² McGuire, Hunter Holmes and Lydston, G. Frank, “Sexual Crimes Among the Southern Negroes—Scientifically Considered—An Open Correspondence,” Virginia Medical Monthly 20 (May 1893): 105–25Google Scholar; McGuire quotation 105. G. Frank Lydston, professor in the Chicago College of Physicians and Surgeons, was a noted authority on venereal disease and sex.

³ Purdon, John E., “Social Selection: The Extirpation of Criminality and Hereditary Disease,” Transactions of the Medical Association of the State of Alabama (1901): 459–66Google Scholar, quotation 463. [Hereafter referred to as TMASA (year): page.]

⁴ Laughlin quoted in Lombardo, Paul A., “Three Generations, No Imbeciles: New Light on Buck v. Bell” New York University Law Review 60 (Apr. 1985): 30–62Google Scholar; Laughlin quotation 51; second quotation 30. Laughlin was Assistant Director of the New York-based Eugenics Record Office, America's oldest and largest eugenics clearinghouse.

⁵ McMurphy, J. P., “Birth Control: A Public Health Problem” TMASA (1927): 343–50Google Scholar, quotation 347.

⁶ Historian Edward Larson contends that distinctively Deep Southern notions of the family and religion, coupled with hostility toward progressive social reform, retarded the adoption of eugenics in the lower South. Arguing that Virginia and North Carolina represented “border states,” Larson discounts their experiences as reflective of truly “southern” eugenics. Larson, Edward J., Sex, Race, and Science: Eugenics in the Deep South (Baltimore, 1995), 7–18Google Scholar, designation as border states, 3. Larson's categorization supports his analysis but obscures the complexity of southern eugenics. This paper uses the traditional intraregional demarcations based on the Civil War and Secession. Delaware, Maryland, West Virginia, Kentucky, and Missouri constitute the border states; Virginia, North Carolina, Tennessee, and Arkansas comprise the upper South; and South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, and Texas represent the lower South, corresponding to Larson's Deep South. Choosing Virginia and Alabama not only comports with traditional notions of the upper and lower South, it also juxtaposes the only two states to host the capital of the Confederate States of America, which allowed citizens of both states to lay particular claim to southern authenticity.

⁷ Paul K. Longmore and Lori Urmansky note that between 1900 and 1930, “various state sanctioned institutions brought many disabled people under professional supervision either to mend them into fit citizens or to sequester them permanently for society's safety.” Longmore, Paul K. and Urmansky, Lori, eds., The New Disability History: American Perspectives (New York, 2001), 22Google Scholar. For a useful thumbnail sketch of the debate over social control theory, see Noll, Steven, Feeble-Minded in Our Midst: Institutions for the Mentally Retarded in the South, 1900-1940 (Chapel Hill, 1995), 6–8Google Scholar.

⁸ Steven Noll alludes to this idea, but does not develop it. , Noll, Feebk-Minded in Our Midst, 90Google Scholar.

⁹ For the medical society presidents, see TMASA (1967)Google Scholar, MC29, folder 3.18, UAB Archives, University of Alabama at Birmingham. The author thanks Joan Klein and Jodi Koste, respectively archivists at the University of Virginia Health Sciences Center and Virginia Commonwealth University (Medical College of Virginia), for compiling the list of Medical Society' of Virginia presidents from various sources. Steven Noll notes the influence of these leaders. Noll, Feeble-Minded in Our Midst, 61. Many other doctors, prominent and less prominent, from both states, are not quoted here because they would be redundant. These doctors' ideas moved from the periphery of medical thought as radical novelties, to the center as progressive conventional wisdom, then again to the periphery as dangerous, fascistic, inhumane impulses. This paper is concerned with how eugenic ideas became central to professional thinking and what the implications of that shift were for medical theory and practice; it cannot and does not attempt to make an absolute measure of these ideas' impact on patients.

¹⁰ Sir Galton, Francis, Inquiries into Human Faculty and Its Development (London, 1883), 24–25CrossRefGoogle Scholar. The literature on eugenics has blossomed in the past 20 years. Important general treatments with specific relevance to the present study include: Kline, Wendy, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkeley, 2001)Google Scholar; Carlson, Elof Axel, The Unfit: A History of a Bad Idea (Cold Spring Harbor, NY, 2001)Google Scholar; Paul, Diane B., The Politics of Heredity: Essays on Eugenics, Biomedidne, and the Nature-Nurture Debate (Albany, NY, 1998)Google Scholar, and Controlling Human Heredity: 1865 to the Present (Adantic Highlands, NJ, 1995)Google Scholar; Kevles, Daniel J., In the Name of Eugenics: Genetics and the Uses of Human Heredity (New York, 1985)Google Scholar; Ludmerer, Kenneth M., Genetics and American Society: A Historical Appraisal (Baltimore, 1972)Google Scholar; Pickens, Donald K., Eugenics and the Progressives (Nashville, TE, 1968)Google Scholar; and Haller, Mark H., Eugenics: Hereditarian Attitudes in American Thought (New Brunswick, NJ, 1963)Google Scholar. Schoen, Johanna, Choice and Coercion: Birth Control, Sterilisation, and Abortion in Public Health and Welfare (Chapel Hill, 2005)Google Scholar; , Larson, Sex, Race, and ScienceGoogle Scholar; Trent, James W Jr, Inventing the Feeble Mind: A History of Mental Retardation in the United States (Berkeley, 1994)Google Scholar; and , Noll, Feeble-Minded in Our MidstGoogle Scholar are most directly relevant.

