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Eugenics and Healthy Families. Interdependence and Legitimation

  1. Prof Mary D. Lagerwey, Phd, RN ORCID iD Western Michigan University, Bronson School of Nursing, USA

Abstract

There was significant popular support for eugenics in the first part of the twentieth century. Discourses from various organizations promoting the health of children and families interacted with eugenic discourses and provided support for eugenics to health care providers and the general public. Linking eugenics with better health of the population was an essential aspect of legitimizing eugenics among the general population. The American Journal of Nursing (AJN) provided an avenue for informing nurses about eugenics, gaining their support, and encouraging them to gain support for the movement among their patients and the public. This paper provides an overview of organizations in the US focused on or encompassing the eugenics movement and an analysis of eugenic discourses in AJN. All issues of AJN from 1900–1950 were read for eugenic and related language. These texts then were analyzed for authoritative, moral, rational, and story-telling support for eugenics. Nursing leaders worked closely with eugenic societies and organizations that were designed to improve the health of infants, children, and families. Eugenics was seen as a tool to reduce social and health problems, and eugenic leaders looked to these organizations and nursing to gain broad public support. AJN participated in the work of legitimizing eugenics through various means of legitimation, including appeals to authority, nurses’ moral values, the rationality of science, and moral tales.

Keywords

1. Introduction

The term “eugenics” was introduced into public discourse in 1883 when Sir Francis Galton of Great Britain wrote of eugenics as a science of racial improvement through controlled breeding. The term has since taken on broad and at times contradictory meanings, ranging from negative eugenic practices of euthanasia and non-consensual sterilization to limit reproduction among those deemed physically or mentally “unfit” or “socially inadequate” to positive eugenic practices that encouraged the healthy, fit, and native-born to have larger families and protect their children’s health. Eugenics included legislation, institutionalization, marriage restrictions, and quotas on immigration.

This paper provides an exemplar of how eugenics interacted with discourses of infant, child, and family health, how it gained popular support, and of one venue by which it was legitimized to and by the nursing profession. The first section of the paper discusses some of the distinctive characteristics and contexts of eugenics in the US [1] and of various associations that were established to prevent illness and improve the health of the population, particularly of children and families. Nursing groups and individual nurses were active members of many of these organizations and helped translate eugenic concepts into everyday life. The next section is an analysis of the American Journal of Nursing (AJN) from 1900–1950 to determine how texts in this popular journal reflected and provided legitimation for eugenic discourses and practices over time. During those years AJN was the official journal of the American Nurses Association (ANA) and the most widely-read nursing journal in the US.

Legitimation refers to justifications and explanations that provide a normative validity to discourses. The concept draws from a rich tradition of critical theory, social, and linguistic scholarship as developed by Theo Van Leeuwen. [2]

2. Background

In 1907, the US state of Indiana passed the world’s first law legalizing non-consensual sterilization. Laws in Japan were passed on the heels of US laws; later in 1907, the first of Japan’s Leprosy Prevention laws allowed for lepers to be segregated in sanatoria; many were sterilized without their permission. [3] “In 1921, the Canadian National Committee for Mental Hygiene recommended sterilization of those with mental defects or disorders.” [4] This law was interpreted broadly in Alberta, in British Columbia, and in “14 different federally operated Indian Hospitals across Canada.” [5] Eugenic laws in Switzerland, Denmark, and the state of Veracruz in Mexico [6] preceded eugenic legislation in Germany, which did not pass eugenic laws until 1933 when the Nazi regime came to power. [7] By World War II, non-consensual sterilization was legal in Nordic countries, Switzerland, Austria, Estonia, Mexico, Canada, Japan, and the United States. [8] Throughout these countries, as well as in Scandinavia and much of northern Europe, however, eugenic practices preceded, were broader than, and were not dependent upon, sterilization laws.

As the first country to legalize non-consensual sterilization, and the country whose laws formed a model for Nazi Germany’s eugenic laws, [9] the US provides a case study in eugenics as not just political sets of laws, but also as a movement that required, and for many years received, broad public support. Gallup polls from 1938 found that 84 % of the US population supported mandatory sterilization for the “unfit” [10]. The nursing profession’s public discourses provide a fitting perspective from which to obtain a glimpse into legitimation not only for negative eugenics such as sterilization of the unfit, but also for positive eugenics. Nurses worked closely with everyday matters of families’ health and were gaining recognition as knowledgeable health care providers. As in other western countries, nursing was becoming more professionalized, with individual states requiring licensure for practice, and standardization of curricular content. Public health nurses had significant and often long-term contact with families and enjoyed more professional independence than their counterparts in hospitals. [11]

The eugenics movement grew in legitimacy at a time when much of the industrialized world had been transitioning from a rural to a more urban society. Within the US the Great Migration of African Americans from the rural south to northern cities and new immigrants settling in cities, combined with racism and xenophobia, contributed to overcrowding, poverty, and unhygienic living conditions. Microbiology had identified the causes of many diseases, but the poverty and overcrowding in many large cities made it difficult to control the spread of infectious disease. [12]

Eugenic leaders such as Harry Laughlin, the Eugenics Record Office Superintendent, led successful efforts to pass legislation to restrict immigration from countries outside northern Europe. [13] This was coupled with dire warnings of “race suicide,” a decrease in the percentage of the population who were white, native-born, and “fit”. AJN did not publish overtly anti-immigrant articles, but many articles addressed social problems and conditions of poverty commonly experienced by immigrants and racial and ethnic minorities.

