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A lasting legacy: The life and work of Rudolph Matas

1985; Elsevier BV; Volume: 2; Issue: 4 Linguagem: Inglês

10.1016/0741-5214(85)90022-9

1097-6809

A. Robert Cordell,

The official seal of the Southern Association for Vascular Surgery is round and bears in its center the likeness of an impressive gentleman with a mustache and goatee (Fig. 1).That gentleman is Dr. Rudolph Matas. His selection for this prominent position was made on firm ground, because he is most commonly thought of as the father of vascular surgery. Because he was a native of Louisiana, he is also appropriately a person whose likeness should appear on the seal of a southern association such as ours. Let us look at the life of this man whose impressive contributions helped to create the speciality of modern vascular surgery of which we are a part. What was he like? What of his personality and which of his characteristics brought him to this place of eminence? A careful perusal of his life and times shows them to be fascinating.1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar Rudolph Matas was born at Bonnet Carre, a plantation approximately 50 miles downriver from New Orleans. His father, Narciso, was the plantation's physician. Narciso and his bride. Teresa, had come to New Orleans in 1856. Not yet 20 years old, Narciso had an adventurous spirit and was constantly looking for new opportunities. He retained that spirit throughout his life and in the process was to deeply alienate his wife. Narciso first operated a pharmacy in New Orleans but within a year enrolled at the New Orleans College of Medicine, earning a doctorate in pharmacy in 1858 and a doctorate in medicine in 1859. Their first child, a girl, died shortly after her birth in 1858. In 1859 after they had each survived a bout of yellow fever, Narciso and Teresa moved to Bonnet Carre, where on Sept. 11, 1860, Rudolph, their only son, was born. In 1863, having dealt with cotton speculators and General Benjamin “Beast” Butler's Union army of occupation, Narciso found it expedient to leave Louisiana for a while, so he took Teresa and young Rudolph to Paris where he could study ophthalmology. There Rudolph was exposed for the first time to a medical environment. Narciso's fellow students often gathered in the Matas' apartment for study and discussions on the practice of ocular surgery, using papier-mache and plaster eyes as well as real eyes obtained from an abattoir. At 5 or 6 years of age, Rudolph could name all the anatomic features of the eye. One wonders whether these early experiences may have influenced his eventual choice of a career; certainly, they show the emergence of some of the qualities of his adulthood—his perceptiveness and exceptional memory. At any rate, young Rudolph was precocious, and his accomplishments even as a teenager and a young man were always advanced for his age. Because of the move to Paris, then moves to Barcelona, New Orleans, Brownsville, Texas—where Rudolph acquired a baby sister, Elvira—and once again to New Orleans, his elementary and secondary schooling was interrupted. However at the age of 17 years, he entered the Medical Department of the University of Louisiana, later to become Tulane University. One other occurrence in Rudolph's younger years influenced the course of his later career. When he was 7 years old, during a typical epidemic year when over 3000 residents of New Orleans died of yellow fever, he contracted the dread disease but, like his parents, survived.1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar The immunity he thus obtained protected him during subsequent epidemics and was of great value when, still a medical student, he spent 3 months in Havana as a member of the Yellow Fever Commission (Fig. 2), which was seeking to discover how the infection was transmitted.That Commission did not find the answer, but, in large part through Rudolph's interest and his work with photomicrographs of the blood cells of yellow fever victims, the Commission laid the ground work that served later to substantiate Dr. Carlos Juan Finlay's demonstration of the role of the mosquito as the vector in that disease. Dr. Finlay, a Cuban who had been a member of the auxiliary Yellow Fever Commission, unfortunately made his demonstration in an era when many erroneous theories were strongly entrenched, and for years he was called the “mosquito maniac.” During those years Matas alone supported Finlay's hypothesis—which, of course, was correct, as we know now—and it was Matas who converted William Gorgas to the “mosquito hypothesis.” It is Gorgas, rather than Finlay, who is today most commonly credited with ridding the world of yellow fever. In time Finlay was named Chief Public