Dr. Richard DeWall, the inventor of an early heart-lung machine used in cardiac surgery worldwide, played a critical role in the founding of Wright State’s medical school
During four years of surgical residency at the University of Minnesota, Dr. Julie Gilkeson, now a clinical professor in surgery at Boonshoft School of Medicine, handled beakers and pipettes used by Dr. C. Walton Lillehei and other pioneering giants of cardiac surgery.
During two subsequent years as a fellow in vascular and endovascular surgery at Baylor College of Medicine, she saw those same Minnesota names and faces in the background of tributes to cardiac surgery icons Michael E. DeBakey and Denton Cooley.
But it wasn’t until she joined Dayton Surgeons Inc. that the founder and director of the Kettering Amputation Prevention Center came face-to-face with one of her field’s foundational figures, Dr. Richard DeWall.
“One, I didn’t know he was alive,” Gilkeson told the audience at the inaugural Richard DeWall, M.D., Endowed Lecture, delivered last March at the Kettering Medical Center’s Dean Amphitheater.
Two, she had had no notion that, in addition to fashioning a heart-lung machine of a “remarkable, simple, elegant design that changed the world,” DeWall wrote the original and largely unaltered proposal for the founding of Wright State’s school of medicine, using another remarkable, simple, elegant design.
Gilkeson told an audience that included DeWall and his wife, Diane, that meeting such a major figure in her field’s history felt like being dropped from real life into the midst of a video game.
As it turns out, going back in time with DeWall to re-imagine both of his major contributions at times invokes a similar sensation.
A first important discovery
As the woodland seemed to pour through an expanse of sliding glass doors into a back room of his home in the Little Woods area of Oakwood, 88-year-old Richard DeWall speculated that with a brother and two sisters 13, 10, and 9 years older, he might have been “an afterthought or a mistake.”
More clearly, his early life was influenced by a mistake made by a general practitioner in the prairie town of Morris, Minnesota, 150 miles west of Minneapolis.
A botched operation for a bowel obstruction not only deprived then 14-year-old DeWall of his father, an investment banker, who died days later; it also deprived Herman DeWall of the pleasure of watching his youngest blossom into a high school high jumper, the left tackle on Morris’s 1943 championship football team, a senior class president, and the student the yearbook staff singled out as “most likely to succeed.”
DeWall was feeling decidedly less than a success a decade later when, after working to become a general practitioner in Anoka, Minnesota, he made his first important medical discovery.
“I knew it wasn’t for me. I wasn’t cut out to be a GP I just didn’t like it.”
Married and with a “very pregnant” wife, however, he had to carve out a new niche for himself in medicine. He started by taking a model of a mitral valve he had carved from Plaster of Paris to his former instructor, Dr. Richard Varco, at the University of Minnesota Medical School.
From the model and the discussion they had over it, Varco picked up DeWall’s interest in biomedical research and decided to encourage that interest.
“One of his young associates, Dr. Walt Lillehei, had a research lab in the basement,” DeWall said.
Although the lab’s budget had no line item for a research assistant, Lillehei “could pay me as an animal attendant.” DeWall said.
So while Dr. Morely Cohen and later Dr. Herbert Warden performed heart operations on animals to test procedures for human use, said DeWall, “I just got the dogs out of the cages and set them out for surgery.”
Young, damaged hearts
Today, cardiac bypass surgery is most commonly associated with the treatment of adults with obstructions in their coronary arteries.
But in the early 1950s, rubella, also called German measles, had coincided with a baby boom to flood waiting rooms at Minnesota’s largest regional medical center with children who had damaged hearts.
While in basic training during World War II, DeWall himself had developed a heart murmur as the result of “an enormous epidemic of scarlet fever” at the Great Lakes Naval Station north of Chicago. “I think I went in with a company of 120 men, and only half of them graduated on time. The rest were in the hospital.”
Because he’d completed only a year’s service by war’s end and was at risk for induction during the Korean conflict, Dr. DeWall volunteered for alternative service with the U.S. Public Health Service and served at the Marine Hospital in Staten, Island, New York.
After seeing a 15-year-old boy being treated at the hospital for rheumatic valvular heart disease, DeWall found himself asking a basic question: “The heart is fundamentally a pump. Why don’t we just open the pump and replace the valve, because people have been doing that with pumps for 2,000 years?”
That thought led to the plaster model DeWall brought to Varco.
From the animal lab to the OR
DeWall’s first project was to help a surgical team develop what was known as cross-circulation—a technique that would allow surgeons to briefly open and repair a child’s heart while diverting blood around the heart and lungs.
During the operation, a small, calibrated pump was to be used to transport blood through the child’s body, using blood supplied by a donor—presumably a parent—in the operating room. The idea for cross circulation came to Cohen when his wife was pregnant, and he envisioned it as a parallel to a mother providing blood to a growing fetus.
