Francisco Montbrun-Ríos belonged to the Faculty of Medicine of the Central University of Venezuela for 77 years (1930-2007). He performed as a brilliant student, excellent professor of anatomy and surgery, and outstanding surgeon at the Vargas Hospital and the Medical Center of Caracas. He participated in the foundation of the "José María Vargas" School of Medicine (JMVSM), the reform of medical studies and the drafting of norms and university regulations. He wrote textbooks of anatomy, published research papers, and introduced surgical techniques in Venezuela. As Minister of Health, he promoted the development of a national health system and the cooperation with the Faculty of Medicine. He was a founding member of the Venezuelan Society of Surgery, the College of Physicians of the Federal District, and the Venezuelan Medical Federation. He was member of the American College of Surgeons, the International College of Surgeons, the Latin American Federation of Surgery, and the National Academy of Medicine of Venezuela. He was awarded the title of Honorary Professor and received many awards and recognitions.
Keys words: anatomist; Central University; Venezuela; medical education; surgeons; surgery; history of medicine; “José María Vargas” School of Medicine
Francisco Montbrun Ríos perteneció a la Facultad de Medicina de la Universidad Central de Venezuela durante 77 años (1930- 2007). Estudiante brillante, excelente profesor de anatomía y de cirugía, cirujano destacado en el Hospital Vargas y en el Centro Médico de Caracas. Participó en la fundación de la Escuela de Medicina “José María Vargas”, la reforma de los estudios médicos y la redacción de normas y reglamentos universitarios. Escribió libros de texto de anatomía, publicó trabajos de investigación e introdujo técnicas quirúrgicas en Venezuela. Como Ministro de Sanidad y Asistencia Social, promovió el desarrollo de un sistema nacional de salud y la cooperación con la Facultad de Medicina. Fue miembro fundador de la Sociedad Venezolana de Cirugía, el Colegio de Médicos del Distrito Federal y la Federación Médica Venezolana. Fue miembro del American College of Surgeons, el International College of Surgeons, la Federación Latinoamericana de Cirugía y la Academia Nacional de Medicina de Venezuela. Fue nombrado Profesor Honorario y recibió numerosos premios y reconocimientos por su labor.
Palabras clave Universidad Central; Venezuela; anatomía, cirugía; educación médica; historia de la medicina; Escuela de Medicina “José María Vargas”; Hospital Vargas
A person's life is linked to a geographical scope, a nation, an age, a history, a culture, families. Knowing a person's life also informs us about many other related subjects. I wrote this paper to help preserve the memory of Francisco Montbrun Ríos (FMR), a kind, hard-working, and admired man, who influenced the lives of others, and the institutions where he served. I am a witness and participant of some stages of his life, as a student, colleague at the university and the National Academy of Medicine, and his third wife.
Francisco Montbrun Ríos was born on December 27, 1913 at Santa Rosalía Parish, Caracas, Venezuela, to Domingo Montbrun Betancourt, a native of Caracas, and Carmen Ríos Ojeda de Montbrun, a native of Miranda, Carabobo State. He was baptized according to the Roman ritual with the name of Francisco Antonio de Jesús Montbrun Ríos. The Montbrun-Ríos family (Fig 2) had six children: Gisela, Carmen María, Trina, Domingo, Francisco, and Enrique (2).
Francisco's life began in a country with 2.35 million inhabitants, under the dictatorship of Juan Vicente Gómez (3). Constitutional guarantees were suspended, 75% of the population was illiterate, 80% was rural. The agricultural production was rudimentary; food intake was low. The mortality rate was 30 per thousand inhabitants; tuberculosis, the leading cause of death; infant mortality: 200 deaths of children under one year per thousand live births; life expectancy at birth, under 32 years (4); petroleum production had just begun in Sucre State (3). The city of Caracas had approximately 800 hectares and 85,000 inhabitants, 3.6% of the country's population (5). People moved mainly on foot, in horse-drawn carts, on electric trams and railways. The Central University of Venezuela (Universidad Central de Venezuela, UCV) was closed to contain political unrest. It remained closed until 1922 (6).
The family surname Montbrun came to Venezuela from France. It is written on the Arc de Triomphe of Paris, honoring Major General Louis Pierre Montbrun (7). FMR earliest known ancestors, Antonio Montbrun and Luisa Certes, lived in Toulouse, France. Their son Dominique came to Puerto Cabello, Venezuela in 1780 and married María del Carmen Zamorán, descendent of Jayme de Agüero, one of the Spanish conquistadores (Fig 2).
José Leandro Montbrun Zamorán, fought during the war of independence, achieving the rank of Brigadier General, and was distinguished as “Prócer de la Independencia” by a law of May 19, 1869. Domingo Montbrun Otero was a Physician Surgeon graduated from the Central University of Venezuela, Army Surgeon, and Member of the England Royal College of Surgeons. José Leandro Montbrun Otero and José María Montbrun were Army Colonels (8). Domingo Montbrun Betancourt dropped out of medical school when his father died. He worked at the Bank of Venezuela, where he held a high office and was a public relations pioneer (9). FMR's Neuroanatomy Volume I dedication to his father reads: "His personality, integrity and honesty, has been for me the paradigm of my ambitions, oriented by his noble and austere life, framed within the impartiality and justice of his wise counsel" (10).
The parents-children relationship in the Montbrun-Rios family was close. In a letter (11), Domingo addresses Francisco, who was in Paris, France, like this: "Family letters have great spiritual significance because they are guided by sincerity and the verb of love"..."you do not imagine how your mother and I read that letter of yours where you show the purity of your noble feelings, we think they are identical to those of your brothers and sisters. I, under the mastery of my heart, have analyzed one by one the feelings of my children and I see in all the summit of love, generosity, nobility. What more reward can I expect from the Supreme Maker? I love your way of thinking as a Christian and a philosopher”. Domingo Montbrun Betancourt (Fig. 5A) died on 18 August 1956.