Health Officer of Cuba, and in 1941 Rudolph was called to Havana to be awarded the first Finlay Medal, “as the world's first, foremost, and most consistent mantenedor del Finlayismo—Defender of Finlayism.”1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar Rudolph Matas became a Doctor of Medicine at 19 years of age. He served for 2 years as a house officer at Charity Hospital in New Orleans and afterwards set up practice in a small office in that city. From 1885 to 1894 he served at different times as demonstrator of anatomy and instructor in surgery. Photographs from that era show him to be moderately tall, stocky and full-faced, dark-haired and dark-eyed, heavily mustachioed and bearded. By 1900 the beard was still dark but had been shaped into the goatee he wore for the rest of his 97 years. Perhaps the turning point of Matas' career came in March 1888 when a plantation field hand named Manuel Harris was admitted to Charity Hospital with a leaking aneurysm of the brachial artery. The accepted treatment until that time was to ligate both inlet and outlet vessels, the so-called Hunterian ligation developed by John Hunter of London. However, as most surgeons knew, all too frequently gangrene, amputation, and death followed that operative procedure. Recognizing that a one-armed field hand would find employment difficult, Matas tried every technique known at that time to stop the leakage, including pressure dressings, before he finally decided to operate. In his high-pitched voice he announced to the operating room attendants, “My, my! We will have to empty this sac or dissect it right out of his arm.” Carrying on his steady, clucking monologue, punctuated by a succession of “my, my, my's,” and an occasional “con-fusion!,”2Clark M. Pioneer with a scalpel (book review of Cohn I. Rudolph Matas).Sat Rev Lit. Aug 20, 1960; : 17-18Google Scholar his favorite expletive, he opened the aneurysm and completed the endoaneurysmorrhaphy that bears his name today. His patient recovered and left the hospital after 15 days with his arm intact and functional. This new technique was hailed later as “the greatest advance in vascular surgery in 200 years,” and from it Matas achieved extraordinary fame. Although he did not, as he said, “muster sufficient courage”3Matas R. Personal experiences in vascular surgery.Ann Surg. 1940; 112: 801-826Google Scholar to attempt it again for 12 years, he thereafter performed 622 vascular operations, at least 260 of which were on aneurysms of the large arteries. Extensive experience and study of aneurysmal sacs led Matas to classify aneurysmorrhaphy into three basic types: obliterative, restorative, and reconstructive. Obliterative aneurysmorrhaphy involved the use of sutures from within the aneurysm itself for total obliteration of the sac as well as the entry and exit artery. He first called this procedure “obliterative endoaneurysmorrhaphy without arterioplasty.” Among 98 total endoaneurysmorrhaphies from his personal practice, 68 were obliterative, 25 restorative, and five reconstructive.4ed 9. Modern surgery. WB Saunders Co, Philadelphia1926Google Scholar He modified the obliterative endoaneurysmorrhaphy for cases in which one orifice of communication was present, as in a saccular aneurysm, which thereby allows closure of this orifice without occlusion of the parent artery. He called this procedure “endoaneurysmorrhaphy with partial arterioplasty.” For fusiform aneurysms with two openings close together on the floor of the sac, Matas devised a procedure called “endoaneurysmorrhaphy with complete arterioplasty,” wherein he placed a catheter into the artery and closed the sac walls over the catheter, removing it to tie down the last sutures; he then obliterated the sac with additional sutures. These ingenious techniques were landmarks in the history of surgery and served as a foundation for the modern-day treatment of aneurysm. Mortality in the 98 total endoancurysmorrhaphics was remarkably low for that era; five deaths occurred, three of which were due to extrinsic causes. If those three are omitted, the mortality rate was only 2.4%, without gangrene in any of the patients. These monumental accomplishments have had a continuing major influence in vascular surgery throughout the years. Other major contributions to surgery during the long period of his practice include confirmation that the appendix was more often intraperitoneal than extraperitoneal, his strong endorsement of laparotomy in the treatment of acute appendicitis, the first thyroidectomy to control malignancy reported in the history of New Orleans, and the first attempt to treat acute hypovolemia by saline solution injections administered intravenously (this led to the widespread use of saline solution infusions