OF THE PARTS PROPER TO A CHILD IN THE WOMB: HOW IT IS FORMED THERE, AND THE MANNER OF ITS SITUATION THEREIN.
IN the last chapter I treated of conception, showed what it was, how accomplished, its signs, and how she who had conceived ought to order herself during the time of her pregnancy. Now, before I come to speak of her delivery, it is necessary that the midwife be first acquainted with the parts proper to a child in the womb, and also that she knows how it is formed, and the manner of its situation and decumbiture there; which are so necessary to her, that without the knowledge thereof no one can tell how to deliver a woman as she ought. This therefore shall be the work of this chapter I shall begin with the first of these
SECT. I. Of the Parts proper to a Child in the Womb.
In this section I must first tell you what I mean by the parts proper to the child in the womb, and they are only those that either help or nourish it, whilst it is lodged in that dark repository of nature, and that help and clothe and defend it there, and are cast away as of no more use, after it is born; and these the two, to wit, the umbilicus, or navel vessels and the fecundinum: By the first it is nourished, and by the second clothed and defended from wrong. Of each of these I shall speak distinctly; and, first,
Of the Umbilicus, or Navel-Vessels.
These are four in number, viz., one vein, two arteries, and the vessel which is called Urachos: (1) The vein is that by which the infant is nourished, from the time of its conception till the time of its delivery; till, being brought into the light of this world, it has the same way of concocting its food as we have. This vein ariseth from the liver of the child, and is divided into two parts when it hath passed the navel; and these two are again divided and sub-divided, the branches being upheld by the skin called Chorion (of which I shall speak by and by), and are joined to the veins of the mother's womb, from whence they have their blood for the nourishment of the child. (2) The arteries are two on each side, which proceed from the back branches of the great artery of the mother; and the vital blood is carried by these to the child, being ready concocted by the mother. (3) A nervous or sinewy production is led from the bottom of the bladder of the infant to the navel, and this is called Urachos; and its use it to convey the urine of the infant from the bladder to the Allantois. Anatomists do very much vary in their opinions concerning this, some denying any such thing to be in the delivery of women, and others on the contrary affirming it; but experience has testified there is such a thing. For Bartholomew Carbrolius, the ordinary doctor of anatomies to the college of physicians at Montpelier in France, records the history of a maid, whose water being a long time stopped, at last issued out through her navel. And Johannes Fernelius speaks of the same thing that happened to a man of thirty years of age, who, having a stoppage in the neck of the bladder, his urine issued out of his navel many months together, and that without any prejudice at all to his health, which he ascribes to the ill lying of his navel, whereby the Urachos was not well dried. And Volchier Coltas quotes such another instance in a maid of 34 years of age at Nuremberg, in Germany. These instances, though they happen but rarely, are very sufficient to prove that there is such a thing as an Urachos in men. These four vessels before mentioned, to wit, one vein, two arteries, and the Urachos, do join near to the navel, and are united by a skin which they have from the chorion, and so become like a gut or rope, and are altogether void of sense; and this is that which the good women call the navel-string. The vessels are thus joined together, that so they might neither be broken, severed, nor entangled; and when the infant is born are of no use, save only to make the ligament which stops the hole of the navel, and some other physical use, etc.
Of the Secundine, or After-Birth.
Setting aside the name given to this by the Greeks and Latins, it is called in English by the name of Secundine, after-birth, and after-burden, which are held to be four in number.
1. The first is called Placentia, because it resembles the form of a cake, and is knit both to the navel and Chorion, and makes up the greatest part of the secundine or after-birth. The flesh of it is like that of the milt, or spleen, soft, red, and tending something to blackness, and hath many small veins and arteries in it; and certainly the chief use of it is for containing the child in the womb.
2. The second is the Chorion. This skin, and that called the Amnios, involve the child round, both above and underneath and on both sides, which the Allantois doth not. This skin is that which is most commonly called the secundine, as it is thick and white, garnished with many small veins and arteries, ending in the Placentia before named, being very light and slippery. Its use is not only to cover the child round about, but also to receive and safely bind up the roots, and the veins and arteries, or navel vessels before described,
3. The third thing which makes up the secundine is the Allantois, of which there is a great dispute amongst anatomists. Some say there is such a thing, and others that there is not. Those that will have it to be a membrane say it is white, soft and exceedingly thin, and just under the Placentia, where it is knit to the Urachos, from whence it receives the urine; and its office is to keep it separate from the sweat, that the saltness of it may not offend the tender skin of the child.
4. The fourth and last covering of the child is called Amnios, and it is white, soft, and transparent, being nourished by some very small veins and arteries. Its use is not only to wrap the child round, but also to retain the sweat of the child.
