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User:Elena Govoni/sandbox/Edoardo Porro

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Bronze medal 1901

BIOGRAPHY

Porro was born in Padua on September 13, 1842 where his father Giovanni had been transferred as a Land Registry engineer, and he died in Milan on July 18, 1902.

He was raised in Milan where he went to “Ginnasio Liceale dell' Arcidiocesi” and he enrolled in 1860 in medical school at the University of Pavia, where medical luminaries were teaching.  He received his early education in Padua, and he obtained his medical diploma at the University of Pavia (in 1866) (MEDICAL MEMORIAL reference) at the age of twenty-three.

            Dopo aver completato il dottorato a Pavia, nel dicembre 1868 giunse come assistente medico alla scuola di ostetricia di Milano. Nel marzo 1871, dopo la morte di Lazzati, fu incaricato di questa scuola. Nel 1876 Porro fu nominato alla facoltà di medicina di Pavia alla cattedra di ostetricia divenuta vacante dopo la morte di Lovati. Nel 1882 rinunciò a tale incarico per assumere la direzione della scuola di ostetricia di Milano (S: Caterina) (UNIPAVIA reference), che mantenne fino alla morte. Una malattia renale cronica, che più volte aveva seriamente minacciato la sua vita, travolse l'uomo apparentemente ancora vigoroso.

             

Porro seguì gli anni di corso senza spiccare particolarmente negli studi. All'esame di anatomia umana - la base conoscitiva di un chirurgo- sostenuto con Panizza, aveva ottenuto un misero diciotto su trenta.

Military service

He graduated in August 1865 and, after a brief internship at the Ospedale Maggiore in Milan, instead of devoting himself at once to the pursuit of his profession, he volunteered as a soldier and doctor under Garibaldi, and followed the revolutionary leader in the cause of Italian unity in the campaign of 1866 in the Tyrol, and even though he was a fervent catholic, he was present the following year at the surrender of Mentana. This delusional event closed his soldier-career.

Medical career

Next year (1868) he was appointed to the position of assistant in the department of obstetrics at the “Ospedale Maggiore” in Milan. For over seven years he devoted himself to the study and practice of obstetrics and gynaecology as an instructor and a clinician.

He was influenced by his personal and professional relationship in the battlefield with Malachia De Cristoforis, who translated Charles West’s “Lectures on the disease of women” after meeting him in London.

In march 1871, after the intendant’s death, Porro temporarily took on the directorship of the Ospizio di Maternità and of the Regia Scuola Ostetrica of Milan.

Among the most powerful influences on his mind in favour of  the Cesarean section, was his systematic investigation into the results of induction of premature labour during his residence in Milan. In 1871 he published “Risultati apparenti e risultati veri del parto prematuro artificiale”.

Illness

On june 28 1871 he performed an internal podalic version on a woman affected by syphilis with bare hands, as surgical gloves will only be introduced by the American surgeon William Stewart Halsted in 1889; during this operation he cut his hand and got infected with the disease.

His health slowly declined, manifesting recurrent infections like exanthema and inflammations, neuralgia, nephritis which eventually lead him to death.

For years he lived with syphilis trying all known treatments, while still maintaining his directorship until the end of 1872.

Even though he was tormented by his illness he started a fervent research activity for the Opera Pia di Santa Corona in Milan, putting in a theoretical framework his previous observations on Caesarean section.

In 1875 he obtained the appointment of Professor of Obstetrics in the University of Pavia, 'not by the protection of the great or by caprice of fortune, but by the force of true and real merit.' The epoch-making operation, with which we associate the name of Porro, was first performed on May 21, 1876. The operation was far removed from being a mere stroke of happy chance, or the fortuitous result of operative proceedings commenced under a misapprehension or mistaken diagnosis, as has been so often the case in the initial stages of advances in gynaecology.

He stood in favor of letting women get therapeutic abortions rather than getting to risk their life during childbirth, even going against his collegues.

 In 1882, after a seven years' incumbency, Porro resigned his chair in Pavia and returned to Milan as Director of the Maternity Hospital.

During this period of time, Porro published a large number of contributions, on various subjects, to the progress of obstetrics and gynaecology. Later in Milan, he devoted a considerable share of his energies to administrative, sanitary, and medico-legal work. Most noteworthy were the much-needed improvements in the sanitary condition of the hospitals, especially of the Ospedale Maggiore. His last contribution to gynaecology, that on Ovarioclasia, was published in 1888.

Porro’s achievements are not acknowledged widely but his revolutionary operation performed under chloroform anaesthesia and using the methods of Lister led to further developments in technique that ushered in the modern era of caesarean section. His standing has been affected in part by the nature of the operation that involved the radical measure of hysterectomy. This is overshadowed by the demonstration that it is a life-saving procedure capable of delivering a live infant. The Bronze medal struck by the Italian government in 1901 attests to his reputation as a leading obstetrician of the late 19th century, and as one who could be considered a founding father of the modern caesarean section.  (MEDICAL MEMORIAL reference)

HISTORY OF THE CAESAREAN CUT

Until the 1700s the Caesarean section, with the exception of very few cases, that should be considered anecdotal, was only practiced on dead women, since the attempt of performing it on a living woman, was invariably followed by her death as a consequence of the hemorrhagic or septic complications, which characterized the post-operatory course.

It was only after the 1700 that the operation started losing its religious character and started becoming purely obstetric.

