VOLUME 62, No.2 THE QUARTERLY REVIEW OF BIOLOGY JUNE 1987

INVOLUNTARY STERILIZATION IN THE UNITED STATES: A SURGICAL SOLUTION

PHILIP R. REILLY Eunice Kennedy Shriver Center, Waltham) Massachusetts 02254 USA

ABSTRACT Although the eugenics movement in the United Statesflourished during the first quarter ofthe 20th Century, its roots lie in concerns over the cost ofcaring for ((defective" persons, concerns that first became manifest in the 19th Century. The history ofstate-supported programs ofinvoluntary sterili­ zation indicates that this ((surgical solution" persisted until the 1950s. A review of the archives ofprominent eugenicists, the records ofeugenic organizations, important legal cases, and state reports indicates that public support for the involuntary sterilization ofinsane and retarded persons was broad and sustained. During the early 1930s there was a dramatic increase in the number ofsterilizations performed upon mildly retardedyoung women. This change in policy was aproduct ofthe Depression. Institu­ tional officials were concerned that such women might bear children for whom they could not provide adequate parental care, and thus would put more demands on strained sodal services. There is little evidence to suggest that the excesses of the J.Vazi sterilization program (initiated in 1934) altered American programs. Data are presented here to show that a number ofstate-supported eu­ genic sterilization programs were quite active long after scientists had refuted the eugenic thesis.

BACKGROUND lums there was growing despair as the mid­ century thesis (Sequin, 1846) that the retarded T THE CLOSE of the 19th Century in and insane were educable faded. About 1880, Athe United States several distinct develop­ physicians who were doing research into the ments coalesced to create a climate favorable causes ofidiocy and insanity developed the no­ to the rise of sterilization programs aimed at tion ofa "neuropathic diathesis" (Kerlin, 1881) criminals, the insane, and feebleminded per­ that relied on hereditary factors to explain sons. Evolutionary theory demanded a biolog­ problems as diverse as alcoholism, epilepsy, ical view of man. Francis Galton (Darwin's and crime. As one investigator wrote, "there cousin), an eminent scientist, invented the is every reason to suppose epilepsy in the chil­ science ofeugenics (Galton, 1869, 1874, 1883) dren may have its hereditary predisposition in which he fitted to the tenets of Darwinism. some form ofhabitual crime on the part ofthe In the United States concern about defec­ parent" (Clarke, 1879). tive persons could be found in many quarters. The most important event preceding the rise Southern whites who opposed miscegenation of sterilization programs was probably the sought intellectual proof that the Negro was publication ofRichard Dugdale's (1875) study inferior. American criminologists and prison of the ':Jukes;' a New York family with a officials (Boies, 1893) were heavily influenced propensity for almshouses, taverns, brothels, by Lombroso's arguments that most criminal andjails. The ':Jukes" spawned a new field in behavior was biologically determined (Lom­ sociology: extended field studies of degener­ broso-Ferrero, 1972). Among the physicians ate families, a field that reached its apogee at and social workers who ran the nation's asy- the Eugenics Record Office (ERO) in Cold

© 1987 by the Stony Brook Foundation, Inc. All rights reserved.

153 154 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62

Spring Harbor (Danielson and Davenport, tomy was published by Ochsner, a young 1912; Estabrook and Davenport, 1912). From Chicago surgeon. Dissatisfied with castration 1910 through 1914 more than 120 articles about as a therapy for severe prostatic hypertrophy, eugenics appeared in magazines, a volume of he guessed that cutting the vasa deferentia print making it one of the nation's favorite might cause the tissue to involute. But when topics. his patients told him that after the vasectomy Soon after becoming Director ofthe Station they noted no impairment ofsexual desire or for Experimental Evolution at Cold Spring function, he immediately grasped the eugenic Harbor, Charles B. Davenport, one of the implications ofthe new operation. Ochsner ar­ earliest American champions of Mendelian gued that vasectomy could eliminate criminal­ genetics, moved to apply the principle ofpar­ ity inherited from the "father's side" and that ticulate inheritance to humans. Among his it "could reasonably be suggested for chronic most important colleagues was H. H. God­ inebriates, imbeciles, perverts and paupers" dard, who published an immensely popular (Ochsner, 1899). study of the "Kallikaks:' a family that he Three years later Sharp, a surgeon at the claimed had an eminent line and a degener­ Indiana Reformatory, reported the first large ate line running in parallel over many genera­ study on the effects ofvasectomy. He claimed tions. The book did much to rationalize prin­ that his 42 vasectomized patients felt stronger, ciples of negative eugenics (Goddard, 1912). slept better, performed more satisfactorily in During the period from 1890 to 1917 the the prison school, and felt less desire to mastur­ United States was washed by a tidal wave of bate! Sharp urged physicians to lobby for a law immigrants. Assimilation was painful. The to empower directors of state institutions "to economy was so perturbed by the dramatic ex­ render every male sterile who passes its por­ pansion ofthe labor pool that, despite a com­ tals, whether it be almshouse, insane asylum, mitment to internationalism, even the great institute for the feebleminded, reformatory or unions called for restrictions on immigration prison" (Sharp, 1902:414). (Higham, 1965). From 1875 on, proposals to During the next few years there was a spate curb immigration were constantly before the of articles by physicians claiming that vasec­ Congress. Starting with the "Chinese Exclu­ tomy offered a solution to the problem oflim­ sion Acts" in the early 1880s, the federal iting the births ofdefective persons. Some phy­ government gradually built its legal seawalls sicians began to lobby vigorously for mass higher. Duringthe 1890s the Boston-based Im­ sterilization. For example, a Philadelphia urol­ migration Restriction League sought to justify ogist drafted a compulsory sterilization law legal barriers to entry on the grounds that some that passed both legislative bodies in Pennsyl­ races were inferior to the average American vania, but died under a gubernatorial veto stock (Ludmerer, 1972). This argument be­ (Mears, 1909). came a major issue in American eugenics. In 1907 the Governor ofIndiana signed the The late 19th Century spawned numerous nation's first sterilization law. It initiated the plans to control the "germ plasm" of unfit in­ involuntary sterilization ofany habitual crimi­ dividuals. In many states young retarded nal' rapist, idiot, or imbecile committed to a women were institutionalized during their state institution and diagnosed by physicians reproductive years. State laws were passed to as "unimprovable:' After having operated on forbid marriage by alcoholics, epileptics, the 200 Indiana prisoners, Sharp quickly emerged retarded, and persons with chronic diseases as the national authority on eugenic steriliza­ (Davenport, 1913a). Some legislatures consid­ tion. A tireless advocate, he even underwrote ered proposals to castrate criminals (Daniel, the publication of a pamphlet, "Vasectomy"~ 1907), and a few superintendents of asylums (Sharp, 1909). In it he affixed tear-out post actually engaged in mass castration (Daniel, cards so that readers could mail a preprinted 1894). It was at thisjuncture that a technolog­ statement supporting compulsory sterilization ical innovation helped to reorient social policy. laws to their legislative representatives! Although the simplicity of vasectomy fo­ THE SURGICAL SOLUTION cused their attention upon defective men, the The first American case report of a vasec- eugenicists were also concerned about defec- JUNE 1987 INVOLUNTARY STERILIZATION 155

