This week, we're continuing our look at the 'Fremen Mirage', the notion that 'hard times' breed 'strong men' and 'good times' create 'weak men' - this time by tracing the intellectual history of the idea, starting in the ancient Mediterranean.https://acoup.blog/2020/02/07/collections-the-fremen-mirage-part-iiia-by-the-princess-irulan/ …
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That said, I think the squalor note is overplaying things. Living conditions in terms of diet and sanitation and such in Europe in the Middle Ages were not appreciably worse than other regions. The urban poor in China/ME/India lived in squalor too.
Not saying Europe wasn't a backwater in the Middle Ages - in many ways it was. But I see no reason to assume that European 'immune systems' were appreciably stronger than, say, Chinese ones. The 'germs' part of Guns, Germs and Steel only works in the New World.