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IMBECILES

My friend David Hodges in Memphis, Tennessee, recently called my attention to a superb book entitled Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck by Adam Cohen, a graduate of Harvard Law School, a former member of The New York Times editorial board, and a senior writer for Time magazine. ¹

William C. Roberts, MD.

In 1927, the US Supreme Court upheld eugenic sterilization in the Buck v. Bell case that allowed the state of Virginia to sterilize Carrie Buck, a young woman wrongly labeled “feebleminded.” The court that decided Buck v. Bell included some of the most distinguished men in the annals of American law. The chief justice was William Howard Taft, who had served as US president before joining the bench. Other members included Louis Brandeis, the towering progressive who had made his name as “the people’s attorney,” and Oliver Wendell Holmes Jr., widely considered to be one of the greatest legal minds in American history. The legendary Mr. Holmes wrote the 1927 ruling. Holmes, the Harvard-educated scion of several of Boston’s most distinguished families, was scornful of the poorly educated Carrie and her working-class mother. Based on scant information about Carrie, her mother Emma, and Carrie’s child, he declared: “Three generations of imbeciles are enough.” Holmes’s opinion for an 8 to 1 majority did not merely uphold Virginia’s sterilization law; it delivered a call to all Americans to identify those among them who should not be allowed to reproduce—and to sterilize them in large numbers. Holmes wrote that the nation must sterilize those who “sap the strength of the State … 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.”

Modern eugenics emerged in England among the followers of Charles Darwin, crossed the Atlantic in the 1920s, and became a full-fledged intellectual craze. Some of America’s leading citizens led the charge. John D. Rockefeller Jr., the world’s wealthiest man, funded scientific research into what he called the “defective human” who should be bred out of the population. Alexander Graham Bell, the inventor of the telephone, became chairman of the Board of the Scientific Directors of the Eugenics Record Office in Cold Spring Harbor, New York, the leading organization advocating eugenic sterilization. Former President Theodore Roosevelt took to the pages of a national magazine to insist that the unfit must be “forbidden to leave offspring behind them.” Scientists formed organizations to research and promote eugenics in big cities and small towns.

Hereditary improvement was the intellectual issue of the day. Albert Edward Wiggam, a popular lecturer, traveled the country promoting an updated version of the 10 commandments based on eugenic principles. Women’s clubs filled their agendas with lectures on identifying the hereditarily defective and arranging eugenic marriages. Clergymen competed in international eugenic sermon contests organized on topics like “Religion and eugenics: Does the church have any responsibility for improving human stock?” Bestselling books explained the concept of “race betterment” to an eager public, and mass-market magazines urged their readers to do their part to breed superior human beings. Hollywood released a feature-length horror movie showing the frightening consequences of allowing “defective” babies to live.

Conferences and public events were held to promote eugenics research and education. At the Sesquicentennial Exposition in Philadelphia, celebrating the Declaration of Independence’s 150th anniversary, the American Eugenics Society mounted an exhibit that explained the terrible threat with flashing lights. Every 48 seconds, the lights indicated, a mentally deficient person was born in the USA, while only every 7.5 seconds was a “high-grade person” born who would “have the ability to do creative work and be fit for leadership.”

Universities embraced eugenics and gave it their intellectual imprimatur. Eugenics was taught at 376 universities and colleges including Harvard, Columbia, Berkeley, and Cornell. Prominent professors were outspoken in support.

The driving force behind the eugenics movement of the 1920s was, historians suggest, the collective fears of the Anglo-Saxon upper and middle classes about a changing America. Record levels of immigration were transforming the nation’s ethnic and religious makeup. The increased industrialization and urbanization were fraying community and family ties.

The eugenics movement offered two solutions: one for the threat from without and one for the danger from within. An answer to the foreign threat was new immigration laws to limit the number of Italians, Eastern European Jews, and other non-Northern Europeans admitted to this country. The eugenicists claimed the groups they wanted to exclude had inordinately high levels of physical and mental hereditary defects that were degrading America’s gene pool. Congress held hearings at which eugenicists explained the biological deficiencies of various nationalities. Their arguments were well received by senators and representatives who overwhelmingly shared the eugenicists’ prejudices. Accordingly, Congress adopted the Immigration Act of 1924, which opened the door to more immigrants from northern Europe and shut it for southern and eastern Europeans.