tive women. Salpingectomy, the surgical clo­ spoken advocate of radical eugenics policies sure of the Fallopian tubes, or oviducts, was (Lydston, 1912). The editor ofthe Texas Medi­ not yet perfected as a surgical operation, and calJournal regularly published pro-sterilization the morbidity after intra-abdominal operations articles (Daniel, 1909). was high. Eugenic theoreticians had little Between 1907 and 1913, 16 legislatures choice but to support long-term segregation passed sterilization bills, 12 ofwhich became offeebleminded women. They were, however, law and 4 ofwhich were vetoed. The evidence comforted in their belief that most feeble­ is circumstantial but strong (Reilly, 1983a) that minded women became prostitutes and were a mere handful of activists played a key role frequently rendered sterile by pelvic inflam­ in pushing this legislation. Sharp's work in In­ matory disease (Ochsner, 1899). diana and Hatch's efforts in California were Pro-sterilization arguments peaked in the obviously influential. In NewJersey, Dr. David medical literature in 1910, when roughly one­ Weeks, Chief Physician at the Village for halfofthe 40 articles published since 1900 on Epileptics, lobbied for and later implemented the subject appeared. These articles almost a sterilization law (Smith v. Board ofExaminers, unanimously favored involuntary sterilization 1913). In Oregon, an activist woman physician of the feebleminded. As time went by, physi­ spearheaded a pro-sterilization drive (Owens cian advocates suggested casting the eugenic Adair, 1905). nets more widely. Appeals to colleagues that they lobby for enabling laws were commonly HARRY HAMILTON LAUGHLIN heard at annual meetings ofstate medical so­ The history of American eugenics, espe­ cieties (Reilly, 1983a). At the annual meeting cially ofinvoluntary sterilization, is the chroni­ of the American Medical Association, Sharp cle of a small, dedicated group of activists enthralled his listeners with reports on a se­ whose ideas attracted widespread interest in ries of456 vasectomies performed upon crimi­ society. At the center stood Harry Hamilton nals in Indiana. After hearing him, Rosen­ Laughlin, a Missouri school teacher recruited wasser, a NewJersey official, announced that by Davenport in 1910, and a ~an who devoted he would seek a bill for the compulsory sterili­ his life to the cause ofeugenics (Haller, 1973). zation ofhabitual criminals in his state (Sharp, In 1907 Laughlin, after some restless years 1907). NewJersey enacted such a law eighteen of high-school teaching, obtained a post as a months later. biology instructor at a small college. Excited The most successful physician lobbyist was by the rediscovery of Mendelian genetics, he F. W. Hatch, Secretary of the State Lunacy plunged into breeding experiments and wrote Commission in California. In 1909, he drafted to Davenport for advice in analyzing his results a sterilization law and helped to convince the (Laughlin, 1907). Correspondence led to an legislature (which was highly sensitive to eu­ invitation to study genetics at Cold Spring genic issues because of the influx of"racially Harbor for the summer, and Laughlin inferior" Chinese and Mexicans) to adopt it. returned from his visit to New York with After the law was enacted, Hatch was ap­ renewed commitment to genetics. Over the pointed General Superintendent of State next two years he assisted Davenport in gather­ Hospitals and was authorized to implement the ing data for his studies. In the autumn of 1910 new law. Until his death in 1924, Hatch he moved to Cold Spring Harbor to become directed eugenic sterilization programs in ten the first and only Superintendent of the Eu­ state hospitals and approved 3000 steriliza­ genics Record Office (ERO), a post he held tions - nearly halfofthe nation's total (Pope­ for 29 years (Hassencahl, 1980). noe, 1933). Laughlin worked tirelessly to develop the By 1912, support for engenical sterilization ERO. His two major tasks were (1) to train an was widespread among physicians. Even emi­ army of field workers (young women who nent professors such as Lewellys Barker (who would work at state hospitals and asylums to succeeded Osler as Physician-in-Chiefat The amass pedigree studies), and (2) to store and Johns Hopkins Hospital), cautiously favored index the massive amount ofmaterial that this such programs (Barker, 1910). G. F. Lydston, army generated. A meticulous person, Laugh­ a prominent Chicago surgeon, was an out- lin triple-indexed the pedigrees and stored 156 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62

them in fire-proof vaults. Today these hun­ tified before that body, and warned that the dreds ofthousands ofcards slumber peacefully nation's hospitals would soon be filled with im­ in a cellar at the University of Minnesota. migrants (Laughlin, 1923a). His testimony When Laughlin arrived at Cold Spring Har­ provided AlbertJohnson, the Chairman ofthe bor, the first field workers were already iden­ Committee, with the scientific ammunition he tifying persons who might be at high risk for needed in his campaign for a restrictive im­ bearing feebleminded children. By the close migration law. In 1921 he appointed Laugh­ of 1912, when he participated in a committee lin an "Expert Eugenical Agent" and charged to study "the best practical means of cutting him to study "alien inmates and inmates of offthe defective germ plasm in the American recent foreign extraction in the several state population" (Hassencahl, 1980: 95), Laughlin institutions for the socially inadequate" (Has­ strongly favored involuntary sterilization. This sencahl, 1980: 182). The goal was to show ir­ blue-ribbon group concluded that "approxi­ refutably that the foreign-born were draining mately 10 percent ofour population, primar­ American resources. ily through inherent defect and weakness, are The plan was simple. Starting with a set of an economic and moral burden on the 90 per­ census figures that described the portion ofthe cent and a constant source of danger to the American population represented by each na­ national and racial life" (Davenport, 1913b: 94). tional group (e.g., Italian, Swedish), Laugh­ Laughlin reduced the committee's work to lin calculated the number of each group that publishable form (Laughlin, 1914a,b). The he expected to find in the institutional popu­ longer ofthe two monographs, an exhaustive 1ation. Ifa greater-than-expected number ap­ legal study, included a model bill that tried to peared in his survey of 93 institutions, then cast the eugenics net as widely as possible with­ that group was contributing a disproportion­ out violating the U.S. Constitution. With this ate share ofsocially inadequate citizens to the publication Laughlin emerged as a leading fig­ American melting pot. Laughlin (1923b) found ure in the eugenics movement. He began to only 91 per cent ofthe expected number ofna­ receive important speaking invitations, such tive whites in the institutional sample, but de­ as one to the First National Conference on termined that the institutions housed 125 per Race Betterment, in January, 1914 (Hassen­ cent of the expected number of foreign-born cahl, 1980). persons and 143 per cent of those to be ex­ The war years (1914-1918) slowed the eu­ pected from southeastern Europe. He con­ genics movement. American eyes turned to the cluded that while "making all logical al­ trenches, and the tide of immigrants from lowances for environmental conditions, which southeastern Europe subsided. For Laughlin may be unfavorable to the immigrant, the re­ it was a period ofconsolidation. Eager to rub cent immigrants (largely from southern and shoulders with leading geneticists, he earned eastern Europe), as a whole, present a higher a doctorate in biology at Princeton University percentage ofinborn socially inadequate qual­ and published his only really scientific papers ities than do the older stocks" (Laughlin, (on mitosis in the root tip of the onion, e.g., 1923b: 755). As the Committee commissioned Laughlin, 1918). no other studies, Laughlin's findings helped During the early 1920s Laughlin became the to build a staunchly pro-restrictionist record. nation's leading expert on the twin eugenic Laughlin's report may not have swayed policies of restrictive immigration and selec­ many votes in an already restrictionist Con­ tive sterilization. In 1920 the Bureau of the gress (the Immigration Act of 1921 preceded Census released the results of a demographic his work), but it did help to entrench a study of634 "institutions for the care ofdefec­ national-origins quota system that was much tive, dependent and delinquent classes" (Has­ more ambitious than earlier plans. The sys­ sencahl, 1980: 171) that was based largely on tem, which limited the annual immigration of survey work that he had performed for it. His people from each European country to three finding that immigrants were over-represented per cent ofthe number ofAmericans that had in these institutions came to the attention of claimed that country as place of origin in the the House Committee on Immigration and Census of1890, sharply curtailed the flow from Naturalization. In April, 1920, Laughlin tes- southeastern Europe (Garis, 1927~. Laughlin's JUNE 1987 INVOLUNTARY STERILIZATION 157

