FROM FAMILY TOWARDS FRIENDS – THE PENDULUM IS SWINGING

When I was young I was convinced that family is the most important thing in life. No one will ever give me the love and care that my mother has given me. She has sent me off with a hug and kiss to school since I was a little boy. I have never got the same feeling when someone has told me they are proud of me other than when my father said it to me. I have always felt more loved and accepted by all but with my wife these words take a different meaning altogether. My siblings have fought with me for every bit of parental love and affection but still they remain most precious. But as I am graying with age this support system is slowly eroding. Both my parents are no more. I lost my little sister to cancer. True, in bargain we have two sons, both young men by now, launching into their own careers. Busy with our respective medical practices, though we do not have time to feel lonely today but what will we be doing tomorrow when we choose to slow down? I am sure I am not the only person who is bothering along these lines.

When we are young, we get our main support from our parents and siblings.  We rely on them for emotional support and for socialization.  But as we get older, we become more interested in what our peers think of us. There are at least two reasons for this.  First, we will need to form lasting relationships (including, presumably, romantic relationships) with people of our own age.  For this reason, the opinions of people our own age matter a great deal.  Secondly, family is a constant thing.  Our family has to love us no matter what.  People in our peer group are not like that.  We have to worry about how they will perceive us and we get more pleasure from their acceptance because it is not automatic; we earn it. These peers are usually our class mates in school and batch-mates in colleges and we call them ‘friends’.

Our family is our family by decree of birth. Our friends choose to be our friends, but our family doesn't choose us. By this same theory we cannot choose our relatives but we can and we do choose our friends. A family succeeds when it is friendly towards each other and there's nothing stopping you from considering a good friend your family! Your friends, they're the ones who accept you. If they don't, they're not your friends. Your family, if they don't accept you, you just have to live with them anyway. 

Class reunions and batch-meets usually help us by keeping us young. With the recent explosion in the world of communication, Facebook and Whats App have rekindled many a dormant ambers of friendship and camaraderie, and believe me, these are vital for survival! We have long branched out of the joint family structure to nuclear units to lonely couples to, worse still, lone survivors. All the comforts which science provides can in no way take away this loneliness and so friends are vital. When children are away in their own world, our world is populated by only our friends!

Strangely enough friends are not only vital for quality of survival but also quantity of remaining days. In a 10-year longevity study of people aged 70 and older, researchers at the Centre for Ageing Studies at Flinders University in Adelaide, Australia concluded that a network of good friends is more likely than close family relationships to increase longevity in older people. The research report is based on the Australian Longitudinal Study of Ageing (ALSA).They  used a series of interviews with nearly 1,500 older people to assess how much contact they had with their different social networks, including children, relatives, friends, and other confidantes. The group was monitored annually for four years and then less often for a decade. The researchers also considered how economic, social, environmental and lifestyle factors affected the health and well-being of the seniors in the study. Based on results from the study, researchers learned:

·         Close relationships with children and relatives had little effect on longevity rates for older people during the 10-year study.

·         People with extensive networks of good friends and confidantes outlived those with the fewest friends by 22 percent.

·         The positive effects of friendships on longevity continued throughout the decade, regardless of other profound life changes such as the death of a spouse or other close family members.

While the study couldn’t say for certain why close friendships have such a dramatic effect on longevity, the authors of the report speculated that friends may encourage older people to take better care of themselves—by cutting down on smoking and drinking, for example, or seeking medical treatment earlier for symptoms that may indicate serious problems. Friends may also help seniors get through difficult times in their lives, by offering coping mechanisms and having a positive effect on mood and self-esteem.

Having your good friend’s phone number memorized or on speed-dial is the emotional version of having 911 pre-programmed. You know immediately where to turn when real trouble happens. Thank heaven I haven’t had to make one of those calls but I am fortunate that if I happen to land in trouble I have a support system of friends who care about me and will listen even if it is the dead of the night. Not only will they listen, they’ll listen without judging me. They’ll listen and offer comfort without ever saying, “I told you so” or “I knew this would happen.” In other words, they never sound like scolding parents.

In many ways, best friends say what you wish your parents might have said to you. After all, friends are part of the family you create instead of the family you’re born into—and they can understand many aspects of your life that your own family members cannot or will not accept. I expect a great deal from my truly good friends—don’t you? Don’t you expect your friends to see straight through you-to look beyond the window dressing, or even the blackout curtains, to see what’s really inside? Don’t you expect your best friends to know not only what you choose to portray for the world to see but also to know what you keep the “junk drawers” of your life?

