One of the problems the literature on the history of eugenics as a whole has is that it has a tendency to want to forget the ways American eugenics was like Nazi eugenics. It gets hidden in explorations of specific socio-cultural products or institutional aspects of the eugenics movement, or from (justified) theoretical and methodological attacks on legitimately bad histories of eugenics (like War Against the Weak or Better for all the World). It even comes from a desire to acknowledge all the ways American eugenics was like Nazi eugenics, but excavates those processes, impulses, and trends which are unique to the American experience.
Now, to be clear from the beginning: Nazi eugenics and American eugenics did spring from largely different intellectual, cultural, social, and political circumstances. But the fact of the matter is, at least 63,000 (officially, and likely many, many more) individuals were sterilized by the state in America during the twentieth century. Thus I’d like to take the eugenics movement as it operated for a large proportion of a particular profession (medical practitioners), and see where it takes us. What we’ll see is that there are some striking similarities between American and Nazi eugenics that are not so easily forgotten. Perhaps the most visible of these is the central role doctors, physicians, and other medical practitioners played in the sterilization of thousands upon thousands of “unfit” people.
The eugenics movement arrived in the United States in 1907 (when the first compulsory sterilization law was enacted in Indiana) and remained a potent force until its slow decline and transformation beginning in the late 1930s. Whereas we will see below that, in Nazi Germany, eugenics enjoyed critical scientific and institutional support from medical scientists and physicians both as front-line practitioners and experimenters as well as ethical justification by medical bureaucrats, in the United States this was not the case. While at its apex in the early 1930s some thirty two states had enacted eugenic sterilization laws, the movement in the United States is characterized best as having had a diffused, decentralized, and multifaceted nature. There is no doubt that many physicians and medical practitioners in the United States were eugenicists. But what is equally certain is that, for the most part, the America eugenics movement from 1907-1945 remained, both in quality and quantity, composed of politicians, non-medical scientists (ichthyologists, entomologists, biologists, sociologists, paleontologists), and bureaucrats far more than physicians and other medical practitioners.
The qualification to this is in direct settings where both forced and voluntary sterilizations did take place in the United States—some 21,000 by 1935 and 64,000 by 1960, by most estimates—and that was the prison ward and the mental hospital. Leading the charge were California, with the most involuntary sterilizations during the period in question, and Virginia, with the second most.
So who were the medical practitioners central to the American movement?
Physicians in mental hospitals and prisons: Plenty of historians have looked at the history of the vasectomy and the salpingectomy, the rise of eugenic sterilization laws, the debate at the legislative level over both the desirability and parameters of such laws, the legislative debate surrounding them, and the differences that existed between the various states when it came to implementing and sustaining involuntary sterilization of citizens.They show that medical practitioners argued for greater degrees of eugenic sterilization not only in the Eugenical News (the leading forum at the national level), but alsothe discussions at the local level by physicians at mental hospitals in Ohio, Maine, Virginia, Minnesota, North Carolina, and, of course, California,
Psychiatrists: Other historians have shown how psychiatrists as a group of professionals fighting for validation and legitimization in an environment where they were uniquely predisposed to assimilate ideas about the heritability of defective characteristics advanced eugenic ideas. Indeed, at the same time that they were facing pressure from politicians and the federal government to modernize and standardize as a scientific discipline, psychiatrists participated in the public eugenics debate both in Canada and the United States. By looking at patient court cases at mental hospitals and state asylums, national legislation, and internal debates among the rank of file of psychiatry in varied places like New York, California, Rhode Island, Mississippi, and Toronto, we can get a valuable look at how an emerging discipline navigates the waters of an often murky and ambiguous scientific endeavor.
A change in the air: Reform Eugenics: Beginning in the mid-1930s, the emergence of a new, more sophisticated genetics brought with it a “reform eugenics,” which at once recognized the perverted state the eugenics movement lay in at that moment, but still sought after the original Galton vision of a humanity free from its pernicious biology by excising the identifiably genetically unfit. This is evidenced by the fact that the Third International Congress of Eugenics, held in New York in 1932, saw an attendance of only about a hundred people. Reflecting the developments of nearly half a century of experimentation and theorizing, by this time genetics had begun to inform the movement and change its nature.
It can be marked particularly by the publication of a 1936 report by a committee of the American Neurological Association, itself a strong opponent of eugenics throughout the entirety of its existence in the United States. Headed by prominent Boston psychiatrist Abraham Myerson, and drawing upon independent conclusions as well as the findings of the Brock committee report, this group found no sound scientific basis for sterilization on account of immorality or character defect. Human conduct and character are matters of too complex a nature, too interwoven with social conditions, to permit any definite conclusions to be drawn concerning the part which heredity plays in their genesis.
This change was reified primarily in the makeup of the eugenics movement as well as a slight shift to its message. In the case of the former, it meant that medical professionals became the new spokespeople, albeit of a eugenics that was far less oppressive, naïve, confident, and involuntary than before. For some diseases, like Huntington’s chorea, it was clear that dominant genetic traits were indeed often passed from parent to offspring. In such cases, physicians from the mid-1930s on took it upon themselves to present such evidence to parents and suggest the outcome of carrying a pregnancy to term—but leave the ultimate decision to them. In the case of most other conditions, doctors began to conclude that genetic traits were, at best, only indices of a range of phenotypic presentations that were determined equally by environment—both external (what we would normally think of in the nature vs. nurture debate) and genetic (in terms of the chromosomal milieu that connected specific genes to each other).
