Abstract
In the history of caesarean section, the work of the Italian obstetrician Eduardo Porro represents a pivotal stage in the development of the procedure in the modern era. Porro performed a hysterectomy during a caesarean operation in order to control haemorrhage and prevent peritonitis. The first case 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. Both mother and child survived and his paper was published in Milan in the same year, Dell’ amputazione utero-ovarica come complemento di taglio Cesereo. 1 The Porro operation led to an improved outcome for mother and child but at the cost of the mother's future fertility.
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’. 2 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. 3
Eduardo Porro was born in Padua in September 1842 and obtained his medical degree from the University of Pavia in 1866. He undertook postgraduate training at L'Ospedale Maggiore in Milan but interrupted his studies to fight for Italian unification under Garibaldi. He became Professor of obstetrics in Pavia in 1875 and moved to the chair in Milan in 1882. He made further scientific contributions until his death in 1902 and was also active in liberal democracy. In 1891 he was elected to the Italian Senate. 4
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 (Figure 1) 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.
Bronze medal struck in 1901 honouring Eduardo Porro (1842– 1902)