The Fort Above the River

Of all the metaphors that serve to give poetic life to that great river, perhaps those from biology are the most common. Writer and humorist Garrison Keillor, in William Harvey-like fashion, calls the Mississippi the "artery of a continent, lifeblood of a country." Harvey was the English physician who described the circulation of blood and the role of the heart in the early 17th century.

The late historian Stephen Ambrose saw the river as the "spine of our nation" because it knits the country together and connects the American heartland to the world. A central nervous system.

I have not encountered a urological metaphor, at least not in polite company, even though the Mississippi River is the third largest drainage system in the world (after the Amazon and the Congo); its effluence from high-intensity farming in the Midwest is altering the Gulf of Mexico, maybe for good.

That the Mississippi might be viewed as our DNA, bearer of the code that makes us what we are, also has not been advanced, so far as I know. The ancient woodland people and their descendants who lived along its banks saw the river as a great life-giver, constantly spinning out new life, which is what DNA does. Sort of.

In the realm of high science, Richard Dawkins, the British evolutionary biologist, uses "river" to describe the universal genetic system of life in his book River Out of Eden [1995]. The river "flows through time, not space. It is a river of information, not a river of bones and tissues: a river of abstract instructions for building bodies, not a river of solid bodies themselves."

Physicist Stephen Wolfram doesn't give rivers any special play in his tome A New Kind of Science [2002]. The filigrees of river systems as seen from space are merely what happens when the world operates as a giant computational engine through which simple rules yield patterns in nature of unfathomable complexity and beauty.

The Mississippi River may not be a source of abstract instructions for the making of a nation, but its power to elicit metaphor for who we are is undiminished.

Closer to home, Fort Snelling provided the early environment for developments that have made Minnesota, at the beginning of the 21st century, synonymous with the extension of life through medicine and public health.

In 1805, Lieutenant Zebulon Pike negotiated the purchase of 100,000 acres of land where the Minnesota River joined the Mississippi, then the edge of the frontier. President Thomas Jefferson wanted the land to be used as a military fort. Construction began in 1819.

The history of American medicine and the history of our westward expansion cross paths at several junctures. Post hospitals like the Fort Snelling Hospital were known for providing some of the best medical care in the country. Fort Snelling was a link in a chain of frontier outposts that Joseph Lovell, the Army's surgeon general, saw as essential for the contributions they could make to medical science. Early in his tenure he ordered his surgeons in the field "to submit reports on the diseases they treated and on the weather and climate, as well as on landscape features, such as elevation, drainage, and vegetation, that might affect the health of the men." [The Army Medical Department 1818-1865, Office of Medical History, Office of the Surgeon General]

From the accounts of Fort Snelling surgeons, beginning with post surgeon Edward Purcell, we know that the winters were deadly. Scurvy was a the main health threat at the outset, replaced by cholera in 1833. That was the year one of the great frontier surgeons of the time, Nathan Jarvis, was assigned to the fort. Jarvis was also a gifted writer, artist, teacher and musician, and like many of his peers the best educated man at the post. He was responsible for treating Indian patients as well as soldiers, their families and settlers. The Indian agency provided him 25 cents an Indian for smallpox vaccinations, with funds provided by Congress through the newly established Department of Indian Affairs.

Smallpox, brought to the Midwest by European settlers, devastated Indian tribes throughout the 19th century and threatened to make whole nations extinct. Indian agent Henry Rowe Schoolcraft, who discovered Lake Itasca as the source of the Mississippi in 1832, was instructed by Secretary of War Lewis Cass to persuade the tribes to agree to vaccination against smallpox. Later he wrote "The smallpox, a scourge to the aborigines" [1851].

But the federal government itself was more interested in tracking numbers of the infected among the tribes. Epidemiology, such as it was, triumphed over treatment and prevention [Early United States Government Interest in Native American Health, National Library of Medicine].

From the Deep Woods: Ohiyesa

If Charles Eastman was vaccinated against smallpox, I haven't been able to find out. If he was it probably occurred at the Lower Sioux Agency near Redwood Falls, where he was born in 1858.

