Memory Lane
On Professor João Cid dos Santos
João Cid dos Santos (fig 1) was a world-renowned specialist in Angiology and Vascular Surgery, and one of the most brilliant and lucid minds of the Portuguese intelligentsia. Remembering his personality and work is an exercise against the oblivion and indifference that seems to be spreading among part of the contemporary elite, concerned with immediacy, forgetting History and its lessons.
His work is testimony to an era of creativity, technical and scientific innovation that marked Medicine. He had an impact on the international scientific community, which recognised him as one of the pioneers and founders of modern Vascular Surgery; he is still being quoted in contemporary vascular literature, despite the indifference that prevailed in his country.
I would like to congratulate you on this initiative and thank you for the opportunity to give my testimony.
I met João Cid dos Santos as a Surgical Clinic student, then as an Intern in his Department and, lastly, as one of his grandsons in Vascular Surgery, a word he used in the letter of recommendation with which he sponsored by Fellowship with HHG Eastcott, at St. Mary's Hospital, in London.
I owe him the inspiration that changed my career path and the open door to the international scientific world, which began in 1973 when, with this support, I first attended the scientific meeting of the International Cardiovascular Society (ICVS) in which Professor Cid dos Santos was elected President, an occasion captured in the photo shown below (fig.2).
In the labyrinth of remembrance, the unmistakable profile, with bushy eyebrows and a piercing and witty look, marked his friendliness and gentleness towards the young, his deep sense of exigency and precision, which spared none of his assistants and close associates, his unforgettable lectures, where the exercise of clinical reasoning dazzled us.
The sudden change in pose and gesture; he had large, expressive hands which moved in a way that emphasised his intonation, his timely intellectual ramblings, as, without losing sight of the logic and consistency of his presentation, he astonished and fascinated the audience as did certain musical scores where, rather than the flow of notes, it is the sudden change of tone and rhythm that illuminates the spirit and reveals the essence of the work.
He was an accomplished pianist, his culture was vast and eclectic - it truly substantiated this Renaissance man to whom nothing was indifferent, as he himself wrote about his Father, Professor Reynaldo dos Santos. He loved Life and its charms. The recipe for Eggs a la Professor, which is still on the daily menu of a restaurant in the S. Bento area, remained for posterity.
Two key contributions stand out from his scientific work: the creation of venous Imaging with the introduction of Phlebography in the 1930s, following the scientific path of the Portuguese School of Angiography, and the discovery of Endarterectomy in 1946, an innovative technique for clearing blocked arteries.
The first phlebography was performed in 1936 (Figure 3) by direct exposure of the internal saphenous vein together with the injection of contrast to allow viewing both this vein and the common and iliac femoral veins.
This discovery kicked off an intense research and development program with the introduction of new original techniques that enabled the full visualisation of the venous system and its functional study, a key contribution dubbed by the scientific community as the Phlebographic School of Lisbon. This research resulted in a new scientific and clinical approach he called Sur quelques vérités premières oubliées ou méconnues de l'anatomo-physiologie normale et pathologique du système veineux. Leur application à la pathologie et à la thérapeutique published in 1948, which is still relevant today.
For decades, Phlebography was the most important diagnostic tool in Venous Pathology and the gold standard used in the validation of new diagnostic technologies. Contemporary Imaging - EcoDoppler and CT angiography or MR angiography - replaced phlebography in 95% of the clinical cases. But the substance remained unchanged: the research on new methodologies followed the road travelled by Phlebography. More than a diagnostic technique, João Cid dos Santos gave us a path, a method for venous research, and therein lies the perennial nature of his contribution!
In the early 1980s, after returning to Portugal, I was invited to a conference in London, on Lessons learned from Phlebography - The Lisbon School in the context of a Symposium dedicated to research on the venous system organised by the Royal Society of Medicine and preparing my presentation was an unforgettable experience, from the sense of belonging, albeit with the inexorable distance of youth, to a school of scientific thought that had been an inescapable landmark in the research on the venous system, to the anguishing responsibility of giving an overview of the consistent body of new scientific knowledge brought by Phlebography and, lastly, the tranquillity of feeling a sense of achievement in paying tribute to the School led by Cid dos Santos, where I had begun my training in the vascular area.
