Should I go to the doctor?

53263-03c5ce5a93f30da8d6bc9c71b8abfcc3A piece for the church newsletter, provoked by my son who asked pertinent questions last week

I’ve been to A&E twice recently. It was very quiet, in contrast to what it was like BC – before covid. I hear that GP surgeries are quiet too because people are nervous about going. What with the virus and all, people are anxious about lots of things, especially their health – or lack of same. This is because they’ve not been taught properly about human biology. I thought I’d begin to rectify the defect.

The first and most important rule is: it’s probably not worth going.

  • When cats and dogs are ill, they lie still until they get better. On the whole, we get better despite doctors, not because of them.
  • Surgeries and hospitals are full of ill people so you might catch something.
  • People die in hospitals, so if you don’t go, you won’t die (there’s a logical fallacy there).
  • Doctors sometimes don’t listen: they jump to conclusions because they’re in a hurry to get rid of you due to government rules.
  • Doctors often don’t know, but they bluster because you expect them to know everything.

Now, read my lips: if you can’t see blood, if you can walk and talk normally, if your excretory functions are more or less as usual, and if you have only a few aches and pains, stop moaning and don’t be such a wuss. It’ll probably get better on its own, though you may die first.

Sometimes, though, needs must.

  • Blood belongs in blood vessels – end of. If you see blood where it shouldn’t be, take action. Of course, if you cut yourself, you’ll bleed – I don’t mean that.
  • Broken bones, torn ligaments and torn tendons need fixing. If it’s not a bit better after a few days, find a joiner.
  • Plumbing. This is a biggie. There are lots of pipes in the body: blood, lymph, food, digestive juices, piss. They can get blocked, they can leak.
    • Always look at your faeces. Any inexplicable change in colour, consistency or smell needs attention. Blood on or in stools or on bog paper is suspicious unless you can account for it (e.g. piles). Dark stools might mean bleeding higher up, perhaps in the stomach, the blood being digested on the way down giving dark turds. But be sensible: if you had six pints of Guinness last night, don’t be surprised if the turds are dark. If you’re on iron tablets likewise. Use common sense if the Guinness has left you with any.
    • If you’re constipated, you probably need to adjust your diet. There are other more serious causes, but common things are common so we’ll stick with common.
    • If you’ve got the squits, chances are you’ve got an infection. Let it out. Diarrhoea is the body’s way of expelling the irritating agent, so don’t take things to bung yourself up.
    • Urine: again, blood or inexplicable change always need attention.
    • The combination of pale stools and dark urine is serious. Bile (gall), dark green, passes in a tube from liver to intestine to help digest fats. If it doesn’t get there (gall stones or some other blockage) stools will be pale and, because fats are undigested, fatty and floating. Bile needs to get out somehow, so it passes into the blood, makes the skin yellow (jaundice), and is excreted by the kidneys into the urine, so the urine is dark. Gallstones are usually associated with pain and are easily dealt with, but other causes of blockage are not. The bile duct passes through the pancreas so pancreatic cancer can block it. By the time symptoms appear, the cancer is well advanced so it’s time to contact an undertaker.
  • Electrics: nerves and brain. Funny turns, weakness, tingling, numbness, paralysis, and so on. Doctors like to know what the cause is, and if it’s something pressing on the brain or nerves, then there’s hope. Otherwise, little can usually be done except easing the symptoms. Nerves recover very slowly if at all. If part of the brain is wiped out, another part can sometimes be trained to take over its function, but it’s very slow and unpredictable.

Some people think that disease is a punishment from an irascible sky pixie for stuff you’ve done or not done. This is drivel. We are machines. Machines break down. Things go wrong. Sometimes they can be fixed. Sometimes they can’t. Sometimes the treatment is worse than the disease so it’s better to put up with it, though this may be a great burden for you and those you live with.

Take responsibility for yourself. If you stuff your face with cream cakes don’t be surprised if you get fat and suffer from the diseases of obesity. And don’t expect to feel at 65 as good as you did at 20. Get real.

You’re going to die, and you don’t know when, so no matter how young you are, make a will, get your affairs in order, and make peace with those you feel you need to (but don’t go overboard – some people are gobshites and they’re not worth the effort).

Meanwhile, keep smiling, and remember that life is a terminal condition.

A funny turn

3B10211C00000578-4002910-image-a-7_1480976584455As Facebook friends may have read, a couple of weeks ago I had a funny turn.

