Sterilizing the Unfit

The eugenics movement began as a pseudo-scientific study, but one with some practical applications. Restricting immigration was one practical step. The other major eugenics initiative of the 1920s was promoting sterilization of the unfit.

Sterilization is a medical term which refers to killing germs. To keep a wound from becoming infected, physicians work hard to keep everything sterile. Before penicillin was discovered, wounds were sterilized by cauterization, searing the exposed flesh with red-hot metal. Surgeons preparing to operate are scrupulous about the sterile field, the area covered with sheets that have been heated to kill all bacteria, and they use instruments that have been sterilized by heat or by immersion in alcohol.

The eugenic sterilization campaign was not about colonies of bacteria; it was about colonies of feeble-minded people. The "germs" that the eugenicists wanted to kill were the germ cells of the unfit. When eugenicists talked about sterilization, they meant a procedure that would make a person incapable of having children.

To sterilize someone, you can remove part of his or her reproductive system. If a surgeon removes the womb or uterus from a young woman, she cannot have children. This operation is called a hysterectomy. A responsible physician caring for a patient who has cancer of the uterus may treat her by removing her uterus; a eugenicist caring for the human race might remove a healthy uterus to rid society of future difficulties. Similarly, if a physician removes a young man's testicles -- or castrates him -- he will not have children. Castration is routine on farms; for example, beef comes from steers, which are castrated males. Routine or not, the operations can be physically and emotionally traumatic.

It is possible to sterilize men and women using less serious operations. A doctor can cut the tubes that deliver the germ cells, the woman's ovum and the man's sperm. Cutting the tubes between a woman's ovaries and her uterus is called a salpingectomy. The comparable operation for a man is called a vasectomy. After these operations, the patient can still engage in sexual activity, but will not have children.

In the 1920s, eugenicists in the United States and elsewhere pressed hard for sterilization laws, to give physicians and the heads of institutions the authority to sterilize their patients, with or without their consent. With (and sometimes without) these laws, they sterilized tens of thousands of vulnerable people. Most of the operations were salpingectomies and vasectomies.

American laws permitting sterilization of the feeble-minded began in Pennsylvania, in 1905. Fortunately, the governor vetoed the law immediately. But other states passed laws and began to implement them. The push for sterilization did not gain full steam, though, until after World War I. Then, with the IQ tests available, the mental health lobby began promoting eugenic sterilization. By 1930, 27 states had started sterilization campaigns.

Other countries that passed or at least debated similar laws included Britain, South Africa, Germany, Australia, New Zealand, Canada, Finland and Sweden, Norway and Switzerland.

In the United States, eugenic sterilization continued for decades. In some states, laws permitted the operation, but few were done. Some states ended the practice. But by the mid-1950s, 27 states reported almost 60,000 sterilizations performed.

California led the way, with two fifths of the total, or 19,985. More women than men were sterilized: 23,667 men compared to 35,519 women.

The statistics do not show the inhumanity of the sterilization campaign. To understand what the eugenics movement did, it is important to look at specific examples.

One of the most destructive dramas in the eugenics movement played out in central Virginia. Virginia's forced sterilization law was challenged in court immediately. The case involved a young woman named Carrie Buck, who lived in an institution for the feeble-minded near Lynchburg. The head of the hospital was enthusiastic about eugenics, and many women were sterilized there without their knowledge, let alone consent. The hospital decided to sterilize Carrie Buck openly, under the new law. There was a trial in Amherst, Virginia, and "experts" testified that she was feeble-minded. In fact, the experts testified that she was from a family of immoral degenerates. Carrie and her mother and her "illegitimate" daughter were all judged to be unfit.

The case reached the U.S. Supreme Court, where Oliver Wendell Holmes wrote the decision that opened the floodgates of forced sterilization and permitted 30 states to assault 60,000 people over the next 40 years. The key sentence in the decision was simple: "Three generations of imbeciles is enough." The Court voted 8-1 (with only Pierce Butler dissenting) to allow the states to sterilize the dysgenic.

Who were these "three generations of imbeciles"?

