07febblog

November 18, 2006

Letter-to-the-Editor submission on:
ACOG Committee Opinion No. 348: Umbilical Cord Blood Gas and Acid-Base
Analysis.

To the Editor:

I have concerns about ACOG Opinion 348. The technique indicates the umbilical
cord should be clamped immediately after delivery. Not all infants breathe
immediately at birth [1, 2]. With placental respiration no longer available, outcome
will depend upon how quickly pulmonary respiration can be established.

Hemoglobin receives oxygen in exchange for carbon dioxide, in the lungs or
placenta. Until blood is transferred into the capillary system supplying the alveoli,
gas exchange cannot take place in the lungs [3]. Traditional textbooks taught that
pulmonary function should be established before clamping the cord. See
http://www.conradsimon.org/VI-References.shtml#TextbookQuotes for how opinion
has changed over the decades.

Hypoxia during late gestation was shown (in experiments with monkeys) to produce
the neuropathology underlying cerebral palsy [4]. The brainstem pattern of damage
caused by total asphyxia after birth was confirmed in the same experiments. The
auditory pathway was most prominently involved. Even minimal impairment of the
auditory system may interfere with language development.

Statistics on respiratory depression at birth are similar to those for increased
prevalence of autism. Delay in establishing respiration is associated with autism, as
are signs of newborn encephalopathy [5, 6].

Could a sample of cord blood, or blood from the newborn, be obtained without
irreversibly clamping off continuing circulation to the placenta after birth?

Eileen Nicole Simon, PhD, RN
Conrad Simon Memorial Research Initiative,
www.conradsimon.org
11 Hayes Avenue
Lexington , Massachusetts

REFERENCES

1. Baskett TF, Allen VM, O'Connell CM, Allen AC. Predictors of respiratory depression at birth in the
term infant. BJOG. 2006 Jul;113(7):769-74.

2. Milsom I, Ladfors L, Thiringer K, Niklasson A, Odeback A, Thornberg E. Influence of maternal,
obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban
population. Acta Obstet Gynecol Scand. 2002 Oct;81(10):909-17.

3. Mercer JS, Skovgaard RL, Peareara-Eaves J, Bowman TA. Nuchal cord management and
nurse-midwifery practice.J Midwifery Womens Health. 2005 Sep-Oct;50(5):373-9.

4. Myers RE. Two patterns of perinatal brain damage and their conditions of occurrence.
Am J Obstet Gynecol. 1972 Jan 15;112(2):246-76.

5. Glasson EJ, Bower C, Petterson B, de Klerk N, Chaney G, Hallmayer JF. Perinatal factors and
the development of autism: a population study. Arch Gen Psychiatry. 2004 Jun;61(6):618-27.

6. Badawi N, Dixon G, Felix JF, Keogh JM, Petterson B, Stanley FJ, Kurinczuk JJ. Autism following
a history of newborn encephalopathy: more than a coincidence? Dev Med Child Neurol. 2006
Feb;48(2):85-9.

11 Feb 2007 -
Language disorder and auditory system damage caused by asphyxia at birth
In 1967, my son Conrad's nursery school teacher suggested that I have him evaluated
for autism. I had never heard of autism. Among some of the things I read back then, I
found the remark that autism is a "wastebasket" diagnosis. I disagree. The language
disorder is distinctive, characterized by echolalic speech and "delayed echolalia."
Kanner referred to the speech of the children he first reported as "metaphorical and
irrelevant."

The speech of children with autism is "metaphorical" because it consists of phrase
fragments that at best are tangential to context. "Put your coat on," meant "I want to go
out" to Conrad, even in the heat of summer. Use of phrase fragments is irrelevant when
they seem to be recited for no reason at all. "All the king's horses and all the king's men
couldn't put poor Humpty Dumpty together again," seemed irrelevant, but was Conrad's
way of expressing sadness.

An article on asphyxia at birth, by William Windle in the October 1969 issue of Scientific
American, showed big ugly holes in the midbrain auditory pathway of monkeys subjected
to suffocation at birth. That for me was the answer to why Conrad's speech development
had been so strange. He wasn't detecting words in the speech around him, just the
sound envelope (or phrase). He did pick up meaning and emotional nuance, but you
had to know Conrad well to understand that he did try to make pragmatic use of what
speech he had.

