Embryology and Obstetrics in ancient samhitas

One of the three streams of medical education in ancient India was Obstetrics (The science of mid-wifery) and Paediatrics, which had as its original teachers -Kashyapa, Vasishta, Atri and Bhrigu. The codification of the practices of this school was made by Vagbhata (6^th century AD), who in addition to capturing the knowledge of Obstetrics and Paediatrics, also documented facets of the other six segments of Ayurveda, in his Ashtanga-sangraha.

The Ashtanga-sangraha was updated by Vagbhata II in the seventh century AD. The updated version is known as Ashtanga-hridaya.

In addition to these specialized secular texts, the Atharva-veda and the associated Garbhopanishad (800 BCE) are repositories of knowledge in this domain of medicine.

The knowledge found in this ancient Sanskrit literature is presented in two sections:

• Embryology
• Obstetrics

Embryology – Blood Circulation in the Foetus

Kintugarbhomaturudarasthossnatinaveti I

Atrocyatenasnati I Yadihasniyatsyadasya

punsamatrtakalamnacedamasti I Katharh

tarhiNabhyarnnadipratisthita I

Tasyarnaparamaturhrdayamasrita

maturannarasamabhivahangarbharn

prtnayatyabhivarddhayatitadyathakulyah

kedaramabhisarnsrayantyobhavayanti tad vat II

Translated as – Does the fetus in the mother’s womb eat or not? It is said here that it does not eat. If it were to eat, later (there would be) fecal matter. That does not exist.

Then how?

In the navel (of the child) a tubular vessel is fixed. In that (vessel) another (vessel) sheltering in mother’s heart, carrying the digested food of the mother the tubular vessel satisfies and grows the fetus just as canals pervading the fields nourish them.

Source

Bhela-samhita, Sarira-sthanam, Adhyayah 4, Paragraph 31 (Vedic Period)

Etymology

Nadi = Tubular vessel

Western Reference

In the year 1604, an Italian physician Heironymus Fabricius published a book Defornata foetu (On the formation of the fetus). It is the first important study of embryology in the West and describes blood circulation in the umbilical cord.

Embryology – Fetal Growth and Development

Caturthesarvangapratyangavibhagah

pravyaktobhavati, garbhahrdaya-

pravyaktibhavaccetanadhaturabhivyakto

bhavati, kasmat ? Tatsthanatvat I Tasrnad

garbhacaturthernasyabhiprayamindriyarthesu

karoti .Dvihrdayarncanarlrndauhrdinim

acaksate, dauhrdavimananatkubjarnkunirn

khanjarnjadarnvamanarnvikrtaksarn

anaksarnvanarisutarnjanayati, tasmatsa

yadyadicchettattattasyaidapayet I

Labdhadauhrda hi viryavantarncirayusarnca

putrarnjanayati II

Translated as – In the fourth month, the division of all the major and minor organs manifests. Because of the manifestation of the heart, the gaining of consciousness (also) becomes evident.

How?

because of its position. Therefore, in the fourth month of pregnancy, (the fetus) seeks sense objects. (The fetus) communicates its desire to the pregnant woman. By the dishonoring of such desires, the woman generates hunchbacked, crippled, lame, paralytic, dwarfed, cross-eyed or blind child. Therefore, whatever she desires should be given to her. The pregnant woman who gets what she desires generates energetic and long-living child.

Source

Susruta-samhita, Sarira-sthanam, Adhyayah 3, Paragraph 18 (6^th  Century BCE)

Notes

The Puranas (Hindu mythology) have at least two stories of learning by children in the womb-

• Prahlada about Vishnu from sage Narada, which preempted the post birth teachings of his rakshasa father Hiranyakashipu and
• Abimanyu of warfare from his father Arjuna.

It is today accepted that the happiness of the child in the womb (by implication of the mother) determines all aspects of a person’s growth.

The threat of begetting a defective child is held out possibly to ensure that the pregnant woman is kept happy all the time.

Western Reference

1. Limb buds appear late in the 4^th week or early 5^th week. In the 7^th week, embryo – the three parts characteristic of the adult extremities – can be recognized and muscular development of arm reaches almost complete organization by 7 weeks. (Lewis, 1901 – 1902 AD).
2. Histological differentiation of gonads – the male or female organs – occurs in the 7^th week of development, 14-16 mm stage. (Gillman, 1948 AD)
3. Fetal heart tones can often be detected as early as the 16^th week (Reid, 1962 AD).