Eastman was one of the first Indian physicians. As the government doctor at the Pine Ridge Agency in South Dakota from 1890-93, undoubtedly he vaccinated many Indian children and probably some white children, too. He was known to travel great distances to treat white settlers.

Charles Eastman was the grandson of Seth Eastman, the famous Fort Snelling artist. His mother was Wakantankawin (Holy Woman). Her English name was Mary Nancy Eastman. She was Seth Eastman's daughter with Wakan Inajin Win (Stands Sacred) who was the youngest daughter of the Mdewakanton Sioux Chief Cloud Man. Charles Eastman's father was Ite Wakanhdi Ota, Many Lightnings, a Wahpeton Sioux.

After an early boyhood around Redwood Falls, Eastman fled with his family to Manitoba following the U.S.-Dakota War of 1862. His father, who narrowly escaped hanging after the war, changed his name to Jacob Eastman and converted to Christianity. He saw to it that his son was baptized and enrolled him in a missionary school near Flandreau, North Dakota. After two years Eastman walked 150 miles to the Santee Normal Training School in Nebraska. Upon graduation he was sent by a benefactor to Beloit College in Wisconsin, then to Dartmouth College, graduating in 1883. Shortly thereafter he attended the Boston University School of Medicine, attaining his degree in 1890. The Pine Ridge Agency was his first job.

On January 1st, 1891, three days after the massacre at Wounded Knee Creek, Eastman led an expedition of a hundred Indian and white volunteers to attend to survivors, if any, of the slaughter by the Seventh Cavalry. The scene was horrific.

"It took all of my nerve to keep my composure in the face of this spectacle and of the excitement and grief of my Indian companions, nearly every one of whom was crying aloud or singing his death song," Eastman wrote in his book From the Deep Woods to Civilization [1916]. "The white men became very nervous, but I set to examining and uncovering every body to see if any were living. Although they had been lying untended in the snow and cold for two days and nights, a number had survived. Among them I found a baby of about a year old warmly wrapped and entirely unhurt. I brought her in, and she was afterward adopted and educated by an army officer."

Back at the agency, a chapel was converted to serve as a hospital. The head nurse was Eastman's fiancée, Elaine Goodale. A native of Massachusetts, Goodale was recruited by General Samuel Chapman Armstrong to work at the American Indian Department of a school he had established primarily to educate freed slaves following the Civil War, the Hampton Normal and Agricultural Institute in Virginia. She became a teacher of Sioux students who in turn taught her their language. She was also a public relations writer for the Institute, today Hampton University. In 1890 she became the first supervisor of Indian education in the Dakotas.

In 1893, Charles and Elaine Eastman left the Pine Ridge Agency over disputes with governmental policy and moved to Imnejah-skah or "White Cliff," St. Paul, Minnesota. Charles had it in mind to establish a medical practice in the city. To do so, he had to pass the state's medical examination, instituted in 1887 at the behest of Perry Millard, the first dean of the College of Medicine at the University of Minnesota.

"I had to wait for the regular state medical examination before being admitted to practice, as Minnesota was one of the first states to pass such a law, and the examinations were searching and covered three days' time," Eastman wrote. "If I remember rightly, there were some forty-five applicants who took them with me, and I was told that nearly half of them failed to pass. It was especially hard on country practitioners who had practiced successfully for many years but were weak in theory of medicine along certain lines."

Eastman passed the board but was unsuccessful in establishing a regular practice. He traveled from reservation to reservation with his black bag for a time, then turned to other activities -- as an advocate for organizations like the YMCA and Boy Scouts and writing and lecturing as the nation's leading spokesman for American Indian culture and values. He died in 1939.

He is known as Ohiyesa, the "Winner." The name was conferred on him by Chief Blue Earth (Mahkato) of the Wahpeton band of Sioux, chief of the "Dwellers Among the Leaves." As Eastman describes it in his book Indian Boyhood [1902], one midsummer's eve the Wahpeton and Kaposia Sioux gathered to watch their men play a game of stick ball, what we know as lacrosse. Chief Blue Earth announced that a little Wahpeton boy, should they win, would be named Ohiyesa in honor of the victory. As so it was.

