
5 Early Childhood Influences Born on a form near Lake Park Minnesota – mid north part of the stateFather immigrated to US from Norway in 1881Mother born on a farm near Lake Park Minnesota – Norwegian parentsMother died when OHW was 7 years
7 Early Childhood Influences OHW: prepared to make farming a careerFather was impressed with ability to handle sick farm animalsDelivered some 300 piglets from 50 sows who had trouble farrowingOHW interested in veterinary medicine but father insisted on Human Medicine
8 Early Childhood Influences An 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.
9 II. Undergraduate and Medical School: Early Education and Early Academic Career 1915 OHW enrolled in the University of Minnesota College of Science, Literature and Arts, NOT Agriculture or Veterinary School1918 Entered Medical School after a summer of hauling hay and manure on the family farmOHW comment: “through the avenues of pigs and manure and a good spread of each, I finally got into medicine”.
10 II. OHW: Academic Process 1919 – Bachelor of ArtsDoctor of Medicine – accelerated due to WWI.Finished #1 in Medical SchoolElected to AOA
12 II. Post-Medical School Activities Rotating Internship at University of Minnesota. Did not get residency in Surgery.Influenced by Dr. George E. Fahr Professor of MedicineGreat enthusiasm for observation and researchOHW decided he did not want private practice
13 II. Post-Medical School Activities 1924: Spent a year at Mayo Clinic as a Surgical fellow6 months on diagnostic service with Henry S. Plummer6 months on operative service of William Mayo and Frank C. MannOHW: William Mayo was a “Surgeon’s Surgeon”Great operating surgeonRemembers everybodyFrank Mann: Animal Farm and research laboratories frequented by OHW
15 II. Surgery Training Continued 1925: OHW returned to University of Minnesota and became the chief resident in Surgery at UMH1926: Offer to go into private practice in S.D. for $15,000/yr.Offer to stay at University of Minnesota as Assistant Professor for $3000/yr.
16 III. Appointment of Department of Surgery Head 1920s: UM converting faculty from part time to full time faculty1925: Arthur Strachauer, Head resigned1926: Search committee formed and interviewed three candidatesFrances C. Newton – HarvardMont R. Reid – CincinnatiOwen H. Wangensteen – MinnesotaNewton and Reid: commented “there is nothing worth while here nor will there ever be”.Medical School groomed OHW
17 II. Surgical Training1926: Dean Lyons, arranged for a sabbatical leave to travel and study in EuropeFall 1927-Fall 1928 OHW, wife and 2 yr. old daughter went to EuropePrimary site for research was Bern, Switzerland
19 II. Europe ReflectionsOHW: Recommendation of William Mayo more valuable than the President of U.S.OHW: Treated like royalty by top echelon of well known German Professors of Surgery
20 II. German Professors of Surgery Ferdinand Sauerbruch →→ BerlinRudolf Nissen →→ BerlinMartin Kirshner →→ TubingenPaul Sudeck →→ HambergFrederick Voelscher →→ Halle
21 II. Work in Bern Switzerland Professor Dominique deQuerainProfessor ArcherPublished work with deQuerain on “The Blood Supply of the Normal and Diseased Thyroid Gland”.OHW: Deeply impressed with deQuerainRecounted: Professor deQuerain read widely over the entire range of Surgery and was likely to reply to a narration of a new America practice with “ Ja, das weiss ich schon” (that of course I already know).
22 III. Appointments to Surgery Chair Dr. Strachauer agreed to postpone retirementOHW sent to Europe for maturing and gathering ideasFound active surgical research labs in Heidelberg and EdinburghOHW found German professors totally engaged in clinical activities and private practice
23 III. Road to Chair1928: Return from Europe – promoted to Associate Professor of Surgery1930: Appointed Head Department of SurgeryNamed full Professor
24 III. OHW View on Operation of Department of Surgery Felt his only power was the power of appointmentHis judgments of whom to elevate to departmental responsibility decided by:Persons motivationPersons competenceInterest in researchInterest in teachingLikely contributions to the overall enterprise
25 III. Wangensteen’s Operational Philosophies Professors most important role is to: Create or help synthesize an atmosphere in which the learning becomes:AbsorbingEngagingInterest in researchFascinating adventures and experiences
27 IV. Basis for Scientific and Educational Achievements The TeamOwen H. Wangensteen M.D., PhD - SurgeryMaurice Visscher PhD, M.DRay M. Amberg - Director University HospitalHarold S. Diehl – Dean SOMMinnesota Legislature“The moons were in correct alignment”
31 IV. Members of the Team Maurice B. Visscher PhD, M.D. Early work with radioisotopesGround breaking research on digestion: Head Dept. of PhysiologyStarted weekly meetings with OHW & Dept. of SurgeryPioneer in Interdisciplinary collaborationHeart Surgeons: Christiaan Barnard, C. Walton Lillehei, Norman Shumway, many others spent part of Surgery residences in Visscher’s Physiology Dept.