Conrad had a traumatic birth, and only after several minutes of resuscitation, did he
finally emit a weak cry. He was sent home with me as a "well baby," but he had loud
sometimes strained breathing, especially while asleep, which I was told was due to a
"collapsing trachea." I was up much of the night during his first year, and feel quite sure
he could have succumbed to sudden-infant-death.

Many children with autism suffered complications at birth. None of the research papers
that report statistics on this make more than passing mention of the brain. My letters to
the editors in response to these articles have mostly been rejected. I will post some of
these in this blog as I go along.

The brain damage caused by oxygen deprivation at birth needs to be more widely
recognized. I have tried by many means to get responses from the professional experts,
who time after time claim that birth complications are not the cause of autism. Rather,
they claim, autism causes the complications. This to me is absurd, and needs to be
challenged.

I posted my "viewpoint" on the brain disorder in autism on http://conradsimon.org in April
2000. I have received many responses, from all over the world. Among these I learned
about the obstetric protocol that mandates clamping the umbilical cord as soon after birth
as possible, with no stipulation that the infant must be breathing first. I am sure that most
obstetricians and midwives do wait for the first breath, but some may not, and this is
dangerous. Thus for this update of my "viewpoint," I decided that "evidence of error"
would be a more suitable titile.

David Kirby's book, Evidence of Harm, has gained wide acclaim among parents who feel
that vaccinations caused their child's autism. Oxygen insufficiency at birth impairs the
blood-brain-barrier (BBB), as described in the articles by Ranck & Windle (1959) and
Lucey et al. (1964). Then mercury, bilirubin, or any other toxic substance can get into
the neurons. I discussed this on the web when I posted my first "viewpoint" in April 2000.

Administering the Hep B vaccine in the newborn nursery does not sound reasonable, and
could cause harm, especially in babies already compromised by anoxia. I am now quite
angry, and believe most of us are unknowing victims of a grave medical error in the
delivery room. How many women are told about umbilical cord clamping? What is the
evidence that has led to this becoming a standard practice? Why are the neonatologists
ignoring the evidence that has so long been available of how the brain is damaged by a
lapse in respiration at birth?

13 Feb 2007 -
The inferior colliculus, loss of speech understanding following bilateral injury
I believe the whole world should come to know the importance of the inferior colliculus -
as much as everyone knows how important the spinal cord is for control of body
movements, or the importance of autonomic control of respiration and heart-rate in the
brainstem, or that of Broca's area in the frontal cortex for expressive language, and
Wernicke's area in the temporal lobe for language comprehension.

A most dramatic revelation of how important the inferior colliculi are has come from
reports of MRI findings of injury to the inferior colliculi in people who have lost the ability
to comprehend spoken language. I check in PubMed almost daily with keyword "inferior
colliculus," and had found the three reports of Meyer et al. (1996), Johkura et al. (1998),
and Masude et al. (2000). Then in December 2004, I found the report by Pan et al, who
cited two additional reports and presented the case of their own patient.

I, of course, immediately wrote a letter to the editor of the journal, Neurology, and pointed
out the long forgotten research in which damage of the inferior colliculi was the most
prominent result of subjecting monkeys to asphyxia (really suffocation) at birth. My letter
with a response from the authors was posted on-line in March 2005 at:
http://www.neurology.org/cgi/eletters/63/12/2387. It appeared in print in July in
Neurology, 2005 Jul 26;65(2):339.

Meanwhile, I was so excited and anxious for the chance to engage in discussion with
other people, I signed up for a course in the spring of 2005 - at Harvard Extension School
of course. The course was Cognitive Neuroscience, which I picked because of its
emphasis on using functional MRI (fMRI) to look for activity in the brain in response to
various environmental stimuli. The course, taught by Harvard professor Yuhong Jiang,
involved an assignment to present a research proposal to the rest of the class. My
proposal is now also online at http://www.inferiorcolliculus.org/presentation.html. I have
contacted several research groups in the Boston area, and received a few polite replies,
but no offers to join them and get to work.

I still believe the day will come when everyone will know how very important the inferior
colliculi in the midbrain auditory pathway are.

12 Feb 2007 -
Sixteen hours at work, at the MA state hospital for mentally ill prison inmates
For a little over 15 years I have worked at the Massachusetts State Hospital for mentally
ill prison inmates. Monday was one of those days I worked a "double" (16 hours).
Morning shift I worked on the unit where I worked full-time for several years as a Mental
Health Worker. At morning rounds I learned that arrangements were being made for
discharge of one of our patients to a Department of Mental Health (DMH) hospital. He
has long resisted such a move, fearing possible loss of control over sudden rage, which
preceded his having murdered a family member. Most of our patients are at the center
of horrible family tragedies. Patricide, matricide, and fratricide are crimes frequently
found in patient records.

