'v^. ■"\ K-. '^ M '-k ^1 'm:f-}-'-\-^ *»^- ^, -VUr' <> -"v »V • •** «»J „. ALBERT R. MANN UBRARY AT CORNELL UNIVERSITY h'.l H M^l^^^ff^ l^iMWPIW—WI JMJ^lg^ IRfiwpiiffWiffwg : Ww^^P ^ iy**' 'BtfTfinHiriiiiiMft9- -JUSHBBB BB«™=- -SmHBES^ HIGHSMI TH 45 220 Cornell University Library HV 4989.L3 Eugenical sterilization in **i« 'J"'**!'.,^* IIIIIIIMII 111! J I HI lllllll lllilllllllll lllllilllllHl null"' 3 1924 013 882 109 ^r c^i^ 6^ V— -5.,^V^ ^^.^tUr 7^^^'^* ^ li^l Cornell University Library The original of tiiis book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/cletails/cu31924013882109 Eugenical Sterilization in the United States By Harry Hamilton Laughlin, D. Sc. Assistant Director of the Eugenics Record Office, Carnegie Institution of Washington, Cold Spring Harbor, Long Island, New York, and Eugenics Associate of the Psychopathic Laboratory of the Municipal Court of Chicago. Published by the Psychopathic Laboratory of the Municipal Court OF Chicago December, 1922 a Z_3 Copyright, 1832, by the Municipal Court of Chicago. C^V^^, ^ 3/ FRED KUtlN CO. PRINTBRS Chioaqo, Illinois *'^.?J 1 Keep the Life Stream Pure. Introduction Dr. Harry H. Laughlin, Eugenics Associate of the Psychopathic Laboratory of th? Municipal Court of Chicago, and Eugenics Director of Carnegie Institution of Washington, Cold Springs Harbor, N. Y., has rendered the nation a signal service in the preparation of this work; "Eugenical Sterilization in the United States." Since the rediscovery of Mendel's Law of Heredity and the recent advances made by the biologists and psychopathologists in respect-to the causes of mental and physical defects in the human race, with the conse- quent revelation of the great role played by heredity as a producing cause, the science of eugenics has become of vital importapce. "Eugenics," says Professor Irving Fisher, "stands against the forces which work for racial deterioration, and for improvement and vigor, intelligence and moral fiber of the human race. It represents the high- est form of patriotism and humanitarianism, while at the same time it offers immediate advantages to ourselves and to our children. By eugenic measures, for instance, our burden of taxes can be reduced by decreas- ing the number of degenerates, delinquents and defectives supported in public institutions; such measures will also increase safeguards against crimes committed against our persons or our property." America, in particular, needs to protect herself against indiscriminate immigration, criminal degenerates, and race suicide. The success" of democracy^ depends upon the quality of its individual elements. If in these elements the racial values are high, government will be equal to all the economic, educational, religious and scientific demands of the times. If, on the^ontrary, Jhere, is a^.constant and .^progressive racial degeneracy, it is only a question of time when popular self-govern- ment will be impossible, and will be succeeded by chaos, and finally a dictatorship. Dr. Laughlin is well qualified for the work he has undertaken. For twelve years4}e has been in immediate charge of the Eugenics Record Office (founded in 1910 by Mrs. E. H. Harriman and since 1918 a part of the Carnegie Institution of Washington), located at Cold Spring Harbor, Long Island, New York. There he. js^ engaged in organizing and con- ducting eugenical investigatjonf He is, also, Expert Eugenics Agent of the Xlommittee on Immigration and Naturalization of the House of Representatives of Washington, D. C, and recently organized the ex- hibits of the Second International Congress of Eugenics in New York City. As a product of scientific research the book will have permanent value. The importance and usefulness of the work is not to be gauged by the [V] extent of its circulation. Enough copies will be published to reach the leaders of the medical, legal and clerical professions, the press and mem- bers of legislative bodies. The Municipal Court of Chicago, which has for years made an in- tensive study of crime prevention, punishment and suppression, feels privileged to be able to make another notable contribution in this field. The courts have special functions to perform in the suppression of crime. The first of these is to enforce the laws impartially and justly. Incidental to this duty much original information comes to the judges of our courts, and it has been the policy of the Municipal Court to make pub- lic such incidental information, as the relationship between degeneracy and crime and their relationship to heredity, through the reports of its Psychopathic Laboratory. In the performance of this duty the Municipal Court of Chicago has pointed out the need of the permanent segregation of incorrigible defectives, which serves three purposes: First, the pro- tection of society from the individual offender ; second, the protection of the individual from himself, and, third, the restriction of propagation of the defective type due to heredity. The .alternative to segregation is to continue to do what we have been doing, that is, incarcerate the offender for a*time, more or less brief, and then permit him freedom to repeat his oflfensCj^jaid to propagate his kind. Segregation is necessary, even though sterilization were invoked. Sterilization protects future generations, while segregation safeguards the present as well. /The segregation of incorrigible defectives on farm colonies as a measure of crime prevention is urgently needed in the State of Illinois. However, in a number of states, fifteen up to the present time, experiments have been made with sterilization. The two theories of segregation and sterilization are not antagonistic, but both may be invoked. With the intention of covering every phase of crime prevention, the Municipal Court of Chicago publishes this work as an important contribu- tion to that cause. We desire to make acknowledgment to the sculptor, Charles Haag, for the use of his "Fountain of the Ages," to illustrate the significance of heredity arid the continuity of the blood stream. Harry Olson, Chief Justice. [vi] Preface This volume is intended primarily for practical use. It is designed to be of particular service to j four classes of personsT First, to law-makers^ who have to decide upon matters of policy to be worked out in legislation regulating eugenical sterilization; second, to judges of the courts, upon whom, in most of the states having sterilizatiori statutes, devolves the duty of deciding upon the constitutionality of new statutes, and of deter- mining cacogenic individuals and of ordering their sexual sterilization; third, to administrative officers who represent the state in locating, and in eugenically analyzing persons alleged to be cacogenic, and who are re- sponsible for carrying out the orders of the courts; and fourth, to in- dividual citizens who, in the exercise of their civic rights and duties, desire to take the initiative in reporting for official determination and action, specific cases of obvious family degeneracy. The work is designed also as an historical record of the several types of activities which characterized the early days of modern eugenical sterilization, and of the later working out, through legislation, litigation, experimental administration and scientific research, of a conservative state policy in reference to eugenical sterilization as an aid in protecting the country's family stocks from deterioration. The facts here reported have been secured, and the analyses and prin- ciples here given have been worked out during^thc^ast ten years. The present study _was. .begun by the author in', 1911,: as secre tary of a committee appointed by the Eugenics Section of ^the American Breeders' 7rssociatiorr^'to~Stu3y and to Report on the Best Practical Meaas., for ^Cutting Off the Defective Gerrn-Plajm in the Aujexlcan Population." Of this committee,(^Ir^_Bleecker Van Wagenen was chairman-.\ He reported a summary of the first j^ar's work to the First IhTerhafional Congress of Eugenics in London in 1912. In Febftiary, 1914, under the authorship of the secretary, it issued bulletins 10-a and 10-b of the Eugenics Record Office, entitled respectively, "The Scope of the Committee's Work," and "The Legal, Legislative and Administrative Aspects of Sterilization." The statistics reported in this work are brought down to January 1, 1921, and the legal records to January 1, 1922. Great care has been taken to insure completeness and accuracy of record and fact throughout the study, and an attempt has been made to cover the whole field of policy, legality and practice. Thanks are due for hearty co-operation in securing the facts needed for this work, to the superintendents of the custodial institutions in which eugenical sterilizing operations have been performed, to state officials [vii] who willingly supplied copies of official records, to judges of the courts of law before whom seven sterilization statutes have been tested, to the attorneys-at-law who have generously given legal advice and opinions, to many physicians who have been consulted in reference to the medical aspect of the problem, to the scientific field investigators of the Eugenics Record Office, to surgeons who have furnished case-records of persons sexually sterilized, and to authors and publishers of the several text-books on anatomy and surgery who have kindly permitted quotations in refer- ence to the technique of given sterilizing operations. Besides these many persons who have so generously aided the investi- gations, special obligations are due to Dr. Charles B. Davenport, Director of the Eugenics Record Office, for many constructive suggestions and for constant encouragement throughout the investigations, and to Hon. Harry Olson, Chief Justice of the Municipal Court of Chicago, for kindly writing the foreword, for rendering an opinion on the legal aspects of sterilization, which appears as Section 1 of Chapter IX, and for publishing the whole of these studies under the auspices of the Psychopathic Labora- tory of his court. Harry Hamilton Laughlin. Cold Spring Harbor, Long Island, N. Y., January 1, 1922. [ viii 1 Contents CHAPTER I. Chronological List of Laws, Amendments, Executive Vetoes, Repeals, Official Legal Opinions, Board Orders and Court Decisions Relating to Eugenical Sterilization Previous to January 1, 1922. CHAPTER IL Analysis, by States, of Sterilization Laws Enacted Prior to January 1, 1922. Page 1. Indiana 6 2. Washington. a. First Statute 6 b. Second Statute 6 3. California. a. First statute 6 b. Second statute 7 c. Amendment to second statute 7 d. Sterilization provision in act establishing Pacific Colony 8 4. Connecticut 8 5. Nevada ; 8 6. Iowa. a. First statute 8 b. Second statute 9 c. Third statute 9 7. New Jersey , 10 / i) New York .10 9. North Dakota 10 10. Michigan 1 ., 11 11. Kansas. a. First statute 11 b. Second statute 13 12. Wisconsin 13 13. Nebraska 13 34. Oregon 13 15. South Dakota 13 CHAPTER III. Texts and Legislative Records of the Eugenical Sterilization Laws. A. Laws Enacted Prior to January 1, 1932. 1. Indiana 15 2. Washington. a. First Statute 15 b. Second Statute 15 [ix] EuGENiCAi, Sterilization in the United States /ie courts 3. California. ^^^^ a. First statute b. Second statute c. Amendment to second statute d. Sterilization provision in act establishing Pacific Colony 19 4. Connecticut. a. First statute ^^ b. Sterilization provision of first statute extended to Mansfield State Training School and Hospital " 5. Nevada ^^ 6. Iowa. a. First statute ^^ b. Second statute ^^ c. Third statute ^^ 7. New Jersey ^^ 8. New York. a. Statute 25 b. Repeal 26 9. North Dakota 26 10. Michigan 28 11. Kansas. a. First statute 29 b. Second statute 30 12. Wisconsin 31 13. Nebraska 33 14. Oregon 33 15. South Dakota 34 B. Eugenical Sterilization Bills Vetoed. 1. Pennsylvania. A. Veto of 1905. a. Text of Bill 35 b. Veto Message '35 B. Veto of 1921. a. Text of Bill 37 b. Veto Message 38 C. Notes on the Situation in Pennsylvania 39 2. Oregon. A. Bill vetoed. a. Text of Bill 40 b. Veto Message 40 B. Law revoked by referendum. a. Text of law 41 b. Legislative and referendum record 42 3. Vermont. a. Text of Bill 44 b. Veto Message 45 4. , Nebraska. a. Text of Bill 46 b. Veto Message 47 JiuGENiCAi, Sterilization in vat Unitud States xi ^1 5. Idaho. Page i a. Text of Bill ' 48 b. Veto Message 50 CHAPTER IV. Statistical and Descriptive Summary of Eugenical Sterilization in the Several States. I. Institutional Statistics and Official Reports and Opinions. 1.! California 52 3. Connecticut 61 3. Indiana 63 4. Iowa 64 5. Kansas 69 6. Michigan 73 7. Nebraska 74 8. Nevada 79 9. New Jersey .' . 80 lOy New York 81 11. North Dakota 87 12. Oregon 88 13. South Dakota 90 14. Washington 91 15. Wisconsin 92 11. Summary. A. Statistical Summary to January 1, 1921. a. States and institutions 96 b. Total number of eugenical sterilization operations in all fifteen states . . 96 1. By sex 96 2. By radicalness of operation 96 3. By classes 96 4. By states 96 5. By time 96 B. Descriptive Summary • 97 CHAPTER V. Analysis of the Eugenical Sterilization Laws by Subject. 1. The Motives of the Sterilization Statutes. A. The motive of heredity 99 B. Therapeutic motive 100 C. Punitive motive 101 2. Executive Agencies 102 3. Provisions for Making Family History Studies 104 4. Biological Criteria for Determining the Applicabilty of the Law to a Particular Individual ; 104 5. Court Procedure Provided by the Several Sterilization Statutes 107 6. Legal Counsel for the State arid for Persons Nominated for the Operation.... 110 7.J Is the Consent of the Patient or Guardian a Necessary Pre-requisite to Legal Eugenical Sterilization ? 110 8. Type of Operation and Manner of its Performance Ill 9, Bad Biology in the Eugenical Sterilization Statutes 113 xii EuGENiGAL Sterilization in the United States Page 10. Mandatory and Optional Elements in the Laws 11* 11. Sexual Sterilization of Criminals ll'' 12. Legal Liability of Executive Agents and Surgeons 1^* 13. Punishment for Dereliction in Executing the Law 1^5 14. Punishment for the Illegal Use of Sexual Sterilization 125 15. The Legal Aspect of Sexual Sterilization for Therapeutic Purposes 127 16. The Sexual Sterilization of Inmates of Custodial Institutions Prior to their Release 128 17. Class Legislation 130 18. What Constitutes Due Process of Law in Eugenical Sterilization? 138 19. Records and Reports Required by Law 137 20. Costs and Appropriations 139 CHAPTER VI. Analytical Outline of Litigation Groxving Out of the Several Eugenical Sterilization Statutes Previous to January 1, 1922. Introduction 142 1. Washington 142 2. New Jersey .■ 142 3. Iowa 143 4. Michigan 143 3. New York 144 6. Nevada 145 7. Indiana -. 145 8. Oregon 146 Summary: The Present Legal Status of Eugenical Sterilization 147 CHAPTER VII. Detailed Review of Litigation Growing Out of the Several Eu^^enical Sterilization Statutes. PART I— WASHINGTON. 1. Superior Court 149 3. State Supreme Court. a. Brief of Appellant 149 b. Brief of Respondent 152 c. Decision of Supreme Court 159 PART II— NEW JERSEY. 1. Board of Examiners. a. Order for Sterilization 164 2. State Supreme Court. a. Writ of Certiorari 165 b. On Certiorari — Reasons 165 c. Brief of Appellant 166 d. Brief of Defendants Igg e. Brief of Elmore T. Elver, amicus curiae 172 f. Decision of Supreme Court 1^4 PART III— IOWA. 1. State Board of Parole. a. Order for Sterilization ^.^g XVUOJSJNICAI, STERILIZATION IN THE UniT^D STATES xiii 3. United States District Court. Page a. Temporary Restraining Order 180 b. Bill of Complaint 181 c. Amendment to Bill of Complaint 183 d. Reports of Attorney-General 184 e. Minutes of Meeting of Board of Parole 185 f. Decision of District Court 186 g. Order for Temporary Injunction 190 3. United States Supreme Court. a. Brief of Plaintiffs in Error 191 b. Supplementary Brief 198 c. Decision of Supreme Court of United States 200 PART IV-.MICHIGAN. 1. Probate Court of Lapeer County. a. Notice by Board of Control to Guardian 203 b. Reply to Notice 204 c. Petition of Superintendent 204 d. Order Denying Petition 205 e.. Notice of Appeal 305 3. Circuit Court of Lapeer County. a. Order Dismissing Appeal 206 b. Opinion of Circuit Judge 306 3. State Supreme Court. a. Petition to Supreme Court 207 b. Order of Supreme Court 208 c Return of Respondent 209 d. Brief of Attorney-General as amicus curiae 209 e. Decision of Supreme Court 213 PART V— NEW YORK 1. State Board of Examiners. a. Origin of Test Case 217 2. Supreme Court, Albany County. a. Affidavit and Order Appointing Counsel 217 b. Summons and Complaint 219 c. Answer 221 d. Findings of Fact and Conclusions of Law 221 e. Exceptions of Defendant to Conclusions of Law 222 f. Opinion of Rudd, J 222 g. Judgment of Supreme Court 227 h. Notice of Appeal * 228 i. Stipulation for Settlement of Case 228 j. Order Settling Case 229 k. Stipulation Waiving Certification. 239 3. Appellate Division, Supreme Court. a. Brief for Plaintiff-Respondent 329 b. Decision 234 xiv EUGENICAL STERIUZATION IN THE UnITED STATES 4. Court of Appeals. 234 a. Brief on Behalf of Defendants b. Case Pending PART VI— NEVADA. 1. District Court of the Fourth Judicial District of the State of Nevada. a. Sentence 2. United States District Court in and for Nevada. a. Petition of Plaintiff ^*® b. Order to Show Cause and Restraining Order 247 24R c. Answer d. Stipulation ^^ e. Plaintiff's Brief 249 f . Decision of United States District Court 250 PART VII— INDIANA. 1. Circuit Court of Clark County. a. Petition of Plaintiff 256 b. Consent of Next Friend 257 c. Demurrer Filed by Defendants 257 d. Demurrer overruled and excepted 257 e. Judgment 257 . f . Notice of Appeal 258 g. Praecipe for Transcript 258 8. State Supreme Court. a. Appellant's Brief 258 b. Appellee's Brief 264 c. Judgment 269 PART VIII— OREGON. 1. State Board of Eugenics. a. Record of Investigation 271 b. Findings 271 c. Order for Sterilization 272 3. Circuit Court for the County of Marion. a. Demurrer 272 b. Brief of Defendant in Support of Demurrer 273 c. Points and Authorities (By Smith & Shields, and Allan Bynon, amicus curiae, in support of defendant's demurrer) , , 279 d. Answering Brief of Plaintiff 283 e. Opinion of Percy R. Kelly and Geo. G. Bingham, Judges 287 f. Decision of the Circuit Court 889 CHAPTER VIII. Case and Family Histories of Individual Subjects of Litigation Growing Out of the Several Eugenical Sterilization Laws. Introduction 291 1. Peter Feilen, moral pervert, Washington 292 2. Alice Stnith, epileptic and feeble-minded, New Jersey 292 EuGENicAiv Sterilization in the United States xv Page 3. Rudolph Davis, felon, Iowa 304 4. Nora Reynolds, feeble-minded, Michigan 305 5. Frank Osborn, feeble-minded, New York 305 G. Pearley C. Mickle, moral pervert, Nevada 311 7. Warren Wallace Smith, moral pervert, Indiana 312 8. Jacob Cline, moral pervert, Oregon 318 CHAPTER IX. Legal Opinion. 1. Opinion by Honorable Harry Olson, Chief Justice, Municipal Court of Chicago. 333 3. Official Opinion of the Attorney-General of California on the Asexualization Law 334 3. Opinion of the Attorney-General of Connecticut on the Asexualization Act.... 338 4. Additional Opinion by the Attorney-General of Connecticut 333 5. Opinion by Louis Marshall, Esquire 334 6. Brief by Charles A. Boston, Esquire 336 Summary 336 CHAPTER X. The Right of the State to Limit Human Reproduction in the Interests of Race Betterment. Introduction 338 A. Parallel Cases of the Restriction of Personal Liberty in the Interests of the General Welfare. 1. Compulsory Vaccination 339 3. Quarantine 341 B, Legislative and Judicial Activities Regulating or Limiting Human Repro- duction. 1. Limitation of Marriage 343 a. List of legal limiting causes 343 b. The special case of venereal and other transmissible diseases. bl. Analysis of laws limiting marriage on account of venereal or other transmissible diseases 343 b2. Constitutionality of the Wisconsin statute requiring certificate of health for males before marriage license is issued 344 c. Judicial annulment of marriage in the interest of public health and racial welfare 345 cl. Wisconsin Supreme Court 345 c3. New York Court (New York County) 345 c3. New Jersey Court of Chancery (concealment of insanity) 346 c4. New Jersey Court of Chancery (concealment of venereal disease). 2. Birth Control 346 a. Review of criminal statutes on Birth Control: Judge J. C. Ruppenthal 347 b. Conclusions 348 3. Control of Immigration ' 349 4. Institutional Segregation of Social Inadequates 350 a. Quotation from Dr. Henry M. Hurd 350 b. Conclusion ,. 351 xvi EuGENiCAi. Steriuzation in thb United States Page 5. Eugenical Sterilization. „> a. Cases of Eugenical Sterilization in States having neither autflorizing nor restricting statutes 351 al. Case of M H of Massachusetts 352 a3. Case of "X" of Illinois 354 b. Legal Situation in England 355 bl. Would it be lawful to sterilize? 355 b3. Who should operate? 356 b3. Penalties for wrongfully operating 356 Conclusion ; 356 C. Possible New Fields for Eugenical Legislative Activity 356 I. Eugenical Education 356 8. Compulsory Reporting of Cases of Cacogenesis 357 3. Registering Trained Eugenical Investigators 358 Summary 359 CHAPTER XL Eugenical Diagnosis. A. Guiding Principles for the Determination of Potential Parenthood of Socially Inadequate Offsoring. I. General Factors of the Task 362 a. Pedigree-facts 362 b. Knowledge of heredity 363 c. Application 'of pedigree-facts to the rules of heredity 363 II. Notes on Practical Eugenical Diagnosis 364 {t. Divergence between personal qualities and breeding qualities 364 2. The individual of pure stock 364 3. The individual of mixed stock 364 'ij Range of individual breeding qualities 365 5. The complexity of hereditary traits or characters 365 6. Specific rules of inheritance. a. Recessive traits 365 b. Dominant traits 365 c. Sex-linked traits 365 d. Other types of inheritance 366 7. Hereditary nature of the co-parent 366 8. Eugenical salvage — the separation of good trnits from bad in the same individual 367 9. The faclor of environment 367 10. Eugenical standards. a. The biological standard 368 b. The legal standard 368 U; Types of the socially inadequate 369 Ci^f Common sense and pedigree study 369 Summary 370 B. List of Characters in Man Classified According to Their Method of Inherit- ance. I. Traits which blend in the F, offspring 372 EuGENicAi, Sterilization in the United States xvii Page II. Traits showing dominance of one condition and recessiveness of the allelomorph in the first generation and segregation in subsequent genera- tions of offspring 373 III. Sex-linked traits 376 IV. Probably Mendelian, but dominance imperfect or uncertain 377 V. Clearly hereditary, but rule of inheritance uncertain 377 VI. Associated traits 380 C. Tables Showing Types of Matings and Offspring. Type a. In case the defect is recessive 381 Type b. In case the defect is dominant 382 Type c. A sex-linked trait 383 Type d. A trait that blends 384 Type e. A composite trait 385 D. References. 1. Research Institutions 392 2. Societies 392 3. Universities and colleges with active departments of genetics 393 4. Custodial institutions for socially inadequate conducting field studies in eugenics 393 5. Courts which have undertaken scientific eugenical studies 394 6. Journals 394 7. Books 394 CHAPTER XII. The Anatomical and Surgical Aspects of Eugenical Sterilization. Section A. Anatomy, Description of the Human Male and Female Reproduc- tive Mechanisms and an Explanation of their Functions 397 a. Reproductive mechanism of the human male 398 b. Reproductive mechanism of the human female 402 Section B. Surgery. The Principal Types of Surgical Operations Used in Ef- fecting Sexual Sterilization. 1. Male. (1) Phallo-orchidectomy 407 (2) Phallectomy 407 (3) Castration (Orchidectomy) 409 (4) Spermectomy 410 (5) Vasectomy 410 (6) Ligation of the vas deferens 411 (7) X-ray treatment 413 2. Female. (1) Pan-hystero-kolpectomy 414 (2) Hystero-salpingo-oophorectomy 414 (3) Oophoro-hysterectomy 414 (4) Hysterectomy 414 (5) Salpingo-oophorectomy 415 (6) Oophorectomy (ovariectomy, ovariotomy, castration, spaying) 415 (7) Curetting or cauterizing the intra-uterine tubal openings 417 (8) Salpingectomy 419 (9) Ligation of Fallopian Tubes 421 (10) X-ray treatment 421 Xviii EUGUNICAL SffiRII/IZATlON IN THE UNITED STATES Summary. Page a. Types of Eugenical Sterilization Available. 1. For the male 422 2. For the female 422 b. Future Methods 422 c. Weighing the Matter of Type of Eugenical Sterilization in Relation to Eugenical Policy • 423 Appendix: Continence and Contraception 423 CHAPTER XIII. The Physiological and Mental Effects of Sexual Sterilization. Introduction 425 1. The Normal Course of Sexual Functions 425 2. Functions of the Sex-Glands, Other than Reproduction. a. Male— Testes 425 b. Female — Ovaries 428 3. Classification of the Case-Histories 429 a. Type of social inadequacy 430 b. Sex 430 c. Age 430 d. Type of operation 431 4. Testimony on the Effects of Sexual Sterilization. A. Primary Testimony 431 B. Supplementary Testimony 431 a. A. W. Wilmarth, M. D., Superintendent Wisconsin Home for Feeble- minded 431 b. Havelock Ellis, from his book "The Sexual Impulse" 432 c. Robert Reid Rentoul, M. D., from his book "Race Culture or Race Suicide" 433 d. Martin W. Barr, M. D., in his book "Mental Defectives" 433 c. F. C. Cave, M. D., Journal of Psycho- Asthenics 1911 ; 434 5. Summary: A. Functions of the Sex-Glands 434 B. Effects of Sexual Sterilization. I. Anatomical and physiological effects by sex, age and type of operation. (A) Male. (a) Vasectomy or its functional equivalent. (1) Before puberty 434 (2) During adolescent and adult life 435 (3) In old age 435 (b) Castration. (1) Before puberty 435 (2) During adolescent and adult life 435 (3) In old age 435 (B) Female. (a) Salpingectomy or its functional equivalent. (1 ) Before puberty 435 (2) During reproductive period 435 (3) After the climacteric 435 EuGENiCAL Sterilization in the United States xix (b) Oophorectomy, Page (1) Before puberty 435 (2) During reproductive period 435 (3) After the climacteric 435 II. General Summary of Evidence on the Mental and Temperamental Effects of Sexual Sterilization 436 III. Summary of Evidence on Sexual Sterilization as a Therapeutic Agent... 436 CHAPTER XIV. The Legal, Biological and Practical Requirements for an. Effective Eugenical Sterilization Law. Introduction 438 A. Commonly Stated Objections to the Existing Sterilization Laws. 1. In advance of public opinion 438 2. Violation of the Bill of Rights 438 3. Ill-adapted to their implied purposes , 439 4. Inadequate executive machinery «.,. 439 5. Lack of cooperation among sociologists 439 6. Encourages immorality 439 B. Requirements for an Effective Eugenical Sterilization Law. a. Legal requirements. 1. Class legislation 440 3. Due process of law 441 3. Cruel and unusual punishment 442 4. Bill of attainder 443 5. Twice in jeopardy of life and limb , 442 6. Ex post facto , 443 b. Biological and eugenical requirements. 1. Standard for legal parenthood 443 2. The line of demarcation between eugenic and cacogenic 443 3. Insurance against reproduction by cacogenic persons 443 4. Development of eugenic standards 443 5. Suspension of order for eugenical sterilization 443 6. Adequate evidence of cacogenesis 443 c. Practical requirements. 1. Well-trained executive > 443 3. Due provision for prompt court procedure 443 3. Ample funds for enforcement 444 4. Due provision for modern surgical work 444 Conclusion • 444 CHAPTER XV. Model Eugenical Sterilization Law. A. Principles Suggested for a Standard State Law : 446 B. Full Text for a Model State Law. Section 1. Short title 446 Section 2. Definitions. a. Socially inadequate person 446 b. Socially inadequate classes 446 X3f EuGENicAi; Sterilization in the United States Page c. Heredity **'' d. Potential parent e. To procreate f. Potential parent of socially inadequate offspring **''' g. Cacogenic person h. Custodial institution **' i. Inmate ' j. Eugenical sterilization "'' Section 3. Office of State Eugenicist **'' Section 4. Qualifications of State Eugenicist 447 Section 5. Term of office, appointment and responsibility 447 Section 6. Seal 447 Section 7. Duties of State Eugenicist. a. Field surveys 448 b. Further examinations 448 c. Roster custodial institutions 448 d. Case-histories '. 448 e. Records, S'ate Eugenicist's Office 448 f. Other duties 448 Section 8. Cooperation by custodial institutions 448 Section 9. Power to administer oaths and make arrests 448 Section 10. Opinion of State Eugenicist 448 Section 11. Appointment of date for hearing 449 Section 13. Notification of parties concerned 449 Section 13. State's legal counsel 449 Section 14. Determination by jury 449 Section 15. Judgment 449 Section 16. Appeals 450 Section 17. Type of eugenical sterilization 450 Section 18. Manner of consummation 450 Section 19. Liability 450 Section 20. Illegal destruction of reproductive functions 450 Section 21. Punishment of responsible head of institution for dereliction 450 Section 22. Supremacy of this act 451 Section 23. When effective 451 C. The Federal Government and Eugenical Sterilization, a. Principles suggested for a Federal Statute 451 b. Comment ' _ _ 45^ CHAPTER XVI. Explanatory Comments on the Model Sterilization Law. Introduction ... P'"^f^" 454 Section 1. Short title ... 454 Section 3. Definitions. a. Socially inadequate person b. Socially inadequate classes ... 455 c. Heredity 455 d. Potential parent ■ 455 EUGENICAL STURIUZATION IN TH]J UniTED STATES Xxi Page e. To procreate 455 f. Potential parent of sccially inadequate offspring 455 g. A cacogenic person 456 h. Custodial institution , 456 i. . Inmate 456 j. Eugenical sterilization 456 Section 3. Office of State Eugenicist 456 Section 4. Qualifications of State Eugenicist 457 Section 5. Term of office, appointment and responsibility 457 Section 6. Seal 457 Section 1. Duties of State Eugenicist 457 Section 8. Cooperation by custodial institutions 458 Section 9. Power to administer oaths and to make arrests 458 Section 10. Opinion of State Eugenicist 458 Section 11. Appointment of date for hearing 458 Section 13. Notification of parties concerned 458 Section 13. The State's legal counsel 459 Section 14. Determination by jury 459 Section 15. Judgment 469 Section 16. Appeals 459 Section 17. Type of eugenical sterilization 459 Section 18. Manner of consummation 459 Section 19. Liability 460 Section 30. Illegal destruction of reproductive functions 460 Section 21. Punishment of responsible head of institution for dereliction 460 Section 23. Supremacy of this act 460 Section 23. When effective 460 Appendix: Appropriations 460 CHAPTER XVII. Set of Forms Suggested for the Use of the State Eugenicist, the Courts, Private Citizens, and Custodial Institutions in Administering the Model Eugenical -^ , , T- Sterilization Law. Model rorms. 1. Case Record by State Eugenicist 464 a. Historical record 466 b. Record of investigation by State Eugenicist 467 c. Report to State Eugenicist 467 2. Information or complaint by private citizen to State Eugenicist y^ i&t 3. Institutional record of individual inmate prepared for State Eugenicist..,<< . . . 468 4. Report of State Eugenicist (a. opinion, b. evidence, and c. petition)/? 469 5. Action begun by private citizen , 470 a. Individual petition to court - 470 b. Order of court denying private petition .' 471 c. Order of court to State Eugenicist to investigate a particular case 471 6. Hearing I 473 a. Proclamation appointing time and place for hearing 472 b. Summons of propositus 472 1. Summons to propositus in case such propositus is not an inmate of a custodial institution and is personally capable of understanding the nature of a summons 473 xxii EuGENiCAL Sterilization in the United States Page 2. Order to guardian or custodian of propositus in case such propositus is an inmate of a custodial institution or lives under guardianship in the population at large ^'^^ 3. Order for arrest and presentation to court of the person of the pro- positus in case such propositus is neither an inmate of a custodial institution, nor living under guardianship in the population at large nor is capable of understanding the nature of a summons 474 c. Notification to Attorney-General 474 d. Instruction of Attorney-General to County Attorney 475 e. Appointment of legal counsel for the propositus 475 f. Notification of State Eugenicist 476 g. Subpoena for witnesses 476 h. Summons for jury 476 7. Judgment and order. a. Verdict of jury 477 b. Judgment of the court 477 c. Order to State Eugenicist for the eugenical sterilization of a cacogenic person in the population at large 478 d. Order to State Eugenicist for the eugenical sterilization of a cacogenic person who is an inmate of a custodial institution 479 e. Order to responsible head of custodial institution 480 f. Order to State Eugenicist for the temporary suspension of an order for eugenical sterilization 481 g. Order to a cacogenic person whose eugenical sterilization has been temporarily suspended, to report periodically to the State Eupenicist 482 h. Order to State Eugenicist for the eugenical sterilization of a cacogenic person, the original order for whose sterilization has been temporarily suspended 483 8. Execution of Order. a. Contract with surgeon or physician to eugenically sterilize. 1. A cacogenic person in the population at large 484 3. A cacogenic person who is an inmate of a custodial institution 485 b. Report of surgeon or physician to State Eugenicist 486 c. Return of State Eugenicist to court in case of the eugenical sterilization of a cacogenic person in the population at large 487 d. Return of State Eugenicist to court in case of the eugenical sterilization of a cacogenic person who is an inmate of a custodial institution 488 e. Semiannual return of State Eugenicist to the court in case an original order for eugenical sterili2ation has been temporarily suspended 489 9. InstitutidJ^al data kept by State Eugenicist. a. Roster of custodial institutions 490 b. Monthly institutional report to State Eugenicist of accessions and losses ^ 492 10. Record of an {(Tidividual case of sterilization. a. Case recordj of eugenical rterilization 493 11. Appropriations;. a. Working jiraft of appropriations section to be inserted in the proper place in t^e state's appropriation bills, according to the legislative practice of the piirticular state 494 List of Illustrations Page Figure 1. Schematic Representation of Genital Tract in the Male 398 Figure 2. The Testis and its Coverings 399 Figure 3. The Structure of the Spermatic Cord 400 Figure 4. A Sectional View of the Testis 401 Figure 5. The Development of a Human Spermatozoon 403 Figure 6. Schematic Representation of the Genital Tract in the Female 403 Figure 7. The Ovary, Fallopian Tube and Uterus in Place 403 Figure 8. A Diagrammatic Section of the Human Ovary 404 Figure 9. A Mature Human Ovum 405 Figure 10. The Operation of Castration 409 Figure 11. The Operation of Vasectomy 410 Figure 12. The Abdominal Incision used in Salpingectomy and Oophorectomy 415 Figure 13. The Operation of Oophorectomy (Kelly-Noble) 416 Figure 14. The Operation of Salpingectomy (Warbasse) 419 Figure 15. The Operation of Salpingectomy (Margaret H. Smyth) 420 Pedigree Charts — Chapter 8 Pedigree Chart of Alice Smith 304A Pedigree Chart of Warren Wallace Smith 320A Pedigree Chart of the H . . . . Family of Massachusetts 353 xxm CHAPTER I. CHRONOLOGICAL LIST OF LAWS, AMENDMENTS, EXECUTIVE VETOES, REPEALS. OFFICIAL LEGAL OPINIONS, BOARD ORDERS, AND COURT DECISIONS . RELATING TO EUGENICAL STERILIZATION PREVIOUS TO JANUARY I. 1922. Date. State and Action. Specific Nature of Official Action. 1. March 30, 1905... 2. March 9, 1907 3. February 23, 1909. 4. March 22, 1909... 5. April 26, 1909 6. August 12, 1909.. , 7. March, 2, 1910..., 8. March 17, 1911... 9. April 10, 1911 10. April 21, 1911 11. September 30, 1911 12. April 16, 1912 13. May 31, 1912 14. September 3, 1912 15. December 9, 1912. 16. January 31, 1913.. 17. February 18, 1913. 18. March 13, 1913... 19. March 14, 1913... 20. April 1, 1913 21. April 14, 1913. 23. April 19, 1913. Pennsylvania. Veto. . Indiana. Statute . . . . Oregon. Veto ...... Washington. Statute . California. Statute . . Connecticut. Statute California. Opinion . Nevada. Statute Iowa. Statute New Jersey. Statute. Washington. Order . . New York. Statute New Jersey. Order. Washington. Court De- cision Connecticut. Opinion., Vermont. Veto Oregon. Statute North Dakota. Statute Kansas. Statute Michigan. Statute . . . Nebraska. Veto Iowa. Statute Bill vetoed. (See p. 35.) Chapter 215. (See p. 15.) Bill vetoed. (See p. 40.) Chapter 249, Sec. 35 Criminal Code. (See P. 15.) Chapter 730. (See p. 17.) Chapter 209. (See p. 19.) Attorney General of the State rendered an opinion defending the constitutional- ity of the Act of April 26, 1909. (See p. 332.) Section 28 Crimes and Punishments Act. (See p. 31.) Chapter 129. (See p. 31.) Chapter 190. (See p. 23.) Superior Court of King County, as an additional punishment, ordered sterili- zation by vasectomy of Peter Feilen. (See p. 149.) Chapter 445. (See p. 25.) Board of Examiners ordered the steriliza- tion by salpingectomy of Alice Smith, an inmate of the State Village for Epi- leptics at Skillman. (See p. 164.) Supreme Court of State held the Act of March 22, 1909, constitutional. (See p. 159.) Attorney General of the State rendered an opinion upholding the constitutional- ity of the Act of August 13, 1909. (See P. 326.) Bill vetoed. (See p 44.) Chapter 63. To become effective June 3, 1913. (See p. 42.) Chapter 56. (See p. 26.) Chapter 305. (See p 29.) Act No. 34. To become effective August 14, 1913. (See p. 28.) Bill vetoed. (See p. 46.) Chapter 187, Second Statute, also repeals Act of April 10, 1911. (See p. 22.) List of Laws, etc.. Relating to Eugenicai, Sterilization Date. State and Action. Specific Nature of Official Action. 33. May 31, 1913 24. June 13, 1913 25. July 30, 1913 26. November 4, 1913. 27. November 18, 1913 Oregon. Referendum . . California. Statute . . . . Wisconsin. Statute . . . . Oregon, Revocation . . New Jersey. Court De- cision 28. March 5, 1914 29. June 24, 1914. 30. June 1, 1915. Iowa. Order Iowa. Court Decision.. New York. Initiating Test Case 31. July 4, 1915. 32. July 8, 1915 33. August 14, 1915... 34. September 17, 1915 Iowa. Statute . . . , Nebraska. Statute Nevada. Order . . , New York. Court De- Referendum for repeal of Law of Febru- ary 19, 1913, duly invoked. Law held in abeyance until decision. (See p. 41.) Chapter 363, Second Statute, also repeals Act of April 26, 1909. (See p. 18.) Chapter 693. (See p. 31.) Referendum duly jevoked Act of Febru- ary 18, 1913. (See p. 42.) Supreme Court of the State set aside the order of the Board of Examiners of May 31, 1912, for the sterilization by salpingectomy of Alice Smith, an in- mate of the State Village for Epileptics, and held the Act of April 21, 1911, "un- constitutional." (See p. 174.) State Board of Parole ordered steriliza- tion by vasettomy of Rudolph Davis, No. 10,406, an inmate of penitentiary at Fort Madison, twice convicted of felony. (See p. 179.) U. S. District Court, District of Southern Iowa, Eastern Division, held the Act of April 19, 1913, •'unconstitutional." (See p. 186.) Dr. Lemon Thompson of the ■ Board of Examiners made application to the Supreme Court — Albany County, for the appointment of legal counsel to defend Frank Osborn, an inmate of the State Custodial Asylum, in a test case. (See p. 217.) Chapter 802, Third Statute, also repeals Act of April 19, 1913. (See p. 23.) Chapter 237. (See p. 32.) Fourth Judicial Court of Nevada (County of Elko) ordered as an additional punishment the sterilization by vasecto- my of Peariey C. Mickle. (See p. 243.) State Supreme Court — Albany County, held the statute "unconstitutional and invalid" and issued an order in which the Board of Examiners was "perpetu- ally enjoined and restrained from per- forming or permitting to be performed the aforesaid threatened operation." (See p. 221.) List op Laws, etc.. Relating to Eugenicai, Sterilization Date. State and Action. Specific Nature of Official Action. 35. May 4, 1916. Michigan. Court De- 36. May 21, 1917...,. 37. May 26, 1917 38. July 1, 1917 39. July 26, 1917 40- July 31, 1917 41. September 10, 1917 43. January 15, 1917., Oregon. Statute Kansas. Statute South Dakota. Statute. California. Statute . . . . California. Statute . . . . Michigan. Court De- cision Iowa. Court Decision. 43. March 8, 1918 New York. Court De- cision 44. March 28, 1918. Michigan. Court De- cision 45. May 25, 1918. Nevada. Court Decision Probate Court of Lapeer County denied the petition of the Michigan Home and Training School at Lapeer to order the sterilization of Nora Reynolds, an in-' mate of said institution, on the ground that the Act of April 1, 1913, is un- constitutional. (See p. 203.) Chapter 279. (See p. 33.) Chapter 299. (See p. 30.) Chapter 236 (S. B. 257.) (See p. 34.) Chapter 489, Amends the Act of June 13, 1913. (See p. 18.) Section 42, Chapter 776. (See p. 19.) Ex- tended provisions of Sterilization Law to the Pacific Colony. Order of Circuit Court of Lapeer County sustaining decision of Probate Court of same County that the Act of April 1, 1913, is "unconstitutional." (See p. 206.) The U. S. Supreme Court reversed the decision of June 24, 1914, of the District Court because meanwhile (July 4, 1915) Iowa repealed the Act of April 19, 1913, and enacted a new (the third) steriliza- tion statute. Case not tried on its merits. (See p. 200.) At a Special Term, the Supreme Court of Albany County sustained the findings of September 17, 1915, of the same court, perpetually enjoining the Board of Examiners from sterilizing by vasec- tomy Frank Osborn, an inmate of the Rome Custodial Asylum, and holding the Act of April 16, 1912 "unconstitu- tional and invalid." (See p. 221.) State Supreme Court sustained decision of Probate Court of Lapeer County of May 4. 1916, and of Circuit Court of the same county of September 10, 1917, that the Act of April 1, 1913, is uncon- stitutional. (See p. 213.) The U. S. District Court in and for the District of Nevada held the Nevada Act of March 17, 1911 "unconstitu- tional." (See p. 245.) List o? Laws, Utc, Relating to Eugenical Sterilization Date. 46. July 1, 1918. 47. March 18, 1919. 48. April 3, 1919... 49. December 4, 1919. 50. May 10, 1930. 51. May 11, 1931. 5k May 35, 1981 53. January 37, 1931. 54. March 8, 1931 55. December 13, 1931 State and Action. New York. Court De- cision Idaho. Veto Connecticut. Statute Indiana. Court Decision New York. Statute Re- pealed Indiana. Court Decision Pennsylvanj^. Veto . . . Oregon. Order Washington. Statute . . Oregon. Court Decision Specific Nature of Official Action. Supreme Court, Appellate Division, Third Department. "Judgment unanimously affirmed on the opinion of Rudd, J., at Special Term." (See p. 234.) Bill vetoed. (See p. 50.) Chapter 69 Public Acts of 1919 (see p. 19). Extended the provisions of the Sterilization Law to the Mansfield State Training School and Hospital. (See p. 30.) Circuit Court of Clark County held "Vasectomy Law" (Chap. 315, 1907) unconstitutional. Judge James W. For- tune. (See p. 257.) L. 1920. Chap. 619. (See p. 26.) State Supreme Court (No. 23,709, Appeal from Clark County Circuit Court). Sustained the decision of the Trial Court holding the "Vasectomy Law" (Chap. 215, 1907) unconstitutional. (See p. 358.) Bill vetoed. (See p. 38.) Oregon State Board of Eugenics ordered the sterilization of Jacob Cline, an in- mate of the Oregon State Penitentiary. (See p. 272.) Chapter 53 of the Session Laws of 1921, H. B. 190. (See p. 15.) Circuit Court of the State of Oregon for the County of Marion held the statute of February 19; 1917, unconstitutional. (See p. 289.) CHAPTER II. ANALYSIS, BY STATES, OF STERILIZATION LAWS ENACTED PRIOR TO JANUARY 1, 1922 1. Indiana 6 3. Washington: a. First Statute 6 b. Second Statute 6 3. California: a. First Statute 6 b. Second Statute 7 c. Amendment to Second Statute 7 d. Sterilization Provision in Act establishing Pacific Colon; 8 4. Connecticut 8 5. Nevada 8 6. Iowa: a. First Statute 8 b. Second Statute 9 c. Third Statute 9 7. New Jersey 10 8. New York 10 9. North Dakota 10 ] 0. Michigan • 11 11. Kansas: a. First Statute 11 b. Second Statute 13 12. Wiscon.sin : 13 13. Nebraska 13 14. Oregon 13 15. South Dakota 13 Analysis, by States, of Sterilization Laws 1. INDIANA. Date of Approval of Statute. March 9, 1907. Reference in State Laws. Chapter 215, Laws of 1907. Persons Subject. Inmates of all State in- stitutions who are deemed by a commis- sion of three surgeons to be unimprovable, physically and mentally, and unfit for procre- ation. Executive Agents Provided. For each subject institution a Committee of Experts, consisting of two skilled surgeons of recog- nized ability, who shall act in conjunction with the regular institution physician and Board of Managers for the particular insti- tution. Basis of Selection: Procedure. I nad vis- ability of procreation and improbability of improvement of mental and physical condi- tion, in judgment of Committee of Experts and Board of Managers of the institution. Type of Operation Authorized. "Such operation for the prevention of procreation as shall be decided safest and rriost effective." State's Motive. Purely eugenic. Appropriations Available for Enforcing the Act. "In no case shall the consultation fee be more than $3.00 to each expert to be paid out of the funds appropriated for the maintenance of the institution." Present Legal Status, January 1, 1922. AftP"- Ji?- !,ig been a dead letter since the iiid ^ of Governor Thomas R. Mar- shall in 1909, this law was tested by the courts and declared unconstitutional May 11, 1921, by decision of the State Supreme Court. 2. WASHINGTON. (a.) First Statute. Date of Approval of Statute. March 22, 1909. Reference in State Laws. Chapter 240, Section 35, Criminal Code Statutes of 1909. Persons Subject. Habitual criminals and persons adjudged guilty of carnal abuse of female persons under ten years of age, or of rape. / Executive Agencies Provided. The CourU passing sentence for offense may in addition direct operation to be performed. Basis of Selection: Procedure. Charac- ter of subject and his previous unsocial acts. ' of Operation Authorized. "An op- for the prevention of procreation." State's Motive. Purely punitive. Appropriations Available for Enforcing the Act. No provision made for special ap- propriation. ; Present Legal Status, January 1, 1922. Iconstitutional by decree of State Supreme y Cou rt September 3, 1912. (b.) Second Statute. Date of Approval of Statute. March 8, 1921. Reference in State Laws. Chapter 53, of the Session Laws of 1921. Persons Subject. Feeble-minded, insane, epileptic, habitual criminals, moral degen- erates and sexual perverts (in institutions) showing hereditary degeneracy. Executive Agents Provided. The institu- tional Board of Health. Basis of Selection. Inadvisability of pro- creation and improbability of improvement in condition of the subject, in the judgment of said Board, after due consideration. Basis of Procedure. Order of Board served on inmate or legal guardian. Inmate or guardian may make appeal within fifteen days to Superior Court of county in which institution is located. No operation shall be performed until expiration of time for appeal or, if appealed, until decision of court or jury. Type of Operation Authorized. "Such surgical operation for sexual sterilization as may be specified in the order of the Institu- tional Board of Health" and "to be per- formed with due regard for the physical condition of the inmate and in a safe and humane manner." State's Motive. Primarily eugenic and secondarily for the personal benefit of the inmate. Appropriations Available for Enforcing the Act. "The State shall be liable only for the actual traveling expenses of the members of the Board incurred in the performance of their duties," such expenses to be paid "from the moneys appropriated for the maintenance of the institution." /Present Legal Status. January 1st, 1922. ^Not tested by courts. 3. CALIFORNIA. (") First Statute. Date of Approval of Statute. April 26, 1909. Analysis, by State;s, of Steriwzation Laws Reference in State Laws. Chapter 270, Sta- tutes of 1909. Persons Subject. Inmates of State hospi- tals and home for feeble-minded, and in- mates of State prisons committed for life, or showing sex or moral perversions, or twice committed for sexual offenses, or three times for other crimes. Executive Agencies Provided. Board con- sisting of superintendent or resident phy- sician of each subject institution in consulta- tion with the general superintendent of State hospitals and the secretary State Board of Health. Basis of Selection: Procedure. Decision by entire board or any two of them that asexualization will be beneficial, or conducive to the benefit of the physical, mental or moral condition of the inmate. Type of Operation Authorized. "Asex- ualization." State's Motive. Mainly eugenic, also for the physical, mental or moral benefit of in- mate, also partly punitive in certain cases. Appropriations Available for Enforcing the Act. No provision made for special appropriation. • Legal Status, January 1, 1922. Constitu- tional by decree of State Supreme Court, September 3, 1912, (b.) Second Statute. Date of Approval. June 13, 1919. (Re- peals first statute, April 26, 1909.) Reference in State Laws. Chapter 363, Statutes of 1913. Persons Subject. Inmates of State hospi- tals and home for feeble-minded and recidi- visits of all prisons of the State. Act does not apply to voluntary patients in State hospitals. Executive Agencies Provided, (a) State Commission in Lunacy, for the insane, (b) Resident Physician of the particular State prison, the general superintetident of State hospitals and secretary State Board of Health, for recidivists, (c) Medical Super- intendent of any State hospital, for "idiots and fools." Basis of Selection: Procedure. Discre- tion of the commission before the release of persons ''affected with hereditary insanity or incurable chronic mania or dementia." Dis- cretion of resident physician of any State prison in consultation with the general super- intendent of State hospitals and secretary of the State Board of Health in cases of recidivists; provided asexualization would benefit such recidivist, and that such recidi- vist has been twice convicted for sexual offenses, or three times for any other crime in any State or country. Discretion of the medical superintendent of any hospital may asexualize any minor, "idiot or fool" under his care, with the written consent of the parent, or guardian if such "idiot or fool" be an adult, and said medical superintendent shall perform such operation at the request of such parents or guardians. Type of Operation Authorized. "Asexuali- zation." State's Motive. Mainly eugenic, also in some cases therapeutic and punitive. Appropriations Available for Enforcing the Act. No provision made for special appropriation. Present Legal Status, January 1, 1922. Not tested by courts. (c.) Amendment to Act of June 13, 1913. Date of Approval of Statute, May 17, 1917. Reference in State Laws. Chapter 489, Laws of 1917. Persons Subject. Any person who has been lawfully committed to any State hospi- tal for the insane, or who has been an inmate of Sonoma State Home, and who is afflicted with mental disease which may )i • . ". j,! inherited and is likely to be transmitted to descendants, the various grades of feebk mindedness, those suffering from perversion or marked departures from normal mental- ity, or from diseases of a syphilitic nature. Executive Agencies Provided. State Com- mission in Lunacy, for the insane. Resident Physician of the respective State prisons, the general superintendent of State hospitals and secretary State Board of Health for recidivists. Medical superintendent of any State hospital for "idiots or fools." Basis of Selection: Procedure. Discre- tion of Commission before release of a person afflicted with mental disease which may have been inherited and is likely to be transmitted to descendants, the various grades of feeble-mindedness, those suffering from perversion or marked departures from normal mentality or from diseases of a syphilitic nature. Type of Operation Authorized. "Asex- ualization." State's Motive. Purely eugenic. Appropriations Available for Enforcing the Act. No provision made for special appropriation. Present Legal Status, January 1, 1922. Not tested by courts. 8 AnAi:,ysis, by States, of Stbriwzation Laws (df) Sterilization Provision in Act estab- lishing Pacific Colony. Date at Approval of Statute. June 1, 1917. Reference in State Laws. Section 42, Chapter 776, Laws of 1917. Persons Subject. Any inmate of Pacific Colony and who is feeble-minded or is afflicted with incurable chronic mania or de- mentia. Executive Agencies Provided. Board of Trustees, on the recommendation of the superintendent approved by a clinical psy- chologist holding degree of Ph.D., and a physician qualified to serve under Section 19 of this Act. Basis of Selection: Procedure. Discre- tion of Commission before release of a person who is feeble-minded or is afflicted with incurable chronic mania or dementia. Type of Operation Authorized. "Sterili- zation." State's Motive. Purely eugenic. Appropriations Available for Enforcing the Act. No provision made for special ; 'iropriation. Present Legal Status, January 1, 1922. Not teste?d by courts. 4. CONNECTICUT. Date of Approval of Statute. August 13, 1909. Reference in State Lawrs. Chapter 209, Public Acts of 1909. Persons Subject. Inmates of State prisons and of State hospitals at Middletown and Norwich. Executive Agencies Provided. Board of three surgeons, consisting of the resident physician and two others appointed by the superintendent of the particular institution, one member of said board appointed to per- form operation. Basis of Selection: Procedure. Decision by majority of Board, after examining the mental and physical condition of the subject, his record and family history, of the improb- ability of improvement of the physical and mental condition and the consequent inadvis- ability of procreation, or of the probability of substantial improvement of the mental and physical condition of subject thereby. Type of Operation Authorized. ."Vasect- omy or Oophorectomy in a safe and humane manner." For operations, except as author- ized by law, a fine of not more than $1,000 or 5 years' imy-i .unment, or both, is pro- vided. State's Motive. Mainly/ eugenic, also therapeutic. / Appropriations Available for Enforcing the Act. Board making /such examination and surgeon performing such operation shall receive from the State such; compensation for services rendered as warden of State prison or superintendent of either such hospital shall deem reasonable. /Present Legal Status, i January 1, 1922. I Constitutional according to the opinion of the Attorney General of the State, December 9, 1912. (Not tested hy courts. 5. NEVADA. Date of Approval of Statute. March 17, 1911. Reference in State Laws. Section 28, Crimes and Punishment Act. Persons Subject. Habitual criminals, and persons adjudged guilty of carnal abuse of female persons under ten years of age. Executive Agencies Provided. The Court passing sentence for offense may in addition direct the operation to be performed. Basis of Selection: Procedure. Character of subject and his previous unsocial acts. Type of Operation Authorized. "An operation for the prevention of procreation, except castration." State's Motive. Purely punitive. Appropriations Available for Enforcing the Act. No provision made for special appropriation. / Present Legal Status, January 1, 1923. / Unconstitutional by decision of Federal Dis- \ trict^Coiirt, May 25, 1918. '''" ^~ 1 6. IOWA. (a.) First Statute. j Date of Approval. Ajiril 10, 1911. Reference in State Ls|ws. Chapter 129, Acts of 34th General Assembly, 1911. Persons Subject. Inmajes of public insti- tutions for criminals, idipts, feeble-minded, imbeciles, drunkards, drug fiends, epileptics, syphilitics, etc. * Executive Agencies Provided. Board con- sisting of the managing officer and surgical superintendent of each institution with mem- bers of State Board of Paftle; the operation being performed by the surgeon of the insti- tution. Analysis, by States, of Sterilization L,aws Basis of Selection: Procedure. Decision by a majority of board, after examining mental and physical condition of subject, of the improbability of mental or physical im- provement, and the consequent inadvisability of procreation, or of the probable substantial improvement thereby, or continual evidence on part of subject of being a moral or sexual pervert. Type of. Operation Authorized. Vasec- tomy or salpingectomy. For operations, except as authorized by this Act, punishable by fine of "'not more than $1,000, or impris- onment in the penitentiary, not to exceed one year, or both." State's Motive. Mainly eugenic, also punitive in cases of certain felons and sex offenders, also therapeutic. Appropriations Available for Enforcing the Act. No provision made for special appropriation. ,' Present Legal Status, January 1, 1922.; (Repealed^ ApriLlO, 1913. _^- (b) Second Statute. Date of Approval. April 19, 1913. (Re- peals first statute, April 10, 1911.) Reference in State Laws. Chapter 187, Acts of 35th General Assembly, 1913. Persons Subject. Inmates of public insti- tutions for criminals, rapists, idiots, feeble- minded, imbeciles, lunatics, drunkards, drug fiends, epileptics, syphilitics, moral and sexual perverts, and diseased and degenerate persons. Compulsory in cases of persons twice convicted of felony, or of sexual offense other than "white slavery,'' for which offense one conviction makes sterilization mandatory. Executive Agencies Provided. State Board of Parole with the managing officer and physician of each institution for their respective institutions. Upon application to the Board of Parole or to any judge of the district court, by persons afflicted with syphilis or epilepsy, said board or court may authorize vasectomy or salpingectomy as the case may be. Upon submitting to such operation by one of the contracting parties and making said fact known to the second party, the law restricting marriage of such persons shall be void. Board "directed to examine annually or oftener" the mental and physical condition and family history of inmates of institutions with the view of de- termining the prospects of procreation by such individuals, and to report annually to the governor the proceeding "and also observation and statistics regarding its benefit.'' Basis of Selection: Procedure. Decision by a majority of special board (Board of Parole, managing officer and physician of institution) that procreation by inmate would produce children with a tendency to disease, degeneracy, deformity or that physical or mental condition of inmate would be im- proved thereby, or that inmate is a sexual or moral pervert, operation to be performed by the physician of the institution, or by one selected by him. Type of Operation Authorized. Vasec- tomy or salpingectomy. For operations, ex- cept as authorized by this Act, punishable by fine of "not more than $1,000, or impris- onment in the penitentiary, not to exceed one year, or both." State's Motive. Mainly eugenic, also punitive in cases of certain felons and sex- offenders, also therapeutic. Appropriations Available for Enfott ■• the Act. No provision made for special appropriation. Present 'Legal Status, January 1, 1922. Repealed April 16, 1915, after having been decided unconstitutional by Federal Distric Court, June 34, 1914. (c) Third Statute. Date of Approval. April 16, 1915. (Re- peals second statute April 19, 1913.) Reference in State Laws. Chapter 303, Acts of 36th General Assembly, 1915. Persons Subject. Institutional inmates afflicted with insanity, idiocy, imbecility, feeble-mindedness, or syphilis. Executive Agencies Provided. The super- intendent of any hospital for the insane and a majority of his medical staff, with the approval of the Board of Control or a ma- jority of the members thereof. Basis of Selection: Procedure. Decision of superintendent and his medical staff that it is for the best interests of the patient and society, with written consent of husband or wife, parent, guardian or next of kin. Type of Operation Authorized. Vasec- tomy or salpingectomy. Operations ex- cept as authorized by this Act, punishable by a fine of "not more than $1,000 or impris- onment in penitentiary, not to exceed one year, or both." State's Motive. Mainly eugenic, or puni- tive in cases of certain felons and sex offenders, also therapeutic. 10 Analysis, by States, of Steriwzation Laws Appropriations Available for Enforcing this Act No provision made for special appropriation. Pies.ent Legal Status, January 1, 19i82. Not '"si..;J by courts. 7. NEW JERSEY. Date of Approval. April 21, 1911. Reference in State Laws. Chapter 190, Statutes of 1911. Persons Subject. Inmates of State re- formatories, charitable and penal institutions (rapists and confirmed criminals.) Executive Agencies Provided. Board of Examiners, consisting of one surgeon, one neurologist, each of recognized ability, ap- pointed- by the governor by and with the advice of the Senate, acting in conjunction with the Commissioner of Charities and Cor- rections; any person qualified under the laws of the State under direction of chief physician of institution being allowed to perform oper- ation, orders subject to review by Supreme Court, or any justice thereof. Basis of Selection: Procedure. Unani- mous decision of board in conjunction with chief physician of the institution, after examining the mental and physical condition of subject, of the improbability of improve- ment of his condition and the consequent inadvisability of procreation. Type of Operation Authorized. "Such operation for the prevention of procreation as shall be decided by said Board of Examin- ers to be most effective." State's Motive. Purely eugenic. Appropriations Available for EMorcing the Act. There shall be paid out of the funds appropriated for maintenance of such institutions to each physician of said board of examiners, a compensation of not more than $10.00 per diem, for each day actually given to such work or examination, and his actual and necessary expenses in going to, holding and returning from such examina- tion." The judge of Court of Common ' Pleas appointing any counsel under this Act may fix compensation to be paid him, and it shall be paid, as other court expenses are now paid. Present Legal Status, January 1, 1922. Declared unconstitutional by State Supreme Court, V /ember 18, 1913. 8. NEW YORK. Date of Approval. April 16, 1913. Reference in State Laws. Chapter 445, Laws of 1912. Persons Subject. Inmates of State hos- pitals for the insane, State prisons, reforma- .tories, and charitable institutions,, and rapists, and confirmed criminals in penal institutions. Executive Agencies Provided. Board of Examiners, consisting of one surgeon, one neurologist, one practitioner of medicine appointed by governor for five years, one of its members being appointed by the Board to perform operation. All orders shall be subject to review by Supreme Court or any justice thereof. Basis of Selection: Procedure. Decision by majority of board, after examining mental and physical condition of subject, his record and family history, of the improbabil- ity of improvement of his condition and the consequent inadvisability of procreation or of the probability of substantial improvement of subject's condition thereby. Type of Operation Authorized. Any operation for the prevention of procreation. Type determined by the Board of Examin- ers. Except for medical necessity, unauthor- ized operation constitutes a misdemeanor. State's Motive. Purely eugenic. Appropriations Available for Enforcing the Act. "The compensation shall be $10.00 per diem for each day actually engaged in performance of duties of the board, and their actual and necessary traveling expenses." Judge of court appointing counsel under this Act may fix compensation to be paid him. $5,000 appropriated for 1913-14. Present Legal Status, January 1, 1922. Declared unconstitutional by the Supreme ^ Court of Albany County, March 5, 1918, and by Appellate Division July 1, 1918. Appeal pending before the Court of Appeals when the statute was repealed by the State Legis- lature, May 10, 1920. (L. 1920. Chap. 619.) 9. NORTH DAKOTA. Date of Approval. March 13, 1913. Reference in State Laws. Chapter 56, Laws of 191S. Persons Subject. Inmates of State prisons, reform school, school for feeble- minded, and asylum or hospital for insane. Executive Agencies Provided. Board, consisting of chief medical officer of the Analysis, by StateIs, of Sterilization Laws 11 particular subject institution, secretary of notice being given subject, with option of State Board of Health and one competerim~. hearing in court. physician and surgeon of good standing and experience, who shall be appointed by State Board of Control; the latter designating some skilled surgeon, who may or may not be one of their own number, to perform the operation. Basis for Selection: Procedure. Decision of the board or even by the chief medical officer of the institution, after examining mental and physical condition of subject of the improbability of physical or mental im- provement, and the consequent inadvisability of procreation, or of the probability of sub- stantial improvement of subject's condition thereby. Type of Operation Authorized. "Surgi- cal operation for sterilization.'' State's Motive. Mainly eugenic, also therapeutic. Appropriations Available for Enforcing the Act. The per diem compensation of the members appointed by the State Board of Control shall be fixed by that board in the letter of appointment, and shall not exceed $10.00 per day, while in actual performance of their duties; and the per diem, and actual, and necessary expenses of such members shall be allowed and paid in same manner as is provided for by law for the payment of salaries and expenses of members, agents and employees of State Board of Control; also the investigation and securing, at ex- pense of county, transcripts of records of convictions from other counties and States, and also such evidence of identification as ma y be obtained. Present Legal Status, January 1, 1922. ^Not te sted_by_ce4irtei 10. MICHIGAN. Date of Approval. April 1, 1913. Reference in State Laws. Act No. 34, Public Acts of 1913. Persons Subject. Inmates of State insti- tutions maintained wholly or in part by public expense. Executive Agencies Provided. Board for each institution to consist of the members of the board of control of each particular institution and the physicians or surgeons in charge thereof; such board to direct some competent physician or surgeon to perform operation. " -"•t an institution has no physician at ■■ bard of Mana- gers may hire operatic >rmed, 30 days' Basis for Selection: Procedure. Decision by a majority of the board, after examining physical and mental condition of subject, of the improbability of improvement of mental or physical condition, and the consequent inadvisability of procreation or of the prob- ability of substantial improvement of the subject's condition thereby. Type of Operation Authorized. Vasec- tomy or salpingectomy, in a safe and humane manner, or improvements thereon less dangerous to life. For operation, except as authorized by this Act, or for medical neces- sity, punishable by fine, not more than $1,000 or imprisonment for not more than 5 years, or both. State's Motive. Mainly eugenic, also therapeutic. Appropriations Available for Enforcing the Act. The institution physician or sur- geon performing operation shall receive no compensation therefor; if any surgeons are hired, these shall be allowed for their serv- ices the compensation fixed by the statutes, for the examination and certification of an insane person. The several sums necessary to carry out the provisions of this Act shall be paid out of general fund of State, upon the warrant of the auditor-general. |~~Present Legal Status, January 1, 1922. Declared unconstitutional .by State Supre"-" j Court, March 28, 1918. 11. KANSAS. (a) First Statute. Date of Approval March 14, 1913. Reference in State Laws. Chapter 305 Session Laws of 1913. Persons Subject. Inmates of all State in- stitutions entrusted with the care or custody of habitual criminals, idiots, epileptics, im- beciles and insane; "habitual criminal" to mean "a person who has been convicted of some felony involving moral turpitude." Executive Agencies Provided. By an au- thority "'consisting of the managing officers of each and every institution of the State in conjunction with competent surgical assist- ants, who shall report its conclusions to the district court, or any court of competent jurisdiction,, in or for the district, from which such inmate has been committed; the final order of sterilization lying with the court, who shall appoint one of the 'author- ity' to perform operation." 12 Analysis, by States, of Steriiy the General A8sem.l)ly of the State of Iowa: Section 1. Detention or Confinement of Fe- males for Prostitution Purposes. Whoever shall unlawfully detain or confine any female by force, false pretence, or intimidation In any room, house, building or premises in this state, against the will of such female, for pur- poses of prostitution or with intent to cause such female to become a. prostitute, and be guilty of fornication or concubinage therein, or shall by force, false pretence, confinement, or intimidation, attempt to prevent any feriiale so as aforesaid detained, from leaving such room, house, building, or premises, and who- ever aids, assists, or abets by force, false pretence, confinement, or intimidation, in keeping, conflning, or unlawfully detaining any female in any room, house, building or prem- ises in this state, against the will of such female, for the purpose of prostitution, forni- cation, or concubinage, shall on conviction, be imprisoned in the penitentiary not less than one nor more than ten years. Approved March 25, A. D. 1909. 22 Legis^ativh; Records op the Sterilization Laws eral Assembly, or who has been twice con- victed of some other sexual offense, or has been three times convicted of felony, and each such convict or inmate shall be sub- jected to this same operation of vasectomy or ligation of the Fallopian tubes, as the case may be, by the surgeon of the institu- tion. Section 2. Penalty. Except as authorized in this act, every person who shall perform, encourage, assist in or otherwise promote the performance of either of the operations described in Section 1 of this act, for the purpose of destroying the power to procreate the human species, or any person who shall knowingly permit either of such operations to be performed upon such persons, unless the same shall be a medical necessity, shall be fined not more than one thousand ($1,000) dollars, or imprisoned in the county jail not to exceed one year, or both. (b) Second Law. Date of Law: July 4, 1913. This statute repeals the first sterilization law, Chapter 129, Acts of the Thirty-fourth General Assembly, April 10, 1911. The bill was introduced March 10, 1913, by Representative Col. Halgrims, of Hum- boldt, Iowa. It passed the House April 17, 1«13— 61 ayes, 7 noes; the Senate April 18, 1913 — 27 ayes, 11 noes. It was approved April 19, 1913, by Gov- ernor George W. Clarke. It appears on the Iowa laws of 1913, Chapter 187, Acts of the Thirty-fifth Gen- eral Assembly. AN ACT to repeal the law as it appears in chapter one hundred twenty-nine (129) of the acts of the Thirty-fourth General As- sembly, and to enact a substitute therefor relating to the prevention of the procreation of criminals, rapists, idiots, feeble-minded, imbeciles, lunatics, drunkards, drug fiends, epileptics, syphilitics, moral and sexual per- verts, and diseased and degenerate persons. Be it enacted by the General Assembly of the State of Iowa: Section 1. Unsexing of criminals, idiots, etc. Board of Parole; Duties. That it shall be the duty of the state board of parole, with the managing officer and the physician of each public institution in the state, entrusted with the care and custody of crim- inals, rapists, idiots, feeble-minded, imbeciles, lunatics, drunkards, drug fiends, epileptics, syphilitics moral and sexual perverts, and diseased and degenerate persons, and they are hereby authorized and directed to, an- nually or oftener, examine into the mental and physical condition, the records and family history of the inmates of such institu- tions, with a view of determining whether it is improper or inadvisable to allow any of such inmates to procreate and to judge of such matters; If a majority of them decide that procreation by any such inmates would produce children with a tendency to disease, deformity, crime, insanity, feeble-minded- ness, idiocy, imbecility, epilepsy, or alcohol- ism, or if the physical or mental condition of any such inmate will probably be mate- rially improved thereby, or if such inmate is an epileptic or syphilitic, or gives evidence, while he is an inmate of such institution, that he or she is a moral or sexual pervert, then the physician of the institution, or one selected by him, shall perform the operation of vasectomy or ligation of the Fallopian tubes, as the case may be, upon such person. Provided that such operation shall be per- formed upon every convict or inmate of such institution who has been convicted of prostitution or violation of the law as laid down in chapter two hundred sixteen (216)* of the acts of the Thirty-third General Assembly, or who has been twice convicted of other sexual offenses, including soliciting, as defined in section four thousand nine hun- dred seventy-five-c (4975-c)** of the supple- ment to the code, 1907, or who has been twice convicted of a felony, and each such convict or inmate shall be subject to this same operation of vasectomy or ligation of the Fallopian tubes, as the case may be, by the physician of the institution, or one se- Lcted by him. Section 2. Certain persons, operations upon application. Those afflicted with syphilis or epilepsy may apply to the board of parole, or any judge of the district court, and upon order of such board or judge, the operation of vasectomy or ligation of the Fallopian tubes may be performed upon such person, and any law restricting mar- • See footnote, page 21. ••Sec. 4975-0. SoUoltiag' for tha Pnrpoi* of ProBtltnUon— Fanalt7. That any person who shall ask, request, or soUcJt another to have carnal knowledge with any female for a con- sideration or otherwise, shall be punished by imprisonment in the penitentiary not exceed- ing five years or imprisonment In the county jail not exceeding one year, or by a fine not exceeding one thousand dollars, or both such fine and Jail imprisonment. (31 Q. A., eh. 16B.) Legislative Records of the Sterilization Laws 23 riage of such persons shall be void and of none effect, in case one of the contracting parties has submitted to such operation and the same was known to both parties before their marriage. Section 3. Annual report. The board of parole shall make an annual report to the governor of the state, fully covering their proceedings under the authority of this act, and also observations and statistics regard- ing its benefits. Section 4. Unsexing prohibited except as authorized — penalty. Except as authorized in this act, every person who shall perform, encourage, assist in or otherwise promote the performance of either of the operations described in section one (1) of this act, for the purpose of destroying the power to pro- create the human species, or any person who shall knowingly permit either of such operations to be performed upon such per- sons, unless the same shall be a medical necessity, shall be fined not more than one thousand dollars ($1,000.00), or imprisoned in the penitentiary not to exceed one year, or both. (c) Third Law. Date of Law: July 4, 1915. The bill was introduced on February 18, 1915, by the Committee on Public Health (Dr. A. W. Slaught, of Ottumwa, Chairman), as a Committee Bill. It passed the House, March 6, 1915 — 76 ayes, 13 noes; the Senate, April 12, 1915 — 31 ayes, 6 noes. It was approved April 16, 1915, by Gov- ernor George W. Clarke. It appears on the Iowa statutes as Chapter 203 of the Laws of the Thirty-sixth General Assembly (1915). AN ACT to repeal the law as it appears in chapter nineteen-B (19-B) supplement to the code, 1913, and to enact a substitute therefor to prevent the procreation of the insane, idiots, imbeciles and feeble-minded. Be it enacted by the General Assembly of the State of Iowa: That the law as it appears in Chapter nineteen-B (19-B) of title twelve (1?) sup- plement to the code, 1913, be and the same is hereby repealed and the following enacted in lieu thereof: Section 1. Sterilization Authorized. That whenever the superintendent of any hospital for the insane and a majority of his medical staflf shall after investigation and examina- tion, agree that it is for the best interests of the patient and society, they are hereby authorized to perform, or cause to be per- formed by some capable physician or sur- geon, the operation of sterilization on any such . patient confined in said institution afflicted with insanity, idiocy, imbecility, feeble-mindedness or syphilis; provided that said operation is approved by the board of control or a majority thereof; and provided further, that the superintendent of the hos- pital shall have secured the written consent of the husband or wife, if the patient is a married person, and if an unmarried person, the written consent of the parent, guardian or next of kin, if any there be within this state, that said operation shall be performed. Section 2. Operation Defined. The oper- ation to be performed upon a male person shall be what is known as vasectomy, and upon a female person what is known as a section of the Fallopian tubes with implanta- tion of the uterine muscles. Section 3. Annual Report. The board of control shall make an annual report to the governor of the state fully covering their proceedings under the authority of this act, and also their observations and statistics re- garding its benefits. Section 4. Unauthorized Operations — Penalty. Except as authorized in this act every person who shall perform, encourage, assist in, or otherwise promote the perform- ance of either of the operations described in section two (2) of this act for the purpose of destroying the power to procreate the human species, or any person who shall knowingly permit either of such operations to be performed upon such person unless the same shall be a medical necessity, shall be fined not more than one thousand dollars ($1,000), or imprisoned in the penitentiary not to exceed one year, or both. 7. NEW JERSEY. Date of Law: April 31, 1911. The bill was introduced on February 27, 1911, by Representative B. H. White, of Mount Holly, New Jersey. It passed the House March 28, 1911^;— 33 ayes, 6 noes; the Senate April 18, 1911 — 12 ayes, noes 0. It was approved April 31, 1911, by Gov- ernor Woodrow Wilson. It appears on the New Jersey statutes of 1911 as Chapter 190. AN ACT to authorize and provide for the sterilization of feeble-minded (including 24 L,e;gisi,ative Records of the Sterilization Laws idiots, imbeciles and morons), epileptics, rapists, certain criminals and other defectives. WHEREAS, heredity plays a most im- portant part in the transmission of feeble- mindedness, epilepsy, criminal, tendencies, and other defects: Be it enacted by the Senate and General Assembly of the State of New Jersey: 1. . Immediately after the passage of this act, the Governor shall appoint by and with, the advice of the Senate, a surgeon and neurologist, each of recognized ability, one for a term of three (3) years and one for a term of (5) years; their successors each to be appointed for the full term of five years, who in conjunction with the Commissioner of Charities and Corrections shall be known as and is hereby created the "Board of Examiners of Feeble-minded (including idiots, imbeciles and morons). Epileptics and other Defectives," whose duty it shall be to examine into the mental and physical condi- tion of the feeble-minded, epileptic, certain criminal and other defective inmates con- fined in the several reformatories, charitable, and penal institutions in the counties and state. Any vacancy occurring in said Board of Examiners shall be filled by appointment of the Governor for the unexpired term. 2. The criminals who shall come within the operation of this law shall be those who have been convicted of the crime of rape, or of such succession of offenses against the criminal law as in the opinion of this board of examiners shall be deemed to be sufficient evidence of confirmed criminal tendencies. 3. Upon application of the superintendent or other administrative officer of any institu- tion in which such inmates are or may be confined or upon its own motion, the said board of examiners may call a meeting to take evidence and examine into the mental and physical condition of such inmates con- fined as aforesaid, and if said board of examiners, in conjunction with the chief phy- sician of the institution, unanirnously find that procreation is inadvisable and that there is no probability that the condition of such inmate so examined will improve to such an extent as to render procreation by such inmate advisable, it shall be lawful to per- form such operation for the prevention of procreation as shall be decided by said board of examiners to be most effective, and there- upon it shall and may be lawful for any surgeon qualified under the laws of this state, under the direction of the chief physi- cian of said institution, to perform such oper- ation ; previous to said hearing the said board shall apply to any judge of the Court of Common Pleas, of the county in which said person is confined, for the assignment of counsel to represent the person to be ex- amined, said counsel to act at said hearing and in any subsequent proceedings, and no order made by said board of examiners shall become effective until five days after it shall have been filed with the clerk of the Court of Common Pleas of the county in which said examination is held, and a copy shall have been served upon the counsel appointed to represent the person examined, proof of service of the said copy of the order to be filed with the clerk of the Court of Common Pleas. All orders made under the provision of this act shall be subject to review by the Supreme Court or any justice thereof, and said court may upon appeal from any order grant a stay which shall be effective until such appeal shall have been decided. The judge of the Court of Common Pleas appointing any counsel under this act may fix the compensation to be paid him, and it shall be paid as other court expenses are now paid. No surgeon performing an operation under the provisions of this law shall be held to account therefor, but the order of the board of examiners shall be a full warrant and authority therefor. 4. The record taken upon the examination of every such inmate, signed by the said board of examiners, shall be preserved in the institution where such inmate is con- fined, and a copy thereof filed with the Com- missioner of Charities and Corrections, and ohe year after the performing of the oper- ation the superintendent or other adminis- trative officer of the institution wherein such inmate is confined shall report to the board of examiners the condition of the inmate and the effect of such operation upon such inmate. A copy of the report shall be filed with the record of the examination. 5. There shall be paid, out of the funds appropriated for maintenance of such insti- tutions, to each physician of said board of examiners, a compensation of not more than ten ($10) dollars per diem for each day actually given to such work or examination, and his actual and necessary expenses in going to, holding and returning from such examination. When in the judgment of the board of examiners it is necessary to secure the assist- ance of a surgeon outside the medical staff Legislative Records op the Sterilization Laws 25 of the institution to perform or assist in said operation, the necessary expenses of such surgeon shall be paid from the maintenance account of such institution. 6. If any provisions of this act shall be questioned in any court, and the provisions of this act with reference to any class of persons enumerated therein shall be held to be unconstitutional and void, such determina- tion shall not be deemed to invalidate the entire act, but only such provisions thereof with reference to the class in question as are specifically under review and particularly passed upon by the decision of the court. 7. This act shall take effect immediately. 8. NEW YORK. (a) Text of Law. Date of Law: April 16, 1913. The bill was introduced on March 5, 1912, by Assemblyman Robert P. Bush, of Horse- heads, N, Y. It passed the House March 25, 1912 — 78 ayes, 9 noes; the Senate March 29, 1912 — 48 ayes, noes 0. It was approved April 16, 1912, by Gov- ernor John A. Dix. It appears on the New York statutes as Public Health Law (L. 1909, Chapter 49), Art. 19 (Section 350-353), as amended by L. 1912, Chapter 445. AN ACT to amend the public health law, in relation to operations for the prevention of procreation. The people of the State of New York, represented in Senate and Assembly, do enact as follows: Section 1. Article eighteen of chapter forty-nine of the laws of nineteen hundred and nine, entitled, "An act in relation to public health constituting chapter forty-five of the consolidated 'laws,'' as renumbered article nineteen by section five of chapter one hundred and twenty-eight of the laws of nineteen hundred and eleven, is hereby made article twenty thereof, and sections three hundred and fifty and three hundred and fifty-one of such chapter are hereby renum- bered sections three hundred and sixty and three hundred and sixty-one, respectively. Section 2. Such chapter is hereby amended by inserting therein a new article, to be article nineteen thereof, to read as follows: ARTICLE 19. Operations for the Prevention of Procreation. Section 350. Board of Examiners; com- pensation and expenses. Section 361. General powers and duties of the board, persons to be operated upon. Section 352. Appointment of counsel to persons to be operated upon. Section 353. Unauthorized and illegal operations. Section 350. Board of Examiners; com- pensation and expenses. Immediately after the passage of this act the Governor shall appoint one surgeon, one neurologist and one practitioner of medicine, each with at least ten years' experience in the actual prac- tice of his profession, for a term of five years, to be known as the board of exami- ners of feeble-minded, criminals and other defectives, which board is hereby created. The compensation of the members of such board shall be ten dollars per diem for each day actually engaged in the performance of the duties of the board, and their actual and necessary traveling expenses. Any vacan- cies occurring in said board shall be filled by appointment of the Governor for the unex- pired term. Section 351. General powers and duties of the board; persons to be operated upon. It shall be the duty of the said board to ex- amine into the mental and physical condition and the record and family history of the feeble-minded, epileptic, criminal and other defective inmates confined in the several state hospitals for the insane, state prisons, re- formatories, and charitable and penal insti- tutions in the state, and if in the judgment of the majority of said board procreation by any such person would produce children with an inherited tendency to crime, insanity, feeble-mindedness, idiocy, or imbecility, and there is no probability that the condition of any such person so examined will improve to such an extent as to render procreation by any such person advisable, or if the physical or mental condition of any such person will be substantially improved thereby, then said board shall appoint one of its members to perform such operation for the prevention of procreation as shall be decided by said board to be most effective. The criminals who shall come within the operation of this law shall be those who have been convicted of the crime of rape or of such succession of offenses against the criminal law as in the opinion of the board shall be deemed to be sufficient evidence of confirmed criminal tendencies. Section 352. Appointment of counsel to person to be operated upon. The board of 26 Legislative Records op the Steriwzation Laws examiners shall apply to any judge of the_ Supreme Court or county judge of the county in which said person is confined for the appointment of counsel to represent the person to be examined. Said counsel to act a* a hearing before the judge and in any subsequent proceedings, and no order made by said board shall become effective until five days after it shall have been filed with the clerk of the court and a copy shall have been served upon the counsel appointed to represent the person examined and proof of service of said copy of the order to be filed with the clerk of the court. All orders made under provisions of this act shall be subject to review by the Supreme Court or any jus- tice thereof, and said court may upon appeal from any order grant a stay, which shall be effective until such appeal shall have been decided. The judge of the court appointing any counsel under this act may fix the compensation to be paid him. No surgeon performing an operation under the provisions of this act shall be held to account therefor. The record taken upon the exami- nation of every such inmate, signed by the said board of examiners, shall be preserved by the institution where said inmate is con- fined, and one year after the performance of the operation the superintendent or other administrative officer of the institution wherein such inmate is confined shall report to the board of examiners the condition of the inmate and the effect of such operation upon such inmate, and a copy of the report shall be filed with the record of the examina- tion. Section 353. Unauthorized and illegal operations. Except as authorized by this act, every person who shall perform, encour- age, assist in, or otherwise permit the per- formance of the operation for the purpose of destroying the power to procreate the human species, or any person who shall knowingly permit such operation to be performed upon such person, unless the same shall be a medi- cal necessity, shall be guilty of a misde- meanor. Section 3. This act shall take effect imme- diately. (b) The Repeal of the New York Sterili- zation Statute. The New York sterilization law of 1912 was repealed May 10, 1920. The repealing bill was introduced by Senator Henry M. Sage of New York April 8th. It passed the Senate April 14th, 49 yeas, nays. It passed the Assembly April 21st, 142 yeas, nays. and was signed by Governor Alfred E. Smith May 10th. The repealing act appears in the statutes of New York as "L. 1920, Chap. 619." The full text of the act is as follows: AN ACT To repeal article nineteen of the public health law, relating to operations for the prevention of procreation. The People of the State of New York, represented in Senate and Assembly, do enact as follows: Section 1. Article nineteen of chapter forty-nine of the laws of nineteen hundred and nine, entitled "An act in relation to public health, constituting chapter forty-five of the consolidated laws," as such article was added by chapter four hundred and forty- five of the laws of nineteen hundred and twelve, is hereby repealed. Section 2. This act shall take effect immediately. 9. NORTH DAKOTA. Date of Law: March 13, 1913. The bill was introduced on February 8, 1913, by Representative W. H. Northrup, Luverne, North Dakota. It passed the House February 17, 1913 — 73 ayes, 20 noes; the Senate March 6, 1913 — 34 ayes, 4 noes. It was approved March 13, 1913, by Gov- ernor L. B. Hanna. It appears on the North Dakota statutes as Chapter 56 of the laws of 1913. (Chapter 24, Sections 11429-11438, Compiled Laws of North Dakota, 1913.) AN ACT to prevent procreation of con- firmed criminals, insane, idiots, defectives, and rapists; providing for a board of medi- cal examiners and making a provision for carrying out of same. Be it enacted by the Legislative Assembly of the State of North Dakota: Section 1. Whenever the warden, super- intendent, or head of any state prison, re- form school, state school for feeble-minded, or of any state hospital or state asylum for insane shall certify in writing that he be- lieves that the mental or physical condition of any inmate would be improved thereby, or that procreation by such inmate would be likely to result in defective or feeble-minded children with criminal tendencies, and that the condition of such inmate is not likely to improve, so as to make procreation by such person desirable or beneficial to the community, it shall be lawful to perform a Legislative Records of the Sterilization Laws 27 surgical operation for the sterilization of such inmate as hereafter provided. Section 2. For the purpose of carrying into effect the provisions of this act the chief medical officer of any such institution, the secretary of the state board of health and one other competent physician and surgeon, whose appointment is hereinafter provided for, shall constitute the board of examiners for such institution. The third member of such board shall be a competent physician and surgeon of good standing and of at least ten years' practice of his profession in North Dakota, who shall forthwith be appointed by the State board of control and who shall serve during the pleasure of said board of control. One such appointment may be made in each county in which any of such institutions is located, or one may be appointed to act for any two or more of such institutions to be named in the letter of appointment. The per diem compensa- tion of such member so appointed shall be fixed by the state board of control in the letter of appointment and shall not be in excess of $10.00 per day, a duplicate of this letter shall be filed with the state auditor, and the ^er diem and actual necessary ex- penses of such member shall be allowed and paid in the same manner as is provided for by law for the payment of the salaries and expenses of the members, agents, and em- ployees of the state board of control. Section 3. When the superintendent oi any such institution shall deem it advisable that such operation be performed on any one or more of the inmates thereof he shall make such recommendation in writing signed by him, and file one copy thereof with the board of control and one with the chief medical officer of such institution, where- upon the chief medical officer of such institu- tion shall forthwith call a meeting of such board of examiners, to be held at such insti- tution at a date not less than fifteen days after the issuance of such call, and such call shall be in writing, signed by such chief medical officer, and shall clearly set forth the date and object of such meeting and shall contain the names of all inmates whose cases are to be considered at such meeting. Section 4. At such meeting such board of examiners shall diligently inquire into the mental and physical conditipn of each inmate so considered, and as far as practicable into his family history, and for that purpose any member of said board may administer an oath to any witness whom it is desired to examine, and such hearing may be adjourned from day to day, and, if necessary, sessions may he held elsewhere than at such institu- tion. Section 5. After fully inquiring into the condition of each such person such board of examiners shall make separate written find- ings for each of the persons whose condition has been inquired into, and such findings shall either order that such inmate be steril- ized by such operation as may be deemed best, or shall find that sterilization is not necessary or desirable, or shall continue the case to a time and place therein named or upon future call for further observation and inquiry, and such hearings shall be conducted according to the provisions of section 4 of this act. If such board in its findings order such operation upon such inmate, it shall, in such findings, designate what operation is to be performed and its purpose, and shall designate some skilled surgeon, who may not be one of their own number, who shall perform it. Section G. Such institutions shall keep all files in any proceedings under this act and full minutes of such meetings, and for that purpose the chief medical officer of such institution shall be the secretary of such board of examiners and custodian of its records. Section 7. When in the opinion of the chief medical officer of any such institution such operation would be necessary or de- sirable upon any inmate thereof, for any of the purposes herein set forth, and such inmate requests in writing that such oper- ation be performed, or consents thereto in writing, he may perform or procure the performance of such operation without bringing the matter to the attention of such board of examiners. When any such oper- ation is performed under the provisions of this section it shall be the duty of the chief medical officer who performs or procures the performance of such operation to immedi- ately report to the state board of control the details of such operation upon such blanks as the board of control may prescribe. Section 8. Whenever the state's attorney of any county shall have reason to believe that any person who shall be convicted of felony has been twice or more previously convicted of felonies in North Dakota and elsewhere, it shall be the duty of such state's attorney to investigate and to secure at the expense of the county, transcripts of records of conviction from other counties and states 28 Legislative Records of the Sterilization Laws and also such evidence of identification as may be obtained. Such proof when obtained shall be forwarded to the state board of con- trol, who shall thereupon notify the chief medical officers of the institution to which such person is committed and the secretary of the state board of health, and such case shall be dealt with in accordance with the procedure stated in section 1 of this act. Section 9. No surgeon who shall skillfully perform any operation as authorized by this act shall be held accountable therefor, but the findings and order of this said board of examiners or the court, or the consent of such inmate and parents or guardian shall be his full warrant and authority therefor. Section 10. It shall be the duty of the chief medical officer of any such institution in which any sterilized inmates are confined to make careful observation of each of such inmates, particularly with the view to ascer- taining the effect of such operation upon the moral, mental and physical condition of such sterilized persons, and once a year, and oftener if called for by the Governor, to make report on each of such persons in writ- ing, keeping a copy of such report on file in such institution and furnishing copies to the Governor, the state board of control and the secretary of the state board of health. Section 11. (Emergency.) WHEREAS, heredity plays a most important part in the transmission of crime, insanity, idiocy, and imbecility, and our institutions for degener- ates are overcrowded on account of the lack of adequate means of checking the ever- increasing numbers of this class; and whereas, there is now no provision in law authorizing an operation for the sterilization of defective persons, this act shall take effect and be in force from and after its passage and approval. 