report rationalized that reference base. He writings of Harry H. Laughlin also provide showed that people from southeastern Europe much material. were difficult to assimilate. Would it not be un­ Four small but influential groups lobbied fair to open the gates to those who were un­ hard for these laws: physicians (especially those likely to adapt to new ways? Would it not be working at state facilities), scientific eugeni­ unfair to bias immigration flow in favor ofnew­ cists (including prominent biologists like David comers? The succeeding Immigration Act of Starr Jordan, President of Stanford Univer­ 1924 was the greatest triumph ofthe eugenics sity), lawyers andjudges, and a striking num­ movement. ber of members of the nation's richest fami­ In 1920 the indefatigable Laughlin finished lies. There were, ofcourse, opponents as well. his exhaustive study ofeugenical sterilization. But, except for a handful ofacademic sociolo­ The 1300-page manuscript, which strongly fa­ gists and social workers, they were less visible vored involuntary sterilization of institution­ and less vocal. Having already mentioned alized persons, could not be published with­ some scientists and physicians, I shall briefly out philanthropic support. Both the Carnegie note the other supporters of this legislation. Institution (Hassencahl, 1980) and the Rock­ Among the influential lawyers who pushed efeller Foundation (Davis, 1921) refused to un­ for sterilization laws was Eugene Smith, Presi­ derwrite the cost. At this juncture, Harry Ol­ dent of the National Prison Association. He son, a Chicagojudge and a staunch eugenicist, viewed sterilization as the only solution to a arranged for the Chicago Municipal Psy­ dangerously spiraling prison budget (Smith, chopathic Laboratory (devoted to biological 1908). Warren Foster (1909), SeniorJudge of studies ofcrime) to publish the work (Laugh­ New York County, argued in popular periodi­ lin, 1922). It solidified Laughlin's standingwith cals that recidivists should be sterilized. He the inner circle of eugenicists. assured his readers that scientists had proved Throughout the 1930s Laughlin was a tire­ that criminality was hereditary, and that a less advocate of sterilization, but his stature compulsory sterilization law would not violate in the scientific community deteriorated as the the U.S. Constitution. His campaign provoked science of genetics matured. After Davenport a critical editorial by The New }0rk Times, but retired in 1934, John C. Merriam, President in 1912 New York did enact a sterilization law. ofthe Carnegie Institution ofWashington, be­ The enthusiastic support that America's gan to reduce Laughlin's budget at the Eu­ wealthiest families provided to the eugenics genics Record Office. Nevertheless, Laughlin movement is a curious feature of its history. remained a prominent figure and was fre­ First among many was Mrs. E. H. Harriman, quently called upon to advise civic groups who almost single-handedly supported the Eu­ about eugenic policy. For example, he acted genics Record Office in its first five years. The as special consultant to the State ofConnecti­ second largest financial supporter ofthe ERO cut in its survey of"human resources:' Then, wasJohn D. Rockefeller, who gave it $400 each in 1938, President Merriam cut offLaughlin's month (Davenport, 1911). Other famous eu­ research funds and guaranteed his salary for genic philanthropists included Dr. John Har­ only three months longer (Merriam, 1938). In vey Kellogg (brother to the cereal magnate), a matter of days Laughlin ended his 29 years who organized the First Race Betterment Con­ at Cold Spring Harbor, and the Eugenics Rec­ ference, held in 1914, and Samuel Fels, ord Office was closed (Hassencahl, 1980). Philadelphia soap manufacturer. Theodore Laughlin died in 1942. Roosevelt was an ardent eugenicist, one who urged Americans to have large families in or­ der to avoid racial dilution by the weaker im­ THE EARLY STERILIZATION LAWS migrant stock (Roosevelt, 1914). In studying the rapid rise of the early ster­ Of the vocal opponents of the eugenics ilization legislation, one is hampered by a pau­ movement, Alexander Johnson and Franz city ofstate legislative historical materials. For­ Boas were among the most important. John­ tunately, a few studies (Rhode Island State son, leader of the National Conference of Library Legislative Reference Bureau, 1913) Charities and Correction, thought that steril­ shed light on the origin ofthis legislation. The ization was less humane than institutional 158 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62 segregation. He dreamed of"orderly celibate cratic patterns were documented in other states communities segregated from the body poli­ (Laughlin, 1922). tic;' where the feebleminded and insane would Although the activities of persons opposed be safe and could be largely self-supporting to sterilization are difficult to document, the Oohnson, 1909). Boas, a Columbia University record of lawsuits attacking the constitution­ anthropologist, conducted a special study for ality of sterilization laws makes it clear that Congress to determine whether immigrants the courts were in general unfriendly to eu­ were actually being assimilated into Ameri­ genic policy. Between 1912 and 1921 eight laws can culture. His findings (Immigration Com­ were challenged, and seven were held to be un­ mission, 1910) argued that Hebrews and constitutional. The first two cases were brought Sicilians were easily assimilable- a conclusion by convicted rapists, who argued that steril­ that was anathema to most eugenicists. ization violated the Eighth Amendment's pro­ The extraordinary legislative success of hibition ofcruel and unusual punishment. The proposals to sterilize defective persons suggests Supreme Court ofWashington, impressed with that there was substantial support by the Dr. Sharp's reports that vasectomy was sim­ general public for such a plan. Between 1905 ple, quick, and painless, upheld its state law and 1917 the legislatures of 17 states passed (State v. Feilen, 1912). But, a few years later, a sterilization laws, usually by a large majority federal court in Nevada ruled that vasectomy vote. Most were modeled after the Indiana was an "unusual" punishment and struck down plan, which covered "confirmed criminals, a criminal sterilization law (Mickle v. Henrichs, idiots, imbeciles, and rapists:' In Indiana, if 1918). two outside surgeons agreed with the institu­ In six states (NewJersey, Iowa, Michigan, tion's physician that there was no prognosis for New York, Indiana, and Oregon), constitu­ "improvement:' such persons could be steril­ tional attacks were leveled at laws that autho­ ized without their consent. In California, the rized sterilization of feebleminded or insane focus was on sterilizing the insane. The law persons who resided in state institutions. The permitted authorities to condition a patient's plaintiffs argued that laws aimed only at in­ discharge from a state hospital upon a consent stitutionalized persons violated the Equal Pro­ to undergo sterilization. As the hospitalization tection Clause and that the procedural safe­ was ofindeterminate length, people rarely re­ guards were so inadequate that they ran afoul fused sterilization, so the consent was rendered of the Due Process Clause. All six courts in­ nugatory (Laughlin, 1922). validated the laws, but they divided in their How vigorously were these laws imple­ reasoning. The three that found a violation of mented? From 1907 to 1921 there were 3233 the Equal Protection Clause did not clearly op­ sterilizations performed under state laws. A pose eugenical sterilization. Their concern was total of 1853 men (72 by castration) and 1380 for uniform treatment ofall feebleminded per­ women (100 by castration) were sterilized. sons. The three that relied on due-process ar­ About 2700 operations were performed on the guments to reject the laws were more an­ insane, 400 on the feebleminded, and 130 on tagonistic to the underlying policy. An Iowa criminals. California's program was by far the judge characterized sterilization as a degrad­ largest (Laughlin, 1922). ing act that could cause "mental torture" (Davis Sterilization programs ebbed and flowed ac­ v. Berry, 1914). cording to the views of key state and institu­ The New York case was especially interest­ tional officials. For example, in 1909 the new ing because prominent eugenicists testified. It Governor of Indiana quashed that state's ac­ grew out ofa dispute between the superinten­ tive program. In New York, activity varied dent ofthe Rome Custodial Asylum, who op­ from institution to institution. In the State posed sterilization, and the institution's Board Hospital at Buffalo the superintendent, who of Examiners, who favored it. To resolve the believed that pregnancy exacerbated schizo­ matter, the Board voted to sterilize a young phrenia, authorized 12 hysterectomies, but in feebleminded man named Frank Osborn, who most other hospitals no sterilizations were per­ quickly sued. At the trial, the superintendent mitted, despite the state law. Similar idiosyn- argued that there were no convincing data to JUNE 1987 INVOLUNTAR Y STERILIZATION 159

