Edward William Alton Ochsner kept a plain, metal card file in which he recorded close to 50 years worth of medical experiences, research, and insights. The most populated topics were filed as  Cancer, Lung  and  Cancer, Bronchogenic.  These reflected his areas of greatest interest, for which he would go on to produce groundbreaking work. Of his many lifetime accomplishments, he is perhaps best known for being the first to report a link between cigarette smoking and lung cancer. This was just one of the many ways in which Ochsner worked to effect social change. The establishment of the Ochsner Health System in New Orleans was born from this similar passion. Ochsner went on to become one of the giants of his generation as a result of this tireless work as a leader, educator, and mentor

Costantino, MD, Christina L.

Cowan, MD, Scott W.

Winter, MD, Jordan M.

Yeo, MD, Charles J.

English

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Surgery, Gibbon Society HistoricalProfiles Department of Surgery6-1-2015Alton Ochsner, MD (1896-1981): surgical pioneerand legacy linking smoking and disease.Christina L. Costantino, MDThomas Jefferson University, christina.costantino@jefferson.eduJordan M. Winter, MDThomas Jefferson University, Jordan.Winter@jefferson.eduCharles J. Yeo, MDThomas Jefferson University, Charles.Yeo@jefferson.eduScott W. Cowan, MDThomas Jefferson University, Scott.Cowan@jefferson.eduLet us know how access to this document benefits youFollow this and additional works at: http://jdc.jefferson.edu/gibbonsocietyprofilesPart of the History of Science, Technology, and Medicine Commons, and the Surgery CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Surgery, Gibbon Society Historical Profiles by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationCostantino, MD, Christina L.; Winter, MD, Jordan M.; Yeo, MD, Charles J.; and Cowan, MD, ScottW., "Alton Ochsner, MD (1896-1981): surgical pioneer and legacy linking smoking and disease."(2015). Department of Surgery, Gibbon Society Historical Profiles. Paper 28.http://jdc.jefferson.edu/gibbonsocietyprofiles/28Surgical HistoryAlton Ochsner, MD (1896–1981): SurgicalPioneer and Legacy Linking Smoking and DiseaseCHRISTINA L. COSTANTINO, M.D., JORDAN M. WINTER, M.D., CHARLES J. YEO, M.D., SCOTT W. COWAN, M.D.From the Department of Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia,PennsylvaniaEdward William Alton Ochsner kept a plain, metal card file in which he recorded close to 50 yearsworth of medical experiences, research, and insights. The most populated topics were filed as“Cancer, Lung” and “Cancer, Bronchogenic.” These reflected his areas of greatest interest, forwhich he would go on to produce groundbreaking work. Of his many lifetime accomplishments,he is perhaps best known for being the first to report a link between cigarette smoking and lungcancer. This was just one of the many ways in which Ochsner worked to effect social change. Theestablishment of the Ochsner Health System in New Orleans was born from this similar passion.Ochsner went on to become one of the giants of his generation as a result of this tireless work asa leader, educator, and mentor.B ORN ON MAY 4, 1896 in a modest home at Kimball,South Dakota, Ochsner (Fig. 1) was the only sonof seven children. An intelligent young man with bothpoise and discipline, he paved his own path of success.Ochsner excelled in academics from an early age. Hegraduated from the University of South Dakota in 1918and subsequently pursued a career in medicine. At thattime, his cousin, Albert John Ochsner (AJ Ochsner here-after) was a prominent Chicago surgeon who stronglyinfluenced Alton Ochsner’s medical course and surgicaltraining. His cousin recommended that Ochsner matric-ulate at theWashington University School of Medicine inSt. Louis. Heeding his cousin’s advice, Ochsner receivedhis MD degree in 1920, followed by one year of trainingin internal medicine at the Barnes Hospital.1Ochsner then began his surgical residency trainingunder his cousin, AJ Ochsner, who played a large rolein shaping his mentee’s work ethic and professionallife as a young surgeon.1 During his surgical training,AJ Ochsner arranged for Alton to spend time in Europereceiving arguably the world’s most advanced surgi-cal