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A Simple and Painless Procedure
On a cloudy afternoon on October 19, 1927, as a chilly autumn wind swept down off the Blue Ridge Mountains, rattling the windows of the infirmary at the Virginia Colony for Epileptics and Feeble-minded, Dr. John H. Bell jotted a few notes about an operation he had performed earlier that day. He was the superintendent of this sprawling institution, a campus of regimented brick dormitories and rolling farmland set amid the bluffs overlooking Lynchburg, and one of the country’s finest. The morning’s procedure was simple, and dozens of such operations had taken place here over the years. But for this patient he wrote with particular care, since it was a case that might draw a bit of attention.
“Patient sterilized this morning under authority of Act of Assembly in 1926, providing for the sterilization of mental defectives, and as ordered by the Board of Directors of this institution,” he wrote. “She went to the operating room at 9:30 and returned to her bed at 10:30, recovered promptly from the anaesthesia with no untoward after effects anticipated. One inch was removed from each Fallopian tube, the tubes ligated and the ends cauterized by carbolic acid followed by alcohol, and the edges of the broad ligaments brought together with continuous suture. Abdominal wound was united with layer sutures and the approximation of the closure was good.”
The patient lying before him on the operating table that morning was Carrie Buck, a plump, twenty-one-year-old woman who had been under his care at the Colony for over three years. He knew her well. On the day she was admitted, he had been the first to examine her, and he took special note of her dark eyes and slight features, her low, narrow forehead and high cheekbones. He would see her in the Colony’s cafeteria, where she was assigned to work, and his words to her were usually cordial and kind. Yet during most of this time, Dr. Bell and Carrie Buck had been, in name at least, legal adversaries.
So, as he finished his surgical report, he decided to add another formal comment: “This is the first case operated on under the sterilization law, and the case was carried through the courts of the State and the United States Supreme Court to test the constitutionality of the Virginia act, and an appeal before the Supreme Court for a rehearing recently having been denied.”
It was a momentous day. It had taken over three years to test and litigate Carrie’s case, but less than an hour to cut and ligate her Fallopian tubes. But for Dr. Bell, this operation was far more than a legal victory. As a “test case,” it had been a carefully orchestrated lawsuit meant not only to sterilize Carrie against her will, but also to protect a bold but controversial social policy he believed would improve the welfare of the nation. Today was the beginning. It was cold, but outside the window, beyond the white, two-tiered veranda on the front façade of the infirmary, Dr. Bell could look out over the Colony and consider the long battle he and other reformers had been fighting for decades.
Beyond the veranda, the parallel rows of austere brick dormitories made this state-run institution look something like a military camp, its geometric precision imposing order on a vast Virginia wilderness, even as magnolias and elms gave the Colony the gentle, pastoral feel of a Southern plantation, peaceful and decorous, like Jefferson’s Monticello just hours to the north. Dr. Bell, too, had devoted his life, both as a physician and a scientist, to building a more perfect land. Sterilizing Carrie just may have been one of the most important things he had ever done, and as he considered her surgery he may have even dared to think, as a colleague would later tell him, that “a hundred years from now you will still have a place in this history of which your descendents may well be proud.”
Yes, our descendants may well be proud. In the end, real progress in this history, in this quest to battle disease and human suffering, will be found in our descendants, Dr. Bell believed. This was why he had to sterilize Carrie, and this was why he was dedicated to the care of epileptics and feebleminded. To those not familiar with the recent discoveries of “genetics”—a new term in science—Carrie might have seemed a normal girl, if sassy and simple and even a little slow. But Dr. Bell knew she carried within her, like the taint of original sin, the defective “germ-plasm” she would pass on to her children. A defect in her genes made her unusually promiscuous, unable to control herself, and prone to bear a child out of wedlock without shame. It kept her—and her mother Emma before her—from being a productive, law-abiding citizen. And he could say with all confidence, too, that Carrie’s illegitimate daughter Vivian, not quite three years old, would follow the same wanton path.
