Enrique Bernardo Núñez de Villavicencio Palomino

He is one of the most important figures in the history of Cuban medicine, not only for having been an eminent surgeon and initiator of numerous surgical techniques in our country, for having conducted outstanding teaching work and for being the author of abundant scientific bibliography, but also because when José Martí's stirring words called Cubans to fulfill their duty in defense of the nascent homeland, he did not hesitate to abandon a comfortable and secure economic and social position and risk his brilliant future in Cuban surgery to join the ranks of the Liberation Army, bring glory to Mambi military medicine and later in peacetime, with the same patriotic spirit, hold important positions in national health until culminating his work as the most honest and creative Secretary of Health and Welfare and Minister of Public Health and Social Assistance in our historical period of bourgeois liberal republic.

Don Emiliano Núñez de Villavicencio y Álvarez, father of Dr. Enrique Núñez, was one of the most respected and beloved physicians in Cuba of his time. Born in Havana on October 3, 1845, he graduated from our old capital university with a degree in medicine and surgery on May 25, 1867 and with a doctorate one year later, on November 3, 1868. Married to Adolfina Palomino, he settled in the neighboring town of Madruga, where his famous son Enrique Bernardo was born on January 16, 1872.

Dr. Enrique Núñez demonstrated from his earliest years great intellectual gifts. Before turning five years old he began his primary education with educator Loreto Macía and by that age he was already reading perfectly. At the secular school of the distinguished pedagogue Melitón Pérez, affiliated with the Institute of Secondary Education in Havana, he completed his primary education and all his pre-university studies, graduating with a bachelor's degree in arts on September 27, 1886, at fourteen years of age, with one of the best records of his class and in his father's rich library he would satisfy his great thirst for knowledge.

Following the example of his father, who was always his ideal model, he enrolled in the medicine program at the University of Havana in the 1886-1887 academic year, to develop work of brilliance rarely achieved, which comprised 30 subjects: 29 outstanding grades, one notable grade, 19 ordinary prizes, 3 honorific mentions, outstanding and extraordinary prize for the degree of licentiate and outstanding and extraordinary prize for the doctoral degree. He received his licentiate degree on June 27, 1893 and his doctorate on September 7, 1894. The solemn conferral of this latter degree took place in the Great Hall of the University of Havana on October 24, 1894, sponsored by his constant teacher, Professor Gabriel Casuso Roque. His doctoral thesis constituted the first of his remarkable monographs, Contribution to the Study of Malaria in the Puerperium, Havana, 1894.

These brilliant academic results were accompanied by truly exhausting work in the wards and surgical halls of the Hospital Nuestra Señora de las Mercedes, where his father had him admitted as an external student from the second year of his studies, to later continue as an internal student and honorary physician attached to the Surgery Service. There, guided by his two great masters, Doctors Gabriel Casuso Roque and Francisco Domínguez Roldán, he went through the long apprenticeship of general and gynecological surgery.

Upon completing the fifth year of his studies in 1892 he attended the practical operations course taught by Dr. Domínguez Roldán at the same hospital, where all ligatures, amputations and disarticulations were performed using innovative techniques and it is said that when he took his licentiate examination, he performed, before the tribunal, the ligation of the femoral artery in Hunter's canal. Impressed by his great skill, the president of the Tribunal, none other than Professor of Descriptive Anatomy Dr. Jorge F. Horstmann y Cantos, had to say to him: "this is new, the Frenchman taught you this," referring to Dr. Domínguez Roldán, who had completed all his medical and surgical training in Paris.

During his student years Dr. Núñez began his voluminous medical bibliography. Upon completing his third year in 1889, he publishes his first article in the student journal The School of Medicine, titled "Notes on Anatomical Technique." Already in the fourth and fifth years, in the journal Medical Progress, directed by Dr. Casuso, his articles appear: "Decapitation of the Humerus from Traumatic Injury" and "Acute Pemphigus," in this latter work he leads to his final conclusion after meticulous differential diagnosis.

Due to the brilliance of his medical studies, Dr. Enrique Núñez never had to pay tuition nor fees for his degrees. His father, a very practical man, had saved all the money his son had economized for him and upon completing his licentiate studies was able to give him a substantial sum, which the studious young man invested in a profitable study trip to hospitals in New York.