Embryology – Deformity in the new born child

Yadahyasyahsonitegarbhasayabijabhagah

pradosamapadyate, tadavandhyarnjanayati,

yadapunarasyahsonitegarbhasayablja-

bhagavayavahpradosamapadyate, tada

putiprajarnjanayati, yadatvasyasonite

garbasayabijabhagavayavahstnkaranarnca

sarlrabijabhaganamekadesahpradosam

apadyate, tadastyakrtibhuyisthamastriyarn

vartarnnamajanayati, tam

strivyapadamacajsatel II

Translated as – When in her blood, a part of the seed that has reached the uterus is vitiated, then she produces a sterile girl child.

When again, in her blood, a portion of a part of the seed that has reached the uterus is vitiated, then she gives birth to a stillborn child.

When in her blood, a portion of a part of the seed that has reached the uterus or a part of the seed that causes female organs (in the child) is vitiated then, (she) germinates a non-female, with female characteristics called ‘Varta’.

Source

Charaka-samhita, Sarira-sthanam, Adhyayah 4, Paragraph 30 (1^st Century BCE)

Notes

This paragraph deals with the adverse effects of humors on the ovum as well as the seed (of the male) that has reached the uterus. The damage to the seed itself is seen in three levels, affecting:

• the seed
• a part of the seed
• a portion of a part of the seed,

possibly corresponding with the modern understanding of:

• the semen or the ovum
• the chromosome of the semen or the ovum
• and the gene.

It is heartening to note that 3000 years ago, congenital deformity was traced to the genes of the parent and not attributed to supernatural factors.

Obstetrics – Regimen for Pregnant Women

Paramatonirvikaramapyayyamanasya

garbhasyamasemasekarrnopadeksyamah

Translated as – Now (we) shall advise the measures, month by month of the fetus growing without malady.

Prathamemasesankitacedgarbhamapanna

kslramanupaskrtamrnatravacchitarn kale

kalepibet, samtyarnevacabhojanamsayarn

pratascabhufijlta I

Translated as – In the first month if (she is) suspected to have attained pregnancy, should drink milk unboiled and a little cold, regularly, should eat only wholesome food in evening and morning.

Dvitiyernaseksiramevaca

madhurausadhasiddham ;

Translated as – In the second month, only milk boiled with sweet medicines,

Trtiyemaseksiram

madhusarpibhyamupasarnsrjya;

Translated as – In the third month, milk after mixing with honey and ghee,

Caturthemase

klranavanltamakamatramasnlyat;

Translated as – In the fourth month, should consume milk with butter of 1 aksa (12 gms),

Pan came masekslrasarpih;

Translated as – In the fifth month, ghee directly obtained from milk.

Sasthernaseksirasarpirmadhurausadha-ksirausdhasiddham:

Tadevasaptamemase

Translated as – In the sixth month, ghee directly obtained from milk boiled with sweet medicines, in the seventh month, the same.

Atascaivasyastailatpicumyonau

praid.ayedgarbhasthanamargasnehanartham

Yadidarn karma pratharnarnmasarn

Samupadayopadiimanmasattenagarbhinya

garbhasamayegarbhadharinikuksi-

katiparsvaprstharnmrdubhavati, vatascanulornah

sampadyate, mutrapurisecaprakrtibhute;

putrarncestarnsampadupetarnsukhinarn

sukhenaisa kale prajayataiti II

Translated as – If this action advised from first to the ninth month (be followed) by that pregnant woman, her placenta, pelvis, hip, sides and back become soft, the flatus attains downward movement, urine and stool become normal, come out with ease, the skin and nails attain softness, strength and (good) complexion increases, and thus she generates a desired son with excellence and health, easily on time.

Source

Charaka-samhita, Sarira-sthanam, Adhyayah 8, Paragraph 32 (l st Century BCE)

Notes

This prescription looks at good progeny and normal delivery as the objectives of the care of pregnant women. Food is seen as an integral and important part of care. In the first three months, calcium is needed for the formation of bones. Hence, the prescription of generous quantity of milk. Milk, an organic substance is readily absorbed and therefore superior to other kinds of calcium ingestion. The regimen looks at the prevention of post-delivery birth mark instead of looking at it as an issue to be handled after the delivery. Milk, milk, milk! is today’s prescription also.

Current Relevance

Both milk consumption and vitamin D intake were significant predictors of birth weight, said Kristine G. Koski, Ph.D., Director of the School of Dietetics and Human Nutrition at McGill University in Canada.

“For every 215 milliliters of milk that you drink … it correlates with an extra 41 grams of birth weight,” medical expert Dr. Marla Shapiro said.

Medical experts say smaller babies have higher rates of hypertension, obesity and diabetes as they age. According to Scotsman, the report, whose authors included Dr Kristine Koski the Director of the School of Dietetics and Human Nutrition at McGill University in Canada said: “Our study showed that restricting milk or vitamin D intake during pregnancy lowered infant birth weight in otherwise healthy, non-smoking, well-educated mothers.”