It was 3:45 pm. I was sitting crossed-legged with twenty other seven-year olds under a wall of flat glass windows. An eerie calm had settled outside, where a short time before there had been whipping winds and a sky as green as Kermit the Frog. My mom whisked into the building, her sensible yet fashionable heels clicking on the worn linoleum, and the petals of her flowered dress rippling with her gait. Shocked that I was not huddled in an enclosed room, she took one look at my position under the windows and told me it was time to go. That was the last time I ever saw my after-school program. Everyone knows not to take cover under glass during a tornado.

On the way home, my mom angled the car around downed branches the width of tree trunks and garbage cans lolling down the curb. The world was spent: siding dangled from the edge of condos, and telephone poles were precariously tilted, if they stood at all. People ambled about, assessing the damage as the neighborhood settled into a collective sigh. A policeman at the end of the lane directed traffic to make only a right turn onto the main street because of downed power lines to the left, the direction of our house. My mom said, exasperated, “Now we’ll never get home!” My mom, always tough and calm, was worried. It wasn’t until that moment that I got scared too.

We did, eventually, make our way to our still-intact home. Thinking back on that moment, one of a few post-tornado moments during my Indiana childhood, I note most how my fear was derived from my parents’ fear. I always felt safe and happy when at their side, but in the rare moments when they were fearful, I became beside myself with terror.

When I was growing up my mom and I would sometimes watch horror movies while sitting on our worn, brown suede couch. When the background music began its inevitable, this-is-the-scariest-part crescendo, I would turn my head 90 degrees to the right and look straight into my mom’s eyes. For the entire duration, my mom would calmly report that the masked man was bludgeoning the babysitter or wryly observe, “Oh, looks like the psycho wasn’t dead after all.” Sometimes she’d insert an, “Ew, gross!” exclamation when something bloody took her by surprise. I got all the emotion I could handle by looking into her eyes during those parts; she became a sort of “closed captioning” for me—recapping what my senses wouldn’t let me experience first-hand.

When I was a child and swam competitively for years with the local swim club, my parents attended every swim meet I participated in. They would sweat it out on the hot bleachers of the indoor pool deck, fanning themselves as they sat for hours in the backless bleachers waiting for my race to begin. If I became nervous before my event, as I always did, I’d scan the population of faces in ordered rows until I found my parents. My dad, always looking for me, would catch my eye and give me a thumbs up with a double eyebrow raise and a big smile for support. I would immediately feel relief and was instantly braver because he believed in me.

When I graduated from my small-town college and decided to move to New York City without a job, a friend, or a long-term place to stay, my parents took care not to discourage me. Instead, they threw an early birthday party for me and did the tough thing—they bought me luggage, in acceptance that I had to live my dreams, even if they took me far away from family. Upon unpacking that luggage, I found a tiny yellow post-it that my parents and older sister signed that said, “Love ya!!!” with each of their familiar signatures surrounding it. Beneath it was a card that said, “You Must Take Your Chance.” Never once did they remind me of my shy demeanor or annoying tendency to throw up repeatedly when travelling on my own. Never once did they ask me to stay with them forever, even though their eyes might have mentioned it.

 As an adult, I still gauge fear by my parents’ eyes. A few years ago, during a phone call that bridged the 1000-mile gap between our homes, my mom told me my dad was diagnosed with a brain tumor. She spoke flatly, like a tiny person standing in the mouth of a huge cave, every syllable clear and solitary. There were no reverberations, no hints of emotion. I tried to be the echo of her stillness. But when I arrived at my parent’s house and looked into my mom’s eyes, I knew we were in trouble.

The night before my dad’s brain surgery, he and I sat in cushioned deck chairs on the shaded back porch of the house. He looked intently into my face and asked if I thought he was doing the right thing by having surgery and if I thought he was going to be okay. His doctor had given him 6-12 months to live and flatly stated that this condition had a high mortality rate. Surgery could buy him time, but most likely he would not survive. My dad’s tumor gave him short term memory loss, so he forgot all of that. What he remembered was that he trusted me. What I knew was that every moment we’re given here on earth, we are living. If there was even a one percent chance that my dad would live, what’s to say he wouldn’t be in that one percent? Sitting on the porch that night, I breathed in, collecting all the calm I could from the cheerful summer day, erased fear from my face, and answered, “You’ve improved so much in this past week on medicine alone. I think you’re going to be fine.”

