The Impact of the Plague in Tudor and Stuart England

by Paul Slack, Routledge & Kegan Paul, 1985

When he wrote this book Paul Slack (at the time a Fellow and Tutor in Modern History at Exeter College in Oxford) was more interested in the social response to the disease than in the disease itself, devoting almost half of the book to this subject.  But he also realized that to understand the social response he needed to understand aspects of the disease itself, such as frequency of occurrence, which social groups and locales were affected and the mortality rates.  The addressing of these questions occupies the first half of the book.  The time period that he is covering, as indicated by the title, is the sixteenth and seventeenth centuries.

Part I of the book gives us an introduction to the disease and its manifestations, as well as an overview of its impact on society and the attitudes and actions that resulted.  The cause of the plague was not known, and it was attributed to both natural and supernatural agents.  Similarly, the treatment of it incorporated both natural and supernatural elements.  Books and pamphlets were published that included both herbal remedies and prayers.  Special sermons were preached during plague outbreaks, and sometimes plague fasts were held.  Diagnosis was not exact and there were other diseases prowling the populations such as typhus, the sweating fever and malaria, leading to further confusion and uncertainty.  The plague itself was manifested in several ways.  There was the bubonic plague with its carbuncles, buboes and spots, which sometimes occurred in a mild form, without marked visible symptoms.  A more deadly variant of the disease was septicaemic plague, in which the bacilli invaded the blood stream, causing death before the external symptoms of plague had time to appear.  A third variety is pneumonic plague, which may begin as a case of bubonic plague that becomes complicated by pneumonia.  This latter variant changes the disease vector from fleas to humans as the bacteria is coughed out in the sputum of the victims and inhaled by the people around them.  It was highly contagious, had a shorter incubation period than bubonic plague, and left untreated was almost 100 percent fatal.

Along with the fear and uncertainty that an outbreak of plague invoked, it also placed a much more practical strain on the society in the loss of its members, sometimes in large numbers (a quarter to a third of a town’s population).  This depressed the economy as well as straining the infrastructure as those as yet untouched by the disease struggled to deal with the dead bodies that needed to be disposed of as quickly as possible.  Knowledge of the plague was passed down essentially unchanged from the time of the Black Death.  The first medical book printed in English was a Little Book on plague, published in 1486 probably as a result of an outbreak of the sweating sickness.  Outbreaks of diseases often seemed to inspire the printing of books on the plague, and in the second half of the sixteenth century a growing number of them were religious tracts and sermons.

Part II of the book examines the frequency and severity of outbreaks using parish records and the number of wills probated as indicators of the presence of plague.  Slack examines the records of Essex and Devon counties in an attempt to understand what kinds of communities were most likely to be affected by the plague.  From there he moves on to the urban settings of Exeter, Bristol and Norwich and then to the metropolitan setting of London.  From his case studies in the counties of Essex and Devon he draws two conclusions: 1) bubonic plague could cause a greater number of mortalities in a shorter time span than any other epidemic disease; and 2) that most communities suffered at least one epidemic during the course of a century and were lucky if they did not suffer more.  The risk was generally greater in towns than in rural areas, although living in the country was not a guarantee of safety.

He finds a more consistent picture when he examines the records of Exeter, Bristol and Norwich.  Although they differ in the timing and severity of the epidemics in all three cities the occurrence of plague was connected with the economic and social conditions of the communities.  Plague was a part of urban life.  It was a regular visitor to all three cities.  It struck Norwich in 1544, 1554, 1579, 1584 and 1589.  The frequency and severity in Norwich may be due to the fact of its nearness to the Low Countries and its large immigrant population.  It struck Bristol in 1565 and 1575 and Exeter in 1570 and 1590.  It tended to be concentrated in fringe parishes that were primarily inhabited by poor laborers.  In urban areas the occurrence of plague had a definite social dimension.

By the sixteenth century London had already gained a reputation as being filthy and plague was seldom completely absent from it.  The best records come from the city itself in the bills of mortality that it published in the seventeenth century.  These documented not only the number of deaths but also their locations, making possible the charting of the progress of the disease through the city.  A fresh outbreak would often begin, as would be expected, in the east, near the river and the docks, although that was not always the case.  Once again, the most affected parishes were on the fringes of the city where the poor resided.

