Fernando Namora, in Francisco Gentil 1878-1964.
The fight against cancer in Portugal is inseparable from the name of IPO founder, Francisco Gentil, one of the most remarkable figures of Portuguese medicine, reputed surgeon, with high sense of public service, a capacity to make things happen and a pioneer vision well ahead of his time.
His legacy still lives on at “Instituto Português de Oncologia Francisco Gentil”, (Portuguese Institute of Oncology Francisco Gentil), in Lisbon, Porto and Coimbra. The specific approach to cancer in Portugal and the implementation of innovative research, teaching and assistance to patient goals is due to his vision. But not only that: he was the main driver of training, teaching and nursing, to such an extent that, in 1940, he created the Technical School for Nurses (later on Higher School for Nursing Francisco Gentil), the first in the country offering a three-year course and requiring as previous qualifications the 2nd cycle of secondary education.
Francisco Gentil was also the mentor for the creation of the Portuguese League against Cancer, (Liga Portuguesa contra o Cancro), as he quickly perceived that institutions like the one, he founded, require strong support from the civil society to fulfil their targets. In addition to be the IPO founder, he also set up, in 1957, a Health Care Service for the Staff, the first Staff Health Care hospital department of the country.
Francisco Gentil’s vision was so ahead of the times he lived, that only 60 years later did the International Union Against Cancer and the World Health Organization issued guidelines and definitions which was common practice in IPO since its foundation.
The writer and physician, Fernando Namora, who worked with Francisco Gentil in IPO, dedicated a biography to him highlighting his work and his vigorous personality: «And master Gentil lives on because he was the architect, worker and enabler of a company that challenges a giant: the fight against cancer in Portugal. Starting from scratch and in an environment that panics before any initiatives, he, from tenacity to tenacity, making good use of his wisdom and haughtiness, his prestige weapons, builds an Institute of Oncology. He had a sharp instinct of opportunity and accurate knowledge of men: in order to convince them he never bent down, never used humiliation or flattery to achieve his purpose: he asserted himself as a sovereign granting bounties instead of accepting them ».
«The patient in first place»
«The patient in first place» was the principle that Francisco Gentil did not allow anyone to forget. Fernando Namora also highlights this concern of the IPO founder: «The patient above everything else. The patient, in the institute, as in the several departments that Prof. Gentil headed, was royalty; nothing seemed to be too much for his/her benefit: comfort and solicitude, therapeutics and dedication. All Francisco Gentil’s creations were based on this motto: the patient in first place». And woe betide those who did not comply with this. It is said that Francisco Gentil would immediately say «Estrada de Benfica!» (Benfica road!) and that person would never return to the Institute.
It was usual, at the time, for patients to be «recommended» by someone. And one day, during the physician’s visit to the patients, there was one who had no recommendation at all. Francisco Gentil turned to his collaborators and said: «This patient is recommended by the director!» And that is how all patients with no recommendation started to be considered.
His attitude, informal and very close to the patients, sometimes led to ridiculous situations. When he ended his surgeries, he would go to the wards to see the operated patients, still wearing his white coat and cap that he used in the OR. It is said that once, seeing him dressed like this, a patient said ‘this hospital is so good that the cook comes here every day to find out if the food was good’…
When he was allowed to build IPO, through Decree of the Government of 1923, Francisco Gentil put into practice his ideas and vision of what a modern hospital should be like, dedicated to the patients and to the research on diseases, concerned with the teaching and with all its employees who complement the physician’s mission: «IPO has never intended to monopolize the treatment of people with cancer or the complex study of several scientific or social aspects of oncology, but it wants to gather all honest efforts towards the creation of the perfect knowledge of the disease and an assistance limited by the humane duties that have always guided us (…) and there we have, all over the country, the precarious life of many hospitals, proving the need of organizing something where there is constant renewal, a pace of progressive acceleration and being able to live within the standards where the ‘duties’ do not stifle the ‘rights’ which, as a rule, due to the lack of critical sense, do everything to twist it, harming a work project which should only have principles of humanity as its guide ».
