1. Contributions to Thoracic Surgery and Beyond
Rudolph Matas, M.D.
Contributions to Thoracic Surgery and Beyond
John L. Ochsner Medical History Lecture
The New Orleans Conference - VII
Michael C. Trotter, M.D., FACS, FACC
Delta Regional Medical Center
Greenville, Mississippi

2. Dr. John

3. Rex, Johnny O, The Godfather of Cardiothoracic Surgery

4. Isidore Cohn, Sr., M.D., on Dr. Matas
“She could not know that nearly a century later, his mental faculties undimmed, this baby, born before Lincoln became President, would look back from the atomic age, recalling a glimpse of Farragut’s fleet as the first real memory of a life that made him one of the greatest surgeons the world has ever known.”

5. J. Gordon Scannell, M.D., on Dr. Matas
“His life span including watching the death of a patient from renal failure after laparotomy performed with Listerian carbolic acid spray to use of cardiopulmonary bypass in resection of thoracic aortic aneurysms.”

6. Matas: A Unique Life in Medicine
1977
2001
2001
2010

7. Early Life Born 1860 – Bonnet Carre, Louisiana
Dr. Narcisco Matas – plantation physician
1863: Family returned to Spain
Paris – Spain – New Orleans – Brownsville, TX – Matamoros, Mexico
Age 7: Survived yellow fever and became immune
Education: Migratory & interrupted – fluent in multiple languages

8. University of Louisiana Medical Dept. (Tulane)
1877: Well prepared
Selected to travel with the Yellow Fever Commission to Cuba as interpreter
Graduated age 19
Best student in his class
Early supporter of “Finlayism”

9. Yellow Fever Commission - 1879

10. Yellow Fever

11. New Graduate
Competed for and received 2 yr. internship at Charity Hospital
Appointed Physician of the New Orleans Spanish Benevolent Society
Named to Visiting Staff of Charity Hospital
Part owner and Associate Editor of the New Orleans Medical and Surgical Journal
“one of the finest and most remunerative medical practices in the professional annals of New Orleans”

12. Dr. Matas

13. Father of Modern Vascular Surgery 1888
Manuel Harris, 26 yo laborer
GSW arm with birdshot 2 mo. previously
CHNO: traumatic aneurysm brachial artery
3 weeks: compressor/forced flexion
Options: amputate or attempt to ligate
Ligated artery above aneurysm: pulsations ceased
POD 9: Pulsations returned

14. Endoaneurysmorrhaphy
POD 14: Returned to OR – Esmarch tourniquet - ligated artery below aneurysm – remained pulsatile
Opened aneurysm – 3 orifices – ligatures intact – oversewed the orifices
Did well postop
1898: Doing well – palpable radial pulse
Did not perform again until 1900

15. Endoaneurysmorrhaphy
1898: “It seemed to me that any surgeon similarly situated would have instinctively adopted this single way of getting out of a difficulty.”

16. Surgical Immortality

17. Vascular Surgery
1924
1903
1940

18. Professor and Chairman Department of Surgery Tulane University

19. The World of Surgery
Matas: Lived the medical/surgical and literary/historical life
Will Mayo: Matas was “the world’s best educated physician.”
William Halsted: Right orchiectomy for seminoma in 1903
Friendship and correspondence until Halsted’s death in 1922

20. The World of Surgery

21. Admiration and Respect

22. Other Matas ‘Firsts’ 1888: First use of IV saline in surgical patients
1899: First use of spinal anesthesia
1923: First successful aortic ligation for aneurysm
1924: First use of gastric drainage via nasogastric tube

23. Thoracic Surgery
Alton Ochsner: “It is only natural that he would be interested in procedures which would facilitate the performance of operations within the thorax.”
1897: Intralaryngeal insufflation – artificial respiration in opium narcosis
1899: “Until the danger of seriously interfering with the respiratory functions by inducing acute collapse of the lung is clearly eliminated or is reduced to a safe minimum, the analogy between the pleura and peritoneum from the surgical point of view will never exist.”

24. Fell-O’Dwyer Apparatus
1901: “The sudden admission of air in the pleura through a large fenestrum is one of the greatest danger elements in intrathoracic surgery and one of the most serious obstacles in advancement of surgery of the chest.”

25. “Clinical Respiratory Machine”
Matas/Smythe
Modified bellows with pump and 2 cylinders
Abandoned negative pressure cylinder
Added funnel through which to give chloroform

26. Intralaryngeal Insufflation
Intratracheal insufflation
Positive pressure ventilation
Milestone in thoracic surgery
CHNO: Birthplace of modern vascular surgery and modern thoracic surgery

27. Thoracic Surgery
DeBakey credited Matas for the development of thoracic surgery in the U.S.

28. Thoracic Surgery
1900
1899
1922

29. Monocular Vision 1908: Operation for tubo-ovarian abscess
Pus contaminated his gown
Wiped brow with contaminated gown
Abscess was gonococcal
Developed gonococcal conjunctivitis right eye
Treatment unsuccessful - enucleation

30. Monocular Vision Acquired artificial eye
Carried on practice, operating, reading, writing, and teaching for 40 years – no trace of handicap
Matas: “in consequence of my practically perfect adaption to the monocular state, I find myself tramping along life’s journey with a sure-step and plugging along as if nothing had happened.”