Part III of the book examines the social reactions to the plague and the actions that resulted. The strategies to battle the plague began in London as part of the government’s general pursuit of social policies that might benefit the common man and improve social order.  England lagged behind other countries in their adoption of measures to control the spread of plague and often simply adopted and adapted strategies already in use abroad.  In 1518 Cardinal Wolsey founded the College of Physicians to improve English medical care, which also marked the beginning of public policy regarding plague.  Those policies primarily focused upon separating out the infected to pesthouses or shutting them up in their own homes.  Neither policy was rigorously enforced, the former because of the cost of establishing and running pesthouses and the latter in part because of the humanitarian issues raised and in part because of the difficulty of enforcing the isolation.  It was much better to prevent the outbreak of plague itself, and to that end quarantines were enforced on ships and goods arriving from areas where a plague outbreak was known to have occurred.

The publication of the bills of mortality in London documented for all to see the incidence and location of plague deaths.  The advent of newspapers helped to spread this information outside of the city.  This unprecedented supply of information allowed patterns of infection to be seen and helped to rationalize the reactions to plague, at least among the educated.  Although the carriers of the plague were not identified and without a germ theory of disease its cause remained unknown it did help to destroy the claims of its supernatural origins.

Plague broke down the social order, existing divisions were often exacerbated.  The people resisted the efforts of the officials to impose plague regulations because they saw them to be as threatening as the disease itself.  The public resisted the imposition of the regulations and the plague rate rose, which led the government to go to greater and greater lengths to enforce them.  While the public were concerned with the suffering of themselves and their fellows, the officials were concerned with maintaining order, and they viewed the plague as part of the broader problem of poverty.

Mission and Method

The early nineteenth-century French public health movement
Ann F. La Berge, Cambridge University Press, 1992


Drawing from official archives, this book is more a history of institutions than it is of the people who were affected by those institutions.  Instead it focuses on a select group of men who served on the Paris health council and as editors of the Annales d’hygiéne publique et de médecine légale and how they created and institutionalized the idea of public health and hygiene, as well as how they put those ideas into practice through their work on health councils, in their publications and in their investigations.

Public health measures have generally been dominated by two different missions, emergency measures whose primary purpose is to deal with epidemics and regulations for dealing with public nuisances and waste disposal.  The former measures were usually temporary, enforced only in times of crisis, and the latter measures were applied mainly to larger towns and cities, where the higher population density made such regulations a necessity.  The idea of public health prominent in late-eighteenth-century France was dominated by an Enlightenment approach that emphasized progress, rational reform, education, natural law, empiricism and humanitarianism.  It included preventive medicine as well as practices aimed at improving the quality of life, and reducing mortality and morbidity.

While it had its foundation in the Enlightenment, the public health movement developed amidst the competing ideologies of liberalism, conservatism, socialism and statism, with liberalism and statism dominating.  The liberals wanted a minimal amount of state intervention, preferring solutions that were local and individual with the private practice of medicine, while the statists felt that the state should assume the primary role in public health reform and management and that public health experts should serve as advisors to the state, even proposing a medical civil service.  The debate between liberalism and statism took place within the context of scientism, the idea that science was the key to progress and that the scientific approach was the best way to achieve positive knowledge.

During the Revolution the national government had accepted responsibility for national health, and both Napoleon and the Bourbons had continued the tradition.  By the 1820s several public health programs were in place including a nationwide vaccination program, a national health care program of both epidemic physicians and health officers, a national administration of sanitation and a Royal Academy of Medicine to replace the Royal Society of Medicine.  There were institutions at the national level as well as at the local level with municipal and departmental health councils.  There also arose the idea of a public hygienist.  These were not simply physicians, but rather physicians who were willing to practice empirical science in order to understand the causes of disease and death, who would undergo special training for their job and who would work in cooperation with other specialists including chemists and engineers.

A major component of the mission of public hygienists was to investigate all possible causes of disease and death and to make recommendations for their solution.  In the process they encountered a wide range of health problems and issues.  Not only were they involved in sanitary reform and ensuring the purity of food and drink, but they also examined more complicated social welfare issues such as prostitution, wet nursing, foundlings and child labor laws.  Their approach to such problems varied but they all recommended regulation, inspection, and legislation to help improve public health.