After his surgery, my mom, sister, and I walked down the hallway to see my dad in the intensive care unit. I have a nauseous fear of hospitals, one I inherited from my dad: a feeling that the hallway is too long, that the patients behind the floor-to-ceiling windows are unprotected so near to the thin glass walls, their bodies storming inside. We shakily entered Dad’s room, and he smiled at us and groggily said, “I feel fine,” then crossed his eyes and stuck out his tongue to prove his normalcy. I relaxed, seeing his face, seeing he was okay. I think he did it for that reason.

I guess that is what love is—reassuring each other in the eye of a storm, being the wall of calm and protective peace within the whirl of a tornado.

Jakus AE et al. Hyperelastic “bone”: A highly versatile, growth factor-free, osteoregenerative, scalable, and surgically friendly biomaterial. Science Translational Medicine. September 2016.

Bone implantation surgery is both challenging for doctors and a painful process for patients, especially children. It usually requires either harvesting existing bone tissue from elsewhere in the body, or using metallic implants. While these approaches may work for adults, they are not a permanent solution when used for growing children. In a recent study, scientists reported a 3D printable ink that forms a synthetic bone implant and induces bone generation and growth. This biomaterial is composed of a mix of 90% hydroxyapatite, a calcium mineral found in human bone, and 10% biodegradable polymer, which is commonly used in medical applications, including sutures. The key feature of this new hyper-elastic biomaterial is its ability to create porous structures where blood vessels and other cells can infiltrate to create a scaffold. Animal studies showed that when stem cells are placed on these scaffolds, they turn into bone cells and initiate the regeneration process. Additional factors can also be easily integrated into the biomaterial, such as antibiotics to prevent post-surgery infections or growth factors to further enhance the regeneration process. The advantage of 3D printing technology will enable doctors to create personalized bone structures with custom shapes and properties for each patient.  In the near future, hospitals with biomaterial and 3D printing facilities may revolutionize the field of craniofacial and orthopedic surgery.

Gene behind “sixth sense” discovered

Chesler AT et al. The Role of PIEZO2 in Human Mechanosensation. The New England Journal of Medicine. September 2016

Close your eyes and bring your finger to your nose. It’s an easy task for almost all of us, isn’t it? Awareness of the position of one’s body in space is called proprioception, also commonly known as the “sixth sense.” A recent study describes the cases of two patients who lack proprioception. These patients could not walk, keep their balance, or even touch their noses when blindfolded. Genetic analyses revealed that both patients had mutations on a gene called PIEZO2, suggesting that this gene is responsible for the sense of touch and proprioception in humans. Further investigation of the PIEZO2 gene showed that it controls mechanosensation by generating nerve signals in response to any force touching the skin, thus allowing us to sense the touch. The patients seem to compensate for a lack of proprioception by relying primarily on vision. While these patients have non-functional PIEZ02 genes, there is an intriguing possibility that there could be other variations of this gene in the human population, which may generate a spectrum of symptoms from superior athletic performance to clumsiness, depending on the P

Before anasthesia, even routine surgeries were painful and dangerous. Its advent has allowed for amazing advances in public health and patient safety.

Humanity has faced various kinds of health problems throughout history, and will be facing them until the end of time. Even someone who has not yet suffered from an illness, will almost certainly suffer from one in the future. Let’s take a moment to reflect on all the people who are currently undergoing treatment at hospitals in the hopes of curing an illness.

From time to time we visit close friends and relatives who have undergone such operations. We wish them health and talk with them a little. We ask them how the operation felt, how many stitches they have. They usually say, “They injected me with something and I don’t remember the rest.” Then they may show us their gall bladder, wrapped in gauze, or their kidney stone, which was removed. Have you ever pondered how it is possible not to feel any pain during these kinds of operations, or how it is possible not to remember anything?

Surgical practices have advanced so much in present times. Heart, liver, and kidney transplants are now commonplace, as are finger and arm reattachments. Anesthesia, which makes all of these operations possible and painless, is a great blessing. Even the small and simple surgeries performed just 150 years ago were very difficult for surgeons – not to mention very painful for patients.

In his famous book on physiology and treatment, The Canon of Medicine the renowned 10th and 11th century scholar, Avicenna (Ibn-i Sina) (980-1037), defines anesthesia as, “a numbing and a cooling remedy.” He gives pathophysiological commentary on the influences of anesthetics and analgesics, and summarized painkilling methods as following:

1. A mixture prepared from linseed and dill should be applied to the area of pain.
2. Decreasing the sensitivity of the area of pain by increasing the moisture of the area, or providing narcotics for sleep.
3. Providing cooling and analgesic and anesthetic medicine.