The Phlebographic Archive, which was unique and exemplarily organised, with more than twenty thousand exams, a silent but living witness to this unique work, was unfortunately lost without being microfilmed and in the absence of a modern organisation to preserve it for future generations. Nobody realised that is was a family heirloom, like those we don't wear every day, but we insist on keeping, no matter what! There is, however, a book written by his closest associates, entitled Venous Disease of the Lower Limbs, which I still read with interest today.
And it's really interesting to realise that , nowadays, the first step of the modern endovascular intervention in the deep venous system is the phlebographic confirmation of the pathology. Phlebography is still a vital roadmap.
Endarterectomy was the other historical landmark of Cid dos Santos' scientific contribution. For this reason, he was considered, together with Michael DeBakey, one of the founding fathers of modern reconstructive arterial surgery (Figure 4).
It was a quantum leap in the therapeutic intervention in blocked arteries.
The innovator's mark is this ability to break up the establishment, the scientifically correct, the strength to open new roads never travelled, and this was the sublime moment of scientific creation and opportunity seized by João Cid dos Santos.
It was a victory over scientific prejudice, built on truth: the myth of the inviolability of the intima as he said in his memorable Leriche Memorial Lecture which he delivered in Edinburgh in 1975, as President of the ICVS, only months before his death, where, with the unquestionable scientific authority and the usual brilliance of his presentations, he retraced the journey from embolectomy to endarterectomy.
The new technique consisted of removing a segment of the arterial wall and the thrombus associated with it, as shown in figure 5, and in order to achieve that he designed special instruments that I still used in my surgical practice; its technical principles remain valid and endarterectomy is still today, in the 21st century, despite the shift in the paradigm of operation determined by the modern endovascular intervention, a surgical technique we use in various vascular sectors, from the carotid and the aorta and its branches to the arteries of the limbs. It has survived the test of Time.
In September 1997, we organised a commemorative session for the 50th anniversary of Endarterectomy, in the context of the 11th Annual Meeting of the European Society of Vascular Surgery (ESVS), of which he had been President, in which we analysed the developments in arterial surgery in the 50 years since the introduction of Cid dos Santos' technique. This session, chaired by Debakey and Eastcott, was a moment of major scientific and ethical praise, which filled us all with deep joy and pride.
Cid dos Santos was also responsible for the first successful repair of an abdominal aortic aneurysm, shortly after the introduction of the Dacron grafts by DeBakey, and introduced a new surgical procedure for performing lumbar sympathicectomy. However, arterial surgery didn't grow as much as it needed and deserved in his Department, despite the brilliance of his activity and his modern approach to the organisation and structuring of both his Department and the Reynaldo dos Santos Angiography Centre.
Forty-six years ago, in 1972, when I joined the Surgical Clinic Department as a specialist intern, arterial surgeries were only performed once a week (on Wednesdays), limiting the number of patients that were operated on and hindering the development of a case-by-case approach comparable, in numbers and diversity, to those followed by other European centres at the time.
The creation of the Reynaldo dos Santos Angiography Centre, subsidised by the then Institute for High Culture, and a Scientific Illustration Centre, financed by Professor Cid dos Santos himself, in which Olga Bragança made drawings illustrating surgeries and the endarterectomy technique, allowed accurately preserving a number of documents for future memory.
João Cid dos Santos had a capacity for intellectual seduction that attracted his associates and young interns, a quality considered by George Steiner as an attribute of the true Master. He was clearly concerned about the continuity of his work and he surely felt deeply hurt by the indifference that surrounded him, by the lack of institutional support of both the State and private Foundations, by the inability to create the autonomous Vascular Surgery department he had envisaged - which only became a reality in 1986, thanks to one of his initial Assistants, Professor Luís Teixeira Diniz. He knew how to recognise the merit and enthusiasm of his younger colleagues, whom he called his grandchildren, a group in which he included me, as he made it clear in the exam I had to take to become a surgeon, the last one he chaired, when, contrary to the rules, he called us - we were two candidates - and, much to the surprise of a room full of assistants, said that he left us his vascular inheritance. These encouraging words, at an unforgettable moment of my final Surgery Internship exam, which he chaired, the prophetic tone with which he anticipated difficulties, the enthusiasm and the strength that he then knew how to convey, were the Ariadne's thread I followed to accomplish the professional imperative I tried to honour.
