The interpretation of the Porro uterus in relation to the third stage of labour / by D. Berry Hart.

  • David Berry Hart
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Licence: Public Domain Mark

Credit: The interpretation of the Porro uterus in relation to the third stage of labour / by D. Berry Hart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    RELATION TO THE THIRD STAGE OF LABOUR. By D. BERRY HART, M.D., F.R.C.P.E., F.R.S.E., Lecturer on Midwifery and Diseases of Women, Surgeons’ Hall, Edinburgh ; Honorary Fellow of the American Gynaecological Society ; Correspond- ing Fellow of the Leipzig Obstetrical Society ; Honorary Fellow of the Berlin Obstetrical Society, &c. When Porro, in 1870, performed Caesarean section according to his well-known method, he not only made the first distinct advance in the perfecting of that operation, but gave obstetri- cians specimens on which the phenomena of the Third stage could be studied in a way no other natural experiment has since afforded. Since 1886, when Barbour published the most outstanding and able paper on such specimens, the whole question of the third stage mechanism has been debated without any final agreement as to its nature, and, indeed, at present an apathy on this subject has come over the profession—over both investigator and practical obstetrician. The real reason of this blight on investigation has been that the question has usually been investigated on the supposition that the separation must take place in such a way as to check hsemorrhage, i.e. during a pain; and any view as to its occurrence by any other mechanism, after a pain, for instance, has been viewed with the greatest suspicion, especially by the general practitioner, to whom the phrase, “ relaxation after a pain ” is anathema, and “ uterus like a cricket ball,” the only safe and satisfactory descriptive term. Matthews Duncan held strongly that the placenta separated from shrinkage of the placental site, and when confronted with the fact ascertained by Barbour, that a shrinkage from 7 ins. x 7 ins. to 4 ins. X 4 ins. did not bring about separation, merely remarked in the well-deserved eulogy he gave Barbour, that he had no doubt the placenta separated at a lower shrinkage area. The great thing to explain in the Third stage is how the placenta separates. If we can explain that, everything else is easy. Curiously enough, in Germany, the question of the third stage is not looked at in this way; separation and expulsion are considered together, and there has consequently never been the controversy there we have had here; the whole question is
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