Download - Owen H. Wangensteen , M.D. PhD
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