That is the reason why I have a bunch of friends, smarter, funnier, braver, and more beautiful than me.  There’s nobody in the world with their particular talents and strengths.  Yet, like many extraordinary people, they shrug off their magic as if it’s nothing special. Through our best friends, we are rescued, repaired, and rejuvenated time and time again. May we always be able to rely on them and may we never take them for granted. My life is on a friendship pacemaker and I am sure it will last a lifetime!

SECESSION OR FEDERALISM – WHAT IS THE ANSWER?

There are many citizens living in Kashmir in India, Quebec in Canada, Flanders in Belgium, Scotland in the United Kingdom and Catalonia in Spain do not consider themselves merely part of a region but an independent nation that has no state of its own. Delusion…..you may call it, but they hope to live and die for this elusive goal. Greater self-rule is the central objective of the so-called nationalist political movements. Whether they are organized political parties as characteristically found in European regions or disorganized gangs as seen in Kashmir their theme of secession is a common thread that links them all. The possibility of secession has been part of their politics for years. Yet while secession is mentioned as one option for the future, mainstream parties perceive it as a Utopian formula rather than a viable alternative. This results partly from a genuine allegiance to the existing states by many of these regions' residents, but also from the fear of the unknown and a surprising lack of information about the economic costs of remaining part of these states and the potential economic uncertainties of independence.

While Scotland as an independent country, taking into account all its resources, would be among the twenty wealthiest countries on earth - according to analysis by the Financial Times, ahead of countries such as Italy, France, the UK and Japan can you imagine a flood ravaged Kashmir without the Government of India helping it out?   With independence the secessionists feel they can make their wealth work much better for the people living here……..but where is that wealth. That wealth lies in the bond they share with the greater nation and not in isolation.

Crimea, another flashpoint, is an autonomous region of Ukraine located south of the Ukrainian mainland on the Crimean Peninsula, voted overwhelmingly in a referendum to secede from Ukraine and join Russia. The United States, the European Union (EU), the Ukraine government and representatives of Crimean Tatars condemned the referendum, saying it violated Ukraine's constitution and international law. A United Nations General Assembly resolution was subsequently passed that declared the Crimean referendum invalid and the incorporation of Crimea into Russia illegal. As was expected Ukraine declared Crimea a territory temporarily occupied by Russia.

Veneto is one of Italy's richest regions. Many of its residents however, believe the Italian government is inefficiently using its wealth on the poorer southern parts of the country, and that an independent Venice would be better off without having to carry the burden of much of the rest of Italy.

Another region close to a flashpoint is Belgium's Dutch-speaking part of Flanders. With a unique identity quite distinct from the southern French-speaking region of Wallonia, the Flemish nationalist movement has seen a surge in recent years. Linguistic division and the socio-economic imbalance between the two regions have only underscored their differences, especially cultural and economic, over the last few years.

Kurdistan comprises parts of northern Iraq, north-western Iran, eastern Turkey and eastern Syria. It is home to the Kurdish-speaking people, who have long agitated for a homeland of their own. Kurdistan has commonly been described as the "world's most populous stateless nation".

Closer to home we have problems in both China and Pakistan.  Apart from the decades-long unrest in Tibet, which has been under Chinese control since the 1950s, China is also facing persistent unrest in the restive province of Xinjiang, the traditional home of the Uyghurs, an ethnic Muslim minority. Separatists seeking the independence of Xinjiang from China want to govern themselves and call the region "East Turkestan".

Baloch nationalism is a movement that claims the Baloch people, an ethno-linguistic group mainly found in Pakistan, Iran and Afghanistan are a distinct nation. The movement propagates the view that Muslims are not a nation (the opposite of the concept behind the creation of Pakistan) and that ethnic loyalty must surpass religious loyalty, though this view has been challenged by both the 1971 independence of East Pakistan and the discrimination many Muhajir people have historically faced within Pakistan.

Current conventional wisdom in the European Union and the United States sees the issue of secession as something outdated or even dangerous. Mainstream politicians, diplomats and academics tend to present it as a senseless option at a moment in history where the focus is building a united Europe and a free-trade world. The thought of the wars in the former Yugoslavia and its ultimate Balkanization makes many fear such an option. However, I do not deny that the situation in Catalonia, Flanders or Scotland is not comparable - these stateless nations are well-established democratic societies that respect human rights and free-market economies within the European Union. Thus, Catalans, Flemish or Scots cannot ignore that full political independence remains a serious option for them. Their desire for secession needs to be objectively analyzed and the costs and benefits properly weighed. But when you compare their prosperity with the stark poverty of Kashmir, you realize how senseless and foolish their battle cry is.