10. MICHIGAN. Date of Law: August 1, 1913. The bill was introduced on January 13, 1913, by Representative Arthur Odell, of Allegan, Michigan. It passed the House February 18, 1918 — 72 ayes, 16 noes; the Senate March 19, 1913 — 21 ayes, 9 noes. It was approved April 1, 1913, by Gov- ernor Woodbridge N. Ferris. It appears on the Michigan statutes of 1913 as Act No. 34, Public Acts 1913, page 52. AN ACT to authorize the sterilization of mentally defective persons maintained wholly or in part by public expense in public institu- tions in this state, and to provide a penalty for the unauthorized use of the operations provided for. The people of the State of Michigan enact: Section 1. Authority is given to the management of any institution maintained wholly or in part by public expense, in whose custody may be held individuals who have been by a court of competent jurisdiction adjudged to be and who are mentally de- fective or insane, to render incapable of pro- creation, by vasectomy or salpingectomy or by the improvement of said surgical oper- ation which is least dangerous to life and will best accomplish the purpose, any person who is mentally defective or insane. Section 2. The boards of the aforesaid institutions and the physicians or surgeons in charge of each of said institutions shall for each of their respective institutions con- stitute a board, the duty of which shall be to examine such inmates of said institutions as are reported to them by the warden or medi- ■ cal superintendent to be persons by whom procreation would , be inadvisable. Such board shall receive the report of insanity experts hereinafter mentioned, examine the physical and mental condition of such per- sons, and their record and family history so far as the same can be ascertained, and if in the judgment of a majority of said board procreation by any such person would pro- duce children with an inherited tendency to insanity, feeble-mindedness, idiocy, or imbe- cility, and there is no probability that the condition of any such person so examined will improve to such an extent as to render proci^eation by any such person advisable, or if the physical or mental condition of any such person so examined will be substan- tially improved thereby, then said board shall direct a competent physician or sur- geon, with such other assistants as may be necessary, to perform the operation of vasec- tomy or salpingectomy, or any other oper- ation or improvement on vasectomy or sal- pingectomy recognized by the medical pro- fession, as the case may be, upon such person. Such operation shall be performed in a safe and humane manner, and the board making such examination, and the institution physician or surgeon, shall receive no extra compensation therefor; provided, that at least thirty days' notice shall be given to the parents or guardian of such person before the performing of such operation; said notice to specify the purpose, time and place of such examination; provided further. Lbgisi of the vas, the testicular secretion is ab- sorbed. Since performing -these operations we are led to believe, by the improvement in general and mental health, that there is a distinct beneficial result from the absorption of the testicular secretion. "The first attempts to consciously utilize the internal secretion of the testicles wer< made, as is well known, by Brown-Sequard. who experimented with testicular extracts in 1889. He reported a remarkable result from the subcutaneous injection of testicular ex- tracts. They were said to increase bodilj and mental vigor, etc. Many of the results claimed were evidently due to suggestion However, since beginning these sterilization operations, we are led to believe that by tht improvement in mental and general health that there is a definite beneficial effect from this operation and may lead to important findings as an organo therajjeutic agent. "The cases suflfering from depression, in- abilitv to concentrate and extreme nervous- Statisticai, Summary oi? Eugenicai, STERir,izATioN 57 ness are those who are principally benefited. Men who responded to no other form of treatment, in from two to three weeks after the operation have shown marked improve- ment both mentally and physically and later have been discharged from the hospital in their normal mental condition and in ex- cellent physical health. The women are benefited only by the fact that they are pro- tected from the recurrence of their mental trouble through the nervous strain incidental to child-bearing and also the worry that they might again become pregnant, which would more than likely mean their return to the hospital, perhaps to make it their permanent home. The most important fea- ture in these cases is that the state will not have their children, their grandchildren or their great-grandchildren to care for. "For the tubectomy, an incision is made low down in the medium line of the abdomen so that the slight scar left is covered with pubic hair and is not noticed by the patient. The incision is made only large enough to insert the first and second fingers. The tube is then withdrawn by the fingers, a small incision is made in the isthmus (or re- stricted portion) of the tube, and 1 or 2 cm of the tube is resected. The serous covering is then sutured over with fine catgut, the tube dropped back in the abdomi- nal cavity and the external incision closed. Patients are able to be up within three or four days after the operation. Should any pelvic disease be found present, the incision is lengthened and the condition remedied at the time of the operation. "To my mind California — through the enactment of this law, and seeing that its provisions are carried out — is leading the world in providing that the patients com- mitted to her various state institutions are receiving the benefits of sterilization — not alone for its curative eflfects — but to prevent thg filling of her institutions in the future, from the offsprings of the insane who re- cover or partially recover and are permitted' to again go out into the world and reproduce ' their like — a large percentage of whom ' through inheritance and under unfavorable environments or dissipation, at length take '* the places of their ancestors in the institu- te tions for the insane throughout the state. "If the insane who are capable of reproduc- ing are not sterilized before leaving the hos- '■ pital, it naturally follows that we will have an ever-increasing, endless chain of insane and defective wards to care for. "I made the rather broad statement that California was leading the world in this very important procedure. In doing so I am well aware there are several other states in which this operation is authorized, but from sta- tistics which I have been able to gather, 1 feel that we, in this state, are doing more of this work than is being done elsewhere. "I would like to see the law made broader whereby those addicted to the use of alcohol or drugs could be sterilized upon their sec- ond commitment to an insane hospital." (b) (Quoted from letter.) "In most cases I have had the consent of the relatives before operating, but this is not necessary. We have had decided beneficial results from the operation on our men patients, and many of them recover after the operation, who had shown no previous improvement under other forms of treatment. This is especially true in nervous cases, and the depressed type of manic depressive insanity. I consider the sterilization act the most important law which has been placed on the statute books as a eugenical measure. I think this law should be broadened so that alcoholics and drug habitues could be sterilized upon the second admission to a state hospital." January, 1918. (c) Report to State Commission in Luna- cy, June, 1918 (p. 41). Sterilization and Other Surgery. "During the past year, as in former years, we have continued to sterilize our men and women patients — under 50 years of age — who have prospects of leaving the hospital, and as stated in my former report, we have found this operation very beneficial in a great number of our men patients who have responded to no other forms of treatment." (d) (Quoted from letter.) "I think the policy of eugenical sterilization is a very praiseworthy one, and feel that it should be more strictly enforced, not only for the pre- vention of the production of undesirables but for the benefit of the patients themselves. "I would suggest that drug and inebriety cases be sterilized on their second admission to the hospital. "Our policy is to select certain men under forty-five and women of child-bearing age for sterilization. After obtaining the per- mission of the General Superintendent of 5S ^TATisTiCAiv Summary of Eugbnical Sterilization State Hospitals and of the Secretary of State Board of Health in reference to these selected cases, we perform the operation. "We nofe the mental condition of patients sterilized as long as they remain in the hos- pital and receive reports from relatives and friends monthly from those who leave the hospital on parole. We have, however, prac- tically no reports from those who are discharged." April 4, 1921. 'i. Napa State Hospital, Napa. A. C. Matth'ews, Medical Superintendent. "There are no special physiological or mental eflfects, either immediate or remote, follow- ing sterilizations. We do not perform castration or ovariotomy for sterilization as we do not believe in the principle. "We do not operate without obtaining first, the consent of the relatives. The cases for sterilization are carefully selected, pick- ing out those from which there is danger of transmitting the nervous instability to off- spring. "Inasmuch as the State Sterilization Law has been declared unconstitutional in the States of New Jersey and New York, and I believe, also in Michigan, we do not care to have a test case brought into the Supreme Court of this State, fearing that a like action would be taken. This accounts for the rea- son that we do not sterilize any cases without first receiving the consent of the relatives. "In the Eastern States, the law was de- clared unconstitutional as it was declared 'class legislation,' inasmuch as it applied only to that particular class of mental cases that were confined in the State Institutions and did not include the same class of cases outside of institutions. If a law could be so framed, and the work of such a law satisfactorily carried out as applying to mental cases, both in and out of an institu- tion, I do not think that it would be declared unconstitutional. "I certainly approve of the .sterilization law. I feel that the movement in this di- rection has received a serious setback in declaring the law uiiconstitution;.! in some of our Easterri Slates." Jani';,r>, 1921. 3. Agnew State Hospital, Agnew. Dr. Leonard Stocking, Medical . Superintendent. (Quoted from letter.) "The sterilization law is working very satisfactorily, and with- out friction or objection. We almost in- variably obtain the consent of the most interested relatives, or the patient, or of both. The operation is performed whenever in our judgment it is advisable. In my opin- ion it is of very little medical value. However, in a number of cases in performing the oper- ation for sterilization we have found conditions necessitating more extensive oper- ation for the good of the patient, such as removing appendix, ovary, etc. Unquestion- ably the statute is of great eugenica' value " January, 1918. 4. Mendocino State Hospital, Talmage. John Lewis Richard, Medical Superin- tendent. "This hospital has accurate records of the mental condition of patients sterilized since 1910. Cases which have pronounced history of hereditary feeble-mindedness or hypersexuality are selected for sterilization. Under the present law they are recommended by the Medical Superintendent for operation and permission of the State Commission in Lunacy must be secured. "Some measure should be taken for legal protection of those authorized to perform this operation. We believe that eugenical sterilization is a desirable measure.'' Janu- ary, 1921. 5. Southern California State Hospital, Pat- ton. Dr. John A. Reily, Medical Super- intendent. (a) (Quoted from letter.) "Except in case of moral delinquency, we have secured the consent of the nearest relative. We have reason to believe that some physical and mental benefit is derived from the operation, and, as a means of improving the human stock, sterilization of the defective and de- linquent must, of necessity, be of great value. "Just now we are extremely busy in ap- plying the principles of eugenics, having sterilized in this institution alone during the month of March approximately 43 cases. Other institutions of California are doing similar wOrk. As a matter of fact, this state is accomplishing more at this time than all of the rest of the United States combined. "I regretted to learn recently that a 32 4. Hospital for insane, Lincoln. 28 () 44 78 5. Penitentiary, Lincoln .0 U o 6. Industrial School for Boys, Kearney o 7. Industrial Home, Milford . 8. Girls' Industrial .School, Geneva 9. Industrial Farm for Women, York Total to January 1, 1921.. 87 62 6 155 Statistical Summary of. Eugenical Sterilization 75 Notes on the Enforcement of the Kugenical Sterilization Law in Nebraska.^ In the character of the law and the compe- tency of its application, Nebraska shares with California, Washington and Oregon the claim to the most business-like and scien- tific administration of eugenical sterilization. 1. Biennial Report of the Board of Exami- ners of Defectives. (a) First Biennial Report, 1916. To His Excellency, Honorable John H. Morehead, Governor, and to the Honor- able Members of the Board of Commis- sioners of State Institutions, Howard Kennedy, Henry Gerdes and Silas A. Holcomb: "Gentlemen: "We, the members of the Board of Ex- aminers of Defectives, desire to submit our report covering the period of time from the creation of the Board to the 30th day of November, 1916. "It has been the policy of the Board of Examiners of Defectives to adopt a con- servative policy in dealing with all applicants for sterilization. We have ever kept in mind the contention of the critics to sterili- zation, that the so-called geniuses are some- times victims of acute neurosis. "In each of our institutions we observe the criminal, the delinquent and otherwise defective individual, a ward of the state through no fault of his, but by reason of an endowment the product of faulty mating and ancestral defection. This fact has convinced the Board that a certain duty confronts us in each applicant for sterilization; first, to determine in the ancestral st'rain the ten- dency to insanity or feeble-mindedness; second, to carefully weigh the probable re- sult of procreation and its effect upon the coming generation and to act with the thought of protecting the individual and safeguarding the interests of the state. "We recognize the feeble-minded class as the most prolific class and potentially the most dangerous from the standpoint of race standards. We have, therefore, unhesitat- ingly authorized the sterilization of the male feeble-minded wherever application was made. With the female feeble-minded we have recognized complications which made the task of disposing of these applicants less simple. In the first place the surgical pro- cedure is much more complicated and after sterilization the social problem is a compH- 'Institutions 5, G, 7 and 8 did not supply historical comment. cated one as such individuals may become prostitutes and carriers of venereal diseases. We have, therefore, advocated custodial care rather than sterilization in the case of the feeble-minded female. In • the applicants in which the condition was one of frank insan- ity we have been guided largely by the wishes of the patient and relatives in author- izing sterilization. We have refused sterili- zation or parole in other instances and have permitted some cases to be paroled- without sterilization, being guided by the family history as well as the specific form of mental alienation from which the applicant was suf- fering. "We are pleased to report that universal good results have been obtained in all cases sterilized. In each institution extreme care has been exercised and in no instances have difficulties or complications arisen. We include herewith a table which will reveal in a general way the efforts of the Board. "Respectfully submitted, "B. F. WILLIAMS, Chairman. "W. S. FAST, Secretary. "GEORGE E. CHARLTON, "D. G. GRIFFITHS. "H. WINNETT ORR." Table Containing Patients Coming Under the Observation of the Board of Exami- ners of Defectives for the Period Ending November 30, 1916: Men. women. Total. Whole number of patients passed upon 40 49 89 Number ordered sterilized.. 15 30 35 Sterilized according to law.. 9 6 15 Number authorized paroled without sterilization 20 36 46 Number examined, action de- ferred 5 3 8 No patient examined from the penitentiary, either of the industrial schools or industrial home. November, 1916. (b) Second Biennial Report, 1918: "To his Excellency, Honorable Keith Ne- ville, Governor, and to the Honorable Members of the Board of Commissioners of State Institutions, Henry Gerdes, Silas A. Holcomb, and Eugene O. Mayfield. "Gentlemen: "We submit herewith the Second Biennial Report of the Board of Examiners of De- fectives, covering the period beginning De- cember 1, 1916, and ending November 30, 1918. This Board was created and appointed by the Board of Commissioners of State Institutions complying with Chapter 337, 76 Statistical Summary of-Eugunical Stbrilization Laws of Nebraska, 1915, entitled 'An Act to authorize the sterilization of feeble-minded and insane inmates of state institutions, in certain cases, and to provide for the appoint- ment of a commission, and to define their powers and duties in connection therewith.' . "There have been ten meetings of the Board of Examiners of Defectives held dur- ing the past two years. Meetings are called by the chairman on request of the superin- tendents of the different state hospitals. Appended to this report will be found five tables; Table I, referring to the Ingleside Hospital for the Insane; Table II, the Ne- braska Hospital for the Insane; Table III, Hospital for the Insane of Nebraska; Table IV, Nebraska Institution for Feeble-Minded Youth; Table V, combined report of the action of the Board as it pertains to all of the institutions. There was a total of 835 patients examined in four state institutions. The institutions were given authority to sterilize 77 patients before parole or dis- charge be granted, 43 patients have been sterilized, the remaining 34 patients still re- main residents of the institutions, they being as yet unable mentally to take their former place in society. "Section 1 of the law;; governing this Board reads as follows: 'Sterilization of feeble-minded or insane inmates of state institutions. — Hereafter no feeble-minded or insane inmate, physically capable of bearing or begetting offspring, shall be paroled or discharged from the institution for the feeble-minded, or the hospital for the insane, nor paroled from the penitentiary reforma- tory, industrial home, industrial schools or other such state institutions, except as here- inafter provided, or by order of a court of competent jurisdiction.' "It will be noted that the Board has riot been called upon to examine any patients from the State Penitentiary, the Nebraska Industrial Home, State Industrial School, nor the Girls' Industrial School. All patients examined were from the three hospitals for the insane and the institution for feeble- minded. "The Board has adopted and followed a conservative policy in dealing with appli- cants for sterilization. No controversies have been invited nor entered into, preju- dices in most cases have been overcome and religious scruples have always been re- spected. No patients have been sterilized without full consent of the relatives and the consent of the patient himself. Authority to sterilize has not been given in any case until after careful consideration of the per- sonal and family history of the patient and the Board convinced that the patient was capable of bearing or begetting offspring and that the offspring 'would inherit a ten- dency to feeble-mindedness, insanity, or degeneracy, and that such children would probably become a social menace and that procreation by such inmate would be harm- ful to society.' In every case operated upon, recovery was prompt and complete. "Respectfully submitted, "W. S. FAST. Chairman. "D. G. GRIFFITHS, Secretary. "G. E. CHARLTON. "J. D. CASE. "B. A. FINKLE." (c) Statistical Report of Board of Exam- iners of Defectives: INGLESIDE HOSPITAL FOR THE INSANE, INGLESIDE, NEBRASKA Table of Patients Coming Under the Observation of the Board of Examiners of Defectives for the Biennium Ending November 30, 1918. TABLE I. M F T Number examined 50 44 94 Authority given for sterilization before parole or discharge 12 4 16 Authority given to parole or discharge with- out sterilization 34 30 54 Action deferred 14 10 34 Total 50 44 94 Sterilized according to law 13 1 13 -JM^mM^ Statistical Summary of Eugenicai, Sterilization 77 NEBRASKA HOSPITAL FOR THE INSANE, LINCOLN, NEBRASKA Table of Patients Coming Under the Observation of the Board of Examiners of Defectives for the Biennium Ending November 30, 1918. TABLE II. M F T Number examined 36 4(; gg Authority given for sterilization before parole or discharge 15 lo ai Authority given to parole or discharge with- out sterilization 13 33 35 Action deferred 8 % ly Total 36 4G 82 * * * * t Sterilized acording to law 4 10 14 HOSPITAL FOR THE INSANE OF NEBRASKA, NORFOLK, NEBRASKA Table of Patients Coming Under the Observation of the Board of Examiners of Defectives for the Biennium Ending November 30, 1918. TABLE III. M F T Number examined 35 31 56 Authority given for sterilization before parole or discharge 23 4 27 Authority given to parole or discharge with- out .".terilization 5 16 21 Action deferred 7 1 8 Total 35 21 56 't* ^ "1^ T* 'K Sterilized according to law 10 3 13 NEBRASKA INSTITUTION FOR FEEBLE-MINDED YOUTH, BEATRICE, NEBRASKA Table of Patients Coming Under the Observation of the Board of Examiners of Defectives for the Biennium Ending November 30, 1918. TABLE IV. M F T Number examined 2 1 3 Authority given for sterilization before parole or discharge 2 1 3 Authority given to parole or discharge with- out sterilization Action deferred Total 3 1 3 Sterilized according to law 3 1 3 78 Statistical Summary of Eugenicai, Sterilization Combined Tables of Patients from the Ingleside Hospital for the Insane, Nebraska Hospital for the Insane, Hospital for the. Insane of Nebraska, and the Nebraska Institution for Feeble-Minded Youth, Coming under the Observation of the Board of Examiners of Defectives for the Biennium Ending November 30, 1918. TABLE V. M F T Number examined 133 112 235 Authority given for sterilization before parole or discharge 53 25 77 Authority given to parole or discharge with- out sterilization 42 68 110 Action deferred 29 19 48 Total 123 112' 235 ***** Sterilized according to law 38 15 4:i Institutional Reports. 3. State Hospital, Ingleside. W. S. Fast, In response to inquiries the following Superintendent, information and opinions were given: "All patients of child-bearing age, other- 1. Nebraska Institution for Feeble-Minded wise eligible for parole or discharge, are Youth, Beatrice. passed upon by the Sterilization Board. (a) Dr. D. G. Griffiths, Superintendent: There have been no changes in this law "The Nebraska sterilization law applies which has been in effect for a period of five only to inmates of state institutions, and years, nor have I any changes to suggest, only then when they are about to be dis- The law should always be administered by charged during the child-bearing period. As conservative physicians. Personal and fam- far as it goes the law has been very satis- i'y histories, individual characteristics, etc., factory in our state. The operations under etc., should be taken into consideration in it are limited in number, and have been determining whether or not patients should entered into at all times with a great deal of be sterilized." February, 1921. precaution. I think the act was not passed 4 Nebraska Hospital for the Insane, on a medical basis, but for its eugenical. Lincoln, (a) Dr. Lawrence B. Pilsbury, value." April, 1918. Superintendent. (b) J. A. Buford, M. D Assistant Super- ,,y^^ ^jj, ^^^.^^ ^^ j,^^ ^^^^,^^^j ^^p^^^ intendent: "The State of Nebraska has a ^j^^^ ^^ j^^^^ sterilized in this institution Board for exammation of mental defectives. ^^^^^ ^^^^ ^^^ ^j^ ^^^^^„ ^„^^^ ^^^ ^^^^^^^ Before being discharged from this institu- ^j ^g^g. ^^^ ^^ ^j^^ ^^^^^ ^^.^^ ^ ^.^^ ^^^^^ tion, patients must appear before this Board, ;^^^^j,^ ^„j ^j,^ ^^^^^ p^^i^^^^ ^„ ^^.^^ and upon their recommendation, they are • *^ insane, ordered sterilized and discharged. This „_ , ^, -i .■ u » i ... ^ ^, cj. ^ n ^<- J- Tr One of them was an epileptic, but 1 work IS done at the State Orthopedic Hos- ,, , , ,. , • , , ■, ,■ . , , . , .. , , suppose that when a patient is both epileptic pital, Lincoln, Nebraska. j . , , , , ^^ . and insane you would have such patient "Our suggestions have been embodied in classified as insane. The analytic table does certain bills mtroduced in the Legislature ^^^ ^^^^ ^^ p^^^j^^ f^^ j,,i^ contingency, nor by request of the Nebraska Children s Code ^oes it provide for hysterectomy, pan- Commission. hysterectomy nor the removal of tube on "I am heartily in favor of it and urge the ^^g jj^g ^^^ ^vary on the other, although adoption of some such measure under proper ^i, „f ^^^3^ procedures are- sterilizing oper- supervision and regulation." January, 1921. ations 2. Hospital for Insane, Norfolk. G. E. "Of the men sterilized, one, H. C, was a Charlton, Superintendent. high grade imbecile with a record of repeated "I would do away with that part of the thefts. He left the hospital in good physical sterilization statute requiring the consent of condition and I have heard nothing of him the nearest relative." January, 1981. since. Another, U. T., was a case of manic- Statistical Summary of Eugenical Steriwzation 79 In response to inquiry, Dr. Pilsbury stated that, in his opinion, the medical value of the statute was probably very little, but that, theoretically, the eugenical value should be considerable, so far as reducing the incidence of insanity and feeble-mindedness is con- cerned; but that custodial segregation would, in time, of course, bring about the same result. March, 1918. (b) J. D. Case, Superintendent: "Hered- ity, age, civil condition, physical condition all are taken into consideration in cases passed upon by the Board of Examiners of Defec- tives, consisting of five specialists in nervous and mental diseases. "Eugenical sterilization is very important if carefully applied in cases which are care- fully selected by a competent board." January, 1921. 9. Industrial Farm for Women, York. Dr. Alma J. Chapman, Superintendent. "When Hazel Scott was ready to be paroled she came before the Sterilization Board and they recommended sterilization. This was done at the Orthopedic Hospital, Lincoln, Nebraska. She had had a child at the Nebraska Industrial Home at Milford, Nebraska, and has spent most of her life in institutions. So we had her examined before the Sterilization Board. Her sister signed a paper giving her consent. "I am in favor of sterilization, especially for patients paroled from insane asylums." January, 1921. 8. NEVADA. The statute dates from 1911. Present of the criminal courts, subject to the act, but status (January 1, 1922): Inoperative; de- performed no eugenical sterilizing operations clared unconstitutional by Federal Court, under it. 1918. One (1) state institution was, by order depressive insanity and had apparently entirely recovered from his attack when he left the hospital recently. He has a history of repeated attacks of insanity, and the steril- izing operation seemed to have no influence one way or the other on his recovery. The other male patient, W. S., had also a' history of repeated manic-depressive attacks and ran away from the hospital recently without full recovery. The operation had no effect on his mental condition. "Of the women, one, E. B., was a case of dementia praecox on a defective basis. Both tubes were removed and the patient is still in the hospital and shows slight mental im- provement. Another, K. A., also a dementia- praecox patient, had the right tube and left ovary removed. She left the hospital soon afterward and her present condition is un- known. "Another woman, G. D., sister of the pre- ceding, a manic-depressive case, had both tubes removed and left the hospital some- what improved mentally. Another, A. B., diagnosed as dementia praecox, had both tubes removed and is now in the hospital in about the same condition. "P. E., a case of manic-depressive insanitj-. had both tubes resected, but she had practi- cally recovered from her attack before the operation was performed. She left the hos- pital later and is still away on parole. "A sixth woman, G. K., is an insane epileptic and in her case a hysterectomy was performed. She is still in the hospital in an unimproved condition." Vasectomy 1. State Penitentiary. Carson City Castration Salpingectomy Ovariotomy Ttatal Total to January- 1. 1921... Notes on the Enforcement of the Eugenical Sterilization Law in Nevada. In this state eugenical sterilization existed solely as a punishment and its first attempted use resulted in the federal courts declaring it "cruel and unusual." In response to inquiries the following information and opinions were given: 1. Nevada State Penitentiary, Carson City. (a) R. B. Henrichs, Warden. "There is a Sterilization Law in this state, but as the only sentence imposed was never carried out, but was taken to the Supreme Court and is still pending, I am not in a position to make a report." January, 1918. (b) "I do not believe in sterilization." January, 1921. 80 Statisticai, Summary of Eugbnical Sterilization 9. NEW JERSEY. The statute dates from 1911. Present institutions of the same types, were subject status (January 1, 1922): Declared uncon- to the act; however, no eugenical sterilizing stitutional by state courts, 1913. Ten (10) operations were performed under it. The state institutions, also the several county ten state institutions are as follows: MALES FEMALES Vasectomy Castration Salpingectomy Ovariotomy Total 1. State Prison, Trenton 2. Reformatory, Rahway 3. Home for Girls, Trenton 4. Home for Boys, Jamesburg. . . 5. State Hospital, Trenton 6. State Hospital, Morris Plains. 7. State Village for Epileptics, Skillman 8. Colony for Feeble - Minded Males, New Lisbon 9. Reformatory for Women, • Clinton 10. Institution for Feeble-Minded • Women, Vineland ■ Total to January 1, 1921... Notes on the Enforcement of the Eugenical Sterilization Law in New Jersey.^ The first attempted use of the statute (by the State Village for Epileptics at Skillman)' in this state resulted in a test case before the courts which declared it to be class legislation so far as epileptics are concerned. This adverse decision, while not specifically applying to subject institutions for other types of the socially inadequate, resulted in their declining to make use of the statute for fear of similar prevention by the courts so that this law has always been a dead letter. In response to inquiries the following information and opinions were given: 3. State Home for Girls, Trenton. Eliza- beth V. H. Mansell, Superintendent. "One of the first acts of Governor Wilson was to sign the sterilization bill, but it was immediately afterward pronounced unconsti- tutional." January, 1918. 4. Home for Boys, Jamesburg. Rudolph W. Remser, Resident Physician. "I believe with Dr. August Hoch that this, in general, is a matter of education of the public conscience in regard to the great re- sponsibility of marriage and parenthood rather than legislation, especially in juveniles in whom the percentage of definite psychoses is so small." January, 1921. 5. State Hospital, Trenton. Dr. Henry A. Cotton, Superintendent, reports that no operations were performed under this law, which was declared unconstitutional but that, in his opinion, " Institutions 1, 2, 7 and 9 did not supply historical comment. both the medical and eugenical values of such a statute would be good. February, 1918. 6. State Hospital, Morris Plains, (a) Dr. Britton D. Evans, Medical Director. "I have to advise you that the Sterilization Statute was declared unconstitutional in this State, and as no patients have ever been re- ported upon, I can give you no data on the subject." February, 1918. (b) Marcus A. Curry, Superintendent. "I am of the opinion that eugenical steriliza- tion properly safeguarded and supervised would be a valuable agent in decreasing the supply of the socially unfit. "If the present statute had not been de- clared unconstitutional it might have been practical and effective, but without actual testing it is impossible to state." January, 1921. 8. Colony for Feebl«-Minded Males, New Lisbon. J. Frank Macomber, Superintendent, gave it as his opinion that the principal value of the sterilization law was experi- mental; that it was the proper thing for feeble-minded males, but its value was very questionable when applied to females. Jan- uary, 1918. 10. Institution for Feeble-Minded Women, Vineland. Geo. B. Thorn, Superin- tendent. "We have not taken advantage of the Sterilization Law which is in effect in this state. fcjTATisTiCAi, Summary oP EugUnicai, Sti^riuzation 81 "We feel it would be a wonderful help in was declared unconstitutional. The law the administration of this institution were affecting this institution is not the same, but we able to avail ourselves of this statute, as we have not made a test case as yet. We there has been some difference of opinion as are having considerable discussion in New to the legality of same. Jersey as to how to have this law amended "A test case had been tried in one of the so that it will be constitutional." January, courts where a patient was operated on, at 1931. Skillman, N. J., and from their standpoint, 10. NEW YORK. The statute dates from 1913. Present (30) state institutions were subject to the status (January 1, 1923) : Repealed 1930, act before its repeal; they performed eugen- after having been declared unconstitutional ical sterilizing operations as follows: by the lower state courts in 1918. Thirty MALES PEMAIiES ' Vasectomy Castiation Salplneoctomy Orariotomy Total 1. State Prison, Auburn 10 1 3. Clinton State Prison, Danne- mora 3. Sing Sing Prison, Ossining... 4. Great Meadow Prison, Com- stock 5. Farm for Boys, Valatie 6. Reformatory, Elmira 7. Eastern New York Reforma- tory, Napanoch 8. Agricultural and Industrial School, Industry 0. 9. Training School for Girls, Hudson 10. Western House of Refuge for Women, Albion 11. Reformatory for Women, Bed- ford Hills 13. Institution for Feeble-Mindcd Children, Syracuse 13. Newark State School, Newark 14. Custodial Asylum, Rome 15. Craig Colony for Epileptics, Sonyea 36. Letchworth Village, Thiells.. 17. Matteawan State Hospital, • Beacon 18. State Hospital, Utica 19. State Hospital, Willard 30. Hudson River State Hospital, Poughkeepsie 31. State Hospital, Middletown. . . .0 22. State Hospital, Buffalo 13 13 23. State Hospital, Binghamton.. 24. St. Lawrence State Hospital, Ogdensburg 25. State Hospital, Rochester.... 26. Gowanda State Hospital, Collins 34 5 39 27. State Hospital, Kings Park... 28. State Hospital, Central Islip.. «■ 29. Long Island State Hospital, Brooklyn '. • . • 30. Manhattan State Hospital, Ward's Island, N. Y _0_ Total to January 1, 1921... 10 36 5 43 82 Statisticai, Summary of Eugenical Sterilization Notes on the Enforcement of the Eugenical Sterilization Law in New York." The State of New York in its Eugenical Sterilization Statute provided for a "Board of Examiners of Feeble-Minded Criminals and other Defectives," and appropriated $29,835.00 for the execution of the statute. The money appears to have been spent large- ly for fees and traveling expenses,' and no printed report was ever issued, nor, from the detailed reports of institutions, did the Board of Examiners ever attempt any serious study or accomplish anything other than to bring a test case before the State courts. It appears also that the law was originally passed, not at the instance of persons inter- ested in eugenics, but for the primary purpose of creating a commission for "de- serving friends." The statute was copied almost bodily from the New Jersey law, and no effort was made to improve or adapt it. In short, the history of this law in New York State is a record of politics, incompe- tency and discredit. It has set back eugen- ical progress among the state's institutions more than ten years. The two institutions in this state which practice eugenical sterilization, namely, the State Hospitals at Buffalo and at Collins, operate under their own responsibility. They did not attempt to use the sterilization statute when it was in force. (a) Excerpts from correspondence of Hon. Francis M. Hugo, Secretary of State for New York, and from that of Dr. Lemon Thomson, Member of the Board of Exam- iners of Feeble-Minded 'Criminals and other Defectives, together with a Statement of Appropriations and Expenditures of said Board furnished by Comptroller Eugene M. Travis: Hon. Francis M. Hugo, Secretary of State. "We give below the names, addresses, dates of appointment, expirations df terms, etc., of persons who were appointed on the Board of Examiners of Feeble-Minded Criminals and other Defectives, which is the Commis- sion you referred to and which was estab- lished by 'Chapter 445 of the Laws of 1912.' » Institutions 3, 4, B, 8 17, 18, 19, 24, 25 and 29 did not supply historical comment. ' See p. 83 "Comptroller's Report," and p. 189 "Costs and Appropriations." "Charles H. Andrews, M. D., of Buffalo, N. Y., appointed August 36, 1913; no expira- tion of term given. "Lemon Thomson, M. D., of Glens Falls, N. Y., appointed August 86, 1913; no expira- tion of term given. "Charles C. Duryee, M. D., of Schenectady, N. Y., appointed August 26, 1913; no expira- tion of term given. "John V. Hennessy, of Albany, N. Y., appointed March 9, 1914, for a term to expire August 36, 1917; Vice Duryee, resigned. "William J. Wansboro, M. D., of Albany, N. Y., appointed July 32, 1914; no expiration of term given; to succeed John V. Hennessy, M. D., deceased. "According to our records the present Members of the Board are as follows: "Charles H. Andrews, M. D., of Buffalo, N. Y. "Lemon Thomson, M. D., of Glens Falls, N. Y. "William J. Wansboro, M. D., of Albany, N. Y." February, 1918. Dr. Lemon Thomson, dens Falls, N. Y. "I regret to state that our work on the board of examinations of feeble-minded, etc., resulted in a total fizzle. We spent more time with the Legislature to get an appro- priation to carry on the work than we were spending on the work itself. Finally we got a case before the court for a legal deci- sion, and it is now more than two years since the closing of the case. Attorneys failed to put in their briefs, consequently we had no hope of getting a decision. A little more than a year ago, having become disgusted with the whole affair, I wrote to the Secretary of the Governor as to whether Governor Whitman favored further investi- gation in that direction. Not hearing from the Governor's Secretary, I threw up the whole matter in disgust, as I did not feel like spending my money on work in which we could not get a decision. It is a disgrace to the State that they have taken no amount of interest in the same. "As to reports I do not know where to put my hand on them, but if they would be of any service to you, I will gladly look up same and forward them to you, but we did not get so far as to have any printed re- ports." February, 1918. Statistical Summary of Eugenicai, Stsriuzation 83 2i rt* o O § W o o g t- Q CO O CO to o T-1 (M o (M o Tt «o 00 g O (M W3 (M d o vn wo w:) Cf> CO r-l T-t iH iH tH rH rt OS Oi Oi CJ Ci OS OS Oi Ci Oi Ol PQ rH' ■H 1-1 »H iH T-l iH tH ^ r-f rH 1-H Oi -H"r-i 1-1 1-1 iHi-l Ti tH t-i i-lrHrH r-( r-< tH iH ri i-< r-T tH i-T r-T i-l' r4 tH* t-h r-T tH OOO O O O OO O O C O^^ h^ ^ s CO •* iH rH C^ OS "* in i-C iH OS O o o t- CO Oi 0-. >ni o CO »r; C". o CO CO COt-THWt-t^QCTji r-i O CO -f (N iH CT. 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C m O a; rt5 >> :3 a-?.. t— 1 - g ,— — 1— P3 c c HHtr 84 Statisticai, Summary of Eugenicai< SteriuzAion (b) National Christian League for Pro- motion of Purity (New York). Elizabeth B. Grannis, President, March 9, 1931, writes: "Some people should be segregated, but not more than one-quarter or one-third of those who now occupy public institutions, and are supported by public funds. If the economic phase of this question could be properly understood a multitude of sensible people would come to the front in behalf of sterilization. "We have had a number of cases that ought to be known to every intelligent indi- vidual. One young man whom I took out of the idiot asylum on Randall's Island, pro- nounced incurable (there was nothing the matter with him but silly, contemptible parentage who didn't know enough to man- age him) — he was given to self-indulgence, and pronounced by the boy doctors, incur- able. In a few weeks after I took him out. he was sterilized, and in a very few weeks becan^e so self-responsible and self-respect- ing, no longer a cowered, machine-made nervous wreck that he had been, * * * we obtained a position for him with the Rem- ington Typewriter Co.,, at $3.50 per week. His salary was raised every few weeks until within a very few months he was getting seven dollars a week. He is now a full- fledged United States soldier, with never a symptom of any feeble-mindedness having occurred to any federal authority who ex- amined him. Another young man who had been in the Binghamton Asylum five years is now in camp with excellent record, having been pronounced incurable by the young doctors, and in my repeated correspondence it was stated by the superintendent that it was not probable that he could ever become self-supporting. The first position he obtained was as elevator man with ,$40.00 a month income for his service. Today both of these young men are attending night school, but both in camp, displaying whole- some ambition, with promises to fit them- selves for business and to be alw.iys a credit to those who helped in securing their dis- charge. The one who was in five years attended one of our meetings in which he made an address, stating, 'Today I am a free man, walking the streets like any other citizen instead of being behind bars and locked in, with no freedom of individual action.' "I could mention a case of a young woman sent home from every boarding school for improper conduct. Sterilization settled her, and prevented serious distress and mis- fortune." (c) In response to inquiries the following information and opinions were given: 1. Auburn State Prison, Auburn, (a) Dr. Frank L. Heacox, Physician. "The State Commission made a special study of a few cases, but no recommendations were made as to the cases investigated. One oper- ation of double vasectomy was performed on one patient at his own and his family's request. The patient was a youth twenty years of age, who was suffering from tuber- cular testicles." Dr. Heacox stated that, in his opinion, the medical value of the statute was very little, but that eugenically it was invaluable. March, 1918. (b) "Our one case of eugenical steriliza- tion was a voluntary one." January, 1921. 2. Clinton State Prison, Dannemora. Dr. John R. Ross, Medical Superintendent. "There is no doubt in my mind that this operation, if carried out extensively among the insane, feeble-minded and certain of the criminal type, would be of great eugenical value. I feel, however, that it would be impossible to perform this operation to any extent until there has been an educational campaign among the public." February, 1918. 6. New York State Reformatory, Elmira. Frank E. Christian, Superintendent (a) "Several cases were examined by the Commission, but nothing more accom- plished. Medically the statute was excellent in selected cases, and eugenically it was a good measure." January, 1918. (b) "The New York Sterilization Law, now repealed, was never popular enough to be enforced. A number of our segregable defective delinquents ought to come under the jurisdiction of a practical sterilization law. We believe it to be practical in cases of extreme degeneracy." January, 1921. 7. Eastern New York Reformatory, Na- panoch. (a) Dr. W. N. Thayer, Jr., Physi- cian, reported that no operations had been performed there, that the institution had never been visited by the Committee; that he would not care to offer an opinion con- cerning the medical value of the statute, but that its eugenical value was good, if applied to cases of feeble-mindedness and recurrent insanity. Dr. Thayer did not consider crime hereditary. January, 1918. (b) "Eugenical sterilization is not neces- sary in cases requiring permanent custody Statisticai< Summary of Eugunicai, Steriwzation 85 but it should be done in cases of feeble- minded individuals not in custody." Janu- ary, 1921. 9. Training School for Girls, Hudson. Dr. Hortense V. Bruce, Superintendent. "We have never attempted to do anything under the authority of the Sterilization Law as we understood that the matter would have to come into the courts. In fact, the Commissioners sought to have us select a patient only in order to have a test case to bring into court. Therefore, this institution has nothing but a negative report.'' Febru- ary, 1918. 10. Western House of Kefuge for Women, Albion. Dr. D. E. Ollswang, Physician. "I think that the Sterilization Law is excellent, and certainly ought to be carried out in all institutions of this nature. It would greatly decrease the number of feeble-minded and inferior children born." January, 1918. 11. Reformatory for Women, Bedford HUIs. (a) Mary C. Conant, Physician. While four cases were reported. Dr. Conant, resi- dent physician, states that "'none of the four cases were primarily for sterilization. In the first case tubes were diseased, and the other three cases were Caesarian sections for con- tracted pelves. Under the circumstances sterilization seemed desirable." Doubtless these operations would have been performed •under due course of professional practice, regardless of the so-called Sterilization Law. Superintendent Helen A. Cobb writes: "My understanding of the Sterilization Law in this state is that it has not got beyond the statute books in Albany. No operations primarily for this purpose have been per- formed in this institution." January, 1918. (b) O. M. Grover, M. D., Resident Physi- cian. "I think all mental defectives who are custodial charges should be sterilized." January, 1921. 12. (a) Institution for Feeble-Minded Children, Syracuse. Dr. O. H. Cobb, Super- intendent. "The medical and eugenical values of the .sterilization statute are nil." January, 1918. (b) "We have done none of this at this institution and from our viewpoint this pro- cedure is nott practicable in New ;York State at this time." January, 1921. 13. Newark State School, Newark. Dr. Ethan A. Nevin, Superintendent. "The State Commission made some preliminary investi- gations but no cases from this institution were recommended for operation. I under- stand, through the failure of the legislature to provide funds for this commission, that it has practically become extinct. I have not had sufficient evidence presented to me to convince me that this is a wise method of dealing with this proposition." February, 1918. 14. Custodial Asylum, Rome. Dr. Charles Bernstein, Superintendent, from whose institution the test case for the New York statute arose, reported that there had been no operations under the law in his institution; that he could not in the ordinary course of professional practice perform any operation under this law that would be for- bidden or illegal without it; that, in his opinion, there was no medical value in the statute; and that, instead of being of eugen- ical value, the statute was a eugenical hin- drance." January, 1918. 15. Craig Colony for Epileptics, Sonyea. Dr. Wm. T. Shanahan, Superintendent. "The Commission visited the Colony, but nothing was done in the way of attempting to enforce the Act." Dr. Shanahan reported that, in his opinion, the statute was of doubtful medical and eugenical values. January, 1918. 16. Letchworth Village, Thiells. Dr. Charles S. Little, Superintendent. "The Sterilization Law in this state has not been put in practice, and I doubt if it ever will be, although I do not know of any good reason why it should not be done, if public sentiment would be favorable to it." February, 1918. 20. Hudson River State Hospital, Pough- keepsie. Dr. Walter G. Ryon, Superin- tendent. "No cases have been sterilized on account of the prejudice existing against the operation on the part of patients and their relatives. The hospital's policy is not to antagonize them. Some have been given the alternative)' in seeking discharge, but have not accepted it." Superintendent Ryon gave it as his opinion that if an operation is for purely sterilizing purposes, he could under the law perform operations which would be illegal without it. In answer to inquiry concerning the medical and eugen- ical values of the statute he wrote: "The eugenical value is great. The medical value consists in increasing the propriety, and therefore, the frequency of paroling and dis- charging convalescent insane." February, 1918. 86 Statistical Summary of Eugbnical Sterilization 31. State Hospital, Middletown. Dr. M. C. Ashley, Superintendent, reported that while they had not performed any opera- tions in his hospital because funds had not been provided for the purpose, still, in his opinion, both the medical and eugenical pos- sibilities of the statute were excellent. Janu- ary, 1918. 23. State Hospital, Buffalo. (a) Dr. Arthur W. Kurd, Superintend- ent, in answer to inquiries, reported that he was doubtful whether the law, as it stood before tested in the courts, was applicable to inmates of the hospitals for the insane. He stated also that in reference to the medi- cal value to the institution: "That it may be of a great deal of value in selected cases, as child-bearing, for instance, brings on re- current attacks of insanity. Eugenically the statute is of much value in preventing the propagation of defectives." "* * * Since 1912 six sterilizations have been done in this institution on women to produce sterility on account of the mental condition, which made it unwise that the patients should have any more children, and in two instances where, the mental condition was in unmarried insane women and was accompanied by immoral tendencies. In each one of the cases we obtained the written consent of the relatives, which was filed in the case before such an operation was under- taken. We have always felt that indiscrimi- nate sterilization among the insane was not indicated, but believe very . strongly in it, and think it is of very great value in de- creasing the number of people who would be born with a bad heredity, and also in saving the strength of women, for instance: If continued child-bearing would weaken the system, and in that way increase the tendency to mental breakdown." February, 1918. (b) F. W. Parsons, Superintendent. "Thefe have not been any untoward mental or physical effects resulting from our cases of salpingectomy, as the menstruation has continued uninterrupted. Before operating we obtain and file the written consent of husband, parent or guardian. Several de- fectives of bad moral tendencies were steril- ized before they were allowed to. go on parole, also a number of insane women with good intelligence and who had repeated at- tacks of insanity, during pregnancy or the puerperium. "The sterilization act is not in force in New York State. The hospital assumes the responsibility.'' January, 1921. 23. Binghampton State Hospital, Bing- hampton. Dr. Charles G. Wagner, Medical Superintendent. (a) "We have .never performed any operations for sterilization and do not con- template any such operations. You, of course, appreciate that the State Hospital Commission with headquarters at Albany, N. Y., has charge of all of the State hospitals in New York State and we have received no instructions from the Commission re- garding the application of eugenical steriliza- tion statute to which you refer." February, 1918. (b) "Approve of the theory but .the prac- tice has not been applied in this state." January, 1921. 26. Gowanda State Hospital, Collins. Dr. C. A. Potter, Superintendent. (a) In answer to inquiry concerning the medical and eugenical values of the statute, Dr. Potter replied: "If properly amended, the law would be of very great value in pre- venting recurrence of attacks of insanity, one of our cases has proven this conclusively. If enforced, after amendment, its eugenical value would be greater than any law of recent years which applies to institutions." February, 1918. (b) "We note that several of our patients who have been sterilized have had no mental breakdown since the operation and have been able to fill their places in the house- hold since they have not been exposed to pregnancy. Those cases which became in- sane on account of child-bearing or have a bad heredity but who could remain outside if not exposed to frequent child-bearing, are selected for sterilization and written consent is obtained from the husband or legal guard- ian, or nearest relative, the whole process and reasons therefor having been thor- oughly explained. The public should be shown that insane, epileptics, feeble-minded and criminals have no right to procreate, from an economic standpoint as well as from the point of eugenics. The insane, feeble-minded, epilep- tics and criminals of child-beairing age should be sterilized." January, 1921. 27. State Hospital, Kings Park. Di". Wm. A. Macy, Superintendent (deceased). (a) "I am not familiar enough with the statute to form a positive opinion as to its medical value, but a statute of this sort is of Statisticai, Summary o-e Eugenicai, STE;RmzATioN 87 value only when public opinioij^is educated to an appreciative point. With sufficient public support behind a law it should prove of value, especially in paroled or discharged cases of chronic insanity, mental deficiency and frequently recurring cases of mental disorder." January, 1918. (b) Wm. C. Garvin, Superintendent. "(1) Sterilization of patients in institutions seems superfluous. (2) In extramural cases or in cases about to be paroled or discharged we have not been able to convince ourselves that compulsory sterilization would be justi- fied in the absence of indications for com- mitment to an institution." January, 1921. 28. State Hospital, Central Islip. Dr. G. A. Smith, Superintendent, writes that no surgical .sterilization of inmates has been performed in his institution, and that he is uncertain as to whether in the ordinary course of professional practice he could per- form any operation under the sterilization law which would be forbidden or illegal without it. He responded, also, that in his opinion the law had no direct medical value. but that it was of eugenical value in cases of idiots, imbeciles, mental defectives and epileptics confined in institutions. March, 1918. 30. Manhattan State Hospital, Ward's Island, New York City. (a) Dr. Marcus B. Heyman, Superin- tendent, stated that, in his opinion, there was no medical value in the sterilization statute, but that its eugenical value con- sisted in the possibility of preventing pro- creation by constitutionally defective indi- viduals. February, 1918. (b) "There has never at any time been any patients in this hospital sterilized with a view to eugenics. It is not the policy of this hospital to make such recommendations. This question does not seem to be a medical question but rather a moral and ethical question. "I am of the opinion that the New York State Law authorizing sterilization was re- pealed, although I am not positive of this. In any event the law was so cumbersome that it was impractical." January, 1921. 11. NORTH DAKOTA. The statute dates from 1913. Present They have performed eugenical sterilizing status (January 1, 1922): Active. Four operations as follows: (4) state institutions are subject to the act. FEMALES - 1. Reform School, Mandan 2. State Penitentiary, Bismarck., 3. Hospital for Insane, Jamestown 4. Feeble Minded Institution, Grafton Vasectomy 11 Castration Salpingectomy Orariotomy Q 7 Total 18 Total to January 1, 1921... 15 Notes of the Enforcement of the Eugenical Sterilization Law in North Dakota.^ Like Connecticut, North Dakota is acting conservatively under her sterilization statute. The further use of it is a matter of educa- tion and increased interest. In response to inquiries the following information and opinions were given: 3. Hospital for Insane, Jamestown. (a) Dr. Wm. M. Hotchkiss, Superin- tendent. "I have had no difficulty in secur- ing the consent of parent or relative when patient refuses to have the operation per- formed. The statute is of inestimable eugen- ical value, because of its possibilities in elimi- nating, defective hereditary influences. Since the law has been in effect we have sterilized thirty males and two females; but we have 1 Institutions 1 and 2 did not supply historical comment. 8 23 done much less than contemplated, because the lack of finance prevented the hiring oi surgical nurses. We have eleven cases of females wha are to be operated on when possible." March, 1918. (b) A. W. Ogden, M. D., Assistant Superintendent. "The present State Board of Administration of North Dakota do not favor eugenical sterilization and there are many relatives of patients who oppose it, and on account of these facts there has been nothing done along this line for some time." February, 1921. 4. The Institution for the Feeble-Minded, Grafton. (a) Dr. A. R. T. Wylie, Superintendent. "We have as yet had no operations which came strictly under this law. One member of the Medical Board is opposed to such action from moral standpoints and this has Statisticai< Summary of Eugenical Sterimzation somewhat hindered its application here. mental andjjhysical improvement in certain However, we have performed a number 6f of our cases. In my opinion, in eugenical operations but with the consent of the value, the law is good." February, 1918. parents. (b) "The operation of sterilization is "The law is quite broad, and we think we usually preliminary to discharge. It is our can perform operations under it which would policy to secure the consent of the parent, be forbidden otherwise. We approve of such operations in properly "The law has some medical value in that selected cases." January, 1921. operations of this sort have resulted in 12. OREGON. The statute dates from 1917. Present They have performed eugenical sterilizing status (January 1, 1933): Active. Four operations as follows: (4) state institutions are subject to the act. MALES FEMALES Vasectomy Castration Salpingectomy Ovariotomy Total 1. State Hospital,* Salem 1 33 30 11 74 3. Eastern Oregon State Hospi- tal, Pendleton 33 8 40 3. Institution for Feeble-Minded, Salem 10 10 4. State Penitentiary, Salem 13 3 Total January 1, 1931 3 66 40 19 127 Notes on the Enforcement of the Eugenical "The law is working satisfactorily in this Sterilization Law in Oregon. State but we feel that it is too soon to say Oregon is the only state which has a °i i"st how much value it is going to be." State Board of Eugenics acting under that February, 1921. specific title. The law is functioning satis- (a) Excerpts from letters of the State factorily in all of the institutions to which Board of Eugenics, and State Board of it applies. Along with California and Ne- Health: braska, this state is developing her steriliza- State Board of Eugenics: "In answer to tion policy scientifically and progressively. your inquiry, while this law was passed in The Oregon law provides for a State 1917 very little has been done as yet and Board of Eugenics. According to section no report has been issued. At the last meet- one of the statute, this Board is entirely ing of the Board in December, about twenty ex-officio, and serves without compensation. persons were ordered sterilized. In two "The State Board of Eugenics is composed instances the patients appealed from the deci- of the State Board of Health, the Superin- sion of the Board. Owing to lack of in- tendents of the Oregon State Hospital, formation we are now at a loss how to Eastern Oregon State Hospital, and the handle these appealed cases.' Our Attorney- Institution for the Feeble-Minded, and the General is unable to enlighten us on the Warden of the State Penitentiary. The subject and if you can supply us with any Secretary of the Board of Health is also information or advise us where we could Secretary of the Eugenics Board. The secure such information, we would appre- present members are; ciate it very much." ROBERT E. L. Dr. W. B. Morse, President, Salem. HOLT, STATE HEALTH OFFICER. Dr. C. J. Smith, Vice-President, Portland. March, 1918. Dr. Andrew C. Smith, Portland. State Board of Health: "Your favor of Dr. F. M. Brooks, Portland. August 22d received in which you request Dr. George E. Houck, Roseburg. a recent report of our eugenical sterilization Dr. J. H. Rosenberg, Prinevillc. law. I regret to inform you that this work Dr. R. E. Lee Steiner, Salem. has not been published but the facts are Dr. W. D. McNary, Pendleton. essentially as follows: Dr. J. N. Smith, Salem. "The Eugenics Board is composed of the Mr. L. H. Compton, Salem. State Board of Health and the Superintend- Dr. Frederick D. Strieker, Secretary, ents of the insane asylums and the feeble- Portland, minded institutions of the State. The Secre- tary of the Board of Health is also Secretary •February 14, 1921, twelve cases pending be- _( ,. „ tt. .„.„;-„ d„„,j fore the State Board of Eugenics. °i '"^ Eugenics Board. Statistical Summary of Eugeinicai, Sterilization 89 "The Board meets at such intervals as necessary to examme cases needing steriliza- tion. At the present time cases which come under this class are purely institutional, and resolve themselves into those insane who are sterilized for their physical well-being, and the other class of the cyclic type who are paroled from the insane asylums and those feeble-minded cases which are paroled or sent to their homes for vacation periods or any other reason, and are sterilized prior to their discharge. Public sentiment in this way has not been aroused and the work is moving smoothly. "We have not decided yet to adopt a policy of doing widespread sterilization; by widespread I mean civic cases which come into court or are apprehended in other ways. "Upon our compilation of data, we will be pleased to send you a printed copy." DAVID N. ROBERG, M. D., STATE HEALTH OFFICER. September, 1919. (b) In response to inquiries the follow- ing information and opinions were given: 1. State Hospital, Salem. Dr. R. E. Lee Steiner, Superintendent. (a) "Cases are recommended to the State Board of Eugen- ics, who meet at the institution to examine the patients and go over their histories. The Board then decides what shall be done, and notifies relatives or guardians concern- ing their decision. Fifteen days are allowed for appeal to the Circuit Court.'' Dr. Steiner stated that he considered the law valuable as an educational measure, which might lead to more practical legislation, that its pos- sible eugenical value was limited as the law now stands, but that it opens the way to amendments in the future, which would be of great eugenical value. All of the 13 males who were operated upon in his institution were castrated. In all fcJur female cases the ovaries were removed. All of the 16 cases, both males and females, were flagrant mas- turbators or sex perverts. January, 1918. (b) "We have been operating for four years with a great many cases considered and a great many unsexed and sterilized with splendid results. For obvious reasons we are not advertising, but are continuing to do the best work possible. We will be able to show a remarkably fine statement in due course of time." From the Fourth Biennial Report of the Oregon State Board of Control for the biennial period ending September 30, 1920, Dr. Steiner says: "It will be noticed that thirty operations for sterilization have been done. All of these were by the direction of the State Board of Eugenics. No untoward or unfavorable re- sults have occurred, and the operations have been beneficial in all cases. It has been rather difficult for the public as well as the patients and relatives to get the right point of view and appreciate the immediate and remote benefits to be derived from this means of preventing the increase of insanity; but I think there is reason to hope that their increasing enlightenment will cause these operations to be resorted to much more extensively in the future." January, 1921. (c) L. F. Griffiths, First Assistant Physi- cian. "We maintain full clinical history of patients sterilized, together with notes added a few months after the operation. In carry- ing out the law prospects are selected by the staff who submit the patients together with their clinical history and reasons for sterili- zation, to the State Board of Eugenics. If the Board favors the operation they notify relative or guardian and give time for appeal which may be taken through the regular Courts. "We believe great good can finally be accomplished but that only such cases should be selected, regarding which there can be no doubt of its advisability." January, 1921. 2. Eastern Oregon State Hospital, Pen- dleton. (a) Dr. W. D. McNary, Superintendent. "The application of this law was placed in the hands of the State Board of Health and the heads of several state institutions. But it has been found to be rather impractical in application, as it was so framed as to make it difficult to apply to the class o» cases that it was most desirable to reach. The consent of relatives or guardian was required and appeal to the courts provided for, and after attempting to utilize it in a few cases at the Oregon State Hospital at Salem and meeting with protest and annoy- ing complications it was decided not to do anything further toward its enforcement." April, 1918. (b) "We maintain the usual case, personal and •family history. Cases are selected by the superintendent, referred to the State Board of Eugenics, examined and passed on by the Board and if favorable, the super- intendent is ordered to operate. Relatives are notified previous to operation and have redress by appeal to courts. 90 Statisticai, Summary of Eugbnical Sterilization "Eugenical sterilization is a proper, justi- should be fiable and beneficial procedure." January, Eugenics. 1931. 3. Institution for Feeble-Minded, Salem, (a) Dr. J. N. Smith, Superintendent, stated that no operations had been per- formed in his institution under this Act, and its medical value was unknown. He held that its eugenical value was considerable. January, 1918. (b) "We have performed ten cases of eugenical sterilization and have twelve cases now pending before the State Board of Eugenics." February, 1921. 4. Oregon State Penitentiary, Salem. (a) Charles A. Murphy, Warden. In the Oregon State Penitentiary there was, up to the time of this report, one case of eugenical sterilization. Exhibit A. (Report of Warden to Board of Eugenics.) OREGON STATE PENITENTIARY. Salem, Oregon, June 28, 1917. In re Chester Vanderpool, Prisoner No. 6770. CRIME: Larceny in dwelling. COUNTY: Multnomah. SENTENCE: 1 to 7 years. RECEIVED: February 3, 1913. Age 23. "This fellow has served two terms in the Oregon Reform School; he escaped from here June 10, 1913, and was returned June 11, 1915; he escaped again January 28, 1917, and was returned June 7, 1917. "It appears that the prisoner is the victim of unfortunate ancestral conditions from which he can never escape; his mother is feeble-minded, and his career has been one of continuous difficulty; sometimes not criminal in its tendency but always disobe- dient and unmanageable. I believe his case 13. SOUTH The statute dates from 1917. Present status (January 1, 1922) : Inactive. One (1) state institution is subject to the act, but considered by the Board of "CHAS. A. MURPHY, Warden." Exhibit B. (Order of Sterilization.) STATE BOARD OF EUGENICS. Selling Building. Portland, Oregon, Jan. 7, 1918. To Chas. A. Murphy, Warden, State Penitentiary, Salem, Oregon. IN RE CHESTER VANDERPOOL PRISONER NO. 6770. At a regular meeting of the Oregon State Board of Eugenics, held December 20, 1917, and after full and complete examination of the above named inmate, it is the decision of the Board that he be sterilized by vasec- tomy. This notice constitutes an order to that effect, said order to be carried out as provided in Section 9, Chapter 279, Session Laws of 1917. (Signed): ROBERT E. L. HOLT, Secretary. In reply to the question. What are the medical and eugenical values of the statute? Mr. Murphy wrote: "This statute prevents the bringing into the world of mental de- fectives by feeble-minded persons and those of criminal tendencies that are very pro- nounced. Regarding its eugenical value, the law has been in operation so short a time that I am unable to say." March, 1918. (b) L. H. Compton, Warden. "Cases for sterilization are referred to the State Board of Eugenics by the Warden. The prisoners are then given a hearing before this Board. The two prisoners recently cas- trated were released shortly after the opera- tion and we have had no chance to study the effects. "I believe this is the only way to handle feeble-minded, insane, sexual perverts, etc. It stops the breed, which is the desired result although its effect on the individual is usually very beneficial." January, 1921. DAKOTA. eugenical sterilizing operations have not yet been instituted. The institution subject to the act is: 1. State Institution for Minded, Redfield MALES VaBectomy CastraUon Fceblc- FEMALES Salpingectomy Orarlotomy Total to January 1, 1921... Statisticai, Summary of Eugunicai, Sterilization 91 Notes on the Enforcement of the Eugenical Sterilization Law in South Dakota. In this state the law applies to one institu- tion only but the administrative authority of this institution has never made use of it. In response to inquiry the following in- formation and opinion were given: In South Dakota the sterilization statute is applicable only to: 1. State Institution for Feeble-Minded, Redfield. Dr. J. K. Kutnewsky, Superin- tendent, reported that as yet nothing had been done about the enforcement of this law, because there was some question concerning its constitutionality. He declined to com- ment upon its eugenical value, and stated that its medical value was questionable. May, 1918. 14. WASHINGTON. The statutes date from 1909. Second stat- ute, 1921. Present status (January 1, 1932): Theoretically operative, having been sus- tained by the State Supreme Court in 1910, but practically a dead letter. Second statute not tested by court. Two (2) state institu- tions, as the executive agents of the criminal courts, are subject to the first act. They have performed eugenical sterilizing opera- tions as follows: Vasectomy 1. State Penitentiary, Walla Walla 1 2. State Reformatory, Monroe... Total to January 1, 1921... 1 Notes on the Enforcement of the Eugenical Sterilization Law in Washington. The sterilization law of 1909 in this state is like the law of Nevada, for which it served as a model, purely punitive in its motives and application, but unlike the case in Nevada, the Supreme Court of the State of Wash- ington upheld its constitutionality. In Washington the first sterilization law was applicable only to criminal court cases, and only by implication to the custodial in- stitutions—the State Penitentiary and the State Reformatory which are the executive agents of the court orders. The second law, that of 1921, is of much wider scope, applying to inmates of institu- tions for the feeble minded and insane as well as of the State Penitentiary and State Reformatory. It is purely eugenic and therapeutic in its motives. In response to inquiry the following information and opinions were given: 1. Washington State Penitentiary, Walla Walla. Superintendent Henry Drum says: "In the case of Peter Feilen no action has been taken as yet to carry into effect that pro- vision of the sentence calling for vasectomy; the status of the case being that it has been held in abeyance until the expiration of the time for appeal to the United States Supreme Court, which, as I understand it, will be in September of this year. There are petitions from friends of this man who do not believe he was justly convicted or that the crime, Castration - FEMALES ■ Salpingectomy Ovariotomy Total 1 i of which he was convicted, ever occurred. What the final result will be cannot at this lime be determined. "We have one other case here — that of a young man of doubtful normal mental condi- tion. In this case the commitment contains an order that 'an operation be performed upon the said William Henry Harrison Revenue for the prevention of procreation, and said operation not to be performed until further order from the Court.' It might appear that the intention of the Court, in making the provision that the operation should not take place until further orders of the Court, was that it should be a saving clause in the event that the young man, now under a life sentence, should be discharged from prison." August 23, 1913. 2. State Reformatory, Monroe. (a) Donald B. Olson, Superintendent. "Section 35 of 1909 Laws of Washington has not been carried out as far as it affects the inmates of this institution. We have no authority from the courts to perform such an operation, consequently none has been performed. I am in favor of the law when carefully worked out." February, 1918. (b) P. H. Raymond, Chaplain. "I am heartily in favor of the sterilization statute, if worked out with judicial care. I am also anxious to know if the law has been operated in other states and with what results, and if within your powers to supply any informa- tion concerning it, I would appreciate your sending it." February, 1918. 92 Statisticai, Summary op Eugbnical Sterilization (c) Geo. P. Dubuque, Secretary. "Al- though we believe m sterilization it has never been done at this institution." January, 1921. IN THE COURTS. Honorable George B. Holden,. Judge of the Superior Court, County of Yakima, State of Washington, makes the following statement of two cases recently before his court: (a) "The case in question is that of State of Washington vs. John Hill, upon whom I suspended judgment and suggested an opera- tion for the prevention of procreation. This, however, was merely a suggestion, and not a part of the judgment in the case. "On January 30, 1922, John Hill pleaded guilty to the crime of grand larceny. The theft was of a number of hams, which he took by stealth because of his impoverished condition; their value, however, being more than $25.00, he was guilty of grand larceny and subject, under our indeterminate sen- tence law, to not less than six months, nor more than fifteen years, imprisonment in the state penitentiary, which was the judgment of the court and the judgment was sus- pended during good behavior. The facts of the case, which led to the suggestion that he submit to! a voluntary operation for the prevention of procreation, and to which suggestion he assented after the details of the operation (vasectomy) and its results were explained to him, are as follows: "Hill is a Russian beet sugar laborer, with a wife and five children, all under the age of eleven years. He is robust physically, about forty years of age, and his wife some years his junior. Hill, his wife and five children are all mentally subnormal, even for their situation in life. For many months the children have been half starved and half clothed. It was apparent that he could not provide them with the common necessities of life, to say nothing of giving them any sort of advantages in the world by way of education or other preparation to battle for themselves. He was forced to steal to pre- vent them from starvation, or to apply for public aid. The case was brought to the attention of the authorities through the dis- covery of the theft of the hams, since which time he and his family are partially dependent upon public charity, and without the addition of more children to the family, will un- doubtedly continue to be more or less a public charge; with more children, the ex- tent of demand for public charity will be in- creased. Under these conditions, the opera- tion was suggested to him and after explana- tion, as before stated, he consented." (b) "I had occasion to order such an operation upon the defendant in the case of State vs. Chris McCauley on the 12th day of December, 1921. The history of this case, so far as is known, is as follows: "McCauley was convicted in King County, Washington, February 25, 1918, under the name of Harry Taylor, of the crime of burglary in the second degree, and sentenced to the State Reformatory, at Monroe, Washington. Some time subsequent to his sentence, it was learned by the Board of Control, that he had previously been con- victed of a felony in connection with dyna- miting a store at Cle Elum, Washington, and had served five years in the State Peni- tentiary at Walla Walla, for this offense; thereupon he was ordered transferred from the State Reformatory to the State Peni- tentiary, at Walla Walla, from which latter institution he was later paroled, and on September 17, 1921, he was convicted in this (Yakima) county of the crime of grand larceny. Thereupon he was informed against as an habitual criminal and convicted by a jury on November 30, 1921, and sentenced by me on December 12, 1921, to the State Penitentiary, at Walla Walla, for a period of not more than twenty years, nor less than ten years, and an operation was directed to be performed upon him by the warden of the penitentiary for the pre- vention of procreation. "This man, about 35 years of age, is sub- normal mentally and has every appearance and indication of immorality. He has a strain of negro blood in his veins and has a lustful and disgusting appearance. "The subject of sterilization is one that must receive more attention from the Ameri- can public." March 10, 1922. The statute dates from 1913 status (January 1, 1922). Active. Eleven (11) state institutions, also the several county institutions of the same types, are subject to the act (see p. 31, chapter III), 16. WISCONSIN. Present although the State Board of Control feels that neither institutions 6, 7 or 8 below listed, should be thus included. The state institu- tions have performed eugenical sterilizing operations as follc^ws: Statisticai. Summary o? Eugenicai, Sterilization 93 MAI,ES Vasectomy Castcatlon 1. State Prison, Waupun o 3. State Reformatory, Green Bay 3. State Hospital for Insane, Mendota 4. Northern Hospital for Insane, Winnebago o 5. Home for Feeble - Minded, Chippewa Falls 15 o 6. Public School, Sparta 7. Industrial School for Boys, Waukesha 8. Industrial School for Girls, Milwaukee 9. Southern Wisconsin Home for Feeble-Minded and Epileptics, Union Grove o 10. Industrial Home for Women, Taycheedah 11. Central State Hospital for the Insane, Waupun FEMALES Salplngeotomy Ovariotomy Total 61 76 Total to January 1, 1931... 15 Notes on the Enforcement of the Eugenical Sterilization Law in Wisconsin.^ Although the Wisconsin law is applicable to several types of institutions, the State Board of Control has thus far used it only in cases in the State School for the Feeble- Minded at Chippewa Falls. In this they are acting conservatively and because it is generally recognized that so far as degen- eracy is concerned, feeble-mindedness is more readily diagnosed than insanity and also when the problem of social menace due to worthless offspring is involved, feeble- mindedness deserves to be dealt with before insanity. The extension of this law to other institutions is a matter of conservative de- velopment and doubtless will be made when the state administrative system is prepared for it. The law seems to be working intelli- gently and effectively. From the Report of the Wisconsin State Board of Control, 1917-1918, pp. 6 and 7. "At various times since the legislature gave such authority, operations have been performed on inmates of both sexes of the Home for Feeble-Minded. There have been but few objections by the parents or rela- tives, and frequently the parents have re- quested that the operation be performed. Fifty-eight inmates have been sterilized, di- vided about equally between the sexes. Many of these, especially the females, have > Institutions 4, 8 and 10 did not supply historical comment. 61 76 been paroled, and most of them are doing well. But few have been returned to the home. "It is the intention of the Board to con- tinue these operations." Excerpts from letters of the State Board of Control. "I note that there is a question upon which you want information, about which you did not write me before; that you are receiving returns from a good many of the state insti- tutions of Wisconsin, which are subject to the sterilization law, but that this state differs from many others having such laws, in that the law is applicable to county institutions. "Under the sterilization law of Wisconsin we have power to sterilize any chronic insane inmate of a county asylum. We have thirty- five county asylums in this state with a population of about 6,300. Up to the present time none of the classes which we have power to sterilize have been sterilized except the feeble-minded. "The Board did not think it wise to pro- ceed with too much haste in the sterilization of mental defectives and it was thought best to sterilize at different times a number of feeble-minded patients and wait until it was determined what effect the operation had upon them. We find that it has little or no effect upon their mental condition. "We are now placing out in homes some of the feeble-minded persons who have been sterilized. This is done as an experiment to 94 Statisticai, Summary of Eugunical Sterilization determine whether it is advisable and safe to place these persons in homes. Those that have been placed out have only been a short time in homes and it is yet difficult to deter- mine whether the plan is going to be a suc- cess. If it is successful, we in time will •have quite a large number of feeble-minded persons placed out in homes. "No report has yet been made upon the sterilization of defectives, except the reports b'y the superintendent of the Home for the Feeble-Minded and the report which is in- cluded in our last biennial report. "M. J. TAPPINS, Secretary." February, 1918. "Since the date of the last report we have caused about one hundred and fifty persons to be sterilized. All of these were inmates of the Home for the Feeble-Minded and divided about equally between the sexes. A number of those that had been sterilized have been released from the Home, especially females. There have been no bad results from the operations; so far as we can determine, the operation has little or no effect upon the mentality of the individual. "It is the intention of the Board to con- tinue to exercise the authority given by statute to perform these operations. We have not yet extended it to the criminal classes; but that will probably be done in the future. M. J. Tappins, Secretary." February, 1919. "The correct number of operations for sterilization that have been performed is 76, of which 16 were males and 60 females. There was an error in our report of 1918 in the number. "During the war period practically no operations were performed because the sur- geon who did the operating was engaged in war work. A number of the inmates who were sterilized have been placed out in homes and are getting along reasonably well, and thus far the result of the operations has been satisfactory to the Board. Of course, the operation results in little or no change in the mental condition of the person operated upon. "Thus far no action has been, brought in the courts to determine the constitutionality of the sterilization law, and we hope that no such action will be brought, because in many of the states where actions have been brought the law has been declared uncon- stitutional. We do not want such a result here in Wisconsin because we believe that the sterilization of mental defectives will have a tendency to reduce the number in this class. M. J. Tappins, Secretary." February, 1930. "With reference to the organization of Sterilization Boards which may have been appointed or are now authorized to enforce the Sterilization Law in Wisconsin, you are advised that no permanent board has been created." "The State Board of Control from time to tiiTie appoints one surgeon and alienist who together with the Superintendent of the in- stitution act as a board in making a physi- cal and mental examination upon the in- mates committed to our Wisconsin Home for the Feeble-minded and upon their, find- ings and recommendations, this board au- thorizes that an operation for the prevention of procreation may be performed." H. W. WILLIAMS, Statistician, February, 1921. "Although the act authorizes this Board from time to time to appoint one surgeon and an alienist whose duty it shall be in con- junction with the Superintendent of Insti- tutions having charge of the criminal in- sane, feeble-minded and epileptic to exam- ine into their mental and physical condition and report as to the advisability of perform- ing the operation for the prevention of pro- creation, we have not as yet carried these investigations beyond the inmates of our Wisconsin Home for the Feeble-Minded and at the present time it is the policy of this Board not to go beyond this class of people in the sterilization of mental defec- tives." "Since this law has been in effect there has been no legal action introduced in any of the Courts or any adverse opinions ren- dered by the Attorney General of this state, which would in any way have a ten- dency to defeat the operation of the law." 11. W. WILLIAMS. Statistician. February, 1921. In response to inquiries the follow- ing information and opinions were given: 1. State Prison, Waupun. Wisconsin State Prison (only signature given) "Take our name from your inquiry list." Janu- ary, 1921. 2. State Reformatory, Green Bay. Dr. C. O. Latham, Physician, reports that, medi- cally he has had no opportunity to follow case histories, but that eugenically the stat- ute is of undoubted value. January, 1918. Statistical Summary of Eugenical Steriuzation 95 3. State Hospital for Insane, Mendota. F. I. Drake, M. D., Superintendent. When asked concerning his judgment in reference to the general policy of eugenical sterilization, Dr. Drake's laconic reply was: "Excellent." Jan- uary, 1921. 5. Home for Feeble-Minded, Chippewa Falls, (a) Dr. A. W. Wilmarth, Superin- tendent. '■♦ * » I might add that the statute legalizing sterilization in this state was passed for the following reasons: "It was found that the high-grade imbe- cile almost invariably cohabited with those who were also defective to some degree. Sometimes this was legalized by marriage, sometimes not. In every case, the offspring were generally defective. It was found that these physically strong and mentally cun- ning defectives could not be sequestrated successfully without curtailing their freedom of action more than was desirable. Many elope, others are discharged by that "court of last resort," a jury of laymen who know nothing about them. Parole was followed, more often than not, by the birth of more children. The operation here is primarily to prevent conception. No organ is removed except if found actually diseased, so that the health of the patient demands it. A small ijortion is removed from the cord, or tube, sufficient to make conception impossible. In that way, we hope, and expect, to be able to parole some to their friends where they can live a broader life than here, and where in case of a single indiscretion, should they escape the vigilance of their guardians, it would not be followed by the birth of offspring whose whole life would be a trag- edy." February, 1918. (b) "* * * Some of these operations were made at the request of parents, and none of them against the relatives' wishes. Where objections were filed, no operation has been performed. "* * * The cases are so uniform that I can see no advantage in taking time for sep- arate reports. The operation was limited to section, and ligating of both ends of the spermatic cords in the males, and the tubes in the females. "In the brief time which has elapsed, we have seen no change in the mental or physi- cal characteristics of these cases, nor do we see any reasons for expecting any. "The sole reason for operation is to pre- vent conception; many of our wards, com- ing from reasonably good homes, with par- ents who can, to a considerable extent, guard their children. This operation will prevent the serious results which may occur from even a single indiscretion. =" * *" February, 1918-. (c) In response to inquiry concerning the medical and eugenical values of the statute. Dr. Wilmarth replied: "No operations were undertaken that were not primarily for the purpose of sterilization. After operations we do not expect these cases to be able to turn over to the public ten sub-normal children, as one women has in this state. Some fam- ilies have sent four and five. We hope to diminish the number who need care, until it more nearly approaches the number we are able to care for. We expect no other re- sults." February, 1918. (d) A. L. Beier, M. D. Superintendent. "The procedure as outlined in the provisions of the Wisconsin Sterilization Act is fol- lowed in this institution. The production of sterility in mental defects by surgical meth- ods is the most powerful and effective means that we have at our disposal to prevent their propagation." "During the last biennial period or from July 1, 1918 to June 30, 1920, 17 inmates were operated upon for the prevention of procreation under the Sterilization Act. In each case their recovery from the operation was satisfactory and complete and as was expected no marked change was noted in their mental condition." February, 1931. 6. Public School, Sparta. L. H. Prince, Superintendent. "I have no suggestions to make at the present time, but I am in favor of the general policy of eugenical steriliza- tion." January, 1921. 7. Industrial School for Boys, Wauke- sha. Oscar Lee, Superintendent. "Ster- ilization is not practiced in this institution." January, 1921. 9. Southern Wisconsin Home for Feeble- Minded and Epileptics, Union Grove. H. C. Werner, Superintendent. "No cases were selected in this institution for sterilization because we have at present no hospital facili- ties for such work. It is advisable in se- lected cases only." January, 1921. 11. Central State Hospital for the In- sane. Waupun. Dr. Rock Sleyster, Superin- tendent. "This is to advise you that our State Board of Control has not ordered any of this work applied to this institution. The only place in Wisconsin where anything has been done is the Home for the Feeble- 96 . Statisticai, Summary o^ EugEnicai, StEriwzation Minded at Chippewa Falls." February, 1918. Milwaukee County Hospital for Mental Diseases. Wauwatosa. Dr. A. W. Young, Superintendent, reports that there have been no operations under this Act in his institu- tion. He holds the opinion that the medical value of the statute is good, and that eugeni- cally it would work out for the benefit of humanity. January, 1918. II. SUMMARY OF EUGENICAL STERI- LIZATION IN THE SEVERAL STATES. A. Statistical Summary to January 1, 1921. (a) States and Institutions. 1. Total number of states which have or have had eugenical sterilization laws 15 (a) Number of states with laws still in force 9 (b) Number of states in which the courts have held the steriliza- tion laws unconstitutional , 5 (c) Number of states which have re- pealed their sterilization laws, after having been declared un- constitutional 1 3. Number of states in which steriliza- tion bills have been vetoed or sterili- zation laws revoked by referendum. . 5 3. Total number of state* institutions which are or have been legally en- titled to practice eugenical steriliza- tion 124 4. Number of state institutions at pre- sent legally entitled to such practice. 70 5. Number of such state mstitutions which, to a greater or less extent, have practiced legalized eugenical sterilization 31 6. Number of state institutions which were or are entitled to such practice but which have not made use of it. 03 7. Greatest number of operations per' formed by any one institution (Southern California State Hospital, Patton) 1 ,009 8. Number of states having eugenical sterilization laws unattacked by the courts but which have made no use of them (South Dakota) 1 9. Number of states in which all of the state institutions authorized to prac- tice eugenical sterilization, have made use of it. (Oregon) 1 • In Michigan, New Jersey and Wisconsin, certain types of county and other municipal institutions are, or were, subject to the act. (b) Total number of Eugenical Sterili- zation Operations in all Fifteen (15) States from beginning of legalized operations, in 1907, to January 1, 1921 3,233 1. By Sex. Males (vasectomy 1,781; castration 72) 1,853 Females (salpingectomy 1,280; ovari- otomy 100) 1,380 Total 3,233 2. By Radicalness of Operation. Less Radical (vasectomy 1,781; sal- pingectomy 1,280) 3,061 More Radical (castration 72; ovario- tomy 100) 172 Total 3,233 3. By Classes. In Institutions for the 1. Feeble-minded 403 2. Insane 2,700 3. Criminalistic 130 Total 3,233 4. By States. 1. California 2,558 2. Connecticut 27 3. Indiana 120 4. Iowa 49 5. Kansas 54 6. Michigan 1 7. Nebraska 155 8. Nevada " 9. New Jersey 10. New York 42 1 1. North Dakota 23 1 2. Oregon 12" 13. South Dakota 1 4. Washington 1 ] 5. Wisconsin 76 Total 3,233 r.. By Time. Prior to January 1, 1919: Males (vasectomy 1,376; castration 25) 1,401 Females (salpingectomy 836; ovariotomy 80) 916 2,317 Between January 1, 1919 and January 1, 1921: Males (vasectomy 405; castration 47) 452 Females (salpingectomy 444; ovariotomy 20) 464 916 Total since beginning, in 1907, of legalized sterilization 3,233 Statisticai, Summary of Eugenical Steriwzation 97 B. Descriptive Summary. Among the fifteen states which have en- acted eugenical sterilization statutes the law is still on the statute books, unattacked by the courts and therefore still available for use, in the following nine states: California, Connecticut, Iowa, Kansas, Nebraska, North Dakota, South Dakota, Washington, and Wisconsin. California, Connecticut, Kansas, Iowa, and Washington, have each enacted more than one eugenical steriliza- tion statute. In California and Nebraska the law is functioning in a very satisfactory man- ner. In Connecticut, North Dakota and Wisconsin, similarly, the law is being ap- plied without challenge in a satisfactory manner but to a very limited extent. In Washington and Nebraska special executive machinery of proven competency is en- trusted with the enforcement of the steriliza- tion law. In Kansas and Iowa it has fallen into disuse. In South Dakota the statute is practically a dead letter. In Iowa the law of 1913 was declared un- constitutional; it was repealed and re-en- acted in new, and apparently constitutional form, in 1915. In New York the law was de- clared unconstitutional by the courts (1918) and repealed (1920), but has not yet been re-enacted by the Legislature. In New Jer- sey, Nevada, Michigan, Indiana, and Oregon, the laws were declared unconstitutionl by the courts but are still on the statute books, dead letters. In the State of Washington litigation resulted in upholding the consti- tutionality of a very drastic eugenical and punitive sterilization law. Eugenical sterilization laws have been ve- toed by the Governors of Pennsylvania (1905, 1921), Oregon (1909), Vermont (1913), Nebraska (1913), and Idaho (1919), subsequently, however, Oregon (1917), and Nebraska (1915) enacted successful laws. In Oregon also, a former sterilization law was revoked (1913) by referendum. In analyzing the tables of this chapter it will be noticed that under the law thus far there have been eugenical sterilizations in only State Institutions for the (1) insane, (2) feeble-minded and (3) criminalistic. No eugenical sterilization operations have thus far been performed in — (a) State Institutions for the (1) ineb- riates, (3) diseased, (3) blind, (4) deaf, (5) deformed, (6) dependent, (7) epileptic, nor in (b) County, Municipal or Private In- stitutions for any type of the socially inade- quate, nor (c) Among the socially inadequates and cacogenic individuals in the . population at large. PRACTICAL ASPECTS. The extension of the provisions of the ster- ilization law to all cacogenic persons of a given legal standard, whether within cus- todial institutions or in the population at large, is both a legal and a practical re- quirement for eugenical effectiveness. In the matter of legal authorization and control of eugenical sterilization it may be safely concluded that the experimental per- iod is rapidly passing. It is now known what attitude the courts generally will take toward specific elements in laws authoriz- ing sterilization. Also the practical eugeni- cal standard for sterilization is fairly well established. In any particular case this standard can be scientifically applied in a satisfactory manner by medical diagnosis and eugenical field work. In such cases it remains, of course, for the courts to deter- mine the legal validity of the facts thus pre- sented and to order or to refuse the appli- cation of the law. The nature of adminis- trative machinery which will work and which will fail is, from the experiments already made, fairly well known, so that if the prin- ciple of eugenical sterilization has public sup- port, practically any state legislature can, if it chooses, enact a functioning law. (See Model Sterilization Law, Chapter XV.) CHAPTER V. ANALYSIS OF THE STERILIZATION LAWS BY SUBJECT. 1. The Motives of the Sterilization Statutes 99 A. The Motive of Heredity 99 B. Therapeutic Motive 100 C. Punitive Motive 101 2. Executive Agencies 102 3. Provisions for Making Family History Studies 104 4. Biological Criteria for Determining the Applicability of the Law to a Particular Individual 104 5. Court Procedure Provided by the Several Sterilization Statutes 107 6. Legal Counsel for the State and for Persons Nominated for the Operation 110 7. Is the Consent of the Patient or Guardian a Necessary Pre-requisite to Legal Eugenical Sterilization ? 110 8. Type of Operation and Manner of its Performance Ill 9. Bad Biology in the Eugenical Sterilization Statutes 113 10. Mandatory and Optional Elements in the Laws 114 11. Sexual Sterilization of Criminals 117 13. Legal Liability of Executive Agents and Surgeons 184 13. Punishment for Dereliction in Executing the Law 185 14. Punishment for the Illegal Use of Sexual Sterilization 186 15. The Legal Aspect of Sexual Sterilization for Therapeutic Purposes 187 16. The Sexual Sterilization of Inmates of Custodial Institutions Prior to Their Release 188 17. Class Legislation 130 18. What Constitutes Due Process of Law in Eugenical Sterilization? 