It may surprise you to learn that the eugenics movement in Germany was not the sole creation of Hitler or the Nationalist Socialist regime. In fact, it officially began there earlier than in the United States, with the Society for Racial Hygiene coalescing in Berlin in 1905. Yet during its first two and a half decades of existence, the movement had trouble securing legitimacy and garnering a widespread following before the early 1930s. On July 14th, 1933, the Law for the Prevention of Progeny of Sufferers from Hereditary Disease was approved, and allowed (just like its American counterparts) for the sterilization of the feebleminded, schizophrenic, manic-depressive, epileptic, blind, and deaf, among a plethora of others. This law also set up the foundation for the emergence of the “eugenic courts” which oversaw all cases prosecuted by the state with the aim of involuntary sterilization. Relatively quickly, though not exclusively, eugenic sterilization morphed into the Holocaust. This is the defining feature of Nazi eugenics, and the principal way it differed from American eugenics. Both were perpetrated by medical practitioners, and grew from the notion that a portion of the population should be excised for the good of the gene pool. In Germany, as we will see, they just took it to the next logical step and eliminated the “unfit” instead of just sterilizing them.
Generally in looking at Hadamar, Treblinka, and Auschwitz, historians of eugenics in Germany have argued that physicians in Nazi Germany who killed were, just like any other professional, primarily motivated by a desire to raise their income, advance their careers, and benefit from the social advancement that came with participating in an ideological framework which placed them at the top of the food chain. The Nazi eugenic program was directed by the Chancellery of the Fuhrer in conjunction with the Health Department of the Reich Ministry of the Interior. In other words—it enjoyed a far more centralized, codified, and unified apparatus and voice. It came in two flavors: the euthanizing and sterilization of the disabled and terminally ill in hospitals by primarily physicians and medical practitioners, and the mass murder in the concentration camps by Nazi officers under the direction and advisement of physicians and medical practitioners.
Killing Wards: Doctors (both the newly licensed and the old), nurses, and aides all participated in this killing program. From 26 cities across Germany, caravans of the disabled and unwanted arrived at such hospitals, usually at night. Patients were not always killed outright; in fact, many of the T4 sites used more indirect (though no less fatal) methods of killing. For instance, doctors there made extensive use of the sedatives luminal and veronal, which if given in sufficient doses caused pneumonia and death within two to three days. At the same time, children 1-5 years old were murdered by way of slowly reducing their caloric intake until, over the course of several days, they starved to death. After 1941, Hitler ordered this process, which was initially centralized, altered as publicity and propaganda campaigns began to reveal the scope and mechanisms of the T4 killings. Hitler ordered the practices slightly changed and the hospitals decentralized to the countryside to avoid further publicity, and thereafter the T4 killings were characterized by a “wild euthanasia” which saw individual medical practitioners decide who lived and died with much less oversight and much more arbitrariness than before. The troublesome, irritating, sexually prolific, indigent and ill were all killed with equal equanimity.
T4 Centers and Concentration Camps: Notable names: Friedrich Mennecke (Eichberg), Imfried Eberl (Treblinka), Friedrich Entress (Auschwitz). Beginning as a location for the killing of disabled adults, the T4 killings (marked by designation 14f13) were expanded beginning in the winter of 1939-40 and beginning in late 1941 what would come to be known as the concentration camp genocide. Physicians and medical practitioners played a critical role in these activities. Some physicians (in fact, 7% of all physicians in Germany during the era, far above any other professional group) served in the SS in the camps themselves and made preliminary “special selections” that were then confirmed by other doctors after. Doctors inspected the forms of incoming unwanteds, made camp selections, oversaw the dispersal of gas, pronounced the death of those murdered, and subsequently wrote their death certificates. At the same time, 33% of all physicians were members of the Nazi Physicians League, the Nationalist Socialist arm which targeted doctors as part of its ideological agenda. 45% were members of the Nazi Party itself. This is compared to 25% for lawyers and 24% for teachers. Methods used included Zyklon B, and phenol injections to the heart
What did they get out of this? Physicians and medical practitioners enjoyed a myriad of benefits. They were named institutional director of regional hospitals; oversaw extensive and well-funded research programs (the most well-known is certainly Mengele, the most eugenically minded of these) which conducted experiments on the disabled and abled alike, as well as the old, the young, and twins; enjoyed the social status and increased pay of their position.
From the point of view of the individual transported for sterilization, Germany and the United States in many respects would have looked very similar. Sterilization (or termination) would have been submitted or recommended by someone with medical experience. The sterilization (or euthanizing) procedure would have been approved by a doctor, or a group of doctors (the Board of Mental Health, for instance, in Kansas). It would have been carried out by a doctor. Were American and Nazi eugenics exactly the same? Nope. They had different intellectual, sociocultural, and ideological roots. They happened under different auspices. But to the individual placed on the sterilizing (or killing) table, it didn’t matter. As historians who frequently get bound up in the larger questions driving historical inquiry, we’d do well to remember that.
The tl;dr version of this discussion is this: Doctors in the United States and Nazi Germany were absolutely crucial to the popularization and implementation of eugenic practices which stole bodily liberty from tens of thousands of people. But whereas in Germany these practices were sanctioned and directed by a more or less central state apparatus (encouraging dissenters to shut up or get out), in the United States there remained no unified federal control and no central voice or dogma, and so disagreement was allowed to propagate such that the public and professional winds of opinion changed by 1945. For the individuals sterilized, it didn’t matter though. They were getting sterilized in the name of some greater good either way.