3. Eugenic Organizations in the United States

Much of the eugenics movement in the US was organized around five societies, with overlapping memberships. The American Breeders Association (ABA) was organized in 1903 and grew out of the American Agricultural Colleges and Experimental Stations’ focus on livestock and other farm animals. It published the Journal of Heredity. Its purpose was to apply Mendel’s 1865 research on hereditary patterns of dominant and recessive traits to eugenic research on human inheritance. The association captured some of the nation’s optimism for the potential to eliminate inherited disease through controlled breeding. Charles Davenport, a zoologist and the Director of the Station for Experimental Evolution in Cold Spring Harbor, Long Island, New York, worked closely with the ABA. In 1914 the ABA changed its name to the American Genetic Association. It continues today with a focus on genetic research. [14]

The Race Betterment Foundation was founded in 1911, supported by John Kellogg of Kellogg Cereal fame. International Conferences for Race Betterment were held in 1914, 1915, and 1928. It did not survive Kellogg’s death in 1943. [15]

The Galton Society, founded in 1918 in New York City, was exclusive, overtly racist, and nativist, yet had close ties with more moderate eugenics organizations, the Eugenics Records Office (ERO), and eugenics leaders in Europe. Harry Laughlin, superintendent of the ERO, drafted the US legislation on which Germany’s eugenics laws were modeled. [16] The Galton Society supported German Nazi views in its journal, Eugenical News, which it published with the Eugenics Record Office (ERO). The Galton Society disbanded in 1939. [17]

The Eugenics Record Office (ERO) was not strictly a society, but its influence was significant, and it worked closely with other eugenic societies. The ERO considered women superior observers of families and employed them as field-workers and researchers who collected multi-generational family data and analyzed the data to identify intergenerational eugenic patterns. [18]

The goals of the fifth organization, the American Eugenics Society (AES), included legitimation of eugenics through education of the public. The AES originated at the 1921 Second International Congress of Eugenics, was officially incorporated in 1926, and was renamed the Society for Social Biology in 1972. Its members lobbied for eugenic legislation such as immigration restrictions and mandatory sterilization of the “unfit.” It promoted eugenics through social agencies, professional groups, and public exhibits, linking eugenics with discourses of physical, social, and family health. The AES sponsored several conferences on eugenics for professions with significant contact with the public, including social work, education, and nursing. Its assertion at the March 20, 1937 Conference on Education and Eugenics summarized its approach to popularizing eugenics. “[E]ugenic propaganda will go furthest if it is treated as incidental to all other social advance.” [19]

Eugenics education included positive eugenics and called upon the “well-born” to have large families, reinforcing traditional gender roles among the middle and upper classes. [20] Perhaps the best-known example of this was a variation on the baby contests held at cultural events such as rural county and state fairs, which had been popular during the latter part of the 19th century. It was a small step to infuse the contests with agriculturally-based eugenic ideals of breeding. An idealized robust rural identity, health for future generations, and nurses’ participation in eugenic discourses came together in the popular Better Baby Contests. The AES relied on professional women such as nurses to educate women in so-called “scientific motherhood” and euthentics, the means of providing the best environments for children to reach their full genetic potential. [21]

The first Better Baby Contest was in 1908 in Louisiana. This and subsequent contests used standardized measurements and criteria to evaluate how children were developing compared to their peers. Physical and intellectual testing were conducted, with the two seen as interdependent domains of health.

Photographs of the contests show nurses in starched white uniforms and caps judging babies and toddlers in curtained-off sections of large tented pavilions, with proud mothers looking on or holding their children. [22] Conference Proceedings from the first National Conference for Race Betterment contained quotes from mothers who had brought their young children to compete in Better Baby Contests, illustrating scientific motherhood, or dual emphasis of eugenics and euthenics. “I did not bring my baby because I expected him to win a prize, but to learn if there is anything wrong and what I can do to aid his development”. [23] Parents were to correct areas in which their children scored low. These contests quickly spread to 40 states before World War I, with over 100,000 babies examined at agricultural fairs in 1914. [24] Photographs of winners were prominently displayed in Eugenic magazines and local newspapers, and at national eugenics conferences.

The American Eugenics Society soon realized that a stronger eugenic message could be communicated by incorporating other family members into the contests, assessing family lineage, and focusing on the health of future generations. The first Fitter Family Contest was held at the 1920 Kansas State Free Fair. Teams of health care providers, including nurses, performed physical and psychological exams on family members. Individual family members were given overall letter grades of eugenic health, and families with the highest grade averages were given silver trophies. All families with an average of B+ or better were given bronze medals, engraved with a quote from Psalm 16:6 that lent religious authority to the competition and the award: “Yea, I have a goodly heritage". Photographs of winning families were prominently displayed in the AES’s Eugenics: A Journal of Race Betterment and local newspapers, and at national eugenics conferences. [25]

The AES held a conference, The Relation of Eugenics to the Field of Nursing, on February 24, 1937. US nursing leaders, as well as ASE members from public health, education, infant and child health, and visiting nurse services attended. [26] Charles Davenport and nursing leaders such as Naomi Duetsch, Director of Public Health Nursing at the Federal Children’s Bureau, and Lillian Hudson, Professor of Nursing Education at Teachers College in New York City spoke of the moral duty of nurses to understand eugenics as a science and guide for practice. Papers were presented on the role of public health nurses in identifying cases for sterilization, the fit between eugenics and good nursing care for infants and children, and application of eugenic principles. Marie Kopp, a German eugenicist, presented a paper that Osborn cited as “The Nature and Operation of the German Eugenical [sic] Program.” [27] Kopp contextualized German eugenics laws within severe health and social problems there and provided details on related legislation and practices, such as the Race and Hygiene and Marriage Health Law of November 1935, that contained bans on marriage between Jews and non-Jews. A paper by Katharine Faville, Associate Dean, Western Reserve University School, discussed “The need for teaching eugenics in schools of nursing”. [28]