Yes, our descendants may well be proud. Science was revealing the subtleties of nature, the mysterious, microscopic forces that somehow passed on human traits, the genes that kept generations of families mired in poverty, ignorance, and the cesspool of immoral behavior. These families were a breed afflicted by this low-grade mental deficiency called “feeble-mindedness,” the primary cause, Dr. Bell and other reformers believed, of the social ills weakening the fabric of the nation. These people weren’t insane, exactly. They were not “idiots” or “imbeciles”—terms doctors had long used for people with more noticeable mental defects. No, they were simply a population who behaved like perpetual adolescents—mental dullards without developed moral consciences. To the untrained layperson, someone afflicted with feeblemindedness might even appear normal. So scientists had just devised a new term for these unmasked defectives: “morons.” These people engaged in the unhealthy and antisocial practice of masturbation, which led to sexual impurity and hosts of illegitimate children. These frequented saloons and whorehouses, filled state almshouses and prisons, and worst of all, passed their feebleminded genes to their children.
Biologically speaking, science was revealing perhaps the greatest menace to the future of the human race: fecund, feebleminded females.
This surreptitious menace arose from a strange irony in evolution, Dr. Bell believed. Mankind, the most intelligent and ingenious of creatures, had reached its lofty status through millions of years of toil and struggle. The law of the survival of the fittest had always weeded out the weak and foolish, allowing the best of the race to keep evolving to a higher state. But as this clever species made life less nasty and brutish, as it began to protect the weak of mind and frail of body, the genetic pool began to be polluted. Christian charity and enlightened altruism—and even advances in medical science—had disrupted the natural laws of progress and allowed the weak to live and breed. For Dr. Bell, this irony was made even more ominous as the strong were choosing lives of ease and leisure, shunning large families and the burdens of rearing children. The fitter families of the human race, especially those of the most intelligent Northern European “Nordic” stocks, were reproducing less, while the degenerate stocks were running amok. If nothing were done, the strong might start to lose this battle of genetic survival.
These fears were not simply his own. Many of the world’s leaders, Dr. Bell knew, felt the same. Former president Theodore Roosevelt had called this trend “race suicide,” and had felt that America’s greatness was being threatened not only by rampant poverty but also its cozy affluence. He had once proclaimed, “Some day we will realize that the prime duty, the inescapable duty, of the good citizen of the right type is to leave his or her blood behind him in the world; and that we have no business to permit the perpetuation of citizens of the wrong type.” The inventor Alexander Graham Bell, the social crusader Margaret Sanger, and the administrators of the Harriman, Carnegie, and Rockefeller philanthropic foundations were each calling for state-sanctioned programs of better breeding. The editorial pages of newspapers such as the New York Times, scholars at Harvard, Yale, and Stanford, as well as professional associations of doctors and social workers were each urging the nation’s legislatures to quell the tide of “hereditary defectives.”
In addition, many British leaders supported compulsory sterilization to purify their nation’s genetic pool. When Winston Churchill was home secretary, he had once written to Prime Minister Herbert Asquith urging support for a sterilization bill before Parliament. “The unnatural and increasingly rapid growth of the feeble-minded and insane classes, coupled as it is with a steady restriction among all the thrifty, energetic and superior stocks, constitutes a national and race danger which it is impossible to exaggerate,” he explained. “I feel that the source from which all the streams of madness is fed should be cut off and sealed up before the year has passed. . . . [A] simple surgical operation would allow these individuals to live in the world without causing much inconvenience to others.”
Now, after nearly twenty years of effort, the case of Carrie Buck provided the most resounding legal affirmation of this theory of genetic engineering. In the Supreme Court case that bore Bell’s name, Justice Oliver Wendell Holmes, Jr., feared the United States would be “swamped with incompetence” if women like Carrie continued to have children. “It is better for all the world,” he wrote in the majority decision of Buck v. Bell, “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. . . . Three generations of imbeciles are enough.”
