We can honor the past without living in it

Malachi Sheahan III, MD
Malachi Sheahan III, MD, peels back the layers on why a decision by the Southern Association for Vascular Surgery (SAVS) to replace its signature emblem is the right one.

Imagine you are considering moving to a country where you will be an ethnic minority. For example, suppose I am contemplating a position at a hospital in Ghana. I would spend a lot of time thinking about how my family and I would fit in with the cultures of that nation. How would we be perceived by its population? Suppose, in my research, I came across these quotes from the head of the hospital’s board of directors:

“These characteristics tend to confirm the lowly status of the white man in the scale of human evolution, and to establish closer analogies with primitive anthropoids than exist between these and other races of mankind.” “The degenerative tendencies of the white race revealed by statistics, are due, essentially, to the influence of unfavorable hygienic surroundings; to unfavorable social (including moral) environment; to all the causes which lead to a bad heredity, vice, dependency, and degradation, and which are acting simultaneously upon this ethnologically inferior and passive race which is struggling for existence with our superior and dominant population.”

What if their chair of anesthesia had authored a paper with the following passage: “Confining ourselves to the salient peculiarities of surgical interest, we shall insist, with all observers, on the lessened sensibility of the white nervous system to pain and shock. It is also believed—and my personal experience confirms this impression—that the tactile sensibility as revealed by the aesthesiometer is lessened. This would appear to be associated with a histological difference in the development and shape of the tactile papillae of the skin. This diminished peripheral sensibility is in harmony with the inferior organization of the white race. Diminished sensibility is not peculiar to whites, but common to all primitive races. Livingston was one of the first to call attention to the fact that white people can undergo the most painful operations with apparent indifference. This combination of circumstances—i.e. a naturally diminished peripheral sensibility, coupled with a more passive condition of the mind—makes the white man a most favorable subject for all kinds of surgical treatment with or without preliminary anesthesia.” What should I think? Maybe there’s some flexibility in the base pay? Of course, I would not join a place where the figureheads view me as inferior. Yet these quotes are not from some mythical figures in Ghana, but have been taken almost directly—except for reversing the races—from the writings of Rudolph Matas, whose face adorns the seal of the Southern Association for Vascular Surgery (SAVS).

This, however, is about to change. In his 2023 SAVS Presidential Address, William D. Jordan, MD, acknowledged a concern “that our image among many young surgeons is negatively impacted by having his likeness on our seal. Many of us have great respect for the work he has done, but some have expressed concerns about parts of his academic work that was offensive and not respectful to disadvantaged groups of the day.” President Jordan then called on members of the society to help design a new seal and “turn our eyes to the future.”

This clash between past and present is certainly not unique to our field. Perhaps the most public and possibly illuminating debate came over the presence of Confederate monuments in the United States. Defenders of the statues often cite their role in preserving history. A look at the actual timeline of their construction points to a more dubious purpose.

The American Civil War exacted a disastrous toll on the population of the South. Approximately 20% of Southern White men of military age were killed. Almost every family lost at least one member. In the decades after the war, numerous memorials were built to remember the dead. These were placed in solemn areas for contemplation, such as cemeteries. Starting around 1890 and peaking in the early 1900s, a new type of monument began to appear. Giant stone statues of Confederate leaders like Generals Robert E. Lee and Thomas “Stonewall” Jackson were erected. Now, instead of places for reflection, the monuments were positioned in public areas, such as town squares, courthouses, and state capitols. Rather than mourning the dead, the purpose of the new statues was clearly a validation of Confederate values during the Jim Crow segregation era. They seemed unequivocally designed and located to intimidate and discourage Black Americans from asserting their rights. Need more evidence? Ask Senator John Sharp Williams from Mississippi. At a 1927 dedication ceremony for a statue of Jefferson Davis, Senator Williams proclaimed that “[t]he cause of White Racial Supremacy, which . . . is not a ‘Lost Cause.’ It is a Cause Triumphant. . . The white man’s family, life, his code of social ethics, his racial integrity—in a word his civilization—the destruction of which in the slave states was dreaded . . . are safe.” See? These racists wanted to make it so clear that the Confederate statues represented White Supremacy that they just straight up handed out receipts.

Decades later, a new surge of Confederate imagery appeared as a backlash to the Civil Rights Movement. Georgia redesigned its state flag to include the Confederate symbol in 1956, and in 1961, South Carolina began to fly the rebel battle flag at its capitol building, where it would remain until 2015. Also undermining the claim that these monuments were constructed to preserve the local history of the South is that they were erected in 31 states. The Confederacy only consisted of eleven.