Why was the expansion of arterial surgery in his Department hindered?
Time brings detachment and exemption. Cid dos Santos' work was never recognised by the established Powers, from the State to private Foundations, which largely overlooked the activity he developed and underestimated the international impact of his work.
The dominant culture was not that of innovation, free and daring spirits were feared, the resources available for research, which was becoming increasingly complex and expensive, requiring instruments other than the forks, knives and spoons that Cid Santos recognised in a very clear-sighted way, were very scarce, almost non-existent.
The prevailing authoritarian conservatism crushed the Faculty of Medicine and the University, destroyed the concept of University Hospital, subordinated academic life to assistential realities, hindering the creative academic experience.
Furthermore, the way in which professional careers and pre- and post-graduate education were organised did not encourage research. We lacked the institutional flexibility that, in other more progressive countries, allowed students and new graduates to devote time and energy to research projects, serving as an enthusiastic, young and creative workforce for serious scientific research. In the 1960s and 70s, the internship combined with the graduation thesis was a mitigating way of offering a few opportunities for research, but we were always far from the English, Nordic, and American programmes that had the necessary flexibility in post-graduate education to allow physicians to pursue their research over reasonably long periods of time, exclusively and without jeopardising their careers, with the obvious benefits brought about by credits and competences.
Another reason was the lack of availability and/or scientific productivity of the areas related to basic sciences, which had experienced a period of intense renewal in the 1920s and 30s, under the impulse of the generation of 1911, but suffered the obvious negative impact of the various aforementioned constraints, from the prevailing intellectual conformism to the scarcity of resources and the desertification of the School, a consequence of the dictatorial regime. The truth is that, without a strong basic research sector, provided with properly equipped laboratories that master the techniques and instrumentation required to interrogate nature, clinical research will never be able to go beyond the immediate and more traditional questions.
Notwithstanding all these vicissitudes, and 50 years later, João Cid dos Santos' scientific work remains an inescapable landmark and endarterectomy was the most original, lasting and important Portuguese contribution to the history of Surgery and is still widely quoted in international medical literature.
He had a very contemporary perspective on the autonomy and independence of his speciality and on the importance of angiography, which he regarded as part of an indivisible unit of Vascular Surgery as a whole, reflected in the organisation he envisaged for his Department and in the defence of the outrance of that model, in view of new concepts and habits.
It is worth recalling his eloquent defence of this concept in a text written in 1972 in honour of E. J. Wylie from S. Francisco:
“Vascular surgery is a world apart under every point of view: examination, medical and surgical treatment, post-operative period and follow-up. This accounts for the necessity of having a single independent unit for this particular surgery. And a separate department of angiography is just as inadmissible although this is the case in many places in the world. A vascular service without its own angiographic unit is like a body without a limb. Angiograms are the eyes of the vascular surgeon; without them, he at once becomes a mole.”
Vascular Surgery only established itself as an autonomous speciality in Europe in the late 1990s, and it is interesting to note that the decisive meeting was held in Lisbon!
The modernity of his vision stood the test of Time and the evolution of arterial surgery, a fact confirmed by the developments in Endovascular Surgery that have occurred over the last decade. Today, angiography is more than a diagnostic test, it's the first stage of a treatment and the indispensable method for implementing the multiple endovascular solutions that are increasingly influencing the treatment of vascular diseases, and, therefore, should continue to be an art practised by vascular surgeons.
Therefore, it's not difficult to understand the bitterness of his final days, the dismay at the approaches that threatened the values he respected and which he summed up in a frequent outburst nothing is taken seriously in this country, which he, in fact, wrote down and to which he warned me, as plea for the future, when I said goodbye to him in the hot summer of '75, in his magnificent house at Largo da Rosa, before leaving for England.
It as a warning and a plea!
His independent spirit was not compatible with the culture of subservience of the time, which unfortunately insists on persisting. After a brief spell in Politics as an independent member of the National Assembly, where his early warning about Medical Education and hospital organisation was both a milestone and a disillusion, because he did not betray his Thought and his beliefs and that led him to leave the Assembly; the fact that the Minister of Health brought proceedings against him, as a result of his commitment to uphold the Report on Medical Careers produced by the Medical Association was truly deplorable.
