Well fellow readers I am off to the Southern Medical Association. I have two presentaions an oral presentaion before the section of surgery and a poster for the general meeting at large.
The oral presentaion is the Soul of the Surgeon : Annotations
Here is the presentation in RTF from the Powerpoint:
The Soul of The Surgeon
• Annotations
• Southern Medical Association,
• Surgery Section
• New Orleans, Louisiana
• Friday November 12, 2004
• James T. Evans ,M.D., FACS
• jamestevansmd@medscape.com
Annotate
• To furnish a literary work with critical commentary or explanatory notes
• From The American Heritage Dictionary, Fourth Edition, copyright 2000.
• http://joyofsurgery.blogspot.com
The World’s Best Known Surgeon
• Author = Alexander J Walt
• Journal = Surgery 1983 Oct:94(4)582-90.
• Presents the case that Henry Norman Bethune should be acknowledged as the world’s best known surgeon.
• Bethune was Mao Tse-tung’s Army surgeon immortalized in “The Red Book”
Most Important Surgical Address
• The Soul of the Surgeon
• By Rudolph Matas, M.D., FACS
• jamestevansmd@medscape.com
The Soul of the Surgeon
• First delivered as the Annual Oration of the Mississippi State Medical Association in Hattiesburg, Mississippi, May 1915.
• Published in the Transactions of the Mississippi State Medical Association.
• Published serially in the Mississippi Doctor
• Published as a limited edition book in 1921 by Touro Infirmary, New Orleans
The Soul of the Surgeon
• Revised, updated, shortened for Dr. Matas’ Presidential Address of the American College of Surgeons Oct 30, 1925 in Philadelphia.
• Printed in the Yearbook of the American College of Surgeons, 1926, p 71-78.
• Reprinted in book form in 1955 and labeled the Third Edition, Including an Introduction by Dr. Matas, himself.
The Soul of the Surgeon
• Portions included in French in address to French Congress of Surgeons 1926.
• Matas’ address was so well received that he was made Honorary President of the French Congress of Surgeons.
• A portion of Matas’ address to the Southern Surgical contained material from The Soul of the Surgeon.
Content and Context
• “I will, therefore, permit myself to indulge in some rambling thoughts on a subject with which, form the very nature of my life-work, I am most familiar, if not best qualified to speak – I mean the Surgeon, or, rather, the Soul of the Surgeon himself.”
Content and Context
• “…the Soul of the Surgeon – if we may define the soul as ‘the ethical and emotional part of man’s nature, the seat of the sentiments and feelings as distinguished from pure intellect’ – is a part of his makeup that is unknown to the masses; and the profound emotions which agitate him and with which he is rarely credited…”
Content and Context
• “But, in the presence of the cynical and grossly material concept of the surgeon’s role in the social fabric, it is only fair that something should be said to prove the baselessness of the charge that he is mercenary, soul-less, indifferent to the fate of his fellows, greedy of gold, and thirsting for publicity and notoriety.”
Content and Context
• “In spite of our modernity or up-to-dateness, we still live in an atmosphere which has not been depurated of all the somber traditions which hang around the memory of practitioners of surgery of past generations.”
• “…unfeeling or cruel, if not actually brutal”
• “…callous heart and indifferent sensibilities
The Soul of the Past Surgeons
• “What we learn by the writings and the teachings of Guy de Chauliac, Ambrose Pare and their contemporaries, their predecessors and successors, is, that the Soul of the True Surgeon has remained ever faithful and quick to the call of pain of humanity, and that the harsh friction incident to his calling, has never, through- out the ages touched or tarnished the surgeon’s motives.”
Names - 1
• 1- Prentiss
• 2- Davis
• 3- Lamar
• 4- Williams
• 5- Chaille
• 6- Pasteur
• 7- Lister
Lamar - 1
• Lucius Quintus Cincinnatus Lamar was born in Putnam County, Georgia, on September 17, 1825, into an aristocratic planter family. He attended Emory College and became a lawyer. He was elected to Georgia State legislature. He then decided to move westward to Mississippi to seek his fortune. He took up residence and opened a law practice in Oxford, MS.
Lamar – 2
• After marriage, he became a faculty member at the University of Mississippi, a position he no doubt secured with the help of his father- in – law, Augustus Baldwin Longstreet, the University President.
• During the Civil War, Lamar formed the 19th Mississippi regiment of volunteers and fought against Union General George McClellan in Virginia.
