STRONG, intelligent, useful families are becoming smaller and smaller. Irresponsible, diseased, defective parents, on the other hand, do not limit their families correspondingly. There can be but one result. That result is race degeneration.

The law of self preservation is as necessary for a nation as for an individual.

When families that send a child to an institution for the feebleminded average twice as large as families that send a child to the university, it is time for society to act.

What Can Be Done?

There is one outstanding, practical, humane measure which, properly administered, will go far to change this trend toward human deterioration.

This measure is the sterilization, by a harmless surgical operation, of men and women who are so seriously defective that, for the protection of themselves and their families, of society and of posterity, they should not bear and rear children.

This measure is not a novelty. More than 150,000,000 people are now living under laws which provide for official, legal sterilization. It has back of it 35 years of successful application in the United States. But, because of the lack of general knowledge concerning it. there still exist even among educated people a great deal of misinformation and understanding about it. Such ignorance is the main obstacle in the way of necessary extension of this humanitarian measure.

The purpose of this pamphlet is to tell briefly what eugenic sterilization is and what it is not; to describe the results to individual and community as demonstrated by a critical study of the first 6,000 operations in California, extending over a period of twenty years.

Not Punishment But Protection

Let this be fully understood at the outset: sterilization as considered in these pages removes no organs or tissues from the body, interferes with no blood or nerve supply, produces no physical change. It merely cuts and seals the tubes through which the germ‐cells, ‐‐the spermatozoa and ova,‐‐must pass if conception is to result. It does not in any degree unsex the individual, except in making parenthood impossible. Such a result should be, and, in the great majority of cases is, welcomed by the persons who are sterilized, because it is performed only in cases where parenthood is manifestly undesirable from every point of view.

Sterilization is not a punishment but a protection. It carries no stigma or humiliation. It is a humane measure designed to meet the best interest of all concerned, and for this purpose there is no known measure that can take its place.

The study which demonstrates the truth of these statements and which is here reported briefly, was organized at the beginning of 1926 by E. S. Gosney of Pasadena with the assistance of a group of specialists in various fields. It is embodied in more than a score of technical papers in various scientific journals in which the original data have been analyzed by refined statistical methods and made public. Anyone interested can turn to these original papers and verify the facts for himself.

Patients Are Pleased

The patients sterilized in the California institutions were found in 6 cases out of every 7 to be satisfied with the operation and the results. The exceptions were only such as would be expected in a group of persons who had gone through severe mental illness.

A typical objection would be this: "Sterilization is a wonderful measure and every insane person ought to be sterilized. But of course it was not needed in my case as I was never insane,‐‐just had a little nervous breakdown which has now cleared up," etc.

In no case was any cogent or rational objection made to the operation. Broadly speaking, it is not too much to say that the best friends of sterilization in California are those who have been sterilized in the state institutions and who know from personal experience what this protection means to them in their own lives.

The families of the sterilized patients likewise approve almost universally of the operation. No one realizes better than they the undesirability of further child‐bearing when the parents are unable to support the children or train them properly, and when the children themselves may inherit a handicap that will darken their future lives. If the children are normal, they will suffer by being brought up by a parent who is insane or feebleminded. They may seem to be normal, but later reveal the inherited tendencies. These facts are present in the minds of relatives as the outgrowth of tragic experience.

Homes Are Protected

In no instance has the operation broken up a home or disturbed a family relationship. On the contrary, case after case might be cited in which sterilization has been responsible for keeping a family together and allowing the patient to remain in his own home instead of spending the rest of his life in an institution. For these reasons, many of the patients who are sterilized have either come voluntarily to the state hospital or have been brought by their relatives primarily for the purpose of sterilization and for nothing else.

A canvass of the medical officers, probation officers, parole authorities, and social workers of the state who have had close observation of the workings of California's eugenic sterilization law during the past quarter of a century disclosed that they are virtually unanimous in its support, holding it to be desirable in principle and satisfactory in practice. The criticism most frequently voiced by them is that it is not applied more widely. While nearly all of the feebleminded are sterilized before release from state institutions in California, only 1 in 12 of the insane has been sterilized during the life of this law.

What Happens Afterward

Careful follow‐up of the feebleminded patients paroled after sterilization shows that two‐thirds of them have made good outside of the institution. Failures have been due to lack of intelligence or to temperamental defects, for the most part.

Many of the feebleminded girls have married after sterilization and these marriages have been reasonably successful in the great majority of cases. Since there are no children, both husband and wife can work out so that, even if neither one is very efficient economically, the joint earnings of the two support them comfortably. Probably neither one could have carried successfully the responsibility of a family of children,‐‐to say nothing of the prospects of children with such inheritance, brought up by such parents.