support assertions that the prevalence of reflected the weakening ofSouthern white so­ feebleminded people was rising; he argued fur­ ciety's control over the lives of Blacks. Of ther that vasectomy might harm "high grade" course, anti-miscegenation laws are as old as feebleminded men by encouraging immoral­ slavery itself (Wadlington, 1966). After the ity. Of the several eugenicists who testitifed, Civil War, however, the burgeoning "colored" Davenport, the most important, adopted the population (largely a product ofinstitutional­ most conciliatory position. Perhaps sensing de­ ized rape before then) stimulated the enact­ feat, he favored segregation over involuntary ment ofnew laws that redefined as "Negro" per­ sterilization. The court, concerned that the law sons with ever smaller fractions of black sacrificed individual rights to "save expense for ancestry (Mencke, 1959). This trend culmi­ future generations;' struck it down (In re nated in 1924, when Virginia adopted a law Thompson, 1918). that defined as White "one who has no trace From 1918 to 1921, the years during which whatsoever ofany blood other than Caucasian." these cases were decided, sterilization laws It forbade the issuance ofmarriage licenses un­ faded as quickly as they had appeared. One til officials had "reasonable assurance" that reason why the courts were less sympathetic statements as to the color of both man and to sterilization laws than the legislatures had woman were correct, it voided all existing in­ been was that sterilization petitions (like com­ terracial marriages (regardless ofwhether they mitment orders) touch the judiciary's historic were contracted legally elsewhere), and it role as protector of the weak. The judges made cohabitation by such couples a felony. demanded clear proof that the individual TheVirginia Racial Integrity Act was enforced would benefit from being sterilized. Another by Walter Plecker, Director of the Bureau of reason may have been that scientific challenges Vital Statistics, a zealous eugenicist who cor­ to eugenical theories about crime began to ap­ responded regularly with Laughlin (Reilly, pear. For example, two physicians who stud­ 1983b). ied behavior found "no proofofthe existence The early 1920s were also marked by an in­ of hereditary criminalistic traits" (Spaulding terest in biological theories of criminality and Healy, 1914: 42). somewhat akin to those legitimized in the 19th Century by Lombroso. Orthodox criminolo­ THE 1920s gists were not responsible for this development After World War I arguments that eugeni­ (Parmelee, 1918; Sutherland, 1924). Tabloid cal sterilization programs were needed to pro­ journalists did foster a popular interest in tect the nation's "racial strength" resurfaced. hereditary criminality. World's Work, a popu­ The major impetus was the sudden arrival of lar monthly, featured five articles on the bio­ hundreds of thousands of immigrants from logical basis of crime. One recounted the in­ southeastern Europe and Russia- people with novative efforts ofHarry Olson, ChiefJustice languages and cultures that were unfamiliar of the Chicago Municipal Court. Convinced to Americans (Ludmerer, 1972). The xenopho­ that most criminals were mentally abnormal, bia triggered by this massive influx reinforced Olson started a Psychopathic Laboratory and concern for the dangers ofmiscegenation and hired a psychometrician to develop screening helped to renew interest in biological theories tests to identify people with criminal minds of crime. Some eugenicists wrote inflamma­ (Strother, 1924). tory essays. Madison Grant, a wealthy New During the 1920s many eugenics clubs and Yorker and conservation enthusiast, argued societies sprouted, but only two, the Ameri­ that there were a multitude ofscientifically dis­ can Eugenics Society (AES) and the Human tinct races and that admission of "inferior" Betterment Foundation (HBF), exerted a sig­ types threatened the nation (Grant, 1916). nificant influence on sterilization policy. The Grant's was the most prominent of a whole AES was conceived at the Second International genre ofpopular essays warning Americans to Congress of Eugenics in 1921 by Henry Fair­ beware ofdiluting their racial vigor (Stoddard, field Osborn, President of the American 1920). Museum of Natural History, together with a The concurrent concern for miscegenation small group ofcolleagues. By 1923 the new so- 160 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62 ciety was sufficiently well organized to lobby Gosney's death in 1942 (Pasadena Star News, against a New York bill supporting special edu­ 1942). cation for the handicapped, an idea that it con­ Despite the constitutional inadequacies of sidered to be dysgenic (AES Memorandum, earlier statutes, in the mid-1920s involuntary 1923). sterilization became a major legislative issue. In 1925 Irving Fisher, a Yale professor, relo­ During the period from 1923 to 1925 steril­ cated the AES headquarters in New Haven. ization laws were enacted in twelve states. For the next few years its major goal was pub­ Drafted with greater concern for constitutional lic education. The AES published several issues than pre-war legislation these laws usu­ pamphlets, sponsored "fitter family" contests ally required the assent ofparents or guardians and underwrote the cost of several book and preserved the patient's right to a jury trial projects by its members (Whitney, 1928). The on the question ofwhether he or she was "the Depression ofthe 1930s caused a great fall in potential parent of socially inadequate off­ donations to the Society and when Ellsworth spring" (Laughlin, 1926: 65). Huntington, a Yale geographer, became presi­ Opponents ofsterilization quickly attacked dent of the society in 1934, it was moribund. the new laws. InJune, 1925, the highest Michi­ With the aid of Frederick Osborn, a wealthy gan court upheld Michigan's sterilization stat­ relative ofthe founder, Huntington breathed ute and ruled that the program was ''justified new life into the organization. Huntington and by the findings of Biological Science" (Smith Osborn redirected the aims ofthe AES toward v. Probate, 1925). The really crucial case in­ "positive" eugenics policies such as family plan­ volved the constitutionality of a Virginia law ning and personal hygiene (Huntington, 1935). that was decided by the United States Supreme After World War II, the Society evolved into Court. In May, 1927, Oliver Wendell Holmes, one for the study of social biology and con­ writing for the majority, upheld the involun­ cerned itself with issues such as population, tary sterilization ofthe feebleminded, conclud­ nutrition, and education. The major influence ing: "It is better for all the world, if instead of the AES on sterilization policy was in its of waiting to execute degenerative offspring early days, when some of its educational ma­ for crime, or to let them starve for their imbe­ terials did favor sterilization laws. cility, society can prevent those who are The wealthiest eugenics organization was manifestly unfit from continuing their kind. the Human Betterment Foundation (HBF), The principle that sustains compulsory vacci­ started by a California millionaire named Ezra nation is broad enough to cover cuttingthe Fal­ Gosney. In 1926 Gosney convened a group of lopian tubes" (Buckv. Bell, 1927: 205). The Su­ experts to study the efficacy of California's preme Court's decision greatly boosted the sterilization program. This group confirmed pace at which sterilization programs were the long-term safety of undergoing steriliza­ enacted and implemented. During the next tion and concluded that Californiahad benefit­ few years the number of states with steriliza­ ted from the sterilization of prison and other tion laws jumped from 17 to 30, and the num­ institutional inmates. Gosney came to believe ber ofsterilizations performed on institution­ that a massive sterilization program could re­ alized persons rose substantially. The years duce the number ofmentally defective persons 1927 to 1942 were a triumphant period for per­ by one-halfin "three or four generations" (Gos­ sons who believed that sterilization would help ney and Popenoe, 1929). During the 1930s the solve some pressing social problems. HBF was the most vocal advocate of eugeni­ cal sterilization. It mailed hundreds of thou­ YEARS OF TRIUMPH sands ofeugenics pamphlets to college teachers What was the driving force behind the sec­ across the nation, sponsored a column on "so­ ond wave ofsterilization laws? As was the case cial eugenics" in the Los Angeles Times, aired before World War I, a small group ofactivitists radio programs, and underwrote hundreds of from influential quarters persuaded scientifi­ lectures. The HBF also meticulously collected cally unsophisticated legislators that steriliza­ annual sterilization data and published an an­ tion was necessary, humane, and just. nual score card. It remained vigorous until The lobbyists succeeded in part because of JUNE 1987 INVOLUNTARY STERILIZATION 161