Having thus described the parts proper to the child in the womb, I will next proceed to speak of the formation of the child therein, as soon as I have explained the hard terms in this section, that those for whose help this is designed may understand what they read. There is none, sure, can be so ignorant as not to know that a vein is that which receives blood from the liver, and distributes it in several branches to all parts of the body. Arteries proceed from tho heart, are in a continual motion, and by their continual motion quicken the body. Nerve is the same with sinew, and is that by which the brain adds sense and motion to the body. Placentia properly signifies a sugar cake; but in this section it is used to signify a spongy piece of flesh, resembling a cake full of veins and arteries, and is made to receive the mother's blood appointed for the infant's nourishment in the womb. Chorion is the outward skin which compasseth the child in the womb. The Amnios is the inner skin which compasseth the child in the womb. The Allantois is the skin that holds the urine of the child during the time that it abides in the womb. The Urachos is the vessel that conveys the urine from the child in the womb to the Allantois. I now proceed to
SECT. II. Of the Formation of the Child in the Womb.
To speak of the formation of the child in the womb we must begin where nature begins; and that is, at the act of coition, in which the womb having received the generative seed, without which there can be no conception, the womb immediately shuts up itself so close that not the point of a needle can enter the inward orifice; and this it does partly to binder the issuing out of the seed again, and partly to cherish it by an inbred heat, the better to provoke it to action; which is one reason why women's bellies are so lank at their first conception. The woman having thus conceived, the first thing which is operative in the conception is the spirit, whereof the seed is full, which, nature quickening by the heat of the womb, stirs it up to action. This seed consists of very different parts, of which some are more and some are less pure. The internal spirits therefore separate those parts that are less pure, which are thick, cold and clammy, from them that are more pure and noble. The less pure are cast to the outsides, and with them the seed is circled round, and of them the membranes are made, in which that seed which is the most pure is wrapped round and kept close together, that it may be defended from cold and other accidents, and operate the better.
The first thing that is formed is the Amnios, the next the Chorion; and they enwrap the seed round as it were a curtain. Soon after this (for the seed thus shut up in the woman lies not idle) the navel veil is bred, which pierceth those skins, being yet very tender, and carries a drop of blood from the veins of the mother's womb to the seed; from which drop is formed the liver, from which liver there is quickly bred the Vena Cava, or chief vein, from which all the rest of the veins that nourish the body spring; and now the seed hath something to nourish it, whilst it performs the rest of nature's work, and also blood administered to every part of it to form flesh.
This vein being formed, the navel arteries are soon after formed, then the great artery, of which all others are but branches, and then the heart; for the liver furnisheth the arteries with blood to form the heart, the arteries being made of seed, but the heart and the flesh of blood. After this the brain is formed, and then the nerves, to give sense and motion to the infant. Afterwards the bones and flesh are formed, all of the bones, first the Vertebrae or chin bones, and then the skull, etc.
As to the time in which this curious part of nature's workmanship is formed, physicians assign four different reasons wherein this microcosm is formed, and its formation perfected in the womb. The first is immediately after coition; the second time of forming, say they, is when the womb by the force of its own innate power and virtue makes a manifest mutation or coagulation in the seed, so that all the substances thereof seems coagulated flesh and blood, which happens about the twelfth or fourteenth day after copulation; and though this concretion of fleshy mass abound with spirits, yet it remains undistinguishable without any form, and may be called a rough draft of the Foetus or Embryo, The third time in which this fabric is come to some further maturity is, when the principal parts may be in some measure distinguished, and one may discern the Liver, umbilical veins, arteries, nerves, brain and heart; and this is about eighteen days after conception. The fourth and last time assigned by physicians for the formation of the child, is about the thirtieth day after conception for a male, but for a female, they tell us forty-two or forty-five days are required, though for what reason I know not, nor does it appear by the birth: for if the male receives its formation fifteen days sooner than the female, why should it not be born so much sooner too? But, as to that, every day's experience shows us the contrary, for women go the full time of nine months both with male and female. But at this time of thirty days (or some will have it forty-five), the outward parts may be also seen exquisitely elaborate, and distinguished by joints; and from this time the Child begins to be animated, though as yet there is no sensible motion; and has all the parts of the body, though small and very tender, yet entirely formed and figured, although not longer in the whole than one's middle finger; and from thenceforward, the blood flowing every day more and more to the womb, not by intervals like their courses, but continually, it grows bigger and stronger to the end of nine months, being the full time of a woman's ordinary labour.
