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A Philosophers' Magazine (1) survey last
year ranked On the Origin of Species... (2)
as the third most important tract on the human condition.
Tufts University philosopher Daniel C. Dennett wrote that
Natural Selection is "the single best idea anybody ever
had", ahead of both Newton's and Einstein's contributions.
(3)
Charles Robert Darwin (1809-1882) developed
his evidence 150 years or so before that word mutated into
medico-political mantra. Although no randomized controlled
trials were needed to develop it, his monumental thesis has
endured mostly unscathed. The principles he identified that
govern evolution have been modified and refined in healthy
contrast and debate by Dennett, the late Stephen J. Gould,
and others, but remain as one of the few scientific and biologic
concepts that have not eventually been overturned. Pardon
me while I replace some hormones - the leeches have left me
feeling somewhat peckish.
Darwin, who was somewhat aimless at age
22, signed on in 1831as an unpaid gentleman's companion to
The Beagle's young Captain, Vice-Admiral Robert FitzRoy. He
had studied Classics at Shrewsbury, then Medicine at Edinburgh
but quit because he hated it and moved to Theology at Christ's
College, Cambridge where his real interests involved studying
biology as an amateur. The 90 foot ship's five year expedition
around Cape Horn to Patagonia began at Christmas, its primary
purpose to determine military and commercial potential of
South America's east coast with view to Britain's reclaiming
the Falkland Islands, or Malvinas from Argentina. Darwin explored
the Galapagos Islands for a month, musing mostly about finch
beaks, but as the voyage progressed visited many other locales,
developing detailed knowledge of their flora, fauna and geology
and a theory about coral reefs.
On returning to England Charles took his
friend French botanist Frederic Gérard’s advice:
"(No scientist should) examine the question of species
who has not minutely described many." and spent the next
eight years meticulously studying barnacles. Although he published
various papers on his discoveries by 1846 placing himself
in scientific front ranks, Darwin procrastinated with publishing
his principles of evolution for 23 years. He was finally provoked
to do in so in 1859 by threat of pre-emption by naturalist
Alfred Russel Wallace (1822-1913) who had come to similar
conclusions independently, but graciously sent Darwin his
material in 1858, a memoir from the Malay Archipelago, and
credited him for the original ideas (as Darwin did Wallace).
When publisher John Murray sent Reverend Whitwell Elwin the
manuscript of On the Origin of Species...,
the distinguished Quarterly Review editor advised that the
subject was "too controversial" and that instead
Darwin should write a book about pigeons. Nevertheless, the
book was published and gradually attracted serious attention
and controversy. Thereafter, when Karl Marx invited Charles
to write an introduction to Das Kapital,
he declined.
At the British Association for the Advancement
of Science's annual meeting the next year, Darwin's implication
that Genesis might be inaccurate caused "roars of outrage
from men, and sobbing and fainting by ladies". "Soapy
Sam" Wilberforce, Bishop of Oxford tried to prevail with
bombastic God-fearing critique, but when he tried to silence
heckler Dr. Thomas Huxley with “Is it through your grandmother
or your grandfather that you are descended from the apes?",
Huxley shut him down with "I should most certainly rather
be descended from an ape than from a man who prostitutes his
education and his eloquence to the worship of prejudice and
falsehood.' Another Darwin detractor was ex-Captain FitzRoy.
Ironically, in developing his ideas, Darwin had relied on
his boss's voyage records as he had kept such poor notes himself.
FitzRoy shook the Bible in anger at his former friend and
aide, but with little consequence; five years later the Vice-Admiral
committed suicide by cutting his own throat.
Darwin married his cousin Emma Wedgwood
in 1839, retired with an inheritance of £5000 per year
(~ $500,000 in current dollars, with Income Tax still unevolved),
and eventually fathered 10 children, eight of whom survived
him. Charles and Emma were grandchildren of Josiah Wedgwood,
founder of the pottery firm. Emma's family were devout Unitarians,
whereas Charles's father Robert Waring and paternal grandfather
Erasmus Darwin, a remarkable MD, scientist and poet, were
agnostics. From the beginning of their marriage Emma felt
a "painful void", and that Charles's scientific
perspective made him insensitive to Christianity. Despite
deep concern, she only mentioned this in a letter which Charles
kept all his life. The dichotomy may partly explain why Darwin
delayed publication so long. Having remarried after Emma's
death, Charles spent most of his latter years in moody reflection
the darkened living room of his home Down House in Kent, emerging
only for daily promenades inspecting his garden, conservatories,
pigeons and other birds. It was not realized until after his
death that his chronic ill health was the result of Chagas'
Disease which he contracted from an insect bite while in South
America.
