Tuesday, October 30, 2012

A Brief History of Down syndrome - Part 6: From Eugenics to Extermination

With the popularity of eugenic theories, the segregation and institutionalization of the differently abled and general public vilification, a fertile ground had been prepared for what came next.

A Call for Euthanasia

Many countries followed America's eugenics movement and imitated it's legislation.  In countries such as France, Belgium, Sweden, England and Germany, eugenic principles were introduced into everyday life.  Many US states had passed sterilization laws, Indiana being the first in 1907.

The 1912 International Eugenics Congress featured a paper called "Preliminary Report of the Committee of the Eugenic Section of the American Breeders' Association to Study and to Report on the Best Practical Means for Cutting Off the Defective Germ-Plasm in the Human Population", in which ten solutions were put forth to deal with the "socially unfit".  They were, in order:  Life segregation (or segregation during the reproductive period), Sterilization, Restrictive Marriage laws and customs, Eugenic Education of the public and of prospective marriage mates, Systems of matings purporting to remove defective traits, General environmental betterment, Polygamy, Euthanasia, Neo-Malthusian doctrine, artificial interference to prevent conception and Laissez-faire. An 1918 Eugenics Textbook "Applied Eugenics" by Paul Popenoe and Roswell H. Johnson, listed many suggestions as well, among which:
"... the first method which presents itself is execution. This has been used since the beginning of the race, very probably, although rarely with a distinct understanding of its eugenic effect; and its value in keeping up the standard of the race should not be underestimated."
American eugenicists felt that American society was not ready yet to implement organized euthanasia, however many institutions and physicians within employed their own methods.  Passive methods included allowing infants to starve to death (such as famed MD and wanna-be-movie star Harry J Haiselden) and withholding treatment. One large institution in Illinois however, fed it's patients tuberculosis infected milk believing that the genetically superior inmates would have immunity.  That particular institution, not surprisingly, had a 30 to 40 percent death rate per year.  Sterilization remained the most popular method;  in the first year of California's sterilization legislation for example, 9,782 people were sterilized.  Most of these were women.

Charles Davenport, author of Eugenics, The Science of Human Improvement by Better Breeding and one of the creators of the Eugenics Record Office (with funding from the estate of railroad baron E. H. Harriman) was particularly close with his German colleagues; even after America was in the grips of the Great Depression, American charities such as the Carnegie Institute and Rockefeller Foundation continued to fund German eugenics research.   However, the eugenics world continued to watch closely the American "accomplishments" of "biological courts", involuntary sterilization, segregation, detention, propaganda, perpetuating of pseudo-science and the ongoing discussion of euthanasia.

In 1924, an imprisoned corporal of the German Army began to study eugenic writings, including those of Davenport, Popenoe, Leon Witney and Madison Grant, who blamed the corruption of the Nordic ideal on Jews, Slavs, Afro-Americans and many others who were not blonde or blue eyed.  In his book The Passing of the Great Race or The Racial Bias of European History, Grant wrote:
"Mistaken regard for what are believed to be divine laws and a sentimental belief in the sanctity of human life, tend to prevent both the elimination of defective infants and the sterilization of such adults as are themselves of no value to the community. The laws of nature require the obliteration of the unfit, and human life is valuable only when it is of use to the community or race."  
"You are bearing this too".  Courtesy of H. E. A. R. T.
The young corporal, Adolf Hitler, went on to write fan mail to both Whitney and Grant. Hitler's letter to Grant thanked him for his book and referred to it as "my bible". In his own book, Mein Kampf, published shortly thereafter, Hitler echoed his eugenics heroes with the following call for euthanasia:
"The demand that defective people be prevented from propagating equally defective offspring is a demand of the clearest reason and if systematically executed represents the most humane act of mankind. It will spare millions of unfortunates undeserved sufferings, and consequently will lead to a rising improvement of health as a whole."
He also references the United States frequently, including his his admiration of restricting immigration.  His keen interest in American eugenics legislation is reflected in this comment to a comrade;
Nazi Eugenics propaganda poster from 1939,
stating "We Do Not Stand Alone"
"...it is possible to a large extent to prevent unhealthy and severely handicapped beings from coming into the world. I have studied with interest the laws of several American states concerning prevention of reproduction by people whose progeny would, in all probability, be of no value or be injurious to the racial stock."
Adolf Hitler came to power on January 30, 1933.  For the first 10 years of the 12 year Reich, eugenicists welcomed his proposed fulfillment of their tenets of identification, segregation, sterilization, eugenic courts and euthanasia.  In July of 1933, Germany passed the "Law for the Prevention of Heriditarily Diseased Offspring".  This law provided legal grounds for the sterilization of people deemed by a court hearing to be "unfit".  This law provided that any person with a hereditary disease could be sterilized if there was a high probability of it being passed on to future generations.  Those listed included "Congenital Mental Deficiency" (such as Down syndrome), schizophrenia, bipolar disorder, epilepsy, Huntington's chorea, blindness, deafness, any severe deformity and those with severe alcoholism.  In the general public, the notion of the "useless eater" was perpetuated.

Children at the Schönbrunn Psychiatric Hospital, 1934.
(Bundesarchiv, Bild 152-04-28 / Friedrich Franz Bauer / CC-BY-SA\)
In 1934, the superintendent of Virgina's Western State Hospital complained in the local paper "The Germans are beating us at their own game".   For years, Nazi doctors would continue to routinely consult with eugenicists across America.

Extermination and Aktion T4

The first incidence of state performed euthanasia in Germany was known as the "Child K" case.  Hitler was approached by the parents of a "deformed" child and asked his permission to allow the child to be put to death.  After consulting with his personal physician and chancellor, Hitler granted the child's doctor the ability to euthanize the child.