¹¹ Bans on wedlock between diseased and well people, people of differing races, or people with disabilities believed to be hereditary all fell under the rubric of eugenic marriage restrictions. Immigration restriction in America focused particularly on excluding Asians and people from southeastern Europe. Higham, John, Strangers in the Eand: Patterns of American Nativism, 1860-1925, 2d. ed. (New Brunswick, NJ, 1988)Google Scholar.

¹² Hofstadter, Richard, Social Darwinism in American Thought, rev. ed. (New York, 1959)Google Scholar. Simply reading the medical literature reveals that many physicians operated from a social Darwinian perspective, notwithstanding Bannister's, Robert C. conclusions in Social Darwinism: Science and Myth in Anglo-American Social Thought (Philadelphia, 1979)Google Scholar.

¹³ See, for example, Carrington, Charles V., “Keep the Race Pure,” Virginia Medical Semi-Monthly 18 (Dec. 1913): 434Google Scholar.

¹⁴ , Kevles, In the Name of Eugenics, 101.Google Scholar

¹⁵ Wiebe, Robert, The Search for Order, 1870-1920 (New York, 1967).Google Scholar

¹⁶ Barringer, Paul Brandon, “The American Negro: His Past and Future,”Google Scholar address delivered before the Tri-State Medical Association of Virginia and the Carolinas (Feb. 29, 1900), 3-4. Offprints of Barringer's three major addresses on African Americans reside in the Paul Brandon Barringer Papers, Box 10, Folder “1896-1925 Printed Material re Race Relations,” RG 2588, Special Collections, Alderman Library, University of Virginia [hereafter referred to as Barringer Papers]. The medical society found this speech so exceptional that, by unanimous vote, it ordered the paper printed and “sent to all the medical societies in the South with the recommendation that they seriously consider the facts therein set forth.” Barringer's ideas are echoed in, Einer, A., M.D., “Medical Supervision of Matrimony,” Virginia Medical Semi-Monthly 9 (Feb. 10, 1905): 490Google Scholar. Einer's paper had initially been delivered before the Southwest Virginia Medical Society at Bristol, Virginia-Tennessee in January of 1904. See also Williams, J. W., “Heredity—Eugenics,” Virginia Medical Semi-Monthly 18 (Dec. 1913): 460Google Scholar.

¹⁷ Barringer, Paul Brandon, “The Sacrifice of a Race,” address delivered before the Race Conference (May 10, 1900Google Scholar ), Barringer Papers, 6.

¹⁸ Jordan, Harvey Ernest, “Heredity as a Factor in the Improvement of Social Conditions,” American breeders Magazine 2 (1911): 249Google Scholar. Jordan's speech was reprinted as an article in the A-merican breeders Magazine, which became the first great journal of eugenics and genetics in America. Jordan was a histologist, not a medical doctor, yet he was immensely respected by Virginia physicians, eventually becoming dean of Virginia's medical school. For more on his career as a pioneering Virginia eugenicist, see, Dorr, Gregory Michael, “Segregation's Science: The American Eugenics Movement and Virginia, 1900-1980,” (Ph.D. diss., University of Virginia, 2000), 136–90Google Scholar.

¹⁹ Jordan, Harvey Ernest, “Eugenics: the Rearing of the Human Thoroughbred,” Cleveland Medical Journal 11 (1912): 876Google Scholar, 881. See also Jordan, Harvey Ernest, “Eugenics—Its Data, Scope, and Promise as Seen by the Anatomist,” in Eugenics: Twelve University Lectures, ed. Aldrich, Morton A. (New York, 1914), 117Google Scholar; and, “Dr. Jordan on ‘Eugenics’,” The Daily Progress (Charlottesville, VA), Jan. 16, 1913, 1 and 6Google Scholar.

²⁰ Pardow, William Dempsey, “Degeneracy,” TMASA (1907): 229Google Scholar. For nearly identical earlier statements, see Sommerville, William Glassell, “Needed Reforms in the Management of Youthful and Insane Criminals,” TMASA (1901): 381Google Scholar; and Webb, Francis Asberry, “Degeneracy, The Physician as a Factor in its Prevention,” TMASA (1906): 363Google Scholar.

²¹ Pardow, W D., “Annual Message of the President,” TMASA (1918): 10.Google Scholar

²² Ibid., 11. Five years earlier, C. P. Wertenbaker called for a similar eugenics bureau in Virginia's state health department. , Wertenbaker, “Should Virginia Have a Marriage Law Based on Eugenics,” Virginia Medical Monthly (1913): 423Google Scholar.