While it is common to hear a Kashmiri refer to us as ‘you Indians’, as if he or she is from Mars, many Catalans too do not consider themselves Spanish but exclusively Catalan. Such feelings raise eyebrows in other parts of Spain, Europe and elsewhere, but are widely accepted as legitimate within Catalonia. The French speaking Quebecers find it extremely difficult to blend with the English speaking rest of Canada, but if language decided nationhood then we in India would have had a thousand nations within our boundaries. 

The key goal of Catalonia's main political party, Convergència i Unió (CiU), which has governed the region for more than twenty years, is to gain higher levels of self-government. It defines itself as Catalan nationalist (or Catalanist) and frequently refers to the Catalans' right to political self-determination. With this party's support, the Catalan Parliament declared some time ago that it would not renounce this right. Yet it does not seek full independence from Spain.  Scotland similarly now has 45% of its citizens voting for an independent Scotland so that they have more rights to use their resources to provide a better life to their people - control over their tax system to attract more employers to invest in Scotland, creating more and better local jobs. This means more opportunities for young people, closer to home, keeping families together. Better pensions, improved child care facilities, better schools and hospitals were all promised by the proponents of secession, but if things do not exist already can they not be achieved staying within the union? What is the actual answer to these problems – is it federalism or is it secession? 

There are broadly three main arguments for the independence of Catalonia. The first is that since the Catalan cultural and language is neither understood nor accepted in Spain (and so neither protected nor fostered), the second is that a well-defined political entity such as Catalonia should be mature enough to govern itself with its own voice in the European Union or the United Nations in order to address the problems specific to it. Finally, there is the belief that Catalonia would be better off economically by seceding. In particular, proponents of the last argument refer to the fact that Catalonia pays much more into Spain's central treasury than it gets back and thus there exists a fiscal imbalance.  Scots too feel that with their vast oil reserves they will be a far more prosperous nation if they break away. The nuclear arsenal stationed in Scotland makes them militarily impregnable.

The economic arguments are contested particularly in poor states like Kashmir. Without the Indian Army they will be nonexistent within hours of secession.  Moreover, economics is forcing countries to come together and not break up any further and globalization and the European Union have brought about the blurring of borders. But only a few seem willing to undertake a serious economic assessment of an eventual secession, as this has become a "politically incorrect" issue in British, Canadian, Indian and Spanish politics.

           

An independent Kashmir is neither morally legitimate nor historically justified, and with little hesitation I can say the same thing about Scotland, Catalonia and Quebec. As a part of the respective unions they can remain influential but alone they run the risk of becoming irrelevant. Once in 1947 we have lost the chance of becoming a great nation, because of some religious fundamentalists and some over ambitious politicians. We cannot afford to allow either to raise their ugly heads ever in future. So when we Indians say that Kashmir is an integral part of India, we are not over zealously beating our chest, we are stating the obvious. For the agents of terror and the stone pelting mob it is time to introspect – would they have lived to see this day had the gallant Indian Army not been there to save them from floods, incursions and terror?

WELCOME TO THE NEW CHIEF JUSTICE OF INDIA!

      

Your Honour, we the citizens of this great Nation welcome you to the august post with a lot of expectations. Your worthy predecessors have left you with an unenviable task of managing quite a mess and I, a samanya nagarik (ordinary citizen), who is scared of entering the temple of justice because there are no exit doors, am honestly scared of the courts. Justice is delayed beyond all reasonable limits of time and generations have perished without justice being delivered and guilty being punished. Government remains the main litigant in your courts and for lesser mortals like us you hardly have any time left.

Your Honour, while I am scared of annoying you, may I most respectfully ask you is our judiciary accountable to anybody? I know there is God up there, but let’s not bother Him with our business. The judicial tardiness has emboldened the goons, the thugs, the cheats, the corrupt politicians, the inefficient babus and the unprofessional police force. Justice is running so far behind them that there is no way it will catch up with them in this lifetime. With 30 million pending cases, over four million in the High Court and 65,000 Supreme Court, the poor are worst affected while the rich can afford expensive lawyers and change the course of dispensation of the law in their favour! Under such circumstances how can I be optimistic with your assuming the high office Your Honour?