They were aided in their work by the existence of the Annales d’hygiéne publique et de médecine légale, which was unique to France.  It was the first journal in the West devoted to public health and legal medicine.  In it ideas were exchanged and research published.  The journal also reviewed or published most of the major French works on public hygiene and served as an international forum on public health issues, including the coverage of foreign developments and publications.  This commitment to promoting and publishing their ideas was also mirrored by their educational efforts at the local level.  Because many programs were voluntary (vaccination against small pox, for example), their effectiveness depended upon the public understanding the advantages of compliance and the public hygienists were instrumental in that education process by providing reports of their benefits that were based on more scientific foundations.

This period also saw the application of statistics to the effort to understand the contributing factors of disease and death, if not their causes.  Louis-René Villermé did extensive statistical studies of Paris and his findings linking poverty and death contributed to the notion of death as a social disease.

Health Reform in 19th Century America

Ronald Numbers, Prophetess of health : Ellen G. White and the origins of the Seventh-Day Adventist health reform, Knoxville : University of Tennessee Press, 1992

Ellen G. White is one of four nineteenth-century founders of a major American religious sect (the others are: Joseph Smith - Mormon, Mary Baker Eddy - Christian Science and Charles Taze Russell - Jehovah’s Witnesses), but she is not widely known outside of her church.  Yet when she died in 1915 she left behind a legacy that consisted not only of the Seventh-day Adventist Church, but also sanitariums and hospitals located throughout the world.  She also inspired an educational system that is still highly regarded, traveled, lectured, and wrote dozens of books.  She was born Ellen Gould Harmon, along with her twin sister Elizabeth, on November 26, 1827.

Her influence sprang from the visions that she began experiencing in 1844, when she was seventeen.  These trances lasted anywhere from a few minutes to several hours, and during them she received messages about events both in the future and the past, heavenly and earthly.  These visions were accepted as genuine revelations from God, and her followers (with her encouragement) regarded her as a true prophetess on a par with the prophets of the Bible.

On June 5, 1863, in Otsego, Michigan, she received her vision regarding health, in which God revealed to her the hygienic laws that should be followed by Seventh-day Adventists.  They were to give up eating meat and other stimulating food, neither drink alcohol nor use tobacco, and avoid medical drugs.  When they were sick they were supposed to rely on the remedies of Nature, including fresh air, sunshine, rest, proper diet, exercise and water.  Women were to cease wearing the fashionable clothing of the time (including hoop skirts and corsets) and wear “short” skirts and pantaloons.  Followers were also supposed to curb their “animal passions” (masturbation was an especial evil leading to deformity of mind and body, not to mention spirit).

Health reform was not new.  In the early nineteenth century, America was not a healthy or hygienic place.  Americans ate too much meat and not enough vegetables and fruits.  Their food was heavy with grease and fats, and they drank too much Brazilian coffee.  Public sanitation was horribly inadequate, and personal hygiene wasn’t much better.  Most Americans seldom, if ever, bathed.


In the 1830s, Sylvester Graham launched a full-blown health crusade.  In the summer of 1830 the Pennsylvania Society for Discouraging the Use of Ardent Spirits invited him to come and lecture under its auspices.  He accepted and was soon giving lectures featuring his scientific and moral arguments against consumption of alcohol.  Reverend William Metcalfe was also preaching in Philadelphia at this time.  He was the author of the first American tract on vegetarianism and had brought his English congregation over in 1817 and established the vegetarian Bible Christian Church.  Graham added the vegetarianism to his lectures on temperance.  In 1831 he broke away from the Society and was lecturing at the Franklin Institute on a broad range of topics including proper diet and the control of the passions.  The 1832 cholera epidemic thrust Graham and his health reforms into the spotlight.

Another reformer, important partly because he was associated with the Millerites (as was Ellen White) and also because her reforms mirror many of his, was Larkin B. Coles.  His claim to health reform fame lie in two books: Philosophy of Health: Natural Principles of Health and Cure and The Beauties and Deformities of Tobacco-Using.  His view of health reform was a moralistic one, and was not unique among health reformers.  But both Cole and White saw obedience to these laws of health mainly as a requirement for entry into heaven rather than as a means for living a more enjoyable and healthy life on earth.

