- Welcome to the Department of Surgery
- UTHSCSA and the Department of Surgery historical timeline, including photos
- Dr. Arthur McFee's history of the Department of Surgery
- Dr. Arthur McFee's history of the Health Science Center
- Dr. Arthur McFee's history of the City of San Antonio in relation
to UTHSCSA and the Dept of Surgery
- July 12, 2004 lecture / presentation by Arthur McFee, MD, Professor Emeritus, UTHSCSA Department of Surgery (very large RealVideo file - 103mb)
- Past Chairs and Faculty
History of the development of the Department of Surgery
With gratitude to Arthur S. McFee, MD, Professor Emeritus
UTHSCSA Department of Surgery
It is interesting that in all the hectic developmental activities and events for the university as a whole, the department of surgery has been an island of some calm and stability. Owen H Wangensteen, MD, was Chief of the Department of Surgery at the University of Minnesota from 1931 to 1967. He died in 1982. Dr. Wangensteen stands firmly in the ranks of the 3rd generation of major surgical educators in this country. Halsted alone was the first generation; his trainees the 2nd; and a small group which included Owen Wangensteen, and others the third. He built, from very meager beginnings, an extremely formidable department producing more than thirty professors and several chairs.
His position in American Surgery is assured and memorialized in the Surgical Forum of the American College of Surgeons which he fostered and which bears his name.
Dr. Wangensteen is the professional grandfather of this department. He was indeed an individual to whom much of the rigamarole of surgical education today would be foreign. Much of what he did was without guidelines, and without interference from agencies and committees; and much was good. An abiding aim in his thinking was that clinical problems could be successfully dissected in the laboratory and by investigation. He fostered much excellent research which helped to build the profession as we know it.
If Dr. Wangensteen was our professional grandfather, there were several professional fathers. Dr. Aust was named chair in July 1965, 18 months before the controversy over hospital annual funding erupted. His first recruit was Dr. David Root who actually came to San Antonio before Dr. Aust in April 1966. Early faculty members included Dr. Anatolio B. Cruz, Dr. Carlos Pestana, Dr. Waid Rogers, and Dr. Arthur McFee. All these individuals were in General Surgery. Dr. Leo Cuello came in Cardiothoracic Surgery and Dr. Jim Story in Neurosurgery. A recent retiree from the Air Force, Dr. Charles Rockwood, came in Orthopaedics. All of these individuals except Drs. Pestana and Rockwood came from the University of Minnesota. Most of these people knew one another fairly well and had established a comfortable working relationship over several years. To be able to assemble such a homogenous group in recruiting is rare if not unique. The fact that, with the exception of Dr. Cuello who left in 1972, the group stayed intact for over 30 years is even more remarkable. The group had the very enviable task of establishing a university surgical department where none had existed before. In essence, we could write our own rules; we had much enthusiasm and enjoyed an aura of 'anything can be done'. Interestedly enough, in 2006, with the exception of Dr. Story who has fully retired to a ranching existence, all of the individual initial members of this group maintain some contact with the department.
In the years preceding the establishment of the medical school a surgical house staff had existed at the Robert B. Green Hospital since its reconstitution in1955. In this institution the surgical staff was volunteer and unpaid. The house staff was free and unrestrained. The Chief was Dr. Albert Hartman, a prominent local surgeon and a relatively scholarly person whose standards and devotion produced some very capable surgeons. The house staff in general was free from restraints and regulations accepted as routine today. They were independent agents for administrative and clinical decisions. The first step in imposing some degree of order on this chaos fell to Dr. Root, as a true 'Lone Ranger' in 1966. Quite understandably, his effort were not met with much enthusiasm by the house staff; and some years were needed to develop a straightforward program. Up to 1967, candidates at that hospital received their credentials from the hospital district. The 1st graduate of the University of Texas Medical School Department of Surgery was Dr. Hermann Wolff in 1968.
The 1st phase of department development lasted approximately one and one half decades from 1967-1982. It is a bit difficult without being maudlin to describe the general feeling then. There was an aura of something new, something that we were shaping, and the attendant euphoria was palpable. The fact that Hemisfair took place from April to October in 1968 only reinforced this feeling. Circumstances also reinforced the sense of exploration. There were few staff. The population served was growing. Of necessity, much individual responsibility was delegated to housestaff because it had to be. The ABSITE was in the future as was recertification. In the 1st decade of our existence, we were privileged to graduate a number of extremely capable individuals who could assume independent responsibility very easily since they had already done it. In 1974, in the midst of this period, the Aust Society was born. It noted its 32nd annual meeting in 2007.