138 19. Records and Reports Required by Law 137 20. Costs and Appropriations 139 Analysis of rnt Steriwzation Laws by Subject 99 1. JHE MOTIVES OF THE STERILI- ^ ZATION STATUTES. By impRcation all of the sterilization stat- utes are eugenical. Still the three motives of eugenical betterment, therapeutic value to the patient, and punishment for crimes in- volving moral turpitude or confirmed crim- inalistic tendencies, are, in different statutes, variously combined, while in one state, Nevada, the law is purely punitive. Also in Washington the first statute, 1909, was purely punitive, but the second, 1931, is primarily eugenical. The motive of human steriliza- tion as authorized by law should be purely eugenical — that is, it should seek to improve the racial qualities of future generations. A. The Motive of Heredity. So far as the recognition of heredity as a factor in determining social adequacy on the part of individuals is concerned,, we find the following provisions in the statutes: 1. INDIANA. (Preface) "An act to pre- vent procreation of confirmed criminals, idiots, imbeciles and rapists * * *" "* * * Whereas, heredity plays a most important part in the transmission of crime, idiocy, and imbecility: * * *" 3. WASHINGTON. First Law: No reference. Second Law (Preface) "An Act to pre- vent the procreation of feeble-minded, insane, epileptic, habitual criminals, moral degen- erates and sexual perverts * * *" (Section 1.) "* * * who are persons po- tential to producing offspring who, because of inheritance of inferior or anti-social traits, would probably become a social menace or wards of the State." 3. CALIFORNIA. Second Law: This statute applies to inmates of state institutions who are afHicted with hereditary insanity or incurable chronic mania or dementia. Amendment to Second Sterilization Law: This amendment emphasizes the relation of heredity to social degeneracy by including in reference to the specifications of inmates of institutions subject to the act the follow- ing new phrases: (Section 2) "* * * who is afflicted with mental disease which may. have been inherited and is likely to be transmitted to descendants, the various grades of feeble- mindedness, those suffering from perversion or marked departures from normal mentality or from disease of a syphilitic nature * * *." 4. CONNECTICUT. (Section 1) "* * * if in the judgment of a majority of said board procreation by any such person would pro- duce children with an inherited tendency to crime, insanity, feeble-mindedness or imbe- cility * * *." 5. IOWA. First Law (Preface) "AN ACT to prevent the procreation of habitual criminals, idiots, feeble-minded and imbeciles * * *" (Section 1) "* * * that procreation by any such inmate would produce children with a tendency to disease, crime, insanity, feeble-mindedness, idiocy or imbecility * * *" Second Law (Preface) "* * * relating to the prevention of the procreation of crimin- als, rapists, idiots, feeble-minded, imbeciles, lunatics, drunkards, drug-fiends, epileptics, syphilitics, moral and sexual perverts, and diseased and degenerate persons * * *" (Section 1) "* * * that procreation by any such inmates would produce children with a tendency to disease, deformity, crime, in- sanity, feeble-mindedness, idiocy, imbecility, epilepsy, or alcoholism * * *" Third Law (Preface) "* * * to prevent the procreation of the insane, idiots, imbe- ciles and feeble-minded * * *" (Section 1) "* * * that it is better for the interests of * * * and society • * * " 6. NEW JERSEY (Preface). "WHERE- AS, heredity plays a most important part in the transmission of feeble-mindedness, epilepsy, criminal tendencies and other de- fects * * •" 7. NEW YORK (Section 351). Referring to the inmates of institutions and examina- tions of them by the board, the law provides, "* * * if procreation by any such person would produce children with an inherited tendency to crime, insanity, feeble-mind- edness, idiocy or imbecility * * *" 8. NORTH DAKOTA (Preface). "AN ACT to prevent procreation of confirmed criminals, insane, idiots, defectives, and rap- ists * * *" (Section 1) "* * * or that pro- creation by such inmate would likely result in defective or feeble-minded children with criminal tendencies * * *" (Section 11) "Whereas, heredity plays a most important part in the transmission of crime, insanity, idiocy, and imbecility, and our institutions for degenerates are overcrowded on account of the lack of adequate tneans of checking the ever-increasing numbers of this class; and whereas, there is now no provision in law authorizing an operation for the sterili- zation of defective persons, this act shall take effect and be in force from and after its passage and approval." 100 Analysis of the Steriuzation Laws by Subject 9. MICHIGAN (Section 2). "* * * if procreation by any such person would pro- duce children with an inherited tendency to insanity, feeble-mindedness, idiocy or im- becility * » * *" 10. KANSAS. First Statute (Preface). "An act to prevent the procreation of habitual criminals, idiots, epileptics, imbeciles, and in- sane, and providing a penalty for the viola- tion thereof." (Section 1) procrea- tion by any such inmate or inmates would produce children with an inherited tenden- cy to crime, insanity, feeble-mindedness, epi- lepsy, idiocy, or imbecility * * *." Second Statute (Preface) "An act to pre- vent the procreation of habitual criminals idiots, epileptics, imbeciles and insane * * *" (Section l) "* * * procreation by any such inmate would be likely to result in defect- ive or feeble-minded children with criminal tendencies * * *" 11. WISCONSIN. This statute is eugen- ical by implication in that its preface states: "An act * * * relating to the prevention _ of criminality, insanity, feeble-mindedness, epi- lepsy * * *" 12. NEBRASKA. (Section 3) "* * * that such an inmate is capable of bearing or be- getting offspring, that children borne or be- gotten by such inmate would inherit a ten- dency to feeble-mindedness, insanity, or de- generacy, that such children would probably become a social menace and that procreation by such inmate would be harmful to society # # *t> 13. • OREGON. (Preface) "An act to pre- vent the procreation of feeble-minded, in- sane, epileptic, habitual criminals, moral de- generates and sexual perverts * * *" (Sec- tion 2) " * * ' who are persons potential to producing offspring, who, because of in- heritance of inferior or antisocial traits, would probably become a social menace, or a ward of the Slate." 14. SOUTH DAKOTA. (Preface) "An act entitled, An Act for the Prevention of the Procreation of Idiots, Imbeciles and Feeble- Minded Persons. (Section 2) "* * * that the procreation by any of said inmates would produce children with a tendency to disease, feeble-mindedness, idiocy, or imbecility * * *" B. The Therapeutic Motive.' If for sound medical reasons the physi- cians and surgeons of a custodial institu- tion find that an operation involving the ' See also page 127. destruction of the reproductive fuiT'aons would be beneficial to any particular inmates, certainly in no state in the Union would it be legally beyond the province of the au- thorities of the particular institution to order such an operation or treatment, provided the ordering of operations or treatments of equally serious surgical sequence, but which do not involve the destruction of reproduc- tive functions, might legally be ordered by such same authority. Nevertheless the stat- utes have often seen fit to add a therapeutical motive to the eugenical one which actuates most of the laws in relation to sexual sterili- zation. 1. INDIANA. No direct reference. 2. WASHINGTON, First Law: No direct reference. Second Law (Section 3) "* * * no person shall be emasculated under the authority of this act except that such operation shall be found to be necessary to improve the physi- cal, mental, neural or psychic condition of the inmate." 3. CALIFORNIA. First Law (Section 1) "• * * would be beneficial and conducive to the benefit of the physical, mental or moral condition of any inmate * * *" Second Law (Section 2) "* * * it will be beneficial and conducive to the benefit of the physical, mental or moral condition of any recidivist * * *" 4. CONNECTICUT. (Section 1) "* * * if the physical or mental condition of any such person will be substantially improved thereby • * •" 5. NEVADA. No direct reference. 6. IOWA. Second Law (Section 1) "* * * or if the physical or mental condition of any such inmate would probably be mate- rially improved thereby * * *." Third Law (Section 1) that it is for the best interests of the inmate * * *." 7. NEW JERSEY. No direct reference. 8. NEW YORK. (Section 1) "* * * or if the physical or mental condition of any such person will be substantially improved thereby * ' *." 9. .NORTH DAKOTA. (Section l) "• * » whenever the warden, superintendent * • * shall certify in writing that he believes the mental or physical condition of any in- mate would be improved thereby * * *" 10. MICHIGAN. (Section 2) "* * • or if the physical or mental condition of any such person would be improved thereby * * *■" Anai^ysis op the Steriwzation Laws by Subject 101 11. KANSAS. First Law (Section 1) "* * * or if tlie physical or mental condition of any such person will be materially im- proved thereby * * *" Second Law. No direct reference. 13. WISCONSIN. No direct reference. 13. NEBRASKA. No direct reference. 14. OREGON. (Section 3) "* * * or if the physical or mental condition of any such person will be substantially improved there- by * ' *" 15. SOUTH DAKOTA. (Section 2) "* * * or if the mental condition of any such inmate will probably be materially improved thereby * * *" C. Punitive Motive. 1. INDIANA. No reference. 2. WASHINGTON. First Law "* * * the Court may, in addition to such other pun- ishment or confinement as may be imposed, direct an operation to be performed upon such person for the prevention of procre- ation * * *" Second Law: Although this law is prima- rily not punitive in its motive, it applies to (Section 10) "* * * criminals, who have been convicted three or more times of a felony and sentenced to serve in the penitentiary therefor.'' 3. CALIFORNIA. 'First Law: It is doubtful whether the application to criminals of sterilization under this statute is punitive, or is meant only to establish a criterion for locating persons who are constitutional de- generates. (Section 1) "Provided, that in the case of an inmate or convict confined in any of the state prisons of this state, such operation shall not be performed unless the said inmate or convict has been committed to a state prison in this or in some other state or country at least two times for some sexual offense, or at least three times for any other crime, and shall have given evidence while an inmate in a state prison in this state that he is a moral and sexual pervert; and provided further, that in the case of con- victs sentenced to state prison for life who exhibit continued evidence of moral and sex- ual depravity, the right to asexualize them, as provided in this act, shall apply, whether they have been inmates of a state prison either in this or any other state or country more than one time." Following the ruling of the Federal Court in the Iowa case, it is probable that if the above reference were punitive in any degree. it would be declared to be a bill of attain- der, and would render the act unconstitu- tional. Second Law. (Section 2) "* * * pro- vided, that such operation shall not be per- formed unless the said recidivist has been committed to a state prison in this or some other state or country at least two times for rape, assault with intent to commit rape, or seduction, or at least three times for any other crime or crimes, and shall have given evidence while an inmate of a state prison in this state that he is a moral or sexual degenerate or pervert; and provided, further that in the case of convicts sentenced to state prison for life, who exhibit continued evi- dence of moral and sexual depravity, the right to asexualize them, as provided in this section, shall apply whether they shall have been inmates of a state prison in this or any other country or state more than one time or not; * * '" The same comment which accompanies the provisions similar to these in the first California law apply equally well to these provisions. The fact that this law in Cali- fornia is functioning so splendidly and that no test case has arisen under it, leads one to incline toward the belief that the above reference to criminals who are subject to the act is meant not to be punitive, but only to establish a criterion for hereditary de- generacy. 4. CONNECTICUT. No reference. 5. NEVADA. "* * * the court may, in addition to such other punishment or confine- ment as may be imposed, direct an opera- tion to be performed upon such person for the prevention of procreation * * *" 6. IOWA. First Law (Section 1) "Pro- vided that such operation shall be performed upon any convict or inmate of such insti- tution who has been convicted of prostitu- tion or violation of the law, as laid down in chapter two hundred and sixteen, acts of the thirty-third general assembly, or who has been twice convicted of some other sexual offense, or has been three times con- victed of felony, and each such convict or inmate shall be subjected to this same oper- ation of vasectomy or ligation of the Fallo- pian tubes, as the case may be * * *." Second Law. (Section 1) "Provided that such operation shall be performed upon every convict or inmate of such institution who has been convicted of prostitution or violation of the law as laid down in chapter f 102 Anai,ysis oif THE Sterilization Laws by Subject 316 of the acts of the thirty-third general assembly, or who has been twice convicted of other sexual offenses, including solicit- ing, as defined in section 4975-c of the sup- plement to the code, 1907, or who has been twice convicted of a felony, and each such convict or inmate shall be subject to this same operation of vasectomy or ligation of the Fallopian tubes, as the case may be * * *." These provisions were the ones which caused the Federal District Court to declare the Iowa statute a bill of attainder, and a denial of equal protection of the laws. It assumes here that these provisions are purely punitive. Had they been looked upon as in no manner punitive, but as establishing in place of the usual pedigree studies criteria for the de- termination of that degree of hereditary degeneracy which the state forbids to re- produce itself, then a different outcome might have resulted from the litigation, but the Court took the view that the motive was punitive, and consequently the act was de- clared unconstitutional. Third Law. This statute, which repeals the law of 1913, because the latter was de- clared unconstitutional, does not apply to inmates of prisons, and furthermore applies only to inmates of hospitals for the insane, and then only with the consent of the patient or his guardian or next of kin. 7. NEW JERSEY. This statute in refer- ence to its applicability to criminals was not tested by the courts, therefore it is difficult to determine whether section 2 is punitive or is meant only to establish a criterion for de- termining hereditary degeneracy. Section 2 reads: "The criminals who shall come with- in the operation of this law shall be those who have been convicted of the crime of rape, or of such succession of offenses against the criminal law as in the opinion of this board of examiners shall be deemed to be sufficient evidence of confirmed crimin- al tendencies." 8. NEW YORK. The situation here is the same as in New Jersey. A part of section 351 reads: "The criminals who shall come within the operation of this law shall be those who have been convicted of the crime of rape or of such succession of offenses against the criminal law as in the opinion of the board shall be deemed to be sufficient evidence of confirmed criminal tendencies." 9. NORTH DAKOTA. No reference. 10. MICHIGAN. No reference. 11. KANSAS. First Law: No reference Second Law: No reference. 12. WISCONSIN. No reference. 13. NEBRASKA. No reference. 14. OREGON. (Section 4) "The purpose of said investigation, findings, and orders of said Board shall be for the betterment of the physical, mental, neural, or psychic con- dition of the inmate, or to protect society from the menace of procreation by said in- mate, and not in any manner as a punitive measure; * * *" (Section 10) "The crimi- nals who shall come within the operation of this law shall be those who have been con- victed three or more times of a felony in the courts of any state and sentenced to serve in the penitentiary therefor.'' It is evidently the intention of this law, as shown in Section 10, to act not as a puni- tive measure, but as a criterion for locating inmates of prisons who are hereditarily de^ generate. 15. SOUTH DAKOTA. No reference. Sterilization laws should of course apply to degenerates and defectives who have been convicted of crime on the same terms as to persons equally degenerate or defective who have not been sentenced to prison. But the location among. prisoners of such indi- viduals should be effected by modern pedi- gree studies rather than by the rules based upon the number of commitments and the type of crime for which punishment is being meted out; because the latter criterion is not nearly so effective as the pedigree method, but on the other hand most certain in many cases to be mistaken for a punitive measure. 2. EXECUTIVE AGENCIES. The location of persons who are poten- tial parents of socially inadequate offspring and the securing of case history and family pedigree evidence sufficient for legal proof of such parenthood, is such an involved and arduous task that the principal execu- tive agent of a sterilization statute should be a professional eugenicist who should de- vote all of his time and attention to the duties of his office, and who should be aided by an ample corps of assistants. This officer, the State Eugenicist, would be ex- pected to invoke the operation of the law in particular cases by nominating to the courts of competent jurisdiction certain in- dividuals for eugenical sterilization. When such cases are contested, expert testimony Analysis of the Sterilization Laws by Subject 103 must be available for just decisions, at which time trained psychologists, eugenicists, an- thropologists and physicians each, within his particular realm of specialization, may be considered competent witnesses. The great- est error which a legislature could make in enacting a just eugenical sterilization stat- ute would be to delegate its enforcement and execution solely to physicians and surgeons, entirely ignoring the other fields of expert knowledge equally pertinent to the prob- lems in hand with the skill possessed by the practitioner of medicine. If a sterilization law is meant to be taken seriously, it must contain mandatory fea- tures, and consequently its enforcement is much more apt to be effectively carried out if entrusted to particular persons whose prin- cipal business is the enforcement of such a statute, than if made an extra duty of an ex- isting body of officers who can give only a portion of their time and attention to the tasks imposed by the new statute. In examining the sterilization statutes of the 15 states which have thus far enacted such laws, we find the following executive agencies provided: 1. INDIANA. For each subject institu- tion a Committee of Experts, consisting of two skilled surgeons of recognized ability and the regular institution physician. Ap- pointment of committee compulsory. 2. WASHINGTON. First Statute. Judge of the Criminal Court in cases adjudged guilty of carnal abuse of female persons under ten years of age, or of rape. Second Statute. An institutional Board of Health. 3. CALIFORNIA. First Statute. Board, consisting of superintendent or resident physician, with the general superintendent of state hospitals, and the secretary of the State Board of Health. Second Statute. (1) For the insane, the State Commission in Lunacy. (3) For re- cidivists, the resident physician of the par- ticular prison, the general superintendent of state hospitals, and the secretary of the State Board of Health. (3) For "idiots and fools", the medical superintendent of any state hospital. Third Statute. Same as under the Second Statute. Fourth Statute. Board of Trustees of Padfic Colony, on a recommendation of the superintendent thereof, "approved by a clinical psychologist holding the degree Ph. D., and a physician qualified to serve" un- der the act establishing said colony. 4. CONNECTICUT. For each subject institution a board of three surgeons, one of whom is the resident physician of the par- ticular institution. Appointment of board compulsory but not compulsory to bring cases before them. 5. NEVADA. The Criminal Court, in passing sentence for carnal abuse of a female person under ten years of age, or for rape. 6. IOWA. First Statute. Board consist- ing of the managing officer and surgical superintendent of each institution, with members of State Board of Parole. Second Statute. Board consisting of the managing officer and surgical superinten- dent of each institution, with members of State Board of Parole. Third Statute. Superintendent of any hospital for the insane, and a majority of his medical staff, with the approval of the Board of Control thereof. 7. NEW JERSEY. Board of Examiners consisting of one surgeon, one neurologist, and the State Commissioner of Charities and Corrections. 8. NEW YORK. Board of Examiners consisting of one surgeon, one neurologist, and the State Commissioner of Charities and Corrections. 9. NORTH DAKOTA. For each subject institution, a Board consisting of the chief medical officer of the particular institution, the secretary of State Board of Health, and one competent physician and surgeon. 10. MICHIGAN. For each subject insti- tution, the Board of the particular institution and the physician or surgeon in charge there- of. 11. KANSAS. First Statute. Managing officers of the particular institution in con- junction with competent surgical assistants. Second Statute. For each subject institu- tion, the chief medical officer of the particu- lar institution, the governing board thereof, and the 'secretary of State Board of Health. 12. WISCONSIN. Special Board con- sisting of one surgeon and one alienist in conjunction with the superintendent of the institution and the State Board of Control. 13. NEBRASKA. Five physicians ap- pointed by the Board of Commissioners of State Institutions from the medical staffs of 104 Analysis of the Steriuzation Laws by Subject the state institutions, of whom three shall be from the institutions for the feeble-minded and the insane. 14. OREGON. State Board of Eugenics, composed of the State Board of Health, and the superintendents of the several sub- ject state institutions. Secretary of the State Board of Health is ex officio the Secretary of the State Board of Eugenics. 15. SOUTH DAKOTA. State Board of Charities and Corrections, the superintendent of the single subject institution, and the physician thereof. 3. PROVISIONS (EITHER DIRECT OR IMPLIED) IN THE SEVERAL STATUTES FOR MAKING FAMILY HISTORY OR PEDIGREE STUDIES OF THE PERSONS SELECTED FOR EUGEN- ICAL STERILIZATION. Connecticut Law of 1909 (Chapter 209, Section 1). "* * * shall examine the physical and mental condition of such persons and their record and family his- tory. * * *" New York Law of 1912 (Chapter 445, Sec- tion 2). "* * * to examine into the mental and physical condition and the record and family history of the feeble-minded, epileptic, criminal and other defective in- mates. * * *" North Dakota Law of 1913 (Chapter 56, Section 4). "* * * shall diligently in- quire into the mental and physical condition of each inmate so considered, and as far as practicable into his family history. * * *" Kansas Law of 1913 (Chapter 305, Sec- tion 1). "* * * shall examine the physi- cal and mental condition of such inmate or inmates, the history thereof so far as can be, ascertained. * * *" Michigan Law of 1913 (Act No. 34, Sec- tion 3). "* * * shall examine the physi- cal and mental condition of such persons and their record and family history so far as the same can be ascertained. * * *" Iowa Law of 1913 (Chapter 187, Acts of the Thirty-fifth. General Assembly, Section 1.) "* * * to examine into the mental and physical condition, the records and family history of the inmates. * * *" California Law of 1913 (Chapter 363, Sec- tion 1). "* * * and who is afflicted with hereditary insanity. * # #n Nebraska Law of 1915 (Chapter 237, Sec- tion 3). "* * * to examine into the innate traits, the mental and physical condi- tions, the personal records, and the family traits and histories of all inmates. * * *" Oregon Law of 1917 (Chapter 279, Sec- tion 3). "* * * to examine into the innate traits, the mental and physical condi- tions, the personal records, and the family traits and histories of all persons so re- ported as far as the same can be ascer- tained. * * •" Kansas Law of 1917 (Chapter 299, Section 4). "* * * shall diligently inquire into the mental and physical condition of each inmate so considered, and as far as practica- ble into his or her family history. * * *" South Dakota Law of 1917 (Chapter 236, Secton 1). "* * * to examine into the mental and physical condition, the records and family history of the inmates. * * *" California Law of 1917 (Chapter 489, Sec- tion 1). "* * * and who is afflcted with mental disease which may have been in- herited and is likely to be transmitted to descendants.* * *" Washington Law of 1921 (Chapter 53, Sec- tion 2). "* * * to examine into the innate traits, the mental and physical conditions, the personal records, and the family traits and histories of all persons so reported, so far as the same can be ascertained * * *." 4. THE BIOLOGICAL CRITERIA FOR DETERMINING THE APPLICABIL- ITY OF THE LAW TO A PAR- TICULAR INDIVIDUAL. All of the laws state with more or less precision what natural classes are to be included within their scope, but as with all laws, the determination of 'the application in particular cases must be entrusted to executive and judicial machinery. The law also must lay down certain rules for the guidance of its executive agents in determin- ing what individual persons fall within this class. The logical plan for determining the cugenical necessity for sexual sterilization is of course to require pedigree studies, and to provide further for the analysis of such studies by persons skilled in the, modern science of human genetics. A person within the classes named and who by such a pro- cedure is demonstrated to be a potential parent of defectives, and who is to remail' Analysis of the; Steriwzation Laws by Subject 105 in the population at large, should be sub- jected to eugenical sterilization. It would remain only for the administrative body to determine the facts, after which the applica- tion of the law should be automatically effected by court orders. Most of the existing laws leave much to the discretion and judgment of their execu- tive agents, without requiring pedigree studies. An examination of the several sterilization statutes reveals the following situation : 1. INDIANA. "If, in the judgment of this committee of experts and the board of managers, procreation is inadvisable, and there is no probability of improvement of the mental and physical condition of the inmate, it shall be lawful. * * *" 2. WASHINGTON. First Law: Steril- ization may be ordered by the court in certain cases, in its discretion. No standards of hereditary degeneracy are laid down. Second Law. "* * * if in the judgment of a majority of the said Board (institutional Board of Health) procreation by any such person would produce children with an inherited tendency to feeble-mindedness, insanity, epilepsy, criminality or degeneracy, and there is no probability that the condition of such person so examined will improve to such an extent as to render procreation by any such person advisable, or if the physical or mental condition of any such person will be substantially improved thereby, then it shall be the duty of said Board to make an order directing * * * to perform * * * such a type of sterilization as may be deemed best • * •." 3. CALIFORNIA. First Law: The Superintendent of an institution, at his dis- cretion, calls into consultation the superin- tendent of the state hospitals and the secretary of the state board of health, who examine into the particulars of the case, "and if in their opinion, or in the opinion of any three of them, asexualization will be bene- ficial • • • they may perform the same. • *.•" (Section 1.) Second Law: Section 1 requires the care- ful investigation of all circumstances of the case, and provides for the same consultation and opinion as the earlier statute. Amendment to 'Second Law: This estab- lishes additional standards for limiting the selection of inmates for sterilization to those suffering from certain types of hereditary diseases. The law establishing the Pacific Colony in California permits the operation upon the recommendation of a superintendent, ap- proved by a clinical psychologist and a quali- fied physician. 4. CONNECTICUT. In Connecticut the board "* * * .shall examine the physical and mental condition of such persons and their record and family history, so far as the same can be ascertained, and if the judgment of a majority of said board, procreation by any such person would produce children" of a certain degenerate nature, "* * * then said board shall appoint one of its members to perform the operation * * *." (Section 1.) 5. NEVADA. The court may, in its dis- cretion, in passing sentence for certain crimes, add the punishment of sterilization. There are no legal requirements as to evidence of hereditary degeneracy. 6. IOWA. First Law: This statute calls upon the heads of institutions to examine into the mental and physical condition of the inmates "* * * with a view to deter- mining whether it is improper or inadvisable to allow any of such inmates to procreate '■* * *," and to call into consultation the members of the state board of parole. "The members of such board and the managing officers and the surgical superintendent of such institutions shall judge of such matters." (Section 1.) Second Law: This statute follows the first law of 1913 in this respect. Third Law: Whenever the superintend- ent of any hospital for the insane, and the majority of his medical staff, after investiga- tion and examination, agree that it is best "* * * said operation shall be per- formed." (Section 1.) 7. NEW JERSEY. According to this statute, the superintendent of an institution or the board of examiners itself may "* • * take evidence and examine into the mental and physical condition of such inmates * * *" as are selected for the particular examination. If the board unani- mously finds "* * * that procreation is inadvisable, it shall be lawful to perform * * *" an operation of sterilization. (Section 3.) 8. NEW YORK. The board of examin- ers must "* * * examine into the mental and physical condition and the family history" of the inmates of institutions, "* * * and 106 Analysis of the Steriwzation Laws by Subject if in the judgment of a majority of said board procreation * * *" by any particular inmate would produce defectives, the opera- tion is authorized. (Section 351.) 9. NORTH DAKOTA. Whe;iever the executive officer of an institution certifies in writing "* * " thai: he believes that the mental or physical condition of any inmate would be improved * * *" by steriliza- tion, or that procreation by such inmate would produce defective children, it shall be lawful to sterilize the particular inmate. (Section 1.) 10. MICHIGAN. The board of the par- ticular institution "* * * shall receive the re- port of insanity experts, • * * examine the physical and mental condition of such per- sons and their , record and family history so far as the same can be ascertained, and if in the judgment of a majority of said board procreation by such person would produce * * *" defective offspring, the board may direct sterilization. 11. KANSAS. The managing authority of the institution shall examine the physical and mental condition of the inmates and the history thereof, so far as it can be ascer- tained, and if in the judgment of such author- ity procreation by any such inmate or in- mates would produce children" of a degen- erate nature, the said authority shall report "* * * their conclusions with a recom- mendation to the District court * * *. The court shall thereupon hear and deter- mine, the matter whether * * • the pur- poses of this act will be accomplished by such order * * *" for sterilization, and "* * * shall adjudge that such operation shall be perfdrmed." (Section 1.) Second Law: The superintendent of a custodial institution may certify in writing to the governing board of the institution that he "believes that the mental or physical condition of any inmate would be likely to be improved" by sterilization, and that the off- spring of such inmate would be likely "to result in defective or feeble-minded children with criminal tendencies." The board of examiners shall then "diligently inquire into the mental and physical condition of each inmate so considered and as far as practica- ble into his or her family history, and for that purpose any member of said board may administer an oath to any witness whom it is desired to examine." (Sections 1 and 4.) 13. WISCONSIN. In this state the board of control submits to a body of experts thi names of such inmates of institutions "whose mental and physical condition they desire examined, and said experts and the superin- tendent of said institution shall meet, take evidence and examine into the mental and physical condition of such inmate * * *. If such experts and superintendent unani- mously find that procreation is inadvisable, it shall be lawful to perform such operation * * *" of sterilization. (Sections 2 and 3.) 13. ReBRASKA. The board of examin- ers are directed to "examine into the innate traits, the mental and physical conditions, the personal records and the family traits and histories'' of all inmates who are about to be discharged or paroled from state institutions, "* * * and if after a careful examination and investigation such board of examiners find that such inmate" is capable of bearing or begetting children who would probably "inherit a tendency to feeble-mindedness, insanity or degeneracy, that such children would probably become a social menace, and that procreation by such inmate would be harmful to society * * *," sterilization may be ordered. (Section 3.) 14. OREGON. This statute requires that the executive officers of institutions report quarterly to the State Board of Eugenics all inmates "* * * who are persons potential to producing offspring, who because of the inheritance of inferior or antisocial traits, would probably become a social menace, or a ward of the State.'' The State Board of Eugenics shall "examine into the innate traits and the mental and physical conditions, the personal records and the family traits and histories of all persons so reported * * *" and shall have power to summon witnesses and administer oaths, "and if in the judgment of a majority of the said Board procreation by any such person would produce children * * *" of a degenerate nature. "• * * then it shall be the duty of said Board to make an order directing" the sterilization of the particular inmate. ir,. SOUTH DAKOTA. In this state the law requires that the superintendent of the state home for the feeble-minded "examine into the mental and physical condition, the records and family history of the inmates of said institution with a view of determining whether it is improper or inadvisable to allow any such inmate to procreate, and to make an annual report of said examinations to the State Board of Charities and Correc- tions." It is then the duty ofithe board to Analysis of the Sterilization Laws by Subject 107 examine into the matter for the purpose of determining "whether it is improper or in- advisable to allow any such inmates to pro- create * * *." The decision and order is based upon the vote of the majority of the board. The Michigan statute recognizes the necessity of expert examination and analysis of reports in order to determine proper sub- jects for eugenical sterilization. It also recognizes the necessity of performing the actual sterilizing operation by trained ex- perts. (Section 3.) "In case an institution has no physician at its head, authority is given to the board of managers to cause such operation to be performed, |to hire ex- pert physicians to examine and report on the condition of the subject, and to perform the operation with such other assistants as may be necessary: Provided, Before said opera- tion is ordered there shall first be secured from two physicians having qualifications prescribed by law for examiners in insanity a written statement or report that such oper- ation is desirable in the interests of the patient or the good of the community; and, provided further, that these physicians shall be allowed for their services the compensa- tion fixed by the statutes for the examina- tion and certification of an insane person. The several sums necessary to carry out the provisions of this act shall be certified to be correct by the respective boards and shall be paid out of the general fund of the State upon the warrant of the auditor-general." It is interesting to observe that in several instances the law expects members of the board of examiners, by investigating the mental and physical condition of an inmate, to be able to determine the nature of his hereditary qualities. This, of course, is im- possible. Not only must the individual be given a thorough examination, but his pedi- gree must be studied before, under the exist- ing stage of genetical knowledge at least, it is possible to determine the hereditary nature of the propositus, and consequently possible to designate any particular degenerate as a proper subject for eugenical sterilization. Provisions for the calling of witnesses and the passing of expert opinion are valuable, but the principal stress should be laid upon requirements for family history studies and their analysis by experts, in order to de- termine whether a particular individual is, within the definition of the standards set by the law, a potential parent of socially inade- quate offspring. 6. COURT PROCEDURE PROVIDED BY THE SEVERAL STERIL- IZATION STATUTES. As elsewhere stated in these studies, the executive agents of the several sterilization laws have been given three types of pro- cedure: First, executive or ministerial dis- cretion. Second, hearing before or exami- nation by a board or commission in a quasi- judicial manner. Third, hearing and trial before an established) court of law. Court procedure is provided by the stat- utes as follows: 1. INDIANA. No provision. 3. WASHINGTON. First Law: Steril- ization may be imposed as an additional sen- tence in certain criminal cases. Second Law: The law requires that, after careful investigation into the condition of the subject inmate, the examining board make separate written findings of each case to be preserved in the records of the board and a copy thereof furnished to the superin- tendent of the institution where such inmate is confined, upon which a copy of the order of said board shall be served on such inmate or his legal guardian. Any such inmate or his guardian desiring to appeal from the decision of the board may take an appeal into the Superior Court, after filing an informal notice thereof with the secretary of said board within fifteen days of the date when notice of the board's decision was served. (Section 6.) "Upon an appeal being taken, the secretary of the said board where the notice of appeal is filed, must within fifteen days thereafter, or such further time as the court or the judge thereof may allow, transmit a certified copy of the notice of appeal and transcript of the proceedings, findings and order of the board, to the clerk of the court appealed to. The trial shall be a trial de novo at law as pro- vided by the statutes of the state, for the trial of actions at law ' * *." (Section 7.) "If the court or jury shall affirm the find- ings of said board, said court shall enter a judgment, adjudging that the order of said board shall be carried out as herein pro- vided; if the court fail to affirm the decision of said board appealed from, then said order shall be null and void and of no further effect." 3. CALIFORNIA. First Law: No pro- vision. Second Law: No provision. Amendment to Second Law and 108 Analysis of the Steriuzation Laws by Subject Sterilization Provisions of Law Establish- ing Pacific Colony. No provisions. 4. CONNECTICUT. No. provisions. 5. NEVADA. Sterilization may be im- posed as an additional sentence in certain criminal cases. 0. IOWA. First Law. No provisions. Second Law. Section 2: "Those afflicted with syphilis or epilepsy may apply to the board of parole, or any judge of the dis- trict court, and upon order of such board or judge, the operation of vasectomy or ligation of the fallopian tubes may be per- formed upon such persons." Third Law. No provisions. 7. NEW JERSEY. The law provides for the examination of inmates of particular institutions by a board of examiners who may in their discretion find that procrea- tion by the particular inmate would be inad- visable. The law continues: (Section 3.) "* * * previous' to said hearing the said board shall apply to any judge of the Court of Common Pleas, of the county in which said person is confined, for the assignment of counsel to represent the person to be examined, said counsel to act at said hearing and in any subsequent proceedings, and no order made by said board of examiners shall become effective until five days after it shall have been filed with the clerk of the Court of Common Pleas, of the county in which said examination is held, and a copy shall have been served upon the counsel appointed to represent the person examined, proof of service of the said copy of the order to be filed with the clerk of the Court of Common Pleas. All orders made under the provisions of this act shall be subject to review by the Supreme Court or any justice thereof, and said court may upon appeal from any order grant a stay which shall be effective until such appeal shall have been decided. The judge of the Court of Common Pleas appointing any counsel under this act may fix the compensation to be paid him, and it shall be paid as other court expenses are now paid. * * *" 8. NEW YORK. The law provides that the board of examiners shall investigate the particular cases and, if such board deter- mines upon sterilization, the following pro- cedure is provided: (Section 353.) ''The board of examiners shall apply to any judge of the Supreme Court or county judge of the county in which said person is confined for the appointment of counsel to represent the person to be examined. Said counsel to act at a hearing before the judge and in any subsequent proceedings, and no order made by said board shall become efifective until five days after it shall have been filed with the clerk of the court and a copy shall have been served upon the counsel appointed to represent the person examined and proof of service of said copy of the order to be filed with the clerk of the court. All orders made under provisions of this act shall be subject to review by the Supreme Court or any justice thereof, and said court may upon appeal from any order grant a stay which shall be effective until such appeal shall have been decided. The judge of the court ap- pointing any counsel under this act may fix the compensation to be paid him. No sur- geon performing an operation under the provisions of this act shall be held to account therefor. The record taken upon the ex- amination of every such inmate, signed by the said board of examiners, shall be pre- served by the institution where said inmate is confined, and one year after the perform- ance of the operation the superintendent or other administrative officer of the institution wherein such inmate is confined shall report to the board of examiners the condition of the inmate and the eflfect of such operation upon such inmate, and a copy of 'the report shall be filed with the record of the exami- nation." 9. NORTH DAKOTA. No provisions. 10. MICHIGAN. In this state the statute provides for investigations and, under certain conditions, for the order for steriliza- tion, after which the procedure is as fol- lows: (Section 2.) "The boards of the afore- said institutions and the physicians or sur- geons in charge of each of said institutions shall for each of their respective institutions constitute a board, the duty of which shall be to examine such inmates of said institu- tions as are reported to them by the warden or medical superintendent to be persons by whom procreation would be inadvisable. Such board shall receive the report of in- sanity experts hereinafter mentioned, ex- amine the physical and mental condition of such persons and their record and family history so far as the same can be ascer- tained, and if in the judgment of. a majority of said board procreation by any such per- son would produce children with an inherited tendency to insanity, feeble-mindedness, Analysis of thb; Sterilization Laws by Subject 109 idiocy, or imbecility, and there is no prob- ability that the condition of such person so examined will improve to such an extent as to render procreation by any such person advisable, or if the physical or mental condi- tion of any such person will be substantially improved thereby, then said board shall direct a competent physician or surgeon, with such other assistants as may be neces- sary, to perform the operation of vasectomy or salpingectomy or any other operation or improvement on vasectomy or salpingec- tomy recognized by the medical profession, as the case may be, upon such person. Such operation shall be performed in a safe and humane manner, and the board making such examination, and the institution physician or surgeon, shall receive no extra compensa- tion therefor; Provided, That at least thirty days' notice shall be given to the parents or guardian of such person before the per- forming of such operation; said notice to specify the purpose, time and place of such examination; Provided further, That when said parents or guardian object to the per- formance of such operation, then the ques- tion of the sanity of such person shall be re- ferred to the probate court of the county in which the institution is located, where the question of sanity and the necessity for this operation shall be determined as in other sanity cases before such courts." 11. KANSAS. First Law. This stat- ute prgvides for investigation by the manag- ing officers of institutions and, in case they find sterilization applicable in the particu- lar case, under the statute, then (Section 1) "* * * said authority shall report their con- clusions with a recommendation to the dis- trict court or any court of competent juris- diction in and for the district from which such inmate or inmates has been committed to such institution or institutions. The court shall thereupon hear and determine the mat- ter, and! if satisfied that :the subject is an habltM criminal within the meaning of this act, or is insane, an idiot, imbecile or an ep- ileptic, and that the purposes of this act will be accomplished . by such order, shall ad- judge that such operation shall be performed, and shall appoint one of the J authority sign- ing sugh report to perform the operation of vasecjjorny or oophorectomy, as the case -may; be, upon such person. The county attorney .of the county in which the hearing is, had may be directed by the court to repre- sent the state in the proceedings." Second Law. No provisions. 13. WISCONSIN. No provisions. 13. NEBRASKA. No provisions, 14. OREGON. In this state the applica- tion of the law is ministerial, unless the in- mate nominated for sterilization desires to appeal from the decision of the state board of eugenics, in which case the statute makes the following provisions; (Sections 6, 7, and 8.) "Any such inmate desiring to appeal from the decision of the said Board, or in case the person is under guardianship or dis- ability, then the guardian of said inmate may take an appeal to the circuit court of , the county in which the institution, in which the inmate is confined, is located. "An informal notice of appeal filed with the secretary of said Board either by the in- mate or some one in his behalf, shall be all that is necessary to make the appeal; pro- vided, said notice shall be filed within 15 days of the date when notice of the Board's de- cision is served on the inmate or his guard- ian, and said notice of appeal shall stay all proceedings of said Board in said matter un- til the same is heard and determined on said appeal; provided further, that no op- eration shall be performed, upon any inmate, until the time for appeal from the decision of the Board has expired. "Upon an appeal being taken, the secretary of the said Board where the notice of ap- peal is filed, must within fifteen days there- after, or such further time as the court or judge thereof may allow, transmit a certified copy of the notice of appeal and transcript of the proceedings, findings, and order of the Board, to the clerk of the court appealed to. "The trial shall be a trial de novo at law as provided by the statutes of the State, for the trial of actions at law. Upon such ap- peal, if the inmate be without sufficient means to employ an attorney, then such at- torney shall be compensated by the State upon order of the court; and it shall be the duty of the district attorney of the county wherein such trial is had to represent the said Board. "If the court or jury shall affirm the find- ings of said Board, said court shall enter a judgment, adjudging that the order of the said Board shall be carried out as herein provided; if the court fail to affirm the de- cision of said Board, appealed from, then said order shall be null and void and of no further effect." no Analysis of the Sterilization Laws by Subject 15. SOUTH DAKOTA. No provisions. 6. LEGAL COUNSEL FOR THE STATE AND FOR PERSONS NOMINATED FOR THE OPERATION UNDER THE STERILIZATION STAT- UTES. 1. NEW JERSEY. For the Defendant. The board of examiners may apply to any judge of the court of common pleas of the county in which the defendant is confined for the appointment of counsel to represent such person. Compensation for such counsel is fixed by the judge appointing him. 3. NEW YORK. For the Defendant. The board of examiners may apply to any judge of the supreme court or county judge of the county in which the person nominated for sterilization is confined for appointment of counsel to represent such person. The compensation "for such counsel to be deter- mined by the judge appointing him. 3. NORTH DAKOTA. In this state the procedure is ministerial rather than judicial, nevertheless provision is made for the aid of the state's law officers as follows: (Sec- tion 8) "Whenever the state's attorney of any county shall have reason to believe that any person who shall be convicted of fel- ony has been twice or more previously con- victed of felonies in North Dakota and else- where, it shall be the duty of such state's attorney to investigate and to secure at the expense of the county, transcripts of rec- ords of conviction from other counties and states and also such evidence of identifica- tion as may be obtained. Such proof when obtained shall be forwarded to the state board of control, who shall thereupon noti- fy the chief medical officers of the institu- tion to which such person is committed and the secretary of the state board of health, and such case shall be dealt with in accord- ance with the procedure stated in section 1 of this act." 4. MICHIGAN. No provisions. 5. KANSAS. (Section 1) "* " » the county attorney of the county in which the hearing is had may be directed by the court to represent the state in the proceed- ings " * *." 6. WISCONSIN. No provisions. 7. OREGON. The procedure is ministe- rial in uncontested cases, but when contested cases may be finally determined by the courts of the state. The state board of eu- genics "* * * shall have power to summon witnesses and any member of said board may administer an oath to any witness whom it is desired to examine ' * *" For the Defendant. In case the matter comes before the courts for final decision (Section 7) "* * * if the inmate be without sufficient means to employ an attorney, then such an attorney shall be compensated by the state upon the order of the court.'' For the State. (Section 7) "* * *and it shall be the duty of the district attorney of the county wherein such trial is had to rep- resent said board. * * *" By implication, by custom, and by other statutes governing the representation of the state in contested cases, the attorney-gener- al or the county attorneys of the states and counties interested act as legal counsel in up- holding the statutes and the boards or offi- cers seeking to enforce it. In the Model Law provision is made for the appointment of legal counsel by the court in case the person nominated for ster- ilization is financially unable to provide such counsel. The State Eugenicist and the state's interests in applying the law are well looked out for, so far as legal counsel is concerned, by the attorney-general and the county attorney of the county in which the particular case arises. 8. WASHINGTON. The law of 1921 provides for legal counsel only in cases of appeal. For the Defendant. (Sec. 6) "* * * if the inmate be without financial means to employ an attorney, then the court shall appoint an attorney to represent said inmate and' such attorney shall be compensated by the State upon order of the court." For the State. "* * * it shall be the duty of the district attorney of the county wherein such trial is had to represent the said board." 7. IS THE CONSENT OF THE PA- TIENT OR GUARDIAN A NECES- SARY PREREQUISITE TO LEG- AL EUGENICAL STERILIZA- TION? - Second California Law, 1909. ( Chapter 363, Sec. 1) "whether with or without the consent of the patient * * *" Michigan Law, 1913. (Act No. 34, Pub- lic Acts, Sec. 2) "Provided, That at least thirty days' notice shall be given to the parents or guardian of such person before the performing of such operation; said notice to specify the purpose, time and place Analysis of the Sterilization Laws by Subject 111 of such examination; Provided further, That when said parents or guardian object to the performance of such operation, then the question of the sanity of such person shall be referred to the probate court * * *" Wisconsin Law, 1913. (Chapter 693, Sec. 4.) "Before such operation shall be per- formed it shall be the duty of the state board of control to give at least thirty days' notice in writing to the husband or wife, parent or guardian, if the same shall be known, and if unknown, to the person with whom such inmate last resided." i Third Iowa Law, 1915 (Chapter 203, 36th General Assembly, Sec. 1) "* * * and pro- vided further, that the superintendent of the hospital shall have secured the written consent of the husband or wife, if the patient is a married person, and if an un- married person, the written consent of the parent, guardian or next of kin, if there be within this state, that said operation shall be performed." Nebraska Law, 1915. (Chapter 237, Sec. 4) "Before any such operation shall be per- formed, the nature, character and consequen- ces of such operation shall be fully explained to such inmate and to the husband, wife, par- ent, guardian, or nearest of kin of such in- mate and no such operation shall be per- formed without the written consent of such husband, wife, parent, guardian, or nearest kin, as the case may be, and the assent of such inmate so far as said inmate is capable of assenting thereto." Amendment to the Second California Law, 1917. (Chapter 489, Sec. 1) "whether with or without the consent of the patient * * *" California Law Establishing Pacific Col- ony, 1917. (Chapter 776, Sec. 42) "whether with or without the consent of the inmate I Oregon Law, 1917. (Chapter 279, Sec. 5) "* * * and if an operation is deemed neces- sary by said Board, then a copy of the or- der of said Board shall forthwith be served on said inmate, or in the case of an insane person upon his legal guardian, and if such insane person have no legal guardian then upon his nearest known kin within the State of Oregon, and if such person have no knoWn kin within the State of Oregon, then upon the custodian guardian of such insane person •* *", Kansas Law, 1917. (Chapter 305, Sec. 1) "* * * but before such operation shall be performed a written notice shall be served on such inmate, and guardian, if there be one, of the time and place of a meeting and hearing at least thirty days prior thereto; and said inmate shall have the right to be represented by counsel and may introduce such evidence as may be desired * * *" Washington Law, 1921 (Chapter 53, Sec. 4). "* * * if an operation is deemed neces- sary by said board, then a copy of the order of said board shall forthwith be served on said inmate, or in the case of an insane person, upon his legal guardian, and if such insane person have no legal guardian, then upon his nearest known kin within the State of Washington, and if such insane person have no known kin within the State of Wash- ington, then upon the custodian guardian of such insane person." 8. TYPE OF OPERATION AND MANNER OF ITS PER- FORMANCE. In eugenical sterilization the principal object is permanently to destroy the repro- ductive function of the individual. In the male, there are two common operations — first, the less serious one known as vasec- tomy, which consists in removing a short section of each of the vasa deferentia. This may be performed without anaesthetic in a few minutes by a competent surgeon, with less pain to the subject than accompanies the pulling of a tooth. With local anaes- thetic it is accompanied by practically no pain or distress to the patient. Second, the more radical operation is castration; this re- quires hospital attention and consists in the complete removal of the testes. In the female the surgical operations for sexual sterilization are much more serious than in the male, because all the former op- erations require the opening of the abdom- inal cavity. Consequently the sterilization of the female calls for much more skill and care, and also for more time for conval- escence, than are required in sterilizing the male. The less radical of the operations in sterilizing the female is known as salping- ectomy, which consists in removing a sec- tion of the Fallopian tubes (oviducts.) The more radical operations are known as oophorectomy (or ovariotomy) and uterec- tomy (or hysterectomy.) The former con- sists in removing the ovaries; the latter in removing the uterus. If the sole object of these operations is eugenical, that is, no subsidiary therapeutic 112 Analysis op the Sterilization Laws by Subject value is i sought, logically enough the opera- tion should be of the minimum radicalness required under the existing stage of surgi- cal advance, permanently to destroy the re- productive functions. Such operations con- sist in the male of vasectomy, and in the fe- male of salpingectomy. A simpler operation could hardly be desired for the male, but for the female it is greatly to be hoped that surgical science will soon develop a less radical method whereby sexual sterility may be wrought. Although sterilization is much more serious surgically in the female than in the male, there is one compensation. Much more frequently in the female than in the male the need for abdominal surgery for therapeutic purposes is present, consequently quite often in the female the therapeutic val- ue of an abdominal operation may be achieved as an accompaniment to sexual sterilization. It is suggested that scarifying the horns of the uterus and thus effecting sterilization by occluding the terminal openings of the Fallopian tubes may be developed surgically to the point of practicability. Because such an operation I would not involve the opening of the abdominal cavity, it would provide for females an operation comparable in sim- plicity with vasectomy in the male. X-rays, which are known to destroy cer- tain tissues, are being successfully employed experimentally for sexual sterilization. But, like scarifying the horns of the uterus, sur- gical technique has not yet developed this agency to the point of general practical value. Thus while surgical science is work- ing upon the problem, it has as yet produced nothing practicable that is simpler than vas- ectomy in the male and salpingectomy in the female. But even if much simpler methods should be developed, it would appear the part of wisdom to write the law wide enough to permit the application of that particular method for effecting sterility which in each case would be best adapted to the thera- peutic needs of the individual, and which in the light of the existing methods of approved surgery, would in each case prove the least serious surgically. Many of the laws quite properly require that the operation of sexual sterilization be effected "in a safe and humane manner." This again is a provision which might well be in- cluded within the model sterilization statute, because it is an additional safe-guard around the rights of the particular individuals who are subjected to actual sterilizing operations. The following is a series of literal ab- stracts of the several statutes in reference to the surgical type of operation 'and the man- ner of its performance: 1. INDIANA. "* * * it shall be law- ful for the surgeons to perform such an operation for the prevention of procreation as shall be decided safest and most effec- tive." 2. WASHINGTON. First Law. "* * * an operation * * * for the prevention of pro- creation." Second Law "* * * such surgical oper- ation as may be specified in the order of the Institutional Board of Health. All such operations shall be performed with a due regard for the physical condition of the in- mate and in a safe and humane manner." 3. CALIFORNIA. First Law, Section 1. "* * ** if in their opinion * * * asexual- ization will be beneficial to such inmate, pa- tient or convict, they may perform the same; * * *" Second Law, Section 1. "* * * the state commission in lunacy may * * * cause such a person to be asexualized * * *" 4. CONNECTICUT. Section 1. "* * * said board shall appoint one of its members to perform the operation of vasectomy or oophorectomy * * *. Such operation shall be performed in a safe and humane man- ner 5. NEVADA. "* * * direct an operation to be performed upon such person for the prevention of procreation; provided the op- eration so performed shall not consist of cas- tration." 6. IOWA. First Law, Section 1. "*** then the surgeon of the institution shall per- form the operation of vasectomy or ligation of the Fallopian tubes, as the case may be, upon such person." Second Law, Section 1. "* ' * then the physician of the institution, or one selected by him, shall perform the operation of vas- ectomy, or ligation of the Fallopian tubes, as the case may be, upon such person." Third Law, Section 1. "* " * they are hereby authorized to perform or cause to be performed by sorrve capable physician or surgeon, the operation of sterilization * * Section; 2. "The operation to be per- formed upon a male person shall be what is known as vasectomy, and upon a female person what is known as a section of the Fallopian tubes with implantation in the uterine muscles." Analysis oe' the Sterilization Laws by Subject 113 U# # -H 7. NEW JERSEY. Section 1. it shall be lawful to perform such opera- tion for the prevention of procreation as shall be decided by said board of examiners to be most effective * * *" 8. NEW YORK. Section 351. "* * * then said board shall appoint one of its members to perform such operation for the prevention of procreation as shall be decided by said board to be most effective * * *" 9. NORTH DAKOTA. Section 1. "* * * it shall be lavirful to perform a sur- gical operation for the sterilization of such inmate * * *" Section 5. "* * * shall designate some skilled surgeon, who may not be one of their own number, who shall perform it." 10. MICHIGAN. Section 1. "* * * to render incapable of procreation by vasec- tomy or salpingectomy, or by the improve- ment of said surgical operation which is least dangerous to life and will best accom- plish the purpose, * * *." Section 2. "* * * then said board shall direct a competent physician or surgeon, with such other assistants as may be neces- sary, to perform the operation of vasec- tomy or salpingectomy, or any other opera- tion or improvement on vasectomy or sal- pingectomy recognized by the medical pro- fession, * * *. Such operation shall be per- formed in a safe and humane manner, * * *" 11. KANSAS. First Law, Section 1. "* * * and shall appoint one of the author- ity signing such report to perform the op- eration of vasectomy or oophorectomy, as the case may be, * * *. Such operation shall be performed in a safe and humane man- ner, * * *" Second Law, Section 5. "* * * if a male person, either the operation of vasectomy or asexualization; if a female, either the operation of salpingectomy or oophorec- tomy; and shall designate some competent surgeon, who may either be connected with such institution or otherwise, who shall per- form the operation." 12. WISCONSIN. Section 3. "* * * "that such operation be performed for the prevention of procreation as shall be de- cided safest and most effective * * *" 13. NEBRASKA. Section 3. "* * * that such operation be performed for the prevention of procreation as in the judg- ment of said board of examiners shall be most appropriate to each individual case." 14. OREGON. Section 3. "* * * to perform or cause to be performed upon such inmate such a type of sterilization as may be deemed best by said board." Section 4. "* * * and no person shall be emasculated under the authority of this Act except that such operation shall be found necessary to improve the physical, mental, neural, or psychic condition of the inmate." Section 9. "* * * all operations shall be performed with due regard for the physical condition of the inmate, and in a safe and humane manner." 15. SOUTH DAKOTA. Section 2. "* * * then the physician of the institution, or one selected by him, shall perform the operation of vasectomy or ligation of the Fallopian tubes, as the case may be * * *" 9. BAD BIOLOGY IN THE EUGENI- CAL STERILIZATION STATUTES. In many of the sterilization laws there is a phrase evidently intended to throw an ad- ditional safeguard around the individual in securing him against unjust and uneugenical sterilization. It is that phrase which implies that an individual may, because of his con- dition, be today a potential parent of de- fectives and undesirables, and in the future, on account of some recovery, may become so changed that parenthood on his or her part becomes desirable for the state. This is equivalent to saying that an individual may be a mongrel today and a thoroughbred to- morrow, which, of course, is contrary to all practical observation and to all biologi- cal teaching. There may be medical and social reasons why a person is an undesir- able procreator today and a desirable one tomorrow — in such cases there should be medical or social treatment, not eugenical sterilization — but so far as hereditary traits are concerned, there is no such change. Eu- genical sterilization can be justified only on the grounds of hereditary and constitu- tional degeneracy. Once a degenerate, so far as hereditary qualities are concerned, al- ways a degenerate. If both the literal and implied motives of these laws were purely therapeutic, then, because an individual who is diseased today might recover so as to make procreation medically or hygienically desirable on his part, the phrase would be understandable, but even in such cases it would have no legal use because no surgeon now hesitates, on account of legal restraint, to perform, for 114 ANAI.YSIS OF THE Sterilization Laws by Subject purely therapeutical reasons, an operation which incidentally results in procreative ster- ility. The phrases run as follows: Indiana Law of 1907 (Chapter 315) "* * * and there is no probabilty of improvement of the mental and physical condition of the inmate * * *" Connecticut Law of 1909. (Chapter 209, Sec. 1) "* * * and there is no probability that the condition of any such person so examined will improve to such an extent as to render procreation by any such person advisable * * *" Iowa Law of 1911. (Chapter 139, Thirty- fourth General Assembly, Sec. 1) "* * * and there is no probability that the condition of any such inmate so examined will improve to such an extent as to render procreation' by any such inmate advisable. * * *" New Jersey Law of 1911. (Chapter 190, Sec. 3) "* * * and there is no probability that the condition of such inmate so exam- ined will improve to such an extent as to render procreation by such inmate advis- able * • •" New York Law of 1912. (Chapter 49, Laws of 1909, as amended by Sec. 351 of Chapter 445.) "* * * and there is no prob- ability that the condition of any such person so examined will improve to such an extent as to render procreation by any such person advisable * * •" North Dakota Law of 1913. (Chapter 56, Sec. 1) "* • • and that the condition of such inmate is not likely to improve so as to make procreation by any such person desirable or beneficial to the commun- ity • * •" Kansas Law of 1913. (Chapter 305, Sec. 1) "* * • and there is no probability that the condition of any such inmate or inmates so examined will improve to such an ex- tent as to render procreation by any such inmate or inmates advisable * * *" Michigan Law of 1913. (Public Act 34, Sec. 2) "* * • and there is no probability that the condition of such person so exam- ined will improve to such an extent as to render procreation by any such person ad- visable • • •" Oregon Law of 1917. (Chapter S79, Sec. 3) "* * * and there is no probability that the condition of such person so examined will improve to such an extent as to render procreation by any such person advis- able • • •" Kansas Law of 1917. (Chapter 299, Sec. 1) "* * * and that the condition of such inmate is not likely to improve so as to make procreation by such person desirable or beneficial to the state * * *" Evidently this false idea and objectionable expression have been copied from statute to statute. Because they are founded on biological misconceptions they should be dropped from future laws. The matter of human heredity is much more deeply seated than a passing condition which may make an individual a parent of good pedigree to- day and one of undesirable hereditary traits tomorrow. 10. THE MANDATORY AND OPTION- AL ELEMENTS IN THE SEVER- AL STERILIZATION LAWS. If a law is meant to be compulsory, then of course there must be no gaps in its chain of mandates, which begins with the order for the appointment of executive officers, and ends with the actual surgical operation of sterilization. A single "'may'' inserted in the chain of execution makes the whole procedure an optional, or at lea%t a non-com- pulsory one. The principal elements in the chain are: (l) The appointment of execu- tive agents: (2) the examination of indi- viduals alleged to be subject to the act; (3) the determination of the facts in particular cases, whether the particular person is sub- ject to eugenical sterilization; (4) the or- der for the actual sterilizing operation. Which statutes require eugenical ster- ilization, and which make it optional on the part of the executive agents? By thus com- paring what the laws order, with what their executive agents have done, we arrive at a judgment concerning the effectiveness of the execution of the law in different states, and may be able also to locate the particular weak points in the chain of statutory order and practical execution. Finally, such an analysis may aid in drafting a successful act whose intent is mandatory. 1. INDIANA, 1907. The law provides for the compulsory appointment of a com- mittee of experts in each institution, whose duty it shall be to examine the condition of inmates recommended for sterilization. If this committee decides in favor of the ster- ilization of the inmate, "* * * it shall be lawful for the surgeons to perform such op- eration for the prevention of procreation as shall be decided safest and most effective." Chap. 215, Laws of 1907. Anai,ysis of thu Stdriwzation Laws by Subject 115 a. WASHINGTON, 1909. As a puni- tive measure for criminals and rapists, " the court may direct an operation to be performed upon such a person for the pre- vention of procreation ." Chap. 240, sec. 35, Criminal Code, Lavirs of 1909. Second Sterihzation Law, 1981. "It shall be and is hereby declared the duty of the superintendents, of all state institutions hav- ing the care of individuals held in restraint to report quarterly to the Institutional Board of Health, all feeble-minded, insane, etc., * * * then it shall be the duty of said Board to make an order directing the super- intendent of the institution in which such inmate is confined to perform or cause to be performed upon such inmate such a type of sterilization as may be deemed best by said Board." But, like the law of Oregon, this statute- provides for a possibility of such inmate, his legal guardian or nearest kin to appeal from the decision of the Board within fifteen days from date of notice served upon him. 3. CALIFORNIA, (a) First Steriliza- tion Law, 1909, provides that a resident physician of an institution, together with the superintendent of the institution and the secretary of the state board of health, may constitute a board to determine wheth- er asexualization will be of physical, mental, or moral benefit to an inmate; if they decide in favor of asexualization, " ihey may perform the same " Chap. 730, Sec. 1, Laws of 1909. (b) Second Sterilization Law, 1913, Chap. 363. Sec. 1 provides that the state commission in lunacy " may cause to be asexual- ized " before his or her release or dis- charge from an institution, any person in a state hospital for the insane afflicted with hereditary insanity or incurable chronic mania or dementia. Sec. 3 applies to convicts in state prisons, and provides tha-t in the case of recidivists who, in the judgment of a board of physi- cians, will be benefited by such operation, the board " may perform the same " Sec. 3 provides that any idiot, if a minor, "may be asexualized ." If an adult, by the consent or request of the parent or guardian of such idiot, the superintendent of a state ho^ital " shall perform such opera- tion ." (c) Amendment to Second Sterilization Law, 1917. Sec. 1 provides that the state commission in lunacy " ^may cause to be asexualized " before his or her release or discharge from a state hospital for the insane, any person of the class described, comprising those afflicted with hereditary mental disease, feeble-mindedness or syphilis. (Chapter 489, Sec. 1, Laws of 1917.) (d) Sterilization Provision establishing the Pacific Colony, Sec. 43, Chapter 776, Laws of 1917. This provides that before the release or discharge of an inmate of the Pacific CoTony who is feeble-minded or af- flicted with incurable chronic mania or de- mentia, the board of trustees, etc., after a careful investigation, " may cause such person to be sterilized; and such steriliza- tion shall be lawful ." 4. CONNECTICUT, 1909. The state prison and the hospitals for the insane are directed to appoint boards of examination, and in the case of inmates by whom proc- reation is judged inadvisable, " — said board shall appoint one of its members to perform the operation ." (Chap. 309, sec. 1, Pub- lic Acts 1909.) 5. NEVADA, 1911. In punishment for the crime of rape, " the court may direct an operation to be performed upon such person for the prevention of procrea- tion." (Section 38 of the Crimes and Pun- ishment act.) 6. IOWA, (a) First Sterilization Law, 1911. The state board of parole, in con- junction with the managing officer or super- intendent of each institution, shall examine into the condition of inmates of these insti- tutions, and if they decide that procreation is inadvisable, or that an operation will be beneficial, " the surgeon of the institu- tion shall perform the operation " Also certain classes of convicts or inmates of in- stitutions, as prostitutes, sexual offenders, etc., " shall be subjected to this same operation ' (Chapter 139, Sec. 1, Acts of the Thirty-third General Assembly.) (b) Second Sterilization Law, 1913 Sec. 1 provides as above for a board of examiners and provides that, when such a board shall determine a person to be unfit to procreate, " then the physician of the institution shall perform the operation upon such person ." Sec. 3 is in regard to operatiops upon ap- plication, and provides that those afflicted with syphilis or epilepsy "may apply to the board of parole " " and upon or- 116 Anai^ysis of the Sterilization Laws by Subject der the operation may be performed upon such person ." (Chap. 187, Acts of the Thirty-fourth General Assembly.) (c) Third Sterilization Law, 1915, pro- vides that when the superintendent and ma- jority of the staff of a hospital for the in- sane agree that it is for the best interests of the patient and society, and provided that the individual and his or her family con- sent, " ^they are hereby authorized to per- form the operation of sterilization on any such patient ."(Chap. 203, Section 1, Laws of the Thirty-sixth General Assembly.) 7. NEW JERSEY, 1911. If, after ex- amination, the board of examiners and chief physician of an institution find that pro- creation on the part of an inmate is inadvis- able, " — it shall be lawful to perform such operation ." But first the law provides for appointment of counsel, etc., and makes the order of the board of examiners sub- ject to review by the Supreme Court. (Chap. 190, Sec. 1, Laws of 1911.) 8. NEW YORK, 1912. The law pro- vides for the appointment of a board of ex- aminers with authority to determine wheth- er an inmate of an institution should, either for his own good or that of society, be ster- ilized. If procreation in the case of such inmate is deemed inadvisable, " said board shall appoint one of its members to perform such operation for the prevention of procreation ." Here as in the New Jersey law, the appointment of counsel is provided for. (Article 19 of Chapter 49, Laws of 1909, as amended by Chapter 445, Laws of 1912.) 9. NORTH DAKOTA, 1913. Chapter 56, Sec. 1, provides that when procreation by an inmate of a state institution shall be deemed inadvisable, " it shall be lawful to per- form a surgical operation for the steriliza- tion of such inmate as hereafter provided." The law further provides for a board of examiners, and in Section 5 provides that if this board order such operation, "it shall designate some skilled surgeon who shall perform it." Section 7 deals with inmates who request the performance of such operation, or give their consent thereto in writing, and pro- vides that in such cases the chief medical officer of an institution " may perform such operation without bringing the 10. MICHIGAN, 1913. Act No. 34, Public Acts 1913. Section 1 authorizes the operation to pre- vent procreation to be performed on men- tally defective or insane inmates of public institutions. The boards and physicians of such institu- tions shall determine what inmates are persons by whom procreation would be in- advisable, and in such cases " said board shall direct a competent physician or surgeon to perform the operation upon such person ." (Section 2.) 11. KANSAS. (a) First Sterilization Law, 1913 (Chap. 305, pp. 535-526.) Section 1 of this act pro- vides that the managing officers of all state institutions shall, with the assistance of competent surgeons, examine inmates who in their opinion should not be allowed to procreate, and report the result of such ex- amination to a court, with a recommendation to such court. If the court, after a hearing, determines that the purpose of the act will be fulfilled by such an operation, they " shall adjudge that such operation shall be performed, and shall appoint one of the authority -to perform the opera- tion. " (b) Second Sterilization Law, 1917. (Chap. 299.) Section 1 provides that in the case of inmates of institutions whose physical or mental condition would be iikdy to result in defective or feeble-minded children with criminal tendencies, " it shall be lawful to perform a surgical operation for the steril- ization of such inmate ." Section 5 provides that the board of ex- aminers, after making full inquiry into the condition of the inmate, if sterilization be ordered, " shall designate what operation is to be performed and shall designate some competent surgeon who shall perform the operation ." matter to the attention of such board of examination ." 12. WISCONSIN, 1913. (Chap. 693, Sec. 3.) The law in this state provides that the state board of control shall appoint a committee of experts to examine inmates of institutions, and if such experts and the superintendent of the institution find procre- ation to be inadvisable on the part of an inmate, " it shall be lawful to perform such operation for the prevention of procre- ation as shall be safest and most effective ." Analysis of the Sterilization Laws by Subject 117 13. NEBRASKA, 1916. (Chap. 237.) Before the discharge or parole of any in- mate of an institution for feeble-minded or insane, a board of examiners shall determine whether or not procreation by such inmate would be harmful to society, and if such is decided to be the case, " it shall be a condition prerequisite to the parole or discharge of such inmate that said inmate be made sterile, and that such operation be performed for the prevention of procreation ." (Sec. 3.) 14. OREGON, 1917. (Chap. 279.) This statute provides for the establishment of a State Board of Eugenics, to whom the super- intendents of state institutions shall report all inmates who are in their judgment poten- tially capable of producing offspring likely to become a social menace or wards of the State. The State Board of Eugenics shall examine such reported inmates, and when they consider procreation inadvisable, they shall order the superintendent of the institu- tion in which such inmate is confined to " perform or cause to be performed upon such inmate such a type of sterilization as may be deemed best by said Board." (Sec. 3.) But before such order can be car- ried out, a copy shall be served on said inmate, or his guardian, and fifteen days shall be allowed for the inmate to appeal from the decision of said Board (Sec. 6). After the time for appeal has expired, or in case the inmate has appealed and the order has been affirmed by a judgment of the court, " it is hereby made his (the superintendent of the institution's) lawful duty to perform such surgical opera- tion as may be specified ." (Sec, 9.) 15. SOUTH DAKOTA, 1917. (Chap. 236.) The State Board of Charities and Cor- rections, together with the superintendent of the State Home for Feeble-Minded Persons, shall determine whether any inmates should not be allowed to procreate, and in such cases " the physician of the institution shall perform the operation upon such person." (Sec. 2.) 11. SEXUAL STERILIZATION OF CRIMINALS. It would be unfortunate indeed if crimi- nologists, the public, or the courts associated eugenical sterilization more closely with criminalistic individuals than with the in- sane, the feeble-minded, or any other of the ten types of socially inadequate individuals which comprise the whole range of socially unadapted types. A criminal is a person who has been convicted of crime. Crime is arbitrarily defined by the legislative author- ity of the State. A criminal may, or may not, be a degenerate. On the other hand the term criminalistic is biological and social rather than legal. It means an individual who, regardless of the nature of the statu- tory laws of the state or the freedom or incarceration of the subject himself, is anti- social in his instincts and conduct to a degree which renders him a willful or at least a careless menace to the community. If one could prove that a given individual youth, before puberty, would upon maturity become a rapist or a sexual pervert, and that such tendencies were hereditary, society would be justified in sterilizing such indi- vidual, as a preventive measure, because the removal of the sex-gland before puberty stops the development of sex-impulses. Eugenical interests would be served if, in such cases degenerate inheritance lines were cut off, and current society would be pro- tected against the anti-social conduct of the individual operated upon. But, to vasec- tomize or castrate an adult for the purpose of destroying his or her sex impulses is without purpose, because such operations upon adults destroy neither the sex-impulses nor the capacity for coitus. The science of internal secretions is still in its infancy. Ultimately this department of physiology may have something to con- tribute which will be of service to criminol- ogists and social agencies which seek to govern impulses by controlling internal se- cretions. Thus, the therapeutic promise of sterilization is not great enough to justify its widespread use. There is, however, a modicum of control over the impulses to be derived from castration, which small per- sonal and social benefit could be well con- sidered as a secondary matter in determining upon the particular type of sterilization in a given case in which eugenical sterilization has been decided upon. For this reason in the model law the State Eugenicist is given authority to decide upon the particular type of sterilizing operation or treatment, in order that he may, in consultation with medical authorities, select that particular type which, as the law states, will give due consideration to possible therapeutic benefit. For eugenical purposes the legal term crim- inal carries little meaning, but criminalistic connotes an hereditary degenerate make-up. Only those persons who constitute the latter 118 Analysis of the Sterii&e6n6T6a,'' XntematloBal Congress Criminal Antbropology, Amster- dam, 1901. NS,cke, ICenrolo^scIieB Centralblatt, March 1, 1909. The original account of these opera- tions is reproduced in the Psrehlatriscli- ITenrologlscIie 'WoclienBClizUt, No. 2, 1909, with an approving comment by the editor. Dr. Bresler. Flood, "Castration of Idiot Children," Ameri- can Journal Fsyclioloery, Jan., 1899; also Alienist and Henrolofist, Aug., 1909, p. 348. Havelock Ellis, Sex in Relation to Society (V61. VI of Studies in the Psychology of Sex), pp. 614-615, Castration and Negative Eugenics. Millant, Castration Criminelle et Ifaniaque, 1902. 12. LEGAL LIABILITY OF EXECU- TIVE AGENTS AND SURGEONS IN EXECUTING THE SEVERAL EUGENICAL STERILIZATION LAWS. The responsibility for eugenical steriliza- tion, or sterilization for therapeutic mo- tives must, of course, rest entirely with the law. It would be not only unfair, but also quite illogical to hold the executive agents of the statute personally or criminally liable for executing both the letter and the spirit of the law in cases which undoubtedly fall within the scope of the statute itself. However, some of the sterilization laws have deemed it fitting to make special provisions in reference to the immunity from criminal liability on the part of the particular executive agents. 1. INDIANA. No reference. 3. WASHINGTON. First Law: No reference. Second Law: (Sec. 9.) "No surgeon per- forming the operation provided for in the Analysis of the Sterilization Laws by Subject 125 preceding section under the direction of the superintendent, or other officer in charge of • such institution, shall be held criminally liable therefor or civilly liable for any loss or damage on account thereof, except in case of negligence in the performance of such operation." 3. CALIFORNIA. First law. No reference. Second Law — Section 1. "* * * Asexua- lization, whether with or without the con- sent of the patient, shall be lawful and shall not render said Commission, its members or any person participating in the operation, liable either civilly or criminally." Sterilization Provision of law of Califor- nia establishing Pacific Colony. This statute follows the exact wording of the second California statute, in reference to freedom from civil or criminal liability. i. CONNECTICUT. No reference. 5. NEVADA. No reference. 6. IOWA. First Law. No reference. Second law — no reference. Third law — no reference. 7. NEW JERSEY. Section 3. "* * * No surgeon performing an operation under the provisions of this law shall be held to ac- count therefor, but the order of the Board of Examiners shall be a full warrant and au- thority therefor.'' 8. NEW YORK. Section 352. "* * * No surgeon performing the operation under the provisions of this Act shall be held to ac- count therefor." 9. NORTH DAKOTA. Section 9. "* * * No surgeon who shall skillfully perform any operation as authorized by this Act shall be held accountable therefor, but the findings and order of this said Board of Examiners by the court, or the consent of such inmate and parents or guardian shall be his full war- rant and authority therefor." 10. MICHIGAN. No reference. 11. KANSAS. First Law. No reference. Second Law — no reference. 12. WISCONSIN. No reference. 13. NEBRASKA. No reference. 14. OREGON. No reference. 15. SOUTH DAKOTA. No reference. 13. PUNISHMENT FOR DERELIC- TION IN EXECUTING THE LAW. Most of the sterilization statutes present so many dangers in the mandatory chain between the legislative enactment and the actual sterilization of the particular subject that the effect of such laws is to make them an optional agency in the hands of their executive agents. However, after certain preliminary processes have, on the option of their executive agents, been got through with, one of the statutes makes mandatory, under pain of fine or imprisonment, the fur- ther execution of the law. An examinatioti of the statutes reveals the following situation in this regard: KANSAS. First Sterilization Law, Chap- ter 305, Laws of 1913, Section 3. "Any man- aging officers herein charged with any duty specified in section 1, who shall fail, neglect or refuse for sixty days or more in the per- formance thereof, shall be guilty of a mis- demeanor and subject to a fine of not more than one hundred dollars, or imprisonment in the county jail for not more than thirty days, or both such fine and imprisonment." Doubtless the laws governing administra- tive officers generally, in many other states, would be applicable to officers who are dere- lict in enforcing the sterilization statute. It would seem that in a model sterilization stat- ute little need would be found for this par- ticular provision, but that great care should be taken by legislative provision to insure the appointment of competent and honest men. The laws of the state covering executive derelicts generally should be de- pended upon to insure competent activity on the part of a particular executive agent. 14. PUNISHMENT FOR THE ILLE- GAL USE OF SEXUAL STERILI- ZATION. With the advent of eugenical sterilization and the spread, among surgeons of prac- tice and skill in sterilizing operations, and further with the spread of the knowledge that many physicians and surgeons possess a relatively simple method of making indi- viduals sexually sterile, there will doubtless be an appeal to the medical and surgical profession on the part of certain irresponsi- ble and sexually indulgent individuals to be made sexually sterile, in order that they may ply their trade or indulge their sexual appe- tites more freely and with less danger of parenthood than is possible in the case of persons who are sexually fertile. It is prob- able that the hereditary moral qualities of such persons would be found to be of such low value to the state that the perpetuation 126 Analysis of the Sterilization Laws by Subject of their kind would be of little value. Still there is the moral and hygienic aspect of un- bridled license, and the matter of tampering illegally with a function, so vital to the in- terests of the state as the reproductive pow- er, is of such moment that several of the sterilization statutes have sought to control the illegal use of surgical sexual steriliza- tion by devoting a section of the statute to defining what constitutes the illegal use of sexual sterilization and prescribing punish- ments for breach of the law. In reviewing these statutes we find the following provisions : 1. CONNECTICUT. Sterilization Stat- ute, Chapter 209, Public Acts 1909, Section 2: "Except as authorized by this act, every per- son who shall perform, encourage, assist in, or otherwise promote the performance of either of the operations described in section one, of this act, for the purpose of destroying the power to procreate the humane species, or any person who shall knowingly permit either of such operations to be performed upon such person, unless the same shall be a medical necessity, shall be fined not more than one thousand dollars, or imprisoned in the state prison not more than five years, or both." 2. IOWA. First Sterilization Law, Chap- ter 129, Acts of 34th General Assembly, Sec- tion 2: "Except as authorized in this act, every person who shall perform, encourage, assist in or otherwise promote the perform- ance of either of the operations described in Sec. 1 of this act, for the purpose of destroy- ing the power to procreate the human species, or any person who shall knowingly permit either of such operations to be performed upon such persons, unless the same shall be a medical necessity, shall be fined not more than one thousand ($1,000.00) dollars, or im- prisoned in the county jail not to exceed one year, or both." Second Sterilization Law, Chapter 187, Acts of 35th General Assembly, Section 4 : "Except as authorized in this act, every person who shall perform, encourage, assist in or otherwise promote the performance of either of the operations described in sec- tion one of this act, for the purpose of de- stroying the power to procreate the human species, or any person who shall knowingly permit either of such operations to be per- formed upon such persons, unless the same shall be a medical necessity, shall be fined not more than one thousand dollars, or im- prisoned in the penitentiary not to exceed one year, or both." Third Sterilization Law, Chapter 202, Acts* of 36th General Assembly, Section 4: "Ex- cept as authorized in this act, every person who shall perform, encourage, assist in, or otherwise promote the performance oi the operations described in section two of this act for the purpose of destroying the pow- er to procreate the human species, or any person who shall knowingly permit either of such operations to be performed upon such person, unless the same shall be a medi- cal necessity, shall be fined not more than one thousand dollars, or imprisoned in the penitentiary not to exceed one year, or both." 3. NEW YORK. Public Health Law, 1912, Article 19, Sec. 353: "Except as author- ized by this act, every person who shall per- form, encourage, assist in, or otherwise per- mit the performance of the operation for the purpose of destroying the power to pro- create the human species, or any such person who shall knowingly permit such operation to be performed upon such person, unless same shall be a medical necessity, shall be guilty of a misdemeanor." 4. MICHIGAN. Public Acts 1913, Act No. 34, Section 5: "Except as authorized by this act, every person who shall perform, en- courage, assist in, or otherwise promote the performance of either of the operations described in section one of this act, for the purpose of destroying the power to procre- ate the human species, or any person who shall knowingly permit either of such op- erations to be performed upon such person, unless the same shall be a medical necessity, shall be guilty of a felony, and upon con- viction thereof shall be fined not more than one thousand dollars, or imprisoned in the state prison not more than five years or both, at the discretion of the court before whom the said person or persons were so convicted." 5. KANSAS. First Law, Chapter 305, Session Laws of 1913, Section 2: "Except as authorized by this act, every person who shall perform, encourage, assist in, or oth- erwise promote the performance of either of the operations, described in section 1 of this act, for the purpose of destroying the power to procreate the human species, or any person who shall knowingly permit either of such operations to be performed upon such a person, unless the same shall Analysis of the Sterilization Laws by Subject 127 be a medical necessity, shall be fined not more than one thousand dollars, or impris- oned in the county jail not exceeding one year, or both.'' Second Law, Chapter 299, Session Laws of 1917, Section 7: "Except as authorized by this act, every person who shall perform, encourage, assist in or otherwise promote the performance of either of the operations described in this act, for the purpose of destroying the power to procreate the human species, unless same shall be a medical necessity, shall be fined not less than $100.00 nor more than $500.00, and imprisoned in the county jail not less than six months nor exceeding one year.'' 6. WISCONSIN. Chapter 693, Laws of 1913. Section 3. "* * * provided, however, that the operation shall not be performed except in such cases as authorized by the said board of control." Because of the liabilities of abuse of sur- gical sexual sterilization if the practice be- comes widespread for eugenic^l purposes, it would appear wise to include in future statutes provisions against the illegal use of this method of preventing human repro- duction. 15. THE LEGAL ASPECT OF SEXUAL STERILIZATION FOR THERA- PEUTIC PURPOSES.' To each of the 124 state institutions for the various types of the socially inadequate classes which are or have been subject to the several sterilization laws, the following questions were put: 1. Can you, in ordinary course of your professional practice, perform any operation under this law that would be forbidden or illegal without it? Answers : Institution not under the law: 16 No: 25 Yes: 15 Must have consent of patient, or State Board of Health, etc.... 7 •Law declared unconstitutional. ..... 8 No cases : 20 Law specifies classes 2 Applicable only to parole cases.... 