Lamar - 3
• C.S.A. President Jefferson Davis appointed Lamar ambassador to Russia but he was never recognized since the Confederacy’s sovereignty could not be obtained.
• Lamar returned to Mississippi after the war and resumed both his law practice and faculty position, as Head of the Law Department at the University.
Lamar – 4
• 1872 – elected to Congress, first Democrat since Radical Reconstruction.
• 1877 – United States Senate
• 1884 – Cabinet member Grover Cleveland’s administration.
• 1888 – appointed United States Supreme Court. Authored major decisions for States Rights and limited Federal political power particularly in civil rights.
Names - 2
• 8- Horace
• 9- Bernard Shaw
• 10 -Dr. Chalmers Da Costa
• 11- Zola
• 12- Fecondite
• 13- Gaude
• 14- Napoleon
Horace
• Horace was a Roman poet who lived from 65 to 8 B.C. We call him Horace in English, but to his contemporaries and fellow countrymen he was Quintus Horatius Flaccus. Among his poetry are four books of odes (known in Latin as "carmina"), containing just over one hundred individual poems (103, to be exact). In one of these odes (3.30) Horace bragged that his poetry would live as long as Vestal Virgins climbed the Capitoline Hill in Rome. You won't find any Vestal Virgins in Rome today, but Horace's odes are still read and enjoyed, more than 2000 years after he wrote them.
Names - 3
• 15- Dr. John B. Murphy
• 16- Dr. Charles A.L. Reed
• 17- J.M. Finney
• 18- Dominique Larrey
• 19- Ambroise Pare
• 20- Prometheus
• 21- Pierre de l’Estoile
Finney
• Biography
• J. M. T. Finney, Jr., was born in Natchez, Mississippi. He received his B.S. in 1915 from Princeton University and his M.D. in 1919 from the Johns Hopkins University School of Medicine. He was a surgeon and faculty member at Johns Hopkins, as well as a partner with his father in private practice in general surgery. Finney was a member of several medical associations including the Baltimore City Medical Society, serving as its president in 1950. He was also vice president of the Finney-Howell Cancer Research fund. Finney authored several published papers and delivered a Hunterian Lecture to the Hunterian Society in London in 1949.
Names - 4
• 22- Archbishop of Lyon
• 23- Catherine de Medici
• 24- King of France
• 25- Guise
• 26- Guy de Chauliac
• 27- Conan Doyle
• 28- Juggins
• 29- Archer
Names - 5
• 30- Dr. John Brown
• 31- Dr. Cheever
• 32- Bob Sawyer
• 33- Terence
• 34- Joseph Pancoast
• 35- Velpeau
• 36- Pirogoff
Names - 6
• 37- Gross
• 38- Raphael
• 39- Michael Angelo
• 40- Leonardo
• 41- Murillo
• 42- Faure
Elie Faure
• Faure, Élie 1873—1937, French art historian. Trained in surgery, he brought his scientific knowledge to bear in his study of the history of art, relating it to the progress of human culture. Of his long list of critical and historical works, the best known is his History of Art (5 vol., 1909—21; tr. by Walter Pach, 1937).
Diego Rivera’s La Operacion
Jean-Luis Faure
• Diego Rivera’s sketch La Operacion in Paris in 1920 reflects the skill of Jean-Luis Faure, the brother of Elie Faure. It was this skilled surgeon to whom Matas referred.
• Others might have thought that Dr. Matas’ fabled art collection would have cemented the reference to Elie. However, among Dr. Matas notes is a reference to Jean-Luis as a French Surgeon who performed his aneurysm procedure!
Epilogue - 1
• The life of a surgeon though a hard one, is indeed a beautiful life. Let me repeat reverently these lines from Faure: “When the last hour comes to the conscientious and honest surgeon, no one can lie down to sleep the slumber of eternal night, with greater composure and peace. Happy is he, who, listening to the voice of his conscience, shall hear her murmuring
Epilogue - 2
• In his ear the comforting words which tell him that, whatever his failings and shortcomings, he has done more good than evil; that on this earth, where joy and misery travel side by side, his hands, though blood stained, not unlike those of the Savior, have relieved more suffering than they have caused pain.”
Conclusion
• Rudolph Matas was a genuine scholar, orator, founding member and President of the American College of Surgeons. His lasting contributions to surgery are numerous; however, his lasting fame can be attributed in large measure to his ownership of the world’s most famous surgical speech: The Soul of the Surgeon
• jamestevansmd@medscape.com
Lagniappe
• A famous Louisiana tradition.