The history of the Ríos family (Fig. 3) began in 1838 with the arrival in Puerto Cabello of Manuel Ríos and his wife Carmela (9). They came from Cádiz, Spain, interested in acquiring farmland from patriot soldiers who participated in the war of independence. They managed to buy a plot near Montecarmelo, where they grew coffee and tobacco. Their son Felix Ríos was born in 1841. Unfortunately, Manuel died shortly after in conflicts with former landowners. Carmela had to sell the plot and pursue minor trades to survive. In 1854 Félix Ríos moved to Miranda, State of Carabobo, where he devoted himself to the retail trade of household equipment, horse, tobacco, and coffee. A hard working and thrifty man, he invested his profits, purchased 20 small farms, and accumulated a fortune. In 1879 he married Ramoncita Ojeda. Carmen Ríos Ojeda was born in 1880. At the age of 10 she was sent to the Ursulina Nuns College in Curacao for seven years. She learned French and was educated to become a good mother and housewife. She returned to Caracas, where the family had moved in 1880. She died on 22 June 1970. In Miranda FMR learned to ride and tame horses. “Grandpa Felix died at the time of the solar eclipse on February 3, 1916" (9).
FMR married three times. The wives were Mercedes Urbaneja Blanco, biology professor at the Faculty of Sciences of the UCV; Vicki Straetger Rosenthal, philosophy professor at the Simon Bolivar University, and Lilia Cruz, physiology professor at the “José María Vargas” School of Medicine (Fig. 4). He had two children: Gloria Montbrun de Incerpi (1938), architect, married to Gianfranco Incerpi, engineer, residing in Florence, Italy, and Juan Francisco Montbrun Straetger (1982), graphic designer, publicist, and photographer, based in Miami, USA (Fig. 5). FMR had four grandchildren Incerpi-Montbrun: Francisco, Enrique, Georgia, and Vanessa. Among his great-grandchildren: Adriana, Julia, Gaia, Simón, Maria Carolina, Emiliana, Beatrice and Francisco.
"I learned to read with my paternal aunts. I went to school in second grade”. Montbrun studied at the Federal School "Republic of Paraguay". He earned the top grade of 20 points on a 1-20 scale, on the Higher Elementary Primary Instruction exams submitted to the Instruction Council (2). “The resources available for teaching were very scarce, the premises were insufficient, many children were left out without being able to hear the classes" (9).
FMR graduated from Bachelor of Philosophy in 1930 with an average of 18 points at the Colegio "San Agustín" (2).
At the School of Medicine of the Central University of Venezuela, from 1930 to 1936, Montbrun´s grade point average was 19.7. The Summa Cum Laude distinction currently bestowed to graduates, who earn an average of 19-20 points, did not exist then at UCV. He did Internships (1934-1936) at the Vargas Hospital and the Venezuelan Red Cross’ Carlos J. Bello Hospital, in Caracas. His Doctoral Thesis entitled "Normal joint mechanics of the knee - traumatology of the meniscus of the knee", was the best surgery thesis of his class, and the Gold Medal "Pablo Acosta Ortiz" was conferred upon him (2). The mentor, Germán de las Casas, was the founder of Traumatology in Venezuela. The title of Doctor of Medical Sciences was awarded to him on September 26, 1936.
Dr. Montbrun won three competitions for the surgery residency at the Vargas Hospital (1937, 1938, and 1941-1943), and worked there as operating room director from 1937 to 1939. He practiced elective surgery at the Hospital Obrero and the Bolivarian Hospital from 1936 to 1939, and emergency surgery at the Puesto de Socorro (1936-1947) (2).
In March 1939 FMR obtained a one-year scholarship from the Venezuelan Ministry of Education to study abroad. In Paris, France, he attended lectures of general surgery at the Clamart Amphitheater and studied under the tutelage of professors Jean Braine and Judet. He learned gynecology at the Broca Hospital with Professor Moucquot. He studied anatomy and did anatomical research at the École Practique with Professor Henry Rouvière in the Faculty of Medicine of the University of Paris. He trained in anatomical drawing with Professor of Fine Arts Armand Moreau, who made the drawings for the Treaty of Human Anatomy written by Rouvière. Francisco Montbrun left France in August of 1939: “Unfortunately, the beginning of world war II and the threat of the Nazi invasion of France led to the suspension of activities at the University and forced me to leave for the United States of America to continue studying on the Ministry of National Education scholarship. We traveled by boat from Biarritz to New York, after a hasty departure from Paris with safe conduct” (9).
"At Mount Sinai Hospital in New York I enrolled in a two-month course on vaginal cytology taught by one of the great experts of that time. Simultaneously, I worked performing gynecological examinations, vaginal cytology, and biopsies on black and Latino patients. This learning was especially useful for my patients' care in Venezuela" (9). His skill and precision were recognized by the supervisory staff (2).
From October 1939 to May 1940, under the auspices of the Rockefeller Foundation, FMR went to Yale University School of Medicine to learn and teach general anatomy, neuroanatomy, and neurophysiology under the direction of Edgar Allen. He also took a six month neuroanatomy specialization course taught by Ralph Meader in the Department of Anatomy.
In 1944 FMR won a Lilly Foundation Fellowship to go to the University of Pennsylvania Graduate School of Medicine. He took courses in Emergency Surgery and War Surgery at the Graduate Hospital of Philadelphia.
FMR learned several surgical techniques at the Rawson Hospital and the Clinical Hospital in Buenos Aires in 1947.
To learn about Medical Education, he visited Stanford University in June 1961, the Schools of Medicine at Ribeirao Preto, Brazil; Mendoza, Argentina; Concepción and Santiago in Chile, under the auspice of the Pan-American Health Organization in 1962; and in 1964, the Medical Institutes of Moscow, Leningrad, Kiev, and Yerevan to observe scientific research done by medical students (12).
