by Edwin Black
Margaret Sanger gave hope to multitudes. For many, she redefined hope. In the process, she split a nation. But when the smoke cleared on the great biological torment of the twentieth century, Margaret Sanger’s movement stands as a powerful example of American eugenics’ ability to pervade, infect and distort the most dedicated causes and the most visionary reformers. None was untouchable. If one who loved humanity as much as Sanger could only love a small fraction of it, her story stands as one of the saddest chapters in the history of eugenics.
CHAPTER 8
Blinded
Why did blindness prevention rise to the top of the eugenic agenda in the 1920s?
Because mass sterilization, sequestration, birth control and scientific classifications of the mentally defective, socially unfit and racially inferior were just the leading edge of the war against the weak. Eugenic crusaders were keen to launch the next offensive: outlawing marriage to stymie procreation by those deemed inferior. To set a medicolegal precedent that could be broadly applied to all defectives, eugenicists rallied behind the obviously appealing issue of blindness. Who could argue with a campaign to prevent blindness?
Eugenicists, however, carefully added a key adjective to their cause: hereditary. Therefore, their drive was not to reduce blindness arising from accident or illness, but to prevent the far less common problem of “hereditary blindness.” How? By banning marriage for individuals who were blind, or anyone with even a single case of blindness in his or her family. According to the plan, such individuals could also be forcibly sterilized and segregated-even if they were already married. If eugenicists could successfully lobby for legislation to prevent hereditary blindness by prohibiting suspect marriages, the concept of marriage restriction could then be broadened to include all categories of the unfit. Marriage could then be denied to a wide group of undesirables, from the feebleminded and epileptic to paupers and the socially inadequate.
Lucien Howe was a legendary champion in the cause of better vision. He is credited with helping preserve the eyesight of generations of Americans. A late nineteenth-century pioneer in ophthalmology, he had founded the Buffalo Eye and Ear Infirmary in 1876. He also aided thousands by insisting that newborns’ eyes be bathed with silver nitrate drops to fight neonatal infection; in 1890, this practice became law in New York State under a statute sometimes dubbed “The Howe Law.” His monumental two-volume study, Muscles of the Eye (1907), became a standard in the field. In 1918, Howe was elected president of the American Ophthalmologic Society, and he enjoyed prestige throughout American and European ocular medicine. For his accomplishments, he would be awarded a gold medal by the National Committee for the Prevention of Blindness. Later, he helped fund the Howe Laboratory of Ophthalmology at Harvard University. Indeed, so revered was the handlebar-mustachioed eye doctor that the American Ophthalmological Society would create the Lucien Howe Medal to recognize lifetime achievement in the field.1
Howe became a eugenic activist early on. He quickly rose to the executive committee of the Eugenics Research Association, then became a member of the International Eugenic Congress’s Committee on Immigration, and ultimately became president of the Eugenics Research Association.2 It was Howe who led the charge to segregate, sterilize and ban marriages of blind people and their relatives as a prelude to similar measures for people suspected of other illnesses and handicaps.