This poster proclaims “Sterilization is liberation, not
a punishment.”
and asks “Who would want to be
responsible for this?”
and features three children

with disabilities.  Photo courtesy of Calvin College
By August 18th 1939, Hitler had created the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses (Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden) which required mandatory registration of all births of developmentally delayed and handicapped children by doctors and midwives.  Children up to three years of age had to be reported to the offices of  the Reich Health Ministry. Code named Aktion T4, Hitler ordered the "mercy killing" of all deemed "life unworthy of life";  this plan focused initially on newborns and young children. The program was managed by Hitler's personal physician, Karl Brandt and the chief of Hitler's private chancellery, Philipp Bouler (the same two whose counsel he sought with Child K). To be included in this program were those with "idiocy and mongolism" (Down syndrome), those with blindness and deafness, microcephaly, hydrocephalus, absence of limbs, mid line defects of the head and spine and paralysis (such as cerebral palsy).  The decision to end a child's life was based on the results of a questionnaire.  No medical examination took place or records were consulted.  Three "medical experts" placed a red + or a blue - on a form marked "treatment".  A minus sign represented a decision by an "expert" to not kill the child.  Three plus signs meant the issue of a euthanasia warrant and transfer to a "Children's Specialty Department".  A unanimous decision was required;  in the event of a split decision, the child was "observed" for a period of time and another attempt would be made to achieve a consensus.

Photobucket Photobucket Photobucket

"Life unworthy of life"

These children were sent to one of six facilities where they were killed by drugs or by starvation.  It is belived that 8,000 children were to lose their lives this way.  In October of the same year, this decree was extended to include older children and adults.  Hitler backdated his declaration to September first and increased the power of
"the authority of certain physicians to be designated by name in such manner that persons who, according to human judgment, are incurable can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death." 
This would not only dispose of the "useless eaters" but also free up beds in hospitals for wounded Nazi soldiers.  Questionnaires were sent to institutions for the mentally ill, chronically ill and hospitals.  Patients were required to be reported if they had schizophrenia, epilepsy, dementia, paralysis, syphillis, developmental delays, encephalitis, neurological conditions, had been in hospital or institutionalized for 5 years or more, was criminally insane, was a foreigner or was Jewish, African-American or Gypsy.

Tiergartenstraße 4, Courtesy of H. E. A. R. T.
There were four main divisions that aided the program that were created in 1939.  The first, the Reichsarbeitsgemeinschaft Heil- und Pflegeanstalten (RAG) was responsible for the distribution and return of the registration forms to the institutions.  The completed forms were forwarded to the "experts" who decided the patients fate.  The Gemeinnützige Krankentransport GmbH" (Gekrat)  was charged with transporting the patients via Gekrat buses to the killing centres, while the Gemeinnützige Stiftung für Anstaltspflege" (Stiftung) created extermination sites by renting spaces, setting up the equipment, hiring staff and managing their budgets.  Finally the  Zentralverrechnungsstelle Heil- und Pflegeanstalten" (ZVST) served as the central clearing office.  The main office was located in Berlin on Tiergartenstraße 4, which gave the program it's name of "T4".  Physicians and medical assistants were eager to assist with this programme as the salaries were made very attractive.

Six main euthenasia sites were created across Germany and Austria.  In January 1940, Brandenburg (near Berlin), Grafeneck (near Stuttgart) and Hartheim (near Linz, Austria) were established;  both Brandenburg and Grafeneck ceased functioning (officially) between September and December of the same year.  Sonnenstin/Pirna (near Dresden) opened in April of 1940 and Bernberg (near Magdeburg) was established in September.  The last to open was Hadamar (near Koblenz) which opened in January the following year (and closed that August).  Bernburg ceased operation in April 1943, while Sonnenstein/Pirna ended in August 1943.  Hartheim was the last to cease it's operation, which it did officially in December of 1944. The Zwischenanstalten were intermediate stops between the patients institution of origin and the killing centres.  They also managed the capacity of the centres and were tasked with 'cover up' for inquiring relatives. It was at Brandenburg, a converted prison, that the first Nazi gas exterminations took place. The T4 victims were gassed in chambers disguised as showers and their remains burned in giant ovens. Families were told that the victims had died of various illnesses including pneumonia or heart failure.  They would each recieve an urn contianing mixed ashes.  The routine deception and gassing/cremation would be used again, only on a much larger scale.

The billowing chimney at Hadamar. Ashes with
human hair would rain down upon the townspeople.
Courtesy of H. E. A. R. T.
Although it was a top secret operation, Aktion T4 became difficult to hide, especially with the dwindiling numbers of the mentally or physically disabled and mentally ill.  Also, the thick, constant, maloderous plumes of smoke from the crematoriums was also difficult to conceal.  It is rumoured that at Haldamar, a former hospital for the mentally ill, children would watch the incoming buses and taunt the inhabitants with "here are some more to be gassed".   Ashes containing human hair would rain down on the town.  Those aware of the goings-on at the six centers were either in favour of the program or completely silenced by fear.

The following three testimonials speak volumes about the killing centres (in this case, Hadamar):
“After doors were closed, the air was sucked out of the gas chamber through a ventilator by the same doctor who carried out the earlier `examination.’ Then for about ten minutes, carbon monoxide was let in [by that doctor] and its effect observed through a small window. As soon as he thought that those shut in had died, he had the gas chamber emptied. First fresh air was introduced through the ventilator, and the gas was forced out. From the beginning of the gassing until the reopening of the gas chamber took about one hour. The corpses that were to be dissected were removed to a special room. However, the great majority of corpses were immediately taken to the ovens and burned there.”
"Through it I saw 40-45 men who were pressed together in the next room and were now slowly dying. Some lay on the ground, others had slumped down, many had their mouths open as if they could not get any more air. The form of death was so painful that one cannot talk of a humane killing, especially since many of the dead men may have had moments of clarity. I watched the process for about 2-3 minutes and then left because I could no longer bear to look and felt sick.”
“Did I ever watch a gassing? Dear God, unfortunately, yes. And it was all due to my curiosity.... Downstairs on the left was a short pathway, and there I looked through the window.... In the chamber there were patients, naked people, some semi-collapsed, others with their mouths terribly wide open, their chests heaving. I saw that, I have never seen anything more gruesome. I turned away, went up the steps, upstairs was a toilet. I vomited everything I had eaten. This pursued me days on end.... Looking into the chamber, I could not imagine that this was completely without pain. Of course, I am a layman and this is just my opinion. A few were lying on the ground. The spines of all the naked people protruded. Some sat on the bench with their mouth wide open, their eyes wide open, and breathing with difficulty.”
[Testimonials courtesy of H. E. A. R. T]

A Catholic Bishop in Münster, named Clemens von Galen, delivered a sermon on August 3, 1941 which denounced Aktion T4 as murder.  The Nazi party was publicly condemned and the faithful encouraged to withdraw from the party due to their "ungodly" policies.  Hitler officially suspended the program 20 days later and in retaliation, beheaded three priests.  At that point, over 70 000 lives had been ended.  Although it had officially been stopped, it continued quietly in the background, especially in the hospitals of conqured territories and for those that remained in the institutions.  Instead of gas, patients were poisoned or starved to death.  Physicians were encouraged to err on the side of death when considering such an action.

