Images, science, and rights of the early modern fetus

Abstract

How do we define the beginnings of human life? Images, science, and culture have offered insight into this question. The early modern period (1500–1800) is particularly rich for examining the understanding of the human fetus. Using the 1712 Essay on the Possibility and Probability of a Child’s Being Born Alive, and Live, in the Latter End of the Fifth Solar, or in the Beginning of the Sixth Lunar Month, this paper argues that evolving knowledge of the fetus failed to modify cultural norms for defining the beginning of human life. This compares with contemporary 21st century observations and how our definition of the beginning of human life has not been modified.

Thus we are men, and we know not how; there is something in us that can be without us, and will be after us; though it is strange that it hath no history what it was before us, nor cannot tell how it entered in us.—Sir Thomas Browne, Religio Medici¹

As Sir Thomas Browne suggests, we know not how or when that spark of humanity, the soul, enters into us. The definition of what constitutes the beginning and end of human life poses an evolving problem as the science of biology advances. How does ensoulment relate to the biological beginning of human life? Even as the understanding of the biology of conception/fertilization has progressed, science has served only to inform what constitutes the beginning of human life.² The definition is in fact culturally determined. Nevertheless, as science progresses and the possibility of creating life from cloned cells or even preserved DNA occurs, how will culture look upon this potential for life, and what effect will that have on the cultural determinants of the definition of the beginning of human life?

The early modern period from 1500 to 1800 offers a particularly rich period to examine the understanding of the human fetus through new images and evolving science of the fetus during the latter part of that period. Did those new images and that new scientific understanding of the fetus alter cultural concepts of the beginning of human life? This was also an era of new and innovative thought promoted by the great philosophers Erasmus (1469–1536), Descartes (1596–1650), Hobbes (1588–1679), Locke (1632–1704), and Kant (1724–1804). A key figure during this period was Sir Thomas Browne (1605–1682).³

Browne was born in London in 1605. A graduate of Oxford, he studied medicine at Padua and Montpellier and completed his medical studies at Leiden in 1633. He returned to practice in Norwich, England, until his death in 1682. Browne was a polymath, delving into diverse fields of science, medicine, and religion. He wrote some of the richest prose in the English language and reflected on the meanings of life and religion in his famous book, Religio Medici. In the 17th century, Browne pondered the question posed in the opening of this paper on the understanding and definition of when “human life” begins.

THE CASE

David Dickson, a physician in Edinburgh, Scotland, and member of the Royal Academy of Physicians and Surgeons of Edinburgh, argued in his 1712 Essay⁴ in defense of a natural explanation for the birth and survival of the child of a Mr. Elder and his wife at approximately 24 weeks’ gestation. The church contended that it was impossible for a child born this early to survive, thus placing the couple under suspicion of out-of-wedlock conjugal relations because they had been married for only 6 months. Mr. Elder, as a member of the clergy, faced expulsion from the church. Dickson argued that “from the first conception in their mother’s womb [infants] are alive and increase in activity, till at length their motion is perceptible by the Mothers.” To defend his position, Dickson used arguments based on the science of the times, in which he was obviously well versed.

From a contemporary scientific standpoint, it is more likely that this infant was further along in gestation than 24 weeks and was growth retarded, as the likelihood of survival of an infant this premature in 1700 is questionable given the immaturity of the respiratory system. Nevertheless, this Essay provides an entry point to review the imaging and biological understanding of the fetus and the cultural/religious rights ascribed to it during the early modern period, with particular emphasis on the period from 1600 to 1800.

THE IMAGES

The images available to the lay public, midwives, and physicians during the early modern period were symbolic. Rebecca Whitely noted that these “images were immensely popular in midwifery and surgical books in Europe in the 16th and 17th century and even widely read by the lay public.”⁵ Figures 1a and b come from a book on midwifery published in Germany in 1513. The book was translated into English in 1545 and made available to a broad reading audience for the first time—men and women, professional and lay.⁶ As noted by Whitely, “These images seem strange to a modern eye, but they were not pinioned by ideas of physiological truth.” They were “used primarily to help visualize the fetus for the work of the midwife and surgeon among living bodies.”⁶ Figure 1c is a symbolic sketch of a fetus attached but floating outside an opened womb and is the only image of a fetus that Vesalius offered in the 1543 edition of De Fabrica.⁶ Although Vesalius’ other anatomical drawings of female reproductive anatomy are true to reality, this particular image lacks detail. Finally, Figure 1d comes from The Expert Midwife or an Excellent and Most Necessary Treatise on the Generation and Birth of Man, published in 1637 and attributed to Jakob Ruff.⁶ Again, these images represent working pictures that were used to inform midwives.