²³ Bell, J. H., “The Protoplasmic Blight,” Virginia Medical Monthly 57 (Aug. 1930): 314Google Scholar; Pardow, W. D., “Committee on Mental Hygiene (Report of Chairman),” TMASA (1930): 33Google Scholar.

²⁴ Historian Nicole Hahn Rafter called degeneracy theory “a set of ideas that, although almost forgotten today, nonetheless tremendously influenced turn-of-the-century thinking about the nature of social problems.” Rafter, Nicole Hahn, Creating horn Criminals (Urbana, 1997), 36–37Google Scholar, quotation 36. The ur-study of degeneration, which became an ideological touch-stone for Virginia and Alabama eugenicists, actually appeared in 1877. Richard Dugdale traced the genealogy (or pedigree, in eugenic parlance) of a “degenerate” New York family in his book The Jukes: A Study in Crime, Pauperism, Disease, and Heredity (1877; New York, 1910)Google Scholar. Rafter, Nicole Hahn, ed., White Trash: The Eugenic Family Studies, 1877-1919 (Boston, 1988), 1–47Google Scholar; , Rafter, Born Criminals, 38–39Google Scholar; , Larson, Sex, Race, and Science, 19Google Scholar.

²⁵ , Einer, “Medical Supervision of Matrimony,” 492.Google Scholar

²⁶ In 1913, Dr. Williams, J. W. listed “syphilis, tuberculosis, and especially alcohol and morphine”Google Scholaras “protoplasmic poisons” that compromised hereditary integrity. , Williams, “Heredity—Eugenics,” 461Google Scholar. The result of syphilitic infection, a former president of the Medical Society of Virginia averred, was “an enfeebled race.” Upshur, John N., “Venereal Diseases as a Social Menace,” Virginia Medical Semi-Monthly 9 (Oct. 1904): 293Google Scholar. See also, Call, Manfred, “A Plan for the Prevention of Venereal Disease,”Google ScholarIbid., 294; , Carrington, “Keep the Race Pure,” 438Google Scholar.

²⁷ Searcy, James T., “Mental Abnormalities,” TMASA (1904), 373–74.Google Scholar

²⁸ Searcy and others borrowed heavily from then-current notions of criminal anthropology. See, , Rafter, Creating Born Criminals, ch. 6, esp. 118–24Google Scholar. , Searcy, “Mental Abnormalities,” 374Google Scholar. The notion of enduring “stigmata of degeneracy” also appears in McConnico, Frank Hawthorne, “Heredity—Its Relation to Vice and Crime,” TMASA (1910): 352Google Scholar.

²⁹ Barrow, Bernard, “Vasectomy for the Defective Negro with His Consent,” Virginia Medical Semi-Monthly 14 (Aug. 1910): 226Google Scholar. See also , Schoen, Choice and Coercion, 93–94Google Scholar.

³⁰ See Dr. Sholl in the discussion of Sommerville's paper, TNASA (1907), 230Google Scholar; , McConnico, “Heredity,” 351–52Google Scholar; Hale, Stephen F., “Random Thoughts on Medical Matters,” TMASA (1910): 585Google Scholar; Bell, Walter Howard, “Sterilization of the Unfit,” TMASA (1911): 451Google Scholar. Edward Larson recounts Alabama physicians' shift from resistance to acceptance of sterilization between 1900 and 1910. , Larson, Sex, Race, and Science, 50Google Scholar.

³¹ James Trent provides the fullest explication of the creation of the feebleminded as a diagnostic, clinical category. See , Trent, Inventing the Feeble Mind, especially 155–66Google Scholar. Virginia physicians received a communication in their medical journal on just this matter. See Gordon, Alfred, “Mendelian Laws of Heredity and Their Relation to Eugenics,” Virginia Medical Semi-Monthly 20 (May 1915): 53–60Google Scholar.

³² , Rafter, White TrashGoogle Scholar; Estabrook, Arthur H., The Jukes in 1915 (Washington, DC, 1916)Google Scholar.

³³ Partlow, William Dempsey in “Proceedings,” TMASA (1916): 34Google Scholar. Partlow continued to hold quasi-Lamarckian views about the relationship of heredity and environment. See Pardow, William Dempsey, “Mental Hygiene,” TMASA (1915): 555Google Scholar.

³⁴ Drewry, William Francis, “The Mental Defectives,” Virginia Medical'Semi-Monthly 16 (Dec. 1912): 505.Google Scholar

³⁵ , Carrington, “Keep the Race Pure,” 436Google Scholar. Emphasis in original. See also Doctor Haines, Thomas H., “Report of the State Committee on Mental Hygiene,” TMASA (1919): 37Google Scholar. Haines was an official with the National Committee for Mental Hygiene, one of the first major professional organizations dealing with feeblemindedness, and an organization that employed many eugenicists, including Haines. See , Larson, Sex, Race, and Science, 59–60Google Scholar; Dowbiggin, Ian, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940 (Ithaca, NY, 1997), 127–29Google Scholar; , Haller, Eugenics, 71Google Scholar; , Pickens, Eugenics and the Progressives, 154Google Scholar; , Rafter, Creating Born Criminals, 176Google Scholar.