• Getting a little extra.
• jamestevansmd@medscape.com
Photo Of Matas
Rudolph Matas
• 1860-1957
• Rudolph Matas was born in New Orleans on September 1, 1860 . In his childhood,
• he spent several years with his family in their native Spain ,as well as France, but returned to New Orleans and in 1877 enrolled in the Medical College of Louisiana, now known as Tulane University .
Rudolph Matas
• In 1879, Matas, a medical student, was chosen to travel with the U.S. Yellow Fever Commission to Havana to serve as laboratory assistant and interpreter.
• There he met Dr. Carlos Finlay, the first to suggest the mosquito as the yellow fever
• vector.
• Matas was, for a time, the sole supporter of the theory.
Rudolph Matas, M.D.
• Matas received his degree in medicine from the Medical Department of the
• University of Louisiana, now Tulane University, in 1880.
• Matas' first landmark paper was published in 1885; in it, he unequivocally defined the cecum and appendix as intraperitoneal organs.
Rudolph Matas,M.D.
• Subsequent milestones include his use of spinal anesthesia in 1889, the first in the United States ,
• his development of the intravenous drip,
• and his use of endotracheal intubation with positive-pressure ventilation to ramatically improve the safety of thoracic surgery.
Rudolph Matas,M.D.
• Matas’ most renowned achievement, however, was his development of the intra-saccular technique for the surgical treatment of aneurysm.
• Previously, surgical treatment of aneurysm was limited to proximal and distal vessel ligation.
Rudolph Matas, M.D.
• Matas' technique, initially an improvisation to control bleeding from a brachial artery aneurysm fed by numerous collaterals, involved opening the sac and obliterating the ostia of the collaterals from inside; it was later refined to preserve the patency of the parent artery in favorable cases.
Rudolph Matas,M.D.
• Matas' career was one of distinction from the outset: at 23 he was appointed director of the New Orleans Medical and Surgical Journal.
• In 1895 he was elected Professor of Surgery at Tulane University, a post he held until he became Emeritus Professor in 1927.
Rudolph Matas,M.D.
• He was also active as surgeon and consultant at Charity Hospital, Touro Infirmary, and the Ear, Eye, Nose and Throat Hospital - all in New Orleans - throughout a long career.
• Matas continued his surgical practice and
• civic and academic pursuits until the age of 92, five years before his death.
Rudolph Matas,M.D.
• Dr. Matas was a pioneer of the first rank in the surgery of the blood vessels, chest and abdomen. His introduction of the suture for the cure of aneurism won him international fame and caused Sir William Osler to hail him as the "Father of Vascular Surgery" and the "Modern Antyllus".
Antyllus
• Antyllus' method :
• An operation for aneurysm whereby is applied two ligatures to the artery and cut between them.
Antyllus
• Antyllus was one of the most important physicians in Greek antiquity, particularly famous as a surgeon. He lived after Galen, but before Oribasius, late third and early fourth century AD. Little is known about his life and his works have been lost, but writings of various authors, particularly Oribasius, Aëtius and Rhazes, enable us to get some impression of him.
Antyllus
• One of the most daring and accomplished of surgeons, Antyllus is particularly remembered for his work on the surgery of aneurysm. He was first to recognize two forms of aneurysm – the developmental caused by dilatation and the traumatic following wounding of an artery.
Antyllus
• Antyllus operated on the eye, did tracheotomies and performed a radical operation for hydrocele. He also gives detailed advice for the operation of tumours, and in a chapter on resection he presents evidence he was a keen and skilful operator.
Content and Context
• Three Themes
• 1 – Economic evils = fee-splitting
• 2 – Peer review and control =
• American College of Surgeons
• 3 – Emotional, ethical, psychological
• aspects of the life of a Surgeon
Content and Context
• “But, in the presence of the cynical and grossly material concept of the surgeon’s role in the social fabric, it is only fair that something should be said to prove the baselessness of the charge that he is mercenary, soul-less, indifferent to the fate of his fellows, greedy of gold, and thirsting for publicity and notoriety.”
Content and Context
• Classification of Evil Surgeons
• 1- Quacks
• 2- Imposters
• 3- Knaves
QUACK
• An untrained person who pretends to be a physician and dispenses medical advice and treatment.