These are difficult times in which the values and the very essence of the profession are changing.
The new challenges arising in the practice of Medicine require physicians and their scientific and professional organisations to think carefully and respond appropriately.
As part of this, João Cid dos Santos' mental independence, critical intelligence and strong sense of ethics can serve as a beacon and an inspiration; we can find them in his writings, some of which were given to me by chance as part of a historian's collection. The following are some excerpts of his interventions:
“.. Education must be at the forefront of the concerns of any country that wishes to be civilised. I'm not talking about a means of testing the human brain with knowledge, but rather about what determines the usefulness and activity of Man in this world: the Education of the Mind.
And then he would add:
...Let's think like Men next to those olive trees among which Socrates fought for Education and Ethics. And let's conjecture as Physicians under the branches of this secular plantain in Kos that symbolises the great philosopher of our profession. Let's not neglect the murmur of this age-old foliage - these are inexorable warnings.
And he vehemently stated:
Let a new generation of navigators arise, this time with winged spirits. Only then can a new Dawn rise.
These are undeniably lucid warnings, a call for the revitalisation of the spirit, for the pursuit of personal and professional excellence.
João Cid dos Santos, whose memory is celebrated in this issue of News@FMUL, was one of the most illustrious Professors of the Faculty of Medicine, a Man of Choice, a superior mind, and a nonconformist.
When I think of his example, of the struggle for the survival of the mind, of his determination to overcome the indifference, apathy, and slander of a society which his Father had characterised as too ignorant to understand and not independent enough to judge,, the image that comes to my mind is that of the boldness that prompted Prometheus to steal fire from the gods for the benefit of humans.
As he mentioned in the aforementioned intervention in the final Surgery exam, it is crucial to know how to break the chains that, in mythology, bound Prometheus to an eternal punishment for his temerity, but which, in Life, bind us to conformism and indifference, and to know how to focus our energy to force and open new paths to build our personal and collective future.
Along that path, the memory of João Cid dos Santos' lucidity, intelligence and culture and the strength of his example were a beacon to which we owe our inspiration, enthusiasm, guidance, and courage.
Professor José Fernandes e Fernandes
Former Director of FMUL and specialist in Vascular Surgery
His work is testimony to an era of creativity, technical and scientific innovation that marked Medicine. He had an impact on the international scientific community, which recognised him as one of the pioneers and founders of modern Vascular Surgery; he is still being quoted in contemporary vascular literature, despite the indifference that prevailed in his country.
I would like to congratulate you on this initiative and thank you for the opportunity to give my testimony.
I met João Cid dos Santos as a Surgical Clinic student, then as an Intern in his Department and, lastly, as one of his grandsons in Vascular Surgery, a word he used in the letter of recommendation with which he sponsored by Fellowship with HHG Eastcott, at St. Mary's Hospital, in London.
I owe him the inspiration that changed my career path and the open door to the international scientific world, which began in 1973 when, with this support, I first attended the scientific meeting of the International Cardiovascular Society (ICVS) in which Professor Cid dos Santos was elected President, an occasion captured in the photo shown below (fig.2).
In the labyrinth of remembrance, the unmistakable profile, with bushy eyebrows and a piercing and witty look, marked his friendliness and gentleness towards the young, his deep sense of exigency and precision, which spared none of his assistants and close associates, his unforgettable lectures, where the exercise of clinical reasoning dazzled us.
The sudden change in pose and gesture; he had large, expressive hands which moved in a way that emphasised his intonation, his timely intellectual ramblings, as, without losing sight of the logic and consistency of his presentation, he astonished and fascinated the audience as did certain musical scores where, rather than the flow of notes, it is the sudden change of tone and rhythm that illuminates the spirit and reveals the essence of the work.
He was an accomplished pianist, his culture was vast and eclectic - it truly substantiated this Renaissance man to whom nothing was indifferent, as he himself wrote about his Father, Professor Reynaldo dos Santos. He loved Life and its charms. The recipe for Eggs a la Professor, which is still on the daily menu of a restaurant in the S. Bento area, remained for posterity.
