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"Instruments of social reform"

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"Instruments of social reform" Britishness and the medical regulation of the unfit
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Britishness and the medical regulation of the unfit
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Schaefer, Natalie L. ( author )
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Denver, Colo.
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University of Colorado Denver
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Master's ( Master of arts)
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University of Colorado Denver
Degree Divisions:
Department of History, CU Denver
Degree Disciplines:
History

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Subjects / Keywords:
Poor laws -- History -- Great Britain ( lcsh )
Poor laws -- Mental health -- History -- Great Britain ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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During the nineteenth century, the rise of the middle class and professionalization of medical experts marked an important change in British society. In the medical profession, which had only recognized general practitioners, surgeons, and apothecaries some medical men worked to establish themselves as experts in mental health. At the same time, social changes led to Britons having strong desire to redefine themselves as a moral nation in opposition to some of the increasingly democratizing nations throughout Europe. Part of this effort was the State establishment of a pauper asylum system. Through the creation of the asylum system, medical men were able to take control over identifying the insane and utilized that control to remove individuals from British society who they defined as not belonging. To do so, they created and maintained an environment that prohibited procreation. As the asylum system grew throughout the nineteenth century, medical professionals like Robert Rentoul began a medical conversation regarding proper treatment and solutions for dealing with what seemed to be a rapidly degenerating British population. Through the asylum system and the subsequent conversations about alternatives to a costly asylum system, medical professionals not only established themselves as experts on mental health, but also as "instruments of social reform" through defining the nation and regulating the procreation of "unfit" people.
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Includes bibliographical references.
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System requirements: Adobe Reader.
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by Natalie L. Schaefer.

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University of Colorado Denver Collections
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Auraria Library
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All applicable rights reserved by the source institution and holding location.
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982698224 ( OCLC )
ocn982698224
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LD1193.L57 2016m S44 ( lcc )

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Full Text
INSTRUMENTS OF SOCIAL REFORM:
BRITISHNESS AND THE MEDICAL REGULATION OF THE UNFIT
by
NATALIE L. SCHAEFER B.A., University of Northern Colorado, 2007
A thesis submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirements for the degree of Master of Arts History Program
2016


This thesis for the Master of Arts degree by Natalie L. Schaefer has been approved for the History Program by
Marjorie Levine-Clark, Chair Christopher Agee
Rebecca Hunt


Schaefer, Natalie Lynn (M.A., History)
Instruments of Social Reform: Britishness and Medical Regulation of the Unfit Thesis directed by Associate Professor Marjorie Levine-Clark
ABSTRACT
During the nineteenth century, the rise of the middle class and professionalization of medical experts marked an important change in British society. In the medical profession, which had only recognized general practitioners, surgeons, and apothecaries some medical men worked to establish themselves as experts in mental health. At the same time, social changes led to Britons having strong desire to redefine themselves as a moral nation in opposition to some of the increasingly democratizing nations throughout Europe. Part of this effort was the State establishment of a pauper asylum system. Through the creation of the asylum system, medical men were able to take control over identifying the insane and utilized that control to remove individuals from British society who they defined as not belonging. To do so, they created and maintained an environment that prohibited procreation. As the asylum system grew throughout the nineteenth century, medical professionals like Robert Rentoul began a medical conversation regarding proper treatment and solutions for dealing with what seemed to be a rapidly degenerating British population. Through the asylum system and the subsequent conversations about alternatives to a costly asylum system, medical professionals not only established themselves as experts on mental health, but also as instruments of social reform through defining the nation and regulating the procreation of unfit people.
The form and content of this abstract are approved. I recommend its publication.
Approved: Maijorie Levine-Clark
iii


ACKNOWLEDGEMENTS
I would like to extend my sincerest gratitude to a number of individuals who have been incredibly helpful and supportive as I have worked through the graduate program at the University of Colorado Denver. First, I would like to thank my co-workers and friends at Evergreen Middle School who have been incredibly supportive of me throughout my graduate program. I would also like to thank Professor Marjorie Levine-Clark for serving as both my advisor and committee chair. I have greatly appreciated working with you am thankful for all of the time and effort you have offered to help me in the development of this thesis. I would also like to thank Professor Christopher Agee for being my minor advisor and second reader. I enjoyed being a part of your class, learning from you, and benefiting from your perspective and expertise. Additionally, I am very thankful to Professor Rebecca Hunt who not only graciously joined my thesis committee without having me as a student, but also provided direction and perspective. Finally, I would like to thank Professor Pamela Laird who has been incredibly helpful and supportive throughout my time at the University of Colorado Denver. I cannot express just how much I appreciate you.
IV


DEDICATION
Completing this thesis marks the end of a six-year journey toward the completion of my masters program. In those six years, I have undergone an incredible amount of personal and academic growth that I simply could not have endured without the support of the group of women to whom I dedicate this thesis. First, to Sally Hobler, Lisa Neale, Karen Cravens, Kelley Young, and Dani Wise you all have provided infinite support, friendship, and love for which I am eternally grateful. To Marjorie Levine-Clark they say when you find someone who is passionate about and interested in the same things you are, to keep those people in your life. Thank you for sharing your passion and being so caring and supportive. And, to Tristin Koch -you are the best thing that has happened to me. Thank you for taking this journey with me for all of your love, encouragement, confidence, and support.
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TABLE OF CONTENTS
CHAPTER
I. INTRODUCTION....................................... 1
II. THE PAUPER ASYLUM SYSTEM............................8
III. STERILIZATION: AN ANSWER TO DEGENERATION...........27
IV. EARLY TWENTIETH-CENTURY MENTAL-HEALTH CARE.........43
V. AN EUGENIC MOVEMENT: THE UNFIT AFTER WORLD WAR 1...52
VI. CONCLUSION.........................................72
BIBLIOGRAPHY................................................76
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LIST OF FIGURES
FIGURE
3.1 Graphic of the Aerial View of Hanwell Asylum: 1843 .......................21
3.2 Photograph of the Entrance to Hanwell Asylum..............................22
3.3 Ground Plan of Hanwell Lunatic Asylum.....................................23
3.4 Ground Floor Plan of Claybury Asylum......................................23
6.1 Graphic from Marie Stopes Contraception..................................69
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CHAPTER I
INTRODUCTION
It does not make the defective criminal into an honest man. It does not make the unemployable ament into a useful citizen. It does not make the immoral feeble-minded into a moral being. It does not enable the pauper or vagrant defective to earn his own living.1 L.A. Parry, a surgeon designated as a member of the Fellowship of the Royal College of Surgeons, wrote this of proposed sterilization policies in Britain in 1927. Parrys assessment was one of the few dissenting voices among medical professionals regarding the sterilization of individuals in Britain who were labeled as unfit. Conversations about the sterilization of the unfit developed as a result of Robert Rentouls Proposed Sterilization of Certain Mental and Physical Degenerates published in 1903.
Yet, this proposal was not the first effort on behalf of medical men to regulate the procreation of so-called degenerates. Throughout the course of the nineteenth century, the British government established a public asylum system. Initially, as Elaine Showalter, indicated, the intentions of asylum administrators like John Conolly, the administrator at Hanwell Asylum from 1839 to 1843, were optimistic about the role of asylums to cure individuals of their mental maladies. Medical men, like Conolly, believed that they could offer care in the asylum that was both humane and effective at curing individuals of
1 L.A. Parry, The Problem of Mental Deficiency, The British Medical Journal Vol. 2, No. 3493 (Dec. 17, 1927): 1166.
1


mental illness.2 However, by the end of the century it was clear that even a benevolent system was largely ineffective as a curative process. Ultimately, the system was most successful in creating an environment in which the insane were unable to reproduce. Through the process of creating and regulating the State asylum system throughout the nineteenth century, medical professionals established themselves as experts in the growing field of mental health. They utilized their professional opinions as a platform from which to assert themselves through the early twentieth century in debates about definitions of true Britishness in relationship to who had a right to reproduce.
In Britons, Linda Colley explored definitions of Britishness from 1707 through 1837. In regards to definitions of Britishness during the nineteenth century, she framed her argument in terms of British loss of the American colonies at the end of the eighteenth century and a desire among the population to insure that the nation would maintain its superior identity. She described one of the most important elements of this definition of Britishness as a claim on moral superiority. Through the process of both ending the British slave trade, as well as the end of slavery in Britain and its colonies, Britain worked to create an image of itself as a moral nation. They could not, Colley explained, identify as the most democratic nation because, unlike other European nations, Britain did not extend universal male voting rights or the right to vote for women until
2 Elaine Showalter, The Female Malady: Women, Madness, and English Culture 1830-1980 (New York: Pantheon Books, 1985), 44-50.
2


after World War 1.3 Showalter also notes this desire to associate Britishness with morality in the efforts to reform asylums that took place during the nineteenth century.4
By the end of the century leading up to World War I, Paul Ward has shown, British identity continued to be associated with morality. Ward argues that the image of the British nation became domesticated in the period leading up to World War I. He explains that the royal family provided a model and images of the nation as family were popular. This image was particularly clear in the masculine role of the protector of the nation during the Great War. When the Germans invaded Belgium, Ward writes, Britishness came to be defined as everything that was not German. This definition included a controlled sexuality that was directly opposed to the Germans who, as the British press described, had raped the Belgians in their invasion. This, worked to reinforce already existing notions of Britishness as concerned with honour, decency and fair play.. ,5 These qualities are evident in the asylum system and the conversations about the proper care and treatment of the insane. Subsequently, they became part of the early twentieth-century medical conversations about groups of people who did not belong as part of the nation.6
My initial interest in this topic stemmed from an intriguing set of sources in the London Metropolitan Archives. There I engaged with a number of different types of
3 Linda Colley, Britons: Forging the Nation 1707-1837 (New Haven: Yale University Press, 1992), 356-367.
4 Showalter, The Female Malady, 44-50.
5 Paul Ward, Britishness Since 1870 (London: Routledge, 2004), 40.
6 Ward, Britishness.
3


records that asylums kept for their patients. In each record book, I witnessed hundreds of stories of individuals whose conditions marked them different enough from the general population that someone, generally a medical man, believed they required targeted treatment and removal to an asylum. The most intriguing of these documents were the photographs of patients kept in the late nineteenth century. Each face humanized the people I read about. This humanization of the patients caused me the greatest concern when I read Robert RentouTs proposition to sterilize mental and physical degenerates. RentouTs argument focused so much on the financial benefits of sterilization over the costly asylum system that he came across as void of empathy.7 Yet, it was his argument that made me want to examine what these asylums were really like and explore the perspectives of other medical professionals at the time regarding sterilization.
Scholars who have explored nineteenth century asylums, sterilization laws, or eugenics have focused on each of these topics individually. For example, Elaine Murphys The Administration of Insanity in England 1800 to 1870, Peter McCandlesss Liberty and Lunacy: The Victorians and Wrongful Confinement, J.K. Waltons Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840-70, and N. Herveys A Slavish Bowing Down: the Lunacy Commission and the Psychiatric Profession 1845-60 focus on treatments provided by the asylums and the administration of the asylums by both medical and political professionals.8 Andrew Scull
7 Robert Reid Rentoul, Proposed Sterilization of Certain Mental and Physical Degenerates: An Appeal to Asylum Managers and Others (London: Walter Scott Publishing Co., 1903).
8 Elaine Murphy, The Administration of Insanity in England 1800 to 1870, in The Confinement of the Insane: International Perspectives, 1800-1965, ed. Roy Porter and David Wright (Cambridge: Cambridge University Press, 2003), 334-349. Peter
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does explore the ineffectiveness of the asylums, which I will include as part of my analysis, but he does not explore their unintended effectiveness as a form a reproductive control.9
Finally, in the area of eugenics and sterilization, scholars have explored these topics in relation to one another. For example, Ann Farmer, Pauline Mazumdar, and Richard Overy all address eugenics and the role eugenic thinking played in the policies of sterilization and contraceptives. However, they maintain a focus on eugenics from the 1920s and do not examine the ways in which earlier practices in the asylums or earlier conversations among medical professionals closely resembled the arguments presented by eugenicists.101 will address asylums, sterilization, and eugenics as ideas and practices that developed earlier than the 1920s and that shaped the professionalization of medical men, but also provided a venue in which medical professionals could advise on issues of national identity in Britain.
McCandless, Liberty and Lunacy: The Victorians and Wrongful Confinement, in Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, ed. Andrew Scull (Philadelphia: University of Pennsylvania Press, 1981), 339-362. J.K. Walton, Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840-70, in The Anatomy of Madness: Essays in the History of Psychiatry, ed. W.F. Bynum et al. (London: Tavistock Publications, 1985), 132-146. N. Hervey, A Slavish Bowing Down: the Lunacy Commission and the Psychiatric Profession 1845-60, in The Anatomy of Madness: Essays in the History of Psychiatry, ed. W.F. Bynum et al. (London: Tavistock Publications, 1985), 98-131.
9 Andrew Scull, Madness: A Very Short Introduction (Oxford: Oxford University Press, 2011).
10 Ann Farmer, By Their Fruits: Eugenics, Population Control, and the Abortion Campaign (Washington, D.C.: Catholic University of America Press, 2008). Pauline M.H. Mazumdar, Eugenics, Human Genetics and Human Failings: The Eugenics Society, its Sources and its Critics in Britain (London: Routledge, 1992). Richard Overy, The Twilight Years: The Paradox of Britain Between the Wars (New York: Viking, 2009).
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In chapter two, I will address the creation of the pauper asylum system in the nineteenth century. In this section, I will explore the changes in the treatment of and attitudes towards the insane that took place from the beginning of the creation of the system to the end of the century. I will argue that the asylum system itself helped to establish medical men as experts in the growing field of mental health. Additionally, through the asylum policies and procedures, nineteenth-century medical men may not have fully understood how to cure mental illness, but they united in a belief that insane individuals did not belong in the larger society.
Efforts to maintain mental patients separate from the general public are the focus of chapter three. In this chapter I will show that the pauper asylums were located in such a way as to keep mental patients away from the general population. Moreover, asylums created a venue in which individuals who were classified as not belonging could experience some elements of British identity while not presenting a danger to Britishness through procreation. In chapter four, I will show that the limited knowledge of mental health and preconceived notions held by many medical men throughout the first part of the twentieth century created a medico-political environment in which medical men imagined sterilization as a reasonable solution to a perceived mental health epidemic. However, it is important to note that the British State did not legislate to sterilize any of the groups of people proposed throughout these conversations. This will lead directly to a focus on the changing nature of mental health care in the first part of the twentieth century in chapter five. I will show that World War I contributed to changes in the care of the insane and fed medical and political concerns that the British race was degenerating.
6


Finally, in the sixth chapter, I will focus on the establishment of a eugenics movement in Britain and the expansion of policies that were initially intended to address the issue of insanity and were instead directed at a group of people identified as unfit. While the definition of Britishness changed throughout the nineteenth and early-twentieth centuries, what remained was an effort on behalf of medical professionals to claim that their expertise qualified them to define who did not belong and to advise policy-makers on how best to address those who did not belong. In effect, medical men operated as instruments of social reform.
Throughout this thesis I use a number of different terms to refer to various groups deemed unfit. When directly referenced by the author, I have provided clarification on these terms as indicated by the author. Often, individuals utilized similar terms but defined them in different ways. I have also utilized the same terms as the author of the source provided as to maintain the language provided, not to insert my own connotations or judgments on the use of terms. Terms often found throughout the primary and secondary literature referenced here include defective, degenerate, lunatic, insane, and epileptic. Each term refers to a particular set of people and cannot necessarily be utilized interchangeably; however, I have included each as part of a collective group of people deemed unfit in the sources throughout the period I address.
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CHAPTER II
THE CREATION OF THE PAUPER ASYLUM SYSTEM
During the nineteenth century, the State established asylums for Londons poor who were deemed insane. Officials established asylums in order to remove the insane from the workhouses and to ensure they would receive care. Initially, medical administrators at the asylums knew little about the brain or mental conditions; however, they provided the best care they knew how. This care included recreational activities and access to outdoor spaces. Throughout the century, the state asylums for London filled quickly requiring a greater number of facilities. When the State first created the pauper asylum system, asylum documents reflect that medical professionals were novices in the field of mental health. They studied their patients in an effort to understand and treat mental maladies. Yet, the records suggest that their focus for most of the nineteenth century was on the physical attributes they could find associated with mental illness. Eventually, the ever growing number of people placed in asylums became so vast that the stress placed upon the existing asylums as well as on the ratepayers who financially supported the asylum system led many individuals to question the usefulness of the asylums.
The creation of the pauper asylum system marked a significant paradigm shift in the history of British asylums. As Scull explains, changes within the administration of asylums allowed for more humane care of the insane than the previously existing madhouse system. According to Scull, in eighteenth and early nineteenth-century madhouses, it was not uncommon to witness patients chained to walls or floors or even suffering from severe frostbite. Yet, nineteenth-century asylums provided a space where
8


asylum administrators seemed more concerned about curing the insane and providing a therapeutic space for these patients. Scull argues this shift was largely a result of greater visibility of the asylum system through central control of the asylums.11
The care and treatment of the insane also underwent significant change in the first half of the nineteenth century as a result of State legislation. Initially, those people with mental disorders who could not afford treatment on their own established relationships with others at workhouses throughout London. The State had established workhouses as places where individuals who were unable to support themselves were able to receive a place to live and work. While in the workhouse, the lunatics fell into the care of their fellow poor who not only were unable to financially support themselves, but also did not have the medical or psychological training to adequately care for these individuals. According to Murphy, it was not until the passage of the 1808 County Asylums Act, also known as the Wynn Act, that the State provided an opportunity for local governing authorities to establish their own asylums. Yet, few counties actually did so. Instead, families who could not afford to send their own family members to private asylums were left to care for them themselves. Murphy estimates that between one-fourth and one-third of the insane were cared for in workhouses. Under the 1834 New Poor Law, the State extended its control over asylums and workhouses by implementing the Poor Law Commission and Lunacy Commission as oversight committees. Then, in 1845 the State passed the Asylums Act which formally mandated the creation of pauper asylums for the care of the insane. Nevertheless, many individuals who were identified as insane,
11 Scull, Madness, 46-52.
9


continued to be housed in the workhouse system due to lack of space in county asylums.12
The first purpose-built pauper asylum in London, Hanwell Asylum, opened its doors to Londons pauper insane in 1831. By the end of the century, there were five such purpose-built facilities for London: Hanwell, Colney Hatch, Banstead, Cane-Hill, and Claybury. Although the generalized sentiment among medical and governing professionals was optimistic at the inception of the pauper asylum system and they believed they could genuinely help people who could not care for themselves, the ultimate success of the asylum system was that it created homo-social environments that effectively limited the ability of those within the asylum to procreate.
Conversations about mental health in Britain during the first half of the nineteenth century focused on who could best care for those with some kind of mental difference. One common conversation concerned whether those individuals deemed insane should be cared for at home or elsewhere. In an 1843 document entitled Notice of the Establishment for the Treatment of Nervous and Mental Maladies, John Parkin explains that many people expressed a desire to treat the insane at home. However, he suggests that it was in the patients best interest to be cared for by experts. Experts, Parkin continues, would give patients their best chance at recovery because those experts would be able to see multiple patients and through experience find cures for various mental maladies.13 While Parkin did not consider the circumstances of the home life and the
12 Murphy, The Administration of Insanity, 334-349.
13 John Parkin, On the Medical and Moral Treatment of Insanity, Including a Notice of the Establishment for the Treatment of Nervous and Mental Maladies (Manor Cottage, Kings Road, Chelsea, London: 1843).
10


familys ability to be able to support insane members of the family, the concern regarding the pauper insane was similar. Within the workhouse system established under the Poor Law, those who could not take care of themselves often required care from other individuals in the workhouse, leaving insane individuals at the mercy of their fellow poor. These concerns suggest that the asylum system optimistically encouraged the insane to obtain treatment from experts because medical professionals genuinely believed they would be able to help the insane. It also suggests that medical professionals were establishing themselves as experts on mental health in the first half of the nineteenth century.14
Many historians have commented on the rise of professions in nineteenth century Britain. Irvine Loudon explained that in the first half of the nineteenth century, those with medical knowledge actively worked to gain respect in British communities through their expert knowledge and professional practices.15 Jeanne Peterson identified a desire among medical men in nineteenth-century Britain to separate themselves from the working-class through the organization of the medical profession as well as State regulations of the medical profession.16
On the other hand, records of dissemination of medical knowledge as well as asylum patient records indicate that medical professionals knew very little about the care and cure of mental health throughout the nineteenth century. In The Human Brain:
14 Scull, Madness, 48.
15 Irvine Loudon, Medical Care and the General Practitioner, 1750-1850 (Oxford: Clarendon Press, 1986).
16 Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley: University of California Press, 1978).
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Histological and Coarse Methods of Research: A Manual for Students and Asylum Medical Offices (1882), W. Bevan Lewis, the Deputy Medical Superintendent to the West Riding Lunatic Asylum, discusses dissections of the human brain. He reports on what membranes in the brains should look like as well on the proper arrangements of the vessels and arteries in the brain. Lewis suggests that checking for signs of inflammation is important to understanding the origin of mental defects and even explains that if one were to touch the brain there are certain areas that should feel soft while other areas should feel tough.17 This suggests that as late as the 1880s medical professionals believed that mental health was caused by a physical abnormality in the brain that could actually be felt or seen by the medical professional.
When the asylums first opened, the records of patients indicate that medical professionals who worked in the asylum system had limited knowledge of the cause and cure of mental disorders, but also sought to gain further knowledge on mental health through the study and care of their own patients. As Guenter Risse and John Harley Warner have written, case records can be valuable resources in historical study, but they are limited in what they provide. They explain that medical records reveal much about what the medical practitioners who wrote the records thought or believed about the nature of the body and illness. However, they do not typically contain the patients own thinking or feeling about their own health or medical care.18 The Hanwell Case Ledgers from 1831
17 W. Bevan Lewis, The Human Brain: Histological and Coarse Methods of Research: A Manual for Students and Asylum Medical Officers (London: J. and A. Churchill, 1882).
18 Guenter B. Risse and John Harley Warner, Reconstructing Clinical Activities: Patient Records in Medical History in The Journal of the Society for the Social History of Medicine 5 (1992): 183-205.
12