The gas chambers used in the euthanasia centres were a testing ground;  the Nazi party used the Aktion T4 experience to aid in the construction of the death camps in places such as Auschwitz and Treblinka.  In fact, many SS officers that participated in the killing centres would go on to command in the camps.  Although officially abandoned, Aktion T4 was still considered a "success" and became the opening chapter in what would become the Holocaust.

Meanwhile, in the Allied countries, increasing numbers of institutional workers were being drafted, leaving the already overcrowded conditions even more destitute.  Although the horrors of the camps and Aktion T4 were exposed after the war, people continued to be sterilized against their will, long after eugenics was abandoned as a "science". In parts of Canada for example, this would continue well into the 1970's.

[Next time:  Abandonment and Abuse]


Black, Edwin. War Against the Weak: Eugenics and America's Campaign to Create a Master Race. New York: Four Walls Eight Windows, 2003. Print.

"Disability History Exhibit." Disability History Panels. Alaska Department of Health and Social Services, n.d. Web. <http://www.hss.state.ak.us/gcdse/history/HTML_Content_Main.htm>.

Grant, Madison. The Passing of the Great Race or The Racial Bias of European History. New York: Charles Scribner's Sons, 1916. Print.

Hitler, Adolf. Mein Kampf. Germany: Eher Verlag, 1925. Print.

Lifton, Robert J. The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Basic, 2000. The Holocaust History Project. Web.

"Nazi Eugenics and Euthanasia." Holocaust Education & Archive Research Team. H. E. A. R. T., 2010. Web. <www.HolocaustResearchProject.org>.

Paralells in Time; A History of Developmental Disabilities, The Minnesota Governor's Council on Developmental Disabilities, 2012.

Popenoe, Paul, and Roswell H. Johnson. Applied Eugenics. New York: MacMillan, 1918. The Project Gutenberg EBook of Applied Eugenics. Project Gutenberg, 17 Oct. 2006. Web. <http://www.gutenberg.org/files/19560/19560-h/19560-h.htm>.

Van Wagenen, Bleeker, "Preliminary Report of the Committee of the Eugenic Section of the American Breeders' Association to Study and to Report on the Best Practical Means for Cutting Off the Defective Germ-Plasm in the Human Population" (2009). College of Law Faculty Publications. Paper 74. <http://digitalarchive.gsu.edu/col_facpub/74> 

[Originally appeared on Down Wit Dat]  

Tuesday, October 23, 2012

A Brief History of Down syndrome - Part 5: From Education to Eugenics

A Brief History of Down syndrome, Part 5: From Education to Eugenics

The training schools for the developmentally delayed in the middle 1800's were an instant success;  although they did not offer a cure, they did show improvements in behaviour, physical prowress and social interactions.  Many students were able to develop skills that would ensure a successful return to their loved ones.

Sadly, a post-Civil war poor economy did not allow for many employment opportunities for the developmentally disabled in America, no matter how well trained.  Jobs were scarce and there were many new immigrants who were willing to work for low wages.  People with disabilities were looked at as burdens and were counted (once again) amongst criminals, prostitutes and vagrants in the census reports. 

Not surprisingly, there was a simultaneous increase in the demand for training schools;  many of the existing schools expanded and initially served a broader disabled community.  However, as time went on, the schools quickly became asylums, providing only rudimentary care for their 'inmates'.  By 1875, many US states had started construction on institutions for the developmentally disabled.  The leaders of these new institutions were now doctors;  1876 saw the establishment of the Association of Medical Officers of the American Institutions for Idiotic and Feeble-Minded Persons (who would later become the American Association for Mental Retardation, now the American Association of Intellectual and Developmental Disabilities or AAIDD).  One of the primary purposes of this organization is taken from Article II of their constitution:
"The object of the Association shall be the discussion of all questions relating to the causes, conditions, and statistics of idiocy, and the management, training, and education of idiots and feeble-minded persons; it will also lend its influence to the establishment and fostering of institutions for this purpose." 
How Boys are Taught Simple Manual Labor, Massachusetts School
for the Feeble-Minded, William A. Webster, circa 1903.
Photo courtesy of the Harvard Art Museums/Fogg Museum
The institutions were now medically based,the differently abled now "sick" and in need of treatment (and surely, cure).  The superintendents believed that each disability should be grouped accordingly, creating a colony system within the institution itself.  Examples of such are an "epileptic colony", a building for "low-grades" or lower functioning individuals and a "girls cottage".   The focus had shifted from educating young people to return to the community to housing a large number of individuals of all ages and abilities. To stay financially solvent, these institutions began to train some of the higher functioning inmates to work in the asylum.  They provided cheap (slave) labour as the institutions became self sufficient, often running their own farms and even power plants.  Often located in very rural settings, the inmates were essentially cut off from the rest of society.  Cheap farm land and abandoned farms in depressed rural areas was purchased  allowing for the creation of "farm colonies" where higher functioning "patients" provided hard physical labour, without pay, to produce enough food for one of the large institutions.  These farms also relieved some of the overcrowding of the main institution.  Care was custodial at best, with the idea that safety and security was all that could be expected. 

Both Seguin and Howe, two physicians, educators and advocates for the disabled, foresaw the new direction that the schools were heading to.  Instead of presenting the keynote address for a groundbreaking for a new institution in New York, Howe begged them not to open it instead.  Regardless, the populations in the institutions continued to rise.  There were, on average, 250 people per institution in 1890;  that number had doubled by 1905.