From there, in fulfillment of a promise he had made to Dr. Casuso to report everything he saw of surgical interest, he sends a series of articles under the generic title "Correspondence from New York," which appear in Medical Progress, beginning with the November 1893 issue.

In the first, titled "On Surgery in the Hospitals (of New York)," he makes a general description of the operating rooms and some of the surgical procedures he witnesses at New York Hospital, Mount Sinai Hospital, Roosevelt Hospital, Woman's Hospital and Manhattan Eye and Ear Hospital. In the second, "On Hernia Operations in New York Hospitals," he discusses the surgical fever that existed at that time in the United States and which he qualifies as operationmania and above all as hernia-mania. In the third, "On Appendicitis Operations in New York," with severe critical judgment he calls intransigent the American surgeons who operate on all appendicitis patients without sometimes confirming the diagnosis and without employing medical means. These are followed by equally interesting pieces: "On Alexander's Operation and Hysteropexy in New York Hospitals," "On Electrotherapy in Gynecology" and "The Sloane Maternity Hospital of New York."

From this city he also sends, as an applicant for corresponding membership in the Royal Academy of Medical, Physical and Natural Sciences of Havana, his important study "Electricity in the Treatment of Some Menstrual Disorders," in which he gathers his personal experience in this technique alongside Dr. Goelet in New York and which appears published in Medical Progress and in Annals of the Royal Academy of Medical, Physical and Natural Sciences of Havana (1894).

Always attentive to what was published in the capital of the colony, he debates from a distance with Dr. Nicolás Gómez Rosas, who publishes in the Journal of Medical Sciences his work "Antepartum Septicemia. Latent Microbism" which Dr. Núñez refutes with two articles he titles: "Septicemia or Malaria?" and "Malaria and not Septicemia," which appear in Medical Progress.

Upon his return to Cuba he begins his teaching career upon being named in 1894 assistant professor of the chair of Obstetrics and Gynecology Clinic at the Faculty of Medicine and auxiliary professor of Obstetrics and Gynecology of the Practical School of Medicine, a non-state institution founded by Dr. José Pereda Gálvez in Havana in 1893. The titular professor of this latter chair was Dr. Eusebio Hernández Pérez, the greatest figure in Cuban obstetrics of all time, who would later achieve the rank of brigadier general alongside Generalissimo Máximo Gómez Báez in our last wars of independence against Spain.

In these early years of professional practice, Dr. Enrique Núñez worked intensively as assistant to Dr. Casuso in his surgical interventions, both at the latter's private clinic located on Jesús del Monte Street and at Hospital Nuestra Señora de las Mercedes and in the procedures performed by the famous surgeon and gynecologist in his patients' homes, who were quite numerous, as well as honorary physician of the Hospital for Women of San Francisco de Paula.

The scientific prestige of the young physician was further consolidated when on April 4, 1895 he was admitted as a full member of the Society of Clinical Studies of Havana, the oldest of Cuban medical societies, with his monograph Clinical Considerations on Serum Therapy in Diphtheria, in which he gives for the first time in Cuba the precise rules for the application of antidiphtheritic serum.

When one follows with some care the scientific life of Dr. Enrique Núñez, one might think that his multiple patient care and teaching duties and the production of his important bibliography occupied all his time, but nothing could be further from the truth. The home of the Núñez de Villavicencio and Palomino family was a true center of patriotism where people actively conspired for Cuban independence, as were also Hospital Nuestra Señora de las Mercedes under the direction of Don Emiliano, the private clinic of Dr. Casuso and the Practical School of Medicine in Havana, from which almost all of its professors went off to war and revolutionary exile.

When Dr. José A. González Lanuza, who was head of the Delegation of the Cuban Revolutionary Party in Havana, was detained and deported, Don Emiliano Núñez de Villavicencio was appointed to the position, who shortly thereafter, when he was working in the office of the director of Hospital Nuestra Señora de las Mercedes, was detained by a group of Spanish military men on February 11, 1897 and the Captain General of the Island quickly ordered his deportation to the prisons of Fernando Poo Island, Equatorial Africa, to which destination he was sent on the steamship Buenos Aires on February 28 of the same year.