Corruption in judiciary is no more a hush hush affair. The various recent scams like the CWG scam, 2G scam, Adarsh Society scam, including rapes and other atrocities in the society etc. have emphasized both the conduct of politicians and public dignitaries, including the common man, and also on the drawbacks in the functioning of Indian judiciary. Pointing fingers towards the halo however is not possible on account of the fear of contempt. There is no provision for registering an FIR against a judge taking bribes without taking permission from your office, So, Your Honour, those who are meant to uphold the law are way above the law!

There is a total lack of transparency in the functioning of your haloed office Your Honour. For some reasons best known to your brothers in the bar the legal mammoth system which you preside upon is totally out of the ambit of the Right to Information (RTI) Act. Thus, in the functioning of the judiciary, the substantial issues like the quality of justice and accountability are not known properly. The Indian judicial system still incorporates certain features inherited from the British judicial system during their centuries of colonial rule in India. We have to do a major overhaul of "de-Britishising" of the system. Is there a continuing education programme for our judges? Are they upgrading themselves with the changing times? Laws that criminalize homosexuality, should they be staying in your books? Why has computerization and digitization not acted as the steroid shot, which the system so badly needs? Why is all this hushed in a conspiracy of silence?

The plight of the undertrials, who are denied justice for ages, is worse than pitiable in our jails. Often the expenses and pain and agony of defending themselves in courts is worse than serving the actual sentence. Why is there no committee constituted by those in the stratosphere of the legal system to act against the stalling tactics of the lawyers? The rich and powerful people can bring the police and the law to their sides, and the police can harass or silence inconvenient and poor persons, during the long ordeals in the courts. And I am not even willing to mention the plight and public humiliation of victims of rape and domestic violence when they stand in front of your brother judges pleading for justice!

Another big concern which I have is that the judiciary and the common man never interact and so fail to sensitize each other. We do not have the jury system and so the common man is invariably a litigant. He is never a part of the judicial decision making and so never considers the judiciary to be his own.

When information and communication technologies are rapidly changing the life of our countrymen dramatically, the India legal system still looks like a domineering and pretentious Imperial vestige appearing to belong to an elite class and far away from the common people and our country. Don’t you feel Your Honour your system of justice is totally out of place and out of time and tune with democratic procedures and norms, that please only a certain section of the society with vested interests.

I wish the Honourable Supreme Court gets down to the more serious task of reinventing itself, making itself more relevant to the society it is expected to serve and clearing its own backlog. It is very easy to point fingers at every Tom Dick and Harry, be a fortune teller and predict riots and arson after demonetization one day and serve judicial populism the next day admonishing political parties not to ask for votes along the lines of caste, creed and religion, but introspection is the need of the hour. Why should the courts run only one session and that too with a long lunch break? Why can't we have evening courts? If other professionals can work round the clock, why can't the legal profession do the same? The hospitals do not close their shutters at 5 PM. The Airlines, the Railway, and even the Metro construction goes on round the clock. If judges are less than optimum in numbers so are the doctors, but they never complain. The shoulder the extra burden and they deliver. When will the legal fraternity stop complaining and start delivering?

Am I asking for too much Your Honour?

WHAT DO I GIVE YOU THIS NEW YEAR?

At this time of the year, I wish I was Santa Clause. The obese guy with a red cap and white beards, riding a reindeer driven vehicle despite the vociferously malignant animal rights enthusiasts, knows exactly what each person on this planet wishes and has for centuries never given a gift which has gone unappreciated. So, inspired by him, I am granting you a gift which I feel is most appropriate for you! In fact I am challenging Mr. Clause today and giving all my friends the same gift and yet expecting it to be genuinely cherished and appreciated.

I am not offering something you can touch, but something you can be touched by. I am sending you a reminder of one very special thing, one that may be the secret of living. I'd like to share this thought with you, because you're a beautiful combination of things that make you YOU - the one I treasure.

I ask you to think of all the people who live or have ever lived on our planet since the very beginning of time. None of them are like you. Do you realize what a miraculous thing it is to be you! Nobody has the same combination of talents, abilities, sorrows and opportunities. No one has the same friends, the same acquaintances. Nobody's finger prints are the same like you and no one has eyes like you. No one has the same sorrows and the same family jokes or No one has the same ambitions and the same concerns or the same goals as you. No one! You are unique. 

Nobody can speak your words. Nobody can smile your smile. No one can leave the same impact on another person as you do. Enjoy how unique you truly are, let it flow out and touch your family and friends, and all the people you meet.  

Accept and enjoy this uniqueness. You don't have to pretend to be more like others expect you to be. Be yourself unhesitatingly, be different. No one in the world has the same things going on in their mind, soul, or spirit as you have going on in yours.  It is a gift only to you. Treasure and share your uniqueness with us all. You have a unique gift for the rest of us. Don’t deprive us of our gift this festive season!