The eugenicists’ answer to the internal threat was a set of laws designed to prevent the “unfit” from reproducing. They began in 1895 with a law prohibiting various kinds of people deemed to be hereditarily unworthy from marrying in Connecticut and then got other states to pass such laws. They promoted “segregation”: placing “defective” people in state institutions during their reproductive years to prevent them from passing their flaws on to a new generation. Finally, the eugenicists turned to sterilization, their favored solution. Marriage laws were weak; eugenicists feared defective people would simply reproduce out of wedlock. Segregation was expensive. States could not build enough institutions to house all the people eugenicists wanted to stop from having children. Sterilization, however, was completely effective, and it could be carried out on a mass scale.

Starting with Indiana in 1907, states adopted legislation authorizing forced sterilization of people judged to have hereditary defects. Within 6 years, 12 states had such laws. They called for sterilizing anyone with “defective” traits, such as epilepsy, criminality, alcoholism, or “dependency,” another word for poverty. Their greatest target was the “feebleminded,” a loose designation that included people who were mentally challenged, women considered to be excessively interested in sex, and various other categories of individuals who offended the middle-class sensibilities of judges and social workers.

Fears of “the rising tide of feeblemindedness” rose to panic levels. Experts studied the problem intensely and issued reports on subjects like the “menace of feeblemindedness” among California public school children. A leading psychologist published an influential study arguing that feeblemindedness “underlies all our social problems,” including crime, poverty, and prostitution.

The eugenicists insisted society’s response had to be commensurate with the enormity of the threat. A nationwide response was required with each state doing its part. Every American had to be eugenically investigated and evaluated for possible sterilization. One eugenic sterilization leader insisted that to remove the “lowest one-tenth” of the nation, 15 million people would have to be sterilized.

Virginia was not in the forefront of the eugenics sterilization movement, actually quite the opposite. What set it apart was its relative cautiousness. Virginia did not produce its sterilization law until 1924, 17 years after Indiana’s. Then, on the advice of lawyers, the state’s mental hospitals decided they would not sterilize anyone until Virginia’s law had been tested in the courts, all the way to the US Supreme Court. To accomplish this, the hospitals decided to create a test legal case.

It was Carrie Buck’s misfortune to be at the wrong place at the wrong time. She had been sent to Virginia’s Colony for Epileptics and Feebleminded just when the superintendent was trying to find an inmate to put at the center of the test case. Carrie had precisely the personal attributes eugenicists were looking for: she had been designated feebleminded, and as a woman who had given birth out of wedlock at age 17, she embodied the eugenic nightmare of the feebleminded reproducing rapidly and flooding the nation with “defectives.” Carrie also came from the sort of family eugenicists wanted to put in the spotlight. Her mother also was a colony inmate who had been designated feebleminded, and she had other relatives in the institution, something that could help the state establish a hereditary pattern. But Carrie was not feebleminded, despite what the state’s unreliable intelligence testing reported. Her school records, which the colony ignored, revealed her to be of perfectly normal intelligence. Her pregnancy was the result of rape. She obviously was not a threat to society but its victim.

Four of the nation’s most respected professions were involved in Carrie Buck’s case—medicine, academia, law, and the judiciary—in the form of four powerful men. These men each sided forcefully with the eugenic cause, and their power and prestige resulted in Carrie’s being sterilized.

Albert Priddy was the physician who selected Carrie to be the first person operated on under Virginia’s law. Dr. Priddy served as superintendent of the Colony for Epileptics and Feebleminded where Carrie was an inmate. In his campaign for eugenic sterilization, Dr. Priddy had much of the medical profession behind him. Doctors across the country took leading roles in promoting eugenics and eugenic sterilization. Medical journals were full of articles advocating sterilization. Not every prominent doctor, of course, supported eugenic sterilization, but few spoke out against it.

Harry Laughlin, the head of the Eugenics Record Office, was the scientist who gave his expert opinion that the Virginia law should be upheld and that Carrie should be sterilized. Laughlin also had been a key supporter of the Immigration Act of 1924. He wrote a 502-page treatise for supporting eugenic sterilization. It was he who proposed sterilizing 15 million Americans, and he was doing more than anyone else to make that vision a reality. Harry Laughlin was a college professor who had a doctorate in biology from Princeton. He wrote, “You may live but you must not propagate.”

Aubrey Strode was the lawyer who drafted the Virginia Sterilization Law and went on to defend it in the US Supreme Court. Unlike Dr. Priddy and Laughlin, however, Strode was not a pro-eugenics ideologue.

