Tuberculosis, Heredity and Environment

Halliday Sutherland was the defendant in the celebrated 1923 “Birth Control Libel Trial,”—Stopes v. Sutherland. Historians cite only his 1919 conversion to Catholicism as the reason for his criticism of Marie Stopes in his 1921 book, Birth Control. The truth is more complex than that.

The background to the case is partially revealed when you understand the interplay between doctors and Eugenists.

Eugenists considered the efforts of doctors, focused as they were on infection and environment, as misplaced, because the primary cause of disease was heredity. The heredity of people termed the “weaker stocks” of society inherited disease and a susceptibility to it.

Some eugenists argued that the “weaker stocks” of society should be limited by discouraging the number of offspring they produced or by compulsorily sterilizing them. Others were more radical, such as the playwright George Bernard Shaw who, in a lecture to the Eugenics Education Society in 1910,  suggested:

We should find ourselves committed to killing a great many people whom we now leave living, and to leave living a great many people whom we at present kill. We should have to get rid of all ideas about capital punishment …
A part of eugenic politics would finally land us in an extensive use of the lethal chamber. A great many people would have to be put out of existence simply because it wastes other people’s time to look after them.

The majority of eugenists at that time did not share Shaw’s views, and were wary of his support. The founder of eugenics, Sir Francis Galton had written to his protégé, Karl Pearson shortly before the lecture on 26th February 1910 expressing his unease: “Bernard Shaw is about to give a lecture to the Eugenics Education Society. It is to be hoped that he will be under self-control and not be too extravagant.” High hopes indeed! Shaw’s talk caused sensational headlines in the press gave a great deal of publicity for eugenics as a new and potentially radical movement.

Sensational headlines do not spur a man to action. It is possible for a person to be aware of things with which he disagrees and ignore them, and get on with life. That Sutherland did oppose eugenists was owing to the tuberculosis agenda of the eugenists.

What did eugenists propose for the treatment of tuberculosis? The work of Karl Pearson holds the answer to this question. Pearson was the protégé and biographer of the founder of modern eugenics Sir Francis Galton, a Fellow of the Royal Society, and a brilliant intellect advancing the field of statistics. Pearson was the Galton Professor of Eugenics at University College, London. His views and work were at the centre of mainstream eugenics and provided scientific respectability to their views. His views can be garnered by a reading of two lectures he gave:

• Nature and Nurture: The Problem of the Future
• Tuberculosis, heredity and environment

…and which can be summarised in four points:

1. Nature is significantly more important than nurture in its influence on a situation. British reformers had focussed on improving the environment (nurture) and, by ignoring the more powerful influence (nature), had not achieved the benefits of reform.
2. Following Koch’s discovery of tubercle bacilli, too much emphasis had been placed on infection and environment as the cause of consumption, rather than on heredity.
3. Doctors, particularly those working to implement the Edinburgh System had not cured tuberculosis and falsely claimed that their efforts were successful. Their  records and statistics were self-serving. Pearson believed that they did not understand what they were doing: it was an experiment they were conducting and they did not have a clue.
4. The 1 1/2 million pound government expenditure on tuberculosis at that time should cease, and the money given to eugenists to address the real causes of the disease: heredity.

Pearson on the relative importance of nature and nurture in influencing a situation

Pearson On April 28, 1910 Pearson gave the Presidential Address at the Annual General Meeting of the Social and Political Education League. His topic: Nature and Nurture: The Problem of the Future. He spoke of the inconsistency of standards between scientific problems and social problems and how those who dealt with the social problems lacked the data-driven and statistical analysis of scientists:

For I picked up a journal termed the Sociological Review the other day, and the first article that attracted my attention was by a distinguished professor of philosophy, entitled “National Degeneracy”, and the problem was solved to the satisfaction of the professor in some ten pages of type, without a single figure, without a single sign that he had knowledge of the immense biological complexity of a question which for a true answer needs not verbal disquisition but an intensive study of heredity in man, of differential marriage rates, differential fertility, selective death rates, to say nothing of immigration and emigration, and of the correlation of all of these with the social and antisocial qualities of the several reproductive groups in the community.