I wish you the strength to be inspired by the fact that you are UNIQUE. And don't you ever try to change that. Because you're perfect that way! You are a perfect you, and people will value you because you are YOU.

I am one of those countless people who are inspired by your uniqueness. Don’t change; I still have to take the best out of you, my friend!

Happy New Year!!

FRIENDS – I LIKE THEM RICH AND INFLUENTIAL!

Who are the people whom you call friends? Do you have many? Do you have some? Do you have any? Do you use this term ‘friend’ very loosely in an all encompassing manner? Or are you very choosy when it comes to conferring this title? There are many with whom I interact day in and day out - they are my colleagues from work, my batch-mates from King George’s Medical College, my school-mates from Colvin, my neighbors, my acquaintances, my patients and their relatives but just because I know them by their first name they do not qualify for the coveted title of ‘friend’. Over the years I have put a very high price tag on this title!

So naturally, the next questions who can qualify to be my friend? I am of the opinion that when I take an interest in someone, I do to a certain extent like them to reflect the qualities, morals and values that I have in life, but that doesn't mean if one is lacking them, they have no chance of qualifying. That is because though I like myself, I do not like my prototypes. One me is enough, the second one will surely be intolerable! So what are the qualities I look for in a friend? There are only two in fact – rich and influential…….but with a twist

To qualify as my friend I look for richness in honesty, reliability and trustworthiness. The next three qualities which attract me are individuality, positivity and openness. And the last three are empathy, humor and passion. With these ‘navaratnas’ (nine jewels in Sanskrit and Hindi) I expect the person to have an everlasting influence and an indelible impression on me and constantly improve me as a human being. If I don’t strike a bargain, I can call the person every other name but not a 'friend'.

Friendship is a win-win relationship in which both friends end up winning and there are no losers. Honesty and trust go hand in hand. If someone can’t look into my eyes and be straight with me I suddenly switch off. I much prefer the truth, even if it is a little blunt at times - I have no time for lies. There is no litmus test for trust but generally I trust my instinct, I usually know who I can and cannot trust. My attitude is; trust them until they prove me wrong.

I enjoy the company of people who love being 'themselves' and are clearly comfortable with their life, who are happy with who they are and what they do for a living. They don’t always struggle to prove themselves right but enjoy everything that life brings in their way. If they promise me something, they go an extra mile to deliver and they don’t make excuses. I am not a saint at all times so I need friends with a certain amount of tolerance and understanding which I hope to reciprocate.

I like happy people! I like people who are full of life, dynamic and impulsive. Our attitude plays a vital role in our social interactions, how we view things makes us who we are - either effervescence of positivity and optimism or grave stone of negativity and pessimism. But if we learn to focus on the good and not waste time thinking about the things that bug us, we display a radiant and positive attitude which in turn is infectious. I need a friend who can laugh and love to see others laugh and live in the moment and for the moment. His/her company should mean instant joy and optimism all around!

Gossips and idle chit-chat is not my style, but to open closed books is not my hobby either. I admire people who are brave enough to share their thoughts with me and express an opinion of their own that may be absolutely contrary to mine. That does not mean that I tolerate cold hearted and mean spirited people, their opinions may differ and we may disagree at times but never be disagreeable. Their warmth, kindness, consideration and love cannot be linked to whether we see eye to eye.

I love people with a passion for life. When someone is passionate or enthusiastic about life, their energy and drive draws me in. Passion oozes out of them and I can't help but admire this.  Such people have a mission in life and are goal oriented and I feel inspired in their company. I like people to have morals and I like them live by their morals and not someone else's. Morals not only give their character structure and substance they also sets standards of decency.

When we step back and look at our mythology the two most outstanding examples of good friends were Karna and Krishna, but this where their similarities ended. Duryodhan broke all the rules of the prevailing caste system and gave Karna, the son of the charioteer, a status which his skill, talent and knowledge deserved. Karna in order to show his gratitude towards this unconditional friendship vowed to help and assist Duryodhan all through his life and in all conditions, good or bad. This is the reason why he did not side with Pandavas even when Lord Krishna exploded with the truth that he is one of the Pandava brothers and son of non other than Lord Surya himself. Krishna, on the other hand, was a friend to both, Sudama, the poor Brahmin and Arjuna, the Pandava archer prince but his friendship was not blind. He did not hesitate to suggest course correction to either of his friends when they were blinded by ‘moha’ or mirage of worldly bondages and to Arjun he offered the ultimate gift of friendship – the essence of Gita!