Figure 1.

Images of the fetus, both symbolic (a–d) and anatomical (e–g), from the 16th to 17th centuries. (a, b) “The Byrthe Fygures,” 1545. From Rosslin E; Raynalde T (trans). The Byrth of Mankynde, Otherwyse Named the Womans Booke. London: Thomas Raynalde; 1545. (c) Vesalius A. De Humani Corporis Fabrica Librorum Epitome, 1543. Courtesy of the University of Texas Medical Branch, Moody Medical Library, Blocker Collection. (d) Ruff J. The Expert Midwife or an Excellent and Most Necessary Treatise on the Generation and Birth of Man, 1637. (e) Chamberlaine J. Imitations of Original Drawings by Leonardo da Vinci, 1796. Courtesy of the University of Texas Medical Branch, Moody Medical Library, Blocker Collection. (f) Siegmund JD. Diagram of a fetus. Wellcome Collection. (g) Hunter W. Anatomia Uteri Humani Gravidi Tabulis Illustrata, 1774. Courtesy of the University of Texas Medical Branch, Moody Medical Library, Blocker Collection.

The next set of images demonstrate anatomically correct images pinioned to physiological truth. They come from dissections of the gravid uterus. Figure 1e comes from Leonardo Da Vinci’s private notebooks and was drawn sometime between 1510 and 1512.⁷ He was the first to accurately depict the human fetus in utero. Unfortunately, his notebooks resided in the Royal Collection at Windsor Castle in England beginning at some time in the 17th century and were not published until the 19th century. Figure 1f demonstrates a fetus lying on its side in an opened dissected uterus from one of the earliest books on obstetrics attributed to Justin Dietrich Siegmund, published in 1723.⁸ This is for the most part an anatomically correct depiction of the fetus, but with less detail than was to come later. Figure 1g is from William Hunter’s greatest work, Anatomia Uteri Humani Gravidi, published in 1774.⁹ These are remarkable images documenting in this particular figure the fetus in utero at term. The portfolio, however, includes images that range down to an 8-week conceptus. These are truly amazing images that depict the human fetus as accurately as any contemporary work of art, photography, ultrasound, or in utero video. Yet, these images probably were unavailable to the vast majority of lay public, midwives, and even practicing physicians. More than likely, the symbolic figures featured in Figure 1 informed the physician David Dickson what a fetus might look like.

THE SCIENCE

Joseph Needham in the 1959 edition of his book, The History of Embryology, noted the extraordinary amount of work being accomplished in the science of embryology from the period of 1600 to 1800.¹⁰ Until this period, the pedagogy of procreation had been dictated by the ancients. Sara Dubow in her book, Ourselves Unborn: A History of the Fetus in Modern America (2017), quoted historian Matthew Cobb who explained that the “link between copulation and pregnancy was firmly established by observing domesticated animals when humanity invented agriculture around nine thousand years ago … and although it was understood that a woman could become pregnant only if she had sexual intercourse with a man, and that a woman’s menstrual flow ceased when she was pregnant, less understood was the relationship between those facts.”¹¹ Dubow went on to relate that “Western explanations of this process can be traced back to the 5th century BC, when Hippocrates posited that human generation resulted through the interaction between two kinds of semen—a man’s ejaculate and a woman’s menstrual blood.” Aristotle elaborated on this idea, according to Dubow, “theorizing that the dynamic creative male semen transformed the passive plastic menstrual blood into what he called an embryon.” Aristotle concluded, according to Dubow, “that what began as a flesh like substance resolved itself into its distinct parts over a period of time—forty days for a male embryon to become a fetus and ninety days to become a formed female fetus.”¹¹ This theory thus constitutes the original formulation of the epigeneticist theory that a fetus formed from a homogenous mass that evolved into distinct parts and organs.

Aristotle’s theory remained intact for over 1000 years. Harvey in the 1653 English edition of his book, The Generation of Animals, rejected Aristotle’s theory that male semen transformed female menstrual blood into an embryon by theorizing that female ovaries produced eggs that were propelled into the womb by the magnetic force of male semen.¹¹ Harvey, nevertheless, concurred with Aristotle in observing that “embryos began as a homogenous mass, from which the organs derive one after another by the process of formation or epigenesis.” The actual discovery of mammalian ova did not occur until 1826 and was reported by Karl Earnst von Baer.¹¹

Dickson may have had access to van Leeuwenhoek, who along with Ham published in the Philosophical Transactions of the Royal Society in 1677 their observations of spermatozoa or “animalcules in the melt of cod.”¹¹ Hartsoecker, a contemporary and colleague of van Leeuwenhoek, claimed to have seen an already formed human or “animaliculum” within spermatozoids as early as 1674, but had not published his observations. So began the contentious debate between the theories of “preformation,” the idea that the human was complete and preformed lying within the spermatozoa, and “epigenesis,” the theory that organs developed from a homogeneous mass. These debates continued through the mid-19th century. Turning back to Dickson’s Essay, he subscribed to the preformists’ ideas and, based on his recently acquired knowledge of the animaliculum or preformed human within the spermatozoa, explained the possibility of a fetus coming to maturity more quickly if the animaliculum within an ovum was more mature at conception, thus coming to “perfection” at a much earlier time in gestation.