That was July 1862. In August, a historic insult at the Lower Sioux Agency precipitated a murder, then another, and another, and soon a war and afterward the execution of 38 Dakota in Mankato, the country's largest mass execution and one sanctioned by its president, Abraham Lincoln.

Chief Blue Earth shares his name with a river that joins the Minnesota River in Mankato, the Blue Earth River. That river shares its name with the community of Blue Earth in south central Minnesota which it encompasses.

Blue Earth, my birthplace.

New Vistas in a Scientific Age: Medtronic's Stephen Oesterle

The headquarters campus of Medtronic, Inc., the world's leading medical technology company, lies a mile east of the Mississippi River on the north side of Interstate 694 in Fridley.

Medtronic is to Minnesota commerce, technology and health care in the 21st century what Fort Snelling was to frontier exploration and medicine in the upper Mississippi Valley during the 19th. Its devices and therapies are used by millions of patients around the world, including Vice President Dick Cheney. It is the state's most valuable company on Wall Street, with a market capitalization of $57 billion. Its growth over the past decade has been remarkable.

I attended the company's annual shareholder meeting in August 1994 because I was involved in the dedication of a bronze statue that day of Medtronic co-founder Earl Bakken. The statue was done by artist and sculptor George Bassett. Bassett's studio is located on the Blue Earth River near Winnebago, Minnesota. His fashioning the image of Bakken, a great Minnesota inventor and entrepreneur, rested on long experience sculpting both contemporary public figures and themes from the Old West.

About the time of the shareholder meeting in 1994 Medtronic surpassed $1 billion in annual sales. Sales were $6.4 billion in 2002. In January 2003 Medtronic ranked 65th in Fortune magazine's "100 Best Companies to Work For." It is the only Minnesota company listed.

I visited Medtronic's new campus, dedicated in November 2000, three times last year. The first time, in early July, was for a gathering of local medical device makers who came to hear the late Minnesota Senator Paul Wellstone and his colleague from Connecticut, Senator Christopher Dodd, talk about legislation that would expedite the approval process for medical devices by the U.S. Food and Drug Administration. Over the years Wellstone had warmed to the needs of the state's medical device industry, admitting to conservative columnist Robert Novak that his interest was "counterintuitive" given his politics. That acknowledgement came at a meeting in Washington, DC to celebrate passage of the Medical Device User Fee and Modernization Act of 2002 two days before his death last October.

In late July I brought a group of summer undergraduate students in biomedical engineering to Medtronic for a tour of its exhibits and its new Materials and Biosciences Center. Our tour guide was Rebecca Bergman, Medtronic vice president of science and technology.

My last visit, in early November, was to talk with Stephen N. Oesterle. Oesterle joined the company in January 2002 as senior vice president of medicine and technology. He is responsible for the firm's scientific research direction, strategic investment, and the development of cooperative relationships between Medtronic and medical communities around the world.

Oesterle brings impeccable credentials to his job. An Oregon native, he is a 1973 summa cum laude graduate of Harvard University. He attended Yale University School of Medicine, receiving his medical doctorate in 1977. For the next six years he was an intern and resident at Massachusetts General Hospital and then a fellow in interventional cardiology at Stanford University.

For the past 20 years Oesterle has established himself as a leading clinician, teacher and innovator in the field of cardiac catheterization, in Los Angeles, at Georgetown University, Stanford, and finally at the Harvard University Medical School and Massachusetts General Hospital, which he left to join Medtronic.

Oesterle set up medical device development centers while at Stanford and Mass General. In 2001 he performed the world's first successful coronary artery bypass operation with a catheter, getting the job done with a small incision in the patient's leg rather than opening his chest ["Roundabout route to heart bypass," Nature, May 29, 2001].

Oesterle, in his early 50s, is slender and fit, of medium height with swept back blond hair and resolute blue eyes. He has an engaging manner: he wants to know what you think. As we sat down to talk at his conference table, overlooking Interstate 694, it occurred to me that he is dealing with a new geography, a noncoastal dynamism with its own characteristic actions and reactions. Its own capabilities and challenges.

I asked him why he left a good job as director of invasive cardiology services at Massachusetts General Hospital to come to Medtronic and Minnesota.