contain generalized narratives about intake meetings between medical professionals and patients. The register is essentially a large book of plain lined paper without suggested fields for intake personnel to fill in. The narratives contained within these records do not provide much information about particular medical data for each patient and records were kept on a case by case basis making it difficult to show the relationship between particular pieces of data for each patient because they did not necessarily record similar information for each patient. Some common elements within the narratives include information about the physical condition of the patient including any visible bodily mutilation and notes about the hygiene and eating habits of the patients.19 Much like the knowledge included in Lewis The Human Brain these early records of patients show that medical professionals were looking for physical markers of mental disorder.
Additionally, the intake professionals notations of the patients eating habits reveal an interest in exploring the correlation, if any, between mental health and the foods that individuals ate.
Over time, medical records for asylum patients became more regimented and focused on connections between heredity and mental health as well. Unlike the 1831 records, the 1853 Hanwell Register of Patients, provided space for intake professionals to record similar information for each patient upon entry into the asylum. One reason for this change in record keeping was the fact that the 1845 Pauper Lunatic Asylum Act mandated that certain information be kept and that the asylums were required to record information for each patient within one month of the patients entry into the asylum. The 1853 Register of Patients at Hanwell contained information such as if the patient had
19 Hanwell Asylum, Female Case Ledger, (1831).
13


been previously admitted, marital status, occupation, previous abode, who sent the patient to the asylum, bodily condition, and form of mental disorder. The types of mental disorders noted in this record were: melancholia, mania, imbecility, senility, and hysteria. As well as the form of the disorder, the records also suggest that medical professionals within the asylums were collecting data about the causes of the mental disorder presumably in order study the common features of mental health cases. For example, the records provided information about the supposed cause of the disease, the persons bodily condition at intake, and notes pertaining to whether the person was a congenital idiot. This final note is particularly interesting because it suggests that medical professionals were looking for clear correlations between heredity and mental disorder.20 Although the study of the link between heredity and mental illness did not become a primary focus of medical professionals until the late nineteenth century, the desire to understand the causes of mental illness indicates that medical professionals wanted to find a way of preventing mental illness.
While numerous patients were included in the Hanwell 1853 Patient Record, some patients stand out for the comments made regarding the causes of their mental disorders. The records indicated that one woman, Elizabeth Wakeham, had been diagnosed with hysteria caused by nursing. Another woman, Sarah Broadbent was listed as having melancholia caused by intemperance. Other records defined poverty as a cause
20 Hanwell Asylum, Register of Patients, (1853). The Pauper Lunatic Asylums Act, 1845.
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of melancholia, epilepsy as the cause of imbecility, and age as the cause of senile insanity.21
Although the connections between the cause and kind of disorder are interesting in the value they can provide regarding the degree of understanding medical professionals had of mental disorder at the time, they also inform about biases in mental health. When linking ideas such as poverty and intemperance to mental health, medical professionals showed a bias toward populations within British society who fell outside of the recognized British ideal. For example, Marjorie Levine-Clark shows that the ability to work was an essential element of a British mans identity. This norm, she explains, also extended to poor women. It was in this context, Levine-Clark argues, that some medical professionals listed poverty or unemployment as a cause of insanity. 22 This link also demonstrates that medical professionals may have believed that if a person exhibited particular qualities, like being impoverished or intemperate, then they could be susceptible to insanity.
By the end of the century, records for patients at Hanwell became much more regimented. Instead of maintaining narratives organically gained through entrance interviews between patients and intake personnel, the casebooks from the 1890s took the form of meticulously ordered surveys on specific aspects of each patients condition and background. The books actually contained cells for each response as though they were
21 Hanwell Asylum. Register of Patients. 1853.
22 Marjorie Levine-Clark, '"Embarrassed Circumstances': Gender, Poverty, and Insanity in the West Riding of England in the Mid Victorian Years," in Sex and Seclusion, Class and Custody. Perspectives on Gender and Class in the History of British and Irish Psychiatry, eds. Jonathan Andrews and Anne Digby, 123-148 (Amsterdam: Rodopi, 2004).
15


made expressly for the purpose of keeping records of incoming patients, unlike the registers from 1831 that contained only clean, lined paper. These new registers contained over fifty different questions and responses for each patient. Some of the patient information was simply regarding the patients home life including age, address, religious affiliation, occupation, marital status, education, and the number and ages of children. As Risse and Warner indicate, this was fairly typical for nineteenth-century medical case records.23 Then, the records provided information about the patients condition at the time of entry to the asylum including the particular affliction, whether the patient was epileptic, suicidal, or dangerous, how many previous attacks of nervous disorders the patient may have had, and mental state.24
The pieces of information obtained regarding the patients bodily health, behaviors, and heredity are the most significant in exploring how medical professionals sought to understand mental illness. Similar to the patient case records kept in the 1831 and 1853, medical professionals paid attention to the physical condition of the body. The records from the 1890s, however, provided greater detail. They included information about the condition of the patients digestive, circulatory, respiratory, and genitourinary systems as well as speech, special senses, pulse, gait, development, temperament, and
23 Risse and Warner, Reconstructing, 185.
24 Hanwell Asylum, Casebook, Females No. 14 (29 September 1891-10 August 1892). Hanwell Asylum, Register of Admissions No. 6 (London County Asylum. 23 April 1898-3 January 1900). City of London Lunatic Asylum, Casebook Females No. 12 (23 June 1896 October 1899).
16


weight.25 As before, in an effort to keep records of patient conditions, especially regarding systems not clearly linked with mental health, medical professionals continued to look for correlations between other physical conditions and the persons state of the mind.
Additionally, asylum records also provide evidence that medical professionals wondered about the possible links between particular behaviors patients exhibited and their mental health. For example, the intake records in the 1890s include detailed information regarding disposition and habits in health similar to earlier records. They also questioned the patients cleanliness, eating, and sleep habits as well as indicated whether the patient was temperate.26 As before, the determination to keep track of cleanliness and temperance show that medical professionals may have maintained biases toward the unkempt or intemperate individuals in society as well as biases toward the mentally defective. These biases may have influenced not only the care individuals received but also overall attitudes toward these members of society as individuals who simply did not belong.
Finally, one of the most significant differences between the earliest asylum records and those kept near the end of the century is the amount of detail in questions regarding the patients heredity. Asylum records contain information about the individuals nationality, number of people in their families, number of people in the
25 Hanwell Asylum, Casebook, Females No. 14. Hanwell Asylum, Register of Admissions No. 6. City of London Lunatic Asylum, Casebook Females No. 12.
26 Hanwell Asylum, Casebook, Females No. 14. Hanwell Asylum, Register of Admissions No. 6. City of London Lunatic Asylum, Casebook Females No. 12.
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family who were then living, as well as if there was a family history of nervous disorders, the family history of phthisis, number of relatives affected by a mental malady, if the patients parents had related prior to marriage, and a family history of intemperance.27 Direct questioning of the family history of mental disease indicates that medical professionals wondered, if not believed, whether heredity could have been a cause of mental illness. In addition, asking if the patients parents had related prior to marriage or if the patients family had a history of alcoholism indicates an increased suspicion on behalf of medical professionals that mental illness could be caused by disobeying societal norms at the time by drinking to excess or entering into sexual relationships prior to marriage. It may even suggest that medical professionals wondered if mental illness, sexual promiscuity, or intemperance could indicate one another or occurred simultaneously in a cause/effect relationship. In that case, finding the cause of the mental disorder could help professionals to identify, treat, and possibly cure the disorder.
Although the government established an asylum system with the intent of helping patients, the records indicate that the system was highly ineffective at curing mental defects. In The Care and Cure of the Insane, a report regarding Londons lunatic asylums from 1875-1877, J. Mortimer Granville, M.D. criticizes almost every element of the asylum system, including the physical structures of the facilities and the approach to treatment of the insane. In regards to the facility at Colney Hatch (the second dedicated pauper asylum for London), Granville writes, as an institution for the care and cure of
27 Hanwell Asylum, Casebook, Females No. 14. Hanwell Asylum, Register of Admissions No. 6. City of London Lunatic Asylum, Casebook Females No. 12.
18


the insane it is organised on a system elaborately heretical in conception, and based on principles and a notion of the object in view with the best of compassing it which we believe to be wholly false, impracticable, and disastrous.28 He explains that his criticisms of the asylum stem from his belief that the committee (the London County Council) maintained far too much control over the asylum and that the day-to-day practices of the asylum should have rested in the hands of the medical professionals. Additionally, he claims that the asylum relied too heavily on treating patients in group settings. He states, mental diseases cannot be treated as a heterogeneous heap of mutually antagonistic idiosyncrasies.29 Instead, he suggests that medical professionals would be much more effective in treating patients on an individual basis whereby the professionals would gain distinct knowledge of the patients needs and be able to respond accordingly. Granville indicates the same type of practice occurred at Hanwell. He writes, treatment is humane, intelligent, and, in a broad sense, moral and suasive; but it necessarily lacks individuality, and that special character which arises from dealing with a limited number of cases directly.30 These criticisms indicate that Granville did not witness a system that was highly effective in its treatment of patients.
Moreover, Granville also indicates that the very nature of the physical structures of the asylum were not effective in the treatment of the mentally ill. Of Hanwell Asylum he states that it was too much like a prison and refers to it as a depository for criminals.
28 J. Mortimer Granville, The Care and Cure of the Insane: Being the Reports of The Lancet Commission on Lunatic Asylums, 1875-6-7: For Middlesex, the City of London, and Surrey, Volume 1 (London: Hardwick and Bogue, 1877), 145.
29 Granville, Care and Cure of Insane, 153.
30 Granville, Care and Cure of Insane, 81.
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Additionally, he explains that part of the reason the asylums did not treat patients on an individual basis and instead treated them in group settings was because the asylums were simply too overcrowded. He could not imagine that with the number of people living at the asylum patients were properly cared for because they could not be so. Granville indicates that even the Home Secretary stated that within the asylum system little emphasis was placed on the curative process and that the facilities had simply becoming housing facilities for the pauper mentally defective.31 Scull also acknowledges this point in arguing that asylums became what he coins museums of madness. He writes, Here the insane were shut up in multiple senses of that term, isolated from the larger society, objects first of pity, then of fear and disdain.32 While Sculls argument supports the idea that the asylums were ineffective at treating and curing metal illness, by isolating the insane in asylums, the State was also able to prevent patients from reproducing.
While the asylums may not have been effective at curing patients, the asylums were effective at removing individuals from the general population and maintaining an environment in which patients could not procreate. Although the documents the asylums kept and the meeting minutes for the various committees who, over time, controlled the asylums do not mention the intention of keeping the insane separate from the general population, both the locations of and the layout of the asylums clearly mark a separation between the insane and the sane.
31 Granville, Care and Cure of Insane, 75-88.
32 Scull, Madness, 51.
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Of the five pauper asylums for London established in the nineteenth century, not one was closer than seven miles from central London. The closest asylum to central London was Colney Hatch, which was seven miles away, while the farthest, Cane-Hill was approximately fifteen miles away. Images of the asylums depict imposing structures spanning numerous acres of land. The entrance gate itself suggests that it was an entity of its own separate from the rest of the world. Plus, the asylums actually acted to establish themselves as self-sufficient by raising their own animals, growing their own produce, and maintaining their own infrastructure (such as sewage). Not only did this physically separate the patient population from the rest of society, it also created a situation in which spouses, especially spouses of the poor, would be unable to visit the asylum often.33
Figure 3.1 The graphic of Hanwell Asylum published in the Illustrated London News 20 May 1843 shows the vast grounds and structure of the asylum.
33 Sussex Lunatic Asylum, Haywards Heath, Regulations and Orders of the Committee of Visitors for the Management and Conduct of the Asylum (London: Sussex Lunatic Asylum, Haywards Heath, 27 April 1861).
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Figure 3.2: The gated entrance to Hanwell Asylum shown in this photograph demonstrates its imposing size. The entrance clearly demarcates the asylum as a separate
space.
One of the most important elements of the asylum system was the ability of asylum administrators to segregate the genders thereby creating an environment in which the insane could not procreate. In notes regarding the Sussex Lunatic Asylum, the regulations indicate that men and women were not only to be kept in separate wards, but also that they should be treated in separate infirmaries. Moreover, they also established that when female patients were visited, they should be accompanied by the head attendant from the asylum. This separation of males and females is also evident in the layout maps for the pauper asylums. They show male and female wards on opposite wings of the asylums as well as separate infirmaries, airing courts, and bathhouses. By maintaining gender segregation in the asylums, the asylum system established an environment in
22


which those individuals who were labeled as mentally defective were unable to develop sexually intimate relationships.
Figure 3.3: The Ground Floor Plan of Hanwell Asylum shows men and women were housed in separate wings of the facility. It provided separate housing, airing courts, and
even surgeon's rooms.
Figure 3.4: In the ground floor plan of the Claybury Asylum, one can see the separation of male and female patients similar to the separation at Hanwell Asylum. Claybury opened later than Hanwell and it shows not only did males and females have separate wards and facilities, their wings were separated by a central section containing spaces including kitchens and delivery. Note that the female side of the facility also contains the laundry where female patients could work while at the asylum.
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Moreover, this self-sustaining system provided opportunities for patients to experience vital elements of British character including work and making contributions to society, even if those contributions were to the smaller community of the asylum. As Levine-Clark has written, work played an important part in the gendered experience of Britishness. She explains that for men, the ability to work and adequately earn a living to support ones family was a vital element of a Victorian mans expression of his Britishness and a necessity for poor women.34 While Showalter has shown that for middle- and upper-class Victorian women, society could view working outside the home as a sign of womans insanity.35 According to the Regulations of the Sussex Lunatic Asylum in 1861, proper care of the insane included ensuring that they were employed at the asylum as often as possible in occupations suited to their ability.36 For women, the regulations specify that work could include needle-work, straw-work, house-keeping, or linen washing. While for men, it indicates that they should have access to tools and workshops.37 Providing opportunities for patients to work indicates that asylum administrators valued work as an element of British character, even for poor women, that the insane could experience even while being isolated from the general population.
Although the asylum may have been effective in establishing a gender segregated sub-culture, not in curing the insane, the asylums grew at alarming rates throughout the nineteenth century. In a series of newspaper clippings from 1890-1900 kept by the
34 Levine-Clark, Embarrassed Circumstances, 127-130.
35 Showalter, The Female Malady, 121-144.
36 Sussex Lunatic Asylum, Regulations and Orders.
37 Sussex Lunatic Asylum, Regulations and Orders.
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London County Asylums, a number of articles show that many people in British society saw insanity as a problem that faced nineteenth-century London. One of the common elements in these clippings includes a concern that the growing number of people in asylums was increasing at a far greater rate than the asylums could provide service. For example, when Hanwell Asylum first opened its doors it was set up to serve 500 patients. By 1881, Hanwell had over 1,891 patients. Another asylum like Hanwell, Colney Hatch, only the second purpose-built pauper asylum for London, was established for up to 1,250 patients. Yet, within ten years, not only had more asylums opened, but Colney Hatch itself housed over 2,000 patients. In one 1894 article entitled, Lunacy in London, the author expressed concern regarding the rate of diagnosis of insanity. The author indicated that approximately 11,000 people received services at the five London pauper asylums. Many articles also explained that the cost of running asylums, especially given the number of patients then housed in asylums, was increasingly difficult to maintain. Lunacy in London explains that the cost of running Londons pauper asylums was over 400,000 Pounds annually. In one Evening News and Post article from 26 October 1890, the author questions the use of ratepayers money to accommodate the insane and suggests that families should bear the burden of caring for family members either by housing and caring for them themselves or by paying for family members to receive
38
services at private institutions.
The increasing number of asylum patients indicates that the asylums were not curing and releasing people back to the general population. Moreover, these numbers 38
38 London County Asylums, Lunacy in London Asylums Department Newspaper Cuttings (1890-1900).
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may also be the result of medical professionals changing the professional criteria used to identify patients as needing asylum services. Presumably, these differences in professional opinion resulted from a deeper medical understanding of insanity. In any case, both medical professionals and others in the British population became increasingly concerned about the mental health problem as the nineteenth century came to a close.
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CHAPTER III
STERILIZATION: AN ANSWER TO DEGENERATION
By the beginning of the twentieth century, the problem of housing asylum patients was such a significant one that one medical man suggested sterilization of the insane as an alternative to the gender segregation in asylums. His suggestion spurred extensive conversations among many medical and political stakeholders in Britain. Although sterilization became the main topic of conversation among medical professionals regarding the proper treatment of the insane at the beginning of the century, it was not the only suggestion. As indicated in a British Medical Journal article, The Marriage of Epileptics, the author advocated restrictions on marriage for anyone deemed unfit to produce offspring. He explained that while society would likely not accept sterilization nor extend political power to execute such individuals, he wrote, All that society can do at present to protect itself is to set its canon against the marriage of persons whose offspring would be likely to swell the number of the unfit of the criminal, who are a burden to the State and a danger to the community.39 These conversations centered around each stakeholders own definition of Britishness and how to best ensure that the British population was the strongest it could be. The rationale advocates for sterilization and marriage certificates offered in their suggestions for replacements for the asylum system focused on the reproductive possibilities of the unfit. Therefore, these arguments suggest that at least one purpose of asylums was deterring reproduction for fear of the rising number of British citizens identified as mentally deficient. Medical professionals
39 The Marriage of Epileptics, The British Medical Journal Vol. 1, No. 2363 (Apr. 14, 1906): 877.
27


defined the deficiency problem as a biological defect thereby justifying their role in identifying the mentally deficient and presenting sterilization as a solution to the problem. By the start of the twentieth century, they had also abandoned their focus on proving physical markers of mental illness and instead concentrated on linking mental defects to heredity.
In 1903, Robert Rentoul, a British doctor and surgeon who specialized in womens health and reproduction, suggested in Proposed Sterilization of Certain Mental and Physical Degenerates that mental defectives in Britain should be sterilized. In his book, Rentoul advocates sterilization in response to fears that Britains population was becoming physically and mentally weaker than it had been in the past. He cites reproduction as the predominant fear among medical professionals in having insane/degenerate individuals among the general population. For example, he writes, Some degenerates who, although they may have a right to marry, have no right to beget a tainted offspring one which may be a danger to the public welfare, to themselves, or a tax upon private or public charity.40 Not only does this show that Rentoul believed procreation of degenerates endangered society, but also that the role of the medical professional and the State was to protect society from this danger.
Rentoul relies on statistics from both the asylum system and the military to support his position. According to Rentoul, of the 32,525,716 who then lived in England and Wales, 1 in 301.32 people were identified as lunatics. He also explains that thousands of lunatics who were discharged from the asylums as recovered by the London County
40 Rentoul, Proposed Sterilization, 7.
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Council, a county agency responsible for the administration of Londons asylums, were readmitted to the asylum, many within a year of their discharge. This, he explains, was verification that asylums were not curing people and that insanity was a danger to society, because these individuals were released from the asylum into the general population.41
In the article Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840-70, John Walton argues that asylum patients attempts to reenter the general public were largely unsuccessful. One of the reasons, Walton explains, was that they had trouble finding jobs. It was much easier, he argues, for the patients to continue working in the jobs they had acquired at the asylum. In addition, when pauper patients in particular attempted to reenter society, they no longer qualified for public assistance of any kind making it difficult for them to establish a foundation upon which they may have been able to find housing or work.42 Waltons argument confirms Rentouls assertion that the asylum system was not working to cure mental illness. Yet, the failure of the asylums was only part of argument he used to support his sterilization idea.
Rentoul provides evidence from the Report of the Army Medical Department 1901 as evidence that the British population was degenerating. He explains that the military rejected 21,522 of the 76,750 recruits that year by deeming them unfit. In addition, Rentoul indicates that the military later discharged another 1,014 recruits within one year, citing them as unfit as well. Just some of the causes for rejection or discharge
41 Rentoul, Proposed Sterilization, 7.
42 Walton, Casting Out, 142.
29


