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In an interesting twist, our use of C-Sections elective or necessary, is resulting in a reliance on future medical interventions. Right now countries like Brazil which has one of the highest C-Section rates have created an issue where more babies are being born with bigger heads to more women with overly narrow hips. The medical intervention is saving lives but passing on genes that perpetuate the catastrophe. I read recently that if Brazil were to lose access to C-Sections they'd have close to a 60% mother/infant mortality rate. That means their population would implode.

It's a thread I pull in the cataclysm of my novel Paradox as the characters begin to grapple with the odd relationship we have with technology vs. nature.

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It might be interesting to write something explicitly about the concept of unforeseen consequences like this. I've written about them before in limited amount, here: https://goatfury.substack.com/p/the-best-laid-plans (but there's just so much more room here for additional examples/angles).

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Oh God, there are so many! Like even regarding your sanitation. Washing hands good.....but right now our food is so clean that it's actually reducing our gut biome and causing intestinal distress which triggers anxiety in the brain.

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Interesting. Just to add to the thinking here.

An ofttimes indication for elective CS is cephalo-pelvic dystocia - the maximum dimension of the baby’s head larger than the corresponding largest dimension of the pelvic funnel in the mother (the head will get stuck in 2nd stage of labour in effect) and may lead to mishap and imperil the mother and baby. Complications in the 2nd stage are to be avoided, in other words. Please note this isn’t the sole cause of such problems.

Thing is, there’s a positive correlation between maternal femur length and pelvic outlet dimensions. Also, femur length is a large component of adult height.

So, small stature women may well be at slightly more risk of CP dystocia over large population samples.

Now, as stated, such complications may contribute to an increase in perinatal maternal mortality, so historically there have been intervention fashions in obstetrics which involved the post-partum sterilisation of women with short femurs who experienced CP dystocia and required a section for non-progression in the 2nd stage. Call these “the bad old days”, if you like.

Unfortunately poor nutrition also correlates positively with short femur length in adults. Poor nutrition may well be associated with poverty in terms of socioeconomic status.

You can fill in the blanks.

Well intended actions may unfortunately have a eugenic bias. I don’t like how this feels when applied to large populations. The poor get sterilised more frequently (or once did - unintentionally I’m pretty certain). It’s all very complicated. However this population mortality/morbidity problem remains as some of it relates to prenatal maternal nutrition.

Just thoughts.

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wow ... that is truly amazing.

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It took a long time. Dr. Charles Knowlton wrote a letter titled "Erysipelas and Puerperal Fever" to the Boston Medical and Surgical Journal, published March 6 1844, describing his suspicion that he had infected a patient and caused her death. The backlash was pretty intense and included statements such as "A Doctor's hands are clean!" Oliver Wendell Holmes had read his paper, "The Contagiousness of Puerperal Fever" before the Boston Society for Medical Improvement about a year earlier. I cover this in Chapter 43 of my Knowlton biography, An Infidel Body-Snatcher and the Fruits of His Philosophy.

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That's awesome, Dan. Did I do all right with this story today? I could have written a ton more, but I really wanted to make sure that what I was saying was right.

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I don't know as much about incubators, but it looked right. I'm really fascinated by the debates physicians had in journals like the BMSJ (now the New England Journal of Medicine). The stakes were high and the arguments often came down to the authority of canonical texts vs. the observations of anomalies by doctors. It got so intense that "Empiric" was used as a slur. All this at a time when medicine was trying to establish itself as a legitimate profession, partly by emulating other professions (the law and ministry) whose authority derived from mastery of texts.

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Thanks, Dan! Have you written on Substack about medical history? I'm always fascinated by how we got here.

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Nathan, our first, had to be pulled out using a vacuum cup because his heartbeat was slowing and he wasn't getting enough oxygen. My wife was moments away from having to undergo an emergency C-section if that didn't work.

I can't understate how lucky we are to live in a modern world where these tools are available and the above is nothing more than an anecdote.

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Amazing. My partner's younger brother was born in the late 80s, and he spent his first month in an incubator. Alley says he looked like a little old man!

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Nice read, thank you. However... "The effects of civilization often make a condition worse before they make it better..." - WTH? 😈

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The agricultural and industrial revolutions both made the human existence vastly worse by most measures for a long time before they made things better. That's subjective, but you can certainly quantify things like life expectancy and overall health during life. Those went down a ton during the early parts of both revolutions, and stayed down for a long time before going up above prehistoric norms.

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My first thought was the different responses to Covid 19 and how to prevent its spread. There were a lot of guesses, especially when test showed the survival of Covid 19 on different materials for days. Transmission via air born particles was believed from early on, but distances traveled, density of the infected particles, whether a cloth mask or a medical mask protected was and maybe still is debated.

What is acceptable for protecting one from the disease with actions, shutting down non essential work for weeks at a time, shutting down schools for months, even more than a year, and the resulting ramifications on learning and social support systems for physical, mental, and chemical abuse, etc.

We were fortunate and was already working remotely when things shut down. I was free to be with my three grandchildren to help them learn remotely. We had our bubble and kept from getting Covid till the winter after vaccines were available, so its intensity did not require hospitalization when older people were considered more at risk.

Hopefully we can take the best practices we learned for diagnosing quickly and precisely, and enacting proper preventative procedures.

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Yeah, covid sucked... a LOT. There wasn't a simple, ready solution to anything, and that air of uncertainty really added to all the tension. I don't especially want to live through that again, but if I do, at least I'll be older and wiser next time. Hopefully everyone else doesn't forget all those lessons we learned (like they did after 1918).

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Semmelweis had his supporters, who helped make his hand-washing idea plausible. One of them was the noted British physician Joseph Lister, who is often erroneously credited with the idea.

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I'm glad I didn't erroneously credit Lister! Alternative history: hand soap could be called Listerine today.

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Andrew ... I believe one quality of a very good post is the depth of the comments it inspires. This one wins on both counts. Thank you once again.

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Thanks so much, Joyce. Having a conversation here is extremely important to me, and I'm always excited whenever I can get folks thinking. Every now and then, someone picks up a thread I drop and writes something really good!

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This was such a cool topic. I’m sure there are more examples just like this of how what was once a radical concept dramatically improved mortality rates.

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Kristi, let me know if you come across any of these in the next week or so! I know that keeping my ears peeled often means I'll hear a little fact-nugget; I'm hoping you can catch something interesting. I love this stuff.

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