favorable views expressed in the medical My analysis of surveys conducted by the profession. During the period from 1926 to Human Betterment Foundation permit mini­ 1936 about 60 articles, the vast majority in fa­ mum estimates ofmass sterilization and com­ vor ofeugenical sterilization, appeared. A few pel some striking conclusions: physicians played crucial roles. For example, (1) Between 1907 and 1963 there were eu­ Dr. Robert Dickinson, a noted gynecologist, genical sterilization programs in 30 states. presented a pro-sterilization exhibit at the 1928 More than 60,000 persons were sterilized pur­ meeting ofthe American Medical Association suant to state laws. (Editorial, 1928). A visitor to the 1929 meet­ (2) Although sterilization reached its zenith ing ofthe American Association for the Study during the 1930s, several states vigorously pur­ of the Feeble-Minded reported that his col­ sued this activity throughout the 1940s and leagues were convinced that it was "absolutely 1950s. impossible to cope with the problem of (3) At any particular time, a few programs feeblemindedness without judicious use of were much more active than the rest. In the sterilization" (Editorial, 1929: 136). In 1930, 1920s and 1930s California and a few mid­ that organization voted 227 to 16 in favor of western states were most active. After World sterilization of the "mentally defective" War II, several southern states accounted for (Watkins, 1930). Throughout the 1930s, the more than halfofthe involuntary sterilizations American Association for the Study of the performed upon institutionalized persons. Feeble-Minded strongly favored eugenical (4) Beginning about 1930, there was a dra­ sterilization. In the general medical commu­ matic rise in the percentage of women who nity support for it was strong, but not uniform. were sterilized. Only 18 state medical societies officially backed (5) No revulsion against Nazi sterilization sterilization programs (Whitten, 1935). Yet in policy seems to have curtailed American steril­ some states the support of physicians was ex­ ization programs. Indeed, more than one-half tremely strong. For example, one investigator ofall eugenic sterilizations occurred after the halted his further efforts to survey the views Nazi program was fully operational. ofIndiana physicians on sterilization because From 1929 to 1941 the Human Betterment he found agreement among more than 400 of Foundation conducted annual surveys ofstate them so homogeneous (Harshman, 1934). institutions to chart the progress of steriliza­ The legislative victories were impressive; tion. Letters from hospital officials indicate nevertheless, the crucial measure of whether what factors influenced their programs. The eugenic notions triumphed is to count the ac­ most important determinants of the scope of tual number ofsterilizations performed. I dis­ a program's operation were the complexity of agree with Kevles (1985) who has character­ the due-process requirements of the relevant ized the number ofpersons who were subjected laws, the level offunding, and the attitudes of to involuntary sterilization as relatively small. the superintendents themselves. A West Vir­ As he put it, "[flrom 1907 to 1928 fewer than ginia official complained that his law had so nine thousand people had been eugenically many amendments as to "practically annul it" sterilized in the United States" (p. 106). Al­ (Denham, 1933). An Arizona physician re­ though Kelves has enriched our understand­ ported that there was no money to pay for sur.. ing of the prominence of eugenic ideas in gery (Develin, 1933). On the other hand, in American intellectual life, his failure to ana­ Alabama a physician superintendent reported lyze carefully available statistics on steriliza­ that he had secured funds to sterilize every pa­ tion led him to underestimate the impact of tient before discharge from the state hospital eugenic laws. For example, he noted that "by and had operated upon 184 persons in two the mid-thirties some twenty thousand sterili­ years (Partlow, 1935). zations had been legally performed in the The HBF surveys strongly suggested that United States" (p~ 112) and that enforcement the total number of sterilizations performed ofthe laws pursuant to which these operations upon institutionalized persons was under­ were performed "was minuscule by 1950" (p. reported. Respondents frequently indicated 169). that eugenic operations were conducted out- 162 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62 side the confines ofstate hospitals. The Assis­ virtually all the sterilized persons were women. tant Attorney General of Maine wrote that This fact becomes even more impressive when "many more operations have been performed one considers that the salpingectomy opera­ (than are reported) but I suppose we shall have tion incurred a relatively high morbidity and to go by the records" (Folsom, 1936: 1). An In­ a much higher cost than did vasectomy. In diana superintendent asserted that "hundreds California, at least five women died after un­ of operations have been done in the commu­ dergoing eugenical sterilization (Gosney and nity" (Dunham, 1936: 1). Popenoe, 1929). Until 1918, only 1422 eugenical sterilizations During the 1930s institutionalized men were were reported as performed pursuant to state also being sterilized in unprecedented num­ law. Ironically, the sterilization rate began to bers. This was largely a consequence of the rise during the very period when the courts great increase in the total number ofstate pro­ were rejecting the first round of sterilization grams. Unlike the "menace of the feeble­ statutes (1917-1918). During 1918 to 1920 there minded" that haunted policy before World War were 1811 reported sterilizations, a four-fold I, the new concern was to cope with harsh eco­ increase over the rate in the prior decade. Dur­ nomic realities. As many superintendents saw ing the 1920s annual sterilization figures were it, fewer babies born to incompetent parents stable (Fig. 1), but in 1929 there was a large might mean fewer state wards in the future. increase in sterilizations. Throughout the Sterilizing and paroling mildly retarded 1930s more than 2000 institutionalized persons women eased overcrowding and, it was argued, were sterilized each year, a rate triple that of permitted them to live more successful lives the early 1920s. than ifthey were burdened with children (State This rapid increase reflected changing con­ Board of Control of Minnesota, 1934). cerns and changing policy. In the Depression The triumph of eugenic sterilization pro­ years superintendents of many hospitals, grams in the United States during the 1930s strapped by tight budgets, decided to sterilize influenced other nations. Canada, Germany, mildly retarded young women. Before 1929 Sweden, Norway, Finland, France, andJapan about 53 per cent ofall eugenical sterilizations enacted sterilization laws. In England, steril­ had been performed on men. Between 1929 ization was ultimately rejected, but in Ger­ and 1935 there were 14,651 reported opera­ many the Nazis sterilized more than 50,000 tions, 9327 upon women and 5324 on men. "unfit" persons within one year after enacting In several states (e.g., Minnesota, Wisconsin) a eugenics law.

