The Dawn of the 20th Century

In the years from the Civil War until the dawn of the 20th century, profound changes occurred in medicine. These changes were reflected in events at both Charity and Tulane School of Medicine. In 1885, the first ambulance service at Charity began. At that time third and fourth year Tulane medical students competed via testing for a spot as an intern at Charity. Once made an intern, the student had to live in the hospital, “subject to call, day or night, to any of the duties assigned to him.” Every eight days the intern was subject to 48 continuous hours of ambulance duty. The tradition of using interns as Charity ambulance physicians continued well into the 1960’s. In one disturbing story, the ambulance took so long to arrive on the scene of its first call that the ailing patient recovered and had left. The intern, however, did not want to return empty handed, so he and his driver forcibly took a young black man back to Charity and claimed he was their patient. Nonetheless, being chosen for the Charity Ambulance Corps was seen as a great honor for interns.

It is easy to forget how revolutionary the late 19th century was in the history and development of medicine. Germ theory evolved around this time. In 1881 Louis Pasteur had discovered that attenuated cultures of bacteria could induce immunity. By 1897, Robert Koch was making advances in steam sterilization, Joseph Lister had successfully used carbonic acid to kill bacteria in wounds, and the tubercle bacillus had been isolated. In 1896 Charity received its first x-ray machine. In 1900 the Aedes aegypti mosquito was identified as the vector for yellow fever via the Reed Commission’s work.

Rudolph Matas, the father of vascular surgery, is one of Tulane’s most illustrious graduates. Born in Louisiana to Spanish immigrants, Matas matriculated at the University of Louisiana Medical Department in 1878. In 1879, Matas, then a medical student, accompanied then dean of Tulane Dr. Stanford Chaille to Cuba to search for the cause of yellow fever. While they did not identify a cause, they did take photomicrographs of tissue obtained at autopsy. Using these photomicrographs, Cuban Dr. Carlos Finlay was the first to suggest mosquitoes as vectors of yellow fever, in 1881. Matas championed this idea but it was not until 1900 and the work of the Reed Commission was this theory proven. Matas won a coveted spot as an intern at Charity, and in 1883 was appointed a demonstrator of anatomy for the medical school. In 1885, at the age of 24, he published his first landmark paper than defined the cecum and appendix as intraperitoneal structures, rather than retroperitoneal as had been assumed. In 1888, Matas performed the first successful endoaneurysmal repair operation. In 1894 Matas was appointed to the prestigious Chair of Surgery at Tulane. His list of innovations continued: the first to perform surgery under spinal anesthesia, among the first to perform a thyroidectomy, the first to use intravenous fluids during surgery, and the first use of intralaryngeal insufflation to prevent surgically induced pneumothorax during chest surgery.

At the same time, medical education was lagging behind. A watershed moment in the history of medical education was the publication of the Flexner report in 1910. This report studied 155 American and Canadian medical schools and found 75% of them were wholly inadequate in terms of teaching future physicians. Tulane, however, was ranked among the top three Southern medical schools, along with Vanderbilt and the University of Texas, and among the top seven schools nationally.

Medical students continued to play important roles for health in the city. In 1914, a Swedish sailor and his roommate were discovered to have bubonic plague. Hysteria ensued in the city, with widespread fear of rats and the spread of plague. In response to this, city officials organized teams of rat patrols made up of Tulane medical students. These teams were sent throughout the slums of the city, filling garbage cans with dead rats and dissecting and culturing lymph nodes for evidence of the plague bacillus. It was claimed Tulane medical students were thanked for killing “nearly one-fourth of the total rodent population of New Orleans.”

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