Walter E. Fernald, the then president of the American Association on Mental Deficiency, described the institutions as an economic solution to the disabled.  In his words, "each hundred dollars invested [in institutions] now saves a thousand [dollars] in the next generation.".  Money allocated to the poorhouses and almshouses by the state was already being redirected to the large institutions as well.  By the close of the century, the annual cost of housing a person in such a place ranged from $150 to $250 USD.  In a generation, the public view towards the differently abled, especially the developmentally delayed, had gone from one of compassion and eduction to fear and segregation.  By 1923 there were over 80 "schools", "farms", "hospitals", "institutes" and "academies" for the disabled.   With it's inmates no longer welcome in the outside world, these asylums could now say that they were relieving society of a great burden. 

Protect Us from the Feeble

As the institutions grew and conditions continued to worsen, the public perception of the disabled and "feeble-minded" continued to decline as well.  Such "illnesses" were considered to be moral failings of the person or their parents.

Immigration to North America was at an all time high and by 1900, one in seven Americans was born elsewhere.  Fear and suspicion of both immigrants and disabled persons was also growing exponentially;  this was only augmented by government actions that segregated and excluded these new Americans, which in turn only reinforced and systematized prejudices.  The US Public Health Service classified the following together as one group: "criminals, defectives and delinquents". With this in mind, the Public Health Service, administered the new Binel IQ test to immigrants at Ellis Island.  Devised originally by the French psychologist (on behest of his government) Alfred Binet,  it was created to quickly identify developmentally delayed children for placement in 'special education'.  Even Binet himself felt that case studies were more appropriate, however such assessments were lengthy and costly, especially on the larger numbers of people seeking entrance into such facilities.  However, there were three codicils to his test:  one, the scores are not to be considered permanent. Two, the scale was to be a rough guide for the identification and aid of developmentally delayed children and, three a low score did not determine an innate incapability on the part of the child.  However, these tenets were easily brushed aside and from the testing at Ellis Island, it was determined that "79% of the Italians, 80% of the Hungarians, 83% of the Jews, and 87% of the Russians are feeble-minded.", a conclusion which now, scientifically, legitimized the marginalization and prejudice.

As time went on, the view of the institutions shifted further from education to protection;  once again the developmentally and physically disabled had become demonized and the public now needed protection.

The Rise of Eugenics

Much like in centuries past, the uncertainty of the economy and world affairs provided a fertile ground for the reappearance of ideas now known as Social Darwinism and Eugenics.  The term "Eugenics" was coined in 1883 in Inquiries into Human Faculty and Its Development, a book written by Sir Francis Galton, cousin to Charles Darwin.  The Eugenics movement advocated for the improvement of society through the elimination of certain traits.

Misinformation and propaganda began to circulate, citing supposed immorality and the danger to the future of humankind.   Feeble mindedness needed to be controlled, if not cured.  The term moral imbecility also included such things as juvenile delinquency, behaviour problems and epilepsy and was regarded as a main cause of societal ills including poverty, alcoholism, prostitution, violence and crime in general. Often, those who committed crimes were portrayed in the newspapers in such a way to suggest developmental delay.
Henry Goddard, a psychiatrist at The Vineland Training School, translated the Binet IQ test into English and made a few adjustments;  he developed a category of developmental delay known as "moron", which became synonymous with 'moral imbecile' and reinforced the notion that feeble mindedness and therefore delinquency, was hereditary.

John Harvey Kellogg, the inventor of corn flakes, ran a holistic sanatorium in Battle Creek Michigan.  In 1906, he created the Race Betterment Foundation, which would hold Eugenics conferences at the sanitarium in the years to come (1914, 1915 and 1928).

The year 1909 saw the publication of The Eugenics Review, the journal of the Eugenics Education Society in Britain. Galton, who was the honorary president, wrote the foreword.

In his 1910 book, Eugenics, The Science of Human Improvement by Better Breeding, Charles Davenport speaks of the formation of a 'Committee on Eugenics' from the American Breeder's Society including such famous names as himself, David Starr Jordan, botanist Luther BurbankAlexander Graham Bell, zoologist V. L. Kellogg, Swiss psychiatrist (and future president of the American Psychiatric Association) Adolf Meyer, naturalist J. Arthur Thomson, W. E. Castle, Charles HendersonAleš Hrdlička, Herbert J. Webber, C. E. Woodruff,  and Frederick A. Woods (who coined the phrase Historiometry).  According to Davenport, the "various duties of this Committee may be summed up in the three words:  investigation, education and legislation".  On the surface, this sounds very philanthropic, however, Davenport later continues on with the following:

"...This three or four percent of our population is a fearful drag on our civilization.  Shall we as an intelligent people, proud of our control of nature in other respects, do nothing but vote more taxes or be satisfied with the great gifts and bequests that philanthropists have made for the support of the delinquent, defective and dependent classes?  Shall we not rather take the steps that scientific study dictates as necessary and dry up the springs that feed the torrent of defective and degenerate protoplasm?"

"...If only one-half of one percent of the 30 million dollars annually spent on hospitals, 20 millions on insane asylums, 20 millions for almshouses, 13 millions on prisons, and 5 millions on the feeble minded, deaf and blind were spent on the study of the bad germ-plasm that makes necessary the annual expenditure of nearly 100 millions in the care of its produce we might hope to learn just how it is being reproduced and the best way to diminish its further spread."

A "sub-committee on Feeble-Mindedness" was also created;  it was "under the chairmanship of Dr. A. F. Rogers, Superintendent of the Minnesota School for Feeble Minded and Colony of Epileptics, and with Dr. H. H. Goddard, Director of the Department of Psychological Research at the New Jersey Training School for Feeble-Minded Boys and Girls."  Similar committees were created for other "problems", including "Insanity" (Chaired by Dr. Adolf Meyer), eye defects, deafness, crippled limbs, disease, musculature, etc.  The 'main committee' was given the task of obtaining records from American families regarding "the inheritance of characteristics of health, ability and temperament".  At the time of publication, only 300 of the 5000 family records forms had been returned to be studied, so it was suggested that "data of this sort might be collected by the national Bureau of Census...".   