5,000 4,000

3,000 -~ 2,000 1,000

J l A --..~_--- ~ .--..._---..:y--....---"""---...... ~---- _--A.,,__ 1919 1920 1930 1940 1950 1959 Persons Sterilized

FIG. 1. STERILIZATIONS PERFORMED EACH YEAR UPON INSTITUTIONALIZED PERSONS, 1919-1959 JUNE 1987 INVOLUNTARY STERILIZATION 163

Proposals favoring eugenical sterilization sterilization policy. The Nazis restructured tax were common in England early in this cen­ laws to favor childbearing and enacted a law tury. In 1907 Galton's colleagues organized the to curb reproduction by "defective" persons. Eugenics Education Society (EES), which soon This law created a system of "Hereditary included hundreds of prominent academi­ Health Courts" that judged petitions brought cians. Although committed to eugenic ideals, by public health officials recommending that the EES pursued a moderate course, stopping certain citizens burdened with any of a long short of a policy that included involuntary list of disorders (feeblemindedness, schizo­ sterilization (Searle, 1976). The major legis­ phrenia, manic depressive insanity, epilepsy, lative action during this era was the Mental Huntington's chorea, hereditary blindness, Deficiency Act of 1913, a law that clearly fa­ hereditary deafness, severe physical deformity, vored educational programs for the feeble­ or habitual drunkenness) be subjected to com­ minded-a decidedly dysgenic policy. pulsory sterilization. In 1934, the courts heard During the late twenties the EES, troubled 64,499 petitions and ordered 56,244 steriliza­ by the rising welfare budget, did lobby for tions, for a "eugenic conviction" rate of87 per voluntary eugenic sterilization. In 1931 the cent (Cook, 1935). House of Commons rejected such a bill, but During the middle 1930s the Nazis cast an it created a Committee to study the question. even larger net. In 1934 the German Supreme Three years later it filed a report that roundly Court ruled that the law applied to non­ criticized programs like those in the United Germans living in Germany, a decision that States as being inadequately supported by threatened gypsies. From 1935 through 1939 genetic evidence (Brock, 1934). the annual number ofeugenical sterilizations The German interest in eugenics had roots grew rapidly. Unfortunately, key records per­ that were entwined with 19th Century Euro­ ished during the war. Yet in 1951 the "Central pean racial thought, a topic beyond the scope Association of Sterilized People in West Ger­ of this review. In the early years of this cen­ many" charged that from 1934 to 1945 the tury a spate ofbooks preached the need to pro­ Nazis sterilized 3,500,000 people, often on the tect the Nordic germ plasm. A German eu­ flimsiest pretext (New lVrk Herald 1Jibune, 1951). genics society was formed in 1905, and in 1907 The Nazi program was eugenics run amok. the first sterilization bill was offered in the In the United States no program even ap­ Reichstag (Lenz, 1934). It failed to pass. The proached it in scope or daring. devastation ofWorld War I halted the German eugenic movement, but by 1921 groups were CRITICS OF EUGENIC STERILIZATION again actively lobbying for eugenics programs. The difficulty of explaining why eugenic Ofparticular importance was the publication ideas appealed so strongly to some Americans by three prominent German scientists, Erwin extends to the task of understanding why in­ Baur, Eugen Fischer, and Fritz Lenz, in 1923 t~rest faded when it did. Ofcourse, there were ofa textbook on human heredity and eugenics. a1 Nays critics. At various times geneticists, so­ The contribution of Baur, an eminent plant cial scientists, physicians, and (most effec­ geneticist who did not usually stray from his tively) the Catholic Church opposed steriliza­ area ofexpertise, is notable. According to Glass tion programs. After World War II civil (1981), Baur was deeply troubled by the suffer­ libertarians, lawyers, patients' families, and pa­ ing of Germans during the occupation of the tients themselves repudiated the old notions. Rhineland and became concerned that it was During the heyday of eugenics the science essential for the more robust German citizens ofgenetics was also making important strides. to reproduce vigorously in order to counter the After training with Thomas Hunt Morgan in influx ofinferior types. According to Popenoe Columbia's fly room, talented graduate stu­ (1935), Lenz influenced Hitler's ideas on ra­ dents brought Drosophila genetics to other cial purity. universities. By the mid-1920s quite a number When the Nazis swept into power, they ofacademic geneticists were critical ofthe un­ quickly implemented a program to encourage sophisticated ways of the eugenicists. Yet few larger, healthier families. According to Kopp tried to counter the eugenicist's political ac­ (1935), Gosney and Popenoe influenced Nazi tivities (Haller, 1963; Ludmerer, 1972). 164 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62

The first major scientist to take on the eu­ Americanism like the complete prohibition of genicists was Herbert Spencer Jennings, a alcoholic beverages" (Haldane, 1938: 86). His zoologist at TheJohns Hopkins University. He book did much to alert the growing genetics severely criticized the statistical methods used community to the need to refute the quasi­ by Laughlin to conduct his immigration scientific eugenicists (Glass, pers. commun., studies and offered his arguments both in sci­ 1985). entific periodicals Oennings, 1924) and popu­ Catholic priests were among the earliest lar magazines Oennings, 1923). He consis­ critics of eugenical sterilization. Their attack tently argued that sterilizing the feebleminded became intense after World War I, and was was a futile gesture, although he quite ap­ part ofa larger concern over the efforts ofeu­ proved ofthe use ofvoluntary sterilization by genicists to restrict immigration. In the United enlightened couples at high risk for bearing States, the Catholic Church, a small minority defective children aennings, 1930). in a Protestant nation, was a church of im­ A few leading geneticists criticized the var­ migrants. By the mid-1920s eugenicists had ious famous pedigree studies. Morgan, a man recognized the Catholic Church as a major who shunned political battles, contented him­ enemy. They attributed the gubernatorial veto self only with dismissing the studies of the of a Colorado sterilization bill to lobbying 'Jukes" and "Kallikaks" as inadequate investi­ by the Denver Chapter of the Knights of gations ofthe interaction between genetic and Columbus Oohnson, 1927). environmental influences (Morgan, 1925). In 1930 Pope Pius XI issued Casti Connubi, Raymond Pearl was more vocal. He ridiculed the encyclical on Christian marriage, which the early pedigree work and urged eugenicists included the first official condemnation of to throwaway their "old-fashioned rubbish" eugenical sterilization. Pius XI asserted that (Pearl, 1927: 263). Another important critic civil authorities had no right to deprive guilt­ was HermannJoseph Muller, renowned for the less persons of a "natural faculty by medical discovery that radiation induces mutations. At action" (Pius XI, 1939: 96-97). Casti Cannubi the Third International Congress ofEugenics rallied Catholic organizations to oppose eu­ he shocked the audience by attacking its most genic laws. This action in turn polarized some dearly held tenets (Carlson, 1982). Protestant groups to argue in favor ofeugeni­ During the 1930s developments in Europe cal sterilization. greatly increased concern among geneticists During the 1940s Catholic opposition to that substantial harm might be done in the ser­ both eugenic sterilization and elective steril­ vice of state-supported eugenic policy. No ization to limit family size was widespread. doubt influenced by the economic climate, the Leading eugenicists saw Catholic opposition English National Council of Labour Women as their "greatest obstacle:' According to Olden passed a resolution in favor ofsterilizing defec­ (1945), a founder ofthe NewJersey Steriliza­ tive persons. Soon after they swept to power tion League, Roman Catholic priests defeated in 1933, the Nazis dismissed hundreds ofJew­ proposed laws in Wisconsin, Maine, Alabama, ish professors. Events like these provoked the and Pennsylvania. Olden reported that in Al­ great British geneticist, J. B. S. Haldane, to abama, priests and nuns had "invaded" the launch a scathing attack on eugenics. legislature and that in Pennsylvania lobbying Later published as Hered£ty and Pol£t£cs (Hal­ against sterilization had been masterminded dane, 1938), his book masterfully separated by the Cardinal's office. Catholic opposition genetic fact from political fantasy. For exam­ to sterilization played a major role in delay­ ple, Haldane pointed out that the eugenic idea ing widespread elective surgery to limit fam­ popular in 1910 (an era of full employment) ily size. that pauperism was genetically determined was The first important clinical critique of eu­ untenable during a Depression in which genic sterilization was developed by Dr. Walter 1,500,000 Englishmen were out of work. Not Fernald (1919), a Boston psychiatrist. After a little of Haldane's book deflates the perfec­ studying 646 non-sterilized feebleminded per­ tionist dreams of those who advocated steril­ sons who had been discharged from institu­ ization. After demonstrating the weakness of tions, he found that few ofthem became par­ its scientific foundations, he dismissed "com­ ents. He concluded that the eugenicists had pulsory sterilization" ". .. as a piece of crude mistaken the relatively high fertility ofpersons JUNE 1987 INVOLUNTAR Y STERILIZATION 165