In closing remarks Henry Osborn, a founder of the Galton Society and member of the AES, noted that some aspects of German eugenics could not have been enacted without a dictator. Alta E. Dines, a leader in public health and Director of the Bureau of Nursing Education, attended the conference and wrote a report for AES, including the role of public health nurses, noting that with 220,000 nurses in the US with daily patient contact and 20,000 public health nurses, nurses were ideally situated to these tasks, provided they were adequately educated on eugenics. Curricular recommendations were included. Although the American Journal of Nursing routinely covered conference proceedings and meetings of interest to nursing, it did not cover this event.

4. Nurses, Family Health and Eugenics

Discourses of the eugenics movement interacted with those of several organizations and movements in which nurses actively participated, including child and family health, and prevention of sexually transmitted diseases and alcohol abuse. The eugenics movement had close ties with the American Social Hygiene Association (ASHA). This association was formed in 1914 to prevent what were then called venereal diseases, with their often-devastating impact on families. The association included nurse leaders and promoted inclusion of social hygiene content in nursing curricula. Much of the eugenic rhetoric on social hygiene was integrated with eugenic discourses based on the notion that “germ cells” of parents were damaged by alcohol, and that detailed family histories could identify those at risk for transmitting these defective genes. Nurses’ roles included preventative education and gathering family histories. AJN’s News and Announcements sections carried frequent items about meetings of the ASHA and eugenic components of their agendas, and curricular recommendations encouraged nursing programs to include social hygiene and eugenics together in their curricula.

Although there are no definitive statistics for infant mortality in the early 20th century, reported deaths of children under the age of one year for all registered areas in the US were 286.7/100,000 population [29] and there was general consensus that these rates were alarmingly high and needed to be tackled with collaboration from many sectors of society. AJN reported on meetings of the American Association for the Study and Prevention of Infant Mortality (AASPIM). Leading members included Mary Adelade Nutting, Professor and Chair of Johns Hopkins School of Nursing, as well as prominent members of eugenics associations such as Irving Fisher, founding president of the AES and Charles Davenport, Head of the Eugenics Record Office.

In his opening address at the AASPIM’s first meeting in 1910, Irving Fisher spoke of preventing infant mortality as congruent with natural selection, concluding that, “this [eugenics] movement aims to remove the interferences with natural selection which modern civilization has created.” [30] Annual meetings were held from 1910–1918, with eugenic sections and topics for discussion at each meeting [31] and coverage in AJN.

Although eugenic and public health discourses clearly interacted, the relationship between the two was at times ambivalent and controversial. Was heredity biological only, or did it rely on childrearing practices? Does eugenics speed up or interfere with natural selection? At the 1914 National Conference on Race Betterment, some, such as Paul Popenoe and John Harvey Kellogg, argued that public health measures such as sanitation and immunization were dysgenic in that they increased chances of survival and reproduction of the unfit. Some, such as nurse midwife Mary Breckinridge, held that good stock needed education and good health care to have a healthy environment to thrive and reproduce healthy children. [32]

Another nurse, Margaret Sanger (1879–1966), is closely associated with both birth control and eugenics. Although she shared the eugenic goal of limiting reproduction by newer immigrants from countries outside northern Europe, eugenics leaders supported neither reproductive choice nor Sanger’s emphasis on the health of women, particularly mothers. [33]

Nonetheless, the birth control movement sought rational scientific and moral legitimation from the eugenics movement. Birth control activists often used the language of eugenics and appealed to the moral value of caring for the health of children and future generations. They found common ground in the belief that, “Every child has the right to be well born.“  [34]

Eugenic organizations such as the AES appealed to women’s increasing independence and provided respectable venues for involvement in social concerns. [35] In some areas women’s organizations and eugenics overlapped, but much of the collaboration between organizations for women’s reforms and mainstream eugenics had dissipated by the early twentieth century as women’s reforms were excluded from eugenic platforms. AJN, however, covered and integrated infant and child health and social hygiene with eugenic discourses. Women’s rights and birth control were deemed too controversial and were avoided. [36]

5. Analysis of AJN Texts

Method

It is beyond the scope of this paper to present an analysis of all US nursing publications from the time under study. However, one widely distributed nursing journal, at that time published by ANA and its predecessors, provides an exemplar of how nursing texts from the first half of the twentieth century worked to legitimize eugenics as an area for nursing knowledge and a means of improving health, and data on how eugenics was presented to and by nurses. AJN was first published on October 1, 1900, with a purpose of keeping members of the ANA “educated and informed of nursing issues and procedures and that the gospel of unselfish devotion to the care of the sick might be spread, with propaganda for securing to the profession a status whereby its usefulness should be increased.” [37] AJN informed its readers, reflected wider discourses, and played a part in constructing the meaning of eugenics for its readers. Journals such as AJN have the power to shape reactions to events. [38] This study examines one forum for eugenics discourse published for a nursing readership in the United States. It explores the extent and manner in which nurses reading AJN from 1900–1950 would have been exposed to eugenics discourses.

