Clinical and Health Affairs
Philanthropy and Scientific Medicine: The History of the University of Minnesota’s Cancer Institute
By Aimee Slaughter and John H. Kersey, M.D.
■ The University of Minnesota’s Cancer Institute was established in 1925 with a gift from the Citizens Aid Society. The Institute was the first cancer hospital in Minnesota, and its focus on patient care, research, and education laid the foundation for the eventual formation of the Masonic Cancer Center. This article describes the origins of interdisciplinary cancer care at the University of Minnesota.
In 1925, the University of Minnesota opened a new Cancer Institute, complete with 50 hospital beds, half a gram of radium, and a state-of-the-art X-ray machine. The Institute was established with a gift from the Citizens Aid Society, under the leadership of Carolyn McKnight Christian, and supported by the Society through the 1930s. The Cancer Institute laid the foundation for the eventual formation of the Masonic Cancer Center in 1991, which is now a National Cancer Institute (NCI)-designated Comprehensive Cancer Center. This article describes the origins of organized cancer care at the University of Minnesota, a history that began more than 80 years ago and involves patients, physicians, scientists, and philanthropists.
Science Meets Philanthropy
The 1920s and 1930s were a time of hope in American medicine and cancer care.1-3 Medicine was beginning to be presented as an explicitly scientific endeavor, in part because of developments such as aseptic surgery and medical X-rays. At the same time, Americans were becoming more concerned about cancer, which was seen as a modern malady. This led to a growing interest in specialized cancer care. By the early 1930s, there were about a hundred cancer hospitals or centers in the United States, according to the count of historian Patrice Pinell.4 Although some of these were small in size and limited in scope, they were part of a growing movement to organize care around cancer.4
In the first part of the 20th century, radical surgery was generally the preferred treatment for cancer. William Stewart Halsted at Johns Hopkins University, for example, championed the radical mastectomy. But some cancers, including some advanced cases that were considered inoperable, responded well to radiation therapy. X-rays and radioactivity were used therapeutically, especially for superficial conditions. However, radiation therapy was still relatively new and not universally accepted by the medical profession, partly because of its novelty and pressure from socially powerful surgeons who were concerned about losing some of their patients to radiation therapists.
Leaders at the University of Minnesota, however, supported the idea of using radiation therapy, sometimes in combination with surgery, and brought on staff with expertise in the area. Dr. Karl Wilhelm Stenstrom, a Swedish physicist with experience in radium therapy, was hired in 1926, and Dr. Leo Rigler was sent to Sweden for a year’s training with world-class radiologists and appointed director of the Division of Radiology in 1927. Stenstrom and Rigler worked together closely, demonstrating how physicists and physicians could share their knowledge of and experience with radiation therapy.
The cancer center might not have gotten off the ground, however, if it were not for the efforts and vision of Carolyn McKnight Christian (Figure 1), president of the Citizens Aid Society. The Citizens Aid Society was founded in 1916 by her father-in-law, grain miller George H. Christian. After the death of her husband, George Chase Christian, from cancer in 1919, she resolved to combat the disease through philanthropic support of research, education, and treatment.
The Society initially provided $250,000 (more than $3 million in today’s dollars) to form the Institute, with $50,000 of this dedicated to the purchase of an X-ray machine and a half-gram of radium, which cost $30,000 (its purchase required additional support from the Howard Baker fund). By the early 1930s, the Society was supporting the Institute with annual gifts of about $8,000.5 This support was essential because the university insisted that the Institute be self-sufficient. (This goal was not always met, however, and the university occasionally approved small, stop-gap gifts and provided several thousand dollars a year as well from 1932 to 1934.) In addition to their financial support, the Citizens Aid Society and Christian helped chart the course of the Institute. “The gift places a new emphasis upon thoroughly scientific investigation and methods of treatment of one of the dread ailments of humanity,” wrote University of Minnesota President Lotus Coffman in a letter to Carolyn McKnight Christian on April 17, 1923.6
A First of its Kind
The Cancer Institute was unique in that it had a combined commitment to patient care, research, and education. It was state-of-the-art in its approach to caring for patients. The Institute employed “scientific medicine,” which referred not just to its use of the new radiation therapies but also to its methods for managing patient care. There was systematic record keeping, and physicians made informed treatment decisions based on pathology reports and other standardized, easily trackable and comparable information in those records. It also used state-of-the-art equipment. With funding from the Citizens Aid Society, the Institute installed new X-ray machines in 1930 and in 1938, ensuring that patients would receive modern care and that students would train with the most current equipment. Most of the patients treated with the deep (200 kV) X-ray were cancer patients; superficial (100 kV) X-ray was used to treat those with skin cancer. (Patients with nonmalignant conditions such as acne and plantar warts were also treated with superficial X-ray.7)
The Institute’s supply of radium was kept in a radium emanation plant (Figure 2), a common practice at the time. The plant was set up by one of the leading radium therapists of the day, Dr. Gioacchino Failla of what is now Memorial Sloan-Kettering Cancer Center in New York.8,9 Radium continually decays into radon gas, then called radium emanation. Radium emanation plants processed the radon and collected it in tiny glass needles or seeds, which were then implanted into tumors. Because of radon’s short half-life, using radium emanation seeds allowed for safer and more manageable treatments compared with using radium salts, which were originally used for radium therapy.