oflow socioeconomic status for that ofthe men­ thesis. Nevertheless, prior to World War II, so­ tally defective. Despite his refutation ofa ma­ cial scientists were not much involved in ef­ jortenet ofeugenic thought, the study had no forts to halt sterilization programs. After the immediate impact on social policy. War, as psychologists replaced physicians in Just as a few zealous e1Jgenicists did so much much ofthe mental health field, some ofthem to enhance their cause, a single physician challenged established sterilization policy. Also played a crucial role in attacking the beliefs after World War II, in 1950, the families of upon which eugenical sterilization was retarded persons formed their own lobbying grounded. This was Dr. Abraham Myerson, group, the National Association for Retarded a neurologist at Tufts University, who began Children (NARC). By 1960 it had achieved an to question eugenics in the mid-1920s (Myer­ important political presence, a success that was son, 1928). In 1930, he published a study show­ redoubled when President Kennedy took of­ ing that the feebleminded were born in roughly fice. NARC and its allies rejected eugenic equal proportions in all segments of society, sterilization. In 1962 the President's Commis­ a finding that contrasted sharply with the eu­ sion on Mental Retardation reaffirmed this genic thesis that a relatively few persons in the view. By the early 1960s most state steriliza­ lower classes produced a disproportionate tion programs had stopped. number (Myerson and Elkind, 1930). With the onset of World War II there had In 1934 the American Neurological Associ­ been a sharp decline in the number ofeugenic ation asked Myerson to chair an investigation sterilizations in the United States. Although ofeugenic sterilization. The committee's con­ manpower shortages were significant, other clusions rejected several major eugenic no­ factors were also at work. In 1939 the Eugenics tions. It determined that the increasing num­ Record Office closed its doors, and in 1942 the ber of institutionalized persons was the Human Betterment Foundation ceased its ac­ consequence ofa better system ofmedical care, tivities. Later in that year the Supreme Court, and was not due to a rising incidence in births considering its first sterilization case in 15 of retarded persons. It also reported that the years, struck down an Oklahoma law that per­ most common affliction suffered by newly in­ mitted certain thrice-convicted felons to be stitutionalized persons was cerebral athero­ sterilized (Sk£nnerv. Oklahoma, 1942). Although sclerosis, a fact explained by the increasing its specific impact is difficult to assess, the post­ longevity ofthe population. Overall, the com­ war civil rights movement also surely con­ mittee found that "the race is not going to the tributed to the failure ofsterilization programs dogs, as has been the favorite assertion for to return to earlier levels. Despite these some time" (Myerson, 1936a: 6). It concluded changes, some sterilization programs con­ that there was no pressing need for involun­ tinued, albeit at reduced activity levels. tary sterilization programs, but that voluntary Between 1942 and 1946 there were only half sterilization might be a reasonable option for as many eugenic sterilizations annually as had some individuals. been performed annually during the 1930s. The report had an immediate political im­ Reports of institutional officials make it clear pact. The New 10rk T£mes published a letter that this decline was almost completely owing summarizing the report's findings (Myerson, to a lack of surgeons and nurses (Taromianz, 1936b). It provided important ammunition 1944; Perry, 1945). The Supreme Court deci­ with which opponents torpedoed a steriliza­ sion was not important in causing the decline. tion bill then under consideration in Albany Avoiding an opportunity to overrule Buck ~ Bell (Cooper, 1936). From the mid-1930s onward, (1927), theJustices instead demanded that in­ sterilization bills fared less well than during voluntary sterilization be practiced in accor­ the preceding decade. Nevertheless, already­ dance with the Equal Protection Clause. The entrenched programs continued to sterilize Oklahoma law was struck down because it about 2500 institutionalized persons each year. spared certain "white collar" criminals from a punitive measure aimed at other thrice­ AFTER WORLD WAR II convicted persons, not simply because it in­ During the 1920s behavioral psychologists volved sterilization. (Watson, 1927) had advanced views ofintelli­ In charting the sterilization trends during gence that were incompatible with the eugenic the 1940s and 1950s I have relied primarily on 166 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62 the surveys conducted annually by the Steril­ southern programs were racially motivated. ization League ofNewJersey, a group founded Only as to South Carolina, where in 1956 all in 1937 that underwent several changes of 23 eugenical sterilizations were performed name. After some internal feuding in the early upon "Negro females" (Hall, 1956), might such 1940s the organization, refueled financially by suspicion be entertained. The North Carolina Clarence Gamble, a physician and a relative program was unique in that it was directed of the wealthy soap family, renamed itself largely at non-institutionalized, rural young Birthright, Inc. Besides being instrumental in women (Woodside, 1950). As recently as 1963 maintaining sterilization statistics, Birthright, the state paid for the eugenic sterilization of largely thanks to the zeal of Dr. Gamble, 193 persons, ofwhom 183 were young women helped stimulate several states to initiate new (Casebolt, 1963). Despite their persistence, the programs. His greatest victory was in North southern programs must be seen as a local Carolina, where he obtained government ap­ eddy in a tide of decline. proval to conduct extensive mental testing on grade-school children and then used those data to identify persons who would "benefit" from INVOLUNTARY STERILIZATION TODAY sterilization. Within a few years North Caro­ During the 1960s the practice ofsterilizing lina had one of the nation's largest eugenic retarded persons in state institutions virtually sterilization programs (Woodside, 1950). ceased. Still, the laws remained. In 1961 there During the late 1940s there was no definite were eugenic sterilization laws on the books indication that sterilization programs were of 28 states (Landman and McIntyre, 1961). about to decline further. After hitting a low Between 1961 and 1976 five laws were repealed, of 1183 in 1944, there were 1526 operations in six were amended, and one state (West Vir­ 1950. Slight declines in many states were ginia) adopted its first sterilization statute. balanced by rapid increases in North Carolina Since 1976 there has been a trend to repeal the and Georgia. By 1950, however, there were laws. Currently, eugenic sterilization ofinstitu­ strong signs that sterilization was in disfavor tionalized retarded persons is permissible in even among institutional officials. For exam­ 19 states, but the laws are rarely invoked. A pIe, during the 1930s and 1940s 100 persons few states have even enacted laws that expressly in San Quentin prison had been sterilized each forbid sterilization of any persons in state in­ year. In 1950 the prison surgeon told Birth­ stitutions. On the otherhand, several constitu­ right that new officials at the Department of tional attacks upon involuntary sterilization Correction were "entirely adverse" to the pro­ have failed (In re Cavitt, 1968, Cook v. State, gram (Stanley, 1950: 1). Several institutional 1972; In re Moore, 1976). superintendents in other states informed Birth­ If the mid-1930s saw the zenith of eugenic right that they no longer believed that heredity sterilization, the mid-1960s saw its nadir. The was a major factor in mental retardation (Mis­ pendulum ofpolicy continues to swing, how­ souri official, 1950). During that year steril­ ever. The late 1960s saw the first lawsuits ization bills were considered in only four states, brought by parents of non-institutionalized and all of them were rejected (Butler, 1950). retarded females on the basis that sterilization There were major changes in state steril­ was both economically essential and psycho­ ization programs in 1952. The California pro­ logically beneficial to the family's efforts to gram, for years the nation's most active, was maintain the adult daughters at home (Frazier moribund, dropping from 275 sterilizations in v. Levi, 1968). 1950 to only 39 in 1952. In that year Georgia, In 1973 the debate over the sterilization of North Carolina, and Virginia (having together institutionalized persons whom officials had sterilized 673 persons) were responsible for 53 decided were unfit to be parents flared in the per cent ofthe national total. General declines media. The mother of a young man whom in most other states continued throughout the physicians at the Partlow State School in Ala­ 1950s and by 1958, when Georgia, North bama wished to sterilize challenged the con­ Carolina, and Virginia sterilized 574 persons, stitutionality ofthe enabling statute. When Al­ they accounted for 76 per cent ofthe reported abama officials argued that they did not need operations. The data do not suggest that the statutory authority so long as consent was ob- JUNE 1987 INVOLUNTAR Y STERILIZATION 167