• From American Heritage Dictionary
Quack
• “The quack is a loud-mouthed pretender, a person who seeks to gain confidence by unworthy methods or an individual who claims to have a specific for various disorders of manners, morals, finance, and politics.”
• “Advertises undisguisedly in newspapers”
• From Rudolph Matas’ Soul of the Surgeon
Impostor
• One who engages in deception under an assumed name or identity.
• From American Heritage Dictionary
Impostor – from Matas
• “…regarded as regular practitioners…”
• “…trained in safe methods …”
• “…desecrate their ministry and their art for purely sordid, sinister motives.”
• …see an operation in any and every complaint”
• “…a patient’s pathology shrivel into a negligible quantity when it is discovered that the pocket-book is empty…”
Knave
• An unprincipled, crafty fellow
• From American Heritage Dictionary
Knave from Matas
• “…insanely ambitious for reputation and prestige as marvelous operators…”
• “…allow their vanity to eclipse their reason and their morals…”
• “…multiply one’s successes, with even modest surgical training, by removing healthy organs…”
• “…not included within the …Faculty.”
Fee-splitting
• Classification
• Dr. John B. Murphy
• “57 varieties”
• “…band of looters and outlawed camp followers…”
• “…relaxation of the moral conscience…”
American College of Surgeons
• “The American College of Surgeons was organized with the express purpose of doing away with these very evils of which we have been speaking.”
• “…eliminate commercialism and graft…”
• “… raise the standards of morals, of ethics, and of education…”
Annotated Alice
The annotated Alice:
• Alice’s adventures in Wonderland &
• Through the looking glass
• Carroll, Lewis 18-32-1898
• Tenniel, John 1820-1914
• Gardner, Martin 1914-
• The groundbreaking text which exposed the mathematical puzzles and word riddles.
Prentiss
• Sargeant S. Prentiss was in the flower of his forensic fame. He had not, at that time, mingled largely in federal politics. He had made but few enemies; and had not "staled his presence," but was in all the freshness of his unmatched faculties. At this day it is difficult for any one to appreciate the enthusiasm which greeted this gifted man, the admiration which was felt for him, and the affection which followed him.
Prentiss
• He was to Mississippi, in her youth, what Jenny Lind is to the musical world, or what Charles Fox, whom he resembled in many things, was to the whig party of England in his day. Why he was so, it is not difficult to see. He was a type of his times, a representative of the qualities of the people, or rather of the better qualities of the wilder and more impetuous part of them.
John Chalmers Da Costa
• John Chalmers Da Costa (1863-1933)
• Jefferson Medical College Class of 1885
• John C. Da Costa was the successor to W. W. Keen as the chair of the Jefferson
• Medical College Department of Surgery in 1907 and, in 1910, became the first Samuel D. Gross Professor.
Da Costa
• His skills as a teacher of surgery were unsurpassed, and his Wednesday afternoon clinic in the amphitheater before the combined junior and senior classes became a memorable event. Born on 15 November 1863 in Washington D.C. the Da Costa family moved to Philadelphia when Da Costa was fifteen.
Da Costa
• Da Costa entered the University of Pennsylvania at the age of seventeen where he studied chemistry for two years. He then matriculated at Jefferson Medical College and graduated, as class valedictorian, in 1885.
Da Costa
• In 1887, Da Costa began his academic career at Jefferson Medical College with an appointment as Assistant in the surgical outpatient department and as Assistant Demonstrator of Anatomy. This began an affiliation that would last for over forty years.
Da Costa
• While at Jefferson, Da Costa wrote Modern Surgery, General and Operative (1894) a work that became a classic throughout U.S. medical schools going through ten editions; the last in 1931.
• During World War I, Da Costa served as a junior lieutenant in the Navy and eventually rose to the rank of commander.
Da Costa
• In 1919, Da Costa sailed on the George Washington on a special mission to
• tend to ailing U.S. President Wilson during negotiations for the peace treaty of World War I and the League of Nations.
Da Costa
• But it was Da Costa's lectures in the "pit" that students remembered years afterward. Mixing history and literature into
his lectures, Da Costa was also remembered for numerous pithy aphorisms such as "A surgeon is like a postage stamp. He is useless when stuck on himself."
Da Costa
• Da Costa also held a life-long interest in the Philadelphia Fire Department probably due to his father and uncle's membership in volunteer fire departments. Whenever he could, Da Costa would ride out with the Fire Chief in order to render aid to injured firemen. In addition, he served for over 30 years as surgeon to the Firemen's Pension Fund.