Biruni, another Islamic scholar from the 11th century, documented his work with analgesic and anesthetic medicine. One of his writings recommends boiling the root tubers of henbane, Mandragora, horned poppy (Glaucium flavum), and Iris, together with the attar of roses and vinegar.

In his pharmacological works of the 12th and 13th centuries, Samarqandi recorded the analgesic, sedative (calming), anesthetic, and hypnotic effects of opium, mandragora, henbane, lettuce, beaver testicles, aloe vera, and coriander.

During the end of the 17th century, in Italy, anasthesia was performed by preventing the patients from breathing until they lost consciousness, and then immediately performing surgery on the patient who had fainted. This was called the asphyxia technique. The surgeries performed were relatively easy, such as the cutting of an arm or leg. The surgeon who was fast was considered the best, because patients could wake up during the surgery – that is, if they survived the procedure.

Another interesting anesthetic technique was making the patient lose consciousness by hitting them on the head. The hitting had to be done, “Hard enough to break the shell of an almond but gentle enough not to destroy its seed.” However, a bitter truth is that many patients were killed during this process.

Many have suffered the consequences of the absence of anesthesia in the past. Dr. Warren, a professor at Boston’s Massachusetts General Hospital in 1846, had placed his operating room on the very top floor of the hospital in order to avoid disturbing others with the screams of the suffering patients. One day, while examining one of patient’s tongues with pliers and a scalpel, he pulled the tongue of the patient without warning, and cut off his tongue with the scalpel. Afterwards, without hesitation, he cauterized his patient’s tongue with a hot iron. Dr. Warren observed the screaming, moaning, and suffering of the patients with no sign of emotion. He did not seem disturbed, and this was the exact attitude he needed in order to perform his duty. However, years later when enough advancement was done in the area of anesthesia, he couldn’t hold back his tears during the first operation that was performed with anesthesia.

Surgeries performed without anesthesia were hard on surgeon and patient alike. During his studies, the English gynecologist, Doctor James Young Simpson, fainted while cutting off a breast and considered quitting being a surgeon. Prof. Dr. Robert Liston was a famous surgeon at London University College. Dr. Liston had a reputation for being rude, arrogant, and strong. But he had no choice: he was forced to cut off a leg in 28 seconds, as anesthesia was not yet developed.

As can be seen from these examples, the absence of anesthesia, and the incredible suffering of the patients, pushed surgeons to be incredibly fast and emotionally insensitive. This period of time defined surgeons as strict, insensitive, and despotic. This went on until 1846, when William Thomas Morton performed the first surgery with anesthesia.

Since then, anesthesia has made surgeries much easier for all involved. Today, the definition of general anesthesia is total or partial loss of sensation in a human or animal body before surgical intervention.

Usually, anesthesia is performed by injecting medicine into the blood, or by making a patient breath an anesthetic gas. First, the patient loses consciousness, and then, with the help of muscle relaxants, the patient is put in a state of paralysis. Artificial respiration is performed until the end of the operation with the help of breathing machines called ventilators. For this purpose, an endotracheal tube is inserted in the windpipe of the patient and they are hooked to an anesthesia machine. This feeds oxygen, air, and the anesthetic gas to the patient. The anesthesia doctor controls the patient’s breathing, blood pressure, and heart rhythm, as well as other various, vital parameters, and the fluids that will be fed to the patient throughout the surgery. By doing this, the continuity of the anesthesia is made possible. When the surgery is over, the anesthetic drugs are no longer fed to the patient. When the muscle relaxants lose their effect and breathing returns to normal, the endotracheal tube is taken out and the patient is taken to another room to wake up. This is where the patient opens their eyes; it’s almost like a re-birth.

The chemicals in cannabis, opium, and coca were the essence of the first drugs used for general anesthesia; they are still being used, partially, in modern times. These chemicals, and some synthetic chemicals like them, are used for anesthesia and can be used after surgery in order to soothe pain. Most of our contemporary drugs are mostly synthetic, and they require many years of difficult education to be properly handled. It takes four years of additional education, after medical school, for a surgeon to become proficient with anesthetics.