The notion of legitimation as developed by van Leeuwen [39] was used to examine references to eugenic and related concepts in AJN. According to van Leeuwen, there are four types or bases of legitimation: authority of individuals or institutions, moral values and evaluations, rationality, and the use of stories.

AJN was chosen for its broad readership, coverage of news related to the nursing profession, and frequent articles on nursing policy, education, and practice. Each issue was read and entries that included the word eugenics, as well as the language of eugenic discourse, such as race suicide, mandatory sterilization, purity, the unfit, feeble-minded, and degenerate were analyzed. Type, length, and authorship of entries were noted. Some texts were originally written for nursing audiences, while others were reprints of papers previously published or read at conferences, meetings, or lectures. Those included in this paper were of particular relevance for illustrating legitimation of eugenics and concerns for the health of families.

6. Findings

1900–1909

The first notable mention of eugenics in AJN was in 1909 in a section titled, “Foreign Department in Charge of Lavinia Dock, R.N.” This article “The Eugenics Education Society of England,” lent legitimacy to the eugenic movement by placing it within contexts of scientific advancement, support by the International Council of Nurses’ (ICN) president and the British Government, and association with Lavinia Dock. Further legitimacy came through language of moral goodness of fit with existing nursing care for families, and cautionary tales of the impact on families of unchecked fertility among “degenerates.”

1910–1919

In the second decade of the twentieth century, specific references to eugenics and its ideologies became more prevalent, with 29 articles mentioning eugenics and three about the feeble-minded. Eugenics appeared in several “Nursing News and Announcements” sections. In the November 1911 issue, the news section was 23 pages long, and included a report from Indiana State Nurses Association’s annual convention. A page from this report was devoted to eugenics. [40] Legitimizing appears in this and other news items about presentations on eugenics to nurses, emphasized the authority of science and international collaboration, and the moral duty of “educating the public.” [41] An announcement in the March 1912 “Nursing News and Announcements” section recommending Public Health Lectures at the Academy of Medicine on “Sex Hygiene in Relation to Eugenics” illustrated interaction between public health and eugenics. [42]

Physicians, often in connection with eugenics organizations, lent their authority to discourses of health and eugenics. Fifteen articles specifically included eugenics and three discussed the “feeble-minded.” Some articles written by physicians and eugenics leaders were re-printed or written specifically for nurses. These entries were consistent with AJN’s practice of publishing informative articles meant to keep nurses current on developments in health care.

Thus we find articles that described eugenics and presented authoritative legitimation. A section titled “Editor’s Miscellany” contained a long reprint of “Practical Eugenics”, written by John N. Hurty, M. D. Indiana State Board of Health Secretary and avid supporter of eugenic sterilization laws. [43] The article was originally published in the January 1912 issue of Social Diseases, and reprinted in two parts in AJN, in February (four pages) and March (12 pages) 1912. In the February article Hurty emphasized the authority of medicine. As this is the first informational article of any length on eugenics in AJN, his use of analogies and cautionary storytelling present eugenics as commonsense and rational. He appealed to moral legitimation by drawing an analogy between physical and moral “blindness” and between breeding animals and people: “Now at last, we realize that the human race is to be improved by applying exactly the same laws to and that will perfect the breed of the lower animals.” [44] Cautionary tales told of preventable burdens to society from “imbeciles” and the “unfit” allowed to reproduce, and of a talented musician who is “an imbecile and now suffers from impulsive insanity.” [45]

Reflecting on the musician, a “graduate of one of our minor colleges,” [46] he lamented that the man’s grandfather had not been sterilized before he had children. Hurty concluded with appeals to moral and rational forms of legitimation. “It is certainly useless, unnecessary, cruel, bad every way, to permit the procreation of the unfit and then bear ourselves to the earth with a burden of taxation to care for them.” [47]

In part two in the following month, AJN published the remainder of Hurty’s article, which contained even more vivid arguments. This section began with the claim that education and religion have been unsuccessful and unable to “improve the race … decrease crime and increase morality.” [48] Again, Hurty drew legitimating analogies with laudatory tales of animal breeding and cautionary tales of children in an orphan asylum.

Although Hurty wrote here of the science of eugenics, moral legitimation was strong in this article, with arguments again about eugenics being much more effective than religion or education in humanely improving civilization and preventing suffering, and in using scarce resources responsibly. Hurty also likened war to dysgenic practices, linking eugenics with peace, claiming that the Great War had claimed the lives of the men most eugenically fit to become fathers.

Arthur R. Hamilton, Director of Extension Work at the Eugenic Records Office, wrote in a similar vein of the science of eugenics but wrote specifically for nurses and AJN. His article “Science of Eugenics and the Nursing Profession” appeared in the March 1915 issue. References to a “eugenic conscience” and an appeal to future generations to be protected by eugenic practices as “a trust and responsibility” [49] formed moral legitimations for eugenics.

A couple of years later, AJN published shorter pieces by registered nurses concerning the “feeble-minded”. A two-page reprint of a paper read by Lucia L Jaquith, RN and Superintendent of the Memorial Hospital in Worcester, Massachusetts, at the Massachusetts State Nurses Association meeting in October 2013, appeared in the January 1914 issue. In this paper, “The Menace of the Feeble-Minded” Jaquith encouraged nurses to gain public and family support for segregating “feeble-minded” women with appeals to moral norms of the day. Here interests of eugenics and social hygiene intersected, as Jaquith wrote of “feeble-minded” women as promiscuous and fertile. Segregation was considered preferable to sterilization because “the effect of turning 60,000 sterile feeble-minded women loose on society is too easy to forecast, the results to morals and in the spread of disease would be appalling.” [50] Jaquith also relied on authoritative legitimacy by quoting physicians who were leaders in supporting eugenics.