It is important to recognize and celebrate the achievements of historical figures. Still, we must maintain a critical perspective and acknowledge the full context of their lives and actions. We should strive to learn from the past while recognizing the limitations and biases inherent in our understanding. We can admire Thomas Jefferson’s accomplishments without ignoring his status as a slave owner. The latter should be scrutinized and studied as an example of the dangerous potential of the duality of man. Location and context are critical. Immortalizing individuals with giant marble statues seems more the domain of authoritarian regimes than advanced democracies.

Some argue that judging historical figures through the standards of today is unfair and term it presentism. There is ample evidence that as we become more easily connected to others through technology, our empathy grows. Princeton philosopher Peter Singer calls this our expanding moral circle. Social media also brings quick and global judgment to perceived bad behavior. It’s hard to be a jerk in private these days. As @maplecocaine posted, “Each day on twitter there is one main character. The goal is to never be it.” We take it as a point of fact that knowledge improves with time, so why wouldn’t morality?

We probably just need to be more careful about who we idolize. Most of history’s “greats” had serious character flaws. Winston Churchill hated Indians and sent the Black and Tans to ravage Ireland. Mother Theresa glorified poverty and told the unfortunate to accept their suffering. What about Gandi, John Lennon, or Albert Einstein? Racist, abuser, and chauvinist. At least to some.

While idolizing historical figures can provide inspiration and motivation, it can also lead to a distorted view of history and prevent critical examination of the past. We may be less likely to hold these individuals accountable for their actions or to acknowledge the harm that they caused. This can perpetuate a culture of impunity, where those in positions of power are immune from scrutiny or consequences.

Other scientific communities have also had to re-evaluate the honors they have bestowed on historical figures. The Association of American Medical Colleges (AAMC) recently decided to rename its prestigious Abraham Flexner Award. Flexner was responsible for a report in the early 1900s that revolutionized medica training. Unfortunately, the report also contained a myriad of racist and sexist ideas, and led to the closure of most of the historically Black medical schools in the US. Even the world of botany has been affected. Carl Linnaeus, the developer of the genus and species classification system, had his name attached to the Entomological Society of America’s annual competition. Unfortunately, Linnaeus used his system to classify humans by variety and assigned more positive traits to those with lighter skin tones. In removing the name, the society’s president, Dr. Alvin M. Simmons, stated, “A name can be replaced, but each entomologist brings a unique and valuable contribution to our society that is irreplaceable.” A valid point. Why make a divisive figure the symbol of your society?

So, what of Dr. Rudolph Matas? He is perhaps the most significant surgeon to come from my adopted home of New Orleans. Am I advocating for his erasure from our history? His cancellation? Absolutely not. As the head of the Tulane University and Louisiana State University (LSU) vascular programs, I am as much the caretaker of his legacy as any. I strongly recommend that all surgeons take the time to learn about this innovative and trailblazing man and his remarkable life. Sir William Osler, MD, hailed him as the “Father of Vascular Surgery.” The definitive account of his life: Rudolph Matas: A Biography of One of the Great Pioneers in Surgery was written by Isidore Cohn, MD, the father of my former chair of surgery at LSU. I would also enthusiastically endorse John Ochsner’s 2001 Journal of Vascular Surgery article “The complex life of Rudolph Matas.” Although here, his poor wife has to bear the indignity of having her portrait labeled “Fig. 8. Adrienne Matas in the early time of her weight gain.”

We must reconcile our desire to preserve the past while projecting symbols of inclusion. When a prospective member of SAVS looks at the seal and sees Rudolph Matas staring back, what do they think? Is he wearing sunglasses? Projecting Matas as the singular emblem of our society sends the message that this man, above all others, represents our ideals. A task, perhaps, too heavy for any solitary man or woman to carry.

I strongly believe in the wisdom that can be gained through studying our predecessors. Nearly every editorial I have written has looked to the past to provide context for our present. Surgeons must find a way to make our history relevant and illuminating to the next generation. Naming awards and creating symbols accomplish neither. I am certain this will engender some discussion, and not all of it favorable (please folks, it’s “you’re” a woke jackass). Clearly, some will see this as an attempt to erase history. But if that is your opinion, what is your vision here? Would you go to work for my mythical hospital in Ghana? Matas’s opinions on race may seem harmlessly antiquated, but what about when they are directed at you? When we start debating “was it racist for the time?”, we all lose.

Progress and tradition will battle without end. Our symbols and conventions must be able to endure the scrutiny of time. As Dr. Jordan said, rather than focus on the divisive errors of the past, surgeons should work together to produce solutions for our common future.


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