Perspectives in Biology and Medicine

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 24 · Number 3 · Spring 1981 MEDICINE'S MILLENARIANISM WILLIAM A. SILVERMAN* The increase in size of the perinatal industry over the past 3 decades has been startling. I can recall the time when very few physicians took an active interest in problems of the fetus and the newborn infant. Now the new perinatologists make up the largest single group of subspecialists in the American Academy of Pediatrics. What intrigues me about this growth phenomenon is the optimistic premise which seems to underlie it: discovery and understanding will be achieved more quickly by a mass assault on our ignorance. The most revealing example of this reasoning I can think of is the ambitious effort to investigate poor outcome of pregnancy that took form in the 1950s. It was heralded as a scientific study and entitled "The Collaborative Project on Cerebral Palsy, Mental Retardation and Other Neurological and Sensory Disorders of Infancy and Childhood" (in recent years the title has been shortened, mercifully, to "The Collaborative Perinatal Project"). The planning for this enormous investigation was begun in 1952 by representatives from the National Institute of Neurological Diseases and Blindness along with well-known investigators in a variety of disciplines [I]. It was decided that teams of observers would collect information and measurements in 30,00050 ,000 pregnant women and in the subsequent outcomes of the pregnancies , including serial observations of the liveborn offspring over a period of 10-15 years. The first of twelve collaborating institutions joined the study in 1957. A pretest was carried out for 154 years, and the formal enrollment of pregnant women began in January 1959. InThis paper, in somewhat different form, was presented on October 16, 1979, at the Apgar Award Symposium, "The Scientific Method in Clinical Perinatology, Section on Perinatal Pediatrics." American Academy of Pediatrics, San Francisco. ?Address: 90 LaCuesta Drive, Greenbrae, California 94904. '©1981 by The University of Chicago. 0031-5982/81/2403-0241$01.00 Perspectives in Biology and Medicine ¦ Spring 1981 | 339 take was completed on December 31, 1965, and the longitudinal observations continue to the present day. At this point I wish to raise two questions. First, Where did the idea come from that the scientific method consists of the wholesale collection of observations about natural events? And, second, When did the notion arise that the massed efforts by careful observers can accelerate the rate at which knowledge about the material world increases? You may be as startled as I was to learn that these ideas can be traced to the Bible (or, more accurately, to an interpretation of biblical text). The inspiration came from the Book of Daniel, chapter 12, in which the prophet described the final age of the world before the millennium. And in verse 4 it is foretold that at the time of the end ". . . many shall run to and fro, and knowledge shall be increased." These innocent lines of Scripture played a surprising role in the development of science and medicine— for they were used by Francis Bacon to resolve a basic dilemma facing his coreligionists in the seventeenth century [2]. If Man originally fell owing to his pursuit of knowledge, how was it now possible for him to seek knowledge without falling from grace? Bacon argued that all knowledge must recognize and be limited by the primacy of religion. Probing what he defined as "secondary causes" would, therefore, incur no risk of transgression. Instead, these explorations would glorify God and restore Man's dominion over nature. The notion of restoration was central to Bacon's thesis: the idea was to recapture intellectual attributes lost by Adam at the time of the Fall. The pursuit would lead to the millennium: a return to the conditions of life associated with the Garden of Eden. According to the prophet Daniel, Man was destined to regain a position of dominance. Each step to increase knowledge was a move toward the millennial condition. Bacon proposed "... a total reconstruction of all human knowledge ... to extend the power and dominion of the human race over the universe." The project was set out in a book entitled Instaurano Magna which appeared in 1620. On the title page (fig...