Science as a Social Construct

Douglas, Mary.  “Environments at Risk” in Science in Context, Barry Barnes & David Edge, eds.  Cambridge, MA, MIT Press, 1982 (pp. 260-75)

Science in Context is a collection of essays focusing on the sociology of science.  The purpose of the collection, as stated in the General Introduction, is to “provide a tolerable indication of what is going on in the sociology of science, and, more importantly, of what kind of social activity science is, and what its significance is.”  The primary focus of the collection is on the relationship between the sub-culture of science and the wider culture that surrounds it, especially as it relates to science as a source of knowledge and competence and as a cognitive authority for evaluating knowledge claims.

Central to the ideas of sociology of science are the writings of Thomas Kuhn, especially his book The Structure of Scientific Revolutions.  From Kuhn, sociologists of science have concluded that science is a social construct, and that even statements of scientific fact have a conventional character.  Because it is constructed and not intrinsic to the natural world, they conclude that it cannot be self-sustaining, and if it cannot be self-sustaining in the sub-culture of science, then neither can it be self-sustaining in mainstream culture.  There is nothing in science that implicitly reveals its correctness and so its standing in society depends upon the degree of trust and authority with which society imbues scientists and institutions.

In her essay, Mary Douglas examines the issue of credibility in the context of the ecology movement.  She is concerned with how beliefs arise and how they gain support.  The approach she takes is of the anthropologist from Mars, an hypothetical being that is agnostic when it comes to beliefs about the Earth’s environment.  In her view this suspension of belief is what allows us to confront the fundamental question of credibility.  She asserts that civilizations throughout history have viewed their environments to be at risk, although the risks they identified were generally not the same, but she claims that all civilizations pin responsibility for the crisis in the same way.  The environment is put at risk by human folly, hate and greed.

In the present, however, we have an added factor: self-knowledge.  Because we can compare our beliefs with those of others we lose the filtering mechanism that those earlier civilizations possessed.  We no longer have anything to restrict our perception of the sources of knowledge.  Credibility is easier in a limited belief system, but how do you determine credibility when opposing sides of an issue both make sense?  This is the question confronting environmentalists in our age.

Through various anthropological examples she endeavors to show that the credibility of a belief regarding how the environment will react to human action depends upon the moral commitment of the community to a particular set of institutions.  For example, bison do not like fratricide (murder within the tribe), so such an act endangers the well-being of the tribe and as a result has special sanctions.  So long as the institutions in question maintain the loyalty of the community, nothing can overthrow the beliefs that support those institutions.  If those institutions lose the support of the community, she claims that the beliefs are easily changed.  A particular view of the universe and the society holding that view are thus interdependent.  They form a single system and neither can exist without the other.  Any given environment that we know thus exists as a structure of meaningful distinctions.

In this credibility debate the role of laymen and social scientists is to examine the sources of our own bias.  Because we lack the moral consensus that gives credibility to ecological warnings we do not listen to the scientists.  Similarly, because we lack a discriminating principle we are easily overwhelmed by our pollution fears.  This discriminating principle comes from social structures and it allows a culture to select which dangers it will fear and also to set up a belief system that will address those dangers.  Without that structure we are prey to every dread and right and wrong cease to exist.  This is the price of full self-consciousness, but it is a price that she feels we must pay.  When we do that the classifications of social life will be gone and we will recognize that every environment is simply a mask and support structure for a certain kind of society.  Understanding both the nature and value of that society is as important as understanding the sources and nature of the pollution that puts our environment at risk.

Mary Douglas deliberately picks an area of science where our understanding is incomplete and in which the debate over competing theories has become politically charged.  Consensus is not the final arbiter of a scientific theory or hypothesis.  Unfortunately in the case of the environment politicians and advocates have created a situation where that is the level at which the discussion of the various theories and hypotheses is taking place.

Michael Kater, "Doctors under Hitler", Chapel Hill: University of North Carolina Press, 1989.

This monograph is a sociohistorical study of the medical profession under the Third Reich and rests on the author’s previous work analyzing doctors and medicine from Wilhelm II to Hitler.  It draws upon documents in the Federal Archive of Koblenz and the Berlin Document Center.  Primary material was also drawn from the student archive in Würzburg and other regional West German archives.  He also drew on the papers of the former panel physicians’ association, the KVD, as well as the predominant professional journals and memoirs of physicians that lived beyond 1945.