31. Matas at Work

32. Matas the Teacher Polar opposite of Halsted
Never upset: “My, my, my!” or “Con-fusion!”
Abreast of the world’s literature
Elevated the standard of surgical care: internationally, nationally, regionally, locally
1912: First in U.S. to appreciate significance of moving picture as educational asset – “The Cinematograph as an Aid to Education and Research”
‘Professor’ – most revered title

33. Matas the Teacher

34. Matas’ Influence
1915
1927

35. History of Medicine “What can the past teach us?”
Knew the historical evolution of any clinical subject
AAHM, Tulane HOM Society, MLA
Encyclopedic knowledge and phenomenal memory

36. Accolades Bibliography: approx. 600 entries Six honorary degrees
Numerous awards including Henry Jacob Bigelow Medal in 1926
Member of practically every surgical association in the world

37. Organized Medicine 1909: President, American Surgical Assn.
1910: President, Southern Surgical & Gynecological Assn.
1920: President, American Assn. for Thoracic Surgery

38. Organized Medicine
‘All work and no play…..’

39. American College of Surgeons
1913: An Original Founder
: President

40. Organized Medicine Few, if any, debated or questioned his wisdom
His words = extremely valuable (and often prolonged)
Disdained government influence in medical affairs
Huey P. Long: extreme distaste
Reformed the provision of medical care and elevated hospital care

41. Military Service – WW I
Enlisted entire junior and senior medical school classes
Headed Red Cross Base Hospital 24 of the Tulane Unit
Promoted to Major
Created courses for new techniques of battlefield surgery (8 courses, 134 physicians, 9 months)

42. Personal Life Parents: Dr. Narcisco and Teresa Matas of Catalonia
Narcisco: ‘Physician-adventurer’
Teresa: 10 years older than Narcisco
1869: Elvira born
Medical school: Parents separated

43. Mrs. Teresa Matas and Elvira
Moved to New Orleans and lived with Matas
Attempted to alienate Matas from his father
Unsuccessful

44. Adrienne Goslee Landry
Matas: Love at first sight
Adrienne: Father was a patient; married with infant son
Husband left – pregnant with second child
Matas delivered
Harper’s Magazine (1887) – “A Creole Belle”

45. Personal Life
Teresa Matas: tried to prevent relationship with Adrienne and friendship with Lafcadio Hearn but failed
Returned to Catalonia with Elvira
Lafcadio Hearn

46. Personal Life Purchased St. Charles Ave. (2255) home
Adrienne and her extended family moved in – housekeeper and secretary
Ex-husband remarried - nullified first marriage
1895: Matas & Adrienne married in Vicksburg
Adopted Arthur and Lucian Landry

47. Personal Life Arthur Landry died with TB.
1902: Adrienne & Matas’ only child was stillborn.
Narcisco Matas separated from second wife, came to live with Matas, and shortly died of stroke.

48. Personal Tragedy
Death photograph
Matas was devastated.

49. Adrienne Matas Died of pneumonia in 1918
Matas wrote exquisitely and lovingly about her.

50. Elvira Matas Lived in Catalonia
Matas tried to renew relationship with his sister.
Spanish Civil War: Matas got her safely to Paris
Returned to Catalonia
Died before reconciliation

51. Matas the New Orleanian
1940: Times-Picayune Loving Cup as Outstanding Citizen of New Orleans
Selected by Times-Picayune as one of the individuals that defined New Orleans in the 20th century
Long history of support for Tulane Medical School Library
Renamed for him in 1937
Left $1 million and his vast personal library to the RML

52. The Soul of the Surgeon

53. The Soul of the Surgeon
One of the finest medical articles ever written
“Gentleness, compassion, tenderness do not exclude firmness. Persuasiveness and authority may travel hand-in-hand. Neither are resoluteness and an inflexible will incompatible with an inexhaustible patience and genuine sympathy.”

54. Final Days Wheelchair bound after 1954
Hospitalized last 3 years of his life
Kept home open and servant retained
Died September 27, 1957
Age 97
Alton Ochsner: “No one realizes better than I that to succeed Dr. Matas is impossible.”

55. Conclusions
From yellow fever to aneurysms and the successful treatment of both, he was a physician and surgeon for the ages.
‘The Surgical Osler’
Immortalized in the medical profession
Physician and surgeon of the highest order
One of the greatest teachers and mentors in medical history

56. Thank you!