Raimundo García Menocal García Menocal

The Master of Surgery in Cuba. He had the distinction of being the one who founded the first School of Nursing in Cuba in 1899, and finally ended up working in the Secretariat of Health and Welfare, where he also brought his innovative spirit to important reforms.

He was the first to perform in Cuba the Mac Ewen operation or scarification of the inner tunic of an aneurysmal sac. The observations by him and Doctor Presno Bastiony on arteriovenous and popliteal aneurysms, 1891 and 1908 respectively, were mentioned by French professors Monod and Vauvertz in their study on "Treatment of arteriovenous aneurysms" (1910).

Doctor García-Menocal was a member of an illustrious family established in Cuba since the late seventeenth century. Engineer Aniceto García-Menocal Martín was one of the designers and builders of the Panama Canal; Armando García-Menocal Martín, one of the immortals of Cuban art and Commander of the Liberating Army; engineer Mario García-Menocal y Deop, Major General of the Liberating Army and President of the Republic (1913-1921). With him went to the independence war of 1895-1898 his brothers Pablo, Tomás Guatimoc (physician) and Juan Manuel, who achieved the rank of Colonel, Gustavo that of Commander and Fausto that of Captain and his father Gabriel García-Menocal Martín fought in the Ten Years' War (1868-1878); Augusto García-Menocal y Córdova, distinguished painter and professor of the famous "San Alejandro" Academy of Havana, and others.

At the Royal and Literary University of Havana, Doctor Raimundo García Menocal completed part of his medical studies, to graduate from the University of Zaragoza as a Licentiate in Medicine and Surgery (1876) and achieve his Doctorate from the Havana University (1881) with the thesis "Theory on the pathogenesis of purulent infection and the true practical utility of so-called aseptic treatments," for which he obtained the Extraordinary Prize in that degree.

At the Hospital "San Felipe y Santiago" of Havana, later Hospital "Nuestra Señora de las Mercedes," he performed brilliant surgical work that led him to be considered the best Cuban surgeon of all time. It is sufficient to say that he was the first to perform successfully in the Island the following operations: transperietal nephrectomy, nephrolithotomy, appendectomy, Boltini operation, perineal prostatectomy, osteoplasty, scarification of the inner tunic of an aneurysmal sac or Mac Ewen operation, resection of Gasser's ganglion, laryngectomy, gastronomy, Whitehead operation or excision of rectal mucosa to treat hemorrhages, laparo-myomectomy and others, as well as his own procedure for skin decortication in elephantiasis of the lower limbs. He initiated asepsis and antisepsis in Cuba and studies of medical mycology.

Doctor Menocal possessed exceptional conditions, difficult to gather in a surgeon. Extraordinary anatomical knowledge, he mastered pathological anatomy and histology, knew laboratory technique, had medical learning like any internist, admirable powers of observation, exquisite manual skill, incomparable serenity, extraordinary goodness of soul, as if in him had incarnated everything that J. L. Faure claims for the soul of the surgeon.

A master of a new kind, he restricted exhibitionist manifestations, in order to carry out with the greatest possible objectivity the demonstration of his cases. He was a man of few words, especially when he began to teach his course, but in halting phrases, sometimes with monosyllables, he said more to all his students than most Cuban medical masters with their beautiful dissertations filled with citations that were forgotten faster than the time they lasted.

His meticulous examinations of the patient, his apt observations in which he revealed his vast knowledge, brought to the spirit of the student that unbreakable faith that the student needs to feel for his master, and when after tripling the time designated by academic disciplines for attendance at his class came the moment to part from him, we all felt the heaviness of not being able to continue at his side. Behold the impression that the work of he who can be called the Master of our surgeons left on the students of the University.

His initiatives extended to considerably modifying the general teaching of medicine during the time of his role as dean, during which period numerous departments of the School were transformed, creating the Anatomical Department. Various laboratories were installed and operated, which only existed nominally in the School of Medicine. He awakened enthusiasm in his colleagues at the School, setting healthy examples for all and thus achieving great progress in the teaching of medicine in Cuba.