FETAL RIGHTS AND ETHICS

The imaging of the fetus was becoming more sophisticated and anatomically correct, but such images were restricted to an elite group, that is, the anatomists who were dissecting cadavers and the aristocracy who underwrote the publication of their exclusive artistic portfolios. The lay public was limited to symbolic figures of what a fetus might look like. The science that was evolving in understanding procreation, though beginning to proliferate through experimental and observational work, was still primitive. Thus, despite the evolving imagery and science of the fetus, understanding the ethical value and philosophical meaning of a fetus was by and large regulated by religious doctrine.

Jewish tradition, based on Talmudic interpretation of scripture from Exodus 21:22-23, discusses the reparation extracted from someone outside the family who might have caused a miscarriage in a pregnant woman. The interpretation does not consider this miscarriage as murder of the fetus, but does require payment to the family for the loss of life. Jewish tradition does not consider the fetus a person until after the actual birthing process.¹² Catholic tradition that existed through the early modern period dates to ancient Aristotelian theories and Augustinian interpretation that ensoulment began at 40 days for males and 90 days for females.^11,p19 This timing of ensoulment continued until 1869, when Pope Pius IX dropped the distinction between fetus animatus and fetus inanimatus, making any intentional removal of a fetus at any stage of pregnancy an excommunicable offense.¹³ English common law between the 16th and 18th centuries designated a pregnancy as “official” at the time of quickening, or about 14 to 18 weeks’ gestation.¹³

In considering Dickson’s Essay, the Church of Scotland’s interest in this case had more to do with its obsession with sex than with any issues of fetal rights. Langley in his article, “Infanticide and Midwifery in Early Modern Scotland,” wrote that “illegitimate children were an expense to parish coffers and thus, besides morality issues, the Church was interested for economic reasons.”¹⁴ Thus, “understanding the timing of a child’s conception and the length of gestation of a premature infant was necessary in order to gauge parentage.” The case defended by Dickson was a doubly trying matter, as it required explanation from a biological perspective in order to defend the “honor” of one of the church’s own clergy.

21ST Century PERSPECTIVES

In contrast to the early modern period, 21st century images of the fetus obtained by the use of fetal ultrasound and intrauterine videos provide the public and, in particular, the parents with images of the fetus that bestow a much more personal and intimate knowledge than could have been imagined in the early modern period. Contemporary science with the discovery of DNA promotes the concept that biological life is a continuum extending even prior to conception. According to Scott Gilbert,

The metabolic view takes the stance that a single developmental moment marking the beginning of human life does not exist. Both the sperm and egg cells should individually be considered to be units of life in the same respect as any other single or multicellular organism. Thus, neither the union of two gametes nor any developmental point thereafter should be designated as the beginning of new life.¹⁵

Carried even further, the possibility of creating another biologic organism from a cloned cell begs the question of whether or not there is the need for gametes and what property/personal rights might be associated with the DNA residing in any cell. Yet from the legal and fetal rights perspective at a federal level, Roe v. Wade bases its ruling on the timing of viability and thus the right for life of the fetus at 23 to 24 weeks’ gestation.¹⁶

Thus, David Dickson’s situation in 1712 was not dissimilar from our 21st century situation. That is, despite rapidly evolving imagery and science in both eras, the definition of when human life begins continues to be dictated by social, cultural, religious, and political convictions. Despite Dr. Dickson’s testimony, the presbytery voted to suspend Mr. Elder from the clergy. Science, in this case, failed to carry the day.⁴

So, how is the question of when human life begins answered? Bernard-Henri Levy, a French philosopher, wrote in an essay in the New York Times:

Being human means taking a leap out of the natural order. To be human requires an escape, in one way or another, from that mass of atoms, cells, and particles from which you and I and everything else is composed. It is to be endowed with a soul, which—even if it is immaterial, without expanse or density, even if it is perfectly invisible, impalpable and inconsistent—acts as a passport out of nature into our human essence.¹⁷

This observation seems to imply that our humanity transcends our biology. In conclusion, we are left where we started with Sir Thomas Browne’s observation: “Thus we are men [and women] and we know not how.”³