Most people (99.9999 percent, or some such approximation) by instinct would stop
before taking another person's life. It is the other 0.0001 (approximate) percent that
present a problem for families and society as a whole. I feel better about the discharge
plans for the patient above, because of his own clear concerns over losing control.
Some of our patients continue to confabulate for years after their crime about "reasons"
for their rage reaction. In fact, uncontrollable rage seems to me often in the same
category as an epileptic attack. Many of our patients suffer from seizure disorders,
clearly an impairment for any hope of a normal life. I should look into the statistics for
epileptic disorders. Somehow I sense that, like autism, there may be an increased
prevalence lately.

Second shift I worked in the Intensive Treatment Unit (ITU), where patients are closely
monitored following loss of control and assault on others, or following self-injury, which
is often a desperate cry for help. This is a fairly social unit. Patients talking back and
forth between rooms, correctional officers chatting about football and other male
interests, and nurses and mental health workers discussing concerns often mostly
about family issues. Is it because many of us have problems within our own families that
we work at a state hospital? I don't know, but most of us have worked there many
years, and often return after trying employment elsewhere.

More later on working with the mentally ill in corrections, and the autism spectrum in
corrections.

Blog Focus:

What is the primary reason for the increased prevalence of autism? What
specific impairment in the brain results in the characteristic language
disorder? Other relevant but sometimes randomly interspersed topics.

Developmental language disorder is the most serious handicap for children with
autism. A brief lapse in respiration at birth can cause damage in the midbrain auditory
pathway, and disrupt maturation of the language areas of the developing cerebral
cortex. Complications at birth have long been noted as part of the background of
children who later become autistic.

A break with tradition since the 1980s in obstetric practice mandates clamping the
umbilical cord immediately at birth, without mention of whether the infant is yet
breathing. Most obstetricians and midwives would appear to instinctively wait for the
first breath before clamping the cord. However, concerns over "respiratory
depression" at birth suggest that the new protocol may be too often adhered to without
regard for whether respiration has been taken over by the newborn's lungs.

The American College of Obstetrics and Gynecology (ACOG) needs to modify the
current protocol. Infants who do not breath immediately at birth are among those for
whom concerns of "respiratory depression" have been voiced. The statistics for
"respiratory depression" and current prevalence of autism are too similar for comfort.

Autism appears to be on the increase. Damage in the auditory pathway must be
considered as possibly responsible for the language disorder of children with autism.
Lack of oxygen at birth, because of its specific effect on the brain, should be a major
focus of research.

To date, birth complications have been dismissed as the result rather than cause of
autism, with at best some passing mention of dopamine or other non-specific
hypothetical problem within the brain. This is an outrage, and will be a major focus of
this autism blog.

15 Feb 2007 -
Letter comparing statistics for "respiratory depression" & autism prevalence
Below is a letter I wrote to the British Journal of Obstetrics and Gynecology (BJOG)
on the article by Baskett et al comparing statistics on "respiratory depression" at birth
with those for prevalence of autism. The letter was (in true British style) politely
rejected - I might post the rejection at some point. All rejections hurt. Following the
letter-to-the-editor is the email message I sent to earlier to the lead author. I did not
receive a reply. Here once more was my effort to engage in discussion, preceded by
the required cover-letter for this journal:

November 1, 2006
Editor-in-Chief
BJOG

Dear Editor,

I am submitting the attached letter in response to the article by TF Baskett et al.
Predictors of respiratory depression at birth in the term infant. BJOG. 2006
Jul;113(7):769-74.

The statistics they present are of possible interest in their similarity to statistics on the
recent increased prevalence of autism. Autism is associated with low Apgar scores
and lapse in respiration in many cases, although autism is associated with many
etiological factors.

The effect of all etiologic factors associated with autism on a common system in the
brain needs clarification. Ischemic damage of nuclei of the brainstem auditory system
was long ago reported by RE Myers, who inflicted catastrophic asphyxia on newborn
monkeys. Other etiological factors may affect the same brainstem nuclei, which have
the highest blood-flow and metabolism in the brain (space did not allow discussing
this in a short letter).