Medical research done in the last two centuries about the dosage and quantity of these chemicals has advanced the practice of anesthesia incredibly. All this research provides a very good answer to why drugs have been created. While surgeons use the chemicals extracted from cannabis, opium, and coca, and from the synthetic chemicals like them, as a service to humanity, it is really hard to understand why some ill intentioned people use them for the detriment of human health.

Open heart surgery is performed after putting the patient to sleep under a general anesthetic. The chest is then opened by the surgeon, and the heart is temporarily bypassed or deactivated for the duration of surgery (although in some new techniques like beating heart surgery or minimal invasion heart surgery, the operation is possible without deactivation of the heart) During this period the functions of the heart are performed by an artificial lung mechanism called the heart-lung machine (cardiopulmonary bypass machine). Performing surgery on a working heart cases where there is no facility for beating heart surgery would be like trying to repair the engine of a car while it is in motion. This is why it is necessary to temporarily prevent the functions of the heart during the operation, which requires great care and accuracy.

Stopping the heart

During this procedure the patient is connected to the machine, thin pipes called cannulae are inserted into the main veins which lead to the heart, and thus the blood which goes to the heart is directed into the heart-lung pump, fed with oxygen, and then redirected into the body. Preventing the function of the heart is not a very difficult process. When the heart-lung machine is activated and the blood is cooled and redirected into the blood vessels, the body temperature is reduced to below 30°C, and this lowers the heart rate and assists the heart to stop functioning. The actual stopping of the heart is performed by feeding a serum containing a concentrated solution of potassium ions into the coronary artery, which feeds the heart muscle. Potassium ions are normally found in the human body but in a fixed proportion; potassium is an electrolyte which, if increased, causes a defect in the heart’s rhythm and can lead to ceasing of the heart function. Feeding the coronary artery rapidly with a rich potassium solution causes the heart to stop within a few seconds and allows the surgeon to perform the operation on a non-functioning, motionless heart.

The heart should not be stopped from functioning for a long period, even if the heart-lung pump is performing the function of the heart successfully. Under normal conditions the pump cannot perform the whole duty of the actual heart and lungs. When the body temperature is reduced, there is a reduction of functioning in many organs of the body to such an extent that they almost stop working, especially the brain. This means that every organ freezes and if the patient’s pulse were taken within this period, they would be assessed as dead.

Restarting the heart

To restart the heart following the operation a reversal of the procedure performed at the beginning of surgery is necessary; the temperature of the body is increased to 36.5–37°C again with the help of the heart-lung pump, and at the same time the amount of potassium in the blood is reduced to a normal level. This is usually executed by ensuring the normal function of the kidneys which discard the potassium from the body. This is when the function of the heart is monitored closely because there is a reversal in the process of inducing low body temperature and the excess of potassium which caused the heart to stop. In other words, the barrier which stopped the flowing river is removed; therefore, according to the laws of physics, the trapped fluid should flow again at great speed, and although following surgery the majority of hearts do begin to function again when these procedures are performed, there is unfortunately no actual guarantee. There may be certain complications or even causes which we have not yet discovered, in which case an electric shock of 10–20 joules is delivered directly to the heart muscle to encourage it to function normally. If this is unsuccessful, medication such as adrenalin, which induces the functioning of the heart, is given to the patient. If, following these repeated procedures, there is no effect, and, regardless of all the effort, the heart does not function, then everything is performed again from the beginning, including the operation. But there is always the possibility that the desired result may not be achieved. Human beings always face the prospect of death in daily life, and although there is a very slim chance of death, with such a big operation there is always the possibility.

The result

We are normally totally unaware of the rhythmic incidents, a combination of great harmony, occurring within our bodies. Even breathing, a necessity for every living creature to stay alive, is not an action which we activate and continue of our own will. Sight, hearing, hunger and senses are acts of nature over which we have little direct will or power. Nevertheless, they are all events which we can only describe as divine miracles and what a great blessing it is that none of these complex functions of our bodies have been left to us humans.

I am not a tailor, I do not make or sell clothes for a living, I am not in the textile business in any way. Even so, what had brought me to this exhibition was curiosity about such devices as stitches, stitching needles, scissors and the like. More precisely, I had come to see what I could find out about the history and development of such devices in relation to cutting and joining in surgical procedures, especially sutures. 