Out walking the dog I felt fuzzy headed, vision even more blurry than usual, unable to walk in a straight line, slurred speech. No drink taken. Transient ischaemic attack (ministroke) thought I as I was lumbering about. Or brain tumour, or cerebellar disease, or inner ear disease.

I sat down, minded by two kind passers by who said I was pale and unsteady. Susan walked the dog home, brought the car and off to hospital. I was in hospital a fair bit as a child for tonsils, nasal polyps (x 3), appendix, teeth and broken bones, so I dislike hospitals intensely. Not only that, people die in them. So the fact that I willingly went says something important.

A&E was quiet. I was tended with efficiency and good humour. I was given a mask and learnt that nobody knows how to stop them steaming up your specs. ECG normal, head CT normal, BP 135/75 – beat that, suckers, given the amount of salt and butter I consume.

High dose aspirin was administered, blood thinner and statins prescribed. Statins I don’t like. Doctors don’t always know the difference between good and bad cholesterol. and the evidence for the efficacy of statins is equivocal. Anyhoo, when I had them once before they didn’t agree with me so I stopped them PDQ.

There’s an MRI next week and they mentioned continuous ambulatory heart monitoring. But I feel as if I’ll be wasting their time. I’ve no idea what caused the symptoms, and they don’t fit into any recognised disease pattern.

You see, dear reader, we’re just machines, and machines have glitches. Sometimes we know what causes the glitch, sometimes we don’t. I’ve found that the cure for a computer glitch is usually to turn it off then on again; for a TV or washing machine glitch, a hard bash or three usually does the trick.

So on this well-established principle, my treatment for this funny turn (a recognised medical expression by the way) was: kill or cure. The very next day I took up running.

Back in the 1980s I was a regular runner – not particularly fast but I could go for ages. Often up at 5.30 am to run a few miles in north Nottingham to Bulwell and back from Sherwood (a suburb, not the forest). A friend and I often went for a few miles round Wollaton Park at lunchtime, showering afterwards in the Anatomy mortuary, much to the amusement of the staff if not the cadavers. I even ran three half marathons.

In the 1990s I was at it again at lunchtime in Dublin from St Stephen’s Green to Phoenix Park and back with a colleague (students were shocked to see that Professors had legs), and at home in Djouce woods in County Wicklow. I opened the car boot, in jumped Petra (a ridgeback/lab cross, a wonderful dog) and up to the woods. We had a great time on the tracks and pathways. The woods, opposite Powerscourt waterfall, were known as an IRA training ground, but we never saw or heard anything interesting. I was really quite fit and lean. Then life intervened and I became, let’s say, less lean. Weightlifting became my thing.

Now senza gym and provoked by a funny turn it’s back to running.

But gently—not because I might die, for I certainly shall, but because I wish to minimise pain. At the age of 70 next month, muscles are good but ligaments and tendons are much more brittle. It hurts when they tear or rupture.  Joint cartilages, too, need care.

Will I ever be back at the gym? When will it re-open? Will I at this age be allowed out of the house? Let me tell you, girls and boys, if the government says I’m not, I may well need to be visited in prison because doubtless some nosey parker reincarnation of an East German Stasi gobshite will report me for being a very naughty boy.

What if running provokes a catastrophic blowout? Well, that’ll be that. You’re welcome to the party after the funeral, if allowed. What doesn’t kill me makes me stronger, as my ole pal Fred Kneeshaw said.

But never mind. Her Majesty’s Government is in control. I have every confidence that they will act sensibly over gyms: reopen them now please. I have every confidence that they will raise money to pay for the largesse they’re doling out by making the super-rich pay more tax, by making multinationals like Amazon pay more tax, by stopping drug companies (they’re all evil) charging extortionately for things that are cheap to make, and by closing tax havens. Funds will cascade into government coffers. As I say, I have every confidence.

Meanwhile, back at the ranch, every day in every way it gets easier and easier. And the dog is having a great time.

Corona and Cassandra 2

Blue-COVID-BannerAn update of my previous blog.

“When we get back to normal …”

Not when, but if.

Coronavirus is the virus. Covid19 is the disease it causes. Coronaviruses have been with us a long time. The flu virus is one of them. Some common colds are caused by coronaviruses. Covid19 is caused by a new strain—hence the adjective novel. I dare say, dear reader, that you knew this. But I’m ashamed to say it hadn’t dawned on me until fairly recently. Now on with the plot.