From 1934 to 1936 as Teaching Assistant (Preparador), FMR was the only person responsible for the preparation and control of the practical works of Histology at the Central University of Venezuela School of Medicine (CUVSM). “The laboratory had about five light monocular microscopes, and a few slides, preparations that had a great historical value, since some of them were originals of Dr. Jose Gregorio Hernández, pride of our School of Medicine" (13).
Chief of Practical Works of Topographic Anatomy (1937-1940) earned by open competition. He directed and supervised cadaver dissections performed by medical students.
Professor of Anatomical Technique II (1940-1944), under the direction of Manuel Corachán García. The classes were theoretical-practical, with dissections. To the general anatomy, FMR added the practical teaching of neuroanatomy (2).
Professor of Anatomy: FMR began in 1943 under the direction of José Izquierdo. From 1946 to 1954 he was Associate Professor of Descriptive and Topographic Anatomy (Fig. 6). In 1955 he was promoted to Full Professor (2). On October 15, 1953, he was appointed chairman, replacing José Izquierdo, who retired on July 2, 1952 (14) at the UCV School of Medicine, until 1960, when he moved to the "José María Vargas" School of Medicine, the new school within the UCV Faculty of Medicine, where he served as Head of the Chair of Human Anatomy and Chairman of the Department of Morphological Sciences for 16 years, from 1960 to 1976. He continued as an active member of the Anatomy Faculty until 2001.
The Anatomical Institute located near the Vargas Hospital, at the San Lorenzo Square, was inaugurated June 25, 1911 by Luis Razetti, Chair of Anatomy. FMR was its Director from 1944 to 1948 and from 1955 to 1959. In 1949 Montbrun acted as an advisor for the construction of a new building for the Anatomical Institute in the modern Central University campus, “Ciudad Universitaria de Caracas”. The new edifice was inaugurated March 27, 1952. The Anatomical Institute was named after José Izquierdo (1887-1975) on April 23, 1969 (Fig. 7). The University City of Caracas is in the UNESCO World Heritage list (15). The old building in San Lorenzo was demolished in 1960 to give way for the construction of one of the basic sciences edifices of the Vargas School of Medicine, inaugurated in 1962. Montbrun was also an adviser for that construction process.
In his master classes, FMR used to draw with colored chalks on a board, to illustrate the anatomical planes. His anatomical drawings were greatly admired and are persistently remembered by his disciples. He pioneered the use of audiovisual media with the projection of color slides, which he combined with his wonderful drawings. Many of the slides were drawn and photographed by himself at home. Starting in 1941, he perfected and individualized the teaching of neuroanatomy in Venezuela based on the knowledge of the functional pathways and topographic organization, analyzing serial vertical-transverse and horizontal sections of the brain and the spinal cord, following the concepts of Andrew T. Rasmussen, University of Minnesota, USA (2).
To cover all human anatomy, he wrote, from 1949 to 1993, 27 syllabi (several editions of twelve issues), presented as atlases, with text on the left and figures on the right, “to make learning very objective, because the student always has a figure in sight”. They were of low cost for the students and easily adapted to the evolution of knowledge. In 1999, FMR published two books “Concise Anatomy, Volume I: Bones and Joints of the Head, and Volume II: Soft Parts of the Head and Neck, and in 2000, three volumes of Neuroanatomy: I: Morphology of the Spinal Cord and Brain Stem, II: The human brain, and III: Organization of functional nervous pathways in the central nervous system (Fig. 8). He introduced the new anatomical nomenclature, the PNA (Parisiensia Nomina Anatomica), whose sixth edition, the Nomina Anatomica (NA), was approved at the XII World Congress of Anatomy in London, in 1985. In his books he used the words in Spanish translated from Latin.
Other contributions to the study of human anatomy were the introduction of new methods for the conservation of cadaveric material, the design of a dissection table, made of stainless steel with a storage compartment for permanently storing the corpse and with a hydraulic lifting mechanism, to expose it when required for dissection or demonstration. The dissection tables were manufactured by the Schaeck company and are still in use at the two medical schools of UCV. He led the construction of tanks for the preservation of corpses at the Anatomical Institute and the Vargas School.
“José María Vargas, founder of the Chair of Anatomy, gave his first lecture on October 31, 1827. The classroom organized by Vargas, located in the southwest corner of the old university, today Palace of the Academies, remained unchanged. In 1930, when our unforgettable professor Master José Izquierdo was standing on the same wooden platform, we felt moved to the time of our Father of Medicine, a century earlier” (16).
In the introduction to his Neuroanatomy volume I, FMR wrote: "Razetti was the initiator of neuroanatomy teaching in our midst. He said in January 1900: “today we begin the study of the anatomy of the nervous system. Modern works have made a real and momentous revolution in our knowledge of this wonderful apparatus" ... "the positivist philosophy asserted that there was no need to resort to the hypothesis of the vital principle or the immortal soul when nerve functions have their origin in food and in the combustion of carbon" (10). In the same book, FMR mentions that José Gregorio Hernández, disciple of Matias Duval, famous for his studies of the nervous system, was a teacher of Rafael Rangel from 1899 to 1903. “Rangel made histological preparations of the brain and spinal cord comparable to those of Santiago Ramón y Cajal”.
Ildemaro Torres (Fig. 9 D), excellent professor of anatomy and histology at Venezuelan and Chilean universities, wrote: "Every afternoon of class the students grouped at the gates of the Anatomical Institute saw him arrive in his car, punctual, and elegant in the attire, the gestures and the greeting; minutes later he appeared with his characteristic brown robe and in his hand a wooden box full of colored chalks. He would enter the auditorium and begin his dazzling display of drawings of the human body, sort of miracle coming out of his hands on the surface of the green board, to student wonder and admiration, and even an encouragement to the fantasy of his students with artistic inclinations”. "For a young man who enters a difficult career such as Medicine it is a fortunate circumstance and of the highest significance in its inspiring essence, having a teacher like Francisco Montbrun was" (17).