included defective vision, tooth loss or decay, disease of veins, varicocele, under chest measurement, and malnourishment. Each of these criteria for discharge included thousands of recruits, which Rentoul argues was a direct result of hereditary degeneration.43
Nature, Rentoul explained, should and would naturally deal with the problem of degeneration, but he argued, society kept nature from running its course. According to Rentoul, left to its own devices, nature would make unfit people sterile or make them miscarry if they were to become pregnant. Additionally, he argued that suicide was natures method of dealing with lunatics evidenced by the statistical data he quoted from The Fifty-Fifth Report of the Commissioners in Lunacy, 1901. This document indicated that one in four lunatics exhibited suicidal tendencies. Yet, Rentoul suggested that through the process of charity and efforts to keep individuals from committing suicide, society was actually working toward survival of the unfit.44
Ultimately, Rentoul suggested that the solution to this degeneration problem was to ensure that those deemed unfit were unable to reproduce. He wrote, We must recognise that almost every degenerate has been produced by parents who have violated some law of nature.45 In response, he explained that those who were likely to produce unfit offspring should not be able to marry. Additionally, anyone who had an hereditary disease should be sterilized. The cases Rentoul labeled as necessary to sterilize included
43 Rentoul, Proposed Sterilization, 3.
44 Rentoul, Proposed Sterilization, 6/7.
45 Rentoul, Proposed Sterilization, 11.
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individuals diagnosed with leprosy, cancer, epilepsy, or advanced organic disease of the heart, lungs, or kidneys as well as anyone medical professionals identified as an idiot, imbecile, cretin, lunatic, or weak-minded. Moreover, he also suggested that individuals with venereal diseases should be sterilized, sexual degenerates should be sterilized, and prostitutes should be sterilized.46 These arguments show that Rentoul believed important elements of being British were mental and physical strength and that if individuals exhibited weaknesses in these areas, not only did they not exhibit true British qualities, they also should not procreate, thereby adding to the degeneracy problem.
Moreover, much like was the case with the creation of the pauper asylums, Rentoul advocated service to the state and promoting the common good as an important element of the British ideal. At the very beginning of Proposed Sterilization of Certain Mental and Physical Degenerates, Rentoul provides two quotations from outside sources. The first by Herbert Spencer reads, To be a good animal is the first requisite to success in life, and to be a nation of good animals is the first condition to national prosperity.47 When this quotation is applied to British national identity, it appears that what Rentoul holds as an important element of Britishness is an ability to contribute to national prosperity. His argument regarding sterilization involves sterilizing any individual who was not able to contribute to society. Rentoul even directly argues this belief in his statement regarding sterilization of prostitutes. He writes, Children born of such are not
46 Rentoul, Proposed Sterilization, 17.
47 Rentoul, Proposed Sterilization, 1.
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likely to be of any benefit to the State.48 Therefore, if an individual did not have the ability or inclination to benefit the State, in RentouTs opinion, that individual should not be able to produce offspring who, he suggests, would also not benefit the State.
Similarly, the second epigraph that Rentoul provides suggests that another important element of RentouTs ideal British character was a willingness and ability to prioritize the public health as well as contribution to the state. The quote by Lord Beaconsfield states, The Public Health is the foundation on which repose the happiness of the people and the power of a country. The care of the Public Health is the first duty of a statesman.49 In the first sentence of the quotation, Beaconsfields determination that the public health is the foundation suggests that without the public health neither happiness nor power would be able to exist. Additionally, his statement that Public Health is the first duty of a statesman shows that he believes the role of the British government is to ensure that the foundation upon which the nations happiness and power resides should be the most important focus of the state. When this statement is paired with RentouTs claim regarding sterilization, it suggests that Rentoul believed the supposed degeneration of the British citizenry required intervention on behalf of the state. It also suggests that Rentoul imagined medical men as a type of statesmen who could comment and legislate on the health of the nation.
Moreover, the list of credentials that Rentoul provides at the beginning of his book also suggests that he wanted to represent himself as an expert to legitimize his argument about public policy on sterilization. His credentials include Doctor of
48 Rentoul, Proposed Sterilization, 17.
49 Rentoul, Proposed Sterilization, 1.
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Medicine; late member of the General Council of Medical Education for the U.K.; member of the Royal College of Surgeons, England; licentiate of the Royal College of Physicians, Edinburgh; honorary member Manchester Medio-Ethical Association; author of Womens Health, Causes and Treatment of Abortion, and Medical Charity Reform; and witness before two House of Commons Committees Upon Death Registration and Midwives Registration.50 It is unlikely that Rentoul would feel as compelled to provide such an extensive list of his medical experience and expertise if he did not see a need to establish why those who read his proposal should take his opinion seriously.
Rentouls various articles published in the British Medical Journal throughout 1904 as well as his initial Proposed Sterilization of Certain Mental and Physical Degenerates created a great deal of controversy among members of the British medical community. In the years leading up to World War I, the British Medical Journal published a large number of articles and correspondence that both directly and indirectly responded to Rentouls proposition. These professional conversations reveal what types of people each individual believed belonged in the community of Britishness51 and fears that so-called mental degenerates would procreate and lead to further degeneracy of the British people. In each argument the biases and values of the writer were reflected in how he or she defined or imagined the ideal British citizen. These conversations
50 Rentoul, Proposed Sterilization.
51 Kathleen Paul, Whitewashing Britain: Race and Citizenship in the Postwar Era (Ithaca: Cornell University Press, 1997). Paul developed the phrase, communities of Britishness in her argument about policymakers understanding of different facets of the British community. I use it here to refer to a larger understanding of the collective British community and ideals associated with that identity.
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centered around cognitive and physical abilities, morality, ability to contribute to the State, and individual rights.
In the first article published in the British Medical Journal regarding Rentoufs Proposal, the author presented some of the main components of Rentoufs argument. First, the author showed that Rentoul indicated that the most important problems facing society were lunacy and mental degeneracy. Additionally, the author explained that Rentoul believed sterilization would assist in resolving the problem because the State would not simply allow mental degenerates to commit suicide, nor could the State kill these individuals. He wrote, as we cannot kill the offspring of unhealthy marriages for these poor degenerates have a perfect right to live, no matter how their parents have acted, we should prevent them from propagating their degeneracy.52 While this statement supports Rentoufs belief that mental degenerates did not fit the model of an ideal citizen, it also suggests that Rentoufs definition of true Britishness included parenthood. Directly aligning an individuals ability to have children and the perceived need to regulate this ability indicates the salience of parenthood as an element of British life. Therefore, if the State sterilized people who did not fit the ideal, those who were sterilized would also not be able to fulfill their duties as procreative citizens, yet another way those labeled degenerate would not be able to contribute to society.
The author of A Short Way with Degenerates, did offer a caution to the medical community regarding the implementation of sterilization policies. He explained
52 A Short Way with Degenerates, The British Medical Journal, Vol. 1, No. 2254 (Mar. 12, 1904), 625.
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that there is evidently a fine field for the surgeons knife as an instrument of social
reform.53 According to this author, Rentoul suggested that within each County Council
there be a Board appointed that would include both a medical expert and an expert in law
who would be responsible for determining if the State should sterilize individuals who
met a certain set of criteria. Additionally, each county would only have two individuals
who would be qualified and licensed to perform sterilization procedures. By providing
this kind of expertise, the author explained, a new order of specialists would be created
whose beneficent function in the State could not fail to increase the honor in which the
medical profession is already held in this country. This statement shows that if the
sterilization proposal were to go into effect in Britain, the medical community would be
serving the larger British community, thereby meeting one of the requirements of
Rentouls ideal British citizen. The end result for these medical professionals would be
increased respect from the community for their service. But, he also posits:
Are we prepared to rise to the height of Dr. Rentouls great idea, and accept this noble mission which he seeks to impose upon us? If we do, there will be only one thing left to make our position as saviors of society complete that is, that we be entrusted with the high function of purging the body politic of toxic substances by performing the duties of the public executioner...54
Here, the author illustrated both the promise and problem of sterilization. Through the
implementation of sterilization policies, medical men could gain prestige and fulfillment
of their own image of an ideal British citizen. On the other hand, the implementation of
sterilization policies would also require medical men to participate in actions that may or
may not have seemed moral in the name of the greater good. Medical concerns regarding
53 A Short Way with Degenerates, 626.
54 A Short Way with Degenerates, 626.
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the medical ethics involved in sterilization show that morality was an important characteristic of what many people at the time imagined as an ideal British citizen.
In response to the cautions to his proposal published by The British Medical Journal, Rentoul explains the morality behind his proposal and extends his proposal as the most civilized thing the British government could do to address the issue of degeneracy. In the correspondence section from The British Medical Journal March, 19, 1904 Rentoul offers that sterilization is actually a natural process that occurs to keep the degenerate from procreating. He explains that many people are bom sterile and that this naturally keeps individuals who should not procreate from contributing to the population. However, he explains that not all degenerates are born sterile as evidenced by the fact that a large number of female imbeciles are yearly bringing forth illegitimate imbecile infants; and that a large number of lunatics are allowed out of asylums, either to marry or to resume conjugal relations.55 In this instance, he shows that neither the natural process of sterilization nor the segregation of the sexes established by the asylum system sufficiently ensured that degenerates would not have children. Therefore, according to Rentoul, the enforcement of a sterilization policy was an important element of dealing with the degeneracy issue.
Furthermore, Rentoul explains that sterilization is actually a moral action because the alternatives to sterilization are so immoral. Rentoul argues that some individuals had proposed murdering degenerates in order to ensure that they not be able to procreate.
55 Robert Rentoul, Proposed Sterilization of Certain Degenerates, The British Medical Journal, Vol. 1, No. 2255 (Mar. 19, 1904), 695.
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However, Rentoul writes that this would mean Britain would sink to the level of the South Sea islanders and become murderers.56 He also suggests that because the court system would be used to determine which individuals should be sterilized, this made the process more just. Finally, he addresses the idea that degenerates could be given contraception instead of requiring them to be sterilized. However, he explains that by their very nature degenerates would not actually use contraception with fidelity; therefore, contraception would not actually solve the problem.57 This statement indicates that not only did Rentoul believe that the most moral option to prevent degeneracy was sterilization, but also that an important element of his definition of Britishness was the ability to control ones sexual desires or at least the outcome of those desires. By arguing that degenerates would be unable to successfully utilize contraception, he shows that this inability to control reproduction effectively actually further disqualified degenerates from belonging in the national community.
Although Rentoul attempted to show that sterilization was the only rational way for dealing with the problem of degeneracy in Britain, one of the most important arguments against sterilization was an inability on behalf of the medical community to scientifically prove that heredity caused mental deficiencies. In a 1906 article from The British Medical Journal entitled, The Marriage of Epileptics, the author indicates that in the United States the government favored marriage regulations over sterilization as a solution to keep particular individuals from having children. An important element of the
56 Rentoul, Proposed Sterilization of Certain Degenerates, 695.
57 Rentoul, Proposed Sterilization of Certain Degenerates, 695.
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decision to regulate marriage instead of the reproductive body, the author writes, was the inability to link heredity with mental degeneracy.58 Edwin Goodall further explores the idea of linking heredity with mental degeneracy in An Address on the Hospital Treatment of Curable Cases of Mental Disorder. Goodall argues that there was a need for additional information regarding what he explains is a correlation between the number of people born to parents with mental deficiency who themselves had mental deficiencies. At most, Goodall explains, some studies showed that there did seem to be a number of people with mental defects who came from families with similar characteristics; but there was not yet enough information pertaining to the number of children who were bom to parents with mental defects who did not exhibit any such qualities.59 Without adequate evidence that mental deficiency was directly passed from one generation to the next, many people both in the medical community and throughout Britain refused to fully support sterilization as the response to degeneracy.
In Counting the Degenerates: The Statistics of Race Deterioration, historian Richard Soloway asserts that many British medical professionals continued to rely on their own presuppositions regarding British degeneration even though existing data suggested little proof that any actual degeneration took place. Soloway explains that degeneration theories were closely linked both with Social Darwinism, the attempt to apply the ideas of natural selection and survival of the fittest to the sociological and
58 The Marriage of Epileptics, The British Medical Journal Vol. 1, No. 2363 (Apr. 14, 1906): 877-878, accessed 4 November 2014, http://www.jstor.org/stable/20289325.
59 Edwin Goodall, An Address On the Hospital Treatment of Curable Cases of Mental Disorder, The British Medical Journal Vol. 2, No. 2391 (Oct. 27, 1906): 1084-1086, accessed 4 November 2014, http://www.jstor.org/stable/20291673.
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political studies of human population, and what were then newer theories of biological inheritance including Mendelian genetics and Gabons law of ancestral inheritance. While many medical authorities, Soloway claims, referenced improved public health including declining mortality rates, especially for children, the most pessimistic of the medical professionals continued to cite anecdotal evidence including the British efforts in the Boer War, as proof that degeneration was occurring rapidly. Fears that the British would not be able to maintain their historical dominance continued through the Great War and were only quieted, Soloway argues, by the proliferation of working-class use of birth control both during and after the war. Soloway writes, the debate over deterioration always had more to do with contemporary middle- and upper-class anxieties about economic, social, political and cultural change tha[n] it did with quantifiable reality.60 Rentouls response to the degeneracy issue and his undeterred adherence to sterilization as the most adequate solution situates Rentoul among the group of pessimistic medical professionals Soloway discussed.
In a November, 1906 article from The American Journal of Sociology Rentoul directly responded to the claim that there was not enough information to fully evaluate the role of heredity in mental deficiency. He expressed agreement with this claim and proposed that asylum administrators did not keep detailed enough records in order to have the kinds of statistical data people wanted regarding mental deficiency. Yet, Rentoul explained that even if the data did not exist to show that heredity was a major cause of
60 Richard Soloway, Counting the Degenerates: The Statistics of Race Deterioration in Edwardian England, Journal of Contemporary History Vol. 17 No. 1 (Jan., 1982): 137-164, accessed 9 August 2015, http://www.jstor.org/stable/260448.
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degeneracy, degeneracy was still a significant problem, and sterilization was still the best
option for dealing with it.61
In order to show that sterilization was the best option for dealing with the degeneracy problem, Rentoul offered several alternatives to sterilization and discredited each of these options. As before, one option he mentioned was the use of contraceptives. In order to discredit this idea, Rentoul asked, Is it likely that lunatics, idiots, epileptics, confirmed criminals, habitual inebriates, and footpads would use such methods?61 62 Rentoul continued to support the position that degenerates would not use contraceptives by the very nature of their degeneracy. In addition, Rentoul offered and discredited the idea that degenerates could be imprisoned as an alternative to sterilization. If these individuals were to be imprisoned, Rentoul argued the cost to the State, and therefore the public, would be exorbitant. He wrote, In one year only over £18,000,000 were expended in the up keep of degenerates in the United Kingdom, and, if all degenerates were immured, I have calculated that at least £5o,ooo,ooo annually would be required. Such a sum would cause a public revolt of the already overburdened taxpayers.63 As in the arguments regarding asylums at the end of the nineteenth century, the amount of money taxpayers would need to pay to ensure that mental degenerates would be kept in a State-funded facility would be too great to earn their support. Additionally, Rentoul
61 Robert R. Rentoul, Proposed Sterilization of Certain Mental Degenerates,
The British Medical Journal Vol. 2, No. 2387 (Sep. 29, 1906): 765, accessed 4 November 2014, http ://www.j stor. org/stable/20291303.
62 Rentoul, Proposed Sterilization, (1906), 324.
63 Rentoul, Proposed Sterilization, (1906), 324.
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explained that encouraging suicide would only deal with the problem in the immediate time and would not prevent the problem in the future. Moreover, Rentoul did not believe that State-issued marriage certificates would have any effect on the state of national degeneracy because so many children were born out of wedlock in the first place.64 The only option in dealing with deficiency that Rentoul did not discredit was sterilization, because he believed it to be the best option for addressing the issue of degeneracy.
Rentoul argued that one important criticism of sterilization was that it violated the rights of the individual. These rights were an important element of the British ideal. As Desmond King explains, although according to liberal ideals, rights should be extended equally to all individuals in society, in both Britain and the United States, placing restrictions on those rights has been pervasive while, he writes, the breaking of such restrictions is a feature of American and British political development.65 Similarly, Colley argued that although Britain had been one of the most democratic nations in Europe leading up to 1865, it did not maintain that status. She explained that by European standards, Britain actually became one of the least democratic nations up to World War I as indicated by the fact that the British State did not extend universal manhood suffrage nor offer any British women the vote until after World War I.66 While Rentoul acknowledged the importance of individual rights and that sterilization of certain individuals might violate those rights, he advocated for sterilization as an opportunity to
64 Rentoul, Proposed Sterilization, (1906), 324.
65 Desmond King, In the Name of Liberalism: Illiberal Social Policy in the USA and Britain (Oxford: Oxford University Press, 1999), 12/13.
66 Colley, Britons, 356.
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protect future generations. Rentoul wrote, I plead on behalf of the unborn, of the infants and children of the future the coming race and against our present Christian custom of stamping the unoffending child with a mental defect which will prevent it from being a useful citizen. What right have we to ruin absolutely the childrens chances in life? None whatever.67 In this statement, Rentoul shows that he believed that the most important element of being British was the ability to contribute to society. He also suggests that if the State allowed degenerates to procreate, even if this would support their individual rights, it would potentially produce individuals who would be unlikely of obtaining the most important characteristic of a British citizen. In his ardent support for sterilization, Rentoul demonstrated his belief that the common good outweighed individual rights and that the role of the medical professional in such a situation was to protect the common good.
67 Rentoul, Proposed Sterilization, (1906), 324-325.
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CHAPTER IV
EARLY TWENTIETH-CENTURY MENTAL-HEALTH CARE
While the first part of the twentieth century involved a great deal of change in the care and treatment of mental illness, approaches remained largely ineffective. As Scull indicates, one of the biggest changes in the treatment of the insane was Sigmund Freuds psychoanalysis. Scull explains that British psychologists did not adhere to the notion that the libido was the primary cause of mental illness although they accepted that sex could play a part in the development of mental illness. Freuds theories, Scull argues, posed a particular challenge to British psychologists because they removed the separation of mental illness and class. Whereas many had believed that mental illness was a particular problem among the poor, Freuds notion suggested that mental illness could be housed within all elements of society.68 In the end, although mental illness became a more accepted field of medical study in the early twentieth century, it remained relatively new and largely misunderstood.
State records of asylums reflect an overarching lack of understanding regarding mental health among people of the medical community. Lunacy in London (November 10, 1906), a periodic check-in on Londons asylum system, directs attention to the numbers of individuals in asylums as well as continued investigation of asylum patients. According to this British Medical Journal article, the asylums noted a diminishing rate of increase in patients that called into question the existence of a degeneracy problem. Almost six years later, F. W. Mott also called into question the validity of the data regarding the number of asylum patients. In his article A Lecture on Sanity and
68 Scull, Madness, 73-77.
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Insanity, published in The British Medical Journal. He explains that the rising number of insane individuals was actually more apparent than real. Over time, Mott argues, the medical community had become better at identifying and keeping record of the number of insane people and the number of deaths overall had decreased. Therefore, the instances of insanity were probably not much higher than they once were. Moreover, Mott reminds the medical community that the year of the publication of the article, 1912, was actually one of the first years in which universities offered Doctor of Public Health diplomas in medical psychology. Thus, a level of expertise in the field of mental health was quite new in 1912.69 In both the understanding of the number of individuals housed in asylums as well as the educational opportunities offered to medical professionals seeking to better understand mental health, the level of understanding suggests that mental health remained a fluid area of medical expertise.
Meanwhile, the inability of medical experts to show that heredity was the primary cause of mental degeneracy created a substantial debate regarding morality. The British Medical Journal published an article August 24, 1912 in which the author refers to a Mental Deficient Bill, which likely referred to the bill that later became The Mental Deficiency Act of 1913. The Act established four classes of individuals who could qualify as mentally deficient idiot, imbecile, feeble-minded, and moral defective. The Lunacy Commission thus had the responsibility, under the directive of the Act, of
69 Lunacy in London, The British Medical Journal, Vol. 2, No. 2393 (Nov. 10, 1906), 1311-1312.
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identifying and determining the best course of treatment for each individual.70 According to the article, the Catholic Church spoke out against the Mental Deficiency Bill, citing the bill as immoral. The morality the article called into question was the morality of the unsexing mentally deficient people through medical alteration of the reproductive system. However, the BMJ author explains that the bill did not deal directly with sterilization; therefore, it was unfair to criticize the bill for that reason even if sterilization could be considered immoral.71
In addition, the BMJ article suggests that to disregard the need to regulate the procreative capacities the mentally deficient in Britain was less moral. One argument the author uses to support the Mental Deficiency Bill is to assert his opposition to the use of asylums as institutions for the mentally deficient. Asylums, the author explains, were not much different from prisons. Additionally, at least in prison, the author notes, people are aware of the crimes they had committed that caused them to be incarcerated; in the case of the mentally deficient, the author argues,, they do not necessarily understand the actions that had led to the impending consequence of compulsory permanent control that the asylums established.72 Near the end of the article, the author included a section regarding a movement on behalf of a group of people called eugenists. This was one of the earliest mentions of eugenists in the BMJ articles regarding the mentally defective
70 Meanwood Park Hospital, The Mental Deficiency Act 1913, accessed 15 March 2016, http://www.meanwoodpark.co.uk/a-resource/the-mental-deficiency-act-1913/.
71 Mental Deficients and the Community, The British Medical Journal, Vol. 2, No. 2695 (Aug. 24, 1912), 450-451.
72 Mental Deficients, The British Medical Journal, 450-451.
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and sterilization. In defense of the Mental Deficiency Bill and eugenists, the BMJ author
writes, The eugenists are to-day mainly searching for fuller knowledge, and to instill the
idea of a newer and wider evolutional morality namely, that in our duty to our
neighbour we must henceforth include our duty to posterity.73 This statement
demonstrates that this author supported a type of morality that placed the common good
above the individual. In addition, it also suggests that legislating for the common good
would ultimately be the most positive thing for individuals as well, who would then not
be placed in prison-like institutions without full comprehension of their crimes.
Doctor Alex Mooney responded to the BMJ article, discrediting the eugenists
comment as a feigned version of morality and suggesting that true morality had not yet
been a center of conversation in the question of mentally deficiency. He writes:
the elimination of mentally defective children will be effected, not by confining mentally defective people in institutions, but by remedying those defects in our social organization that breed poverty, disease, and unhealthy living. It will be effected by raising the morality of the race, by a recognition of the evil of sin. It will be effected by the recognition of the obligations of justice and charity imposed by Divine law, and forgotten by so many people for whom this life is the beginning and the end of all things, and who, logically enough, endeavor to have all those things which afford them pleasure, and give them what they call a good time on earth.74
This shows that Mooney believed morality was grounded in a religious understanding of moral behavior. He also suggests that the most effective response, the most moral response, to the problem of the mentally defective would be to address the circumstances that exist within society that may have actually been contributing to the large number of
73 Mental Deficients, 451.
74 Alex. P. Mooney, Mental Deficients and the Community, The British Medical Journal, Vol. 2, No. 2696 (Aug. 31, 1912), accessed 23 October 2014, http://www.jstor.org/stable/25298430.521.
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people housed in asylums. He claims that situations like poverty, disease, and unhealthy living, or environmental causes, may have been greater causes or contributors to mental defect than heredity and that until people were willing to address those conditions, then the issue would likely continue to exist. Moreover, Mooney explains that the suggestion that the Act did not address sterilization was false. He states that it was the first time the purpose of an Act had been to prevent procreation and that it really was just eugenist propaganda shrouded in moral rhetoric.75 Mooneys argument shows that his version of morality entailed the treatment of the social root of the problem, not simply treating the supposed biological symptoms.
In 1913, the State passed The Mental Deficiency Bill, which was specifically directed at criminals. The bill included both criminals who did not understand their circumstances and mentally defective individuals with a propensity for crime. It established the rule of law concluding that individuals who exhibited criminal behavior could be placed in the care of mental institutions. Not only did it directly establish a connection between mentally deficient people and criminal behavior, it also suggested that many people believed the mentally defective and criminals were not exclusive groups of people but rather could actually be the same. By linking crime and mental deficiency, medical experts and political leaders suggested that it could be possible to regulate or eradicate crime through sterilization. The debate over morality suggests that stakeholders in mental illness did not agree on a prioritized list of proper British morality. Yet, it also suggests that both groups of people imagined morality as a key feature of true Britishness.
75 Mooney, Mental Deficients, 520-521.
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In the years just prior to the First World War, the articles regarding mental deficiencies included in The British Medical Journal focused on eugenics and the desire on behalf of many members of the medical community to prove unequivocally that heredity was a significant cause of degeneracy. Just one month prior to the publication of Mooneys response, the First International Eugenics Congress was held in London. The British Medical Journal published an article in the week following the Congress, highlighting the key speakers and events. One speaker, Professor Punnett, indicated that feeble-mindedness was easily assigned to heredity, reasoning that if at least one parent had a mental deficiency then the child would likely have a similar deficiency. He claimed, There was every reason to expect that a policy of strict segregation would rapidly bring about the elimination of this character.76 Dr. Mott discussed his findings from research on 20,000 individuals in the London County Asylums. According to Mott, of the 20,000 he studied, 715 were either parents and their children or siblings of one another. The only conclusion he was able to make from his study was that it did appear more likely to have a child with some kind of mental deficiency if both parents of that child had a mental deficiency. He argued that at the time further study was required in order to understand the role of heredity in degeneracy.77 Yet, the articles suggest that the desire to directly link heredity and insanity as well as mental deficiency persisted.
Yet, even with the eugenics movements demand to prove the hereditary influence in degeneracy, Mott and others in the medical community questioned the validity of the
76 First International Eugenics Congress The British Medical Journal, Vol. 2, No. 2692 (Aug. 3, 1912): 254, accessed 4 November 2014, http://www.jstor.org/stable/25298080.
77 First International Eugenics Congress, The British Medical Journal, 253-255.
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perceived benefit of removing certain individuals from the British gene pool. In a November, 1912 issue of The British Medical Journal, an author further addressed Motts claims regarding heredity and insanity. According to the article, Mott claimed the science did not support a conclusion that heredity directly causes insanity, but rather that individuals have a greater tendency toward insanity based on their heredity. Instead, Mott offered an alternative to heredity. Dr. Mott adds as an importantin many instances, perhaps, the onlycause, the enforced suppression by modern social conditions of the reproductive functions and the maternal instincts in women an emotional temperament and mental instability. Therefore, solutions like segregation of the insane or sterilization of the insane would have little to no impact on the degeneracy problem as they would not necessarily address the cause of the situation. The article claims that based on Motts assertions:
We have no right, he states emphatically, to say that because a parent is insane the children must necessarily be insane or useless to the race. This should be a warning to the eugenists not to allow themselves to be carried too far by their zeal for the betterment of the race, or there is a chance of their reducing mankind to a dead level of dull mediocrity. In rooting up the weeds they run the risk of destroying the flowers.78
Essentially, this warning explains that Motts findings showed that family did not necessarily determine the success of the individual. State legislation of procreation of the unfit could eliminate potentially productive members of society whose parent(s) may or may not have had an hereditary mental defect.
78 Heredity in Relation to Insanity, The British Medical Journal Vol. 2, No. 2705 (Nov. 2, 1912): 1237, accessed 23 October 2014, http://www.jstor.org/stable/25299207.
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Mott does suggest that instead of addressing the elimination of certain individuals from the population, a more effective solution to the population problem would be to focus on the addition of individuals with desirable qualities. At the end of the BMJ article, the author quotes Mott as saying:
When hereditary health as shown by longevity, fertility, and mental stability in a stockis regarded as a greater set for happiness in the family and the nation than hereditary wealth, then will be the time for the rich and comparatively prosperous to suggest the desirability of sterilization of the pauper imbecile and insane. For no one supposes that it would be carried out in all classes.79
In sum, this author concluded that the medical community should focus its attention on
the conditions that allowed people to live longer, have more children, and be more
mentally stable and value those qualities over wealth maintained within a single class.
Moreover, it also demonstrates an unspoken understanding that the proposed
sterilizations that had then been discussed since Rentouls initial proposal in 1903 would
be limited to working-class British citizens.
Medical efforts to prove the link between heredity and disease were not limited to
insanity. In Medicine and Eugenics, John Cowper includes a number of studies that were
being conducted in 1913 to demonstrate the relationship between heredity and disease.
Only in the final part of his article does Cowper address the issue of defectives and
deficiency. In Cowpers opinion, the term degenerate applied to criminals, lunatics, the
feeble-minded, epileptics, alcoholics, and other neurotic degenerates. Cowper agrees that
degeneracy was an important problem facing the British population and argues that the
government should intervene to gain the greatest degree of understanding regarding such
a problem. He provides evidence that one of the doctors from Banstead, one of Londons
79 Heredity in Relation to Insanity, The British Medical Journal, 1238.
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pauper asylums, indicated that there was not enough existing data to truly analyze the role of heredity in degeneracy. Cowper argues that the government should request and support additional statistical study of the asylum population in an effort to better understand and respond to the population struggle in Britain.80
However, what Cowper and other medical professionals interested in the British population problem did not know was that Britain would soon face a large blow to the overall population. In 1914, Britain entered World War I resulting in a dramatic decline in Britains population. Following the war, Britain experienced an influenza pandemic, which only exacerbated the population problem. During the period from 1914 to 1918, Britain incurred a loss of between approximately 723,000 and 885,000 military personnel. Estimations of civilian losses are around 100,000. In addition to the lives lost during the war, from June 1918 to May of 1919 the general population was hit with an approximate loss of 152,000 people to influenza in England and Wales alone.81 During this period, there was a marked absence of articles in the BMJ pertaining to sterilization or degeneracy. These conversations did not recommence until 1922.
80 John Cowper, Medicine and Eugenics, The British Medical Journal, Vol. 2, No. 2742 (Jul. 19, 1913), 115-118.
81 J.M. Winter, Britains Lost Generation of the First World War, in Population Statistics, Vol. 31 No. 3 (Nov., 1977), 449-466. Dmitri Jdanov, et al., Estimates of Mortality and Population Changes in England and Wales Over the Two World Wars, in Demographic Research, Vol. 13 (Nov. 17, 2005), 389-414. Nadege Mougel, World War I Casualties, trans. Julie Gratz, last modified 2011, http://www.centre-robert-schuman.org/userfiles/files/REPERES%20-%20module%201-l-l%20-%20explanatory%20notes%20-%20World%20War%20I%20casualties%20-%20EN.pdf.
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CHAPTER V
A EUGENIC MOVEMENT: THE UNFIT AFTER WORLD WAR I
In the period following the end of World War I, many medical professionals continued to attempt to show that any perceived degeneracy was a direct result of a family history of degeneracy. During this period, it also became increasingly difficult to advocate for policies that would limit procreation because of the number of losses incurred as a result of the war. As Winter explains, the perception among the British population was that the majority of men who lost their lives during the war came from the ruling class. Additionally, due to the number of losses, many women in Britain were left without marriageable prospects, especially women from the ruling class.82 In this demographic environment, those who sought to advocate for contraception and other procreative limitations, faced a great deal of controversy. Yet, medical professionals were determined to find a clear link between heredity and mental illness as well as other forms of degeneracy. These included criminal activity and sexual misconduct.
According to R.A. Gibbons, a gynecologist at the Grosvenor Hospital for Women, both environment and heredity played an important role in the growing number of individuals labeled as insane in Britain. Gibbons gender marks a distinct difference in the conversation, in that women had not published articles in the BMJ regarding procreation, heredity, and the unfit. Opportunities for women in the medical profession expanded at the beginning of the twentieth century and the British government even enfranchised some women following the end of World War I. Gibbons explained that the
82 Winter, Britains Lost Generation, 449-466.
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greater cause of these cases of insanity was heredity.83 Alternately, Robert Hutchison argued that while heredity certainly played a part in the cause of some mental defects, he did not note a strong enough correlation between heredity and mental defect to suggest that heredity was the main cause of such ailments.84 G. Archdall Reids conclusions corresponded with Hutchisons. He argued that while there was a great deal of evidence to suggest that individuals inherit qualities such as eye color and hair color from their families, there was limited evidence suggesting that heredity played as strong a role in the inheritance of mental defects.85 These conclusions were also supported by evidence from the United States, where W. Arnott Dickson indicated that sterilizations were already occurring with little to no effect on the resulting rate of mental defects among the population.86 In their quest to demonstrate that heredity was the primary cause of degeneracy, most medical professionals were limited to concluding that at most there was a correlation between heredity and degeneracy, not a direct causal link.
Even though the medical community struggled to provide scientific evidence sufficient to prove that heredity was the primary cause of mental deficiency, many
83 William A. Potts, et al., Discussion On Mental Deficiency in Its Social Aspects, The British Medical Journal, Vol. 2, No. 3267 (Aug. 11, 1923): 219-234, accessed 21 October 2014.
84 Robert Hutchison, J. S. Pearse and J. H. Garrett, The British Medical Journal, Vol. 2, No. 3220 (Sep. 16, 1922), pp. 531-532.
85 G. Archdall Reid, Sterilization of Mental Defectives, The British Medical Journal Vol. 2, No. 3221 (Sep. 23, 1922): 579-580, accessed 23 October 2014,
http ://www.j stor. org / stable/20421176.
86 W. Arnott Dickson and L. Margaret Lister, Sterilization of Mental Defectives, The British Medical Journal Vol. 2, No. 3215 (Aug. 12, 1922): 285, accessed 23 October 2014, http://www.jstor.org/stable/20420815.
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medical professionals continued to defend the role of heredity using empirical evidence. For example, L. Margaret Lister referred to her time as a medical officer during which she was able to visit a number of schools. She explained that each time she visited a school she typically encountered at least one student with a mental defect. In one anecdote she writes, In one school I had a mentally defective boy of 13 years of age. He could learn nothing and could not even speak intelligibly. His mother came to me complaining bitterly that it was hard that he could not leave school to go to work. She did not in the least realize that he was mentally defective, because she said, When I was at school I could never learn anything myself.87 Listers assessment of the situation was that it was clear that the boy had inherited his defect. Similarly, George Riddell also refers to case studies involving mental defects to support his claim about the role of heredity. One story he provides is of a woman who was accused of killing her baby. He indicates that she had a very bad family history in which many of her relatives had committed suicide suggesting that she had inherited the mental problem. Additionally, he reports that in one circumstance he witnessed a three-week old child who had been living in appalling conditions. Riddell explains that both parents of the child were mentally deficient. Moreover, he indicates that the parents had a total of eleven children of which four were in mental homes, two had died previously, and another was found dead in the home. In this case, Riddell argues that not only were the parents the cause of the mental defect, but also, it was clear from the situation that these mentally defective adults made
87 Dickson and Lister, Sterilization, 285.
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poor parents who were unable to properly care for their children.88 Although it unclear why there was a strong desire among members of the medical community to prove that heredity was the primary cause of mental defect, this desire may have been due to the prevalence of Darwinian theory in European medical thought or even an impulse to show that medical professionals maintained their authority over understandings of the body and heredity. However, anecdotal and empirical evidence suggested the same findings as the medical science at the time there was clearly a link between heredity and deficiency, but possibly only a tendency.
One argument that was new to the mental deficiency/sterilization discourse
following World War I was a fear that if the government were to legislate the
reproductive abilities of those individuals who were identified as mentally defective, they
could also actually contribute to population degeneracy. James R. Whitwell provided
findings from a particular study conducted in Denmark. Whitwell explained that while
the study found that heredity was a cause of mental defect, it also found a large number
of individuals who were born to families in which mental deficiency had been a problem
who had actually made astonishing contributions to society. He writes:
These same forty-four families, however, also produced two cabinet ministers, one ambassador, three bishops, eight prominent clergymen, three generals, several other military officers, three admirals, several other high naval officers, three members of the High Court of Justice, two headmasters, two directors of well-known institutions, eight hospital physicians, nine university professors, at least twenty-three holders of academic doctorates, and a large number of eminent
88 George Allardice Riddell, Baron 1865-1934, Medico-Legal Problems (London: H.K. Lewis and Co. Ltd., 1929), 77-78.
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officials, business men, members of Parliament, physicians, teacher, and others of value to the community.89
This statement created some controversy among members of the medical community who directly responded. In one response, Norman Haire explains that it did not matter that some successful individuals came from families with mental defects because, in his opinion, the consequences of defect far outweighed the contributions of those individuals.90 In another response, Reid argues that it did not really matter if individuals with titles resulted from family lines containing idiocy. He writes, Idiocy may be latent even in these exalted personages. Moreover, dignity of that sort does not usually imply genius, but, as a rule, only a golden spoon.91 Reids argument indicates a skepticism both that degeneracy necessarily resulted from heredity and that positions of authority or success necessarily resulted from intelligence, skill, or merit. In both cases, this statement directly challenges the position that heredity was the primary cause of degeneracy and expresses fear of the loss to society that may take place from sterilizing individuals who some believed were likely to give birth to degenerated offspring.
89 James R. Whitwell, Claude A. P. Truman and P. Broome Giles, Sterilization of Mental Defectives, The British Medical Journal Vol. 2, No. 3210 (Jul. 8, 1922): 64, accessed 23 October 2014, http://www.jstor.org/stable/20420511.
90 Norman Haire, Sterilization of Mental Defectives, The British Medical Journal Vol. 2, No. 3216 (Aug. 19, 1922): 328, accessed 23 October 2014. http://www.jstor.org/stable/20420874.
91 G. Archdall Reid, Sterilization of Mental Defectives, The British Medical Journal Vol. 2, No. 3217 (Aug. 26, 1922): 401, accessed 23 October 2014, http://www.jstor.org/stable/20420947.
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Moreover, arguments about sterilization following World War I were also different from the arguments that occurred prior to World War I because they directly incorporated issues regarding masculinity. Medical professionals cited cases of shell shock as one indicator of British degeneracy following World War I. They explained that men who suffered from shell shock did not exhibit the strength required of British masculinity, thereby showing their degeneracy. Ward explained that in the period leading up to WWI, British masculinity was defined by the conquest, extension and defence of the Greater Britain of the Empire.92 According to Joanna Bourke, by the end of World War I, the British Army had addressed over 80,000 cases of shell shock that resulted from the experience of the war. Bourke explains that symptoms included hallucinationlike events involving individuals imagining war scenes while in situations completely removed from the war both in time and space as well as phantom pains in various body parts when an individual had killed an enemy by causing harm in the same bodily location.93 These symptoms showed a kind of weakness that defied expectations of masculinity.
In Martin Stones, Shellshock and the Psychologists, he explains that cases of shell shock both during and after World War I posed a particular threat to the mental health world because they identified nonphysical indicators for mental health issues. Doctors examined brains of those who had suffered from shell shock and did not find
92 Ward, Britishness, 38.
93 Joanna Bourke, Shell Shock During World War I, BBC, updated 10 March 2011 http://www.bbc.co.uk/history/worldwars/wwone/shellshock_01.shtm, accessed 8 January 2016.
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physical indicators that the disease existed in such a form. Additionally, they identified a problem in mental health at a period when they were attempting to link the hereditary causes of the disease and those who ended up with shell shock got it as a result of their experience in the war, clearly identifying environmental or conditional causes, not heredity. Some medical professionals continued to support the idea that shell-shock was simply an indicator of a greater issue of inherited degeneracy. Stone describes one military officer C.S. Myers who argued that shell-shock patients should be locked up in asylums or even court-martialed and shot for shirking their duties both as members of the military and as men. These cases, Stone explains, caused some medical professionals to conclude that patients who appeared to have symptoms of shell-shock were actually faking their ailments. To some, Stone argues, these behaviors, both the shell-shock itself and the supposed feigning of its symptoms, also caused many to call into question shellshock patients masculinity. Yet, the questioning of the individuals masculinity was at odds with the fact that a vast number of shell-shock patients were military officers who had volunteered for their service.94
Medical professionals in The British Medical Journal also debated the implications cases of shell-shock posed to society. P. Broome Giles, who was a physician for over fifty-one years, had worked in county hospitals with mental cases and acted as a commandant of two military convalescent hospitals during the war, expressed in the British Medical Journal that not only did he believe that no mental deficient
94 Martin Stone, Shellshock and the Psychologists, in The Anatomy of Madness: Essays in the History of Psychiatry, eds. W.F. Bynum, Roy Porter, and Michael Shepherd, 242-271 (London: Tavistock Publications, 1985).
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should by law be allowed to be a parent, but also that so-called shell shock could often be traced to family mental weakness and that taxpayer money should not be wasted attempting to treat cases of shell-shock.95 Similarly, William A. Potts explains that some of the cases of shell-shock that occurred during the war involved individuals who could be labeled as mentally defective. As such, Potts argues that these cases should not receive treatment from the government. If the government were to offer treatment, then that treatment would be ineffective due to the fact that these people were mentally defective and the cost would place an unnecessary burden upon taxpayers and the government.96 In both arguments, the inclusion of shell-shock cases in debates about the proper treatment of defectives suggests that some medical professionals questioned both the validity of shell-shock as an actual malady and also questioned the masculinity of men diagnosed with shell-shock. This allowed them to group shell-shock victims from the war with other groups marked as deficient and disqualify them as truly British.
Many of the arguments regarding deficiency found in the British Medical Journal in the decade following World War I identified additional negative qualities and behaviors that many believed coincided with mental deficiency. McCandless described the associations medical professionals made between a variety of behaviors and insanity as part of his argument about wrongful confinement of individuals. He asserted that doctors often had subjective standards of insanity and explains that that subjectivity could lead to wrongful confinement in asylums. McCandless wrote, it can hardly be surprising
95 Whitwell, et al., Sterilization, 64-65, quote page 65.
96 Potts, et al., Discussion, 219-234.
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that they [medical professionals] frequently confused insanity with immorality and other forms of nonconformity.97 One of the behaviors often cited in The British Medical Journal as an indicator of defying British ideals was a voracious sexual appetite. In a review of A. F. Tredgolds book, Mental Deficiency, the reviewer cited Tredgolds statement that one way mentally deficient people threatened society was their rate of propagation.98 Similarly, R.A. Gibbons wrote, It is extraordinary how prolific these mental defectives are.99 Both statements suggest that some medical professionals thought that birthrates among mentally deficient people were higher than birthrates among the general population, indicating an unchecked sexual drive. Gibbons continued, Dr. Barr states that the sexual impulses are over exaggerated, and they reproduce their kind from two to six times more rapidly than normal people.100 Arguments regarding increased sexual expression among the mentally defective are also identified in references to statements found in the BMJ that segregating the mentally defective population would result in decreased problems related to both prostitution and venereal disease.101 From the ways each of these professionals discusses hyper-sexuality they
97 McCandless, Wrongful Confinement, 350-351.
98 Review: Mental Deficiency, The British Medical Journal, Vol. 1, No. 3242 (Feb. 17, 1923): 291, accessed 17 November 2015.
99 R. A. Gibbons, Sterilization of The Unfit. The British Medical Journal Vol. 1, No. 3253 (May 5, 1923): 756, accessed 23 October 2014,
http ://www.j stor. org / stable/20423 318.
100 Gibbons, Sterilization of the Unfit, 756.
101 The Social Aspects of Mental Defect, The British Medical Journal Vol. 2, No. 3267 (Aug. 11, 1923): 249-250, accessed 23 October 2014,
http ://www.j stor. org / stable/20424277.
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associated with mentally defective people they reveal a shared belief that to be able to control ones sexual desires was a characteristic they valued in British citizenry. In addition, because mentally defective people could not control these desires, in their professional opinions, defectives posed a threat to British society. They, in fact, were not normal.
Yet, sexual desire and expression were not the only fears regarding the mentally defective and the threat defectives posed to society. Additional claims regarding indecency among the mentally defective included both alcoholism and criminal behavior. In The Social Aspects of Mental Defect, the author suggests that removing mentally defective people from society both by segregation and sterilization would result in fewer cases of inebriety, prostitution, pauperism, and crime.102 Similarly, William A. Potts identified alcoholism as a characteristic present in many mentally defective individuals and that although mental defect and alcoholism do not exist in a purely cause and effect relationship he explains, alcoholism often claims as victims men and women whose judgment and self-control are so poorly developed as to constitute a form of feeblemindedness.103 For this reason, both Potts and Henry Devine argue that the mentally defective should be segregated in institutions.104 Proof of mental deficiency alone was not enough for medical professionals to convince government officials or the public that
102 The Social Aspects of Mental Defect, The British Medical Journal, 249.
103 William A. Potts, et al, Discussion On Mental Deficiency in Its Social Aspects, The British Medical Journal, Vol. 2, No. 3267 (Aug. 11, 1923): 219-234, accessed 21 October 2014.
104 Potts, et al., Discussion, 219-234.
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mentally deficient individuals did not belong in the general population and should not procreate. In order to bolster their arguments, medical professionals not only broadened the definition of mental deficiency, they also provided evidence that beyond the fear that mentally deficient people would reproduce they presented additional challenges to society. While there was some agreement among medical professionals that mentally defective individuals posed a particular threat to the British population in the decade following World War I, medical professionals did not necessarily agree on the proper treatment of these individuals. By the time of the First World War, asylums had increased to such alarming numbers that, Showalter explains, they could no longer be seen as the familial place of respite for the insane. Instead, they became increasingly jail-like in nature where the need for control and management outweighed the desire for clinical treatment.105
Prior to World War I, a great deal of the conversations that took place among medical professionals regarding the treatment of the mentally defective involved the solution to sterilize such individuals. However, in the years following the war, sterilization no longer occupied the same dominance in these professional conversations and was replaced with other solutions. One reason that sterilization seems to have gone away as the primary solution is that it remained difficult to scientifically prove that heredity was a direct cause of mental defect even though eugenic-minded groups focused on proving hereditary causes. Additionally, some medical professionals continued to argue that sterilization was not morally correct. Potts writes, If defectives have a right to
105 Showalter, The Female Malady, 50.
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live, they have a right to live as unmutilated individuals, indicating his belief that British society could not morally/ethically choose to alter the body of another individual.106 Another reason was that with the arguments regarding additional undesirable characteristics associated with mental defect, many believed that sterilization would not adequately resolve the problem of the mentally defective. For example, Parry, explains in his 1927 article, The Problem of Mental Deficiency, that while sterilization may attempt to regulate the ability of the mentally defective to have children, it would not address their promiscuous behavior which would allow mentally defective people to continue to contribute to sexual offenses as well as cases of venereal disease. In reference to sterilization he writes:
It does not make the defective criminal into an honest man. It does not make the unemployable ament into a useful citizen. It does not make the immoral feebleminded into a moral being. It does not enable the pauper or vagrant defective to earn his own living.107
This not only shows that Parry did not believe that sterilization would resolve the problem of the mentally defective, it also identifies Parrys perspective on true Britishness and his understanding that the mentally defective could not meet these qualities. According to Parry, true British characteristics included honesty, usefulness, morality, and the ability to work for a living.108 Due to the fact that these characteristics became so closely identified with how to cure the mentally defective, sterilization could no longer be the primary proposal for addressing the those cures.
106 Potts, et al., Discussion, 221.
107 Parry, The Problem, 1166.
108 Parry, The Problem, 1166.
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While sterilization no longer seemed like a viable solution, Parry, and others like him, offered segregation of the mentally defective as a more effective response. Parry argued that placing mentally defective people into institutions would remove any potential harm that these individuals could cause to society. In addition, he also argued that the mentally defective would actually be happier in institutions where they can be anti-social as he claims is in their nature to be. Similarly, Devine argued that segregation would actually be a two-fold solution in that it would achieve [t]he prevention of delinquency, vagrancy, prostitution, etc. as well as ensure that mentally defective people would not produce inferior children.109 One of the problems with segregation Devine identifies is that under the system that existed in Britain in the 1920s, segregation was limited to the people who diagnosed with the worst kinds of mental defects who were also the individuals that were least likely to have children among the mentally defective. Devine argues that the State should extend segregation for all people labeled as defective as a means of prevent[ing] in some degree the propagation of the unfit.110 While the application of the idea of segregation was broader in the 1920s than efforts to segregate the mentally deficient in the nineteenth and early twentieth centuries, both solutions could achieve the same desired effect of eliminating the mentally defective from the reproducing population.
Medical professionals also offered State regulation of marriage certificates as an alternative to sterilization in the post-war years. In Sterilization of Mental Defectives
109 Potts, et al., Discussion, 224.
110 Potts, et al., Discussion, 225.
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(1922), Gibbons advocates the use of marriage certificates in addition to sterilization. Gibbons suggests that while anyone who could potentially have child with a mental defect as a result of hereditary factors, the State should only offer marriage certificates in situations in which the couple would not be likely to have a child with a mental defect as a result of hereditary factors. In the following year, Gibbons continued to argue for marriage certificates as a regulatory policy as it would prevent the union of those with strong tendencies to insanity on either side, or those who showed signs of mental weakness, for they cannot be cured, and their offspring are defective.111 This reflects a belief that procreation necessarily resulted from marriage unions and that if British society could properly regulate who could and could not obtain marriage certificates, it could also regulate who could reproduce. Through this regulation of marriage then, procreation could also be limited even in cases where sterilization may or may not have been carried out.
Similarly, Norman Haire reiterates the same argument regarding the regulation of marriage certificates for the mentally defective in his book, Hymen: Or the Future of Marriage. He explains that society fully supported the idea of regulating marriage in situations where incest could occur because society perceived harm that could result from such marriages. However, he argues that marriages involving the mentally defective would result in greater harm to society by producing unfit children; yet, the public was not equally interested in regulating marriage of mental defectives. Haire suggests that while many individuals claim that marriage certificates and sterilization challenge British
111 Gibbons, Sterilization of the Unfit, 756.
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morals, he believes that allowing individuals with illnesses, including mental defects, to
marry and reproduce is actually more morally questionable, and, in his opinion:
Physically or mentally defective children are of no use to Societythey are indeed a burden to it, both in times of peace and in times of war. They are often not only unproductivethey actually handicap the progress of useful citizens by competing with them in the struggle for existence; and indeed, with our modem extreme humanitarianism, we often pamper the weed to the detriment of the useful plant.112
Haire frames his argument in direct conjunction with his vision of true Britishness. He supports marriage certificates and sterilization in cases of mental defect because he acknowledges that this particular group of people do not fit his vision of British character. Therefore, not only could these individuals not fit into British society, they would actually place a burden upon the rest of society.
Much like Haires support of marriage certificates and sterilization, Marie Carmichael Stopes advocated the use of contraceptives as an option for addressing procreation among elements of British society that she argued posed a danger to the nation. Stopes was an expert in both palaeobotany and philosophy who became a vocal advocate for the use of contraceptives and the eugenic movement. In her book, Contraception (Birth Control) Its Theory, History and Practice: A Manual for the Medical and Legal Professions, she defends the use of contraceptives in cases of active syphilis, congenital blindness, virulent tuberculosis, acute heart disease of various types, kidney diseases of various types, epilepsy, leprosy, diabetes, and [mjarked feeblemindedness [For such cases sterilization is to be preferred as they are likely to be to
112 Norman Haire, Hymen: Or The Future of Marriage (London: Kegan Paul, Trench, Trubner& Co., 1927), 77.
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careless to use contraceptives effectively.].113 In addition, she also argues that any woman who experienced any of the following as a result pregnancy should also use contraceptives: puerperal insanity, severe albuminuria, serious eclampsia, toxaemis, spinal and pelvic deformation, caesarean section within two years.114 Stopes frames her support of contraception as a societal need. She claims that if individuals who had any of the diseases or defects mentioned above did have children, then these problems would only be perpetuated, resulting in a weaker population.
Stopes also incorporated her own class perceptions in her argument. She claimed that contraception could also be a solution to some of the abortion issues in that abortion most frequently used by poor and ignorant women who are denied the necessary contraceptive knowledge, and many and various as they are, all can fairly be described as physiologically harmful as well as legally criminal.115 Stopes was very much against the use of abortion and offered contraception as an alternative. Additionally, she argued that in impoverished homes, contraception should be used in cases where the household was already raising as many children as it could financially support: contraception is obviously indicated rather than the saddling of the community with children or a very doubtful racial value.116 By defining the use of abortion as being more often utilized by poor and ignorant women and a desire to regulate procreation among the poor who
113 Marie Carmichael Stopes, Contraception (Birth Control) Its Theory, History and Practice: A Manual for the Medical and Legal Professions (London: John Bale, Sons and Danielson, 1923), 35.
114 Stopes, Contraception, 35.
115 Stopes, Contraception, 54.
116 Stopes, Contraception, 37.
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would produce children that would then become a burden on society, Stopes revealed her bias against the poor and also centered her advocacy of the use of contraception for the poor in particular.
While Stopes wrote, [a]ll will agree in her argument that contraception should be used in eugenic circumstances, her proposals caused a great deal of controversy, even among the medical community. In Contraception she anticipates some of the backlash against her position and attempts to defuse those anticipated arguments. For example, she explains that some people were against the use of contraceptives because they violated nature. Yet, she argues, all medicine is against nature in that humans developed it. In addition, Stopes explains that many criticized the use of contraceptives because it would result in race suicide. She refutes this argument indicating that allowing the unfit to procreate was actually a greater threat to the British race.117 Stopes argument shows her support for the desire among eugenists to regulate the procreation of individuals in British society who did not meet their definitions of Britishness.
Even though Stopes strongly advocated for the use of contraceptives in order to meet eugenic goals, Deborah Cohen has shown that in the administration of the Mothers Clinics, Stopes actions did not fully align with her eugenic ideology. In 1921, Stopes and her husband, Humphrey Verdon Roe, opened their first Mothers Clinic in a North London working-class district. Mothers clinics were birth-control clinics that worked to help women prevent unwanted pregnancies, regulate the number of years between the birth of children within a family, and assist couples who could not have children. In this
117 Stopes, Contraception, 211-212.
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capacity, Cohen explains, Stopes established a system that worked to make women feel empowered to control their own reproductive capabilities. While Cohen acknowledged Stopes unwavering public support of eugenic regulation of reproduction, Cohen also demonstrated that the clinics themselves offered contraceptive options to upper-, middle-, and working-class women. In the act of offering contraceptives to upper- and middle-class women, Cohen argued, Stopes actually violated her advocacy of positive eugenics and the propagation of the fittest members of British society. According to Cohen, the actions Stopes took to make contraceptives available to the female population demonstrated Stopes prioritization of her concern for the health and happiness of her patients above her eugenic ideology.118
^>ET£ mot.

