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By Tim Brady On a desperate night in 1931, a patient at the University of Minnesota hospital lay critically ill following surgery. Her intestine was obstructed, causing the walls of the organ to become distended. The distension threatened the circulation of her blood, which could quickly prompt a gangrenous response and, in a very short time, take her life. The condition is a frequent occurrence following abdominal surgery or injury when the intestine becomes twisted, folded, or kinked. In the 1930s, the standard protocol in this situation was immediate surgery to remove the blocked section of the intestine. Surgery carried other risks, however, including the possibility that the contents of the bowel would spill during the procedure and cause infection. But without treatment, the distension could grow until the bowel ruptured, killing the patient. Owen Wangensteen (B.S. ’19, M.D. ’21, Ph.D. ’25), the recently appointed head of the Department of Surgery at the University of Minnesota, had been pondering this problem for some time. His experiments had led him to look for alternative ways to release the pressure of gases and fluids in the body—the source of the distension. If these were drawn off, went Wangensteen’s theory, the need for further surgery would be alleviated and the intestine might begin the process of healing. The problem on that night in 1931 was that no device for drawing off these fluids and gases yet existed. So Wangensteen improvised. He inserted a rubber tube through the patient’s nose and down to her small intestine. He attached the outside end of the tube to a siphon bottle, and to the siphon bottle he attached receptacles for gas and liquid, likewise hooked by rubber hose. After priming the siphon, intestinal fluids and gas began drawing off, flowing into the receptacles, and the patient improved almost instantly. The Wangensteen suction procedure turned out to be just the first sign that an extraordinary individual was making his mark on the history of medicine at the University. But at the time, his contraption seemed too simple a solution for a problem that had confounded surgeons for years. Even after a pump was added to Wangensteen’s basic invention to make the siphoning process easier and more consistent, the medical world was slow to accept the procedure. When World War II began, however, and as stretcher after stretcher carried GIs with abdominal injuries into field hospitals, doubts about the effectiveness of Wangensteen’s invention vanished. Soldiers around the world were saved by Dr. Wangensteen’s elegantly simple invention. Its use became so prevalent that U.S. Army surgical wards were nicknamed “Wangensteen alleys” by staff. By the end of the war, an
For all its success, however, this life-saving invention was only one in a long line of distinguished achievements in Wangensteen’s remarkably fruitful career. In time, Wangensteen would mold a small army of renowned surgeons and send them forth to lead hospital and university surgical staffs around the nation; he would build one of the world’s great surgical departments at the University of Minnesota; and through his guidance and encouragement, the nature of heart surgery would be forever changed by the work of doctors who studied and worked at the U of M. In the rarefied world of academic surgery, Wangensteen is primarily remembered for shaping that remarkable department at the University and mentoring and instructing a generation of gifted doctors, whose names read like a who’s who of post-war surgical giants. There was C. Walton Lillehei (B.S. ’39, M.D. ’41), the great pioneer of open-heart surgery at the University of Minnesota; F. John Lewis (M.D. ’41), who with Lillehei performed the first-ever open-heart surgery; Christiaan Barnard (Ph.D. ’58), the famous South African surgeon who performed the world’s first heart transplant; and Norman Shumway (M.D. ’56), who became chief of cardiovascular surgery at Stanford University. Shumway did the first heart transplant in the United States (soon after Barnard’s South African surgery) and the first heart and lung transplant in the world and became known as the “Father of Transplant Surgery.” All these, and many more shining lights in the surgical arts, were brought to the University of Minnesota by Wangensteen and nurtured by his guidance and instruction. For 37 years, “The Chief,” as his residents called Dr. Owen Wangensteen, ruled the University of Minnesota’s Department of Surgery with a unique blend of medical brilliance, administrative finesse, and an instinctive gift for spotting talent in young surgeons. Wangensteen, with characteristic earthiness, liked to claim that he was just “a plumber of the alimentary canal.” (“I have worked at both ends, but largely in between,” he would say with a smile.) Born in 1898, Owen Wangensteen arrived at the University of Minnesota as a farm boy from Lake Park, Minnesota, a town near Detroit Lakes in the western reaches of the state. As a high school student, he longed to be a veterinarian and battled briefly over the matter with his father, who preferred that his son be a medical doctor. The Wangensteens raised hogs. A particularly hard summer of work on the farm convinced Owen that, as his father had suggested, an easier life awaited him in Minneapolis. “Through the portals of pigs and manure—too much of each—” he would say later, “I became a doctor.” Wangensteen entered the University through a special program established during World War I that allowed for accelerated study