Every display in the great hall was presented by a team of experts who were there to answer questions. I asked many. In the end, rather to my surprise, I met one expert who was able to give me the kind of help I was looking for. He was Paul Breuer from Aachen, representing the German company SNF MANF, who, as it happens, manufacture surgical needles. Paul Breuer astonished me with his knowledge of a wide range of methods for sewing skin, including the use of ants. Naturally, I was intrigued, and Paul promised to post to me a photograph of an ant being used as a skin stitch, after his return to Aachen.

An embroidery equipment specialist, Caroline Sayers, of the company DATA STITCH, said she could design an ant stitch, if I could supply her with a suitable photograph. The very next day after I had supplied the photograph, the ant was scanned, digitized and an embroidery machine executed for us the amazing ant stitch.

My curiosity about this unusual suture technique led me to further investigations which finally bore fruit when I came across Welcome Institute for the History of Medicine’s 1973 publication, Albucasis on surgery and instruments. This book is a definitive edition of the original Arabic text with English translation and commentary by MS. Spink and G.L. Lewis.

In Book 2, Chapter 85, on suture materials used by the Arab surgeons, Albucasis (the Latinized version of Abu l-Qasim) mentions two techniques. Spink and Lewis, 1973, p.538, comment:

1. Ants’ nippers. This is not a classical method; but is said to be used by African tribes as a way of bringing skin edges together (modern Michel clips); evidently the Arabian ant-nippers acted in the same way.

2. Gut sutures. Gut was used by the earliest Greeks for bow-strings; but it is not mentioned as used for surgical purposes until the Arab era of surgery. Albucasis then describes it as ‘rubbed-down gut, well cleansed’. This may be the earliest reference to this now universal suture material.

Abu l-Qasim’s own account (ibid., p.550) is a vivid description of sutures using ants and cat gut:

Some men of experience have said that when a wound occurs in the intestine and it is small, it should be sutured in this manner, namely: ants with large heads are taken; then the edges of the wound are brought together and one of these ants is applied by its jaws then the head is cut off, and it will stick and will not loosen. Then another ant is applied near the first; and you proceed after this manner with a number of ants according to the size of the wound. Then reduce the intestine and sew up the wound; for the heads will remain sticking to the intestine until it is healed up; and no harm will come to the patient.

The intestine may be sewn up with fine suture which is extracted from an animals gut and sticks to it after being threaded in a needle. The method is that the end is taken of this suture made of gut, well scraped; and to this end is fixed a linen thread, twisted, and then that thread is passed through the needle affixed to the suture of animalis gut, with which the intestine is sewn and then replaced in the abdominal cavity (Abu l-Qasim al-Zahrawi, Al-Tasrif, Book 2 Chapter 85).

Abu l-Qasim Al-Zahrawi (936-1013) wrote his remarkable surgery manual Al-Tasrif during the period of Arab/Islamic rule in Spain about a thousand years ago. I felt a curious and wonderful sensation at the link between an ant stitch, mentioned and talked about in an exhibition of textile craftsmanship in Manchester near the end of the twentieth century, and the dedication and craftsmanly skills of the Muslim scholar who, a millenium before, had adapted the use of ants, and invented the use of cat gut, for making sutures. This was not the only contribution this extraordinary man made to the development of modern surgery techniques, nor was he the only Muslim to have made significant and striking advances in the field of medicine.

It is hard not to feel awe (and, naturally, some pride) at the achievement of the Muslims in that great period of Islamic civilization. I have no doubt that their success was owed to the excellence of their faith and their consequent commitment to working for the improvement of human well-being and the advancement of learning. And I realize that I am merely at the beginning of a long quest for information about what was achieved by Muslims dedicated to Islam in the broadest sense-namely, a way that improves the quality of human life and the quality of our understanding of the world we live in.

What is malformation? If a little girl, with six fingers on one hand, says she loves her sixth finger very much, how do we tell her she is malformed?

Blepharoptosis is a condition in which the upper eyelid droops in consequence of paralysis of muscles or nerves. But would we say that having drooping eyelids, eyes with short palpebral fissures, is a malformation? Would we not then have to say that most Chinese and Japanese have somewhat ‘malformed’ eyes?.

If the little girl’s sixth finger causes her no impediment, except for its appearance, would it be right to think of it as a ‘disability’ or a ‘problem’? On that criterion, obesity or anorexia nervosa could also be considered as disability. They are not only disagreeable in appearance but also impair physical and social function. Such impairment must surely be part of any definition of disability.