for other disorders), and the advancement of thoracic surgery with a new method for keeping the lungs inflated with the use of an endotracheal tube.1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar In 1895 Matas became Professor and Head of the Department of Surgery at Tulane. He remained Head of the Department of Surgery at Tulane until 1927 when he was named Emeritus Professor. His personal life during those years did not run as smoothly. His parents, who had never been happy together, separated and divorced, and his father remarried. His mother and Elvira, his sister, became very bitter, vindictive women who attempted to dominate Rudolph and to prevent him (unsuccessfully) from keeping in touch with Narciso, who had settled in Tucson. Soon after starting his practice, while attending a dying patient in Charity Hospital, Rudolph saw across the bedside “a beautiful woman... with dark fathomless eyes...” who “possessed me completely from the moment I first saw her. I realized that in a single instant I had found and lost the one woman who could have made my life complete.”1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar This dark-haired beauty was Adrienne Goslee Landry, the daughter of the dying patient. She was married, albeit unhappily; since both she and Rudolph were Roman Catholic, a divorce for her seemed unthinkable, as would be their marriage. She separated from her husband before her second son was born, and in time, she, her two sons, her mother, and her six brothers moved into a house that Rudolph had remodeled so that his office and living quarters were separate from theirs. “Dearest Adri” served as his friend, housekeeper, and secretary, but never as his mistress. Not until 1895, 14 years after she and Rudolph had first met, did Adrienne learn that her marriage to Landry had been annulled by the Church and that he had remarried. Thus she was free to marry Rudolph and did so. In a handsome and comfortable mansion in which they lived with Adrienne's two sons by her former marriage, they enjoyed 23 years of happy married life. In 1902 their only son died at birth, and in 1918 Adrienne also died of pneumonia following an attack of influenza superimposed on chronic nephritis complicated by hypertension and angina pectoris. Although Narciso rejoiced in his son's happy marriage and suffered with him when he lost his only child, Teresa and Elvira remained bitter, and if they sent condolences, those could not be found among Rudolph's personal papers. They had tried desperately to keep Adrienne and Rudolph from marrying and they never became resigned to the fact that the marriage had taken place. For some years, beginning in 1883, Rudolph had a close friendship with the eccentric but brilliant journalist, Lafcadio Hearn. They spent many hours discussing art, writing, the history of medical practice, beauty, and truth, and the companionship meant much to Rudolph. They corresponded when Hearn lived in Martinique, and Rudolph kept the letters until his death. However, without explanation, Hearn broke off all ties with Matas when he moved to Japan. An event occurred in 1908 that threatened both Matas' professional career and his confidence in himself. An infection in the right eye had developed after he had operated on a patient with gonorrheal pelvic inflammatory disease. One hundred twelve days later, after experiencing excruciating pain from the corrosive infective process, which had caused glaucoma and rupture of the iris through the cornea, he was forced to undergo enucleation. He was morbidly sensitive about the loss of his eye and refused to appear in public until an artificial eye had been made to his satisfaction. For the rest of his life he usually turned his head away slightly to the right when photographed so that his artificial eye would be less noticeable. However, his main concern, and the reason he resisted enucleation for as long as he did, was the fear that the loss of binocular vision would interfere with his ability to perform the delicate procedures that even then characterized the field of vascular surgery. As time went on, however, and he saw no diminution in his operative skill, he became more resigned to his fate and was able to write to a friend who himself had just undergone an enucleation:I am pleased to state in spite of the additional handicap of a marked myopia and astigmatism in my remaining eye, I have never done more minute and exacting work than in the seven years that have elapsed since the accident which deprived me of my right and best eye.... My heartfelt congratulations on your splendid recovery—a recovery which will permit us, the cyclopeans, to enjoy the privilege of your conspicuous and inspiring example as a member of our band, just