The absorbing power of the umbilical vein continues till the fifth month; during the second or third, the fœtus receives a good deal of nourishment from the liquor amnii, which at this period contains a considerable quantity of albuminous matter; this diminishes in the latter months of pregnancy. Moreover the body of the fœtus begins to be covered with the vernix caseosa towards the seventh month, so that in the eighth and ninth months the absorption of liquor amnii by the skin is considerably impeded.
How far the full formed placenta, as seen after the fifth month, serves as a means of nutrition to the fœtus, may still be a matter of doubt; its chief use after this period is, as we have already shown, for the purpose of producing certain changes in the blood of the fœtus analogous to those of respiration;[29] still, however, it would seem that its function of nutrition is not entirely at an end, even at a late period of pregnancy. The numerous little granules of phosphate of lime, which are frequently found on the uterine surface of a full-grown placenta at a time when ossification is rapidly advancing in the fœtal skeleton, would surely lead us to infer that the placenta in some way or other supplies the materials for this process.
Fœtal circulation. We have already shown, that, in the early stages of development, the heart of the embryo is single, consisting of one auricle and one ventricle; that a septum gradually divides these into two parts until the double heart is formed, leaving two openings of communication between the right and left sides, the one between the auricles called the foramen ovale, the other between the pulmonary artery and aorta, viz. the ductus arteriosus.
From these and other peculiarities it will be seen that the fœtal circulation differs essentially from that of a child after birth; and, in order to comprehend the nature and mechanism of the changes which take place in it when respiration first commences, it will be necessary that these peculiarities should be thoroughly understood. The condition of the fœtus must also be remembered: surrounded by the liquor amnii, the fœtus does not respire; its lungs have as yet been unemployed; they are therefore small and collapsed, and present a firm solid mass, nearly resembling liver in appearance. In this state but little blood from the pulmonary arteries can circulate through them; for, as the extreme ramifications of these vessels are distributed upon the mucous membrane lining the bronchi and air-cells, the free passage of blood through them will in great measure depend upon a previous condition of the air-cells. The pulmonary arteries in the fœtal state are therefore small, and transmit but a small quantity of blood into their numerous ramifications, just sufficient to keep pervious these vessels which after birth are to be so greatly distended: in this state the lungs when thrown into water sink.
Hence, as the pulmonary arteries do not afford a sufficiently free exit to the contents of the right side of the fœtal heart, nature has provided it with a peculiar means for carrying off the overplus quantity of blood, which is poured into the right auricle from the vena cava. This is attained first by the foramen ovale, an oval-shaped opening in the septum between the right and left auricles, and furnished with a semilunar valvular flap, so constructed, as to allow a free passage for the blood from the right to the left auricle, but none in the contrary direction. By this means a considerable quantity of blood is transmitted at once from the right to the left auricle, and, consequently, much less into the right ventricle and pulmonary artery. Still, however, more blood passes into the right ventricle than the pulmonary artery, in the collapsed state of the fœtal lungs, is capable of conveying away. The pulmonary artery is therefore continued beyond its bifurcation into the aorta at its curvature, by means of the ductus arteriosus, which, in the full-grown fœtus, forms a short thick passage between these two vessels; and in this manner is the right ventricle enabled to get rid of its surplus quantity of blood. Thus we see that the fœtal heart although consisting of two auricles and two ventricles, continues to perform the functions only of a single heart, both ventricles assisting simultaneously to propel the same column of blood, viz. that of the aorta, and thus enabling the heart to act with considerable power.
The chief part of the blood, which flows through the iliac arteries, instead of being sent to the inferior extremities, is carried into the umbilical arteries, which passing up along the sides of the bladder meet the umbilical vein at the navel, and thus form the vessels of the umbilical cord. These arteries convey the blood of the fœtus to the placenta, where, having undergone changes to which we have already alluded, it is returned by the umbilical vein. This vessel, which afterwards forms the round ligament of the liver, passes through the umbilicus along the anterior edge of the suspensory ligament; it supplies the left lobe with blood, and having given off a communicating branch to the vena portæ, which supplies the right lobe, it passes at once by a short passage, called canalis venosus, into the vena cava.
Thus, then, the peculiarities of the fœtal circulation may be considered as four, viz. the foramen ovale, or passage from the right to the left auricle; the ductus arteriosus, or communication from the bifurcation of the pulmonary artery into the arch of the aorta; the umbilical arteries arising from the iliac arteries, and carrying the blood along the cord into the placenta; and, lastly, the canalis venosus, or passage between the umbilical vein and vena cava.
Let us now examine the changes which take place in the fœtal circulation at the moment of the child’s birth. The child, which had hitherto been immersed in the bland and warm medium of the liquor amnii, is at once exposed to the action of the external air. By means of the sympathy existing between the skin and respiratory muscles, sudden and convulsive efforts at inspiration take place; the air-cells of the lungs become partially inflated, and, after a short time as the respiration increases in power and activity, become distended throughout their whole extent. The thorax rises; the flaccid diaphragm, which hitherto had been pushed up by the large fœtal liver, now contracts, pressing down the liver into its natural situation. The lungs, from being a hard solid heavy substance, resembling liver, at once become inflated, elastic, and crepitous, light and permeable to air in every part.
The capillary terminations of the pulmonary artery, which ramify in the mucous membrane, forming the parietes of the air-cells, and which hitherto had been firmly compressed by the collapsed state of the fœtal lungs, are suddenly rendered pervious throughout their whole extent. By this means, a vacuum, as it were, is formed in the ramifications of the pulmonary artery; each inspiration is accompanied by a rush of blood from the right ventricle into the newly-inflated structure. The pulmonary artery, at its bifurcation, swells and becomes turgid: the blood is carried off into its numerous ramifications as fast as the right ventricle can supply it; this may be easily understood from the law, in anatomy, viz. that the area of two arteries is greater than that of the trunk from which they bifurcate. From this state of distension, the distance between the pulmonary artery and the aorta is increased; the ductus arteriosus, which has now become empty, is stretched, and thus partially closed; the right auricle, which, but for the foramen ovale, could not have cleared itself of the whole quantity of blood which was poured into it from the vena cava, is now enabled to transmit its entire contents into the right ventricle; the left auricle, which before birth was supplied only by the foramen ovale from the right auricle, is now rapidly filled by the blood brought into it by the four pulmonary veins;—the equilibrium between the two auricles becomes altered;—the right, which hitherto had been somewhat gorged with blood, is now able to clear itself with facility; whereas, the left, which was but partially supplied, is now distended with a much greater quantity: there is now rather a disposition for the blood to regurgitate from the left to the right auricle; this, however, is prevented by the semilunar fold of the foramen ovale, which now acts as a valve, and generally becomes firmly attached to the septum. The obliteration of the canalis venosus at the posterior margin of the liver, and of the umbilical vein at the anterior edge, may, we think, be explained by the changes which necessarily follow the inflation of the lungs: the diaphragm, when it contracts, pulls down the liver into its natural situation; the distance, therefore, between the liver and the heart is increased, and the canalis venosus is consequently stretched, and considerably pressed upon, and precisely the same results follow with the umbilical vein.