Figure 6.1: This graphic from Stopes' Contraception visually demonstrates Scopes' belief that the use of contraception could resolve population issues in post-World War I Britain.
118 Deborah A. Cohen, Private Lives in Public Spaces: Marie Stopes, the Mothers' Clinics and the Practice of Contraception, in History Workshop, No. 35 (Spring, 1993), 95-116, accessed 27 April 2016, http://0-www.jstor.org.skyline.ucdenver.edu/stable/4289208.
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Ultimately, through the process of determining the best course of action regarding the mentally deficient, medical professionals established themselves as expert advisors on public policy regarding the mentally deficient and advised that it was the States responsibility and in the States best interest to regulate the propagation of those individuals they deemed unfit for British society. According to Potts, the majority of defectives can only be detected by careful investigation, their diagnosis requiring thorough and sometimes repeated examinations by those who have made a special study.119 Those who have made a special study indicate that expertise in the area of mental deficiency belonged to medical professionals. By fortifying medicine as the fount of knowledge in mental health, medical professionals created a situation in which others, including political leaders, could not question their authority on the subject. This allowed medical professionals to advise the State in the area of mental health. Thereby medical professionals professed their own versions of unfit and advised policy-makers in terms of their own ideals of Britishness. Additionally, professionals like Gibbons framed their arguments in terms of what was best for the State regarding the treatment of the unfit. These arguments included statements such as this would be done for the advantage of the State in reference to keeping feeble-minded people from procreating. Some medical professionals even blamed the State for interfering with what they thought was keeping a natural process of elimination from occurring. Gibbons explains that policies like the Poor Law actually allowed unfit people to continue to pose a threat to society.120 Yet, unfit was a classification established by individuals who posited their own perspectives
119 Potts, et al., Discussion, 219.
120 Gibbons, Sterilization of the Unfit, 755.
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as absolute truths established through science even when the scientific evidence could not prove their perspectives to be true. In fact, the science suggested that their hypotheses regarding procreation and natural elimination of unfit individuals from the population were false hypotheses. In the end, because there was not sufficient data supporting heredity as a primary cause of insanity and other forms of degeneration, the State did not implement sterilization policies in Britain.
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CHAPTER VI
CONCLUSION
During the nineteenth and early twentieth centuries in Britain, medical professionals established themselves as experts in their field and then utilized that expertise as a platform from which to advise on policies that sought to regulate reproduction. In an effort to provide specialized care to mentally defective individuals, medical professionals recommended the creation of a pauper asylum system. When the asylums first opened, although medical knowledge of the care and treatment of insanity was limited, medical men optimistically believed they could learn about and cure many kinds of mental defect. Over time, the patient population in Londons pauper asylums grew at what became an alarming rate. Medical and political experts feared a serious mental health crisis was rising throughout Britain. Some interpreted this perceived crisis to indicate a degeneration problem among British citizens and looked for ways to control reproduction. The State asylum system offered an opportunity to exert reproductive control over individuals who qualified for asylum treatment. While neither the State nor asylum administrators directly referenced the role of the asylum in reproductive control, State regulations demanded strict oversight of asylum patients and rules and structures that enforced gender segregation at the asylums. These regulations, rules, and structures established environments in which it was incredibly difficult, if not impossible, for the patient population to procreate.
By the beginning of the twentieth century, the growth of the asylum population had increased to such a level that it could no longer sustain itself. As a result, medical professionals, beginning with Robert Rentoul, recommended alternatives for the asylum
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system to control reproduction. Sterilization, marriage certificates, and contraceptives gained popularity in both the medical and political arenas as alternatives to the asylum system. However, the very notion that the asylum system could be replaced by policies that would directly regulate procreation among people who had been labeled as defective or degenerated indicates that at least part of the goal of State asylums in the nineteenth century was to control the reproductive ability of asylum patients.
Taking a closer look at the structure and operation of the asylums reveals that the asylums were set up to effectively regulate procreation. While there was not documentation in which medical men or policy makers cited the regulation of procreation as an asylum goal, they did build structures that physically separated males and females within the asylums. Additionally, the asylums were located in areas where there was quite a distance between asylum patients and the general population. These structures actively maintained environments in which those who did not fit medical experts definitions of proper British character were deterred from cross-gender social interaction thereby keeping them from reproducing.
During World War I, Britain suffered a great deal of population loss that caused a number of medical and political professionals to write about a population crisis and suggest possible actions for addressing this population concern. Yet, conversations about the population continued to include sterilization to maintain State regulations over procreation. Some medical professionals attempted to prove that various forms of degeneration from insanity to criminal behavior were directly caused by inherited characteristics. Eventually, these opinions led to the rise of a eugenic movement in Britain,
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Although, the scientific community in Britain was unable to prove that heredity was the primary cause of degeneration, a number of medical professionals continued to support theories of inherited degeneration often based on their own experience with different populations. Some, like Marie Stopes, even offered suggestions including the widespread use of contraception among certain elements of society as a solution to the degenerating race problem. Each of these arguments was based on beliefs about true Britishness.
The convergence of these conversations proves that one of the most important elements of truly being British both in the nineteenth and twentieth century was the ability to reproduce, thereby creating the next generation of British citizens. The power to control that ability represented the greatest level of control one individual could have over him or herself, or that a government could have over an individual.
Beginning with the ability to influence legislation over abortion, medical men/professionals claimed their own legitimacy in deciding who could and could not meet the most fundamental requirements of British national identity. They claimed their position as the keepers of true Britishness by establishing themselves as experts on the body, but extended their claim into expertise on inheritance of characteristics. In both the period before and after World War I, British medical experts and political stakeholders argued that the British race was deteriorating as Britain lost the economic and political hegemony they maintained throughout the nineteenth century. This challenge to the British national identity caused a great deal of fear about the role of Britain not only internationally but domestically as well. Racial degeneration was just part of that fear. Baron Riddell wrote, The propagation of undesirables is a national menace, and the
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condemnation of high-grades to a celibate life an unjustifiable act of cruelty.121 While actions and arguments against the reproduction of groups of people in a society who medical professionals defined as outside of the British ideal remained prevalent through the nineteenth and early twentieth century, it is important to remember that there were also dissenting voices. Those dissenting voices offered humanity as a priority over control. People like psychiatrist John Conolly imagined moral management of asylums where patients would be well treated and would not be subject to the violence and restraint of earlier generations. Even Doctor Marie Stopes, a staunch advocate of eugenics, placed womens ability to control their own reproduction through contraceptives above her own eugenic thinking in the administration of her Mothers Clinics. While both Conolly and Stopes ultimately supported policies that maintained control over individuals, they show that while certain ideologies could lead to greater State control over the population, the State must also keep in mind the value of rights and individuals. Sometimes, humanity, however flawed, is more important than what may seem like a difficult decision made for the greater good.
121 Riddell, Medico-Legal, 88.
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" INSTRUMENTS OF SOCIAL REFORM :" BRITISHNESS AND THE MEDICAL REGULATION OF THE UNFIT by NATALIE L. SCHAEFER B.A., University of Northern Colorado, 2007 A thesis submitted to the Faculty of the Graduate School of the University of Colorado in part ial fulfillment of the requirements for the degree of Master of Arts History Program 2016