Finally, it was the great Oliver Wendell Holmes Jr. who lent his enormous intellectual prestige to the sterilization cause. Holmes had long been a supporter of eugenics, and he had suggested years earlier that the best route to societal reform lay in “taking in hand life and trying to build a race.” Of all the professions, the judiciary played the most disappointing role.

Who was Carrie Buck? She was born in 1906. Her father left home shortly thereafter. Her single mother subsequently fell on hard times. Carrie was taken in by a foster family in Charlottesville, Virginia, theoretically a chance to grow up in a well-off loving family, but that was not to be. In her years of living with the Dobbs, Carrie became less of a daughter and more of a maid. She was taken out of school in the sixth grade and from then on worked essentially as a housemaid in the Dobbs house and also did house chores for neighbors.

When Carrie became pregnant out of wedlock at age 17, the Dobbs kicked her out of their house and soon she was before a judge and two physicians who decided that Carrie was feebleminded and therefore needed to be in an institution. The word “feebleminded” was widely used at the time but only vaguely defined. There was no precise medical description. It was a catch-all term that covered a wide range of reported deficiencies: it might mean that a person was of low intelligence or that he or she behaved in ways that offended the middle-class sensibilities of doctors, judges, or social workers. In the case of young women, it often meant exhibiting what was regarded as an excessive or inappropriate interest in sex.

There was no proof that Carrie was mentally deficient, and her grades from school showed no lack of intelligence. Carrie was never epileptic. When she appeared before the Commission of Feeblemindedness, she had no lawyer or guardian to look out for her interests. There was no one at the hearing to argue that she was neither feebleminded nor epileptic. She was far from delinquent. Carrie had proceeded from grade to grade without incident and left school only when the Dobbs removed her, for housework duties. Her mother had also been committed to the Colony for Epileptics and Feebleminded, and there was no evidence that she was feebleminded or epileptic either.

In the 1920s, states began building institutions for the feebleminded in record numbers. The main purpose of this drive to institutionalize the feebleminded in state hospitals and in specialized schools was not better care or training. It was to “segregate” them in a secure facility where they could not reproduce. There was a view at the time that feebleminded women were almost invariably immoral and if at large usually became carriers of venereal disease or gave birth to children who would be as defective as themselves.

When Carrie arrived at the institution, she soon reunited with her mother. The two women became close for the first time in years. Carrie was also able to keep in touch with her daughter, Vivian, who was taken in by the Dobbs family.

The Buck v. Bell case breathed new life into the sterilization movement. In the years leading up to 1924, the eugenicists had encountered substantial opposition in courts and statehouses across the country. Now supporters of sterilization laws were emboldened, and their opponents were suddenly on the defense. The main obstacle to the sterilization laws remained the Catholic Church and its members.

Despite some resistance in the years after the Supreme Court’s decision, the number of eugenic sterilizations increased sharply due both to the new laws and to an increased willingness to use those already in place. In 1925, there were just 322 sterilizations of institutionalized people worldwide. In the 2 years 1928 and 1929, that number jumped to 2362, more than triple the annual rate before the court’s ruling in 1927.

There was also a significant change in gender of the people being sterilized. At the end of 1927, men made up about 53% of all the legal sterilizations that had been performed in the USA. Over the next 5 years, 67% of the institutionalized people who were sterilized were women. Many of the women, institutional records show, were admitted for the express purpose of being sterilized and then were released. There was also a pronounced class bias of who was sterilized. Poor women like Carrie were the most common victims of the eugenics sterilization program. The procedures were performed so often on poor white southerners that the procedure acquired a nickname, “Mississippi appendectomies.” Virginia was one of the main drivers in the increase of sterilization. The people who were sterilized, like Carrie, often were not told what was being done to them. Many tried to have children later and did not understand why they were unable to conceive.

The reach of Buck v. Bell extended beyond the USA. The Nazi Party, which was on the rise in Germany, used the USA as a model for its own eugenic sterilization program! The Nazis carried out a total of 375,000 forced eugenic sterilizations, and in the Nuremberg trials that followed World War II, the Buck v. Bell case was cited in defense of their actions. Other European countries also adopted eugenic sterilization laws along the American model. Denmark enacted “voluntary” sterilization in 1929 and forced sterilization of “mental defectives” in 1934. Sweden and Norway enacted sterilization laws in 1934 followed by Finland in 1935, Estonia in 1936, and Iceland in 1938. The US “pioneered” eugenic sterilization for the rest of the world!

