They were wives and daughters. Sisters. Unwed mothers. Children. Even a 10-year-old boy. Some were blind or mentally retarded. Toward the end they were mostly black and poor. North Carolina sterilized them all, more than 7,600 people.
For more than 40 years North Carolina ran one of the nation's largest and most aggressive sterilization programs. It expanded after World War II, even as most other states pulled back in light of the horrors of Hitler's Germany.
Contrary to common belief, many of the thousands marked for sterilization were ordinary citizens, many of them young women guilty of nothing worse than engaging in premarital sex.
I don't want it. I don't approve of it, sir. I don't want
a sterilize operation.... Let me go home, see if I get along all right.
Have mercy on me and let me do that.
— A woman pleading with the eugenics board, 1945.
The sterilization program ended in 1974, but its legacy will not go away. Many of its victims are still alive and they bear witness to a bureaucracy that trampled on the rights of the poor and the powerless.
In response to a Winston-Salem Journal investigation of the state sterilization program, the Wake Forest University School of Medicine is looking into its own role in the eugenics movement.
The state program was run by the Eugenics Board of North Carolina, a panel of five bureaucrats who usually decided cases in a few minutes. It was inspired by the eugenics movement, which made exaggerated claims that mental illness, genetic defects and social ills could be eliminated by sterilization. The system granted excessive power to welfare workers, browbeat women into being sterilized and had ineffective safeguards.
“They don't want to hear how I feel, or what's going on in my mind. You're pregnant — you need to get sterilization,” said Nial Cox Ramirez, recalling her sterilization in 1965 after having one out-of-wedlock child.
“And they had the nerve to tell me, "That's what's best for you,'” she said recently.
North Carolina sealed most records of the eugenics board and until recently few details were known about how the board operated, or the nature of cases it handled.
The Winston-Salem Journal obtained and examined thousands of these documents. It found that:
- More than 2,000 people ages 18 and younger were sterilized in many questionable cases, including a10-year-old who was castrated. Children were sterilized over the objections of their parents, and the consent process was often a sham.
- The program had been racially balanced in the early years, but by the late 1960s more than 60 percent of those sterilized were black, and 99 percent were female.
- Doctors performed sterilizations without authorization and the eugenics board backdated approval. Forsyth County engaged in an illegal sterilization campaign beyond the state program.
- Major eugenics research at Wake Forest University was paid for by a patron whose long history of ties to science had a racial agenda that included a visit to a 1935 Nazi eugenics conference and extensive efforts to overturn key civil-rights legislation.
North Carolina's eugenics law, passed in 1929 and rewritten in 1933, allowed sterilizations for three reasons — epilepsy, sickness and feeblemindedness. But the board almost routinely violated the spirit, if not the letter, of the law by passing judgment on many other things, from promiscuity to homosexuality.
Though more than 30 states had eugenic sterilization programs, North Carolina's record of dramatically expanding the program after 1945 and targeting blacks in the general population was different from most.
“That's quite astounding,” said Steve Selden, a professor at the University of Maryland and author of Inheriting Shame: the Story of Eugenics & Racism in America. “It's simply a story that has not been told.”
Paul Lombardo, the head of the University of Virginia's Center for Biomedical Ethics, said that North Carolina was “a unique example.” Others have wondered why that was the case.
“Why did it happen in North Carolina and not elsewhere?” asked Daniel Kevles, a professor of history at Yale University and the author of In the Name of Eugenics.
One reason was a group of Winston-Salem's elite who formed the Human Betterment League in 1947. Hosiery king James G. Hanes and Alice Shelton Gray, a trained nurse and another member of the local elite, joined forces with Dr. Clarence Gamble of Boston, the heir to the Procter & Gamble fortune. The group launched a massive publicity campaign in North Carolina to promote sterilization programs. Newspapers — including the Journal — bought into it, asked few hard questions, and paved the way for the eugenics board to expand its activities.
“I regret that the Journal, in its past, played a role in legitimizing these barbaric activities,” said publisher Jon Witherspoon. “On behalf of the Journal, I apologize for the paper's part in depriving these individuals of their basic human rights.”
The rich helped bankroll the program's expansion, and part of the motivation was financial. Awash with inherited money, Hanes and Gamble were concerned about how much welfare mothers and the mentally ill were costing taxpayers.