Carlos Hernández (Fig. 9 A), professor of anatomy, and former president of the National Academy of Medicine stated: "He set out to transform his collaborators in the Chair of Anatomy into integral teachers. He was a master of future teachers" (18). Alba Cardozo, currently JMVSM Chair of Anatomy wrote: "I owe Dr. Montbrun my training and integration to the Anatomy Faculty of the Vargas School. He will always be a great example for us" (19).
Miguel Zerpa (Fig. 9C), academic, professor of surgery at JMVSM, refers: "His anatomy lessons were impeccable, reinforced by extraordinary drawings he executed on the board with chalks of all colors, especially black to emphasize the limits of anatomical structures. They were beautiful paintings, works of art" (20).
Manuel Romera, medical illustrator, wrote: "At the Vargas School Francisco Montbrun was the paradigm of the teacher-artist. I received classes from this master, octogenarian at the time. Most impressive was how well lessons were understood, the progressive understanding of anatomical structures as the teacher added layers to the drawing with different colors. We used neuroanatomy manuals written by Professor Montbrun and illustrated with schemes of his own hand, which appeared signed as "Framo", contraction of his first and last name" (21).
FMR was designated Honorary Member of the Pan American Association of Anatomy at the XI Pan American Congress of Anatomy, in October 1995. (Fig. 10 B)
As a Resident Surgeon at the Vargas Hospital (1937-1939, 1941-1943), Dr. Montbrun demonstrated his teaching vocation showing a "permanent attitude of teaching and training interns to fulfill the very demanding activities of an emergency department. The 12-hour shift each day was attended by the resident surgeon, eventually assisted by the hospital's medical resident and two or three interns" (2). In October 1943 he received a Recognition Diploma from the students (Fig. 11A)
FMR´s surgery professor career at the Central University of Venezuela began in 1942 as a teaching assistant. He was appointed Professor of Therapeutic Surgical Clinic in the Faculty of Medicine in 1944, Associate Professor in 1948 and Full Professor in 1955. Simultaneously, in 1944, he won the position of Second Deputy and in 1945 First Deputy of the Surgery Service No. 1 at the Vargas Hospital of Caracas. He also taught Surgical Pathology for one year in 1946. In 1958 the Chair of Therapeutic Surgical Clinic of the Faculty of Medicine moved to the Surgery Service No. 3 of the University Clinical Hospital inaugurated in 1956 at the Ciudad Universitaria de Caracas. Montbrun and one of the deputies, Carlos Hernández, remained at Vargas Hospital and, with new staff, organized a new Surgery Service, which was soon recognized by the Faculty of Medicine creating another Chair of Surgical Clinic, of which FMR was appointed chief (Fig. 12). This Chair was later attached to the “Jose María Vargas” School of Medicine and his chairmanship extended until 1966, when he devoted himself exclusively to anatomy. FMR completed 30 years of public service as a surgeon at the Vargas Hospital, and 22 years as professor of surgery, making important contributions to the formation and training of many surgeons and professors of surgery. He introduced in Venezuela several surgical techniques, such as vaginal hysterectomy, its combination with the operative cure of genital prolapse, uterine pexia transplanting the round ligaments to pecten, trachelectomy, tracheloplasty, colpoperineoplasty and others. He also introduced and applied norms for the practice of a safe surgery. "The quality of the work and the good organization allowed us to perform two-teams surgery: a) simultaneous gynecological surgery with abdominal and vaginal interventions, and b) simultaneous polyvalent surgery, with or without association to the gynecological area, for example: cholecystectomy with thyroidectomy, gastrectomy with mastectomy. The results were very satisfactory, with zero mortality and an infection rate of 3.65 percent. The proper registration allowed us to publish the results obtained (2). Our Service was granted Honorable Mentions for its work in the years 1958 and 1959 and the Gold Medal "José María Vargas", in the year 1960, as the most outstanding surgery service in the Vargas hospital during that year" (2, 6).
Carlos Hernandez, one of his disciples, wrote, “His surgical pedagogy emphasized the preservation of vital elements and organic functions. His anatomical surgery was performed with a sense of perfection. His extraordinary manual dexterity, the fine treatment of the tissues, the precision in the search of the anatomical elements, made his interventions clean, easy and unequivocal, beneficial for the patients and a masterful demonstration for all the surgeons who trained with him” … “We received severe and disciplined treatment. It was a hard and exhausting journey to transmit to us his values and the refined surgical techniques that contributed to the formation of the deputies of the Service” (18)… “always willing to give advice, accept inquiries about complicated cases, or the existential problems of each of us and to share his enjoyable, frank and friendly conversation” (22) … “Medical ethics is his permanent teaching, he taught us how to treat the patient and his family and to respect their rights, to live the commitment to be a doctor, to overcome the temptations to which the inexperienced doctor is exposed“ (22). Miguel Zerpa, professor of surgery and academic, said: “His behavior adhered to the strictest standards of medical and citizen ethics. He was a guide, inspirational, companion and friend. His permanent presence among us is a guarantee of seriousness, commitment, and example for future generations. He marked my life as a student and as a doctor throughout my career" (23).
Dr. Montbrun was a leader in the creation of the "José María Vargas" School of Medicine (JMVSM) at UCV. He used to say: “My participation in this event is my most precious credential" (2).
The Medical Faculty of Caracas was created on June 24, 1827 by decree of Simón Bolivar, the country´s president. The Vargas Hospital was inaugurated in 1891.The professorships of medical, surgical, and obstetrical clinics of the School of Medicine settled in the Vargas Hospital in 1895 (14). A new hospital, the University Clinical Hospital, was inaugurated in 1956 at a new campus, the University City of Caracas. The School of Medicine moved to the new campus. The Vargas Hospital was going to be demolished. However, a group of professors known as “the Vargas Group” fought to keep the Vargas Hospital open for patients and students and to create a new school of medicine instead of expanding the existing one. They succeeded because the Clinical Hospital of the University City was insufficient to serve the country's growing population and medical students, the need to increase the number of physicians, and the aspiration to modernize medical education considering experiences of universities in developed countries (24-26).