So let us decide once and for all, what sort of a friend we need – a Karna, who will be with us through thick and thin no matter how wrong we are or a Krishna who will guide our destiny and enrich our lives! The choice is yours!

WHY IS BENGAL ALWAYS ANGRY?

The smartest thing that my parents did was they migrated out of West Bengal. They were sorry, they were lonely, they were homesick and they were miserable to move out of home, but they were determined to live a better life and give their children better opportunities, something that simply wasn't possible in Kolkata. My father would often lament that his home state is not progressing. We Bengalis spend too much time in intellectualising simple issues, debating on non-issues, and procrastinating instead of working towards a better life, he felt. While Bengal was on the forefront of our freedom struggle, after partition it just fell apart. Punjab too was divided and still by sheer determination and hard work it was soon on road to recovery but Bengal still holds the grudge of being wronged! 

The state is perpetually angry and violent and is obsessed with the idea that it is being punished and victimized. Since the last three decades it could never see eye to eye with the government in the centre, irrespective of which party was ruling in Kolkata or in New Delhi. People are always in protest mode and whoever holds the biggest protest in Brigade Parade Ground is considered the most popular and most powerful! Imagine the irony, the lady who singlehandedly shooed away Tata from Singoor and handed the Nano factory on a platter to Modi in Gujarat, was elected by the people to become their Chief Minister! A person who deprived the people of industry, opportunities and jobs was rewarded by the same people! What does it say about the political atmosphere prevailing in the state?
                                                                                                           
Today Bengal is in a stagnant corner while Odisha, Assam and smaller states are rapidly progressing. Even literature, cinema and football are all stagnating and we have not had the champions like Rabindranath Thakur, Satyajit Ray and P. K. Banerjee in recent years. Saurabh Ganguli is perhaps the only bright star in the horizon today. The Chief Minister is angry and foul mouthed, her supporters are angry and equally foul mouthed and her representatives in the  assembly and parliament are also the same. The saner and smarter ones, and there are plenty - both in and out of politics, are side lined and the angry and rabid ones hog the limelight. They are all obsessed with an intellectual halo, which sadly doesn't exist, and a sense of victimhood, which only they have to shed. 

Gopal Krishna Gokhle once said 'What Bengal thinks today, India thinks tomorrow '. I hope he is proven wrong. We in India aspire to be a bunch of achievers and not a group of angry, ever complaining men and women who feel that the world is conspiring against them. The Nation is waiting patiently for Bengal to rise and shine once again not only for the sake of all Bengalis but for the sake of all Indians. The cancer of discontent, anger, frustration and protest must be uprooted by Bengalis themselves. The Nation is hoping and praying for saner senses to prevail and prosper!

THE STORY OF CAESARIAN SECTION

I hope you remember my esteemed senior colleague from Thrissur, Prof. Hirji Adenwalla. He told us the story of Cortisone and Insulin. Now this is another gem from the master story teller!

It is difficult to comprehend today that up to the year 1867 if a woman survived a caesarian section it was considered a clinical curiosity and the hundreds of years before that you could count on the fingers of one hand the number of women who lived after a caesarian. A few of the babies thus delivered  survived, the majority died because these caesarians were conducted on an already dead or a dying mother as a last resort, and on the part of the surgeon it was considered as sheer surgical bravado. The Catholic Church had issued a diktat that no mother should be buried with a child in utero. The child should be removed, baptized and then the mother and child were to be buried. Can you imagine that this was one of the indications for a caesarian? Compare this depressing scenario with the mortality reported less than a hundred years later in 1949. The University of Zurich reported a mortality of 0.66 percent. Today in the 20th Century the mortality is almost infinitesimal and an obstetrician would hang his head in shame if he lost a mother after a caesarian.