tained from the retarded person, the federal United States Supreme Court (Stump v. Spark­ judge not only overturned the law, but decreed man, 1978). strict guidelines to control the process ofper­ The majority ofappellate courts have ruled forming "voluntary" sterilizations at Partlow. that local courts ofgeneraljurisdiction do have The key feature was the creation ofan outside the power to evaluate petitions to sterilize committee to review all the sterilization peti­ retarded persons. In a leading case, the highest tions ("HYatt v. Aderholt, 1973). court in New Jersey held that the parents of Also in 1973 the Department of Health, an adolescent girl with Down's Syndrome Education and Welfare (HEW) became en­ might obtain surgical sterilization for her if meshed in a highly publicized sterilization they could provide clear and convincing evi­ scandal. That summer it was reported that an dence that it was in "her best interests" (In re Alabama physician working in a family plan­ Grady, 1981). Since then, high courts in ning clinic funded by HEW had sterilized sev­ Colorado, Massachusetts, and Pennsylvania eral young, poor black women without their have ruled in a similar manner. These deci­ consent. The National Welfare Rights Orga­ sions promise that in the future the families nization and two of the women sued to block of some retarded persons will in appropriate the use ofall federal funds to pay for steriliza­ circumstances be able to obtain sterilizations tions. This prompted HEW to draft strict new for them, regardless of their institutional regulations; but a federal judge struck them status. down, holding the HEW could not provide The great era ofsterilization, however, has sterilization services to any legally incompe­ passed, although grim reminde'rs of un­ tent persons (Relf v. Weinberger, 1974). Re­ sophisticated programs that once flourished vamped several times, the HEW guidelines linger. In Virginia persons sterilized for eu­ were subject to continuous litigation for five genic reasons decades ago have sued the state, years. Late in 1978 "final rules" were issued that on grounds that it was a violation oftheir civil prohibited sterilization ofsome persons (those rights. Depositions taken before the trial in­ under 21 and all mentally incompetent per­ dicated that many of the persons who were sons) and created elaborate consent mecha­ sterilized were not retarded (Poe v. Lynchburg, nisms for competent persons who requested 1981). Although they lost their argument that sterilization, to be paid for by public funds the operations were performed pursuant to an (Federal Register, 1978). unconstitutional law, the plaintiffs did win a During the last five years the debate over settlement that requires Virginia to attempt sterilizing the mentally retarded, although no to locate all persons who were sterilized by the longer cast in a eugenic context, has reheated. state and inform them ofthe consequences of The key issue now is how to resolve the ten­ the operation. Well into the 1970s a few states sions between the society's duty to protect the (Iowa, North Carolina, Oregon) still operated incompetent person and the right ofthat per­ sterilization programs. Between 1971 and 1977 son to be sterilized. The court must be con­ the Iowa Board of Eugenics considered 215 vinced that the operation will benefit the pa­ sterilization petitions and authorized 179 of tient. More than 20 appellate courts have them (Howard v. Des Moines Register, 1979). recently been asked to consider sterilization Is the saga ofinvoluntary sterilization over? petitions. This spate oflitigation has resulted Our present knowledge of human genetics because physicians are extremely reluctant to makes the return ofmass eugenic sterilization run the risk ofviolating the civil rights ofthe very unlikely. However, it is more difficult to retarded. The courts have split sharply. In the predict the future of sterilization programs absence ofexpress statutory authority, six high founded on other arguments. During the 1960s state courts have refused to authorize sterili­ a number ofstate legislatures considered bills zation orders (In the Matter ofS.C.E., 1977). to tie welfare payments to "voluntary" steril­ This abdication ofpower by the courts was in ization (Paul, 1968). In 1980 a Texas official part stimulated by an unusual lawsuit in which made a similar suggestion (New }0rk Times, a sterilized woman later sued the judge who 1980). Unscientific opinion polls conducted by approved the surgery. Ultimately, the princi­ magazines and newspapers in Texas (The Texas ple of judicial immunity was upheld by the Observer, 1981) and Massachusetts (The Boston 168 THE QUARTERLY REVIEW OF BIOLOGY VOLUME 62

Globe, 1982) have found significant support for States may transpire in other countries, with involuntary sterilization of the retarded. different legal codes and different population The pressing demands of population con­ pressures. As resources continue to shrink and trol in India and China have resulted in social the earthly neighborhood becomes more policies that create strong incentives to be steri­ crowded, societal incentives in favor of steril­ lized. Since launching the "one child" program ization may some day be as common as com­ in 1979, China has rapidly altered the social pulsory immunizations, but the eugenic vision fabric of one billion people (Intercom, 1981). is not likely to provide its intellectual rationale. What may not happen here in the United

REFEREN"CES

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