Pearson compared this to the accuracy expected of scientific problems:

What would you think of the physicist who told you that the position of the plumb-line depended partly on gravity and partly on the rotation of the earth? Would you not at once ask him to define quantitatively the relative influence of both factors? How is it possible to evolve a working policy for social reform if we do not know whether 1 per cent. or 90 per cent.  of the observed evil is due to nature?

In Pearson’s opinion, the focus had all been on nurture, not nature and that this had not produced a national revival.

 We have had twenty to thirty years now of technical instruction, university and polytechnic engineering schools, we have had a population immensely larger that in 1800 to draw from…Yet has that system produced for us any four names which will stand out in the future like those of Arkwright, Watt and the Stephensons? These men would have benefited immensely by modern technical training, But will nurture alone produce such men? If so why is it that no Englishman of our period of technical education has been the discoverer of motor-car, submarine, or aeroplane? Can we assert that, relatively to the size of our population, the period of bettered environment has led to greater provision of capable men in craftsmanship, in the arts, in science, in literature, or in politics? Nay, when we talk among ourselves, and not in the world’s market-place, are we not rather conscious of a present dearth of national ability? – of an uncomfortable doubt as to whether we have leaders who lead, writers who can write so as to stir national feeling and national conscience, or sufficient men able to preserve by feats of enterprise and daring the old racial reputation for endurance and strength?

For Pearson, the problem was that the reforms in Britain has focussed on nurture not nature:

If we look back on the more than fifty years during the betterment of nurture has been our chief policy, can we honestly assert that the nation has grown – relatively to other nations – in its number of able men of all types, in its power of action, in its self-control, in its enterprise and its originality? Yet I do not think there is any single nation which since 1840 has so continuously and successfully worked at improving environment as our own country. Might we not on the basis of such doubts legitimately demand that the problem of nurture and nature should receive closer attention; that we should not for another fifty years confine our attention to nurture?

Later he draws on the importance between the focus of nurture rather than nature:

…in a primitive society a harsh environment undoubtedly checks the survival of all forms of physical and mental defect. Further, in civilised society all legislation which provides nurture for the feebler at the cost of the socially fitter must be detrimental to racial efficiency UNLESS (i) it is accompanied by some check to the reproduction of the unfit, or (ii) we can show that nurture rather than nature dominates the production of the mentally or physically desirable members of our community.

On Britain’s report, Pearson had given an “F”. The mistake in its social policy was to provide environmental improvements as its primary aim and, in seeking to “advance the nation by legislation which has hampered nature, to provide nurture for the feeble, for the inherently weak stock” who were so flawed as to be incapable of being useful members of  society.

Pearson then asserted that the influence of heredity is between five and ten times more influential on people than their environment.

Now I will not dogmatically assert that environment matters not at all; phases of it may be discovered which produce more effect than any we have yet been able to deal with. But I think it is safe to say that the influence of environment is not one-fifth of heredity, and quite possibly not one-tenth of it. There is no real comparison between nature and nurture; it is essentially the man who makes his environment; and not the environment that makes the man. The race will progress fastest where consciously or unconsciously success in life, power to reproduce its kind, lies within native worth. Hard environment may be the salvation of a race, easy environment its destruction. If you will think this point out in detail, I believe you will see the explanation of many great historical movements. Barbarism has too often triumphed over civilisation, because a hard environment had maintained, an easy environment suspended, the force of natural selection – the power of the nature factor.

The seeds of conflict were sown. Doctors treated patients based on infection and environment, but not heredity were merely playing at the margins of the problem.

Pearson on Tuberculosis, heredity and environment 

On March 12, 1912 Pearson gave a lecture at the Galton Laboratory for National Eugenics. In the opening part of the talk, he stated that this the “importance of the discovery of Koch cannot be overrated” it had led to the emphasis of infection as being the cause of the disease and “the result was an immediate neglect both of the hereditary factor and of the environmental factor.”

Pearson then used statistical analysis to establish the causes of the disease. His findings confirmed that heredity was greater than environment or infection.

Pearson was withering on the work of doctors  in the tuberculosis system and he urged them to:

Admit that the sanatorium treatment is purely experimental, admit that dispensaries are another experiment, and that tuberculin is another and perhaps more hazardous one, and there is nothing more to be said than the words” Experiment, but record your observations in such manner that the trained mind can ultimately measure their bearing on human welfare.”