Generation of imbeciles #1. Emma Buck was not a model citizen. She lived in Charlottesville, with no fixed address, and got in various kinds of trouble. At some point, social workers decided that the time had come to get her off the streets, and there was a hearing to determine whether she was feeble-minded. The hearing was little more than a formality, but it was still degrading. Her inquisitor tested her ability to carry out simple tasks by demanding that she pick up a book and deliver it to someone else in the room. She ignored this demeaning request. Her refusal -- dignified or spunky or sullen, take your pick -- was taken as evidence of feeblemindedness, and Emma Buck was locked up in a hospital near Lynchburg.

Generation of imbeciles #2. Emma had three children: Carrie, Doris and Roy. Carrie became pregnant when she was a teenager, so the Commonwealth sterilized her. Doris was also sterilized, although she didn't even know what they had done to her until a reporter showed her and her husband the hospital records decades later. Finally understanding why they had no children, she wept. Roy had three children, so the Buck family may have survived despite the grim determination of the eugenicists.

When the mother, Emma, was locked up, Carrie was placed in foster care in Charlottesville. Things worked passably until she became pregnant. Years after the event, when she had no reason to lie (although there was no way to corroborate her story), she said that she became pregnant when her guardian's nephew raped her. Her guardian, whether or not he knew the father's identity, was apparently mortified by her pregnancy and swept her out of society along with her mother. Carrie was institutionalized because she was pregnant, which indicated to some people that she was an immoral, feebleminded, syphilitic Jukes & Kallikaks epidemic in the making. After some years in the hospital near Lynchburg, she wangled her way out as a domestic worker, and made her way in the world. She married a local sheriff named William Eagle. After his death, she moved north to Front Royal, Virginia, where she picked apples and married Charles Detamore, an orchard worker. She did some cleaning and nursing. Her life was not extraordinary, but no one who knew her after she left Lynchburg ever considered her feeble-minded.

Generation #3. Carrie's child, Vivian, was declared feeble-minded because she did not smile and coo at a social worker who visited her as an infant one afternoon. Vivian went to school in Charlottesville, and was a normal student. Despite her failure to coo as an infant, she was on the honor roll one spring. She died of the measles when she was eight.

Three generations of imbeciles: a street person who didn't jump when ordered to do so, a rape victim, and an honor student.

There was enough resistance to eugenic sterilization to prevent the campaign from sweeping the entire nation. And there were some heroes, including the lone dissenter on the Supreme Court, Justice Pierce Butler. Butler was a Roman Catholic, and while the decision was pending, critics wondered aloud whether he would be ruled by Rome and would vote against sterilization. In the end, Butler did not explain his vote; he simply noted that he dissented from the ruling.

Eugenicists made repeated efforts to pass sterilization laws in Alabama, but they were stymied repeatedly by the Catholics there. Catholics were not a strong voting bloc; only three percent of the people were Catholic. But that handful worked very hard on this issue, and beat back the laws for several years.

This story of Carrie Buck is told in detail in an excellent book by J. David Smith and K. Ray Nelson, The Sterilization of Carrie Buck (Far Hills, NJ: New Horizon Press: 1989).

The entire text of the Supreme Court decision follows.