32 IV. Members of the Team Ray M. Amberg – Director UMH 1935-1964 Hospital growth: 400 beds to 760 bedsadditional 40 beds plannedPharmacistCultivated and experienced excellent working relationship with Minnesota legislatureUMH budget was a line itemInstituted free hospital care for members of legislature
38 IV. Members of the Team Dean Harald S. Diehl Medical School Dean 1936 Established MN Medical Foundation for purpose of advancement of the Medical SchoolPublishes Bulletin of MMFOHW was 2nd PresidentSkilled fund-raiserMMF Scholar ships to Medical studentsBy 1967 >$10,000,000 channeled to Medical SchoolEstablished compulsory TBC and CXR for all patients and personnel in hospitalEstablished School of Public Health 1944
39 IV. Harald S. Diehl Harald S. Diehl Affiliation with Veterans Administration HospitalEstablished first Distinguished Award for Alumni 1951; Rules and regulations regarding private patients at UMHBig building programPsychopathic Hospital unit 1936Variety Club Heart Hospital 1951Mayo Memorial Building (14 stories)Masonic Memorial Hospital 1956New Biomedical Library 1958
41 IV. Wangensteen and Funding of Research Management of affluent patientsNo billsPrivate meeting at discharge“whatever you would like to donate will go to research funds“I am always on the prowl for sources of support, a responsibility that incites insomnia and creates the necessity for giving much thought during working hours to this modern day problem of professors”.
42 IV. Wangensteen and Funding of Research : 2 fellows in General Surgery department7 fellows state funds63 fellows USPHSFriends of Department
49 V. Scientific Accomplishments Studies in Intestinal ObstructionOHW – Referred himself as “a plumber of the alimentary tract”, having worked at both ends but mainly in the middle”.Wangensteen suction deviceRevolutionized diagnosis and managementReduced mortality from 41%-5%
50 V. Scientific Accomplishments Wangensteens Suction DeviceEstimated by Dr. Visscher: saved 100,000 lives by 1960 & 1,000,000 by 1981Device was never patentedDetermined that swallowed air caused mechanical distention of bowel and not “toxic factor”.Published a textbook: The Therapeutic Problem in Bowel Obstructions: A Physiological and Clinical consideration 1937.
52 V. Scientific Accomplishments Revised techniques of radical resection of stomach and colonInitiated 2nd “look” for exploring the abdomen at intervalsIntroduced concepts of gastric cooling for control of massive hemorrhageProposed development of a surgical forum for young residents to publish research results-1941Developed UM Cancer Detection Center 1948
53 VI. Education Innovation Affiliation between the medical and Graduate schools at UMEffected in 1914 with 839 fellows registered (1960)35% from UMH15% from VAH12% from MGH5% from AH33% from other hospitalsOHW felt registration in Graduate School signifies: Intent to pursue a graduate degree: monthly stipend
54 VI. Shift from Part-Time to Full-Time Faculty Took salaries from part-time faculty to hire more surgical fellows.Created backlash with Dean of Graduate SchoolEnlisted friends = Dean Lyon Med SchoolLotus Coffman President UMWilliam J. MayoHarsh words for Dean Graduate school “Richard Scammon was a great teacher in my days as a student but it takes other qualities to be a great Dean.
55 VI. Further Considerations OHW Episode “Kindergarten Cabal”A shift of emphasis to more active participation by young full-time staff for patient care in hospitalIf shift had failed it would have been decades to make the transaction
56 VI. Departmental Budgets & Personnel 1930: $30, fellows1940: 9 fellowsSignificant IncreasefellowsLegislative Budget Inc. 500%
57 VI. Growth of Department of Surgery DepressionContraction, dissipation, diversion of interest because of war effortreal spirit of the department formedPart-time and full-time associates came to accept OHW and his general plan for development of the department
59 VI. OHW Philosophy on Departmental Operation Decentralized mannerEach faculty afforded staff status and is autonomousDoes not need to consult OHWRarely offers gratuitous adviseEach full-time professor controls 15 beds in hospitalResidents comment on going on Rounds with OHW: “If you follow him with a pencil and paper, you can write down 20 original ideas each day”.
60 VI. Surgical Training50% of fellows in General Surgery spend time in experimental laboratoriesTraining 7-8 yearsEarn PhD in basic scienceInstructor at 5 or 6th year
63 VI. OHW View of Role of Professor TeacherSurgeonInvestigatorSide-line cheerleaderRegimental water carrierCreate an atmosphere friendly to learningAbility to recognize every type of talent
64 VI. Lessons for Time In Europe 1927-1928 Only two laboratories actually doing experimental work:Eugene Enderlen – HeidlebergDavid Wilke – EdinburghFeels no department head can neglect the experimental laboratory
65 VI. Philosophy of OHWThe University offers the perspective full-time clinician who professes to follow the academic line the opportunity of making something of himself. He must take care not to become to absorbed in making something for himself.
66 VI. OHW: Student Involvement Creation of the James E. Moore SocietyFor Scholarship in Medical Students12 Senior students12 junior studentsMonthly meeting at Professor homesSeniors present research papers1st Dr. Wangensteen’s home
67 VII. Summary Farm boy from rural Minnesota Inspiration from father George E. Fahr M.D. – excitement for learningEuropean trip – research needOrganization of departmentMultiple Scientific AdvancementsEducational innovations
71 BibliographyWangensteen OH: Impressions from A Surgical Study Trip Aboard. Minnesota Medicine 1929; 12:Wangensteen OH: Education of a Surgeon. J. Med. Educ.1960; 35:Wangensteen OH: The Minnesota Experience in Surgical Graduate Education Surgery 1960; 48:Wangensteen OH: The Fascination of Scholarship and Research: Their Importance in the Education of Surgeons. J. Surg Res.1961; 1: 5-7Wangensteen OH: The Therapeutic Problem in Bowel ObstructionsCharles C. Thomas 1937 Springfield, IL
72 Wangensteen OH: Glimpses of the University of Minnesota Surgery Department. Journal-Lancet 1963; 83:Wangensteen OH: Then and Now – The Surgical Arena Three Decades Ago. Journal- Lancet 1957; 77:Dietzman R: James Edward Moore: Educator and Surgeon.The Journal Lancet April 1963: