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I
did
not choose the title of this presentation. Had I
done so, I would have been more careful in my
selection of words. The foetus is part of my
province of medical practice, and personality is
part of yours. But whereas I am sure you that you
could all define, describe and even recognize a
foetus, I am not so confident that I can define
personality. One dictionary offers 'what
constitutes an individual as a distinct person,'
but does not define what the 'what' is. Another
dictionary asserts 'the state of existing as a
thinking intelligent being'. This definition might
lead to the inference that personality increases
pro rata with intelligence, or that some people may
not have a personality at all if we followed
Bertrand Russell's dictum that 'most people would
rather die than think and many, in fact,
do!'
My
copy of the late Ken Stallworthy's Manual of
Psychiatry is more help with the definition that
'personality is the individual as a whole with
everything about him which makes him different from
other people,' because we can certainly distinguish
foetuses from each other and from other people.
With the next sentence - 'personality is determined
by what is born in the individual in the first
place and by everything which subsequently happens
to him in the second' - we are really in business.
Not only can I tell you what is apparent of what is
born in the foetus, but I can also describe the
environment in which he lives, the stimuli to which
he is exposed, and the responses which he displays.
Therefore it might have been more apt to title this
presentation 'A day in the life of the foetus,' and
together we can revisit a stage of life which we
all experienced but which, superficially at least,
none of us remembers.
Such
a journey is justified for several reasons. For
many centuries interest in foetal life was
restricted to anatomical studies by embryologists
or to mechanical problems in delivery as they
presented to the accoucheur. The legacies of this
era are well known - particularly the attitude
that, apart from some aimless kicking which began
in the fifth month, the foetus was a placid,
dependent, fragile vegetable who developed quietly
in preparation for a life which started at birth.
In the present century, many disciplines have
extended their interest to include the foetus, but
in fields from surgery to psychiatry the tendency
has been to start with adult life and work
backwards - knowing what the adult state was, one
worked back to what seemed a reasonable starting
point to reach that goal. Therefore, in fields from
physiology and biochemistry to education and
psychology, there has grown up the habit of
regarding the foetus and the neonate as a poorly
functioning adult rather than as a splendidly
functioning baby.
Until
recently, the human foetus in situ was inaccessible
to study and this seclusion has had two further
unfortunate results. First, much reliance has been
placed on animal experiment in spite of the fact
that there is more variation throughout the
mammalian order in reproductive physiology than in
the physiology of any other body function. Second,
for want of experimental verification or
repudiation, theories have flourished without
serious challenge. As a consequence, at one
extreme, J.J. Rousseau and his pupils could regard
the foetus as a witless tadpole with a mind like a
cleanly washed slate - the tabula rasa - and at the
other extreme some interpreters of dreams
considered the foetus a skilled voyeur, spying on
his parents having intercourse - a sort of 'what
the butler saw' through the cervix.
If,
with regret, we must abandon such fascinating
conjecture, I hope that we can replace it with
equally interesting fact, because recent advances
in foetal diagnosis and therapy have provided both
the technology and opportunity to piece together a
new picture of the foetus. Far from being an inert
passenger in a pregnant mother, the foetus is very
much in command of the pregnancy. It is the foetus
who guarantees the endocrine success of pregnancy
and induces all manner of changes in maternal
physiology to make her a suitable host. It is the
foetus who, single-handed, solves the homograft
problem - no mean feat when we reflect that,
biologically, it is quite possible for a woman to
bear more than her own body weight of babies, all
immunological foreigners, during her reproductive
career. It is the foetus who determines the
duration of pregnancy. It is the foetus who decides
which way he will lie in pregnancy and which way he
will present in labour. Even in labour the foetus
is not entirely passive - neither the toothpaste in
the tube nor the cork in the champagne bottle, as
required by the old hydraulic theories of the
mechanics of labour. Much of the behaviour of the
neonate and infant can now be observed in utero
and, by corollary, a better understanding of the
foetus and his environment puts the behaviour and
problems of the neonate in better
perspective.
In
his warm and humid microclimate, the foetus is in
neither stupor nor hypoxic coma. From the few
electroencephalographic studies, he appears to show
cyclical activity, the lighter periods of which
correspond in the neonate to a drowsy wakefulness
from which he is readily aroused by a variety of
stimuli. Like all internal organs, the uterus is
insensitive to touch, indeed, to all stimuli except
stretch. Hence foetal movements are not felt in the
uterus but in the maternal abdominal wall, which
explains why quickening is not apparent until 16 to
22 weeks of gestation. The foetus has been moving
his limbs and truck since about eight weeks, but
some 10 or more weeks elapse before these movements
are strong enough to be transmitted to the
abdominal wall. In some 40 per cent of pregnancies,
an additional cushion, the placenta, is on the
anterior uterine wall, and this phenomenon plus
variation in foetal position explains why maternal
account or external palpation may be a very erratic
guide to foetal vigour and welfare.
Foetal
comfort determines foetal position, but comfort
presents no problem in the first half of pregnancy
when the foetus inhabits a relatively large and
globular cavity. He is under no restriction and has
no axis of stability. Occasionally these conditions
still prevail in late pregnancy - in the presence
of polyhydramnios, or with a uterine cavity
truncated by a fundal or praevia placenta - and
then we see an unstable lie. Normally, however, in
the second half of pregnancy, the uterine cavity is
no longer globular but becomes progressively more
ovoid with the lower pole narrower, and the foetus
elongates more rapidly than the uterus. Therefore
the foetus tends to be corralled into a
longitudinal lie. However, amniotic fluid volume
reaches a maximum at about 28 to 32 weeks, and
until this time the foetus is far from cramped and
under no obligation to lie well flexed. As amniotic
fluid volume diminishes and foetal bulk increases
from 32 weeks to term, comfort becomes more
difficult to achieve. If he chooses to flex his
knees, the foetus will present by the vertex as his
head forms a smaller pole than his back, thighs,
calves and feet, and this disposition corresponds
to the polarity of the uterine cavity. If however
he elects to extend his knees, he will fit in best
as a breech since his tapering trunk and thighs
form a smaller pole than his head, calves, and
feet.
Variations
of uterine contour, unusual size or location of the
placental, and the presence of another foetus may
all present further challenges to foetal comfort
and ingenuity and produce stable malpresentations.
Foetal position, whether he lies with his spine
anterior, posterior, or lateral, is determined by
other influences. In late pregnancy, the most
important of these are the location of the
placental, which converts the circular cross
section of the uterus to an oval, the tone of
mother's uterine and abdominal wall, the shape of
the maternal lumbar lordosis, and the inclination
of the pelvic brim. Maternal movement and change of
maternal position, Brazton-Hicks contractions, and
external palpation all disturb the foetus and may
provoke him to seek a new position of comfort. He
will repeatedly and purposefully seek to avoid the
sustained pressure of a microphone or phonendoscope
or of a knuckle on prominences.
The
mechanism by which the foetus changes ends in the
uterus is simple - he propels himself around by his
feet and legs. The mechanism by which he changes
sides is more subtle - he employs an elegant
longitudinal spiral roll and at the midpoint of his
turn has a 180 degree twist in his spine. He first
extends his head and rotates it, next his shoulders
rotate and finally his lumbar spine and legs - in
fact, he is using his long spinal reflexes. Insofar
as this is the obvious way to turn over, there
would be nothing remarkable about it except that
according to textbooks of neonatal and infant
locomotor function the baby does not roll over
using his long spinal reflexes until 14 to 20 weeks
of extrauterine life. However, we have unequivocal
films of the foetus using this mechanism at least
as early as 26 weeks gestation, and it is apparent
that the reason we do not see this behaviour in the
neonate is not that he lacks the neural
co-ordination but that a trick which is simple in a
state of neutral buoyancy becomes difficult under
the new-found tyranny of gravity.
The
very early embryo develops in flexion, but beyond
this stage there is little evidence to justify the
traditional assumption that flexion is fundamental
in foetal musculoskeletal development. In
midpregnancy with plenty of room, neutral buoyancy
and intervertebral discs virtually synovial joints,
he can assume postures difficult or impossible for
the child or adult. In late pregnancy, as the
foetus elongates more than the uterus, he must fold
to fit in. Commonly the attitude is again one of
flexion, but sometimes he elects to lie with neck,
trunk or limbs extended and sometimes grossly
hyperextended, a preference he will continue to
express as his position of comfort after birth,
particularly in sleep, if nursed naked in a warm
environment.
Foetal
movement is necessary for the proper development of
foetal bones and joints. The foetus without muscles
- amyotrophia congenita - has the slender bone
structure more familiar in the victim of paralytic
poliomyelitis. From the characteristic and uniform
angulations in different limb segments, it is
apparent that the fractures in the foetus with
fragilitas osseum, the 'battered baby in utero,'
are self-inflicted by the baby's own muscles. The
foetus who is severely constrained in utero like a
pound of deep frozen sausages with extreme
oligohydramnios presents an assortment of
compression deformities with severe restriction of
joint range of movement.
The
realization that the foetus himself determines the
way he will lie in pregnancy and present in labour
by making the best he can of the space and shape
available to him puts the practice of version in
new perspective, and nowadays fewer obstetricians
assume that they know better than the foetus how he
will be most comfortable. Of course, in selecting a
position of comfort in later pregnancy, the foetus
may have chosen a position which is difficult or
impossible for vaginal delivery. In this regard he
may be accused of lack of foresight, but this is a
trait not unknown in adults.
The
foetus is responsive to pressure and touch.
Tickling the foetal scalp at surgical induction of
labour provokes movement, stroking the palm of a
prolapsed arm elicits a grasp reflex, and to
plantar stimulation the footling breech obliges
with an upgoing toe. Being totally immersed, the
foetus does not feel wet nor cough or choke with
his airway full of fluid. The peripheral sensation
of wetness and the irritation of fluid in the
airways are dependent on surface tension effects at
gas/fluid interfaces, and normally wetness is a new
experience at birth. That this experience, however,
may be startling if not uncomfortable for the
foetus is suggested by the one recorded case of air
amniography where the presence of a substantial
volume of intraamniotic air led to prolonged loud
foetal crying.
Since
the foetus lacks an external surface of his own,
his temperature inevitably cannot be les than his
mother's. Among many other functions, the placenta
is his heat exchanger and its performance may be
gauged by the fact that foetal temperature is
normally 0.5 - 1.5 degrees Celsius above maternal
core temperature. If mother runs a fever the foetus
must also. The walls of the foetal world are
probably not thermally homogenous, as thermography
shows that the areas of the maternal abdominal wall
over the placental site are several degrees hotter
than areas over the chorion laeve. Although the
range of ambient temperature to which the foetus is
exposed is limited, his awareness of and reactions
to thermal stimulation are intact before birth. If
cold saline is run into the amniotic cavity, he
shows appropriate motor and circulatory
responses.
The
foetus responds with violent movement to needle
puncture and to the intramuscular or
intraperitoneal injection of cold or hypertonic
solutions. Although we would accept, rather
selfishly, that these stimuli are painful for
adults and children and, to judge from his
behaviour, painful for the neonate, we are not
entitled, I understand, to assert that the foetus
feels pain. In this context I think Bertrand
Russell's remark in his Human Knowledge, its Scope
and Limitations, rather apt - he relates 'A
fisherman once told me that fish have neither sense
nor sensation but how he knew this he could not
tell me.' It would seem prudent to consider at
least the possibility that birth is a painful
experience for a baby. Radiological observation
shows foetal limbs flailing during contractions,
and if one attempts to reproduce in the neonate by
manual compression a mere fraction of the cranial
deformation that may occur in the course of a
single contraction the baby protests very
violently. And yet, all that has been written by
poets and lyricists about cries of newborn babies
would suggest that newborn babies cried for fun or
joie de vivre - which they never do afterwards -
and in all the discussions that have ever taken
place on pain relief in childbirth only maternal
pain has been considered. Karelitz in New York has
shown that, as judged by the strength of stimuli
required to arouse them, the first sleep of
neonates is more profound than any subsequent
sleep, and this is perhaps hardly cause for
surprise when we know that labour may represent
very prolonged stimulation and interference with
normal foetal activity cycles.
The
foetus drinks amniotic fluid in a phasic pattern
throughout pregnancy, and measurement by isotropic
techniques shows that his consumption has an
affective rate of interquartile range 15 to 40 ml
per hour in the third trimester. Now the foetus has
a much larger number and a much wider distribution
of taste buds in his oral cavity than the child or
adult, but no-one knows - or can recall - whether
the taste or flavour of amniotic fluid varies much
or if, for instance, meconium stained fluid tastes
worse than normal fluid. However, experimental
modification of the taste of amniotic fluid
produces dramatic results. Foetal drinking rates
crash after the injection of the contrast medium
Lipiodol - an iodinated poppy seed oil which tastes
foul to an adult or child and which causes a
neonate to grimace and cry. Conversely, de Snoo
(1937) claimed that saccharin stimulated foetal
swallowing, and our isotopic measurements support
this claim with usually an approximate doubling of
rate. However, some foetuses drink less after
saccharin injection and perhaps, like the author,
they find saccharin in concentration bitter rather
than sweet.
Foetal
swallowing appears the major if not the only route
of disposal of amniotic fluid colloid and hence,
especially in the second half of pregnancy, has an
increasingly important effect on amniotic fluid
homeostasis and volume. The foetus who cannot
swallow, for example with oesophageal or duodenal
atresia, has a polyhydramnios. Since foetal
swallowing powerfully influences if not regulates
amniotic fluid volume, what influences or regulates
foetal swallowing? Now the foetus gains nourishment
from amniotic fluid, for he digests the
constituents of amniotic fluid. His calorie intake
from this source may reach 40 calories per day and
the foetus who cannot swallow is 'small for dates.'
Traditionally it has been assumed that hunger is a
brand new sensation after birth, that in utero an
obliging mother and faithful placenta have supplied
baby's every need. However, the sight of babies
with gross intrauterine malnutrition makes it
rather hard to believe that every foetus lives in a
metabolic Nirvana. Could foetal hunger be the
stimulus to foetal swallowing? Rather contrary to
expectation on this hypothesis, in general, large,
well-nourished babies swallow at a high rate and
small, grossly malnourished babies at a very low
rate. We could of course suggest that the
malnourished child has passed beyond the hunger
pangs and into the state of apathy and anorexia
known from extrauterine starvation. However, the
fact that the large, well-nourished feotus has a
bulimia and the small, malnourished foetus an
anorexia accords well with endocrine evidence that
much of what has been called traditionally
placental insufficiency is in fact primarily foetal
and of hypothalamic origin.
Foetal
hiccups are common and often can be induced by
irrigating the amniotic cavity with cold solutions.
Foetal hiccups are easily recognized, and mother
should be reassured, for some have misgivings about
these episodic series of clonic movements,
especially if there is an epileptic somewhere in
the family cupboard.
The
foetus is not only experienced in swallowing, but
also in many cases in suckling. In the neurological
examination of the neonate, the 'seeking' or
'rooting' reflex is elicited by stroking the
circumoral area. The baby opens his mouth and turns
to the stimulus. This reflex is clearly the
mechanism by which baby homes on the nipple and
underlines the tremendous importance of feeding to
the neonate. Indeed his face and mouth are the only
part of his body the neonate can reliably locate in
space and the mouth remains one of the chief tools
of exploration in infancy. Since the foetus is
often lying with hands and feet in close proximity
to his face, he may readily elicit a seeking reflex
himself. Accordingly, it is not uncommon in
obstetric radiology to detect the foetus sucking
thumbs, fingers or toes, and thumbsucking has been
photographed in the 9-week abortus. Incidentally,
the common observation in neonates of clenched
fists, which would appear to preclude thumbsucking,
is not a feature of babyhood really but of high
thermal tone in muscle. Careful examination of hand
position in x-rays shows that usually the foetus
with his low thermal tone in his warm environment
has his hands relaxed and his thumbs
protruding.
Perhaps
nowhere does the notion of foetal life as a time of
quiescence, of patient and blind development of
structures in anticipation of a life and function
to begin at birth, die harder than in the concept
of the pregnant uterus as a dark and silent world.
Indeed even as great a neurophysiologist as Sir
Charles Sherrington (1951) could speak of 'the
miracle of the human eye developing in darkness for
seeing in light and the miracle of the human ear
developing in silent water for hearing in vibrant
air.' As anyone familiar with a phonendoscope
knows, a pregnant abdomen is not silent, and the
uterus and amniotic cavity, especially with any
degree of polyhydramnios, may be readily
transilluminated with a torch in a darkened room.
Given a naked abdomen in sunshine, light
intensities would be much higher. With a fibre
optic light conduit and photomultiplier, not only
can the intrauterine illumination produced by an
external tungsten or quartz iodide lamp be
recorded, but the shadow cast by the foetus is
detectible.
Now,
for activation of visual pathways, there is
strictly no threshold, for the visual rods respond
individually to single photons. Sure enough, Smith
(1965) at University College Hospital found that
flashing lights applied to the maternal abdominal
wall produced fluctuations in foetal heart rate.
However, with the high attenuation in tissue, the
abnormal spectral composition and the boring view,
what the foetus lacks is adequate illumination and
a worthwhile image for practice in cone or macular
vision. At birth he can see but does not know what
he is looking at. Confident recognition of familiar
people and reassurance from the sight alone of
mother takes some 4 to 7 months of extrauterine
life to acquire. However, before this age the baby
can be reassured by a familiar voice alone in the
dark, and we have to argue either that auditory
recognition of patterns matures more rapidly than
visual recognition, or that auditory experience
began earlier. The latter seems more likely.
Sudden
noise in a quiet room - the dropped gallipot or
maternal voice - startles the foetus lined up under
an image intensifier, and from at least 25 weeks
the foetus will jump in synchrony with the
tympanist's contribution to an orchestral
performance. By applying intermittent pure tones by
hydrophone or air microphone to the maternal
abdominal wall, foetal audiometric curves may be
constructed by recording the abrupt changes in
foetal heart rate. There is dispute among the
professionals as to sound energy levels reaching
the foetus (a given sound energy produces higher
sound pressure levels in fluid) and naturally the
state of foetal wakefulness and the maintenance of
attention span are very hit and miss. Nevertheless,
averaging of foetal electroencephalographic records
with repeated stimuli shows sound evoked cortical
potentials and demonstrates as does experience with
deaf mothers that the foetus is responsing
directly. Both habituation and conditioning - dare
we say learning? - have been noted.
With
tympanic membranes damped by fluid in both middle
and external ears, the foetus could be expected to
have a relative high-tone deafness, but higher
frequencies suffer less loss than low frequencies
in transmission through tissues and fluid.
Therefore, it is probably that with sound, unlike
light, intrauterine spectra are similar to
extrauterine. Further, it is worth nothing that,
unlike most foetal organs which start off in
miniature, the structures of the inner ear are very
nearly of adult size from initial development. This
magnitude of course is necessary because cochlear
spectral response obeys simple physical laws
dependent on cochlear dimensions. If, for instance,
the cochlea grew in proportion to the rest of the
body, babies and children would hear in a different
frequency range from adults and the communication
gap between generations would be even wider than it
is already.
However,
it is not only external sound which bombards the
foetus. The pregnant uterus or abdomen is itself a
very noisy place. The loudest sounds to reach the
foetus or an intrauterine phonocatheter are
maternal borborygmi peaking to 85 decibels.
Reaching and below 55db the content is richer in
pattern and meaning - the intermittent voice and
the all pervading bruits, pulsing in synchrony with
the maternal heart beat, of blood in the great
arteries supplying the uterus and placental bed.
Does this long exposure explain why a baby is
comforted by holding him to your chest or is lulled
to sleep by the old wives' alarm clock, or the
modern magnetic tape of a heart beat? Does this
experience explain why the tick of a grandfather
clock in a quiet study or library can be a
reassurance rather than a distraction, why people
asked to set a metronome to a rate which
'satisfies' them will usually choose a rate in the
50-90 beat per minute range - and twins show a
strong concordance in independent choice? Elias
Carnetti points out that all the drum rhythms in
the world belong to one or other of two basic
patterns - either the rapid tattoo of animal hooves
or the measured beat of a human heart. The animal
hoof pattern is easy to understand from the ritual
and sympathetic magic of hunting cultures. Yet,
interestingly, the heart beat rhythm is more
widespread in the world - even in groups like the
plains Indians who hunted the great herds of bison.
Is this rhythm deeply imprinted on human
consciousness from foetal life?
Not
only do the human eye and ear, therefore, not
develop in darkness and silence, but there is also
good reason to believe from experimental work and
comparative physiology that they would not develop
properly in those conditions anyways. As with other
foetal organs, development of structure and
development of function go hand in hand. And if the
function cannot be subserved without the
development of the structure, equally the stimulus
of the function is necessary for the proper
maturation of the structure.
The
mechanism by which a concept of sensory space
develops has long been a troublesome topic for
psychologists. However, for the amateur dabbler,
the subject has received some much-needed
simplification by the evidence that the various
sensory modalities all feed and share a common
space, and that this space in fact is the effective
motor space. This synthesis certainly has logical
simplicity to anyone who compares, say, the tunnel
vision of the jet pilot or freeway driver with the
short cone extending just a few yards ahead of the
walker on rough ground and encompassing the field
of the next few paces. Parallels in auditory
function are easily drawn. When does such a concept
of space begin? Refined experiment on the neonate
suggests that his sensory space is a little ball,
that although he may receive visual and auditory
signals from more distant sources he is not much
interested in anything outside a sphere which
extends just beyond his toes - a restriction which
very neatly corresponds to his recently vacated
home.
This
then is our picture of the foetus. He does not live
in a padded, unchanging cocoon in a state of total
sensory deprivation, but in a plastic, reactive
structure which buffers and filters, perhaps
distorts, but does not eliminate the outside world.
Nor is the foetus himself inert and stuporose, but
active and responsive.
Since
on the one hand the foetus is exposed to a variety
of stimuli, and on the other hand can sense and
respond to them, presumably we have the
prerequisites for learning of some sort. Is there
in fact any evidence or suggestion that the foetus
has learned anything in utero? Study is
understandably difficult, for not only are nature
and nurture at least as intricately entangled in
intrauterine life as in extrauterine life, but for
good measure any but the briefest observation and
tests after birth may be compromised by the high
rate of learning in the neonate. For instance,
babies who have had as few as 10 heel punctures for
blood samples in the first 72 hours after birth,
for weeks or months afterwards will promptly cry if
you thoughtlessly grasp their foot.