1 Don't know 8 No such law 4 No answer : 18 Total 124 3. What in your opinion is the medical value of the statute? Answers : Decided value : 21 Slight value 8 No opinion to offer : 20 No value 8 No answer : 67 Total 124 3. What is the eugenical value of the law? Answers : Decided value: 50 Doubtful 5 No opinion 6 No value 2 No answer : 61 ' See also page 100. Total 134 For therapeutic purposes it would appear that the existing la>vs may be regarded as superfluousy because they grant no new authority and impose no additional respon- sibility. It is true that many of the sterili- zation statutes permitted; the sterilization of certain inmates on the grounds that such operation might benefit the physical and mental condition of the particular inmate. It seems probable, however, that the laws controlling the medical and surgical treat- ment of inmates of institutions generally cover surgical operations which were based upon sound medical reasons, and which op- erations incidentally involve the destruction of the reproductive functions of the indi- vidual. Just as the attempt to make sexual sterilization a punishment for crime has proven to be entirely repugnant to our in- stitutions, and of little eugenical value, the authority granted to use sterilizing opera- tions for therapeutic purposes is entirely superfluous and of no eugenical value. Eu- genical sterilization has but one purpose, the cutting off of the descent lines of indi- viduals with defective and degenerate heredi- tary traits. Punishment for crime, and rem- edies for physical ailments of the particular individual, are problems not for eugenics, but respectively for criminology and for medicine. Many cases are reported in different states in which surgeons, without regard to stat- utes in reference to eugenical sterilization, but apparently entirely safe-guarded by oth- er laws controlling surgical practice, have by surgical means sexually sterilized their 128 Analysis of the Sterilization Laws by Subject patients. In these cases several motives have been reported: first, to forestall pos- sible future pregnancies which would be apt to be obstetrically difficult; second, oth. er cases which would be especially burden- some economically or socially; and third, on account of eugenical desirability. It is here pertinent to call attention to the fact (p. 86, Chapter IV) that the Buffalo State Hos- pital practices eugenical sterilization on its own responsibility. But in even more cases sexual sterilization has been performed as an accompaniment, surgically unnecessary but desirable for one or more of the above stated reasons, of gyne- cological operations. In such cases it ap- pears that sexual sterilization was not justi- fied on its own account, but was made a by-product of operations having other pri- mary purposes. 16. THE SEXUAL STERILIZATION OF INMATES OF CUSTODIAL INSTITUTIONS, PRIOR TO THEIR RELEASE. No eugenical purpose would be served by the sexual sterilization of inmates of our larger custodial institutions unless such in- mates are to be released into the population at large while still in the reproductive per- iod. It is true that in some of the smaller alms-houses and ill-managed custodial in- stitutions, female inmates are known to give birth to children who were conceived while the particular inmate was still in the insti- tution, or while away on short parole, or at intervals between the commitment periods. But such occurrences are becoming rarer. If segregation in modern custodial institutions were general in the case of potential parents of degenerates, and such custodial care in all cases continued until the end of reproductive period of the particular in- mates, there would be no object in eugeni- cal sterilization. But the inmates of the custodial institutions and the potential par- ents of socially inadequate offspring are not in any state to any great degree one and the same class. Inmates of institutions are of two classes — potential parents of degener- ate offspring, and persons who are not such. Similarly the same two classes exist in the population at large. This is the reason why eugenical sterilization laws which apply only to the inmates of institutions constitute "class legislation" in that such statutes create an unnatural and arbitrary sub-class within a larger natural class, some of which • natural class are in institutions and some of whom are in the population at large. But to this entire general natural class, not to its arbitrary sub-class, the law, in order to be constitutional on the grounds of "equal protection of the laws'' must apply. The superintendents of some of the larger custodial institutions oppose sterilization be- cause they feel that sterilization if extensive- ly used would cause society to diminish its support of extensive segregation of inade- quates. They fear that it is proposed to apply sterilization to socially incapable and degenerate individuals, then turn such per- sons on their own resources and on charity in the population at large. They point out that if individuals of low natural inhibitory powers are sexually sterile, the knowledge of such sterility will break down the last modicum of self-restraint which these un- fortunates possess in reference to sexual matters; that as a result sexual license, ac- companied by moral deterioration and in the spread of ■Venereal disease, would be greatly increased. But here there is a confusion of the func- tions of a custodial institution and eugeni- cal sterilization. Custodial segregation, if continued long enough in a modern in- stitution, will safely take the place of sex- ual sterilization. But sexual sterilization cannot take the place of custodial care of a degenerate or defective individual. It would appear then that the statute should apply to the potential parents of defectives who are in institutions, but that the actual perform- ance of the sterilizing operation or treat- ment may, in the case of the inmates of the institutions, be well suspended until the par- ticular inmate is about to be released into the population at large. And if in the mean- time the particular inmate has, due to dis- ease or medical treatment or old age, lost the reproductive function, then of course there would be no eugenical object, even up- on release of such an inmate, in executing the legal order for destroying the reproduc- tive functions. With those laws which permit sexual ster- ilization for punitive or therapeutic, rather than for eugenical purposes, the application of the operation to inmates of institutions, regardless of their prospect of release or parole while still potential parents, is quite logical; but with the passing of punitive ster- ilization, and the superfluous nature of spe- cial legislation permitting sterilization for Analysis of the Sterilization Laws by Subject 129 therapeutic purposes, the eugenical motive alone remains. This logically calls for sexual sterilization of potential parents of degen- erates, who are inmates of custodial institu- tions, only in case such inmates are to be released or discharged while still capable of procreation. The laws in reference to the relation be- tween the termination of custodial care and the time set for sterilizing the particular inmate are summarized as follows: 1. INDIANA. The law applies only to the inmates of certain institutions. There is no provision for suspending the order for execution in the case of life prisoners, nor is there any authorization for sterilizing poten- tial parents of defectives in the population at large. 2. WASHINGTON. In Washington the first law is punitive and applies equally at the discretion of the judge in case of convic- tion for rape to a person committed for life and one committed for the minimum period. The second law applies generally to de- fective and criminal individuals in institu- tions. Its intent is absolutely eugenical and therapeutic. 3. CALIFORNIA. The first statute ap- plies generally to inmates of non-punitive institutions, but in the case of convicts sen- tenced to a state prison for life, and who exhibit continued evidence of moral and sexual depravity, the right to asexualize them shall apply. This last provision must be purely therapeutic in its intent; certainly it has no eugenical bearing. Second California statute applies only to inmates of institutions, with the same pro- vision as the first statute for application to life prisoners. This statute, however, im- plies a more logically eugenical meaning by authorizing the state commission in lun- acy, after consideration, to cause inmates of institutions to be asexualized before the release or discharge of such persons from institutional custody. The third and fourth statutes modify in no manner the provisions of the second in reference to the time of application of au- thorized sterilization. 4. CONNECTICUT. The law applies only to inmates of institutions, with no pro- vision for excepting individuals who are com- mitted for life, or who are not potential parents. 5. IOWA. The first law applies only to inmates of institutions, with no provision in reference to the probable length of period of commitment or potential parenthood. The second statute applies to the inmates of institutions, and also permits the board of parole or a district court to authorize the sterilization of persons at large who are afilicted with syphilis or epilepsy. The third sterilization law of Iowa applies only to inmates of institutions, with no pro- vision for excepting the inmates apparently to be confined for life, and who are not po- tential parents. 6. NEW JERSEY. The law applies only to the inmates of the institutions, with no provision for excepting individuals appar- ently to be confined for life, or who are not potential parents. 7. NEW YORK. The law applies only to the inmates of institutions, with no provi- sion for excepting individuals apparently to be confined for life, or who are not poten- tial parents. 8. NORTH DAKOTA. This law applies only to the inmates of institutions, with no provision for excepting individuals appar- ently to be confined for life, or who are not potential parents. 9. MICHIGAN. The law applies only to the inmates of institutions, with no provision for excepting inmates apparently to be con- fined for life, or who are not potential par- ents. 10. KANSAS. The first and second stat- utes of Kansas apply to the inmates of in- stitutions, with no provision for excepting inmates, apparently to be confined for life, or who are not potential parents. 11. WISCONSIN. The law applies only to the inmates of institutions, with no provi- sion for excepting inmates apparently to be confined for life, or who are not potential parents. 13. NEBRASKA. The sterilization statute of Nebraska was the first in letter and spirit to recognize the eugenical purpose of the Act by modifying its application of ster- ilization to the inmates of institutions. It applies only to such inmates as are "physi- cally capable of bearing or begetting off- spring," and provides further that if after the investigation of the "farnily traits and history of all inmates who may be subject to parole or discharge from the institution," it is found "that such inmate is capable of bearing or begetting oflFspring," "* * * that such children would probably become a so- 130 Analysis of the Sterilization I^aws by Subject cial menace, and that the procreation by such inmate would be harmful to society, and that such inmate should not be paroled or discharged, as the case may be, unless ster- ilized, then in every such case it shall be a condition prerequisite to the parole or dis- charge of such inmate, that said inmate be made sterile." 13. OREOON. The law applies only to the inmates of institutions, with no provision for excepting individuals apparently to be confined for life, or who are not potential parents. 14. SOUTH DAKOTA. The law applies only to the inmates of institutions, with no provision for excepting individuals appar- ently to be confined for life, or who are not potential parents. Twenty-two laws in reference to sterili- zation have been written on the statute books of American states. In only one instance was the law made applicable to persons in the population at large. This exception is to a very limited class authorized to be eu- genically sterilized by the second steriliza- tion law of Iowa (1913, Chap. 187, Acts of the 35th General Assembly, Sec. 3) "Those afflicted with syphilis or epilepsy may apply to the board of parole, or any judge of the district court, and upon order of such board or judge, the operation of vasectomy or liga- tion of the Fallopian tubes may be per- formed upon such person, and any law restricting marriage of such person shall be void and of none effect, in case one of the contracting parties has submitted to such operation and the same was known to both parties before their marriage." The student of eugenics, in making this particular analysis of the laws with reference to their attitude toward applying eugeni- cal sterilization only to those potential par- ents of defective offspring who are inmates of institutions and who are to be discharged into the population at large while still physi- cally able to bear or to procreate young, finds that the Nebraska statute stands out as the only law which has at all grasped the eugenical purpose of applying a sterili- zation statute to the inmates of custodial institutions for the several types of socially unadapted. 17. CLASS LEGISLATION Section 1 of the XlVth Amendment to the Constitution of the United States provides that "no State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property without due pro- cess of law, nor deny to any person with- in its jurisdiction the equal protection of the laws." The violation of the latter provis- ion of this section, the denial of equal protection of the laws, constitutes what is called "class legislation." The law must, of course, establish certain standards and speci- fications for the application of the law. In so doing it creates legal classes, but these classes must, under this provision, be natur- al classes. They must not be too much sub- divided or too artificial or arbitrary in their inclusions and limitations. In other words, the law, in depriving individuals of life, lib- erty, or property, must apply with equal force and without favor or hindrance to all persons within the state who conform to the general specifications set by the statute. Five of the eugenical sterilization statutes, Indiana (Chapter 215, Laws of 1907), New Jersey, (Chapter 190, Session Laws of 1911), Iowa, (Chapter 187 Session Laws of 1913), New York (Chapter 445, Session Laws of 1912) and Michigan, (Act No. 34 Sessions Laws of 1913) — have been declared un- constitutional, among other objections, in four cases on the ground that the statute, as drawn, constituted "class legislation." The judges in rendering their opinions in some cases criticised the expediency of the law and the effectiveness of its administration, matters which, of course, should be attended to by the legislative and executive depart- ments, respectively. But in each case, fin- ally, the court exercised its undoubted ju- dicial prerogative in passing upon the con- stitutionality of the act There is another specification which cus- tom demands of our American state legisla- tion, and that is that there be a reasonable adaption of the means which the statute provides for effecting the desired end. There must be a compensation in benefit to the general welfare for the intrusion upon what . might be called personal or natural rights of the citizen. Thus, if vaccination had been proven to be of no avail, doubtless the courts would have refused to uphold the constitu- tionality of a statute which so invaded the rights of the citizen to a great extent and still offered no return to the general wel- fare. But vaccination having proved its medical worth, the courts quite generally have sustained the most radical provisions for compulsory vaccination. Analysis of the Sterilization Laws by Subject 131 In relation to eugenical sterilization, what is the natural class to which the remedy- must be applieJ, without constituting "class legislation" or denying the equal protection of the laws to all residents within the juris- diction of a given state? The New Jersey court held that to apply sterilization to ep- ileptic, inmates of an institution and not to the epileptics of the same degree of degen- eracy in the population at large constituted ■'class legislation." The court in this case moreover suggested that the limits of unde- sirable parenthood would be difficult to es- tablish, that if the principle of sterilization of degenerates were upheld, there would be no logical termination for its application. This latter opinion was of course not that of students of the socially indequate classes who had canvassed the whole field of so- cially handicapped and had learned that the classification of social inadequates and defi- nitions which set them off quite sharply from the normal population are generally agreed upon by sociologists and eugenicists. If a particular state seeks to limit its steri- lization laws to natural classes of degener- ates, may it not contend that its segrega- tion and commitment laws are so thorough that only in institu;tions are persons of degenerate stock who logically fall within the eugenical ban to be found? Could it not also contend that the sterilization of all feeble-minded persons of a certain degree of mental defect constitute a natural class to whom eugenical sterilization could be logically applied without any possibility of denying equal protection of the laws to all citizens of the state. It might even be ar- gued that there is so much hereditary sal- vage in the insane classes, and so many types of the insane — indeed modern institu- tions often show thirty classes in their diag- nosis reports — that the inclusion of the in- sane in the same category with the feeble- minded would be illogical and would work eugenical harm in many cases. If in future cases the courts uphold the narrower view of "class legislation" which has been upheld by the four cases above mentioned, then doubtless the states will be found bereft of a power for race betterment which they may in the future care to exercise. The model sterilization statute, however, has no quarrel with "class legislation" be- cause it applies to all individuals in the state, whether in institutions or in the population at large, who conform to a certain stand- ard stated in the statute of degenerate parenthood, regardless also of the particular type of defectiveness, whether feeble-minded, insane, criminalistic, or with gross physical defects. The law must thus, in order to be logical, not subject persons who are indi- vidually handicapped mentally or physically to sexual sterilization if their individual han- dicap is the result of accident or environment circumstances, and is not based upon heredi- tary qualities. This distinction is certainly sound biologically, and its application helps to define more sharply the natural classes which the law holds should be made the basis for legislation. A court, in seeking to avoid discrimination by including all the insane persons within the scope of a sterili- zation law, would defeat its own purpose by not making the exceptions above described. A canvass of the statutes finds the follow- ing limitations of the application of eugeni- cal sterilization, that is, individuals are se- lected for sterilization within these classes. 1. INDIANA. Inmates of institutions en- trusted with the care of confirmed criminals, idiots, rapists and imbeciles. 2. WASHINGTON. First Law. Those adjudged guilty of carnal abuse of a female person under ten years of age, or rape. Second Law. Inmates of State custodial institutions who are feeble-minded, insane, epileptic, habitual criminals, itioral degen- erates and sexual perverts. 3. CALIFORNIA. First Law. Inmates of the state hospitals and the California Home for the Care and Training of Feeble- Minded Children, and convicts in the state prisons. Second Law. Inmates of state hospitals for the insane, the Sonoma State Home, convicts in state prisons, and idiots. Amendment to the Second Law. No ex- tension of classes. Law establishing the Pacific Colony. Ap- plication of sterilization statutes to inmates of the Pacific Colony. 4. CONNECTICUT. Inmates of the state prison and the state hospitals for the insane at Middletown and Norwich. 5. NEVADA. Those adjudged guilty of carnal abuse of a female person under ten years of age, or of rape. 6. IOWA. First Statute. Inmates of each public institution in the state entrusted with the care of criminals, idiots, feeble- minded, imbeciles, drunkards, drug-fiends, epileptics and syphilitics. Second Law: All public institutions in the state entrusted with the care of crimi- 132 Analysis of the Sterilization Laws by Subject nals, rapists, idiots, feeble-minded, imbe- ciles, lunatics, drunkards, drug-fiends, epi- leptics, syphilitics, moral and sexual per- verts, and diseased and degenerate persons; also persons in the population at large who are afflicted with syphilis or epilepsy and who may voluntarily apply to a district court. Third Law. Inmates of the state hos- pitals for the insane. 7. NEW JERSEY. Feeble-minded, epilep- tic, and other defective inmates confined in the several reformatories, charitable and penal institutions in the counties and state, criminals who have been convicted of the crime of rape or of such succession of of- fenses against the criminal law as in the opinion of the board of examiners shall be deemed to be sufficient evidence of con- firmed criminal tendencies. 8. NEW YORK. Feeble-minded, epileptic, criminal and other defective inmates con- fined in the several state hospitals for the insane, state prisons, ' reformatories and charitable and penal institutions in the state, including criminals who have been convicted of the crime of rape, or of such succession of offenses against the criminal law as in the opinion of the board shall be deemed sufficient evidence of confirmed criminal tendencies. 9. NORTH DAKOTA. Inmates of the state prison, reform school, state school for feeble-minded, and the state hospitals and asylums for the insane. 10. MICHIGAN. Inmates of all institu- tions maintained wholly or in part by public expense, who have been adjudged by a court of competent jurisdiction to be mentally defective or insane. 11. KANSAS. First Law. Inmates of all state institutions entrusted with the care and custody of habitual criminals, idiots, epilep- tics, imbeciles, and insane. Second Law; Inmates of the state peni- tentiary, the Hutchinson Reformatory, the state hospitals for the insane, the state hos- pitals for epileptics, the state Home for Feeblc-Minded, and the state Industrial School for Girls. 13. WISCONSIN. Inmates of state and county institutions for the criminal, insane, feeble-minded and epileptic classes. 13. NEBRASKA. Inmates of institutions for the feeble-minded and insane, the peni- tentiary, reformatory, industrial home and industrial schools. 14. OREGON. Inmates of the Oregon state hospitals and the Oregon penitentiary, who are feeble-minded, Ihsane, epileptic, habitual criminals, moral degenerates and sexual perverts. 15. SOUTH DAKOTA. Inmates of the state home for feeble-minded persons. This canvass shows a rather limited appli- cation of the principle of eugenical steriliza- tion, but as the principles which govern the determination of degenerate parenthood and practical methods of gathering pedigree evi- dence are still not widely diffused among the social and eugenical workers of the country, these laws may be considered safe and sound in that they apply to such indi- viduals who by due process of law have been declared to be socially unadapted to a degree which constitutes them a social menace. The decisions of the court in reference to their limited application, together with wider spread of the knowledge of human pedigree studies, will justify the correction of this objection of so limited an applica- tion that the statutes are apt to be held to constitute "class legislation." 18. WHAT CONSTITUTES DUE PRO- CESS OF LAW IN EUGENICAL STERILIZATION? Whenever a law commands that some- thing be done in reference to individuals of a certain class, the members of which present a given legally defined condition, and the execution of the thing ordered is, or may be, distasteful or objectionable to the par- ticular individuals afifected, such a law is always considered an infringement of the personal liberty of the individuals affected by it. But this is the nature of all law — to command what shall be done and what shall not be done. A democracy permits such infringement of personal rights only in case the law applies without favor or discrimina- tion to all members of the natural class pre- senting the legally defined conditions. In applying such a statute in America there must always be due process of law. This may be effected by requiring court pro- cedure in cases involving a relatively great infringement on personal liberty, or by entrusting the application of the law to executive agents who in their discretion may decide summarily that the law applies or does not apply in a particular case. Obvi- ously enough, this latter type of summary administration is applicable only to the less serious infringements on personal liberty, Analysis of thu Sterilization Laws by Subject 133 and the rights of persons affected by the laws are further safe-guarded by providing for appeals to the courts in case of apparent or supposed abuse of power. In reference to eugenical sterilization, the following questions arise: Is sterilization a surgical operation, and in compulsory cases an infringement on personal liberty to such an extent that it should be ordered only as a result of court procedure in which the indi- vidual propositus has a right to be heard, or may it be classed with those lesser in- fringements or intrusions on personal liberty which are entrusted in their execution to the arbitrary discretion of executive agents? Does the fact that sterilization results in the inability of the individual operated upon to produce young have any bearing on the matter, or will the law take into consider- ation only the danger to life of the surgical operation itself, and in the case of young persons the physiological consequences in development? Will all sterilizing operations come under the same class as to requiring due process of law — that is, will vasectomy, or even castration, in the male, and sterili- zation by scarifying and X-rays in the fe- male, be classed as not endangering life, and therefore be ordered by an executive agent, whereas those operations upon the female which involve the opening of the abdominal cavity be classed with those dangerous to life, and therefore be ordered only with the consent of the patient, or by court order, after hearing and trial? The arguments for requiring court pro- cedure in each case may be summed up as follows : (a) The destruction of the reproductive powers will effect directly the character of the next generation, and consequently is a matter of great social importance. (b) So far as the individual and the family are concerned, sterilization cuts most deeply into the most fundamental of all natural functions. (c) There is no necessity for haste in eugenical sterilization, as in the case of vac- cination for an impending epidemic of small- pox, or the commitment of the insane who are momentarily in danger of committing serious anti-social acts. (d) The determination of defective par- enthood is a matter which requires careful, extensive and technical study, and cannot be effected summarily and without due investi- gation. Eugenical sterilization lays a safe and sane democratic foundation for laws which will in the future govern not only the interests of race betterment, but be used to limit the human race, due to the prospect of over- population. If summarily applied, such limitation would be fraught with the greatest possibility for wrong to the individual and the race. The necessity, while population is still relatively sparse, for developing an effective and just court procedure for the determination of defective parenthood is very great. _ The arguments for entrusting eugenical administration to executive or administrative discretion are: (a) Potential parenthood of defectives is defined by legislative authority, and its exe- cution should be entrusted to scientific and ^honest agents who will, as in the case of vaccination, determine the necessity for the application to individual cases. (b) An honest executive agent is much more, apt to make a thorough and expeditious examination than is a court, which often permits cases to drag on for years; mean- while the potential parent of defectives would be reproducing his or her defective stock. (c) Quarantine rests on individual execu- tive discretion under a general statute, and not on court procedure in each case. (d) The commitment of insane to insti- tutions, which involves as great an invasion of liberty as can be imagined, is entrusted to executive agents who are not required to conduct court procedure in order to make commitment legal. (e) In institutional cases, vaccination, dental work, operations for rupture, and many other surgical and medical treatments are permitted on the discretion of the super- intendent, regardless of the consent of the individual, and certainly without court order. Even in punitive cases wardens and prin- cipals of prisons and reform schools are per- mitted considerable latitude in administering disciplinary punishment. If sterilization is for the benefit of the individual, should it not fall within this same category of remedial agencies placed at the disposal of superin- tendents of institutions? There are two groups of statutes in refer- ence to their attitude toward the seriousness of eugenical sterilization as an invasion of personal freedom. The first group consists of those laws in which due process of law is achieved by making eugenical sterilization 134 Analysis of the; Stbriwzation Laws by Subject the subject of ministerial discretion, and not requiring court procedure in each case. In the second group are those statutes which evidently hold that eugenical sterilization is so fraught with possibilities for wrong to the individual in depriving him of life or liberty or of natural functions that if due process of law be effected, it is necessary in each case to provide court procedure, with the right to be heard, and the application of the order for sterilization as a result of the law and the evidence. It may even be held that the facts of the case jjiay be determined legally by jury. All of this does not, of .course, imply that the state has not the right to impose eugen- ical sterilization upon defective families, but that in the orders for particular cases there is a difference of opinion in this early period of sterilization legislation concerning what constitutes due process of law. Under the term executive discretion are included all of those means of determination other than court procedure. Many states have sought to insure justice and effitiency by setting up a sort of semi-judicial commis- sion, or entrusting the final determination to a board of directors. The essential feature of proceedings under such boards is, how- ever, non-judicial in that the right of the person nominated for sterilization to be heard directly or by a mixed friend and attorney, and the application of the law solely upon the facts and the evidence, is lacking. It is clear that a state may effect legal eugenical sterilization, so far as satisfying due process of law, either through (a) the summary discretion of an administrative officer, or (b) a semi-judicial board of ex- aminers or commission, or (c) court pro- cedure based on law and evidence. In the model law which accompanies this study, procedure is provided as follows: A trained eugenicist acts in the executive capacity by securing evidence relative to socially inadequate parenthood, then brings the evidence before courts of competent jurisdiction who determine upon sterilization in accordance with the law and the evidence. If the law is properly drawn, court pro- cedure may after the first few cases be expedited almost as promptly as under purely executive procedure. Thus in every case the people of the state will be assured that the most punctilious regard has been had for the rights of the particular indi- vidual nominated for sterilization, and the opportunity for abuse of authority in execut- ing a law fraught with such responsibilities to the state is reduced to a minimum. There are three groups of states in refer- ence to their attitude in regard to what constitutes due process of law in ordering eugenical sterilization: GROUP I. States which effect due process of law through administrative dis- cretion, or quasi-judicial boards or commis- sions. There is, of course, nothing to prevent the subject about to be operated upon, to appeal to the court for a hearing, but such appeal must be made and decided on the general laws of the state and not in accord- ance with a specific provision of the sterili- zation statute, GROUP II. States which provide for the investigation and ordering of eugenical sterilization by an administrative quasi ju- dicial board or commission, but which pro- vide, also, for an easy and convenient appeal to the courts by the subject. GROUP III. States which require court procedure in each particular case. GROUP I. Administrative Discretion. 1. INDIANA. The executive board con- sists of the regular institutional physician and two skilled surgeons, who make recom- mendations to the board of managers of the institution. "If, in the judgment of this committee of experts and the board of man- agers, procreation is inadvisable * * * it shall be lawful for the surgeons to perform such operations * * *." 2. CALIFORNIA. First Law: "When- ever in the opinion of the medical superin- tendent * * * it would be beneficial and conducive to the benefit of the physical, mental or moral condition of any inmate * * * he shall call in consultation the gen- eral superintendent • • * they may per- form the same." Second Law: "* * * the state com- mission in lunacy may in its discretion, after a careful investigation of all the circum- stances, cause such a person to be asexual- ized * * *" Amendment to the Second Law of Cali- fornia: "Before any person who has been lawfully committed to any state hospital for the insane * • * shall' be released or discharged therefrom, the state commission may * * after examination, Analysis of the Steriuzation Laws by Subject 135 cause such person to be asexualized, and suck asexualization whether with or without the consent of the patient shall be lawful » * * tt Law establishing the Pacific Colony. Sec- tion 45: "Before any inmate * * * ghall be released or discharged therefrom, the board of trustees on the recommendation of the superintendent * * « may cause such person to be sterilized; and such sterili- zation, whether with or without the consent of the inmate, shall be lawful * * *." 3. CONNECTICUT. The institutional physician and two skilled surgeons "* * * shall constitute a board, the duty of which shall be to examine such inmates of said institutions » * * and if, in the judg- ment of a majority of said -board, procre- ation by any such person would produce children with an inherited tendency to crime * * * then said board shall appoint one of its members to perform the operation * * » j> 4. IOWA. First Law: "The members of such board and the managing officer and the surgical superintendent of such institu- tion shall judge of such matters." Second Law: "If a majority of them decide that procreation by any such inmates would produce children with a tendency to disease * * ♦ then the physician of the institution * * ♦ shall perform the oper- ation." Third Law: "* * * that whenever the superintendent and a majority of his medical staff shall * » * agree that it is for the best interests of the patient and society, they are hereby authorized to perform the operation of sterilization * * * and pro- vided further that the superintendent of the hospital shall have secured the written con- sent of the husband or wife, if the patient is a married person, and if an unmarried per- son, the written consent of the parent, guard- ian or next of kin, if any there be within this state * * •." 5. NORTH DAKOTA. "If such board in its findings order such operation upon such inmate, it shall, in such findings, designate what operation is to be performed * * *." (Section 5.) 6. KANSA-S. Second Law: The second sterilization law of Kansas differs from the first largely in that the first statute required court procedure in each particular case, whereas the second statute, that of 1917, organizes a board . of examiners who may make final disposition of cases nominated to them by the authorities of the different institutions. (Section 1.) "But before such operation shall be performed a written notice shall be served on such inmate, and guardian, if there be one, of the time and place of a meeting and hearing at least thirty days prior thereto; and said inmate shall have the right to be represented by counsel and may introduce such evidence as may be desired." 7. WISCONSIN. (Sections.) "If such experts and superintendent unanimously find that procreation is inadvisable, it shall be lawful to perform such operation * * *." 8. NEBRASKA. The board of commis- sioners of state institutions designate a board of examiners consisting of five institutional physicians, three of whom constitute a quorum. "A determination or order of said board must be concurred in by at least three members thereof." This board, after an investigation, may order that (Section 3) "* * * it shall be a condition prerequisite to the parole or discharge of such inmate that said inmate be made sterile * * *." (Section 4). "Before any such operation shall be performed, the nature, character and consequences of such operation shall be fully explained to such inmate and to the husband, wife, parent, guardian or nearest kin, as the case may be, and the assent of such inmate so far as said inmate is capable of assenting thereto." 9. SOUTH DAKOTA. In this state the superintendent of the institution for feeble- minded persons makes a nomination to the State Board of Charities. (Section 3) "* * * that it shall be the duty of said board * * * to determine whether it is improper of inadvisable to allow any such inmates to procreate * * *." If the board so decide "* * * then the physician of the institution * * * shall perform the operation ♦ * * »» GROUP II. Administrative Discretion with Provisions for Easy and Convenient Appeal to Court Procedure. 1. MICHIGAN. Authority is given to the management of any institution maintained wholly or in part by public expense "* * * to render incapable of procreation * * * any person who is mentally , defective or insane * * *." Provision is made for the notification of the parent or guardian of 136 Anai. Reynolds, a Mentally Defec- I tive Inmate of The Michigan f" Home and Training School. J I. Your petitioner, H. A. Haynes, respect- fully represents that he resides in the City of Lapeer, in said county, that he is inter- ested in said matter and makes this petition as medical superintendent of the Michigan Home and Training School and for and in behalf of the Board of Control of the said Michigan Home and Training School. II. Your petitioner further represents that it has been reported to- the Board of Control of said Michigan Home and Training School by the superintendent thereof that said Nora Reynolds is a person by whom procreation would be inadvisable and upon the report of experts and from the examination of the physical and mental condition of said Nora Reynolds together with her family history in the judgment of the said Board of Control procreation by the said Nora Reynolds would produce children with an inherent tendency to insanity, feeble-mindedness and idiocy or imbecility, and that there is no probability that the condition of the said Nora Reynolds will improve to such an extent as to render procreation by her advis- Detailed Review of Litigation — Michigan 205 able, therefore, it has been ordered by the said Board of Control that a surgical opera- tion known as salpingectomy be performed upon said Nora Reynolds by some competent surgeon employed for that purpose. III. Your petitioner further represents that upon the 23d day of April, 1915, John Roach of the City of Lapeer was duly appointed by the Probate Court of said- County of Lapeer as guardian of said Nora Reynolds. IV. Your petitioner further shows that the 7th day of June, A. D. 1915, was the date fixed by the said Board of Control of the Michi- gan Home and Training School for said operation, and that thirty days before the time fixed for said operation notice was duly served upon John Roach, the guardian of said Nora Reynolds, at the City of Lapeer, in said County of Lapeer, a copy of which notice is hereto annexed and marked Exhibit "A," and that before the time fixed in said notice for said operation, the said John Roach, as guardian of said Nora Reynolds, filed with the said Board of Control of the said Michigan Home and Training School written objections to the performance of said operation, a copy of said objections is hereto attached and marked Exhibit "B." Your petitioner therefore prays that a time be fixed for hearing of this petition before the said Probate Court for the County of Lapeer as is provided in Section 2 of Act 34 of the Public Acts of the State of Michigan for 1913, and at such hearing this court shall determine the mental defective- ness or insanity of said Nora Reynolds and the necessity for said operation. And your petitioner will ever pray. H. A. HAYNES. d. Order of the Probate Coiu-t of Lapeer County Denying Petition. STATE OF MICHIGAN, THE PROBATE COURT FOR THE COUNTY OF LAPEER. At a session of said court, held at the Probate Office in the City of Lapeer, in said County, the 4th day of May, A. D. 1916. Present, Hon. Daniel F. Zuhlke, Judge of Probate. In the matter of Nora Reynolds, a men- tally defective inmate of the Michigan Home and Training School. H. A. Haynes, Medical Superintendent of the said Michigan Home and Training School, having for and in behalf of the Board of Control of the said Michigan Home and Training School filed in said court his petition praying that a time be fixed for hearing of his said petition before said Pro- bate Court for the County of Lapeer, as provided in Section 2 of Act No. 34 of the Public Acts of the State of Michigan for the year 1913, and that at such hearing this Court shall determine the mental defective- ness or insanity of the said Nora Reynolds, and the necessity, for an operation as pro- vided in said Act No. 34 of the Public Acts of 1913. After reading and considering said petition, this Court believing that the said Act No. 34 of the Public Acts of 1913 is un- constitutional, and this Court therefore refuses to hear said petition. It is Ordered, That the prayer of said petition be denied and the said petition be and is hereby dismissed. DANIEL F. ZUHLKE, [Seal] Judge of Probate. e. Notice of Appeal to Circuit Court: STATE OF MICHIGAN, THE PROBATE COURT FOR THE COUNTY OF LAPEER. To the Probate Court for said County: In the matter of Nora Reynolds, a men- tally defective inmate of the Michigan Home and Training School. I, H. A. Haynes, respectfully represent that I reside in the City of Lapeer, in said County, and am interested in said matter as medical superintendent of the Michigan Home and Training School, acting for and in behalf of the Board of Control of said Michigan Home and Training School. I further represent that I am aggrieved by the order of said court made on the 4th day of May, A. D. 1916, and I hereby give notice of an appeal to the Circuit Court for said County from the said order for the follow- ing reasons, viz: 1. That the said court erred in refusing to determine the mental defectiveness or insanity of Nora Reynolds, and the necessity for an operation as provided by Act 34 of the Public Acts of 1913. 2. That the court erred in refusing to hear the petition filed in accordance with Act 34 of the Public Acts of 1913. 3. That the court erred in denying the prayer of said petition and in dismissing the same. 206 Detaii,i;d Review oe Litigation — Michigan 4. That the court erred in holding Act 34 of the Public Acts of 1913 unconstitutional. 5. That Act 34 of the Public Acts of 1913 violates no provision of the constitution of the United States. 6. That Act 34 of the Public Acts of 1913 violates no provision of the Constitution of the State of Michigan. Dated this 19th day of May, A. D. 1916. H. A. HAYNES, Medical Superintendent of the Michigan Home and Training School. The appeal was duly allowed by Hon. Daniel F. Zuhlke, Judge of Probate, on May 20, 1916. 2. CIRCUIT COURT OF LAPEER COUNTY. September 10, 1917, the Circuit Court of Lapeer County sustained the decision of the Probate Court, on the ground that the Act of April 1, 1913, is contrary to Section 1, Article XIV of the Constitution of (the United States, and is class legislation. PRINCIPAL DOCUMENTS: a. Order of Circuit Court of Lapeer County dismissing the appeal from the Probate Court: STATE OF MICHIGAN, THE CIRCUIT COURT OF THE COUNTY OF LAPEER. In Re Nora Reynolds, a Men- ) tally Defective Person. ( At a session of said court held at the Court House, in the City of Lapeer, on the 10th day of September, 1917. Present: Hon. William B. Williams, Circuit Judge. In this cause an appeal was taken from an order of the Probate Court to the effect that Act 34 of the Public Acts of 1913 is unconsti- tutional. After due consideration of the briefs of counsel for the respective parties, it appearing to my satisfaction that said Act is unconstitutional in that it is in violation of Section 1 of Article XIV of the Consti- tution of the United States, and is class legis- lation, it is ordered that said appeal be, and the same is hereby dismissed, and the order of the Probate Court is affirmed, but without costs to either party. WILLIAM B. WILLIAMS, Circuit Judge. b. Opinion of William B. Williams, Cir- cuit Judge: STATE OF MICHIGAN, THE CIRCUIT COURT FOR THE COUNTY OF LAPEER. In Re Nora Rejmolds, a Men- tally Defective Person. OPINION. This is a proceeding to test the consti- tutionality of Act 34, Public Acts of 1913. Nora Reynolds is an inmate, of the Michigan Home and Training School. The Board of Control of said institution took the proper preliminary steps to determine whether the operation of salpingectomy should be per- formed on her, the object of said operation being to make it impossible for her to bear children. On the hearing in the Probate Court, Act 34 was held unconstitutional, and an appeal was taken to the Circuit Court. I am of the opinion that the act in question is clearly in violation of Section 1 of Article XIV of the Declaration of Rights of the Constitution of the United States. That it is class legisla- tion, and therefore, unconstitutional. The object of the statute is clear and the result sought to be reached is much to be desired but the statute so limits the class of feeble-minded persons who may be brought within its provisions as to almost entirely subvert its object and make it clearly class legislation. It will be observed that the Act is only applicable to that class of feeble-minded persons who are inmates of institutions maintained wholly or. in part at public ex- pense. The same reason obtains for steriliz- ing feeble-minded persons who are inmates of private institutions, and it is certainly more imperative for sterilization of feeble- minded persons who are under no restraint in any institution, either public or private, yet this statute makes it a felony to sterilize such persons. A similar statute has recently been held unconstitutional by the Supreme Court of New Jersey : Smith vs. Board of Examiners of Feeble-Minded, 88 Atl. 963. The reasons there given why the Act is unconstitutional seem to me so conclusive that I am content to base my conclusion on the reasoning of that case. I have not considered the question whether the Act might be upheld as a proper police regulation if it applied to all feeble-min have cost the State approximately $10,000 since they became State charges. The sources of our information are exam- inations of individual records, examination of said Frank Osborn and members of his family, relatives and neighbors who have been intimately acquainted with his family during their lifetime. The said board have carefully examined into said Frank Osborn's mental and physical condition and it is the judgment of a ma- jority of said board that procreation by said Frank Osborn would produce children with an inherited tendency to feeble-mindedness, and there is no probability that his condi- tion will improve to such an extent as to render procreation advisable. His physical condition is such that no harm will come to him, so far as the board is able to ascertain, from the operation. If said Frank Osborn was operated upon so that he could not procreate, in my opinion he would be able to earn his living if placed in the care and custody of some other person, but without such an operation, it would be inadvisable to release him, even under such circumstances. Before the operation is performed on said Frank Osborn, your board asks, in accord- ance with the provisions of said Section 352 of the Public Health Law, that the court appoint counsel to represent him. I also ask that a hearing be had before the judge who signs the order for which I am now applying and that said counsel be instructed to represent said Frank Osborn upon such hearing. I therefore apply for an order in accord- ance with said Section 353 of the Public Health Law. No previous or other application has been made to any judge for the order herein asked for. LEMON THOMSON. Subscribed and sworn to before me this 1st day of June, 1915. W. M. THOMAS, • Notary Public, Albany, N. Y. b. Summons and Complaint. SUPREME COURT, COUNTY OF ALBANY. FRANK OSBORN, Plaintiff, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded, Criminals and other De- fectives, Defendants. To the Above-named Defendants: You are hereby summoned to answer the complaint in this action, and to serve a copy of your answer on the plaintiff's attorney within twenty days after the service of this summons, exclusive of the day of service; and in case of your failure to appear or answer, judgment will be taken against you by default for the relief demanded in the complaint. Trial to be held in the County of Abany. Dated, July 19, 1915. ELLIS J. STALEY, Plaintiff's Attorney. Office and Postoffice address: 95 State St., Albany, N. Y. SUPREME COURT, ALBANY COUNTY. FRANK OSBORN, Plaintiff, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded, .Criminals and other De- fectives, Defendants The plaintiff, complaining of the defend- ants, alleges, upon information and belief: First: That the plaintiff is a resident of the State of New York, a citizen of the United States of America and of the age of twenty-two years. Second: That on or about the 16th day of April, 1912, a certain bill which had been theretofore duly passed by the Senate and Assembly of the State of New York, was signed by the Governor of said State and 220 Detahbd ReviBw of Litigation — New York filed in the office of the Secretary of State as an Act of the Legislature, being known as Chapter 445 of the Laws of 1913, a copy of which said Act is hereunto annexed marked "Schedule A." Third: That pursuant to the provisions of said Chapter 445 of the Laws of 1912, Lemon Thomson, M. D., Charles H. An- drews, M. D., and William J. Wansboro, M. D., were appointed as members of the Board of Examiners of Feeble-minded, Criminals and other Defectives, and at all the times hereinafter mentioned did, and now do, compose the said Board of Examiners of Feeble-minded, Criminals and other De- fectives. Fourth: That the said Act, Chapter 445 of the Laws of 1913, in many respects vio- lates the Constitution of the United States and does not secure the blessings of liberty to the citizens of the United States and their posterity as therein guaranteed, and is there- fore, unconstitutional and void, and particu- larly in that it violates Section 10 of Article I thereof in being a Bill of Attainder and an ex post facto law; subdivision 3 of Section 3 of Article III in depriving citizens of the right to trial by jury; Section 3 of Article IV in depriving citizens of the State of New York of privileges and immunities to which citizens of other states are entitled; Article V of the amendments to said Constitution in compelling a citizen to be a witness against himself and depriving citizens of life, liberty and property, without due process of law; Article VIII of said amendments in author- izing the infliction of cruel and unusual pun- ishment; Section 1 of Article XIV of said amendments in abridging privileges and immunities of citizens and depriving persons of life, liberty and property without due process of law and denying to persons within its jurisdiction the equal protection of the laws. Fifth: That the said Act, Chapter 445 of the Laws of 1913, in many respects violates the Constitution of the State of New York and does not secure the blessings of freedom to the people of said State, as therein guar- anteed, and is therefore, unconstitutional and void, and particularly in that it violates Sec- tion 1 of Article I thereof in depriving citi- zens of rights and privileges without the law of the land; Section 3 of Article I thereof in depriving citizens of the right to trial by jury; Section 5 of said Article I thereof in authorizing the infliction of cruel and un- usual punishment; Section 6 of said Article I thereof in depriving persons of life, liberty and property, without due process of law, and Section 1 of Article VI thereof in con- ferring upon a board or commission and a justice of the Supreme Court or certain county judges, powers exclusively vested in the Supreme Court. Sixth: That this plaintiff is, and for several months last past, has been, confined in the Rome Custodial Asylum, a State chari- table institution, at Rome, N. Y., and that while so confined therein was examined by the defendants herein, and that said defend- ants composing the said Board of Examiners, threatened to have performed, and are about to perform, an operation upon this plaintiff for the prevention of procreation pursuant to the power and authority so attempted to be conferred as aforesaid, by the provisions of said Act, known also as Article XIX of the Public Health Law; and that in pursuance of its said purpose so to perform said opera- tion upon this plaintiff, the said defendants presented through the Attorney-General of the State of New York, an application to the Hon. Alden Chester, a justice of the Supreme Court, for the appointment of counsel to represent this plaintiff pursuant to Section 352 of said Act, and that an order was ac- cordingly made thereon by said justice appointing Ellis J. Staley, counselor at law, of the City of Albany, N. Y., as such counsel. Seventh: That unless said defendants are enjoined and restrained from so performing, or causing to be performed, the said threat- ened operation, this plaintiff will suffer irrep- arable injury and damage for which no adequate remedy at law exists. Wherefore, the plaintiff demands judgment that the said defendants, composing the said Board of Examiners, and each of them, and their successors in office, be perpetually en- joined and restrained from performing or permitting to be performed the aforesaid threatened operation and that during the pendency of this action the said defendants be enjoined and restrained from performing, or permitting to be performed, said threat- ened operation; and that plaintiff may have such other or other and further relief as may be just, together with costs of this action. ELLIS J. STALEY, Attorney for Plaintiff. Office and Postoffice Address: 95 State St., Albany, N. Y. DETAILED Review of Litigation — New York 221 STATE OF NEW YORK, ■COUNTY OF ALBANY, ss: Ellis J. Staley, being duly sworn, says that he is the attorney for the plaintiff herein; that he has read the foregoing complaint and knows the contents thereof, that the same is true of his own knowledge except as to the matters therein stated to be alleged upon information and belief and that as to those matters he believes it to be true. Deponent further says, that the reason why this verification is made by deponent and not by the plaintiff is that the plaintiff is not now within the County of Albany, which is the county within which deponent resides and has his office, and that the sources of deponent's information and grounds of his belief are an examination of an affidavit of the defendant Thomson verified June 1, 1915, and filed in the Albany County Clerk's office, and conversations had by a representative of deponent with the plaintiff relating to the matters set forth in said complaint. ELLIS J. STALEY. Sworn to before me this 19th day of July, 1915. G. LEROY BUTLER, Notary Public, Albany, N. Y. c. Answer. SUPREME COURT, ALBANY COUNTY. FRANK OSBORN, Plaintiff, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded, Criminals and other De- fectives, Defendants. The defendants for an answer to the com- plaint of the plaintiff herein: First: Deny upon information and belief the allegations set forth in paragraphs "Fourth," "Fifth," and "Seventh" of the complaint. Wherefore, defendants demand judgment dismissing the complaint, with costs. Dated, September 3, 1915. EGBURT E. WOODBURY, Attorney-General and Attorney for the Defendants. Office and Postoffice Address: Capitol, Albany, N. Y. STATE OF NEW YORK, COUNTY OF ALBANY, ss: Lemon Thomson, being duly sworn, says: I am one of the defendants in the above entitled action. I have read the foregoing answer and know the contents thereof, and the same is true of my knowledge except as to the matter therein stated to be alleged upon information and belief, and that as to those matters I believe it to be true. LEMON THOMSON. Sworn to before me this 7th day of Sep- tember, 1915. FLORENCE E. BUSHWELL, Notary Pulplic, Albany County. d. Findings of Fact and Conclusions of Law. At a Special Term of the Supreme Court of the State of New York held at the City of Albany, N. Y., on the 17th day of Sep- tember, 1915. Present: HON. WILLIAM P. RUDD, Justice. SUPREME COURT, COUNTY OF ALBANY. FRANK OSBOR.N, Plaintiff, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded, Criminals and other De- fectives, Defendants. The issues in this action coming on to be tried by the court at the above Special Terra held by the undersigned, without a jury, and having been tried commencing on the 17th day of September, 1915, and the allegations and evidence of the parties having been heard; now, after hearing Ellis J. Staley, attorney for plaintiff, and J. Sheldon Frost of counsel and Wilber W. Chambers, Deputy Attorney-General of counsel for the defend- ants; due deliberation having been had; I find and decide as follows: FINDINGS OF FACT. First: That the plaintiff is a resident of the State of New York, a citizen of the United States of America, and of the age of twenty-two years. Second: That on or about the 16th day of April, 1912, a certain bill which had been 222 DETAILED Review op Litigation — New York theretofore duly passed by the Senate and Assembly of the State of New York, was signed by the Governor of said State and filed in the office of the Secretary of State as an Act of the Legislature, the same being known as Chapter 445 of the Laws of 1912. Third: That pursuant to the provisions of said Chapter 445 of the Laws of 1912, Lemon Thomson, M. D., Charles H. An- drews, M. D., and William J. Wansboro, M. D., the defendants herein, were appointed as members of the Board of Examiners of Feeble-Minded, Criminals and other Defec- tives, and now compose the said board of examiners of feeble-minded, criminals and other defectives. Fourth: That said Frank Osborn is, and since 1907 has been confined as an inmate in the Rome Custodial Asylum, a State chari- table institution located at Rome, New York, and is a person physically strong but men- tally defective and in the class known as feeble-minded, possessing a mental capacity according to the Binet test of about eight years. Fifth: That shortly prior to the com- mencement of this action the said Board of Examiners pursuant to the said act examined into the mental and physical condition and the record and family history of said Frank Osborn and determined that procreation by him would produce children with an inherited tendency to feeble-mindedness; that there was no probability that this condition would improve to such an extent as to render pro- creation advisable and prepared for the per- formance of the operation of vasectomy upon him. Sixth: That the said Board of Examiners, unless restrained by this court, will cause to be performed upon said Frank Osborn, the aforesaid operation. CONCLUSIONS OF LAW. First: That the plaintiff, Frank Osborn, has no adequate remedy at law for the afore- said threatened injuries and damage. Second: The Chapter 445 of the Laws of 1912, known as Article XIX of the Public Health Law, is unconstitutional and invalid. Third: That the defendants, Lemon Thomson, Charles H. Andrews and William J. Wansboro, composing the Board of Ex- aminers of feeble-minded, criminals and other defectives, and each of them and their agents, representatives and successors in office be perpetually enjoined and restrained from performing or permitting to be per- formed the aforesaid threatened operation. Fourth: That the plaintiff recover of the defendants the costs and disbursements of this action to be taxed by the clerk. Judgment in accordance with the fore- going is hereby directed. WM. P. RUDD, Justice Supreme Court. e. Exceptions of Defendant to Conclusions of Law. SUPREME COURT, COUNTY OF ALBANY. FRANK OSBORN, Plaintiff, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded, Criminals and other De- fectives, Defendants. The defendants hereby except to the con- clusions of law made by Hon. William P. Rudd, Justice of the Supreme Court, and filed in the office of the clerk of the County of Albany on the 8th day of March, 1918, as follows : First: Except to the conclusion of law marked "First." Second: Except to the conclusion of law marked "Second." Third: Except to the conclusion of law marked "Third." Fourth: Except to the conclusion of law marked "Fourth." Dated, March 10th, 1918. Yours, etc., MERTON E. LEWIS, Attorney-General and Attorney for Defendants. Office and Postoffice Address: Capitol, Albany, N. Y. To: HON. ELLIS J. STALEY, Attorney for Plaintiff, 93 State St., Albany, N. Y. HON. LUTHER C. WARNER, County Clerk of Albany County. f. Opinion of Rudd, J. SUPREME COURT, ALBANY COUNTY. Detailed Review of Litigation — New York 223 In the Matter of the Application of LEMON THOMSON, M. D., .CHARLES H. ANDREWS, M. D., and WILLIAM J. WANS- BORO, M. D., composing the Board of Examiners of Feeble- Minded, Criminals and Other De- fectives, appointed pursuant to Section 350 of the Public Health Law of the State of New York, for the appointment of counsel to represent Frank Osborn, a person to be examined pursuant to Section 353 of the Public Health Law. Merton E. Lewis, Esq., Attorney- General, for the Applicants. Wilber W. Chambers, Esq., Deputy Attor- ney-General, of Counsel. Ellis J. Staley, Esq., Attorney for Re- spondent. J. Sheldon Frost, Esq., of Counsel. SUPREME COURT, ALBANY COUNTY. FRANK OSBORN, Plaintiffs, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- minded, Criminals and Defectives, Defendants. Ellis J. Staley, Esq., Attorney for Plaintiff. J. Sheldon Frost, Esq., of Counsel. Merton E. Lewis, Esq., Attorney-General, for the Defendants. Wilber W. Chambers, Esq., of Counsel. Trial had before William P. Rudd, Justice of the Supreme Court, at Special Term, under Stipulation signed by the Attorneys representing the respective parties. MEMORANDUM. Rudd, J.: Chapter 445 of the Laws of 1913 is an act amending the Public Health Law by adding Section 19 thereto, in relation to operations for the prevention of procre- ation. It provides in substance as follows: 1. The appointment of a Board of Exam- iners consisting of one surgeon, one neurol- ogist and one practitioner of medicine to be known as the Board of Examiners of Feeble- minded, Criminals and other Defectives. 3. Making it the duty of this board to examine into the mental and physical condi- tion and the record and family history of the feeble-minded, epileptic, criminals and other defectives confined as inmates in the several State hospitals for the insane. State prisons, reformatories, and charitable and penal institutions of the State, and if, in the judgment of the majority of said board, pro- creation by any such person would produce children with an inherited tendency to crime, insanity, feeble-mindedness, idiocy or imbe- cility, and that there is no probability that the condition of any such person will improve to such an extent as to render procreation by any such person advisable, or if the physical or mental condition of such person will be substantially improved thereby, that then the board shall appoint one of its mem- bers to perform such operation for the pre- vention of procreation as shall be decided by said board to be most effective. The criminals who shall come within the operation of this law shall be those who have been convicted of the crime of rape or of such succession of offenses against the Criminal Law as in the opinion of the board shall be deemed in the criminal examined to be sufficient evidence of confirmed criminal tendencies. 3. It is the duty of this board to apply to any Judge of the Supreme Court or County Judge of the county in which said person is confined for the appointment of counsel to represent the person to be ex- amined. The counsel shall act for such person at a hearing before the judge or in any subsequent proceedings, and no order made by the board shall become effective until five days after it shall hav been filed with the clerk of the court and a copy shall have been served upon the counsel appointed to represent the person examined. Orders made by the board are subject to review by the Supreme Court or any justice thereof. Under this law a Board of Examiners was appointed consisting of the petitioners herein. Such board determined to perform the oper- ation known as vasectomy upon Frank Osborn, an inmate of the Rome Custodial Asylum, 23 years of age, strong physically, who has been an inmate of that institution for several years, and who is in the class known as feeble-minded. As indicated by the title above, Frank Osbcsrn through counsel appointed by Mr. Justice Chester, began action against the members constituting the Board of Exam- 224 DbtaiIvI^d Review oif Litigation — New York iners asking a permanent injunction restrain- ing the carrying out of the determination of the board with reference to an operation upon him; and in the action thus brought are raised questions as to the constitutional- ity of the act. We have under consideration the questions which have arisen in review of the deter- mination of the board and those which result from the challenge by the counsel of Frank Osborn, against the constitutionality of the act. We will first consider the determination of the board. ^ Dr. Lemon Thomson, one of the Board of Examiners, testified in substance that the board had selected Frank Osborn after learning as to his family and after sub- mitting him to a somewhat superficial exam- ination physically and mentally; and that such selection was made because in the opinion of the commission Osborn could not probably procreate normal offspring. His was what the Board of Examiners thought a bad case. Dr. Thomson says that he has never per- formed the operation of vasectomy for ster- ilization; that in his opinion no benefit would come to the patient from the operation so far as rendering him free from the dangers of the infection of a venereal disease; that the operation would not weaken' in Frank Osborn the tendency of the rapist. Dr. Andrews, a member of the Board of Examiners, testified that he had never per- formed the operation, and that he had never seen it performed; and while the statute re- quired that the board should determine upon the operation which would be most effective, he stated that vasectomy would not be the most effective operation but, on the other hand, that castration would be. He further testified that he had not given any study to any particular phase of this question. Dr. Wansboro, of the Board of Examiners, was not called. Dr. Bernstein, superintendent of the Rome Custodial Asylum, where Frank Osborn has been, as an inmate, since H)07, Smd in which there are cared for over 1,300 patients, testi- fied that Osborn was of a higher grade of feeble-mindedness; that the actual number of feeble-minded in our state had not propor- tionately increased in 35 years; that because of the demands of society there developed many social failures; that there had been a persistent demand for the removal of such individuals from temptations in the commu- nity; and these social failures are forced upon the attention of the state, and it has been accepted as a principle that the state must care for defectives; that such people should not be looked after by any social or political division of the state. The doctor testified that he had observed 5,000 feeble-minded patients; that Osborn could not earn his living outside of the institution if he were turned out into the world; that he had an "eight year'' mental capacity; that all patients in the institution are segregated; and upon the question of Osborn being able to pro- create normal children he said: "We are taught that the dominant traits appear in one-quarter, when the parentage is mixed as regards traits; that it is only in cases of feeble-mindedness of both parents that yot would look generally for an increase oi feeble-mindedness among offspring." In other words, that when one parent is feeble-minded and the other of norma; mental capacity that the tendency is reces- sive, that is, towards the normal. The doctor testified that vasectomy would not change any of the criminal tendencies of the feeble-minded at all; it would only elimi- nate the one element of procreation; that in his opinion one of the conditions which would result from a general enforcement oi the law, as is here determined, would be to tend to create a class of people by them- selves who would feel that they were so different from normal humanity that they would go back to promiscuous sexual rela- tions and that there would be known places where these people were harbored and there they would tend to collect. That among a class of such persons upon whom the oper- ation of sterilization has been performed you would find increased sexual intercourse, and that such increased illicit intercourse is a promoter of disease and general demoraliza- tion. Dr. Bernstein, knowing Frank Osborn as an inmate of the institution of which he was superintendent, testified that he was not in favor of the operation upon Osborn which has been recommended. He further said that he did not know of one case in the 1,300 in the institution that it would be de- sirable to operate upon, giving as a reason that it would not help the boy, and it would not help society. Osborn will have to be supervised and cared for just as well and just as much after the operation as before; after the operation of vasectomy he will want to go where the girls are just as much as he does now; that society needs protection from DuTAiivED Review of Litigation — New York 225 the raping of little girls and the frightening of them just as much as it wants protection from a future generation of dependents and delinquents. That vasectomy upon Osborn is not going to give us the thing society wants to have, protection from his possible ravages. In the doctor's opinion this legis- lation is in advance of our enlightenment — we don't know today what we are dealing with; that a careful and scientific study of ductless glands and their secretions shows that when such secretions forming in the body are interfered, with, physiological teaching indicates that conditions are created which affect the brain and the nervous sys- tem; and that such interference with the secretions does not cause or bring about a cure or a remedy such as is sought. Frank Osborn testified. He did a small sum in addition; knows the days of the week; knows his age; but said he did not know what this inquiry or proceeding meant. Dr. Davenport, a biologist, testified that he agreed with the statements made by Dr. Sharp of Indianapolis in an article entitled, "Vasectomy as a means of preventing pro- creation in defectives," in the statement there contained that "defective persons are not necessarily to become a public charge, for included within this class are to be found the most gifted as well as the most vicious, weakest and ordinarily the most unhappy of mankind," and mentioning a few of such instances in the names of Chatterton, Gold- smith, Coleridge and Charles Lamb. This statute grows out of studies and efforts of those who are interested in the subject of eugenics, which has to do with the improvement of the population by taking advantage of laws of heredity; with improv- ing through better breeding. It deals with the inheritance of traits; with changes in population through differential fecundity; the greater or less fecundity of the different classes of population; with changes of popu- lation from emigration; or better or worse strains, with hereditary basis of the traits of population. That there is to be found much of good in the most degenerate families known in our land, mentioning the Jukes and the Nams. The doctor testified that he has not advo- cated the operation of vasectomy, and that in his opinion segregation of the sexes would be better. Mr. Van Wagenen, who has studied and written upon the problems of eugenics, testi- fied that it would be well if voluntary accept- ance of such an operation could be had; that when such operations have been done against the will of the patient the psychic effects have been bad; that he would never recom- mend such an operation except upon those who consented. Dr. Coakley, a specialist in vivisection, testified as to the danger of infection because of the retained secretions in the body; that in the operation the vas deferens is severed, but that it can be reunited even after a considerable length of time, and therefore, nothing is accomplished. Dr. Fernald, superintendent of the school for feeble-minded in Massachusetts, testified that he had never seen an authorized medical statement based upon actual facts which would justify claims made for the results in Indiana where such a law is in operation; that the operation of vasectomy does not in the slightest interfere with the physical act of sex intercourse; that illicit intercourse would result, and the effect thereof would be the exchanging of the burden of feeble- mindedness for the burden of sex immorality or sex diseases and of insanity resulting in that condition which would be quite as seri- ous and would affect people who are pro- ducers and burden bearers. It would prejudice many right-thinking persons who are interested in those who are afflicted against institutions, when it is known that under the law such an operation would be possible against the wishes of the person upon whom the operation is to be made. The testimony shows that the operation of vasectomy upon the male is simple in its character; that it can be done without anaes- thesia, quite painless. That upon the female is is serious in its character, requiring an abdominal section and the risks incident thereto. A well authenticated case upon the records shows that in the case of a woman having been sterilized because of feeble-mindedness she was freed from any danger incident to childbirth, was therefore freely inclined to improper sexual relations, and her lack of moral character becoming generally known she was the victim of constant sexual rela- .tions with the boys and men of the little village where she lived; that she became diseased resulting in an epidemic of venereal disease in the locality. .The court has set forth sufficient of the testimony and of that portion of it which is practically uncontradicted to indicate that the determination of the Board of Examiners 226 Detailed Review oe Litigation — New York to cause the operation of vasectomy upon Frank Osborn is not justified either upon the facts as they today exist or in the hope of benefits to come. The members of the Board of Examiners apparently know very little about the sub- ject. They have given it no particular study. They are not, in the opinion of the court, justified in the determination which they have reached, and, therefore, upon review of the determination which the board has made, this court reverses the same. The action above entitled was brought by Frank Osborn against the defendants as members of the Board of Examiners for an injunction restraining the board from caus- ing to be performed an operation upon him to prevent procreation. It is claimed that the law in question vio- lates the Constitution of the United States in many respects; that it is a Bill of Attain- der; that it is depriving citizens of a trial by jury; and also of the privileges or immu- nities to which citizens of other states are entitled; that it is compelling a citizen to be a witness against himself, and depriving him of life, liberty and property without due process of law; that it permits infliction of a cruel and unusual punishment; that it abridges the privileges and immunities of citizens in depriving persons of life, liberty and property without due process of law, and denying to persons within its jurisdiction the equal protection of the law. It is conceded that the proper form of raising the question of unconstitutionality herein involved, is by an action asking a permanent injunction. A similar law has been declared unconsti- tutional by the Supreme Court of New Jer- sey in the case of Smith against the Board of Examiners, 88 Atlantic Reporter, 963, in an opinion written by Judge Garrison. The New Jersey statute gave to the Board of Examiners discretion to determine the form of operation most effective, as does the New York Law. It was thus given to the board to do almost anything which in their opinion would effec- tively destroy the power of procreation in Frank Osborn, or of any male or female feeble-minded inmate of a State hospital. The statute seems to vest in the board the discretion to do what Judge Garrison sajd of the New Jersey Law: "The statute is broad enough to authorize an operation for the removal of any one (in the female) of these three organs, that is the ovary, the fallopian tube and the uterus, which arc essential to procreation." , The subject of the operation in the New Jersey case was an inmate of the State Village for Epileptics, and the New Jersey court said: "While the case in hand raises the very important and novel question whether it is one of the attributes of govern- ment to essay the theoretical improvement of society by destroying the function of pro- creation in certain of its members who are malefactors against its laws, it is evident that the decision of that question carries with it certain logical consequences, having far- reaching results. For the feeble-minded and epileptics are not the only persons in the community whose elimination as undesirable citizens would or might in the judgment of the legislature, be a distinct benefit to so- ciety. If the enforced sterility of this class be a legitimate exercise of governmental power, a wide field of legislative activity and duty is thrown open to which it would be difficult to assign a legal limit." Frank Osborn is not a malefactor. He is mentally deficient. He is defective without personal responsibility for such defect. It must be assumed that he is poor in the sense that there are no parents or friends to give him a home and provide for him, and so he becomes a ward of the state to be cared for and treated and strengthened and developed, if possible. He is no different from many others running no doubt into the thousands in our state who are not within the confines of a State institution, and who together taken with those who are in institutions and simi- larly situated, mentally and physically, make up a large class of mentally deficient people. Can it be said that the law can direct the physical mutilation of the bodies of those who are in the State's care, and not be con- cerned with the same class of persons who are in the world at large? The laws of our State which have been sustained by our courts as a proper exercise of the police power are not found to be a justification of this law. The statute under consideration concerns certain classes of criminals as well as de- fectives. In the consideration of the ques- tion here we have properly confined our thoughts to the facts which have developed in the testimony, and those facts only relate to the feeble-minded. The operation upon the feeble-minded is in no sense in the nature of a penalty, and Detaii,i;d Review of Litigation — New York 227 therefore, whether it is an unusual and cruel punishment is not involved. The entire purpose of the enactment seems to be to save expense to future generations in the operation of eleemosynary institutions organized by the people of the State to care for those who are afflicted; the theory being that if the Board of Examiners should con- clude that every feeble-minded inmate of a public institution should be operated upon either by the operation known as vasectomy or the more radical operation of castration that then the State woud be justified in turn- ing all the people of this class at large to find their own way, trusting that they, in accordance with the theory of the law, could no longer procreate; the State being thus relieved of their care during their lives and freed from the danger of the burden in the future of their abnormal oflfspring. Such does not seem to this court to be the proper exercise of the police power. It seems to be a tendency almost inhuman in its nature. The subject of this inquiry is, ac- cording to the testimony of physicians, physi- cally strong. The same witnesses testified that if turned out into the world after or without the operation he could not care for himself or make a living; that at present, situated as he is, he works and helps the State in meeting the burden upon it in his care. The last section of the statute under con- sideration provides that "Except as author- ized by this act every person who shall per- form, encourage, assist in or otherwise permit the performance of the operation for the purpose of destroying the power to pro- create the human species, or any person who shall knowingly permit such operation to be performed upon such person, unless the same shall be a medical necessity, shall be guilty of a misdemeanor." It seems clear that Frank Osborn is not given the equal protection of the laws, having in mind many others situated as he is who are not within the walls of a public institu- tion, to which equal protection he is entitled with them. There is afforded to the young man similarly situated as to his physical and mental makeup, who is cared for by his par- ents in his own home, whose sexual tenden- cies and capacity may be the same as Osborn's, the protection of the law which makes it a misdemeanor for any person to assist or take part in the operation of vasec- tomy upon such a subject, while Frank Osborn, because he is an inmate of a State hospital, is not only not protected, but he is subject to such operation without his consent when determination is reached by the board created under this statute. It seems, therefore, that the provisions of the Federal Constitution to which this law is offensive is that part of the Fourteenth Amendment which declares "that no state * * * shall deny to any person within its jurisdiction the equal protection of the laws." The law certainly denies to some persons of a class and similarly situated the pro- tection which is afforded to others of the same class. The State has power, many times sustained by the courts, to protect the health, morals and welfare of the people, but such protec- tion cannot be afforded unless it applies to all alike. The courts have sustained the laws which prohibit the marriage contract between epi- leptics within certain ages, enacted for the same purpose and to accomplish the same end as the law we are considering, but such laws thus sustained have related to all epilep- tics, they do not alone relate to the unfortu- nates within hospitals. Our attention is called to an interesting and most readable opinion by the Attorney- General of California. His conclusion is "as regards the castration of confirmed criminals and rapists, and those guilty of sexual crimes, I am of the opinion that these are grave constitutional questions" but "as restricted to the sterilization of the inmates of prisons and hospitals by the method of vasectomy, I am of the opinion that there are no legal inhibitions upon this enlightened piece of legislation which is an awakening note to a new era and a great advance toward that day when man's inhu- manity to man will have acquired a meaning beyond mere frothy sentiment." Why sterilization by vasectomy of patients in a hospital, who are grouped as a class with rapists in a State prison, strikes an awaken- ing note in a new era and will lead to the day to which the Attorney-General so poeti- cally refers, is beyond the comprehension of this court and is not enlightening. Our conclusion is that the statute is un- constitutional and therefore invalid. Judgment may be entered accordingly. g. Judgment of Supreme Court. At a Special Term of the Supreme Court of the State of New York, held at the City 228 DETAILED Review of Litigation — New York of Albany, N. Y., on the 17th day of Sep- tember, 1915. Present: HON. WM. P. RUDD, Justice. SUPREME COURT, COUNTY OF ALBANY. FRANK OSBORN, Plaintiff, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded, Criminals and other De- fectives, Defendants. The defendant above named having volun- tarily generally appeared in this action by Hon. Egburt E. Woodbury, Attorney-Gen- eral, as their attorney and having served an answer herein; and the issues raised thereby having been duly brought on for trial at the above Special Term and a trial thereof hav- ing been had before the undersigned, without a jury, commencing on the 17th day of Sep- tember, 1915; and the plaintiff having appeared upon said trial by Ellis J. Staley, his attorney, and by J. Sheldon Frost, of counsel, and the defendants having appeared by Hon. Wilber W. Chambers, Deputy Attorney-General, of counsel; and a decision containing a statement of the facts found and the conclusions of law thereon and di- recting judgment as hereinafter set forth having been duly made and this day filed herein; and the plaintiff's costs and disburse- ments having been duly taxed at the sum of one hundred and eight dollars. Now, upon filing the summons, complaint and answer, and upon the decision filed herein as afore- said, it is, on motion of Ellis J. Staley, attor- ney for plaintiff, Adjudged and decreed as follows: First: That the defendants. Lemon Thomson, Charles H. Andrews and William J. Wansboro, composing the Board of Ex- aminers of Feeble-minded Criminals and other Defectives, and each of them and their agents, representatives and successors in office, be perpetually enjoined and restrained from performing or permitting to be per- formed upon said Frank Osborn the opera- tion of vasectomy. Second: That the plaintiff, Frank Osborn, recover of the defendants. Lemon Thomson, Charles H. Andrews and William J. Wans- boro, composing the Board of Examiners of Feeble-minded Criminals and other Defec- tives, the sum of one hundred and eight dollars, his costs and disbursements of this action. Judgment entered this 8th day of March, 1918. WILLIAM P. RUDD, Justice Supreme Court. L. C. WARNER, Clerk. h. Notice of Appeal. SUPREME COURT, ALBANY COUNTY. FRANK OSBORN, Plaintiff-Respondent, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded Criminals and other De- fectives, Defendants-Appellants. PLEASE TAKE NOTICE that the above named defendants hereby appeal to the Appellate Division of the Supreme Court for the Third Department, from the judgment of the Supreme Court herein entered in this action in the office of the clerk of Albany County on the 8th day of March, 1918, wherein it was adjudged that the defendants be perpetually enjoined and restrained from performing an operation on plaintiff, and the said defendants appeal from each and every part of said judgment as well as from the whole thereof. Dated, March 26, 1918. MERTON E. LEWIS, Attorney-General and Attorney for the Defendant. Office and Postoffice Address: Capitol, Albany, N. Y. To: HON. ELLIS J. STALEY, Attorney for Plaintiff, 95 State Street, Albany, N. Y. HON. LUTHER C. WARNER, Clerk of the County of Albany. i. Stipulation for Settlement of Case. It is hereby stipulated that the foregoing case contains all the evidence given in the trial of this action, and may be settled as hereinbefore set forth and signed and ordered Detailed Review oe Litigation — New York 229 filed by the justice before whom this case was tried. Dated, May 1, 1918. MERTON E. LEWIS, Attorney- General ; Attorney for Appellant. ELLIS J. STALEY, Attorney for Respondent. j. Order Settling Case. The foregoing case contains all the evi- dence given and proceedings had upon the trial of this action, and is hereby settled and signed by the undersigned, before whom this action was tried without a jury, and ordered filed in the office of the Clerk of Albany County. Dated, May 1, 1918. WILLIAM P. RUDD, Justice, k. Stipulation Waiving Certification. It is hereby stipulated by the attorneys for the respective parties herein that the fore- going summons and complaint, answer, order appointing counsel, minutes of trial, findings of fact and conclusions of law, ex- ceptions to conclusions of law, and opinion of Mr. Justice Rudd, judgment and notice of appeal therefrom are true and correct copies of the originals thereof, and of the whole of such originals, and certification of the same is hereby waived. Dated, May 1, 1918. MERTON E. LEWIS, Attorney- General ; Attorney for Appellant. ELLIS J. STALEY, Attorney for Respondent. 