Eugenic leaders understood their campaign was never about blindness alone. Blindness was only the test case to usher in sweeping eugenic marriage restrictions. Eugenicists had sought such laws since the days of Galton, who had encouraged eugenically sound marriage and discouraged unsound unions. Of course marriage prohibitions for cultural, religious, economic and health reasons had flourished throughout history. In modern times, many such traditions continued in law throughout Europe. These mainly banned marriage to partners of certain ages, close familial relationships and serious health conditions. But the United States, with its numerous overlapping jurisdictions, led the world in marriage restriction laws, based on various factors of age, kinship, race and health. For example, marriage between whites and persons of African ancestry was criminalized in many states, including California, Maryland and North Dakota, plus the entire South. Montana outlawed marriage between whites and persons of Japanese or Chinese descent. Nevada forbade unions between whites and Malays. Several states legislated against intermarriage between whites and Native Americans.3
Eugenicists saw America’s marriage laws as ways of halting procreation between defectives, because in addition to broad laws against race mixing, many states prohibited marriage for anyone deemed insane, epileptic, feebleminded or syphilitic. Delaware even criminalized marriage between paupers. No wonder radical British eugenicist Robert Rentoul proudly enumerated American state laws in his 1906 book Race Culture; Or, Race Suicide?, commenting, “It is to these States we must look for guidance if we wish to… lessen the chances of children being degenerates.”4
In preparing to instigate eugenic marriage legislation, Davenport circulated a state-by-state survey in 1913. It was part of an ERO bulletin entitled State Laws Limiting Marriage Selection Examined in the Light of Eugenics. In 1915, the Journal of Heredity, the renamed American Breeders Magazine, published an in-depth article by U.S. Assistant Surgeon General W. C. Rucker castigating the existing marriage laws as insufficient from a eugenic perspective. Rucker admitted that the movement preferred “permanent isolation of the defective classes,” and continued, “neither the science of eugenics nor public sentiment is ready for [purely eugenic marriage] legislation.” Hence, the only laws that would be viable, he suggested, would be “strictly… hygienic in intent.”5
Enter the cause to prevent hereditary blindness.
In 1918, Howe began in earnest by compiling initial financial data from leading agencies serving the blind, tabulating an institution-by-institution cost per blind person. Cleveland’s public school system spent $275 for each of its 153 blind pupils. The California School for the Deaf and Blind spent $396.90 per blind student. Maine’s Workshop for the Blind topped the list, spending $865 for each of its forty individuals.6
Adding lost wages to custodial and medical care, Howe settled on the figure of$3.8 million as the national cost of blindness-a number he advertised to press his point. But how many people actually suffered from hereditary blindness? Howe knew from the outset that the number was small, estimated at about 7 percent of the existing blind population. No one knew for sure because so much blindness at birth was caused by problem pregnancies or poor delivery conditions. Eugenical News reported that the 1910 census initially counted 57,272 blind individuals in America, but then came to learn that nearly 4,500 of these cases were erroneously recorded. After further investigation, the Census Bureau reported that more than 90 percent of blind people had no blind relatives at all. Indeed, of 29,242 blind persons questioned, only thirty-one replied that both parents were also blind.7
Yet Howe and the eugenics movement seized upon hereditary blindness as their cause du jour. Howe and Laughlin contracted with a Pennsylvania printer to publish a fifty-two-page Bibliography of Hereditary Eye Defects, which included numerous European studies. The pages of Eugenical News became filled with articles on hereditary blindness. One issue contained four articles in a row on the topic. Howe became chairman of a Committee on Hereditary Blindness within the Section on Ophthalmology of the American Medical Association. The AMA Section committee voted to add a geneticist-Laughlin was chosen-plus a practitioner “especially conversant with the good and also with the bad effects of sterilization.” The sterilization expert chosen was Dr. David C. Peyton, of the Indiana Reformatory, who had succeeded eugenic sterilization pioneer Harry Clay Sharp.8
The AMA Section committee then began a joint program with the ERO to register family pedigrees of blind people. Four-page forms were printed. Each bore the distinct imprimatur of the “Carnegie Institution of Washington, Eugenics Record Office, founded by Mrs. E. H. Harriman,” but at the top als
o declared official AMA cosponsorship. The subheadline read “in cooperation with the Committee on Hereditary Blindness, Section of Ophthalmology of the American Medical Association” and then credited Laughlin.9
Employing careful vagueness, the forms requested “any authentic family-record of what seem to be hereditary eye defects,” and then explained how to “plot the family pedigree-chart.” Ten thousand of these forms, entitled “Eye Defect Schedule,” were printed at a cost of $91.76, half of which was defrayed by the ERO and half by the AMA Section. They were then mailed to America’s leading institutions for the blind, as well as schools and help organizations, such as the Cleveland School for the Blind, the Blind Girls Home in Nashville, and the Illinois Industrial Home for the Blind.10
Even the ERO form admitted that delivering the family members’ names could only hope to “lessen, to some extent at least, the frequency of hereditary blindness.” But, cooperating with the request, many in the ophthalmo-logic community began handing over the names of those who were blind or related to blind people. “I am much interested in this investigation,” Laughlin wrote to Howe, “and feel sure that under your leadership, the committee will be able to secure many interesting first-hand pedigrees which will not only throw light upon the manner of inheritance of the traits involved, but will as well provide first-hand information which may be used for practical eugenical purposes in cutting off the descent lines of individuals carrying the potentiality for offspring with seriously handicapping eye defects.”11
The ERO now possessed yet another target list of unfit individuals.