Davenport, along with Harry Laughlin and financial support from Mrs. E. H. Harriman (the widow of the railroad baron), created the Eugenics Record Office in 1910.

Kallikaks, Morons and the Justification of Sterilization

The lineages of "Martin Kallikak"
Goddard administered his modified Binet test again, this time to 1.75 million army recruits in 1917 and found that 40% of the white, male population was feeble minded.  By 1912, he had written The Kallikak Family: A Study in the Heredity of Feeble-Mindedness, a supposed genealogical account (and moral tale) of a patient in The Vineland Training School.  Named Deborah "Kallikak" (a name made up of the Greek word kallos or beautiful and kakos meaning bad)Goddard maintained that Deborah's great-great-grandfather was a soldier in the Revolutionary war who "dallied with a feeble minded bar maid".  Although he was to go on and marry a proper Quaker wife and father healthy upstanding citizens, his earlier indiscretion fathered another line.  That resulting lineage, Goddard maintained, not only produced Deborah, whom he described as:
"...a typical illustration of the mentality of a high-grade feeble-minded person, the moron, the delinquent, the kind of girl or woman who fills our reformatories.  They are wayward, they get in all sorts of troubles and difficulties, sexually and otherwise, and yet we have been accustomed to account for their defects on the basis of viciousness, environment or ignorance."

The caption reads: "Great-grandson of
"Daddy" Kallikak.  This boy is an imbecile
of the Mongolian type"
...but also a variety of 'degenerate' members of the family, including those felt to be feeble-minded, sexually immoral, alcoholic, insane, syphilitic, criminals, deaf, tuberculous or simply died in infancy. Many case studies of are provided with accompanying photographs, which, even to the most untrained eye of today, appear to be poorly altered to appear more monstrous. However, at the time, this publication did what it was supposed to do; provide 'proof' that feeble mindedness and therefore, all of society's problems, were hereditary.   

"There are Kallikak families all about us. They are multiplying at twice the rate of the general population, and not until we recognize this fact, and work on this basis, will we begin to solve [our] social problems."

 It also validated the use of segregation in an institutional setting and "...sterilization may be accepted as a makeshift, as a help to solve this problem because the conditions have become so intolerable." Clearly, sterilization was the solution for the time being, until something more permanent could be devised.

The first International Congress of Eugenics was held in London in 1912 (they would be held again in 1921 and 1932) .  Attendees of note were Winston Churchill, then the First Lord of the British Admiralty, Chief Justice Lord Alverstone, Lord Balfour and then ambassadors of France, Greece and Norway.  In the US, the Galton Society was created in 1918;  it further popularized eugenic theories through its newsletter the Eugenical News.  Contributors included racist authors Madison Grant and Lothrop Stoddard.

By 1915, many of America's prominent universities were offering courses on eugenics:  Brown, Harvard, Columbia and Cornell are among those that taught these theories.  This is not surprising given the academic backing of eugenics from such persons as psychologists Edward Thorndike and Leta Hollingworth, as well as psychometricians Carl Brigham and Robert Yerkes.  Goddard took his presentation on the road and using lantern slides, warned the masses of the "rising tide of feeble mindedness".

A 1917 movie, entitled "The Black Stork"  told the fictional story of a couple that were "ill matched" and as a result, gave birth to a disabled baby.  The baby in the movie was "mercifully killed" by starvation by eugenicist Harry J Haiselden, who not only starred in the movie as himself, was in real life was a prominent Chicago physician who refused to give life saving care to "defective" babies.  Not only were the dying infants displayed to journalists, but he also documented them publicly in the Hearst Newspapers.

Photo from the North Carolina State Board of
Charities and Public Welfare Biennial Report
of the State Board of Charities and Public Welfare,
December 1, 1920 to June 30, 1922
The American Eugenics Society was formed after the second Intentional Congress and formed committees to better aid in popularizing their theories.  These committees included "Co-operation with Clergymen", "Sermon Contests", "Crime Prevention", "Selective Immigration" and "Formal Education".  They also sponsored "Fitter Families Contests" and Eugenics information booths at various state fairs.  An example of this is a display in Philadelphia in 1926 that featured flashing lights to illustrate the dire consequences of uncontrolled inferior procreation and the phrase "...some Americans are born to be a burden on the rest"The National Education Association's Committee on Racial Well Being also sponsored programs to help college professors include eugenic doctrine in their classes throughout the 1920's.

By 1924, the US Congress passed the Immigration Restriction Act, specifically targeting those from Europe and Eastern Europe, the majority of which had been labeled "feeble minded" a decade before.  Those who were differently abled with mild to moderate disabilities were now considered morons and part of the "moral menace".  As the institutions were overflowing, the superintendents, many of which have been named here as Eugenicists (and promoted the idea of the degenerate moron), 'paroled' the higher functioning patients after sterilizing them.  It did not take long however, for lower functioning individuals to also be sterilized, especially those who displayed habits considered to be obscene.  The men were forced to undergo vasectomies and the females underwent tubal ligation. 

Photo courtesy of the DNA Learning Center,
Cold Spring Harbour Laboratory
One contested sterilization case made it to the US Supreme Court in 1927.  In Buck v. Bell, Carrie Buck was an young woman that had been declared feeble minded and scheduled for sterilization.  A family tree, brought forth during the trial showed that she was the child of a feeble minded woman and that her then infant daughter was the same.  The Chief Justice, the iconic Oliver Wendell Holmes Jr., stated that:
“It is better for all the world, if instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.  The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough.”

Carrie was sterilized and it was found later that she was, in fact, of normal intelligence, as was her daughter who went on to win awards in school.  The entire family tree had been fabricated and her entrance into the institution was surmised to be a cover up of her rape at the hands of a foster-cousin, from which her daughter had originated.  Carrie went on to be paroled from the institution, got married and eventually died in 1983 in a nursing home.  She was buried next to her daughter Vivian, who had been adopted by Carrie's former foster parents (due to her supposed lack of competence) and died at eight years of age.  Buck v. Bell has never been overturned.