His love for his chair was intense, not abandoning it even in the period preceding his death, when he was appointed to occupy the Secretariat of Health and Welfare, which he held when it caught up with him. Perhaps this immense burden of work that he imposed on himself, to which he felt obligated, contributed to hastening it, partly by his patriotic duty and partly by the attraction he felt for the teaching of Surgical Clinic.

The surgical mentality of Dr. Menocal was complex, if one takes as a standard the divisions and concepts that Cathelin has established in this regard.

He was far from being an anatomical type surgeon, even though he possessed great knowledge of Anatomy; but he was a surgeon rapid in the greatest sense that can be conceived. His fingers, endowed with marvelous skill, sometimes played a greater role than his scissors and his scalpels.

He had a special condition for hemostasis; with vertiginous speed his always sure forceps fell upon the bleeding vessel, his marvelous skill, which united with his anatomical knowledge meant that for him the boundaries of inoperability were unknown. Tumors of the neck, of the axilla, etc., were always approachable for him.

He possessed a prevailing condition within his surgical instinct; cold blood. He knew his surgical technique impeccably, but Menocal was a physiologist surgeon. Moreover, genius had kissed his artist's hand, and when he began a technique, more than once he made modifications adaptable to the case in question, to overcome an inconvenience, to take advantage of an unforeseen circumstance, and in this way, after all, he had his own technique that produced enviable results.

He did not possess that condition of Surgeon-Professor that Cathelin proclaims, if one judges solely as such one of easy speech, brilliant oratorical gestures and clear images; instead he possessed extraordinary systematization proper to that character, and the admirable gift of synthesis, knowing how to emphasize the interesting points of the operative act, the difficulty to overcome, and he preferred to demonstrate rather than to speak. He used the fewest possible instruments; he was the opposite type of the instrumentalist surgeon. He brilliantly adapted his technique to the surgical material offered to him, showing more than once in this way the manual aptitude he possessed and the ingenuity proper to his innate surgical condition.

As a citizen he also played a principal role in his country. Conspiring first for the freedom of his country and later emigrated, Doctor Menocal also deserved all the honors of a patriot. He was one who contributed not only pecuniary fruits and effective work; but the charitable soul that sweetened the sad condition of some of the emigrated patriots, bringing happiness or consolation to the heart of homes with his knowledge. After emigration, when he returned to his country, he continued his clean history, serving as Councilman of the City Council, reorganizing the Municipal Health Service.

He had the distinction of being the one who founded the first School of Nursing in Cuba in 1899, and finally he ended up working in the Secretariat of Health and Welfare, where he also brought his innovative spirit to important reforms. An excellent father, a loyal friend, a correct gentleman, he had the same clarity of soul that was in his person. His attractive appearance, that of a gentleman, enjoyed the goodwill of anyone who saw him for the first time.

A fervent patriot, at the beginning of the independence war of 1895-1898 he emigrated to the United States where he performed important work re-operating surgically on the wounded brought out of the Island. He was Dean of the Faculty of Medicine (1900-1901) and Secretary of Health and Welfare (1916-1917); he belonged to the Academy of Medical, Physical and Natural Sciences of Havana, to the Society of Clinical Studies of Havana and to numerous surgical institutions of Europe and America.

On more than one occasion he was an inventor; precisely in that surgery little known to European physicians that characterizes the colonial surgeon, the master had his own techniques, his method for the treatment of elephantiasis of the extremities and a plastic surgery that he practiced admirably: osteoplasty for lesions of filarial elephantiasis.

An expert gynecologist, an obstetrician of frank successes, a dedicated urologist, he handled like few the instrument that made Guyon famous; he practiced cystoscopy when few did so in Cuba and was one of the first to use ureteral catheterization. Abdominal and thoracic surgery held no secrets for him, in a word, he was the most general surgeon that can be conceived.

Another brilliant aspect of Professor Menocal was his work as Professor of Dermatology and Syphilography, to whose chair he opposed in 1909. This subject existed in the study plans and had not been filled, when to the surprise of all, Doctor Menocal opposed it and his students had the opportunity to follow his admirable exercises.