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ii This thesis for the Master of Arts degree by Natalie L. Schaefer has been approved for the History Program by Marjorie Levine Clark, Chair Chris topher Agee Rebecca Hunt 29 April 2016

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iii Schaefer, Natalie Lynn (M.A., History) "Instruments of Social Reform:" Britishness and Medical Regulation of the Unfit Thesis directed by Associate Professor Marjorie Levine Clark ABSTRACT During the nineteent h century t he rise of the middle class and professionalization of medical experts marked an important change in British society In the medical profession which had only recognized general practitioners, surgeons, and apothecaries some medical men worked to establis h themselves as experts in mental health. At the same time, social changes led to Britons having strong desire to redefine themselves as a moral nation in opposition to some of the increasingly democratizing nations throughout Europe. Part of this effort w as the State establishment of a pauper asylum system. Through the creation of the asylum system, medical men were able to take control over identifying the insane and utilized that control to remove individuals from British society who they defined as not belonging. To do so, they created and maintained an environment that prohibited procreation. As the asylum system grew throughout the nineteenth century medical professionals like Robert Rentoul began a medical conversation regarding proper treatment and solutions for dealing with what seemed to be a rapidly degenerating British population. Through the asylum system and the subsequent conversations about alternatives to a costly asylum system, medical professionals not only established themselves as expert s on mental health, but also as "instruments of social refor m" through defining the nation and regulating the procreation of "unfit" people. The form and content of this abstract are approved. I recommend its publication. Approved: Marjorie Levine Clark

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iv A CKNOWLEDGEMENTS I would like to extend my sincerest gratitude to a number of individuals who have been incredibly helpful and supportive as I have worked through the graduate program at the University of Colorado Denver First, I would like to thank my co workers and friends at Evergreen Middle School who have been incredibly supportive of me throughout my graduate program. I would also like to thank Professor Marjorie Levine Clark for serving as both my advisor and committee chair. I have greatly apprecia ted working with you am thankful for all of the time and effort you have offered to help me in the development of this thesis. I would also like to thank Professor Christopher Agee for being my minor advisor and second reader. I enjoyed being a part of you r class, learning from you, and benefiting from your perspective and expertise. Additionally, I am very thankful to Professor Rebecca Hunt who not only graciously joined my thesis committee without having me as a student, but also provided direction and pe rspective. Finally, I would like to thank Professor Pamela Laird who has been incredibly helpful and supportive throughout my time at the University of Colorado Denver I cannot express just how much I appreciate you.

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v DEDICATION Completing this thesis m arks the end of a six year journey toward the completion of my master's program. In those six years, I have undergone an incredible amount of personal and academic growth that I simply could not have endured without the support of the group of women to who m I dedicate this thesis. First, to Sally Hobler, Lisa Neale, Karen Cravens, Kelley Young, and Dani Wise you all have provided infinite support, friendship, and love for which I am eternally grateful. To Marjorie Levine Clark they say when you find som eone who is passionate about and interested in the same things you are, to keep those people in your life. Thank you for sharing your passion and being so caring and supportive. And, to Tristin Koch you are the best thing that has happened to me. Thank y ou for taking this journey with me for all of your love, encouragement, confidence, and support.

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vi TABLE OF CONTENTS CHAPTER I. INTRODUCTION... 1 II. THE P AUPER ASYLUM SYSTEM ... 8 III. STERILIZATION: AN ANSWER TO DEGENERATI ON .. 27 IV. EARLY TWENTIETH CENTURY MENTAL HEALTH CARE ... 43 V. AN EUGENIC MOVEMENT: THE UNFIT AFTER WORLD WAR I .. 52 VI. CONCLUSION 72 BIBLIOGRAPHY 76

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vii LIST OF FIGURES FIGURE 3.1 Graphic of t he Aerial View of Hanwell Asylum: 1843 .. ... 21 3.2 Photograph of the Entrance to Hanwell Asylum .. 22 3.3 Ground Plan of Hanwell Lunatic Asylum 23 3.4 Ground Floor Plan of Claybury Asylum 23 6.1 Graphic from Marie Stopes' Contraception .. 69

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1 CHAPTER I INTRODUCTION "It does not make the defective criminal into an honest man. It does not make the unemployable ament into a useful citizen. It does not make the immoral feeb le minded into a moral being. It does not enable the pauper or vagrant defective to earn his own living." 1 L.A. Parry, a surgeon designated as a member of the Fellowship of the Royal College of Surgeons, wrote this of proposed sterilization policies in Bri tain in 1927. Parry's assessment was one of the few dissenting voices among medical professionals regarding the sterilization of individuals in Britain who were labeled as "unfit." Conversations about the sterilization of the unfit developed as a result of Robert Rentoul's Proposed Sterilization of Certain Mental and Physical Degenerates published in 1903. Yet, this proposal was not the first effort on behalf of medical men to regulate the procreation of so called degenerates. Throughout the course of the nineteenth century, the British government established a public asylum system. Initially, as Elaine Showalter, indicated, the intention s of asylum administrators like John Conolly, the administrator at Hanwell Asylum from 1839 to 1843, were optimistic abou t the role of asylums to cure individuals of their mental maladies Medical men, like Conolly, believed that they could offer care in the asylum that was both humane and effective at curing individuals of 1 L.A. Parry, The Problem of Mental Deficiency ," The British Medical Journal Vol. 2, No. 3493 (Dec. 17, 1927): 1166

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2 mental illness. 2 However, by the end of the century it was clear that even a benevolent system w as largely ineffective as a curative process Ultimately, the system was most successful in creating an environment in which the "insane" were unable to reproduce. Through the process of creating and regulating the State asylum system throughout the nineteenth century, medical professionals established themselves as experts in the growing field of mental health. They utilized their professional opinions as a platform from which to assert themselves through the ea rly twentieth century in debates about definitions of true Britishness in relationship to who had a right to reproduce In Britons Linda Colley explored definitions of Britishness from 1707 through 1837. In regards to definitions of Britishness during th e nineteenth century, she framed her argument in terms of British loss of the American colonies at the end of the eighteenth century and a desire among the population to insure that the nation would maintain its superior identity. She described one of the most important elements of this definition of Britishness as a claim on moral superiority. Through the process of both ending the British slave trade, as well as the end of slavery in Britain and its colonies, Britain worked to create an image of itself as a moral nation. They could not, Colley explained, identify as the most democratic nation because, unlike other European nations, Britain did not extend universal male voting rights or the right to vote for women until 2 Elaine Showalter, The Female Malady: Women, Madness, and English Culture 1830 1980 (New York: Pantheon Books, 1985), 44 50.

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3 after World War I. 3 Showalter also n otes this desire to associate Britishness with morality in the efforts to reform asylums that took place during the nineteenth century. 4 By the end of the century leading up to World War I, Paul Ward has shown, British identity continued to be associated w ith morality. Ward argue s that the image of the British nation became domesticated in the period leading up to World War I. He explains that the royal family provided a model and images of the nation as family were popular This image was particularly clea r in the masculine role of the protector of the nation during the Great War. W hen the Germans invaded Belgium, Ward write s Britishness came to be defined as everything that was not German. This definition included a controlled sexuality that was directly opposed to the Germans who, as the British press described had "raped" the Belgians in their invasion. This, worked to "reinforce already existing notions of Britishness as concerned with honour, decency and fair play" 5 These qualities are evident in the asylum system and the conversations about the proper care and treatment of the insane S ubsequently they became part of the early twentieth century medical conversations about groups of people who did not belong as part of the nation. 6 My initial intere st in this topic stemmed from an intriguing set of sources in the London Metropolitan Archive s There I engaged with a number of different types of 3 Linda Colley, Britons: Forging the Nation 1707 1837 ( New Haven: Yale University Press, 1992 ), 356 367 4 Showalter, The Female Malady, 44 50. 5 Paul Ward, Britishness Since 1870 (London: Routledge, 2004), 40. 6 Ward, Britishness.