After establishing a successful record of test operations on dogs, the team was granted approval to move the cross-circulation procedure to the hospital operating rooms in March of 1954. DeWall soon followed. “Since I had the experience in managing the pump with the laboratory experiments, I was designated the clinical perfusionist.”
In the course of 18 months, the team performed 45 surgeries on children with good results: 28 patients, or 62 percent, went home, and 49 percent were alive 30 years later. But during 1954, Dr. Lillehei decided the team needed a heart-lung machine of the sort then being developed at the Mayo Clinic and said to DeWall: “That would be a good project for you.”
“I always appreciated it that he gave it to me as an option,” DeWall said. “Of course, I didn’t know anything about it at that time, and I had no training at all,” attributes that aligned perfectly with his supervisor’s wishes.
Lillehei’s two admonitions were: “Don’t use a bubble system” to oxygenate blood, because of its “very poor history,” and “avoid libraries and literature searches” that might lead DeWall to repeat the mistakes of others.
Told to rely on his own mechanical sensitivities, DeWall went to work in the basement lab.
During the ensuing months—lightning speed in comparison to the development of today’s biotechnologies—DeWall leveraged those sensitivities against the fundamentals of engineering, science, and medicine he’d learned in his university education.
To infuse donor blood with fresh oxygen, he experimented with exposing the surface of blood to oxygen in an inclined tube. Practicality led him to substitute a helix for the tube, allowing the same principles to work in a compact design suited for an operating room.
His search for affordable equipment on a shoestring budget led DeWall to flexible tubing a friend of Lillehei was using to pump mayonnaise in a factory. The result anticipated the ingenious devices 1980s television hero Angus MacGyver used in innumerable tight spots.
“Fortuitously, the polyvinyl was very much blood compatible,” DeWall said, unlike commonly used glass tubing, which disrupted blood’s capacity to clot.
The tubing’s flexibility and strength paid additional dividends when DeWall experimented with infusing blood with oxygen under three atmospheres of pressure, enough to enrich the blood plasma itself with oxygen. Part of that strategy proved unsuccessful: The pressure produced the same sort of unwanted bubbles experienced by divers who return too quickly to atmospheric pressure from the pressure under water, an obvious danger to patients.
Along the way, however, DeWall learned valuable lessons about bubble management, among them that bubbles tend to rise to the top in any oxygenating system and can be kept safely away from the patient by drawing blood from the bottom of a reservoir rather than the top. As a result, when DeWall finally decided the only practical way to oxygenate blood was to ignore Lillehei’s admonition and send bubbles of oxygen through a helical reservoir of blood, he was prepared.
DeWall also came up with a practical approach to problems with carbon dioxide, which is 20 times more soluble in blood than oxygen is. Reasoning that fewer large bubbles of oxygen would present a smaller total surface area for reaction than more numerous small bubbles, he fashioned larger bubbles by pumping oxygen through 18 large-bore No. 22 needles pushed through a rubber stopper.
The ultimate outcome of DeWall’s work was reported in 1955 in a medical journal that said surgeons at the University of Minnesota began using “a bubble oxygenator, which costs less than $15 and serves as a temporary replacement for the human lungs during direct-vision intracardiac surgery.”
An important vote of confidence
Both the simple construction and low cost contrasted with a Mayo Clinic model that required four technologists to run and was beyond the financial means of most hospitals. The same characteristics also generated some suspicion.
“Mine was kind of a Rube Goldberg affair,” DeWall told Dr. William S. Stoney during an interview that was one of a series conducted on the history of cardiac surgery by the Annette and Irwin Eskind Biomedical Library at Vanderbilt University Medical School. “It was really bizarre,” looking like “a bunch of tubes kind of gathered in a heap and on a stand.”
“Every bend, and every curve, every piece had a purpose in it,” DeWall added, “but if you didn’t know what the purpose was, it looked very strange and peculiar.”
As a result, many people who tried to replicate it failed, and a major figure of the time urged surgeons not to use it. The criticism would have proven a problem had not Dr. Denton Cooley come to its defense.
Once Cooley reported his great success in using it in 125 cases, DeWall said, “That was the end of the discussion.”
The next step
Use of DeWall’s oxygenator quickly spread around the globe, securing him a place in the history of cardiac surgery.
When the university passed the oxygenator program on to the private sector for production and distribution, DeWall made a more modest move in the smaller world of the operating theater.
Without applying or getting additional training, “I was assigned to the residency program” in thoracic surgery, he said.
Finishing his residency in 1960, he had spent a year on the medical school’s faculty in charge of one of the surgery divisions when an opportunity arose at the Chicago Medical School.
“They needed a chief of surgery down there, and I hoped to just duplicate what we had at Minnesota,” he said. Foremost in his mind was bringing to that medical school Minnesota’s success in being “a great enhancement to the community outside its walls.”