Of his sons, Federico had already gone off to war where he would achieve the rank of commander and Enrique, who had made a trip to the United States in 1895 for revolutionary purposes, left Cuba definitively at the end of 1896 and departed from San Salvador, Bahamas, in the first days of March 1897 on the steamship Laurada expedition, commanded by Major General Carlos Roloff Mialofsky and Brigadier General Joaquín Castillo Duany, known in our history as "Roloff's Great Expedition," which arrived at Cuba's coasts at Manopilón, the inlet of Júcaro, Banes, northern Oriente, on March 14, 1897.

Already in the insurgent camps he was incorporated with the rank of commander to the Staff of Lieutenant General Calixto García Íñiguez, who appointed him Chief of Military Health of the 2nd Army Corps. Under the orders of his immortal chief, he participates in all the important military actions that take place after his arrival in the provinces of Oriente and Camagüey. In the Battle of Las Tunas, one of the bloodiest of the war, in which his immediate chief, then Brigadier General Mario García Menocal Deop, was seriously wounded, he performs a rapid surgical intervention that saves his life; his careful attention during convalescence quickly returns him to the insurgent ranks. For his outstanding performance, Lieutenant General Calixto García proposes him for promotion to the rank of lieutenant colonel, dated December 1, 1897.

Recovered from his wounds, General García Menocal is assigned to command an invasion contingent that must proceed to the western provinces and take charge of the command of the 5th Army Corps. As physician of his Staff, Lieutenant Colonel Enrique Núñez crosses the Trocha from Júcaro to Morón on July 9, 1898 and conducts the entire last campaign of the west, ending the war under the command of that chief and achieving the rank of sanitary colonel.

But what is important about Dr. Núñez's performance in the campaign is having brought, together with his teacher Professor Francisco Domínguez Roldán, also a sanitary colonel of the Liberation Army of Cuba, a quality heretofore undreamed of to campaign surgery in our wars of independence.

The Liberation Army of Cuba in its last war against Spain was able to count on three of the greatest figures of Cuban surgery of all time, when they were at the pinnacle of their surgical faculties, Doctors Francisco Domínguez Roldán and Enrique Núñez de Villavicencio y Palomino in the front lines of combat, as well as in the field hospitals and in the rear in the United States, to intervene or reintervene on those who by almost incredible means reached them, Dr. Raimundo García Menocal y García Menocal, the greatest figure of our surgery.

We owe to Dr. Enrique Núñez himself valuable testimonies of what this difficult scientific work was like. On April 16, 1899, still with the dust of combat on his skin, he reads before the Society of Clinical Studies of Havana his work "Considerations on Surgical Intervention in Wounds Produced by Firearms," a study of incalculable historical-medical value based on the notes from clinical sheets carefully preserved by him of the 334 cases he surgically intervened on during the war and which he dedicates, deeply moved, "To the memory of Cuban physicians who died in the campaign." This work was published in "Archives of the Society of Clinical Studies of Havana" (1899) and many years later reproduced in Notebooks of History of Public Health No. 38 (1968).

At the III Pan-American Medical Congress held in Havana in February 1901, he presents two other works that complement the aforementioned one, one read in the session of February 6 titled "Notes on Bone Trauma Observed in the Cuban Campaign," published in the Journal of the Medical-Pharmaceutical Association (1901) and another in the session of February 4, titled "How to Apply Elastic Compression to Obtain Provisional Hemostasis in Interventions on the Shoulder," in which he presents a procedure of his own, used in the campaign, which he published in Medical Progress (1901).

With the war ended, the United States government did not recognize the government of the Republic of Cuba in Arms and only agreed to dialogue with the Leadership of the Liberation Army. The Cuban side then agreed to elect an Assembly of Representatives of the Liberation Army that would represent national interests in this difficult situation created by the expansionist ambitions of a foreign country that presented itself to us first as a disinterested ally in the war and suddenly became thereafter a voracious enemy of our independence.