By 1928, Eugenics was taught in over 376 courses in the US, which covered approximately 20,000 students.  High school science textbooks between 1914 and 1948 presented Eugenics as fact, creating two entire generations that believed in segregation, restriction of immigration and sterilization of the "unfit".  Compulsory sterilizations of the developmentally and physically disabled were performed worldwide, including in Canada, Sweden, Switzerland, Denmark, Norway, Finland, Estonia, Iceland, Panama and the United Kingdom. The Eugenics movement eventually lost scientific credibility, but not before hundreds of thousands of developmentally and physically people had been sterilized in the name of social purity.

[Next time: Extermination]


Buck v. Bell, 274 U.S. 200 (1927) <caselaw.lp.findlaw.com>

Burr Johnson, Kate. North Carolina State Board of Charities and Public Welfare Biennial Report of the State Board of Charities and Public Welfare, December 1, 1920 to June 30, 1922. Raleigh: North Carolina State Board of Charities and Public Welfare, 1922. University of North Carolina at Chapel Hill. The University Library. Web. <http://docsouth.unc.edu/>.

Davenport, C. B. Eugenics, The Science of Human Improvement by Better Breeding. New York: Henry Holt and, 1910. Print.

Goddard, Henery Herbert, The Kallikak Family: A Study of the Heredity of Feeble-Mindedness, (2009). College of Law Faculty Publications. http://digitalarchive.gsu.edu/col_facpub/7

Paralells in Time; A History of Developmental Disabilities, The Minnesota Governor's Council on Developmental Disabilities, 2012.

Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feebleminded Persons. Vol. 1,2. Philadelphia: J. B. Lippincott &, 1877. Print.

Selden, Steve. "Social Origins of Eugenics." Social Origins of Eugenics. University of Maryland, n.d. Web. <http://www.eugenicsarchive.org/html/eugenics/essay6text.html>.

[Originally appeared on Down Wit Dat

Tuesday, October 2, 2012

A Brief History of Down syndrome - Part 4: The Roots of Institutionalization and Eugenics

Those who cannot remember the past are condemned to repeat it.” -- George Santayana

Where We Have Been:  The Roots of Institutionalization and Eugenics

In past installments of A Brief History of Down syndrome, we have explored the origins of the name, examples of Down syndrome in art (dating back to prehistory) and looked at famous families with a member with Trisomy 21.  In this entry, I aim to show the history of the learning disabled including societal roles and treatment.  Many people have a vague understanding that up until recently, people were institutionalized indefinitely for having mental illnesses and developmental delays. Some may also be aware of the atrocities performed on those with disabilities before and during the Second World War.  However, what brought society to these extremes? Where have we been that has brought us to where we are now?  What were we thinking?

Ancient Perceptions of the Developmentally Delayed

Both Plato (L) and Aristotle (R) endorsed what would be Eugenics
According to historians, the first mention of learning disorders was recorded in what is known as "The Therapeutic Papyrus of Thebes" dating roughly to 1550 BC.  Both Greek and Roman mythology are rampant with stories and imagery of infanticide;  this does not appear to be by accident.   Children deemed unfit or unwanted in ancient Rome (including girls) were 'discarded' in sewers or left to the elements to die (be "exposed").  Often a cord would be tied to their feet to alert anyone that may find them of their unworthiness and discourage them from being adopted.  They were also frequently thrown in the Tiber river and if left alive, were certainly the objects of much derision and were often sold into slavery.  Those with intellectual disabilities in particular were referred to as 'idiots'. Plato (427-347 B.C.) in The Republic promoted selective breeding (of humans) and infanticide:
"..the best of either sex should be united with the best as often, and the inferior with the inferior, as seldom as possible; and that they should rear the offspring of the one sort of union, but not of the other, if the flock is to be maintained in first-rate condition... but the offspring of the inferior, or of the better when they chance to be deformed, will be put away in some mysterious, unknown place, as they should be."
Aristotle (384-322BC), stated in Politics:  "As to the exposure and rearing of children, let there be a law that no deformed child shall live..."  Such a law is reported to have existed in Sparta, where according to legend, children deemed unfit were thrown into a chasm near Mount Taygetus.  The practice of keeping a 'fool' (a mentally challenged or physically disabled person) as a source of entertainment also dates back to ancient Rome.  With the rise of Christianity however, the practice of infanticide was discouraged.  St. Paul (5-67AD), in particular, encouraged his followers to "...comfort the feeble minded, support the weak, be patient toward all men.". 

Claudius Galen (138-201), often called the father of Neurology, described the brain as "the seat" of intellectual functioning.  On the subject of intellectual disability:
"Slow thinking is due to the brain's heaviness. Its firmness and stability produce the faculty of memory. Imbecility results from the rarefaction and diminution in quality of the animal spirits and from the coldness and humidity of the brain."
Visiting the revolving cradle or baby hatch.
Seven edicts were issued from Rome between 315 and 451.  Included in these were the Councils of Vaison (442), Aris (452) and  Agde (505) which stated that unwanted children should be abandoned in a church and granted sanctuary within for 10 days.  Special marble basins were placed at church doors to receive the newborn infants.  Abandoning them to the elements was now considered to be homicide.  The Council of Nice (325) stated that each (Christian) village should create a hostel for the sick, poor and homeless (a xenodochium).  Later, many of these would convert to a brefotropio or an asylum for orphaned children. The Archbishop of Milan, Datheus, has been credited with creating the first asylum for abandoned children in 787.  A revolving receptacle delivered the infant anonymously to the asylum;  a bell was rung to announce the child's arrival.

During the Dark or Middle ages after the fall of Rome, there appeared to be two approaches to the mentally delayed. Parallel to the concept of 'loathsome imperfection' existed the idea of the "Children of a caring God" or "Les enfents du Bon Dieu" which can be found in the writings of Confucius, Zoroaster and the Koran.  Although special, these 'divine idiots' were still considered abnormal and separate from the rest of society.