The May 1914 issue contained a three-page response from Ellen Bertha Bradley, RN, “The Problem of the Feeble-Minded”. We again see authoritative legitimacy as Bradley drew support from male eugenic leaders – physicians and an attorney. Echoing messages of the Women’s Temperance League, she made a moral appeal to nurses’ duty to educate potential fathers on the eugenic dangers of any alcohol consumption. Bradley aligned eugenics with the temperance movement, citing alcohol as a leading cause of “degeneracy” among the children of those who drank. [51]

The American Association for Study and Prevention of Infant Mortality had a separate section on Nurses Associations and Social Workers. Its meetings were covered in some detail in AJN’s “Nursing News and Announcements” sections. In 1912, four and a half pages were given to coverage of the third annual meeting of the Association. Of these almost an entire page was devoted to eugenics. The chair presented “The Rearing of the Human Thoroughbred,” [52] providing legitimation through the authority of traditional agricultural practices and fairs, with their Better Baby and Fitter Family contests.

1920–1929

During the 1920s, there were twelve entries in AJN about eugenics. As in the previous decade, nurses wrote about “feeble-mindedness”, but the writers emphasized families’ care for their children and nurses’ moral duty to educate and support families in this care. In 1922 and 1926, V. M. McDonald, RN, wrote of “The feeble-minded as an Individual” [53] and “Changing Concepts of Feeble-Mindedness.” McDonald legitimized her call for “defectives” to be raised in “good homes” with moral, rational, and scientific arguments. She questioned the validity of hastily trained “diagnosticians of mental defect” [54] and presented her recommendations as “the newer point of view,” [55] a correction to public misunderstanding, faulty treatment, and neglect of the needs of persons who are “feeble-minded”. She concluded by quoting a medical authority from the New York State Commission for Mental Defectives, offering a moral and rational argument that challenged and delegitimized some aspects of eugenic practice. “If all defectives could be brought up in good homes they would cease to be the social menace they are now.” [56] The 1926 article provided authoritative and moral scientific arguments that the danger from the “feeble-minded” and their children is rather small, and largely tied to neglect. Its author recommended specific interventions to care for the “feeble-minded”.

Eugenics also was normalized by its presentation as of international interest. In October 1925, AJN included a paper by Annie W. Goodrich, Dean of the Yale Graduate School of Nursing and of the Army School of Nursing, read at the July 1925 International Council of Nurses in Helsingfors, Finland. A half-page photo shows Goodrich addressing a large crowd in an elaborate three-tiered auditorium. Goodrich spoke of increasing rates of inherited mental illness and of her hopes that the science of eugenics would eliminated these and other “evils.” This could be done, she believed, by applying agricultural knowledge to human reproduction. She appealed to the nurse’s moral values, saying she “must take her part” and draw on “tradition, and personal volition … [and] instinct to the conversation of the race.” [57]

Following the 1927 Buck v. Bell Supreme Court decision, AJN invited Leon Whitney, to write a “statement on the legal sterilization.” [58] Whitney was Field Secretary of the American Eugenics Society and in 1934 generated controversy with public support of “Nazi Germany’s sterilization program.” [59] AJN described the article, “Eugenical Sterilization” published in the September 1927 issue of AJN, as “authoritative”. In the article court-mandated sterilization on the basis of eugenic factors was given legitimation through authority, morals, and rationale. Whitney wrote that eugenic sterilization had been declared constitutional by U. S. Supreme Court and “now the matter is settled.” [60] Further authoritative legitimation was given with an extensive quote on eugenics from Justice Holmes, and reference to the large number of states (22) with sterilization laws and the claim that many more would follow within the next year. Furthermore, he claimed the authority of medical science by describing three methods of sterilization in some detail. Moral legitimation was given by describing sterilization as “one of the kindest inventions of man” [61] and having the intent of protection of society from the dangerously “unfit.” [62] Finally, relying on moral and rational legitimation, he claimed that there was no evidence of harm having been done to Carrie Buck or her family; rather her sterilization was of general benefit to society.

In a May 1929 article, “The Ills this Flesh is Heir to” Anna Wallace, who served as assistant editor for the Joint Committee of Eugenical News, appealed to scientific legitimacy with two charts demonstrating simple Mendelian inheritance of dominant and recessive genes for fur color in rats and eye color in people. She argued for the need for significantly more data. [63]

During the 1920s, texts in AJN presented eugenics as a modern science that held a promise of preventing physical and social problems, but also presented arguments delegitimizing claims of great danger from the “feeble-minded”. Authoritative legitimacy was granted through book reviews and numerous news articles advertising educational lectures on eugenics for the public or nursing. Healthy families were possible only through eugenic practices, but also needed family and professional care.

1930–1939

Throughout the 1930s eugenic discourses were interwoven with language addressing nurses in public health, nursing education, infant and child health, and visiting nurse services. Nan Ewing urged nurses were to provide antepartum care with eugenics in mind.

