Professor José Fragata’s Jubilation Class

Book Presentation “Heart and Lungs”

Publishers: Prof José Fragata/Dra Helena Antunes

Introductory text:Fausto Pinto

The teaching of Medicine should be a dynamic process that requires, from all those involved in it, a great availability and ability to adapt to new realities that, naturally, interfere directly or indirectly with the way that same teaching will develop. At the same time, it is essential to establish a balance so as not to run the risk of mischaracterizing what has been an absolutely fabulous evolutionary process, which must not, however, lose sight of its founding Hippocratic values and principles. Respect for the past, however, cannot inhibit us from rethinking and streamlining the future, which is why it was with great satisfaction and honor that I accepted Professor José Fragata’s invitation to present the “Heart” part of the book he edited and which now sees the light of day “Heart and Lungs”.

The importance of a work base and solid learning in Medicine continues to be unquestionable, despite the multiple innovations that are gradually being introduced, in what we can consider a new Medical Education, in the spirit well mirrored by Ortega y Gasset when he said “Only it is possible to move forward when you look far away. Progress is only possible when you think big.” And I think that Prof Fragata’s life example ends up also being reflected in the way in which he surely thought and produced this book, which will go down in the history of medical publications in Portuguese, as an example and a reference.

In fact, the use of the book in cardiology as a study and learning companion has a long and fascinating history. in 2980 BC, referring to the observation of the pulse. Later, in Greece, Hippocrates, in 460 BC, makes exquisite descriptions of the prognostic significance of symptoms and signs, such as dyspnea. The first reference to the anatomy of the human heart is by Erasistratos and Herophilos, of Alexandria, in 310 BC and Celsus of Rome, in 25 BC, writes De Re Medicina where he includes several recommendations such as phlebotomy for dyspnea. Later Leonardo da Vinci in 1452 publishes the famous drawings of the heart. In 1543 Vesalius writes De Fabrica Humani Corporis, where he describes the human heart. In 1555 he makes the first ante mortem description of an aortic aneurysm which was confirmed two years later at autopsy. In 1618, Albertini, in Italy, wrote the first treatise on the heart, although with little important information, being more a review of theories from the Ancient and Medieval Ages, with a long discussion on palpitations and syncope. And it is in 1628 that one of the historical milestones in the history of Cardiology is published, Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, by William Harvey, an Englishman studying in Italy, where he proved the existence of blood circulation. Fast forward to 1715, in France, Vieussens publishes Traité du coeur, another historical milestone, where some cardiac alterations are described, including mitral stenosis and associated dyspnoea. In 1761 Morgagni, in Italy, publishes De Sedibus et Causis Morborum, where an extensive discussion of the pathological anatomy of many cardiovascular situations is made, including calcification of the coronary arteries. In 1768 Heberden, in England, made his famous description of angina pectoris, which he also suffered from. And so on, until the 20th century, in which several figures stand out, of which I would like to highlight in the first half of the century, Paul Dudley White, Roosevelt’s physician, with the first edition of his treatise Heart Disease being published in 1931 and , without a doubt, the one who is considered the Father of modern cardiology, Eugene Braunwald, from Harvard, who embodied one of the best-known cardiological treatises in the world, with the first edition in 1980 and which, since then, multiple editions have been edited, having known how to adapt to the new times. In Portugal, some books have also been published, allowing me to highlight here the recent project initiated by Prof. Lino Gonçalves, when President of the Portuguese Society of Cardiology, together with CEMP (Conselho de Escolas Médicas Portuguesas), which appointed me as co -editor of the book, which is already available in digital format. And it is in this sequence and in this broth of cardiovascular science that the book “Coração e Lung” appears.

This book contains a set of chapters that cover the entire cardiology area, in its various aspects, in an up-to-date, pedagogical, easy-to-read and pragmatic way. And it has a peculiarity that, deep down, is the natural signature of Prof Fragata, that is, in all nine areas that he dissected (literally), from arrhythmias to congenital heart diseases, there is a sub-chapter dedicated to the role of surgery in the respective area . And it ends with a chapter on simulation applied to medicine, an essential element in medical education today.