An 'idiot cage'
After the Crusades (1101-1272), the incidence of leprosy began to decrease and former leper colonies were converted to house what society considered to be 'deviant'.  Included in these "Cities of the Damned" were the physically disabled and the mentally delayed as well as those with incurable diseases, the homeless, the mentally ill, orphans, criminals, prostitutes and widows. 'Idiot cages' were often erected in town squares to contain those less fortunate to 'keep them out of trouble'.  It is possible that these provided entertainment for the townspeople.  Often, sailors were paid to take those deemed to be a burden away; this begat the 'ship of fools' where 'undesirables', such as the learning disabled, were sailed from port to port to provide entertainment for the locals.  The ships were later abandoned and the people left to fend for themselves and ultimately, perish.

A "ship of fools"

It is around this time that Maimonides (1135-1204), the Jewish philosopher and physician, wrote that problems of learning and memory were produced by the phlegmatic brain due to the presence of too much humidity. Maimonides proscribed to an idea originally devised by Hippocrates (460-370 BC), that the body was controlled by four humors and personality, temperament, intelligence and overall health was determined by their balance.  This theory would continue to flourish for several centuries to come.

Although founded in 1247 as a priory, St. Mary of Bethlehem asylum or "Bedlam" became a hospital in 1337 and began admitting 'deviants' in 1357.  Among the inventory in 1398, it was found to have, for a total census of twenty patients: four sets of manacles, eleven chains of irons, six locks and keys and two stocks. In stark contrast to Bedlam however, is the town of Geel in Belgium.  During this same time, a community of foster care was set up where the townspeople opened their doors to the mentally ill and delayed.  It is reported that they ate, slept and worked like members of the family.  Similar programs would not exist world wide until hundreds of years later.  These practices have continued in Geel until the present day.  What was then a small village is now a hub of mental health and related services in present day Europe.

Woodcutting from the 1497 play Das Narrenschiff or "Ship of Fools"

Martin Luther (1483-1546) credited as being one of the fathers of Christian reformation, openly called for the killing of the mentally disabled for he felt that they were possessed by the devil:
"Eight years ago, there was one at Dessau whom I, Martinus Luther, saw and grappled with. He was twelve years old, had the use of his eyes and all his senses, so that one might think that he was a normal child … So I said to the Prince of Anhalt: "If I were the Prince, I should take this child to the Moldau River which flows near Dessau and drown him..."
"...Was firmly of the opinion that such changelings were a mass of flesh with no soul. For it is in the Devil‟s power that he corrupts people who have reason and souls when he possesses them. The devil sits in such changelings where their soul should have been!"
Felix Plater

The first distinction between the mentally ill and the intellectually disabled was made by Paracelsus (1493-1541), a Swiss physician and botanist.  Likening them both to animals and acknowledging that there were many different 'kinds' of both, he stated that the feeble-minded were not unlike a healthy animal, while the psychopath was very much a sick animal.  Another Swiss physician, Felix Plater (1536-1614), proposed the term 'alienation' to describe both the mentally ill and the developmentally delayed.  As a result, psychiatrists were referred to as 'alienists' for the next few centuries.  Unlike many of his peers before and after him, he explored the life of his charges by actually living and experiencing the cells, cages and conditions that his patients did.  Truly a compassionate man for the times, he declared that the dungeon-like conditions that his patients lived in should not be permitted in society. On the subject of the developmentally delayed;
"Now we see many (foolish or simple from the beginning) who even in infancy showed signs of simplicity in their movements and laughter, who did not pay attention easily, or who were docile and yet they do not learn. If anyone asks them to do any kind of task, they laugh and joke, they cajole, and they make mischief. They take great delight and seem satisfied in the habit of these simple actions, and so they are taught in their homes..."
"We have known others who are less foolish, who correctly attend to many tasks of life, who are able to perform certain skills, yet they show their dullness, in that they long to be praised and at the same time they say and do foolish things..."

"Some people have dullness from before birth. Such persons have deformed heads, or they spoke with a large tongue and at the same time with a humorous throat, or they were deformed in their general appearance."
The Beggars by Pieter Bruegel (1568).
Although the Catholic church continued to found hospitals, homes for the blind and orphanages, most physically and mentally disabled persons eked out meager existences by begging.  Queen Elizabeth I of England ensured that several laws were passed during 1563 and 1601 to aid the disadvantaged.  Known as the 'Elizabethan Poor Laws' they ensured the creation of Almshouses for the aged poor, Workhouses for the employable poor and basic care was provided for the 'unemployable poor'.  Regardless, the conditions in these facilities was abysmal. Two French facilities were created decades later: in 1657, the Salpêtrière (containing 1,416 women and children) and the Bicêtre (which contained 1,615 men).

Philip Pinel (1745-1826), the French 'Alienist', believed that those labelled 'mentally deranged' suffered from a disease process instead of simply having sinful or immoral natures.  He removed the restraints and chains from the Bicêtre and the Salpêtrière and instead employed more gentle methods on the inhabitants there (who were now referred to as 'patients').

Despite these inroads in both the scientific world and societal compassion, the stigma against the less fortunate and different continued.   Rev. Thomas Malthus (1766-1834) published "Essay on the Principle of Polulation..."  in 1798 which openly criticized the Poor Laws.  His proposed methods included curbing the birth rate and the elimination of undesirable traits, which he surmised, could not occur without "condemning all the bad specimens to celibacy...".

With the rise of the industrial revolution, people emigrated en masse to urban areas in the hopes of finding work.  Factories often employed poor children cheaply;  factory owners were pressured by the local parish authorities to take one "imbecile" for every twenty typical children.  In this time, the deviant and undesirable were subjected to "warning out" and "passing on" where they were loaded in a cart and dropped off at the next town.

Bedlam, William Hogarth, 1735
In 1751, a hospital in Philadelphia created a separate section for people with developmental delays and mental illness. This unit was moved to the cellar by 1756 and much like other hospitals of it's day, including Bedlam, put the inmates on display for a small fee. In fact, many of the cells had street level windows and it was quite a past-time to watch the 'antics' of the patients.