Buck v. Bell No. 292 SUPREME COURT OF THE UNITED STATES 274 U.S. 200 April 22, 1927 May 2, 1927 ERROR TO THE SUPREME COURT OF APPEALS OF THE STATE OF VIRGINIA Syllabus      1. The Virginia statute providing for the sexual sterilization of inmates of institutions supported by the State who shall be found to be afflicted with an hereditary form of insanity or imbecility, is within the power of the State under the Fourteenth Amendment. P. 207 .      2. Failure to extend the provision to persons outside the institutions named does not render it obnoxious to the Equal Protection Clause. P. 208 .      143 Va. 310, affirmed.      Opinions      ERROR to a judgment of the Supreme Court of Appeals of the State of Virginia which affirmed a judgment ordering [p*201] the Superintendent of the State Colony of Epileptics and Feeble Minded to perform the operation of salpingectomy on Carrie Buck, the plaintiff in error. [p*205]      HOLMES, J., Opinion of the Court      Mr. JUSTICE HOLMES delivered the opinion of the Court.      This is a writ of error to review a judgment of the Supreme Court of Appeals of the State of Virginia affirming a judgment of the Circuit Court of Amherst County by which the defendant in error, the superintendent of the State Colony for Epileptics and Feeble Minded, was ordered to perform the operation of salpingectomy upon Carrie Buck, the plaintiff in error, for the purpose of making her sterile. 143 Va. 310. The case comes here upon the contention that the statute authorizing the judgment is void under the Fourteenth Amendment as denying to the plaintiff in error due process of law and the equal protection of the laws.      Carrie Buck is a feeble minded white woman who was committed to the State Colony above mentioned in due form. She is the daughter of a feeble minded mother in the same institution, and the mother of an illegitimate feeble minded child. She was eighteen years old at the time of the trial of her case in the Circuit Court, in the latter part of 1924. An Act of Virginia, approved March 20, 1924, recites that the health of the patient and the welfare of society may be promoted in certain cases by the sterilization of mental defectives, under careful safeguard, &c.; that the sterilization may be effected in males by vasectomy and in females by salpingectomy, without serious pain or substantial danger to life; that the Commonwealth is supporting in various institutions many defective persons who, if now discharged, would become [p*206] a menace, but, if incapable of procreating, might be discharged with safety and become self-supporting with benefit to themselves and to society, and that experience has shown that heredity plays an important part in the transmission of insanity, imbecility, &c. The statute then enacts that, whenever the superintendent of certain institutions, including the above-named State Colony, shall be of opinion that it is for the best interests of the patients and of society that an inmate under his care should be sexually sterilized, he may have the operation performed upon any patient afflicted with hereditary forms of insanity, imbecility, &c., on complying with the very careful provisions by which the act protects the patients from possible abuse.      The superintendent first presents a petition to the special board of directors of his hospital or colony, stating the facts and the grounds for his opinion, verified by affidavit. Notice of the petition and of the time and place of the hearing in the institution is to be served upon the inmate, and also upon his guardian, and if there is no guardian, the superintendent is to apply to the Circuit Court of the County to appoint one. If the inmate is a minor, notice also is to be given to his parents, if any, with a copy of the petition. The board is to see to it that the inmate may attend the hearings if desired by him or his guardian. The evidence is all to be reduced to writing, and, after the board has made its order for or against the operation, the superintendent, or the inmate, or his guardian, may appeal to the Circuit Court of the County. The Circuit Court may consider the record of the board and the evidence before it and such other admissible evidence as may be offered, and may affirm, revise, or reverse the order of the board and enter such order as it deems just. Finally any party may apply to the Supreme Court of Appeals, which, if it grants the appeal, is to hear the case upon the record of the trial [p*207] in the Circuit Court, and may enter such order as it thinks the Circuit Court should have entered. There can be no doubt that, so far as procedure is concerned, the rights of the patient are most carefully considered, and, as every step in this case was taken in scrupulous compliance with the statute and after months of observation, there is no doubt that, in that respect, the plaintiff in error has had due process of law.      The attack is not upon the procedure, but upon the substantive law. It seems to be contended that in no circumstances could such an order be justified. It certainly is contended that the order cannot be justified upon the existing grounds. The judgment finds the facts that have been recited, and that Carrie Buck is the probable potential parent of socially inadequate offspring, likewise afflicted, that she may be sexually sterilized without detriment to her general health, and that her welfare and that of society will be promoted by her sterilization, and thereupon makes the order. In view of the general declarations of the legislature and the specific findings of the Court, obviously we cannot say as matter of law that the grounds do not exist, and, if they exist, they justify the result. We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson v. Massachusetts, 197 U.S. 11. Three generations of imbeciles are enough. [p*208]      But, it is said, however it might be if this reasoning were applied generally, it fails when it is confined to the small number who are in the institutions named and is not applied to the multitudes outside. It is the usual last resort of constitutional arguments to point out shortcomings of this sort. But the answer is that the law does all that is needed when it does all that it can, indicates a policy, applies it to all within the lines, and seeks to bring within the lines all similarly situated so far and so fast as its means allow. Of course, so far as the operations enable those who otherwise must be kept confined to be returned to the world, and thus open the asylum to others, the equality aimed at will be more nearly reached.      Judgment affirmed.      MR. JUSTICE BUTLER dissents.

1. What is "sterilization"? What is coercive sterilization, and why would anyone do it?
2. Describe briefly the American campaign for coercive sterilization.
3. Who was Carrie Buck, and why was she sterilized?
4. Identify Oliver Wendell Holmes. What did he say in his opinion in the Buck v. Bell case?
5. Who resisted coercive sterilization?

Discuss: Is sexual activity public or private? Is marriage public or private? Is having children a public decision, or a private decision?

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