³⁶ See , Wertenbaker, “Should Virginia Have a Marriage Law Based on Eugenics,” 422.Google Scholar

³⁷ Historians have long observed that eugenicists trumpeted the savings eugenic programs offered the state. See , Trent, Inventing the Feeble Mind, 192–93Google Scholar. For Virginia doctors making this argument, see Noll, Steven, “The Sterilization of Willie Mallory” in “Bad” Mothers: The Politics of Blame in Twentieth-Century America, ed. Ladd-Taylor, Molly and Umansky, Lauri (New York, 1998), 42–43Google Scholar.

³⁸ For more on the affinity between eugenics and public health, see, Pernick, Martin S., “Eugenics and Public Health in American History,” American journal of Public Health 87 (November 1997): 1767–72CrossRefGoogle ScholarPubMed; Stern, Alexandra Minna, “Making Better Babies: Public Health and Race Betterment in Indiana, 1920-1935,” American journal of Public Health 92 (May 2002): 742–52CrossRefGoogle ScholarPubMed.

³⁹ Bankston, Richard Coopender, “The Outlook of Medicine is Toward Prevention,” TMASA (1901): 282Google Scholar, 284, 285. Applauding the rise of scientific medicine, Nicholas Senn declared, “Preventive medicine is the medicine of the future, and the final triumph of scientific medicine will be the suppression of disease.” Senn, Nicholas, “The Final Triumph of Scientific Medicine,” TMASA (1907): 205Google Scholar. That same year, William Partlow concluded, “In a word, Preventive Medicine is a modern idea.” Partlow, William Dempsey, “Degeneracy,” TMASA (1907): 217Google Scholar; Pardow refined this concept in 1915, writing, “The greatest word in general medicine now is prevention and so it will come to be in psychiatry.” Pardow, William Dempsey, “Mental Hygiene,” TMASA (1915): 552Google Scholar. Seven years later, V. J. Gragg applied the progressive notion of conservation to human life while noting, “The manner in which a community deals with public health problems is a safe index to its state of civilization.” Gragg, V. J., “The Health Officer and the Conservation of Human Life and Energy,” TMASA (1914): 489Google Scholar.

⁴⁰ Green, Henry, “Annual Oration,” TMASA (1913): 155Google Scholar. As late as 1927, the President of the MASA claimed that preventive medicine represented “the crowning accomplishment, the brightest star in the galaxy of medical achievement in all the centuries.” “President's Address,” TMASA (1927): 10Google Scholar.

⁴¹ , Einer, “Medical Supervision of Matrimony,” 490.Google Scholar

⁴² , Dew, “Sterilization of the Feeble-Minded,” 7.Google Scholar

⁴³ , Dew, “Sterilization of the Feeble-Minded, Insane and Habitual Criminals,” 8Google Scholar. See also , Carrington, “Keep the Race Pure,” 434Google Scholar. For the notion of the clinical gaze and its relation to power, see Foucault, Michel, The Birth of the Clinic: An Archeology of Medical Perception, trans. Smith, A. M. Sheridan (London, 1973)Google Scholar. Dr. , Harper, in “Discussion” of Partlow's 1907 paper, 229Google Scholar. Both barnyard metaphor and marriage restriction echoed in , McConnico, “Heredity,” 356Google Scholar and 357, respectively.

⁴⁵ Baynton, Douglas C., “Disability and the Justification of Inequality in American History,” in The New Disability History: American Perspectives, ch. 1Google Scholar. Mary Klages discusses the creation of cultural images that portrayed the disabled as “abnormal” others in the way racism and sexism cast women and ethnic minorities as “others” in Woeful Afflictions: Disability and Sentimentality in Victorian Era America (Philadelphia, 1999), 4–5Google Scholar.

⁴⁶ Mental debility, compounded by unfavorable race, class, and gender status, might result in a “quadruple burden.” Steven Noll describes the “double burden” of being black and feebleminded. , Noll, Feeble-Minded in Our Midst, ch. 5Google Scholar.

⁴⁷ The formulation “contempt and pity” is borrowed from DuBois, W. E. B., The Souls of Black Folk, (1903; New York, 1989), 4–5Google Scholar.

⁴⁸ This is true of both Alabama and Virginia. Of those authors advocating eugenic control, the majority in both states were either superintendents of institutions caring for the feebleminded, or their protégés.

⁴⁹ Hoffman, Frederick L., Race Traits and the Tendencies of the American Negro (Washington, 1896).Google Scholar

⁵⁰ Quotations from Claiborne, John Herbert, “The Negro,” Virginia Medical Semi-Monthly 5 (Apr. 1900): 5Google Scholar. Barringer, Paul Brandon, “The American Negro,” 10–11Google Scholar, note 15, above. For a detailed discussion of Barringer's work, see , Dorr, “Segregation's Science,” 99–122Google Scholar. See also Hodges, J. Addison, “The Effect of Freedom Upon the Physical and Psychological Development of the Negro,” Virginia Medical Semi-Monthly 5 (May 1900): 106–10Google Scholar. Barringer, Claiborne, and Hodges held the presidency of the Medical Society of Virginia. Hodges was a professor in Richmond's University College of Medicine (now Medical College of Virginia). These ideas were also repeated in an article by a Texas physician. Orr, James, “Some Suggestions of Interest to Physicians on the Scientific Aspect of the Race Question, with Particular Reference to the White and Negro Races,” Virginia Medical Semi-Monthly 8 (May 1903): 90–95Google Scholar.