In a paper published in 1960 (24), FMR expressed his feelings: "At first, we felt deeply the absence of students, who had gone with the University. The hospital corridors were left alone, and the joy, the continuous agitation of youth disappeared to accommodate the conventual tranquility and the silence of quiet labor” … "But the old hospital, which had marked the life of medicine in the country minute by minute since 1891, could not die, nor could it fall to the category of asylum of the abandoned elders, or the incurables waiting stoically for the end of their lives” … "At last, the idea of staying had to overcome. I was accompanied in that purpose by the creative dynamism of Otto Lima Gómez, the serene equanimity of Fernando Ruben Coronil, and the fervent ideals of an entire group of colleagues, in which the capacity of Luis Manuel Manzanilla, the experience of Eduardo Carbonell, the perseverance of Blas Bruni Celli and the continuously innovative attitude of Francisco Kerdel and Jacinto Convit, played a major influence on the work we were since committed to doing" … "In keeping with our spirit of reform, we had to found a new school of medicine" (24). Francisco Montbrun gave the inaugural anatomy lecture to the first-year students in a ceremony presided by the Dean of the Faculty of Medicine, Rafael José Neri, on November 17, 1960 (Fig. 13).
The University Council approved the creation of the JMVSM, linked to the old hospital, in July 1961. The medical school at the University City campus was later named “Luis Razetti” School of Medicine.
FMR continued teaching surgery at the Vargas Hospital. There was a transition period beginning in 1958 during which new clinic chairs were created. He chaired Surgical Clinic VI, later called B, until 1966. He was chairman of the Department of Morphological Sciences and head of the Anatomy Faculty at the JMVSM from 1960 to 1976 and continued teaching anatomy until his retirement in 2001.
FMR was a leader within the Vargas Group, president of the Admission Commission of the Faculty of Medicine (1955-1960), member of the Planning Commission of the new school, appointed by the Faculty Council in August 1960, chaired by Dean Rafael José Neri, with José Ignacio Baldó, Alfredo Borjas, Fernando Rubén Coronil and Otto Lima Gómez; member of the Technical Commission that drafted the JMVSM new curriculum, which began to be implemented in November 1962. (This paper´s author started her studies of medicine that year (27)). FMR participated in the Commission appointed by the University Council in July 1961 to collect the materials required by the National Council of Universities (NCU) for the approval of the Vargas School. On September 24, 1965, the JMVSM was approved by the NCU. The class that started in 1960 graduated in 1966. In the list of professors at the Vargas School in July 1961, when it was approved by the University Council, Montbrun appeared as Head of Anatomy Chair, Head of Neuroanatomy Chair, Head of Surgical Therapeutics VI Clinical Chair, and Head of Surgery Service 1 at Vargas Hospital (25).
FMR recounts: (2): "The Faculty faced, during the years 1958-1960, a growing crisis, resulting from the explosive increase of aspirants to study medicine as the number of high schools had multiplied. There were real battles in the entrance exams. Strikes of all kinds were unleashed in the face of the impossibility of the University to expand its capacity with contempt for the teaching quality of its Faculties. There was a tendency to ease tension with improvised solutions, such was the opening of a First Year Special Course of Medicine at the Faculty of Veterinary Medicine in Maracay. Despite the good intention of the teachers, it could not conform to the pedagogical rules. Therefore, we had to think about an extension of our Faculty of Medicine, in Caracas itself. In June 1958, in a presentation at a seminary promoted by the Association of Teachers, I concluded that it is not advisable to teach large conglomerates, even if the pedagogical principles are respected. Crowds create confusion and discard the familiarity between the teacher and the student, as well as the camaraderie between the students. Instead of widening a large school, as in the case of Caracas, it is preferable to create an additional small school".
In a long letter addressed to the Dean on June 6, 1960, FMR wrote (12): "In the Vargas group there is a human element that can organize preclinical courses. If we add to this the collaboration that José Agustín Catalá wants to provide, regarding the physical infrastructure, we will have at hand the two main elements to arrange the aforementioned courses and thus carry out a splendid pedagogical work". Later, "If such a thing is definitively resolved by you and those who worthily advise you in the direction of the Faculty, it will be both the country and the University who will derive great benefits". It was necessary to enable premises for preclinical teaching at various locations of the Vargas Hospital (25). The Dean announced the approval by the University Council for the creation of the Vargas School, during the commemoration of the 70th birthday of the Vargas Hospital in July 1961. FMR addressed the audience (Fig. 14)
"In the middle of 1959 Otto Lima Gómez and I were appointed by the Rector Francisco De Venanzi to project an adaptation of the ruined building of the old Anatomical Institute located in the Corner of San Lorenzo, to hold the seminars and other activities of the postgraduate courses that were currently being held in the Vargas Hospital. Instead, the old Anatomical Institute (Fig. 7C) was demolished. In its place, a building with nine floors, auditoriums and laboratories, was constructed. It was inaugurated in 1962”. It is known today as the Edifice of Basic Sciences I. FMR advised and maintained close contact with the architect and engineer in charge of the construction work. "The Basic Sciences section complemented the Vargas Hospital to integrate the Medical School Complex, which had a much stronger base than the infrastructure being built; it was his human ensemble, the "Vargas Family", composed of affectivity, generating harmony and understanding, determinants of a unitary action, even with the passion of the different political ideas of the time” … “Manzanilla acted as Teaching Coordinator, Otto Lima Gómez organized the clinical level, while I oversaw the preclinical" (2).