training under the tutorship of Professor PaulClairmont in Zurich and Professor Victor Schmieden inFrankfurt.1 During his time there, Ochsner introducedto his European colleagues the concept of bloodtransfusions and widely became a resource to otherslearning in Europe.2 It was during these two years thatOchsner met and married Isabel Kathryn Lockwood.Together they had four children, three of which weresons who grew up to be surgeons as their father.1Ochsner’s deep interest in education and researchbrought him to the University of Wisconsin in 1926,where he became a member of the faculty. Ochsner wasjust 30-years old when an extraordinary professionalopportunity presented itself. The renowned and idolizedchairman of surgery at Tulane University School ofMedicine, Rudolph Matas, was readying for retirement.2At that time, the leadership at Tulane advocatedappointing a new chair from outside their network whocould dedicate all their time to the department. Ina controversial and unprecedented turn of events, AltonOchsner at the young age of 31 was offered the positionas chairman of the Department of Surgery at TulaneSchool of Medicine.1 Ochsner accepted this position andwent on to establish a premier academic surgical trainingprogram at New Orlean’s Charity Hospital from whichhe built his lasting legacy.1As chairman, Ochsner founded his surgical departmentbased on both teaching and research that focused on theeducation of residents and medical students alike. It wasin the amphitheater of Charity Hospital that Ochsner’sfamous “bull pen” took place. This event consisted of theintense cross-examination of a fourth year medical stu-dent on making and defending a particular diagnosiswhile hundreds of students and faculty watched.1Ochsner’s idea was to induce psychological stress andforce students to perform well under these circum-stances, as he felt it was an inevitable part of the medicalprofession and was a necessary skill as a physician.1Address correspondence and reprint requests to Scott W. Cowan,M.D., Department of Surgery, Thomas Jefferson University,1100 Walnut Street, 5th Floor, Philadelphia, PA 19107. E-mail:Scott.Cowan@jefferson.edu.547In the 1930s, while at Tulane University, Ochsner in-vited student Michael DeBakey to work in his laboratory.This began a lasting mentored friendship. Ochsnerencouraged DeBakey to pursue a surgical career afternoting his student’s intellect, technical skills, and in-genuity. Dr. DeBakey even served as a babysitter forOchsner’s four children.1It was in 1936 that Ochsner and DeBakey debuted theirseminal work. They were the first to speculate abouta causal relationship between tobacco and lung cancer.3In 1939, in a paper published in Surgery, Gynecology andObstetrics, entitled “Primary Pulmonary Malignancy”,he and Dr. Michael DeBakey reported their findings.In our opinion the increase in smoking with the universalcustom of inhaling is probably a responsible factor, asthe inhaled smoke, constantly repeated over a long pe-riod of time, undoubtedly is a source of chronic irritationto the bronchial mucosa4As the first to document the link between cancerand tobacco, Ochsner was a pioneer in the waragainst smoking throughout the remainder of hiscareer, working tirelessly to expose what he believedto be the health hazards of tobacco.5 He was criti-cized by his peers for this controversial idea butdecades later it would prove to be one of his greatestcontributions.1 DeBakey and Ochsner remainedextremely close throughout the remainder of theircareers. DeBakey went on to train the next generationof surgeons, including Ochsner’s sons, and create hisown legacy as one of the premier surgeons of histime.1FIG. 1. E. W. Alton Ochsner, Sr. Tulane contributions to science and medicine. For more details visit http://www.tulane.edu/;matas/historical/medschool/doctors/ochsner.htm.THE AMERICAN SURGEON June 2015548 Vol. 81One of Ochsner’s most lasting legacies today is theOchsner Clinic in New Orleans. Ochsner outlined hisvision for the new hospital model to a patient’s hus-band who so happened to be the chairman of the boardof Hibernia National Bank.6 His vision was to founda private institution where patients could receive high-quality care concentrated in a single center—a newsystem for delivering