He held this chair with the same activities as that of Surgical Clinic. He devoted himself intensely to mycoses in our country; he studied earnestly the histopathology of our dermatoses and wrote a Manual of Skin Diseases and Syphilis, dedicated to his students. He was the precursor of dermatology in Cuba and from him today's specialists took their inclinations.

His work as a publicist was extraordinary. Nearly one hundred works were published by him in the medical press and they are the best sample of this new phase of activity. Varied are the subjects he addressed and not all within the strict branch of surgery.

Doctor Raimundo Menocal was elected in 1891 a member of this Academy, where those who were his colleagues had the possibility of knowing his interesting work. His admirable entrance work "Contribution to the abbreviated treatment of fractures" was a brilliant exposition of his talent directed in the practical sense.

He died at the estate "Durañona," Marianao, he exercised his profession until a treacherous illness, rapid in its development, cut short his life in Havana on August 1, 1917. Official mourning was declared by the Executive Power of the Republic while the body remained unburied and it was displayed in the Presidential Palace.

Doctor Raimundo García-Menocal, the most eminent teaching and scientific personality of these chairs, perhaps for the reason pointed out, did not produce a textbook; however, for the other chair he held in the same Faculty and of which he was founder, first as a complementary course, Diseases of the Skin and Syphilis, he published two books: "Treatise on Diseases of the Skin and Syphilis" (1907), a volume of 565 pages, and "Manual of Diseases of the Skin and Syphilis" (1911), truly a second revised and enlarged edition of 660 pages. In these works he makes a detailed study of mycoses in Cuba and introduces histopathology in the study of samples of dermatoses.

His important and numerous scientific work comprises, furthermore, 13 articles published in Cuban, North American and European journals, among which stand out: "Contribution to the study of hypo-toxic funiculitis in warm countries" (1905), published in the Journal de Urologie, Paris, and in which he contributed original techniques such as his method for the treatment of elephantiasis of the extremities (1889), and osteoplasty for elephantiatic lesions (1910). He was one of those who contributed most to introducing anesthesia methods in our country and despite the importance of the interventions he performed, his mortality was very low, and it is sufficient to say that from 1893 to 1894 when he performed 284 surgical operations there were no deaths.

Although all professors are to a greater or lesser extent outstanding figures of Cuban surgery of his time, indisputably Doctor Raimundo García Menocal was the one who left the deepest mark on his students and in the history of surgery in the country. Doctor Bernardo Escobar Laredo, who knew him before the Master began his teaching career, described him with the following words:

"He always dresses cleanly, correctly; he wears the classic morning coat and does not abandon the white handkerchief. He scrutinizes when he looks at you and is one of those who studies you when he speaks. And he speaks little, slowly; with excessive spareness when he speaks scientifically."

The medical historian Doctor José A. Martínez-Fortún Foyo, his student at the beginning of his teaching work, said the following about him:

"Doctor Menocal is a great man, strong, of distinguished bearing, of Nordic appearance and character, serious, reserved, of few words, speaks softly, somewhat rough in his manner and considered a great Master. His class is completely practical and clinical, at the patient's bedside. Each student attends to his case. We make the daily rounds with him and it is rare the day that he does not ask questions, and he does so with his head down, without looking at the student, and only makes a sign of displeasure when he is not answered well. Everything that is answered to him seems little, he asks for more and more [...]. He performed numerous and risky operations. It seemed he liked big, bloody interventions. We were amazed by his speed, his cool blood and his own technique [...].

His assistant Ferrán helped him in operations, but seemed 'blurry' next to the Master."

Doctor Torroella Mata, who knew him in the final years of his teaching, who could not be his student and who later became one of his brightest successors in the chair, said:

"The teaching of Surgical Clinic was under the responsibility of Professor Raimundo Menocal, an exemplary model of competence, experience and industriousness. It was a great loss for us that the year before we enrolled in his subject, Menocal left the University to take charge of the Secretariat of Health and Welfare."