To make up the Assembly, delegates were to be chosen from among the personalities of the Revolution whose talent, patriotism and honesty were beyond any doubt and the members of the 5th Army Corps did not have to think much to elect Dr. Enrique Núñez as one of their representatives. On October 24, 1898, upon the constitution of the board of age, Lieutenant General Calixto García was appointed president as the oldest member and Doctors Enrique Núñez and José Nicolás Ferrer y Mena, both physicians and the youngest members, were appointed as secretaries.

Within the Assembly, which met first in Santa Cruz del Sur and later in Marianao and El Cerro, Dr. Núñez was going to perform, as everyone expected, a manly action in favor of national interests in the face of the enemies of the homeland during the short but turbulent life of the revolutionary body. A few days before the infamous session in which Generalissimo Máximo Gómez was removed from office, Dr. Núñez resigned his position in the Assembly on March 9, 1899, disagreeing with the course events were taking, with the worst passions being inflamed, and he temporarily withdrew from public life to return again to his patients and scientific tasks.

Back in the Santa Magdalena and San Felipe wards of Hospital Nuestra Señora de las Mercedes, his work will be so brilliant that it permanently inscribes his name among the greats of Cuban surgery of all time.

With the implementation of a new curriculum in all careers at the University of Havana, known as the Lanuza Plan, for having been its inspiration the then Secretary of Public Instruction and Fine Arts and eminent legal scholar Dr. José A. González Lanuza, upon the recommendation of his teacher Dr. Gabriel Casuso, Dr. Enrique Núñez was appointed titular professor of Surgical Pathology on December 30, 1899 and took office on January 1, 1900.

In charge of this subject he teaches the 1899-1900 course, but with the implementation by Military Order No. 266 of June 30, 1900 of the second curriculum after the cessation of Spanish rule, a true comprehensive reform of higher and secondary education in Cuba, known as the Varona Plan, for having been designed and structured by the illustrious Cuban positivist philosopher Dr. Enrique José Varona y Pera, then Secretary of Public Instruction and Fine Arts, the subject of Surgical Pathology becomes a single chair with Gynecology and its clinic under the direction of Dr. Gabriel Casuso and the position of auxiliary professor is put up for opposition, which Dr. Enrique Núñez obtains in a competition in which he demonstrated his profound knowledge and his oral presentation about the different methods of hysteropexy was much commented on.

Since this chair had two subjects and only one auxiliary professor, a second position of that rank was created in December 1901, which was also obtained in very brilliant opposition another great figure of Cuban surgery, Dr. Enrique Fortún André. The Faculty of Medicine of the University of Havana then had the best Cuban surgeons in their chair positions: in Descriptive Anatomy, Doctors José Varela Zequeira and José A. Presno Bastiony; in Topographic Anatomy, Dr. Francisco Domínguez Roldán; in Surgical Pathology and Gynecology with its clinic, Doctors Gabriel Casuso Roque, Enrique Núñez de Villavicencio y Palomino and Enrique Fortún André and in Surgical Clinic, Dr. Raimundo García Menocal y García Menocal. The Cuban School of Surgery would set standards from then on in the surgery of the continent.

Along with his chair at the Faculty of Medicine, Dr. Núñez held another, very dear to him, in Gynecology at the Nursing School of Hospital Nuestra Señora de las Mercedes, from its founding in August 1899, for which he published a small textbook, Notions of Gynecology, Rambla and Bouza Printing, Havana, 1901, in which he compiled his lectures at that school and he was chosen, among all the professors, to deliver the central address at the graduation of the first Cuban nurses in 1902.

For his Gynecology course at the Faculty of Medicine, he did not write any text, but translated from French the book that for many years was the textbook in Cuba and other Spanish-speaking countries in his translation, published by Espasa Editorial of Barcelona (1904). The Spanish edition of the Manual of Gynecology by Dr. André Boursier, professor of Gynecological Clinic at the Faculty of Medicine of Bordeaux, a volume of 927 pages with 286 illustrations inserted in the text, is not only a great translation work by Dr. Enrique Núñez, but to it he added, enriching it, besides an illuminating introduction, very valuable footnotes and an original chapter on "Gynecological Technique" of 68 pages in the first part of the work. The second Spanish edition of this book, expanded to 944 pages and published also by Espasa Editorial, was also in charge of Dr. Núñez.