What has this to do with obstetrics? The
foundation of Darwin's corpus is that reproduction of all
species evolves toward success, not failure. There is no reason
to believe that this applies any less to the human descendents
of Mitochondrial Eve than to any other species. The adaptive
responses to bipedalism, longer gestation and an enlarged
cranium happened long ago. So how is it that our obstetric
culture has come to believe, and behave as if the highly evolved
human female physiologic processes of pregnancy, labour and
birth are intrinsically unsafe, and not to be trusted to work?
That humans tend to want the less than fit to survive is no
explanation, except for that minority of fetuses who are critically
"unfit". And equally puzzling, why do we presume
that technology and standardized rituals will make those processes
safe where, or rather if they are not?
Edward Hon, inventor of electronic fetal
monitoring, warned repeatedly, and sadly with prescient accuracy,
about what would happen if his "Machine that Goes Ping"
was used in uncomplicated pregnancy and labour. Among those
cautions, at a 1987 conference entitled "Crisis in Obstetrics:
The Management of Labour", Hon commented "If you
mess around with a process that works well 98% of the time,
there is much potential for harm." Yet, obstetric care
is "evolving" progressively toward standardization,
in a proliferation of rituals as patterned, repetitive responses
to predetermined beliefs. (4) These are hauntingly analogous
to the birth superstitions of "traditional" societies.
In this technocratic mindset the female body is presumed to
be an unpredictable, inherently defective machine. Through
such processes, womens' prenatal situations are categorized
and labeled, and their management reduced to a single "consensus",
ending all possibility of debate, if not thought. (5) Although
giving birth is perhaps the most uniquely individual experience
of a woman's life, her individuality is subsumed into a category.
From that point, impersonality rules, and the individual is
presumed to be unreliable in contrast to the method. (6)
Ritual labour induction at 41 weeks, on
the grounds of gestation alone, is but one example of such
reductionist illogic. This horrendous resource wastage is
in pursuit of the tenuous possibility – based on evidence
from multiple studies conducted over a decade ago –
that optimistically, 1000 inductions would be necessary to
possibly prevent one perinatal death. (7)
Thomas W. Clark suggested that credible
explanations of human behaviour prove that we do not choose
our acts "scientifically", independent of surrounding
influences. Thus, although medicine claims to be founded on
scientific knowledge (8) medical care and what governs it
is not necessarily a scientific activity. Perhaps this explains
part of the apparent contentment with anti-Darwinian thinking
whereby so many women are somehow "unable" to begin
labour on their own at the appropriate time for them, then
give birth, without interference. In these defaults to illogic
methodology triumphs over reason. Darwin also understood that
human choices are illogical, marked by "the indelible
stamp of (our) lowly origin", but he kept relatively quiet
about it.
References
1. The Philosopher's
Magazine Issue 15 Summer 2001
www.philosophers.co.uk
2. Darwin, C On the Origin of Species by Natural
Selection, The Voyage of the Beagle,
The Descent of Man and Selection
in Relation to Sex www.literature.org/authors/darwin-charles
3. www.wikipedia.com/wiki/Daniel+Dennett
4. Davis-Floyd, RE Birth as an American
Rite of Passage 1992 Berkeley: University of California
Press
5. Hall, PF The Consensus Cult J Soc Obstet
Gynaec Can 2000; 22:1 (8)
6. Ellul, Jacques The Technological
Society 1965 NY Albert A Knopf
7. Menticouglou S, Hall PF Routine Induction
of Labour at 41 weeks gestation: Nonsensus Consensus BJOG
2002;109:8 (485-91)
8. Sassower R, Grodin MA Scientific uncertainty
and medical responsibility Theoretical Medicine 1987;8:221-34
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