By early 1921, ERO assistant director Howard Banker was able to brag to Ohio State University dean George Arps, “Records [have] already been collected of several hundred families, in which hereditary eye defects existed…. “ Banker then confided, “In spite of evident reasons for drastic remedies, it does not seem advisable to recommend now any radical methods…. “‘12
Nonetheless, the outlines of anti-blind legislation were taking shape. Howe published a major article in the November 1919 edition of Journal of Heredity, entitled “The Relation of Hereditary Eye Defects to Genetics and Eugenics.” The piece was not a clinical paper, but rather a call to legislative action. First, Howe guesstimated that the number of blind people in America had almost doubled to 100,000 since the 1910 census. (His own calculations of official reports from ten states, including the populous ones of New York, Massachusetts and Ohio, reported a total of only 23,630, indicating virtually no national increase.) Howe’s article then addressed the entire blind population as though all of the exaggerated 100,000 suffered from a hereditary condition. Yet Howe knew that hereditary blindness constituted just a small percentage of the total, and even that fraction was falling fast. Because of medical and surgical advances, and as corrective lenses became more commonplace, estimates of hereditary blindness were constantly being reduced.13
As though his statistics and projections were authentic, Howe railed, “It is unjust to the blind to allow them to be brought into existence simply to lead miserable lives…. The longer we delay action to prevent this blindness, the more difficult the problem becomes.” His plan? Give blind people and their families the option of being isolated or sterilized. “A large part, if not all, of this misery and expense,” promised Howe, “could be gradually eradicated by sequestration or by sterilization, if the transmitter of the defect preferred the later.” Howe suggested that authorities wait to discover a blind person, and then go back and get the rest of his family.14
Howe’s article asked colleagues to carefully study sterilization laws applying to the feebleminded. “Where such eugenic laws have been enacted… [they] could be properly amended.” Under Howe’s plan, incarcerated blind people would be required to labor at jobs commensurate with their intelligence; such work would lessen their “sense of restraint.” In a final flourish, Howe asked, “What are we going to do about it? That is the question at last forced on ophthalmologists….”15
By 1921, the ERO and AMA Section subcommittee had drafted sweeping legislation that pushed far beyond hereditary blindness or even general blindness. It targeted all people with imperfect vision. Under the proposal, any taxpayer could condemn such a person and his family as “defective.” Such a measure would, of course, apply to anyone with blurry vision or even glasses, or any family that included someone with imperfect vision. According to the plan, one ophthalmologist and one eugenic practitioner, such as Laughlin, would render the official assessment. The ERO and AMA Section subcommittee’s draft law was entitled, “An Act for the Partial Prevention of Hereditary Blindness.”16
The draft law read: “When a man and woman contemplate marriage, if a visual defect exists in one or both of the contracting parties, or in the family of either, so apparent that any taxpayer fears that the children of such a union are liable to become public charges, for which that taxpayer would probably be assessed, then such taxpayer… may apply to the County Judge for an injunction against such a marriage.” The judge would then “appoint at least two experts to advise him concerning the probabilities of the further transmission of the eye defect.” The experts were specified as a qualified ophthalmologist and “a person especially well versed in distinguishing family traits which are apt to reappear…. “ Upon the advice of the two experts, the judge could then decide to prohibit any planned marriage, which might yield “at least one child who might have more or less imperfect vision….”17