Yes, our descendants may well be proud. Actually, this idea wasn’t new at all, Dr. Bell would muse. “Racial improvement” was a practice as old as the first great civilizations of the world. Didn’t remarkably heroic races cast their defective infants in the River Tiber or leave them upon the mountainside to starve? “The idea of elimination, by one way or another, of those who were expected to be disqualified for a certain standard of physical and mental perfection, has come down to us through a great space of time,” he would later maintain. “And it persists as strongly in the minds of people today as it did in the minds of the ancient Spartans and Romans. . . . Such efforts to preserve a healthy race, cruel as they may seem, were after all but the pursuit of natural laws: the buds unfit to mature, fall; and the weaklings of the flock must perish.”
Sterilization, by contrast, was humane. It was simple and relatively painless. It took nothing from the patient but the ability to pass on the causes of human misery. Far from cruel, forced sterilization represented science and altruism at their most advanced, with goals heroic and noble. Sterilizing Carrie today marked a return to pursuing those natural laws of “elimination”—not in an arbitrary and brutish way, but in a way ordered by science and guided by reason. If science had revealed the congenital, hereditary nature of human imperfection, it was now revealing a path toward restoration.
“It is not foolish to hitch one’s wagon to a star, for the unbelievable theory of today becomes the proven laboratory fact of tomorrow,” Dr. Bell would explain. “And while perhaps a Utopia may never arise out of our efforts to better our brother’s condition in this world in which we live, nevertheless, much that is practical and useful and elevating to all can be developed and carried to a successful conclusion by the simple formula of all who are interested in these things pulling together towards a common goal: a citizenry purged of mental and physical handicaps.”
This was his faith, a faith in science and progress, and a faith informed by a long-held vision of American destiny. After putting Carrie’s chart in order, Dr. Bell could pick up the day’s newspaper and read about the throngs of people in Baltimore cheering Charles Lindbergh, the great American airman who had flown across the ocean alone and was now making a triumphant tour of all forty-eight states. It was indeed a momentous day. But beyond those cheers, Dr. Bell believed America’s greatness was much more evident here in the calm, quiet infirmary at the Virginia Colony. America, more than any other nation, held the promise of being a land of innocence, free from the defects of the past. This land could be, as so many others had believed, a city upon a hill, a beacon to all civilizations, so long as its citizens remained vigilant, persevered in virtue, and held to their sense of civic duty. Now the Supreme Court had recognized the wisdom gleaned from science and declared this harmless procedure a constitutionally valid means to combat the country’s social ills. Forced sterilization would be effective, Dr. Bell knew, and would help purge from American society those defects found deep within human nature. Today was surely the dawn of a new era, not only for the country, but for all the world.
An Epic Quest in the Modern World
In the early decades of the twentieth century, not long after the technology of surgical sterilization had been devised, state governments throughout the United States began a quest for racial purity that would change the lives of thousands of their citizens. By 1927, before Carrie Buck lay prostrate beneath Dr. Bell’s surgical blade, almost 8,500 American citizens had been forcibly sterilized. This “official” figure, taken from informal surveys by proponents of the procedure and representing only what surgeons chose to report, would reach well over 65,000 in the decades to come.
Ill-educated and poor, these people were operated upon and mostly forgotten. But they were first the subjects of methodical research programs in which scientists tried to trace and then eradicate the gene pool that caused what they casually referred to as “the three D’s”: dependency, delinquency, and mental deficiency. Hundreds of fieldworkers fanned out into the country to visit prisons, mental institutions, and the poor rural hamlets where many of their research subjects dwelled. They collected tens of thousands of pages of data on these subjects’ family pedigrees. Armed with this data, which appeared to show a genetic predisposition toward moral deviance and mental deficiency handed down through generations, scientists persuaded state legislatures—and, in the case of Carrie Buck, the U.S. Supreme Court—to enact laws giving states the power to sterilize these genetically “defective” Americans.
From the Hardcover edition.