FRANCISCO MONTBRUN (1913-2007): OUTSTANDING VENEZUELAN ANATOMIST

Francisco Montbrun (1913-2007), an outstanding anatomist, was Professor of Anatomy for 64 years at the Universidad Central de Venezuela (UCV) from 1937 to 2001, and founder of the “José María Vargas” School of Medicine and its Human Anatomy Department in 1960. A renowned surgeon, he worked at Hospital Vargas in Caracas and was a Professor of Surgery for 23 years at Facultad de Medicina, UCV. He mentored several generations of anatomists, physicians, surgeons, and university professors. Montbrun was appointed honorary professor. He held important management, representative and administrative positions at the Central University of Venezuela and the Venezuelan government. He wrote textbooks of anatomy and neuroanatomy, published research papers, and introduced surgical techniques in Venezuela. He contributed greatly to improve the teaching and development of anatomy and neuroanatomy, and the medical studies in Venezuela. During his extensive and productive public, medical and academic career, Montbrun received multiple awards and acknowledgements. He was an Individual of Number of the National Academy of Medicine and Minister of Health.

Desempeñó, importantes funciones administrativas, gerenciales y representativas en la Universidad Central de Venezuela y en el gobierno nacional. Escribió libros de anatomía y neuroanatomía, publicó trabajos de investigación e introdujo técnicas quirúrgicas en Venezuela. Contribuyó de manera significativa a mejorar la enseñanza y el desarrollo de la anatomía y la neuroanatomía, y los estudios de medicina en Venezuela. Durante su extensa y productiva carrera en el sector público, en la academia y en la medicina, Montbrun recibió numerosos premios y reconocimientos. Fue Individuo de Número de la Academia Nacional de Medicina y Ministro de Sanidad y Asistencia Social.

INTRODUCTION
The study of medicine in Venezuela began on October 10, 1763, at the Real y Pontificia Universidad de Caracas, 42 years after the founding of the university in 1721. Venezuela was a Spanish colony. The Spanish physician, Dr. Lorenzo Campins y Ballester, was the first professor of medicine. José Francisco Molina, who graduated in 1775, was the first Venezuelan medical doctor. The Royal and Pontifical University of Caracas became the Central University of Venezuela in 1826 by decree of the Liberator, Simon Bolivar, and the Caracas Medical Faculty was founded by him in 1827 (Bruni-Celli, 1958).
www.anatclinar.com.ar Dr. José María Vargas started the study of anatomy and anatomic dissections at the Caracas Medical Faculty on 1827. He taught human anatomy courses for more than twentyfive years.
In 1838, he wrote "Course of Anatomical Lessons and Demonstrations", the first book for the teaching and learning of human anatomy to be printed in Venezuela. During the second half of the nineteenth century, medical studies continued in the prevailing adverse socioeconomic conditions and hostilities until a new period of progress began in the twentieth century with teachers of anatomy and surgery such as Pablo Acosta Ortiz, Luís Razetti, José Izquierdo, Francisco Montbrun and others (Bruni-Celli, 1958). The aim of this paper is to present a brief review of the contributions made by Francisco Montbrun (Fig.1) to human anatomy, surgery, and medical education in Venezuela during his long professional career.  He had three sisters and two brothers. In those days, Caracas, the capital of Venezuela, was a town with a population of 85 000 and few buildings other than colonial-style houses. People travelled mainly on foot, horse-drawn carriages, electric trams and by rail. The country´s population was 2.3 million, 75% of them were illiterate, 80% rural, and the agricultural production techniques were rudimentary. Oil production had barely begun, the oil boom and concomitant improvement of economic indicators were still a long way off. Francisco Montbrun, whose family was not wealthy, did piece work, among other things, as a horse tamer, a skill he had learned in his early years on the farm of his maternal grandfather, Felix Rios, and later on, as a medical student, by going to patients' houses to give injections (Cruz, 2020 1944-1948 and 1955-1959