Attempts of operation on living women started, with the aim of saving both the mother and the child, when natural childbirth was impossible.

No real progress was made, though: the technique was still inadequate and lethal in almost all cases, especially for the mother; which can be easily observed from the European statistics collected by Alfonso Corradi in his work “Dell’ostetricia in Italia dalla metà del secolo scorso fino al presente” (1874-77): according to his statistics the mother’s mortality was over 60%, which he considered inaccurate since the mortality in obstetrical clinics was over 90%.

Until the latter part of the 19th century, caesarean section was considered the most hazardous of operations and was rarely performed. The mortality was virtually 100%. The attitude towards the operation was epitomized in the editorial in the London Medico-Chirurgical Review of 1825: ‘A more cruel, bloody, and ill-judged operation is not, we think, recorded in the annals of surgery’.  (ALESSANDRO LIVI STUDIO MEDICO reference)

PORRO’S OPERATION

Introduction

 

In the history of the caesarean section, the work of the Italian obstetrician Eduardo Porro represents a pivotal stage in the development of the procedure in the modern era. It was a surgical, obstetric, but also human revolution. (VITA.IT reference)

Porro performed a hysterectomy during a caesarean operation in order to control haemorrhage and prevent perito-nitis. (MEDICAL MEMORIAL reference)

Clarifying what can be considered a true Porro’s operation, Godson writes: “Cæsarean section, followed by removal of the uterus, together with its appendages, including the ovaries, leaving only the cervical portion of the uterus”.

Porro’s procedure contemplated the amputation of both the uterus and the ovaries after the Caesarean cut had been performed. The infection of these organs was, infact, as Porro had correctly hypothesised, the cause of death in nearly all cases.  (MUSEI DI PAVIA reference/ SI SALVò ANCHE LA MADRE)

The experiments

He started experimenting with the Caesarean section on 3 rabbits. (ALESSANDRO LIVI reference)

He was inspired to experiment on animals, before attempting the amputation on women, from the great experimenter Eusebio Oehl. (UNIPAVIA reference)

The animals he operated, were able to recover, but the little bunnies did not survive because in order to avoid a spontaneous birth, the operation was performed too early on.

Thanks to these experiments the physician obtained proof that the removal of the uterus could have been a plausible therapeutic option. ( E si salvò anche la madre reference)- During the years 1874-75, Porro made many experiments in the removal of the uterus in pregnant rabbits, and took such opportunities as came in his way of operating on the cadaver, with the object of preparing himself for the operation which he ultimately performed on the living patient.

 The first case: Julia Cavallini

The first case was on May 21st, 1876, was a 25-year-old primigravid, Julia Cavallini, who was referred to Porro’s clinic in Pavia because of a suspected malformed pelvis from childhood rickets. (MEDICAL MEMORIAL reference)

The operation was performed under chloroform, in a teaching room (because of an outbreak of puerperal fever in the clinic). (ALESSANDRO LIVI reference)

Both mother and child survived, thus establishing a claim for the serious consideration of this operation as a substitute for the ordinary Cæsarean section, leading to an improved outcome for both, at the cost of the mother’s future fertility. (MEDICAL MEMORIAL reference)

He published the case to the world a few months later “Della amputazione utero-ovarico come complemento di taglio cesareo”(Milan, 1876), where he describes the operation with analytic precision (MUSEI UNIPAVIA reference).

Diffusion of the operation

The work of Porro attracted the attention of the medical profession in Europe to the achievements of Italian physicians and surgeons to an extent unknown since the schools of Padua and Bologna began to decline.

Porro encountered some resistance from colleagues who raised ethical questions: causing the sterility of the women undergoing this operation was considered immoral. The physician, a passionate catholic, decided to seek advice from the Bishop of Pavia, who reassured him and recognized him the right to “sacrifice a part for the sake of the whole” ( “il diritto di sacrificare una parte a favore della salute del tutto”) (UNIPAVIA reference/SI SALVò ANCHE LA MADRE)

It is interesting to note that this case was maybe the first, in the history of medicine, in which progress raises a new moral concern.

Porro’s operation was enthusiastically taken up in both Europe and the USA. Within five years of his initial operation, 50 cases delivered by the Porro method showed a maternal mortality of 58% and infant survival of 86%, a major advance for the time. (MEDICAL MEMORIAL reference)

It would be appropriate to call attention to the following astounding facts: in the Vienna Hospital, from 1784 to 1884, there had not been a recovery after a Cæsarean section, and in Italy the same operation was almost always fatal. On the other hand, nearly half of Porro's operations have been successful, notwithstanding that the operation has been performed by as many as thirty-five different surgeons.

Porro’s technique has not disappeared from today’s obstetrics. It has been improved and is, sometimes, still used in emergency situations and difficult cases, when the removal of the uterus is the only way to stop the haemorrhage. (POST PARTUM reference/VITA/E SI SALVò ANCHE LA MADRE)

Porro was not, however, the first to remove the gravid uterus in a living woman. This had already been done in America by Dr. Horatio Store of Boston,-U.S.A., in1869, his operation was one of necessity rather than one of election .

-Indian medical journal

To understand the impact of Porro worldwide

In the February 1891 issue of The Indian medical gazette, a civil surgeon titled his article “Case of Porto’s operation. Describing in detail all the steps of him performing Porro’s operation on a young woman with a really small pelvis who delivered a dead baby because she had been in labour for like 5 days. He manages to save the woman.

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