⁵¹ , Hodges, “Effect of Freedom,” 110.Google Scholar

⁵² James, Norman G., “Hereditary Syphilis in the Negro,” TMASA (1906): 538–39Google Scholar. James thanks Barringer for his papers “American Negro, His Past and His Future,” and “Sacrifice of a Race,” from which he clearly draws much information (536).

⁵³ The Virginia Medical Monthly proclaimed that the “vast majority” of African Americans were “shifdess, improvident, and content themselves on living from hand to mouth” while they engaged in crime. See, “Alarming Negro Death Rate,” Virginia Medical Monthly 12 (Apr. 1907): 23–24Google Scholar.

⁵⁴ When Alabama conducted its first state survey of feeblemindedness, eugenicists examined the reform schools for white boys and girls and the reform School for Juvenile Negro Boys in Mt. Meigs, attempting to assess the total eugenic threat this group presented. See, Partlow, W. D., “Report of State Committee on Mental Hygiene,” TMASA (1920): 32Google Scholar.

⁵⁵ On disabled/abled “forbidden love,” see Norden, Martin F., The Cinema of Isolation: A History of Physical Disability in the Movies (New Brunswick, NJ, 1994), 52–53Google Scholar.

⁵⁶ , Rudolph, “State Care and Training of the Feebleminded,” 562.Google Scholar

⁵⁷ Partlow, W. D., “Pathology of Mental Rehabilitation or Mental Conservation vs. Mental Rehabilitation,” TMASA (1928): 321–28Google Scholar, quotations 323, 324, 325, 327.

⁵⁸ Ibid. Partlow added sterilization to the therapeutic arsenal. While Dr. Rudolph believed that “in certain cases” sterilization was appropriate, he noted that “public sentiment is so strongly against it, that I fear it will be at best only a partial remedy.” , Rudolph, “State Care and Training,” 563Google Scholar.

⁵⁹ See Barringer's three major addresses, note 16, above.

⁶⁰ , Larson, Sex, Race, and Science, ch. 1.Google Scholar

⁶¹ Led by the Anglo-Saxon Clubs of America and vigorously promoted by Doctor Walter A. Plecker, public health physician and state registrar of vital statistics, the campaign for Virginia's Racial Integrity Act marked the high point of Virginia's eugenic campaign. Plecker made this connection explicidy in Plecker, Walter A., “Eugenics or Race Deterioration— Which?” Virginia Medical Monthly 52 (Aug. 1925): 285Google Scholar. For the literature on these two laws, see , Dorr, “Segregation's Science,” Chapters 5Google Scholar and 6; Smith, John Douglas, “The Campaign for Racial Purity and the Erosion of Paternalism in Virginia, 1922-1930: ‘Nominally White, Biologically Mixed, Legally Negro,’” journal of Southern History 68 (Feb. 2002): 65–106CrossRefGoogle Scholar; Sherman, Richard, ‘“The Last Stand’: The Fight for Racial Integrity in Virginia in the 1920s,” journal of Southern History 54 (Feb. 1988): 69–92CrossRefGoogle Scholar; Lombardo, Paul A., “Miscegenation, Eugenics, and Racism: Historical Footnotes to leaving v. Virginia” University of California, Davis Law Review 21 (1988): 421–52Google Scholar; , Lombardo, “Three Generations, No Imbeciles”Google Scholar; Smith, J. David, The Eugenic Assault on America: Scenes in Red, White and Black (Fairfax, VA, 1993)Google Scholar; and Holloway, Philippa Elizabeth, “Tending to Deviance: Sexuality and Public Policy in Urban Virginia, Richmond and Norfolk, 1920-1950” (Ph.D. diss., The Ohio State University, 1999)Google Scholar.

⁶² Steven Noll makes this claim. , Noll, Feeble-Mindedin Our Midst, 103Google Scholar. Noll also downplays the role of race in southern attempts to control the feebleminded (92-93).

⁶³ Drewry, William F., “Central State Hospital,” Institutional Care of the Insane in the United States and Canada 3 (1916): 735Google Scholar. Himstedt, Erin, “Not for Their Own Good: African American Mental Health and Eugenic Sterilization Programs in Virginia” (M.A. thesis, University of Virginia, 1995), 6–20Google Scholar.

