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Contributions to Thoracic Surgery and Beyond

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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!


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