But this too raises a question. If an abnormality does not cause impairment of function, but only makes a person ugly, do we consider it a disability? Who will judge the level of ugliness, the individual or society? A schoolgirl with polydactylism – more than five fingers or five toes; a young man with alopecia universalis – absence at all hair, on the head and body; a teenage girl with ichthyosis vulgaris (xeroderma) – a severe skin disorder which causes an ugly appearance – if such conditions do not cause any impairment, if people have got used to seeing them, the individuals may not perceive themselves as ugly and therefore not feel distress. But if their appearance does disturb others and they feel distressed as a result, should we describe them as normal or disabled’? A little girl in a nursery school may be afraid of holding up a polydactyl hand; his co-workers may be upset by sharing a workplace with a man suffering from alopecia universalis; a hair dresser may not want to cut the hair or manicure the nails of a girl who suffers from ichthyosis vulgaris.

Plainly, clinical definitions do not define or cover disability. Sociological reflections are also important. Sometimes it is more important to ask how people around a particular individual perceive that individual, than to ask how medical science defines his or her condition.

There are situations where individuals do not feel handicapped and find their lives valuable and worth living, but people around them are upset by them and label them as disabled. In contrast to this, there are some cases, in which, the individual is considered medically ‘normal’, is perceived as ‘normal’ by society, and his or her condition does not cause any impairment, but that individual thinks that a particular part of his or her body is a problem and tries to find a ‘solution’ to it. These ‘solutions’ are an important part of the plastic surgeon’s workload. It is not easy to explain the circumstances which disturb people so much that they take the risk of surgery. But we may infer another factor to define disability namely the psychological state of the individual. The individual may not have any physical abnormality but psychologically he or she feels abnormal. Hospital records abound with such cases.

Among the most difficult ‘abnormalities’ are anomalies affecting the newborn and congenital malformations. There are 200 such ‘disabilities’ (see Goodman and Gorlin 1983). Among them are Downs Syndrome, Spina Bifida and Fetal Alcohol Syndrome. The distress caused by such illnesses has led to attempts to identify cases as early as possible. In order to do this, scientists have established new prenatal diagnostic methods such as USG (ultrasound), amniocentesis, CSV (cholonic villi sampling) and photocopy. 60-65% of malformations can be diagnosed with these methods (Goodman and Gorlin, 1983, p.83). However, we must define our aims clearly to protect humankind from being victims of these improvements. Goodman (1986, pp2l4-17) suggests that prenatal diagnosis is used for monitoring the pregnancy, to localize the placenta, to detect multiple pregnancies, to know fetal age correctly, to monitor probable congenital malformation and to make studies about the genetic, biochemical and chromosomal structure of the fetus. These are all aims which are innocent and for the benefit of humankind. But, like all other new technologies, they do raise moral questions.

Before 1977, prenatal diagnosis was rare in Sweden. The number of late terminations because of fetal abnormality was 34 in that year. By the end of the 1980s, this number had reached 100 per year. 40% of these terminations were because of Downs Syndrome and 15% because of NTD (Neural Tube Defect) (Reid, 1991, p.77). Introduction of the technologies to Portugal, Greece and Germany led to new legislation on the termination of pregnancies (Reid, 1991, p.9).

Despite all measures and methods of elimination, disabled babies continue to be born. Maybe attention should be turned to treatment and rehabilitation. Although it is not always possible to correct impairment completely, quality of life can be improved through a variety of rehabilitation methods.

Almost half of handicapped newborns die in the first year of life and 80% of the rest need corrective surgery or lifetime therapy. For this reason, treatment and rehabilitation are costly options. But after the improvement of surgical sciences, especially plastic surgery in recent years, the remediability of many conditions has increased.

Remediability or irremediability of disabilities is of crucial importance in determining the treatment offered to handicapped newborns. Decisions about remediability or irremediability are made by doctors. The reasoning and judgments of philosophers, theologians, sociologists, other experts (and, of course, parents) are informed by data supplied by doctors. The objectivity of that data is not unquestionable. Dr John Freeman (quoted in Kuhse and Singer 1985, p.63) observed: ‘It concerns me greatly that a given child born in Sheffield has a 75% chance of being dead; that the same child born in Baltimore…has a 95% chance of being alive. And yet this is a decision made by the parents on the advice of either Dr Lorber or myself. That is scary.’

In this discussion of the definition of ‘disability’, we have tried to show that it and related terms cannot be solely the domain of doctors. It is true that scientists are vital in this area but they need to be aware of societal and religious issues. We cannot leave decisions about ‘disability’ to scientists who worship only science.