Another physician (and student of Pinel) Jean-Étienne Dominique Esquirol (1782-1840) revolutionized the idea of intellectual disability by dividing it into two categories.  The first category, known as 'imbeciles' were described as:
"... Generally well-formed, and their organization is nearly normal.  They enjoy the use of the intellectual and affective faculties, but in a less degree than the perfect man, and they can be developed only in a certain extent.  Whatever education they may receive, imbeciles never reach the degree of reason, nor the extent and solidity of knowledge, to which their age, education and social relations, would otherwise enable them to obtain.  Placed in the same circumstances as other men, they do not make a like use of their understanding..."
 "...The innocence and jovial manners;  the gayety and piquant repartees;  the pleasant and sometimes very judicious sallies of some imbeciles; have caused them to be admitted to the presence of the great, and even that of kings, to divert them from their distressing ennui, and to afford them recreation.  There is, in courts even, the post of fool."
"Imbeciles possess, therefore, sensibility, a certain degree of intelligence and a weak memory.  They comprehend what is said of them, make use of speech,  of if mute, express themselves by signs.  They are capable of acquiring a certain amount of education, and possess moral affections:  but given up to their own control, they very easily become degraded.  Imperfectly nourished, and poorly protected from the effects of the weather; filthy in their habits, and giving themselves up to errors of regimen;  their health becomes impaired;  the little intelligence with which they were originally endowed, enfeebled; and at length, the imbecile, who is brought to a hospital, presents all the characteristics of idiocy."
"Idiocy" was defined as "the utmost limit of human degradation...".

Édouard Séguin
By the mid 1800's, the increased interest in social issues and the care of the disadvantaged was now producing some rudimentary advocacy;  the learning disabled were now seen as having some worth and were at least trainable if not 'curable'. A reflection of this is the opening of a 'training school' for disabled children in Berlin in 1842;  another opened in Leipzig four years later.  Training schools were also opened in England around this time.  Édouard Séguin (1812-1880), a physician and education specialist opened a private training school for the developmentally delayed in approximately 1840.  1842 also saw the publication of  Séguin's Traitement Moral, Hygiène, et Education des Idiots (The Moral Treatment, Hygiene, and Education of Idiots and Other Backward Children) which is considered to be the first textbook dedicated solely to the diagnosis and treatment of the intellectually disabled.

Roughly at this time, a young doctor named Johann Jakob Guggenbühl (1816-1863) established a school for "cretins" in Interlaken, Switzerland. The Abendberg started with good intentions, however it quickly fell into neglect and abuse as his traveling schedule kept him away from his students for great lengths of time. It was considered to be his personal failure.

Dorothea Dix
One of the more notable among these new advocates was an American Sunday School teacher named Dorothea Dix.  After touring the country and observing the deplorable conditions and treatment of the disenfranchised in America, most notably the mentally delayed and the mentally ill, Dorothea was driven to make changes.  As she was a woman and therefore at the time, ineligible to speak in front of the US congress, she had a well known male social reformer, physician and founder of the Massachusetts School for Idiotic and Feeble-Minded Youth,  Samuel Gridley Howe, to deliver her speech in 1854.  From her observations, we can understand in a very clear manner the treatment that many patients experienced;
"I have myself seen more than nine thousand idiots, epileptics, and insane, in these United States, destitute of appropriate care and protection; and of this vast and most miserable company sought out in jails, in poor-houses, and in private dwellings, there have been hundreds, nay, rather thousands, bound with galling chains, bowed beneath fetters and heavy iron balls, attached to drag-chains, lacerated with ropes, scourged with rods, and terrified beneath storms of profane execrations and cruel blows; now subject to gibes, and scorn, and torturing tricks-now abandoned to the most loathsome necessities, or subject to the vilest and most outrageous violations. These are strong terms, but language fails to convey the astounding truths."
Dorothea's bill to set aside 5 million acres across the US for the creation of federally run, more humane facilities was passed by the US Congress, yet promptly vetoed by then president, Franklin Pierce.

More training schools for the "feeble minded" opened in the US between 1852 and 1858 in Germantown PA, Albany NY and Columbus OH.  Following Séguin's methods, these schools had a focus on education, physical and sensory development, life and social skills.  They were considered a success and many families with learning disabled members turned to them for hope.  Sadly, that hope would be dashed in the years to come. 

[Next time: From Education to Eugenics]

Dix, Dorothea L. "Memorial Of Miss D. L. Dix To the Senate And House Of Representatives Of The United States." Address. In the Senate of the United States. USA. 23 Jan. 1854. Disability History Museum. NEC Foundation of America. Web. <http://www.disabilitymuseum.org/dhm/index.html>.

Esquirol, Etienne. Mental Maladies; a Treatise on Insanity. New York: Hafner Pub., 1845. Internet Archive. Web. <http://archive.org/>. 

Kanner, L. A History of the Care of the Mentally Retarded. Springfield, IL, 1964. 

Luther, Martin. Werke, Kritische Gesamtausgabe: Tischreden. Vol. 5. Böhlau: Weimar, 1912-1921. Print.

Malthus, Thomas Robert. An Essay on the Principle of Population, or a View of Its Past and Present Effects on Human Happiness; with an Inquiry into Our Prospects Respecting the Future Removal or Mitigation of the Evils Which It Occasions. 6th ed. 2 Vols. London: John Murray, 1826. Online Library of Liberty. Web. http://oll.libertyfund.org/index.php?option=com_staticxt.

Millon, Theodore. Masters of the Mind: Exploring the Story of Mental Illness from Ancient Times to the New Millennium. John Wiley and Sons, 2004. Print.

Plato. The Republic, Book V., 360 B.C.E. The Internet Classics Archive. Web Atomics. Web. <http://classics.mit.edu/index.html>.

Scheerenberger, R. C. A History of Mental Retardation. Baltimore: Brookes, 1983. Print.

Schneider, Dona, and Susan M. Macey. "Foundlings, Asylums, Almshouses And Orphanages: Early Roots Of Child Protection." Middle States Geographer, 35 (2002): 92-100. Buffalo State Geography and Planning Department. Buffalo State University. Web. <http://www.buffalostate.edu>.

"Thesselonians 1:5." Holy Bible, King James Version, Cambridge EditionOnline Parallel Bible. Web. http://bible.cc/.

[Originally appeared on Down Wit Dat