The vast majority of patients treated with radium emanation at the Institute had uterine or breast cancers. These cancers were comparatively easy to access with the radium emanation needles, and radiation therapy did not entail disfigurement or the removal of surrounding organs or glands, as surgery often did. There are no long-term records for these patients, so we cannot know how they ultimately fared. However, based on the records of other radium therapists, it is clear that if carefully applied, radium emanation was effective in reducing or eliminating some tumors, in some cases for many years. Physicians at the time had every reason to be optimistic about the possibilities of radium therapy and were hopeful that by providing an alternative to surgery for some cancers, patients would be less fearful and more willing to consult their doctors if they were concerned about any changes in their physiology. In many ways, radium therapy laid the groundwork for the therapeutic use of radioactive isotopes, a practice that spread after World War II and continues today.10
Another important component of the modern scientific medicine the Institute offered was systemized record keeping; its record system was developed by Lillian Dahl, who acted as secretary, receptionist, X-ray technician, film processor, and radiographer. Social work was another valued facet of patient care at the Institute; Lucille Amiotte was hired in 1936 to assist cancer patients and their families with concerns that went beyond their immediate medical needs such as arranging accommodations for those who came from out of town and setting up home care for patients leaving the hospital. The Cancer Institute had strong ties with the pathology lab, which was under the direction of Dr. Rudolph Koucky, whose salary was paid by the Society. The number of pathology samples studied each year grew from 645 in 1925 to 3,785 in 1935, and the majority of the work done in the pathology lab was related to cancer.9
Beyond Patient Care
In 1935, the Cancer Institute reported that during the previous five years it had treated 485 patients with uterine cancer, 415 with breast cancer, 217 with skin cancer, 200 with lip cancer, 147 with prostate cancer, and 967 with other cancers.11 (Those numbers do not represent all cancer patients treated by the hospital, only those admitted through the Cancer Institute.) By the end of the 1930s, the Institute was treating more than 1,000 new patients a year.
Although patient care, whether in the form of treatment or palliative care, was the Institute’s primary focus, some physicians and staff found time for research and outreach as well. Several physicians collaborated, for example, on animal studies on possible causes of cancer. And although comparatively little breakthrough research took place, the Institute’s educational efforts—aimed both at professional and lay audiences—were widespread and influential. The physicians and scientists associated with the Cancer Institute taught courses to University of Minnesota medical students that covered topics including pathology, roentgenology, biophysics, and radiation therapies. They also helped train residents; for example, Stenstrom and Rigler had a three-year program to cooperatively train residents in roentgenology and radium therapy.9 In addition, physicians associated with the Institute spoke at professional conferences, and the Institute hosted leaders in the field who gave addresses on various topics.
The Institute’s physicians also were heavily involved in educational outreach, working with the Citizens Aid Society to distribute pamphlets and give lectures about cancer prevention and treatment. Some gave addresses on WCCO radio. Between 1928 and 1936, pathologist William O’Brien gave 400 radio talks, and cancer was the subject he most frequently discussed. He also gave more than 400 live lectures to civic, professional, religious, and other groups, reaching a total audience of more than 90,000 people.9 Those outreach efforts were particularly important because at the time, cancer carried a large social stigma and was seldom discussed publicly, a reticence that was just starting to change thanks to the efforts of national organizations such as the American Society for the Control of Cancer and local campaigns such as those of the Cancer Institute.
Organizational Challenges
One challenge for the Cancer Institute was the fact that it had no formal department or division status within the medical school. Most of the providers at the Institute held appointments within other departments or divisions, and this distributed organization was often a source of confusion. For example, in 1929, four years after the Institute was founded, the medical school dean, Dr. Elias Lyon, wrote to university President Lotus Coffman asking if he, as dean, or Arthur Strachauer, as director of the Institute, had ultimate say over Cancer Institute decisions.12 The status of the Institute became more uncertain after Strachauer’s retirement in 1930. The Institute was without a director for two years; its affairs were managed by a group of affiliated faculty, sometimes under the informal guidance of chief of surgery Dr. Owen Wangensteen.
In 1932, after consulting with Cancer Institute providers, Dr. Richard Scammon, then dean of the medical school, appointed a five-member committee to direct the Institute, in a way codifying the practice of the previous two years. This committee sent its last three-year report to the Citizens Aid Society in 1939 (the Society had agreed to a three-year funding cycle in 1935); the next report was written in 1942 by medical school dean Dr. Harold Diehl. This appears to have been the last report filed. That report mentioned a 1938 “plan of the Department of Surgery to somewhat decentralize the cancer service”—a plan that appears to have been implemented.13 Cancer care continued to be provided, but it was under the purview of the department of surgery. The Cancer Institute, as an organizational structure, had been dissolved and absorbed. The Citizens Aid Society continued to support the efforts of the University of Minnesota in combating cancer, endowing the George Chase Christian Professorship of Cancer Research, held first by Dr. John Joseph Bittner in 1943.
Conclusion
The University of Minnesota’s Cancer Institute reached thousands of Minnesotans in the 1920s and 1930s with its commitment to scientific cancer care, research, and outreach, which at the time was unique in the state. Its work was recognized in 1937, when the newly created NCI, as part of a larger program designed to train physicians in surgery and radiation therapy, granted support to five fellows at the University of Minnesota, beginning a research tradition that continues to this day.
In many respects, the Cancer Institute was on the leading edge of medical and social efforts to fight cancer. It had a matrix structure, a director with authority, philanthropic partners, institutional support, and a multidisciplinary approach to care and research—all qualities that are found in current NCI-designated cancer centers including the University of Minnesota’s Masonic Cancer Center. MM
Aimee Slaughter is a Ph.D. candidate in the University of Minnesota’s History of Science, Technology, and Medicine Program. John H. Kersey is founding director emeritus of the University of Minnesota’s Masonic Cancer Center.
References
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