3. APPELLATE DIVISION OF THE SUPREME COURT OF THE STATE OF NEW YORK FOR THE THIRD DEPARTMENT. (185 App. Div. 903.) PRINCIPAL DOCUMENTS. a. Brief for Plaintiff-Respondent, by his Attorney, Ellis J. Staley. Argued by J. S. Frost, Albany, N. Y. FRANK OSBORN, Plaintiff-Respondent, against LEMON THOMSON, CHARLES H. ANDREWS and WILLIAM J. WANSBORO, composing the Board of Examiners of Feeble- Minded, Criminals, and Other De- fectives, Defendants-Appellants. The defendants, composing the Board of Examiners of Feeble-minded, Criminals and other Defectives, have appealed from the judgment of- the Special Term whereby they were perpetually restrained from performing the operation of vasectomy upon Frank Osborn, the plaintiff in this action. (Case on Appeal, fol. 1074.) The trial was had before Mr. Justice Rudd at the Albany Special Term. The opinion of the Special Term is printed at folios 995- 1066. The act under which the operation is pro- posed to be performed was passed in 1912 and is known as Chapter 445 of the laws of that year. No operations have been per- formed thereunder (fol. 76) and the applica- tion for the appointment of counsel and for a hearing in respect to the proposed enforce- ment of such law was not made until June, 191S. (Fol. 86.) The selection of Frank Osborn as the sub- ject for such operation was the first made by the Board (fol. 177) and this action was thereafter brought in order that all ques- tions might be presented in a manner recog- nized by established procedure. Evidence was received without technical objection in order that the fullest presentation of facts and of the opinions of those who had made a study of the transmission of mental qualities might be had. A very clear and comprehensive statement of the facts is to be found in the opinion of the learned Special Term. The benefit of the proposed operation, assuming the same might be so effective as to prevent subsequent restoration of procre- ative powers, in this particular instance is clearly of a financial nature only. It is un- disputed that Osborn would be unable to maintain himself were he left to his own resources, possessing as he does, a mental development, according to established tests, of an eight-year-old child. (Fols. 410, 420, 96S-967, 978.) Dr. Thomson, the chairman of the Board, testified at folio 234: "Q. The sole benefit then it is claimed by "your board for this operation is that it "prevents procreation of persons liable to "feeble-mindedness?" A. "Yes, sir.'' Bleeker Van Wagenen, who as appears from the testimony has given much study to the subject of sterilization, testified at folio 781: "I have seen cases where the operation has been performed compulsorily under the 230 Dh;taii,b;d Review of Litigation — New York state law against the will of the individual, and against his violent protest, where the psychic effect has been bad. And along with that there has seemed to be some measure of bad effect physically as well as mentally.'' Dr. Fernald testified at folio 929, in speak- ing of persons upon whom the operation of castration had been performed, as follows: "Q. Have you observed as to whether or not those persons were treated generally as a class by themselves, in a sense? A. Well, my own patients have been jeered at and have been ridiculed. "Q. What have you observed with re- spect to the confidence of the patient himself after the operation, with respect to his deal- ings with the public? A. Well, the male patients who have been castrated had very much less self-confidence — why, less self- respect and confidence, I think, expresses it fully." Dr. Bernstein testified, upon examination by the court beginning at folio 20: "By the Court: "Q. Referring to the situation that the counsel just mentioned, are you in favor of taking this step with reference to Frank Osborn? A. No. Q. Why? A. This step of vasectomy you mean? Q. Yes. Why? A. Because it won't help the boy; it won't help society. The boy will have to be supervised and cared for just as well and as much as if he had the operation as if he does not have the operation. I have the personal history of the boy here showing his tendency to go where the girls are, showing that he has had to be disciplined several times for it. After the operation of vasectomy he will want to go where the girls are just as much as he does now. Now society wants pro- tection from the raping of little girls and frightening them just as they want protec- tion from a future generation of dependents and delinquents." Osborn is now a State charge, segregated from persons of the opposite sex. He would be a public charge were the operation per- formed. It is not apparent wherein the State would be financially benefited by the per- formance of the proposed operation, but, assuming that it might be thus benefited, the question resolves itself into this: Is mutila- tion of the person of an innocent but physi- cally unfortunate human being permissible to that, or any, end? Dr. Charles Bernstein, who for twelve years has been the superintendent of the Rome State Custodial Asylum where Osborn is held as a patient, testified to having observed approximately five thousand cases of feeble-mindedness (fol. 408) and under whose direction seven operations of vasec- tomy had been performed (fol. 444), de- scribed the method of operation as consist- ing of opening the skin directly on the groin and a few tissues below the skin bringing to view the spermatic cord, consisting of the artery and veins to the testicle, the vas deferens which carry the spermatic fluid or nerve supply to the testicle and some other tissue; then the vas deferens, which is tortu- ous or worm-like and two or three times as long as the artery, veins and nerves which are associated with it, is selected from this mass of tissue and about an inch thereof cut out, tying the ends and sewing the wound together. Sometimes the tissue of the scrotum is pulled up to the groin and the cut made through the skin so as not to have a scar appear in the groin, but in either event the tissues under the skin are opened above the groin. (Fols. 445-449.) That but little force is to be given to the assertion of the chairman of the Board of Examiners that the operation is of a most simple and safe character will be manifest from an examination of his testimony upon this subject appearing at folios 204-230. Dr. Coakley testified that while the opera- tion could be performed with one incision, it would be better to make two incisions and that any iircision in the human body involves elements of danger. (Fol. 873.) He said "there is always danger of infection regard- less of the most positive asepsis and the danger of shock can not be explained at all." There is no evidence to show that Osborn possesses the reproductive plasm (sperma- tozoa). It is here proposed to perform the operation upon the mere presumption of the possession of such powers. In a normal person and in matters of property or matri- monial rights, indulgence in such presump- tion might be, and doubtless is, permitted; but it should not be assumed in the case of a defective where physical mutilation is in- volx'ed. Dr. Bernstein testified at folio 459: "What we need to know is in what per- centage of our feeble-minded cases are spermatozoa present at the present time and in how many of these will it reappear after one or two years following the vasectomy. "Q. In other words, in your opinion, Doctor, there may exist among the feeble- minded patients under the charge of the Detailed Review of IvITigation — New York 231 State a considerable number who might be correctly described as being sterile at the present time? A. Yes, sir." The operation of vasectomy does not necessarily prevent procreation. Dr. Bern- stein found the presence of spermatozoa nearly a year after the operation had been performed (fol. 455), and he stated at folio 457, referring to cases where the operation had been performed under his direction; "The real unfortunate situation here is that these cases should have been studied as re- gards the presence or absence of sperma- tozoa in the ejaculated fluid before as well as after the operation.'' Dr. Coakley testified that the vas deferens could be reunited after the operation. (Fol. 843.) Dr. H. C. Sharp, of Indiana, under whose direction most of the operations were per- formed in that state, on October 6, 1915, wrote to the counsel for the respondent a letter which is here inserted by permission of the counsel for the appellants and of which the following is a copy : "The operation to which you refer of reuniting the severed ends of the vas is pos- sible, although a delicate but very simple operation. However, I have never done this operation but in one case, and I did this for the purpose of demonstrating that it was possible." Mr. Boston states that sterilization is a punishment unless a benefit results. (See Appendix.) Mr. Justice Rudd, in his very able opinion, says, at folio 1148: "Frank Osborn is not a malefactor. He is mentally deficient. He is defective without personal responsibility for such defect." The proposition of Justice Rudd is that of an undisputed fact; the proposition of Mr. Boston is manifestly correct. This court may and should assume the accuracy of both. If both are true, no authority can be found for the performance of the proposed operation unless it appears from the record that Osborn is to be benefited thereby. We respectfully submit that the appellants have failed in such respect. To deprive an individual of all hope of progeny, where he has been guilty of no offense, is at least a close approach to cruel and unusual punishment. The case of State V. Feilen (70 Wash., 65, 126 Pac. 75), from which the appellants quote at considerable length, was one where the defendant had been convicted of the crime of rape com- mitted upon a child under ten years of age, sentenced to imprisonment for life and to have the operation of vasectomy "carefully and scientifically performed." The court said the nature of the crime would permit the death penalty had the legislature so de- termined and concluded as follows: "We can not hold that vasectomy is such a cruel punishment as can not be inflicted upon appellant for the horrible and brutal crime of which he has been convicted." The assertion would seem to be justified that vasectomy might not be cruel punish- ment when applied to one convicted of a brutal sexual crime, but as applied to any other crime, much less to an innocent, it becomes cruel and inhuman. Cruel and unusual punishment under the Philippine Bill of Rights was held in Weems vs. United States, 217 U. S. 349; 30 Sup. Ct. Rep. 544, to invalidate a sentence of carry- ing during the term of imprisonment a chain at the ankle hanging from the wrist and perpetually disqualifying from the exercise of political rights. In connection with the review by the Court of a considerable number of cases it is said: "In the applica- tion of a constitution, therefore, our con- templation cannot be only of what has been, but of what may be. Under any other rule a constitution would indeed be as easy of application as it would be deficient in efficacy and power." The New York State statute here in ques- tion assumes to authorize the prevention of procreation by such operation "as shall be decided by said board to be most effective." Under the rule stated by the Supreme Court . of the United States in the recent case above cited, it is permissible for this court to con- sider the possibility of the amputation of the sexual qrgan or even, as was said by Governor Pennypacker of Pennsylvania in his veto message of March 30th, 1905, of a similar statute: "It is plain that the safest and most effective method of preventing pro- creation would be to cut the heads off the inmates and such authority is given by the bill to this staff of scientific experts." In Fisher Co. vs. Woods (187 N. Y., 90), Haight, J., in writing the unanimous opinion of the court, said, at page 95: "The legislative determination as to what is a proper exercise of the police power, is subject to the supervision of the court and in determining the validity of an act it is its duty to consider not only what has been done under the law in a particular instance, but 232 Detaii^ed ReviBw OF Litigation — Ngw York what may be done under and by virtue of its authority. Liberty, in its broad sense, means the right not only of freedom from servitude, imprisonment or restraint, but the right of one to use his faculties in all lawful ways; to live and work where he will, to earn his livelihood in any lawful calling and to pursue any lawful trade or avocation." (Citing numerous cases.) The testimony of Dr. Walter E. Fernald, for twenty-eight years Medical Superintend- ent of the Massachusetts School for Feeble- Minded, and who has had under his charge during the past ten years an average of over 1,000 patients, is entitled to very great con- sideration because of his high standing in his profession and his knowledge gained from specific cases. He states that in the New York Hospitals for the Insane from twelve to twenty-five per cent are public charges because of mental diseases caused by syphilis. (Fol. 948, 930.) He further states that some thirty to thirty-five per cent of his patients are not of the hereditary class. (Fol. 9S3.) In his opinion, in which Dr. Bernstein con- curs, the unsexing of the individual leads to more promiscuous illicit intercourse. Beginning at folio 934, he says: "I feel that sterilization would enormously increase the likelihood of illicit sex inter- course: I believe that with the female the fear of impregnation, in the case of very many — I say this without disrespect — but in the case of very many women is a deterrent to illicit sex intercourse, and with that re- straint removed I believe there would be an enormous increase in the intercourse of women so operated upon. In fact, that has been before the committees of our legislature for the last six or seven years, and I have given that as my principal reaso_n, or one of the principal reasons, for my opposition to the whole principle of sterilization. On the other hand, the sterilization of male patients which renders them incapable of impregnat- ing women would have the same eflfect in that it would cause girls and women to feci that intercourse with that man was abso- lutely safe and could be indulged in without any of the fear of detection, which is within a certain class of wcunen the only thing which keeps them from promiscuous sex re- lations. * * * I had one female patient who was a girl of 17, who was taken home by the overseer of the poor of a certain town and subjected to the operation of ovariotomy. She had been a public charge up to the time because of the fear of the town officials that she would bring other children into the world. After the operation she was turned over to her mother and told that as there was no longer any danger of her having chil- dren the town would no longer assume re- sponsibility. That girl immediately— her mother was a working woman and was not able to safeguard her and not able to watch her — and I was visited in about three months by the clergyman and physician of that village, who told me that that morning their children, a boy of five and a girl of seven, had peeped through a picket fence, with other children, and watched a line of boys who in turn had sex intercourse with this sterilized feeble-minded girl. The physician told me that he thought that very many of the boys and young men in that town had intercourse with her. That she had acquired gonorrhea and that she transmitted gonor- rhea to a very large number of the boys, who in turn had infected other girls and women, and that there was an epidemic of gonorrhea in that little village from the sex relations with this one girl. That was a rather remarkable opportunity to judge of some of the possibilities of the presence in the community of women who were known to be incapable of becoming pregnant. Of course that is partly social. The fact that she was sterile made the authorities feel that it was not a -matter for them. I have no doubt that that fact influenced her mother somewhat in being willing to allow her to be exposed as she was. I have no doubt it was a factor in making those boys and men feel that intercourse with her was fairly safe. I have always felt that the danger of the transmission of venereal diseases would be enormously increased if we should sterilize large numbers of boys and girls, men and women, and allow them to be at large, for those reasons." Supporting the observation of Dr. Fernald, Dr. Bernstein testified at folios 478-479: "Q. Has it been your observation, Doctor, that the probability of offspring is deterrent to illicit intercourse? A. Yes, sir. "Q. So that among a class of persons such as you describe, namely, persons among whom the operation of sterilization has been performed, you would expect to find increased intercourse, would you not? A. Oh, decidedly. "Q. And increased illicit intercourse is a promoter of disease and of idleness, is it not? A. It is very commonly recognized as that." DETAILED Review of Litigation — New York 233 On cross-examination, Dr. Thomson, of the Board of Examiners, testified, beginning at folio 230: "Now, Doctor, the performance of the operation of vasectomy is not an interference with the sensation incident to cohabitation? A. It is not. "Q. So that a feeble-minded individual or any other individual upon whom the opera- tion of vasectomy might be performed would be equally desirous to have intercourse? A. He would be deprived absolutely of nothing than power to procreate. "Q. And one of the purposes of the per- formance of this operation upon inmates of State charitable institutions is that they may be safely allowed their liberty and not kept in enforced segregation from females? A. Yes, sir. "Q. There is a menace to society from illicit intercourse and from intercourse between individuals under unsanitary condi- tions, is there not? A. Yes, sir. "Q. And that condition, and that of vene- real diseases is a serious menace to the future of the race, is it not? A. Why, yes, sir; those who get it. "Q. Then so far as any benefit might come in the direction of the venereal disease wouldn't be affected one way or the other by this operation? A. No effect whatever. "Q. The sole benefit then it is claimed by your Board for this operation is that it pre- vents procreation of persons liable to feeble- mindedness? A. Yes, sir." Manifestly an increase of illicit intercourse means an increase in venereal and other dis- eases, including syphilis, with the resulting increase in the number of feeble-minded. On this phase, Dr. Fernald testified, at folio 930: "The evidence which has been obtained by the use of the modern blood reactions show that different observers have found from ten to thirty per cent of the inmates of our insti- tutions for the feeble-mindeded are feeble- minded because of the congenital syphilis which they inherited from their parents." In matter of Jacobs (98 N. Y., 98) a statute entitled, "An Act to improve the Public Health by prohibiting the manufacture of cigars and the preparation of tobacco in any form in tenement houses in certain cases and regulating the use of tenement houses in certain cases," was held unconstitutional upon the ground that the court was not able to see in the law a sufficient adaptation to the end claimed. In other words, the proposition resolves itself into this: Is not the proposed remedy fraught with more danger than the disease itself? It seems quite certain that the right to trial by jury is denied by this statute. The procedure is not clearly indicated therein. Apparently a majority of the Board may appoint one of its members to perform the operation on a selected criminal or defective inmate of state institutions after an examina- tion into the mental condition, record and family history. The Board then applies to a judge of the Supreme Court or a county judge to appoint counsel; such counsel "to act at a hearing before the judge and in any subsequent proceedings." Then an order may be made by the Board for the operation, which orders are subject to review "by the Supreme Court or any justice thereof." In what manner this review is to be had is not set forth in the statute, but in the absence of any provision for submitting the questions to be reviewed to a jury it would seem that the method must be either by appeal or by certiorari based upon the "record taken upon the examination." The absence of the right to trial by jury would seem to make this statute objectionable as being a Bill of Attainder. The important decisions dealing with the general question of constitutionality of laws of this character are: Smith vs. Board of Examiners, 85 N. J. Law, 146; 88 Atlantic Rep., 963. Davis vs. Berry, 316 Fed. Rep., 413. The only other decision, so far as we have been able to ascertain, is that of State vs. Feilen (70 Wash., 65; 126 Pac. Rep., 75.) An examination of this last case shows that the only constitutional question considered is that of cruel and unusual punishment, and for reasons heretofore pointed out in this brief, it seems wholly inapplicable to Osborn's situation. The respondent refrains from a discussion of the first two cases above, not because of a belief in their lack of importance, but because of a belief that by reason of their very great importance this court will desire to examine the reported decisions in their entirety, rather than to accept such portions thereof as counsel might select for insertion within the limitations of a brief of reasonable length. Among the cases upon which the appel- lants rely are Matter of Viemeister (179 N. Y., 235), and Jacobson vs. Commonwealth 234 Detahed Review oF Litigation — New York of Massachusetts (197 U. S., 11). These cases deal with vaccinations as a health proposition and to avoid the spread of a contagious dis- ease involving no loss or destruction of natural power, physical ability or of a func- tion of life. We submit the following taken from the brief filed by the complainant in Smith vs. Board of Examiners (supra) : "Medicine is admittedly an uncertain science, it is to a large degree experimental and theoretical, for it deals with the mystery of life, death and the infinite phenomena of physical production and reproduction and nothing short of infinite knowledge should be taken as absolute authority when we undertake to finally determine the source of human imperfections, mental and physical. "There is and can be no guarantee that this or that disease is incurable and never will be curable or is necessarily transmit- tible from one generation to another. "There can be no definite line drawn to make a division line between the healthy and the unhealthy, the normal and the ab- normal, for no human is perfect either in mind or body. We are sick or well, sane or insane by comparison only. "This act applies only to those confined in institutions of the State and does not include any of its subjects who may be similarly afflicted who are at large. It is, therefore, directed at a particular class of unfortunates who, by reason of their con- finement alone, are denied the usual pur- suits of happiness, and the ordinary oppor- tunity of procreation and sexual enjoyment. They, however, have forfeited no constitu- tional right. "There is no immediate danger to society for owing to their present situation the possi- bility of the social evil in mind is remote and contingent. It seems a dangerous innovation to give any board or constituted authority, created by legislative enactment only, the power to physically harm one of the State's subjects under less safeguard and formality than is required to inflict a penalty upon criminals who have violated the rules of society and forfeited its protection. "The victims of the operation of this law are unfortunates merely — heirs, perhaps, of the transgressions of others, they have not wronged society, they bear the penalties of an efifctc civilization, are mentally and physi- cally helpless, the wards of the State." An article written by Mr. Charles A. Bos- tofi of the Ntvi York Bar and published in the Journal of Criminal Law ^d Criminol- ogy, in the issue of September, 1913, contains such an able, interesting and exhausting argument upon the question of sterilization that we take the liberty of attaching the same as an appendix to this brief. The respondent contends that the judg- ment of the Special Term should be affirmed, with costs. Respectfully submitted, ELLIS J. STALEY, Attorney for Plaintifif-Respondent. J. S. FROST, Of Counsel. b. Decision of Appellate Division of Su- preme Court. July 1, 1918. "Judgment unanimously affirmed as the opinion of Rudd, -J., at special term." 4. COURT OF APPEALS. (Adv. Sheets No. 950, March 15, 1919. PRINCIPAL DOCUMENTS, a. Brief on Behalf of Defendants-Appel- lants, by Merton E. Lewis, Attorney- General. Argued by Wilber W. Cham- bers, Deputy Attorney-General. IN THE COURT OF APPEALS OF THE STATE OF NEW YORK. FRANK OSBORN, Plaintiff- Respondent, against LEMON THOMSON, and others, composing the Board of Examin- ers of Feeble-Minded Criminals and other Defectives, D ef endants-Appellants. This is an appeal by the Board of Examin- ers of Feeble-Minded, Criminals arid other Defectives from the judgment of the Appel- late Division of the Supreme Court, entered herein in the office of the clerk of said Appellate Division on July 5, 1918, affirming a judgment entered in this action on March 8, 1918, in the office of the clerk of Albany County, perpetually enjoining and restrain- ing the defendants from performing an oper- ation on plaintiflf for the prevention of pro- creation (fols. 1068-1075, 1079-1080, 1098- 1107). Chapter 445 of the Laws of 1912, which is now Article XIX of the Public Health Law, Sections 350-353, created a Board of nUTAll.l'D RlvVH'IW ()!■' T.ITlCA'i'l Np'.W ^'()KK 235 l''.x;imiiu-rs of Fi'oliU'-Miiulod Crliwiii.-ils and (UluT Oofoolivos. The lU'foiulaiits ii\ the aluivo-ontitlod :k-- lioii coi\iiHisi' the said Hoavd. Tliis action was bi'onght by plaintilT against the di-fondants for an injunction lo- straininK IIumu from performing or causing to bo pcrfornicd an oiicralion upon bim to prcYcnl procreation wbicb it is alU-gcd tlu-y bad threatened to perform. I'lie con\plaint alleges thai tbapier Itri of llie Laws of I'.tU' in many respects violates the Constitution of the United States, particidarly in that it violates Section 10 of Article 1, being a Bill of Attainder, and ,in ex post facto law; subdivision :! of Section 3 of Article 111 in deiiriving citizens of a trial by jury; Section a of Article IV in deiniving citizens of the State of New York of the lirivileges and inimtmities to which citizens of other states are entitled; Article V of ibe aniendnienls to the State (.'onstitution in compelling a citi/en to be a witness against liiiuself and deiniving citizens of life, liberty and properly without due iMocess of law; Article \'Ill of said amendments in author- izing the infliction of cruel and unusual pun- isbmenl; Section I of Article X 1 \' of said amendment in abridging privileges and imnuniities of citizens and dejiriving iiersons of life, liberty and property without due process of law, and denying to juMsons within its jurisdiction the equal protection of the laws. In the proceeding which was instituted under said statute, Mr. Kllis .1. Staley was appointed by the court as required by statute, to represent said Frank l)sborn, and the court ti\ed a day in the order made on June ~, 191 a, for a hearing on the advisability of performing an oiieration for the prevention of procreation, in pursuance of said statute. This action and the proceeding mulcr the slalule were consolidated by agreement between the attorneys for the respective parlies. The stipulation (o this ell'ect pro- vided : "That any and all evidence there produced upon said hearing and n|H-«n said trial shall he deemed to have been taken and received so far as the san\e may be iiroperly applicable thereto in both of said be.irings and upon sftid trial, and that both said hearings and said actiiSn may be prosecuted by filing a determination in the .same manner as if such evidence had been separately taken and re- ceived therein." 'I'he question involved is one of law. The leslimony was taken in order that the court might have the beuelit of the opinions of men who bad made a .study of the subject. Mr. Justice Rudd, at Trial Term, wrote an opinion (pp. 303-316) in which be reached the conclusion that Oshorn was denied the equal protection of the laws. POINT I. THE WEIGHT OF EVIDENCE PRO- DIKKD UPON THE TRIAL IS TO THE KEbbXT THAT THE OPERATION PRKSCRIHKD IN THE STATUTE WILL Bl'. BENEFICIAL TO SOCIETY AND THE PERSON OPERATED UPON AND WOULD PROBABLY SAVE THE STAPH A VAST AMOUNT OF MONEY. iDn this head the evidence of Dr. Thom- soii, a member of the Board of Feeble- Minded l^xaminers, was to the eflFect that be had made a careful examination of Oshorn (fols. 118-1~'0) and his family history (fols. lao-isa-l.vi), and that from his investi- gation, the Oshorn family alone had cost the Stale upwards of $10,000 to maintain (fol. 1541. He further testified, as did also Dr. An- drews, that no harm would come to Osborn from the operation (.fols. 156-157, 390-892). Doctors Thomson and Andrews very care- fully described the operation which they intend to perforin on Osborn — that of vasec- tomy, which is the operating for sterilizing males to prevent procreation. It is a minor operation in a male and not serious, and from observation, uo ill effects come from it (fols. l.'iT-1(>8, 388-290). The weight of the evidence is to the effect that vasectomy would absolutely prevent procreation (fols. 349-352, 3SS), and that it is a desirable thing to do in cases of feeble- minded persons. Dr. Bernstein testified that the proportion of feeble-minded in this State is one to every five hundred or one to every three hundred and fifty persons. That is, there is one mental defective to every five hundred or every three hundred and fifty normal individuals, and there are over 32,000 feeble- niiuded persons in this State (fols. 371-:!73). There are tO.OOO feeble-minded persons under Stale care, and it costs the State $1,766,000 to care for them, or at the rate of $176.60 per person (fol. ;!73-;i7;?'). Dr. Bernstein said that there were not as many as 10,000 cared for in New York in Slate institutions, but 236 Detailed Review of Litigation — New York there were 6,000 in State and county institu- tions, and that the cost of these was from $150 to $225 a person (fols. 374-375). In his institution alone there were 1,570 patients. Dr. Davenport, who is connected with the Carnegie Institution of Washington, and who has made a study of heredity and feeble- mindedness (fol. 580), testified: "I have long felt that sterilization laws as they have been enacted by the different states, are premature, because in advance of public sentiment now. On the other hand, I would say, on broad theoretical grounds, I think that the state has a right to prevent procreation, as it has, or does, the right of every one of the functions of the individual, including his life and his liberty. A state which limits itself in its control of the individual is weak, and such limitations tend to destroy society. I hold it to be a loftier duty of the state to protect the happi- ness of the children and adults of the next generation than to protect from assault adults of this generation. I am inclined to think it better, now that the law has been put on the statute books, to retain or amend it, and act conservatively under it." Dr. Bleecker Van Wagenen, who testified on behalf of Osborn, said that he was in favor of the operation, where he would get the consent of those who were to be Operated upon. He said: "I don't say that I would continue that always and forever, but at this present state, to my mind, it is of the utmost importance to the future, that it should for the present. Now, that does not necessarily mean that they cannot do any cases. Quite to the contrary, some hundreds of cases have been done and are continuing to be done under that basis in California, on various types of insane, feeble-minded and epileptics, and so far as I have been informed, at this com- paratively late date, they have not per- formed compulsory operations, but several hundred of the kind through first investigat- ing the family line, • * * and persuading them all, including where it is possible the patient himself or herself, whatever the case may be, that that is a good thing to do, and then performing the operation." (Fols. 813- 814). Dr. Fernald, called on behalf of Osborn, in speaking of the eflFect of the operation on the patient, testified: "I doubt if the operation of vasectomy, if it was safeguarded by proper mental prepara- tion, which would undoubtedly be given, would have any effect whatsoever, so far as that is concerned." (Fol. 923.) So, in the main, the doctors and experts agree that the operation, which is known as a minor one, and which merely consists, ir. the male, of severing the spermatic duct, is a simple operation, not necessary to give an anaesthetic, and could be performed without the use of cocaine even, and the patient suffers no more pain than that of a pinch. The patient would not be confined to his bed. In the female, the operation is not sc simple, but would not be attended with seri- ousness (Fols. 166-167). The operation in the female is performed by the ejfcision of a small portion of the heel of the Fallopian tube and is not severe. The evidence estab- lished that the operation does prevent, as Dr. Thomson testified, procreation. POINT II. THE STATUTE DOES NOT VIO- LATE THE CONSTITUTIONAL RIGHTS OF THE PERSON UPON WHOM THE OPERATION IS TO BE PERFORMED. In our researches we have been able to find only three cases on the subject. Two seem to be against the validity of the law, while one is in favor of it. The Attorneys- General of both California and Connecticut have upheld the constitutionality of such a law in opinions (see appendix to this brief). The cases we have in mind are Smith vs. Board of Examiners, 85 N. J. Law, 146; Davis vs. Berry, 216 Fed. Reporter, 413. Those two are against similar legislation. The case of the State vs. Feilen, 41 Lawyers' Reports (N. S.), 418, also reported in 70 Wash. 65, 165 Pacific, 75, favors the law. But these cases, we urge, are not decisive of the question here. It seems to us that the constitutionality of the statute should be upheld, as being a proper exercise of the police power, in promotion of the health laws of the State. In the case of Davis vs. Berry, supra, the court had before it an Act of the Iowa legis- lature, requiring the performance of the operation of vasectomy on criminals who had been twice convicted of a felony. The District Court distinctly held that the law in question was not void by reason of its being ex post facto, but did condemn the law DbtailEd Reviuw of Litigation — New York 237 because it denies the right of a hearing, and that depriving him of the right to be heard took away the right he had under the Con- stitution to have his day in court, which meant due process of law. The law was not absolutely condemned more than to say that it was the opinion of the court that vasectomy provided the infliction of a cruel and unusual punishment. In the case of Smith vs. Board of Exam- iners of Feeble-Minded Persons, of New Jersey, the court condemned the law, which provided for surgical operations for the pre- vention of procreation upon feeble-minded persons, because the statute was based upon a classification that bore no reasonable rela- tion to the subject of police regulation, and hence denied to the individual of the class so selected the equal protection of the law, granted by the Fourteenth Amendment to the Constitution of the United States. The condemnation of the law as being an im- proper classification was directed against that part of it which required the operation to be performed upon inmates confined in the several charitable institutions in the counties and State. The learned judge pointed out that, "If such object requires the sterilization of the class so selected, then a fortiori does it re- quire the sterilization of the vastly greater class who are not protected from procreation by their confinement in state or county insti- tutions.'' The learned judge concluded: "The con- clusion we have reached is that, without regard to the power of the State to subject its citizens to surgical operations, that shall render procreation by them impossible, the present statute is invalid, in that it denies to the prosecutrix of this writ the equal pro- tection of the laws to which, under the Constitution of the United States she is entitled." In the case of the State vs. Feilen, the court upheld the right of the State to sterilize by means of vasectomy persons convicted of statutory rape, and the learned judge who wrote for the court has covered the ground so thoroughly that we quote liberally there- from: "On the theory that modern scientific investigation shows that idiocy, insanity, imbecility, and criminality are congenital and hereditary, the legislatures of California (Stat. 1909, p. 1093, Chap. 720), Connecticut (Pub. Laws 1909, Chap. 209), Indiana (Laws 1907, Chap. 215), Iowa (Laws 1911. Chap. 139), New Jersey (Laws 1911, Chap. 190), and perhaps other states, in the exercise of the police power, have enacted laws provid- ing for the sterilization of idiots, insane, imbeciles, and habitual criminals. In the enforcement of these statutes vasectomy seems to be a common operation. Dr. Clark Bell, in an article on hereditary criminality and the asexualization of criminals, found at page 134, Vol. 27, Medico-Legal Journal, quotes with approval the following language from an article contributed to Pearson's Magazine for November, 1909, by Warren W. Foster, senior judge of the Court of General Sessions of the Peace of the County of New York: 'Vasectomy is known to the medical profession as "an office operation," painlessly performed in a few minutes, under an anaesthetic (cocaine), through a skin cut half an inch long, and entailing no wound infection, no confinement to bed.' 'It is less - serious than the extraction of a tooth,' to quote from Dr. William D. Belfield, of Chi- cago, one of the pioneers in the movement for the sterilization of criminals by vasec- tomy, an opinion that finds ample corrobora- tion among practitioners. » * * There appears to be a wonderful unanimity of favoring opinion as to the advisability of the steriliza- tion of criminals and the prevention of their further propagation. The Journal of the American Medical Association recommends it, as. does the Chicago Physicians' Club, the Southern District Medical Society, and the Chicago Evening Post, speaking of the In- diana Law, says that it is one of the most important reforms before the people, that 'rarely has a big thing come with so little fanfare of trumpets.' The Chicago Tribune says that 'the sterilization of defectives and habitual criminals is a measure of social economy.' The sterilization of convicts by vasectomy was actually performed for the first time in this country, so far as is known, in October, 1899, by Dr. H. C. Sharp, of Indianapolis, then physician to the Indiana State Reformatory, at Jeflersonville, though the value of the operation for healing pur- poses had long been known. He continued to perform this operation with the consent of the convict (not by legislative authority) ■ for some years. Influential physicians hea'rd' of his work and were so favorably impressed with it that they indorsed the movement, which resulted in the passage of the law now upon the Indiana statute books. Dr. Sharp has this to say of this method of relief to society: 'Vasectomy consists of ligating 238 Detaii^ed Review of Litigation — Nijw York and resecting a small portion of the vas deferens. This operation is, indeed, very simple and easy to perform; I do it without administering an anaesthetic, either general or local. It requires about three minutes' time to perform the operation, and the sub- ject returns to his work immediately, suflfers no inconvenience, and is in no way impaired, for his pursuits of life, liberty, and happiness, but is eflfectively sterilized.' "Must the operation of vasectomy, thus approved by eminent scientific and legal writers, be necessarily held a cruel punish- ment under our constitutional restriction, when applied to one guilty of the crime of which appellant has been convicted? Cruel punishments, in contemplation of such con- stitutional restriction, have been repeatedly discussed and defined, although we have not been cited to, nor have we been able to find, any case in which the operation of vasec- tomy has been discussed." The court held the punishment was not cruel and inhuman and upheld the law. Appended to this brief, the court will find the opinion of Attorney- General Webb of California by his deputy, R. C. Van Fleet, upholding the constitutionality of the Sterili- zation law of that state (Stat. 1909, p. 1093, Chap. 720) and the opinion of Attorney- General Light of Connecticut, in favor of the constitutionality of the same kind of law of that state (Pub. Laws Connecticut, 1909, Chap. 309). These opinions so fully cover the ground that we use them as a part of our brief and in that way simplify the extent of our argu- ment. POINT III. THE LAW IN QUESTION IS A VALID EXERCISE OF THE POLICE POWER AND DOES NOT OFFEND THE CONSTITUTION. For the convenience of the court we shall divide this point into various subheads. (1) POUCE POWER. The police power is an attribute of sovereignty which is possessed by every sovereign state and is a necessary attribute of every civilized government. Judge Cooley defines police power of a state as that which "embraces its whole system of internal regulation, by which the state seeks not only to preserve the public order and to prevent oflfenses against the state, but also establish for the intercourse of citizens with citizens those rules of good manners and good neighborhood which are calculated to prevent conflict of rights, and to insure to each the uninterrupted enjoy- ment of his own so far as is reasonably consistent with a like enjoyment of the rights of others." This definition has been quoted with approval many times. Hathorn vs. Natural Carbonic Gas Co. 194 N. Y., 326, p. 344. By means of this power the Legislature exercises supervision over matters involving the common weal and enforces the observ- ance by each individual member of society of the duties which he owes to others and to the community at large. People vs. King, 110 N. Y. 418. The courts have been unable or unwilling to definitely describe a rule that may be followed which will cover all cases, but instead have determined as each case is pre- sented whether it falls within or without th« appropriate limits. People vs. Budd, 117 N. Y. 1. With this very brief reference to the police power, suffice it to say that it has been defined as the law of necessity and as the power of self protection on the part of the community. State of Wis. vs. Redmon, 14 L. R. A. (N. S.), 239. (2) OVER WHAT SUBJECTS GENERALLY THE POLICE POWER EXTENDS. One of the most important fields of legis- lation in which the State may enact measures under the police power, consists of regula- tions in the interest of public health and safety. Jacobson vs. Massachusetts, 197 U. S. i: For instance, it has been held that law.- may be passed providing for drainage an< sewer systems. (New Orleans Gas Light Co. vs. Drainage Com., 197 U. S. 453). Requiring the owners of a lot which has been declared to be dangerous to the public health to fill it up to a certain level. (Charlestown vs. Werner, 38 S. C. 488.) Making it a penal offense to discharge any refuse matter in a running stream. (People vs. Hupp, 53 Colo., 80, 123 Pac. 651.) Forbidding a riparian owner on a pond from which a municipal water supply is taken, to bathe in the pond. (State vs. Morse, 84 Vermont 387.) For bidding any one to make use of, for the purpose of drinking, of polluted water Detaii^ed Review OF Litigation — New York 239 supply. (State Board of Health vs. St. Johnsbury, 82 Vermont, 276.) Providing for the collection and removal of refuse in thickly populated cities. (State vs. Robb, 100 Me. 180.) Establishing quarantine regulation notices to owners of live stock. (Kimmish vs. Ball, 129 U. S. 217.) Providing for the destruction of noxious weeds. (St. Louis vs. Gait, 179 Mo. 8.) Providing for the destruction of trees attacked by incurable infectious diseases. (State vs. Main, 69 Conn. 123.) For regulation in behalf of public morals like the suppression of gambling. (Ah Sun vs. Wittman, 198 U. S. 500.) For the prevention of fraud and deceit. (People vs. Freeman, 242 111. 373.) To regulate skill and learning in profes- sions. (Dent vs. State of W. Va., 129 U. S. 114.) To enact laws in the promotion of the general welfare. (Chicago, B. and Q. R. R. Co. vs. Illinois, 200 U. S. 561.) It may enact laws to preserve and promote the public welfare even at the expense of private rights. (Walker vs. Jameson, 114 Ind. 591.) An important class of statutes sustained as tending to promote the public welfare are those which relate to physical welfare of the members of the body politic. It has been said that it is to the interest of the State to have strong, robust, healthy citizens, capable of self-support, of bearing arms and adding to the resources of the country. Laws for this purpose are made for the protection of citizens from overwork and requiring a general day of rest to restore his strength and preserve his life for the obvious pro- tection of the public welfare. Holden vs. Hardy, 169 U. S. 366. People vs. Havnar, 149 N. Y. 195. And so we' might go on with many more cases which cover the police power, and which cases have been held to be valid. (3) THE ACT IN QUESTION DOES NOT OFFEND BECAUSE IT IS AN EX POST FACTO LAW. This was clearly held in Davis vs. Berry (sui>ra). The Relator Says It Deprives Him of His Life and Liberty Without Due Process of Law. But it is fundamental that the possession Snd enjoyment by 'the individual of all of his rights, even that of liberty itself, are subject to such reasonable regulations and restraints as are essential to the preservation of health, safety and the welfare of the community. People vs. Morse, 84 Vermont 387. (4) THE RELATOR SAYS IT DEPRIVES HIM OF HIS LIBERTY AND THE EQUAL PROTECTION OF THE LAWS. It has been repeatedly said that the guar- antee of equal protection of the laws means that no persons or classes of persons shall be denied the same protection of the laws which is enjoyed by other persons or other classes under like circumstances and their rights, liberty and property, and in the pur- suit of happiness. Santa Clara County vs. So. Pacific R. R. Co., 118 U. S. 394. Moore vs. Missouri, 159 U. S. 673. The act in question operates against all feeble-minded, epileptics, criminals and other defective inmates confined in State institu- tions. It has been held that the State may classify persons and objects for the purpose of legis- lation so long as the classification is based on proper and justifiable distinction. Chicago, M. and St. Paul R. R. Co. vs. Westby, 178 Fed. 619. And the legislature has a right to dis- criminate amongst those persons and to limit the application of its laws to a portion of them only. Grainger vs. Douglass Park Jockey Club, 148 Fed. 513. The law will be upheld so long as it oper- ates alike on all persons and property similarly situated. Barbier vs. Connell, 113 U. S. 27. It does so operate here — on all persons confined in State institutions, etc. Therefore, it seems to us the classification is reasonable and should be held to not offend the provisions of the Constitution denying relator the equal protection of the laws. (S) THE STATUTE DOES NOT DEPRIVE OSBORN OF HIS LIFE, LIBERTY AND PROPERTY WITH- OUT DUE PROCESS OF THE LAW. The statute specifically gives him notice and opportunity to be heard through an attorney to be appointed by him and to thus defend the proceedings. That is all that the law requires to be done. 240 DETAILED Revibw of Litigation — New York Simon vs. Craft, 183 U. S. 427. We urge that the law in question may be likened unto that which requires compulsory vaccination as a condition of the privilege of attending public schools. Such legislation has been upheld. Matter of Viemeister, 179 N. Y. 335. Jacobson vs. Massachusetts, 197 U. S. 11. In the case of Matter of Viemeister (supra), Section 210 of the Public Health Law which excluded children and persons not vaccinated from the public schools until vaccinated, was attacked on the ground that it violated the constitution. To sustain the law in question here we call the court's attention to the decision of the Court of Appeals in that case in an able opinion written by Judge Vann in 1904. The attack on the law was that it violated the Constitution which guarantees the rights, privileges and liberties of its citizens, but the Court of Appeals sustained the statute as a valid exercise of police power. Judge Vann said (p. 238) : "The police power, which belongs to every sovereign state, may be exerted by the legis- lature subject to the limitations of the Consti- tution, whenever the exercise thereof will promote the public health, safety or welfare. The power of the legislature to decide what laws are necessary to secure these objects is subject to the power of the courts to de- cide whether an act purporting to promote the public health or safety has such a reason- able connection therewith as to appear upon inspection to be adapted to that end. A statute entitled a health law must be a health law in fact as well as in name, and must not attempt in the name of the police power to effect a purpose having no adequate connection with the common good. As we have recently said, it 'must tend in a degree that is perceptible and clear towards the preservation of the health * welfare of the community, as those words have been used and construed in the many cases heretofore decided.' (Health Dept, of N. Y. vs. Rector, etc., 145 N. Y. 38, 39.) When the sole object and general tendency of legislation is to promote the public health, there is no invasion of the Constitution, even if the enforcement of the law interferes to some extent with liberty and property. These principles are so well established as to require no discussion, and we cite but a few of many authorities relating to the subject. * • • "The fact that the belief is not universal is not controlling, for there is scarcely any belief that is accepted by every one. The possibility that the belief may be wrong and that science may yet show it to be wrong is not conclusive, for the legislature has the right to pass laws which, according to the common belief of the people, are adapted to prevent the spread of contagious diseases. In a free country where the government is by the people through their chosen repre- sentatives, practical legislation admits of no other standard of action, for what the people believe is for the common welfare must be accepted as tending to promote the common welfare, whether it does in fact or not. Any other basis would conflict with the spirit of the Constitution and would sanction meas- ures opposed to a republican form of govern- ment. "While we do not decide and cannot decide that vaccination is a preventive of smallpox, we take judicial notice of the fact that this is the common belief of the people of the State and with this fact as a foundation, we hold that the statute in question is a health law, enacted in a reasonable and proper exer- cise of the police power. It operates impar- tially upon all children in the public schooh and is designed not only for their protection but for the protection of all the people of the State. The relator's son is excluded from school only until he complies with the law passed to protect the health of all, himself and his family included. No right conferred or secured by the Constitution was violated by that law or by the action of the school authorities based thereon." We respectfully submit that that part of the health law in question tends to promote the welfare of the community and protect the public health and hence, is a valid exer- cise of the police power. In deciding the questions here involved, we call the court's attention to the fact that in a number of cases the judicial branch of our government has held that the presumption is always in favor of the constitutionality of the statute. People vs. West, 106 N. Y. 293. And the courts have gone so far as to pronounce that in no doubtful case should they determine legislation to be contrary to the Constitution. Munn vs. Illinois, 94 U. S. 113. I>ETAiLUD Review ot Litigation — New York 241 And that the courts will resolve every reasonable doubt in favor of the validity of the enactment. Sinking Fund Cases, 99 U. S. 700, on p. 718. POINT IV. THE JUDGMENT APPEALED FROM SHOULD BE REVERSED AND THE STATUTE HELD CONSTITUTIONAL. Dated, September 30th, 1918. Respectfully submitted, MERTON E. LEWIS, Attorney-General, Attorney for Defendants. WILBER W. CHAMBERS, Deputy Attorney-General, Of Counsel. Appendix: This brief was accompanied by the opinion of the Attorney-General of California upholding the validity of the sterilization statute of that state. (For full text of the opinion see Chapter IX, Sec. 1.) b. Case pending at time of repesd of statute. Pending decision by the Court of Appeals, the legislature of the State of New York re- pealed the statute on May 10, 1930 (Chapter 619 of the Laws of 1930). Upon this repeal the questions involved became purely academic and the appeal in the Court of Appeals was withdrawn. Thus the litigation in the matter of eugenical steril- ization in the State of New York, based upon the Law of 1913 (Chapter 44S), never re- ceived a final judicial opinion of the highest court of the state. CHAPTER VII. (Continued) PART VI. NEVADA. 1. District Court of the Fourth Judicial District of the State of Nevada. a. Sentence , 243 3. United States District Court in and for Nevada. a. Petition of Plaintiflf 245 b. Order to Show Cause and Restraining Order 347 c. Answer 848 d. Stipulation ; 249 e. Plaintiff's Brief 249 f. Decision of United States District Court 250 DutaiIvUd Review of Litigation— Nevada 243 (VI.) NEVADA. (Section 28, Crimes and Punishments, Act March 17, 1911.) The Nevada statute is copied after the first law of the State of Washington. The fact that the first Washington statute was upheld and that of Nevada held invalid was due to differences in the constitutions of the two states; that of Washington forbids cruel punishment while the Nevada Constitution forbids cruel and unusual punishment. 1. DISTRICT COURT OF THE FOURTH JUDICIAL DISTRICT OF THE STATE OF NEVADA. On August 14, 1915, in the District Court of the Fourth Judicial District of the State of Nevada, in and for Elko County, Pearley C. Mickle was sentenced to sterilization as a punishment for rape. The principal documents in the case follow : a. Sentence. August 14, 1915. '•1 J THE STATE OF NEVADA, Plaintiff, vs. \ Rape. PEARLEY C. MICKLE, Defendant. BE IT REMEMBERED, That on the 13th day of August, 1915, same being a regular judicial day of the District Court of the Fourth Judicial District of the State of Nevada, in and for Elko County, the afore- mentioned court being duly convened, with the regular officers thereof present, and the State represented by E. P. Carville, Esq., District Attorney, and C. A. Cantwell, Esq., Assistant District Attorney, the above men- tioned defendant was duly brought before the court and sentenced by Hon. E. J. L. Taber, Judge of said court. COURT: This is the time set for pro- nouncing judgment in the case of the State of Nevada, plaintiff vs. Pearley C. Mickle. Mr; Mickle, you may stand up. As you were informed before today, the District Attorney 'filed an information against you today charging you with the crime of rape, allegfed to have been committed in the- County of Elko, State of Nevada, on the 10th day of August, 1915. The information states that at that time and place you forcibly had- carnal knowledge of a female, Mrs. George W. Fox, against her will and with- out her consent, you being then and there an adult male person. Upon your arraign- ment this morning you entered a plea of guilty to this information, and your plea was entered on the minutes of the court, and with your consent this was the time set for pronouncing judgment or sentence. Have you any legal cause to show why judgment should not now be pronounced against you? DEFENDANT: No, sir, I haven't. COURT: Is there anything you want to say, Mr. Mickle? DEFENDANT: No, sir. COURT: Will you state how old you are? DEFENDANT: Nineteen. COURT: Have you the discharge papers showing his age? CARVILLE: Twenty-two; he was born in '93. DEFENDANT: I enlisted when I was fifteen, but enlisted as eighteen. My mother and father has the birth certificate. COURT: Your folks are living, Mr. Mickle? DEFENDANT: Yes, sir. COURT: Where do they live? DEFENDANT: Mother lives in Port- land, Oregon, and father in New York. COURT: Will you state what your father does? DEFENDANT: A wagon maker. COURT: Your mother is a good woman, is she? DEFENDANT: Yes, sir. COURT: How did you come to commit such a crime as this? DEFENDANT: By drinking steady, and was just sobering up. When I am sobering up it drives me crazy. Whisky and wine puts me ofif my head. COURT: You mean to say you were just sobering up after having been drunk? DEFENDANT: Yes, sir, just sobering up. COURT: Have you ever done anything of this kind before. DEFENDANT: No, sir. COURT: Anything like it at all? DEFENDANT: No, sir, your Honor. COURT: Have you always been a healthy person? DEFENDANT: Yes, sir. COURT: Did you ever have fits of any kind? DEFENDANT: Epileptic fits. COURT: Do you wish to vouch to me for that? Do you assure me that is the truth? 244 Detailed Review of Litigation — Nevada DEFENDANT: Yes, sir, that is the truth; I can prove it. COURT: How long since you had one? DEFENDANT: The last one I had was last March. COURT: How many have you had? DEFENDANT: I have had ten, I guess, in the last four years. COURT: Anything like that in your family before, your father or mother? DEFENDANT: Not that I know of. I have a cousin that has them. COURT: You don't claim to be insane, do you, Mr. Mickle? DEFENDANT: No, sir. COURT: You don't pretend to be crazy ^ DEFENDANT: No, sir. COURT: Well, now, I want to be per- fectly fair with you. A man in your condi- tion is under a strong temptation to tell lies. DEFENDANT: I am not telling any lies, your Honor; I am telling the straight truth. COURT: Sometimes a inan tells a lie when he thinks it will help him, when it is against him and that may be the case with your epilepsy. DEFENDANT: I can prove that. COURT: Would you make that state- ment that you have epileptic fits if you knew it was going to hurt you with me instead of helping you? DEFENDANT: No, sir, I wouldn't. COURT: You mean you would tell a lie about it if you thought it would help you with me? DEFENDANT: No, sir, I wouldn't. COURT: Perhaps you do not under- stand me. Supposing you knew by telling me you had epileptic fits that I would punish you more than I would otherwise. That might seem strange to you, but sup- posing you knew that, would you still say you had them? DEFENDANT: I have. That . is the truth; hope to God to die. COURT: Of course, Mr. Mickle, I wouldn't have you understand what the pun- ishment is, but I don't mean to say when I remind you the court might inflict the death penalty on you, because the 'court cannot do it in this case, but it might affect you injuriously in some other way. And no matter whether it does or not, you still say that is the truth? DEFENDANT: That is the truth, nope to God to die. COURT: Is there any place I could investigate your father or mother, or any- body else you would be willing to have me inquire of whether this is true or not? DEFENDANT: Yes, sir. COURT: Will you tell me their address? DEFENDANT: Yes, sir, Mrs. Jennie Pounds, Ceres, New York. COURT: Is that a small town or village? DEFENDANT: A small village. COURT: You don't need any street address? DEFENDANT: No. COURT: Is that your mother? DEFENDANT: My aunt. COURT: She knows that you had fits? DEFENDANT: Yes, sir, I was there last March when I had these fits. COURT: And she is living, so far as you know, at this time? DEFENDANT: She is living, as far as I know, at this time. COURT: The court now considers and adjudges that you, by reason of your plea of guilty to this information, are guilty of the crime of rape, as therein alleged, and I do now pronounce the judgment and sen- tence of this court that for that crime you be imprisoned and confined in the state prison of this State, and the court fixes as a minimum of such confinement a period of five years; and the court fixes as a maximum the term an^ duration of your natural life. And at this time, by virtue of the provisions of 6293 Revised Laws — Mr. Mickle, I am going to order that an operation be performed upon you. I want to tell you it is not the operation of castra- tion. Do you know what that means? It is not that; It is an operation which many hundreds of men have undergone and that we call baseptoniy (vasectomy?) The opera- tion does not take away the power of sexual intercourse, but it does- take away the power of .begetting children. I was not going to pronounce that sentence until I found from you that you were subject to epileptic fits And I am going to put it in my judgment. I am. going to give considerable time for that to be done, so it need not be done in a hurry, so the authorities at Carson will have plenty of time to investigate and see if you have told the truth. If they find that DETAitED Review op Litigation — Nevada 245 you have told the truth the operation may be performed. While I do not think you are entitled to very much sympathy, still I want to be fair with you and tell you that that operation is not one that causes much pain; in fact, the doctors say it is not so serious as having a tooth pulled, so far as the pain is concerned. Furthermore, they do not open your body to any extent; it is less than half an inch, and is an operation performed in a very few minutes. It doesn't have any such result upon you as castration would. I tell you this in advance so you may know the sentence the court is going to pronounce upon you. The court further pronounces judgment, and orders, adjudges and decrees that an operation be performed upon you for the prevention of procreation; that said opera- tion be performed within one year of the date of your incarceration in the state prison of this State by virtue of this judgment; that the operation to be performed, as hereby ordered, shall be the operation known to medical science as baseptomy (vasectomy?) or such other operation as shall be deter- mined upon by the surgeon or surgeons who shall be designated to perform the same. And the warden of the said State Prison of the State of Nevada, is hereby directed to have this order and judgment carried into effect at the said state prison by some quali- fied and capable surgeon or surgeons; that said operation shall not consist of castration. And the court further orders that said opera- tion shall be performed scientifically and with the greatest care and humanity possible. Mr. Mickle, this court would not have ordered this operation if it had not been for your own statement that you are subject to epileptic fits. And I want' you to understand further, that horrible and loathsome as your crime has been, that this operation is not ordered by this court for the purpose of increasing your punishment. The reason this court makes this order is that epileptic fits are hereditary and it is for that reason. The court wishes to protect society against any oiifspring from you, is why this order is made. Is there anything you wish to say, Mr. Mickle? DEFENDANT: No, sir. COURT: Defendant is remanded. CERTIFICATE. I do hereby certify that oii the 12th day of August, 1915, I was duly appointed, qualified and acting reporter of the Fourth Judicial District Court of the State of Nevada, in and for Elko County; that as such reporter, on said date, I took down in shorthand the proceedings had in the pronouncing of judg- ment and senten-ce on the defendant in the case of The State of Nevada vs. Pearley C. Mickle; that the foregoing, consisting of seven pages, inclusive, is a full, true, and correct transcript of said proceedings. Dated, at Elko, Nevada, this 14th day of August, 1915. B. H. WALTERS, Official Reporter. ENDORSED: FOURTH JUDICIAL DISTRICT COURT OF STATE OF NEVADA, IN AND FOR ELKO COUNTY. THE STATE OF NEVADA, PLAINTIFF, VS. PEARLEY C. MICKLE, DEFENDANT. SENTENCE. TRANSCRIPT. 2. THE UNITED STATES DISTRICT COURT. May 25, 1918. The United States District Court in and of Nevada held that the Nevada Act of March 17, 1911, provides for an unusual punishment and is therefore con- trary to Section 6, Article I of the Constitu- tion of Nevada. PRINCIPAL DOCUMENTS. a. Petition of Plaintiff. Sentence of State District Court: IN THE DISTRICT COURT OF THE UNITED STATES, IN AND FOR THE DISTRICT OF NEVADA. PEARLEY C. MICKLE, Plaintiflf, vs. D. S. DICKERSON, as Warden of the Nevada State Prison, and S- Petition DONALD T. McLEAN, as Physician of the Nevada State Prison, Defendants. J Comes Pearley C. Mickle, the plaintiff above-named, by and through his attorneys, Woodburn & Bartlett, Esqrs., and respect- fully shows unto the above entitled court, the following: I. That the plaintiff is a citizen and resident of the State of Pennsylvania. 246 Detailed Review oe Litigation — Nevada II. That the above-named defendants, D. S. Dickerson and Donald T. McLean, are re- spectively the warden and physician of the Nevada State Prison at Carson City, Nevada, and are citizens and residents of the State of Nevada. III. That on the 14th day of August, A. D. 1915, plaintiff herein was convicted in the Fourth Judicial District Court of the State of Nevada, in and for the County of Elko, of the crime of rape, and on said date was sentenced by the Hon. E. L. Taber, the judge of said court, to an indeterminate sen- tence of not less than five years in the Nevada State Prison; that at the time of pronouncing said sentence said court further ordered and directed, under the supervision and direction of the defendant, D. S. Dicker- son, as warden of the said Nevada State Prison, that within one year from said date an operation be performed upon the person and body of the plaintiff herein to prevent procreation; said operation, as plaintiff is informed and believes, being commonly known and called the operation of vasec- tomy. IV. That said operation of vasectomy which will prevent procreation, was, by said Fourth Judicial District Court of the State of Ne- vada, in and for the County of Elko, ordered to be performed upon the person and body of petitioner under and by virtue of the pro- visions of Section 6293 of the Revised Laws of the State of Nevada, said section being as follows: "Whenever any person shall be adjudged guilty of carnal abuse of a female person under the age of ten years, or of rape, or shall be adjudged to be an habitual criminal, the court may, in addition to such other punishment or confinement as may be im- posed, direct an operation to be performed upon such person, for the prevention of pro- creation; provided, the operation so directed to be performed shall not consist of castra- tion." V. That there is no other pretended authority, statutory or otherwise, in the State of Ne- vada, permitting or authorizing the perform- ance of said operation to prevent procreation upon the person and body of plaintiff, except as contained in said Section 6293 of the Re- vised Laws of the State of Nevada. VI. That petitioner is informed and believes, and upon such information and belief states the fact to be, that said operation of vasec- tomy so ordered by said. Fourth Judicial District Court of the State of Nevada, in and for the County of Elko, consists of the ligation of the fallopian tube of the human body. VII. That said Section 6293 of the Revised Laws of the State of Nevada authorizing the performance of said operation which will prevent procreation is void and of no effect, and violates Section 6, of Article I of the Constitution of the State of Nevada, in that the' punishment therein permitted and author- ized is cruel and unusual; said Constitutional provision being as follows: "Sec. 6: Excessive bail shall not be re- quired, nor excessive fines imposed, nor shall cruel or unusual punishments be inflicted, nor shall witnesses be unreasonably de- tained." VIII. That by virtue and in pursuance of the said order of said Fourth Judicial District Court of the State of Nevada, in and for the County of Elko, the defendant, D. S. Dicker- son, as warden of said Nevada State Prison, has ordered and directed the defendant, Donald T. McLean, as physician of said Nevada State Prison, to perform said opera- tion of vasectomy to prevent procreation upon the body and person of petitioner on the 31st of July, A. D. 1916, and petitioner alleges that said defendants will perform said operation unless restrained from so doing. IX. Plaintiff further shows to the court, and as an additional ground why said operation should not be performed, that the Honorable E. L. Taber, the judge of said Fourth Judi- cial District Court of the State of Nevada, in and for the County of Elko, ordered and directed the performance of said operation to prevent procreation, not as punishment of the crime of rape, as authorized by said Section 6293 of the Revised Laws of the State of Nevada, but for the reason that said de- fendant was an epileptic. X. That there is no authority, statutory or otherwise, authorizing the performance of an operation to prevent procreation upon epi- leptics. Detailed Review op Litigation — Nevada 247 XI. That petitioner was never formally charged with being an epileptic, but was adjudged and decreed to be an epileptic without due process of law in contravention of the Four- teenth Amendment to the Constitution of the United States. Xil. That if said operation is performed, plain- tiff will suffer great and irreparable injury. WHEREFORE, plaintiff prays for an order restraining and enjoining the above- named defendants from the performance of said operation of vasectomy, or any other operation to prevent procreation upon the person and body of the plaintiff herein, and for such other and further relief as to this Honorable Court may seem meet and proper in the premises. WOODBURN & BARTLETT, Solicitors for Petitioner. United States of America, I State of Nevada, Iss: County of Washoe, J William Woodburn, being first duly sworn, deposes and says that he is one of the solic- itors for the plaintiff named in the foregoing petition; that he has read the said petition and knows the contents thereof, and that the statements therein made are true, according to his best information and belief; that he makes this affidavit because of the fact that the said Pearley C. Mickle, plaintiff above named, is absent from the County of Washoe, State of Nevada, and is now an inmate of the Nevada State Prison at Carson City, Nevada. WILLIAM WOODBURN. Subscribed and sworn to before me this 29th day of July, 1916. JONATHAN PAYNE, (Notarial Seal) Notary Public. b. Order to Show Cause and Restraining Order. IN THE DISTRICT COURT OF THE UNITED STATES, IN AND FOR THE DISTRICT OF NEVADA. Pearley C. Mickle, vs. Plaintiff, D. S. Dickerson, as Warden of the Ne- vada State Prison, and Donald T. Mc- Lean, as Physician of the Nevada State Prison, Defendants J Order ■ to Show Cause and Restraining Order. On petition of the plaintiff, duly verified, it is ORDERED, That the said defendant, D. S. Dickerson, as warden of the Nevada State Prison, and the said defendant, Donald T. McLean, as physician of said Nevada State Prison, show cause before this court, at Carson City, Nevada, on the 7th day of August, 1916, at ten o'clock a. m. of said day, why an injunction should not be granted restraining the said defendant, D. S. Dicker- son, as warden of the Nevada State Prison, and the said Donald T. McLean, as physician of the Nevada State Prison, from performing an operation of vasectomy, or any other operation to prevent procreation upon the person and body of Pearley C. Mickle, and for such other and further relief as may seem meet and proper in the premises. And it is further ORDERED, That said defendants, their agents, deputies and em- ployes be, in the meantime, restrained from performing an operation of vasectomy, or any other operation to prevent procreation, upon the person and body of said Pearley C. Mickle on the thirty-first day of July, 1916, or at any other time, until further order of this court. It is further ORDERED, That a copy of the petition filed herein, attached to a copy of this Order, be served upon the said de- fendant, D. S. Dickerson, as warden of the Nevada State Prison, and the said Donald T. McLean, as physician of the Nevada State Prison, from performing an operation of vasectomy, or any other operation to pre- vent procreation upon the person and body of Pearley C. Mickle, and for such other and further relief as may seem meet and proper in the premises. And it is further ORDERED, that said defendants, their agents, deputies and em- ployes be, in the meantime, restrained from permorming an operation of vasectomy, or any other operation to prevent procreation, upon the person and body of said Pearley C. Mickle on the thirty-first day of July, 1916, or at any other time, until further order of this Court. It is further ORDERED that a copy of the petition filed herein, attached to a copy of this Order, be served upon the said de- fendant, D. S. Dickerson, as Warden of the Nevada State Prison, and upon the said Donald T. McLean, as Physician of the said Nevada State Prison. E. L. FARRINGTON, Dated, July 39th, 1916. ^''^''^^ J""^^^- 248 Detailed Review oe Litigation — Nevada ANSWER, c. Answer of Defendants. IN THE DISTRICT COURT OF THE UNITED STATES, IN AND FOR THE DISTRICT OF NEVADA. PEARLEY C. MICKLE, Plaintiff, vs. D. S. DICKERSON, as War- den of the Nevada State >. ANSWER. Prison, and DONALD T. McLean, as Physician of the Nevada State Prison, Defendants./' Come now D. S. DICKERSON and DONALD T. McLEAN, defendants herein, by their attorney, GEO. B. THATCHER, Attorney-General of the State of Nevada, and for answer to the complaint herein admit, deny and aver as follows, to-wit: I. Admit all the matters and things contained in paragraphs I and II of said complaint. 11. Admit that on the date mentioned in para- graph in of said complaint that plaintiff was convicted of the crime of rape as alleged in said paragraph, but allege that the sentence of said court was for not less than a mini- mum of five years and a maximum of life imprisonment, and admit all the other matters and things contained in said para- graph III of said complaint. III. Admit all the matters and things contained in paragraphs IV and V of said complaint. IV. In answer to paragraph VI of said com- plaint these defendants deny that the opera- tion of vasectomy consists of the ligation of the fallopian tube of the human body, but allege that said operation is a resection of the vas deferens. V. In answer to paragraph VII of said com- plaint these defendants deny that the per- formance of said operation is a cruel and unusual punishment within the meaning of Section 6 of Article I of the Constitution of the State of Nevada. VI. Admit all the matters and things contained in paragraph VIII of said complaint. VII. Deny all the matters and things contained in paragraphs numbered IX, X, and XI of said complaint. VIII. Deny all the matters and things contained in paragraph XII of said complaint, and state that if said operation is performed, defend- ant will not suffer great or irreparable injury, or any injury at all. IX. Further answering said complaint, these defendants allege that the plaintiff herein has not legal capacity to bring this action for the reason that it appears from said com- plaint and defendants in this Answer allege that the plaintiflF is an inmate of the Nevada State Prison and is lawfully confined therein under a judgment and sentence of a court of competent jurisdiction upon a criminal charge, which said sentence may extend in duration to the end of the natural life of said plaintiff, and that therefore the said plaintiff is civilly dead and is not entitled to sue, a full and true copy of which judgment and sentence is hereto attached, marked "Exhibit A" and made a part hereof. THEREFORE, having fully answered said complaint, these defendants pray that the restraining order herein may be vacated and set aside, and that they have judgment for costs in this behalf expended. Attorney-Genera!. Attorney for Defendants. State of Nevada, County of Ormsby, ss: DONALD T. McLEAN, being first duly sworn on oath, deposes and says: That he is one of the defendants herein; that he has read the above and foregoing Answer and that the same is true of his own knowledge, except as to the matters which are therein stated to be on information and belief, and as to those matters, he believes it to be true. Subscribed and sworn to before me this day of August, A. D. 1916. Notary Public. Detaii? d 6 :2>ov^/}Ur Son -^iavghfir Heredity Chart of Alice Smitli DE 3 '/. i© t i '* U' " Ua |zj jay ''^'-<'*-/«« I /7//ce •Smith. A-/fw *-/^ *-*f- /-/f'? n^^ EhE^ r~ ~\ fflorrtftte Ijut ^ "S aT/ier ■T^rafern 'Ti^ ^/^e (Til) V ^f? s^t/are of c/rc/e-zjum^at of //r£//t'ic/ua/x ef/^a/^^e^. Jl^s /otv s^i/are ar- c/'rc/e precei/ec/ /y ^m - //fj^h'//i>/ra/ (^^arg£3. ^/! /^7 /^Ci'/i^/^c/a/ /3 r<^f&rr-^€/ 7^ l^u g'ef?era^^/7 '^'la' /ye/Si^/r^/ /7i/^^£r. 17ii/s /^//cf S/77/r^ ><; TV- J?n ^/ T/re C////a/r,;//'s Orp//a// i9Jy/t^/r?^ Say'^^''^'', //■ -7^ — x" /io/?7£ /ar- r/7e z^^^, ■S5>W-/;'^ Brief abstracts of all references to sterili- zation which appeared in this Journal are given In Section 11 of Chapter V, pp. 117, of this book, under the subject "Th« Bcsiul StarlllsKtlon of OrinUnali." CHAPTER X. THE RIGHT OF THE STATE TO LIMIT HUMAN REPRODUCTION IN THE INTERESTS OF RACE BETTERMENT. Introduction 338 A. Parallel Cases of the Restriction of Personal Liberty in the Interests of the General Welfare. 1. Compulsory vaccination 339 2. Quarantine 341 B. Legislative and Judicial Activities Regulating or Limiting Human Reproduction. ^ 1. Limitation of Marriage ' 342 a. List of legal limiting causes 343 b. The special case of venereal and other transmissible diseases. bl. Analysis of laws limiting marriage on account of venereal or other transmissible diseases 343 b3. Constitutionality of the Wisconsin statute requiring certificate' of health for males before marriage license is issued 344 c. Judicial annulment of marriage in the interests of public health and racial welfare 345 cl. Wisconsin Supreme Court 345 c2. New York Supreme Court (New York County) 345 c3. New Jersey Court of Chancery (Concealment of insanity) 346 c4. New Jersey Court of Chancery (Concealment of venereal disease) 346 2. Birth Control 346 a. Review of criminal statutes on Birth Control: Judge J. C. Ruppen- thal 347 b. Conclusions 348 3. Control of Immigration 349 4. Institutional Segregation of Social Inadequates 350 a. Quotation from Dr. Henry M. Hurd 350 b. Conclusion 351 5. Eugenical Sterilization. a. Cases of eugenical sterilization in states having neither authorizing nor restricting statutes 351 al. Case of M H of Massachusetts 353 a2. Case of "' X " of Illinois 354 b. Legal situation in England 355 bl. Would it be lawful to sterilize? 355 b2. Who should operate? 356 b3. Penalties for wrongfully operating 356 c. Concluisi'dn ■ .• • • • 356 C. Possible New Fields for Eugenical Legislative Activity 356 1. Eugenical Education 356 2. Compulsory Reporting of Cases of Cacogenesis 357 3. Registering Trained Eugenical Investigators 358 Summary 359 338 State Rights Rb; Limitation of Human Reproduction INTRODUCTION. The proposal to enact eugenical steriliza- tion laws naturally calls up the question of the constitutionality of the statutes under which the state, through the exercise of its police power, would extend its control over human reproduction to the extent of seizing certain individuals proven by pedigree-study to be potential parents of degenerate or de- fective offspring, and by surgical operation or medical treatment, destroying their re- productive powers. Although eugenical sterilization is a very ancient means of conscious effort to con- serve and improve certain human races, still the proposal to use this means on an exten- sive scale by the authority of statutory law is a relatively new* principle in American legislation. The bolstering up of our de- fective strains by the recent great develop- ment of American custodial institutions ^ for the insane, feeble-minded, criminalistic and other types of the socially inadequate, has created a problem in race-conservation, the degree of which we have not heretofore been compelled to face. Our states are de- voting from 5.4% (Alabama, 1915) to 30.5% (Massachusetts, 1915) of their total state expenditures to maintaining state institu- tions for the socially inadequate. American states, in the interest of the general welfare, have exercised many novel and radical police functions, quite as extreme and no more beneficial than eugenical sterilization. Gen- erally such activities are justified and upheld by the courts, if they can be directed by laws not running counter to the bill of rights, and have for their purpose tjie im- provement of the well-being of the state, and can demonstrate their fitness in ac- complishing their stated purpose. Many of them seek directly to benefit the natural physical, mental and moral qualities of the nation. A state does not hesitate in the interests of organized society to take the life of an individual. This in modern practice is al- ways in punishment for crime, but crime is not the only type of anti-social or of socially ineffective conduct. Crime is, it is true, the only type of such behavior which carries blame with it. But the other types of social inadequacy equally destructive to the securi- ty and vigor of the nation, while not carry- ing blame, carry pity, shame, chagrin, ineffectiveness, and degeneracy. At this point mention might well be made of military conscription. Every soverign state claims this right, although it involves most arbitrarily the control of the conduct and services of the citizen, and places him in great jeopardy of life. It is absolutely non-punitive, but is demanded by the prin- ciple that, in the long run, the welfare of the commonwealth is of vastly more im- portance to the sum total of human happi- ness than is the temporary freedom and personal security of the individual. Personal jeopardy is highly preferable to injury to the state. If we compare the right and duty of military conscription with the right and duty of the state to control human reproduc- tion in the interests of the common welfare, we find that the latter impinges not more upon individual freedom, but with fully as much ultimate common benefit. Within modern times, civilized states have resorted to banishment as a means of pro- tecting their organized society. At present in American states those types of social inadequacy, other than crime, which destroy the effectiveness of the individual and the peace and prosperity of the state, are taken care of in a humane manner by custodial institutions. In such institutions the liberty of the individual is just as completely taken away as in the case of imprisonment for crime. The state may restrain its irrespon- sible members, under the undoubted exercise of its police power, which permits the most severe practice, if in the end the general wel- fare of the organized social life of the com- munity is promoted. Euthanasia is not resorted to in our most highly civilized states, but in some of the less advanced communities of the world, especially those in which the population crowds closely upon the food supply, it is common to remove, often by non-punitive death, the members least necessary to the life of the tribe. The direct means of con- trolling the racial quality of future genera- tions available to our more enlightened and humane states are the legal control of immi- gration and of marriage; social punishment for illegitimacy; the regulation of attempts at birth-control, abortion, and infanticide; teaching the better classes the truth concern- ing human heredity and the necessity of fit 1 First bin vetoed 1905, Pennsylvania. First law enacted 1907, Indiana. " See Statistical Directory of State Institu- tions for the Defective, Dependent and De- linquent Classes, H. H. Laughlln, Bureau of the Census, 1919. STATE Rights Re Limitation oe Human Reproduction 339 and fertile matings among those with the best natural endowments; and finally the limitation of reproduction of degenerates by eugenical sterilization. The novelty of the proposal cannot militate against its legality, if it is proven effective for the purpose pro- posed. When in capital punishment electro- cution was found to be more humane than hanging, it was readily adopted by a number of states. Vaccination may seem harsh and cruel, but when humanely applied the courts have quite universally held that the state is well within the exercise of its undoubted police power in ordering its compulsory application. Ultimately the state must find a biolog- ically, socially, morally, and economically superior substitute for war, pestilence, and famine in culling the human species of its defective strains. Also the state must find eugenically the means to undo the racial ill innocently done the nation by society's chari- tably fostering defective individuals up to parenthood, and encouraging their reproduc- tion. Such pampering has been done by the recent great development of outside charity and hospitalization. The principle here to be applied should be: By all means aid, to the full extent of society's ability, the poor, the unfortunate and the suffering, but permit only those individuals most splendidly en- dowed by nature, with socially valuable physical, mental and moral qualities, to re- produce. Thus a democracy, in order to live, must be willing to investigate new social remedies, to try them out and to accept those which prove adequate to promoting national effect- iveness and racial vigor — the general welfare, it is called in law. The principal guide in trying out novel social legislation is that the activity provided for shall not transgress our Bill of Rights, which we have built up through the centuries at so great an effort. Measures for race improvement must, of course, be effected through due process of law and without denying the equal protection of the laws to all of the inhabitants of the state. Except in cases involving crime, there must be no element of punishment in them. Every .measure designed for promoting the general welfare must stand the practical test of being an effective agency for promoting the good of the race to a degree entirely in keeping' with the severity or radicalness of the remedy. With all species, including man, the life and well-being of the race or nation, as a whole, are vastly more important than the unrestricted and unsocial conduct of the indi- viduals who compose the race, because ex- perience has proven that in the long run individual effectiveness and happiness is assured and promoted only by individual subordination and occasional personal sacri- fice. The sum total of human freedom and human happiness will be greatly promoted, in the long run, by eugenical processes which call for the elimination of degenerate and handicapped strains, from the racial stocks, and the increase of numbers' of citizens highly endowed by nature with splendid mental, physical, and moral qualities. The state, then, must exercise its undoubted right and duty to control human reproduction along the lines of race betterment, and in so doing is fully justified in putting into effect such measures as, in keeping with the Bill of Rights and humane principles, will bring about the desired ends. A. PARALLEL CASES OF THE RE- STRICTION OF PERSONAL LIB- ERTY IN THE INTERESTS OF THE GENERAL WELFARE. Since the proposition to sterilize eugen- ically involves the taking away, in the interests of the state, of a natural endowment of an individual, namely, the reproductive power, it is pertinent to cast about for legis- lation and court decisions which relate to processes bearing an analogy to some aspects of eugenical sterilization. In compulsory minor surgical treatment and in infringement upon personal liberty, in the interests of the general welfare, the state's work in vaccina- tion and quarantine is found to be pertinent. 1. Compulsory Vaccination is analogous to compulsory eugenical sterilization to the extent that both are non-punitive and that both involve the seizure of the individual and subjecting him or her to surgical treat- ment. Both vaccination and sterilization are done supposedly for the public good. Vacci- nation protects the individual and his asso- ciates from a serious and loathsome disease in the more immediate future; eugenical sterilization protects society from racial de- ■igeneracy in the mc*e remote future. Vacci- nation, however, in its operative seriousness and pathological possibilities, greatly exceeds vasectomy, but not castration, in the male, but may not on the average be said to equal in seriousness sterilization of the female by any known process except possibly by X-rays. 340 State Rights Re Limitation oe Human Reproduction The following brief history of legislation and litigation, however, sustains the view that the State may, in the interests of public wel- fare, impose compulsory vaccination upon its residents. From Public Health Bulletin No. 53, pub- lished in January, 1913, and written by J. W. Kerr, Assistant Surgeon General, we quote from page 16: "Questions relating to vaccination have been brought before the judicial branch of the Government under all possible aspects. The courts have been called upon to decide the constitutionality of statutes requiring vacci- nation, the power of the legislature to dele- gate authority to require vaccination, the va- lidity of local ordinances or regulations en- forcing vaccination, the price of vaccination, ,the responsibility for the expenses of vaccina- tion, the form of the certificates used, what vaccination is, whether failure to vaccinate a child constitutes negligence, etc. "Power of States to Enact Compulsory Vac- cination ^aws. — All disputes regarding \ the right of State legislatures, in the exercise of the police power, to enact statutes making vaccination compulsory were definitely settled by the decision of the Supreme Court of the United States in the case of Jacobson v. Massachusetts (197 U. S., 11). The highest tribunal of the land had already as an obiter dictum in Lawton v. Steele (152 U. S. 136) enunciated the principle that the State might order the compulsory vaccination of children, but the Massachusetts case was the first in- stance in which the validity of a State law requiring vaccination was questioned before the Supreme Court on constitutional grounds, the court ruling that the police power of the State covered such cases, and it was for the legislature an*d not for the courts to deter- mine whether vaccination was or was not the best preventive measure against smalliJox. "Similar conclusions have been reached or assumed by a number of State courts with re- spect to compulsory vaccination or making vaccination a condition of attendance at school, signally, in Abeel v. Clark (84 Cal. 226); State Bd, of Health v. Board of Trus- tees (110 Pac, 137); 143 Cal., CBS; Blssell v. Davidson (65 Conn., 183); Harris v. Cox, D. C. Law No. 53015; Morris v. Columbus (102 Ga., 792); Blue v. Beach (115 Ind., 121); Osborn v. rtUHsell (64 Kans., 507); Com. v. Pcnr and Com. V. Jacobson (183 Mass., 2 12); Vlcnieistor v. White (179 N. Y„ 235); re Smith (H6 N. Y., 68); State v. Hay (126 N. C, 999); Field V. Robinson (198 Pa., 638); Stull v. Kobor (215 Pa., 156); McSween v. Bd. of School Trustees (129 S. W. R., 206); State v. Shorrock (55 Wash., 208); the case of State v. Burdge (95 Wis., 390) being the only one In which the court refused to commit itself to the validity of such legislation, taking the view that the question was not presented by the record. "Delegation of Authority. — The doctrine that State legislatures have power to delegate their authority to enforce vaccination to local authorities has been maintained In Morris v. Columbus (102 Ga., 792); Com. v. Pear (183 Mass., 242); re Smith (146 N. Y., 68); State V. Board of Education (81 N. B. R., 568); and somewhat more reservedly in Osborn v. Rus- sell (64 Kans., 507); and Mathews v. Board of Education (127 Mich., 530). "Power of I^ocal Autliorities in the Abeence of I^eglslatlon. — There is a decided lack of har- mony In the decisions of the courts regarding the power of State or local authorities to make vaccination a condition to school attend- ance when no specific authority has been granted by the legislature. The exercise of this power has been upheld in Austin v. School Board (83 Ark., 431); Blue v. Beach (155 Ind., 121); 157 Ind., 25; State v. Zimmerman (86 Minn., 353); re Rebenaok (62 Mo. Ap., 8); State V. Cole (220 Mo., 697); Hutchlns v. Dur- Jiam (137 N. C, 68); Duffield v. School District (162 Pa., 476); Glover v. Board of Education (14 S. D., 139); McSween v. Board of School Trustees (129 S. W. R., 206); and State v. Board of Education (21 Pac, 401); while the use of this power has been animadverted against and its legality denied in Morris v. Columbus (102 Ga., 792); Potts v. Breen (167 111., 67); Lawbaugh v. Board of Education (177 111., 572); 234 111., 422; Osborn v. Russell (64 Kans. 507); Mathews v. Board of Education (127 Mich., 530); and State v. Burdge (95 Wis., 390). Although in some of these cases, nota- bly in the Illinois and Michigan cases, the opinion was expressed that during epidemics or as an emergency measure unvacclnated children might be excluded from school "Mention must be made of the fact that after the decisions in the cases of State v. Zimmerman (86 Minn., 353); Glover v. Board of Education (14 S. D., 139); and State v. Board of Education (21 Utah, 401), acts were promptly passed by the State legislatures of Minnesota, South Dakota, and Utah forbidding compulsory vaccination." We quote two decisions, the first by the California District Court of Appeal, First District, in the case of Williams vs. Wheeler (Dec. 31, 1913) (138 Pacific Reporter, 937). "The history of the legislation on the sub- ject shows that the State of California stands committed to the policy of requiring vaccina- tion as the best preventive means known to medical science for lessening the liability to Infection with a dreaded and dangerous dis- ease. "I'hc board of regents of the University of California has the right to make and enforce rea,sonable rules requiring vaccination as a condition of admission to the university. "The Keneral health is one of the subjects over which the State legislature has control thnuigh the police power, and in the exercise of that control It has the power to pass gen- feral laws. In the nature of health regula- tions, requiring that persons admitted to edu- cational institutions shall be vaccinated. "The rules of the board of regents of the ITnlvcrslty of California required vaccination as a prerequisite to the admission of students to the university. A general State law re- quired that students entering educational in- stitutions in the State must be vaccinated, but a iirovlslon of the law made an exception In State Rights Re Limitation op Human Reproduction 341 cases where the students or their parents or guardians were conscientiously opposed to vaccination. The court held that this provi- sion of the law was not a health regulation and not within the general police powers of the legislature, and that, in view of the broad powers given to the board of regents of the State university by the constitution, the pro- vision in the State law did not nullify or alter the rule of the board of regents." The following is a decision of the Ken- tucky Court of Appeals in the case of the Trustees of Highland Park Schoql District vs. McMurtry (Apr. 13, 1916) (184 South- western Reporter, 390). In Kentucky the State board of health and the local boards of health are both charged, independently, with the preservation of the public health, and they have power to take such action as in the exercise of a reasonable discretion may be deemed necessary to sup- press and prevent the spread of any infec- tious or contagious diseases. Under the laws of Kentucky, when a small- pox epidemic is threatened, it is within the power of a local board of health to require all children attending school to be vaccinated. a' plea for compulsory vac- cination IN DEFENSE OF AS- SEMBLY BILL NO. 474 ENTITLED, "AN ACT REGULATING VACCINA- TION IN THE STATE OF NEW YORK." By CYRUS EDSON, M. D. Health Department, City of New York. 1889. Page 1. (In listing the reasons). No. 2. "That compulsory vaccination is an invasion of personal liberty." Pages 5-6 (In reply) : "It is alleged that the compulsory vacci- nation is an invasion of personal liberty. To a certain extent it is. But is not enforced isolation, removal to the so-called pest-house, a much greater invasion of liberty? "It is my duty to remove to the smallpox hospital all cases of the disease that occur in tenements, apartment houses, hotels, boarding-houses, etc., in New York City. I have seen the babe taken from the arms of its heart-broken mother. Is not this a much greater invasion of personal liberty? It is authorized by the health laws. Compulsory vaccination will do more to effect the pre- vention of such cases than any other measure that can be devised. We have in New York City a class, mostly Bohemians, who are a source of danger to the rest of the people by reason of their prejudice of vaccination. When smallpox appears among them it is almost impossible to stamp it out. Compul- sory vaccination will enable us to compel these people to be protected against small- pox. They will yield only to the strong hand of the law." PENNSYLVANIA STATE VACCINA- TION COMMISSION. Report and Dissenting Reports. March, 1913. Pages 136-7. Vaccination Laws in Other Lands: In practically all of the armies and navies of the civilized world, vaccination and re- vaccination are compulsory. (The following list is given of countries having compulsory vaccination laws). Germany, 1875; Japan, 1885; Hungary, May, 1887; Italy, March, 1893; Roumania, 1894; France, 1902. Sweden requires that children must be vaccinated "before the age of three." Norway has indirect compulsion, requiring the vaccination of all school children. Denmark, by royal decree, April 3, 1810, made attendance at school, permission to receive confirmation, and to be married in the church, dependent on proof of vaccina- tion. It also decreed compulsory vaccination in time of smallpox epidemics. Children must be vaccinated before the age of seven. Belgium. Indirect compulsion through vaccination of school children. Holland. 1892. England: The present law requires that every child shall be vaccinated before reach- ing the age of six months; the penalties of this law may, however, be avoided by a declaration under oath of conscientious ob- jection to vaccination. Conclusion. The legal aspects of the vaccination prob- lem may be summed up as follows: In the absence of constitutional provision to the contrary, a state may, in the exercise of its police power, enact compulsory vaccination laws. Their enactment is a matter of policy wholly within the discretion of the legis- lature. 2. Quarantine. Quarantine involves a sus- pension of the right of a diseased or exposed individual or household to move about in the community, or in any other manner to come in close contact with fellow citizens who are not suffering from or have not been exposed to the same disease. It is analogous to 342 State Rights Rt Limitation of Human Reproduction eugenical sterilization in that both are non- punitive, and that both appear to be abridg- ments of personal liberty of a most serious nature. Quarantine is found to be such a valuable agency in protecting the public from the menace of the spread of contagious diseases that the state has assumed the rights to make suitable quarantine regulations and the courts have sustained their respective states in the reasonable and sound exercise of such author- ity. In the present connection it is pertinent to learn whether, in each particular case, a ministerial or administrative agency, duly established by legislative enactment, may, of its own discretion, impose the quarantine re- striction on a given individual, or whether the removal of such natural liberty as the quarantine involves requires in each particu- lar case court procedure with the right possi- bly to trial by jury. The Illinois Supreme Court, in the case of the People vs. Tait (Dec. 17, 1913), handed down the following decision: "The legislature may, in the exercise of the police power of the state, create ministe- rial boards with power to prescribe ruleS and impose penalties for their violation, and pro- vide for the collection of such penalties, and the exercise of this power by the legislature is not a delegation of legislative power. "Rules and regulations of boards of health must be written, adopted in an official manner, and duly entered of record. "An Illinois law authorized county boards of health to make and enforce rules and regulations to check the spread of communi- cable diseases. The defendant was charged with failing to comply with quarantine regu- lations established by the County Board of Health, and was convicted in the lower court, but the Supreme Court reversed the judg- ment because it did not appear that the rule or regulation under which he was convicted was in writing and had been regularly adopted by the Board of Health and duly entered of record." Conclusion. Quarantine is so demonstrably adapted to promoting the health of the people that, despite its non-punitive taking away of per- sonal liberty, it is undoubtedly constitutional in each of the several states. The balance of private inconvenience against public welfare is in each case decided in favor of the latter. B. LEGISLATIVE AND JUDICIAL ACTIVITIES REGULATING OR LIMITING HUMAN REPRODUC- TION. There are many ways in which the people of a state, either through the pressure of an aroused public opinion acting directly in influencing custom, or acting through its representatives in the legislature by enacting statutory laws, may deny the right of re- production to certain proved defectives or degenerates. The marriage and reproduction mores of a people are so deeply seated in their life that in a self-governing country no statutory law affecting them which has not the support of public opinion may be expected to accom- plish its stated purpose. If, however, public opinion is behind the statute, a modern state by statute may successfully resort to the means described in this chapter, and possibly others, in its legislative eflforts to limit or control the reproduction of individuals social- ly inadequate from defective heredity. 1. Limitation of Marriage. The power of the state to limit marriage' in the interests of race betterment is un- doubted. Practically any rule having a sound biological, medical or social foundation may be enacted into statutory law limiting mar- riage, provided that such limitation applies impartially to all residents of the state who present the given set of limiting conditions. These given conditions, however, must be descriptive of a natural class logically and justly set apart. They must not establish an artificial class in an unfair or discrimina- tory manner. The purpose must be laudable, and its means of attainment must be reason- able. The principal point, therefore, which the courts insist upon is that such laws shall not constitute class legislation, that is, they shall not deny to any natural group or class of citizens the equal protection of the laws guaranteed to the inhabitants of all of the states by the Fourteenth Amendment to the Constitut ion of the United States. 'See 1. American Marrlajre Laws In Their Social Aspects: Hall and Brooke. Russell Sage Foundation. 1919. 2. State Laws Limltinz Marriage Selection, Examined In the Light of Eugenics: Daven- port, Chas. Benedict. Bulletin No. 9, Eugenics Record Office, 1913. 3. Marriage and Divorce Laws of the World: Ringroae. Musson-Draper Co., 1911. 4. Summary of Laws of Several States Governing Marriage and Divorce of Feeble- Mlnded, Epileptic and Insane: Smith, "Wilkin- son & Wagoner. Bulletin No. 82, University of Washington, 1914. 5. Legal Status of Negro- White Amalgama- tion In the United States: A. E. Jenks, Am. Jr. Sociology, March, 1916, pp. 666-678. State Rights Re Limitation of Human Reproduction 343 a. List of Legal Limiting Causes. As a matter of fact, state laws limiting marriage vary in different states on different subjects with the varying strength and par- ticular direction of public pressure. Legal limitations exist in reference to the follow- ing subjects: (l) age, (2) parental consent, (3) license, (4) ceremony, (5) bigamy and previous marriage, (6) consanguinity, (7) marriage by force, menace, duress, or false personation, (8) miscegenation, (9) venereal and other communicable diseases, (10) in- sanity, feeble-mindedness, epilepsy and other forms of hereditary degeneracy, (11) crim- inality, (12) alcoholism and narcoticism. On each of these subjects the right of the state to legislate is undoubted. All states have limitations of some sort, among the most eugenical of which are those relating to certain types of miscegenation and those denying marriage to the insane, feeble- minded and other constitutional degenerates or defectives. The present laws deny mar- riage to individuals personally defective; but, if modern human pedigree studies have proven anything, it is that in individuals per- sonally normal hereditary degeneracy can be located only by family history study. The location of such degeneracy is a difficult task, but is ^necessary as a foundation for the intelligent purging of the race. In those states with the highest percentage of literacy and the greatest development of state institutions, it would be equally logical to limit marriage to persons who can demon- strate the possession .in their family trees of socially valuable mental, physical and tem- peramental qualities. This at present may be a little in advance of public opinion, but as the eugenical sciences make advance and the teachings of biology, medicine and sociology permeate more deeply into the life of the American people, the demand for the limita- tion of marriage to persons of demonstrated natural worth will doubtless be made, and judging by analogy, when such time arrives and such laws have been enacted with due regard for the Bill of Rights, we may logic- ally expect that the courts will sustain them, and that the people will demand their enforce- ment. b. The Special Case of Venereal and Other Transmissible Diseaes. Analysis of only one of these basic factors for limiting marriage will be made here. The possession of venereal or other transmissible diseases as a legal bar to marriage is now being actually developed by the several states, so that its legal status and the proc- esses and vicissitudes of its attainment become' especially instructive. These laws restrict the marriage license to otherwise qualified individuals who can show a clean bill of health so far as venereal infection is concerned. Some of them apply to males only, others to both sexes. This is a new social remedy which medicine and social hygiene have developed, which the legisla- tures have adopted and which the courts appear to be supporting because it is demon- strated to be an effective means for promot- ing general public health. The fact that it is a new remedy does not appear to destroy its efficiency nor its constitutionality. bl. Analysis of Laws Limiting Marriage on Account of Venereal or Other Transmissible Diseases (tqso). Since 1905 thirteen states have, in response to the recent awakening in social hygiene, enacted laws limiting marriage on account of venereal or other transmissible diseases. The following table gives an analysis of their essential features: LAWS LIMITING MARRIAGE LI- CENSE ON ACCOUNT OF VENER- EAL DISEASES. 1920. 1. ALABAMA. General Laws, Regular Session of 1919, No. 178, applicable to males only. 2. INDIANA. Chapter 126, Acts of 1905, applicable to both sexes. 3. MICHIGAN. Chapter 83, R. S. 1846, and Act 128 P. A. 1887 (see C. L. 1915), applicable to both sexes. 4. NEW JERSEY. Chapter 23, Laws of 1917, applicable to both sexes. 