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4 records that asylums kept for their patients. In each record book, I witnessed hundreds of stories of indivi duals whose conditions marked them different enough from the general population that someone, generally a medical man believed they required targeted treatment and removal to an asylum. The most intriguing of these documents were the photographs of patien ts kept in the late nineteenth century. Each face humanized the people I read about. This humanization of the patients caused me the greatest concern when I read Robert Rentoul's proposition to sterilize mental a nd physical degenerates. Rentoul's argument focuse d so much on the financial benefits of sterilization over the c ostly asylum system that he came across as void of empathy. 7 Yet, it was his argument that made me want to examine what these asylums were really like and explore the perspectives of othe r medical professionals at the time regarding sterilization Scholars who have explored nineteenth century asylums, sterilization laws, or eugenics have focused on each of these topics individually. For example, Elaine Murphy's "The Administration of Insa nity in England 1800 to 1870," Peter McCandless' s "Liberty and Lunacy: The Victorians and Wrongful Confinement," J.K. Walton's "Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840 70," and N. Hervey's "A Slavish Bowing Down: the Lunac y Commission and the Psychiatric Profession 1845 60" focus on treatments provided by the asylums and the administration of the asylums by both medical and political professionals. 8 Andrew Scull 7 Robert Reid Rentoul, Proposed Sterilization of Certain Mental and Physical Degenerates: An Appeal to Asylum Managers and Others ( London: Walter Scott Publishing Co., 1903). 8 Elaine Murphy, "The Administration of Insanity in En gland 1800 to 1870," in The Confinement of the Insane: International Perspectives, 1800 1965, ed. Roy Porter and David Wright (Cambridge: Cambridge University Press, 2003), 334 349. Peter

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5 does explore the ineffectiveness of the asylums, which I will include as part of my analysis but he does not ex plore their unintended effectiveness as a form a reproductive control 9 Finally, in the area of eugenics and sterilization, scholars have explored these topics in relation to one another. For example, Ann Farmer, Pauline Mazumdar, and Richard Overy all address eugenics and the role eugenic thinking played in the policies of sterilization and contraceptives. However, they maintain a focus on eugenics from the 1920s and do not examine the ways in which earlie r practices in the asylums or earlier conversations among medical professionals closely resembled the arguments presented by eugeni ci sts. 10 I will address asylums, sterilization, and eugenics as ideas and practices that developed earlier than the 1920s and that shaped the professionalization of medical men, but also provided a venue in which medical professionals could advise on issues of national identity in Britain. McCandless, "Liberty and Lunacy: The Victorians and Wrongful Confine ment," in Madhouses, Mad Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, ed. Andrew Scull (Philadelphia: University of Pennsylvania Press, 1981), 339 362. J.K. Walton, "Casting Out and Bringing Back in Victorian England: Pauper Lunatics, 1840 70," in The Anatomy of Madness: Essays in the History of Psychiatry, ed. W.F. Bynum et al. (London: Tavistock Publications, 1985), 132 146. N. Hervey, "A Slavish Bowing Down: the Lunacy Commission and the Psychiatric Profession 1845 60," in The Anatomy of Madness: Essays in the History of Psychiatry, ed. W.F. Bynum et al. (London: Tavistock Publications, 1985), 98 131. 9 Andrew Scull, Madness: A Very Short Introduction ( Oxford: Oxford University Press, 2011). 10 Ann Farmer, By Their Fruits: Eugenics, Population Control, and the Abortion Campaign ( Washington, D.C.: Catholic University of America Press, 2008). Pauline M.H. Mazumdar, Eugenics, Human Genetics and Human Failings: The Eugenics Society, its Sources and its Critics in Britain ( London : Routledge, 1992). Richard Overy, The Twilight Years: The Paradox of Britain Between the Wars ( New York: Viking, 2009).

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6 In chapter two I will address the creation of the pauper asylum system in the nineteent h century. In this section, I will explore the changes in the treatment of and attitudes towards the insane that took place from the beginning of the creation of the system to the end of the century. I will argue that the asylum system itself helped to est ablish medical men as experts in the growing field of mental health. Additionally, through the asylum policies and procedures, nineteenth century medical men may not have fully understood how to cure mental illness, but they united in a belief that insane individuals did not belong in the larger society. Efforts to maintain mental patients separate from the general p ublic are the focus of chapter three In this chapter I will show that the pauper asylums were located in such a way as to keep mental patient s away from the general population. Moreover, asylums created a venue in which individuals who were classified as not belonging could experience some elements of British identity while not presenting a danger to Britishness through procreation. In chapter four, I will show that the limited knowledge of mental health and preconceived notions held by many medical men throughout the first part of the twentieth century created a medico political environment in which medical men imagined sterilization as a reaso nable solution to a perceived mental health epidemic. However it is important to note that the British State did not legislate to sterilize any of the groups of people proposed throughout these conversations. This will lead directly to a focus on the chan ging nature of mental health care in the first part of th e twentieth century in chapter five I will show that World War I contributed to changes in the care of the insane and fed medical and political concerns that the British race was degenerating.

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7 Fina lly, in the sixth chapte r, I will focus on the establishment of a eugenics movement in Britain and the expansion of policies that were initially intended to address the issue of insanity and were instead directed at a group of people identified as "unfit." While the definition of Britishness changed throughout the nineteenth and early twentieth centuries, what remained was an effort on behalf of medical professionals to claim that their expertise qualified them to define who did not belong and to advise pol icy makers on how best to address those who did not belong. In effect, medical men operated as "instruments of social reform." Throughout this thesis I use a number of different terms to refer to various groups deemed "unfit." When directly referenced by t he author I have provided clarification on these terms as indicated by the author. Often, individuals utilized similar terms but defined them in different ways. I have also utilized the same terms as the author of the source provided as to maintain the la nguage provided, not to insert my own connotations or judgments o n the use of terms. Terms often found throughout the primary and secondary literature referenced here include defective, degenerate, lunatic, insane, and epileptic. Each term refers to a part icular set of people and cannot necessarily be utilized interchangeably; however, I have included each as part of a collective group of people deemed "unfit" in the sources throughout the period I address.

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8 CHAPTER II THE CREATION OF THE PAUPER ASYLUM SY STEM During the nineteenth century, the State established asylums for London's poor who were deemed insane. Officials established asylums in order to remove the insane from the workhouses and to ensure they would receive care. Initially, medical administ rators at the asylums knew little about the brain or mental conditions; however, they provided the best care they knew how. This care included recreational activities and access to outdoor spaces. Throughout the century, the state asylums for London fill ed quickly requiring a greater number of facilities. When the State first created the pauper asylum system asylum documents reflect that medical professionals were novices in the field of mental health. They studied their patients in an effort to underst and and treat mental maladies. Yet, the records suggest that their focus for most of the nineteenth century was on the physical attributes they could find associated with mental illness. Eventually, the ever growing number of people placed in asylums bec ame so vast that the stress placed upon the existing asylums as well as on the ratepayers who financially supported the asylum system led many individuals to question the usefulness of the asylums The creation of the pauper asylum system marked a signific ant paradigm shift in the history of British asylums. As Scull explains, changes within the administration of asylums allowed for more humane care of the insane than the previously existing "madhouse" system. According to Scull, in eighteenth and early nin eteenth century madhouses, it was not uncommon to witness patients chained to walls or floors or even suffering from severe frostbite. Yet, nineteenth century asylums provided a space where

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9 asylum administrators seemed more concerned about curing the insan e and providing a therapeutic space for these patients. Scull argues this shift was largely a result of greater visibility of the asylum system through central control of the asylums. 11 The care and treatment of the insane also underwent significant change in the first half of the nineteenth century as a result of State legislation. Initially, those people with mental disorders who could not afford treatment on their own established relationships with others at workhouses throughout London. The State had e stablished workhouses as places where individuals who were unable to support themselves were able to receive a place to live and work. While in the workhouse, the "lunatics" fell into the care of their fellow poor who not only were unable to financially su pport themselves, but also did not have the medical or psychological training to adequately care for these individuals According to Murphy it was not until the passage of the 1808 County Asylums Act, also known as the Wynn Act, that the State provided an opportunity for local governing authorities to establish their own asylums. Yet, few counties actually did so. Instead, families who could not afford to send their own family members to private asylums were left to care for them themselves. Murphy estima tes that between one fourth and one third o f the insane were cared for in workhouses. Under the 1834 New Poor Law, the State extended its control over asylums and workhouses by implementing the Poor Law Commission and Lunacy Commission as oversight committ ees. Then, in 1845 the State passed the Asylums Act which formally mandated the creation of pauper asylums for the care of the insane. Nevertheless, many individuals who were i dentified as insane 11 Scull, Madness, 46 52.

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10 continued to be housed in the workhouse system due to lack of space in county asylums. 12 The first purpose built pauper asylum in London Hanwell Asylum, opened its doors to London 's pauper insane in 1831. By the end of the century, there were five such purpose built facilities for London: Hanwell, Colney Hatch, B anstead, Cane Hill, and Claybury. Although the generalized sentiment among medical and governing professionals was optimistic at the inception of the pauper asylum system and they believed they could genuinely help people who could not care for themselves, the ultimate success of the asylum system was that it created homo social environments that effectively limited the ability of those within the asylum to procreate. Conversatio ns about mental health in Britain during the first half of the nineteenth centu ry focused on who could best care for those with some kind of mental difference. One common conversation concerned whether those individuals deemed "insane" should be cared for at home or elsewhere. In a n 1843 document entitled Notice of the Establishment for the Treatment of Nervous and Mental Maladies John Parkin explains that many people expressed a desire to treat the insane at home. However, he suggests that it was in the patient's best interest to be cared for by experts. Experts, Parkin continues, w ould give patients their best chance at recovery because those experts would be able to see multiple patients and through experience find cures for various mental maladies. 13 While Parkin did not consider the circumstances of the home life and the 12 Murphy, "The Admin i stration of Insanity ," 334 349. 13 John Parkin, On the Medical and Moral Treatment of In sanity, Including a Notice of the Establishment for the Treatment of Nervous and Mental Maladies (Manor Cottage, King's Road, Chelsea, London: 1843).

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11 family's ability to be able to support insane members of the family, the concern regarding the pauper insane was similar. Within the workhouse system established under the Poor Law, those who could not take care of themselves often required care from other individu als in the workhouse leaving insane individuals at the mercy of their fellow poor. These concerns suggest that the asylum system optimistically encouraged the insane to obtain treatment from experts because medical professionals genuinely believed they wo uld be able to help the insane. It also suggests that medical professionals were establishing themselves as experts on mental health in the first half of the nineteenth century. 14 Many historians have commented on the rise of professions in nineteenth centu ry Britain. Irvine Loudon explained that in the first half of the nineteenth century, those with medical knowledge actively worked to gain respect in British communities through their expert knowledge and professional practices. 15 Jeanne Peterson identified a desire among medical men in nineteenth century Britain to separate themselves from the working class through the organization of the medical profession as well as State regulations of the medical profession. 16 On the other hand, records of dissemination of medical knowledge as well as asylum patient records indicate that medical professionals knew very little about the care and cure of mental health throughout the nineteenth century. In The Human Brain: 14 Scull, Madness, 48. 15 Irvine Loudon, Medical Care and the General Practitioner, 1750 1850 ( Oxford: Cla rendon Press, 1986). 16 Jeanne Peterson, The Medical Profession in Mid Victorian Londo n ( Berkeley: University of California Press, 1978 )

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12 Histological and Coarse Methods of Research: A Manu al for Students and Asylum Medical Offices (1882) W. Bevan Lewis, the Deputy Medical Superintendent to the West Riding Lunatic Asylum, discusses dissections of the human brain. He reports on what membranes in the brains should look like as well on the proper arrangements of the vessels and arteries in the brain. Lewis suggests that checking for signs of inflammation is important to understanding the origin of mental defects and even explains that if one were to touch the brain there are certain areas th at should feel soft while other areas should feel tough. 17 This suggests that as late as the 1880s medical professionals believed that mental health was caused by a physical abnormality in the brain that could actually be felt or seen by the medical profess ional. When the asylums first opened, the records of patients indicate that medical professionals who worked in the asylum system had limited knowledge of the cause and cure of mental disorders, but also sought to gain further knowledge on mental health through the study and care of their own patients. As Guenter Risse and John Harley Warner have written, case records can be valuable resources in historical study, but they are limited in what they provide. They explain that medical records reveal much abo ut what the medical practitioners who wrote the records thought or believed about the nature of the body and illness. However, they do not typically contain the patient's own thinking or feeling about their own health or medical care. 18 The Hanwell Case Led gers from 1831 17 W. Bevan Lewis, The Human Brain: Histological and Coarse Methods of Research: A Manual for Students and Asylum Medica l Officers ( London: J. and A. Churchill, 1882). 18 Guenter B. Risse and John Harley Warner, "Reconstructing Clinical Activities: Patient Records in Medical History" in The Journal of the Society for the Social History of Medicine 5 (1992): 183 205.

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13 contain generalized narratives about intake meetings between medical professionals and patients. The register is essentially a large book of plain lined paper without suggested fields for intake personnel to fill in. The narratives contained within these records do not provide much information about particular medical data for each patient and records were kept on a case by case basis making it difficult to show the relationship between particular pieces of data for each patient because they did not necessarily record similar information for each patient. Some common elements within the narratives include information about the physical condition of the patient including any visible bodily mutilation and notes about the hygiene and eating habi ts of the patients. 19 Much like the knowledge included in Lewis' The Human Brain these early records of patients show that medical professionals were looking for physical markers of mental disorder. Additionally, the intake professional s' notations of the p atient's eating habits reveal an interest in exploring the correlation, if any, between mental health and the foods that individuals ate. Over time, medical records for asylum patients became more regimented and focused on connections between heredity an d mental health as well Unlike the 1831 records, the 1853 Hanwell Register of Patients, provided space for intake professionals to record similar information for each patient upon entry into the asylum. One reason for this change in record keeping was th e fact that the 1845 Pauper Lunatic Asylum Act mandated that certain information be kept and that the asylums were required to record information for each patient within one month of the patient's entry into the asylum. The 1853 Register of Patients at Han well contained information such as if the patient had 19 Hanwe ll Asylum, Female Case Ledger, ( 1831).

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14 been previously admitted, marital status, occupation, previous abode, who sent the patient to the asylum, bodily condition, and form of mental disorder. The types of mental disorders noted in this recor d we re: melancholia, mania, imbecility, senility, and hysteria. As well as the form of the disorder, the records also suggest that medical professionals within the asylums were collecting data about the causes of the mental disorder presumably in order stu dy the common features of mental health cases. For example, the records provide d information about the supposed cause of the disease, the person's bodily condition at intake, and notes pertaining to whether the person was a "congenital idiot." This final n ote is particularly interesting because it suggests that medical professionals were looking for clear correlations between heredity and mental disorder. 20 Although the study of the link between heredity and mental illness did not become a primary focus of m edical professionals until the late nineteenth century, the desire to understand the causes of mental illness indicates that medical professionals wanted to find a way of preventing mental illness. While numerous patients we re included in the Hanwell 1853 Patient Record, some patients stand out for the comments made regarding the cause s of their mental disorder s The records indicate d that one woman, Elizabeth Wakeham, had been diagnosed with hysteria caused by nursing. Another woman, Sarah Broad bent wa s l isted as having melancholia caused by intemperance. Other records define d poverty as a cause 20 Hanwell Asylum, Register of Patients, ( 1853). The Pauper Lunatic Asylums Act 1845.

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15 of melancholia, epilepsy as the cause of imbecility, and age as the cause of senile insanity. 21 Although the connections between the cause and kind of disorder are interesting in the value they can provide regarding the degree of understanding medical professionals had of mental disorder at the time, they also inform about biases in mental health. When linking ideas such as poverty and intemperance to mental health medical professionals show ed a bias toward populations within British society who fell outside of the recognized British ideal For example, Marjorie Levine Clark shows that the ability to work was an essential element of a British man's identity. This nor m, she explains, also extended to poor women. It was in thi s context, Levine Clark argues that some medical professionals listed poverty or unemployment as a cause of insanity. 22 This link also demonstrates that medical professionals may have believed tha t if a person exhibited particular qualities, like being impoverished or intemperate, then they could be susceptible to insanity. By the end of the century, records for patients at Hanwell became much more regimented. Instead of maintaining narratives orga nically gained through entrance interviews between patients and intake personnel, the casebooks from the 1890s took the form of meticulously ordered surveys on specific aspects of each patient 's condition and background. The books actually contain ed cells for each response as though they were 21 Hanwell Asylum. Register of Patients. 1853. 22 Marjorie Levine Clark, "'Embarrassed Circumstances': Gender, Poverty, and Insa nity in the West Riding of England in the Mid Victori an Years," in Sex and Seclusion, Class and Custody : Perspectives on Gender and Class in the History of British and Irish Psychiatry, eds. Jonathan Andrews and Anne Digby 123 148 (Amsterdam: Rodopi, 2004 ).

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16 made expressly for the purpose of keeping record s of incoming patients, unlike the registers from 1831 that contained only clean, lined paper. These new registers contain ed over fifty different questions and responses for each patient. S om e of the patient information wa s simply regarding the patient's home life including age, address, religious affiliation, occupation, marital status, education, and the number and ages of children. As Risse and Warner indicate, this was fairly typical for nineteenth century medical case records. 23 Then, the records provide d information about the patient's condition at the time of entry to the asylum including the particular a ffliction, whether the patient wa s epileptic, suicidal, or dange rous, how many previous attacks of "nervous disorders" the patient may have had, and mental state. 24 The pieces of information obtained regarding the patient 's bodily health, behaviors, and heredity are the most significant in exploring how medical profess ionals sought to understand mental illness. Similar to the patient case records kept in the 1831 and 1853, medical professionals paid attention to the physical condition of the body. The records from the 1890s, however, provide d greater detail. They includ e d information about the condition of the patient's digestive, circulatory, respiratory, and genitourinary systems as well as speech, "special senses," pulse, gait, development, temperament, and 23 Risse and Warner, Reconstructing, 185. 24 Hanwell Asylum, Casebook, Females No. 14 ( 29 September 1891 10 August 1892). Hanwell Asylum, Register of Admissions No. 6 ( London County Asylum. 23 April 1898 3 January 1900). City of London Lunatic Asylum, Ca sebook Females No. 12 ( 23 June 1896 October 1899).

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17 weight. 25 As before, in an effort to keep records of patient c ondition s especially regarding systems not clearly linked with mental health, medical professionals continued to look for correlations between other physical conditions and the person's state of the mind. Additionally, asylum records also provide eviden ce that medical professionals wondered about the possible links between particular behaviors patients exhibited and their mental health. For example, the intake records in the 1890s include detailed information regarding "disposition and habits in health" similar to earlier records. They also questioned the patient's cleanliness, eating, and sleep habits as well as indicated whether the patient was temperate. 26 As before, the determination to keep track of cleanliness and temperance show that medical profess ionals may have maintained biases toward the unke m pt or intemperate individuals in society as well as biases toward the mentally defective. These biases may have influenced not only the care individuals received but also overall attitudes toward these memb ers of society as individuals who simply did not belong. Finally, one of the most significant differences between the earliest asylum records and those kept near the end of the century is the amount of detail in questions regarding the patient 's heredity Asylum records contain information about the individual's nationality, number of people in their families, number of people in the 25 Hanwell Asylum, Casebook, Females No. 14 Hanwell Asylum, Register of Admissions No. 6. City of London Lunatic Asylum, Casebook Females No. 12 26 Hanwell Asylum, Casebook, Females No. 14 Hanwell Asy lum, Register of Admissions No. 6. City of London Lunatic Asylum, Casebook Females No. 12

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18 family who were then living, as well as if there was a family history of "nervous disorders," the family history of phthisi s, number of relatives affected by a mental malady, if the patient's parents had "related prior to marriage," and a family history of intemperance. 27 Direct questioning of the family history of mental disease indicates that medical professionals wondered, i f not believed, whether heredity could have been a cause of mental illness. In addition, asking if the patient's parents had related prior to marriage or if the patient's family had a history of alcoholism indicates an increase d suspicion on behalf of medi cal professionals that mental illness could be caused by disobeying societal norms at the time by drinking to excess or entering into sexual relationships prior to marriage. It may even suggest that medical professionals wondered if mental illness, sexual promiscuity, or intemperance could indicate one another or occurred simultaneously in a cause/effect relationship. In that case, finding the cause of the mental disorder could help professionals to identify, treat, and possibly cure the disorder. Although the government established an asylum system with the intent of helping patients, the records indicate that the system was highly ineffective at curing mental defects. In The Care and Cure of the Insane a report regarding London's lunatic asylums from 187 5 1877, J. Mortimer Granville, M.D. criticizes almost every element of the asylum system including the physical structures of the facilities and the approach to treatment of the insane. In regards to the facility at Colney Hatch (the second dedicated paup er asylum for London), Granville writes, "as an institution for the care and cure of 27 Hanwell Asylum, Casebook, Females No. 14 Hanwell Asylum, Register of Admissions No. 6. City of London Lunatic Asylum, Casebook Females No. 12

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19 the insane it is organised on a system elaborately heretical in conception, and based on principles and a notion of the object in view with the best of compassing it w hich we believe to be wholly false, impracticable, and disastrous." 28 He explains that his criticisms of the asylum stem from his belief that the committee (the London County Council) maintained far too much control over the asylum and that the day to day p ractices of the asylum should have rested in the hands of the medical professionals. Additionally, he claims that the asylum relied too heavily on treating patients in group settings. He states, "mental diseases cannot be treated as a heterogeneous heap of mutually antagonistic idiosyncrasies ." 29 Instead, he suggests that medical professionals would be much more effective in treating patients on an individual basis whereby the professionals would gain distinct knowledge of the patient's needs and be able to respond accordingly. Granville indicates the same type of practice occurred at Hanwell. He writes, treatment is "humane, intelligent, and, in a broad sense, moral and suasive; but it necessarily lacks individuality, and that special character which arises from dealing with a limited number of cases directly." 30 These criticisms indicate that Granville did not witness a system that was highly effective in its treatment of patients. Moreover, Granville also indicates that the very nature of the physical stru ctures of the asylum were not effective in the treatment of the mentally ill. Of Hanwell Asylum he states that it was too much like a prison and refers to it as a "depository for criminals." 28 J. Mortimer Granv ille, The Care and Cure of the Insane: Being the Reports of The Lancet' Commission on Lunatic Asylums, 1875 6 7: For Middlesex, the City of London, and Surrey, Volume 1 ( London: Hardwick and Bogue, 1877), 145. 29 Granville, Care and Cure of Insane 153. 30 Granville, Care and Cure of Insane 81.