Once in a career something comes along that represents an "unambiguous growth opportunity," he said. "I spent 25 years in academic medicine, where you are always constrained by space and money. I wanted the opportunity to make a difference in people's lives without being constrained by financial considerations."

In his position, Oesterle helps to steer investment of a billion dollars a year "to grow and help patients." He is able to evaluate "nascent technologies" that could potentially be used to treat "a broad spectrum of diseases," he said. "For the first time since my first year in medical school I am free to explore diseases, and treatment technologies for them, that range well beyond my own specialty of interventional cardiology."

Now is a "perfect time" for him to do what he's doing, given his grounding in academic medicine and his entrepreneurial experience of being involved in two dozen start-up and emerging companies, he said.

Oesterle's skill as an academic entrepreneur was honed while at Stanford University, where he saw the Silicon Valley boom up close during the 1990s. The valley's culture -- its investors, entrepreneurs, hyperactive dreaming and penchant for risk -- is something he understands. He can speak the language. But he also brings to the table a unique capacity to see trends in technology, how they are converging, and how biomedicine and health care will be transformed as a consequence. The only question is the pace of that transformation.

What role will Minnesota play in it, I asked? What challenges do we face?

"The biggest challenge is to attract the financial market to Minnesota," he said. The recognized life sciences centers of Greater Boston, San Diego, and San Francisco get the publicity but "Minnesota is in a better position to pursue a biotech-device strategy" based on its current strengths and talent pool.

I was reminded of Oesterle's comment when I read an article by New York Times writer Lawrence M. Fisher about the downturn in Silicon Valley ["Job-Rich Silicon Valley Has Turned Fallow, Survey Finds," January 19, 2003]. Fisher interviewed Doug Henton of Collaborative Economics, a leading consulting firm in the valley that advises civic leaders: "Mr. Henton said it was not clear what the next source of economic growth would be, although he suspects it will be the biomedical industry, by combining software with biotechnology and advanced instruments to improve health care."

"Biotechnology grows from the ground up with investment in small firms," Oesterle said. "It will not be led by large firms like Medtronic, Guidant and Boston Scientific."

To participate, Minnesota has to develop a culture that is willing "to invest in failure," to realize that not all start-ups will succeed. "We need some Jim Clarks," he said, citing the brilliant and driven founder of Silicon Graphics, Netscape, Healtheon, and other high-risk start-ups. The state needs more venture funding overall.

And the University of Minnesota "needs a more entrepreneurial ethos and structure," Oesterle said. Faculty should feel comfortable participating in entrepreneurial activities. "It hasn't hurt Stanford."

The first time I saw Oesterle was when he came to Minnesota's defense in the competitive biotech war. That was a talk by the highly regarded economic analyst Joseph Cortright, "Signs of Life: Clustering of Biotechnology in US Metropolitan Areas," at the Humphrey Institute last September. The Brookings Institution in Washington, DC had published his report in June, and the Twin Cities had failed to rank among the top nine biotechnology centers in the country. MBBNet was a co-sponsor of his talk, along with the Humphrey Institute's State and Local Policy Program.

During the Q & A following Cortright's talk, Oesterle stood up, introduced himself, and made a cogent argument that Minnesota's medical technology firms are well positioned to participate in biotechnology on a number of fronts. For one, they can deliver the drugs flowing out of the genomics revolution to where they need to go in the patient's body. "We know how to do that," he said emphatically. Those who make the drugs really don't.

Oesterle spoke at a dinner hosted by Dean Robert Elde of the College of Biological Sciences that evening. His presentation of technological trends -- in biology, materials, miniaturizaton and information -- and the possibilities for Minnesota was a striking counterpoint to Cortright's study, which by design focused almost exclusively on biopharmaceutical drugs and metropolitan areas involved in research and production of them. Oesterle appeared to be in complete command of the horizon, of what it would yield over time.

Minnesota has a rich history both of exploration and entrepreneurship -- in mining, forestry, agriculture, technology, medicine, research and education. There's really no reason to think that, in a scientific age, it won't take a cue from the past, that it won't explore and build anew in keeping with the motto adopted by the Minnesota territory in 1849:

Quae sursum volo videre.

"I want to see what lies beyond."

    --William Hoffman    hoffm003@umn.edu