5. NEW YORK. Domestic Relations Law, Article III, 1917-18, applicable to males of any age and females under 45 years. 6. NORTH DAKOTA. Chapter 207 S. L. 1913, and Chapter 237 S. L. 1919, applica- ble to males of any age and females under 46 years. 7. OREGON. Chapter 187 S. L. 1913, applicable to males only. 8. PENNSYLVANIA. P. L. 1013, 1913, applicable to both sexes. 9. UTAH. Title 46, Chapter I. C. L. 1917, applicable to both sexes. 344 State Rights Re Limitation of Human Reproduction 10. VERMONT. P. A. 198, 1918; P. A. 238, 1917; and P. A. 179, 1919, applicable to both sexes. 11. VIRGINIA. Chapter 300, Acts of the Assembly, 1918, applicable to both sexes. 12. WASHINGTON. Chapter 174 Ses- sion Laws 1909, and Chapter 16, House Bill No. 27, Extraordinary Session 1909, appli- cable to males of any age and females under 45 years. 13. WISCONSIN. Chapter 107, Laws of 1917, applicable to males only. b2. Constitutionality of the Wisconsin Statute Requiring Certificate of Health from Males Before Marriage License is Issued. Perhaps the most far-reaching decision in reference to one of this particular series of statutes (erroneously called "The Eugenics Laws") is that of the Wisconsin Supreme Court in the case of Peterson vs. Widule (June 16, 1914) (140 Northwestern Reporter, 966). The court (Winslow, C. J.) held: "* " * The power of the State to control and regulate by reasonable laws the marriage relation, and to prevent the contracting of marriage bypersoijs afflicted with loathsome or hereditary diseases, which are liable either to be transmitted to the spouse or inherited by the offspring, or both, must on principle be regarded as undeniable. "* * ♦ When the legislature passes a consti- tutional law, that law establishes public policy upon the subjects covered by it, and that policy is not open to question by the courts. "* * * An argument is made that the law is void because the classification is unreason- able, arbitrary, and discriminatory, in that it singles out men about to marry and makes a class of them; there being, as it is argued, no substantial differences which suggest the propriety of different legislative treatment between men who are about to marry and women who are about to marry. Theoret- ically the argument is strong. Women who marry and transmit a loathsome disease to their husbands do just as much harm as men who transmit such a disease to their wives; if women were, in fact, doing this thing as frequently or anywhere nearly as frequently as men, the argument could hardly be met. The medical evidence in the case, however, corroborates what we suppose to be common knowledge, namely, that the great majority of women who marry are pure, while a con- siderable percentage of men have had illicit sexual relations before marriage, and conse- quently that the number of cases where newly married men transmit a venereal dis- ease to their wives is vastly greater than the number of cases where women transmit the disease to their newly married husbands. Classification is not to be condemned because there may be occasional instances in which it does not fit the situation; it is proper if the great mass of situations to which the law applies justify the formation of a class and the application of some special or diflferent legislative provisions to that class. Classifi- cation can rarely be mathematically exact. The question is not whether in some indi- vidual instance there is any perceptible dis- tinction, but 'whether there are characteristics which in a greater degree persist through the one class than in the other,' and which justify the diflferent treatment. (State vs. Evans, 130 Wis., 381; 110 N. W., 241.) That there are such characteristics in the class of un- married men is as certainly true as it is dis- creditable to the male sex. • "It follows that legislation directed against males alone for the purpose of preventing the transmission of venereal diseases is clearly within the police power and just as clearly is not discriminatory. The only question to be considered is whether the law which attempts to accomplish the purpose is unreason- able or unduly invades constitutional rights in its methods of enforcement. "♦ • * por my part I have no sympathy with this statute. I think it tends to dis- courage marriage rather than to prevent the spread of venereal diseases * * *. "* * * But the ineffectiveness of the law, or its folly, if it be foolish, or the fact that it was passed in a modern spirit of legislating first and investigating afterwards, is quite remote from the question of its constitu- tionality. The people must learn to hold their legislators responsible for the enact- ment of laws which, however unwise and absurd, are still within the constitutional power of the legislature.. It will be for the benefit of both the people and the legislature to recognize this responsibility and to know that they can not look to the Supreme Court for relief in every case of an objectionable but constitutional law. So long as the legis- lature believed there was enough venereal disease in this State to justify the enactment of the statute in question, we can not gainsay it, for that was a matter for the legislature to decide. Assuming the prevalence of venereal disease, its contagious nature, and State Rights Re Limitation of Human Reproduction 345 its communicability by contact, it was within the power of the legislature to enact statutes wholly or partially preventive of the spread of this disease. If the legislature libeled the people of this State by making it to appear that venereal diseases were prevalent here, when in fact they were not, the members of that body must for such error answer to the electors and not to the Supreme Court. If I concede, as I must, the power to require a marriage license, I must also concede the power to require of the licensee reasonable qualifications, and it can not be said to be unreasonable that he be free from venereal disease. "I can not imagine how this law can be said to interfere with freedom of worship or liberty of conscience. The notion that mar- riage was a sacrament, not a civil contract creating a status, once vigorously asserted, has long since passed away. A point is made that, requiring the prospective husband to submit to the examination without making the prospective wife do so, conflicts with the Fourteenth Article of the United States Constitution, which forbids the States to deny the equal protection of the law. But the men desiring to jnarry form a very definite class quite germane to the object soiight to be accomplished by the statute. And we read in the learned medical treatises that, while the primary source of venereal infection is usually the prostitute, still such diseases are generally brought into the family by the husband rather than by the wife. The legislature was justified in so deciding * * *. "* * * I find no ground for holding that part of the statute here involved unconsti- tutional * * *." This decision is upheld by Barnes, J., and Timlin, J. (concurring). The dissenting opinions are expressed by Marshall, J., and Vinje, J. The foregoing decision in reference to the most recently adopted specific legal limita- tions to marriage is a type of those involving other fields of legal limitation which amply sustain the power of the state to limit mar- riage in the interests of the hereditary physical, mental and moral endowment of offspring, which may result from particular contemplated marriage unions. In this par- ticular Wisconsin case the extent and flexi- bihty of the state's legislative authority is exemplified by its power to apply the remedy in hand to one sex only, if such limitation is found desirable. c. Judicial Annulment of Marriage in the Interests of Public Health and Racial Wel- fare. In the matter of annulling marriages on account of the development or discovery of mental defect or transmissible disease in one of the marriage mates, in states having no specific statutes covering the matter the courts have varied widely in sustaining or annulling the legality of the marriage con- tract, as the following recent court decisions quoted from the United States Public Health Reports' indicate: cl. WISCONSIN SUPREME COURT, Venereal Disease. Ground for Annul- ment of Marriage. C vs. C . (Oct. 6, 1914.) "One party to a marriage was infected with gonorrhea at the time of the marriage. Upon discovering this fact the other party ceased marital relations. The court held that the facts were sufficient to warrant the annulment of the marriage. "The plaintiff (the wife) sued for divorce. The husband filed a counterclaim, asking that the marriage be annulled. "The court found from the evidence that at the time of the marriage plaintiff knew that she was infected with gonorrhea and that she infected her husband. After his infection the defendant severed marital rela- tions with the plaintiff. The Circuit Court entered judgment annulling the marriage.'' (148 Northwestern Reporter, 865.) c3. NEW YORK SUPREME COURT, SPECIAL TERM, NEW YORK COUNTY. Marriage — Tuberculosis — Annulment of Marriage Because of Fraud in Concealing Disease. Sobol vs. Sobol (Dec. 7, 1914.) "It is proper for a court, in view of the widespread prevalence of tuberculosis and the disastrous consequences to those who suffer from it, to take judicial notice of its infectious character and the fact the close association with a person afflicted with that disease, unless attended with great care, occasions danger of infection to those com- ing into close contact with such person. 1 Cases 1 and 2 quoted from Reprint No. 342 from the Public Health Reports, pp. 69 and 70. Cases 3 and 4 quoted from Reprint No. 410 from the Public Health Reports, pp. 69 and 71. 346 State Rights Rfi Limitation of Human Reproduction "The fraudulent concealment of material facts concerning the condition of his health by one party to a marriage contract justifies the legal annulment of the marriage at the instance of the other party. "The defendant knew before marriage that he was suffering from tuberculosis. He con- cealed this fact from the plaintiff, and repre- sented that certain symptoms of the disease were the result of a cold. Upon discovery of the facts the plaintiff ceased, to cohabit with him. No offspring resulted from the marriage. The court annulled the marriage on the ground of fraudulent concealment and misrepresentation." (150 New York Sup- plement, 248.) c3. NEW JERSEY COURT OF CHANCERY. Marriage — Concealment by One Party of Insanity in Family Not Ground for Annulment. Allen vs. Allen, 95 Atl. Rep., 363. (Sept. 30, 1915.) "In order to enable a court of equity to annul a marriage on the ground of fraud in concealing disease, the proof of the dis- eased condition of the defendant must be clear and convincing. "A marriage can not be annulled by a court of equity for fraudulent concealment by one party of his or her physical condition unless the disease is of such a nature as to render contact seriously dangerous to the other party. "Plaintiff (the wife) asked the court to annul the marriage on the ground that the husband concealed from her the fact that he was afflicted with a taint of hereditary insanity. Some years after the marriage the husband had become insane. The court re- fused to annul the marriage because (1) It was not clearly proved that the insanity was hereditary; and (3) the concealment of in- sanity in the family was not such a fraud as would justify the court in annulling the mar- riage." c4. NEW JERSEY COURT OF CHANCERY. Venereal Disease — Annulment of Marriage — Evidence Not Sufficient to Prove That Defendant Knew That He Was Suf- fering from Syphilis and Fraud- ulently Concealed That Fact. Kaufman vs. Kaufman. (April 1, 1916.) "The fact that one party to a marriage was afflicted with syphilis at the time of the marriage is not sufficient to enable a court to annul the marriage. "Complainant sought to have her marriage annulled on the ground that the defendant (her husband) had fraudulently concealed from her the fact that at the time of the marriage he was suffering from syphilis. The court decided that the evidence was not suffi- cient to prove that the defendant knew when the marriage occurred that he had syphilis and that he had fraudulently concealed that fact." (97 Atlantic Reporter, 490.) 2. Birth Control. All laws of a state which concern sex- morality have a bearing, either directly or indirectly, upon human reproduction. There- fore a consideration of the existing anti-birth control laws, so-called, is pertinent. It is conceivable that the term, birth- control, might have developed a connotation equivalent to eugenics, but as a matter of fact as the term is used at present, birth- control implies the limitation of the number of offspring of a given mother. Primarily, in accordance with the family's economic status, that is, its ability to provide properly for the rearing and training of all of its children. The term implies, also, that this end could be easily accomplished, if the present laws limiting and denying the giving and publication of information concerning the use of mechanical appliances to prevent conception were repealed. The contention is made that, whereas the more favored eco- nomic classes, through wider access to medical literature and advice, have an easier means of securing the desired information and of procuring the mechanical contriv- ances; but, on the other hand, the poorer classes, not having such ready access to physicians, medical supplies, and standard medical literature, are, because of the laws forbidding the dissemination of birth control instruction and the sale of contraceptives, denied equal opportunity. At present the laws regulating the publication and dissemi- nation of knowledge concerning contracep- tion and controlling the distributipn and sale of mechanical contrivances adapted to pre- venting conception are inextricably woven in with the laws against lewdness, obscenity, criminal abortion, prostitution and fornica- tion, which laws have for their prime motives the prevention of sex-immorality. State Rights Re Limitation op Human Reproduction 347 According to a recent school of advocates of birth control a clean cut separation should be made between birth control and sex- immorality, and in consequence the dissemi- nation of instruction in birth control methods, and the manufacture, distribution and sale of mechanical contraceptives be made free from criminal liability. Their opponents oppose this proposal, contending that the present laws are based upon the proper foundation, and that birth control teaching and appliances should continue to be classed legally with criminal abortion and obscenity. a. Review of Criminal Statutes on Birth Control^. Judge J. C. Ruppenthal: "In the United States, laws relating to birth control seem to have been developed since about 1870. Congress, the legislatures of nine- teen states and Porto Rico, and the commis- sion of the Canal Zone, have enacted statutes that clearly and definitely refer " to the pre- vention of conception in women as a practice to be declared a crime by such laws. In Canada, at least Ontario has such a law. Twenty-two more states of the Union, and also Hawaii have statutes which the courts, with liberality of construction or strictness, hold to apply or not apply criminally to the matter of birth control, at least through pre- vention of conception, or "contraception." The District of Columbia, and the states of Rhode Island and Florida have kindred enactments, relating in the states to causing miscarriage of a pregnant woman, and in the District to abortion. Four states, Georgia, New Hamp- shire, New Mexico, and North Carolina, and also Alaska, appear to have no legislation that either certainly or possibly may be held to apply to birth control. All the forty-nine sets of enactments referred to are found in the statute backs under "obscenity" and "offenses against morals," as headings. In most cases the_ phraseology relating to contraception is found embedded among many clauses relating to pornographic or non-mailable matter, to in- decent and Immoral, printing, writing, paint- ing and the like. Colorado, Indiana and "Wyo- ming mention "self-pollution," and Massachu- setts names "self-abuse" along with abortion and prevention of conception. "Clear and definite laws on contraception are found on the statute books of the states of Arizona, California, Colorado, Connecticut, Idaho, Indiana, Iowa, Kansas, Massachusetts, Minnesota, Montana, New Jersey, New York, North Dakota, Ohio, Oklahoma, Washington and Wyoming' — eighteen — as well as Porto Rico, Ontario, the Canal Zone and the United States. The federal laws are quite full in ex- pression, and perhaps served as model for most of the states. "If a court regards written matter relating to contraception or means to accomplish this, as "obscene, vulgar and indecent," then laws apply also in the states of Alabama, Arkan- sas, Delaware, Hawaii, Illinois, Kentucky, Louisiana, Maine, Maryland, Michigan, Missis- sippi, Missouri, Nebraska, Pennsylvania, Ne- vada, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia and Wisconsin — twenty-five in number. In some states a limitation as "if they manifest a tendency to corrupt the morals of youth," or morals generally. " 'Articles and instruments of immoral use or purpose" are denounced, but no specific purpose or object of such is set out, in the laws of Connecticut, Illinois, Kentucky, Louisi- ana. Michigan, Mississippi, Missouri, Nebraska, Oregon, Pennsylvania, Rhode Island and Utah. In Maryland 'obscene and indecent' books are mentioned, and 'obscene' matters in South Carolina, with no more specific designation. In Ontario the law very widely includes the assertion or warranty of the offender, as the language is 'any article intended or represent- ed as a means of preventing conception or causing abortion.' To make prosecutions more easy, Idaho provides that the complaint need not set out any portion of the language al- leged to have been unlawfully used. To aid in capture of contraband articles, instruments and literature or other things, search warrants or seizure, or both, are authorized in Arizona, California, Colorado, Idaho and Nevada. "Where advice or information as to abor- tion is forbidden, though some states, as Min- nesota and New York, carefully discriminate against 'unlawful abortion,' others, as Kansas and Iowa, say, 'procuring abortion,' with no intimation that such could, in any case, be lawful. Kansas, however, in another statute — as to manslaughter of a woman pregnant or her child — excepts 'when i,t shall be neces- sary to save the life of the mother,' and thus inferentially distinguishes acts of two classes. "While some statutes are word for word alike in several states, most of them vary In scope. Among the forbidden acts,. In connec- tion with articles, instruments, books, papers, etc., are to 'exhibit' (United States law and Colorado); 'bring into the state' (Alabama); 'import' (Hawaii); 'buy,' 'sell,' 'lend,' 'keep for sale,' 'have in possession,' (Iowa) ; 'have in possession with intent to sell,' 'have posses- sion with or without intent to sell' (Indiana); 'advertise,' 'distribute' (New York); 'manufac- ture (Missouri and New York); 'has posses- sion with intent to utter or express to view or to sell,' 'for gratuitous distribution' (in Ohio, drug or nostrum; in Kansas, literature) 'conveying notice, hint or reference to,' unde: 'real or fictitious name', (Rhode Island); 'givt information orally' (New York, Minnesota, In- diana) ; 'write, compose, or publish' (notice oi advertisement, in Arizona) ; 'manifesting a tendency to the corruption of the morals of youth or of morals generally,' (Hawaii); 'cau- tions females against its use when in preg- 1 Criminal Statutes on Birth Control: J. C. Ruppenthal, Judge of the Twenty-third Judi- cial District of Kapsas; Judge Advocate U. S. Army. Journal of Crim. Law and Criminol- ogy, May, 1919, pp. 48-50. See also: Abstract of the Criminal Laws of the U. S., the Several States thereof, and Canada, Relating to Birth Control. J. C. Ruppenthal, Jour. Crim. Law and Criminology, May, 1919, pp. 51-61. 348 State Rights Re Limitation of Human Reproduction nancy' (Ohio) ; 'drug or nostrum purporting to be exclusively for the use of females' (Ohio). To meet the ingenuity of evasive devices, New Jersey includes all persons 'who shall in any manner, by recommendation against its use or otherwise give or cause to be given, or aid in giving any information, how or where any of the (literature, instruments, medicines, etc.) may be had or seen or bought or sold.' What- ever is prohibited directly to anyone is usually expanded in terms to include aiding in any way toward the forbidden end. "A few exceptions from the sweeping provi- sions are incorporated. In Ontario the of- fense must be 'knowingly, without lawful ex- cuse or justification;' in New Jersey, 'without ,iust cause.' In some states the law provides that it 'shall not be construed to aftect teach- ing in medical colleges' (Colorado, Indiana, Ohio); 'nor standard medical books' (Colorado, Indiana, Kansas, Ohio) ; 'nor the practice of regular practitioners of medicine and drug- gists (Colorado) in their legitimate business' (Ohio); 'nor works of scientific character, or on anatomy, surgery or obstetrics" (Ken- tucky) ; 'article or instrument used or applied by physicians is not . .. . indecent.' In Con- necticut possession of the things forbidden is unlawful 'unless with intent to aid in their suppression or in enforcing the provisions' of the law. "Almost everything denounced under any of these laws Is non-mailable under the laws of the United States, Colorado, Illinois, Indi- ana, Iowa, Missouri, Nebraska, Ohio and New York. Delivery of such to express or rail- road companies is forbidden by the United States, Illinois, Indiana, and New York. Be- sides forbidding the deposit of such matters in the mails, Colorado adds 'or with any per- son.' "Prom the foregoing It may be seen that no general principle runs through the statutes of all the states, etc. As with laws everywhere that impinge upon sex matters In any way, there is more of tabu and superstition in the choice and chance, the selection and caprice, the inclusions and exclusions of these several enactments than any clear, broad, well-de- fined principle or purpose underlying them. Without such principle, well-defined and gen- erally accepted, the various laws must remain largely haphazard and capricious." b. Conclusions. The dissemination of birth control, so called, instruction, and manufacture, distri- bution and sale of mechanical contraceptives is in most states prohibited by laws socking to prevent sex-immorality. The present anti-birth control criminal laws, which exist in nearly all of the states, are entirely prohibitive or restrictive, and consequently may have worked out in favor of a higher birth rate. All good citizens must approve laws which promote public and personal morality and which forbid and destroy obscenity and prostitution, but the present anti-birth control laws, so-called, do not appear to be well designed to accomplish their desired ends. As a remedy for over-population, which is probably one of the several great causes of modern war, birth control might be efiective by decreasing the numbers of citizens in par- ticular nations, but unless such reduction took place where the population pressure was greatest, it would not operate in the desired manner. Moreover, its operation in prevent- ing war would be eugenically equivalent to preventing war by reducing the population of a nation by famine, or pestilence, which strike down individuals and remove them from parenthood, on a basis, for the most part, indifferent to hereditary worth. Over- population presents a field for eugenical ac- tivity, which calls for building the next generation in numbers equal to the optimum quantitative demand of the nation, and in quality descended from the best blood. Eugenicists criticise birth control, so- called, because of its shortsightedness in favoring birth restriction principally on an economic basis. Birth control becomes then, in a sense, an anti-baby strike. Whereas eugenics favors the restriction of reproduc- tion by the hereditarily less able mental, moral and physical parents, but demands a higher birth rate by those parents possessing the soundest hereditary traits. Thus eugen- ics makes good blood the primary, and present economic status a secondary consid- eration, because there is no constant and high correlation between economic status and hereditary worth. From the analysis of the legal situation it is apparent that a state, in the exercise of its undoubted police authority, may enact stat- utes in reference to birth control information and appliances, and sex-immorality, which statutes influence very greatly the quality and quantity of human reproduction. In the enactment of such laws, however, the state should take care not to substitute the crite- rion of economic condition in place of that of inborn physical, mental and moral quality, in encouraging and limiting birth rate. It is doubtful whether the court interpre- tation of any existing laws would prevent reputable physicians from advising their pa- tients in reference to means of preventing conception, or a standard medical work from publishing facts in reference to the matter. But when birth control ,is talked and prac- ticed in the spirit of obscenity and lewdness, State Rights Rd Limitation of Human Reproduction 349 the law would be expected to restrain its perverters. The legislative and legal world is in need of a new set of guiding principles which shall determine the policy of the state in suppress- ing obscenity and in regulating birth control information and practice in their relation to the immediate public health and morality and to racial welfare, because the present prin- ciples and activities are not duly co-ordinated in the interests of the general welfare. 3. Control of Immigtration.' The control of immigration is a matter of the greatest eugenical import, because whenever two races have lived for long periods of time m the same geographical range of personal acquaintances and contact, racial fusion to some extent has resulted. Therefore the laws controlling immigration have indirectly, and often remotely in time, but nevertheless very definitely a strong governing influence upon the quality of human reproduction. In the United States the authority to control immigration is vested by the Consti- tution in the Federal government. For the most part present social and economic mo- tives have guided our immigration statutes, but it is undeniably within the power of the Federal government to deny admission to immigrants on the basis of cacogenesis, that is the possession of degenerate or undesirable personal hereditary traits. At present be- sides limiting immigration annually to 3 per cent of the foreign-born of the United , States as shown by the Census of 1910, distributed among the several nations ac- cording to their respective quotas, ad- mission is denied certain members of the dependent and defective classes, but the denial of admission is limited to individuals personally defective or degenerates. The matter of pedigree, or blood, which deter- mines the quality of their ofifspring, has not yet been made a matter of serious legislative concern. It is clear that the eugenical principle applied to immigration control would, in substance, read as follows: Admission as immigrants shall be denied- sexually fertile foreigners who, regardless of their personal social adequacy, cannot estab- lish to the satisfaction of definitely estab- lished tests and standards, that In each case the would-be immigrant is equal in the natural worth of his or her hereditary mental, physi- cal and temperamental traits, to the stand- ard which the American people are willing to constitute a considerable portion of its fu- ture population. But before such a rule can be enforced, the science of human heredity must make more progress, and above all, must lay down and demonstrate the validity of specific rules for determining breeding quality. Obviously the task of determination in a specific case involves family history study, and is conse- quently expensive, for such study must be carried out in the home territory of the subject. At first statutes providing for such determinations would, of necessity, have to be experimental, and would apply only to the most patent and easily demonstrated cases; later, as the science of pedigree-study pro- gressed, and the administrative arm of the law became more effective, the statute could be drawn more rigidly. At present both the United States and many of the several states have laws provid- ing for the deportation of certain individuals who are, or who within a definite period of time following admission become, defective in personality, and who consequently are thrown upon public charity for their mainte- nance. Many people of this sort, despite the immigration and quarantine restrictions, find their way past the Federal immigration offi- cials, and settle in different states. The nation deports such persons to the country of origin, while the state may deport only to the state of origin. The present restriction of the migration of degenerates, and . the possible future restriction of the immigration of cacogenical persons, tend to throw upon the communities which permit the reproduc- tion of such anti-social persons the responsi- bility for their care, and thus ultimately is logically to be expected to cause the particu- lar community to seek a more efficient solu- 1 See Annual Report of the Commissioner- General of Immigration for year ending June 30, 1919, which gives the iminigration data for the first hundred years (1819-1919), during which the United States has kept immigration statistics. Govt. Print. Off. Also Annual Report of the Commissioner General of Immigration for year ending June 30, 1921: "The Percentum Limit Act" of May 19, 1921, entitled "An Act to limit the immi- gration of aliens into the United States" as extended by Public Resolution No. 55, 67th Congress, approved May 11, 1922. Senate Reports of the Immigration Commis- sion, presented by Mr. Dillingham, Vols. 1 to 41 (1911). Govt. Print. Off. The Immigration Problem: Jenks & Lauck, Funk & Wagnalls Co., 1917. Immigration Laws (Act of Feb. 5, 1917) and Rules of May 1, 1917. (Third Edition, March, 1919.) Govt. Print. Off. Treaty, Laws and Rules Governing Admis- sion of Chinese — Rules of May 1, 1917. (Second li'ditlon, N.-)V., 1917.) Govt. Print. Off. 350 State Rights Rt Limitation of Human Reproduction tion of its handicap by forbidding certain degenerates to reproduce. Thus the immigration policy of a nation is inextricably tied up with its eugenical problems, but fortunately no one denies the right of a sovereign nation to control by law and treaty its own emigration and immigra- tion policy. 4. Institutional Segregation of Social Inadequates. The state may seek out and segregate' in custodial institutions those individuals of its population who are temporarily or perma- nently socially inadequate. But the state finds that the control of the reproduction of certain types of degenerates cannot be effected solely through the control of the marriage relation, because many of the degenerates of the state are not amenable to law — that is, they are anti-social, the mar- riage laws do not govern their reproduction, hence illegitimacy runs high among them. In such cases the only practicable means of preventing their reproduction is through segregating them in custodial institutions during the reproductive period, or if they remain at large, subjecting them to eugenical sterilization so that they shall not be physiologically able to reproduce. Both segregation and eugenical sterilization in- volve the taking away of the personal liberty without the element of punishment, but liberty is nevertheless taken away, just as completely as is done in the case of a crim- inal who breaks the criminal law and who, by due process of law, is sent to prison. Both in commitment and sterilization the principal motive is the protection of society, the secondary motive the protection of the particular individual. This latter motive is doubtless stronger in commitment than in sterilization. There must, of course, in com- pulsory vaccination, in quarantine, and in commitment to custodial institutions, as well as in imprisonment for crime, be due process of law. But due process of law in the case of crime always implies court procedure, which in turn implies the right to be heard and the assurance of judgment in accordance with the law and the evidence, whereas in case crime is not involved, but a medical or psychiatric or eugenical situation is found, the state may provide due process of law in another manner. It may delegate the en- forcement of the non-punitive types of taking away personal liberty in the interests qf'the public welfare to ministerial or administra- tive bodies or officers, who are authorized to use their own discretion in each particular case. Such laws, of course, cannot prevent recourse to the courts in case of abuse of power. In the case of these social and thera- peutic remedies involving the limitation of personal liberty, the public will co-operate in due proportion to the exigencies of the case and to its enlightenment and patriotism. Thus, in many states, for most of these proc- esses — vaccination, quarantine, commitment to custodial institutions, and eugenical steril- ization — the co-operation of the families con- cerned has been so great that the enforce- ment of the law has been greatly supported by the voluntary element on the part of the persons directly affected. If in each case the individual resisted as in the case of punish- ment for crime, these social, therapeutic and eugenical remedies would' not have such a bright outlook, nor would their present effec- tiveness be very great. a. Quotation from Dr. Henry M. Hurd. Dr. Hurd says,'' in reference to due process of law in commitment of the insane (Vol. 1, pp. 335-6): "Many persons have contended that unless the insane are committed by jury trial, they are restrained of their liberty 'without due process of law,' but it has been clearly pointed out by Ordronauz and others that 'due process of law' means the law of the land, so that any law which is properly placed upon the statutes must be considered 'due process of law.' "In examining the laws of commitment and the procedures under them, I find that in five states of the Union, viz., Colorado, Kentucky, Mississippi, Texas and Wyoming, it is imperative that the commitment of pa- tients shall be after a verdict by a jury. "In four others, viz., Alabama, Massachu- .sclls, Missouri and Wisconsin, a jury is not ' Soo Summnrles of State Laws Relating to the Insane; Keren. Hamilton & Haber, 1917. Summaries of State Laws Relating to the Foelile-mlnded and Bplleptlc: Hamilton & Habor, 1917. Both works published by the Na- tional Committee for Mental Hygiene, N. T. Summary of State Laws Relating to De- pendent Classes: 1913. U. S. Bureau of Cen- .sus. Statistical Directory of State Institutions for Defective, Dependent and Delinquent Classes: H. H. Laughlin, 1919. U. S. Bureau of Census. Annual Census of the Insane, Feeble-minded, Epileptics and Inebriates In Institutions In the U S.: January 1, 1918. H. M. Pollook, Edith M'. Purbush. The National Committee for Mental Hygiene, N. Y. " The Institutional Care of the Insane in the United States and Canada. Four Volumes. Johns Hopkins Press, 1916. State Rights Re Limitation of Human Reproduction 351 imperative, but may be impaneled at the dis- cretion of the court. In five states, viz., Georgia, Kansas, Maryland, Michigan and Washington, a jury must be impaneled when demanded by the patient or his counsel. "In one state, Illinois, a jury or a commis- sion must determine the question of insanity and the presence of the insane person in court is at the discretion of the judge. "In several states, when an appeal is taken from the decision of the judge of probate that a person is insane, the appeal must be tried before a jury. "In ten states, viz., Iowa, Kansas, Louisi- ana, Minnesota, Nebraska, North Dakota, Oklahoma, Pennsylvania, South Dakota and Virginia, the question of insanity is deter- mined by a commission — usually a county commission. "In twenty-four states, viz., Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Idaho, Indi- ana, Maine, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Caro- lina, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont and West Virginia, no mention of a jury is made in the law.'' In the same work (p. 344) in reference to the voluntary admission of patients we read: "No section of any law seems more vague and lacking in uniformity than that govern- ing the admission of voluntary patients to institutions for the insane, as now found in the statutes of the various states. "Out of the 48 states and the District of Columbia, the following 17 states and the District of Columbia already have provisions of law permitting' the admission of voluntary patients, viz., California, Colorado, Connecti- cut, District of Columbia, Illinois, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Vermont-. Wis- consin and Virginia." b. Conclusion. The state undoubtedly possesses the legal right to enact statutes which provide for the punitive imprisonment of persons convicted of crime, and also the involuntary non-puni- tive commitment and custody of persons who because of their social inadequacy are unable properly to care for themselves, or are a public menace. The effective institutional custody of a person prevents, of course, parenthood during the period of commit- ment, and to such an extent the state thus exercises, indirectly but surely, a limited legal control over human reproduction. 5. Eugenical Sterilization. Regardless of the virtues and defects of the eugenical sterilization statutes already enacted, and in the absence of specific consti- tutional denial, legal opinion and judicial de- cision support the power of a state to resort to compulsory eugenical sterilization, if it so chooses and expresses its choice in well- drawn statutes. Neither analysis nor abstract of the evidence supporting this statement will be given here, because this special phase of the subject was extensively treated in the accompanying chapters.' a. Cases of Eugenical Sterilisation in States Having Neither Authorizing nor Restraining Statutes. There have been a number of instances in which sexual sterilization has been put into effect for purely eugenical reasons. As a rule, this has been accomplished on the re- sponsibility of a physician, or by the sugges- tion or at least with the co-operation of the family of the individual sterilized, or in some cases by the action of a court of law. It appears that in 1893 Dr. F. E. Daniel,° of Texas, was one of the earliest of the recent eugenicists to propose sexual sterilization for the purpose of race improvement. Beginning in 1898, Dr. F. Hoyt Pilcher, of the Institu- tion for Feeble-minded Children at Winfield, Kansas, performed a number of operations (58 boys castrated) for avowed eugenical purposes. This aroused considerable oppo- sition, but also brought support to his pro- gram. Indeed his trustees, by resolution, formally upheld his work in seeking in this manner to purge the race of certain defective strains. Dr. Martin W. Barr, Superintendent of the Pennsylvania Training School for Feeble- minded, at Elwyn, Pa., and Dr. Everett Flood, Superintendent of the Monson State Hospital for Epileptics at Palmer, Mass., also were early advocates and testers of eugenical 1 Chapter VI. Analytical Outline of Litiga- tion Growing Out of the Several Sterilization Statutes. Chapter VII. Detailed Review of Litigation Growing Out of the Several Sterilization Stat- utes. Chapter IX. Legal Opinion. 2 F. B. Daniel, Pros. State Med. Association of Tex, "Should Insane Criminals or Sexual Perverts Be Allowed to Procreate?" Medico- legal Journal, Dec, 1893; id., "The Cause and Prevention of Rape." Texas Medical Journal, May, 1904. 352 Statb Rights Rh; Limitation of Human Reproduction sterilization. In 1899 Dr. H. C. Sharp, sur- geon of the Reformatory at Jeflfersonville, Indiana, began the operation of vasectomy for purely eugenical purposes. He continued these operations for at least eight years before they were legalized (1907) in Indiana. In the Cantonal Asylum at Wil,' Switzerland, with the consent of the civil authorities, two men and two women were sterilized for purely eugenical purposes. There are doubt- less many other instances not here recorded, in which the eugenical principle has either operated independently or has been joined with the therapeutic purpose in determining upon operations which have resulted in sexual sterilization. With the rise of modern studies in human heredity, the possibility of using this remedy for preventing the pro- creation of certain degenerates has made substantial progress. The fact that cases of eugenical steriliza- tion have been performed without the sanc- tion of the law, and that no legal recourse was had, nor even desired, nor most prob- ably was possible, points the way for ener- getic administrative and judicial officers to advance eugenical measures. But a measure so wrought with possibilities for good or for evil and so liable to be perverted in arbitrary, unskillful or designing hands, should be di- rected and limited by law. It is, however, a wise law that encourages the co-operation of the person designated for eugenical steril- ization, and of his or her family in carrying out a legally arrived at decision to sterilize. A review of two actual cases of eugenical sterilization in states having no statute on the subject follows: al. The Case of M H of Massachusetts. This case was reported by Dr. Henry P. Frost, Superintendent of the Boston State Hospital for the Insane. In filing this report Doctor Frost writes: "* * * I am sending you an abstract of one of my cases, a man on whom wc recently performed vasectomy in the interest of eugenics — a very feeble step in what you and I agree is the right direction * * *." BRIEF OF VASECTOMY CASE. M H was admitted to the Psychopathic Ward for observation Novem- ber 13, 1911 (Psyco. No. 546). He was dis- charged from there and committed to the Boston State Hospital, November 14, 1911. (Case No. 10302.) Family History: Shows no history of in- sanity or alcoholism. Personal History: Age at admission 42 years. Went to school in Ireland from 6 to 14 years of age, said that all the schoolmas- ters in Ireland could not put anything into his head. Was in a hospital for insane in Ireland about 17 years ago, for about 18 months. Came to this country at the age of 34, and married two years later. Is of good habits; a steady worker. Present Attack: Wife says he has always been as well as at present time, and she considers him in his normal condition. On Sunday while wife was in labor she noticed that he was not right, he sang religious songs, prayed, etc. Exciting cause — preg- nancy of wife, who was alone in the house. The patient was alone with wife when babies were born. Summary of Physical Examination: Tall, middle aged, white, male, emaciated, poorly developed, speech defect, pupils irregular, do not react to light, eyeball prominent apd protruding. Summary of Mental Condition on Admis- sion: Was excited, disturbed, restless, re- sistive and noisy; religious and exhilarated; appeared confused. Showed loquaciousness and distractability. Orientation and memory unimpaired. Insight, negative. Hears the voice of God and has religious delusions based upon this hallucination which he has had for thirty years. Venereal history, nega- tive. Probably no excessive use of alcohol. » Sixteenth Annual Report. 1907 (See also "Sterilization of Unfit" by Havelock Ellis, Eugenics Review, 1909-10. Vol. I, page 203.) In Switzerland, Swiss Cantonal Asylum at Wil (Berne), there were 4 Inmates — 2 men, 2 women — mentally abnormal though not In- sane, and medical authorities wished to dis- charge them. (1) Woman, 25 years, epileptic, liable to attacks of Insanity. She had had two children who were epileptic Idiots and a charge on community. She was strong and anxious to work. (2) Woman, 36 years, weak-minded with occasional attacks excitement. She had had two Illegitimate children, who were charge on community. She was skillful worker. (3) Man, 31 years, physioally well built, psychically a degenerate and frequently com- ing into conflict with the law. (4) Man, 32 years, mentally superior but sex pervert, held for offenses against minors. Sex inclination strong, all four. Municipal authorities opposed to their lit>er- atlon; four children already had to be provided for; if liberation took place the number could not fail to be increased. Deadlock! Sterilization by castration the solution eagerly accepted by all. Operated and set at large. (1) Has been at work ever since and ex- presses herself as content with her condition. (2) Able to earn her own living. (3) Still commits thefts at times but has not been guilty of any sex offenses. (4) 3ame condition as No. 3. State Rights Rk Limitation of Human Reproduction 353 as u OS (» C3 O a J3 T3 0) Oh (0 4. a CD ^.1 ^ 1^ >5 'Si o I ■r I -0:m ■© N B - § ^ S R. !^ -© ■D* -n ^ ^ -o '^ -e >5 5^ '4 >3 to I si •*^ M 354 State Rights Re Limitation of Human Reproduction While here he gradually became quiet and tractable and talked relevantly. Was evasive about delusions but probably less prominent than before. Ate and slept well. Conduct and behavior good. January 22, i<)i2. Was presented at the staff meeting for diagnosis and discharge. It was found that he retains the delusions although he is very quiet and has nothing to say about them. The consensus of opinion was that he belonged in the Allied to Manic Depressive classification, and that he prob- ably has never recovered since his early at- tack 17 years ago; that he is* rather below the average naturally. As to his condition if allowed to go home, he would be dis- charged capable of self-support, as he has been self-supporting nearly all his life. The obstacle to his going is the question of an insane man and a defective woman propagat- ing children and raising a family. No deci- sion was arrived at as to his discharge, but the matter was referred to the social service worker to investigate home conditions and report. Social Service Report in Brief: Investi- gation showed: — Wife of the patient to be of decidedly in- ferior make-up, but fond of her children and a good mother, keeping them and the house in a clean, orderly condition. Said that they had all the children they could provide for, that she did not want any more, but realized that there would probably be more. Family History: Pedigree Chart of H. Family of Mass. (See Chart on preceding page.) Children: First, a girl, 11 years of age. Defective, manner silly and nervous. Has been to school for four years and is now in the first grade. Second, a girl, 8 years of age. Case of re- tarded development recommended for Wa- verly. Appearance of feebleminded child. Now in kindergarten. At times has boon untidy in habits. Third, a boy, 4 years of age. Of normal mental and physical activity. Fourth, a girl, 2 years of age. Does not walk or talk yet. Of anaemic appearance. Fifth and Sixth, twins born just before patient's admission. One died at birth. The other, sickly, died recently. Three others have died in infancy. Sources of Family Income: Patient has been receiving $10 per week for low grade work in a shipping department. Was said to be a steady but not a very in- telligent worker. Employers said that he could probably obtain his old position on discharge from the hospital. Mother's en- tire time taken up with care of children. During patient's residence at the hospital, the family was receiving aid from the church, the city and the Associated Charities. Rela- tives would not help. It was questionable as to how long outside help would be continued. Summary of Report: Mother — inferior, but a good provider and home maker. Father — insane, but harmless and capable of providing for the family. His wife be- came pregnant before marriage and they were married in the police station. Children — two or three defective, one nor- mal. Subsequently to Report: It was suggest- ed that the patient be sterilized before allow- ing him to go home, and the matter was proposed to him, also the Physician, Dr. Wornell (city doctor in district of patient's ■home). The patient did not take kindly to the suggestion, but the doctor thought it would be an excellent idea and agreed to consult with Mrs. H. and advise her, if pos- sible, to persuade Mr. H. that it would be the best solution in the case. About April 9 the patient was visited by wife, and together they consented to vasec- tomy. Vasectomy was performed April 18. The patient went home on trial visit April 28, 1912. a2. The Case of X, of Illinois. Another example of eugenical sterilization brought about through the intervention of a State official, this time a judge of a criminal court in a state in which there is no law- cither directing, authorizing, forbidding or controlling eugenical sterilization, is report- ed in The Survey (Oct. 28, 1916, p. 78) as follows: "SENTENCED TO PRISON OR STERILIZATION. "One of the most respected and experi- enced judges in the criminal court at Chi- cago'set a precedent, which is said to be the first of its kind, in giving a prisoner the choice between going to prison for a criirlc of which he was convicted by a jury or of submitting to sterilization. In offering this alternative from the bench. Judge Marcus State Rights Re Limitation of Human Reproduction 355 A. Kavanaugh said to the prisoner, sixty- five years of age and a married man with children: " 'If I sent you to the penitentiary it means death to you in your present health. At the same time I dare not turn you loose upon the public, for fear this mania with which you seem to be affected may cause you to attempt a similar crime, and then I would be at fault. If you will submit to an operation, with the choice of the best sur- geons by next Saturday, I will set aside your sentence. I cannot compel you to submit and you v/ill have a week to think the matter over. If you decide to do this, it will mean that you do not have to begin your sentence of from one to twenty years in the peni- tentiary.' "The prisoner subsequently decided to be sterilized. "In commenting on the case the judge said he presumed he would be criticized for his proposition to the prisoner, but he wished neither to commit him to what really would be a death sentence, nor to expose the pub- lic to a repetition of his heinous offenses against little girls. " 'One of my reasons for rendering the decision,' he added, 'was to draw public attention to a situation which has been dis- regarded too long. I believe all morons, the criminal insane and habitual criminals, both men and women, should be so treated. To my mind it is a crime against society that this class should be permitted to propagate their kind. As for those who commit out- rages against women and female children, I advocate even more drastic measures, which would make repetition of the acts impossible. It is my hope that public interest may be aroused.' " Under date of June 8, 1918, in response to an inquiry on the part of the Eugenics Record Office, Judge Kavanaugh, responded: "The case happened over a year ago. The prisoner consented to the operation. It may be that the result was purely psychological, but at any rate it has effected an entire change for the better in his disposition, which after all I think is preferable to sen- tencing him to the penitentiary. If he had gone to prison he probably would have been released by this time and returned to ab- solute freedom with his evil disposition intensified. While this alternative ought not be offered in every case, still I think that a major operation should accompany every imprisonment of men who commit outrages upon women or children." b. The Legal Situation in England. -No one doubts the legality of the power of the British Parliament to enact a statute regulating the use of compulsory eugenical sterilization, and for forbidding the illegal or immoral use of the operation. In the absence of such statutes, the legality of eu- genical sterlization would probably depend upon the powers and customs of the Lunacy Commissioners, as supported by their re- spective County Councils, the volunteer ele- ment in securing the cooperation of those to be operated upon, and existing laws gov erning ordinary surgical operations. Dr. R. R. Rentoul \ of Liverpool, who has made a survey of the eugenical steriliza- tion problem in Great Britain, says: "bl. Would it he Lawful to Sterilize? This question can best be answered by referring to precedents, etc. As our references refer chiefly to "castration," they may be taken to illustrate the law and custom as it would now bear upon a much less serious operatior — namely, dividing and ligaturing either the vasa deferentia, spermatic cords, or fallopiar tubes. "I have elsewhere referred to the making of eunuchs in Old and New Testament times, and to the action of Mohammedan countries; to the legality of our present custom of castrating thousands of animals in the United Kingdom, and to ordinary surgical operations upon the ovaries and testes. "With reference to the bearing of the Eng- lish law upon the subject of surgical opera- tions generallj', the law provides that nc surgeon is empowered by law to perforrr any surgical operation upon any person Every operation is legally an assault, and consequently the consent of the patient, or the relatives, or the guardian is secured be- fore operating. The law does not even em- power any surgeon t6 kill the child in the womb with the view of saving the life of the pregnant woman. Sir J. F. Stephen, in his Digest of the Criminal Law, Arts. 204 205 and 206, says that every person has the right to consent to a surgical operation upon himself, or upon his child; that if the person is incapable of giving consent to a surgical operation, it is not a crime to operate with- 1 Race Culture or Race Suicide: Robert Reid Rentoul, M. D. The Walter Scott Pub- lishing Co., Ltd., 1906. pp. 146-148. 356 Static Rights Re IvImitation of Human Reproduction out consent; that every person has a right to consent to the infliction of bodily harm, not amounting to a maim. He states that castration is a "maim." It follows, I think, that all operations when necessary to the saving of life, or in the improving of the person's health, is a justifiable "maim." Fur- ther, I would contend that sterilizing a person so as to save him begetting mental degen- erates is a necessary, and therefore, a law- ful operation. "b3. Who Should Operate? No person should perform the operation of sterilization for the purpose of preventing the begetting of degenerates, without the official permis- sion of the Lunacy Commissioners of Eng- land, Scotland, or Ireland; and the Com- missioners should inquire into the history of the person to be operated upon, and take any other step they consider necessary. No person should operate except those specially appointed by the Commissioners. The re- sult of each operation should be communi- cated to the Commissioners by the person who operated. A report containing full and complete details should be laid annually be- fore both Houses of Parliament. If the Lunacy Commissioners refuse to act, then each County Council, through its Asylum Committee, should sanction the operation. "b3. Penalties for Wrongfully Operating, etc. If any person sterilize any person for the purpose of the prevention of the beget- ting (or the conceiving) of offspring, with- out the consent of the Lunacy Commission- ers; or if any person operate for any im- moral or unlawful purpose; or if any person issue a permit to marry, or join in marriage, or marry any sterilized person without first notifying the fact of sterilization to the non- sterilized person, a penalty of fifteen years' penal servitude should follow conviction in a Court of Law. If a sane husband or sane wife, or the sane man and woman about to become husband and wife, wish to be ster- ilized, such persons must first obtain the consent of the Lunacy Commissioners." c. Conclusion: Not only may a state enact statutes authorizing and regulating eugeni- cal sterilization, but in the absence o^ such statutes, the courts of law and the custodial institutions, by securing the consent of the subjects, may, without legal interference, cause certain of their prisoners and charges to be eugenically sterilized. C. POSSIBLE NEW FIELDS FOR EUGENICAL LEGISLATIVE A C - TIVITY. Neither the science of eugenics, nor the practical application of eugenical principles to legislation generally, has advanced far enough to warrant the compilation of an eugenical code. But, if in the future eugeni- cal considerations modify legislation in many of its several fields of activity, it is logical to look forward to such a code, com- parable, for example, in many respects to the sanitary codes recently compiled and enacted. WhilC' not treating the non-eugenical as- pects of the subjects, an eugenical code would over-rule, and in some cases repeal, incidental eugenical provisions in statutes on many widely different subjects, and would systematize the legislation of the state, having for its purpose the conserva- tion and improvement of the natural or hereditary mental, moral and physical con- stitution of the people. The specific sub- jects for such treatment, because they have an essential eugenical bearing, are as fol- lows: Marriage and divorce; regulation of the immoral aspect of human reproduction, such as obscenity, lewdness, fornication, prostitution, criminal abortion, Und birth control (so-called); illegitimacy; diflferential taxation in favor of number and quality of children; maternal pensions and aid; insti- tutional segregation — of sexually fertile de- fectives and inadequates; human pedigree- registry; immigration; compulsory reporting o.f cases of cacogenesis; eugenical education, and doubtless many more. At present legislation on any of the above- named topics which does not take into con- sideration the relation of the specific matter to human reproduction, and consequently to the diflferential birth-rate which largely determines the future quality of the human stock of the nation, will not function in the greatest interests of the general welfare. Moreover, the nation which by wise legis- lation conserves its better stock, by direct- ing and encouraging its reproduction along eugenical lines, will stand a better chance of success in future international competi- tion. Although most of the above-named sub- jects are themes for future development and legislation, two of them might well be promoted by immediate legislation. 1. Eusenical Education. A state may enact laws providing for eugenical education State Rights Re Limitation of Human Reproduction 357 ' in its schools. Such instruction could be eflfectively given in the elementary grades in connection with the study of history, geo- graphy, nature study and physiology. In the high schools and colleges eugenics, if not made the subject of a' separate course, may be successfully treated in courses de- voted primarily to biology, physiology, psy- chology and sociology, economics and sta- tistics. Such instruction, if properly planned, would include, in a manner appropriate to the age and abilities of the students, the facts of human heredity, the relation between hereditary constitution and the success and achievements of the individual and the race, analysis of the factors of heredity and en- vironment, and practical pedigree-studies, also other factors of eugenical import, such as mate selection, differential migration, differential birth-rate, and differential sur- vival. Logically such instruction would be ex- pected in a generation to react in the de- mand for and the support of legislation directly ordering eugenical measures. A case in point is the influence of the com- pulsory teaching of the deleterious effects of alcohol on the human system. Laws pro- viding for full instruction were enacted a generation ago as "sops" to the temperance faction. They have borne fruit today as important factors in the success of consti- tutional prohibition. 2. Compulsory Reporting of Cases of Cacogenesis. Doubtless a state may legally require licensed charity, social, medical and eugenical field-workers, parole officers, cus- todial institutions and physicians to report cases of social inadequacy and of defective parenthood. Such legislation would be supplementary to more direct measures which the state may enact to handle such cases after they are reported. Recent laws of several states^ which have been supported by the courts, demonstrate the legal authority of the state to require licensed physicians to report certain dis- eases. Such authority is justified because its exercise tends toward the betterment of the general welfare, by protecting the people against ill health. By logical analogy the state could expect to exercise, without suc- cessful attack in the courts, authority re- quiring certain licensed social, medical, char- ity and eugenics workers to report cases of cacogenesis in the interests of protecting the nation against hereditary degeneracy. Such orotection is certainly an essential element in conserving the general welfare. The United States Public Health Service recently published a bulletin entitled "The Right of the Community to Require Physi- cians to Report Cases of Disease coming under their Observation, the Purposes there- of and Reasons therefor as stated by Courts of Last Resort." Although laws requiring the notification of cases of disease are of comparatively recent origin, they have been sustained by the courts because they have proven to be effective agencies in protecting the public health, and when properly drawn they do not violate any of the constitutional provisions of the so-called "bill of rights," nor other constitutional limitations upon legislation. Quoting the above-named bul- letin: "The Supreme Court of the United States in Dobbins v. Los Angeles (195 U. S., 323, at p. 335) said: " 'It may be admitted that every intend- ment is to be made in favor of the lawful- ness of the exercise of municipal power making regulations to promote the public health and safety, and that it is not the province of courts, except in clear cases, to interfere with the exercise of the power reposed by law in municipal corporations for the protection of local rights and the health and welfare of the people in the com- munity.' "The opinion of the same court in Califor- nia Reduction Co. v. Sanitary Works (199 U. S. 306, at p. 318) contains the following statement: " 'It may be taken as firmly established in the jurisprudence of this court that the States possess, because they have never sur- rendered, the power — and therefore munici- pal bodies, under legislative sanction, may exercise the power — to prescribe such regu- lations as may be reasonable, necessary, and appropriate, for the protection of the public health and comfort. * * * Equally well settled is the principle that if a regulation, enacted by competent public authority avow- edly for the protection of the public health, has a real, substantial relation to that object, the courts will not strike it down upon grounds merely of public policy or expe- diency.' " While the law makes it the duty of the licensed physician to report without com- pensation cases of certain diseases, the phy- sician himself is protected by the law from liability to damage which may grow out of such reporting, even though the report itself 358 State Rights Re Limitation of Human Reproduction may later be proven to be based upon false diag-nosis. (Brown v. Purdy, 8 N. Y. St. Rep., 143). Quoting further the above- named report: " The leading court decision regarding the reporting of cases by physicians is State v. Wordin (56 Conn., 216), which was decided December 1, 1887. In that case a physician was prosecuted for the violation of an ordi- nance of the city of Bridgeport, Conn., which provided that physicians must report cases of 'infectious or pestilential disease.' The de- fendant was charged with neglecting to report a case of diphtheria which he attended. He was found guilty and fined. "He appealed, claiming that the ordinance was inoperative and void because (among other reasons) it was unjust and unreasonable, inasmuch as it took professional knowledge for which it paid nothing, interfered with the physicians' lawful business, and imposed a public burden upon a class. "The court (Pardee, J) said: "In conferring authority upon the legis- lature of the city to pass the ordinance the legislature of the State was in the perform- ance of its duty and in the exercise of its power to protect its citizens from exposure to contagious, fatal diseases. "Of absolute necessity this power inheres in every organized community; otherwise there would be only organized suicide. It takes unwritten precedence of all provisions for the protection of rights of property and includes the right to require as much of the services or property of each as may be necessary to the preservation of the lives of all, without provision for payment there- for. * * * "Is an ordinance which requires one to lose a small portion of his time that the lives of many may be saved oflfensive to the constitution? An ordinance requiring the person who in the night season should first discover a dwelling house in the city to be on fire to turn aside and arouse the inmates and sound the alarm without com- pensation would not shock anyone. Nor, wc think, does one requiring the person who first discovers in a crowded street the pres- ence of a contagious, fatal disease to notify without compensation the official charged with the duty of preserving health and pro- tecting life therein. If to compel this gra- tuitous service is to violate the principles of the social compact, it would be better to dissolve and rcorganii^e. 'i' * ■* "In his concession that the ordinance would be valid in the ravages of pestilence, under presence of an overwhelming neces- sity to prevent public calamity, the defend- ant concedes the whole case. An ordinance of this character must be intensely practical; a proper regard for human life demands that a contagious, fatal disease shall be barred rather than driven out. "The inequality of burden of which the defendant complains is only in seeming. Persons ofifering their services to the public as healers of diseases and requiring pecun- iary compensation therefor, thereby assert their ability to detect the presence of it when the great mass of the people can not. The people accede to the truth of their assertion, and in the matter of life surren- der themselves to their keeping. Of course an ordinance in the interest of life must detect the presence of. a fatal contagious disease at the earliest possible moment. Therefore with impartial action it compels that member of the community who is the first to have sight and knowledge of it to give note of warning to others from whom its presence is hidden. It would be idle to require, indeed there would be danger in accepting, this service from those who can not see or do not know. The burden is made to rest upon every member of the only class which is in a condition to con- tribute anything to the accomplishment of the purpose of the ordinance." Conclusion: Judging from the foregoing court decisions sustaining the power of the state to compel physicians, in the interest of the general health of the community, to report cases of communicable diseases, well drawn laws or ordinances requiring medical, social .and eugenical field-workers, in the interest of the hereditary soundness of future generations, to report cases of hered- itary degeneracy would be upheld. 3. Registering Trained Eugenical Investi- gators. There are several types of social field work now being conducted in the United States. Each type has its own aims, methods and ideals, and requires specific talents and training, and has thus become a specialized occupation. However no state has, as yet, registered or licensed these workers, who, like physicians, come in close contact with families. This contact is engineered entirely by diplomatic skill on the part of the worker. Legal registration would make much simpler the relation between field investigators and the person or family supervised, aided, or studied, and would alsQ insure the public State Rfghts Re Limitation oe Human Reproduction 359 against abuse of those confidences which are given to the field investigator. The legal registration of nurses has proven to be of considerable use to the nurses themselves, to the medical profession, and to the communilx- at large. A similar benefit would be expected to arise from the registration of social workers. At present, and until the several types of social work become still more highly stabilized and pro- fessionalized, the general title "registered social worker" should sufiice for all types of social workers. In the future perhaps special legal provisions for registration and certification of eugenical field workers will become desirable. Certainly the latter class of investigators constitute a specially trained group of persons, who, in order to do their work effectively, must enjoy certain privi- leges and must be held to certain responsi- bilities, especially in the homes of families which have one or more members in a custodial institution of one type or another, and from which the field investigator may be working. There is also the matter of professional ,standard to be maintained, and a certain professional contact between field workers and the better and highly talented families, which latter are the subjects of eugenical field investigations quite as often as are degenerates. These constructive studies are, but in another way, just as important to the state as are researches into the family "quali- ties of the socially inadequate. A bill recently introduced into the legis- lature of California by Senator Gates is en- titled ''.^n act to provide for the examina- tion and registration of social workers, creating an examining body therefor, and providing for an association for registered social workers." This is a general bill which lists the several t3fpes of investigations which come under the term "social work," It would doubtless be satisfactory to eugenical investigators to have family history investi- gations specifically listed as one of the sev- eral items under social work, for the pur- pose of certification and registration. By this bill, it would be illegal for anyone not registered after examination, to describe him- self or herself as a "registered social worker." For persons who might do so, the bill pro- vides punishment by fine upon conviction. There is another aspect of legal registra- tion and certification of field investigators which is quite important. Registration would probably enable the properly trained and certified person to testify in court as an expert in matters involving an analysis of human pedigrees. Honorable Harry Olson, Chief Justice, ^Municipal Court of Chicago, (November 3, 1921) said, "Field workers will always be permitted to testify as to the facts, but as to the significance of these facts, especially where they involve mental dis- eases, I think they will never be licensed as physicians are now. Physicians will be called in that field while the eugenical worker will be called only for the facts as investigation has disclosed them, but, of course, the legis- lature can lay down standards, which when made, would qualify an individual as an ex- pert in that particular field." In the matter of reporting cases of hered- itary degeneracy or cacogenesis, the state would find its system working much more effectively if, besides requiring such reports of licensed physicians, it were to register all types of social investigators, and were to require reports on cacogenesis from them also. The reporting of hereditary degen- eracy is as essential an element in purging the state of its degenerate family strains as the compulsory reporting of contagious dis- eases is a necessary factor in protecting the people of the state from pestilence. SUMMARY 1. The doctrine of adequate social remedy. .\ living democracy must believe in and exercise the doctrine of adequate social rem- edies. In the absence of specific constitu- tional prohibition, the courts have generally sustained the power of the state legislative authority to apply any sound and reasonable social remedy for the general betterment. The principal concern of the courts in such cases has been to prevent violation of the bill of rights, especially undue discrimina- tion or class legislation as it is sometimes called. 2. The state's control of life and liberty of criminals. As just and fitting punishment for crime, the state has always exercised, in the in- terests of the public welfare, the right not only to take away a person's liberty by imprisonment, but also in extreme cases to take the life of the individual. 3. Non-punitive control of conduct. But the large group of legal, social or therapeutic remedies which impinge upon personal freedom have no element of pun- ishment in them. Among such remedies are 360 State Rights Re Limitation of Human Reproduction vaccination, quarantine, commitment to hos- pitals for the insane, the feeble-minded, and other types of the socially inadequate, and limiting marriage in the interest of normal, healthy and socially valuable offspring. 4. Control of emigration and immigration. Every sovereign state holds, as an elemen- tal necessary function, the right to decide who of its citizens shall be permitted to leave the country as emigrants, and who among aliens, shall be permitted to enter as visitors or immigrants. This principle bears greatly upon the immediate welfare of the state, but in the long run, if the immigrants be potential parents, it bears vastly more upon the welfare of the state by influencing the character of the inborn qualities of future generations. 5. Military conscription. In demanding rnilitary service, the state exercises its undoubted sovereign authority, under the principle that present individual, welfare, convenience and personal safety are subordinate to the ultimate common welfare of the nation and state. 6. Birth-Control. The laws governing birth-control in the United States are still chaotic and unhar- monized with the protection of public mor- als and in promoting eugenical welfare. The application of a new legislative and judicial principle is needed in this field. Such a principle calls first, for the control of human reproduction on the basis of encouraging high fertility by sound stock, and forbidding reproduction by degenerate stock, regardless of present economic status; second, the ele- ment of the possibility of immorality should be cared for by legal response to the means and spirit exercised in promoting birth- control. 7. Compulsory reporting of hereditary de- generacy. Because of the similarity in method and purpose to the compulsory reporting of cer- tain diseases, the state can, if it so desires, require the compulsory reporting of cases of hereditary degeneracy by licensed physicians and professional social field investigators. It is clear, also, that the state may legally permit private citizens to report cases of ap- parent or presumed family degeneracy. 8. Legalized eugenical sterilization. Both by many close and logical analogies, and by a few direct and specific eugenical sterilization statutes enacted and tested by the courts, the several states of the American Union are demonstrated to possess the power to enact and to enforce statutes which provide for the destruction of the reproductive pow- ers of individuals, provided such particular measures are designed for and proven to be effective in promoting the soundness of the hereditary physical, mental and moral quali- ties of future generatons. CHAPTER XI. EUGENICAL DIAGNOSIS. A. Guiding Principles for the Determination of Potential Parenthood of Socially Inadequate Offspring. General Factors of the Task 363 a. Pedigree-facts 362 b. Knowledge of heredity 363 c. Application of pedigree-facts to the rules of heredity 363 Notes on Practical Eugenical Diagnosis 364 1. Divergence between personal qualities and breeding qualities 364 2. The individual of pure stock 364 3. The individual of mixed stock 364 4. Range of individual breeding qualities 365 5. The complexity of hereditary traits or characters 365 6. Specific rules of inheritance 365 a. Recessive traits 365 b. Dominant traits 365 c. Sex-linked traits 365 . d. Other types of inheritance 366 7. Hereditary nature of the co-parent 366 8. Eugenical salvage — the separation of good traits from bad in the same individual 367 9. The factor of environment 367 10. Eugenical standards 368 a. The biological standard 368 b. The legal standard 368 11. Types of the socially inadequate 369 12. Common sense and pedigree study 369 Summary 370 B. List of characters in man classified according to their method of in- heritance 371 I. Traits which blend in the F; offspring 372 II. Traits showing dominance of one condition and recessiveness of the allelomorph in the first generation and segregation in subsequent generations of offspring 372 III. Sex-linked traits 376 IV. Probably Mendelian, but dominance imperfect or uncertain...; 377 V. Clearly hereditary, but rule of inheritance uncertain 377 VI. Associated traits 380 C. Tables showing types of matings and offspring 380 Type a. In case the defect is recessive 381 Type b. In case the defect is dominant 382 Type c. A sex-hnked trait 383 Type d. A trait that blends 384 Type e. A composite trait 385 D. References 392 1. Research Institutions 392 2. Societies 392 3. Universities and colleges with active depai tments oi: genetics 393 4. Custodial institutions for socially inadequate conducting field studies in eugenics 393 5. Courts which have untertaken scientific eugenical studies 394 6. Journals ^^^ 7. Books 394 362 EuGfiNicAi, Diagnosis EUGENICAL DIAGNOSIS. A. GUIDING PRINCIPLES FOR THE DETERMINATION OF POTENTIAL PARENTHOOD OF SOCIALLY IN- ADEQUATE OFFSPRING. Eugenical diagnosis is the determination, by case-records and pedigree-analysis, of the mental, physical and temperamental traits which a given potential parent may transmit either patently or latently to his or her pos- sible offspring. Such diagnosis includes not only the determination of the limits and possibilities of quality of a given character istic, but also must indicate the distribution and combinations of the traits in question among the possible offspring. Pedigree-analysis is here taken to include also the study of the constitutional make- up of the propositus' because the possession of specific traits by the propositus, when studied in relation to the family distribution of these given qualities, is an important fac- tor in genetical determination. Eugenical diagnosis is equally useful in the determination of the breeding'' qualities of sterling as well as of degenerate individuals. It is clear that the whole task of constructive breeding in man is dependent upon the success of such diagnosis. Wlhile not stated in so many words, the principal end of re- search and the purpose of books and papers on the subject of human heredity is, in its practical aspect, to enable predictions in hereditary behavior to be made. General Factors of the Task. Eugenical diagnosis is not an exact science like mathe- matics, nor yet even so exact as astronomy or engineering, but it is a biological science the sucdess of which, in general, depends upon the application of scientific principles, wide experience and common sense. Specifically its operation involves three fundamental factors: first, the pedigree-facts in the particular case; second, the knowledge of rules governing the inheritance of the (raits in question; and third, the scientific skill with which the two foregoing factors are considered in connec- tion with each other. Parenthetically, it should be here stated that, in practical eugenics, the physician has an important part to play before it is neces- sary for the cugenicist to act. namely, the physician must determine whether the pro- positus is a potential parent, that is, sexually fertile now or prospectively. Of course, no individual can be a "potential parent of socially inadequate offspring" unless he or she is first of all a potential parent. If the physician demonstrates that an individual is a potential parent, then the eugenicist must find out whether the possible offspring of the particular propositus would, according to the established pedigree-facts, the laws of heredity, and within the quality and percent- age standards set by law, be social inade- quates. (a) Pedigree- facts. It has been demon- strated many times in practical breeding ex- periments with plants and animals, and in family history study in man. that selection for parenthood on the basis solely of quali- ties which show in the individual has never resulted in great racial progress. On the other hand, even though the facts of heredity are still imperfectly understood, the selection for parenthood on the basis of both individu- ality and pedigree has resulted in the last two hundred years in the building up, by the civilized nations of the world, of a wonder- fully superior group of highly specialized and highly successful domestic plants and animals. By pedigree-facts are meant authentic records which describe in detail the specific traits under consideration, and the distribu- tion of these traits among the several mem- bers of the family-tree to which the particu- lar propositus belongs. Consorts not blood- kin to the propositus are not to be con- sidered unless such consorts are parents of children who carry blood common with the propositus. To be of practical use, pedigree- facts must be so marshalled that the analyst can by their use trace the descent and re- combination of given hereditary traits in the family-tree under consideration. How to secure adequate pedigree-facts is thel first practical problem which the eugeni- cist meets. It is bein,g solved in the United States at the present time in a satisfactory manner by the training of a corps of profes- sional eugenical field workers. There are now (1922) more than one hundred and fifty such investigators in this country. Their business consists in starting with a gTven individual, called the propositus; then, after ' For definitions se Chap. XV (p. 446). " The word "breeding" Is an elegant one, and, contrary to a connotation which It conveys to many minds, It is not to be Inferred that its use In connection with eugenics Is lowering the methods and standards of human repro- duction to those of plants and animals. To persons acquainted with the subject, breeding connotes the process of Improvement In natural qualities due to careful mate selection. EuGENiCAL Diagnosis 363 securing a thorough case-history of this particular individual, and securing records of medical examination, psychiatrical and anthropological tests, the worker goes to the home territory of the propositus. There from first-hand evidence the family connec- tions of the individual are established, and then, in order to present the family relations to the analyst, clearly and conveniently, a family-tree is plotted in pedigree or genealo- gical fashion. The field worker next pro- ceeds to secure case-histories and bio- graphical records of the various members of the family-tree, with particular emphasis upon those persons closest in blood and kin to the propositus, and upon those traits which are being diagnosed genetically in the propositus. In this work of establishing kinships and individual relationships, the student of human affairs has an advantage over the plant and animal breeders, for the latter, if exact pedi- grees are not kept, except for a few facts of relationship-evidence reconstructible from the evidence furnished by the traits of the individual, loses all hope of restoring them; but in the case of man there are such wide acquaintances and so many records of births, marriages, deaths, and newspaper accounts, church and town records, and often genealo- gical trees maintained by the family, and in addition the facts of individual traits, that the field worker, if he be a specialist in his work, is in most cases able to restore to a satisfying degree of completeness the family-tree and individual analyses of its several members. It is the experience of field workers that practically all of the cus- todial institutions, societies for community betterment, and especially child welfare and charities-and-corrections organizations, are particularly anxious to aid the investigators in ferreting out the truth, when sought for the purpose of eugenical diagnosis. Officers of the law also have proven uniformly co- operative. The evidence is that sources of information and social and individual co- operation are abundant to enable the restor- ation of adequate records of a large per- centage of social inadequates who are thought to be cacogenic. The use of these sources and cooperative aids depends upon the skill and diplomacy of the field worker, which is but one reason why the field worker must be especially adapted and trained to the task of gathering first-hand pedigree- data in the field. There are of course some individual cases concerning whom no family connections can be established, but these arc surprisingly few in relation to the whole numbers of social inadequates found in American communities and custodial institu- tions. Except for the aid of officers of the law and charitable institutions, the method of restoring accurate pedigrees of anti-social and of highly social individuals, or members of the so-called better families, is essentially the same. In both cases the field worker must go to the source of information. Ex- perience has shown that there is not very much difference in the difficulties met in working out these two kinds of pedigrees. If the better families often have more printed records of a genteel nature, such as genealogies, the histories of the more de- generate have, in compensation, records of the courts of law and of aid rendered by individuals and social organizations. b. Knowledge of Heredity. The second factor, the knowledge of the inheritance of particular traits, is one which is becoming much more exact as time passes. Even now, as a result of eugenical arid genetical re- search, the hereditary formulas for many human traits are known. The promising thing about the situation is that by the mod- ern system of investigation the secrets of nature in reference to human heredity yield themselves readily. We cannot here give an account of all of these investigations. It must therefore suffice to give references " to some of the more important books and papers in which the records of these in- vestigations appear. The eugenicist is an expert legal witness, like the physician and the engineer, and must keep abreast of the times by constant reference to the latest literature and current researches in his pro- fession. The sources of research and record which may be of use to the eugenicist are research institutions, scientific societies, the genetical departments of certain universities, the eugenical departments of certain of the greater custodial institutions for the socially inadequate, and a growing number of books and journals. c. Application of pedigree-facts to the rules of heredity. The third factor consists 1 A short, practical bibliography covering a few references to this subject of use to the eugenicist appears at the end of the present chapter. In connection with this bib- liography there is given also a list of research institutions, university departments, custodial institutions and scientific societies which are working on the problems of eugenics and hu- man heredity. 364 EuGENiCAL Diagnosis of the scientific application of the pedigree- facts of the particular case to the demon- strated laws of heredity which govern the particular human qualities in question. Just as the trained eugenical field worker has the task of gathering at first-hand the pedigree- material, and the investigator the task of analyzing pedigrees for the purpose of de- ducing the laws of human heredity, the practical eugenicist in a given case has the task of critically and scientifically coordinat- ing the facts presented by the foregoing two types of workers, to the end that a definite eugenical diagnosis or prediction may be made and demonstrated. Although eugenical diagnosis is rhade on a purely biological basis, without regard to what the statutory law may set up as the legal eugenical standard, as soon as the biological diagnosis is completed, an appli- cation of the demonstrated biological facts to the statutory provisions governing the determination of cacogenesis must be made. The standards of the law are arbitrarily and definitely established, but supposedly reason and logic prevail in their enactment. If in the sum of his hereditary qualities an individual is legally proven to fall Jielow the statutory line or zone of demarcation, such individual may then be legally declared to be a cacogenic person. Thus the eugenicist, so far as law is concerned, is called upon to perfoi-m the services of an expert witness, to apply general rules and principles of science to the facts established in the par- ticular case. Upon the expert testimony of this nature should depend the decision of the court whether the particular individual is, as alleged, a cacogenic person in the eyes of the law, and must therefore be sterilized, or whether the individual is not cacogenic, and therefore may not by state order be made sexually sterile. NOTES ON PRACTICAL EUGENICAL DIAGNOSIS. While there is much to be learned concern- ing human heredity, still science has found out a number of principles which appear to be fundamental in pedigree analysis. These principles and their accompanying explana- tions which follow may be used as practical guides, so far as such guides are at present possible, in determining the genetic or hereditary make-up of a given individual, and consequently in predicting the heredi- tary qualities which the person in question will, under given conditions, transmit to his or her ofifspring 1. The Divergence between personal qualities and breeding qualities. If the re- semblance between the breeding qualities of a given individual and his or her personality were exact, there would, of course, be no biological need for genealogical records in man, nor for pedigree-registry associations for domestic animals and plants. The fact that the germ-plasm carried by the individ- ual is not, except in the case of those few who are thoroughly homozygous, or "pure- bred," an exact reflection of the inborn per- sonal traits, makes the determination of the specific breeding qualities of the selected individual a difficult and complex task, to be achieved only by scientific and painstak- ing analysis and authentic records. The great problem of the eugenicist, as of the constructive breeder of animals and plants, is to indicate as fit for parenthood those in- dividuals who, regardless of their own per- sonalities, carry in their germ-cells the de- terminers for desirable physical, mental and temperamental qualities, sufficient in number and quality to insure, with proper mates, socially valuable offspring. 2. The individual of pure stock. Whether a plant, an animal, or a human being, a pure-bred individual is one in which, or in whom, all of the essential breed characteris- tics are carried in the germ-plasm, and only those qualities which show in the personal- ity of the individual are capable of being transmitted to the offspring of the particular individual. Such purity of blood is obtained, especially among mixed races, only after many generations of prolific breeding prop- erly directed and accompanied by radical culling, and even then, in many of the arbi- trarily indicated non-essentials, it is highly probable that even the most pure individuals will be found to be highly complex or mongrel. But relatively speaking the indi- vidual of pure stock "breeds true." 3. The individual of mixed stock. A mongrel is an individual generally of an undesirable combination of characters, whose body and personality on the one hand, and whose qualities as a sire or a dam on the other, are far apart. Such a person, animal or plant will not "breed true". In order to determine the breeding qualities of an individual of mixed ancestry, it is all the more necessary to secure and to analyze most carefully accurately kept and extensive fiedigree-records. Without EuGENiCAL Diagnosis 365 such records the breeder can only guess con- cerning the nature of a mongrel's offspring. 4. Range of individual breeding quali- ties.^ The potential parent, whether pure- bred or mongrel, carries in the germ-plasm and may pass on to his or her offspring the determiners for at least all of the hered- itary qualities which show in his or her body and personality, and, in addition, may carry the determiners for many qualities which are not patent in the individual; but not all of these potentialities will necessarily pass to the same offspring. Furthermore, the determiner for given quality may pass to a given offspring, but if it be reces- sive to its allelomorph, or hereditary com- plement, which is contributed by the co- parent, it will not show in the fir'st genera- tions, and thus may remain submerged for a number of generations, until a favorable mating permits it to become patent. , 5. The complexity of hereditary traits or characters. In his constitutionr.l make-up, an individual is a composite of hereditary traits. These traits are qualities or charac- teristics to which we give names. They may be (a) simple natural unit traits, for which the rules of inheritance are very clear; or they may be (b) arbitrary unions associated only in name, in which case they are composed of several genetically inde- pendent qualities; or they may be (c) hered- itary complexes associated in the germ- plasm and into each of which in an insepar- able manner many hereditary qualities enter. It is highly probable that a large majority of the hereditary traits in man to which we give names are of this latter highly complex nature. There are also doubtless many such natural complexes which are as yet not named. 6.. Specific rules of inheritance.^ If a trait possessed by the propositus is a single uni*- of inheritance, it is a relatively easy task to make an eugenical diagnosis in reference to the capacities and limitations of its possessor in passing it on to his offspring. From the standpoint of the rules of inheritance, there are three principal types of single unit traits. These deserve special consideration because they are representative of the elementary principles underlying the great bulk of nat- ural inheritance, and into such simple be- havior entities the science of genetics seeks to analyze the more complex characteristics. a. Recessive Traits. These characters are called recessive because if an individual possessing one of them is mated with a member of a race not possessing the same character, the trait disappears in the first generation. (Fi) We shall not here go fur- ther into the details of genetics other than to call attention to the fact that a recessive trait may skip one or more generations; that on the average, in mixed stock, a rela- tively small number of the members of the family are apt to be affected; that affected persons carry the ability to reproduce this particular trait, but not its complement; that a normal member of a family in which the incidence of recessive trait is high may carry a germ-plasm "taint" which can be determined only by many matings, hence with recessive traits there is much more danger of insidiously contaminating the germ-plasm of the family, than is the case with dominant traits; and, finally, if both parents are unaffected and the trait is de- monstrably a recessive one, it is sufficient 'evidence, if it appears in the offspring, that it came from both sides of the house. b. Dominant Traits. The dominant trait is the complement of the recessive. In a first generation cross between pure races, one of which possesses the trait and the other does not, the dominancy of one of the contrasted traits over its mate is demon- strated by the former's appearance in all of the first generaton (Fi) offspring. Prac- tically a dominant trait is recognized because it behaves as follows: It does not skip a generation; on the average, in mixed stock, a relatively large number of members of the family are affected by it; a person who is free individually from the trait cannot carry the "taint" in his blood, and, therefore, with dominant traits, there is less danger of in- sidiously contaminating the germ-plasm of the race than is the case with recessive traits. c. Sex-linked Traits. There are a num- ber of human traits, such as color-blindness and hemophilia, which are dominant in males and recessive in females. Their rule of inheritance is as follows: An affected man may marry a woman of unaffected stock, in which case none of their children will show the trait, and indeed none of the sons will carry it latently in their germ-plasm, but half of the daughters of such a union, while not showing the trait in their bodies, will 1 See pp. 371-380. ^ See Section B of this chapter. A few characters in man classified according to their method of inheritance. Also Tables showing types of matings and offspring.. Section C of this chapter. '^'W"^ 366 EuGENiCAi, Diagnosis possess the potentiality of passing it on to the next generation. If such a "tainted" daughter marries a man who is unafifected, one half of their sons will show the trait personally, the other half will be free from it; while none of their daughters will' show the trait, but one half of them will carry it in the same manner as their mother, while the other half will be entirely free from it, both. personally and in their hereditary capac- ities. If in an exceptional case an afifected man marries a woman who carries the trait in her germ-plasm, half of their sons will show the trait like the father, the other half will be free from it. Of their daughters, one half will carry the determiner for the trait in all of their germ-cells, and may or may not be exceptional by showing it in their own bodies. The other half of the daughters will, like the mother, not show the trait, but carry it in half of their germ-cells. d. Other types of inheritance. The three rules of transmission of unit-traits above described are fundamental in their nature, but in the process of transmis.sion from one generation to another the determiners for these traits often undergo a special series of hazards which destroy the usual simple mathematical calculations known as Men- delism. When such disturbances occur, there are corresponding modifications in the rules of inheritance above outlined. The physical basis ' for such changes is found in such phenomena as linkage, crossing-over, inter- ference, non-disjunction, lethal factors, and the like. It is probable also that evolution- ary changes both of an advantageous or progressive nature and a disadvantageous or degenerative nature are caused by chemi- cal changes in the germ-plasm (the chromo- somes) in the process of transmission from one generation to another, Such changes are known as mutations. Gradually the laws governing different traits and trait-complexes are being worked out in plants, animals and man. It is neces- sary in each case not only to know whether the basic clement in the character being studied is dominant, recessive or sex-linked, but the diagnostician must also be ac- quainted with the inheritance of the parti- cular quality as it behaves in the particular family to which the propositus being sub- jected to eugenical diagnosis belongs. 