Lively reporting and critical analysis of today's health service and public health issues
|Health Matters issue 31 Winter 97/98|
Eugenic sterilisation: Europe's shame
Eugenic ideas were promoted across much of Europe during the 1920s and 1930s, with forcible sterilisation of the 'unfit' a constant demand of the eugenicists. Charles Webster reports on a troubled period in our history
During the summer of 1997, the name of Maria Nordin, a dignified 72-year-old former hospital worker from North Norrland in Sweden, shot to media prominence throughout northern Europe, and her case was even briefly noted in the British press.
Maria Nordin came from a poor family. She was short-sighted and slow at school, taken into an institution in a distant town and eventually released in her teens, but only after being sterilised. It was called voluntary sterilisation, but in effect it was compulsory. Understandably, this humiliating experience left a deep mark on her; with the help of some Swedish journalists, she has at last persuaded the authorities to take notice of her grievance.
Investigators quickly discovered that Maria Nordin's case was by no means unique. She was one of some 60,000 people subjected to sterilisation in Sweden between 1935 and 1976. Most were women, and the majority were labelled as mentally defective, although most probably had only minor physical or social disabilities. This finding has come as a severe embarrassment to the Swedes, and especially the Social Democrats under whom sterilisation was introduced and then greatly extended. The government has apologised, accepted that this 'treatment' constituted abuse, and it is likely that substantial compensation will be paid to survivors. The existence of eugenic sterilisation has severely shaken Swedish public opinion and it blemished the reputation of the internationally renowned Swedish welfare state.
The reverberations of the Nordin affair are by no means over. The curtain has been reluctantly drawn back to reveal an episode that most European states would rather forget, and which aligns them more closely with Nazi Germany than they like to recognise. Sterilisation laws were introduced throughout Scandinavia, as well as in the majority of states in the USA. The Brock Report of 1934 listed 10 western nations which had either introduced, or were in process of introducing, sterilisation laws. Germany was by no means ahead of the field; its 1934 sterilisation law was more draconian than elsewhere but it represented the general direction favoured by experts, and in most other countries sterilisation laws were subsequently extended to be more in accord with German practice.
The collective Swedish amnesia about sterilisation is difficult to explain. From the outset it was viewed as an integral and widely-proclaimed part of the Swedish welfare programme. Since Swedish welfare reform was actively publicised as a model for the rest of Europe, eugenic sterilisation could not have escaped notice elsewhere. The Swedish commitment to eugenic sterilisation was especially emphasised in the widely-known writings of Alva and Gunnar Myrdal; their book on the Crisis of the Population Question of 1934 achieved best-seller status, and was translated into English in 1940. The sequel, Alva Myrdal's Nation and Family, appeared in English in 1941. Both books forcefully argued the case for sterilisation on eugenic grounds, and the second described the work of the Swedish Royal Commission on Population, which produced a report on sterilisation in 1936. This led to strengthening of the sterilisation law, as a consequence of which the number of sterilisations increased and peaked shortly after World War II.
In this sorry tale, the United Kingdom seems to be exonerated since, in common with the Latin countries, it did not introduce sterilisation laws. However the British collective conscience should not remain untroubled. Francis Galton, the cousin of Charles Darwin, was the founder of the pseudo-science of eugenics, which provided the intellectual infrastructure for the advocates of sterilisation and related measures of social control. The Eugenics Society, founded in 1907, was one of the most articulate and effective promoters of both 'positive' and 'negative' eugenics. From the outset, sterilisation was seen by British eugenists as a main plank in their negative eugenics programme. The eugenists inclined to root all social and physical deviance in genetic defect. Sterilisation was promoted as a cheap and easy means of removing from the gene pool the threat of offending groups, ranging from such obvious targets as the insane to any class of 'defectives', or even more widely to what eugenists called the 'social problem group'.