"The Vargas School was conceived according to the ideas presented in the University Education Seminar of 1958, promoted by the Association of Teachers; the I National Seminary of Medical Education, and by the concepts of Medical Education that at that time were the basis of the functioning of the North American Medical Schools of Stanford and Western Reserve. In 1961 the School Technical Commission, of which I was a part, developed a new curriculum which integrated education vertically and horizontally and with multidisciplinary laboratories. It was approved by the Faculty Council in 1962 and began to be applied for the class of 1962, which also premiered the new building of Basic Sciences, and graduated in 1968" (2).
"The Doctrine of the Vargas School has since pursued the formation of a physician according to national reality, who would focus the human being on his biological, psychological and social aspects and relate him to his environment and to the requirements of his family and community. The permanent goal of the School has been to achieve integrated teaching, associating public health, medical practice, vocational training, ethics, and the psychosocial basis required to understand the relation of man with his environment" (2).
"The Vargas School has suffered many vicissitudes over the years. It would be long to list so many setbacks. The 1967 earthquake cracked the columns and walls of the basic sciences building. We lived moments of great anguish. I intervened in the daily and demanding supervision of the reconstruction begun three months later to rehabilitate it, even if it was not possible then to repair the structural damage. A year later we returned to occupy the building again. The teachers and students remained in it for almost twenty years, trying to ignore the danger and insecurity”.
A Physical Infrastructure Commission was appointed in 1981 composed of Drs. José Pierluissi, coordinator, Lilia Cruz, secretary, Francisco Montbrun, Luís Báez, Antonio Rondón Lugo, Jaime Boet, Francisco Castellanos, Jesús Sanabria, Oswaldo Carmona, Pedro Blanco Souchón and Miguel Requena. They collected information from all faculty members about needs and requirements for a new building. The architect Elena Seguías de Ruiz designed the Basic Sciences Edifice II. The Commission searched for financial resources for the construction of the new building and to complete the repair and remodeling of the existing edifice according to the new requirements. Luckily, one of disciples of the Vargas Hospital, Dr. Jaime Lusinchi, came to the Presidency of the Republic in 1984. His thanks to those of us who had contributed to his training led him to approve the provision of extra-university funds. The structural reinforcement and remodeling of the damaged building was done between 1985 and 1988. The construction of the new building by the Ministry of Urban Development, reached 85 % in 1988. Unfortunately, with the change of government the work was paralyzed, and it was not until 1997 that President Rafael Caldera assigned money through Centro Simón Bolívar for the completion of the Basic Sciences Edifice II, years later"… “After a long chain of collective efforts, the “José María Vargas” School of Medicine today is pride of the Central University of Venezuela".
One of the dissection rooms of Edifice I was named after Francisco Montbrun in 1987. The East Auditorium of the Basic Sciences II building was named "Dr. Francisco Montbrun" (Fig. 15) on December 5, 2001 by resolution of the School Council (12).
FMR chaired the committee that organized the I Scientific Research Conferences of the Vargas School, and delivered the inaugural address, commemorating the centenary of the Vargas Hospital (June 30 - July 4, 1991). FMR was Honorary President of the Second Scientific Conferences, 10-15 October 1993. It was part of the effort to encourage teachers and students to conduct research activities.
Diplomas for Distinguished Services. Central University of Venezuela (1950, 1983)
Student Recognitions: Diplomas and plaques: 1974, 1975, 1984, 1986, 2001, 2005, 2007. The XII National Congress of Medical Students, the Venezuelan Federation of Medical Students and the JMVSM Student Center offered FMR a plaque "in recognition of his laudable and admirable academic trajectory, which transcends the boundaries of knowledge and makes him a role model throughout all generations" (9-30-2005)
JMVSM Chair of Anatomy plaque: "in recognition of his meritorious teaching work for 50 years in this chair, during which he has worked with mystique and enthusiasm and whose fruits are reflected in the solid formation of countless medical professionals scattered throughout the country" (1987).
The Vargas Hospital Surgery Service 1 silver platter "in recognition of his guidance and training work" (1961).
Godfather of the JMVSM Class of 117 Physicians-Surgeons in1982. On a metal plaque they wrote: “an emotional and sincere recognition of the arduous and noble task performed by you imparting your knowledge with love, joy, dignity and pride. We hope to realize our noble and wonderful profession by applying ourselves passionately to our work, being our aspiration not only to equal your example, but also to overcome it, having you as a guide and north. We are honored and satisfied to publicly express our appreciation for your unobjectionable work carried out with sensitivity, probity, and honesty” … “Master: A firm and dedicated hand, formal, tenacious, giving day by day encouragement and support, tinging with joy the work of so many years to weave a chain that will have no end" … “You were and will be part of what we are and will be”. On the 20th anniversary of their graduation, written on a silver platter: "With all the affection and recognition to whom gave us the light of his wisdom".
The award of the Title of Honorary Professor was approved by the Faculty of Medicine Council on 10/29/2002 and by the University Council on 11/6/2002. It was delivered by the authorities in a public event held in the auditorium of the Faculty of Medicine on May 22, 2003 (Fig. 16).
The "Alma Mater" Prize awarded annually by the Association of Graduates and Friends of the UCV was conferred to FMR in 2007. His nomination for the prize was made by the Board of Directors of the National Academy of Medicine: "He has been an example of moral, ethical, professional and scientific virtues, with a relevant and outstanding human quality, which he reflected in his teaching activity, in dealing with his disciples and teachers in training, as well as in dealing with his peers and subordinates" ..." “Mentor and guide of multiple professors and physicians". The jury unanimously agreed to give the Prize to “Dr. Francisco Montbrun, who fulfills in a very high degree the bases dictated by the Association of Graduates and Friends of the Central University of Venezuela, which state that the Prize is awarded to whom, "has distinguished in an outstanding way in the field of its professional activity, has shown throughout his performance a spirit attached to justice, equity and human solidarity and whose academic, business, cultural, political and/or sporting contributions have or have had an evident social impact, being able to qualify as an Integral Alumnus" (Feb 8, 2007). The “Alma Mater” Diploma and Sculpture (Fig. 17) were received on March 14, 2007 on FMR behalf by his wife Lilia Cruz.