<Illustration: The action of quickening>
Very great have been the disputes among both philosophers and physicians about the nourishment of the child in the womb, both as to what it is, and which way it receives it. Almaeon was of opinion that the infant drew in its nourishment by its whole body because it is rare and spongy, as a sponge sucks in water on every side; and so he thought the infant sucked blood, not only from its mother's veins, but also from the womb. Democritus held that the child sucked in the nourishment at its mouth. Hippocrates affirms that the child sucks in both nourishment and breath by its mouth from the mother, for which he gives two reasons: 1. That it will suck as soon as it is born, and therefore must have learnt to suck before. 2. Because there are excrements found in the guts as soon as it is born. But neither of these reasons are sufficient to prove his assertion. For, as to the first, "That the child will suck as soon as it is born," it is from a natural instinct; for take a young cat that never saw her dam catch a mouse, and yet she will catch mice herself as soon as she is able. And as to this second reason, it is a sufficient answer to say, that the excrements found in the guts of an infant new-born are not excrements of the first concoction, which is evident, because they don't stink, but are the thickest part of the blood, which is conveyed from the vessels of the spleen to the guts. Having therefore said enough to confute the opinion of the child's receiving the nourishment by the mouth, I do affirm that the child receives its nourishment in the womb by the navel; and that it should be so, is much more consonant to truth and reason; which being granted it will easily follow, that the nourishment the child receives is by the pure blood conveyed info the liver by the navel vein, which is a branch of the Vena Porta, or gate vein, and passeth to the small veins of the liver. Here this blood is made more pure, and the thicker and rawer part of it is conveyed to the spleen and kidneys, and the thick excrement of it to the guts, which is that excrement found there so soon as they are born. The pure part is conveyed to the Vena Cava, and by it distributed throughout the body by the small veins, which, like so many small rivulets, pass to every part of it. This blood is accompanied (as all blood is) with a certain watery substance, the better to convey it through the passage it is to run in, which, as in men, is breathed out by sweating, and contained in the Amnios, as I have already said.
SECT. III. Of the Manner of the Child's lying in the Womb.
I COME now to show after what manner the child lies in the womb; a thing so essential for a midwife to know, that she can be no midwife who is ignorant of it, and yet, even about this, authors extremely differ. For there are not two in ten that agree what is the form that the child lies in the womb, or in what fashion it lies there; and yet this may arise in a great measure from the different figures that the child is found in, according to the different times of the woman's pregnancy; for near the time of its deliverance out of those winding chambers of nature, it oftentimes changes the form in which it lay before for another. Hippocrates affirms the child is so placed in the womb as to have its hands, its knees, and its head bent down towards its feet, so that it lies round together, its hands upon both its knees, and its face between them; so that each eye toucheth each thumb, and its nose betwixt its knees: and Bartholinus was also of the same opinion. Columbus describes the posture of the chilled thus: "The right arm bowed, the fingers whereof under the ear and above the neck; the head bowed down, so that the chin toucheth the breast, the left arm bowed above both breast and face, and the left arm is propped up by the bending of the right elbow; the legs are lift upwards, the right of which is so lifted up that the thigh toucheth the belly, the knees the navel, the heel the left buttock, and the foot is turned back and covereth the secrets; the left thigh toucheth the belly, and the leg is lifted to the breast, the back lying outward." And thus much shall suffice touching the opinion of authors.
I will now show the several situations of the child in the mother's womb, according to the different times of pregnancy, by which those that are contrary to nature, and are the chief cause of all ill labours, will be the more easily conceived by the understanding midwife; it ought, therefore, in the first place, to be observed, that the infant, as well male as female, is generally situated in the midst of the womb; for though sometimes to appearance a woman's belly seems higher on one side than the other, it is so with respect to her belly only, and not of her womb, in the midst of which it is always placed.
<Illustration: Conception to Fourth Month>
<Illustration: Fifth Month to Ninth Month>
But in the second place, a woman's great belly makes different figures, according to the different times of pregnancy; for, when she is young with child. the embryo is always found of a round figure, a little oblong, having the spine moderately turned inwards, the thighs folded, and a little raised, to which the legs are so joined that the heels touch the buttocks; the arms are bending, and the hands placed upon the knees, towards which the head is inclining forwards, so that the chin toucheth the breast; in which posture it resembleth one's sitting to ease nature, and stooping down with the head to see what comes from him. The spine of its back is at that time placed towards the mother's, the head uppermost, the face downwards; and, proportionately to its growth it extends its members by little and little, which were exactly folded in the first month. In this posture it usually keeps till the seventh or eighth month, and then by a natural propensity and disposition of the upper part of the body, the head is turned downwards toward the inward orifice of the womb, tumbling as it were over its head, so that then the feet are uppermost, and the face towards the mother's great gut; and this turning of the infant in this manner, with its head downwards, towards the latter end of a woman's reckoning, is so ordered by nature, that it may thereby be the better disposed for its passage into the world at the time of its mother's labour, which is not then far off; and indeed several children turn not at all until the very time of birth; for in this posture all its joints are most easily extended in corning forth; for by this means the arms and legs cannot hinder its birth, because they cannot be bended against the inward orifice of the womb; and the rest of the body, being very supple, passeth without any difficulty after the head, which is hard and big, being past the birth. 'Tis true there are divers children that lie in the womb in another posture, and come to the birth with their feet downwards, especially if there be twins; for then by their different motions they do so disturb one another, that they seldom come both in the same posture at the time of labour, but one will come with the head, and another with the feet, or perhaps lie across; and sometimes neither of them will come right. But however the child may be situated in the womb, or in whatever posture it presents itself at the time of birth, if it be not with its head forwards, as I have before described, it is always against nature; and the delivery will occasion the mother more pain and danger, and require greater care and skill from the midwife than when the labour is more natural; of which the following scheme will give a great demonstration which is the form of a child in the womb ready for the birth, naked and disrobed of all its tunicles, proper and common.