Journal of Investigative Surgery, 20:269272, 2007 Copyright c Informa Healthcare USA, Inc.

ISSN: 0894-1939 print / 1521-0553 online DOI: 10.1080/08941930701595897

HISTORICAL NOTE

The History of Surgery According to Owen Wangensteen

Luis H. Toledo-Pereyra, MD, PhD Michigan State University/ Kalamazoo Center for Medical Studies, Borgess Research Institute, Kalamazoo, Michigan, and Department of Surgery, Michigan State University, East Lansing, Michigan, USA

ABSTRACT Owen Wangensteen (18981981), the great Minnesota surgical master, made a rm and intense dedication to the history of surgery from the early stages of his exemplary surgical career. While in Germany and Switzerland, he learned from distinguished European professors and clearly realized the importance of history on the understanding and appreciation of important surgical problems. In 1928, on returning to Minneapolis, he began his quest to introduce history into many of his clinical and research laboratory works. In 1930, he attained the surgery chairmanship at the University of Minnesota, and there he excelled until his retirement from surgical practice in 1967. Throughout his career and until he died in 1981, the history of surgery was his continuous and persistent companion. In fact, this discipline, the history of surgery, was indeed part of the family, since his wife Sally Davidson Wangensteen was a dedicated contributor to their common papers and the scholarly jewel of their work, the monumental treatise, The Rise of Surgery: From Empiric Craft to Scientic Discipline.
KEYWORDS history, surgery, Wangensteen

May the spirit of inquiry, the love of learning, and appreciation of the History of Medicine create in our medical schools an intellectual atmosphere that will heighten greater medicine commitment and accountability in its service to mankind. (O. H. Wangensteen and S. D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientic Discipline [1]) he legendary Minnesota surgeon Owen Wangensteen (18981980), throughout his prominent surgical career, frequently pondered the virtues of surgical history [110]. He could not understand why some other surgeons, notable or otherwise, did not cultivate the benets of utilizing history in the teaching of surgery and its well-developed principles. The history of the discipline and the men or women who participated on its development were at the forefront of his teachings. The Minneapolis surgical professor maintained that if all medicine from anatomy to zoology could be taught with special emphasis upon the historical approach, our medical students would be better prepared to cope with the
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problems of the future [1]. He was certainly on target and I clearly support his perspective. How can anyone eliminate or deemphasize the value of history in the surgeons profession or in any other eld of medicine or cultivated discipline? Yet history is ignore more frequently than might be expected. Wangensteen was fully aware of this state of affairs!

BRIEF BIOGRAPHICAL NOTE

Owen Wangensteen began his life on the frontier of Minnesota agricultural land, where he was born in Lake Park on September 21, 1898. Of Norwegian ancestors, he grew up on his fathers farm, where he supervised the care of all animals, particularly the pigs, which were abundant. His level of commitment and attention to the care of the animals oriented him toward a career in medicine. The University of Minnesota was his obvious choice for college and medical school. He graduated at the top of his medical school class of 73 students [3]. Dr. Arthur Strachauer, part-time chairman of surgery at the university, convinced young Owen that surgery was where the action was [3]. However, in 1923, there were no surgical intern positions available at Minnesota. Therefore, he interned in medicine for 1 year and immediately thereafter moved to the reputable Mayo Clinic, just 70 miles southwest of Minneapolis. While at the clinic, he specialized in surgery during 19241925, and attended surgical cases with Dr. William Mayo and Dr. Judd. In addition, he spent some time discussing surgical research with Dr. Frank C. Mann [3]. In 1925, when he returned to Minneapolis, he obtained a PhD and assumed the position of chief resident at the university hospital. A year later, he accepted a full-time job as an assistant professor of surgery offered to him by Dean Lyon. In 1927, Wangensteen traveled to Europe to continue his surgical studies. His wife and 2-year old daughter, Mary, accompanied him to Switzerland and Germany. Armed with a recommendation from the renowned Dr. William Mayo, Wangensteen received unequaled attention from all the European masters, Ferdinand Sauerbruch and Rudolf Wissen (Berlin), Martin Kirschner (Tubingen), Paul Sudeck (Hamburg), and Friedrich Voelcker (Halle) from Germany. Professors de Quervain and Ascher from Berne, Switzerland, were his last two important stops. This special European visit constituted one of the best experiences that
L. H. Toledo-Pereyra

Wangensteen could draw on later throughout his surgical life [3]. In 1928, Wangensteen and family returned to Minnesota and immediately he was promoted to associate professor of surgery. Two years later, in 1930, the initiated professor was elevated to chairman of the surgery department at the age of 32 [3]. Wangensteen concentrated on various surgical developments, on training surgical residents on the development of new surgical techniques for use in gastrointestinal problems, and on the exhaustive study of bowel obstruction and the means to solve this frequently fatal condition by introducing nasogastric suctioning. He also advanced the concept of aggressive radical surgery for cancer, and utilized second-look operations for lymph node metastases. Above all, Wangensteen should be recognized as one of the great surgical mentors of the 20th century. During his tenure at Minnesota, an incredible number of his disciples made subsequent discoveries in all surgical disciplines, which were recognized in the United States and eventually worldwide [5]. Countless numbers of his surgical trainees were to occupy the most important surgical positions in the United States surgical universe [3]. The Wangensteen surgical tradition was a shining light for a great number of surgical trainees and continues through the great deeds performed by all the noted disciples of this unique Minnesota surgeon, teacher, and researcher [310].