Immediate clamping of the umbilical cord is a recent protocol that spans the same
time period as the increased incidence of autism. I hope I have pointed out in my
letter that evidence of a substantial number of term newborns who do not breathe
immediately at birth is important to consider in patient care. A return to the tradition
of waiting for the first breath before clamping the cord should be given thoughtful
consideration.

Sincerely,
Eileen Nicole Simon, PhD, RN
11 Hayes Avenue
Lexington, MA 02420-3521
USA
Eileen4brainresearch@yahoo.com
--
Letter in response to the article by Baskett TF, Allen VM, O'Connell CM, Allen AC.
Predictors of respiratory depression at birth in the term infant. BJOG. 2006
Jul;113(7):769-74.

Baskett et al., in their paper on respiratory depression at birth, reported a delay of up
to 3 minutes in initiating and maintaining respiration in 5.2 per 1000 infants after birth
[1]. Infants with an Apgar score less than 3 at 5 minutes numbered 1 per 1000, and
neonatal seizures occurred in 0.7 per 1000. Infants with at least one of the three
measures yielded a composite outcome of 6.2 per 1000.

These statistics closely resemble those for the increasing prevalence of autism. For
example, the CDC website (www.cdc.gov/ncbddd/autism/), provides prevalence rates
for autism spectrum disorders (ASDs) between 2 and 6 per 1,000 individuals. Putting
it another way, they state that between 1 in 500 (2/1000) to 1 in 166 (6/1000)
children have an ASD. Lately, the 1 in 166 figure is quoted often.

Autism is associated with several medical conditions such as prenatal exposure to
alcohol or other drugs, prenatal infections, tuberous sclerosis, fragile X syndrome,
and other genetic metabolic disorders. However, in PubMed, a search using terms
such as autism & "obstetric complications" yields several citations. Glasson et al. in
2004 identified infants who later developed autism "were more likely to have taken
more than 1 minute before the onset of spontaneous respiration" [2, pp 621-622].

An important goal for autism research will be to investigate the final common pathway
in the brain, susceptible to damage from all etiologic factors. A lapse in respiration at
birth has been shown to have variable and unpredictable effects. However, Myers
(1972) demonstrated, in newborn monkeys, that catastrophic total interruption of
respiration resulted in ischemic damage of the brainstem auditory pathway. He also
demonstrated that a period of chronic partial oxygen insufficiency leads to the more
widespread pattern of neuropathology usually associated with cerebral palsy.

Involvement of brainstem auditory nuclei is an important piece of evidence. Human
children learn to speak "by ear," which requires intact transmission of acoustic
information. Analysis of acoustic signals also takes place within the brainstem nuclei,
and normal development of the language areas of the cortex depends upon trophic
neurotransmitters produced in nuclei of the brainstem auditory pathway. Papers on
these subjects can be found in PubMed using keyword "inferior colliculus," the
auditory nucleus most susceptible to damage.

Baskett et al. noted that after 1996, umbilical artery pH was measured for depressed
infants, which would imply that the modern protocol for clamping the umbilical cord
within seconds following birth was followed. Most infants breathe immediately at birth.
The importance of Baskett et al.'s research is that it provides evidence that a
substantial number may need continuing circulation from the placenta for several
minutes after birth.

Evidence-based medicine must include appropriate care for patients outside
statistical norms. Until the mid-1980s, textbooks of obstetrics taught that the umbilical
cord should not be tied or clamped until the newborn infant was breathing on its own.
A return to this tradition seems warranted.

1. Baskett TF, Allen VM, O'Connell CM, Allen AC. Predictors of respiratory
depression at birth in the term infant. BJOG. 2006 Jul;113(7):769-74.

2. Glasson EJ, Bower C, Petterson B, de Klerk N, Chaney G, Hallmayer JF. Perinatal
factors and the development of autism: a population study. Arch Gen Psychiatry.
2004 Jun;61(6):618-27.

3. Myers RE Two patterns of perinatal brain damage and their conditions of
occurrence. Am J Obstet Gynecol 1972 Jan 15;112(2):246-76.
--
Following is the email message I sent directly to the lead author:
Dear Dr. Baskett,

I just found your article on predictors of respiratory depression at birth. It is too late
to submit a letter-to-the editor, which is why I am contacting you personally.

You discuss umbilical artery pH, and I assume this is part of the protocol described by
Turrentine (Clinical Protocols in Obstetrics, 2003). Current practice now seems to
include clamping the umbilical cord within seconds after birth, whether or not the
infant has begun breathing on its own. Shouldn't this be considered dangerous?
Wouldn't allowing placental respiration to continue protect the infant who does not
breathe right away?