I don’t see any prospect of controlling this pandemic until herd immunity has been achieved. Herd immunity comes from a combination of immunisation and recovery from infection.

  • A vaccine is at least a year away and anyway vaccines don’t always work. The first recorded influenza pandemic was in 1510. We haven’t yet fathomed the disease and a flu vaccine is as far away as ever. Furthermore, the common cold, sometimes of coronaviral aetiology, eludes all cures. The polio vaccine took decades to be usable, though we’ve moved on scientifically from then. I’m old enough to remember the polio epidemic of 1957/8. As an asthmatic child often fighting for breath, pictures of children in iron lungs terrified me.
  • For recovery from infection we need about 60% of the population to be infected, with the inevitable proportion having life threatening disease and dying. The trouble is that this virus has great propensity to mutate. Its mutated forms could be more vicious than the present one, and herd immunity, or vaccines for that matter, for the present strain won’t necessarily work for new ones. So we are faced with the possibility of wave upon wave of epidemic. Epidemics in general are occurring with increasing frequency (Asian flu, polio, SARS, foot & mouth, Ebola, now this … and more).

And of course there’s always the possibility that new viruses will emerge.

Viruses are clever. They use other creatures for reproduction—their only concern—remorselessly. Just as tectonic plates do the “things that come naturally” leading to quakes and tsunamis, so viruses do the “things that come naturally” leading to morbidity and mortality in vulnerable creatures including humans. It is the natural order.

Viruses are as much part of creation as we are. Praying to a sky pixie for delivery from the pestilence of viruses, as religious nutters do, is no more than human arrogance and hubris. We have viruses in our intestines, necessary for digestion, just as we have billions of bacteria living in us and on us, all necessary for an efficient bioeconomy. Are they asking the sky pixie to discern which bugs to zap and which to leave unhindered?

If covid19 were left unchecked, the best option scientifically, it would amount to survival of the fittest. The trouble is that the burden on the health services would soon be catastrophic. The strategy adopted, distancing and such like, spreads the load over a longer period. But no matter how we get there, herd immunity is needed—and may never be achieved. I suspect that governments have been informed of this, but dare not admit it publicly.

This brings me to the reliability of what we are told. Take today’s BBC news item “New data has added to growing evidence that the number of deaths linked to coronavirus in UK care homes may be far higher than those recorded so far.” Note the vagueness. “Deaths linked to coronavirus” – what does that mean? Deaths “may be” linked. They may not. Just because someone with a cough and pneumonia dies, it doesn’t mean they died of covid19, nor does it mean that the virus contributed to their death. Only testing will tell, so we need reliable tests. Not all tests are reliable. If one reads only the headlines, and many of us do just that, it’s easy to panic.

Ultimately—and I wish people would realise this—we’re all going to die, if not of covid19 this month, then something else later. And let me repeat that as someone with a great future behind him, I would expect a younger person who could get back to work to jump the treatment queue before me. I’m ready to die, though I don’t want to yet.

I don’t much care what others think this says about my morality: to me it’s pragmatic necessity. I acknowledge that I have a peculiar, even brutal, attitude to death. It comes from having seen death as welcome in severely ill people especially babies, having handled cadavers in anatomy dissection rooms for 30 years, and having suffered the death of one of my sons.

Turning from biology to economic and political affairs, the consequences of the pandemic could be serious in Europe, and cataclysmic elsewhere.

  • In the west, an economic slump of staggering magnitude is almost certain: some economic historians have said the worst in 10 generations (400 years), others 200 years, and certainly 100 years. As one commentator put it, it’s almost as if the virus were tailor-made to strike at capitalism. The financial markets are in turmoil. What will happen to the banks? Fewer people will be able to buy houses, house prices will plummet (a good thing you might say), savings wiped out, pensions destroyed. Power cuts, shortages, rubbish uncollected, unemployment, poverty, civil unrest, suicides. Back to the middle ages. Governments won’t be able to bail us out: national economies will be in the doldrums for decades after the financial largesse already being handed out. Taxes will rise. This economic reality is already fuelling demands for the lockdown to be lifted so that people can get back to work.
  • Elsewhere – a worst-case scenario
    • China is already buying up commodities now that the prices are rock bottom.
    • The US sees covid19 as China’s fault and demands reparations. China says no. The US refuses to pay back interest on its substantial loans from China. China sees this as an act of economic war. Then what?
    • The slump in oil prices destabilises the Middle East, especially Saudi. Oil supplies are cut. Dictators emerge.
    • The Russian economy being too dependent on oil, Putin invades Ukraine for food and the Baltics for minerals. Will Western Europe fight for the Baltics?
    • The peace since 1945 has been dependent upon economic prosperity. When that is taken away nationalism rises and fights are picked.
    • Africa is devastated. Infected migrants hammer at Europe’s doors. Shots are fired to keep them out: many will be killed.
    • I imagine something similar could happen in South and Central America – poor and populous.
    • The already creaking EU disintegrates.
    • Surveillance becomes intrusive (it’s getting that way already).
    • Totalitarian governments take over. Maybe China takes over. Or Russia.