Contributions to the study of human anatomy
Starting in 1941 and continuing until 2001, he improved and indexed neuroanatomy studies in Venezuela, using a basic functional concept and topographic organization, applying the analysis of vertical-transverse and horizontal sections of the brain and spinal cord. He wrote 27 multi-focused syllabi (several editions of twelve issues, covering the entire anatomy), between 1949 and 1990. They were presented as "an atlas, with the text on the left and the figures on the right, to make learning very objective, because the student always has a figure in sight; of low cost for the student and ready adaption to the evolution of knowledge" (Cruz, 2020 (Fig. 2). Other contributions were: the introduction of new methods for the preservation of cadaveric material; the design and manufacture of stainless steel dissection tables, where the body was permanently stored, and which incorporated a hydraulic lifting mechanism to expose the corpse when required for dissection or demonstration; the introduction of audiovisual techniques for teaching with the projection of color slides in association with manual drawings on the blackboard, using colored chalks to highlight the various anatomical planes. He drew and photographed many of the slides. His anatomical drawings were greatly admired. Many generations of medical students enjoyed his wonderful lectures, his anatomical drawings, his masterful anatomical dissections, and his textbooks (Cardozo de Abreu, 2007;Torres, 2008).

Career as a surgeon
In 1944, he was selected for the position of Second Deputy, and in 1945 for First Deputy of the department of Surgical Therapeutics at the Vargas Hospital, by competitive procedures. He was also Professor of the Therapeutic Surgical Clinic from 1944 to 1946 at the school of medicine. Later, in 1946, he was appointed Professor of the Department of Surgical Pathology, for one year, and Chairman of the Department of Surgical Therapeutic Clinic, a position he maintained from 1946 to 1966. Dr. Montbrun worked at the Vargas Hospital for 30 years, and for 23 years he taught courses in surgery and was responsible for the training of many generations of physicians and surgeons.
His surgical teaching emphasized the preservation of the vital elements of each surgical region, and the preservation of organic functions as much as possible, and he made a point of doing anatomical surgery himself. Montbrun had extraordinary manual dexterity in the treatment of tissues, and accuracy in locating anatomical elements, such that he gained a reputation of carrying out operations that were clean, easy, and decisive, of optimum benefit to patients, and indubitably masterful demonstrations for all the surgeons who trained under him (Cruz, 2020). In 1947, Dr. Montbrun was a founding member of the Centro Medico de Caracas, a private hospital where he practiced general and gynecological surgery until 1988 (Cruz, 2020;Krivoy, 2013). He introduced surgical techniques to Venezuela such as vaginal hysterectomy, which he had learned in Buenos Aires, and its combination with the operative cure of genital prolapse, uterinopexy, transplanting the round ligaments to pecten, trachelectomy, tracheloplasty, colpoperineoplasty and others, which he passed on to his students. He was a founding member of the Venezuelan Society of Surgery in 1944, its president from 1959 to 1961, and honorary member since 1982; Montbrun was also a member of the International Society of Surgery, the Venezuelan Society of Gastroenterology, the International College of Surgeons, a fellow of the American College of Surgeons, president of its Venezuelan Chapter (1971)(1972), honorary Member of the Latin American Federation of Surgery and its Executive President from 1989 to 1991 (Cruz, 2020).

Administrative and leadership positions
During his extensive and productive career as university professor, he held positions in many committees and was very influential in his institution. In 1940 he participated in the commission that studied and planned the building of a new campus,  Medicine. From 1960to 1976 he was member of the School Council. He was an advisor to engineers and architects for the construction of the two basic sciences buildings for the new school and helped to get resources for it (Montbrun, 1992;Cruz, 2019). He was member of UCV´s Electoral Commission (1959-1965) and its president (1965-1967), president of the Commission of Undergraduate Studies of the Faculty of Medicine (1965)(1966)(1967)(1968)(1969)(1970)(1971)(1972) and president of the Medical Faculty Committee for Student Affairs (1972Affairs ( -1976.