That
recognition by voice precedes recognition by sight
and the world preference in drum rhythms is
suggestive of foetal learning, or at least
imprinting. What of circadian rhythms? It is known
that there is not one physiological clock but
numbers of relatively independent clocks, some more
stubborn than others. Moreover, that such rhythms
are modified, if not determined, by activity cycles
rather than of cosmic origin is strongly suggested
by the evidence that the diurnal rhythms of the
inhabitants of fishing villages, living by the
tides, are lunar not solar in periodicity. In this
context, it is interesting to reconsider the claim,
at least of young parents, that the one thing that
shows the foetus is utterly stupid is that many
neonates do not seem to appreciate that night is a
time for sleep.
We
know that maternal movement and change of position
provoke foetal movement, that if we want a foetus
lying still and unsuspecting for some diagnostic or
therapeutic procedure it is necessary to have
mother lying still and comfortable for 15 to 20
minutes to allow the foetus to find a position of
comfort. Further, we must avoid last minute
palpations and auscultations. Compare these
precautions with the performance and restlessness
of many pregnant women in bed - with the leg cramps
and heartburn, the subcostal and pelvic girdle
discomfort, and for variation a trip or two to the
bathroom. The neonate could perhaps be forgiven if,
as a foetus, he had gained the impression that
night was anything but a time for rest.
A
similar cri de coeur concerns these young babies
who cussedly elect to have their briefest rest
periods and shortest intervals between feeds in the
late afternoon and at dinner time just when it
would be most helpful if they would sleep. For the
breast fed baby, a ready explanation arises from
the fact that there is a striking diurnal variation
in the fat content of human milk - from as high as
9 per cent in the early morning to as low as 1
percent in the afternoon. Hence the breast fed baby
may be shortchanged on calories on his afternoon
feeds. However, precisely the same pattern may be
seen in the bottle-fed baby, and we are left with
the suspicion that the foetus may have been
conditioned to the fact that this time of day
represents peak activity for mother and peak uproar
in many households.
A
question very commonly asked is whether maternal
emotion elation, fear, anxiety, may be
communicated to or influence the foetus. Certainly,
with monitored foetal hearts, there may be abrupt
changes in rate with sudden maternal emotions. Such
responses could be mediated indirectly by changes
in maternal arterial pressure, or directly by
substances, for instance catecholamines, which
cross the placenta. It has been argued that since
the foetus experiences only the consequences and
not the cause of the emotion itself the experience
would mean nothing to him. More recently this view
has been challenged on the evidence that the
pharmacological induction of the physiological
responses to fear and anxiety induces the sensation
of fear and anxiety also but this may be
just a learned response.
It
is apparent that many more questions may be asked
but as yet few answers given. What I have tried to
do is to provide a background, so that by asking
the right questions in the right way we might some
time get the right answers. We may not all live to
grow old but we were each once a feotus ourselves.
As such we had some engaging qualities which
unfortunately we lost as we grew older. We were
physically and physiologically robust. We were
supple and not obese. Our most depraved vice was
thumbsucking, and the worst consequence of drinking
liquor was hiccups not alcoholism.
When
our cords were cut, we were not severed from our
mothers but from our own organs - our placentae -
which were appropriate to our old environment but
unnecessary in our new one. We do not regard the
foetal circulatory system, different as it is from
the child's or adult's, as one big heap of
congenital defects but as a system superbly adapted
to his circumstances. We no longer regard foetal
and neonatal renal function, asymmetric as it is by
adult standards, as inferior, but rather entirely
appropriate to the osmometric conditions in which
it has to work. It is too much to ask therefore
that perhaps we should accord also to foetal
personality and behaviour, rudimentary as they may
appear by adult standards, the same consideration
and respect?
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References
de
Snoo, K.: Das trinkende Kind im
Uterus. Mschr. Geburt. Gynak. 105: 88
(1937).
Karelitz, S.: Personal
communication.
Serrington, C.: Man on his Nature, 2nd
Edition (Cambridge University Press,
Cambridge 1951).
Smyth, C. N.: Experimental methods for
testing the integrity of the foetus and
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