Prasad M*, Venkatesh S**
(*Assistant Professor, **Professor, Department of Obstetrics and Gynecology, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bengaluru-66.)
It is largely contended that the current technique of lower segment cesarean section, one of the most commonly performed operative procedures in the world, is passed on from teacher to student without delving deep into the history of the origins of the procedure. This brings us to the stalwart John Munro Kerr (1868-1960).
He was born in Glasgow and after initial schooling, received medical education in different cities including Vienna, Dublin and Berlin. By the age of 32, he achieved the designation of faculty at the university of Glasgow and remained in the position for 40 years. One of his major areas of interest as an obstetrician was the contracted female pelvis and management options for the same. It is to be noted that he started his career in an era where the mortality attributable to cesarean section was almost 50 %. The Kronig procedure (high vertical incision on the uterus) was found unacceptable to him. Though Munro Kerr was not the first to describe the low transverse incision, (Robert Wallace Johnson and Johann Osiander had suggested this in 1700’s independently), Kerr repeatedly reproduced it and perfected it, thereby popularizing it. His initial case series of 107 consecutive cases with just 1 case of scar thinning as against the existing literature of 4 % scar rupture impressed most practising obstetricians of that time.
One of the time-tested clinical examinations for the assessment of adequacy of pelvis is named after Munro-Kerr. While Muller introduced placement of vaginal fingers at the ischial spine to check for adequate descent of the fetal head into the pelvis, Munro-Kerr is credited to have introduced the then rather innovative method of abdominal placement of the thumb to rule out cephalopelvic disproportion at the pelvic inlet. That this test continues to be mentioned, and will always continue to be mentioned in basic textbooks of obstetrics speaks volume about the contribution of this great obstetrician.
He was one of the founding fellows of the Royal College of Obstetricians and Gynecologists, of which he was also the first vice-president. His book ‘Operative Midwifery’ published first in 1908, continues to be published and widely read, albeit in a different name “Munro Kerr’s Operative Obstetrics”.
He retired from his hugely impactful, successful stint as Professor in the university and continued to live a long peaceful life upto the ripe age of 92 years. His career, works, books and memories will continue to inspire generations of obstetricians to come.
- Dunn PM. Professor Munro Kerr (1868-1960) of Glasgow and cesarean delivery. Arch Dis Child Fetal Neonatal Ed. 2008;93(2): F167-9.
- Peleg D, Burke YZ, Solt I, Fisher M. The History of the Low Transverse Cesarean Section: The Pivotal Role of Munro Kerr. Isr Med Assoc J. 2018;5(20):316-319.
- Powell JL. The Kerr Incision: John Martin Munro Kerr (1868–1960). Journal of Pelvic Surgery. 2001; 7(3): 177-8
- Contracted Pelvis. In Konar H, editor. DC Dutta’s Textbook of Obstetrics. 9th ed. New Delhi: Jaypee 2018; pp. 330.
- John Martin Munro Kerr. Available from https://en.wikipedia.org/wiki/John_Martin_Munro_Kerr
- Munro Kerr. A Biography. Available from : https://universitystory.gla.ac.uk/biography/?id=WH2476&type=P
Prasad M, Venkatesh S. Remembering Past Greats: Munro Kerr. JPGO 2019. Volume 6 No.8. Available from: https://www.jpgo.org/2019/08/remembering-past-greats-munro-kerr.html