 At the dawn of the Third Reich, in 1933, there was a surplus of physicians, inherited from the republican era.  These doctors were at first hopeful that the new regime would address issues left over from the health administration of the Weimar Republic, but their hopes were not fulfilled.  Under the republic medical graduates had to spend three years as an assistant in a hospital where they were poorly paid, and forbidden to seek other sources of income.  Establishing themselves as independent practitioners was almost impossible for a doctor straight out of medical school.  One of the complaints lodged by spokesmen for this group was that medical institutions should stop advertising junior positions for bachelors only.  They also emphasized that, after public school teachers, high school teachers, and jurists, they represented the fourth largest group of academically trained professionals born after 1900.

 But under the Third Reich, the medical profession became a microcosm of the larger Nazi sociopolitical system, governed by the Nazi leadership principle and redefined in National Socialist terms.  Physicians now had to present every private contractual arrangement to the Reich Physicians’ Chamber for approval, register with the Nazi medical agencies and keep them informed of any changes in their family status or medical qualifications.  They also had to report on their patients.  All serious cases of alcoholism, ‘incurable’ hereditary or congenital illness (i.e. imbecilism) and highly contagious diseases such as venereal disorders were recorded and reported to the appropriate authority.

 The doctors themselves were required to undergo continued training.  Partly this was to break down the distinction between general practitioners and medical specialists, but it was also to teach them National Socialist concepts of health and medicine.  The unpopularity of these courses was perhaps offset by another change in their profession implemented by the Nazi legislators, its redefinition.  By stating that the medical occupation was not a business, the Reich Physicians’ Chamber was able to exclude anyone who was not properly schooled or licensed.

 This did not do away with medical quacks, however, for the Nazi conception of medicine favored the lay element over ‘school’ medicine.  Instead they created a new class titled “physician of natural healing” open to anyone who could demonstrate the requisite ability.  Anyone in this group with extraordinary talent could enter a medical facility without the usual professional medical qualification, and could even receive a license as a doctor medici.  The Nazis further required that regular doctors had to assist registered lay healers at the latter’s request.

Under the Third Reich medicine became the preeminent academic discipline, with approximately 30 percent of all university faculty being composed of medical teachers by 1935.  Medical faculty also became dominant in university power politics.  Between 1933 and 1945 the percentage of medical faculty serving as rectors increased from 36 to 59 percent.  Along with this increase in power and significance there was the establishment of a new discipline that became a part of the medical curriculum after 1933, Rassenkunde or Rassenhygiene, race hygiene or eugenics.  This ‘science’ consisted of three parts: anthropological, sociological, and medical, and its goal was to improve the superior race, while eliminating the inferior ones.

Kater thus links the professionalization of medicine in the Third Reich with its corruption.  West German doctors saw these events as a struggle between the forces of freedom and democracy against the totalitarianism of the Nazi regime.  A battle which the latter eventually won.  East German doctors, on the other hand, saw these events as the result of a premeditated conspiracy between fascist-minded German doctors and Nazi political leaders.  Kater feels that the truth is somewhere in between, but that it lies closer to the East German perspective, than the West German one.

Treating the Disease vs Treating the Patient

While I was pursuing my History of Science studies at Notre Dame I took a seminar course on Medicine and Society.  My last two posts are from that class.  I came to hate that class and it was a large factor in my decision to drop out of the program, but I did learn some important lessons during it.  The crux of the message that the professor was trying to get across to us was the way that the medical profession dehumanizes the patient and ends up treating the disease, and not the human being.  If you want to see this message in a very disturbing but highly distilled form just watch the film "Wit" with Emma Thompson.

This lesson was reinforced for me this past week when I had to rush home to Ohio because my father was in the hospital.  He went in for something relatively minor but ended up in the hospital for a week being treated for another condition.  A condition that was due, in part, at least, to actions taken by the hospital staff in their treatment of his original issue.  I am not saying that the staff was malicious in their treatment, but they were aggressive and interventionist, so that rather than assuming that the change in his condition might be due to the drugs they had given him they kept chasing symptoms. It quickly became apparent that the treatment was reactive - x happened, so they did y, without ever really trying to understand the whole picture, the patient. In the end my father spent a week in the hospital and underwent a procedure that was probably not really necessary.