From his time as a professor Dr. Luis F. Rodríguez Molina, founder of the chair of Diseases of the Urinary Tract with its clinic, his student and friend, left us an interesting testimony:

"We knew Núñez when he arrived from the revolution with his rank of colonel and we did not hear him speak more of the war except when in his Surgical Pathology classes he spoke to us of the fracture apparatus he improvised with yagua bark and his treatment methods in the campaign [...] A corpulent man with a pleasant demeanor that predisposed people in his favor, with a smiling and rosy face and penetrating gaze. When he spoke he did so in a low voice, and then he would look fixedly at the person listening, as if wanting to observe the effect his words had made. Of measured gait, he contrasted with the activity he imparted in all that he undertook. Of easy comprehension, formidable in polemics, quick in riposte, he handled irony with unparalleled skill. When explaining in class he spoke rapidly, as if his words struggled uselessly to follow the dizzying course of his imagination [...] Endowed with a great memory, he was seen with amazement making lengthy citations of dates and authors with great ease [...] He wrote better than he spoke."

Dr. José A. López del Valle, a great public health expert and titular professor of Hygiene and Sanitary Legislation, also left us another interesting testimony as an educator:

"He was a true professor. He had a firm vocation for teaching, facility with words, beauty in the exposition of ideas and great medical culture. A valuable physician and pedagogue, he analyzed the intellectual worth of his students and assessed with fair judgment the merits of each one. He came to form a school and his former students remember with love the affable and caring teacher who strived to instill his knowledge in them and who, if during exam hours he was inflexible, always proceeded with the utmost justice."

Along with his teaching work his surgical activity is truly dazzling and tireless. He himself has taken charge in his works of making it known through statistical studies, especially in these early years after the war. In "Operations Performed During the Year 1900" (1901) he analyzes 254 operations of general surgery and gynecology performed by him with 7 deaths. In "Operations Performed During the Year 1901" (1902) he comments on 425 interventions with 6 deaths. Other examples are his articles: "Reflections on 97 Laparotomies Performed During the Year 1902" (1903), "Choice of a Surgical Procedure in Pelvic Suppurations in Women" (1903) with 218 observations and "One Hundred Forty Laparotomies Performed During the Year 1903" (1904).

The erudite Dr. Jorge Le Roy y Cassá, in commenting at the Society of Clinical Studies of Havana on the work presented by Dr. Enrique Núñez at its session of April 21, 1904, titled "A Case of Total Bladder Removal," states:

"It is not the first time that Dr. Núñez has given us the opportunity to applaud the premier major operations performed by him in Cuba.

His name is linked to the first Symphysiotomy, whose observation he published with Dr. Casariego. Intraspinal injections of cocaine. Ligation of the brachiocephalic trunk. Bilateral resection of the superior cervical sympathetic ganglion. Modification of the intra-abdominal folding of the round ligaments.

Conservative operations in two cases of uterine inversion. Enucleation of Fibroids. Implantation of the ureter in the bladder and both in the rectum. A case of vaginal anus treated by laparotomy."

These priorities of Dr. Enrique Núñez are recorded in his works: "First Symphysiotomy Performed in Cuba" (1896) in collaboration with Dr. José Casariego y Landa; "Analgesic Results of Intraspinal Cocaine Injections" (1901); "A Case of Ligation of the Brachiocephalic Trunk for Primitive Carotid Aneurysm" (1901); "A Case of Exophthalmic Goiter Treated by Bilateral Resection of the Superior Cervical Sympathetic Ganglion" (1902); "A Procedure for Intra-abdominal Shortening of the Round Ligaments with Uterine Suspension" (1900); "A Case of Uterine Inversion" (1903); "A Case of Uterine Inversion. Reduction by Laparotomy and Posterior Section of the Inversion Ring" (1903); "A Case of Interstitial Fibrous Tumor of the Uterus" (1902); "Ureteral-Vaginal Fistula. Laparatomy Utero-Cysto-Nephrostomy by the Abdominal Route. Cure" (1904) and "A Case of Ano-Colo-Vaginal. Laparotomy, Suture, Cure" (1901).