By a careful study of the cases coming under her observation, and a comparison of the normal and the abnormal, she (the nurse) will understand better and appreciate more the importance of eugenics. … Physical inheritance will have a different meaning. She will feel more reverential toward science which made it possible for countless children to be well born. [64]

At one level, Ewing appealed to rational scientific legitimation, but the strength of her appeal relied on religious language of reverence, invoking both moral and authoritative legitimacy.

Although the National League for Nursing Education (NLNE) published its first Standard Curriculum Guidelines for Schools of Nursing 1917, it was up to individual states whether to adopt them. AJN paid most attention to their content and application to various areas of nursing in the 1930s. Eugenics seems to have found its home most clearly in social hygiene, and was recommended as part of biological, physiological, and eugenic considerations, medical nursing, [65] and social elements in nursing. [66] The NLNE guidelines recommended that eugenics be included in the section on “Modern Social and Health Movements”. Content including the history and aims of the eugenics program should be taught, along with euthenics and Mendelian genetics. Ten hours should be devoted to “Modern Social Conditions”, including feeble-mindedness and degeneracy, and various social ills that have an impact on families’ health. These recommendations remained in the 1927 and 1932 guidelines, but in subsequent versions the social and health movements sections did not make specific reference to eugenics.

A couple of articles reflected a close affinity between the US and German eugenics movements. One echoed some of the curricular recommendations by the NLNE. Ties with Germany and its eugenic program were also reflected in a May 1939 paper by Gertrude Kroeger, a German public health nurse and researcher, who had studied at the University of Chicago. The nearly three-page article was titled “Nursing in Germany: Recent changes in organization and education.” The article began: “Since 1933, important changes have taken place in Germany, first in the organization of nurses; secondly, in their education and in the practice of nursing.” [67] Various religious and secular nursing organizations had been combined into “a national federation which was to include all nurses. This organization was called “Reichsfachschaft Deutscher Schwestern und Pflegerinnen” (National Professional Federation of Nurses and Attendants).” [68] Educational changes included a uniform curriculum and exclusion of non-Aryans from most schools of nursing.

In March 1930, the news section contained a short half-column announcement about an upcoming International Hygiene Exhibition in Dresden.” [69] A “special unit of the 1930 exhibition will be the Hospital Exhibit in which nursing will be included … The purpose of this whole exhibit of which this one is part will be to show the need for racial hygiene and will deal with man in relation to his natural needs and environment.” [70] “This is the International Hygiene Exhibition which will have as its nucleus the Deutsche Hygiene-Museum, an institution founded in 1911, for the purpose of teaching hygiene and health.” [71] Here legitimation came from conflating hygiene as sanitation with the eugenic ideology of racial hygiene. In the US curricular guidelines, as well as the American Social Hygiene Association, likewise linked discourses of hygiene with eugenics. [72]

During the 1930s AJN items addressing eugenics reflected further developments in recommended curricula, some of which was in direct response to the recently published curricular guidelines from the NLNE. Eugenics no longer required overt legitimation from cautionary tales or as a “new science”. Its legitimation was reinforced as eugenics appeared as an accepted part of the body of nursing knowledge, worthy of study and discussion, and woven into curricula and practice.

Several positive book reviews and articles were focused on eugenics content in curricula and practice. Legitimation most frequently came from the authority of the books’ authors, the writer of the review, and of science. Three books reviewed argued for mandatory eugenic sterilization. A review in September 1936 concluded, “Every lay person interested in the vital problem of eugenics should own this book.” [73] In an August 1938 review of Ethics: a Textbook for Nurses, Edith H. Smith, R.N. referred to eugenics and euthenics as being “among the ethical problems with which the young nurses of today are struggling.” [74] This item is unique in presenting eugenics as an ethical problem, although the nature of that problem is not specified. It may be that legitimation of eugenics was becoming more nuanced than in prior years.

1940–1949

In the 1940s, AJN content on eugenics decreased to a handful of book reviews and articles on nursing curricula. We find three book reviews, three reports on findings of curricular surveys, and one report on an educational experience in which eugenics was a specific part of the curriculum. We find variety in the aspects of the curriculum in which eugenics is placed, obstetrics, “venereal disease integrated in pediatrics,” [75] pediatric growth and development, [76] and eye health. [77]

The most substantive entry was written by a board member of the ICN and published in May 1940. In eight pages of text and photos the author described her year-long (August 1938–July 1939) participation, along with 20 other students, in an international educational memorial to Florence Nightingale. The program was for “outstanding nurses of various countries to do advanced work in the field of Public Health.” [78] Banworth mentioned eugenics as one of five subjects in her Administrative course. She pointedly emphasizes the “international aspect” of the program, and glossed over signs of approaching war, such as the interruption of the “September Crisis,” concluding that it was solved by the Munich Settlement. [79] This article, along with the others from this decade are most notable for what was omitted. There was little argument for or explanation of eugenics, little apparent need to legitimize eugenic policies or practices.