⁶⁴ For more on the miserable state of health care for poor white southerners and most black southerners, see Beardsley, Edward H., A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knoxville, TN, 1987)Google Scholar; Smith, Susan, Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950 (Philadelphia, 1995)CrossRefGoogle Scholar; and Grey, Michael R., New Deal Medicine: The Rural Health Programs of the Farm Security Administration (Baltimore, 2002)Google Scholar. I do not dispute that the vast majority of the “defectives” white doctors railed against received little or no medical care from regular practitioners. That said, a large number were incarcerated in state institutions, and many of that cohort were sterilized, in both Alabama and Virginia, during this period. Moreover, what these doctors advocated became the conventional wisdom upon which many doctors acted in their private practices, setting the stage for the well-documented, if ill-quantified, practice of extra-legal and illicit sterilization of poor women and women of color. Known colloquially throughout the South as “Mississippi appendectomies,” this practice testifies to the power of eugenic and eugenics-inspired ideas in a practice that is nearly impossible for the historian to uncover and measure. Yet, in 1974, a federal court found that doctors performed at least 100,000 sterilizations annually without women's informed consent. For the opinion and this number, see, Relf v. Weinberger 372 F. Supp. 1196 (1974); Dorr, Gregory Michael, “Protection or Control?: Women's Health, Sterilization Abuse, and Keif v. Weinberger”Google Scholar paper presented before the Social Science History Association, October 26, 2002.

⁶⁵ Drewry, William F., “Increase of Insanity in the Negro and Causes,” Virginia Medical Semi-Monthly 8 (Dec. 1903): 450.Google Scholar

⁶⁶ Ewell, Jejse, “A Plea for Castration to Prevent Criminal Assault,” Virginia Medical Semi-Monthly 11 (Jan. 1907): 464.Google Scholar

⁶⁷ Carrington, Charles, “Sterilization of Habitual Criminals with Report of Cases,” 389–90Google Scholar; , Carrington, “Sterilization of Habitual Criminals,”Google ScholarIbid., 14 (Dec. 24, 1909): 421-22; and , Carrington, “Hereditary Criminals-The One Sure Cure,”Google ScholarIbid., 15 (Apr. 8, 1910): 4-8. See also , Kevles, In the Name of Eugenics, 108Google Scholar. Lombardo, Paul, “Eugenical Sterilization in Virginia: Aubrey Strode and the Case of Buck v. Bell” (Ph.D. diss., University of Virginia, 1982), 104–08Google Scholar.

⁶⁸ , Carrington, “Sterilization of Habitual Criminals, With Report of Cases,” 390Google Scholar. The second “subject” to come under Carrington's knife was “a debased little negro,” whom Carrington characterized as “a notoriously lusty, beastful Sodomist and masturbator.” Sterilized in 1905, the man was “now a strapping, healthy-looking young buck” (390). The sexually charged imagery describing this “cured” patient underscores Carrington's interest in eugenic sterilization rather than castration. His treatment created a conundrum: it saved society from the “unfit” progeny of inmates, and it was more “humane” than castration, but it relied on inmates remaining imprisoned to protect white women from rape. Thus, women's protection either required additional expenditures to incarcerate criminals, or it was not as important as protecting society from expense.

⁶⁹ Unlike Carrington, Barrow obtained the “consent” of his patients. Judging from Barrow's report, however, the degree to which the men he sterilized understood the procedure remains questionable. His claim that vasectomy could be reversed by “a delicate operation” was an immense overstatement—in fact a technical impossibility then—that undoubtedly misled some of the men.

⁷⁰ Barrow, Bernard, “Vasectomy for the Defective Negro with his Consent,” Virginia Medical Semi-Monthly 15 (Aug. 10, 1910): 226–28.Google Scholar

⁷¹ Criminals, African Americans, and the poor have been subjects for medical experimentation since the first anatomy laws set aside their bodies as dissection material for medical schools. For discussions of the abuse of human experimentation, and the particular abuse of blacks, see Lederer, Susan E., Subjected to Science: Human Experimentation in America before the Second World War (Baltimore, 1995), 15Google Scholar, 76, 107, 115-16, especially 121-23; and Hammar, Lawrence, “The Dark Side to Donovanosis: Color, Climate, Race and Racism in American South Venereology,” journal of Medical Humanities 18 (1997): 40–47CrossRefGoogle ScholarPubMed; and Jones, James H., Bad Blood: The Tuskegee Syphilis Experiment, rev. ed. (New York, 1993)Google Scholar.

⁷² Carrington never reported sterilizing whites. His second paper mentions two more cases, who were “insane, debilitated masturbators” of undisclosed race. Carrington, “Sterilization of Habitual Criminals,” 422. In his third paper, Carrington claims to have sterilized twelve men, only two of whom were not “insane masturbators.” Of those two, one was “an epileptic masturbator” of undisclosed race; the other was a “habitual criminal” who “judging from his color, is the son of a negress by some degenerate white man” and may well have been the second case Carrington sterilized. Thus, it appears that he may have only operated on African Americans.

⁷³ For a more detailed discussion of Carrington, see , Dorr, “Segregation's Science,” 388–96Google Scholar.

⁷⁴ Drewry, William F., Annual Report of Central State Hospital (1917), 17Google Scholar; quoted in , Himstedt, “Not for Their Own Good,” 35Google Scholar.