Two key contributions stand out from his scientific work: the creation of venous Imaging with the introduction of Phlebography in the 1930s, following the scientific path of the Portuguese School of Angiography, and the discovery of Endarterectomy in 1946, an innovative technique for clearing blocked arteries.
The first phlebography was performed in 1936 (Figure 3) by direct exposure of the internal saphenous vein together with the injection of contrast to allow viewing both this vein and the common and iliac femoral veins.
This discovery kicked off an intense research and development program with the introduction of new original techniques that enabled the full visualisation of the venous system and its functional study, a key contribution dubbed by the scientific community as the Phlebographic School of Lisbon. This research resulted in a new scientific and clinical approach he called Sur quelques vérités premières oubliées ou méconnues de l'anatomo-physiologie normale et pathologique du système veineux. Leur application à la pathologie et à la thérapeutique published in 1948, which is still relevant today.
For decades, Phlebography was the most important diagnostic tool in Venous Pathology and the gold standard used in the validation of new diagnostic technologies. Contemporary Imaging - EcoDoppler and CT angiography or MR angiography - replaced phlebography in 95% of the clinical cases. But the substance remained unchanged: the research on new methodologies followed the road travelled by Phlebography. More than a diagnostic technique, João Cid dos Santos gave us a path, a method for venous research, and therein lies the perennial nature of his contribution!
In the early 1980s, after returning to Portugal, I was invited to a conference in London, on Lessons learned from Phlebography - The Lisbon School in the context of a Symposium dedicated to research on the venous system organised by the Royal Society of Medicine and preparing my presentation was an unforgettable experience, from the sense of belonging, albeit with the inexorable distance of youth, to a school of scientific thought that had been an inescapable landmark in the research on the venous system, to the anguishing responsibility of giving an overview of the consistent body of new scientific knowledge brought by Phlebography and, lastly, the tranquillity of feeling a sense of achievement in paying tribute to the School led by Cid dos Santos, where I had begun my training in the vascular area.
The Phlebographic Archive, which was unique and exemplarily organised, with more than twenty thousand exams, a silent but living witness to this unique work, was unfortunately lost without being microfilmed and in the absence of a modern organisation to preserve it for future generations. Nobody realised that is was a family heirloom, like those we don't wear every day, but we insist on keeping, no matter what! There is, however, a book written by his closest associates, entitled Venous Disease of the Lower Limbs, which I still read with interest today.
And it's really interesting to realise that , nowadays, the first step of the modern endovascular intervention in the deep venous system is the phlebographic confirmation of the pathology. Phlebography is still a vital roadmap.
Endarterectomy was the other historical landmark of Cid dos Santos' scientific contribution. For this reason, he was considered, together with Michael DeBakey, one of the founding fathers of modern reconstructive arterial surgery (Figure 4).
It was a quantum leap in the therapeutic intervention in blocked arteries.
The innovator's mark is this ability to break up the establishment, the scientifically correct, the strength to open new roads never travelled, and this was the sublime moment of scientific creation and opportunity seized by João Cid dos Santos.
It was a victory over scientific prejudice, built on truth: the myth of the inviolability of the intima as he said in his memorable Leriche Memorial Lecture which he delivered in Edinburgh in 1975, as President of the ICVS, only months before his death, where, with the unquestionable scientific authority and the usual brilliance of his presentations, he retraced the journey from embolectomy to endarterectomy.
The new technique consisted of removing a segment of the arterial wall and the thrombus associated with it, as shown in figure 5, and in order to achieve that he designed special instruments that I still used in my surgical practice; its technical principles remain valid and endarterectomy is still today, in the 21st century, despite the shift in the paradigm of operation determined by the modern endovascular intervention, a surgical technique we use in various vascular sectors, from the carotid and the aorta and its branches to the arteries of the limbs. It has survived the test of Time.
In September 1997, we organised a commemorative session for the 50th anniversary of Endarterectomy, in the context of the 11th Annual Meeting of the European Society of Vascular Surgery (ESVS), of which he had been President, in which we analysed the developments in arterial surgery in the 50 years since the introduction of Cid dos Santos' technique. This session, chaired by Debakey and Eastcott, was a moment of major scientific and ethical praise, which filled us all with deep joy and pride.
