PORRO'S OPERATION.
unfavorable results from the Caesarean section necessarily led to modifications of the operation, and according to Muller, of Berne, Cavallini, in 1769, removed the gravid uterus from animals, and seeing them survive, deemed a similar operation possible in case of woman. Geser, in 1862, Fogliata, in 1874, Rein, in 1876, performed operations similar to those of Cavallini, and reached the same conclusion. Michaelis, and the younger Stein, were also advocates of the operation, whilst Kilian, in 1850, and other operators, were opposed to it.
In 1868, Storer, of Boston, performed the first utero-ovarian amputa tion in woman. He was doing gastrotromy for the removal of a fibroid tumor from a gravida. At the outset of the operation, the hemorrhage being considerable, he determined on opening the uterus, and extracting the foetus. The hemorrhage still persisting, he pulled the uterus and its annexa outside of the abdominal cavity, threw a ligature around the cer vix at the supra-vaginal junction, and amputated the uterus, the ovaries, and the tubes. Three days thereafter the woman died, and this was for a time fatal to the method. Storer's operation, however, was a matter of necessity, and it is really Porro, who, in face of the difficulties and com plications of the classic Caesarean section, concluded in favor of the utero ovarian amputation under the carbolic spray, and performed it the twenty first of May, 1876. The mother and child were saved, and this too at the maternity in Pavia, where, at the time, puerperal septicaemia was raging. This success encouraged others, and the operation was per formed in Italy, Germany, Austria, Russia, etc. In Franco, Fochier, of Lyons, first performed it in 1879, he was followed by Lucas-Championniere and by Tarsier, and since, especially in Italy, this operation tends towards displacing the classic section. Thus: In the 99 cases which we have collected are included cases of cancer, of tubo-ovarian pregnancy, of uterine rupture, etc., for in all of these
the operation was the utero-ovarian amputation, or that of Porro. We have left out cases of Freund's operation, because they do not belong in this category.
Comparing now the mortality rate from Porro's operation with that from the Caesarean section we obtain: Porro's operation 53.33 per cent. to 56.56 per cent. Caesarean opera tion 54 per cent. to 60 per cent.
We see, hence, that the results obtained from Porro's operation are scarcely better than those from the Caesarean section. We are not now speaking of the children, since, in theory, they should always be saved by either.
Among the causes of death, peritonitis heads the list with 22 cases; shock 3 cases; septicaemia 2 cases; hemorrhage 3 cases; embolism 1 case. In a certain number of cases, the condition of the women was such that only death could be expected.
It is not possible to form an exact opinion from these figures, for if all the cases of Porro's operation have been published, such is not the case with the Caesarean section, and the other operations. What is clearly evident, however, is that, like the Caesarean section, Porro's operation should be, not one of choice, but of absolute necessity, and that the chances of success are the greater if done within twenty-four hours of the onset of contractions.
Pinard thus lays down the indications for the Porro operation: 1. The pelvis does not allow of embryotomy. Here the indication is absolute, and we agree perfectly with our colleague. Preference should be given to the Porro over the ()cesarean section.
2. The pelvis allows embryotomy, but measures less than 2.7 inches. If the foetus is dead, then perform embryotomy, except in case of osteo malacia. If tho infant is alive, the proper operation is a subject for dis• cussion. We would not agree with Pinard, but would say that, the foetus alive or dead, embryotomy should be the choice.
3. The pelvis measures over 2.7 inches. Porro's operation should be absolutely rejected.