Now, you may say that this is unduly bleak. But none of it is beyond the bounds of possibility.

I could be wrong. Part of me hopes I am. Part of me thinks that our lifestyle in the West is dissolute and decadent and needs sorting. But events that lead to correction of our lifestyle will likely lead to horrific, in human terms, sequelae for the third world—which now includes much of our inner urban areas.

Life is a terminal disease, its death rate 100%. People are going to die of this and other viruses. Measles is coming back. Polio and Ebola and Foot & Mouth lurk in the shadows ready to erupt unpredictably. The best thing we could do for one another is to help each other come to terms with uncertainty and mortality. I did my best from the pulpit and I do my best through my blog.

The fact is that there are too many people on the planet. There are far too many cooped up. Maybe the planetary ecosystem is resetting itself. I’m not a proponent of the Gaia theory, but I know that we reap what we sow. At present we are reaping. As far as creatures of the earth are concerned, apes like us are vulnerable, impotent and expendable.

But never mind. The sun is shining, the sky is clear, riverbeds visible, air cleaner. The night sky is spectacular. This virus is doing the planet a favour. Perhaps too it’s the scalpel that releases pus from the putrid abscess of aggressive capitalism.

I thank James Drever and others for help with this, but please don’t associate them with my prognostications.

Corona and Cassandra

Cass

Cassandra

Informed guesswork.

Even experts must be scratching their heads a bit in dealing with the pandemic. It can’t be otherwise, for this is a novel virus, and novel means novel. The virus is more infectious/contagious than was first thought (but not as much as say measles) and more virulent/fatal (but not as much as say Ebola). It’s difficult to plan in such circumstances.

I left full time medical practice in 1976, and I’m no political pundit, but I have a certain breadth of vision, so bear with me as I look ahead.

I don’t see any prospect of “controlling” this pandemic until herd immunity has been achieved. Herd immunity comes from a combination of immunisation and recovery from infection. A vaccine is about a year away, so in the meantime that leaves recovery from infection. We are faced with the prospect of more than half the population needing to be infected with the inevitable proportion having life threatening disease and dying.

If the disease were to be left unchecked, the burden on the health services would soon be catastrophic. The strategy adopted—distancing and such like—spreads the load over a longer period. But ultimately herd immunity is needed. I suspect that governments have been informed of this, but daren’t admit it publicly to a populace that has forgotten how to deal with uncertainty and mortality.

The trouble is that even if herd immunity is achieved, coronavirus, being an RNA virus, may well mutate, the new strain possibly more virulent than its predecessor. So back to square one. And of course there’s always the possibility that new viruses will emerge.

We’re a drop in the ocean compared to New York, Africa, India, the Far East, Central and South America. Economic and political consequences could be serious in Europe, and cataclysmic elsewhere. Read on.

  • China is already buying up commodities now that the prices are rock bottom.
  • US sees covid19 as China’s fault and demands reparations. China says no. US refuses to pay back interest on its very substantial loans from China. China sees this as an act of war. Then what?
  • The slump in oil prices destabilises the Middle East, especially Saudi.  Oil supplies are cut. Dictators emerge.
  • Vladimir Vladimirovich has economic problems in Moscow, the Russian economy too dependent on oil, and invades Ukraine for food and the Baltics for minerals.
  • Africa is devastated. Infected migrants hammer at Europe’s doors. Ammunition is deployed to keep them out.
  • The EU, already creaking, disintegrates.
  • Surveillance becomes intrusive (it’s going that way now).
  • Totalitarian governments take over. China takes over? Russia takes over?

As for the financial largesse being doled out at present, that will have to be paid for. Meanwhile, power cuts, shortages, economic hardship, civil unrest, back to the middle ages.

