1. Owen H. Wangensteen, M.D. PhD
A Legacy of Scientific and Educational Innovation
Innominate Society
Stanley A. Gall, M.D.
November 8, 2011

3. Owen H. Wangensteen M.D., PhD 1898-1981
Professor and Head
Department of Surgery
University of Minnesota Medical School

4. Goals for Presentation
Early childhood influences
Undergraduate and early academic career
Process leading up to appointment of Department of Surgery
Scientific achievements
Educational evaluation

5. Early Childhood Influences
Born on a form near Lake Park Minnesota – mid north part of the state
Father immigrated to US from Norway in 1881
Mother born on a farm near Lake Park Minnesota – Norwegian parents
Mother died when OHW was 7 years

7. Early Childhood Influences
OHW: prepared to make farming a career
Father was impressed with ability to handle sick farm animals
Delivered some 300 piglets from 50 sows who had trouble farrowing
OHW 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 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”.

10. II. OHW: Academic Process
1919 – Bachelor of Arts
Doctor of Medicine – accelerated due to WWI.
Finished #1 in Medical School
Elected 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 Medicine
Great enthusiasm for observation and research
OHW decided he did not want private practice

13. II. Post-Medical School Activities
1924: 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

15. II. Surgery Training Continued
1925: OHW returned to University of Minnesota and became the chief resident in Surgery at UMH
1926: 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 faculty
1925: Arthur Strachauer, Head resigned
1926: Search committee formed and interviewed three candidates
Frances C. Newton – Harvard
Mont R. Reid – Cincinnati
Owen H. Wangensteen – Minnesota
Newton and Reid: commented “there is nothing worth while here nor will there ever be”.
Medical School groomed OHW

17. II. Surgical Training
1926: Dean Lyons, arranged for a sabbatical leave to travel and study in Europe
Fall 1927-Fall 1928 OHW, wife and 2 yr. old daughter went to Europe
Primary site for research was Bern, Switzerland

19. II. Europe Reflections
OHW: 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 →→ Berlin
Rudolf Nissen →→ Berlin
Martin Kirshner →→ Tubingen
Paul Sudeck →→ Hamberg
Frederick Voelscher →→ Halle

21. II. Work in Bern Switzerland
Professor Dominique deQuerain
Professor Archer
Published work with deQuerain on “The Blood Supply of the Normal and Diseased Thyroid Gland”.
OHW: Deeply impressed with deQuerain
Recounted: 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 retirement
OHW sent to Europe for maturing and gathering ideas
Found active surgical research labs in Heidelberg and Edinburgh
OHW found German professors totally engaged in clinical activities and private practice

23. III. Road to Chair
1928: Return from Europe – promoted to Associate Professor of Surgery
1930: Appointed Head Department of Surgery
Named full Professor

24. III. OHW View on Operation of Department of Surgery
Felt his only power was the power of appointment
His judgments of whom to elevate to departmental responsibility decided by:
Persons motivation
Persons competence
Interest in research
Interest in teaching
Likely 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:
Absorbing
Engaging
Interest in research
Fascinating adventures and experiences

26. III. Wangensteen’s Chairmanship
1930 start: 1 faculty
2 surgical interns
1 surgical fellow
130 surgical beds
1966 (retirement) 18 interns
100 Surgical fellows
200 surgical beds

27. IV. Basis for Scientific and Educational Achievements
The Team
Owen H. Wangensteen M.D., PhD - Surgery
Maurice Visscher PhD, M.D
Ray M. Amberg - Director University Hospital
Harold S. Diehl – Dean SOM
Minnesota Legislature
“The moons were in correct alignment”

31. IV. Members of the Team Maurice B. Visscher PhD, M.D.
Early work with radioisotopes
Ground breaking research on digestion
: Head Dept. of Physiology
Started weekly meetings with OHW & Dept. of Surgery
Pioneer in Interdisciplinary collaboration
Heart 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 beds
additional 40 beds planned
Pharmacist
Cultivated and experienced excellent working relationship with Minnesota legislature
UMH budget was a line item
Instituted 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 School
Publishes Bulletin of MMF
OHW was 2nd President
Skilled fund-raiser
MMF Scholar ships to Medical students
By 1967 >$10,000,000 channeled to Medical School
Established compulsory TBC and CXR for all patients and personnel in hospital
Established School of Public Health 1944

39. IV. Harald S. Diehl Harald S. Diehl
Affiliation with Veterans Administration Hospital
Established first Distinguished Award for Alumni 1951; Rules and regulations regarding private patients at UMH
Big building program
Psychopathic Hospital unit 1936
Variety Club Heart Hospital 1951
Mayo Memorial Building (14 stories)
Masonic Memorial Hospital 1956
New Biomedical Library 1958

41. IV. Wangensteen and Funding of Research
Management of affluent patients
No bills
Private 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 department
7 fellows state funds
63 fellows USPHS
Friends of Department

49. V. Scientific Accomplishments
Studies in Intestinal Obstruction
OHW – Referred himself as “a plumber of the alimentary tract”, having worked at both ends but mainly in the middle”.
Wangensteen suction device
Revolutionized diagnosis and management
Reduced mortality from 41%-5%

50. V. Scientific Accomplishments
Wangensteens Suction Device
Estimated by Dr. Visscher: saved 100,000 lives by 1960 & 1,000,000 by 1981
Device was never patented
Determined 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 colon
Initiated 2nd “look” for exploring the abdomen at intervals
Introduced concepts of gastric cooling for control of massive hemorrhage
Proposed development of a surgical forum for young residents to publish research results-1941
Developed UM Cancer Detection Center 1948

53. VI. Education Innovation
Affiliation between the medical and Graduate schools at UM
Effected in 1914 with 839 fellows registered (1960)
35% from UMH
15% from VAH
12% from MGH
5% from AH
33% from other hospitals
OHW 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 School
Enlisted friends = Dean Lyon Med School
Lotus Coffman President UM
William J. Mayo
Harsh 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 hospital
If shift had failed it would have been decades to make the transaction

56. VI. Departmental Budgets & Personnel
1930: $30, fellows
1940: 9 fellows
Significant Increase
fellows
Legislative Budget Inc. 500%

57. VI. Growth of Department of Surgery
Depression
Contraction, dissipation, diversion of interest because of war effort
real spirit of the department formed
Part-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 manner
Each faculty afforded staff status and is autonomous
Does not need to consult OHW
Rarely offers gratuitous advise
Each full-time professor controls 15 beds in hospital
Residents 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 Training
50% of fellows in General Surgery spend time in experimental laboratories
Training 7-8 years
Earn PhD in basic science
Instructor at 5 or 6th year

63. VI. OHW View of Role of Professor
Teacher
Surgeon
Investigator
Side-line cheerleader
Regimental water carrier
Create an atmosphere friendly to learning
Ability to recognize every type of talent

64. VI. Lessons for Time In Europe 1927-1928
Only two laboratories actually doing experimental work:
Eugene Enderlen – Heidleberg
David Wilke – Edinburgh
Feels no department head can neglect the experimental laboratory

65. VI. Philosophy of OHW
The 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 Society
For Scholarship in Medical Students
12 Senior students
12 junior students
Monthly meeting at Professor homes
Seniors present research papers
1st Dr. Wangensteen’s home

67. VII. Summary Farm boy from rural Minnesota Inspiration from father
George E. Fahr M.D. – excitement for learning
European trip – research need
Organization of department
Multiple Scientific Advancements
Educational innovations

71. Bibliography
Wangensteen 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: 5-7
Wangensteen OH: The Therapeutic Problem in Bowel Obstructions
Charles 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: