Few men leave a lasting impact on the scientific community for which they are remembered over a century later. At a time when science was becoming institutionalized and widely accepted, Francesco Parona (1842–1908) was a leading surgeon whose discoveries are still employed in the practice of medicine today. He is most well remembered for his description of a potential space in the forearm that is a common site of infection, now known as the space of Parona (Shin and Meals, 2005). He was also responsible for employing surgical treatments for erectile dysfunction (Shah, 2002). Though descriptions of his life and work are rarely found in the English literature, his contributions to the medical field deserve worldwide recognition.
Francesco Parona was born on 11 January 1842 in Lodi, a small community in Lombardy, Italy (Operti, 1966a). Son of Teresa and Angelo Parona, Francesco was the second boy of seven (Operti, 1966a). All members of the Parona family were very successful in their careers. Francesco's oldest brother, Giovanni Battista (born in 1839), was a Doctor in Jurisprudence like their father (Operti, 1966a). The second brother, Edoardo (born in 1845), was mayor of San Martino Siccomario. Francesco's other siblings pursued careers in the sciences. Corrado (born in 1848) was a Doctor in Medicine and Surgery at the University of Genoa, and was also a member of the Faculty of Physical and Mathematical Sciences (Operti, 1966a). Ernesto (born in 1848) and the youngest Emilio (born in 1856) were also Doctors in Medicine and Surgery. Finally, his second youngest brother, Carlo (born in 1855), was a Doctor in Natural Sciences (Operti, 1966a).
Parona completed his primary studies with honors in Lodi, and went on to attend medical school at the University of Pavia in Lombardy. During his years as a medical student, he learned under the esteemed physicians Oehl, Mantegazza, and Sangalli (Operti, 1966a). After graduating in 1865 at the top of his class, Parona came to study under Bottini, a practicing surgeon at the Hospital of Novara (Operti, 1966a). In 1867, at the age of 25, Parona was named attending surgeon at that same hospital. Once Bottini retired in 1871, Parona became chief of surgery at Maggiore Hospital in Novara at the age of 29 (Operti, 1966a). Parona was a strong-willed and determined individual, and was a prominent figure not only in the scientific community but also in politics. In 1882, even though the government of Novara was still primarily conservative, Parona was elected as deputy to parliament and led a small group of democrats to serve as the opposition (Operti, 1966a). He maintained this position until 1901 when he was appointed Senator, becoming a strong advocate for public health issues affecting his citizens (Operti, 1966a). After completing his service on parliament, he continued to be heavily involved in his community. Parona was a member of several charities and even served as president of a local homeless shelter. He held titles such as President of the National Association of Doctors, President of the Supervisory Board of the Technical Institute, Chairman of the Biella-Novara Railway Committee, and served as a member of the Provincial Health Council and College of Physicians (Operti, 1966a). Though he was an avid and dedicated political figure for several years, his accomplishments in medicine are the main contributions to his legacy. He had a long and prosperous career with significant achievements. Francesco Parona died on August 10, 1908 at the age of 66 due to a stroke that had occurred six days earlier. His funeral was carried out with military honors (Operti, 1966a).1
Like many other surgeons of his time, Parona was interested in building upon current techniques as well as discovering new ones (Operti, 1966a). He believed that the study of anatomy was integral to his success as a surgeon, and this was the basis for many of his publications (Operti, 1966a). His most famed accomplishment is undoubtedly his description of the subtendinous space, now commonly known as Parona's space (Hoppenfeld and Zeide, 1994). His initial description of the space came in his 1876 publication entitled “Dell'oncotomia negli accessi profundi diffusi dell'avambrachio” (“About the radical evacuation of deep abscesses of the forearm”) (Parona, 1876a). The identification of this space in the forearm has had enormous implications in the field of orthopedics and infections of the upper limb (Hoppenfeld and Zeide, 1994). This has been an area of great interest amongst orthopedic specialists, and extensive research has been conducted on Parona's space, which lies between the flexor pollicis longus and flexor digitorum profundus tendons and the pronator quadratus muscle (Parona 1876a; Doyle and Bott, 2003; Shin and Meals, 2005). A study conducted by Scheldrup (1951) involving the anatomical study of 367 human hands found that in 85% of subjects, Parona's space served as a communication between the radial and ulnar bursae (Doyle and Bott, 2003). These bursae of the wrist are continuous with the flexor pollicis longus tendon sheath and the flexor digitorum tendon sheath of the fifth digit (Aguiar et al., 2006). Additional studies have confirmed that in the general population, a connection is commonly found through the space of Parona between these radial and ulnar bursae at the level of the transverse carpal ligament (Nevasier, 1989; Brown and Young, 1993; Jebson, 1998; Berger and Weiss, 2004). If the bursae were to rupture, allowing infection to spread into this area, a “horseshoe abscess” could potentially form (Nevasier, 1989; Tubiana, 1990; Abrams and Botte, 1996; Jebson, 1998; Doyle and Bott, 2003; Berger and Weiss, 2004; Snell, 2008; Siemionow and Eisenmann-Klein, 2010; Trumble and Budoff, 2010). In addition, this space is in communication with the midpalmar space of the hand via the carpal tunnel (Tubiana et al., 1990; Abrams and Botte, 1996; Awori et al., 1999; Schmidt and Lanz, 2004). This has great clinical importance for physicians in dealing with the spread of inflammation, infectious processes and even neoplastic diseases (Brown and Young, 1993; Abrams and Botte, 1996; Schmidt and Lanz, 2004; Aguiar et al., 2006). Furthermore, several authors have reported that for patients with infections of Parona's space, impairment of hand function will likely result, and some conditions could even become life threatening (Kanavel, 1921; Mann, 1988; Rieger and Brug, 1992; Rieger et al., 1996). For these reasons, the prompt treatment of such infections is integral to the full recovery of the patient.