health care in the Gulf South thathe could not achieve within the academic setting. Thevision was so clear that Ochsner and his colleagues,Guy Alvin Caldwell, Edgar Burns, Francis E LeJeune,and Curtis Tyrone were loaned the funds from the bankto found the Ochsner Clinic on January 2, 1942.6Due to Ochsner’s leadership within the partnership, thehospital was given his namesake.6 This was the flagshipof the Ochsner Health System that is well known today.Decades later, his presence in New Orleans is still un-matched as the Ochsner Health Care system has evolvedinto the largest private not-for-profit healthcare system inthe region, encompassing eight hospitals and more than38 neighborhood health centers.6In his lifetime Ochsner held many leadership positions,including serving as the president of the AmericanCancer Society and the American College of Surgeons.5His legacy that remains is one of not only just an educatorand innovative surgeon but also a humanist. He receivedthe Distinguished Service Award of the American Med-ical Association for exceptional contributions to medi-cine in 1967.5 In his 1952 presidential address to theAmerican College of Surgeons, he said;While working for the ‘benefit of humanity,’ let us notforget that our work is also for the ‘benefit of the pa-tients,’ the individual men and women who seek us outin their hours of trial and who need compassion andunderstanding as well as scientific care.1Through the decades, Ochsner documented varioussurgical milestones in the course of his career, servedon 13 editorial boards, published six books and con-tributed to 24 more, and published over 500 manu-scripts.6 He predicted the course of surgical teachingand the multi-disciplinary practice of health care in hispublications.5 He contributed to the evolution of spe-cialization by pioneering surgical approaches to car-cinoma of the lung and esophagus, mediastinal tumors,and peripheral vascular disease.2 These techniquesprovided groundwork for the creation of the subfieldsof thoracic and vascular surgery.2 He predicted surgi-cal specialization to be the course of medicine suchthat group practice would prove to be invaluable.5Retiring at the age of 70 as required by clinic rules,Ochsner performed seven operations on his last day asa clinic surgeon. Ochsner made extraordinary contri-butions to surgery and the field of medicine as a whole.However, he frequently said that he would like to beremembered most for his work as an educator andmentor.1 He died in 1981 at the age of 85.1REFERENCES1. Ventura HO. Alton Ochsner, MD: Physician. Ochsner J 2002;4:48–52.2. DeBakeyME. EdwardWilliamAlton Ochsner, Sr. (1896–1981).Surgery 1982;91:3–5.3. DeBakey ME. Historical perspectives of the American As-sociation for Thoracic Surgery: Alton Ochsner, MD (1896–1981).J Thorac Cardiovasc Surg 2005;130:875–6.4. Ochsner A, DeBakey M. Primary pulmonary malignancy.Surg Gynecol Obstet 1939;48:433–51.5. Trotter M. Alton Ochsner’s card file: a profile of medicalhistory. Ochsner J 2012;10:217–21.6. Porter GH. Alton Ochsner. The man and his contributions.Med Clin North Am 1992;76:1007–13.No. 6 PIONEER AND LEGACY LINKING SMOKING AND DISEASE ? Costantino et al. 549

Alton Ochsner, MD (1896-1981): surgical pioneer and legacy linking smoking and disease.

Edward William Alton Ochsner kept a plain, metal card file in which he recorded close to 50 years worth of medical experiences, research, and insights. The most populated topics were filed as \u22Cancer, Lung\u22 and \u22Cancer, Bronchogenic.\u22 These reflected his areas of greatest interest, for which he would go on to produce groundbreaking work. Of his many lifetime accomplishments, he is perhaps best known for being the first to report a link between cigarette smoking and lung cancer. This was just one of the many ways in which Ochsner worked to effect social change. The establishment of the Ochsner Health System in New Orleans was born from this similar passion. Ochsner went on to become one of the giants of his generation as a result of this tireless work as a leader, educator, and mentor

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Alton Ochsner, MD (1896-1981): surgical pioneer and legacy linking smoking and disease.

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