FMR entered the Medical Center of Caracas the year of its foundation in 1947. He practiced general surgery and gynecology until 1988, taking care of three generations of patients for 41 years. Mothers, daughters, grandmothers, friends, and family members went to his office and continued to call him for advice after he had retired. The Board of Directors and the Medical Society in recognition for “his excellent professional work, personal worth, and contribution in the exercise of medicine that has benefited the development of the institution” awarded him several diplomas and plaques. In July 2007, the journal Pulso Médico published a page in his honor (Fig. 18). Oscar Colina wrote: "We received from the Master valuable and abundant surgical teaching. In addition, daily he gave us lessons in medical ethics and morals, humanities, general culture and, with his actions with the patient, he passed on his great love to our neighbors, all this enlivened by interesting anecdotes and a fine sense of humor" (28). Abraham Krivoy, neurosurgeon, (29) said "I was fortunate to know very closely the teacher Francisco Montbrun in the frequent encounters that we had in the surgical area of the Medical Center of Caracas. He produced a highly positive psychological atmosphere, a kind of natural psychotherapy for all those present in those spontaneous talks in the surgeons' room”.
FMR was a founding member of the Venezuelan Society of Surgery (VSS) in 1944, its vice-president (1957-1959), president (1959 -1961), and honorary member since 1982. In 1961 and 1967 he received the Honorable Mention of the "Guillermo Morales" Award for the best scientific paper presented to the Venezuelan Congress of Surgery. He contributed to the organization of the VI Venezuelan Congress of Surgery and was named Honorary President of the XVIII Venezuelan Congress of Surgery. The VSS awarded him several diplomas, plaques and medals to recognize his “meritorious and valuable work for the benefit of the institution" (1965); “outstanding scientific work as former president of the Venezuelan Society of Surgery” (1984), “his magnificent career in Venezuelan Surgery” (2001 and 2005), “his outstanding career within the Venezuelan Society of Surgery as a founding member, honorary member and president during the period 1959-1961” (2006), the Honorary Member Medal (2006) and the Medal of Merit.
The VSS created this international, biennial, prize on March 11, 1993, as a recognition and tribute to Francisco Montbrun. The competition aims to promote knowledge and innovation of surgical technique. It is awarded at the Congress of the Society.
FMR was member of the International Society of Surgery, senior, the International College of Surgeons, and the American College of Surgeons. He was president of the Venezuelan Chapter of the American College of Surgeons (1971-1972), honorary member of the Latin American Group of Gynecology and Vaginal Surgery, honorary member the Latin American Federation of Surgery (FELAC) and its Executive President from 1989 to 1991. He was Executive Chairman of the XX Venezuelan Congress of Surgery and the VIII Congress of the FELAC, held jointly in Caracas in 1989. As Executive Chairman of FELAC in 1991, FMR participated in the organization of its IX Congress in Mexico City, where he gave the inaugural address at the Palace of Fine Arts.
FMR was elected National Corresponding Member, Post 6, on July 2, 1987. On his induction, he presented the work: "Selecting a technique for the suspension of the vaginal dome in its prolapse after hysterectomy". Elected Individual of Number, seat XXXVIII on February 2, 1995, his paper "Strategies for a Health System" (30) was presented in May 1995 on incorporation, and the reception ceremony (31) occurred on 22 June 1995. The welcome speech was given by the president of the Academy, Carlos Hernández (22).
In Blas Bruni Celli's Juicio crítico: "You arrive at this table at the best hour of your life, loaded with immense reserves of knowledge and kindness" ... "Your paper is full of stimulating and insightful suggestions, precisely when we are raising as a priority and fundamental concern the issue of public health reform. You as a former teacher, have been able to expose it precisely and forcefully” (30).
A well-deserved tribute to the Academic Dr. Francisco Montbrun, was made at the Palace of the Academies on April 7, 2005 by the National Academy of Medicine and many institutions and people related to him. He was awarded several merit diplomas and plaques (1, 32).
"In1937 I was appointed official in the School Hygiene Service. Together with Dr. Joel Valencia Parpacén, I participated in a reorganization of that Division. After six months, the proposed objectives were not achieved, mainly due to a lack of resources. I preferred to resign a short time later" (2).
One of the main goals in the government program of presidential candidate Jaime Lusinchi was the implementation of a national health system. FMR, professor and friend of the candidate, collaborated in the election campaign. President Jaime Lusinchi invited Montbrun to participate in the Health Ministry. He agreed to act as ad honorem advisor within the Health Sector's Governing Commission, created by presidential decree in November 1984, and was elected its Coordinator. The Commission produced a report titled “General Concepts for the Organization and Establishment of the National Health System”; FMR wrote the booklet "Strategy for a National Health System". The Legal Subcommittee, composed of José Rafael Gabaldón, Arnoldo Gabaldón and Francisco Montbrun, developed a Draft Law that was sent to the Legislative Chambers. The Chamber of Deputies and its Health Committee completed a National Health System Law Project, which was approved at the National Congress by consensus of all political fractions. Dr. Jaime Lusinchi, in a special act at the Vargas Hospital in Caracas, signed the execution of that Law, on June 23, 1987. “It was the conclusion of an arduous struggle”. The Minister of Health and Social Assistance was Otto Hernández Pieretti.
From October 1987 to February 1989, FMR served as Minister of Health and Social Assistance.
“During the months I was Minister of Health and Social Welfare, I worked hard to improve the health conditions of our people, and concentrated my work on the normative aspect, trying to achieve an acceptable organization, and the establishment of an efficient structure.”