The young Dr. Wangensteen was interested in pursuing surgery, but the University had a limited surgical program at the time. The sole fellowship available in the department was already taken, so Wangensteen accepted instead a $600 stipend as an internist and waited for his chance to study surgery. That came a couple of years later and, once again, Owen Wangensteen shone as a student. In fact, he so impressed the medical school faculty that, by the time he’d earned his Ph.D. in 1925, he was not only appointed as a surgical instructor at the U, he was tapped, over two outside candidates—veteran academic surgeons from Harvard and Johns Hopkins—to succeed Dr. Arthur Strachauer (M.D. ’08), who was about to retire as head of the Department of Surgery. Except no one told Wangensteen of the appointment. The idea of promoting a 28-year-old to such a prestigious position seemed a little outré to the medical school faculty. Besides, Wangensteen was planning to study abroad for the next couple of years. The search committee decided to keep the news of his promotion quiet until his return. Wangensteen left for Switzerland where he studied European surgical techniques and began researching intestinal obstructions, not knowing that his future had been decided. Wangensteen came back to a program that consisted of three clinical teachers, including himself; one surgical fellow; and 17 part-time clinical professors who were all surgeons in private practice. The budget was $30,000. When Wangensteen finally received his official appointment in 1930, his first move was to boost the department funds and he did so by ruffling the feathers of those 17 part-timers. He politely suggested that since all had a private practice of their own, perhaps they would be willing to donate their University honoraria back to the department. Despite serious griping, most acquiesced and the budget slowly began to climb. Wangensteen would prove to be quite adept at coaxing generosity toward his department. A few years after he was established in surgery, he left staff scratching their heads by deciding not to bill some of the more affluent clients seen at the hospital. His request that they “give something for research instead” would turn out to be a very successful means for raising more funds than a simple fee. Wangensteen was a tremendously hard worker and encouraged the same trait in his students. “Life presents very few bridges to help us over the morass of daily confusions, difficulties, and obstacles,” he wrote. “In our climb, each of us must erect his own Jacob’s ladder. There is no escalator to success.” His day typically began at about 3 in the morning and ended late. A voracious reader, it was claimed of Wangensteen at the time of his retirement in 1967 that no one at the University of Minnesota had checked out more books from the library system. (His
The Chief emphasized rigorous training in basic science as well as much work in the lab. Unusual for a university department of surgery was its emphasis on postgraduate research, which led to scores of Ph.D.’s and M.D.’s matriculating from Wangensteen’s department to academic posts across the nation. His eye for talent was exceptional, and according to one of his most brilliant students, C. Walton Lillehei, often based on intuition. “If he was convinced that a candidate had a good brain and a capacity for work, he would say on the spot: ‘When can you start?” Lillehei said. “Such matters as who he was, where he went to school, and character references were considered irrelevant.” He was tough on his protégés but could be extremely generous with his time and support. Christiaan Barnard remembered that “his demands were so severe, his standards so unyielding, that often I left his office with tears streaming from my eyes.” But when the South African earned his Ph.D. in 1958, he was called into Wangensteen’s office and told that he would need some proper equipment and research funds if he was to do advanced surgery in Cape Town. Wangensteen made a phone call to the National Institutes of Health on Barnard’s behalf, and the future transplant surgeon left Minneapolis knowing that $2,000 in research funds and a heart-lung machine awaited his arrival at the University of Cape Town Medical School. Wangensteen was a fearless risk-taker and encouraged experiment and innovation in the department. When word spread that Lillehei was looking to perform open-heart surgery by means of cross-circulation with a human donor, considerable opposition to the procedure arose in the Medical School; but when an acceptable donor appeared for the surgery and Wangensteen was notified, he sent a note that Lillehei kept for years afterward: “Dear Walt,” it read, “By all means, go ahead! Good Luck! O.H.W.” Wangensteen also made contributions in cancer surgery and in the understanding of gastrointestinal tract disorders. Through the course of his long career, Wangensteen earned a boatload of honorary doctorates, was a president of the American College of Surgeons, and was an honorary member of the Royal College of Surgeons of England. He founded the Surgical Forum of the American College of Surgeons in 1940—it would become a vital means for surgeons around the country to keep abreast of each other’s work. A prodigious writer, Wangensteen authored more than 900 articles in his career and kept writing after his retirement in 1967. With his second wife, Sally, a medical historian, Wangensteen wrote a lengthy history of surgery, The Rise of Surgery: From Empiric Craft to Scientific Discipline, published in 1978 by the University of Minnesota Press. (Wangensteen and his first wife, Helen, divorced in 1954. Together they had three children: Stephen, Owen, and