⁷⁵ , Plecker quoted in , Lombardo, “Miscegenation, Eugenics, and Racism,” 438.Google Scholar

⁷⁶ Plecker, Walter A., Eugenics in Relation to the New Family and the LMW on Racial Integrity (Richmond, 1924), 4, 9.Google Scholar

⁷⁷ Ibid., 23.

⁷⁸ Plecker, Ibid., 24.

⁷⁹ Plecket, Ibid., 1 ; , Dorr, “Segregation's Science,” 541Google Scholar.

⁸⁰ Plecker, Walter A., “Eugenics or Race Deterioration-Which?” Virginia Medical Semi-Monthly 52 (Aug. 1925): 282–88.Google Scholar

⁸¹ See transcript, “Celebration of Dr. J. S. Dejarnette's Fiftieth Anniversary of Continuous Service at the Western State Hospital,” July 21, 1939, 31, Dejarnette Papers, Western State Hospital, Staunton, Virginia.

⁸² Plecker, Walter, “Racial Improvement,” Virginia Medical Monthly (Nov. 1925): 488Google Scholar. , Plecker quoted in , Dorr, “Segregation's Science,” 543Google Scholar.

⁸³ The exact number of patients sterilized by Virginia has been variously estimated at between 7,100 and 8,300. Using the former number, 1,880 blacks and 5,239 whites were sterilized, 26 percent and 74 percent respectively. If one uses the higher number, 1,880 blacks represents approximately 23 percent of the total. See , Dorr, “Segregation's Science,” 629–31Google Scholar. Philip Reilly states that sterilization rates at African-American institutions in Virginia equaled the rates at the various white state hospitals . Reilly, Philip, The Surgical Solution: A History of Involuntary Sterilisation in the United States (Baltimore, 1991), 138Google Scholar.

⁸⁴ , Noll, Feeble-Minded in Our Midst, ch. 5Google Scholar, especially 92-93 and 102.

⁸⁵ , Himstedt, “Not For Their Own Good,” 38–40Google Scholar; 44-45. Significantly, Virginia's sterilization of blacks spiked in 1956-57, years of “massive resistance” to school desegregation. Beginning in 1958, Virginians sought to expand the sterilization laws to the general population-specifically targeting welfare mothers with more than one child. Although these laws never passed, there was some skepticism regarding Virginia sterilization policy. In 1962, Virginia became the first state in the nation to pass a “voluntary” sterilization law that allowed individuals to request sterilization. The bill also immunized from prosecution doctors who performed such sterilizations. See , Dorr, “Segregation's Science,” 770–80Google Scholar. Virginia thus differed from other southern states that initially sterilized modest numbers of African Americans but expanded their programs as the welfare rolls expanded in the 1960s. This also distinguishes Virginia from North Carolina, where women of both races may have used eugenic sterilization as birth control in the early 1960s, causing a spike in the sterilization rates. Schoen, Johanna, “Between Choice and Coercion: Women and the Politics of Sterilization in North Carolina, 1929-1975” Journal of Women's History 13 (Spring 2001), 144CrossRefGoogle Scholar.

⁸⁶ , Himstedt, “Not For Their Own Good,” 27Google Scholar, unpaginated graphs in appendix.

⁸⁷ , Sommerville, “Needed Reforms,” 380Google Scholar, 383, 384.

⁸⁸ Purdon, John E., “Social Selection: The Extirpation of Criminality and Hereditary Disease,” TMASA (1901): 461Google Scholar, 462. This emphasis on “like begets like” became a standard trope. See , McConnico, “Heredity,” 350Google Scholar.

⁸⁹ Purdon noted that “the part played by the members of the medical profession in this coming revolution will be very important, for, indeed, it will call for a special class of experts.” , Purdon, “Social Selection,” 463Google Scholar.

⁹⁰ , Purdon, “Social Selection,” 465.Google Scholar

⁹¹ , McConnico, “Heredity,” 351.Google Scholar

⁹² , McConnico, “Heredity,” 358.Google Scholar

⁹³ Dr. , Partlow in “Discussion”Google Scholar of , McConnico, “Heredity,” 361Google Scholar. Other doctors joined in this discussion. Partlow's remarks are the most anti-sterilization. This stance represents an extension of Partlow's earlier aversion to castration as a solution for crime and criminality. He believed castrating criminals and the mentally impaired would alarm public sentiment and spur convicts “to get vengeance against the law which has so cruelly treated” them. Pardow, in “Discussion” of his own 1907 paper, 231. Pardow became eugenic sterilization's most vigorous Alabamian proponent after 1915. For Pardow's conversion, see , Larson, Sex, Race, and Science, 43–44Google Scholar.

⁹⁴ , Bell, “Sterilization of the Unfit,” 455.Google Scholar

⁹⁵ Rudolph, C. M., “State Care and Training of the Feebleminded,” TMASA (1915): 560.Google Scholar

⁹⁶ , Rudolph, “State Care,” 562Google Scholar. That same year, Dr. L. T. Royster, Virginia's most prominent pediatrician, made similar statements about the burden feebleminded children placed on their families . , Royster, “Problem of the Feebleminded—A Plea for Adequate State Custodial Care,” Virginia Medical Semi-Monthly (Nov. 26, 1915): 408Google Scholar.