“The National Health System was launched in July 1988 on an experimental basis in the States of Anzoátegui, Zulia, and Mérida. By the end of 1988, initial integration of the component institutions of the system, health authorities, state authorities, and the community, had been achieved. The National Health Registry, where all the resources of the system were recorded, and a computerized Efficiency Room, formed the basis of the Organization, which had to be extended throughout the country in ten years. Such was the outlook in February 1989, when another administration began. The latter, of a neoliberal type, clashed entirely with the system organization, conceptualized within the principles of a social democracy, and the initial development stopped.” … "Despite being a Law of the Republic and having been approved unanimously, by consensus of all political fractions, the Law of the National Health System was ignored by the administration of Carlos Andrés Pérez. There was no objection on the part of the National Congress, which passes laws, but does not control their compliance, as it should in a democracy” (2,9).
“I published "Venezuela, a Health Vision (1984-1988)” which summarizes MSHA activities, carried out during the period by Ministers Luis Manuel Manzanilla, Otto Hernández Pieretti and Francisco Montbrun. It was presented to the Council of Ministers, and at the XXXIII meeting of the Pan American Health Organization, (Washington, Sep. 1988). At that PAHO meeting. Venezuela was elected to preside the Executive Committee of the Board of Directors for the following year".
Actions worth noting:
On February 5, 1989 the UCV Faculty of Medicine Council agreed to: "Recognize Dr. Francisco Montbrun, Minister of Health and Social Assistance, his efforts to promote and consolidate academic lines of work in cooperation with this Faculty” … “especially medical training in the area of primary health care, the discussion and implementation of curriculum changes, teaching-assistance integration, research, and development of the Faculty's infrastructure. “It is an act of justice to acknowledge the actions of Dr. Francisco Montbrun in this regard and to publicly thank for his extensive collaboration with this house of study”. The agreement was published in the newspaper "El Nacional".
Other recognitions include Plaques presented by the Venezuelan Society of Ophthalmology, the Hospital "Luis Felipe Guevara Rojas" (El Tigre), the "Concepción Palacios" Maternity, National Institute of Geriatrics; the XXIII Promotion of Postgraduate of Ophthalmology Students; Rotary Club of Caracas, Venezuelan Society of Family Medicine; Anticancer Society of Venezuela. (Honorary Member), Venezuelan Society of Statistics and Health Records; the San Luis Community of the Bolivar District, Falcón State; Community of the Urban Ambulatory La Velita; Pro-Rescue Society of Mariara's Medicatura; Venezuelan Pharmaceutical Federation; Municipal Council, Mara District, Zulia State; Directors of the Ministry of Health and Social Welfare. The members of the Health Sector Governing Committee wrote: "during the time of his presidency, he distinguished by loyalty, responsibility, ethics, inexhaustible ability to work, managing to become the leader and teacher of the National Health System and a co-worker who earned the affection and respect of all" (Jan 31, 1989).
In 1988 FMR was honored as Godfather of the VI Promotion of Family Physicians from the Social Security Institute at Caricuao. On a plaque: "To our Godfather Dr. Francisco Montbrun for his extraordinary work for Family Medicine". In 1991 he was designated Godfather of the first Promotion of Family Medicine graduates at the University of the Orient. Puerto La Cruz. Anzoátegui State (Fig. 20).
FMR was a founding member and promoter of the College of Physicians of the Federal District, Venezuela, a founding member of the Venezuelan Medical Federation, in 1944, and member of the first Executive Committee in the period 1945-1946. He received a plaque of recognition on its fiftieth anniversary in 1995. Montbrun was appointed Honorary Member of the College of Physicians of the State of Merida on March 10, 1987.
He published 74 papers: 49 about surgery and gynecology, 18 about medical education, 7 about other subjects. 5 books of anatomy, 2 books on public health, 27 anatomy syllabi and 37 conferences. They are listed in reference 1.
Dr. Montbrun received 68 honorary and merit diplomas and plaques, and 35 decorations: Order of the Liberator, Grand Officer's Degree; Order of the Liberator, Grand Cordon; Order Diego de Losada, City of Caracas, First Class; Order Andrés Bello. First Class; Order Francisco de Miranda, First Class; Order June 27, First Class; Order Merit of Work, First Class; Order José María Vargas, UCV, First Class; Order Francisco De Venanzi, First Class; Order Central University of Venezuela, First Class; Order National Health Cross, First Class; Order Cristóbal Mendoza, City of Trujillo, First Class; Order José Izquierdo, Federal District College of Physicians; Order Vicente Emilio Sojo, Miranda State Legislative Assembly; Order Francisco Fajardo, Caracas; Paul Harris Fellow Medal, Rotary Club; First Class Augusto Pinaud Medal, Venezuelan Red Cross; Venezuelan Society of Surgery Merit Medal; Municipal Council Medal, Sucre District, Miranda State; First Class Cross of the Armed Forces of Cooperation; First Class Award from the Venezuelan Air Force; Hospital Vargas Prize Medal; Pablo Acosta Ortiz Gold Medal; Latin American Federation of Surgery Associations President Medal; School of Malariology Medal; University Medal of Merit, Zulia University; Concepción Palacios Medal; Venezuelan Society of Surgery Medal; Enrique Tejera Medal; José Ignacio Baldó Medal; Arnoldo Gabaldón Medal; History of Medicine Society Honorary Member Medal; Caracas City Button; Carabobo Sun First Class Medal; Venezuelan Society of Surgery Honorary Member Medal.
FMR liked to travel the world, visit art and science museums, attend concerts, visit parks and natural environments, read about Venezuelan history, practicing boxing, horseback riding, basketball, motorcycling, swimming, and golf. He enjoyed cruising and country life.
Francisco Montbrun died at the age of 93, on May 15, 2007 in Caracas. His memory will remain in all the institutions where he served, in the extension of the geography of Venezuela, where there are countless disciples, patients and friends, but above all, he will be permanently remembered by all of us who loved him intensely.