Italian obstetrician, born September 17, 1842, Padua; died 1902
Biography of Edoardo PorroEduardo Porro was the son of an engineer. He studied medicine at the medical school of the University of Pavia, graduating in 1866. As a young doctor he worked in L'Ospedale Maggiore¨
Later he worked as a young doctor at in Milan before his training was interrupted to serve in the fight for unification of Italy under Garibaldi. He returned to Milan in 1868 and studied obstetrics at the hospital of Santa Caterina and after three years was made director.
Porro's academic standing was recognised in 1875 when he was appointed Professor of obstetrics at the University of Pavia. He remained there until 1882 before he assumed the Chair of obstetrics in Milan where he served the remainder of his professional life. As well as being a leading obstetrician in Europe in the late nineteenth century, he was also involved in politics and liberal democracy and in 1891 was elected to the Italian Senate. Apart from his seminal study on Caesarean section, he published little in the remainder of his professional life. In 1902 he sustained an accidental hand wound while operating on an infected patient and died from the complications of sepsis in that same year.
Porro's First Operation
In 1876, Eduardo Porro reported the first Caesarean hysterectomy in which both infant and mother survived. Storer's operation eight years earlier had been an emergency procedure with the decision to amputate the uterus as a last minute life saving measure to prevent haemorrhage. Porro's operation however was a carefully planned and executed undertaking in more optimal conditions. Although Storer later reported his case, it was largely unrecognised in his day. Porro on the other hand documented his operation in a publication the following year in a paper of 63 pages. It attracted widespread interest throughout the world and became known as Porro's operation.
Porro's paper describes the case in great detail. The mother was a 25-year-old primigravid dwarf Julia Cavillini who was referred to Porro's clinic in Pavia because of a suspected malformed pelvis. She had suffered from rickets between the ages of three and ten and during this period was unable to support herself in the erect position without assistance. She was 148 centimetres tall and had the characteristic bony features of rickets including bowlegs, scoliosis and the right iliac crest was four centimetres higher than the left. Porro also noted the pelvis was narrowed in all planes with a diagonal conjugate of seven centimetres. In addition spondylolisthesis of the lumbar spine resulted in a form of roof over the pelvic inlet. He wrote, “It was obvious that absolute disproportion existed and that caesarean section was mandatory.”
The concept of Caesarean hysterectomy which was the basis of Porro's operation dates back to 1768 when Joseph Cavallini successfully excised the pregnant uteri in dogs and sheep. He concluded that the organ was “not necessary to sustain life” and speculated that in a future generation it might be possible to undertake in humans. “In speculative moments, I have sometimes felt inclined to persuade myself that the dangers of Caesarean operation might be considerably diminished by removal of the uterus. Perhaps this method of operating may prove an eminent and valuable improvement”2.
The first Caesarean hysterectomy was performed in a woman by Horatio Storer in Boston in 1868 3. Storer was a Harvard graduate who trained with James Young Simpson in Edinburgh. In was not until 1876 that Porro performed the first planned and successful operation.
Porro consulted with his colleagues in Pavia and all concurred that vaginal delivery was impossible even with embryotomy. He discussed the case with the Bishop of Pavia who consented on religious grounds to the procedure being performed. His plan was to amputate the uterus through an abdominal incision if he encountered serious haemorrhage during the delivery.
Julia Cavillini was admitted to hospital on May 21 prior to labour. Her membranes were ruptured and chloroform anaesthesia was administered. He records in his paper “at 4.51 pm we began to cut through the abdominal wall, layer by layer through a 12 centimetre incision in the linear alba. After the peritoneal cavity was opened, the uterus was immediately incised, in the same direction and to the same extent as the abdominal incision. Unable to deliver the foetal head with my right hand in the uterus, I finally reached up, grasped and delivered the right leg and thigh, the left leg, trunk, arms and head followed immediately. We extracted a large (3300 gram) female infant alive, healthy, well formed and crying spontaneously. After tying and dividing the umbilical cord we proceeded to extract the placenta, which we removed intact, together with the major portion of the membranes.”
The uterus bled profusely from its cut edges and could not be controlled by a suture. Porro noted, “It was providential that we had made all the preparation necessary for hysterectomy; otherwise the patient would surely have died.” The uterus was held up out of the abdominal wound and a wire snare of Cintrat at the level of the internal os was pulled up tightly and after blood flow was completely shut off, the uterus was excised above the ligature. He proceeded to peritoneal toilet using Lister's carbolized sponges, removed blood clots and then the uterine stump was incorporated into the lower part of the abdominal wound. The post-operative course was marked by a vulvovaginitis, sacral ulcers and suppuration of the abdominal wound as well as a urinary infection. The snare over the gangrenous portion of the uterine stump was removed on day four as was the vaginal drain. Both mother and infant survived and Porro's paper contains a plate of Julia Cavillini during her convalescence.(Figure 1) Soon after at the medical congress of Turin, Porro proclaimed, “I believe that the day is not far off in which medical science will pronounce its solemn verdict approving utero-ovarian amputation in every case of Caesarean section.”
• Eduardo Porro (1842 – 1902) and the Development of Caesarean Section:
The Internet Journal of Gynecology and Obstetrics. 2006, 7 (2).
Main source for this article.
Donald H. Todman, MA, FRACP, FRCP, is affiliated with the School of Medicine,
University of Queensland.