⁹⁷ For a concise recounting of Alabama's eugenic policy making after 1915, see Larson, Edward J. and Nelson, Leonard J. III, “Involuntary Sexual Sterilization of Incompetents in Alabama: Past, Present, and Future,” Alabama Law Review 43 (1992): 412–25Google ScholarPubMed.

⁹⁸ , Noll, Feeble-Minded in Our Midst, 19Google Scholar; , Trent, Inventing the Feeble Mind, 162–66Google Scholar.

⁹⁹ , Larson, Sex, Race, and Science, 153.Google Scholar

¹⁰⁰ , Noll, Feebk-Minded In Our Midst, 92.Google Scholar

¹⁰¹ Arthur Raper reported the Alabama lynching rate as roughly 3.5 times as frequent as Virginia's: 1.31 per 10,000 population in Alabama compared to 38 per 10,000 in Virginia. Raper, Arthur F., The Tragedy of Lynching (1933; Montclair, NJ, 1969), 483Google Scholar.

¹⁰² The brutality of the Alabama prison system and its disregard for inmates' mental status is covered in Curtin, Mary Ellen, Black Prisoners and Their World, Alabama 1865-1900 (Charlottesville, VA, 2000), especially 156–58Google Scholar, 171-72, 174-82, quotation 177; and Mancini, Matthew J., One Dies, Get Another: Convict Leasing in the American South, 1866-1928 (Columbia, SC, 1996), 113–15Google Scholar; 227-30. A 1942 study noted that female and black prisoners never received psychiatric evaluation and argued for the “addition of at least one psychologist to the staff of the Classification Unit.” Moos, Malcolm C., State Penal Administration in Alabama (University, AL, 1942), 173Google Scholar. Despite this recommendation, the state penal system remained so inefficient and brutal that in 1976 the entire system was declared unconstitutional. March, Ray A., Alabama hound: Forty-Five Years inside a Prison System (Tuscaloosa, AL, 1978), viiGoogle Scholar. David M. Oshinsky notes that Mississippi's penal system also consigned feebleminded blacks to its brutal prison farm. Oshinsky, David M., “Worse Than Slavery”: Parchman Farm and the Ordeal of Jim Crow Justice (New York, 1996), 138Google Scholar.

¹⁰³ , Larson, Sex, Race, and Science, 154.Google Scholar

¹⁰⁴ The notion that African Americans, and African-American women in particular, do not deserve social welfare has a long history. For the modern incarnation of this idea, see Hickel, K. Walter, “War, Region, and Social Welfare: Federal Aid to Servicemen's Dependents in the South, 1917-1921,” Journal of American History 87 (Mar. 2001): 1362–91CrossRefGoogle Scholar; Gordon, Linda, Pitied But Not Entitled: Single Mothers and the History of Welfare, 1890-1935 (New York, 1994), 87–88Google Scholar, 123-43 ; Solinger, Ricki, Wake Up Uttle Susie: Single Pregnancy and Race before Wade, Roe v. (New York, 1992)Google Scholar. On the eugenic implications of this trend, see, Schoen, Johanna, Choice and CoercionGoogle Scholar; Gordon, Linda, Woman's Body, Woman's Right: Birth Control in America, rev. ed. (New York, 1990), 349–50Google Scholar; Davis, Angela, Women, Race and Class (New York, 1983), 202–21Google Scholar; and Paul, Julius, “The Return of Punitive Sterilization Proposals: Current Attacks on Illegitimacy and the AFDC Program” Law and Society Review 3 (Aug. 1968): 77–106CrossRefGoogle Scholar.

¹⁰⁵ McMurphy, J. P., “Birth Control, A Public Health Problem,” TMASA (1927): 343Google Scholar, 350. Emphasis mine in both quotations. In 1973, the case Relf v. Weinberger—Keif v. Weinberger, 372 F. Supp. 1196 (1974)Google Scholar; Keif v. Mathews, 403 F. Supp. 1235 (1975)Google Scholar; Keif v. Weinberger, 565 F. 2d 722 (1977)Google Scholar arising from the sterilization of Montgomery, Alabama sisters aged twelve and fourteen years, broke the story of continuing sterilization abuse in America targeting poor women, especially poor women of color. Women filed similar suits in North Carolina, South Carolina, California, and against the Bureau of Indian Affairs. See , Dorr, “Protection or Control"Google Scholar; , Davis, Women, Race and Class, 215–16Google Scholar; , Gordon, Woman's Body, Woman's Right, 433–36Google Scholar. Rutherford, Charlotte, “Reproductive Freedoms and African American Women,” Yale Journal of Lam and Feminism 4 (1992): 273–75Google ScholarPubMed, also comments on sterilization abuse, but never explicitly mentions the Relfs. A more complete treatment from the policy perspective appears in Critchlow, Donald T., Intended Consequences: Birth Control, Abortion, and the Federal Government in America (New York, 1999), 144–47Google Scholar.

¹⁰⁶ See notes 7, 64, and 104, above.