The topic of eugenics appears normalized, an expected, if at times ignored part of nursing curricula. In an August 1940 two-column review of the 1939 Pediatrics and Pediatric Nursing textbook, reviewer Romine referred to the texts’ “factual materials which are either essential or related to the science of pediatrics.” [80] Romine included eugenics as part of the content in a unit on growth and development, noting that this unit “introduces much that is ordinarily omitted in pediatric nursing textbooks.” It is a topic about “which the nurse needs ample information and which she so frequently lacks.” [81] Eugenics needed no defense for inclusion, but teaching materials and instructors at times needed a nudge or reminder to cover the topic. The reference to science linked eugenics rationally to a body of scientific knowledge, and its normalization speaks to a moral form of legitimation in which something is presented as the way things are done. AJN continued its international focus, with short news items in the section “Nursing in Other Lands”. Referencing a May 1936 AJN entry, one news item, titled “New State Regulations in Germany” described changes in length of education for different levels of nursing and the requirement that all nurses and nursing students belong to one of the “recognized nurses associations in Germany.” [82]

As the US entered World War II, much of AJN’s attention shifted to nursing’s involvement in the war effort and care for patients with specific health concerns. Following World War II, the language of eugenics faded from most public and professional discourses. However, the work of legitimation was not so easily undone. As Rydell noted, “eugenics and racism are about ideology—ideas and culture enmeshed in a system of beliefs, values, and practices—that could not be easily displaced by either new scientific knowledge or by the discovery of hideous practices by the Nazis.” [83] Although the term eugenics fell out of favor following the abuses of the Nazi era in which negative eugenics progressed to the murder of millions, compulsory sterilizations continued in the United States into the 1970s, with an estimate of over 19,000 involuntary legal eugenic sterilizations. [84]

7. Discussion

In the first half of the twentieth century, eugenic discourses in AJN were prevalent enough for the average reader to conclude that eugenics was relevant for nursing. Lavinia Dock introduced eugenics in the journal in 1909 with a news article from a eugenics conference in England. In the following two decades, AJN published lengthy articles about eugenics from non-nurses who held positions of legitimizing authority as physicians, scientists, or recognized leaders of eugenic organizations. Eugenics was legitimized as a rational new science. Some of these articles included storytelling, tales warning of what had and could happen when eugenics practices were not applied to the “unfit.” AJN also provided information on how nurses could apply their knowledge about eugenics in their practice: through education on the choice of a spouse, preventing reproduction by the “unfit,” and teaching parents how to help their “well-born” children reach their genetic potential.

AJN began the century paying attention to the “new science of eugenics.” Appeals to existing moral values of nurses helped legitimize eugenics with discourses of improving the health of future generations. By the 1920s, eugenics was on the agendas of numerous health care meetings and conferences covered by AJN, demonstrating interaction between health care and eugenic discourses. This lent moral legitimation to eugenics as beneficial and a concern of nursing. The frequent inclusion of eugenics in AJN articles on curricular development, standards, and evaluation reinforced the legitimacy of eugenics for nurses on authoritative, moral, and rational grounds. Once eugenics was established within nursing curricula and as part of organizations for infant and child health, AJN coverage of eugenics shifted to reporting on meetings, curricular development and evaluation, and book reviews.

What was not found is also important. Eugenics discourses in AJN did not contain overtly racist or anti-immigrant rhetoric. Birth control was mentioned only negatively. Although eugenics was presented as an international movement, the only countries besides the US mentioned specifically as engaging in eugenic discourses were Great Britain, Germany, and Finland. Finally, AJN never mentioned euthanasia as a eugenic measure. Consistent with broader trends, at mid-century the two had not been inexorably linked in the pages of AJN.

AJN entries that included eugenics functioned in several ways. Some were educational entries with authoritative sources and scientific rational. Some included tales of warning. Others appealed to moral values and accepted customs, illness prevention and health promotion. By the 1940s, eugenics moral legitimation relied more on normalization.

Nursing discourses in the United States and as reflected in the pages of AJN resonated with societal interaction with the eugenics movement and its organizations. Nursing leaders often had active roles in eugenic organizations and worked closely with organizations designed to improve the health of infants, women, and families. These organizations were generally supportive of eugenics as a means of reducing suffering, and social and health problems. AJN participated in the work of legitimizing eugenics to its readers and encouraging nurses to legitimize eugenics to their patients and the public. Yet AJN did not speak about eugenics with one voice. At the same time that the Bell v. Buck non-consensual sterilization case was making its way through the US Supreme Court, some nurses were questioning the legitimacy of both involuntary sterilization and treatment of the “feeble-minded” in institutions on moral grounds.

Eugenics was never without its critics, from within scientific communities, nursing, and the public, but neither was it a fringe movement in the United States. An understanding of the dynamics of legitimation of eugenics in a widely-read professional journal can sensitize the professions such as nursing to ethical issues of today.

Acknowledgement

This research was supported by a University of Pennsylvania’s Karen Buhler-Wilkerson Faculty Research Fellowship at the Barbara Bates Center for the Study of the History of Nursing. Support was also received through a Research and Education Development grant from the Western Michigan University College of Health and Human Services, and a sabbatical leave from Western Michigan University.

Mary D. Lagerwey (Prof Dr), Bronson School of Nursing, Western Michigan University, USA

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[1] For more detail and images see the American Eugenics Archive at http://www.eugenicsarchive.org (accessed March 30, 2020) and the American Eugenics Society Records, American Philosophical Society collections and its digital “Genetics and Eugenics” collections at https://www.amphilsoc.org/library/guides (accessed March 30, 2020).

[2] Van Leeuwen 2007, p. 92.

[3] Amy/Rowlands 2018 a.

[4] Amy/Rowlands 2018 a, p. 127.

[5] Amy/Rowlands 2018 a, p. 127.

[6] Amy/Rowlands 2018 a, pp. 126-127.

[7] Amy/Rowlands 2018 b, p. 195.