To these priorities one should add two others, according to Professor Rodríguez Molina, reported by Dr. Núñez in his works: "Three Splenectomies for Spleen Hypertrophy and Ectopia" (1900), which after the one performed by Dr. Ignacio Plasencia y Lizaso are the first reported in Cuba, two performed by Dr. Núñez and one by Dr. Gabriel Casuso and "Transvestical Prostatectomy. Cure" (1904), in which he reports the first one performed in the country.

In 1905 he wins the President Gutiérrez Prize of the Academy of Medical, Physical and Natural Sciences of Havana, the most important science award in Cuba at the time, with the monograph The Surgery of Filarial Manifestations, a subject in which he was a true master and which that same year he published in a 97-page pamphlet illustrated with 50 original figures.

This triumph leads him to be elected as a full academician of the institution on July 13, 1906 and his admission work, which he presents at the session of May 29, 1907, titled "Personal Contribution to Conservative Surgery of the Ovaries," earned high praise from another great figure of Cuban surgery, Dr. Gustavo G. Duplessis y Aizpurua, who delivered the response address. In this monograph he discusses the history of gynecological surgery from 1790 and analyzes 120 patients surgically intervened on by him.

In 1906 he makes a study trip to Paris to update himself in urological surgery techniques with the immortal Master of French Urology, born in Cuba and of deep patriotic sentiments, Professor Joaquín Albarrán Domínguez, who upon seeing Dr. Núñez operate, writes enthusiastically to his brother Pedro, a notable urologist and founder of the Urinary Tract Service of National Hospital Number One (our current General Surgical-Medical Teaching Hospital Calixto García) and qualifies him as "a surgeon of great worth."

Of the rest of his scientific work, which amounts to something more than half a hundred important articles, we will cite only the most outstanding for their originality: "Ichthyol in the Treatment of Psoriasis" (1894); "Value of Posterior Colpotomy and Drainage in Pelvic Inflammation" (1900); "Surgical Treatment of Perirectal Infections" (1900); "Cancer of the Uterus Extending to the Vagina. Laparo-Hysterectomy with Vaginal Wall Resection. Cure" (1901); "A Suturing Procedure for Median Laparotomy" (1901); "Personal Observations on the Treatment of Para- and Perirectal Suppurations" (1902); "Contribution to the Treatment of Diffuse Suppurative Peritonitis" (1902); "Surgical Treatment of Uterine Cancer" (1903); "Blennorrhagic Paraurethritis in Women. Its Surgical Treatment" (1905); "Curability of Cancer" (1908); "Use of Antistreptococcal Serum in Metrorrhagias" (1910) and "Opening of the Ureters into the Rectum for Obstetric Destruction of the Bladder and Urethra" (1910).

To the history of surgery in Cuba he will dedicate, besides the aforementioned works on surgery in the war of independence, two important works: "The Evolution of Surgery in Cuba" (1905), in which he highlights the most important facts and personalities of medical science in the country and laments that due to the indifference of some, many of the observations and findings from the large number of patients who were daily operated on in our hospitals and clinics were not recorded in scientific works and "Abdominal Surgery in 1889" (1916), which was the last scientific article to come from his pen.

Such was his prestige as a surgeon that in order to better serve his growing private clientele, he founded in 1904 a private gynecological clinic with 10 beds on San Lázaro Street No. 400 and due to its great success he partnered with Dr. Alberto Sánchez de Bustamante y Sirven, an eminent professor of Obstetrics, to found the famous Núñez-Bustamante clinic, one of the most important of its time, in which such distinguished physicians as Doctors Nicolás Gómez de Rosas Entenza and Natalio Ruiloba Dowling collaborated.

In 1910 he founded and directed until his death the journal Medical Press, where he became a tenacious defender of the medical profession's interests and advocated for the creation of a national medical college.

When Dr. Enrique Núñez was appointed Secretary of Health and Welfare, the highest position in Cuban public health of the time, many of his contemporaries considered him a true novice in the role and predicted his failure.

However, Dr. Núñez, if not an accomplished public health expert, had never been indifferent to the major problems of Cuban public health. One of his first published works, "Mortality Caused by Infantile Tetanus in Havana" (1894), proves this. Perhaps because of that concern of his, he accepts being one of the hundred physicians appointed by the government of the first American intervention to constitute the new Department of Health and serves briefly as District Inspector.