The eugenics board's files provide another answer to what happened in North Carolina, said Johanna Schoen, an assistant professor of women's history at the University of Iowa who gave the Journal access to a set of 7,000 records that she was allowed to copy more than 10 years ago. Since that time, the N.C. State Archives has declined other requests, and the records are officially closed to the public. The Journal has honored the medical confidentiality of the records.
“This view that we often have of sterilization — and particularly eugenic sterilization — of just being this evil thing that the state does got extremely complicated once I was confronted with these individual stories,” said Schoen.
“There are stories of the state doing incredible evil, and then there are stories of women who really want the sterilization, and then there are stories of women and men who are so mentally ill that they really are totally unable to take care of children ... there are no other solutions,” said Schoen, who has a book on the history of birth control and sterilization forthcoming from the University of North Carolina Press.
The program may have been complex, she said, but one thing is clear.
“I think the problem is that there are cases where sterilization was the solution — but sterilization authorized by the eugenics board is never the solution,” she said. “The very premise that the state had the right to do this was flawed.”
For decades there was little public debate over the program, and it went on operating so quietly that few public officials looked into what the board was doing.
Chris Coley of Raleigh was a staff lawyer with the N.C. attorney general's office in the early 1960s. He attended eugenics board meetings with few reservations. “But later on in life, reflecting back on what I was doing, I was a little bit shocked that there was such a procedure.”
Those who were swept up in the program suffered through the state's flawed premise.
You are absolutely tearing down the laws of God when you do this. God said when he drove Adam and Eve out of the Garden of Eden, — did He tell her to go out and be sterilized? God said go out and multiply. If sterilization isn't against that, what is?
— The grandfather of a 17-year-old girl, eugenics board hearing, 1938
The shadows of science
Good many of these farmers raise hogs and practice that on the female hogs. Spraying (sic) I think they call it. Same type of operation but they don't remove anything like they do in hogs.
— Dr. J.C. Knox, trying to reassure a family protesting the sterilization order for a 13-year-old girl, 1938.
The eugenics movement claimed that human traits such as intelligence, sexuality and criminality were determined almost entirely by genes, or “good blood.”
“It was misguided to assume that all behavior is directly the result of a gene,” Kevles said. “There are a large number of these things that are multigenetic if they are genetic at all, and it was evident that was the case by the 1920s.”
The idea flourished, said Lombardo of the University of Virginia, because it suggested that science could provide a simple solution to complex medical and social problems that have been a part of human existence since the dawn of civilization.
Eliminate the “bad” genes from the population, and future generations would flourish, the eugenics movement claimed — a rallying cry that helped inspire Hitler's idea of a master race.
“It's hopeful, which is why it was so popular. That was the seductive part of it,” Lombardo said.
Earlier this year, Virginia became the first state to issue a statement of regret for its sterilization program. The governor of Oregon apologized for a similar program last week. California led the nation with more than 21,000 sterilizations; Virginia was second with about 8,000, and North Carolina third. Many other states that had sterilization programs have lost the records or, in the case of Oregon, destroyed some of them.
The eugenics movement had so many scientific, medical and legal flaws, Lombardo said, that the idea of denying all access to the material is wrong.
“It does seem clear to me that when the procedures weren't appropriately followed, and people either couldn't understand or didn't know they were being sterilized, states do have an obligation to admit the truth,” he said.
There were warnings from scientists and religious leaders when the program was in its infancy, but North Carolina ignored them.
“Those who act in this way are at fault in losing sight of the fact that the family is more sacred than the state,” Pope Pius XI wrote in a 1931 statement protesting the eugenics movement. “Public Magistrates have no direct power over the bodies of their subjects.”
Inside the room
Thunderstorms rolled across the state and the temperature hit 90 degrees in Raleigh on July 25, 1945. The papers were full of news about the final drive to destroy the Japanese navy in the Pacific, and in previous months the horrible truth of Nazi death camps had shocked even a war-weary world.
There would have been no public mention of the smaller battle that was about to unfold in a small room in a state building. The eugenics board still did not have either a permanent office or a full-time secretary.
The board was considering the case of Sally, a 30-year-old white woman in a state institution.