HOW DID WANGENSTEENS INTEREST IN THE HISTORY OF SURGERY BEGIN?

It is not a simple endeavor to dene the origins of any specic task or interest in the life or accomplishments of anyone, and Wangensteen is no exception. By all appearances the young surgeon visiting Europe, in 1927, developed a taste for the history of surgery. The great European clinics of the day, attended by wellrecognized personalities like Sauerbruch, Kirschner, Sudeck, and Voelcker in Germany, intensied his desire to review the contributions of earlier surgeons who had guided the emerging discipline. Later on, Professor de Quervain in Switzerland reinforced Wangensteens initial desire for historical exploration. Many ideas in the fertile mind of Owen Wangensteen would not be fully expressed until years later, and perhaps some of the ideas waited until his historical career took full force after complete retirement as chief of surgery at the University of Minnesota in 1967 [35].
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Since this European educational trip, it was evident that the surgical specialist had seen with open eyes and accepting spirit the many advances recognized throughout history on European soil. As much as previous European achievements impressed thousands of tourists, the wonders of that continent awed Wangensteen with regard to surgical feats.

HOW WAS WANGENSTEENS INTEREST IN THE HISTORY OF SURGERY SUSTAINED?

Curiosity is an important element in maintaining interest, and Owen Wangensteens curiosity was a prime example since his inquisitive nature never left him. In the same way, his interest in history, particularly the history of surgery, never abandoned him. The extraordinary combination of curiosity and interest guided Professor Wangensteen throughout his life, and frequently these are the forces that nurture all of us in many elds of endeavor. The prodigious memory of Dr. Wangensteen was an asset in recognizing and remembering many important historical facts. This innate ability sustained his appreciation for and interest in the history of surgery [16]. There were no facts that escaped his evaluation, whether they were close or distant in time. He recalled names without difculty and analyzed events easily, as if they had recently occurred [35]. At the top of his game, nothing escaped his attentive response, everything remained under consideration, and, very importantly, all historical facts were alive in his memory. In short, curiosity, interest and a gift for recalling signicant events and personalities fed Dr. Wangensteens intellect and his dedication to the history of surgery. No development in the history of the surgeons arena evaded his attention and consideration.

HOW IMPORTANT WAS THE HISTORY OF SURGERY TO WANGENSTEEN?

Throughout his surgical career, teachings, research, and postsurgical retirement years, Dr. Wangensteen considered the history of surgery as the most special, protable and enjoyable discipline [2]. He could not conceive of surgery without history, and I would add that history could not be created without the benet of surgery. Both are intertwined to the point of complete amalgamation, to the point of complete integration, complete union. History and surgery, though two dis271

ciplines, cannot exist independently, because neither can reach its pinnacle on its own. In one of his classic papers, Dr. Wangensteen addressed the following topic, Has Medical History Importance for Surgeons? [2]. The Minnesota specialist believed that medical history would make the learning process invigorating and pleasurable [2]. He realized that our greatest teachers are numbered among those we have come to know only through the pages of history [2]. He emphasized that teaching history would make our medical students more knowledgeable and involved in the whole surgical enterprise [2]. He recognized the enormous value of surgical history when he stated in his own worthwhile manuscript, I like to think of medical history as an invitation to learning. It is a temptation no surgeon should resist [2]. Professor Wangensteen continued to praise the meritorious value of surgical history, because the social acceptance of the profession is determined in large measure by its accomplishments [2]. The writings and surgical conquests of the past were thoroughly acknowledged by the Minnesota surgeon and great student. In 1978, Dr. Wangensteen and his wife, senior medical historian Sarah Davidson Wangensteen, produced their magnum opus on the history of surgery [1]. With extraordinary diligence and overwhelming care, they both spent unthinkable numbers of hours in the planning, research, development, writing, and rewriting of this unique and outstanding historical manuscript [1]. The Wangensteens dedicated many years of arduous work completing this special scholarly work. Once it was nished, no other work on the history of surgery covered the extensive number of topics referred to in this encyclopedic treaty. The Rise of Surgery: From the Empiric Craft to Scientic Discipline constituted a seminal reference work written mainly from the historical point of view regarding the pathophysiological problems affecting surgical patients and the management of their diseases. From wound management in amputation to debridement, lithotomy, prostatic obstruction, intestinal obstruction, emphysema, ovariotomy, anesthesia, antiseptics, and many more topics, this book analyzed in 785 pages the origins of surgery and related topics [1]. The publication of this splendid treaty by the Minnesota couple left no doubt whatsoever of Dr. Wangensteens determination to position surgery, through its unique history, among some of the most revered and learned professions. No other American
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surgeon since the time of Samuel D. Gross (18051884), had accomplished so much as regards the history of surgery as did Owen H. Wangensteen! As a dedicated labor of love, and with reverence, he traced the specialty he had served for so many years.