A few months later, he moves to the newly created Section of Special Hygiene, in which due to its nature and medical-social purposes he found a broad field for his concerns. With his gifts as a profound observer, he conducted a valuable study on prostitution in our midst that encompassed causes, effects, development and dangers, which he submitted to the Department's leadership with very favorable reception. Later he was appointed president of what was then the Commission of Special Hygiene, from which he developed beneficial initiatives and always demonstrated, as personal characteristics in the position, great strength of character and unquestionable honesty. Moreover, as a member of the Higher Board first and later the National Board of Health, he contributed with his experience and talent to the organization of Cuban public health and to the nationalization of the health services of the republic.

Because of all this, when on May 20, 1913 the President of the Republic, Major General Mario García Menocal, his immediate chief in the War of Independence, appoints him Secretary of Health and Welfare, Dr. Enrique Núñez is a mature man of science who knows the major health problems of the country and who has concrete criteria on how these could be resolved.

From the beginning he gave preferential attention to everything related to the protection and care of destitute children, for which numerous childcare centers were created and the services of Child Hygiene, Sanitary Surveillance of Milk Distribution, Home-Visit Nurses and the Child Sanitary Defense Colony. With the experience gained in this latter institution, the Martí Preventorium was later established, intended to assist pretuberculosis children. His death left truncated his projects on greater care for the protection of pregnant women and newborns.

He tackled with vigor and decision the major problem of remedying the evils of prostitution exploitation. He devoted himself to the improvement of hospital care, for which he waged tough battles in defense of hospital and asylum income and sought to obtain the greatest advantages and budgets for those institutions.

Without a doubt his greatest concern was the expansion of hospital care and welfare in Cuba in general, for which he undertook the most ambitious project in this sense of the entire period of bourgeois liberal republic and which would consist, among others, in the transformation of the old Hospital Number One into the modern General Hospital Calixto García; the construction of a children's hospital with 250 beds; an antituberculosis hospital with 400 beds; a psychiatric hospital with 400 beds in each provincial capital; a national home for the elderly with 400 beds and the expansion of his beloved Hospital Nuestra Señora de las Mercedes, also with 400 beds.

His great work in stone, in the felicitous phrase of Dr. José A. López del Valle, was undoubtedly the construction of the General Hospital Calixto García, as part of the project for developing hospital care in the country.

To begin an undertaking of such magnitude he assigned Dr. Manuel F. Alfonso Seijas, brigadier general of the Liberation Army and at that time Chief of the Desk of the National Directorate of Welfare, to draft a report on the condition of hospitals on the island, which the competent official carried out under the title "Welfare in Cuba" and presented to Dr. Núñez on April 30, 1914.

Regarding Hospital Number One, in reporting on the institution's conditions it wrote:

"In its current state, the Hospital, although it can be used with great effort, completely lacks conditions for its purpose (...The buildings) all of wood, connected by corridors of the same material, old and rotten, with services so detestable that they have forced the Local Health Bureau to order its closure, which has not been carried out due to the impossibility of finding shelter in another similar establishment for the hundreds of sick who are there, more or less well cared for today."

That same year Dr. Enrique Núñez undertook the task of replacing the old wooden buildings with 18 solid masonry constructions. With the assistance of the architects from the Department of Public Works, he personally conceived and planned the work on the new buildings, which he distributed by specialty, and proposed to the National Welfare Board, which approved them unanimously, the names of these buildings as well as their wards. His untimely death prevented him from seeing his great work completed, but in fulfillment of his wishes, in June 1917, the institution was renamed the General Hospital Calixto García in tribute to the immortal hero of our three wars of independence against Spain and his chief in the last of those military conflicts.

Three years later, in the largest of the buildings constructed, the Dr. Enrique Núñez Maternity and Infancy Hospital was inaugurated on May 17, 1920 as an independent unit, currently the orthopedics and traumatology service. That same day a beautiful statue of Dr. Núñez was unveiled in front of that hospital unit, the work of Italian sculptor Luisi, sculpted at the proposal of his inconsolable teacher Dr. Gabriel Casuso, then Rector