Owen Harding Wangensteen (September 21, 1898 – January 13, 1981) was an American surgeon who developed the Wangensteen tube, which used suction to treat small bowel obstruction, an innovation estimated to have saved a million lives by the time of his death. He founded the Surgical Forum at the American College of Surgeons (ACS) and was renowned for his surgical teaching. Amongst his most notable students were Walton Lillehei, Christiaan Barnard, K. Alvin Merendino, Norman Shumway and Edward Eaton Mason. He made contributions to surgical practices in other areas, including appendicitis, peptic ulcers and particularly gastric cancer. In his later life, he showed a keen interest in the history of medicine and co-wrote a number of books on the subject with his wife.
Early life
Owen Harding Wangensteen was born in 1898 to Ove Wangensteen and his wife Hannah and brought up on the family farm in Lake Park, Minnesota. His parents were Norwegian-immigrant farmers and he spent his early years working on the farm. He was the second of four siblings, having an older brother Charles, a younger sister Marian, and a younger brother Theodore; all were born at home. As a child, Wangensteen had aspired to become a farmer, but two events led him to change his mind. After the veterinary physician recommended the slaughter of the family's 30 sows that could not farrow, Wangensteen missed three weeks of school to deliver over 300 piglets by manually extracting them. In addition, he once spent a hot summer hauling manure, and later was recalled telling his story about how his quest to study medicine arose "through the portals of pigs and manure."
Encouraged by his father, Wangensteen attended the University of Minnesota where he obtained his BA, MB, MD, and PhD degrees. His PhD thesis was completed at the University of Minnesota in 1925 on the subject of "The undescended testicle: an experimental and clinical study". He completed his surgical training at the University of Minnesota Hospitals. Wangensteen's mother died from complications of tuberculosis. He was a surgical fellow when his father died. Owen and his elder brother, a lawyer, then supported the younger two.
Career Wangensteen was top of his class when he graduated from medical school in 1921. He spent his internship at the Elliot Hospital at the University of Minnesota, followed by a year-long surgical fellowship at the Mayo Clinic under Henry S. Plummer and William J. Mayo. As was common at that time, he pursued further surgical studies in Western Europe. The Dean, Elias P. Lyon, directed him to Bern, Switzerland where he trained under Professor Fritz de Quervain, who had succeeded the Nobel Laureate Theodor Kocher as professor of surgery. Wangensteen was also able to spend time with Professor Leon Asher at the Physiological Institute in Bern, learning research techniques in basic science. His time there taught him the value of historical perspective and the need to question, a philosophy which he would develop into the Socratic method as applied to surgery. After returning to Minnesota he received a promotion from instructor to assistant professor in 1926 at the University of Minnesota. He was appointed chairman of the Department of Surgery in the University of Minnesota in 1930 when he was 32 and was promoted to full professorship the next year. He served as departmental chair until his retirement in 1967, and was succeeded by John Najarian.
Intestinal obstruction In the 1930s, Wangensteen attended to numerous cases of small bowel intestinal obstruction. In around 80% of cases adhesions resulting from previous abdominal operations were the cause of the obstruction. These could often present months to years after the original operation. The standard treatment was to divide the adhesions with further surgery and create a temporary enterostomy. When, as was usually the case, this was performed as an emergency, many patients died. By 1932, Wangensteen reported that suction via a nasogastric tube was as successful in relieving distension as surgical decompression. A year earlier, he tested and proved on an animal model, the hypothesis that it was swallowed air that caused the gaseous distension in the obstructed intestines. He argued that a tube placed into the stomach to remove the swallowed air in the stomach before it entered the intestines, would be just as effective as enterostomy, but without the accompanying morbidity and mortality. He passed a tube through the nose of a very unwell 72-year-old lady who was admitted with acute intestinal obstruction. Once the tube reached the stomach, he attached a suction device to remove swallowed air and stomach liquid, relieving the distension and resulting in relief of pain. She had surgery to relieve the bowel obstruction and recovered. The technique became known as 'Wangensteen suction' and was introduced into surgical practice around the world. Studies demonstrated that the 44% mortality rate for patients treated for intestinal obstruction between 1917 and 1928 declined to 20% in the years 1927–1937. The technique became, and remains, standard practice for the initial management of small bowel obstruction in the context of previous abdominal surgery. A major systematic review in 2008 demonstrated that the suction technique introduced by Wangensteen was successful in 65% to 81% of patients with small bowel obstruction without peritonitis, avoiding the need for surgery. Maurice Visser estimated that by 1944 the technique had saved over 100,000 lives and by the time of Wangensteen's death in 1981, had saved over one million. For this innovative work the Academy of Surgery awarded him one of the highest American surgical honours, the Samuel D. Gross prize. Wangensteen continued work on prevention of intestinal obstruction. He was especially concerned that the powder on surgeon's gloves predisposed to the formation of adhesions. He warned glove manufacturers of its dangers and conveyed the importance of the removal of powders from surgical gloves. Subsequent animal studies and clinical studies confirmed Wangensteen's suspicions that powdered surgical gloves could lead to adhesion formation. The use of such gloves was banned in Germany, then in the UK and banned by the Food and Drugs Administration in the US from January 2017.
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