The eugenists successfully co-opted support from two important government reports, the Wood Report on Mental Deficiency of 1929 and the Report on Sterilisation of 1934. The Wood Report described the social problem group as embracing the insane, but also a wide and miscellaneous group comprising 'epileptics, paupers, criminals (especially recidivists), unemployables, habitual slum dwellers, prostitutes, inebriates, and other social inefficients'. It was estimated that the social problem group comprised no less than the bottom 10 per cent of the population, which amounted to about 4 million people in England and Wales. The report estimated that 300,000 people should be formally classified as mental defectives; of these, 100,000 were severe cases. The Wood Report also claimed that the incidence of mental deficiency was increasing rapidly, and had doubled since 1908. This finding coincided with eugenists' claims about the rapid decline in national intelligence.
The Wood Committee's broad view of the social problem group was embraced by the Brock Committee, which also gave its imprimatur to sterilisation for those who were mentally defective or had suffered from mental disorder, those who were or were believed to be carriers of grave physical disabilities, or persons likely to transmit mental disorder or defect. The eugenists were apt to include such handicaps as blindness or deafness among the grave physical disabilities, and argued that these individuals were also likely to be candidates for sterilisation on account of associated mental impairment.
On the basis of its success in spreading alarm among the higher social classes, the eugenists attracted wide support. This support created an opportunity for decisive intervention on the policy front. The period between 1930 and 1936 marked the high point of the sterilisation campaign in Britain. The cause was powerfully supported within the social establishment, and Britain seemed to be on the brink of introducing one of the most wide-ranging sterilisation laws. But the sterilisation movement collapsed at its last hurdle. The eugenists were over complacent, and tempted to cast their net too widely, thereby opening their vague proposals to criticism from unsympathetic scientists and lawyers. Apart from isolated individuals, the Labour movement was never sympathetic; when it came to a decision, it joined the Catholic church in opposition. The Conservatives were also reticent owing to their fear of adverse electoral consequences. Finally, the high profile of sterilisation in Nazi ideology frightened away much liberal opinion.
In the UK, eugenic sterilisation seemingly turned out to be little more than a side-show, with no practical impact. The groups vulnerable to such an intervention seemed sufficiently protected by the law. Any doctor performing sterilisation was taking a substantial risk. However, reflecting the passion with which eugenic sterilisation was supported, it is evident that some medical practitioners were willing to defy the law and carry out sterilisation in the interests of what they perceived as the public good. This practice was obviously undertaken with discretion, but there are sufficient traces of its existence to suggest that eugenic sterilisation was current in the UK before World War II. The full evidence of the extent of this practice remains to be uncovered.
The best evidence comes from Leicester, the only major city for which there has been a thorough study of public health activity. The work of John Welshman has demonstrated the extent to which the public health hierarchy in Leicester was motivated by eugenic considerations. In the course of this work he has drawn attention to support for sterilisation among public health doctors. Furthermore, at a conference sponsored by the Committee for Legalising Eugenic Sterilisation in May 1932, C J Bond, a senior surgeon at Leicester Royal Infirmary, described eugenic activities in Leicester, in the course of which it was reported that 'illustrative cases were recorded by Mr Bond in which blind persons and individuals suffering from other forms of transmissible defect had undergone voluntary sterilisation with satisfactory results', and also further 'cases were mentioned in which experience has shown that there is ground for hope that increasing numbers of carriers will avail themselves of sterilisation'.
At the same conference an Alderman Black, representing the Leicester Mental Hospital and Health Committee, paid tribute to the courage and determination of Dr Bond with respect to his 'pioneer work'; Alderman Black called for those attending the conference to embark on a sustained newspaper campaign to promote sterilisation. Writing some years later, C P Blacker, who was the best-known medical academic associated with the sterilisation movement, admitted that 'sterilisation on eugenic grounds has occasionally been performed in this country and without mishap'. For reasons of prudence, Blacker was naturally reserved about this admission, but in the light of this general comment, and specific evidence relating to Leicester and other localities, it may well have been the case that eugenic sterilisation was taking place in Britain to a much greater extent than is yet realised.
On account of the evangelical mission of the British eugenists to promote sterilisation, the fact that it was taking place in Britain without legal sanction, and the advocacy of eugenics even among the more liberal welfare theorists, it is too soon to conclude that the UK can be exonerated over this shameful practice. The sterilisation incident also raises the question of the infiltration of eugenic considerations into regimes of care under the NHS. This is a further point upon which complacency would be ill-advised.