Parona described the proper method of incision in order to evacuate an abscess found in this space, a technique that is still described in present day textbooks and papers (Brown and Young, 1993; Awori et al., 1999; Trumble and Budoff, 2010). Parona was concerned with the accepted method of the time, which was described by Delbeau, and involved making an incision along the anterior forearm down the radial side (Parona, 1876a). Parona explained that this was associated with a much greater chance of injuring branches of the radial nerve due to their close proximity to the incision site (Operti, 1966a). He wrote that a longitudinal incision parallel to the ulna is a much safer method in order to avoid severing a major vessel (Parona, 1876a; Kanavel, 1921; Operti, 1966a). Nowadays, texts describe the proper method of draining such abscesses as making a longitudinal incision just medial to the palmaris longus muscle to avoid excising the median nerve. This current practice parallels the method described by Parona over 130 years earlier (Parona, 1876a; Operti, 1966a; Awori et al., 1999; Trumble and Budoff, 2010).
Parona should also be recognized for his publication entitled “Intorno ad un caso di spina bifida cervical” (“A case of cervical spina bifida”), where he described his encounter with a nine-month-old female who had a large fluid-filled mass on the cervical portion of her dorsal spine (Parona, 1876b). At the time, surgical treatment of spina bifida was controversial and many surgeons were either reluctant to try it or against the practice completely, arguing that it offered little overall benefit to the patient (Operti, 1966d). Parona performed an exploratory puncture to ensure that the mass did not contain any spinal nerve roots. In using the protocol previously described by Rizzoli, Parona then applied constrictive forceps at the base of the tumor to remove it (Parona, 1876b; Anonymous, 1876; Operti, 1966d). This marked the fourth successful recorded case of this treatment for spina bifida (Anonymous, 1876).
As an orthopedic surgeon, Parona was also very interested in designing new devices and instruments for treating trauma patients. In 1877, Parona published “Di un nuovo apparecchio contentivo delle ossa” (“A new device for bones”), which included several original illustrations of apparatuses he designed for immobilization of different parts of patients' limbs after a bone fracture (Operti, 1966b). In his 1879 publication “Intorno ad un caso di frattura del collo anatomico dell'omero con lussazione di quest'osso ed un altro di frattura al condilo esterno dell'omero e sua fuoriuscita da ferita delle parti molli” (“A case of fracture of the anatomical neck of the humerus with dislocation of the bone and another external condyle fracture of the humerus and its exit from the soft parts of the wound”), Parona described a specific case of a 77-year-old woman who sustained a fracture of the humerus with considerable swelling. He gave details of a new device that he invented in order to create suction and aspirate the fluid to lessen discomfort (Operti, 1966b). These records exhibit Parona's creativity and determination to find newer and more innovative methods to improve the well being of his patients.
Parona was also a pioneer in the treatment of tuberculous spondylitis (Operti, 1966c). In his publication entitled “Tubercolosi alla spina dorsal con ascesso al mediastino posteriore” (“Tuberculosis of the spine with posterior mediastinal abscess”), he described two cases of patients with tuberculosis of the spine in which surgical treatment was required to drain a posterior mediastinal abscess (Parona, 1896; Ito et al., 1934; Operti, 1966c). Parona performed a costotransversectomy through a paravertebral incision in order to access the vertebral body and evacuate the abscess. Although complications due to secondary infection arose in the patients over the following months to years, both of these operations were considered successful in the immediate drainage of these abscesses, allowing the patients to have better mobility and comfort (Ito et al., 1934; Operti, 1966c).
Another significant contribution of Parona was the surgical treatment of male impotence. Before his time, impotence was believed by many to be a result of nonbiological causes. For hundreds of years, due to the lack of knowledge of the physiology and pathology of erectile dysfunction, members of both the general public and medical field had thought that there were very few remedies that could possibly alleviate such an ailment (Shah, 2002). Parona revolutionized the field of urology through his recognition of a physiological basis for male impotence, and described his first case in a paper entitled “Imperfetta erezione del pene per varicositá della vena dorsal: osservazione” (“Imperfect erection of the penis by the dorsal vein varicosities: observation”) (Parona, 1873). After a 30-year-old male patient came to see him complaining of the inability to maintain erection, Parona noted large varicosities associated with the dorsal penile vein and immediately postulated that this was causing blood to drain away from the penis at a much faster rate than normal (Parona, 1873; Shah, 2002). He performed the first surgical treatment for impotence, using hypertonic saline to sclerose the vein (Parona, 1873; Shah, 2002; Lue et al., 2004). In the article, Parona reported that the patient was successful with intercourse only five days after the procedure (Parona, 1873; Shah, 2002). This monumental discovery laid the foundation for numerous subsequent procedures to treat impotence involving ligation of the dorsal penile vein (Shah, 2002). To this day, impotence is still a common problem and Parona's innovative work began the movement for treating this condition in a clinical setting. Through his initial publication and the extensive research by others that followed, the general public has become more educated on the pathological basis of impotence, helping to alleviate the social stigma that had been associated with it for hundreds of years (Shah, 2002).
Francesco Parona is remembered as a true pioneer in the field of surgery, as well as an influential figure in both the political and scientific communities. His eagerness for developing new techniques and improving the methods of his predecessors is a true testament to his ingenuity as a clinician. He has left a strong legacy to the field of anatomical sciences, a point that is evident in anatomy texts worldwide, where one can still find the space of the forearm that bears his name.