Since 1975, requirements on training programs have constantly increased and to my mind not to the uniform benefit of trainees. Our case load has gone from 4,000 - 5,000 per year in nine rooms in 1968 to 15 - 16,000 per year in seventeen operating suites plus a Veterans Administration load of additional 6,000 cases. In 2000, the responsibilities of a surgical load at Wilford Hall with its trainees was added. The obligations of the ABSITE, recurring residency review at stated intervals, and recertification demands have all been added in the past 3 decades. Growth has been inevitable but real education is frequently lost in administration.
Our initial department included every surgical division - amazingly in a fair degree of harmony. Over the years, we have fostered a number of new departments; Orthopaedics first, Otorhinolaryongology, Urology, Neurosurgery as part of a Neural Center, Ophthalmology, and Oral Surgery. Several divisions have developed that did not exist in the beginning: Colon and Rectal Surgery, Trauma and Emergency Surgery, Vascular Surgery, Transplantation. In 2006 the department in spite of these disparities was larger than ever. With such development, it is inevitable that the spirit of initial unity would diminish simply because each area articulated different needs and aims. One cannot escape the fact however that each of these departments was born in Surgery.
Occasionally, a situation arises that provides an unique environment. The 1st phase of our departmental development was one such. There were relatively few staff and the photograph of 1986 shows many of the original group together after a decade and half. The feeling of unity was still evident and shared by the house staff; for some years afterward, everybody felt that they were participating in a creative venture and it had to be good. The real closeness of faculty and staff would only grow more distant with time with expansion and with the generally unwelcome imposition of more and more rules and regulations. For those who experienced those years the memory is always fresh and characterized our being in the right place at the right time.
A second phase of development could be dated roughly between 1982 and 1995. It was marked by much of the aforesaid expansion and regulation. More and more responsibility was shifted from the house staff to the faculty which is, I believe counter productive in developing professionals who must think quickly and act on their conclusions. The core nucleus of faculty did remain intact and was responsible for a certain persistence of homogeneity in the department. This phase can be said to have lasted until Dr. Aust retired in 1995.
In a third phase, Dr. Aust was succeeded by Dr. William E. Strodel III. For a number of reasons, this phase became a very difficult time. At his installation he had been charged with expansion, development and recruitment. Much research activity was brought to the department at considerable expense at a time when school-wide collections for clinical work were dropping. At the same time, the governmental fine fell on the school; a high percentage of this fine was assigned to Surgery. This particular event did as much to dispel the remaining feeling of enthusiasm and unity as anything. We became another contracted entity doing business with the government and in so doing became liable to be accused of and prosecuted for fraud.
In the midst of this phase, we effected union with the Department of Surgery at Wilford Hall, which was not welcomed by either the house staff at our institution or that of Wilford Hall. Nearly five years had passed since that union was effected in 2000, and much of the original feeling had been overcome. This phase, for a variety of unrelated reasons, became one of exceptional stress. Dr. Strodel was obliged to address many problems, several of them not of his making and some rising from our own administration's decisions. In 2001, he stepped down and was succeeded on an Interm basis by Dr. Glenn Halff.
Dr. Halff's tenure lasted until August 2005 and, with its close, the 3rd phase ended. It was marked by very quiet accomplishments; the completion of amalgamation with Wilford Hall, the retirement of the departmental debt to the government and a good deal of internal reorganization.
A fourth phase was inaugurated in August 2005 with the arrival of Stephen M. Cohn, MD. It was marked by much activity, reorganization, new projects and recruitment. It underscores the fact academic departments are vital groupings, healthiest when growing and unafraid to assume new responsibilities and challenges.
In the fall of 2008, Dr. Cohn stepped down as Chairman of Surgery. Ronald M. Stewart, MD, Chief of Trauma and Emergency Surgery, and the Jocelyn and Joe Straus Endowed Chair in Trauma Research, assumed the leadership helm as Interim Chair, and in April 2011, was appointed Chair of the Department of Surgery. Dr. Stewart attended medical school here at the Health Science Center, as well as completing the department's general surgery residency program and the Division of Trauma and Emergency Surgery's critical care fellowship. On completion of the critical care fellowship, Dr. Stewart joined the department's Trauma faculty, and has been a resourceful, intelligent, and steadying influence on our department for more than 15 years.
The lessons of the past more than 40 years have shown us the value of stable facilities, the inevitability of growth and change, and benefits that can derive from fostering other areas. The department itself has grown along with its children, and is a remarkable attestation to the fact that the future is always there.