Many things have already been discussed and tested in other places, so that, many times, there is only a need to adapt to local realities, so as not to create unnecessary cleavages, but also not to delay too much the monitoring of the movements that, at an international level, lead to medical science, with an extraordinary dynamic, to often unthinkable goals. Under penalty of losing trains forever, or widening gaps that may become impassable, it is our responsibility, as university students, scientists and doctors, to contribute to the creation of the necessary conditions so that this follow-up can be carried out firmly, as the progress of History, and of Science, is irreversible.

We live in the age of technologies. Every day we are invaded by them, at home, on the street, in schools and, of course, in Universities and, in particular, in Medicine and Science in general. It is, without a doubt, a fascinating time to live in, when almost daily we are confronted with new technological developments with a greater or lesser impact on Medicine and, in particular, on cardiovascular sciences. However, this development sometimes leads to an apparent (sometimes very real) forgetting of the humanist component. Despite these developments, there are several aspects that can never be forgotten, such as the doctor-patient relationship, the importance of human contact, listening, looking, touching, feeling the patient. The importance of being heard and letting oneself be heard, contributing to the happiness of both the individual and his family, renewing hope for a better life, bringing him back to his family and work, to his social, everyday reintegration . All these are weapons that we have as Doctors, and that no technology, no artificial intelligence and certainly no robot will ever replace. I cannot fail to mention, in this regard, João Lobo Antunes when he wisely said: “I don’t know what awaits us, but I know what worries me: is that medicine, excited by science, seduced by technology and stunned by bureaucracy, erase its human face and ignore the unique individuality of each person who suffers, because although more and more ways of treating are being invented, it has not yet been discovered how to alleviate suffering without empathy or compassion.”

We therefore have an added responsibility to prevent this from happening and Prof Fragata has made an excellent contribution to this goal, which also appears in his book, which I am sure will be yet another contribution to not losing sight of the humanist component of our medical profession.

The challenges facing us today are, therefore, extremely complex and difficult, and only a very informed attitude, with great directness, perseverance and modernism, can be victorious. It is therefore necessary that current and future generations face this turning point with optimism and hope in the development and implementation of a healthy and modern practice of medicine in Portugal.

It is, therefore, our obligation, as an academic medical community, to instil this spirit in medical students, that is, in future doctors.

The great René Favaloro, a surgeon of Argentine origin, would have turned 100 two days ago. He was the first cardiac surgeon to perform a coronary bypass, in Cleveland, and he had a life devoted to Medicine/Surgery. One of his best-known quotes is the following: “Prevention must be the most important aspect of our specialty. I’m sure that in the future there will be fewer angioplasties and fewer bypass surgeries. Prevention, combined with advances in molecular biology related to genetics, will help reduce the incidence of cardiovascular disease.” This was said in 1999 by a surgeon and unfortunately, we are still so far from fulfilling this prophecy. For this it is necessary to continue to tread a path that must start in the Faculty’s benches and from there spread to the whole community. And here I leave a small suggestion for the next edition (I’m sure there will be one) to include a chapter on “Cardiovascular Prevention”!!

I will end with the words of Reynaldo dos Santos, still so opportune today, when, in his last lesson, with the title “The Formation of the Elites”, he refers: “Higher education is not just professional preparation, but superior formation of the spirit. the example of the way of thinking, analyzing and judging problems is what models the intelligence of students…” This is the timeless spirit that, I am sure, many of us, where I include our focus today, Prof José Fragata, I would like to see it permeated in future medical generations. This will be our challenge as an academic medical community and the commitment we have a duty to assume, so that together we can tread a successful path, enriching Medical Teaching and Research in Portugal.

This contribution that is launched today and that stands as a testimony of a life totally dedicated to Medicine in its broadest sense, is therefore the guarantee of that and that I am certain will help to form the coming generations of doctors that we want to be able to face the great challenges of the 21st century.

It is therefore this fiber that we need!!! Well Haja Professor José Fragata, my dear friend. THANK YOU VERY MUCH!!!

Fausto J Pinto                   

Lisboa, 14.07.2023

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