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20 Additionally, he explains that part of the reason the asylums did not treat patients on an individual basis and instead treated them in group settings was because the asylums were simply too overcrowded. He could not imagine that with the number of people living at the asylum patients were properly cared for because the y could not be so Granville indicates that even the Home Secretary stated that within the asylum system little emphasis was placed on the "curative process" and that the facilities had simply becoming housing facilities for the pauper mentally defective. 31 Scull also acknowledges this point in arguing that asylums became what he coins "museums of madness." He writes, "Here the insane were shut up in multiple senses of that term, isolated from the larger society, objects first of pity, then of fear and disda in." 32 While Scull's argument supports the idea that the asylums were ineffective at treating and curing metal illness, by isolating the insane in asylums, the State was also able to prevent patients from reproducing. While the asylums may not have been ef fective at curing patients, the asylums were effective at removing individuals from the general population and maintaining an environment in which patients could not procreate. Although the documents the asylums kept and the meeting minutes for the various committees who, over time, controlled the asylums do not mention the intention of keeping the insane separate from the general population, both the locations of and the layout of the asylums clearly mark a separation between the insane and the sane. 31 Granville, Care and Cure of Insane 75 88. 32 Scull, Madness, 51.

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21 Of the five pauper asylums for London established in the nineteenth century, not one was closer than seven miles from central London. The closest asylum to central London was Colney Hatch which was seven miles away, while the farthest, Cane Hill was approxi mately fifteen miles away. Images of the asylums depict imposing structures spanning numerous acres of land. The entrance gate itself suggests that it was an entity of its own separate from the rest of the world. Plus, the asylums actually acted to establi sh themselves as self sufficient by raising their own animals, growing their own produce, and maintaining their own infrastructure (such as sewage) Not only did this p hysically separate the patient population from the rest of society, it also created a si tuation in which spouses, especially spouses of the poor, would be unable to visit the asylum often. 33 "" Sussex Lunatic Asylum, Hayward' s Heath, Regulations and Orders of the Committee of Visitors for the Manag ement and Conduct of the Asylum ( Londo n: Sussex Lunatic Asylum, Hayward's Heath, 27 April 1861 ) Figure 3.1 The graphic of Hanwell Asylum published in the Illustrated London News 20 May 1843 shows the vast grounds and structure of the asylum.

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22 One of the most important elements of the asylum system was the ability of asylum administrators to segregate the genders thereby creating a n envi ronment in which the insane could not procreate In notes regarding the Sussex Lunatic Asylum, the regulations indicate that men and women were not only to be kept in separate wards, but also that they should be treated in separate infirmaries. Moreover, t hey also establish ed that when female patients were visited they should be accompanied by the head attendant from the asylum. This separation of males and females is also evident in the layout maps for the pauper asylums. They show male and female wards o n opposite wings of the asylums as well as separate infirmaries, airing courts, and bathhouses. By maintaining gender segregation in the asylums, the asylum system established an environment in Figure 3.2: The gated entrance to Hanwell Asylum shown in this photograph demonstrates its imposing size. The entrance clearly dema rcates the asylum as a separate space.

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23 which those individuals who were labeled as mentally defectiv e were unable to develop sexual ly intimate relationships. Figure 3.3: The Ground Floor Plan of Hanwell Asylum shows men and wom en were housed in separate wings of the facility. It provided separate housing, airing courts, and even surgeon's rooms. Figure 3.4: In the ground floor plan of the Claybury Asylum, one can see the separation of male and female patients similar to the sep aration at Hanwell Asylum. Claybury opened later than Hanwell and it shows not only did males and females have separate wards and facilities, their wings were separated by a central section containing spaces including kitchens and delivery. Note that the f emale side of the facility also contains the laundry where female patients could work while at the asylum.

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24 Moreover, this self sustaining system provided opportunities for patients to experience vital elements of British character including work and making contributions to society, even if those contributions were to the smaller community of the asylum. As Levine Clark has written, work played an important part in the gendered experience of Britishness. She explains that for men, the ability to work and adequately earn a living to support one's fa mily was a vital element of a Victorian man's expression of his Britishness and a necessity for poor women. 34 While Showalter has shown that for middle and upper class Victorian women, society could view working outside the home as a sign of woman's insani ty. 35 According to the Regulations of the Sussex Lunatic Asylum in 1861, proper care of the insane included ensuring that they were employed at the asylum as often as possible in "occupations suited to their ability." 36 For women, the regulations specify tha t work could include needle work, straw work, house keeping, or linen washing. While for men, it indicates that they should have access to tools and workshops. 37 Providing opportunities for patients to work indicates that asylum administrators valued work a s an element of British character, even for poor women, that the insane could experience even while being isolated from the general population. Although the asylum may have been effective in establishing a gender segregated sub culture, not in curing the insane, the asylums grew at alarming rates throughout the nineteenth century. In a series of newspape r clippings from 1890 1900 kept by the 34 Levine Clark, Embarrassed Circumstances, 127 130. 35 Showalter, The Female Malady, 121 144. 36 Sussex Lunatic Asylum, Regulations and Orders 37 Sussex Lunatic Asylum, Regulations and Orders

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25 London County Asylums, a number of articles show that many people in British society saw insanity as a problem that faced nineteenth century London. One of the common elements in these clippings includes a concern that the growing number of people in asylums was increasing at a far greater rate than the asylums could provide service. For example, when Hanwell Asylum fi rst opened its doors it was set up to serve 500 patients. By 1881, Hanwell had over 1,891 patients. Another asylum like Hanwell, Colney Hatch, only the second purpose built pauper asylum for London, was established for up to 1,250 patients. Yet, within ten years, not only had more asylums opened, but Colney Hatch itself housed over 2,000 patients In one 1894 article entitled, "Lunacy in London," the author expressed concern regarding the rate of diagnosis of insanity. Th e author indicated that approximatel y 11,000 people received services at the five London pauper asylums. Many articles also explain ed that the cost of running asylums, especially given the number of patients then housed in asylums, was increasingly difficult to maintain. "Lunacy in London" e xplains that the cost of running London's pauper asylums was over 400,000 Pounds annually. In one Evening News and Post article from 26 October 1890, the author questions the use of ratepayers money to accommodate the insane and suggests that families sho uld bear the burden of caring for family members either by housing and caring for them themselves or by paying for family members to receive services at private institutions. 38 The increasing number of asylum patients indicate s that the asylums were not cu ring and releasing people back to the general population. Moreover, these numbers 38 London County Asylums, "Lunacy in London" Asylum s Department Newspaper Cuttings ( 1890 1900 )

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26 may also be the result of medical professionals changing the professional criteria used to identify patients as needing asylum services. Presumably, these differences in pro fessional opinion resulted from a deeper medical understanding of insanity. In any case, both medical professionals and others in the British population became increasingly concerned about the mental health problem as the nineteenth century came to a close

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27 CHAPTER III STERILIZATION: AN ANSWER TO DEGENERATION By the beginning of the twentie th century, the problem of housing asylum patients was such a significant one that one medical man suggested sterilization of the insane as an alternative to the ge nder segregation in asylums His suggestion spurred extensive conversations among many medical and politi cal stakeholders in Britain. Although sterilization became the main topic of conversation among medical professionals regarding the proper treatment of the insane at the beginning of the century, it was not the only suggestion. As indicated in a British Medical Journal article, "The Marriage of Epileptics," the author advocated restrictions on marriage for anyone deemed unfit to produce offspring. He exp lained that while society would likely not accept sterilization nor extend political power to execute such individuals, he wrote, "All that society can do at present to protect itself is to set its canon against the marriage of persons whose offspring woul d be likely to swell the number of the unfit of the criminal, who are a burden to the State and a danger to the community." 39 The s e conversation s centered around each stakeholder's own definition of Britishness and how to best ensure that the British popula tio n was the strongest it could be. The rationale advocates for sterilization and marriage certificates offered in their suggestions for replacements for the asylum system focused on the reproductive possibilities of the unfit. Therefore, these arguments s uggest that at least one purpose of asylums was deterring reproduction for fear of the rising number of British citizens identified as mentally deficient. Medical professionals 39 "The Marriage of Epileptic s, The British Medical Journal Vol. 1, No 2363 (Apr. 14, 1906): 877

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28 defined the deficiency problem as a biological defect thereby justifying their role in identifying the mentally deficient and presenting sterilization as a solution to the problem. By the start of the twentieth century, they had also abandoned their focus on proving physical markers of mental illness and instead concentrated on linki ng mental defects to heredity. In 1903, Robert Rentoul a British doctor and surgeon who specialized in women's health and reproduction, s uggested in Proposed Sterilization of Certain Mental and Physical Degenerates th at "mental defectives in Britain sh ould be sterilized In his book, Rentoul advocates sterilization in response to fears that Britain's population was becoming physically and mentally weaker than it had been in the past. He cites reproduction as the predominant fear among medical profession als in having insane/degenerate individuals among the general population. For example, he writes, "Some degenerates who, although they may have a right to marry, have no right to beget a tainted offspring one which may be a danger to the public welfare, to themselves, or a tax upon private or public charity." 40 Not only does this show that Rentoul believed procreation of degenerates endangered society, but also that the role of the medical professional and the State was to protect society from this danger. Rentoul relies on statistics from both the asylum system and the military to support his position. According to Rentoul, of the 32,525,716 who then lived in England and Wales, 1 in 301.32 people were identified as lunatics. He also explains that thousands of "lunatics" who were discharged from the asylums as recovered by the L ondon C ounty 40 Rentoul, Proposed Sterilization, 7.

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29 C ouncil a county agency responsible for the administration of London's asylums, were readmitted to the asylum, many within a year of their discharge. This, he explains, was verification that asylums were not curing people and that insanity was a danger to society because these individuals were released from the asylum into the general population 41 In the article "Casting Out and Bringing Back in Victorian En gland: Paupe r Lunatics, 1840 70 John Walton argues that asylum patients attempt s to reenter the general public were largely unsuccessful One of the reasons Walton explains was that they had trouble finding jobs. It was much easier, he argues, for the patients to continue working in the jobs they had acquired at the asylum. In addition, when pauper patients in particular attempted to reenter society, they no longer qualified for public assistance of any kind making it difficult for them to establish a foundation u pon which they may have been able to find housing or work. 42 Walton's argument confirms Rentoul's assertion that the asylum system was not working to cure mental illness. Yet, the failure of the asylums was only part of argument he used to support his steri lization idea. Rentoul provides evidence from the Report of the Army Medical Department 1901 as evidence that the British population was degenerating. He explains that the military rejected 21,522 of the 76,750 recruits that year by deeming them unfit In addition, Rentoul indicates that the military later discharged another 1,014 recruits within one year, citing them as unfit as well. Just some of the causes for rejection or discharge 41 Rentoul, Proposed St erilization, 7. 42 Walton, "Casting Out," 142.

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30 include d defective vision, tooth loss or decay, disease of veins, varic ocele, under chest measurement, and malnourishment Each of these criteria for discharge included thousands of recruits which Rentoul argues was a direct result of hereditary degeneration. 43 Nature, Rentoul explained should and would naturally deal with the proble m of degeneration, but he argued society kept nature from running its course. According to Rentoul, left to its own devices, nature would make "unfit" people sterile or make them miscarry if they were to become pregnant. Ad ditionally, he argued that suicide wa s "nature's method" of dealing with lunatics evidenced b y the statistical data he quoted from The Fifty Fifth Report of the Commissioners in Lunacy, 1901. This document indicated that one in four lunatics exhibit ed suicidal t endencies. Yet, Rentoul suggested that through the process of charity and efforts to keep individuals from committing suicide, society was actually working toward "survival of the unfit." 44 Ultimately, Rentoul suggested that the solution to this degeneration problem was to ensure that those deemed unfit wer e unable to reproduce. He wrote "We must recognise that almost every degenerate has been produced by parents who have violated some law of nature." 45 In response, he explained that those who we re likely to produce unfit offspring should not be able to marry. Additionally, anyone who had an hereditary disease should be ster ilized. The cases Rentoul labeled as necessary to sterilize include d 43 Rentoul, Proposed Sterilization, 3. 44 Rentoul, Proposed Sterilization, 6/7. #$ %&'()*+, !"#$#%&' ( )*&"+,+-.*+#/ --.

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31 individuals diagnosed with leprosy, cancer, epilepsy, or advanced organic disease of the heart, lungs, or kidneys as well as anyone medical professionals identified as an idio t imbecil e, cretin lunatic, or weak minded Moreover, he also suggested that individuals with venereal diseases should be sterilized, sexual degenerates should b e sterilized, and prostitutes should be sterilized. 46 These arguments show that Rentoul believed important elements of being British were mental and physical strength and that if individuals exhibited weaknesses in these areas, not only did they not exhibit true British qualities, they also should not procreate, thereby adding to the degeneracy problem. Moreover, much like was the case with the creation of the pauper asylums, Rentoul advocate d service to the state and promoting the common good as an importa nt element of the British ideal. At the very beginning of Proposed Sterilization of Certain Mental and Physical Degenerates, Rentoul provides two quotations from outside sources. The first by Herbert Spencer reads, "To be a good animal is the first requis ite to success in life, and to be a nation of good animals is the first condition to national prosperity." 47 When this quotation is applied to British national identity, it appears that what Rentoul holds as an important element of Britishness is an ability to contribute to "national prosperity." His argument regarding sterilization involves sterilizing any individual who was not able to contribute to society. Rentoul even directly argues this belief in his statement regarding sterilization of prostitutes. He writes, "Children born of such are not 46 Rentoul, Proposed Sterilization, 17. 47 Rentoul, Proposed Sterilization, 1.

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32 likely to be of any benefit to the State." 48 Therefore, if an individual did not have the ability or inclination to benefit the State, in Rentoul's opinion, that individual should not be able to produce offspring wh o, he suggests, would also not benefit the State. Similarly, the second epigraph that Rentoul provides suggests that another important element of Rentoul 's ideal British character was a willingness and ability to prioritize the public health as well as c ontribution to the state. The quote by Lord Beaconsfield states, "The Public Health is the foundation on which repose the happiness of the people and the power of a country. The care of the Public Health is the first duty of a statesman." 49 In the first sen tence of the quotation, Beaconsfield's determination that the public health is the "foundation" suggests that without the public health neither "happiness" nor "power" would be able to exist. Additionally, his statement that "Public Health is the first dut y of a statesman" shows that he believes the role of the British government is to ensure that the foundation upon which the nation's happiness and power resides should be the most important focus of the state. When this statement is paired with Rentoul's c laim regarding sterilization, it suggests that Rentoul believed the supposed degeneration of the British citizenry required intervention on behalf of the state. It also suggests that Rentoul imagined medical men as a type of statesmen who could comment and legislate on the health of the nation. Moreover, the list of credentials that Rentoul provides at the beginning of his book also suggests that he wanted to represent himself as an expert to legitimize his argument about public policy on steriliz ation. Hi s credentials include Doctor of 48 Rentoul Proposed Sterilization, 17. 49 Rentoul, Proposed Sterilization 1.

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33 M edicine ; late member of the General Council of Medical Education for the U.K. ; member of the Royal College of Surgeons, England ; licentiate of the Royal College of Physicians, Edinburgh ; honorary member Manchester Medio Eth ical Association ; author of "Women's Health," "Causes and Treatment of Abortion," and "Medical Charity Reform ; and witness before two House of Commons Committees Upon Death Registration and Midwives Registration. 50 It is unlikely that Rentoul would feel as compelled to provide such an extensive list of his medical experience and expertise if he did not see a need to establish why those who read his proposal should take his opinion seriously. Rentoul 's various articles published in the British Medical Jour nal throughout 1904 as well as his initial Proposed Sterilization of Certain Mental and Physical Degenerates created a great deal of controversy among members of the British medical community. In the years leading up to World War I, the British Medical Jou rnal published a large number of articles and correspondence that both directly and indirectly responded to Rentoul's proposition. These professional conversations reveal what types of people each individual believed belonged in the community of Britishne ss 51 and fears that so called "mental degenerates" would procreate and lead to further degeneracy of the British people. In each argument the biases and values of the writer we re reflected in how he or she defined or imagined the ideal British citizen. The se conversations 50 Rentoul, Proposed Sterilization 51 Kathleen Paul, Whitewashing Britain: Race and Citizenship in the Postwar Era (Ithaca: Cornell University Press, 1997). Paul developed the phrase, "co mmunities of Britishness" in her argument about policymakers understanding of different facets of the British community. I use it here to refer to a larger understanding of the collective British community and ideals associated with that identity.

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34 centered around cognitive and physical abilities, morality, ability to contribute to the State, and individual rights. In the first article published in the British Medical Journal regarding Re n toul's Proposal the author presented some of the main components of Rentoul's a rgument. First, the author showed that Rentoul indicated that the most important problem s facing society were lunacy and mental degeneracy. A dditionally, the author explained that Rentoul believed sterilization would as sist in resolving the problem because the State would not simply allow mental degenerates to commit suicide, nor could the State k ill these individuals. He wrote "as we cannot kill the offspring of unhealthy marriages for these poor degenerates have a p erfect right to live, no matter how their parents have acted, we should prevent them from propagating their degeneracy." 52 While this statement supports Rentoul's belief that mental degenerates did not fit the model of an ideal citizen, it also suggests tha t Rentoul's definition of true Britishness included parenthood. Directly aligning an individual's ability to have children and the perceived need to regulate this ability indicates the salience of parenthood as an element of British life. Therefore, if the State sterilized people who did not fit the ideal those who were sterilized would also not be able to fulfill their duties as procreative citizens, yet another way those labeled "degenerate" would not be able to contribute to society. The author of "A Sho rt Way with Degenerates,'" did offer a caution to the medical community regarding the implementation of ster ilization policies. He explained 52 "A Sho rt Way with Degenerates,'" The British Medical Journal Vol. 1, No. 2254 (Mar. 12, 1904), 625.

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35 that "there is evidently a fine field for the surgeon's knife as an instrument of social reform." 53 According to this author Rentoul suggested that within each County Council there be a Board appointed that would include both a medical expert and an expert in law who would be responsible for determining if the State should sterilize individuals who met a certain se t of criteria Additionally, each county would only have two individuals who would be qualified and licensed to perform sterilization procedures. By providing this kind o f expertise, the author explained "a new order of specialists would be created whose beneficent function in the State could not fail to increase the honor in which the medical profession is already held in this country." This statement shows that if the sterilization proposal were to go into effect in Britain, the medical community would b e serving the larger British community, thereby meeting one of the requirement s of Rentoul's ideal British citizen T he end result for these medical professionals would be increased respect from the community for the ir service. But, he also posits: Are we prepared to rise to the height of Dr. Rentoul's great idea, and accept this noble mission which he seeks to impose upon us? If we do, there will be only one thing left to make our position as saviors of society complete that is, that we be entrusted with the high function of purging the body politic of toxic substances by performing the duties of the public executioner 54 Here the author illustrated both the promise and problem of sterilization. Through the implementation of sterilization policies, med ical men could gain prestige and fulfillment of their own image of an ideal British citizen. On the other hand, the implementation of sterilization policies would also require medical men to participate in actions that may or may not have seemed moral in t he name of the greater good Medical concerns regarding 53 "A Short Way with Degenerates, 626. 54 "A Short Way with Degenerates,'" 626.

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36 the medical ethics involved in sterilization show that morality was an important characteristic of what many people at the time imagined as an ideal British citizen In response to the cautions to hi s proposal published by The British Medical Journal, Rentoul explains the morality behind his proposal and extends his proposal as the most civilized thing the British government could do to address the issue of degeneracy. In the correspondence section fr om The British Medical Journal March, 19, 1904 Rentoul offers that sterilization is actually a natural process that occurs to keep the degenerate from procreating. He explains that many people are born sterile and that this naturally keeps individuals who should not procreat e from contributing to the population. However, he explains that not all degenerates are born sterile as evidenced "by the fact that a large number of female imbeciles are yearly bringing forth illegitimate imbecile infants; and that a l arge number of lunatics are allowed out of asylums, either to marry or to resume conjugal relations." 55 In this instance, he shows that neither the natural process of sterilization nor the segregation of the sexes established by the asylum system sufficient ly ensure d that degenerates would not have children. Therefore, according to Rentoul, the enforce ment of a sterilization policy wa s an important element of dealing with the degeneracy issue. Furthermore, Rentoul explains that sterilization is actually a moral action because the alternatives to sterilization are so immoral. Rentoul argues that some individuals had proposed murdering degenerates in order to ensure that they not be able to procreate. 55 Robert Rentoul, "Proposed Sterilization of Certain Degenerates," The Briti sh Medical Journal Vol. 1, No. 2255 (Mar. 19, 1904), 695.

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37 However, Re n toul writes that this would mean Britain would "sink to the level of the South Sea islanders and become murderers." 56 He also suggests that because the court system would be used to determine which individuals should be sterilized this made the process more just. Finally, he addresses the idea that de generates could be given contraception instead of requiring them to be sterilized. However, he explains that by their very nature degenerates would not actually use contraception with fidelity; therefore, contraception would not actually solve the problem. 57 This statement indicates that not only did Rentoul believe that the most moral option to prevent degeneracy was sterilization, but also that an important element of his definition of Britishness was the ability to control one's sexual desires or at least the outcome of those desires. By arguing that degenerates would be unable to successfully utilize contraception he shows that this inability to control reproduction effectively actually further disqualified degenerates from belonging in the national comm unity Although Rentoul attempted to show that sterilization was the only rational way for dealing with the problem of degeneracy in Britain, one of the most important arguments against sterilization was an inability on behalf of the medical community to scientifically prove that heredity caused mental deficiencies. In a 1906 article from The British Medical Journal entitled, "The Marriage of Epileptics," the author indicates that in the United States the government favored marriage regulations over steri lization as a solution to keep particular individuals from having children. An important element of the 56 Rentoul, Proposed Sterilization of Certain Degenerates ," 695. 57 Rentoul, "Proposed Sterilization of Certain Degenerates," 695.