On January 6, 1921, the ERO distributed the draft law for review by several dozen of its core coterie. The mailing list of names was then marked with a plus next to those who approved, and a minus for those opposed. The people consulted included the leading psychologists of the day, such as Goddard, Terman, Yerkes, and Meyer. Apparently, not a few of the respondents either wore glasses or had a family member who did. The vote was divided. Many, such as psychologists Terman and Arps, voted in favor. Several were undecided, but at least half of those polled were opposed.18
Eugenicist Raymond Pearl, of Johns Hopkins University, promptly wrote back with his objections. “It makes the primary initiatory force any taxpayer,” complained Pearl. “This opens the way at once for all sorts of busybodies to work out personal spite by holding up peoples’ marriages pending an investigation .… Anyone who wore glasses contemplating getting married might under the terms of the law stated easily have their progress held up by some neighbor who wanted to make trouble .… Only busybodies would be likely to interest themselves in taking any action under it.”19
Nonetheless, the ERO leadership sent the draft language to every fellow of the AMNs Ophthalmology Section. The nine-page list of ophthalmologists was similarly annotated with a plus or minus sign. Most of the doctors did not respond. But among those who did, not surprisingly, the yeas outpaced the nays. Dr. James Bach of Milwaukee was marked plus. Dr. Olin Barker of Johnstown, Pennsylvania, was marked plus, and was also noted for sending in a patient’s family tree. Dr. David Dennis of Erie, Pennsylvania, was marked plus and noted for sending in three family trees. The ophthalmologist mailing list’s adjusted tally: 88 yes, 40 no.20 That level of support was enough for the ERO.
On April 5, 1921, a New York State senator sympathetic to the eugenic cause introduced Bill #1597. It would amend the state’s Domestic Relations Law with Howe’s measure. It required “the town clerk upon the application for a marriage license to ascertain as to any visual defects in either of such applicants, or in a blood relative of either party…. “ The clerk or any taxpayer could then apply to the local county judge who would then appoint either two physicians, one an ophthalmologist and the other a eugenic doctor, or one person who could fulfill both roles. Based on their testimony, the clerk was then empowered to prohibit the marriage.21
To lobby for the bill, Howe and other eugenicists created a special advisory committee to the Committee to Prevent Hereditary Blindness. Howe was hardly alone within the ophthalmologic community. His advisory committee included some of the leading doct
ors in the field. The long list included Dr. Clarence Loeb of Chicago, associate editor of the Journal of Ophthalmology; Dr. Frank Allport of Chicago, former chairman of the AMA’s Committee on Conservation of Blindness; Dr. G. F. Libby of Denver, author of the “Hereditary Blindness” entry in the Encyclopedia of Ophthalmology; William Morgan of New York, president of the National Committee for the Prevention of Blindness; Professor Victor Vaughan of Ann Arbor, former president of the AMA’s Committee of Preventive Medicine; as well as many other vision experts.22
In September of 1921, Howe and the ERO tried to extend the advisory committee beyond the field of ophthalmology. They sent personalized form letters to prominent New York State doctors, judges and elected officials. The invitations requested permission to add their names to the advisory committee, couching membership as an honorary function. The goal was to create the appearance of a groundswell of informed support among the state’s administrative and medical establishment for the marriage restriction measure.23
Usually, the prominent individuals solicited were only too happy to see their names added to prestigious letterhead advancing a good cause. Few had any understanding of hereditary blindness or the specifics of Howe’s legislative proposal. Often, respondents stated that they knew little about the subject, but were only too happy to join the committee. Only rarely did an individual decline. One who did decline was Dr. H. S. Birkett, an ear, nose and throat doctor with no knowledge of ophthalmologic health; he wrote back, “As this seems to be associated largely with an Ophthalmologic Committee, I would feel myself rather out of place…. I hardly think that my name would be an appropriate one on such a Committee.” ERO organizers routinely kept track of how many eminent people joined or refused. It was all for appearances. At one point, an ERO notation asked for “more judges.”24