He arrived there in 1962 only to find that, like the job he’d taken years before as a family practitioner in Anoka, it was “not meant to be.”
“I wasn’t mentally or psychologically equipped to deal with the administrative role sitting around at desks.” Furthermore, “I was not well supported in my surgical program.”
A mention of this to a colleague in 1966 initiated a contact with Dr. Paul Kedzie, an internationally known cardiologist who had relocated to Dayton’s Cox Heart Institute. Through Kedzie, DeWall met “an outstanding internist/cardiologist by the name of Doug Talbott. They wanted me to come down here as a surgeon.”
Before making the move, the ever-practical inventor surveyed the competition in Indianapolis, Columbus, and Cincinnati and concluded Dayton was a “fertile area” for a practice.
Starting at Cox in August of 1966, DeWall did some research in its animal labs before migrating to Kettering Medical Center, where he built a busy practice operating on patients. With the help of fellow practitioners Dr. Robert Taylor and Dr. Charles O’Brien, “I started the general surgery residency program at Kettering,” DeWall said, adding another piece to Dayton’s medical infrastructure.
Impressed soon after his arrival with the quality of the surgical residency program at Miami Valley Hospital, DeWall concluded Dayton “should have a medical school in support of all this.”
The element of the Minnesota program would take root in the Miami Valley.
DeWall first met with Al Martin, associated with the powerful Kettering Foundation, in the Winters Bank Tower in downtown Dayton. Martin both encouraged him and referred him to Charles W. “Bill” Ingler, a prominent figure in another Dayton powerhouse of the time, National Cash Register. (NCR Chairman Robert S. Oelman would be the first president of WSU’s Board of Trustees.)
Both Martin and Ingler knew that DeWall’s energy, commitment, and proven track record as a builder had the potential to catalyze community support for the project because of a pre-existing condition: The city’s failure earlier that decade to garner state approval for a medical school in Dayton.
The new proposal, however, would have to be different.
In Founding and Fulfillment, his history of Wright State’s development, Ingler writes that, by the early 1960s, Dr. Douglas Bond, dean of the Western Reserve School of Medicine, then one of Ohio’s three medical schools, had rightly concluded that ponderous expense had turned the established model for medical schools into an anachronism.
Summarizing Bond, Ingler writes: “No longer should a medical school contain a large, costly complex, including a major general hospital … that medical clerkships and internships should be provided in the surrounding community hospitals, with big capital savings … and that a medical school should be based in a university with maximum common usage of basic science departments between medical and other university students.”
Despite Bond’s insights, Ingler writes, “politics were again to reign supreme” when Toledo rallied its political base with the help of Paul Block Jr., a copublisher of the Toledo Blade, and bested both Dayton and Akron in the quest to garner the Ohio legislature’s permission to build.
The project ran into the problems Bond had foreseen and would pose problems for the Dayton proposal eventually articulated in a Dayton Journal Herald editorial: “The (Toledo) school has sputtered along without even a full administrative complement while soaking up staggering amounts of capital and operating finds, and even more are being sought.”
The practicalities of invention
DeWall doesn’t recall Ingler mentioning Bond’s model, but there’s no question he took Ingler’s other observation to heart.
“A medical school is a political animal, beyond all else,” DeWall said. “It isn’t something that you just wish would be there. It has to go to a political base, and it has to be sold on that basis.”
“The next step,” he said, “was probably to conceptualize how a medical school could be logically brought into the Dayton community.”
Although DeWall did not consult Bond or his writings, the problems at Toledo led him to the same conclusions: That the way ahead involved foregoing a large university hospital, fashioning the existing resources of Dayton’s medical community into a network, and grafting them to Wright State University.
Political practicalities led DeWall to Republican Ohio State Sen. Clara Weisenborn, who introduced a bill to establish a medical school at Wright State. Its introduction in May of 1967 actually came months before the enrollment at the fledgling branch of Ohio State and Miami universities reached 5,000, the level at which it would become a free-standing institution.
To outsiders, the idea of grafting a medical school to a university still wet behind the ears may have seemed odd. But Dr. Robert J. Kegerreis, then vice president of administration and later university president, said that to Daytonians convinced they had lost their earlier bid for lack of a local university, it seemed the perfect solution.
The loss had been “a bitter blow for the movers and shakers, the establishment here,” he said in a taped interview on file in the university archives.
Soon, DeWall and Kegerreis’ colleague Dr. Robert Conley, the first dean of Wright State’s College of Science and Engineering, were writing the plan to right that earlier wrong.
Making the case
Writing programs “was our forte” in the early days at Wright State, Conley said—an effort devoted largely to “locking and tying the institution into the Dayton community.”
In this case, however, Conley would concentrate on rewriting.