My son, whose story I have told at the link below, needed resuscitation at birth. He
appeared to develop normally at first, but his language development was highly
unusual, which earned him a diagnosis of autism around the age of 3. My reading on
the effects of asphyxia led me to the papers by Windle (1969) and Myers (1972), and
their descriptions of auditory system damage seem like a likely cause of the kind of
developmental language disorder my son had.

Your statistics of 5.2 to 6.2 per 1000 infants with respiratory depression at birth is
quite close to the 1 in 166 children now estimated to have autism. Autism used to be
only about 3 per 10,000. It seems possible to me that the current "epidemic" of
autism might represent those infants who did not breathe right away at birth.

Also, autism afflicts males more often than females in a 4:1 ratio. Did you record
gender of the infants who suffered respiratory depression?

I recently posted a response to an article in the BMJ on umbilical cord blood banking,
in with my views, and some references. It is at
http://bmj.bmjjournals.com/cgi/eletters/333/7572/801#144295

I do hope to hear from you.

Eileen Nicole Simon
Conrad Simon Memorial Research Initiative
To seek understanding of brain system impairments in autism.
http://conradsimon.org/

17 Feb 2007 - Milieu research
I worked today on one of our long-term units - lots of medications to get ready for
more than 50 men before 7:30am, psych meds, GI meds, inhalers for asthma, insulin
and oral hypoglycemic meds. They blame the increase of diabetes (or metabolic
syndrome) on the psych meds, but I'm not so sure. GI, lung, pancreatic dysfunction,
etc can be part of the multi-organ dysfunction that also accompanies hypoxic-
ischemic encephalopathy at birth. The roots of mental illness have long been sought
in childhood. They should also be sought as outcomes of pre- and perinatal
problems.

Victims of prenatal exposure to alcohol and other drugs of abuse are often easily
identified by cranio-facial features and small stature. These are not the norm in our
hospital. Many of our patients were poly-substance abusers themselves, which lead
to liver and GI damage, but many blame substance use on "self-medication" to quiet
"voices" and anxiety.

Weekends, the patient charts are not wheeled out to the treatment team room, but
remain in the nursing trap, and toward the end of my shift I sometimes have time to
peruse them. I become aware of perpetrators of violence and homicides in Boston,
murder in a VA hospital, murder of police officers, and of family members. Many
were briefly front-page news, with mothers and other family members speaking out
about how difficult it was to get recognition and treatment for their son's mental
illness.

One of my sons has said, "Mom, you seem drawn to looking at life's dark underbelly."
Really, I would like to better understand and work toward prevention of these tragic
catastrophes.

19 Feb 2007 - Abstract accepted for IMFAR:
Autism Prevalence and Respiratory Depression at Birth
IMFAR (the International Meeting for Autism Research) will be held May 3-5 in
Seattle, and I plan to attend. My abstract was accepted for a poster presentation,
which makes up for (somewhat) the rejection of my letter to BJOG (entry above on
Feb 15).

The effect on the brain of a brief episode of oxygen deficiency will be my focus. The
ugly holes in the midbrain auditory pathway, produced in monkeys by experimental
asphyxia at birth, and reported many times in human infants who died shortly after
birth.

Impairment of function in the brainstem auditory pathway can be expected to:

Prevent normal development of speech, and
Lead to abnormal maturation of the language areas of the cerebral cortex.

Respiratory depression at birth may be the result of a genetic predisposition, but the
effect on the brain is what I believe is responsible for the developmental language
disorder of children with autism.

The monkeys subjected to asphyxia at birth had no genetic predisposition for the
damage found in the auditory pathway.

The solution would seem to me, to wait for transfer of respiration from the placenta to
the lungs, which can take half an hour or more after birth. The lungs can take over
only after sufficient blood has been transferred into the capillaries surrounding the
alveoli. Respiration depends upon exchange of carbon dioxide for oxygen by the
hemoglobin molecule. Respiration is a chemical reaction with hemoglobin.
Hemoglobin is carried in the red blood cells, which must be transported into the
previously unfilled capillaries of the alveoli before oxygen can be received in
exchange for carbon dioxide in the newly functional lungs.

I will plan to put my poster online, as I did for the Fetal and Neonatal Physiological
Society (FNPS) meeting last September (at http://www.inferiorcolliculus.org/fnps.html).

