There are No Bad Babies:
By saying there are no bad babies, I am not repeating the sentiment that all puppies go to heaven.  What I mean is that only a small proportion of children born have a genetic problem that prevents them from maturing and being able to reproduce.  That is changing now.  Many countries are not having enough babies for long term survival, and that problem is increasing.  But the saying used to be that if a woman conceived and missed her monthly period, that the result would more than likely be a child who would grow up and be able to reproduce.

There are not a lot of people who are genetically so impaired that they are helpless.

And yet we have known for a long time that human DNA is subject to mutation, and the rate of those mutations is high, higher than one per individual per generation.  And at the same time, the human genome is reasonably stable.  Certainly there have been recent changes, and those changes are even accelerating, but that only applies to a very small proportion of the genome.  The human genome is over the long term very stable.  That stability can only be maintained in the face of mutation pressure by eliminating individuals, usually simply fertilized eggs that do not develop, as fast as the mutations accumulate. 

Thousands of years ago, it was believed that health depended on the balance of something called humors.  A humor is something that is distributed throughout the body.  Water is a good example.  And water is a humor.  Indeed, if you have too much or too little you will be ill.  The various forms of bile are humors.  If you have too much bile in your system it is called yellow jaundice, and you will be ill.  If you have too little, then you will have trouble absorbing fats from your gastrointestinal tract, and that will make you ill.  There are many other humors to which the same logic applies. 

The trouble with the belief is that they fancied that there were four and only four humors.  They recognized “black bile,” “yellow bile,” blood and phlegm.  Blood is confined to blood vessels so it is not a humor.  Phlegm is basically mucous and is produced by mucous cells such as those in the airways and the gastrointestinal tract.  It is not a humor.

It was believed that health consisted of having the four “humors” in balance.  It was believed that if there was an excess of a humor, the body would collect some in one place so it could be expelled.  Bleeding people for their health was an attempt to restore the balance.  It was also thought that ones personality depended on what humor or combination predominated. 

It is rather fun to play with the idea of the four humors and see how much they accounted for.  For instance when one has a cold, one feels miserable all over.  Yet it is only a localized viral infection of the upper airway. 

It was not until the 1800’s when pioneers such as Rokitansky in Austria and Vichow in Germany began to explain that a disease was something that happened in a particular location in the body.  The concept was very powerful, and although measuring and even adjusting the levels of humors remains a modern medical practice, it is also very important to be able to locate and measure the diseased area.

The old fashioned practices did not go away at once.  I have heard an eye witness declare that in New York City in to 1950’s one could still see barber shops with jars of leaches in the windows indicated that the barber was willing to do blood letting if anybody wanted it.

The concept of the disease being in a location was a very powerful one.  During the early 1900’s x-rays became available and were eagerly put to the task of locating disease.  This could give clues as to what the illness was, how it was progressing and what could be done about it.  Later that century, ultrasound, gamma rays from radioactive decay and radio waves from the magnetic resonance of nuclei were found to be valuable for the same task.

A diagnostic radiologist, more technically a medical imaging specialist, is primarily involved in using the various forms of energy to create images of what is going on in the body.  His or her attitude is generally that if the patient is ill, there is some sort of imaging protocol that will demonstrate the disease.  What this has to do with fertility is that there is a procedure called a hysterosalpingogram that attempts to determine why a woman may not be able to have children.  Such things as congenital abnormalities and strictures inflammation can alter her anatomy in a way that makes her infertile, and it is such things that the study looks for. 

Most of the time the study is normal.  This is frustrating.  The patient unquestionably has a medical problem.  The best study has been done, and the anatomy is normal.  It is very impressively normal.  Infertility is not due to a localized condition most of the time.  Of course there are humeral causes of infertility.  The hormones that mediate ovulation are humors that may not be functioning properly.  In fact the contraceptive pill is a stratagem to prevent them from functioning normally, and it works very well.  But most of the time, the hormones are perfect.

So of the two classes of disease, anatomical and humoral, neither is the cause.  This frustration leads people to avoid thinking about it very much.  Yet this neither-of-the-above cause is laying waste to great nations and seems bound only to get worse.

Clinical doctors have long understood that the reason a woman does not get pregnant every time she tries is because the mutation rate of human DNA is so high that it takes six tries on average for a fertilized egg to have a set of DNA that permits an embryo to develop.   It is clear that what is going on just now is that those six tries have increased to seven and eight and on and on. 

It is high time we thought more about it. 

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