[8] Broberg/Roll-Hansen 1996, 2005; Amy/Rowlands 2018 a; Amy/Rowlands 2018 b.

[9] Amy/Rowlands 2018 a, pp. 123-126; Amy/Rowlands 2018 b, pp.195-196.

[10] Lombardo 2008, p. 227.

[11] Buhler-Wilkerson 1985, pp. 1155–1161.

[12] See data from the United States Census Bureau from the 19th and 20th centuries for details on changing immigration patterns and growth of urban areas, https://www.census.gov/prod/www/decennial.html, accessed April 1, 2020.

[13] Lombardo 2008.

[14] Engs 2005.

[15] Wilson 2014.

[16] Amy/Rowlands 2018 b, p. 195.

[17] Engs 2005.

[18] Bix 1997; Black 2003.

[19] McCracken, Henry N.: Report on “Conference on Eugenics in Relation to Education” for the 1937 Annual Meeting of the American Eugenics Society, American Eugenics Society Records, American Philosophical Society, Box 1, p. 22.

[20] Kline 2005.

[21] Kline 2005.

[22] See examples in Archives of Michigan Box 850 Folder F2 and in the American Eugenics Society Records, American Philosophical Society collections and its digital “Genetics and Eugenics” collections at https://www.amphilsoc.org/library/guides, accessed March 30, 2020.

[23] Proceedings of the First National Conference on Race Betterment 1912, p. 622.

[24] Kline 2005.

[25] These and many other eugenics images can be found in the American Eugenics Society Records, American Philosophical Society collections and its digital collections at https://www.amphilsoc.org/library/guides (Genetics and Eugenics), accessed March 30, 2020.

[26] Summary of Proceedings-Conference on Eugenics in Relation to Nursing 1937, American Eugenics Society Records, American Philosophical Society, Box 17, Folder 8.

[27] The copy of this address found in the American Philosophical Association archives gives a title of “A Eugenic Program in Operation.” American Eugenics Society Records, American Philosophical Society. “Summary of Proceedings-Conference on Eugenics in Relation to Nursing”, Box 17, Folder 8.

[28] See Lagerwey 2006 for a more detailed analysis of relationships between US and Nazi German Nursing.

[29] According to the Department of Commerce and Labor Bureau of the Census Mortality Statics for 1910, true infant mortality rates were difficult to estimate as births were under-reported while numbers of infant deaths rates were assumed to be more accurate. This would have resulted in reported infant mortality rates that were higher than actual rates.

[30] American Association for Study and Prevention of Infant Mortality: Transactions of the First Annual Meeting. 1910, p. 39.

[31] American Association for Study and Prevention of Infant Mortality: Transactions of the First Annual Meeting 1910.

[32] Pernick 1997, pp. 1767–1772; Goan 2008, p. 109.

[33] Kevles 1985, p. 89; Lagerwey 1999.

[34] Kline 2005 p. 64.

[35] Kevles 1985.

[36] Lagerwey 1999.

[37] Riddle 1925.

[38] Lipstadt 1986, p. 3.

[39] Van Leeuwen 2007, pp. 91–110.

[40] AJN 1911, pp. 155–156.

[41] AJN 1911, p. 156.

[42] AJN 1912, p. 511.

[43] Stern 2007, pp. 2–28.

[44] Hurty 1912 a, p. 451.

[45] Hurty 1912 a, p. 452.

[46] Hurty 1912 a, p. 452.

[47] Hurty 1912 b, pp. 525-536.

[48] Hurty 1912 b, p. 525.

[49] Hamilton 1915, p. 469.

[50] Jaquith 1914, pp. 268–271.

[51] Bradley 1914, pp. 628–731.

[52] Nursing News and Announcements 1912 b, pp. 137–155.

[53] McDonald 1922, pp. 263–266.

[54] McDonald 1922, p. 264.

[55] McDonald 1926, p. 348.

[56] McDonald 1926, p. 348.

[57] Goodrich 1925, pp. 821–826.

[58] Our Contributors 1927, p. 774.

[59] Engs 2005, pp. 7–9.

[60] Whitney 1927, p. 742.

[61] Whitney 1927, p. 743.

[62] Whitney 1927, p. 741.

[63] Wallace 1929, pp. 537–544.

[64] Ewing 1930, p. 414.

[65] Stewart 1934, pp. 1195–1204.

[66] Snow 1934, pp. 367–371; Frost 1934, pp. 371–373.

[67] Kroeger 1939, p. 483.

[68] Kroeger 1939, p. 483.

[69] The International Hygiene Exhibition, Dresden, 1930, p. 274.

[70] The International Hygiene Exhibition, Dresden, 1930, p. 274.

[71] The International Hygiene Exhibition, Dresden, 1930, p. 274.

[72] See for example, Social Hygiene in Schools of Nursing 1930, p. 631, which speaks of “Elementary treatment of breeding; and Eugenics”; American Social Hygiene Association 1930, p. 107.

[73] Baker 1936, p. 989.

[74] Smith 1938, p. 965.

[75] Goldberg/Johnson 1941, p. 695.

[76] Romine 1940, p. 956.

[77] Toelle 1940, p. 192.

[78] Banwarth 1940, p. 492.

[79] Banwarth 1940, p. 494.

[80] Romine 1940, p. 956.

[81] Romine 1940, pp. 956–957.

[82] News about Nursing: Nursing in Other Lands: 1941, p. 623.

[83] Rydell 2010, p. 670.

[84] Lombardo 2008; Schoen 2005.

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