It is hard challenging the medical profession when you are a patient, they are so authoritative, and when there is something wrong you get swept up into their treatment course and it takes over your life.  I saw this myself when I was undergoing treatment for breast cancer.  I tried hard to be an informed patient and question the treatment but there was one week in which I had a CAT scan, a PET scan and two biopsies.  Everything checked out as fine, but that week was quite an ordeal, both physically and emotionally.  My oncologist's conclusion after all of that was that if you did tests and scans you will always find something that is odd, and if you let yourself, you will chase these oddities for quite some time before concluding that while odd, they are not dangerous or unhealthy.  My oncologist now uses me as a poster child for not doing more than is necessary.  He still feels bad about putting me through that ordeal. 

There is a lot of debate going on right now about how to fix the health care system.  Well, one of the things they should do is treat the patient, not the disease.  One of the hardest things about being a doctor is the process of diagnosis (this is actually a place where expert systems could be useful) and rather than being thoughtful or logical about ordering tests they just order a whole suite of them.  It is as if they are throwing a whole bunch of darts at a dart board in the dark, hoping that one of them hits the target.  That is simply not a rational or cost effective approach to treatment.  It isn't good for society and it isn't good for the patient.

Demographics

Fertility, Class and Gender in Britain 1860-1940   
    Simon Szreter, Cambridge University Press, 1996

In the early part of the 20th century there was a growing awareness of a declining birthrate in the industrialized nations.  In Austro-Hungary and France the birth rate in some rural areas had begun to decline substantially during the 18th century, with similar declines taking place among the aristocratic and bourgeois groups as early as the 17th century.  In 1945 a theory of demographic transition was published.  It proposed three stages of demographic development: an initial pre-industrial stage of high birth rates and high death rates, an industrial phase of high birth rates and declining death rates (leading to substantial population growth) and a post-industrial phase of low birth rates and low death rates.

This theory was based upon a single case, that of Britain.  It utilized the findings of the 1911 census, which analyzed the fertility patterns of the British population from 1851-1911 and the newly released study conducted for the Royal Commission on Population that covered the period 1901-1946.  The 1911 census used what has become known as the professional model of social classification in which all male occupations are assigned to one of five grades (professional upper and middle class, intermediate, skilled workers, intermediate, unskilled workers).  The 1911 census analysis found that the higher the social class, the earlier and more rigorously it controlled its fertility.

This classification scheme was based upon three assumptions: 1) the occupation of the male head of household was the best way to classify families; 2) a primary division existed between the higher-status non-manual occupations (they were more professional) and the lower-status manual occupations (assessed according to skill) and 3) the fact that a single hierarchical social grading system was a valid classification scheme.  It should be noted that this scheme excludes women and their labor, both paid and unpaid.  It should also be noted that those living off private means, and thus listing no personal occupation, were classified alongside paupers in a residual category, labeled the unproductive class.

In 1869 Francis Galton published Heredity Genius in which he examined the families of ‘eminent men’ in England in an effort to determine the heritability of both mental and physical qualities.  He went on to coin the term eugenics in 1884.  By the end of the 19th century there was widespread concern that modern society was reversing evolution, leading to the degeneration of the English people.  This was partly driven by an increase in the recorded rates of lunacy from 2.26/10,000 in 1807 to 29.26/10,000 in 1890, (Mathew Thomson, The Problem of Mental Deficiency: Eugenics, Democracy and Social Policy in Britain c. 1870-1959).  By the first decade of the 20th century mental defectives became defined as the central eugenic threat facing the nation.  Greater social awareness plus universal education led to the growing realization of the presence of mentally deficient people in the population.  This heightened awareness coincided with growing fears about the fitness of the population.  In 1907 the Eugenics Education Society was formed.

During the period 1875-1883, the Anthropometric Committee of the British Association for the Advancement of Science provided an hereditary basis for the professional model.  The professional model thus acquired the status of an empirically tested theory.  Despite the fact that it was based upon unexamined social conventions it had been turned into a naturalistic theory of British society’s essential structure.

In the beginning of the 20th century an environmentalist counter movement emerged opposing the ideas of the eugenicists that the poor were poor because of the way they were, rather than because of social or environmental factors.  At the forefront of this movement were the Fabians who, although they shared a nationalistic interpretation of social Darwinism with the hereditarian biometricians, did not agree with them as to the causes or the appropriate political means to achieve the optimal nation.  They held that poverty was not the manifestation of inherited biological deficiencies but rather that the environment was responsible for the moral and material degradation of the working man.