“As I understand this case, it was considered as a consent case in the beginning,” said Clifford Beckwith, representing the state attorney general, as the hearing began. “I understand now that there is a misunderstanding about that. You were not quite sure what you had signed. Is that so?”
“Yes, sir,” replied Sally's parents.
Beckwith told the group, which included a sister and a cousin, that everybody would have an opportunity to speak and that the “misunderstanding” would be cleared up. “We are all working for the same thing — to do the best that can be done for the young lady and for all of you.”
“The misunderstanding was that they did not give it to me right,” Sally's father said. “I can't read nor write or understand writing and went ahead and signed. She's needed at home. No help with the victory garden so that it'll soon be gone. She ain't never been crazy.”
“We are working to do the very best for her,” Beckwith replied.
“As I understand the case, the patient has recovered from her nervous condition at the present time,” Dr. F.L. Welpley said. “She might have recurrent attacks, and if she married and had children they would have a tendency to have some kind of nervous and mental trouble through heredity. The idea would be to operate in such a way as to merely prevent her from having children. It would in no way affect her social life.”
“Sally has never been a filthy girl,” Sally's mother said. “She has just been overworked more than anything else.”
Dr. R.T. Stimpson asked if Sally would be able to care for children, and her mother replied, “She is the best child I have got, and let me tell you, a mother that has raised a large family don't want their children sterile — because I know she don't need it.”
“We are looking after the welfare of the patient and the public, too,” Welpley added. “If Sally had children, two or three might have to go to institutions.”
“I don't see why she needs sterilizing,” her cousin said. “She stays at home and works all the time. Sent her over here (the hospital) because she worked too hard.”
“I never knew hard work made people nervous,” Stimpson said.
“You just never done any,” the cousin shot back. “Try it and see.”
The hearing dragged on for perhaps 45 minutes and, like most other hearing cases, it seems to have been only a formality.
“Is there anything further to say?” Beckwith asked.
“If you would stop this and let me go home,” Sally replied. “Have mercy on me and let me do that.”
“What is decided will be our best judgment,” Beckwith said.
After the hearing the eugenics board voted 4-1 that Sally should be sterilized before release from the state institution.
The story of the eugenic sterilization movement in America has usually been told with sketchy, impersonal statistics, but the Journal's review of the North Carolina records presents the first overview of a eugenics bureaucracy from beginning to end and an inside look at the human tragedy that was taking place behind closed doors.
Few of the people who were sterilized ever appeared before the eugenics board. Officials consistently led the public to believe that the program did not force or pressure people to have sterilizations. But like Sally's family, most who objected did so in vain.
It would ruin her for life. We don't know whether she is ever going to have (children).
— A mother protesting the sterilization order. for her 17-year-old daughter, 1938
We just can't see, Mrs. ——, that you have given us any real reason why it shouldn't be done.
— Reply of board member Paul F. Mickey, representing the state attorney general
White and black, male and female, people were deemed to “need” sterilization for their own good or for the good of society. The individuals were vastly different, but the votes usually weren't - the eugenics board approved more than 90 percent of the petitions it reviewed.
From beginning to end, the records are filled with casual comments, not serious medical discussions.
“Pauper. Needs close supervision. Hypersexuality,” reads part of a 1939 petition that reduced a woman's life to 24 words. Still, that was enough for the eugenics board to conclude that she was feebleminded.
Other excerpts from the minutes read:
She wears men's clothing all time (sic),(1947).
Her mother says that she did not go to school as regularly as she could because she had sleepy spells and slight attacks of epilepsy...., (1954).
She seems lazy and unconcerned,(1960).
... while in school attempted to write love letters to boys she imagined were interested in her, (1962).
The entries got longer by the 1960s, but the extra words were hardly a sign of an improved program. In one case a father suspected of incest asked the eugenics board to sterilize his daughter, as if that were a solution.
This fourteen year old girl lives in a very poor home environment. Both parents appear to be limited, and the father admits to incestuous feelings for (his daughter) to his wife. Mrs.___ has been reported to the agency for sexual promiscuity by her own daughter but does make some efforts to give supervision. After the father admitted his feelings for ___ the mother had ___ carefully examined by a physician who reported that she had had intercourse.... The parents wish sterilization for ___ as they are afraid she will become pregnant.