          

 It is erroneously believed that Caesar was delivered by a caesarian section. The word caesarian is derived from the Latin “Caeso matris utero” which means “cutting of mother’s uterus”. All that Caesar had to do with it is that he passed a law legalising the performance of this operation. It figures in Greek mythology, Apollo is supposed to have cut Aesculapius, the Roman God of Medicine out of the womb of his mother Korina. Aesculapius lived but what happened to the mother we do not know. The written chronicles of many ages and peoples contain reference to “Birth by section”. The Rig-Veda of the Hindus, the Talmud of the Jews and the records of the Romans, the Persians and the Arabs contain reference to this operation. It was mentioned that the history of child birth has ever been filled with pain. Now what was the cause of the death of these unfortunate women? The onus is laid at the door of one Francois Rousset surgeon to the Duke of Savoy. His was considered a classic text book of obstetrics and he was the first to recommend a caesarian section in a living mother for obstructed labour. He laid down certain rules that were followed without question by generations of obstetricians. He dogmatically stated that the womb should never be sutured as the after pains would tear open the incision. Only the abdomen had to be closed. If the mother did not die due to severe bleeding from the un-sutured incision in the uterus, she would die of surgical sepsis which was rampant in the pre-Listerine era. However, it was later discovered that Rousset himself had never done a Caesarian section, he had probably never even witnessed one. But his book became the Bible for any surgeon who dared to undertake a caesarian. They followed him unquestioningly like dumb driven cattle, so women continued to die of severe haemorrhage  as a result.

           

Rousset’s original book was in French but was translated into Latin the language of science by a man called Gaspard Bauhin and he related a number of fantastic cases which he said inspired Rousset to write his book. One of the stories was about a Swiss Butcher named Jacob Sigerhausen who in the year 1500 performed a caesarian on his wife and saved both mother and child. The woman went on to bear five more children whom she delivered normally-a statement which casts grave doubts upon the veracity of his story. From the end of the 17th century there is only one documented case of a caesarian performed on the 21st of April 1610 by a German surgeon in Wittenburg. His name was Trautmann. The caesarian was performed on a Cooper’s (barrel makers) wife, Ursula Opitz. The child survived but the mother died. These inevitable fatal outcomes of caesarian sections gave it ill repute.  Yet no one, no one, asked why women who were operated on according to Rousset’s instructions always died. No one ever doubted the teaching of this death dealing theoretician. Why did nobody make an effort to suture the wound which was the natural thing to do?

The stage now shifts to the San Matteo Hospital in Pavia, Italy and the main actor in this dramatic story is a young 33 year old surgeon trained at the University of Pavia and now held the post of Professor of Obstetrics in the same University. He was a fervent Italian nationalist and had served under Garibaldi. He was a thin earnest man with a pale high forehead and a heavy black beard. His eyes shone with a natural kindness which endeared him to his patients whose suffering he found difficult to bear. His name was Eduardo Porro (1842-1902). It must be admitted that Porro’s concept was originally suggested by a Florentine surgeon named Joseph Cavallini who proved on dogs that the uterus was not essential to life and could be removed with impunity.

            

On April the 27th 1876 a 25 year old girl who had obviously suffered from congenital rickets entered the San Matteo in Pavia to deliver her first baby. The girl was badly stunted and deformed. Porro examined the girl, she was four weeks overdue, she had a severe rachitic pelvis, her diagonal conjugate was 7 cm and her true conjugate was 4 cm or even less. Besides this she had a spondylolisthesis  of the lumbar spine forming a roof over the pelvic inlet. Seeing the girl he was not surprised at these findings. He knew for sure that he could never deliver this baby through the normal passage. A caesarian was imperative to save the baby but the mother would surely die of either haemorrhage or surgical sepsis. This kindly man patted the mother on the shoulder and said, “don’t worry the baby is alive these things take time”. He then let his students examine her, they adjourned to an adjacent room and the case was thrown open to discussion. His students were well trained by him and they all gave him a grave prognosis. At the end of it all a student asked him, “What will you do sir?”, “I will perform a caesarian of course I know the woman will die but we might save the child”. At the back of Porro’s mind was the knowledge that in the last 10 years not a single mother had survived a caesarian section. Porro also knew that caesarians were performed on dead mothers to baptise the children one of the edicts of the Catholic Church. Porro had read about the work of Jean Rena Sigault who proposed expanding the constructed pelvic girdle by cutting open the symphysis pubis, his research told him that it did not work. Sammuel Merriman of England advocated precipitating premature labour when the baby was very small. All the babies died and so did most of the mothers. John Aitken a British gynecologist who died insane in an asylum in the year 1790 proposed that all infection came from the air and therefore, caesarians should be performed under water. Porro said to his students “Gentlemen each proposal is wilder and more desperate than the previous one”. “Gentlemen”, he said “we must put all this aside and listen to what the French surgeon Lebas has to say for he has the answer. Listen to that what he writes. “In all the autopsies that I have performed the incision in the uterus was not closed and did not close on its own as Rousset believed. It was from this highly vascular area of the uterus that the women bled to death and died of shock even before sepsis could carry them away. I have tried to close the wound in the uterus but I did not have the adequate suture material, the after pains caused the incision to open up again”. Of course all these were classical caesarian sections.