Cid dos Santos was also responsible for the first successful repair of an abdominal aortic aneurysm, shortly after the introduction of the Dacron grafts by DeBakey, and introduced a new surgical procedure for performing lumbar sympathicectomy. However, arterial surgery didn't grow as much as it needed and deserved in his Department, despite the brilliance of his activity and his modern approach to the organisation and structuring of both his Department and the Reynaldo dos Santos Angiography Centre.
Forty-six years ago, in 1972, when I joined the Surgical Clinic Department as a specialist intern, arterial surgeries were only performed once a week (on Wednesdays), limiting the number of patients that were operated on and hindering the development of a case-by-case approach comparable, in numbers and diversity, to those followed by other European centres at the time.
The creation of the Reynaldo dos Santos Angiography Centre, subsidised by the then Institute for High Culture, and a Scientific Illustration Centre, financed by Professor Cid dos Santos himself, in which Olga Bragança made drawings illustrating surgeries and the endarterectomy technique, allowed accurately preserving a number of documents for future memory.
João Cid dos Santos had a capacity for intellectual seduction that attracted his associates and young interns, a quality considered by George Steiner as an attribute of the true Master. He was clearly concerned about the continuity of his work and he surely felt deeply hurt by the indifference that surrounded him, by the lack of institutional support of both the State and private Foundations, by the inability to create the autonomous Vascular Surgery department he had envisaged - which only became a reality in 1986, thanks to one of his initial Assistants, Professor Luís Teixeira Diniz. He knew how to recognise the merit and enthusiasm of his younger colleagues, whom he called his grandchildren, a group in which he included me, as he made it clear in the exam I had to take to become a surgeon, the last one he chaired, when, contrary to the rules, he called us - we were two candidates - and, much to the surprise of a room full of assistants, said that he left us his vascular inheritance. These encouraging words, at an unforgettable moment of my final Surgery Internship exam, which he chaired, the prophetic tone with which he anticipated difficulties, the enthusiasm and the strength that he then knew how to convey, were the Ariadne's thread I followed to accomplish the professional imperative I tried to honour.
Why was the expansion of arterial surgery in his Department hindered?
Time brings detachment and exemption. Cid dos Santos' work was never recognised by the established Powers, from the State to private Foundations, which largely overlooked the activity he developed and underestimated the international impact of his work.
The dominant culture was not that of innovation, free and daring spirits were feared, the resources available for research, which was becoming increasingly complex and expensive, requiring instruments other than the forks, knives and spoons that Cid Santos recognised in a very clear-sighted way, were very scarce, almost non-existent.
The prevailing authoritarian conservatism crushed the Faculty of Medicine and the University, destroyed the concept of University Hospital, subordinated academic life to assistential realities, hindering the creative academic experience.
Furthermore, the way in which professional careers and pre- and post-graduate education were organised did not encourage research. We lacked the institutional flexibility that, in other more progressive countries, allowed students and new graduates to devote time and energy to research projects, serving as an enthusiastic, young and creative workforce for serious scientific research. In the 1960s and 70s, the internship combined with the graduation thesis was a mitigating way of offering a few opportunities for research, but we were always far from the English, Nordic, and American programmes that had the necessary flexibility in post-graduate education to allow physicians to pursue their research over reasonably long periods of time, exclusively and without jeopardising their careers, with the obvious benefits brought about by credits and competences.
Another reason was the lack of availability and/or scientific productivity of the areas related to basic sciences, which had experienced a period of intense renewal in the 1920s and 30s, under the impulse of the generation of 1911, but suffered the obvious negative impact of the various aforementioned constraints, from the prevailing intellectual conformism to the scarcity of resources and the desertification of the School, a consequence of the dictatorial regime. The truth is that, without a strong basic research sector, provided with properly equipped laboratories that master the techniques and instrumentation required to interrogate nature, clinical research will never be able to go beyond the immediate and more traditional questions.
Notwithstanding all these vicissitudes, and 50 years later, João Cid dos Santos' scientific work remains an inescapable landmark and endarterectomy was the most original, lasting and important Portuguese contribution to the history of Surgery and is still widely quoted in international medical literature.