Consent: signed by client's father, ___.
— Eugenics board records, 1962
The eugenics board approved the sterilization.
Schoen said she thinks that amidst hundreds of sad stories in the records are part of the explanation for why the North Carolina program continued long after the core scientific and social principles had been rejected in other states. At almost every meeting, she said, there were some cases that appeared to be justified or that presented situations that were much harder to manage before birth control was widely available.
Single illiterate girl, 20 years of age, who is the mother of two children.... At the age of 15 she cut her father in the head with an axe, and he died from injuries received. She shot her brother in the arm which necessitated the amputation of his arm above the elbow. At still another time she poured kerosene on her sister's hand and ignited it....” — Eugenics board minutes, 1949
This 32 year old woman is in her tenth out of wedlock pregnancy, and has seven living children. She loves her children and gives fairly adequate physical care but depends on her father to discipline the children. ... She is quite anxious for the operation as she thinks this is the only way she can stop having children. The parents agree to this.
— Eugenics board minutes, 1962
____ is a patient at ___ Hospital for the fourth time. She has been unable to assume the responsibility for her family since the children were placed in foster care in April 1960. The husband is in and out of prison.... When released from the hospital,___ has returned to her old pattern of prostitution. Since there are so few strengths in the family, sterilization will prevent additional children being born for whom there is no care.
— Eugenics board minutes, 1963
Schoen thinks that the cases of serious mental illness or of people who truly wanted the operation allowed board members to justify their work and overlook the many cases that were far more complicated. After a close examination of more than 7,000 records, Schoen said, she found just 446 cases in which the patient clearly desired the operation.
In thousands of the cases, the records are so sparse or unreliable that it is impossible to tell whether the patient was sterilized willingly or not. While almost all of the petitions showed the “consent” of a relative, patient or guardian, Schoen said, “You can't talk about this consent being freely given.” Patients in state institutions were told that they had to agree to sterilization as a condition of release, and in many cases people on welfare were threatened with loss of benefits, she said.
At one meeting the eugenics board took the official position that approval for operations could not be backdated, but in several other cases it did just that. Reports that many doctors were doing large numbers of sterilizations without approval did not result in investigations or reprimand, even though there was no voluntary sterilization law in North Carolina for individuals until 1963.
In the case of _____, Harnett County, where there had been a change of surgeon not authorized by the Board and the operation of sterilization performed on a date prior to the action of the Board, the Board authorized a nunc pro tunc order (now for then) be issued to include the date the operation was actually performed....
— Eugenics board minutes, 1959
The medically and ethically flawed case summaries meant that even well intentioned eugenics board members could make wrong decisions, Schoen said.
The lack of reliable data came in part from the fact that North Carolina was the only state where social workers had the power to recommend sterilization. With little or no medical training, such workers were poorly equipped to judge complex situations. Some counties did large numbers of sterilizations, while others did almost none. Whether people were sterilized often revolved around the attitude of an individual social worker.
“I never participated, that I recall, in a training course about sterilization,” said Ed Chapin, a former director of the Mecklenburg County Department of Public Welfare who handled sterilization cases in the 1960s. “It was just something you picked up.”
Some social workers got carried away, he said. One of his co-workers started sterilization petitions for almost “his entire caseload,” which was 60 women, Chapin said.
“It was clearly a great option for some people,” he said. “There were some kids ... who were genuinely retarded, and limited. And in those cases it was really a blessing for the family. And there wasn't a lot of resistance to that type of situation.
“But then on the other side of the coin, I think there were individuals who kind of saw this as "Enough's enough, she's already had one or two children, and let's put a stop to it.' Those people were kind of, I think, taken advantage of,” Chapin said.
But for most of the history of the program, there was no public acknowledgment from officials that the issues were complicated and that the state had failed to carry out proper safeguards against abuse. Newspapers and medical journals consistently failed to take hard looks at what was happening. Instead, they chose to repeat official assurances that problems didn't exist.
Medical and legal experts say that a debate over the eugenics movement isn't just one for the history books.
“The ethical issues that were raised by eugenics are likely to be the very same ethical issues that are being raised with genetic research, now and in the future,” said Selden, the University of Maryland professor. “They didn't have the technology to achieve their goals,” he said of the eugenics movement. “We do.”