7. Hereditary nature of the co-parent. In eugenical diagnosis an individual is or is not a potential parent of socially inade- quate offspring, regardless of the hereditary nature of an actual or possible co-parent, A constitutional degenerate will contaminate the race more surely and just as extensively through mating with a sterling as with a mongrel parent, fertility being equal in the two matings. The results of degeneracy may not be so patent in the first generation as when a degenerate mates with a degenerate, never- theless it can be mathematically and biologi- cally demonstrated that they are just as defi- nite and extensive. A co-parent of good quality may raise the standard of the lower parent in the offspring, but the better qual- ities are pulled down in accomplishing this mediocre result. While the principles of segre- gation and recombination of traits insure that, if enough such mediocre families inter- marry, hereditary qualities will again segre- gate themselves into many grades and types of individuals, still such an original mixture is retrogressive from the stand- point of racial progress, because it compli- cates and delays the centering of degenerate qualities in single individuals, which center- ing is essential to culling, unless indeed all contaminated as well as all thoroughly de- generate stock is to be denied the privilege of reproduction. If a potential parent of socially inadequate offspring be already a parent, his or her offspring will serve the useful purpose of aiding eugenical diagnosis of the particular parent, just as in every mating, regardless of its fitness or of the quality of the parents, if children result, their constitutional char- acters throw light upon the genetic make- up of the parents. In objecting to the estimation of eugeni- cal values without regard to the nature of the co-parent, it is often pointed out that in domestic animals the pure-sire method, in which the sire is of the desired stock and the dam may be a mongrel, racial progress is very rapid. This is one case in which the analogy between practical animal breeding and practical eugenical processes in the human race does not hold good. If we are to set up different standards of eugenesis for the twoi sexes, we must as a logical cor- ollary establish a system of polygamy. Moreover the evidence of history shows that in man the so-called pure-sire method of assimilating a lower race into a higher one 1 The Physical Basis of Heredity, by Thomas H. Morgan, gives the latest evidence on the correlation between the behavior of chromatin and of hereditary traits, as they pass from one generation to another. EuGENiCAL Diagnosis 367 has worked out successfully only in nations in which illegitimacy and polygamy are common. In like manner, within the same race, the process of assimilating a lower stock into a higher one by the pure-sire method is not practical in nations in which polygamy and illegitimacy are not permitted, but among whose people the marriage rela- tion is held sacred. It must therefore be uni- versally acknowledged that the eugenesis or cacogenesis of an individual is indepefi- dent of the nature of the co-parent, although the natural traits of the co-parent throw much light on the unborn qualities of the propositus. 8. Eugenical salvage — the separation of good traits from bad in the same individual. Theoretically the unit of eugenesis, and likewise of cacogenesi;, is the hereditary unit-quality or trait, because natural hered- itary qualities are proven in family history descent to be subject to segregation and reconibinatioui The individual,, which in most cases is personally an inseparable com- plex of good and bad hereditary characteris- tics, is also an eugenical or cacogenical unit, depending upon the predominance of valuable or degenerate natural traits. Still more extensive than the individual is the family or strain possessing to a large degree the same hereditary constitution. Thus or- ganized society, in seeking to purge the race of its degenerate qualities, would wish, if- it were possible, to eliminate only the degenerate traits and to retain the valuable. But practically, the law cannot proscribe cer- tain unit-traits in an individual by ordering "that traits 'a' and 'b' shall not be per- mitted to reproduce themselves because they are degenerate, but that the good qualities 'c' and 'd', carried by the same individual who possesses 'a' and 'b', shall be permitted to reproduce". The process by which traits are carried from generation to generation does not permit so clean-cut a system of segregation. If society is to be extremely radical in its culling system, it may proscribe whole families as comprising stock which is undesirable. But the student of pedigrees has learned that in practical eugenics the unit of selection for reproduction or denial of reproduction is not the trait by itself, nor the family, but the individual. It is thus apparent that eugenical. selection must involve, the destruction of some good quali- ties along . with the bad in the individual whose descent lines are cut off, but it is fortunate that eugenical selection does not of necessity involve the eugenical destruc- tion of a whole family because certain of its individuals are proven cacogenic. This necessity of a clean-cut decision as to whether a given individual, with his whole repertoire of hereditary qualities, good and bad, may be permitted to reproduce, presents one of the most serious problems to the eugenicist, as it has done in ail ages to the constructive breeders of plants and animals. The particular question is always this: We have here a given individual of mixed desirable and degenerate hereditary qualities. In the long run, would the race be better off if this mixed personality be denied the right to reproduce, or are some of his sterling qualities so valuable that the race can well afford to permit him to re- produce, meanwhile trusting to the principle of segregation and recombination of traits in later offspring to concentrate the valuable qualities in one set of inviduals and the degenerate in another? The answer to this problem depends, of course, upon the rela- tive social values of the good and bad in the original mixed personality. It is thus obvious that until the biological sciences of medicine, anthropology and genetics make much more progress, it will be impossible to lay down specific rules for governing the salvage of good hereditary qualities when mixed with bad in the same individual. At present, at one end of the series a person possessed of many valuable traits with but few undesirable ones calls for conservation and reproduction; at the other end of the series an individual characterized by many degenerate qualities with but few good ones calls for denial of reproduction. In the middle of this series there is a wide zone which neither the science of heredity nor the statutory law may as yet succesfully attack. Therefore the law may well refuse, for many years at least, to draw a sharp line cutting this series, in an arbitrary manner, into a cacogenic and an eugenic portion. Both the statute and its practical adminis- tration, so far as its application to steriliza- tion is concerned, may well confine their activities to cases of mixed qualities well toward the lower end of the series, because in this latter region there are at present in America many cases the eugenical diagnosis and elimination of which will occupy the administrative resources of the country for many years to come. 9. The factor of environment. The phy- sician, the anthropologist, and the psychia- trist in examining the individual, and the 368 EuGSNiCAi< Diagnosis field worker in the study of the pedigree in (he field, have constantly borne in upon them the necessity of separating, so far as possible, the factors of heredity and environ- ment, in determining the causes of the character and condition of the particular individual. If this separation cannot be accomplished, then neither sociology on the one hand nor eugenics on the other can claim to' be sciences. Eugenics applies to those hereditary constitutional qualities which determine the fundamental limitations and capacities of the individual. In this science as in all others, successful measure- ment and prediction are the criteria of prac- tical worth. If by the study of authentic pedigrees and life histories eugenics can, to a definite degree, predict the hereditary na- ture of the oflfspring of a given person, then to just such degree is eugenical diagnosis a science. It serves no good purpose, either to the student of heredity or of environment, to claim extraordinary potency of the particu- lar factor which the given student repre- sents. The first task in eugenical diag- nosis, as in most of the studies of human nature, is to separate the factors of hered- ity and environment. Some of the clearest demonstrations of the necessity for such separation are shown in the pedigrees of persons who are diagnosed as insane. There are many persons who break down with in- sanity of one type or another, who their physicians declare would not have broken down had their surroundings been different, that is, had they been subjected to different stresses of life. Thus the environmental fac- tor is equally important with the hereditary. In this case it is not the insanity, but the predisposition to it, that is inherited. Field workers report families in which there is a high inciden'ce of a given type of insanity, and among the members of such families it is quite common to have stresses which seem most trivial given as the exciting cause in their families. On the other hand, in fami- lies in which the incidence of the mental disease is very low and the type not serious, oftentimes a most formidable array of excit- ing causes is necessary in order to break down those who are potentially insane. The task of separating the hereditary and environmental factors is difficult, but unless it be clearly accomplished, it is impossible to achieve a definite prediction concerning the hereditary potentiality of a given indi- vidual. 10. Eugenical standards. (a) The biological standard. The biolog- ical standard, below which an individual falling would be classed as uneugenical be- cause of his hereditary potentialities, is an ideal one toward which the eliminative pro- cesses of eugenics must tend if they would ultimately achieve a purging of the race of its degenerate qualities. These biological standards are not subject to arbitrary shift- ing by legislation, but are determined by the practical working out of those biological laws which govern the inheritance of nat- ural traits, and of those laws which in the social organism control mate-selection, in- cluding the differential marriage rate among individuals of varying natural social ade- quacy, also those biological laws which gov- ern differential fecundity and survival. (b) The legal standard. But besides the theoretical eugenical standard, there must for practical purposes be a legal standard for the guidance of administrative officers in selecting individuals for the purpose of denying them the right of parenthood. It is clear that the legal standard must be low enough to exclude from its scope individuals of doubtful eugenical value. This exclusion should be maintained until both the science of heredity and practical eugenical adminis- tration have made considerable further ad- vance. But the present legal standard must nevertheless be a definite one, even if it be neither ideal nor flexible enough to fit every case. A parallel case is that of the law in placing the age of criminal responsibility at seven years. In so doing it may in some cases rate an individual as responsible who, though many years older than seven, is in fact not responsible; whereas it may exclude frorn responsibility an individual of five or six who by the best psychological tests may prove to be morally responsible. Until the criteria for determining moral responsibility are definitely set forth by psychologists, in rules which the law may incorporate, the best the law can do is to set forth this low arbitrary standard. The law must first of all be practical. It must also take cogrnizance of advance in science, and when possible establish a flex- ible standard which will lend itself to adjust- ment to fit the facts of as many cases af possible. In the Model Law as drafted, and reported in Chapter XV of this book, the standard of cacogenesis is placed low, and is as flexible as the existing knowledge of heredity will permit, so that neither individ- JiuGUNiCAL Diagnosis 369 ual injustice nor social injury can be wrought by its application. With the advance of knowledge and increased experience in eu- genical diagnosis and court procedure, the legal standard of cacogenesis may be both raised and made to fit more exactly a still greater percentage of the cases. 11. Types of the socially inadequate. If an individual, regardless of his hereditary constitution, could by proper training be made to serve some Valuable social function and thus to contribute in some manner to the common weal, there could be no object in negative eugenics or the denial of parent- hood to certain individuals, in which case eugenics would have to confine its activities to securing fit matings among its better classes. But as modern society is organized, it has to take cognizance of many individ- uals who, on account of defective or handi- capping inheritance, or other msfortune, are unable, despite training, to maintain them- selves without much social direction and help. They thus constitute a handicap to the well-being of the body politic. Specifically these social inadequates may be classed as follows:— (1) Feeble-minded; (2) Insane (in- cluding the psychopathic); (3) Criminalistic (incl. the delinquent and wayward) ; (4) Epi- leptic; (5) Inebriate (including drug habi- tues); (6) Diseased (including the tubercul- ous, the syphilitic, the leprous, and others with chronic infectious and legally segreg- able diseases); (7) Blind (including those with seriously impaired vision) ; (8) Deaf (including those with seriously impaired hearing); (9) Deformed (including the crippled); and (10) Dependent (including orphans, ne'er-do-wells, the homeless, tramps and paupers). But it must not be thought that every member of these classes of social inade- quates is such because of defective heredity. Only those individuals who-, after their cases have been medically and socially diagnosed and the factors of heredity and environment duly analyzed, are shown to belong to their particular inadequate groups primarily be- because of defective heredity, are to be rated as cacogenic. An individual who loses his sight as the result of a gun-shot wound may be of the greatest eugenical value to the state. On the other hand, an individual, though he may possess vision to a fair de- gree, may carry in his germ-cells the deter- miners for hereditary eye defect, so that if the greatest interests of the race were to be served, this individual would be denied the right of reproduction. The same difference persists throughout all of these groups. Doubtless in the feeble-minded class the factor of environment will be found to play a relatively small part. In insanity, epi- lepsy and deformity, it doubtless plays a greater part, but the problem consists not in weighing one class against another, but in each particular case in determining the hereditary factor and in diagnosing the genetical properties of its possessor. 12. Common sense and pedigree study. In the practical application of all sciences to human affairs, common sense as well as technical rules must be brought into play. After all has been said and done, the eugen- icist when gauging the hereditary qualities of an individual, and applying the pedigree- facts and the demonstrated rules of inherit- ance to the particular case, must, besides using the plainly demonstrated rules, use judg- ment and common sense. The whole per- sonality of the several members of the fam- ily-tree rriust be gauged and the results of such gauging must be applied in the final estimate. Dr. H. B. Webster, of Castine, Maine, in depositing with the Eugenics Record Office the pedigree-description * of a certain anti- social family consisting of 77 members, wrote: "The data collected convinced me that further progeny of this breed is undesirable. In one instance (Pedigree Reference IV, 9), I have obtained consent to sterilization, on eugenic as well as personal grounds. This instance may help to combat the argu- ment that sterilization of the defective is necessarily a cruel and unjustifiable require- ment to demand of them in return for the protection and support which they obtain either by public charity, or private benefi- cence and tolerance. "It is a sound eugenic tenet, that normal persons owe a debt to the community that can only be discharged by the breeding and rearing of another generation as desirable as themselves. Conversely, those defectives who are practically certain to breed prin- cipally defectives, owe a debt to the com- munity that can be discharged only by an adequate guarantee that they shall not con- tribute to the next generation." These .conclusions were based upon a careful study of a compact family group — grandparents, parents, uncles and aunts, brothers and sisters, cousins, and children. The investigator reviewed the life history 1 E. R. O. flies, V. C. 11, p. 1-28, Jan., 1916. 370 EuGENiCAi, Diagnosis of each member of the group, and also made an analysis of the natural traits of each. His testimony concerning the "stock" repre- sented by this particular family is therefore worth considering. Commonly the physician, in rating the part that heredity is apt to play in causing a given trait or disease to appear in a cer- tain individual, counts the total number of known kin of the patient, then counts the number of such kin who are characterized by the given trait, and divides the former number in the latter to secure a percentage or chance of incidence. According to the laws of probability, his method throws some light upon the situation, but it is not so illuminating asl the method of the geneticist, who applies the demonstrated laws of hered- ity to the pedigree in an attempt to diagnose the hereditary make-up of the particular person. The method of the physician is val- uable, but it by no means exhausts the re- sources accessible in such cases. Life in- surance is a sound business and a sound science, and it is based upon chance of occurrence calculated in much the same manner that the physician calculates chance of incidence. This soundness is, however, based upon a wide margin of safety. If similar rules are to be applied in eugenical diagnosis, then the standard of cacogenesis must be very low indeed. It can be raised safely only by the application of genetical analysis in addition to demographic per- centages. In the case of Alice Smith, who was the subject of the test case of the eugenical sterilization law in New Jersey, the student in studying the pedigree-chart (see p. 392), and who is acquainted with the general principles of human heredity and of pedi- gree-selection generally in plants and ani- mals, would not here render a judgment solely upon the basis of an exact and tech- nical application of rules, although such ap- plication could be made; but the final judg- ment of degeneracy is rendered because of the persistence throughout the pedigree of degenerate human qualities from which the race must purge itself, if it is to endure. This particular person is one well toward the lower end of the series, if one arranges the personalities-complex of the American people in order of social value. She is not a borderline case presenting necessity for niceties of differential diagnosis. Thus it seems clear that, in selecting for sterilization, the entire repertoire of heredi- tary qualities must be rated as a whole. If in the personalities of a majority of the near kin of a degenerate propositus there is a similar lack of natural value, it is, as demonstrated by many pedigree-studies, highly improbable that, in the absence of out-mating, socially valuable natural quali- ties would ever appear in the offspring of the propositus. It is pertinent here to make reference to the experience of practical plant and animal breeders. Those breeders who have been most successful in improving their respec- tive stocks have been idealists, but they have also been noted as men of sound judg- ment. They possessed, besides the ability to rate the qualities of an individual, that sound judgment which enabled them, by pedigree-analyses, to estimate the breeding qualities of selected individuals. Similarly if the physician depended en- tirely upon hard and fast rules in diagnosis and treatment, doubtless his efforts would be of but little practical use in treating human disease. The ability to weigh symp- toms and to exercise sound judgment and common sense in diagnosis enables the phy- sician to apply also those facts and prin- ciples which medical science has so labor- iously worked 'i>ut. The eugenicist/in predicting the nature of the hereditary triyts which a given indi- vidual will pass on \f> his offspring, gains efficiency by experience to the same degree that the engineer or physician improves in expertness with trsnning and experience. The eiigenicist who has seen and analyzed pedigrees of the particular trait or complex of traits, which, he is called upon to diag- nose eugenically in a given individual, stands a much better chance of making a correct diagnosis than does the analyst whose work is based upon theory alone. SUMMARY. 1. In the administration of the eugenical sterilization laws, the task of the eugenicist is not to diagnose an individual as insane, feeble-minded, blind, or dependent — the physician, the psychologist, and the social worker do that— but it is to study the case- history and records which the physician, psychologist and social worker provide, and then to secure, through the services of trained eugenical field workers, the pedi- gree and family histories of the persons al- leged to be cacogenic, and finally, to deter- mine, by applying the laws of heredity to the pedigree-facts and family history rer EuGfiNicAi, Diagnosis 371 ords, the quality of the traits of instinct, of mentality, or of physical structure, which the propositus will transmit within a definite percent-ratio to his or her offspring. In the eyes of the law the eugenicist is thus called upon to perform the function of ex- pert witness. 2. It devolves upon the courts of law to apply, in particular cases, the determinations of the eugenicist to the standards established by the eugenical sterilization statutes. 3. The present low standards of eugeni- cal adequacy, which characterize most of the existing sterilization statutes, render the determination of legal cacogenesis a task well within the bounds of feasibility. 4. As in the limitaton of marriage on account of hereditary degeneracy, so in eugenical sterilization, the legal standards of cacogenesis are very low. This is justified because the determination of the exact line between degeneracy and normality is very difficult to ascertain. As the science of eugenics advances, it will be possible, in keep- ing with the assurance of justice and general welfare, to raise both these legal and the bioligical standards. 5. At present modern pedigree analysis, as conducted by students of human hered- ity, offers the most satisfactory method for the definite determination of hereditary un- fitness. B. LIST OF CHARACTERS IN MAN CLASSIFIED ACCORDING TO THEIR METHOD OF INHERIT- ANCE, AND LISTED REGARDLESS OF THEIR PERSONAL OR RACIAL VALUES. JANUARY 1, 1922. In his constitutional make-up, man is a composite of hereditary traits. On analysis these traits are found to follow several dif- ferent rules of inheritance. A few of these rules have been determined and formulated. Research continues, and slowly but surely new methods of inheritance are being found out, and additional specific qualities are being shown to follow one or the other method of transmission from parent to off- spring. It should here be emphasized that, in prac- tical eugenical studies, those individuals who are of so unworthy or degenerate a type as to merit the denial of reproduction-, in the mterests of race conservation, generally show a number of specific traits which are undesirable. In these cases, in addition to demonstrating the possession of a specific genetic unity selected from the degenerate qualities of the accompanying list of good and bad traits, the high incidence of genera! shiftlessness, anti-social conduct and unedu- cability in the family is evidence of a practi- cal nature which must weigh very heavily in determining potential parenthood of so- cially inadequate offspring. Thus the gen- eral social value of the "stock" from which an individual springs is practical evidence which, while not conclusive, cannot be ig- nored in rating the potential parenthood of socially inadequate offspring of a given per- son. Traits. Most of the traits here listed are of no concern in the practical application of eugenical sterilization but they are of immense importance as eugenical factors in mate selection. It is not claimed that the list here presented is exhaustive. In the Trait Book (Bulletin No. 6 of the Eugenics Record Office by Charles B. Davenport) over 6,000 definite human qualities are named, but the science of human genetics is still new so that only a relatively few hereditary human traits have been listed, and definite rules of inheritance have been worked out for still fewer. There are four published tables or lists of hereditary traits in man, recently com- piled and classified on the basis of method of inheritance. They are: (a) The Inheritance of Family Traits, Chapter III, Heredity in Relation to Eugen- ics, by Chas. B. Davenport, 1911. (b) Mendelian Heredity in Man, by Major C. C. Hurst, F. L. S., The Eugenics Review, Vol. IV, April, 1912, pp. 1-15. c) Mendelian Inheritance in Man, (p. 301-, 304, 2nd Ad.), Heredity and Environment in the Development of Men, by Edwin Grant Conklin, 1917. (d) Inherited Characters in Man (table 33, pp. 340-241. Genetics and Eugenics, by W. E. Castle, 1916. These lists have been drawn upon in pre- paring the present tables, but in each case credit has been given the source used. The "name and page" in the accompanying references refer to the titles just quoted, but in most cases the references given are to the source paper of the original investigator. "Bui." refers to the Bulletins of the Eugenics Record Office. "Carnegie" refers to the publications of the Carnegie Institution of Washington. Credit is due Dr. Frederick L. Reichert, Miss Alice M. Hellmer and Miss Mabel L. Earle for assistance in compiling the accom- panying revised lists. 372 EuGENicAi, Diagnosis HUMAN TRAITS WHICH HAVE BEEN SHOWN TO FOLLOW DEFINITE RULES OF INHERITANCE. I Traits which Blend in the Fi Offspring 6 II. Traits which show Dominance or Reccssivcntss to the Normal Condition in the Fi Offspring ; 68 ITI. Sex-Linked Traits 17 IV. Probably Mendelian, but Dominance Imperfect or Uncertain. 16 V. Clearly Hereditary, but Rules of Inheritance Uncertain 53 Total number listed to January 1, 1923 160 VI. Associated Traits 5 pairs I. Traits which Blend in the Fi Ofifspring. Reference 1. General body size Castle' (p. 240) 2. Stature Davenport (Bui. No. 18) E. R. O.' 3. Weight Castle (p. 240). 4. Black skin colort Davenport (Carnegie" No. 188) 5. Hair-form (round vs. flat in cross section)t Castle (p. 240) 6. Shape of head (round vs. long)t Castle (p. 240) It is possible for such traits to ."^how segregation in subsequent generations, but it is probable that a majority of blending traits in man are polygenic in nature, behaving like the inheritance of skin-color in negro-white crosses. II. Traits Showing Dominance of One Condition and Recessiveness of its Allelomorph in the First (Fi) Generation of Offspring, and Segregation in the Second (F,) and Subsequent Generations of Offspring. DOMINANT RECESSIVE REFERENXE ]. Body size and shape (a) Achondroplasy Normal size Conklin* (p. 302) (b) Normal size True dwarfs (i. e. ateleiotic) Conklin (p. 302) 2. Skeleton (a) Brachydactyly (i. e digits and limbs) short Vormal condition Mohr & Wriedt (Carnegie No. 295) (b) Absence of distal ph; danger Vormal condition Cragg & Drinkwater (Eng. Jour. Gen., Vol. VI, 1916- 1917. pp. 81-89) • (c) Polydactyly (i. c. digits ) cxtr? \crmal condition Rafl'le, .\. B. (Lancet 1914, No. 187. 693-4) (d) Syndactyly (i. c. fused Normal condition Parker, R. W., and Robin- webbed or rcducid number son, H. B., 1887. "A Case of of digits) Inherited Malformation of the Hands and Feet" (pp. 181-18U) (e) Symphalangy (i. e. fused Normal condition Gushing, H. (Gen. Vol. I, joints of digits, or ortho- 90-106, Jan. 1916) dactyly) t Method of Inheritance not agreed upon by all Investigators. " Castle, W. E. Genetics and Eugenics, 1916. « E. R. O. E'ugenlos Record Office. » Publications of the Carnegie Institution of Washington. •Conklin, E. G. Heredity and Environment (Revised Edition), 1916. EuGENiCAL Diagnosis 373 DOMINANT RECESSIVE REFERENCE (f) Exostoses (i. e. abnormal Normal condition Teissier, P., and Denechan, outgrowths of long bones) "Un cas d'exostoses osteo- geniques multiples here- didaires et familiales" (Pull, et mem. soc. med. d'hop. de Paris, 1905. 3s., XXII, pp. 647-650) (g) Osteopsathyrosis (i. e. frag- Normal condition Atherton, A., 1894. "Case of ility of bones) Inherited Fragility of Bones" (Dominion Med. Monthly ii., pp. 1-3) (h) Double-jointedness Normal condition Dobell, Horace, 1863. "A Con- i ■ n' "''* tribution to the Natural n -■! :-^T History of Hereditary n — 'i'T^F^TT- Transmission" (Med. Chir. - n -■: — ■»t-tv Trans. Lond. XLVI, pp. 35 - - ^ -,.- , ,._^.,^, to 28) (i) Radio-ulnar Synarthrosis Normal condition Davenport, Taylor, Nelson (E. R. 0. Files) (j) Head form:Brachycephaly Dolichocephaly Frets, G. P. "Heredity of 3. Countenance Headform in Man,'' I93i (a) Hapsburg lip Normal (pp. 59-61) Woods, F. A. "Mental and Moral Heredity in Royalty" (pp. 187-189) Coxe (Austria, 1820, Vol. I, (b) Non-Jewish facial type Tewish facial type 'p. 397) Salaman (Jour. Genet., vol. L, 1910-1911, p. 273-292) 4. Skin (Eug. Rev., vol. Ill, 1911- (a) Pale thick skin Colored thin skin 12, pp. 187-200) (b) Brunet complexionf Intermediate and blond Hurst, C. C. (Eug. Rev., 1912- 13, vol. IV, p. 14) Davenport, Chas B. (Am. Naturalist, 1910, vol. XLIV, pp. 641-673) (c) Intermediatef Blond complexion Hurst, C. C. (Eug. Rev., vol. TV, 1912, p. 13) (d) Normal pigmentation Albinism Stelwagon' (p. 638) (e) Spotted white (Vitiligo) Uniformly colored Stelwagon (p. 642) (f) Tylosis palmae et plantae Normal condition Stelwagon (p. 555) (g) Epidermolysis (i. e. ex- Normal condition Stelwagon (p. 400) cessive formation of blisters) (h) Congenital hypertrichosis Normal condition Stelwagon (p. 1013) (i ) Hypotrichosis (i. e. hair- Normal condition Hyde, J. N. (Jour. Cut. Dis., lessness, associated with 1909, XXVII, pp. 6-7) lack of teeth) (j ) Immunity to Poison Ivyf Susceptibility to Poison Eugenics Record Office Files (Rhus toxicodendron) Ivy (k) Ectodermal abnormalities Normal condition Fisher, H., University (skin thickening, nail mark- Skin Clinic, Koeln, Ger- ing) many (Dermat. Zeitschrift, ■' --r ■1»»l»)-r'T- vol. XXXII, pp. 114-142) t Method of inheritance not agreed upon by all InvestiKators. •Stelwagon. Treatise on Diseases of the Skin. 1907. (8th Edition). 374 EuGENiCAL Diagnosis DOMINANT 5. Hair A. Color (a) White forelock (b) Dark brown (c) Black (d) Canities (i. e. patchy gray- ing of hair) B. Cross Section (a) Curly (i. e. flat in cross section) (b) Beaded (i. e. cross section not uniform, or "monile- thrix") (c) Digital hair 6. Eyes (a) Front of iris pigmented (i. e. brown or black eye) (b) Hereditary cataract (c) Glaucoma (internal pressure and swelling of eye-ball) (d) Ectopia lentis (displaced lens) (e) Retinitis pigmentosaf (i. c. pigmentary degeneration of the retina) (f) Congenital Aphakia (g) Congenital Ptosis RECESSIVE Normal (i. e. solid color) Light brown to "tow" and light reds AH other colors Normal (i. e. solid color) Straight (i. e. round in cross section) Normal (i. e. uniform cross section) REFERENCE 7. Ears (a) Normal condition Absence Only back of iris pig- mented (blue eye) Normal condition Normal condition Normal condition Normal condition Normal condition Normal condition Deaf-mutism Miller, N. (Jour, of Hered., 1915, vol. VI, pp. 165-169) Conklin (p. 301) Morgan (Brit. Med. Jour., 1890, ii, p. 85) Davenport, G. C. & C. B. Heredity of Hair-form in Man" (Am. Naturalist, 1908, bs, XII, pp. 11-13) Dtto. (pp. 138-139) Danforth, C. H. (Am. Jour, of Phys. Anthropology, Sept. 1921) Davenport, G. C. & C. B. (Science, N. S. XXVI, 1907, pp. 589-592 Nettleship, E., 1905. "One Heredity in the Various forms of Cataract" (Rep. Roy. Lond. Ophth. Hosp., v. 16, p. 1) Howe, L., 1887. "A Family History of Blindness from Glaucoma." (Arch. of Ophth., N.Y., XVI, p. 72-76) Lewis, G. G., 1904. "Hered- itary Ectopia Lentis with Report of Cases." (Arch, of Ophthal. XXXIII, No. 3, p. 275) Nettleship, E., 1906. "On Re- tinitis Pigmentosa and Al- lied Diseases." (Rep. Roy. Lond. Ophth. Hosp., v. IT, pts. I, II and III.) Jones, Ralph R., Toms River, N. J. (E. R. O. files) Briggs, H. H. (Tr. Am. Oph. See. 1918, XVI, pp. 255-276) Oph. Soc. 1918, XVI, pp. 255-276 (Also Am. Jour, of Ophth, 1919, 3s, ii, pp. 308-417) St. Hilaire, E., 1900. (La sur- dimutite) Politzer, A., 1907. (Geschichte der Ohrenheilkunde) t Method of inheritance not agreed upon by all Investigators. EuGENiCAL Diagnosis 375 DOMINANT (b) Normal condition RECESSIVE Otosclerosis 8. Intellectual capacityf (a) Average (b) Average 9. Temperament (a) Feebly - inhibited (Hyper- kinetic) 10. Special talents (a) Non-musical (b) Non-artistic 11. Right-handedness 13. Nervous system (a) Huntington's Chorea (b) Muscular atrophy (i. e. pro- grassive neural muscular atrophy) (c) Normal condition (d) Normal condition Ce) Normal condition Very great ("genius") Very small (see also " Nervous System) Over-inhibited (Hypo- kinetic) (f) Normal condition (g) Normal condition (h) Normal condition (i) Normal condition (j) Normal condition (k) Normal condition (1) Normal condition REFERENCE Musical Artistic Left-handedness (and ambidexterityt) Normal condition Normal condition Idiopathic epilepsy Constitutional feeble- mindedness Manic depressive insan- ity Dementia praecox Paranoia Involutional melan- cholia Alcoholism Hysteria Friedrich's ataxia Meniere's disease Lucae, A., 1907, "Die Chroni- sche Progressive Schwer- hoerigkeit" Hammerschlag, V., 1905, "Zur Frage der Vererbbarkeit der Otosklerose" Conklin (p. 301) Conklin (p. 301) Kraepelin, 1899, "Psychiatry." Raecke, 1903, "Transitorische Bewusstseinsstorungen der Epileptiker" Ribot, T., 1896. "The Psycho- logy of the Emotions" Stanton, H. M. "Inheritance of Specific Musical Capaci- ties" (E. R. O. Bui. No. 22, 1922) Hurst, C. C. (Eug. Rev., vol. IV, 1913, p. 23) Drinkwater (Eng. Journal of Genetics, vol. V, 1915-16, pp. 229-241 Hurst, C. C. (Eug. Rev., vol. IV, 1912-13, p. 16) Davenport (E. R, O. Bui. ^No. 17) Charcot and Marie (Rev. de Med., Paris, 1886, VI, pp. 97-138) Turner, W. Aldren "Epilepsy" (1907) Rosanoff and Martin (Jour. Hered. 1915, vol. VI, pp. 34-35 Rosanoff & Orr. "A Study of Heredity in Insanity in the Light of the Mendelian Theory" (Am. Jour, of In- sanity, LXVIII, pp. 321 to 261) Also E. R. O. Bui. No. 5 Rosanoff and Martin (Jour. Hered. 1915, vol. VI, pp. 355-356) Conklin (p. 303) Osier' (p. 1096) Osier' (p. 944) Simon, Chas. E.. (Johns Hop- kins Hosp. Bui. No. 4, 1893, pp. 83-84) t Method of Inheritance not agreed upon by all investigators. 1 Osier, "Wm. Principles and Practice of Mediome. 376 EuGENiCAL Diagnosis DOMINANT RECESSIVE REFERENCE (m) Normal condition Sydenham's chorea (St. Jolly, F., 1891 (Neurol. Cen- Vitus' dance) tralbl., Leipzig, X, 331-326) (n) Normal condition Thomson's disease (lack of muscular tone) Osier (p. 1131) 13. Kidneys (a) Diabetes insipidus Normal condition Osier (p. 439) (b) Diabetes mellitus Normal condition Williams, John R. "A Study of the Significance of Heredity and Infection in Diabetes Mellitus" (Amer. Jour, of Med. Science, N. S., vol. CLIV. pp. 396-406) (c) Normal condition Alkaptonuria (urine dark after oxidation) Osier (p. 692) 14. Respiratory System (a) Normal condition Bronchial asthma June Adkinson (Eugenics Re- search Ass'n, 1919) 15. Palmaris Longus Muscle Absence 16. Teeth Absence Hunt, Harrison R., Univer- (a) Lateral permanent incisors sity of Miss. (E. R. 0. files) III. Sex-Linked Traits. These traits or qualities are "dominant in males and recessive in females.'' REFERENCE 1. Coloboma De Beck, D., 1886, "A Rare Family History of Congenital Coloboma" (Arch, of Ophth. XV, p. 8, and 1894, XXIII, p. 264) 2. Atrophy of optic ner-ve (neuritis optica)t Davenport" (p. 110) 3. Myopia Oswald, A. B., "Hereditary Tendency to Defective Eyesight" (Brit. Med. Jour. Jan. 1911) I -1 Worth, C, "Hereditary Influence in Myopia" (1905, Trans. Ophth. See. Lond., XXVI, pp. 141-143) 4. Color blindness ("Daltonism," inability to Reber, W.. 1895, "Six Instances of distinguish red from green) Color Blind Women" (Med. News, XVI, pp. 95-97) 5. Night blindness (Inability to see by faint Nettleship, E. (Ophth. Soc. Trans, v. light) 2T. p. 269-293) 6. Nystagmus Clarke, Ernest, 1903, "Hereditary Nys- tagmus," Ophthalmoscope (Lond. I, pp. 86-87) 7. Ichthyosis (scaly skin)t Stelwagon (p. 596) Crocker (Dis. of the Skin, 3rd Ed., p. 569) 8. Pattern baldness Osborn, D. (Jour. Hered., Aug. 1916) i). Multiple sclerosis (Differential degeneration Merzbacher, L., 1909, "Gesetzmassig- of the nerve tissue) keiten in der Vererbung und Ver- breitung Verschiedener Familiarer Erkrankungen" (Arch. f. Rassen und Ges. Biologic, VI, pp. 172-198) t Method of Inheritance not agreed upon by all investlgrators ^ Davenport, C. B. Heredity In Relation to Eugenics, 1911. EuGENiCAL Diagnosis 377 10. 11. 12. 13. 14. 15. 16. 17. Gower's muscular atrophy (dystrophia muscu- laris progressiva) Hemophilia Wanderlust Deficiency in sense of smellf Thalassophilia (sea-lust) Toothlessness (toothless man of India) Webbed toes Microphthalmia REFERENCE Osier (p. 933) Osier (pp. 755-756) Davenport "Feebly-Inhibited, 11" (Car- negie No. 236) Glaser (Science, Dec. 27, 1918, pp, 647-648) Davenport and Scudder (Carnegie No. 259) Thadami (Jour, of Heredity, vol. XII, Feb. 1921, pp. 87-88) Richard Schofield (Jour. Hered., Nov. 1920) Ash (Brit. Med. Jour. Lond., Apr. 8, 1922) IV. Probably Mendelian, but Dominance Imperfect or Uncertain. Defective hair and teeth Extra teeth Double set of permanent teeth Harelip and cleft palate Cryptorchism Hypospadias 7. Twining trait (possibly recessive) 8. Dental agnesia (absence of certain teeth) 9. Bi-lobed ear 10. Dent in forehead (possibly dominant) 11. Human protein sensitization 13. Digital anarthrosis 13. Iso-agglutinins (as figured in blood-grouping) 14. The "Catlin mark" 15. Ankylosis (stiffening of joints) 16. Degeneracy of Cornea Castle (p. 241) Davenport (p. 143) Davenport (p. 142) Blades (Dental Cosmos, Nov. 1914), vol. LVI, pp. 1241-1345 Davenport (p. 170) Lingard, A., 1884, "The Hereditary Transmission of Hypospadias and its Transmission by Indirect Atavism" Wakeley, Thomas, 1895, "The Influence of Inheritance on the Tendency to have Twins" Sergi, S. (Jour. Hered. v. V, 1914, p. 559) Schofield, R. (Jour. Hered. v. VIII, 1917, p. 517) Davenport (Jour. Hered., April 1915, vol. VI, pp. 163-164) Cooke & Vander Veer (Jour. Immuno- logy, vol. I, June 1916, pp. 201-305) Drinkwater, H. (Proc. Roy. Soc. Med., 1916-1917, vol. X, pp. 60-68) Reichert, F. L. (Eng. News, June 1933, pp. 65-67) Von Dungern & Hirschfeld (Zeitsch. f. Immunitatsforsch., vol. VIII, 1911, p. 526) Goldsmith, W. M. (Jour, of Hered., 1933, vol. XIII, No. 2, pp. 69-71) E. R. O. Files Davenport (pp. 112-113) V. Clearly Hereditary (i. e. Runs in Families), But Rule of Inheritance Uncertain. Longevity Handclasp E. R. O. Files Hurst, C. C, (Eug. Rev., vol. IV, 1913, pp. 1-17) ■Ill 378 EuGENicAi, Diagnosis 3. Diatheses to many specific diseases, as:- (a) Pneumonia (b) Cancer (c) Abdominal hernia (d) Inguinal hernia 4. Stuttering or stammering 5. Chlorosis 6. Epistaxis (nosebleed) 7. Telangiectasis Splenic anemia with enlargement of the spleen (Gaucher's splenomegaly) 9. Gout 10. Goitre 11. Exophthalmic goitre (Graves' disease) 12. Literary ability 13. Mathematical ability 14. Mechanical ability 15. Cretinism 16. Heart defect 17. 18. 19. 30. 21. 28. 23. 24. 25. 26. Pernicious anaemia Arteriosclerosis Jaundice (hereditary form, splenomegaly with acholuric jaundice) Migraine Rheumatism Von Recklinghausen's disease (neurofibro- matosis) Scoliosis Raynaud's disease Angio-neurotic oedema (Quincke's disease) Milroy's disease (persistent hereditary oede- nia of the legs) REFERENCE Herrman, Chas. (Arch. Ped., vol. XXXIII, 1916, pp. 168-170) Jour. Med. Research, vol. XXXII, 1915 (N. S. vol. XXVII), pp. 159-200 Couch, J. K., 1895, "A Family History of Hernia" Davenport (p. 106) Osier (p. 730) Lane (Jour. Hercd. 1916, vol. VII, pp. 133-134) Weber, F. P., 1907, "Multiple Hered- itary Developmental Angiomata (Te- langiectasis)" Bovaird, D., 1900, "Primary Splenome- galy" (Am. Jour. Med. Sci., vol. CXX, pp. 377-402) Wilson, E., 1869 (Jour. Cutan Med. Lond. Ill, pp. 106-117) Garrod^ A. E., 1902, "The Incidence of Alkaptonuria" Buschan, G., 1894, "Die Basedow'sche Krankheit" J. A. M. A. (Jan. 24, 1920, p. 286) Davenport (p. 54) Davenport (p. 59) Davenport (pp. 55-58) Eug. Rev., vol. II, 1910-1911, pp. 142- 143, and Jordan, D. S. (Eug. Rev., vol. II, pp. 247-248) Vierordt, K.H., 1901, "Die angeborenen Herzkrankheiten" (Spezielle Patho- logic und Therapie, XV, T. I, Ab. 2) Warfield' (p. 158) Osier (p. 887) Osier (p. 1087) Apert, E., 1907, "Traite des maladies familiales et des maladies congeni- tales" (p. 235) Cheadle, W. B., 1900, "Occasional Lec- tures on the Practice of Medicine" Arnozan, X„ et L, Prioleau 1883, "An- nales de Dermat. et de Syph." (2s., iv, pp. 689-698) Blumer, C, 1892, "Hereditare Neigung zu Traumatischer Blasenbildung" (Arch. f. Dermat. und Syph. 1893, pp. 105-70) Davenport (pp. 172-173). Jour. Hered. IX, 1918, p. 130 Edgeworth, F. H. (Lancet, 1911, pp. 216-217) ' Warfleld, IjOuIs M. Arteriosclerosis and Hypertension (3rd Edition). EuGENiCAiv Diagnosis 379 27. Mongolian imbecility (possibly recessive) 28. Amaurotic family idiocy 29. Megalophthalmus 30. Progressive Central Muscular Atrophy (in- fantile form, familial) 31. Hereditary spastic paraslegia 32. Marie's cerebellar hereditary ataxia 33. Paroxysmal familial paralysis 34. Hereditary tremor 35. Handwriting 36. Degeneration of macula lutea 37. Arthritis deformans 38. Spasmodic croup 39. Hereditary icterus 40. Angina pectoris 41. Cystinuria 42. General paralysis 43. Hay fever 44. Hypertrophic emphysema 45. Leprosy 46. Myxoedema 47. Neurasthenia 48. Obesity 49. Paramyoclonus multiplex 50. Periodical paralysis 51. Hereditary finger-print pattern REFERENCE 52. Memory 53. Astigmatism 54. Congenital Dislocation of Thigh-bone Jour. Hered., vol. IX, 1918, p. 23 Herrman, C. (Arch. Ped., vol. XXXIV, 1915, pp. 494-503) Herrman, C. (Arch. Ped., vol. XXXII, 1915, pp. 902-908) Davenport (p. 115) Osier (p. 928) Osier (pp. 938-939) Osier (p. 945) Taylor, E. W. (Jour. Nerv. and Ment. Dis. 1898, vol. XXV, p. 637) Osier (p. 1119) Osier (p. 1066) Davenport (p. 63) Blue, Robert (J. A. M. A. 1919, vol. L'XXIII, pp. 1328-1331 Osier (p. 1134) Osier (pp. 557-558) Osier (p. 837) Osier (p. 690) Osier (p. 922) Osier (p. 612) Osier (p. 646) Osier (p. 152) Osier (p. 875) Osier (p. 1107) Osier (p. 451) Osier (p. 1133) Osier (p. 1119) Wilder, H. H. (Palm and Sole Studies Biol. Bui. 1916, vol. XXX, pp. 135- 172, 211-252) Elderton, E. M. (Biometrika, Oct. 1930, pp. 57-91) Davenport (pp. 59-60) E. R. O. Files ISfareth 1903, "Beitrage zur Luxatio coxde congenitalis" 380 EuGENiCAi, Diagnosis VI. Associated Traits (Possibly Chromosome-Linkage). ONE TRAIT ASSOCIATED TRAITS REFERENCE 1. Brachydactylism Shortness of stature Drinkwater (Eng. Journal Genetics 1916-17, vol. VT, p. 88) 3. Osteopsathyrosis Porcelain-blue color of Herrman, C, 1915, "Blue sclera or ' whites of Seleirosis 1 Associated with eyes'" Brittle Bones" Cockayne, E. A., 1914, "Case of Hereditary Blue Scler- osis and Brittle Bones'' (Proc. Roy. Soc. Med., VII, No. 6, p. 101) 3. Hereditary nail defects Hair defects Nicolle, C, and A. Halipre, 1895, "Maladie familiale caracterisee par des alte- rations des cheveux et des ongles" (Ann. de Derm, et Syph., Vr, pp. 804-811) 4. Niglit Blindness Myopia Strabismus Nettleship, E., 1907, "History of Congenital Stationary Night-blindness" (Ophthal. Soc. Trans., vol. 27, pp. 269 to 293) 5. Feeble-mindedness Epilepsy Davenport (pp. 73-76) EuGENicAi< Diagnosis 381 Type a. In case the defect is recessive, as in many types of manic-depressive in sanity, dementia praecox, and feeble-mindedness. The Propositus. (Individual aflfected personally or in re- Possible Mates Offspring Remarks productive, qualities) Germ- Person- Germ- Person- Germ- Person- cells - ality cells ality cells ality a Nr Normal 1 NN Normal ^50% NN Normal Depending upon, the (Simplex) (Duplex) (Duplex) ^ 50% Nr V(Simplex) Norma! nature of the co- narent, none, 25%, or 50% of the offspring 2 Nr Normal -^35% NN Norma! of the propositus will (Simplex) (Duplex) J 50% Nr j (Simplex) 35% rr ^(Nulliplex) Normal Affected be affected. If the 3 possible types of matings were equally frequent and fertile, 75% of the off- 3 rr Affected ^ 50% Nr Normal spring would be nor- (Nulliplex) j (Simplex) ] 50% rr ^(Nulliplex) Affected mal and 35% affected. b rr Affected 1 NN Normal 100% Nr Normal Diepending( upon the (Nulliplex) (Duplex) (Simplex) nature ' of the co- parent, none, 50%, or 3 Nr Normal /- 50% Nr Normal 100i% of the offspring (Simplex) (Simplex) ] 50% rr ^(Nulliplex) Affected of the propositus will be affected. If the 3 possible types of matings were 3 rr Affected 100% rr Affected equally frequent and (Nulliplex) (Nulliplex) fertile, half of the off- spring would be nor- mal and half affected. TABLES SHOWING THE TYPES' OF MATINGS WHICH MAY BE MADE BY PERSONS INDIVIDUALLY DEGENERATE^ FROM HEREDITARY CAUSES, OR PERSONALLY NORMAL BUT CARRYING DEGENERATE GERMINAL QUALITIES, SHOWING ALSO THE PERSONAL AND GERMINAL NATURES OF THE POSSIBLE OFFSPRING OF EACH SUCH MATING, WORKED OUT IN ACCORDANCE WITH THE KNOWN LAWS OF HEREDITY. ^ There ar^ here worked out only a, few of the known methods of inheritance, but these given comprise the fundamental cases. ' There is no essential difference between the methods of inheritance per se of desirable and undesirable traits. 382 EuGENiCAi, Diagnosis Type b. In case the defect is dominant, as in Huntington's chorea, or some of the types of congenital cataract. The Propositus. (Individual affected . personally or in re- Possible Mates Offspring Remarks productive qualities) Germ- Person- Germ- Person- Germ- Person- cells ality cells ality cells ality a DD Affected 1 DD Affected 1007o DD Affected Regardless of the (Duplex) (Duplex) (Duplex) nature of the co- 2 Dn Affected ^50% DD Affected parent, all of the off- (Simplex;) j (Duplex) "j 50% Dn I (Simplex) Affected spring of the propo- situs vi'ill be affected. 3 nn Normal 100% Dn Affected (Nulliplex) (Simplex) b Dn Affected 1 DD Affected ^50% DD Affected Depending upon, the (Simplex) (Duplex) j (Duplex) i 50^% Dn L (Simplex) Affected nature of the co- parent, all, 75%, or 50% of the offspring of the propositus will 3 Dn Affected ^25% DD Affected be affected. But in no (Simplex) (Duplex) 50% Dn 1 (Simplex) 25% nn ^(Nulliplex) Affected Normal type of mating will less than 50% of the offspring be affected. If the 3 possible types of mating were equally frequent and 3 nn Normal f 50% Dn Affected fertile, T5% of the off- (Nulliplex) (Simplex) ^ 50% nn Normal spring would be af- fected and 25% not I (Nulliplex) affected. NOTE:— Besides the system of nomenclature here given (which was devised by Dr. Charles B. Davenport) the other system (Professor William Bateson) in vogue has Its equivalents as follows: homozygous, if por-itive, is equivalent to duplex; homozygous, if negative, is equivalent to nulliplex: heterozygous is equivalent to simplex. NOTE; — The six Mendelian cases are: Mating Offspring DDX DD = JO0%DD DD X Dr = 50% DD -f- 50% Dr DD X rr = 100% Dr Dr X Dr = 25% DD -f- 50% Dr + )ir,% rr Dr X rr = 50% -|- 50% rr rr X rr = 100% rr. A letter stands for a determiner for a given trait, in the germ-cell. Personally DD and Dr individuals possess the dominant aspect of the trait in question. DD "breeds true," but Dr does not. An rr individual shows the recessive aspect of the trait, and "breeds true." 1. 2. 3. 4. 5. 6. EuGENiCAL Diagnosis 383 Type c. A Sex-Linked Trait. (In man the male is the heterozygous sex.) A trait that is dominant in males but recessive in females, as Haemophilia or Color- blindness. Propositus (Individual af- Offspring fected person- Possible Mates Remark*: ally or in re- A.Wf AXaCAA ^^u productive Males 50% Females 50% qualities) 1. Male HH (Female) Ho (100% HH (100% Depending upon the germ- (a) Ho (Afifected) affected) affected) inal nature of the co-parent, (Affected) either all, half, or none of the possible offspring will be af- Hh (Female) Ho (50% HH (50% fected. In no case will there (Not afifected) affected) affected) be any difference between the per cent of affected and not ho (50% Hh (50% affected in the two sexes of not affected) not affected) the offspring. If the 3 possible types of mating were equally frequen' hh (Female) ho (100% Hh (100% and fertile, 50% of the off- (Not affected) not affected) not affected) spring would be affected and 50% not affected, classifica- tion not based on sex. Depending upon the germ- 2. Female Ho (Male) Ho (100% HH (100% inal nature of the co-parent, (b) HH (Affected) affected) affected) either all of the offspring or (Affected) all of the males and half of ho (Male) Ho (100%* Hh (50% the females will be affected. (Not affected) affected) not affected) Ho (50% affected) If the 2 possible types of mating were equally frequent and fertile, 87^% of the off- spring would be affected and ISyifo nof affected, classifica- tion not based on sex. (c) Hh Ho (Male) Ho (50% HH (50% Depending upon the germ- (Not (Affected) affected) affected) inal nature of the co-parent. affected) ho (50% Hh (50% either half of the males and not affected) not affected) half the females will be of- fected and half not affected, or half the males will be af- ho (Male) Ho (50% Hh (50% fected and half not affected, (Not affected) affec'ed) not affected) and none of the females will be affected. • ho (50% hh (50% If the 3 possible types of not affected) not affected) mating were equally frequent and fertile, 37^% will be af fected and 62^% not affected, classification not based on sex NOTE: — The typical sex-linked cases are: 1. Xy5 X XX5 =50%XyS -|-50%XX?. 3. Xy5 X XX$ =25%Xy3 + 25% Xy^ -|- 25% XX 9 25% XX 9. 384 EuGENiCAL Diagnosis All Xy individual is a. male unmarked by the trait in question. Xy is a male marked by the trait. XX is a female "untainted" by the trait. XX is a female who, while not showing the trait personally, will pass it on to one half of her sons and will "taint" one half of her daughters. Type d. A trait that blends. Propositus (Individual af- fected person- ally or in re- productive qualities) Possible Mates 1. Nr Affected to a small degree 2. rr Affected to a great degree NN Nr NN Nr Offspring NN 50% not affected Nr 50% slightly affected NN 25% not affected Nr 50% slightly affected rr 25% greatly affected Nr 50% slightly affected rr 50% greatly affected n ' ■ ''-:' \ ■ Nr 100% slight affected Nr 50% slightly affected rr 50% greatly affected rr 100% greatly affected Remarks Depending upon the germinal nature of the co-parent, either half of the possible offspring will be normal and half affected; or 25% will be normal, 50% only slightly affected, and 25% greatly affected; or 50% greatly affected and 50% slightly affected. If the 3 possible types of matings were equally frequent and fertile, 25% of the offspring would be normal, 50% slightly affected, and 25% greatly affected. Depending upon the germinal nature of the co-parent, either all of the possible offspring will be slightly affected, or 50% will be slightly affected and 50% greatly affected, or all will be greatly affected. If the 3 possible types of matings were equally frequent and fertile, 50% would be slightly affected and the other 509? greatly affected. EuGENiCAL Diagnosis 385 e. A Composite Trait.' A trait which is a composite of two or more independently inherited traits. In this particular example the composite is composed of one dominant and one recessive trait. For example, if a complex of Huntington's chorea (dominant) and manic depressive insanity (recessive), which are independently inherited, made up a medical entity (which in fact they do not), the rule of inheritance of such entity would be as follows: Propositus^ (Individual carrying the trait either personal- ly or in the germ-plasm.) (a) CCnn (Affected) (b) CC Nn (Not affected) (c) CC NN (Not affected) (d) Ccnn (Affected) (e) CcNn (Not affected) (f) CcNN (Not affected) (g) CC nn (Not affected) (h) cc Nn (Not affected) (i) ccNN (Not affected) Remarks Average frequency of types in offspring. provided that there is equal frequency and fertility of matings with all possible types of mates. 50% affected 50% not affected 35% affected 75% not affected 100% not affected .37^'% 6254% 81^% affected not affected affected not affected 100% not affected 25% 75% 12J4% 87J4% affected not affected affected not affected 100% not affected See the following tables for the working out of each of these cases. • In this complex only two unit-traits are Involved; if, as is probably the case in many characters, a larger number enter, it is at once evident that the situation becomes highly Involved and consequently the possibility of analysis becomes Increasingly difficult. ''C=gene for Huntington's cho^fea; c=Its Absence. N=!gene not capable of developing manic depressive insanity; m=gene for manic depressive insanity. 386 EuGENiCAL Diagnosis (a) Propositus Possible Mates Offspring Remarks CCnn CCnn CC nn (100% affected) Depending upon the (affected) (affected) germinal nature of the CCNn CCnn (50% affected) co-parent, the offspring (not affected) CCNn (50% not affected will be either affected or not affected. CCNN CCNn (100% not affected) If the nine possible (not affected) types of matings were Cc nn CCnn (50% affected) equally frequent and (affected) Cc nn (50% affected) fertile, 50% would be affected and 50% would CCnn (25% affected) be not affected. CcNn Cc nn (25% affected) (not affected) CCNn Cc Nn (25% not affected) (25% not affected) CcNN CCNn (50% not affected) (not affected) Cc Nn (50% not affected) ccnn Cc nn (100% affected) (not affected) cc Nn Cc nn (50% affected) (not affected) Cc Nn (50% not affected) ccNN (not affected) Cc Nn (100% not affected) (b) CCNn CCnn CCnn (50% affected) Depending upon the (not affected) (affected) CCNn (50% not affected) germinal nature of the co-parent, the offspring CCNn (not affected) CCNN (25% not affected) will be either affected CCNn (50% not affected) or not affected. CC nn (25%, affected) If the nine possible types of matings were CCNN CCNn (50% not affected) equally frequent and (not affected) CCNN (50% not affected) fertile, 25% of the off- spring would be af- CCnu (25% affected) fected and 75% would Cc nn CCNn (25% not affected) be not affected. (affected) Cc nn Cc Nn CCNn Cc Nn (257r affected) (25'"/; not affected) (25'/, noraffected) (25% not affected) CcNn CCNN (12}^% not affected) (not affected) Cc NN CCnn (I2y2% not affected) (125/^% affected) Cc nn (12^% affected) JiuGENiCAi, Diagnosis (b) — ^Continued 387 Propositus Possible Mates Offspring Remarks CcNN CC Nn {25% not affected) (not affected) CC NN (35% not affected) Cc Nn (25% not affected) Cc NN (25% not affected) cc nn Cc Nn (50% not affected) (not affected) Cc nn (50% affected) cc Nn Cc NN (35% not affected) (not affected) Cc Nn (50% not affected) Cc nn (35% affected) ccNN Cc Nn (50% not affected) (not affected) Cc NN (50% not affected) (c) CCNN CC nn CCNn (100% not affected) None of the offspring (not affectedt (affected) will be affected, no mat- CCNn CC Nn (50% not affected) ter what the character (not affected) CC NN (50% not affected) of the mating, because the propositus carries CCNN CC NN (100% not affected) no determiner for the n (not affected) (recessive) trait. Cc nn CC Nn (50% not affected) (affected) Cc Nn (50% not affected) CC Nn (25% not affected) CcNn CCNN (25% not affected) (not affected) Cc NN (25% not affected) Cc Nn (25% not affected) CcNN CCNN (50% not affected) (not affected) Cc NN (50% not affected) cc nn Cc Nn (100% not affected) (not affected) cc Nn Cc Nn (50% not affected) (not affected) Cc NN (50% not affected) ccNN Cc NN (100% not affected) (not affected) (d) Cc nn CCnn CCnn (50% affected") Depending upon the (affected) (affected) Cc nn (50% affected) germinal nature of the co-parent, the offspring CCnn (35% affected) will range from all af- CCNn CC Nn (35% not affected) fected to all not af- (not affected) Cc nn (25% not affected) Cc Nn (35%. not affected) fected. 388 EuGENiCAi, Diagnosis (d) — Continued Propositus Possible Mates CCNN ^(not affected) Cc nn (affected) CcNn (not affected) CcNN (not affected) r cc nn (not affected) ccNn (not affected) ccNN (not affected) Offspring CCNn Cc Nn tCnn Cc nn cc nn CCNn Cc Nn cc Nn CCnn Cc nn cc nn CCNn Cc Nn cc Nn Cc nn cc nn Cc Nn cc Nn Cc nn cc nn Cc Nn cc Nn 50% not affected) 50% not affected) 25% affected) 50% affected) 25% not affected) 12^% not affected) 25% not affected) 12^% not affected) 12J^% affected) 25% affected) 12^% not affected) 25% not affected) 50% not affected) 25% not affected) 50% affected) 50% not affected) 25% not affected) 25% not affected) 25% affected) 25% not affected) 50% not affected) 50% not affected) Remarks If the nine possible types of matings were equally frequent and fertile, 375^% of the offspring would be af- fected and 62J^% would be not affected. (e) CcNn (not affected) CCnn (affected) CCNn (not affected) CCNN (not affected) Cc nn (affected) CCnn Cc nn CCNn Cc Nn CCNn Cc Nn CCNN CcNN CC nn Cc nn CCNN CCNn Cc NN Cc Nn CCNn Cc Nn cc Nn CC nn Cc nn cc nn 25% affected) 25% affected) 25% not affected) 25% not affected) 25% nbt affected) 25% not affected) 12^%> not affected) 12^% not affected) 12^% affected) 125^%, affected) 25% not affected) 25% not affected) 257r not affected) 25% not affected) 12J^% not affected) 25% not affected) 12j47f) not affected) 12H% affected) 25% affected) n'/2% not affected) Depending upon the germinal nature of the co-parent, the offspring will be both affected and not affected. If the nine possible types of matings were equally frequent and fertile, 18.75% of the possible offspring, or slightly less than one- fifth, would be affected, and 81.25% would be not affected. Eugunical Diagnosis (e) — Continued 389 Propositus Possible Mates CcNn (not affected) CcNN (not affected) cc nn (not affected) cc Nn (not affected) ccNN (not affected) Offspring CC NN (6J4% not affected) CC Nn (1254% not affected) CCnn (614% affected) Cc NN (I2y2% not affected) Cc Nn (25% not affected) Cc nn (12^% affected) cc NN (654% not affected) cc Nn (12J47p not affected) cc nn (6J4% not affected) CC NN (12K% not affected^ CCNn (12H% not affected) Cc NN (25% not affected) Cc Nn (25% not affected) cc NN (12^% not affected) cc Nn (121^% not affected) Cc nn (25% affected) Cc Nn (25% not affected) cc nn (25% not affected) cc Nn (25% not affected) Cc nn (12;^% affected) Cc Nn (25% not affected) Cc NN (12^% not affected) cc nn (12^% not affected) cc Nn (25% not affected) cc NN (1214% not affected) Cc Nn (25% not affected) Cc NN (25% not affected) cc Nn (25% not affected) cc NN (25% not affected) Remarks (f) CcNN CCnn CCNn (50% not affected) None of the possible (not affected) (affected) Cc Nn (50% not affected) offspring of any mat- ings made by an in- CC Nn (35% not affected) dividual of this type CCNn CC NN (25% not affected) will be affected. (not affected) Cc Nn (35% not affected) Cc NN (25% not affected) CCNN CC NN (50% not affected) (not affected) Cc NN (50% not affected) CC Nn (25% not affected) Cc nn Cc Nn (50% not affected) (affected) cc Nn (25% not affected) 390 EuGENicAi, Diagnosis (f) — Continued Propositus Possible Mates Offspring Remarks CCNn (13^% not affected) CC NN (13J^% not affected) CcNn Cc Nn (35% not affected) (not affected) Cc NN (35% no taffected) cc Nn (12^% not affected) cc NN (131^% not affected) CcNN CCNN (25% not affected) (not affected) Cc NN (50% not affected) cc NN (35% not affected) cc nn Cc Nn (50% not affected) (not affected) cc Nn (50% not affected) Cc Nn (35% not affected) cc Nn cc Nn (25% not affected) (not affected) Cc NN (25% not affected) cc NN (25% not affected) ccNN Cc NN (50% not affected) (not affected) cc NN (50% not affected) (g) ccnn CCnn Cc nn (100% affected) Expending upon the (not affected) (affected) germinal nature of the CCNn Cc nn (50% affected) co-parent the offspring (not affected) Cc Nn (50% not affected) will be either affected or not affected. CCNN Cc Nn (100% not affected) If the nine possible (not affected) types of matings were Cc nn Cc nn (50% affected) equally frequent and (affected) cc nn (50% not affected) fertile, 25% of the off- spring would be affected Cc nn (25% affected) and 75% would be not CcNn Cc Nn (25% not affected) affected. (not affected) cc nn (25% not affected) cc Nn (25% not affected) CcNN Cc Nn (50% not affected) (not affected) cc Nn (50% not affected) cc nn cc nn (100% not affected) (not affected) cc Nn cc Nn (50% not affected) (not affected) cc nn (50% not affected) ccNN cc Nn (100% not affected) (not affected) EuGENiCAi, Diagnosis (h) 391 Propositus cc Nn (not affected) Possible Mates CC nn (affected) CCNn (not affected) CCNN (not affected) Cc nn (affected) CcXn (not affected) CcNN (not affected") cc nn (not affected") cc Nn (not affected) cc NN (not affected) ccNN (not affected) CC nn (affected) CCNn (not affected) CCNN (not affected) Conn (affected) Offspring Cc nn (50% affected) Cc Nn (50% not affected") Cc nn (25% affected) Cc Nn (50% not affected) Cc NN (25% not affected) Cc Nn (50% not affected") Cc NN (50% not affected) Cc nn (25% affected) Cc Nn (35% not affected) cc nn (25% not affected) cc Nn (25% not affected) Cc NN (121'^% not affected) Cc Nn (25% not affected") Cc nn (12J4% affected) cc NN (12H% not affected) cc Nn (25% not affected) cc nn (1254% not affected) Cc Nn (25% not affected) Cc NN (25% not affected) cc Nn (25% not affected) cc NN (25% not affected) cc Nn (50% not affected) cc nn (50% not affected) cc nn (25% not affected) cc Nn (50% not affected) cc NN (25% not affected) cc Nn (50% not affected) cc NN (50% not affected) Remarks Depending upon the germinal nature of the co-parent, the offspring will be either affected or not affected. If the nine possible types of niatings were equally frequent and fertile, 12^% of the off- spring would be affected and S7;4% would be not affected. (i) Cc Nn (100% not affected) Cc Nn (50% not affected) Cc NN (50% not affected) Cc NN (100% not affected) Cc Nn (50% not affected) cc Nn (50% not affected") Regardless of the character of the mating, none of the offspring will be affected, because the propositus carries no determiner for the n (recessive) trait, that is in any case his deter- miner N (Dominant) will be present in the 392 EuGENiCAi, Diagnosis (i) — Continued Propositus Possible Mates CcNn (not affected) CcNN (not affected) cc nn (not affected) cc Nn (not affected) ccNN (not affected) Offspring Cc Nn (35% not affected) Cc NN (35% not affected) cc Nn (25% not affected) cc NN (35% not affected) Cc NN (50% not affected) cc NN (50% not affected) cc Nn (100% not affected) cc Nn (50% not affected) cc NN (50% not affected) cc NN (100% not affected) Remarks offspring and thus de- stroy the possibility of an nn individual. D. REFERENCES 1. Research Institutions. 1. Eugenics Record OfSce, C. B. Davenport, Director; Bulletins on the inherit- ance of special traits; Memoirs describing cacogenic families; Reports, Family History Schedules, etc., Cold Spring Harbor, Long Island. N. Y. 2. Galton Laboratory for National Eugenics, Karl Pearson, Director. Uni- versity of London, publications for sale by Dulau & Co., Ltd.. London. 3. Societies. American Genetic Association, David Fairchild, President. Research Departments for Plants, Animals, and Eugenics, Washington, D. C. Eugenics Research Association, L. F. Barker, President, H. H. Laughlin, Sec'y, Cold Spring Harbor, Long Island, N. Y. Eugenics Education Society, Leonard Darwin, President, London, England, (and several branches). 11 Lincoln's Inn Fields, \\'. C. 2. London, Mrs. A. C. Gotto, Hon. Secretary. Societe Fran^aise d'Eugenique, Lucien March, President, 97 Quai d'Orsay, Paris. France. Deutsche Gesellschaft fiir Rassen-Hygiene, Dr. .Alfred Ploetz, Gundelinden- strasse 5, Miinchen, Germany. Argentine Eugenics Committee, Buenos Aires, Argentina. Sociedade Eugcnica de Sao Paulo, Brazil, Dr. Renato Kehl, Secretary, Rua Libero Badaro 119. Galton Society, Hew York, N. Y., Charles B. Davenport, President. Hungarian Eugenics Society, Dr. Geza von Hoffman, Acting Vice-President, Budapest. Italian Society of Genetics and Eugenics, Dr. Ernest Pestalozza, President, Rome, Italy, Prof. Cesare Artom, Hon. Sec'y, Via Scipioni 273 Race Preservation League, University of Melbourne, Victoria, AustraHa. Laboratorium f. Kemi & Racehygiene, Kristiania-Winderen, Norway, Dr. Ton Alfred Mj^cn, Eugenics Education Society of New South Wales, \3C, Upper Spit Road, Mosraan, Sydney, Australia. Eugenic Education Society of New -Zealand, Dunedin, N. Z. National Committee for Mental Hygiene, Inc., Dr. Thomas W. Salmon. Medical Director, 50 Union Square, New York, N. Y. Race Betterment Foundation and Eugenics Registry, Dr. John Harvey Kellogg, President, Battle Creek, Mich. Eugenicai, Diagnosis 393 Societe beige d'Eugenique, Albert Govaerts, Secretary, Maison des Medicins, 17 Grand'place, Bruxelles, Belgium. International Eugenics Commission, Major Leonard Darwin, Chairman, Dr. Albert Govaerts, Secretary, Brussels, Belgium. 3. Universities and colleges which offer especially active courses in Eugenics and Genetics. ~ Columbia University, New York, N. Y. Harvard University, Cambridge, Mass. Princeton University, Princeton, N. J. Brown University, Providence, Rhode Island. University of California, Berkeley, Cal. University of Pennsylvania, Philadelphia, Pa. University of Michigan, Ann Harbor, Mich. University of Chicago, Chicago, 111. University of Illinois, Urbana, 111. University of Kansas, Lawrence, Kans. University of Iowa, Iowa City, Iowa. University of Ohio, Columbus, Ohio. Southwestern College, Winfield, Kans. N. C. State College of Agriculture and Engineering, Raleigh. N. C. Wilmington College, Wilmington, Ohio. 4. Custodial institutions for various types of socially inadequate, which are conducting active field studies in eugenics. Name of Institution Kings Park State Hospital, Kings Park, N. Y. State Village for Epileptics, Skillman, N. J. State Hospital, Warren, Pa. Danvers State Hospital, Hathorne, Mass. Whittier State School, Whittier, Cal. Monson State Hospital, Palmer, Mass. Middletown State Hospital, Middletown, Conn. Home for Feeble-minded and Epileptic, Lapeer, Mich. Government Hospital for the Insane, Washington Taunton State Hospital, Taunton, Mass. Boston State Hospital, Boston, Mass. School for Feeble-minded and Colony for Epileptics, Fari- bault, Minn. State Institution, Polk, Pa. Letchworth Village, Thiells, N. Y. Eastern Pennsylvania State Institution for Feeble-minded and Epileptic, Pennhurst. Pa. Central Islip State Hospital Bangor State Hospital Girls Training School, Gainesville. Texas Sleighton Farm (Girls Department), Darling, Pa. Northern Hospital for Insane, Logansport, Ind. Southeastern Hospital for Insane, Madison, Ind. Indiana Girls School, Indianapolis, Ind. Clinton Farms, N. J. State Reformatory for Women, Clinton, N.J. Norwich State Hospital, Norwich, Conn. State Industrial School for Girls, Lancaster, Mass. California State Commission in Lunacy, Sacramento, Cal. Phipps Psychiatric Clinic, Baltimore, Md. Superintendent or Director W. C. Garvin David F. Weeks H. W, Mitchell Geo. M. Kline Fred C. Nelles Everett Flood Floyd Haviland H. A. Haynes Wm. A. White Arthur V. Goss J. V. May G. C. Hanna J. M. Murdock Charles S. Little Oscar E. Thomson G. A. Smith Carl J. Hedin Carrie W. Smith M. P. Falconer Fred W. Terflingei J. W. Milligan Kenosha Sessions May Caughey Henry M. Pollock Amy F. Everall Dr. F. W. Hatch Dr \dolf Meyer 394 EuGENiCAt Diagnosis 5. Courts of law which have undertaken scientific eugenical studies as an aid to their functions in determining the cases of personal conduct and in weighing and placing responsibilities. Municipal Court of Chicago. Hon. Harry Olson, Chief Justice. Dr. Wm. J. Hickson, Director of the Psychopathic Laboratory. 6. Journals. Archiv fiir Rassen- und Gesellschafts-Biologie, A. Ploetz, Editor, published by B. G. Teubner, Leipzig and Berlin, Germany. The Eugenics Review, a quarterly journal, published by the Eugenics Education Society, London; Hon. Secretary, Mrs. A. C. Gotto. Eugenical News, a monthly periodical on eugenics, published by the Eugenics Record Office, Cold Spring Harbor, Long Island, N. Y. Journal of Heredity, a monthly journal, published by the American Genetic Association, Washington. Oliver Olson, Acting Editor. Journal of Genetics, a quarterly publication of the University of Cambridge Press. W. Bateson and R. C. Punnett, Editors. Journal of the American Medical Association, Chicago, III. This weekly pub- lication reports abstracts of many of the best original papers on human heredity and eugenics. Mental Hygiene, a quarterly publication of the National Committee for Mental Hygiene, Inc., 50 Union Square, New York. Genetics, bimonthly journal, Geo. H. Schull, Princeton University, Editor, published by Williams & Wilkins Co., Baltimore. Revue d'Eugenique, quarterly review of the Societe Beige d'Eugenique, Palais d'Egmont, Maison des Medecins, Bruxelles, Belgium. Eugenique, publication of the Societe Frangaise d'Eugenique, published by Librairie J. B. Bailliere et Fils, 19, Rue Hautefeuille, Paris. 7. Books. Heredity in Relation to Eugenics, by C. B. Davenport, Henry Holt & Company New York. Eugenics and Heredity, by Coulter, Castle. Tower and Davenport. University of Chicago Press, Chicago. Essays in Eugenics, by Francis Galton, Eugenics Education Society, London. English Men of Science, by Francis Galton, Eugenics Education Society, London. Inquiries into Human Faculty and its Development, by Francis Galton. E. P. Dutton, New York. Hereditary Genius, by Francis Galton, Maamillan Company. Xew York. Natural Inheritance, by Francis Galton, Macmillan Company, N. Y. Applied Eugenics, by Paul Popcnoe and R. H. Johnson, Macmillan Company. N. Y. Ancient Eugenics, by A. G. Roper, B. H. Blackwell Company, London. Heredity in Royalty, by F. A. Woods, Henry Holt & Company, New York. The Influence of Monarchs, by F. A. Woods, Henrv Holt & Company, New York. The Human Harvest, by David Starr Jordan, .American Unitarian Association, Boston. Is, Mankind Advancing? by Mrs. John Martin, Baker & Taylor Companv, New York. The Social Direction of Human Evolution, by W. F. Kellicott, D. Appleton & Company, New York. The Declining Birth Rate, by Arthur Newsholmc, Moffatt, Yard & Company, New York.-. Race Suicide, by M. S. Iseman, The Cosmopolitan Press, New York. The Jukes, by R. L. Dugdale, G. P. Putman & Company, New York. The Jukes, 1915, by A. H. Estabrook, Carnegie Institution of Washington. Jukes-Edwards, by A. E. Winship, R. L. Myers & Co., Harrisburg. EUGENICAI, DlAGHOSIS 395 The Kallikak Family, by H. H. Goddard, Macmillan Company, Ne\\- York. The Hill Folk, Report on a rural community of hereditary defectives, by Florence H. Danielson and Charles B. Davenport. Eugenics Record Office Memoir No. 1. The Nam Family. A Study in Cacogenics. Arthur H. Estabrook and Charles B. Davenport. Eugenics Record Office Memoir No. 2. The Dack Family, by Mrs. Anna Wendt Finlayson. Eugenics Record Office Bulletin No. 15. Psychiatry, by Stewart Paton. J. B. Lippincott. Human Behavior, by Stewart Paton, Charles Scribner's Sons. Signs of Sanity, by Stewart Paton, Charles Scribner's Sons. Manual of Psychiatry, by A. J. RosanofiF, John A. Wiley & Sons. Textbook of Nervous Diseases, by Charles L. Dana, William Wood and Com- pany. Feeble-mindedness, Its Causes and Consequences, by H. H. Goddard, Macmil- lan Company, New York. Mental Deficiency (Amentia), by A. F. Tredgold, Bailliers, Tindall & Cox, London. A Point Scale for Measuring Mental Ability, by Yerkes, Bridges and Hardwick, Warwick & York, Baltimore. Physical Basis of Heredity, by T. H. Morgan, J. B. Lippincott. Mendel's Principles of Heredity, by W. Bateson, The Cambridge University Press. New York. The Cell in Development and Inheritance, by Edmund S. Wilson, Macmillan Company, New York. Genetics: An Introduction to the Study of Heredity, by H. E. Walter, Mac- millan Company, New York. Heredity, by W. E. Castle, D. Appleton & Company, New York. Heredity and Sex, by T. H. Morgan, Macmillan Company, New York. Heredity and Environment, by Edwin G. Conklin, Princeton University Press. The Direction of Human Evolution, by Edwin G. Conklin, Charles Scribner's Sons. How to Make a Eugenical Family Study, by Charles B. Davenport and Harry H. Laughlin, Eugenics Record Office Bulletin No. 13. Readings in Evolution, Genetics and Eugenics, by H. H. Newman, University of Chicago Press. The Trend of the Race, by S. J. Holmes, Harcourt, Brace & Co., New York. Statistical Directory of State Institutions for the Defective, Dependent and Delinquent Classes, by H. H. Laughlin, Bureau of the Census, Washington, D. C. Institutional Care of the Insane in the United States and Canada (in four volumes), by Hurd, Drewry, Dewey, Pilgrim, Blumer and Burgess, John Hopkins Press Summaries of State Laws Relating to the Insane, prepared by John Koren. revised by S. W. Hamilton and Roy Haber, National Committee for Mental Hygiene, Inc., New York. Summaries of State Laws Relating to the Feeble-minded and the Epileptic, prepared by Samuel W. Hamilton and Roy Haber, National Committee for Mental Hygiene, Inc. New York. Race Decadence, by Wm. S Sadler, A. C. McClurg & Co., Chicago •Reports and scientific papers of the International Congresses of Eugenics. 1st Congress, London, 1912. Problems in Eugenics, 2 vol. Description of the Exhibit. 2nd Congress, New York, 1921. Eugenics, Genetics and the Family. Eugenics in Race and State. Description of the Exhibit. CHAPTER XII. THE ANATOMICAL AND SURGICAL ASPECTS OF EUGENICAL STERILIZATION. Section A. Anatomy. Description of the Human Male and Female Re- productive Mechanisms and an Explanation of their Functions 397 a. Reproductive mechanism of the human male 398 b. Reproductive mechanism of the human female 402 Section B. Surgery. The principal types of surgical operations used in effect- ing sexual sterilization 406 1. Male 407 (1) Phallo-orchidectomy 407 (3) Phallectomy 407 (3) Castration (orchidectomy) 409 (4) Spermectomy 410 (5) Vasectomy 410 (6) Ligation of the vas deferens 411 (7) X-ray treatment 412 8. Female 414 (1) Pan-hystero-kolpectomy 414 (2) Hystero-salpingo-oophorectomy 414 (3) Oophoro-hysterectomy 414 (4) Hysterectomy 414 (5) Salpingo-oophorectomy ". 415 (6) Oophorectomy (ovariectomy, ovariotomy, castration, spaying) 415 (7) Curetting or cauterizing the intrauterine tubal openings 416 (8) Salpingectomy 419 (9) Ligation of Fallopian tubes 421 (10) X-ray treatment 421 Summary 422 a. Types of eugenical sterilization available 422 1. For the male 422 a. For the female 422 b. Future methods , 422 c. Weighing the matter of type of eugenical sterilization in relation to eugenical policy 423 Note : Continence and Contraception 423 Anatomical and Surgical Aspects 397 THE ANATOMICAL AND SURGICAL ASPECTS OF EUGENICAL STER- ILIZATION. SECTION A. DESCRIPTION OF THE HUMAN MALE AND FEMALE MECHANISMS OF REPRODUC- TION, AND AN EXPLANATION OF THEIR FUNCTIONS. The internal organs of reproduction and, ultimately, the mature ova and spermatozoa, develop from the mesoderm. In embryonic development the first evidence of the indif- ferent sex-gland is found in the genital ridges which first appear at about the fifth week as small elevations of thickened cells on the Wolffian bodies. In course of devel- opment the mesothelial cells overlying the genital ridges proliferate and, at about the sixth or seventh week, by which time they comprise a tissue of several layers, begin to penetrate the tissue of the ridge. This penetrating tissue is called the germinal epithelium because it ultimately gives rise to the germinal cells or gametes, the ova or spermatozoa, as the case may be. Later, portions of the penetrating germinal epithel- ium become transformed into structures called the sex-cords, each of which includes a number of cells destined to develop into gametes. From the sex-cord or egg column in the female germ-gland there bud off a number of parts, each of which develops into a Graafian follicle. Each of these follicles con- tains a cell destined ultimately to become the mature egg. In the testis the sex-cords undergo a change in which part of the tissue breaks away, leaving other portions which ultimately become the seminiferous tubules, the inner lining of which gives rise to the sex-cells which, during sexual maturity, de- velop into spermatozoa. Until the fourth or fifth week in embryonic life the sex-gland is indifferent, but at this time the embryologist can distinguish the ovary and the testis from each other. It is, however, not until the ninth week of intra- uterine life that the external genitals begin to show distinction. Embryologically there is a close homology throughout the reproductive systems of the two sexes, although in mature life the analo- gous functions are not always performed by homologous structures. The following table ' shows this homology of structure: HOMOLOGIES OF THE SEXUAL SYSTEM. FETAL STRUCTURE FEMALE OiRGANS MALE ORGANS Indifferent sexual gland Ovary Testis Wolffian body- Its middle series of tubules Short tubules of parovarium Vasa efferentia, rete testis and and and coni vasculosi Corresponding part of Wolf- Horizontal or long tube or Tube of epididymis fian duct parovarium Remainder of Wolffian duct Usually altogether disappears; Vas deferens, seminal vesicle, if persistent, Gartner's duct and ejaculatory duct Upper series of short tubules Stalked hydatid of Morgagni Stalked hydatid of Morgagni (pronephros) Lower series of tubules Paroophoron Paradidymis (organ of Gi- raldes) Duct of Miiller— Its upper extremity Fimbria of oviduct Sessile hydatid Succeeding portion Oviduct Usually disappears; if per- sistent, duct of Rathke Remaining portion, by fusion Uterus and vagina Uterus masculinus with its ifellow ^ Heisler, John Clement: Text-book of Embryology, p. 263. delphla, 1907. W. B. Saunders Co., PJilla- 398 Anatomical and Surgical Aspects EXTERNAL ORGANS. FETAL STRUCTURE FEMALE ORGANS MALE ORGANS Genital eminence Clitoris Penis Genital folds Nymphae and bulbi vestibuli Corpus spongiosum, enclosing spongy part of urethra Genital ridge Labia majora Scrotum Urogenital sinus Urethra and vestibule, Glands Prostatic urethra, membran of Bartholin ous urethra, prostate, Cow- per's glands Epididymis tjrethra 'Convoluted tubules in which spcnnulozoa arc manufactured Figure i. Schematic Representation of Genital Tract in ihc Male (a) The Reproductive Mechanism of the Human Male. The essential purpose of the genital sys- tem of the male is the manufarturc, storage and delivery of functioning spermatozoa. This function begins with puberty and con- tinues until late in life. The germ-tract. The spermatozoa are produced by indirect cell-division from a layer of cubical cells lining the basement membrane of the seminiferous tubules of the testes. The mature spermatozoa pass from the seminiferous tubules in which they are manufactured to the epididymis, which «rves as a first storage-reservoir. Thence they may pass through the vas deferens to a second storage-reservoir called the seminal vesicle (or they may shunt this storage); thence accompanied by seinen. through the cjaculatory duct into the urethra, and thence to the outside' During the transit oi, from ten to twenty feet from the place of origin to the outside, the spermatozoa are moved along the earlier stretches of their course by the ciliary action of the lining of the gerin- tract, during which time the spermatozoon has not yet reached maturity. From the seminal vesicles it is driven by ejaculation, which is caused by contraction of the mus- culature of the vasa deferentia, the ejaculat- WW" Anatomtcai, and Surgical Aspects 399 ory ducts, the seminal vesicles and the pros- tate gland. The semen is secreted in most part by the testes, the prostate, the seminal vesicles and Cowper's glands. It is a viscid, opalescent and alkaline fluid, and contains about ten percent of solid matter. Its whit- ish appearance is due to the presence of spermatozoa. The purpose of the fiuid is to maintain the vitality of the spermatozo.i, and to convey them in their course along the seminal passages. The Testes. The testes are a pair of glandular structures, grayish-white in color, dividuals, but the average dimension is from one and a half to two inches in length, one inch in breadth, and a trifle more in thick- ness. The weight varies from twenty-five to thirty grams. According to different au- thorities, each testis contains from two hundred to four hundred lobules or com- partments. Each lobule contains several (one to three or more) seminiferous tubules. Thus in each testis there are six or eight hundred of the latter. Each tubule measures from one hundred and forty to two hundred fi in diameter, and when straightened out Fibrous band (remains of peritoneal sac)' Vas deferens Fibrous coal and fibers of cremaster muscle Tunica vaginalis — Epididymis -Testis Figure 2. The Testis and Its Coverings and resilient in consistency. The testis is suspended in the scrotum by a spermatic cord. Generally the left testis hangs some- what lower than the right. The spei:matic cord consists of the vas deferens, blood vessels, nerves, and the liga- ment of Cloquet, the whole held together by connective tissue suspending the testis, and furnishing the latter gland its blood and nerve supply, and finally conveying from it the mature .spermatozoa. In size the testes vary greatly with in- is about two feet long. At one end each of these tubules terminates blindly, but at the apex of the lobules they unite to form the short tubuli recti, which anastomose into the rate testis, which in turn branches into the vasa efJerentia, of which there are from twelve to fifteen, each about one third of an inch in length. These tubules lead directly into the globus major of the epididymis. The latter structure is a much convoluted canal from fifteen to twenty feet long. The coil is held together by connective tissue. 400 Anatomical and Surgical Aspects The Vas Deferens. The vas deferens is a tubular continuation of the epididymis. It is a cord-Hke duct aljout two feet in length if unravelled. Its lower stretches are con- torted, but its upper portion is straight. It measures about three millimeters in external diameter, and its canal about live-tenths of a millimeter. Its walls have three coats — an outer fibrous, a middle of smooth mus- cular tissue, and an inner longitudinally folded mucus membrane. s-ac is pyramidal in shape andjjn the average measures about two inches in length and one-half inch in breadth at the base. The ejaculatory duct is formed by the junction of the duct leading from the sem- inal vesicle, with the vasa deferens, and is about three-fourths of an inch in length. The ejaculatory duct from each testis emp- ties into the urethra. The Spermatozoon. Leeuwenhoek, the in- Spcmatic artery ! Vas deferens * Veins -^ ('plexus pampinifonnis) — ^remaslcric artery Epididymis Testis Figure 3. The Structure of the Spermatic Cord The Seminal Vesicles. The seminal ves- icles are a pair of membranous structures which branch off from the vasa deferentia. Their function is to serve as storage reser- voirs for the surplus semen and spermatozoa, Each vesicle is a single tube, about live inches long and one-lifth inch in diameter, doubled on itself. They vary greatly in size and shape in different individuals, but each ventor of the microscope, and his pupil Hamm, discovered the spermatozoon in 1677. Thence arose a school of biologists known as animalculists, who held the spermatozoon to be a complete organism in miniature. Their opponents were known as the ovists, who held that the egg contained the germ. According to these two doctrines, the theory of preformation was a sound one. It was Anatomical and Surgical Aspects 401 also very simple, because development would, if it were proved, be simply a process of unfolding. In 17,'j!l Wolff announced tbe doctrine of epigenesis, which holds that the germ is unorganized, and that the union of male and female materials is essential to re- production. The ovists were considerably reinforced in argument when in 17(13 Honnet published the results of his work on partho- genesis. Now we know that both sperm and egg are essential to bi-sexual reproduction, that each is highly organized, and that, espe- cially in the contribution of hereditary genes, the egg and the sperm are practically equiv- alent. J I i The spermatozoon is a highly specialized and very active single cell. Its chromosomes carry the genes for the traits transmitted by heredity, the tail drives the organism along the seminal passages in the male, and after coitus, to the place of fertilization, gener- ally ' in the Fallopian tube of the female. The perforator enables the sperm to enter the egg in the process of fertilization. Ob- servers report the rate of progress of the spermatozoon to be from one and one-tenth millimeters to three and sixth-tenths milli- meters per minute, and estimate that the time required for passage from the upper part of the vagina to the upper part of the Skin Dartos^ Inlercolumnar fascia Cremasteric fascia.. Infundibuliform fascia— - A lobule of the testis --- Visceral tunica vaginalis— PaifSral tunica vaginalis Epididymis Vasa efferentia Vas deferens ■with its artery Spermatic artery" figure 4- A Sectional View of the Testis The spermatozoon is a single cell which in its gross aspect consists of a head or a nucleus, and a vibratory whip-like tail; but a more refined linear division is that into head, neck, body and tail The human spermatozoa are small compared to those of many other mammals. On the average in man they measure ' a total length of from 51 to 58 M, to which length the head contributes 4 to /i, and the tail 41 to 53 ij.. The width of the head is from 3 to 4 fi. The head is oval, but viewed in pro- file appears pear-shaped. At the tip of the head there is a shield of m.odified substance called the head-cap, or perforator. Chemical analysis shows the head to be rich in nucleic acid, and the tail high in proteins and fats. Structurally the tail, which by its vibratory motion serves as a propeller, consists of an axial filament surrounded by a shield of protoplasm. Fallopian tube is about one and one-half hours. The peculiar chemical composition of the semen serves the purpose of maintaining the vitality and motility of the spermatozoa. Under proper environment conditions, such as the female genital tract, the spermatozoa maintain their vitality and motility for a number of days. Comparison with other species of animals throws considerable light upon this problem. The queen bee is fertil- ized but once in her entire life. The turkey hen is said to be fertilized but once a season. The female bat receives the male in the fall, but ovulation and fertilization do not take place until spring. The number of spermatozoa produced in the life-time of a single human male is very J Reference Handbook of the Medical •Sciences, .Vol. VII, p. 822. 2 J. P. MoMurrich: The Development of the Human Body, p. 34. 402 Anatomical and Surgical Aspects great. It has been found that "one cubic miUimeter of human ejaculate contains 60,876 spermatozoa, a single ejaculate, there- fore, containing over 200,000,000. This would indicate that during his lifetime a man may produce 340 billions spermatozoa (Lode)."' Since in each testis there is a total of seven or eight hundred linear feet of seminiferous tubules, in the two testes there are on the average appro.ximately fifteen hundred feet of tubes of 140 /i to 200 /x in caliber, which are lined with spermatozoa- bearing epithelium (Hill). science of heredity to study progeny result- ing from crossing of differently constituted individuals and thereby to learn the rules governing the segregation and recombina- tion of natural traits. The ancestral cells of all spermatozoa and ova have continued in unbroken descent from the germinal cells of the ancestors of the particular individual possessing them. These cells are especially important because they carry within their walls the whole hereditary endowment of their possessors, and consequently inter- ference in human reproduction in the inter- a.c=Anterior centrosome g.c.=Cap a.f=Axial filainent n.=Nuclcus c.p.=:Connecting piece nk.=Neck sh.p.=Chicr piece p.=Proloplasm p.c.=Poslerior cenlrosome Figure 5. The Development of a Human Spermatozoon The process of spermatogenesis is closely analogous to the maturation of the ovum. In each case the ancestral germinal cells are prepared for union by a process of re- duction, as a result of which there remains in the mature germ-cell (ovum or spermato- zoon) only one-half the number of chromo- somes characteristic of the cells of the body tissues of the individual which produces the particular gamete. However, in normal re- production, these chromosomes represent all of the essential characteristics of the species. Thus, an individual who is the product of the union of two such gametes possesses twice over all the essential characteristics of the race. And thus the difference in the repertoire of non-essentials permits the csts of eugenics is centered upon these par- ticular cellular units. (b) The Reproductive Mechanism of the Human Female. In the human species more duties are per- formed by the genital mechanism of the fe- male than by that of the male. In the fe- male, not only must the mature germ-cell (ovum) be produced and delivered to the place of fertilization in the Fallopian tube or uterus, but the uterus must implant the zygote or fertilized egg and nourish it until the fetus is ready for birth. By the process of parturition, the female mechanism must 'J. P. McMurrich: The Development of the Human Body, p. 19. Anatomicai, and Surgical Aspkcts 403 deliver the child, and finally by the secre- tions of the mammary glands, the mother must further nourish the child for a number of months. The Germ-tract. The ova are developed tion must intervene) is discharged from each ovary every twenty-eight days during the re- productive period. Upon being thus dis- charged, the ova are set free in the body cavity near the funnel-chaped openings of the t^-i/ - Pari of lube excised in salpingcclomy' Vagina ' Figure 6. Schematic Representation of the Genital Tract in the Female in the cortex of the ovaries. Tiie cortex comprises that part of the ovary which over- lies the central or medullary portion. Ova are discharged from the Gra.-ilian follicles, which are imbedded in the cortex, by the rupture of the surface (a process known as ovulation). This process is variable and peri- odical, but as a rule one ovum (as yet not ready for fertilization; the process of matura- Fallopian tubes, each of which openings is provided with vibratory cilia. These cilia set up currents from the body fluids which direct the free but non-motile ovum into the tube, whence it is carried by ciliary action the entire length of this duct to its final place of fertilization near the end of the tube or in the cavity of the uterus. Ova, if not fertilized, soon degenerate, but those which Ligament of ovary^ I Mesovarium ; Mesosalpinx 1 [ Isthmus of tube Ampulla^ Fundus Abdominal oriflce Fallopian tube Ligament of ovary ^Round ligament of uterus Neck of uterus -•-Exiernolos (or opening) of uterujs Figure 7. The Ovary, Fallopian Ttibe and Uterus in Place 404 Anatomical and Surgical Aspects unite with the spermatozoa immediately l)e- gin active development. The union of the spermatozoon and ovum is believed to take place usually in the I'^al- lopian tube, whence the fertilized ovum, or zygote, as it is now called, normally migrates to the cavity of the uterus, where it becomes implanted. Under normal conditions, only one spermatozoon penetrates the egg or ovum; others may be present in great num- bers, but they eventually perish. There is thought to be a chemical affinity between the unfertilized ovum and the spermatozoon; at any rate they are brought together by phy- sical or chemical agencies. Immediately after fertilization, a reaction appears to establish a resistance to the penetration of long, three-fourths inch broad, and one-half inch thick. Each ovary is held in place by a suspensory ligament, which is a peritoneal fold, and by the ovarian ligament, which attaches it to the uterus. It is also steadied by the Fallopian tube. Its cortex, or outer portion, contains a number of Graafian fol- licles, each of which carries a potential ovum. These follicles vary in size with age and de- gree of development, from one-sixth inch in diameter when about ready to deliver the ovum, down to the size of pin-head, thence smaller, and finally below the range of the vision of the naked eye. As a Graafian follicle develops, the growing ovum which it contains is surrounded by small cells, and this mass, which fills only a small portion of the fol- Outer covering of ovary Graafian follicles in various stages of development Corpus luteum- Early stages of Graafian follicles lying near surface - Blood vessels Stroma Figure 8. A Diagrainiiwtic Section of the Human Ovary other spermatozoa, at least by this time a definite vitelline membrane surrounds the zygote. The Ovaries. The function of the testes was known long before the analogous female organs were identified. Galen (born l.'JO A. IX) described the ovaries as testes muliebres. William Harvey, in Ifi,';!, laid down the dic- tum that the ovum is the starting ]«)inl common to all aiiini;ils. In 1(1(11 Nicolaus Stcno identified the female sex-gland of mammals with that of sli;irks, ami lirsl named it the ovary; bul il \\,is not initil 1837 that the identity of the human ovum was established. This was the work of K. \l. von Baer. 'The' human ovaries are a pair of dehiscent almond-sha|)ed glands situated one on either side of the uterus in a layer of the broad ligament and below the b'alloiiian tubes. In the mature adult the ovary is reddish-gray in color, and about one and a half inches licle, is attached to the inner lining of the sphere The remainder is filled with the follicular fluid. .According to different au- thorities, from ten to fifty Graafian follicles may be seen at one time bulging on the surface of a functioning ovary. In childhood the surface of the ovary is smooth and even, but in adult life it becomes pitted and librous, due to scars caused by the rupturing of Graafian follicles. The early differentiation of the primitive ova is a feature which deserves special atten- tion. Before a female child is born there are perhaps 100,000 of these potential ova in each ovary, but even before birth their degeneration begins, so that at the time of birth it has been estimated that there still remain perhaps 30,000 or 40,000 potential ova; but only a few of them develop, and the rate is very slow. With puberty the process of ovulation discharges an egg from each ovary. .\s a rule ovulation occurs Anatomicai. and Surgical AspI'CTs 405 generally at the time of menstruation, al- though it has been shown that the two pro- cesses may operate independently. t)vnla- tion continues periodically at intervals of about twenty-eight days until the climac- teric. Thus during the thirty years of active sexual maturity the human female will pro- duce TOO or SOO mature ova. .\fter the climacteric all of these potential egg cells degenerate, and the ovary becomes shrunken and fibrous. After the Graafian follicle discharges its ovum, the reconstructed body which remains is known as the corpus luteum. If the ovum is not fertilized, the corpus luteum (false) reaches its maximum development within a length, and lineally consists of a constricted portion, the cord- like isthmus, which con- nects with the uterus (its caliber barely ad- mits a small bristle), the softer ampulla or dilated portion, which curves over the ovary, and the infundibulum, the funnel-shaped terminal opening of the tube. The margin of the latter is irregular, due to the presence of fimbriae, one of which is attached to the o\ar>-, the remainder being free. While the oviduct is analogous in function to the vas deferens, embryologically these two ducts have a very different descent, the oviduct developing from the duct of Miiller, and the vas deferens from the Wolffian duct. A cross-section of the Fallopian tube Coron Zona pellucida — a radiata 4^v^ Nucleus -?'.X%^ -^/^ — -V_^ ^ ^ "is; ' '--1. Fiaurc o. A Mature Human Ovum week and then begins to shrink, and is en- tirely absorbed within a short time, leaving only a pitted scar. If. however, fertilization occurs, the corpus luteum (truet continues to grow for two or three months, and ac- quires the size of one-third to one-fourth that of the entire ovary. Finally it begins to shrink, but may not totally disappear un- til a month or more after labor. The Fallopian Tubes (or Oviduets). Un- like the case in the human male, in the fe- male the mature gamete does not have a continuous duct for its passageway. The mature egg, after being discharged into the body cavity, is taken up by the open and fimbriated end of the Fallopian tube or oviduct. This latter organ is a muscular trumpet-shaped tube about four inches m shows three coats, first, an outer peritoneal covering: second, two muscular layers (the outer with longitudinal and the inner with •circular fibers): and third, a lining of mu- cous membrane. The latter is folded longi- tudinally, is ciliated, and contains numer- ous glands. These cilia direct currents from the peritoneal cavity to the cavity of the uterus. They thus aid the movement of the ova and impede that of the spermatozoa. The Uterus (or Womb). The uterus is the organ of gestation. It receives, implants and supports the fertilized ovum until the latter develops into a child. It is a hollow pear-shaped organ with thick muscular walls. In non-pregnant adults it measures about three inches in length, two inches in greatest breadth, and one inch in thickness. 