as the Binoculars have been honored by your leadership in the past.1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar Rudolph Matas became world renowned as a surgeon and attained almost every high honor in American as well as in international surgical circles (Fig. 3).He remained active, writing and lecturing until a few years before his death. Perhaps his most memorable address during all those years was that entitled “The Soul of the Surgeon,” which he gave before the Mississippi State Medical Society when he was 55 years old.5Matas R. The soul of a surgeon.1935Google Scholar In “The Soul of the Surgeon,” after reviewing the incredible strides taken by surgery over the preceding years—giving due credit to Pasteur and Lister—Matas turned to his main point: among the many who recognized the value of surgical therapy, few also recognized the uniqueness of the type of person who chose to practice surgery “as a science and an art.” He believed that the rapid advances in surgery had led to excesses that were giving all surgeons a bad name, and that they were all being portrayed as mercenary and soulless, “greedy of gold, and thirsting for publicity and notoriety.” This point of view—and it was the point of view of much of the public—was caused in part by the many quacks and impostors who advertised in the newspapers, but also in part by men who had been trained well and who had truly acquired skills in modern surgical techniques, but who were willing to desecrate their ministry and art for money and fame. Those men, said Matas, despite their knowing better,... see an operation in any and every complaint... resort to all sorts of subterfuge to coax their patients to the operating table. They are the men who see in every cramp, an appendix; in every belch, a gallstone;... in every uterus, a cancer or a fibroid;... in every neurotic woman's abdomen, a floating kidney or a prolapsed or displaced organ, that nothing short of an operation, a laparotomy, can cure or relieve,—provided the patient can pay the necessary fee.5Matas R. The soul of a surgeon.1935Google Scholar Others, Matas said, were insanely ambitious for reputation and prestige as marvelous operators, who allowed their vanity to eclipse their reason and their morals. They would not hesitate to remove normal and inoffensive organs and endanger the lives of their patients to be considered highly successful surgeons. Still others were guilty of fee splitting, in one or more of its many pernicious forms. As one of the officers and founders of the American College of Surgeons, Matas knew whereof he spoke, for that society had been formed expressly to root out fee splitting and other evils of the field of surgery. But, he reminded his listeners, “Let us not... confuse the parasite with the host. Let us not mistake the false for the genuine. The imposter [sic] in surgery is a soulless individual and, as such, he has no place in a discussion on the Soul of the Surgeon—except to repudiate him as counterfeit or false coin.”5Matas R. The soul of a surgeon.1935Google Scholar The soul of the surgeon—as Matas defined it, “the ethical and emotional part of man's nature, the seat of the sentiments and feelings, as distinguished from pure intellect”—could never be truly appreciated or analyzed except by another surgeon. He mentioned historic facts that had helped to distort the surgeon's image into that of a brutal, uncaring person. Speed, rather than concern for cosmesis and function, was the only compassionate way to operate on an unanesthesized patient, but such speed was often interpreted as brutality. After the advent of anesthetics but before the use of antiseptics, the surgeon could, without concern for the patient's pain, perform an operation with painstaking artistry, but there was still the awful period of sepsis, often ending in death, that the patient and family had to bear. Drawing on the writings of some of the great surgeons of the past, Matas concluded with a few paragraphs on the surgeon's life that cannot be paraphrased, although I have shortened them here.It is indeed an impassioned and troubled life,... one in which we can scarcely claim a single moment of mental ease and quiet. It has its great joys, its superb and glorious hours; but it has also its tragic hours, its hours of bitterness and desolation. And yet, the real honest surgeons, all love it. They love it, in spite of its fatigues, its worries and its emotions.5Matas R. The soul of a surgeon.1935Google Scholar Citing Faure, he said,‘... To the true vocary of his art, surgery is beautiful; because it is great; because it is noble. Because, if it is a career involved in violent and often soul-stirring and heart-breaking emotions, it is also a source of deep satisfaction and