20 Feb 2007 - Bibliography update
Found this article in PubMed this morning:

Ultee K, Swart J, van der Deure H, Lasham C, van Baar A. Delayed cord clamping in

preterm infants delivered at 34 to 36 weeks gestation: A randomized controlled trial. Arch

Dis Child Fetal Neonatal Ed. 2007 Feb 16; [Epub ahead of print]

These authors in their abstract conclude, "Immediate clamping of the umbilical cord
should be discouraged."

The obstetric profession will hopefully soon return to the tradition of waiting at least
for the first breath. Meanwhile the lives of too many children have been ruined at the
outset.

I was on my way to the library, where I was able to access the full text, which I am now
studying, and have emailed to friends who are working to change the current cord
clamping protocol. I was also able to obtain:

Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T, Takahashi S, Harada K.

Umbilical cord milking reduces the need for red cell transfusions and improves neonatal

adaptation in infants born less than 29 weeks' gestation: a randomized controlled trial.

Arch Dis Child Fetal Neonatal Ed. 2007 Jan 29; [Epub ahead of print]

I work with a nurse trained in the Philipines who told me they were taught to always
milk the cord at every birth.

Three more:

Gonzalez FF, Miller SP. Does perinatal asphyxia impair cognitive function without cerebral
palsy? Arch Dis Child Fetal Neonatal Ed. 2006 Nov;91(6):F454-9.
Lindstrom K, Lagerroos P, Gillberg C, Fernell E. Teenage outcome after being born at term
with moderate neonatal encephalopathy. Pediatr Neurol. 2006 Oct;35(4):268-74.
Hippler K, Klicpera C. A retrospective analysis of the clinical case records of 'autistic
psychopaths' diagnosed by Hans Asperger and his team at the University Children's
Hospital, Vienna. Philos Trans R Soc Lond B Biol Sci. 2003 Feb 28;358(1430):291-301.

Autism, Asperger syndrome, and cerebral palsy are on a spectrum, which I have tried
to explain before (see http://www.conradsimon.org/Hemoglobin.shtml). I will keep
trying. Brain damage caused by catastrophic total asphyxia or suffocation involves
the brainstem nuclei of high metabolic rate. These same nuclei are spared under
conditions of hypoxia, or partial respiratory insufficiency. Hemoglobin is the molecule
that mediates the chemical exchange of oxygen for carbon dioxide in all body tissues,
except for the lungs (or placenta during fetal life), where carbon dioxide is exchanged
for oxygen. Eyes glaze over? I will keep trying. This is so interesting, and important.

21 Feb 2007 - William Harvey, 1578-1657

William Harvey, through dissection of cold- and warm-blooded animals, described
circulation of blood by the pumping action of the heart [1, 2]. He concluded:

t is absolutely necessary to conclude that the blood is in a state of

ceaseless

motion; that this the act or function which the heart performs by

means of its pulse;

and that is the sole and only end of the motion and

contraction of the heart."

This description predated the discovery of oxygen by more than a century [3]. In his
investigations into the origins of life and fetal development, Harvey further pointed
out the meaning and importance of pulsations of the umbilical cord:

"Moreover, it is a sure way to know whether the Infant that sticketh in the

birth be

alive, or not, by the pulsation of the Vmbilical Arteries. But most

certain it is, that

those Arteries are not moved by the virtue or operation of

the Mothers, but of his

own proper Heart: For they keep a distinct time and

pawze, from the Mothers pulse:

which is easily experimented, if you lay one

hand upon the Mothers wrest, and the

other on the Infants Navel-string.

Nay in a Casarean Section, when the Embryo's

have been yet involved in

the membrane called Chorion, I have oftentimes found

(even when the

Mother was extinct, and stiffe almost with cold) the Vmbilical Arteries

beating, and the Foetus himself lusty."

References:

Harvey, William. Anatomical exercitations concerning the generation of living
creatures to which are added particular discourses of births and of
conceptions, &c.London : Printed by James Young, for Octavian Pulleyn, and
are to be sold at his shop at the sign of the Rose in St. Pauls Church-yard,
1653. From Early English Books Online, http://eebo.chadwyck.com/
Khan IA, Daya SK, Gowda RM. Evolution of the theory of circulation. Int J
Cardiol. 2005 Feb 28;98(3):519-21. (Abstract in PubMed)
Harken AH. Oxygen, politics and the American Revolution (with a note on the
bicentennial of phlogiston). Ann Surg. 1976 Nov;184(5):645-50.

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1345500&blobtype=pdf