PERSONAL RECOLLECTIONS
When I arrived at the University of Minnesota Surgery Program on July 1, 1970, 3 years after Professor Wangensteen had retired as chairman, the aura of his works and developments remained visible through the lives and deeds of his notable disciples. The then upcoming surgical star and now chairman of the Department of Surgery Dr. John S. Najarian (born 1927) had allowed the Wangensteen tradition to ourish and in due time to amalgamate with his own ascending Najarian tradition. The presence of Dr. Wangensteen at many Saturday Grand Rounds gave a sense of historical recollection of a long life dedicated so successfully to surgery. With a spirit of cooperation and understanding of his new position as retired chief, Dr. Wangensteen rarely spoke spontaneously unless asked for his opinion, at which time he offered it with enthusiasm. Respect and camaraderie were the main tenets of the Wangensteen Najarian academic relationship as I saw it. My years at Minnesota (19701976) permitted me to visit with Dr. Wangensteen many times. At this stage, he was fully dedicated to the study of the history of surgery, and was completing his superb work, The Rise of Surgery: From Empiric Craft to Scientic Discipline. I found him to be amiable, pleasant, willing to spend time with me and to help me on any matters that pertained to his area of expertise. He enjoyed researching topics unknown to him or those that were challenging to the understanding of the history of surgery. He was truly a scholar and a kind individual: someone who was easy to work with and who understood the benets of a deep scholarly discussion. In 1972, when I was advancing my interest on the history of medicine as an academic discipline, Dr. Wangensteen was extremely helpful in presenting interesting, new avenues of scholarly historical pursuits. He recommended that I go and talk with Dr. Leonard G. Wilson, the founding chairman of the Department of the History of Medicine. Our informal discussions took me on many worthwhile and exciting roads through the history of surgery. I have always cherished this singular opportunity.
L. H. Toledo-Pereyra

During my surgical residency and my studies in the history of medicine, I often visited with Dr. Wangensteen and frequently spoke with him in the Historical Biomedical Library (now named after him) on the fth oor of Diehl Hall. Every visit was a great and distinct honor, an opportunity to discuss the history of surgery with this extraordinary man of American surgery. At the time, I did not have a well-dened appreciation of his towering presence in American medicine. With historical hindsight, I do now.

CONCLUSIONS
The life and surgical accomplishments of Owen H. Wangensteen remain a lucid example of academic excellence. Of special interest was his commitment to the history of surgery. He delved into the surgical challenges of the day and offered a high-level resolution to surgical problems such as the study and management of intestinal obstruction. He dissected the historical forces that shaped surgical treatment of many of the diseases that were creating high morbidity and mortality. Wangensteen lifted the history of surgery to levels not reached by others surgeons before, except in the writings of Samuel D. Gross. Both Wangensteen and Gross should be remembered as the most distinguished surgical historians of their times. Today we have the likes of Ira Rutkow, a noted surgeon-historian of our era, who has followed in their footsteps.

REFERENCES
[1] Wangensteen OH, Wangensteen SD. The Rise of Surgery: From Empiric Craft to Scientic Discipline. Minneapolis: University of Minnesota Press; 1978. [2] Wangensteen OH. Has medical history importance for surgeons? Surg Gynecol Obstet. 1975;140:434442. [3] Najibi S, Fykberg ER. Owen Wangensteen, A surgical legend and the father of modern management of intestinal obstruction (1998 1981). Digest Surg 2000;17:653659. [4] Leonard AS. A tribute to Dr. Owen H. Wangensteen: The chief. Surgery 1981;88:402406. [5] Peltier LF, Aust JB. LEtoile du nord. An account of Owen Harding Wangensteen. American College of Surgeons; 1994. [6] MacLean LD. Wangensteens surgical forum: A legacy of research. Bull Am Coll Surg. 1993;78:916. [7] Wangensteen OH. Credo of a surgeon following the academic line. J Am Med Assoc. 1961;177:559. [8] Wangensteen OH. The early diagnosis of acute intestinal obstruction with comments on pathology and treatment. West J Surg Obstet Gynecol. 1932;40:117 [9] Wangensteen OH. Historical aspects of the management of acute intestinal obstruction. Surgery 1969;65:363383. [10] Ravitch MM. A Century of Surgery. Philadelphia: Lippincott; 1981.

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