Now, you may say that this is unduly bleak. I admit I can be a bit of a catastrophist. But none of this is beyond the bounds of possibility. Interesting times ahead – a distraction from brexit anyway (remember that?). Don’t expect a quick resolution.

There are too many people on the planet – or at least too many banged up in cities. As far as creatures of the earth are concerned, apes like us are vulnerable, impotent and expendable.

Maybe the planetary ecosystem is resetting itself. A spring clean.

I thank James Drever, Andrew Paterson, and others for their help with this, but please don’t associate them with my prognostications.

What’s your little helper?

drugs-and-addictionSo, girls and boys, out we go for a walk with Bella the Staffy.

As we approach the Trent and Mersey canal, a young man walking purposefully in the same direction overtakes us. We exchange pleasantries. Then, surprisingly, he stops. We catch up with him just as another young man approaches from the opposite direction. With sleight of hand the two guys exchange something. They retreat whence they came.

User and supplier, we mused? Which was which?

What does it take you to get through the day?

  • Nicotine/tobacco. The sense of calming and release can be blissful, I gather.
  • Alcohol? At a funeral of a wealthy 40-something year old who died of alcoholic liver disease, I said from the pulpit that anyone who ever encouraged him to “just have one more” was complicit in his death.
  • Exercise, fitness? The endorphins released are addictive.
  • Sex? Porn? Likewise.
  • Golf? I’m not old enough to play golf, but I’m told that it’s quite popular amongst the brain dead.
  • Other drugs? Cannabis is less dangerous than alcohol. Cannabis rice krispie cakes are delicious.
  • Religion? Yes. The ecstatic trances of mystics are well known to be comparable to—even equate to—orgasm.

Am I saying that for many people religion is merely a prop to help them get through the day, on a par with smoking or drugs or booze?

Yes. That’s exactly what I’m saying.

Here are some other things we can be addicted to: money, power, controlling others, pleasing people, wanting to change people, gambling, internet, social media, books, buying stuff you don’t need, gossiping, criticizing, moaning, being miserable.

Some are financially more expensive than others, but there isn’t one that’s any worse than any other. They can all destroy us. It’s as hard for you to let go of your addiction to new clothes, or whatever, as it is for someone else to put down the drink or the syringe.

They’re like demons. They steal our personalities and stop us being ourselves. They deny us our freedom. They make us obsess about ourselves instead of serving others.

We’re all wounded because of stuff that’s happened to us. We all need something to dull the pain. We develop patterns of behaviour to protect us from these hurts. Whatever “pain relief” we choose—substances, attitudes, activities, religion—can be dangerous. We become addicted to them.

We’re all addicted to something—several things in my case. Look at your addictions. If you think you haven’t any, you’re blind.

All the vain things that charm you most—accept that they are part of you. Think of them as controlling different versions of yourself. Then give that version of yourself a cuddle. You begin to love the hell out of yourself. You might have to accept that some will stay with you till you die.

This is not easy. But even beginning the process is a kind of renewal. Nobody is perfect. Nobody has a perfect upbringing.

We are all in recovery.

Clearing out stables?

2AP1TD2-b598c7937e0cb7c3ddb3d98f6d897d82Isolation, distancing, handwashing

I understand some of the reasons for what we are told to do.

I understand the vague concept of herd immunity, but not the ins and outs of it in this Corona virus phenomenon, which, I gather, is not like other viral epidemics. As a medical student, I never took to epidemiology. It is mathematical in a way that probability and statistics are mathematical, and they always provoked mild panic in me.

In the mid-1970s, virology wasn’t much in evidence on the medical course. As for handwashing, the Professor of Microbiology, one P A Boswell, told us that since urine is sterile but hands are most certainly not, men should wash their hands before having a piss, not after. That has stayed with me.

But …

In an idle moment in Dublin several decades ago I did one of those personality questionnaires that appeal to vanity. It told me that I was more than a little fatalistic. Oddly enough, for such questionnaires are often drivel, I could see that there was truth in that verdict. I am indeed.

So despite my unwilling, chuntering conformity with most instructions from on high at present, a large part of me thinks we should remove all restrictions and let nature take its course.

People will die.

People will die anyway. Part of the present hysteria stems from the expectation that “I can live for ever”. The NHS panders to the notion of immortality and to the notion that at 70 I should feel as good as I did at 20. And it encourages irresponsibility in that people think they can do what they like in the expectation that the NHS will sort them out. In this regard, the NHS is complicit – but that’s another story.