But experiment on human beings is held in itself to be reprehensible. That does not mean that it is not being made day by day; it means simply that it is screened, and the experimental treatment is described as the most efficient and certain cure for human ills. Such description not only disguises its experimental character, but often hides its true nature from the actual experimenter, who forgets the necessity for adequate records to test the value of his work.

before concluding:

It is a counsel of despair to spend millions when you have no evidence of the efficiency of the expenditure, because you have nothing better to propose In the next place, why should we do something when we have nothing better to do? To practice the ineffectual as if it were a proven cure checks the road to better things. Admit it that there is no cure for phthisis  and it incites men to find one, far more actively than to praise existing “cures”.

But Eugenists have something better to propose. No one can study the pedigrees of pathological states, insanity, mental defect, albinism, &c., collected by our laboratory, without being struck by the large proportion of tuberculous members – occasionally the tuberculous man is a brilliant member of our race – but the bulk of the tuberculous belong to stocks which we want ab initio to discourage. Everything which tends to check the multiplication of the unfit, to emphasize that the fertility of the physically and mentally healthy, will pro tanto aid Nature’s method of reducing the phthisical death-rate. That is what the Eugenist proclaims as the “better thing to do”, and £1,500,000 spent in encouraging healthy parentage would do more than the establishment of a sanatorium in every township.

Eugenists believed that heredity as the root cause of mental defects, poor eyesight, insanity, albinism, tuberculosis, alcoholism and other conditions, and sought to establish eugenics as the umbrella, as it were, to address all of the subsidiary conditions. Doctors’ efforts were “built on sand” in that (1) their work was not sufficiently scientific and (2) they were treating the symptoms, not the underlying hereditary cause. Controlling the breeding of the race was the solution and the State was the entity that could achieve this lawfully, through compulsion, licences and incentives.

Was Sutherland aware of Tuberculosis, Heredity and Environment?

Given his involvement in the Edinburgh System, and that he had edited and contributed articles to The Control and Eradication of Tuberculosis: A Series of International Studies published the previous year (in 1911), and given that he was the Medical Officer of the St Marylebone Anti-Tuberculosis Dispensary, Sutherland was aware of Pearson’s views and the eugenic agenda.

In 1912 the British Medical Journal published Sutherland’s article The Soil and the Seed in Tuberculosis in which he argued that the disease was not hereditary. You can read a copy of the article here.

The battle between the supporters and opponents of eugenics continued into the 1920s, 30s and 40s until eugenics became a discredited pseudo-science.

Post-script

Pearson’s criticism of sanatorium treatment uses the word “experiment” no less than seven times:

Admit that the sanatorium treatment is purely experimental, admit that dispensaries are another experiment, and that tuberculin is another and perhaps more hazardous one, and there is nothing more to be said than the words” Experiment, but record your observations in such manner that the trained mind can ultimately measure their bearing on human welfare.”

But experiment on human beings is held in itself to be reprehensible. That does not mean that it is not being made day by day; it means simply that it is screened, and the experimental treatment is described as the most efficient and certain cure for human ills. Such description not only disguises its experimental character, but often hides its true nature from the actual experimenter, who forgets the necessity for adequate records to test the value of his work.

This later echoed in the heading “Exposing the Poor to Experiment” above the passage of Birth Control that was the subject of the Sutherland v. Stopes defamation trial. It appears that the use of the term was a way to accuse your opponents  of experimenting on humans as well as saying: “you don’t really have a clue what you are doing, do you?”

Sources:

• George Bernard Shaw, Lecture to the Eugenics Education Society, reported in The Daily Express, March 4, 1910.
• Sir Francis Galton letter dated 26 Feb 1910 from K Pearson, The life, letters and labours of Francis Galton (3 vols., Cambridge, 1930), III, 427
• Nature and Nurture: The Problem of the Future A Presidential Address delivered by Karl Pearson, F.R.S. at the Annual General Meeting of the Social and Political Education League April 28, 1910.
• Tuberculosis, Heredity and Environment being a lecture by Karl Pearson, F.R.S. at the Galton laboratory for National Eugenics on 12 March 1912. See: http://www.biodiversitylibrary.org/item/77020#page/5/mode/1up
• The Seed or the Soil in Tuberculosis by Halliday Sutherland British Medical Journal. 1912 Nov 23; 2(2708): 1434–1437