In the USA, it was not until the 1960s that popular attitudes toward sterilization began to lose favor. From 1965 to 1979, at least 15 states appealed their sterilization laws, and in 1973 Alabama’s sterilization statute was ruled unconstitutional. In Virginia, sterilization began to decline in the 1960s, but it took a long time to disappear entirely. In 1974, the Virginia legislature repealed the 1927 law.

By the end of the 20th century, legal eugenic sterilization had come to an end, but 60,000 to 70,000 Americans had been involuntarily sterilized between 1907 and 1983. That number included at least 7450 people in Virginia, and the Colony for Epileptics and Feebleminded had become one of the nation’s busiest centers for eugenic sterilization. Virginia, however, was not the most active state; that title went to California, which sterilized about 20,000 people.

In an era when much of the US was caught up in social Darwinism, few paused to contemplate what Charles Darwin had said on the subject. In The Descent of Man, he conceded there might well be practical advantages in abandoning “the weak and helpless,” but doing so, he insisted, also brought with it “an overwhelming present evil.” We must allow the weak to “survive and propagate their kind,” Darwin insisted. Doing anything less, he said, would mean abandoning not only the weak and the helpless but “the noblest part of our nature.”

THE BODY

The Body: A Guide for Occupants is Bill Bryson’s 20th book. ² He has written, among others, travel books, a biography of Shakespeare, a history and dictionary of the English language, and A Short History of Nearly Everything. His latest book is a “fact-studded survey of our physiques,” as one review stated. I loved it. I wish that it had been available when I was in medical school. It is truly a pleasure to read. It is provocative and entertaining throughout.

His first chapter is entitled “How to Build a Human.” He begins with this comment: “When I was a junior high school student, I remember being taught by a biology teacher that all the chemicals that make up the human body could be bought in a hardware store for $5.” According to the Royal Society of Chemistry, 59 elements are needed to construct a human being: six of these—carbon, oxygen, hydrogen, nitrogen, calcium, and phosphorus—account for 99.1% of what makes us. The biggest component in any human, filling 61% of available space, is oxygen. The oxygen is mostly bound up with hydrogen, “which accounts for another 10% of us,” to make water, and water is quite heavy. It is a bit ironic that two of the lightest things in nature, oxygen and hydrogen, when combined form one of the heaviest. Oxygen and hydrogen are also two of the cheapest elements we humans possess. All of our oxygen costs just $14 and our hydrogen a little over $26. Nitrogen (2.6% of us) costs just $0.40 for a body’s worth. We need about 30 pounds of carbon, and that will cost nearly $70,000. Calcium, phosphorus, and potassium, thought to be needed in much smaller amounts, would cost another $74,000. Thorium would cost over $3000 per gram but constitutes just 0.0000001% of us, so we can buy a body’s worth for $0.33. All the tin we require will cost $0.06, and zirconium and niobium will cost just $0.03. The samarium, which accounts for 0.000000007% of our bodies, costs nothing.

Of the 59 elements found in our bodies, 24 are traditionally known as essential elements since we cannot do without them. Most of the others are clearly beneficial, but some are neither harmful nor beneficial but are still in us. Cadmium, for instance, is the 23rd most common element in the body, constituting 0.1% of our bulk, but it is seriously toxic. We get it in our bodies when we eat plants. We probably ingest about 80 micrograms of cadmium a day, and no part of it does us any good. Almost any cell in our body will have a million or more selenium atoms in it. Selenium makes two vital enzymes, a deficiency of which has been linked to hypertension, arthritis, anemia, some cancers, and even possibly reduced sperm counts. We clearly need some selenium. (It is found in nuts, whole wheat bread, and fish, but at the same time too much can poison our liver.)

Altogether, according to the Royal Society of Chemistry, the full cost of building a human being would be in the vicinity of $150,000. Labor and sales tax, of course, would boost costs further. We probably can build a human body for much under $300,000.

Bryson goes on in the first chapter to ask other questions: How many times do we blink in a day? The answer is 14,000, so many times that our eyes are shut for 23 minutes of every waking day. Every second of every day our body undertakes a literally unquantifiable number of tasks without requiring an instant of our attention. In a second our bodies make a million red blood cells. Each of these red blood cells circulate about 150,000 times, repeatedly delivering oxygen to our cells and then, battered and useless, present themselves to other cells to be quietly killed off.