People say “we should protect the vulnerable”. Why?

Both Susan and I are in the at-risk category, or soon will be. One of us is 70, the other 69. One of us has diabetes-2, the other asthma with a propensity to chest infections. One or both of us might die. But that’s going to happen anyway.

If treatments must be rationed, I can’t see why I should be favoured more than younger people with dependants. I have a great future behind me: theirs is in front of them. There is a discussion to be had on the allocation of resources in hard times, but it seems nobody will have it. Instead it all comes down to unexamined “motherhood and apple pie” sentimentality.

Earth cleanses itself

I’ve never had any doubt that there would be some catastrophic event that culled humanity. I’ve wondered about an eruption of the Yellowstone caldera such as may have wiped out dinosaurs; or an extraordinarily large eruption of sunspot plasma that would completely disrupt the earth’s magnetism, electrics and electronic communication; or wars over the availability of water; or MRSA; or viruses.

There are too many humans on the planet. Nature will deal with it.   One thing I’m sure of is that if humanity is wiped, viruses and bacteria and archaea and insects and … will still be around, so evolution can get to work again.

It’s extraordinarily arrogant of humans to expect that other creatures of this earth, including viruses, should stop doing the what-comes-naturally for the sake of human comfort.

I am in control of nothing. Thou art in control of nothing. He/she/it is in control of nothing. We are in control of nothing. You are in control of nothing.

They, viruses, have the future in hand.

I can probably survive like this for a week. The prospect of 12 weeks makes me reach for a sharp knife with which to slit my throat. Of course it’s possible that economic factors will mean no pensions, lootings, hyperinflation, supermarket fights, no food, so I could well have died before then through inanition.

It will do me no harm to live day by day without expectations, even though I find that extraordinarily difficult.

Noli me tangere

247f11754cd5847ddbc149fb2acdc2beA churchy one – sorry.

Archbishops have banned sharing the chalice at communion. The RC diocese of Rome has stopped all communion services for a month.

There will be panicking in the aisles. Mass demonstrations. People will wilt away, craving the sacrament.  Those who are so intrinsically wicked that they need communion several times a week must be inordinately distressed.

This is wonderfully illustrative of the knots into which people tie themselves in order to believe six impossible things before breakfast. I banned intinction years ago. My experience was that only respectable middle class women wanted it so that their lips didn’t have to tread where others had trod before. I pointed out that their hands were filthy from scratching faces, touching hankies, bibles, hymn books, leaflets and pews, and exchanging the peace (thank God that’s gone if only temporarily), the conclusion being that their hands that used to do dishes were actually cesspits of potential infection. They didn’t like that.

The advice and discussion make a mockery of transubstantiation (if anyone really and truly still believes that mediaeval nonsense), and even consubstantiation. Maybe the diocese of Rome has it right – the priest’s hands will be filthy enough, despite alcohol washes, that even the bread/wafer/Host is itself a danger to health – whatever that is.

When the current crisis is over it’ll be fun to see how the justification for banning the common cup is quietly forgotten as former practice is resumed – despite the fact that microorganisms live in us and on us by the billion, and that though they help to keep us in good working order, they can cause real problems if they get into places where they shouldn’t be?

This is the best entertainment the church has provided for a while. Laugh out loud stuff. Confusing an issue with facts is always problematic.

Sex

image

Lunar landing

As some of you will know, the church has its knickers in a twist about sex.

The church—be in no doubt about this—talks bollocks. One of the reasons it can’t recognize balls is that it’s stuck in the past (“surely not” I hear you say) and it ignores biology, the most fundamental thing of all.

So to get the juices flowing, and in preparation for things to come, I offer you this.

Structure

The gonads of the early embryo can develop into either testes or ovaries. It seems that the ovary develops unless hormonal conditions at a certain stage of development ‘switch’ on the testis, as it were. The female is the default setting. Very rarely (1 in over 80,000 births), an individual may have an ovary on one side and a testis on the other, or a gonad may contain both ovarian and testicular tissue.

The ovary stays more or less where it started, but the testis descends into the scrotum. Undescended testes, this descent having been arrested, are common: about 3 in 100 male births. In a sense, an undescended testis signifies incomplete male development.

