Going to Ortolani

Mon, 18 Feb 2008 12:57:17 +0000
Num. 21

Professor Marino Ortolani revolutionised the management of Italic paediatric departments
For over fifty years, children in Ferrara have not simply gone to hospital but "to Ortolani". This identification of the hospital's paediatric department with the doctor who founded and directed it for more than three decades reveals the abiding impression that professor Marino Ortolani made on generations of people in Ferrara.
Arriving in Ferrara in July 1929 to work at the Istituto Provinciale per l'Infanzia, Ortolani came face to face with the reality of the Brefotrofio, where children without mothers were breastfed by young mothers working within the hospital. From this experience Ortolani grasped the importance of the presence of mothers at their children's side to reduce stress throughout their stay in hospital.

During the years after the Second World War, as head of the paediatric department of Ferrara's hospital, Ortolani was among the first in Italy to "maternalise" his department, setting up facilities to accommodate mothers day and night, which other paediatric hospitals claimed was impossible for operational and logistical reasons.

Not just mothers, teachers too. During the 1950s children frequently spent long periods in hospital. Children with tuberculosis, meningitis or polio frequently missed an entire year of education. Bringing teachers to work on the ward helped to prevent this. The same instinct for understanding the city's health needs came to the fore in his approach to thalassemia.

By the early 1950s, Ortolani came to understand that this terrible disease could only be checked by preventative measures. He was the first to promote mass screening of the entire population of the province so that all couples knew their risk of having affected children. To achieve this, Ortolani encouraged the work of two important researchers of the time, professors Silvestroni and Bianco.

Ortolani's ability to involve external experts in health projects in Ferrara came to the fore again some ten years later, with the visit of Professor Wolman, director of the Philadelphia paediatric hospital. Wolman's transfusion technique greatly increased the survival chances of patients with Cooley's disease.

This collaboration led to the establishment of the Microcytemia Centre in Ferrara by the Health Ministry.
However, the professional achievement which made Marino Ortolani's international reputation was his work on congenital dislocation of the hip.

It began almost by chance. One day during the early 1930s a mother consulted him with her baby son, and professor Ortolani noticed a strange sound in the hip during the course of the examination. This find in the joint was unusual, and had not previously been described in paediatric textbooks. An x-ray of the pelvis revealed the presence of congenital dislocation of the hip.

This gave Ortolani the idea that sound could be a clinical sign, a factor which could help early diagnosis of the condition. During the following years, Ortolani examined hundreds of children for this sign, and succeeded in identify a precise manoeuvre, the "clunk test", which enables the physician to detect whether the femoral head is, or might be, dislocated from the acetabulum.

"Ortolani's test" is a widespread diagnostic technique, used throughout the world. Even today it is included and described in every paediatric textbook.

Sustained by solid professional ethics and a dedication to his work which had little to do with his technical training or the qualifications he achieved, Ortolani practised medicine in an essentially practical and intuitive way, which was yet capable of achieving important scientific and therapeutic results.