           

Porro traumatised  by the misery he saw all around him had turned all this over in his mind a thousand times and came to the conclusion that if he could not close the uterus he had only one option and that was to remove it. The choice was a grim and a mutilating one. But if the choice was between certain death and survival by mutilation. The choice was obvious. What made Porro ultimately make his decision in the case of Julie Covallini? Was it the look of suffering of a timid child in her eyes? Or was it the conscience of a brave man accusing himself of being a coward when he knew full well that the only chance he had of saving the woman was by removing the uterus.

           

On the morning of the 21st of May 1876 a nurse reported to Porro that the Covallini woman’s pains had begun. At 10 AM he was informed that her sac had burst. At 20 minutes to five that evening Porro made his incision under chloroform anesthesia, it is recorded that he undertook some half- hearted antiseptic precaution that was slowly creeping into the surgery of those days. There was hardly any bleeding when he opened the peritoneum. But when he made the vertical incision of a classical caesarian section and delivered the baby, he was in a deluge of blood. All the conventional methods of massaging the uterus to make it contract to stop the bleeding were tried, but it was to no avail. For a long moment Porro hesitated then he made his decision. After putting a tourniquet like instrument on the cervix called a “Cintrat serre- naeud” which controlled the haemorrhage and then with a few bold cuts he whipped out the uterus. By today’s standards if you go through the detailed description of the operation which he later wrote, it was crude surgery, but you could say that it was a sub-total Hysterectomy.

           

For days after surgery Julie Covallini hovered between life and death, and Porro hardly left her bedside. For days she remained febrile. Infection had set in, she was delirious and there were several ups and downs when Porro thought he had nearly lost her. However, on the 33rd day after surgery the temperature settled down and at noon the same day Porro found her out of bed for the first time. Both mother and child had survived. A couple of months later Porro published his historical paper titled “Della Amputazione utero-ovario come compliment dal Taglio cesareo”. (utero-ovarian extirpation as a complement to caesarian section). It was carefully written and with extreme restraint. Unlike Semmelweis’s work it created a tremendous stir in the Mecca of Medicine-Vienna.

          

Throughout Europe and America in a short time the operation became a routine procedure, of the first 134 caesarians recorded by Porro’s method, the survival rate was 44%. This was phenomenal success and pinpointed the cause of death to the inability of the surgeon to close the uterus which led to fatal haemorrhage. It also focused the attention of the surgical fraternity to the undeniable fact that if they wanted to avoid the mutilation of a hysterectomy they must find a way to suture the uterus. The blind spot that Francois Rosset had created in the minds of surgeons was for ever removed.

           

As techniques improved and stronger suture material evolved surgeons were able to close the classical vertical opening in the body of the uterus. The credit for first successfully closing the uterus goes to Max Sanger of the University of Giessen in the year 1881 and so Porro’s operation enjoyed centre stage for only six years. But during that time the lives of thousands of women were saved. Marion Sims further improved the technique of suturing the uterus.

           

It was Ferdinand Adolf Kehler of Guntersblum  also a German who first advocated the technique of opening the lower segment of the uterus. Kehler’s operation was first performed in the town of Mackesheim on a 26 year old woman on the 25th of September 1881. With the lower segment caesarian section the classical caesarian section went completely out of vogue, and complications and mortality were further reduced to infinitesimal proportions. This today is the operation of choice performed uniformly all over the world.

           

There is a lesson to learn from this story. The mistake of Francois Rousset and all the mistakes of other like minded  men who postulate without proof have delayed the progress of science and have cost the loss of millions of lives. It was Lord Moynihan who said “there is no greater impotency of mind than the passive acceptance of facts”.

           

What Rousset wrote in 1581 without proof was accepted for 300 years without question and women died by the thousands. No one questioned Rousset. Generations of surgeons were like dumb driven sheep jumping over a fence without a thought. Only one man, a French surgeon by the name of Lebas said that Rousset was wrong, terribly wrong. He said either suture the uterus or remove it otherwise your mothers will continue to die, and it required the courage of one man Eduardo Porro to do what he thought he had to do. Eduardo Porro would have been criticised and ostracised if Julie Covallini and her baby had died. But luck was on the side of this brave man and on the side of millions of women that are alive today after a caesarian section. After this, men like Pasteur, Koch and Joseph Lister marched on to eliminate surgical sepsis and through them a new dawn broke on the surgical horizon.