The clitoris and penis both develop from the same embryonic precursor. The female, again, seems to be the default setting. Penile congenital anomalies such as hypospadias, where the opening is on the under surface of the penis, are surprisingly common (some say 1 in 300 male births). They can be regarded as varying degrees of reversion to the female anatomy. How small does a penis have to be before it is a clitoris? If you’re interested, there are websites (so I’m told) that show all sorts of penile anomalies and how some people have them modified.

The scrotum and the labia majora develop from the same structures: the scrotum is the two labia sewn together. You can see the ‘seam’: you’ll need a mirror unless you have a tolerant friend. How large do labia have to be before they become scrotum-like?

Every adult male prostate gland contains a vestige of the precursor of the uterus.

Every adult female has structures that in males develop into the tube conveying spermatozoa from testis to penis.

Some people are born with external genitalia of one sex and internal genitalia of another. Or a person may be born with genitals that seem to be neither one thing nor the other—a girl may be born with an abnormally large clitoris, or lacking a vaginal opening, or a boy may be born with a small penis, or with a divided scrotum, like labia.

Structural anomalies in the male are more common than in the female, though you may recall the fuss about the South African ‘female’ athlete who was reported to lack both ovaries and uterus.

Chromosomes

Normal male: XY chromosomes. Normal female: XX chromosomes. The incidence of newborns that are neither XX nor XY has been put at about 1 in 1700. Here are some examples:

    • XXX: 1 in 1000. Female, often no other manifestations.
    • XYY: 1 in 1000. Male, often no other manifestations.
    • XXY: Klinefelter’s syndrome. 1 in about 1000, often sterile, males with female fat distribution. May never be diagnosed, so may be commoner than we think.
    • XO: Turner’s syndrome. 1 in about 3000. Appear female, nearly always sterile.
    • Mosaic, some cells XX, some XY. Very uncommon.

Psychological sex – ‘what do I feel or experience?’

We know very little. It seems that a part of the brain may be switched on to ‘I think I’m a male’ at a certain stage of development. It seems, again, that the female is the default state. There are reports of people who feel as if they have been born into the body of the ‘wrong’ gender. There are reports of an area of the human brain that in homosexual men is more like that of heterosexual women than that of heterosexual men: male body, female brain perhaps.

  • If a man admires or envies the muscularity of a male athlete, does that mean he is homosexual? Do rugby players who grab their opponents’ bollocks in the scrum have something else on their minds?
  • If a woman admires a Rubens lady of generous proportion, does that mean she is lesbian?

My view is that we are all on a sliding scale of sexuality, and we move to and fro. But the unfashionable truth is that we don’t know much for certain.

Defining man/male and woman/female

We simplify sex categories into male, female, and sometimes intersex, for cultural purposes. This is unsubtle. There is much scope for naturally occurring structural and chromosomal anomaly, and a spectrum of psychological sex.

Pleasure

To what extent did ancient writers associate procreation with sexual intercourse? In Biblical times, the roles of ova and spermatozoa were not as we know them today. It was held at one stage that semen merely initiated the development of the embryo in the mother, and at another stage that a spermatozoon contained the miniature human and that it was ‘injected’ into the mother, who was merely the vessel (oven) in which the embryo grew. (As an aside, both these shed interesting light on notions of virgin births in Biblical times, even accepting that virgin as we understand the word is the correct translation – which it isn’t.) This matters to the same-sex debate, because it is relevant to whether or not the ancients recognised the importance of pleasure in sexual intercourse—what we might term the psychological “reward” effects that come from the flood of endorphins released in orgasm.

If we say that sexual pleasure is banned, and that intercourse is only for the purpose of procreation, then intercourse must be restricted only to those times in the menstrual cycle when conception is possible. This turns current Catholic teaching on its head, for using the safe period for the avoidance of conception should surely be just as much a ‘sin’ as using a condom. Catholic teaching logically should restrict intercourse to the unsafe period.

So, how do we define man and woman?

  • Inspecting genitalia mightn’t give a definite answer, and who would be daft enough to suggest it?
  • Chromosomal tests might not be a reliable indicator of what gender the person feels.
  • Assessing the ability to engage in vaginal intercourse might do the trick. Doubtless assessors could be appointed by the state – a job for voyeurs (what’s wrong with voyeurism?). If one or both partners were infertile, then intercourse would be only for pleasure, so there might have to be pleasure police.

Conclusion

If we say we are certain, we deceive ourselves, and the truth is not in us.