DeWall came to Conley after meeting Wright State economics professor Norman Anon at a party at Dr. Benjamin Schuster’s home. During the discussion, DeWall mentioned a 20-page brief he’d prepared over the course of three years describing how a medical school at Wright State might be organized, complete with tentative budgets.
Anon introduced DeWall to Wright State’s founding president Dr. Brage Golding, who forwarded DeWall’s plan to Conley unchanged. (Another key player was Frederick White, then a university vice president.)
“It all started through Dick DeWall” Conley said in another archived interview. “We were more the instruments of bringing it about than we were the creator of the ideas.”
DeWall’s design was as practical and serviceable as his bubble oxygenator.
“I didn’t want to develop a school of specialists because I didn’t think it would fly,” he said. “You had to do what was practical. You had to do what would fit.”
He worked with Conley to flesh it out into a proposal.
“In the early days, between Dick and myself, it was like meeting at each other’s table and putting the medical school, the feasibility study together,” Conley said. He described DeWall as “an extremely competent scientist with a deep concern for the delivery of medical services” and “a very serious, quiet gentlemen with very strong convictions.”
Despite that and all the time he spent with DeWall, Conley said in 1985 that “to this day, I don’t know” what motivated DeWall to do such yeoman’s work on the proposal. He did know that at proposal’s end, “We honestly, really believed it was feasible. We honestly really believed we had a case.”
The role of politics
Pioneering heart surgeon dies at 89
Richard A. DeWall, M.D., the inventor of an early heart-lung machine used in cardiac surgery worldwide who played a critical role in founding the Wright State University School of Medicine, died at his Oakwood home on Aug. 15, 2016. He was 89.
To those who love stories of pure or impure politics, the founding of the medical school is dramatic reading.
The two primary accounts are Ingler’s previously mentioned work and an account written by Dr. John R. Beljan, the medical school’s founding dean, who brought with him not only administrative skill and political savvy, but a resume with deep connections to the U.S. Air Force and Washington political circles that landed the seven-year $19.5 million Veterans Administration grant crucial to the school’s founding.
Beljan describes how: A Dayton-area political community committed to the cause threatened to interfere with additional funding to the Ohio State University medical school when it suspected OSU was working behind the scenes against Wright State.
Ohio Rep. C.J. McLin threatened “black voter retaliation” against Ohio Gov. John Gilligan’s re-election bid if Gilligan “killed (the) proposed medical school.”
Republican Weisenborn and Democratic Rep. Paul Leonard promised to visit “a shower of punitive legislation” on the Ohio Board of Regents, “if it withheld funding for necessary studies.”
By the time all that started, DeWall was out of the picture, feeling he’d contributed all he was able and content to leave the politics to Ohioans who knew Ohio politics.
Asked how he managed the herculean task of writing the original proposal (which his wife typed) while carrying on a busy surgical practice, DeWall gave a practical man’s answer: “By working from the time I woke up in the morning until the time I went to bed at night.”
Having accomplished so much and worked at such a bristling pace, DeWall finally paused as he was turning 60, looked to the future, and made another practical decision.
“I could have gone another five years, but I didn’t want to. I just looked at my resources and figured, I have enough to survive, why push it?”
He spent time that hadn’t been available to him during his daughters’ childhoods to spend with those whose bright faces fill a frame in the DeWalls’ first floor den.
Professional awards and honors have come as well, a special one on October 20, 2004, when he received the Lifetime Achievement Award from the University of Minnesota’s Lillehei Heart Institute “for renowned scientific discoveries that forever changed heart surgery and were essential to future cardiovascular research.”
On July 1, 2015, DeWall’s oxygenator received renewed recognition in the “Places of Invention” exhibit in the American Wing of the Smithsonian. A picture of DeWall with the oxygenator included in cocurator Monica M. Smith’s accompanying text, Medical Alley, Minnesota, 1950s: Tight-Knit Community of Tinkerers Keeps Heart Ticking.
Still, at 88, DeWall says he takes more satisfaction in the part he played in founding the Boonshoft School of Medicine, which he has seen expand to include residencies in 13 specialties and fellowships in 10 subspecialties.
“With the bubble oxygenator, you’re dealing with maybe several hundred patients a year,” he reasoned. “With a medical school, when you get it expanded, you’re dealing with thousands.”
Gilkeson concluded her lecture on DeWall with a more generous accounting, saying his bubble oxygenator and its descendants have been responsible for repairing “millions of hearts” worldwide. She also mentioned his 120 published peer-reviewed articles, his hand in multiple cardiopulmonary bypass machines, and his part in validating multiple heart valves.
Gilkeson concluded by calling DeWall “a giant in surgery and a giant for humanity”—clear evidence that DeWall also has become something he never aspired to be: An inspiration to a new generation of Dayton surgeons.