Some of his ideas should be reflected upon even today. Francisco Gentil said that «our hospitals are not rich enough to buy cheap things». As well as: «what is expensive is not to do it but to maintain it». The first place he would examine when he wanted to appraise a hospital was the kitchen: «If the kitchen is in order and clean, the rest will certainly be OK». In the words of Fernando Namora, «his eyes saw far and different. Everything he projected and reduced to precise schemes twenty or thirty years ago, daring innovations, was not contradicted by time: its up-to-datedness is obvious, surprisingly responding to what the facts later imposed and proved».
Francisco Soares Franco Gentil was born in Alcácer do Sal in 1878. Medicine ran in his blood: his great grandfather, Francisco Soares Franco, had been a surgeon of the Royal Court and had written the first Portuguese book on Human Anatomy. Besides the fact that he was the founder of the Medical Science Society, in 1850.
He finished his studies of Medicine in 1900, in the Medical-Surgical School of Lisbon (currently Faculty of Medicine of Lisbon) and performed his first operation in 1898. A gifted surgeon, he worked his way through all levels: intern, surgeon in Hospital de São José, head of department in the ER, director of Maternidade de Santa Bárbara, assistant of the surgical section of Hospitais Civis de Lisboa and Professor-Surgeon in Hospital de Santa Marta. At 27 he took over the position of substitute professor of the surgical section and headed the Anatomical Theatre.
Quite early, Francisco Gentil undertood that the work of a physician has to be complemented with other works – in 1913/14 he was Head Nurse of Hospitais Civis de Lisboa, and in a general meeting the workers of the hospital thanked Francisco Gentil for having been the first who defended their interests and benefits.
The fight against cancer was always present in Francisco Gentil’s professional life. In 1912, the Council of the Faculty of Medicine of Lisbon asked him to organize the Appointment Service for Cancer Patients, which started to operate at Hospital de Santa Marta. He had already the Bénard Guedes cooperating with him and his private installation of X-rays and Marck Athias and Henrique Parreira in the laboratory area (who would become co-founders of IPO). In 1915, they founded a Section of Cancer-related Studies.
He taught at the University of Lisbon for 43 years. In 1911 he became professor of “Cirurgia Operatória” in the recently created at the time Faculty of Medicine of Lisbon and in 1915 he became professor of Surgical Pathology, position that he would hold until his retirement in 1948. Francisco Gentil also played a key role in the medical teaching reform, in 1911, by fighting for the establishment of medical specialties and the teaching hospitals of Lisbon and Porto.
The founder of IPO was also considered an authority in the area of hospital construction: he started by integrating the refurbishment commission of Hospital de São José, and was the great mentor of the Lisbon, Coimbra and Porto IPO’s construction.
He was a voting member of the Legal-Medical Council and a member of the Higher Council of Public Education and of Institute for High Culture. He was also chairman of the Medical Sciences Society and belonged to several medical associations in the country and abroad.
He published widely acclaimed scientific works, both in Portugal and abroad.
In 1953 he received the Grand-Cross of the Military Order of Santiago de Espada for his relevant action for science and for the community and in 1958 he was awarded the Doctor Honoris Causa title by the University of Coimbra.
A stroke forced him to cease functions at the Institute in 1961.
He died in 1964, leaving a legacy that still has its marks in the Portuguese society. In the words of Fernando Namora, «Prof. Francisco Gentil was one of the last specimens of a period which is almost impossible to replicate. One of those powerful and rare personalities in which merits and demerits, coherences and contradictions reach a subjugating, tumultuous, almost fierce greatness, that not all settings allow to thrive. One of those men who being an explosion of nature, burn up routine with their volcanic character, frightening the faint-hearted with their imagination, pushing the indolent ones with their energy, coaxing the disbelievers with their determination, manoeuvring the courtiers, the petty-minded and the perfidious with their cunning, and at the same time destroying the meek with the despotism of their will. Men of this kind project and carry out by themselves what entire generations can only wish for».