He had a very contemporary perspective on the autonomy and independence of his speciality and on the importance of angiography, which he regarded as part of an indivisible unit of Vascular Surgery as a whole, reflected in the organisation he envisaged for his Department and in the defence of the outrance of that model, in view of new concepts and habits.
It is worth recalling his eloquent defence of this concept in a text written in 1972 in honour of E. J. Wylie from S. Francisco:
“Vascular surgery is a world apart under every point of view: examination, medical and surgical treatment, post-operative period and follow-up. This accounts for the necessity of having a single independent unit for this particular surgery. And a separate department of angiography is just as inadmissible although this is the case in many places in the world. A vascular service without its own angiographic unit is like a body without a limb. Angiograms are the eyes of the vascular surgeon; without them, he at once becomes a mole.”
Vascular Surgery only established itself as an autonomous speciality in Europe in the late 1990s, and it is interesting to note that the decisive meeting was held in Lisbon!
The modernity of his vision stood the test of Time and the evolution of arterial surgery, a fact confirmed by the developments in Endovascular Surgery that have occurred over the last decade. Today, angiography is more than a diagnostic test, it's the first stage of a treatment and the indispensable method for implementing the multiple endovascular solutions that are increasingly influencing the treatment of vascular diseases, and, therefore, should continue to be an art practised by vascular surgeons.
Therefore, it's not difficult to understand the bitterness of his final days, the dismay at the approaches that threatened the values he respected and which he summed up in a frequent outburst nothing is taken seriously in this country, which he, in fact, wrote down and to which he warned me, as plea for the future, when I said goodbye to him in the hot summer of '75, in his magnificent house at Largo da Rosa, before leaving for England.
It as a warning and a plea!
His independent spirit was not compatible with the culture of subservience of the time, which unfortunately insists on persisting. After a brief spell in Politics as an independent member of the National Assembly, where his early warning about Medical Education and hospital organisation was both a milestone and a disillusion, because he did not betray his Thought and his beliefs and that led him to leave the Assembly; the fact that the Minister of Health brought proceedings against him, as a result of his commitment to uphold the Report on Medical Careers produced by the Medical Association was truly deplorable.
These are difficult times in which the values and the very essence of the profession are changing.
The new challenges arising in the practice of Medicine require physicians and their scientific and professional organisations to think carefully and respond appropriately.
As part of this, João Cid dos Santos' mental independence, critical intelligence and strong sense of ethics can serve as a beacon and an inspiration; we can find them in his writings, some of which were given to me by chance as part of a historian's collection. The following are some excerpts of his interventions:
“.. Education must be at the forefront of the concerns of any country that wishes to be civilised. I'm not talking about a means of testing the human brain with knowledge, but rather about what determines the usefulness and activity of Man in this world: the Education of the Mind.
And then he would add:
...Let's think like Men next to those olive trees among which Socrates fought for Education and Ethics. And let's conjecture as Physicians under the branches of this secular plantain in Kos that symbolises the great philosopher of our profession. Let's not neglect the murmur of this age-old foliage - these are inexorable warnings.
And he vehemently stated:
Let a new generation of navigators arise, this time with winged spirits. Only then can a new Dawn rise.
These are undeniably lucid warnings, a call for the revitalisation of the spirit, for the pursuit of personal and professional excellence.
João Cid dos Santos, whose memory is celebrated in this issue of News@FMUL, was one of the most illustrious Professors of the Faculty of Medicine, a Man of Choice, a superior mind, and a nonconformist.
When I think of his example, of the struggle for the survival of the mind, of his determination to overcome the indifference, apathy, and slander of a society which his Father had characterised as too ignorant to understand and not independent enough to judge,, the image that comes to my mind is that of the boldness that prompted Prometheus to steal fire from the gods for the benefit of humans.
As he mentioned in the aforementioned intervention in the final Surgery exam, it is crucial to know how to break the chains that, in mythology, bound Prometheus to an eternal punishment for his temerity, but which, in Life, bind us to conformism and indifference, and to know how to focus our energy to force and open new paths to build our personal and collective future.
Along that path, the memory of João Cid dos Santos' lucidity, intelligence and culture and the strength of his example were a beacon to which we owe our inspiration, enthusiasm, guidance, and courage.
Professor José Fernandes e Fernandes
Former Director of FMUL and specialist in Vascular Surgery