406 Anatomicai, and Surgicai, Aspects It weighs from one to one and a half ounces, and is held in position by eight ligaments. The upper portion of the uterus, which lies above the entrance of the Fallopian tubes, is called the fundus. Below the tubes the gradually narrowing central portion is called the body, and the constricted portion, which is about one inch long, is called the cervix or neck. The neck protrudes into the upper anterior end of the vagina, and contains the os uteri, which connects the cavities of the uterus and vagina. It is through this opening that the spermatozoa enter, and from it that the child is delivered at parturition. The growth of the uterus is very slow until the approach of puberty, when, for a time, its development is very rapid. During pregnancy the muscle fibers of the uterus hypertrophy enormously, in order to make room for the fetus, to hold it in place, and finally to act as the principal object of ex- pulsion at the time of parturition. After parturition the uterus rapidly regains its normal size and shape, but neither its cavity nor the os uteri quite reaches the virgin smallness. The Ovum (or Egg). The human ovum is a large non-motile spherical cell which, ac- cording to different authorities, ranges from 0.17 millimeters to 0.35 millimeters in dia- meter, and is thus barely visible to the naked eye. As in all animals, the ovum is immense- ly larger than the spermatozoon. In some species the size ratio of the two kinds of sex-cells is 1 to 100,000. Thus the contrast between the large, spherical and inactive egg and the small, flagellate, and exceedingly motile spermatozoon is very great. After the expulsion of the ovum from the Graafian follicle, an important change must take place before it is ready for fertilization. This change is called maturation, and is , essentially a cell-division by which the, num- ber of chromosomes (the essential bearers of heredity) within the nucleus is reduced to 'one-half the number of the normal cells of the tissues of the body. Thus the egg is prepared to receive a like contribution of one-half the number of trait carrying quali- ties in a similarly reduced nucleus of the spermatozoon. The ovum contains a nucleus or germinal vesicle of relatively large size, being about one-fourth the diameter of the entire ovum. Besides the nucleus, the ovum contains deutoplasm (yolk), which is a nutritive sub- stance, and a still larger quantity of clear cytoplasm. It is surrounded by a zona pel-, lucida, which is a thin film giving it strength. Sometimes the remnants of the covering of smaller outer cells adhere, to which cell-group the term corona radiata is applied. Of the seven or eight hundred ova pro- duced by the average woman, she is of course able to use only a very few (less than a score) in the production of offspring. SECTION B. THE PRINCIPAL TYPES OF SURGICAL OPERATIONS USED IN EFFECTING SEXUAL STERIL- IZATION. The mechanism of human reproduction is so complex that it may be operated upon in either the male or the female in a great number of different manners, any one of which will destroy or at least nullify the essential function of reproduction. Neither is it surprising that an abnormal variation of an hereditary nature, from natural struc- ture, or abnormal development due to in- jury or to the inroads of certain diseases, may so disorder this intricate mechanism that it ceases to function and consequently the individual possessing it is rendered in- capable of begetting, or of conceiving and bringing to birth, a child. In the case of paired organs, such as the testes and vasa deferentia in the male, and the ovaries and Fallopian tubes (oviducts) in the female, it is necessary to perform the operation on both members of the pair. Otherwise the person operated upon, whether male or female, may retain sexual fertility. The matter of permanence of sterilization is equally important with that of effective- ness. Only in the case of the minor and least radical means of sterilization is there a possibility of restoring sexual fertility. Particularly in cases of ligation, whether of vasa deferentia or of Fallopian tubes, is there such a possibility by the surgical re- moval of the obstruction in the gamete- carrying ducts. In certain types of ligation restoration is said to take place naturally without surgical or medical interference. In cases of vasectomy in which only a verj small section (J4 inch or less) of vas defer- ens is removed, there is said to be a pos- sibility of reanastomosing a functioning duct. The permanency of sterilization by scari- fying or cauterizing the intra-uterine tobal Anatomical and Surgical Aspects 407 openings depends upon the skill and effi- ciency with which the particular operations are performed, and because of the great skill required, and the amount of guesswork involved, such operations are to be placed in the list of doubtful efficacy and per- manence. The permanency of sterilization by X-rays is not proven for either sex. With the development of more extensive knowl- edge of this relatively new agency, a method of its use which will assure permanency may be worked out, but at present it is quite uncertain in both efficacy and permanency. All other types of sterilization here listed for both male and female are absolute and per- manent, and when any one of them is prop- erly performed, it is beyond the power of nature or surgical skill to restore sexual fertility. Sexual sterilizing operations in common use fall into two general groups, first, those which destroy or remove the sex glands which manufacture the essential germ-cells, and, second, those which leave the gonad intact, but which interfere with the delivery of the mature germ-cells to the outside in the case of the male, and to the uterus in the case of the female. But there is also a third class which destroys the sexual func- tion by impairing or removing one of the essential organs of coitus or child-bearing. In this class are such operations as the am- putation of the penis in the male, and the extirpation of the vagina or of the uterus in the female. These operations are, how- ever, of little eugenical intent, because they are much too radical for the sole purpose of sterilization. In the case of individuals with undiseased sex-organs, the operations of vasectomy in the male and salpingectomy in the female are, under the present stage of surgical knowledge and practice, greatly to be preferred. The reason is that they are the least radical which produce per- manent sterility. 1. Male. Practically the human male may be made sexually sterile * by operating upon the tes- tes, the spermatic cords, or the penis, all being essential organs of natural reproduc- tion. Any of the following surgical opera- tions or treatments, here listed in order of decreasing radicalness, will effect sexual sterility in this sex: (1) Phallo-orchidectomy. (3) Phallectomy. (3) Castration (Orchidcctomy) " '<) Spermectomy. (5) Vasectomy (6) Ligation of the vas deferens. (7) X-ray Treatment. (1) Phallo-orchidectomy. (Gr. tt>a\\6s, penis; "Spx", testicle; e/CTo/*^, excision.) This operation consists both in castration and in the amputation of the penis. It ap- pears in historical times to have been re- sorted to for the purpose of producing eunuchs with no external genitals. Boys so operated on became the true castrati of the Romans. Phallo-orchidectomy is still re- sorted to by certain African tribes, for the purpose of supplying slaves to the Moham- medan markets. The operation when carried out with barbarous crudeness is said to be accompanied by a high death rate. Even in successful cases the surgical shock is great and requires a longer period of time for convalescence than the ordinary castration There is, of course, no eugenical purpose served by such an operation that cannot be found in much less radical treatment. The minimum radicalness that will produce per- manent sexual sterilization serves the maxi- mum eugenical ends. Phallo-orchidectomy is mutilation in addition to eugenically effective castration. (2) Phallectomy. (Gr. ^oXXos, penis; «kt-o/i^, excision.) This operation consists in the amputation of the penis. It is rarely resorted to, so far as available records go, for social purposes, and has never been used for the achievement of eugenical ends. Its use is limited to practical treatment indicated for purely medical reasons, usually carcmoma. 1 In the wider sense sexual sterility means physiologically Incapable, for whatever cause, of functioning as a parent; In the narrower meaning it applies only to loss of ability to produce active spermatozoa or ova. The term is here used in the wider sense. " "It is important to remember that there are different degrees of castration, for in current language these are seldom distinguished. The Romans recognized four different degrees. 1. True castrati, from whom both the testicles and the penis had been removed. 2. Spadones, from whom the testicles only had been re- moved. 3. Thliblae, in whom the testicles had not been removed, but destroyed by crushing; this practice is referred to by Hippocrates. 4. Thlaslae, in whom the spermatic cord had simply been cut. Millant, from whose Paris thesis (Castration Crlminelle et UTanlaaiu, 1902) : I take these definitions, points out that it was recognized that spadones remained apt for coitus if the operation was performed after puberty, a fact appreciated by many Ro- man ladies, ad secnras libldlnationes, as St. Jerome remarlced, while Martial (lib. iv.) said of a Roman lady who sought eunuchs: "Vult futui Gallia, non parere." (See also Millant, I^es Ennuques k Travers les Acres, 1909, and articles by Lipa Bey and Zambaco, Seznal- FrobUme, Oct. and Dec, 1911.) Havelock Ellis. "The Analysis of the Sex Impulse," p. 9. 408 Anatomical and Surgical Aspects It is a major operation and requires the usual hospital after-treatment of such op- erations. The following is an account of the surgical technique given by Warbasse;' "Amputation of the penis. * ♦ * A sound or catheter is inserted into the urethra and an elastic ligature is placed about the organ at its root. " * * The glans is grasped with tenaculum forceps, drawn forward, and held by an assistant. The assistant also holds the sound. A circular incision is then made through the skin * * * The skin flap is dissected back far enough to provide a flap to cover the stump. The corpora cavernosa are then divided. The urethra with its surrounding spongy tissue is then dissected free and divided at a distance of about 1 cm. (J^ inch) anterior to the point of division of the cavernous bodies. "The dorsal artery and veins are then tied. The constricting ligature is removed. Some blood rushes out of the erectile sinuses and bleeding. then usually stops. The divided surfaces of erectile tissue if covered in by a few sutures of fine catgut passing from side to side. The urethra is then divided on its floor for about 7 mm. (^ inch). The skin is then pulled over the stump. A suture catches the urethra on either side and fastens it to the skin at the lower angle of the wound. The rest of the skin is then approx- imated in a vertical line. The object of longitudinal division of the mouth of the urethra is to insure against cicatricial "nar- rowing. A catheter should be inserted into the bladder for continuous drainage for two days.'' The penis is the organ of copulation, but has nothing to do with manufac'uring the spermatozoa. A man whose penis has been amputated is practically incapable of pro- creating, but his testes may still proliferate active spermatozoa, and his vasa deferentia may still deliver them to the outside. If artificial impregnation by means of the syringe, using the male semen containing active spermatozoa, ever becomes feasible in the human species, as it has proven practical with certain of the largest domestic animals, then phallectomy will not necessarily pre- clude a man from becoming a father. (3) Castration (L castratrio castration); also Orchidectomy (Gr. iSpx", testicle; iKTo/i'/i, excision.) Castration consists in the removal of both testes in their entirety. This operation may be modified by removing only a major por- tion of the testes (the remaining portion is called a "graft")," but by destroying their functional ducts that sterilization is effected without greatly interfering with the gland as an organ of internal secretion. There is an- other variation of castration, namely crush- ing rather than excising the testes in young boys. This operation destroys the functional use of the testes in producing spermatozoa, but apparently does not destroy the property of internal secretion. Thus, in the end re- sults, crushing the testes is much like remov- ing only a major portion of them. So far as information can be obtained, crushing is not resorted to today. Eugenically the most satisfactory form of castration consists in removing both the testes in their entirety. If it is desired only to accomplish steriliza- tion without destroying the endocrine value of the testes, then vasectomy, on account of the simplicity and mildness, would appear to be preferable to removing even a major portion of the testes. A eunuch is a man who was castrated in boyhood. This type of man was known to practically all of the ancient civilized and half-civilized peoples. Eunuchs played an important part in Egyptian, Chinese, Indian, Persian and Roman life. In Mohammedan countries they are still prized as harem attendants. In the papal choir they (soprani) were common until the accession of Leo XIII. It should be pointed out that in historic times most of the cases of castration have been performed not primarily for eugenical purposes, but for commercial or social reasons. The latter motives must be rated as shortsighted because, if a racially valuable individual is unsexed, his natural contribution to the success of the race to which he belongs ends with his own personal existence. Neither ancient nor half-civilized peoples were acquainted with the use of general anaesthesia, but they nevertheless castrated boys and men. The operation is a severe one and today should be performed only under hospital conditions. On account of the shortness of time required, nitrous oxide (laughing gas) is recommended by some surgeons, also the operation may be per- 1 Warbasae, James Peter: Surgical Treat- ment, Vol. III., p. 255. W. B. Saunders Co., Philadelphia, 1919. - Proceedings of the Roy. Soc., Vol. 73, Nt. 1904. Experiments by S. G. Shattook and C. G. Seligman. iW' Anatomical and Surcical Aspects 409 formed under a local anaesthetic. However, a general anaesthetic is usually preferred. Castration is usually unattended by serious complications. In young boys it is even less serious surgically than in adults. In 1886 the value of double castration in treating enlarged prostate glands was demon- strated. As staged elsewhere, vasectomy was, a decade later, proven to be just as efficaci- ous in relieving this ailment. Surgical Technique. (Figure 10.) Preparation for operation.' "Preliminary 1)luut dissection. The isolation of the cord should be carried as high as is necessary. In the case of malignant disease the fascial coverings of the cord should be removed with the cord, and the amputation should be made as high as possible. In ligating the cord, it is best to separate it into several smaller fasciculae and ligate each separately rather than throw a single large ligature around the whole mass. The wound in the scrotum may be closed by a subcuticular suture and compressing dressing applied." ^ \^:^ ll »*^^i^i,,a«rt*» ^ .^BBBL- fi^ 9H;.ryrf|bns'ancl ^B i^H F' ^Hft ^Iv ^^1 i. L P cleansing of the operative regions should be repeated several times at intervals of some hours, and immediately before the operation the penis should be bandaged in sterile gauze, since it is a frequent source of infection in operations about the genitalia." The Operation^' "An incision is begun just below the ex- ternal inguinal opening and is carried down- ward on the scrotum as far as the middle of the testicle. This incision should pass through the skin and the several layers oi fascia down to the cord and the tunica vaginalis. The testicle with the tunica vagi- nalis and the cord should be isolated by Figure lo. The Oteratimi nf Castration After-treatment. "The wound after this operation calls for no special treatment. Wounds of the scro- tum, on account of the folds in the skin, are liable to sepsis. The stump of the cord, unless the precaution is taken "of sewing it into the abdominal ring, may retract and bleed. Hernia is likely to make its appear- ance after castration."^ Genito-Urinary Sur- Surgical Treat- W. B. Saunders 1 White and Martin: gery, 1917, p. 340. -' Warbas.se, James Peter: ment, Vol. Ill, pp. 319-320. Co., Philadelphia, 1919. 3 Crandon-Ehrenfried: Surgical After-Treat- ment. W. B. Saunders & Co., Philadelphia, 1912 (Second Edition). 410 Anatomicai, and Surgical, Aspects Usually the patient elects to remain in bed eight or ten days, but according to some authorities this is not necessary. (4) Spermectomy. (Gr. (^Trfp/ia, seed; ektoiuij, excision.) This operation consists in the ligation and excision of a .section of the spermatic cord. It is, so far as sexual sterilization is con- cerned, the equivalent of vasectomy; but physiologically and surgically is more radical in that in spermectomy the entire spermatic cord, including the nerves, veins and arteries cision of a section (,'4 inch to 1 inch) of each of the vasa deferentia. The vas deferens is the tube, a part of the spermatic cord, which carries the matured spermatozoa from the testis to the epididymis. Vasectomy is the least radical operation for sexual steril- ization upon the male which is sure to be effective. This operation is comparable functionally with salpingectomy in the fe- male, because in each case the sex-germ carrying duct is severed, but anatomically and embryologically the two ducts are Figure II. The Ol'cratioit of I'oscclomy Drawing m.icle under the direction of Dr. Margaret H. Siiiytli. Stockton State Hospital, California which supply the testes, as well ,is (hr vas deferens, which is the essential sex duel, arc excised. Physicians found that in Irealinn pro.st.ilic enlargement spermectomy is just as effective as castration, and still later that vasectomy is just as effective as spermectomy. The consequence is that at present there is practically no therapeutic, and absolutely no eugenical purpose served by spermectomy. (5) Vasectomy. (L, vas, vessel; f'/>To/xiJ, ex- cision.) Vasectomy, which is a refinement of sper- mectomy, consists in the ligation and ex- quitc dilTcrent. the Fallopian tube in the female being deep-seated and embryo- logically developed from the duct of Miller, most of which degenerates in the male fetus. On the other hand, the vas deferens in the male is much smaller in external diameter, is situated near the surface, and embryo- logically develops from the Wolffian duct, most of which degenerates in the female fetus. Dr. H. C. Sharp, surgeon of the Reforma- tory at JefTersonville, Indiana, appears to have been the first to use vasectomy eugen- ically on any scale. His operations of this nature began in 1899. Anatomicai, and Surgicaiv Aspects 411 Surgical Technique. (Figure 11.) Vasectomy is a very simple operation, which is accompanied by very little shock, and may be performed without an anaes- thetic, although most surgeons advise that it be done under local anaesthesia. Its pain wjthout anaesthetic has been compared by men who were vasectomized to that ex- perienced in the extraction of a tooth. In most of the cases reported, the preparation consisted only in a thorough cleansing of the parts with soap and water. The whole operation requires less than five minutes when executed by a skillful surgeon. VASECTOMY FOR THE PURPOSE OF STERILIZATION AS DONE AT THE STOCKTON STATE HOSPITAL. "Roll the vas between the thumb and index finger, separating it from the other structures of the cord. Fix it close against the skin of the scrotum with small tenacu- lum forceps. At this point make incision over the vas about 1 cm in length down to and exposing vas. Lift up the vas with a strong curved needle and cut out a portion Yz inch in length. Leave the lower end free to drop back into the sheath. Tie the upper end with fine silk ligature. Sew up the sheath with fine catgut, leav- ing the upper end of the vas outside of the sheath, to prevent possible union of the cut ends of the vas. Operation is done in a few minutes and in insane patients best /dpne under general anaesthetic, preferably gas. Operation is practically bloodless." Dr. Margaret H. Smyth, Stockton State Hospital, California. May 22, 1921. According to Warbasse} "It may be done under local anesthesia, first anesthetizing the skin and then, after incising the skin, infiltrating the cord with weak cocaine solution, care being taken not to puncture a vein. The skin incision begins just below the external inguinal opening and extends downward in the line of the cord for tYi inches (4 cm.). The coverings of the cord are divided and pressed aside. The vas is isolated and two ligatures are tied about it, 2 cm. (f^ inch) apart. A segment of the vas 1.25 cm. (J4 inch) in length is cut out from between the ligatures. The two stumps should not be tied together. The upper stump should be doubled back upon itself and the ligature tied around the doubled tube. This causes angulation which more securely closes the tube against the entrance of spermatozoa. The skin wound may be closed with a subcuticular suture." After-care. The patient may leave immediately. Parts may feel sore for a day or two, but the patient need not abstain from work. There have been no cases of serious post-operative complications reported from vasectomy per- formed for eugenical purposes. However, in the case of enlargement of the prostate in old men, "Vasectomy done early gives a mortality of from 3 to 5%i. If performed later, the mortality is 10 to 15%."'' but there is practically no relation between vasectomy of young men for eugenical and of old men for therapeutical purposes. Permanency. Vasectomy, properly per- formed, causes absolute and permanent sex- sterility, unless surgery is again resorted to, but even in which case restoration of func- tion is doubtful. Dr. G. Frank Lydston" has described the surgery of re-anastomosis of the vas deferens in cases wherein restoration of function is desired. Dr. Wm. T. Belfield* of Chicago, makes the following three statements: (1) Vasectomy which removes over an inch of the vas offers little chance of restora- tion of the lumen and function of that tube. (2) Vasectomy which removes 54 inch, and leaves the obliquely cut ends of the tube overlapping, permits subsequent restora- tion of the lumen and function of this tube by a modification of the technique described by Mayo, Annals of Surgery, Jan., 1895. (3) Restoration of an outlet after oc- clusion of the epididymis by gonorrhea, has been successful in a minority of the attempts made. (6) Ligation of the vas deferens. The ligation of the whole spermatic cord, or of the vas deferens alone, has been attempted and supported as a means of attaining sexual sterilization in the male. So long as the 1 "Warbasse, James Peter: Surgical Treat- ment, Vol. III., p. 320. W. B. Saunders Co., Philadelphia, 1919. 2 Modern Surgery: Da Costa, p. 1388. 7th Edition. 1918. s Impotence, Sterility and Sex-Gland Implan- tation: Rlverton Press, Chicago, 1917. Chap- ter VI., pp. 92-96. 4 Leter to author, July 29, 1919. 412 AnATOMICAI, and SURGICAI, ASPECTS vas deferens is not a functional duct, whether because a section has been excised, or be- cause it is occluded by ligation, or inflamed following disease, the particular male will be sexually sterile. The successful ligation of the vas deferens is surgically more difficult than its excision. There is a possibility that if the ligature consists of organic substances, it is apt either to be absorbed if too thin, or to suppurate if too thick. According to Dlckinsoni "a flne silk or linen ligature or silver wire is passed about it (the vaa deferens) and drawn snugly enough to obliterate the caliber of the duct, but with in- tention not to cut it through. The ends of the ligature are cut close, the duct dropped back, and the skin closed. The ligature becomes en- cysted. A test made of the semen shows all other elements, and unalterated bulk, but no spermatozoa. If at some subsequent time it is desired to resume this capability for fertili- zation, the wound can be reopened and the little ligature cut off. But experiment has shown that, as with other ligatures, with mu- cous lining in apposition with mucous lining, and particularly with pressure from behind, it is dlfBcult or impossible to shut off a canal. • • • No ligature except a silver wire will last." It is suggested that ligation in two or more places would promote permanence. The surgical severity of the operation is about the same as that accompanying vasec- tomy, but in its after-effects, due to the inflammation from the ligatures, ligation ap- pears be accompanied by more temporary discomfort than that which follows simple vasectomy. Restoration of an occluded vas deferens by surgical interference stands a greater chance in ligation than in ordinary vasec- tomy. Surgeons have had some experience in such work, because in many cases the vasa deferentia are occluded by gonorrheal infection, but the principal reason for expect- ing restoration in the case of ligation is that it is very difficult to secure permanent oc- clusion "in a duct by muco-mucous ap- position." (7) X-ray treatment. Roentgen or X- rays were discovered in ISO.'i by W. K. Roentgen; radium in 1899 by P. and Mme. Curie. Experimentation had not continued long before it was discovered (first in guinea-pigs and rabbits, 1903, and later in man, 1904), that exposure to repeated doses of X-rays caused azoospermia. Sterilization by X-rays is the most subtle of known methods. In the male X-radiation effects sterility by causing the destruction of the epithelial cells lining the tubuli sem- iniferi of the testes, certain of which cells in normal course develop into spermatozoa. The result is that the semen is devoid of spermatozoa. Since X-rays cannot be felt, there is no need for an anaesthetic of any sort in con- nection with their application to effect ster- ility, neither is there any surgical shock accompanying the treatment. If skillfully applied in proper doses, there should be no untoward results. Unskillfully applied, this treatment may result in "Roent- gen burns", and thus seriously damage the tissues affected. Persons who work with X-rays and are subjected to them for long periods of time, without proper protection, suffer greatly from tissue destruction. Dosage and Technique. The American Roentgen Ray Society, Dr. Arthur C. Christie, President, March 17, 1921, reports as follows: "In reference to the use of X-rays for effecting sexual sterilization: (a) Appa- ratus needed: The ordinary 10 kilowatt out- fit with Coolidge tube would be the most satisfactory for this purpose, (b) Dosage: 5 milliamperes; 8 inch spark gap; 10 inch target skin distance; each treatment 8 min- utes through 5 millimeters aluminum filter; both testicles being treated at once, (c) Number of applications: Three, at intervals of four weeks, (d) Physiological consequen- ces: None other than sexual sterility." Comment. There have been so few cases of sexual sterilization of human beings by X-rays, in which clinical records have been kept, that physicians are only just now begin- ning to describe with assurance the tech- nique of the treatment. It appears, how- ever, that the ultimate treatment will .con- sist in several applications each of a few minutes' duration, at intervals of a number of weeks, but the optimum number, duration and intensity of application are still matters of investigation. The principal problems connected with this type of sterilization are those of tissue injury, of effectiveness, and of permanence. The question naturally arises whether a sex- gland, having been made sterile by X-ray will have to be irradiated at certain inter- vals in order to maintain sterility, or whether there is a possibility of restoring fertility through surgical or medical treatment; This, too, is a matter for experimental determina- } Simple Sterilization of Women by Cautery Stricture at the Intra-Uterlne Tubal Openings, Compared with Other M'ethods: Surgery, Gyne- cology and Obstetrics, August, 1916, pp. 203- 214. ANATOMICAIy AND SURGICAI, ASPECTS 413 tion. In order to be of certain eugenical value, it is clear,- of course, that sexual ster- ility must be permanent. From Colwell and Russ ' we learn that in 1903 Frieben, working with rabbits and guinea-pigs, demonstrated that prolonged exposure to- rays produces sterility and atrophy of testes, and showed that sterility Avas due to destruction of the epithelium lining seminiferous tubules. The first hu- man experimental work was done in 1904 by Philipp. Two men were irradiated in the perineal region for therapeutic reasons. The first was exposed to X-rays on thirty suc- cessive days (total of 365 minutes). The second was exposed on eighteen days (total 190 minutes). Examination showed absence of spermatozoa in both subjects. In 1905 Brown and Osgood'' recorded 18 cases of X-ray workers who were subjects of complete azoospermia. These men had done extensive X-ray work for more than three years. Dr. James A. Honeij,' of the Yale Roent- genological Laboratory, wrote: "I feel that practical application of the X-rays to sexual sterilization should not be practiced until considerably more animal experimentation has been undertaken." That much is yet to be learned concern- ing the use of X-rays and radium in effecting sexual sterilization in man, is well set forth by the following letter from Dr. Halsey J. Bagg, Memorial Hospital, 106th street and Central Park West, New York City, who is conducting animal experimentation with radium and X-rays: December 5, 1921. " * * * The whole subject interests me greatly, especially in the light of my recent biological experiments with both X-rays and radium on disturbances in mammalian de- velopment. "I have conferred with our X-ray depart- ment, and they agree that the dose specified in your questionnaire (X-ray outfits com- monly used by dentists) is a 'full skin dose,' but experience here has shown that individ- ual difference in biological reaction is so great that we do not know, how permanent the sterilization might be. I believe that, so far as we know, no scientific experiments have been conducted along these lines on the larger mammals and until such studies are made, we are not justified in drawing firfal conclusions. "There is also a tendency to question the statement that the physiological effects are probably nothing more than psychomental derangement. Physicians I have spoken to suggest that more serious internal secretion changes might result from treating especial- ly younger humans, and from a eugenic standpoint, I suppose, this is just the class you want to reach. Again only experiment- ation can answer the question. "The question of sterilization by radium is also an unanswerable one at the present time. No complete data, that I know of, are available, and in the light of cases, where the reproductive function has been retained, a considerable time after radiura treatment, the physicians I have spoken to, (who have had considerable experience in the use of radium) would not commit themselves so far as to suggest any possible dosage." In a short paper urging the proper protec- tion of X-ray workers on account of their liabili'ty to injury, and especially to sexual sterility. Dr. Alfred C. Jordan' says: "Considering the entirely undefended po- sition of the testes, it is no matter for sur- prise that they should be affected by very small doses of X-rays, provided the doses be repeated often enough. Wisdom sug- gests the advisability of inserting a small protective apron under the clothes as an additional measure. This expedient is in fairly general use, but it is merely an ad- juvant, and cannot be relied upon in the absence of the other measures I have de- scribed. "I am not aware of any reliable data bearing on the interesting question of the possibility of recovery from sterility, once it has become complete; assuming the con- dition to be recognized early enough, say while there are still immobile spermatozoa, it would appear possible that two or three years of complete abstinence from X-ray work might result in some degree of re- covery, but I do not see how a man could expect to recover otherwise .unless he were to take such extreme measures or precaution as would preclude the possibility of his doing really useful work." It may be noted in this connection that investigators quite uniformly report that there is no change or deterioration in po- 1 Radium, X-Rays and the Living Cell. pp. 235-253, 2 Aruerican Jour, of Surgery. Vol. 18, p. 147, 1905. ■5 Letter to tlie author, October 8, 1919. •' Sterility Among X-Ray "Workers: British Medical Journal, July 6, 1907, p. 15. 414 Anatomical and Surgicai, Aspects tency of the men who had become sterile from X-rays. 2. Female. In the female, operations having for their primary purpose the effecting of sex-sterility have not been practiced as extensively as have analogous operations on the male. The reasons are doubtless; first!, that sexual im- pulses of the female affect social life in a less aggressive manner than those of the male; second, that radical types of sexual sterilization carried out on young girls do not cause the radical departure from the normal later development caused by analogous operations ton the male; third, that the essential female genital organs are situated deeply within the abdominal cavity, and con- sequently their surgical treatment requires much more skill than is called for in opera- tions upon the male. The ancients knew little concerning the homologous relations between the testis and the ovary, indeed until recent times the female was looked upon as the soil, and the male as the sup- plier of seed. Surgically it is only in later years (1873) that fairly skillful and safe operations for removing the ovaries were developed, consequently the use of oophorec- tomy for eugenical sterili-;ation is a relatively new agency. The following operations and treatments will cause sex-sterility in the human female: (1) Pan-hystero-kolpectomy. (2) Hystero-salpingo-oophorectomy. (3) Oophoro-hysterectomy. (4) Hysterectomy. (5) Salpingo-oophorectomy. (6) Oophorectomy (ovariectomy, ovario- tomy, castration, spaying). (7) Curetting and Cauterizing Intra-Uter- ine Tubal Openings. (8) Salpingectomy. (9) Ligation of the Fallopian Tubes. (10) X-ray Treatment. This list of sex-sterilizing operations could be considerably extended, but, as i.s the case with several of "the longer names here given, the new appellations would indicate com- posite operations, consisting in several sim- pler operations performed at one time. Hut, notwithstanding this limitation, tlic greater complexity of the female reproductive sys- tem permits a larger repertoire of operations for effecting sexual sterilization than is of- fered in the case of the male. However, unless there is a very urgent pathological Indication, the first four operations here listed as possible for sterilizing the female are so radical that it is not necessary, nor has it ever been suggested, that they be used for purely eugenical purposes. The several other and simpler operations (num- bers 5 to 9) present an ample choice for al- most any conceivable case calling fof eugen- ical sterilization. (1) Pan-hystero-kolpectomy. (Gr. ttos, Troj-, all; varipa, womb; koKttos, vagina; hroit^, ex- cision.) This operation consists, as its hyphenated name indicates, in the extirpation of the womb and the vagina, and the obliteration of cavity made thereby. Obviously it is a very severe operation and is accompanied by great surgical shock. It is never carried out except for the most urgent medical rea- sons, and, so far as known, has never been resorted to for eugenical purposes. (2) Hystero-salpingro-oophorectomy. (Gr. vo-Tcpo, womb: aaXinyi, tube; i-iiv, egg; ^^peir, to bear; e/CTOjn^, excision.) This operation consists in the removal of the uterus, the oviducts and the ovaries. (If following Caesarian section, it is called Caes- arian hysterectomy or Porro's operation.) (3) Oophoro-hysterectomy. (Gr. air, egg; (j>epei,v, to bear; iaripa, womb; iKToiiii, excision.) This term refers to the surgical removal of the ovaries and the uterus. (4) Hysterectomy. (Gr. wrlpo, womb; e/cTo/tt^, excision.) Surgical Technique. Hysterectomy consists in the removal of the uterus. (Panhysterectomy, the removal of all of the uterus.) The following are the variations in the operation: (a) Abdominal hj'sterectomy. performed through the abdominal wall. (b) Vag^inal hysterectomy, performed through the vagina. (c) Para-vaginal liysterectomy, performed through a perineal incision. Other operations on the uterus: 1. Supra- vaginal amputation of the uterus. 2. Curet- tin.c: the intra-uterine tlubal openings. Surgical Technique. Of the above named several variations in hysterectomy the commonest is the abdom- inal variety, of the surgical technique of which Kelly-Noble' gives the following de- scription: '^ "Doyen's Panhysterectomy. In this oper- ation the myomatous uterus is pulled through the abdominal incision and swung forward and down over the pubes. The 1 Kelly-Noble: Gynecology and Abaomlnal Surgrery. W. B. Saunders Co., 1907, Vol. I., P- 701. Anatomical and Surgicai, Aspects 415 posterior vaginal fornix is opened through the pouch of Douglas and the cervix is caught with a tenaculum forceps; The cer- vix is now drawn through the posterior vag- inal incision and strong traction is continued while it is cut away from the vaginal walls laterally and in front. The section is made close to the muscle of the uterus to the, inner side of the attached structures, which are under considerable tension from the trac- tion upon the cervix. The broad ligaments and uterine vessels are clamped if necessary, tirley too radical to be mentioned among the operations executed primarily for eugen- ical purposes. (S) Salpingo-oophorectomy. (Gr. (r&Xmyi, tube; i^&v. egg; ,^^ Court 472 SuGGEjsTDD Forms for Use: of Euge^nicist, Court, Etc. Form 6a. PROCLAMATION APPOINTING A TIME AND PLACE FOR HEARING. In the matter of the legal determination of the potential parenthood of socially inadequate off- spring of one , of , as prescribed by Chapter of the Session I Laws of 19 , of the State of J State of , County. To Whom It May Concern: TAKE NOTICE THAT, WHEREAS, on the day of.. 19 , (Name State Eugenicist or private citizen making allegation and petition) in due form as provided by Chapter of the Session Laws of 19 , of the State of .'. , has presented to this Court evidence concerning the potential parenthood of socially inadequate offspring on the part of one , of ; and, WHEREAS, said has duly petitioned this Court, under the aforesaid statute, legally to determine the question of fact in the matter, I, therefore, in accordance with the aforesaid statute, do hereby appoint the day of , 19 , at o'clock M., at the usual seat of this Court at , as the time and place for a hearing in the aforesaid matter. Witness my hand this day of , 19 Judge of Uie Court Form 6bl. SUMMONS TO PROPOSITUS IN CASE SUCH PROPOSITUS IS NOT AN INMATE OF A CUSTODIAL INSTITUTION AND IS PERSON- ALLY CAPABLE OF UNDERSTANDING THE NATURE OF A SUMMONS. State of , !County. To the Sheriff (or Constable of ) of said County: You are hereby commanded to summon ,of. .'. , to appear before this Court at , on the day of , 19 , at o'clock M., at which time and place proceedings for the deter- mination of the potential parenthood of socially inadequate offspring of said of will be duly instituted, in accordance with Chapter of the Session Laws of 19 , of the State of , known as the Eugenical Sterilization Law. You will make due return of this writ on the day of , 19 WITNESS my hand this day of , 19 Judge of Uie Court. Suggested Forms for Use op Eugenicist, Court, Etc. 473 Form 6b2. ORDER TO GUARDIAN OR CUSTODIAN OF PROPOSITUS IN CASE SUCH PROPOSITUS IS AN INMATE OF A CUSTODIAL INSTITUTION OR LIVES UNDER GUARDIANSHIP IN THE POPULATION AT LARGE. State of , County. In the matter of the legal determination of the \ potential parenthood of socially inadequate off- I spring on the part of , of County. - I ■i To , of , the legal guardian (or custodian) of : WHEREAS, on the day of , 19 , (State Eugenlclst of the State of or by one , a citizen of the State of over twenty-one years of age. and claiming respectable character) duly submitted to this Court in the State of , an allegation that one, , of , is, under the meaning of the said statute, a potential parent of socially inadequate offspring; and, WHEREAS, said allegation was accompanied by supporting evidence in due • form; and, WHEREAS, this Court has duly set the day of , 19 , at o'clock M., at (name the seat of the Court) as the time and place for the institution of proceedings for the legal determination of the above-stated allegation; THEREFORE, I, , , a Judge of County, in accordance with the aforesaid statute, do hereby command that you, as the legal guardian (or custodian) of the said , of , appear personally, or by duly authorized agent, conveying the said , before this Court at the aforesaid time and place, at which time and place proceedings for the legal determination of the question of fact in the afore-stated allegation will be duly furthered. WITNESS my hand this day of , 19 Judge of the Court. 474 SuGGESTSD Forms for Use of Eugenicist, Court, Etc. Foim To , Esq., the County Attorney of. - , County, State of The Attorney-General of the State having been duly notified by the Judge of the Court of. County, that on the day of. ,19 — , at o'clock M. — at the usual seat of said Court, the hearing will be had in the matter of the legal determination of the question of fact whether, as alleged, one , of , is a potential parent of socially inadequate offspring, as defined by Chapter of the Sessions Laws of 19 of the State of. Pursuant to further provisions of this statute, you, as the County Attorney of said County, are hereby instructed to confer with the complaining wit- nesses in the case, and to aid in the capacity of legal counsel for the State in its efforts in this particular case to protect by due process of law the hereditary qualities of fu- ture generations. Attorney General of the State of ' Form 6e. APPOINTMENT OF LEGAL COUNSEL FOR THE PROPOSITUS. In the matter of the legal determination of the po- ^ tential parenthood of socially inadequate offspring of one -,. , of , as prescribed by Chapter of the Session Laws of 19 , of the State of. '.....Court County. WHEREAS, in accordance with Chapter of the Session Laws of 19 , of the State of. , legal action having been duly instituted in the Court for -the legal determination of the question of fact whether, as alleged, one , of. , is a potential parent of socially inadequate offspring; and, WHEREAS, it is the opinion of this Court that the ends of justice would be more surely served by the appointment of legal counsel to represent the aforesaid of. , in a hearing having for its purpose the legal determination of the aforesaid allegation, I therefore, in accordance with the aforesaid statute, and with Chapter (give reference to any other statute of the State which governs the ap- pointment of legal counsel for indigent dependents) hereby appoint , Esq., Counselor-at-Law of the City of. , to represent said of. in the capacity of legal counsel in the aforesaid hearing. The com- pensation to be allowed said counsel shall be... dollars a day while he is actually engaged in this matter. I direct that this order be filed in the archives of this Court and that within ten days from this date a copy be served on said , counsel appointed to represent said Judie of the Court > 476 Suggested Forms for Use of Eugenicist, Court, Etc. Form 6f. NOTIFICATION OF STATE EUGENICIST. In the matter of the legal determination of the' potential parenthood of socially inadequate off- spring by one of , as prescribed by Chapter of the Session Laws of 19 , of the State of State of. , County. To „ , State Eugenicist of the State of : You are hereby notified that on the day of , 19 , at o'clock M., at the usual seat of this Court at , a hearing in the aforesaid matter will be held. This notification is made in consequence of the provisions of Chapter of the Sessions Laws of 19 , of the State of , that the Court before which such a hearing is held shall notify the State Eugenicist concerning the time, place and nature of such hearing. Judge of the - Court. Form 6g. SUBPOENA FOR WITNESSES. State of , County. To the Sheriff (or any Constable) of said County: You are hereby commanded to summon of to be and appear before this Court at , on the ~ day of , 19 , at o'clock M., to testify the truth in the matter of the legal determination of the question of fact whether one .*. , of. , is, as alleged, a potential parent of socially inadequate offspring. HEREOF fail not, under penalty of the law, and have you then and there this writ Given under my hand this day of , 19 Judce ot the Court Form 6h. SUMMONS FOR JURY. State of , County. To the Sheriff (or any Constable) of said County: You are hereby commanded to summon to appear before this Court on the day of. , 19 , at o'clock M., at the usual seat of this Court at , to Serve as jurors in a case pending before me, then and there to-be heard. And this they shall in no wise omit. And have then and there this writ with your doings thereon. Given under my hand this day of 19 Judge ot the Court. Suggested Forms for Use of Eugenicist, Court, Etc. 477 Torm 7a. VERDICT OF JURY. In the matter of the legal determination of the potential parenthood of socially inadequate off- spring of one of , as prescribed by Chap- * ter of the Session Laws of. 19 , of the State of Court. ..County. We, the jury, duly paneled and sworn in the above entitled hearing, do find that the aforesaid , of , is (or is not), as alleged, a potential parent of socially inadequate offspring, and is (or is not), therefore, a cacogenic person. Dated: Form 7b. JUDGMENT OF THE COURT. In the matter of the legal determination of the " potential parenthood of socially inadequate off- spring of one , of , as prescribed by Chapter of the Session Laws of 19 , of the State of \ State of. , County. (The Court's Review of Testimony.) In view of the foregoing facts, I find that the aforenamed , of. , is (or is not), as alleged, and within the meaning of the afore- said statute, a potential parent of socially inadequate offspring, and therefore, in accord- ance with this decision and the aforesaid statute, do hereby declare the aforesaid of to be (or not to be) a cacogenic person. Judge of the Court. Dated: 478 Suggested Forms for Use of Eugenicist, Court, Etc. Form 7c. ORDER TO STATE EUGENICIST FOR THE EUGENICAL STERILIZATION OF A PERSON IN THE POPULATION AT LARGE. In the matter of the legal determination of the" cacogenic personality of one , of , as prescribed by Chapter of the Session Laws of 19 , of the State of State of , County. WHEREAS, by the decision of this Court (or by verdict of a Jury duly sworn and paneled by this Court), one , of , in accordance with Chapter of the Session Laws of 19 — .... of the State of , known as the "Eugenical Sterilization Law," was duly adjudged and declared to be a cacogenic person, and as such is a menace to the natural hereditary capacities of Subsequent generations. THEREFORE, in accordance with the above- named statute and judgment, you are hereby commanded to arrest the said , and to cause the said to be eugenically sterilized in a skillful, safe, and humane manner, with due regard to the possible thesapeutic benefits of such treatment or operation, obtaining, if possible, the consent and cooperation of said and of his _ (or her) (custodian, parents or ^ardian) You are further commanded to execute the order at a date as early as is consistent with the above-stated conditions, and at the consummation of this particular case of eugenical sterilization and the convalescence therefrom, you will release said from your custody, but said shall not be released from your custody until the aforesaid order has been duly executed. You are further commanded, upon the execution of this order, to make due return under oath of the fact to this Court, making sure to prove the identity of the individual eugenically sterilized, and to describe the time, place, type and outcome of the particular operation or treatment. WITNESS my hand this day of , 19 Judse of the ' Court. Suggested Forms for Use of Eugenicist, Court, Etc. 479 S'otm Id. ORDEK TO THE STATE EUQENICIST FOR THE EUGENICAL STERILIZA- TION OF A PERSON WHO IS AN INMATE OF A CUSTODIAL INSTITUTION. In the matter of the legal determination of the " potential parenthood of socially inadequate off- spring by one , of , as prescribed by Chapter of the Session Laws of 19 of the State of. State of- , County. To , State Eugenicist of the State of.. WHEREAS, by the decision of this Court (or by verdict of a jury, duly sworn and paneled by this Court) one, , an' inmate of , a custodial institution located at , in accordance with Chapter of the Session Laws of 19 of the State of , known as the "Eugenical Sterilization Law," was duly adjudged to be a cacogenic person, and as such is a menace to the hereditary capacities of subsequent generations. THEREFORE, in accordance with the above-named statute and decision, you are hereby commanded to cause the said of to be eugenically sterilized in a skillful, safe, and humane manner, with due regard to the possible therapeutic benefits of such treatment or operation, obtaining, if possible, the consent and cooperation of said and of (his or her) (custodian, parent or guardian) This order in the normal course shall be executed before the discharge, release or parole of the aforesaid from the custody of aforesaid institution; Provided, that if, for any cause, as contemplated by the aforesaid statute, the execution of this order is not consummated before the time previously set for the dis- charge, release, or parole of said from the custody of said institution, you are hereby commanded to arrest the said at the instant of discharge, release, or parole from the custody of (his or her) aforesaid institution, and thence to proceed with the execution of this order, to make due return under oath of the fact to this Court, making sure to prove the identity of the individual eugenically sterilized, and to describe the time, place and outcome of the particular operation or treatment. WITNESS my hand this day of , 19 Judge of the Court. 480 Suggested Forms for Use op Eugenicist, Court, Etc. Form 7e. ORDER TO RESPONSIBLE HEAD OF CUSTODIAL INSTITUTION. In the matter of the legal determination of the j potential parenthood of socially inadequate off- I spring of , of , as prescribed by Chapter of the Session Laws of 19 , of the State of State of , County. To , the Responsible Head of.. WHEREAS, one , of , an inmate in the aforenamed custodial institution, has been declared by this Court to be a cacogenic person; and, WHEREAS, on day of , 19 , the State Eugenicist of the State of was duly commanded to cause the said to be eugenically sterilized in a skillful, safe and humane manner, in accordance with the provisions of Chapter of the Session Laws of 19 , of the State of THEREFORE, in accordance with further provisions of said statute, you are hereby commanded to exiend to said State Eugenicist and the physicians and surgeons appointed by him for the purpose, free access to the person of said .' , an inmate of the aforesaid institution, for the purpose of executing this order, and further for said eugenical sterilizing operation or treatment to provide the hospital accommoda- tions of said institution best adapted to such operation or treatment, and further to extend your full cooperation in the execution of said command. You are further commanded that if, on account of lack of adequate hospital facilities in said custodial institution, or the shortness of time elapsing between the issuance of this order and the time previously set for the discharge, release or parole of said , the State Eugenicist does not execute the aforesaid order for eugenical sterilization before the time previously set for the discharge, release or parole of said , you will not fail, under penalty of the law to discharge, release or parole, as the case may be, the said into the custody of whosoever may be the State Eugenicist of the State of at such particular time. WITNESS my hand, this day of , 19 Judge of the - Court. Suggested Forms eor Use op Eugenicist, Court, Etc. 481 Form It. ORDER TO THE STATE EUGENICIST FOR THE TEMPORARY SUSPENSION OF AN ORDER FOR EUGENICAL STERILIZATION. In the matter of the legal determination of the potential parenthood of socially inadequate off- spring of , as prescribed by Chapter of the Session Laws of 19 of the State of State of. , County. To , State Eugenicist of the State of. : WHEREAS, in accordance with the Eugenical SteriHzation Law of the State of , one ; was, on the day of. , 19 , by due process of law in this Court, declared to be a cacogenic person in. accord- ance with the definition of the above-named statute; and, WHEREAS, this Court on the day of 19 , duly ordered the State Eugenicist of the State of to cause the said to be eugenically sterilized; and, WHEREAS, in the opinion of this Court, the conditions are such that the state will, for the time being, be protected from reproduction by the said of ; THEREFORE, in accordance with the above-named act, and the authority by it in me vested, I hereby command the State Eugenicist of the State of to suspend the execution of the order for the eugenical sterilization of the said of. , until further commanded by this Court. The State Eugenicist is further commanded to keep in touch with the said ~ of. , and to report to this Court on June first and December first of each year concerning the protection of the State from reproduction on the part of the said of WITNESS my hand this day of. , 19.. Judge of the ' Court. 482 Suggested Forms ^or Use o^ Eugenicist, Court, Etc. Form 7g. ORDER TO A CACOGENIC PERSON WHOSE EUGENICAL STERILIZATION HAS BEEN TEMPORARILY SUSPENDED, TO REPORT PERIODICALLY TO THE STATE EUGENICIST. In the matter of the legal determination of the potential parenthood of socially inadequate off- spring of , as prescribed by Chapter of the Session Laws of 19 of the State of State of , County. To , of WHEREAS, on the ..,- day of. -..., 19 , in this Court, you, the said of were dul3r declared to be a cacogenic person, and as such were ordered eugenically sterilized; and, WHEREAS, in further accordance with the Eugenical Sterilization Law, this Court has been duly supplied with apparently trustworthy evidence that, for the time being, the State will be protected against your reproduction; and, WHEREAS, this Court has duly ordered the State Eugenicist to defer the execu- tion of the order for your eugenical sterilization, and has further commanded the said State Eugenicist to report on the first day of June and the first day of December of each year to this Court concerning the validity of this protection. THEREFORE, you are hereby commanded to report to the State Eugenicist or his duly appointed agent twice annually, at the time and place named by the State Eugenicist, and there submit to an examination, giving proof concerning the validity of this pro- tection. GIVEN under my hand and seal this day of. _ _ , 19 . Judxe ot tha Court. Suggested Forms ^or Usk o^ Eugenicist, Court, Etc. 483 Form 7h. ORDER TO THE STATE EUGENICIST FOR THE EUGENICAL STERILIZA- TION OF A CACOGENIC PERSON, THE ORIGINAL ORDER FOR WHOSE STERILIZATION HAS BEEN TEMPORARILY SUSPENDED. In the matter of the legal determination of the potential parenthood of socially inadequate oil- spring of. , as prescribed by Chapter of the Session Laws of 19 of the State of- State of , County. To , State Eugenicist of the State of. : WHEREAS, in accordance with the Eugenical Sterilization Law of the State of , one was, on the day of , 19 , by due process of law in this Court, declared to be a cacogenic person in accordance with the definition of the above-named statute; and, WHEREAS, this Court on the day of. , 19.. , duly ordered the State Eugenicist of the State of to cause the said to be eugenically sterilized; and, WHEREAS, apparently trustworthy evidence had been presented to this Court that the State would, for the time being, be amply protected against reproduction by the said ; and, WHEREAS, in accordance with said evidence, this Court temporarily suspended the order for the eugenical sterilization of the said ; and, WHEREAS, it now appears on the evidence presented by the State Eugenicist to this Court that the State is no longer amply protected against reproduction by the said THEREFORE, in accordance with the above-named act and the authority by it in me vested, I hereby command the State Eugenicist of the State of to proceed fortwith with the execution of the original order for the eugenical sterilization of. WITNESS my hand this day of. , 19 Judge of the ■ Court. 484 Suggestbd Forms for Use ojp Eugbnicist, Court, Etc. CONTRACT WITH SURGEON OR PHYSICIAN TO STERILIZE EUQENICAL- LY AN INDIVIDUAL IN THE POPULATION AT LARGE. Subject: The eugenical sterilization of one , of , as commanded by the Court of on the day of , 19 , in accordance with Chapter of the Session Laws of 19 of the State of THIS AGREEMENT entered into this day of , 19 , by and between the State of , represented by , State Eugenicist of said State, party of the first part, and Dr , of. , physician and surgeon, duly licensed by said State, party of the second part. Party of the first part agrees to present the person of one , of , duly ordered by the Court of. County, on the .....day of , 19 , in accordance with Chapter of the Session Laws of 19 of the State of. , to be eugenically sterilized, to the party of the second part (name and locate hospital or office), on or before the day of , 19 Party of the second part agrees to perform upon said _ , of , the operation of , which has for its primary purpose the permanent nullification of the reproductive function, said operation to be performed in a safe and humane manner, with due regard to the possible thera- peutical benefits to be derived therefrom, and in full accordance with modern surgical, sanitary and hospital practice. The party of the second part further agrees to maintain said in accordance with the aforesaid modern hospital and sani- tary practice to the satisfaction of the party of the first part during the period of con- valescence, which period shall be terminated on the judgment and order of the party of the first part. Party of the first part agrees to pay to the party of the second part, for the afore- described services, the sum of dollars, the order for said payment to be issued upon the receipt by the party of the first part of a sworn statement by the party of the second part confirming the identity of the person eugenically sterilized, describing the time, place and nature of the operation or treatment, and the outcome thereof. If for any cause the party of the first part does not present the aforesaid subject of the order of eugenical sterilization on or before the day of , 19 , this contract shall become void. IN WITNESS whereof we have hereunto set our hands this day of. , 19 The State of by , State Eugenicist, party of the first part. , M. D., party of the second part. Suggested Forms for Use of Eugenicist, Court, Etc. 485 Form 8a2. CONTRACT WITH SURGEON OR PHYSICIAN TO STERILIZE EUGENICAL- LY AN INDIVIDUAL INMATE OF A CUSTODIAL INSTITUTION. Subject: The eugenical sterilization of one of , as prescribed by Chapter of the Session Laws of 19 of the State of THIS AGREEMENT entered into this day of , 19 , by and between the State of , by , State Eugenicist of said State, party of the first part, and Dr , of , a physician or surgeon duly licensed by said State, party of the second part, WITNESSETH: Party of the first part agrees on or before the day of , 19 , to provide access for party of the second part and his assist- ants to the person of one , of , an inmate of , a custodial institution located at , said inmate having been duly ordered by the Court of County, on the day of , 19 , in accordance with Chapter of the Session Laws of 19 of the State of , to be eugenically sterilized. Party of the second part agrees to perform upon said of , the operation of , which has for its primary purpose the permanent nullification of the reproductive function, said operation to be performed in a skillful, safe and humane manner, with due regard to the possible therapeutical benefits to be derived therefrom, and in full accordance with modern surgical, sanitary and hospital practice. Party of the first part agrees to furnish to the party of the second part due evidence of legal court order for the eugenical sterilization of the above-named , of , and to pay to the party of the second part, for the afore- described services, the sum of dollars, said payment to be made upon the receipt by the party of the first part from the party of the second part of a sworn statement confirming the identity of the person eugenically sterilized, describing the. time and place of the operation or treatment and the outcome thereof. IN WITNESS whereof we have hereunto set our hands this day of , , 19 The State of jjy , State Eugenicist, party of the first part. , M. D., party of the second part. 486 Suggested Forms for Use op Eugenicist, Court, Etc. rom 8b. - , ;■ ^TjirJUl REPORT OF SURGEON OR PHYSICIAN TO STATE EUGENICIST. Subject: The '^Eugenical Sterilization of one , of , as prescribed by Cliapter of the Session Laws of 19 of the State of To , State Eugenicist of the State of : In accordance with a contract entered into on the day of , 19 , by , State Eugenicist of the State of , party of the first part, and the writer of this report, party of the second part, the party of the second part hereby reports the following: 1. Name of person eugenically sterilized: 3. Age: • ^ 3. Sex: 4. Type of operation: 5. Place of operation: 6. Time of operation: 7. Record: Notes on outcome of operation and convalescence and memorandum on release of patient: Respectfully submitted, M. D. , being duly sworn, says that he personally performed the operation above described and that to the best of his knowledge and belief the above statements are true. Subscribed and sworn to before me this dav of 10 Notary Public. State of , County. Suggested Forms for Use of Eugenicist, Court, Etc. 487 Form Sc. RETURN OF STATE EUGENICIST TO COURT IN CASE OF EUGENICAL STERILIZATION OF AN INDIVIDUAL IN THE POPULATION AT LARGE. In the matter of the eugenical sterilization of one \ , of , j ordered by the Court of the State of J. , on the day of , 19 To the Court of , State of : Pursuant to the command of the Honorable Court aforesaid, issued on the day of , 19 , to the State Eugenicist of said State, to cause the eugeni- cal sterilization of one , of..— , the undersigned State Eugenicist of said State respectfully makes the following return: The aforesaid , of , of whose identity I am duly convinced, was arrested by , a deputy of the under- signed, on the day of , 19 , at , and was eugenically sterilized by the operation (or treatment) technically known as , on the day of , 19 , at , by Dr , of , a physician or surgeon duly licensed by the aforesaid State. Said convalesced as follows : and on the day of , 19 , was released from the custody of the State Eugenicist. All in due accordance with the aforesaid order. Respectfully Returned, state Eugenidst- State of , County. being duly sworn, says that the statements in the above are in accordance with his first-hand knowledge and upon the official reports of his deputy and assistant and that to the best of his knowledge and belief all of said state- ments are true. Subscribed and sworn to before me this day of , 19 Notary Public, County. 488 SuGGHlsTED Forms for Use of Eugenicist, Court, Etc. Form 8d. RETURN OF STATE EUGENICIST TO COURT IN CASE OF EUGENICAL STERILIZATION OF AN INDIVIDUAL INMATE OF A CUSTODIAL INSTITUTION. In the matter of the eugenical sterilization of one " , of , ordered by the Court of the State of , on the day of I , 19 J To the Court of , State of : Pursuant to the command of the Honorable Court aforesaid, issued on the day of , 19 , to the State Eugenicist of said State, to cause the eugeni- cal sterilization of one , of , the undersigned State Eugenicist of said State respectfully makes the following return: The aforesaid , of , of whose identity I am duly convinced, was eugenically sterilized by the operation (or treatment) techni- cally known as , on the day of. , 19 , at , by Dr , of , a physician or surgeon duly licensed by the aforesaid State. Said remained in the custody of the aforesaid Custodial Institution and convalesced as fol- lows: , All of which actions and reports are in due accord with the aforesaid order. Respectfully Returned, state EttgraldBt State of County. Subscribed and sworn to before me this day of 19 Notary Public, County. SUGGESTED J:<'ORMS FOR UsE OF EuGENICIST, CoURT, EtC. 489 Fonu 8e. SEMI-ANNUAL RETURN OF THE STATE EUGENICIST TO THE COURT IN CASE AN ORIGINAL ORDER FOR EUGENICAL STERILIZATION HAS BEEN TEMPORARILY SUSPENDED. Office of the State Eugenicist' of the State of : In the matter of the legal determination of the 1 cacogenic personality of one , | of - , as prescribed by | Chapter of the Session Laws of 19 I Date of this Return : (June 1 or Dec. 1) State of. , County. To the Court of , State of : In compliance with the order of the Honorable Court aforesaid, issued on the day of , 19 , I, State Eugenicist of the State of , respectfully submit the following; (Here the State Eugenicist should report the facts gathered by his field workers, or submitted by the cacogenic person at the first-hand, in reference to the assurance of non- reproduction by said cacogenic person.) Respectfully submitted. state Eueenicist. 490 Suggested Forms for Use op Eugenicist, Court, Etc. INSTITUTIONAL DATA KEPT BY STATE EUGENICIST. LEGAL DEFINITION OF A CUSTODIAL INSTITUTION. From Section 2, Clause g, of Chapter of the Sessions Laws of 19 , of the State of , known as the "Eugenical Sterilization Law.'' "g. A custodial institution is a habitation which, regardless of whether its authority or support be public or private, provides (1) food and lodging, and (2) restraint, treat- ment, training, care or residence for one or more socially inadequate inmates; provided that the term custodial institution shall not apply to a private household in which the socially inadequate member or members are close blood-kin or marriage-relations to, or legally adopted by, an immediate member of the care-taking family." Form 9a. ROSTER OF CUSTODIAL INSTITUTIONS. (This roster should be revised at least once a year.) 1. Name of Institution 3. Where Located 3. 'Year When Opened 4. Name of Responsible Head 1. 3. 3. 5. Types of Inmates, Patients or Pupils 6. Number of Inmates, Patients or Pupils on Date of Report 7. Exclusively for Males, for Females; or for Both Sexes 8. Races Provided for 1. 2. 8. Age Limits of Inmates 10. Territory from which Inmates are Drawn 11. How Maintained. Public, (State, City. County or Town) or Private 12. If Private is Institution Licensed by State? 1. 2. 3. '/Xjs > Suggested Forms for Use oe EuGENicisT, Court, Etc. 49 Weekly Charge per Inmate 14., Date of Fore- going Returns Remarks 1. 2. • 3. NOTE: — For suggestions on other institutional data see the reports of the more progressive Custodial Institutions, and the "Statistical Directory of State Institutions for the Defective, Dependent and Delinquent Classes." H. I-I. Laughlin, Bureau of the Census, 1919. 492 Suggested Forms for Use of Eugenicist, Court, Etc. Form 9b. MONTHLY INSTITUTIONAL REPORT OF ACCESSIONS AND LOSSES, TO STATE EUGENICIST. (These returns should be analyzed and summarized in other tables, following in general the systems used by the more progressive Custodial Institutions.) Name of Institution: Place Located: Name of Responsible Head: REPORT OF ACCESSIONS DURING THE MONTH OF...^ 19 , 1. Name 3. Institution Case Number 3. Home Address 4. Sex 5. Age 6. Diagnosis 7. How Admitted 1. S. 3. 8. Remarks REPORT OF LOSSES DURING THE MONTH OF , 19..„ 1. Name 2. Institution Case Number 3. Home Address 4. Sex 5 Age 6. Diagnosis 7. How Long an Inmate 1. 2. 3. 8. Manner of Loss 9. Remarks 1. 2. 3. Notes on cases which are thought to be highly cacogenical: Names of inmates concerning whom eugenicat field-studies have been made:.. Suggested Forms for Use of Eugenicist, Court, Etc. 493 Form 10a. CASE RECORD OF EUGENICAL STERILIZATION. Case number in files of the State Eugenicist 1. Full name ;. (In case of a married woman, record both maiden and married name.) 2- Sex 3. Age when operated upon 4. Birthplace Present address 5. Name of court which ordered sterilization 6. Date of court order for sterilization 7. Attitude of individual and friends or kin toward operation 8. Type of operation ordered.. 9. Names of surgeons consulted by State Eugenicist in deciding upon particular type of operation 10. Date of operation 11. Surgeon : Name Address.. 12. Condition of individual at time of operation 13. Effects of operation. (Record general and specific morphological, pathological, physiological, psychological, — emotional expression and control, — mental, criminal, social, sex, — masturbation, desire for sexual relations, — and economic effects of the operation. Immediate and remote effects.) NOTE: Add sheets of plain paper for the continuation of the record of this case. Entries should be made from time to time as long as examinations and reports can be secured. Each entry should be dated. 494 Suggested Forms for Use oe Eugenicist, Court, Etc. Form 11a, APPROPRIATIONS Adequate funds for salaries, traveling expenses, etc., will be necessary if the state is to carry out eugenical sterilization in a just and effective manner. Working draft of appropration section to be inserted in the proper place in the state's appropriation bills, according to the legislative practice of the particular state. Section — . Appropriations. For the purpose of executing the provisions of the Eugenical Sterilization Law (Chapter Session Laws ) for the fiscal year ending , the sum of .$ is hereby appropriated, to be expended on requisition of the State Eugenicist (or the head of the department to which the State Eugenicist is directly responsible) as follows: 1. Salary of State Eugenicist $ 3. Salaries of professional field-workers. (To begin this work one such assistant will be needed for each quarter-million inhabitants of the state. Later, as the department • develops, this appropriation will, of course, adjust itself to the policy of the particular state.) Field-workers at $ per annum $ 3. Salaries of stenographers. (Approximately as many stenographers and clerks as field- workers will be required.) Stenographers and Clerks at $ per annum— .$ 4. Traveling expenses for State Eugenicist and staff, and fees and traveling expenses of witnesses (not including court witnesses) aiding said State Eugenicist $.. 5 Rent for office (if ample facilities are not supplied in state owned buildings) $... 6. Office furniture and equipment $.. 7. Printing, supplies, and maintenance service $... 8. Surgical, medical and hospital charges for cases of eugenical sterili- .. zation duly ordered in accordance with the afore-mentioned Act....$.. 9. Court and notary fees (if it is customary for the particular state to make special appropriation directly to the administrative depart- ment for such purpose?) $.. TOTAL if.. INDEX INDEX Achondroplasia, 372. Agnew State Hospital, 55, 58. Agricultural & Industrial School, N. T., 85. Ah Sun vs. Wittman, 239. Alabama (State), 343. Albinism, 373. Alcoholism, 375. Aldridge Case, 162, 197. Alkaptonuria, 376. Allen vs. Pullman Palace Car Co., 192. Amaurotic family idiocy, 379. Ambidexterity, 375. Ambrose, Thomas L., 19. Amendments, 1, 7, 18, 107, 111, 134, 183. American Medico-Psychological Association, 69. American Roentgen Bay So- ciety, 412. Ampulla, 405. Anaemia (pernicious), 378. Analysis of laws, 6. Anarthrosis (digital), 377, Anatomy, 397. Andrews, Charles H., 82, 144, 217. Angina pectoris, 379. Angio-neurotic odema, 378. Animalculists, 400. Ankylosis, 377. Anti-Sterilization League, 43. Aphakia, 374. Appeals, 135. 149, 152, 166, 198. 200, 205, 228, 234, 258, 450, 459. Applegate, C. P., 56, 60, 67. Appropriations, 6, 7, 8, 9, 10 11, 12, 13, 139, 439, 451, 460. Arkansas Building & Loan As- sociation vs. Madden, 192. Archiv. f. Kriminal anthropo- logic, 120. Arteriosclerosis, 378. Arthritis deformans, 379. Asexualization, 53, 324, 433. Ashley, Dr. M. C, 86. Astigmatism, 379. Ataxia (cereballar), 379. Ateleiosls, 372. Atkins vs. Kansas, 197. Atrophy (muscular), 377, 379. Atrophy (optic nerve), 376. Auburn State Prison, 84. Bagg, Dr. Halsey J., 413 Baer, K. E. von, 404. Barbier vs. Connell, 239. Barr, Dr. Martin W., 328, 351, 433. Barrett, Dr. Albert M., 74. Barrow, Dr. Bernard, 418. Bartholim, glands of, 398. Battey, Dr. Robert, 416. Becker, State vs., 153, 156. Beier, Dr. A. L., 95. Bellfleld, Dr. Wm. D., 196. Bell, Dr. Clark, 196. Bell, Wm., 152. Belm vs. Young, 192. Benton vs. Budd, 192. Bernstein, Dr. Charles, 85, 224, 230, 232, 235, 309. Berry, Wm. H, 66, 143, 179. Berzman, State vs., 154. Bibliography, 372, 394. Bigelow vs. Hartford Bridge Company, 192. Bi-lobed ears, 377. Bill of attainder, 442. Bingham, Judge Geo. G., 287. Biology, 104, 113, 368, 443. Bird, W. A. S., 30. Birth Control, 346, 423. Bissell vs. Davison, 324, 327, 328. Blackburn vs. State, 187. Blending trait, 384. Bliss, Dr. Geo. S., 64. Books (see Bibliography). Boston, Chas. A., 120, 231, 336. Brachydactylism, 372, 380. Breeding, 364. Bronchial asthma, 376. Brown, Hon. R. E., 45. Brown, Sequard, 56. Bruce, Hortense V., 85. Bryant, Commissioner vs. Skill- man Hardware Company, 172. Buford, Dr. J. A., 78. Bulbi vestibuli, 398. Bush, Robert P., 25. Butler, Edwin M., Senator, 18. Butler, P. O., 56, 59, 60. Byers, Joseph P., 164. Cacogenics, 357, 443, 447, 456. California, 1, 2, 3, 6, 17, 52, 96, 99, 100, 101, 103, 104, 105, 107, 110, 111, 112, 115, 118, 125, 129, 131, 134, 137, 139. California State Prison, Pol- som, 61. California State Prison, San Quentin, 60. Camfield vs. United States, 173. Cancer (diathesis), 378. Capper, Arthur, 30. Carmiehael, Dr. P. A., 70. Carroll, B. F., 21. Case, J. D., 79. Castrati, 407, 433. Castration, 96, 111, 324, 328, 409, 425, 433, 435, 436. Cataract, 374. Catlin mark, 377. Cave, Dr. P. C, 70, (434. Chadwick, Judge, 162. Chamberlain, Geo. E., 40, 41, 42. Chapman, Dr. Alma J., 79. Charles, H W., 73. Charlestown vs. Werner, 238. Charlton, G. E„ 78. Cherokee State Hospital, 69. Chester, Alden, Justice, 217. Chevannes vs. Priestly, 171. Chicago B. & G. R. R. Company vs. Illinois, 239. Chicago M. & St. Paul R. R. Company vs. Westby, 239. Chlorosis, 378. Christian, Frank E., 84. Christie, Dr. Arthur C., 412, 421. Chromosomes, 401. Clarinda State Hospital, 69. Clarke, Fred P., 56. Clarke, Geo. W., 22, 23. Class legislation, 130, 440. Clattenburg, H. A., 61. Cleft palate, 377. Cline, Jacob, 4, 146, 271, 291, 318. Clinton State Prison, 84. Clitoris, 398. Cloquet, ligament of, 399. Coakley, Dr., 225, 231. Cobb, Dr. O. H., 85. Coffey, 40. Coloboma, 376. Color blindness, 376. Composite trait, 384. Compton, L. H., 90, 271, 320. Conant, Mary C, 85. Coni, vasculose, 397. Conlin, State vs., 324, 327. Connecticut, 1, 4, 8, 19, 61, 96, 99, 100, 101, 105, 108, 112, 114, 115, 118, 125, 126, 129, 13l! 135, 137, 139. Connecticut Hospital, Middle- *ton, 61. Connecticut Hospital, Norwich, 62. Connecticut State Prison, Weth- erfield, 61. Consent of patient, 110. Continence, 423. Contraception, 346, 423. Co-parent, 366. 497 498 IndBx Cooley's Constitutional Limita- tions, 187, 197. Cornea (degeneracy), 377. Corona radiata, 406. Corpus lutcum, 405, 428. Corpus spongiosium, 398. Cosson, Geo. Adjutant-General, 184, 198. Costill, Dr. Henry B., 164, 297. Court Decisions, l' 159, 174, 186, 200, 213, 227, 234, 250, 257, 269, 289. Court procedure, 107. Courts conducting eugenlcal studies, 394. Cowper's glands, 398, 399. Cretinism, 378. Criminals, 117, 328. Croup, 379. Crumbacker, W. P., 68, 69. CryptorcMsm, 377. Cummings vs. State of Mis- souri, 197. Curie, P. and Mme., 412. Custodial institution, 447, 456. Cystinurla, 379. Daniel, Dr. F. E., 351. Davenport, Dr. Chas. B., 225, 236. Davis, D. R., 48, 50. Davis, Rudolph, 2, 143, 179,. 291, 304. Davis vs. Berry, 179, 198, 212, 236, 239, 249, 252. Dawson, Wm. J. G., 59. Deaf mutism, 374. Definitions, 446, 455. Degeneracy, 324, 360, 441. Dementia praecox, 375. Dent in forehead, 377. Dent vs. State of W. Va., 239. Dental agnesia, 377. Dereliction in execution of law, 125, 450, 460. Deutoplasm, 406. Diabetes insipidus, 376. Diabetes mellitus, 376. Diagnosis, 362. Dickie, Wm., 54, 55. Dickerson, D. S., 245. Digital hair, 374. Dinsmore vs. Southern Express Co., 201. Distal phalanges, 372. Dlx, John A., 25. Dominant trait's, 365, 882. Donohoe, Dr. Geo,, 69. Doran, Dr. Albert, 433. Double-jolntedness, 373. • Douglass, State vs., 15 4. Dawdle, 171. Dower, State vs., 156. Dowden, State vs., 187. Drake, Dr. P. I., 95. DruckemiUer, MelvJn, 64. Drum, Henry, 91, 292. Due process of law, 132, 441. Dubuque, Geo. P., 92. Duncan vs. Missouri, 190. Duryee, Dr. Chas. C, 82. Dystrophia, M'uscularis, 377. E. Eastern New York Reforma- tory, 84. Ectopia lentis, 374. Effects of sexual sterilization, 425, 431, 434, 436. Elliott, Margaret M., 64. Ellis, H. Havelock, 120, 432. Elver, Hon. Elmore T., 172. Emasculation, 277. Emigration, 360. England, situation in, 355. Environment, 367. Epigenesis, 401. Epidermolysis, 373. Epilepsy, 290, 375, 380. Epileptics, Institutions for. Village for Epileptics, Indi- ana, 64. State Hospital and Colony, Iowa, 69. State Hospital for Epileptics, Kansas, 70. Farm Colony for Epileptics, Michigan, 74. State Village for Epileptics. N. J., 80, 164. 292. Craig Colony, N. Y., 85. Mansfield State Training School, Conn., 4, 20. Epistaxis, 378. Estabrook, Dr. A. H., 63, 25.';, 256, 291, 312. Eugenlcal Education, 356. Eugenlcal Investigators, 358. Eugenicist, 102, 110, 447, 456. Eunuch, 409, 427. Euthanasia, 338. Evans, Briton D., 80. Exophthalmic goitre, 378. Exostoses, 373. Bye Color, 374, 380. Ex post facto, 442. Fallopian tubes, 111, 112, 130, 401, 405, 421. Family histories, 104, 291. l''arrington. Judge E. L., 247. 250. Fii.st, W. S., 7S. Federal (loveriimenl. 451. Feebleminded, the, 305. Feebleminded, ln.stitiillons for. Ciilcmy for l'\'el)le M'inded Male.M, N. J„ 80. Home Tor Feeble Minded. Wis., 95. IndlaiiM, School for Feeble Minded Youth, 61. Indiana Farm Colony for Feeble Minded, 64. Institution for Feeble Minded Women, N. J., 80. Institution for Feeble Minded Children, N. Y., 85. Institution for the Feeble Minded, N. D., 87. Institution for the Feeble Minded, Oregon, 90. Letchworth Village, N. Y., 85. Michigan Home and Training School, 3, 74, 203, 305. Nebraska Institution fof Fee- ble Minded Youth, 77, 78. Newark State School, N. Y. 85. Pacific Colony, Cal., 3, 8, 19 60. Rome Custodial Asylum, N. Y.; 85, 217, 305. Sonoma State Home, Cal., 7, 18, 19, 55, 59. Southern Wisconsin Home for Feeble Minded, 95. State Home for Feeble Mind- ed, Kans., 70. State Institution for Feeble Minded, S. D., 91. Pe.eblemindedness, 375, 380. Feilen, Peter, 1, 123, 142, 149, 170, 171, 173, 188, 196, 212 215, 233, 236, 237, 249, 252 291, 292, 329. Fenning, Frank A., 121. Fernald, Dr. Walter E., 225, 232 236. Ferris, Woodbrldge N., 28. Field surveys, 448. Fimbriae, 405. Finger-print pattern, 379. Fisher Co.. vs. Woods, 231. Flood, Dr. Everett, 351. Fogarty, Edw. J., 64. Follicular fluid, 404. Forms, 464. Fosters Federal Practice, 192. Foster, Warren F., 122, 196. French vs. Teschermaker, 156. Friedrich's ataxia, 375. Fundus, 406. Gametes, 397. 405. Garcia vs. Territory, 155. Garvin, Dr. Wm. C, 87. Gedkirche. State vs.. 173. Gennat. Dr., 120. Germ tract. 39S. 403. GeniKro.ss, Dr. Frledr, Ludg., 121. Gibson. State vs.. 170. Gillett, Governor James X., 17. Giraldes, organ of, 397. Glands, sex, 425, 428, 434. Glaucoma, 374. Globus major, 400. Glueek. Dr. Bernard, 121. Goitre, 378. Gonad, 407, 426. Good, Dr. A., 119. Goodrich, James P., 63, 255, 313. Gose. Judge, 162. Gould vs. Gould, 170, 324. 327, 331. Gout, 78. Gower's muscular atrophy, 377. Graafian follicles, 403. Graham vs. West Virginia, 187, 194. Index 499 Grainger vs. Douglas Park Jockey Club, 239. Graves, Commonwealth Mass. vs., 187. Gray, W. F., 121. Griffiths, Dr. D. G., 78. Grover, Dr. O. M'., 85. Gulf, Colorado etc. R. R. Co. vs. Ellis, 176, 211. H. Hair, 373, 374, 376, 377, 380. Halgrims, Col., 22 Hamburg - Amer. - Packetf ahrt- Aotien Gesellschaft vs. U. S., 201. Hamilton, Judge, J. W., 319. Handclasp, 377. Handwriting, 379. Hanna, L. B., 26. Hapsburg lip, 373. Harelip, 377. Harvey, William, 404. Hart, Governor L. P., 15. Haskell, Dr. Robert H., 74. Hatch, Dr. F. W., 52, 322. , Hathorn vs. Natural Carbonic Gas Co., 238. Haviland, Dr. C. Floyd, 61. Hay fever, 379. Hay, Governor M'. E., 15. Hayes vs. Missouri, 190. Haynes, Dr. H. A., 74, 144, 203, 305. Heacox, Dr. Frank L., 84. Health Department of N. Y. vs. Rector, 240. Head form, 373. Heart defect, 378. Hemenway, Dr. Henry B., 120. Henrichs, R. B., 79. Hemophilia, 377. Hennessy, John V., 82. Heredity, 99, 363, 365, 447, 455. Heyman, Dr. Marcus B., 87. Hernia, 378. Hill, John, 92. Hilsabeck, State vs., 154. Hinshaw, Dr. T. E., 71. Histories, case, 291, 448. Hobbs vs. State, 154, 162, 197, 252. Hoboken vs. Goodman, 172. Hodges, Geo. H., 29. Holden, Hon. Geo. B., 92. Holden vs. Hardy, 230, 324, 328. Holmes, Justice, 201. Holt, Robert E. L., 88, 90. Honeij, Dr. James A., 413. Hopper vs. Stack, 172. Hooker vs. Burr, 199. Hormone, 427. Hotchkiss, Dr. Wm. M., 87. Howe, J. E., 66, 180. Hoyt, Geo. E., 31. Hubbard, O. S., 70. Hugo, Francis M., 82. Humes, Mo. P^ R. Co. vs., 161. Hunter,. Joel D., 121. Huntington's Cliorea, 375. Kurd, Dr. Arthur W., 86. Hurd, Dr. Henry M., 350. Hurtado vs. California, 325. Hutchinson Reformatory, 3D. Hypertrichosis, 373. Hypertrophic emphysema, 379. Hypospadias, 377. Hypotrichosis, 373. Hysteria, 375. Hysterectomy 111, 414. Hystero-salpingo-oophorec- tomy, 414. Hytatid, 397. Icterus, 379. Ichthyosis, 376. Idaho, 4, 48. Illegal use of sexual steriliza- tion, 125, 356, 450, 466. Immigration, 349, 360. Immorality, 440. Indiana, 1, 4, 6. 15, 63, 96, 99, 100, 101, 103, 105, 107, 112, 114, 118, 124, 129, 131, 134, 137, 139, 145, 255, 343. Industrial Schools. Agricultural and Industrial School, N. Y., 85. Farm for Boys, Valatie, N. Y., 84. Home for Boys, N. J., 80. Indiana Boys' School, 64. Indiana Girls' S'chool, 64. Industrial School for Girls, Kansas, 73. Industrial School for Boys, Kansas, 73. Industrial School for Boys, Neb., 79. Industrial Home, Neb., 79. Industrial School for Girls, Neb., 79. Industrial School for Boys, Wis., 95. Industrial School for Girls, Wis., 95. Preston School of Industry, Cal., 60. Reform School at Mandan, N. D., 87. State Home for Girls, N. J., 80. Training School for Girls, N. Y., 85. Inebriates, State Hospital for, Iowa, 69. Infundibulum, 405. Inmate, 447, 456. Insane, State Hospitals for, Agnew, Cal., 55. Ann Arbor, Mich., 74. Binghamton, N. Y., 86. Buffalo, N. Y., 86. Central Islip, N. Y., 87. Cherokee, Iowa, 69. Clarinda, Iowa, 69. Collins, N.Y., 86. Eldridge, Cal., 55. Independence, Iowa, 69. Ingleside, Neb., 76, 78. Ionia, Mich., 74. Jamestown, N. D.,.87. Kalamazoo, Mich., 73. Kings Park, N. Y., 86. Larned, Kans., 71. Lincoln, Neb., 77, 78. Long Island, N. Y., 87. Manhattan, N. Y., 87. Matteawan, N. T., 85. Mendota, Wis., 95. Middletown, Conn., 61. M'iddletown, N. Y., 86. Morris Plains, N. J., 80. Napa, Cal., 54. Newberry, Mich., 74. Norfolk, Neb., 77, 78. Norwalk, Cal., 56. Norwich, Conn., 62. Ogdensburg, N. Y., 86. Osawatomie, Kans., 70. Patton, Cal., 55,' 96. Pendleton, Ore., 89. Pontiao, Mich., 73. Poughkeepsie, N. Y., 85. Rochester, N. Y., 86. Salem, Ore., 89. Stockton, Cal., 54. Talmage, Cal., 55. Topeka, Kans., 70. Traverse City, Mich., 73. Trenton, N. J., 80. Utlca, N. Y., 85. Waupun, Wis., 95. Willard, N. Y., 85. Winnebago, Wis., 95. Institutions, 393. (See also. Insane, Epileptic, Feeble minded. Industrial Schools, Penitentiaries, Pris- ons, Reformatories.) Intellectual capacity, 375. Involutional melancholia, 375. Iowa, 1, 2, 3, 8, 21, 64, 96, 99, 100, 101, 103, 104, 105, 108, 111, 112, 114, 115, 118, 125, 126, 129, 131, 135, ■ 137, 142, 179. Iowa Board of Control, 68. Iowa Board of Parole, 65, 67, 179, 200, 304. Ishmaels, 63. Iso-agglutinins, 377. Isthmus, 405. J. Jackson, 192. Jacobsen vs. Massachusetts, 171, 172, 238, 240. Jaundice, 378. Jewish facial type, 373. Johnson, Hiram W., 18 Johnston, J. A., 60. Jones, Robert O., 50. Jones, State of Iowa vs., 187. Jones vs. Montague, 201. Jordan, Dr. Alfred C, 413. Journals, 394. _' Journal of Criminal Law' arid Criminology, 121, 122. Jukes, 63, 328. , ' ' ] Juristisch-psychiatris(ih'eGrenz_- fragen, 120. 500 Index Kalamazoo State Hospital, 73. Kansas,.!, 3, 11, 29, 69, 96, 100, 101, 102, 103, 104, 106, 109, 110, 111, 113, 114, 116, 118, 125, 126, 129, 132, 135, 136, 138, 140. Kansas State Penitentiary, 71. Kelcher vs. Putnam, 171. Kelly, Judge Percy R., 287. Kelly vs. People, 187. Kemmler, 162, 189, 197. Kendriek, Hon. W. R. C, 179. Kern, W . B., 60. Kimmish vs. Ball, 239. Kincald, State vs., 160. Kutnewsky, Dr. J. K., 91. J,. Labia majora, 398. Labire, A. R., 34. Lambert vs. Alcorn, 192. Latham, Dr. C. O., 94. Laws, 1, 6, 438. Laws, text of, 15. Laws, analysis of, 99. Lee, Oscar, 95. Leeper vs. Texas, 189. Left-handedness, 375. Legal counsel, 110, 449, 459. Legal requirements, 440. Legislation, 15, 342, 356, 438. Leprosy, 379. Lewelling, L. G., 42. Liability, legal, 124, 450, 460. Libido, 425. Lied vs. Henderson, 193. Light, Jno. H., Attorney Gen- eral, 333. Light vs. United States, 199, 200. Litigation, 142, 149, 164, 179, 203, 217, 243, 256, 271. Little, Dr. Chas. S., 85. Little, Lora C, 43. Lonas vs. State, 170. Longevity, 377. Lowe vs. Kansas, 190. Mackin, Dr. M. C, 69. Macomber, J. Frank, 80. Macula lutea (degeneration), 379. Macy, Dr. Wm. A., 86. Magoun vs. Illinois Trust, 190. Main, Hon. John F., 152. Main, State vs., 289, 324. Mansel, V. H., 80. Mansfleld State Training School, 20. Marcy, Alesc. Jr., 164. Marriage Annulment, 346. Marriage Restriction, 326, 342, 371. Marshall, Louis, 334. Marshall, Thomas R., Governor, 6, 63, 146, 255. Mason, T. R., 48. Mathematical ability, 378. Mating, 381. Matthew, Railroad vs., 190. Matthews, A. C, 54, 58, 325. McCabe vs. A. T. & S. F. Ry Company, 200. M'cCauley, Chris., 92. McCauley, State vs., 155, 197. McCaughry, Charles C, 61. McCoy, Etta Joe., 73. McCoy, James F., 40. McKelvle, Hon. S. R., 47. McKenna, Justice, 329. McLean, Donald T., 245. McNary, Dr. W. D., 89. McPherson, Smith J., 181, 191. Mechanical ability, 378. Meehan vs. Excise Com., 172. Megalophythalmus, 379. Memory, 379. Mendelism, 366. Mendocino State Hospital, 55, 58. Menieres disease, 375. Mesoderm, 397. Metabolism, 426. Meyer, Dr. Adolph, 120. Michigan, 1, 3, 11, 28, 73, 96, 100, 102, 103, 104, 106, 108, 110, 113, 114, 116, 118, 125, 126, 129, 132, 135, 138, 140, 143, 203, 343. Michigan Home and Training School, 74. Mickle, Pearly C., 2, 145, 243, 271, 311. Microphthalmia, 377. Migraine, 378. Mills vs. Green, 201. Milroy's disease, 378. Milwaukee County Hospital for Mental Diseases, 96. Mitchell,- Dr. H. W., 39. Mitchner, Lillian M., 73. Model Forms, 465. Model Law, 110, 446, 454. Mongolian imbecility, 379. Moore vs. State of Missouri, 187, 239. Moral Perverts, 292, 311, 312, 318. Morehead, John H., 32, 48, 75. Morgagni, hytatid of, 397. Morgan, 429. Morris Plains State Hospital, 80. Morris vs. Columbus, 171. Morse, State vs., 238. Mott, David C, 66, 180. Mowrer, Dr. G. E., 68. Multiple sclerosis, 376. Munn vs. State of Illinois, 240. Munson, James D., 73. Murphey, Commonwealth vs., 16S. 161. Murphy, Chas. A., 90. Muscular atrophy, 376. Myopia, 376, 380. Myxoedema, 379. Nail defects, 380. National Christian League for Promotion of Purity, 84. Nebraska, 1, 2, 13, 32, 46, 74, 96, 100, 101, 102, 103, 104, 106, 109, 111, 113, 117, 118, 125, 129, 132, 135, 138, 140. Nebraska Board of Examiners of Defectives, 75. Nelles, Fred C, 60. Neurasthenia, 379. Neurofibromatosis, 378. Nevada, 1, 2, 3, 8, 20, 79, 96 100, 101, 103, 105, 108, 112 115, 118, 125, 131, 136, 137, 145, 243. Nevln, D*. Ethan A., 85. New Jersey, 1, 2, 10, 23, 80, 96, 99, 100, 102, 103, 105, 108, 110, 113, 114, 116, 118, 125, 129, 132, 136, 137, 139, 142, 164, 343. New Jersey Board of Examin- ers of Feeble Minded, etc., 164. New Orleans Gas Light Co. vs. Drainage Co., 238. New York, 1, 2, 3, 4, 10, 25, 81, 96, 99, 100, 102, 103, 104, 105, 108, 110, 113, 114, 116, 118, 125, 126, 129, 132, 136, 137, 139, 144. 217, 343. New York Board of Examiners of Feeble Minded, etc., 164. Night blindness, 376, 380. Noble State Bank vs. Haskell, 170, 172. North Dakota, 1, 10, 26, 87, 96, 99, 100, 102, 103, 104, 106, 108, 110, 113, 114, 116, 118, 125, 129, 132, 133, 138, 139, 343. Northrup, "W. H., 26. Nymphae, 398. Nystagmus, 376. O. Oberholzer, Dr. Emil, 120. Obesity, 379. Dbjections, 438. Odell, Arthur, 28. Oddie, Tasker. L., 21. OUswane, Dr. D. E., 85. Olson, Donald B., 91. Olson, Hon. Harry, 322. O'Neil vs. State of Vermont, 162, 188. 189, 197. Operations, types of. 111, 407, 422, 432. Opinions, legal, 1, 206, 222, 287, 322. OCphorectomy, 111, 329, 415, 416, 428, 434, 435. OOphoro-hysterectomy, 414. Orchldectomy, 409. Orders for sterilisation, 164, 179, 272. Oregon, 1, 2, 3, 4, 13, 33, 40, 88, 96. 100, 101, 102, 104, 106, 109, 110, 111, 113, 114, 117, 118, 125, 130, 132, 136, 138, 140, 146, 271, 343. Oregon State Bofird of Eugenics, 4, 33, 88, 146, 271. Osawatomie State Hospital, 70. Osborn vs. Blank, 187. Index 501 Osborn, Frank, 2, 144, 217, 291, 305. O'Shea, 162, 197. Osteopsathyrosis, 373, 380. Osterreichlsohe Zeltsohrlft fOr Strafreoht, 120. Ostoscleroals, 875. Ostrander, Dr. Herman, 73. OS uteri, 406. Ovaries, 404, 428. Ovariotomy, 53, 96, 111, 482 433. Oviduct, 111, 397, 405. Ovists, 400. Ovum, 397, 406. Owens-Adair, Dr., 41, 43. F. Pacific Colony, Cal., 3, 8, 19, 60. Pacific Express Co. vs. Slebert, 192. Palmaris longus, 376. Pan-hystero-kolpectomy, 414. Paradidymis, 397. Paralysis, 379. Paramyoclonus multiplex, 379. Paranoia, 375. Parker, Judge, 162. Paroophoron, 397. Parovarium, 397. Parsons, F. W., 86. Parthogenesls, 401. Passaic vs. Patterson Bill Post- ing Co., 172. Patchen, State vs., 149. Pattern baldness, 376. Peck, Arthur K., 33. Pedigrees 104, 362, 369. Penis, 398. Penitentiaries. (See also Prisons and Re- formatories.) Iowa, 179, 304. Kansas, 71. Nebraska, 79. Nevada, 79. North Dakota, 87. Oregon, 90, 271,318. Washington, 91, 162. Pennsylvania, 1, 4, 35, 39, 343. Pennsylvania State Vaccination Commission, 341. Pennypacker, Saml. "W., 36. People vs. Morris, 153. People vs. Miner, 194. People vs. King, 238. People vs. Budd, 238. People vs. Hupp, 238. People vs. Freeman, 239. People vs. Havnar, 239. People vs. Morse, 239. People vs. West, 240. Perkins, Elt C, 21. Perry, Dr. M. L., 70. Phalleotomy, 407. Phallo-orchidectomy, 407. Philpott, Austin F., 179. Physiology, 425. Pllcher, Dr. F. Hoyt, 351. Pilsbury, Dr. Lawrence B., 78 Pitts, 192. Pittsburgh, etc. Ry. Co. vs. Board of Public Works, 192. Pituitary, 426. Pneumonia, 378. Poison Ivy, immunity to, 373. Pollock, Dr. Henry M., 62. Pollock, John C. J., 190, 191. Polydactyly, 372. Potentia generandl, 425. Potentia coeundi, 425, 436. Potential parent, 447, 455. Potter, Dr. C. A., 86. Price, W. P., 17. Pridgeon, U. S. vs., 160. Prince, L. H., 95. Prisons. (See also penitentiaries and reformatories.) Auburn State Prison, N. T., 84. California State Prison, San Quentin, 60. California State Prison, Pol- som, 61. Clinton State Prison, Danne- mora, N. Y., 84. Connecticut State Prison, Wethersfleld, 61. Great Meadows Prison, Com- stock, N. T., 84. Indiana State Prison, Michi- gan City, 64. Indiana Woman's Prison, Indianapolis, 64. Indiana State Farm, 64. Industrial Farm for Women, Neb., 79. New Jersey State Prison, Trenton, 80. Sing Sing Prison, Ossining, N. Y., 84. State Prison, Nevada, 245. State Prison, Waupun, Wis., 94. Western House of Refuge for Women, N. Y., 85. Procreate, 447, 455. Propositus, 362. Prostate, 398, 426. Protein sensitization, 377. Protoplasm, 401. Ptosis, 374. Punishment, cruel and unusual, 442. Punitive motive, 101. Quarantine, 133, 341, 438. Radio-ulnar synarthrosis, 373 Rathke, duet of, 397. Raymond, P. H., 91. Raynaud's disease, 378. Read, Horace D., 15. Recessive traits, 365, 381. Records. 137, 271, 448. Redmon, State of Wisconsin vs., 238. Ref ormatori es — (See also Penitentiaries and Prispns.) Clinton, New Jersey, 80. Eastern New York Reforma- tory, 84. Green Bay, Wisconsin, 94. Industrial Home for Women, Wisconsin, 95. Industrial Reformatory, Kan- sas, 73. JefCersonville, Indiana, 63, 256, 312. Monroe, Washington, 91. New York State Reformatory, 84. Rahway, New Jersey, 80. Reformatory for Women, 85. Reily, John A., 55, 58. Rem. & Bal. Code, 153. Remser, W., 80. Rentoul, Dr. R. R., 355, 433. Repeals, 1, 26. Reports, compulsory, 357. Research institutions, 392. Rete testis, 397, 400. Retinitis pigmentosa, 374. Reynolds, Nora, 3, 143, 144, 203, 291, 305. Rheumatism, 378. Richard, John Lewis, 58. Richards, Robert Lewis, 55. Right-handedness, 375. Robb, State vs., 239. Roberg, Dr. David N., 89. Robinson, Dr. C. A., 60. Roentgen, W. K., 412. Rosenfeld, Dr. Ernst, 120. Ross, Dr. John R., 84. Rudd, Honorable William P., 4, 221, 222, 231. Ruppenthal, Judge J. C, 347. Ryon, Dr. Walter G., 85. S. Sadler, Dr. William S., 122. Sage, Henry M., 26. Salpingectomy, 96, 111, 419, 422, 435. Salpingo-oophorectomy, 415. Santa Clara County vs. So. Pacific R. R. Co., 239. Saunders, James C, 179. Schweizerische Zeitschrift fiir Strafrecht, 119. Scoliosis, 378. Scott, A. B., 29. Scott, K. W., 61. Scrotum, 398. Seaboard Air Line Ry. vs. R. R. Com. of Ga., 198. Segregation, 350, 439. Sellers, Dr. L. R., 71. Seminal vesicles, 400. Sex-linked traits, 365, 383. Shanahan, Dr. William T., 85. Sharp, Dr. Harry C, 119, 145, 156, 161, 196, 231, 237, 255, 323, 328, 351,. Shelton vs. Piatt, 192. Shenango vs. Wayne, 17V« Shideler, George A. H., 256. Shumway, H. P., 32. Slier vs. Louisville & Nashville R. R., 199, 200. Simon vs. Craft, 240. 502 Index Skin, 373. Slaught, Dr. A. W., 23. Sleyster, Dr. Rock, 95. Smith, Alfred E., 26. Smith, Alice, 1, 2, 142, 164, 188, 206, 210, 215, 233, 236, 237, 251, 291, 292.. Smith, Andrew C, 271. Smith, Dr. G. A., 87. Smith, J. J.. 61. Smith, Dr. J. N., 90, 271. Smith, Jessie Spaulding, 121. Smith, Walter I., 191. Smith, "Warren Wallace, 146, 255, 291, 312. • Smyth, Dr. Margaret H., 410 411, 418. Social inadequates, 369, 430, 446, 465. Societies, 392. Sonoma State Home, 7, 18, 19, 55, 59. South Dakota, 3, 13, 34, 90, 96, 100, 101. 102, 104, 106, 113, 117, 119, 125, 130, 132, 135 138. Southern California State Hos- pital, 55, 58. Spastic paraplegia, 379. Spaying, 414, 428. Spermatozoon, 397, 398, 400, 401 402. Spermectomy, 410. Splenic anemia, 378. Sproul, William C, 39. St. Johnsbury, State Board of Health vs., 239. St. Louis vs. Gait, 239. Stansbury, Ele, Attorney Gen eral, 257. Statistics, institutional, 52. Steinach, 429. Steiner, Dr. R. E. Lee, 89, 271. Steno, Nicolaus, 404. Stephens, William D., 19. Sterilization, 53, 56, 57, 277, 338, 351, 360, 447, 456. Stewart, R. A., 69. Stocking, Leonard, 55. Stockton State Hospital, 54, 56. Strotl vs. Commonwealth, Mass. 252. Sturtevant vs. Commonwealth, Mass, 187. Stuttering or Stammering, 378. Sumner, Dr. Guilford H., 69. Suprarenal cortex, 426. Surgery, 407. Sydenham's Chorea (St. Vitus' dance), 375. Srayphalangy, 872. Syndactyly, 372. Taber, Honorable E. J. L., Judge 243. Taleifi 376. Talkington, C. E., 64. Tappins, M. J., 94. Teeth, 376, 377. Telangiectasis, 378. Temperament, 376. Testes, 399, 425. Testes mullebres, 404. Testiectomy, 434. Thalassophllia, 377. Thatcher, George B., Attorney General, 248, 250. Thayer, Ethel H., 54. Thayer, Dr. W. N., Jr., 84. Therapeutic purpose, 100, 127, 436. Thigh-bones (dislocation), 379 Thomson's disease, 376. Thomson, Dr. Lemon, 2, 82, 144, 217, 306. Thorn, George B., 81. Thyroid, 426. Thymus, 426. Todd, Arthur J., 120, 121. Tomllnson, Wilbur F., 19. Toothlessness, 377. Topeka State Hospital, 70. Traits, list of, 366, 372. Traverse City State Hospital, 73. Treat, F. S., 68. Tremor, 379. Trenton State Hospital, 80. Tubectomy, 56. Tubull recti, 400. Turpin vs. Lemon, 199. Twice in Jeopardy of life and limb, 442. Twins, 377. Tyler vs. Judges, 199. Tylosis palmae et plantae, 373. Tyrrell, Edward J., 18. Universities, 393. Urethra, 398. Urogenital sinus, 398. Utah, 343. Uterectomy, 111. Uterus, 397, 403, 405. Vaccination, 130, 133, 339, 438. Vagina, 397. Van Wagenen, Dr. Sleeker, 225, 236. Van Waters, State vs., 149, 154. Vasa deferentla, 111, 397, 898, 400, 405, 406, 408, 410, 411, 422, 435, Vasa efterentla, 397, 400. Vasectomy, 66, 96, 130, S25, S27 329, 362, 410, 434. Venereal Diseases, 343, 346. Vermont, 1, 43, 844. Vetoes, 1, 35, 36, 38, 40, 45, 47, 60. Vlemelster and Jacobsen vs. Commonwealth, Mass., 233, 240. Virginia, 344. Vita sexualis, 425. Vitiligo, 873. Voldeng, Dr. M. N., 66, 69. Von Recklinghausen's disease 378. W. Wagner, Dr. Charles G., 86. Walker vs. Jameson, 239. Wanderlust, 377. Wansboro, Dr. William J., 82, 144, 217. Washington, 1, 4, 6, 16, 91, 96, 99, 100, 101, 103, 104, 106, 107, 110, 111, 112, 115, 118, 124, 129, 131, 136, 137, 139, 142, 344. Webb, U, S. Attorney General, 328. Webbed toes, 377. Weeks, Dr. David F., 164, 291, 297. Weeks, F. B., 19. Weems, 61, 162, 1'73, 189, 197, 231, 249, 252. Werner, H. C, 95. West, Oswald, 42. Western House of Refuge, N. T., 85. Whalen vs. Dalahsmutt, 192. Wharton, Criminal Law, 197. White, B. H., 23. White, State vs., 249. Whltten vs. State, 155, 160, 162, 197, 249, 251, 330. Wilcox, F. S., 62. Wilkerson vs. Utah, 162, 197. Williams vs. Boynton, 187. Williams, Dr. Charles F., 146, 266. Williams, H. W^., 94. Williams, Sidney, 152. Williams, State vs., 166, 160, 162, 197. Williams, William B. J., 206. Wilmarth, Dr. A. W., 96. Wilson, Woodrow, 23. Wisconsin, 2, 12, 31, 92, 96, 100, 101, 102. 103, 106, 109, 110. Ill, 113, 116, 118, 126, 126. 129, 132, 135, 138, 140, 149, 344. Wisconsin State Board of Con- trol, 93. Withycombe, James, 33. Witte, Jrax E., 67, 69. WItthaus and Becker, 159. Wolffian bodies, 397. Woodbury, Egburt E., 221. Woodruff vs. New Tork and New England Railroad Com- pany, 327. Woodward, Dr. George, 36. Woodward, State vs., 161, 330. Worbeck, Peter, 34. Wyatt's Case, 162, 197, 250. Wylie, Dr. A. R. T., 87. X-rays, 112, 119, 133, 407, 412, 421, 422. Z. Zeltschrlft fUr die gesamte Strafrechtswlssenschaft, 120, Zona pellucida, 406. Zuhlke, Daniel F., 206. Zygote, 404. "To he a good animal is the frst requisite to success in life, and to he a Nation of good animals is the first condition to National prosperity." — ^Herbert Spencer. ^^«2? . v^>- ■: , r^(*i'.-.*«. '•■.."' •'- • - 1-.* 'r- •"■•k 1 . > • » ".:> ; . p • 1 1 •< ■♦'. '. •■ ,, '-.'l"^ ■j^^Jil*.