Whereas three‐fourths of these feebleminded girls were sex delinquents before sterilization (a record proving, if any proof were needed, that fear of results is no deterrent to promiscuity with such people), only one in every 12 has been a sex offender after sterilization and parole. This is good evidence that sterilization will not increase delinquency when it is made a part of a well organized system of probation and parole.

Sterilization in the California institutions is rarely performed without the consent of the parents, husband or wife, or next of kin. While the state has the power to protect itself by compulsory operation when necessary, the consent of the family is so readily given in most instances that this power need not be used. In any event, the patients' individual rights are fully safeguarded. Operation is performed only when the recommendation of the hospital is approved by the Director of the Department of Institutions and the Director of the Department of Public Health and the patient naturally has also the right of appeal to the courts in case he thinks his rights have not been fully protected.

The Need

Experience everywhere demonstrates that the successful application of eugenic sterilization depends largely on an educated public opinion and the intelligent administration of sound laws.

The need for conservative, sympathetic, and discriminating use of such a measure in selected cases has been widely recognized as imperative since research began to bring forward more exact facts about the problem which confronts the American people.

Careful studies indicate that there are 6,000,000 in the United States who have been, are now, or at some time will be legally committed as insane to state institutions. The number who suffer from equal mental disease sufficient at some time to incapacitate them for work but who are never legally declared insane is about as great, making 10% of the population or 12,000,000 persons subject to mental disease in one of its most serious forms. Altogether apart from the undesirability of perpetuating such forms of mental disease, it needs no argument to maintain that many of this vast number should not have children either for the welfare of those children or for their own welfare, not to mention posterity.

But these 12,000,000 mentally diseased persons are not the whole story. There are 6,‐000,000 additional who, though not mentally diseased, are so deficient in intellect, with an endowment in this respect that is more than 30% below the average, that they are often described as feebleminded. Such handicapped persons are subject to exploitation, likely to get into difficulties with law enforcement officers, and certain to contribute more than their quota to the ranks of delinquency and crime, and much more to those of dependency and pauperism.

Many of these defectives will never produce children, from natural reasons. It goes without saying that protection of the individual and of the race by sterilization would apply only to those defectives who are likely otherwise to produce children which they could not care for and who would be incapable of becoming self‐sustaining, good citizens. In any humanitarian program for the latter group, that will enable them to find their proper place in the community and keep out of trouble, sterilization will often prove to be indispensable, because practicable, harmless, and certain in its results.

America's Burden

This, then, is the situation which America faces now: 18,000,000 persons who are or at some time during life will be burdened by mental disease or mental defect, and in one way or another a charge and tax upon the rest of the population.

It challenges every thoughtful person.

The misery resulting from this insanity and feeblemindedness provides the first reason for grappling with the problem. No stratum of society is immune from such suffering.

The economic burden is tremendous and steadily growing worse. A billion dollars a year would be a low estimate of the cost of caring for these unfortunates; either in or out of institutions. The cost to the community of those who are not cared for,‐‐who are furnishing a large part of the staggering crime bill and the losses due to accidents,‐‐is much greater. Finally, what sort of a government can be expected,‐‐ what progress can be looked for, ‐‐when so large a part of the voters are mentally abnormal?

Is There Any Alternative?

A community can follow one of three courses in dealing with the problem of parenthood among its mentally diseased and mentally deficient members who are not able to control their own fecundity.

1. It may do nothing at all. That is what most communities are now doing. The results are not satisfactory either to the community or to the patients. They are disastrous in their effect in future generations. 2. It may keep such patients under lock and key for the rest of their lives, or at least for the rest of their reproductive lives. Such a policy is too expensive to reach more than a minority, and is therefore impracticable. Even if possible, it would in many cases be an unnecessary hardship or cruelty to the patient. 3. It may use sterilization in selected cases, as an adjunct to a careful system of parole and supervision, which will aid patients to live in the community, to be self‐supporting, and at the same time not put a new burden on society or pass on their handicaps to posterity .

Eugenic sterilization is no panacea, but it is one of the many tested and dependable measures that will help reduce the burdens and increase the happiness and prosperity of the population in this and future generations. As such, it is one among many indispensable procedures in any modern program of social welfare. If recognized as an integral part of a broad system of protection and supervision of those unable to meet unaided the responsibilities of citizenship in a highly competitive industrial system, it can be productive only of good. More over, modern knowledge of heredity has shown that the spread of constitutional defect can be prevented only by preventing the transmission of the defective genes which produce it.