Altogether, it takes 7 billion, billion, billion, or 7 octillion atoms to make our bodies. Bryson indicated that unpacked we are positively enormous. Our lungs, smoothed out, would cover a tennis court and the airways within them would stretch nearly from coast to coast. The length of all our blood vessels would take us 2.5 times around the Earth. Our DNA has a meter of it packed into every cell and so many cells that if we formed all of the DNA in our bodies into a single strand, it would stretch 10 billion miles, to beyond Pluto. Our atoms are the building blocks and themselves are not alive.

The basic unit of life, of course, is the cell. The cell is full of ribosomes and proteins, DNA, RNA, mitochondria, and many other items, but none of those in themselves is alive. The cell itself is nonliving. Yet somehow when all of these things are brought together, life exists. Bryson indicates that the most remarkable thing about our bodies is that nothing is in charge. Each component of the cell responds to signals from other components, all of them bumping and jostling like so many bumper cars, yet somehow all of this random motion results in a smooth, coordinated action.

The heart of the cell is the nucleus: it contains the cell’s DNA—3 feet of it scrunched into a space that may reasonably be called infinitesimal. The reason so much DNA can fit into a cell’s nucleus is that it is exquisitely thin. We may need 20 billion strands of DNA laid side by side to make the width of the finest human hair. Every cell within our bodies holds two copies of our DNA. That’s why we have enough to stretch to Pluto and beyond. DNA exists for just one purpose: to create more DNA. It is simply an instruction manual for making us. The length of DNA is divided into segments called chromosomes and shorter individual units called genes. The sum of all of our genes is the genome. DNA is extremely stable. It can last for tens of thousands of years. DNA passes on information so accurately that it makes only one error per every billion letters copied. Still, because our cells divide so much, that is about 3 errors or mutations per cell division. Most of these mutations the body can ignore, but just occasionally they have lasting significance. That is evolution.

Bryson indicates that not once in the 3 billion years since life began has our personal line of descent been broken. Every one of our ancestors has successfully passed on their genetic material to a new generation before being snuffed out or otherwise sidetracked from the procreative process.

What genes specifically do is provide instructions for building proteins. Most of the useful things in our bodies are proteins. Some speed up chemical changes and are known as enzymes. Others convey chemical messages and are known as hormones. Still others attack pathogens and are called antibodies. Nobody knows how many types of proteins are within our bodies, but estimates range from a few hundred thousand to a million or more.

The paradox of genetics, Bryson indicates, is that we are all very different and genetically practically identical. All humans share 99.9% of their DNA, and yet no two humans are alike. Each person’s DNA will differ from another person’s in 3 to 4 million places, a small proportion of the total but enough to make a big difference between each of us. We also have within us about 100 personal mutations—stretches of genetic instructions that don’t quite match any of the genes given to us by either of our parents. They are ours alone.

The body, as Bryson indicates, is often likened to a machine, but it is so much more than that. It works 24 hours a day for decades without for the most part needing regular service and without the installation of spare parts; it runs on water and a few organic compounds, is soft and accommodatingly mobile and pliant, reproduces itself with enthusiasm, and has emotion. Machines just don’t do all of these things.

Bryson asks how we celebrate the glory of our existence. He answers by saying that most of us do so by eating maximally and exercising minimally. Even when we do nearly everything wrong, our body maintains and preserves us. Five out of every six smokers do not get lung cancer. Most of the people who are prime candidates for heart attacks do not get them. Every day, it has been estimated that between 1 and 5 of our cells turn cancerous, and our immune system captures and kills them. Overall, cancers are uncommon; most cells in the body replicate billions and billions of times without going wrong. Cancer, he indicates, may be a common cause of death but it is not a common event in life.

Our bodies are made up of just over 37 trillion cells operating more or less in perfect concert more or less all the time. Bryson goes on to indicate that our bodies are by no means perfect. He points out that we have pelvises too small to pass children without excruciating pain. Our jaws are too small to accommodate all of our teeth. Most of our organs cannot repair themselves. Nevertheless, the miracle of life, he suggests, is not that we are more endowed with some frailties, but that we aren’t swamped with them.

What is described above is simply the first chapter of this wonderful book. I will come back to this book in later months.

William C. Roberts, MD
August 18, 2020