lasting joy.’5Matas R. The soul of a surgeon.1935Google Scholar Citing DaCosta, he said,‘It is a triumph to successfully complete a difficult and dangerous operation and to know that we have done the best by the patient. It is a triumph to meet and master obstacles. It is a triumph, a splendid one, to save a life by surgery. A man who has long practiced surgery, and practiced it well, has a right to feel that he has not lived in vain; but has done good to his fellow man.’5Matas R. The soul of a surgeon.1935Google Scholar Matas said,Yes, I repeat, surgery is a beautiful art. It is a noble and a soul-stirring calling. I have laid stress upon its pains, its bitterness; but ‘what joy can be sweeter, or can compare with that of conquering disease, triumphing over nature, and to be even stronger than death!’... how happy the moment of inspiration when we are able to conceive a fertile idea, an invitation, or a discovery, which shall help to forge some new weapon against disease and death! What greater compensation than to know that we have done something that will survive our memory, and live through the lapse of time.5Matas R. The soul of a surgeon.1935Google Scholar Obviously Rudolph Matas was one of the good surgeons, a surgeon with a soul. He was a scholar of broad interest, a humanitarian, a man whose simple ways were a mark of his greatness. He was gifted mentally with high intelligence, a remarkable retentive memory, and a keen sense of awareness of the limitations of medicine and surgery during his time. He was extremely highly motivated and was given to hard, exacting work, almost routinely staying up until 2 to 4 o'clock in the morning.1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar His seriousness and dedication to medicine included his profound interest in teaching as well as in improving the standards of patient care. He had a multiplicity of interests in medicine, interests that ranged from infectious disease (yellow fever and typhoid), of course, to vascular surgery—interests that encompassed the politics and economics of medicine at the time and local and national political affairs. Although original in much of his thought, Matas also drew on and extended the work of others, well aware of the fact that total originality and creativity are rare indeed. He was often tardy to lectures, he often spoke too long, and it has been said that he never learned the meaning of a publisher's deadline or space limitations.1Cohn I with Deutsch HB Rudolph Matas A biography of one of the great pioneers in surgery. Doubleday & Co. Inc, Garden City, NY1960Google Scholar But he had an ever-present gentleness with all patients, and his concern for their well-being was a hallmark of his career. The tragedies of his personal life were never allowed to interfere with his relationships with his patients. His friendships and his continued close contact with leaders in medicine, such as Osler, Halsted, and Emile Holman were not only pleasant and important to his career, but they also served as a continuing sustenance to his scientific thought and to his ability to remain in the forefront of medicine. His fluency in French, Spanish, and English served him well in his many trips abroad and within this country. He was an avid reader as well as a writer and he developed an extensive personal library. His meticulous honesty and integrity are apparent from a perusal of his papers. The importance of a good library at a medical center institution was obviously paramount in his thinking, since he left a $1 million endowment to sustain the library at Tulane University School of Medicine, the library that bears his name today. We, as members of the Southern Association for Vascular Surgery, can and should profit from the distinguished life and career of Rudolph Matas, one of the world's foremost vascular surgeons who was so wisely chosen by our founders to grace the center of our seal. He left us a lasting legacy of integrity, hard work, an exploring mind, and a sense of loyalty and compassion, all of which helped him to obtain the position of honor he will always hold. It is my desire to dedicate this address to the memory of my beloved wife, Dewitt Cromer Cordell, who died on Feb. 7, 1984. I express my appreciation to the following people at the Rudolph Matas Medical Library, Tulane University, for their assistance in providing material for this presentation: W. D. Postell, Jr., Director; Ms. Cynthia H. Goldstein, Chief of Technical Services; Ann Holliday, Cataloguer; and Sharon Tadlock, Secretary; to Al Dufour, Photographer and Associate Director, Biomedical Communications, for his assistance with some of the illustrations; and to Sidney W. Lavender II, M.M.S.C., for his help in the preparation of this manuscript.