Of all of Wangensteen’s successes, however, perhaps the most remarkable was the simple reach of his mentoring. By the time Wangensteen retired in 1967, nearly a thousand surgeons had gone through the Department of Surgery at the University of Minnesota. Of those, more than 150 were serving on faculties across the nation and the world, as either heads of surgical departments, full- or part-time professors of surgery, or surgical fellows engaged in academic surgery. The department that had had three full-time staff members when he took over in 1930 had grown to a total of 167 faculty members and an additional 180 surgical fellows when he departed. An article in the New York Times from January 1968 lauding the heart transplants performed by Shumway and Barnard—and by extension Wangensteen and the University of Minnesota—summed up The Chief’s legacy quite nicely: “There are a bunch of little Wangensteens all over the country, highly motivated, working day and night, trying to do the impossible.” The first and genuine Wangensteen died of a heart attack in January 1981. Tim Brady is a regular contributor to Minnesota. He lives in St Paul. Body of Work
Located on the fifth floor of Diehl Hall at the University of Minnesota, the Owen H. Wangensteen Historical Library of Biology and Medicine represents one of the great passions of Dr. Wangensteen. A collection of some 70,000 rare books and journals, the library was amassed primarily through the dedication and foresight of Wangensteen and his wife, Sally, who was a medical editor and member of the History of Science Department faculty. The library is one of the world’s best of its kind and includes a cornucopia of precious volumes, letters, journals, and artifacts that stretch back to the 15th century. Its shelves groan with medical learning, from Padua during the Renaissance, to Edinburgh in the 18th century, to Paris in the early 19th century, to Germany in the late 19th century. The Wangensteen library holds a full cupboard of medical subjects, including a 15th century volume on hygiene (the Regimen Sanitatis Magnine Mediolanensis de Mayneri Mayno), the groundbreaking anatomy textbooks published by Jacopo Berengario da Carpi (1521) and Andreas Vesalius (the library has editions from 1568, 1604, and 1642), and the 19th century “school of surgery” books published by the German doctor Theodor Billroth, who was a particular favorite of the library’s founder and namesake. The library has strong collections on surgery, pharmacy, cardiology, anatomy, obstetrics, pediatrics, orthopedics, ophthalmology, and public health. It also maintains a natural history collection that includes a first edition copy of Darwin’s Origins of the Species.
Open to the public since 1961, the Wangensteen is visited by medical students, young artists interested in taking a peek at the anatomical studies (including some by Albrecht Durer in a 1528 text), and women’s studies classes charting the progress of female health concerns. But it is not exclusively the province of higher education scholars. “Some of my favorite researchers are seventh graders who come here for History Day studies,” says library curator Elaine Challacombe. Obviously, a great number of books and manuscripts at the Wangensteen are precious, rare, and costly. Near the top of the list are the texts of Vesalius and Berengario. Berengario’s book, published within 75 years of Gutenberg’s Bible, was the first anatomical treatise to employ illustrations in the age of the printing press. Vesalius’ work, De humani corporis fabrica, first published in 1543, represents a giant leap forward in the study of anatomy from Galen, the famed Greek doctor who lived in the 2nd century. A strong advocate of the necessity of dissection for the understanding of the human body, Vesalius’ text corrects some of Galen’s misconceptions about the functions of the human body that were still current in the 16th century. The text is accompanied by stunning woodblock engravings from a student of Titian. The descriptions of the workings of the body, with their detailed illustrations, were so advanced for their time that new editions of the book were published all the way up to World War I. When the Owen H. Wangensteen Historical Library of Biology and Medicine first opened its doors to the public in 1961, it held 3,000 volumes of rare medical texts collected over the years by Wangensteen and other medical faculty at the University of Minnesota. Until his death, Wangensteen continued to build the collection by personally adding books to the library and, even more important, by successfully raising funds and establishing a $1 million endowment that provided a means for it to thrive into the present. Over the years Wangensteen and Sally hosted so many fund-raising gatherings in the library’s reception room that Sally would say that the library was built “brick by brick, friend by friend, brownie by brownie.” Sally Wangensteen’s role in the growth and success of the library deserves special mention. She lived into her 80s, a dozen years beyond her husband, and worked at the library until her death. “She had a wonderful sense of humor and was a very practical-minded person,” recalls Challacombe, who has been at the library since 1989. “Every year she would winter in Arizona, and before she left she would have a list of things that needed doing ‘in case I don’t come back.’” Sally died in 1994. Through her good work and her husband’s, the Owen H. Wangensteen Historical Library of Biology and Medicine continues to thrive as it preserves the medical knowledge of the ages. For more information on the library, visit www.wangensteen.lib.umn.edu. —T.B. | |||||||||||||||||||||||||||
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