The Law in Twenty‐seven States

Twenty‐seven states in the Union now have eugenic sterilization laws on their statute books. They are as follows, with the year in which the first law was adopted:

Alabama 1919 Michigan 1913 Vermont 1931 Arizona 1929 Minnesota 1925 Virginia 1924 California 1909 Mississippi 1928 Washington 1909 Connecticut 1909 Nebraska 1915 West Virginia 1929 Delaware 1923 New Hampshire 1917 Wisconsin 1913 Idaho 1925 North Carolina 1919 Indiana 1907 North Dakota 1913 Iowa 1911 Oklahoma 1931 Kansas 1913 Oregon 1917 Montana 1923 South Dakota 1917 Maine 1925 Utah 1925

Outside of the United States, sterilization is now the law in the Canadian provinces of Alberta and British Columbia; in Germany and Denmark; in the state of Vera Cruz, Mexico; the Canton of Vaud, Switzerland; and the Free City of Danzig.

Many of the American states have made little use of these laws. This has been chiefly due to a lack of public education as to the need for such a measure; partly to the fact that some of the earlier laws were badly drawn and not easily workable.

When actual experience, now abundantly available, was lacking, the legislatures of many states were obliged to proceed on theory, and sometimes enacted laws which were crude, indefinite, and unworkable. Several such acts were held unconstitutional by state courts.

In a general way, and without unnecessary faultfinding, we have condemned such laws and all unreliable, unnecessary, or punitive practices contemplated under them. Investigation shows that the statutes of most states could be much improved in the light of recent experience and research and of the court decisions which, condemning certain proposals and practices, have upheld eugenic sterilization laws when they safeguard the rights of the individual as well as the public and posterity.

In this connection we would call special attention to the case of Buck vs. Bell, appealed from Virginia to the United States Supreme Court. The plaintiff was a feebleminded woman, daughter of a feebleminded mother and herself the mother of a feebleminded, illegitimate child. In upholding the Virginia law, and the general principle it contained as constitutional, the court, in a strong decision written by Oliver Wendell Holmes, declared: "Three generations of imbeciles are enough." In time of war, it pointed out, the state calls on the fittest of its citizens to lay down their lives for the common good. In time of peace, shall it not be able to call on some of the most unfit of its citizens, not to sacrifice their lives, but to make a far lesser sacrifice,‐‐one which in most cases is regarded by them not as a sacrifice at all, but as a benefit to themselves,‐‐the renunciation of parenthood, when they are manifestly unfit for it?

The particular form of statute needed in any state must depend upon the organic laws and institutions of that state, and upon the degree of advancement of public opinion. Here are two steps, however, that each state must take in the near future, if it is to keep abreast of the progress of science in the protection of its own citizenship.

1. Provide for the sterilization, compulsory if necessary, (though this provision will rarely be required), of those patients legally committed to state institutions as insane or feebleminded who, if not sterilized before release, would probably have defective children. The procedure should be outlined in detail in the statute and the patient's rights to a hearing in court specifically safeguarded.

As part of the commitment, the court should appoint a legal guardian (who will usually be the husband, wife, or next of kin) and this guardian should represent the patient in all procedures concerned with sterilization, as well as in other personal matters.

This law should also apply to inmates of such institutions as poor farms, prisons, and reformatories, who are found to be insane, feebleminded, or to have other serious hereditary defects.

In the administration of such a law there will always be found borderline and doubtful cases. In such cases sterilization should never be performed except with consent.

2. Where the citizens of a state are sufficiently familiar with the subject to support a further measure, a separate law should be adopted authorizing city, county, and state hospitals supported at public expense to accept voluntary patients in legitimate cases for eugenic sterilization, just as they now do when the sterilization is required merely to save the patient's life, as it often is in women whose hearts, lungs, or kidneys make further maternity dangerous. Such a measure would permit those who need sterilization, but who cannot afford to pay for the operation, to get it at public expense without endangering any public or private interest.

The Human Betterment Foundation will gladly aid those interested in legislation, to get full information on this subject. It has published all the facts available, both historical and experimental, on eugenic sterilization, regardless of whether favorable or unfavorable to any individual's claims or expectations. It is concerned with education, not with propaganda. It is not advocating any particular law for any particular state, but urging citizens everywhere to inform themselves, and make up their own minds, as to the issues involved; to adopt sound and workable laws and to amend those that are out of date or badly drawn.