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38 decision to regulate marriage instead of the reproductive body, the author writes, was the inability to link heredity with mental degeneracy. 58 Edwin Goo dall further explores the idea of linking heredity with mental degeneracy in "An Address on the Hospital Treatment of Curable Cases of Mental Disorder." Goodall argues that there was a need for additional information regarding what he explains is a correla tion between the number of people born to parents with mental deficiency who themselves had mental deficiencies. At most, Goodall explains, some studies showed that there did seem to be a number of people with mental defects who came from families with sim ilar characteristics; but there was not yet enough information pertaining to the number of children who were born to parents with mental defects who did not exhibit any such qualities. 59 Without adequate evidence that mental deficiency was directly passed f rom one generation to the next, many people both in the medical community and throughout Britain refused to fully support sterilization as the response to degeneracy. In "Counting the Degenerates: The Statistics of Race Deterioration," historian Richard S oloway asserts that many British medical professionals continued to rely on their own presuppositions regarding British degeneration even though existing data suggest ed little proof that any actual degeneration took place. Soloway explains that degeneratio n theories were closely linked both with Social Darwinism, the attempt to apply the ideas of natural selection and survival of the fittest to the sociological and 58 "The Marriage of Epileptics, The British Medical Journal Vol 1, No. 2363 (Apr. 14, 1906): 877 878, accessed 4 November 2014, http://www.jstor.org/stable/20289325. 59 Edwin Goodall, "An Address On the Hospital Treatment of C urable Cases of Mental Disorder, The British Medical Journal Vol. 2, No. 2391 (Oct. 27, 19 06): 1084 1086 accessed 4 November 2014, http://www.jstor.org/stable/20291673.

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39 political studies of human population, and what were then newer theories of biological inheri tance including Mendelian genetics and Galton's "law of ancestral inheritance." While many medical authorities, Soloway claims, referenced improved public health including declining mortality rates, especially for children, the most pessimistic of the medi cal professionals continued to cite anecdotal evidence including the British efforts in the Boer War, as proof that degeneration was occurring rapidly. Fears that the British would not be able to maintain their historical dominance continued through the Gr eat War and were only quieted, Soloway argues, by the proliferation of working class use of birth control both during and after the war. Soloway writes, "the debate over deterioration always had more to do with contemporary middle and upper class anxietie s about economic, social, political and cultural change tha[n] it did with quantifiable reality." 60 Rentoul's response to the degeneracy issue and his undeterred adherence to sterilization as the most adequate solution situates Rentoul among the group of pe ssimistic medical professionals Soloway discussed In a November, 1906 article from The American Journal of Sociology Rentoul directly respond ed to the claim that there was not enough information to fully evaluate the role of heredity in mental deficienc y. He expressed agreement with this claim and proposed that asylum administrators did not keep detailed enough records in order to have the kinds of statistical data people want ed regarding mental d eficiency. Yet, Rentoul explained that even if the data di d not exist to show that heredity was a major cause of 60 Richard Soloway, "Counting the Degenerates: The Statistics of Race Det erioration in Edwardian England, Journal of Contemporary History Vol. 17 No. 1 (Jan., 1982): 137 164, a ccessed 9 August 2015, http://www.jstor.org/stable/260448.

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40 degeneracy, degeneracy was still a significant problem and sterilization was still the best option for dealing with it. 61 In order to show that sterilization was the best option for dealing with the de generacy problem, Rentoul offered several alternatives to sterilization and discredit ed each of these options. A s before, one option he mentioned wa s the use of contraceptives. In order to d iscredit this idea, Rentoul asked "Is it likely that lunatics, idiots, epileptics, confirmed criminals, habitual inebriates, and footpads would use such methods?" 62 Rentoul continued to support the position that degenerates would not use contraceptives by the very nature of their degeneracy. In addition, Rentoul offer e d and discredited the idea that degenerates could be imprisoned as an alternative to sterilization. If these individuals were to be imprisoned, Rentoul argued the cost to the State, and therefore the public would be exorbitant. He wrote "In one year only over £1 8,ooo,ooo were expended in the up keep of degenerates in the United Kingdom, and, if all degenerates were immured, I have calculated that at least £ 5o,ooo,ooo annually would be required. Such a sum would cause a public revolt of the already overbur dened taxpayers. 63 As in the arguments regarding asylums at the end of the nineteenth century, the amount of money taxpayers would need to pay to ensure that mental degenerates would be kept in a State funded facility would be too great to earn their suppo rt Additionally, Rentoul 61 Robert R. Rentoul, "Proposed Sterilization of Certain Mental Degen erates, The British Medical Journal Vol. 2, No. 2387 (Sep. 29, 1906): 765, accessed 4 November 2014, http://www.jstor.org/stable /20291303. 62 Rentoul "Proposed Sterilization," (1906), 324. 63 Rentoul "Proposed Sterilization," (1906), 324.

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41 explained that encouraging suicide would only deal with the problem in the immediate time and would not prevent the problem in the future Moreover, Rentoul did not believe that State issued marriage certificates would have any ef fect on the state of national degeneracy because so many children were born out of wedlock in the first place. 64 The only option in dealing with deficiency that Rent ou l did not discredit wa s sterilization because he believed it to be the best option for ad dressing the issue of degeneracy. Rentoul a rgued that one important criticism of sterilization was that it violated the rights of the individual. These rights were an important element of the British ideal. As Desmond King explains, although according to liberal idea l s rights should be extended eq ually to all individuals in society in both Britain and the United States, placing restrictions on those rights has been pervasive while, he writes, "the breaking of such restrictions is a feature of American an d British political development." 65 Similarly, Colley argued that although Britain had been one of the most democratic nations in Europe leading up to 1865, it did not maintain that status. She explained that by European standards, Britain actually became o ne of the least democratic nations up to World War I as indicated by the fact that the British State did not extend universal manhood suffrage nor offer any British women the vote until after World War I. 66 While Rentoul acknowledged the importance of indiv idual rights and that sterilization of certain individuals might violate those rights, he advo cated for sterilization as an opportunity to 64 Rentoul "Proposed Sterilization, (1906), 32 4 65 Desmond King, In the Name of Liberalism: Illiberal Social Policy in the USA and Britain ( Ox ford: Oxf ord University Press, 1999), 12/ 13. 66 Colley, Britons, 356.

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4 2 protect future generations Rentoul wr ote "I plead on behalf of the unborn, of the infants and children of the futur e the coming race and against our present Christian custom of stamping the unoffending child with a mental defect which will prevent it from being a useful citizen. What right have we to ruin absolutely the children's chances in life? None whatever." 67 In this statement, Rentoul shows that he believed that the most important element of being British was the ability to contribute to society He also suggests that if the State allow ed degenerates to procreate, even if this would support their individual rights it would potentially produce individuals who would be unlikely of obtaining the most important characteristic of a British citizen. In his ardent support for sterilization, Rentoul demonstrated his belief that the common good outweighed individual rights and that the role of the medical professional in such a situation was to protect the common good. 67 Rentoul "Proposed Sterilization," (1906), 324 325.

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43 CHAPTER I V EARLY TWENTIETH CENTURY MENTAL HEALTH CARE While the first part of the twentieth century involved a great deal of change in the care and treatment of mental illness, approaches remained largely ineffective. As Scull indicates, one of the biggest changes in the treatment of the insane was Sigmund Freud's psychoanalysis. Scull explains that British psychologists did not adhere to the notion that the libido was the primary cause of mental illness although they accepted that sex could play a part in the development of mental illness. Freud's theories, Scull argues, posed a particular challenge to British psychologists because they removed the s eparation of mental illness and class. Whereas many had believed that mental illness was a particular problem among the poor, Freud's notion suggest ed that mental illness could be housed within all elements of society. 68 In the end, although mental illness became a more accepted field of medical study in the early twentieth century, it remained relatively new and largely misunderstood. State records of asylums reflect an overarching lack of understanding regarding mental health among people of the medical c ommunity. Lunacy in London (November 10, 1906) a periodic check in on London's asylum system, directs attention to the numbers of individuals in asylums as well as continued investigation of asylum patients. According to this British Medical Journal art icle, the asylums noted a diminishing rate of increase in patients that call ed into question the existence of a "degeneracy problem." Almost six years later, F. W. Mott also call ed into question the validity of the data regarding the number of asylum patie nts I n his article "A Lecture on Sanity and 68 Scull, Madness, 73 77.

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44 Insanity published in The British Medical Journal. He explains that the rising number of insane individuals was actually "more apparent than real." Over time, Mott argues, the medical community had become bett er at identifying and keeping record of the number of insane people and the number of deaths overall had decreased. Therefore, the instances of insanity were probably not much higher than they once were. Moreover, Mott reminds the medical community that th e year of the publication of the article, 1912, was actually one of the first years in which universities offered D octor of Public Health diplomas in medical psychology. Thus, a level of expertise in the field of mental health was quite new in 1912. 69 In bo th the understanding of the number of individuals housed in asylums as well as the educational opportunities offered to medical professionals seeking to better understand mental health the level of understanding suggests that mental health remained a flui d a rea of medical expertise. Meanwhile, the inability of medical experts to show that heredity was the primary cause of mental degeneracy created a substantial debate regarding morality. The British Medical Journal published an article August 24, 1912 in which the author refers to a Mental Deficient Bill, which likely referred to the bill that later bec a me The Mental Deficiency Act of 1913. The Act established four classes of individuals who could qualify as mentally deficient idiot, imbecile, feeble min ded, and moral defective. The Lunacy Commission thus had the responsibility, under the directive of the Act, of 69 Lunacy in London, The British Medical Journal Vol. 2, No. 2393 (Nov. 10, 1906), 1311 1312.

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45 identifying and determining the best course of treatment for each individual. 70 According to the article, the Catholic Church spoke out against t he Mental Deficien cy Bill citing the bill as immoral. The morality the article called into question was the morality of the "unsexing" mentally deficient people through medical alteration of the reproductive system. H owever, the BMJ author explains that t he bill did not deal directly with sterilization ; therefore it was unfair to cri ticize the bill for that reason even if sterilization could be considered immoral. 71 In addition, the BMJ article suggests that to disregard the need to regulate the procreativ e capacities the mental ly deficient in Britain was less moral. One argument the author uses to support the Mental Deficiency Bill is to assert his opposition to the use of asylums as institutions for the mentally deficient. Asylums, the author explains, we re not much different from prisons. Additionally, at least in prison, the author notes, people are aware of the crimes they had committed that caused them to be incarcerated ; in the case of the mentally deficient, the author argues, they do not necessari ly understand the actions that had led to the impending consequence of "compulsory permanent control" that the asylums established. 72 Near the end of the article, the author included a section regarding a movement on behalf of a group of people called "euge nists." This was one of the earliest mentions of eugenists in the BMJ articles regarding the mentally defective 70 Mean wood Park Hospital, The Mental Deficiency Act 1913, accessed 15 March 2016, http://www.meanwoodpark.co.uk/a resource/the mental deficiency act 1913/. /! "Mental Deficients and t he Community, The British Medical Journal Vol. 2, No 2695 (Aug. 24, 1912), 4 50 451 72 "Mental Deficients The British Medical Journal, 450 451

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46 and sterilization. In defense of the Mental Deficiency Bill and eugenists, the BMJ author write s "The eugenists are to day mainly searching for fuller knowledge, and to instill the idea of a newer and wider evolutional morality namely, that in our duty to our neighbour we must henceforth include our duty to posterity." 73 This statement demonstrates that this author supported a type of morality t hat placed the common good above the individual. In addition, it also suggests that legislating for the common good would ultimately be the most positive thing for individuals as well who would then not be placed in prison like institutions without full c omprehension of their crimes. Doctor Alex Mooney respon d e d to the BMJ article discredit ing the eugenists comment as a feigned version of morality and suggest ing that true morality had not yet been a center of conversation in the question of mentally de ficiency. He writes: the elimination of mentally defective children will be effected, not by confining mentally defective people in institutions, but by remedying those defects in our social organization that breed poverty, disease, and unhealthy living. It will be effected by raising the morality of the race, by a recognition of the evil of sin. It will be effected by the recognition of the obligations of justice and charity imposed by Divine law, and forgotten by so many people for whom this life is the beginning and the end of all things, and who, logically enough, endeavor to have all those things which afford them pleasure, and give them what they call a good time' on earth. 74 This shows that Mooney believed morality was grounded in a religious unders tanding of moral behavior. He also suggests that the most effective response, the most moral response, to the problem of the mentally defective would be to address the circumstances that exist within society that may have actually been contributing to the large number of 73 Mental Deficients ," 451 74 Alex. P. Mooney, Mental Deficients and t he Community, The British Medical Journal Vol. 2, No. 2696 (Aug. 31, 1912), accessed 23 October 2014, http://ww w.jstor.org/stable/25298430. 521.

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47 people housed in asylums. He claims that situations like "poverty, disease, and unhealthy living," or environmental causes, may have been greater causes or contributors to mental defect than heredity and that until people were willing to ad dress those conditions, then the issue would likely continue to exist. Moreover, Mooney explains that the suggestion that the Act did not address sterilization was false. He states that it was the first time the purpose of an Act had been to prevent procre ation and that it really was just eugenist propaganda shrouded in moral rhetoric. 75 Mooney 's argument shows that his version of morality entailed the treatment of the social root of the problem, not simply treating the supposed biological symptoms. In 1913 the State passed The Mental Deficiency Bill which was specifically directed at criminals The bill included both criminals who did not understand their circumstances and mentally defective individuals with a prop ensity for crime. It established the rule of law concluding that individuals who exhibit ed criminal behavior could be placed in the care of mental institutions. Not only d id it directly establish a connection between mentally deficient people and criminal behavior, it also suggest ed that many peo ple believed the mentally defective and criminals were not exclusive groups of people but rather could actually be the same. By linking crime and mental deficiency, medical experts and political leaders suggested that it could be possible to regulate or er adicate crime through sterilization. The debate over morality suggests that stakeholders in mental illness did not agree on a prioritized list of proper British morality. Yet, it also suggests that both groups of people imagined morality as a key feature o f true Britishness. 75 Mooney, "Mental Deficients," 520 521.

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48 In the years just prior to the First World War, the articles regarding mental deficiencies included in The British Medical Journal focused on eugenics and the desire on behalf of many members of the medical community to prove unequivo cally that heredity was a significant cause of degeneracy. Just one month prior to the publication of Mooney's response, t he First International Eugenics Congress was held in London. The British Medical Journal published an article in the week following th e Congress, highlighting the key speakers and events. One speaker, Professor Punnett, indicated that feeble mindedness was easily assigned to heredity reasoning that if at least one parent had a mental deficiency then the child would likely have a similar deficiency. He claimed, "There was every reason to expect that a policy of strict segregation would rapidly bring about the elimination of this character." 76 Dr. Mott discussed his findings from research on 20,000 individuals in the London County Asylums. According to Mott, of the 20,000 he studied, 715 were either parents and their children or siblings of one another. The only conclusion he was able to make from his study was that it did appear more likely to have a child with some kind of mental deficienc y if both parents of that child had a mental deficiency. He argue d that at the time further study was required in order to understand the role of heredity in degeneracy. 77 Yet, the articles suggest that the desire to directly link heredity and insanity as w ell as mental deficien cy persisted Yet, even with the eugenics movement 's demand to prove the hereditary influence in degeneracy, Mott and others in the medical community questioned the validity of the 76 "First International Eugenics Congress The British Medical Journal Vol. 2, No. 2692 (Aug. 3, 1912): 254, accessed 4 November 2014, http://www.jstor.org/stable/25298080. 77 First International Eugenics Congress ," The British Medical Journal, 253 255

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49 perceived benefit of removing certain individuals f rom the British gene pool In a November, 1912 issue of The British Medical Journal an author further addresse d Mott's claims regarding heredity and insanity. According to the article, Mott claimed the science did not support a conclusion that heredity di rectly causes insanity, but rather that indiv id uals have a greater tendency toward insanity based on their heredity. Instead, Mott offered an alternative to heredity. "Dr. Mott adds as an important in many instances, perhaps, the only cause, the enforced s uppression by modern social conditions of the reproductive functions and the maternal instincts in women an emotional t emperament a nd mental instability." Therefore, solutions like segregation of the insane or sterilization of the insane would have little to no impact on the degeneracy problem as they would not necessarily address the cause of the situation. The article claims that based on Mott's assertions: We have no right, he states emphatically, to say that because a parent is insane the children mus t necessarily be insane or useless to the race. This should be a warning to the eugenists not to allow themselves to be carried too far by their zeal for the betterment of the race, or there is a chance of their reducing mankind to a dead level of dull med iocrity. In rooting up the weeds they run the risk of destroying the flowers. 78 Essentially, this warning explains that Mott's findings show ed that family did not necessarily determine the success of the individual State legislation of procreation of the unfit could eliminate potentially productive members of society whose parent(s) may or may not have had an hereditary mental defect 78 "Heredity in Relation to Insanity, The British Medical Journal Vol. 2, No. 2705 (Nov. 2, 1912): 1237, accessed 23 October 2014, http://www.jstor.org/stable/25299207.

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50 Mott does suggest that instead of addressing the elimination of certain individuals from the popul a tion, a more effective solution to the population problem would be to focus on the addition of individuals with desirable qualities At the end of the BMJ article, the author quotes Mott as saying: When hereditary health as shown by longevity, fertility, and mental stability in a stock is regarded as a greater set for happiness in the family and the nation than hereditary wealth, then will be the time for the rich and comparatively prosperous to suggest the desirability of sterilization of the pauper imbecile and insane. For n o one supposes that it would be carried out in all classes. 79 In sum, this author concluded that the medical community should focus its attention on the conditions that allow ed people to live longer, have more children, and be more mentally stable and valu e those qualities over wealth maintained within a single class. Moreover, it also demonstrates an unspoken understanding that the proposed sterilizations that had then been discussed since Rentoul's initial proposal in 1903 would be limited to working clas s British citizens. Medical efforts to prove the link between heredity and disease were not limited to insanity. In Medicine and Eugenics, John Cowper includes a number of studies that were being conducted in 1913 to demonstrate the relationship between heredity and disease. Only in the final part of his article does Cowper address the issue of defectives and deficiency. In Cowper's opinion, the term degenerate applied to criminals, lunatics, the feeble minded, epileptics, alcoholics, and other neurotic d egenerates. Cowper agrees that degeneracy was an important problem facing the British population and argues that the government should intervene to gain the greatest degree of understanding regarding such a problem. He provides evidence that o ne of the doc tors from Banstead, one of London's 79 Heredity i n Relation to Insanity ," The British Medical Journal 1238

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51 pauper asylums, indicated that there was not enough existing data to truly analyze the role of heredity in degeneracy. Cowper argues that the government should request and support additional statistical study of the asyl um population in an effort to better understand and respond to the population struggle in Britain. 80 However, what Cowper and other medical professionals interested in the British population problem did not know was that Britain would soon face a large blo w to the overall population. In 1914, Britain entered World War I resulting in a dramatic decline in Britain's population. Following the war, Britain experienced an influenza pandemic which only exacerbated the population problem During the period from 1914 to 1918, Britain incurred a loss of between approximately 723,000 and 885,000 military personnel. Estimations of civilian losses are around 100,000. In addition to the lives lost during the war, from June 1918 to May of 1919 the general population was hit with a n approximate loss of 152,000 people to influe nza in England and Wales alone. 81 During this period, there was a marked absence of articles in the BMJ pertaining to sterilization or degeneracy. These conversation s did not recommence until 1922. 80 John Cowper, Medicine and Eugenics, The British Medical Journal Vol. 2, No. 2742 (Jul. 19, 1913), 115 118. 81 J.M. Winter, "Britain's Lost Generation' of the First World War," in Population Statistics, Vol. 31 No. 3 (Nov., 1977), 449 466. Dmitri Jdanov, et al., "Estimates of Mortality and Population Changes in England and Wales Over the Two World Wars," in Demographic Research, Vol. 13 (Nov. 17, 2005), 389 414. Nadege Mougel, "World War I Ca sualties," trans. Julie Gratz, last modified 2011, http://www.centre robert schuman.org/userfiles/files/REPERES%20 %20module%201 1 1%20 %20explanatory%20notes%20 %20World%20War%20I%20casualties%20 %20EN.pdf

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52 CHAPTER V A EUGENIC MOVEMENT: THE UNFIT AFTER WORLD WAR I In the period following the end of World War I, many medical professionals continued to attempt to show that any perceived degeneracy was a direct result of a family history of degeneracy. During t his period, it also became increasingly difficult to advocate for policies that would limit procreation because of the number of los s es incurred as a result of the war. As Winter explains, the perception among the British population was that the majority o f men who lost their lives during the war came from the ruling class. Additionally, due to the number of losses, many women in Britain were left without marriageable prospects, especially women from the ruling class. 82 In this demographic environment, those who sought to advocate for contraception and other procreative limitations, faced a great deal of controversy. Yet, medical professionals were determined to find a clear link between heredity and mental illness as well as other forms of degeneracy These included criminal activity and sexual misconduct. According to R.A. Gibbons, a gynecologist at the Grosvenor Hospital for Women, both environment and heredity played an important role in the growing number of individuals labeled as insane in Britain. Gib bons' gender marks a distinct difference in the conversation, in that women had not published articles in the BMJ regarding procreation, heredity, and the unfit. Opportunities for women in the medical profession expanded at the beginning of the twentieth c entury and the British government even enfranchised some women following the end of World War I. Gibbons explain ed that the 82 Winter, "Britain's Lost Generation,'" 449 466

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53 greater cause of these cases of insanity was heredity. 83 Alternately, Robert Hutchison argue d that while heredity certainly played a part in the cause of some mental defects, he did not note a strong enough correlation between heredity and mental defect to suggest that heredity was the main cause of such ailments. 84 G. A rchdall Reid 's conclusions correspond ed with Hutchison's. He argue d that while there was a great deal of evidence to suggest th at individuals inherit qualities such as eye color and hair color from their families, there was limited evidence suggesting that heredity play ed as strong a role in th e inheritance of mental def ect s 85 These conclusions were also supported by evidence from the United States, where W. Arnott Dickson indicate d that sterilizations were already occurring with little to no effect on the resulting rate of mental defect s among the population. 86 In their quest to demonstrate th at heredity was the primary cause of degeneracy, most medical professionals were limited to concluding that at most there was a correlation between heredity and degeneracy, not a direct causal link. Even though the medical communit y struggled to provide scientific evidence sufficient to prove that heredity was the primary cause of mental deficiency, many 83 William A Potts, et al., "Discussion On Mental Deficiency in Its Social Aspects, The British Medical Journal Vol. 2, No. 3267 (Aug. 11, 1923): 219 234 a ccessed 21 October 2014. 84 Robert Hutchison, J. S. Pearse and J. H. Garrett, The British Medic al Journal, Vol. 2, No. 3220 (Sep. 16, 1922), pp. 531 532. 85 G. Archdall Reid, "Sterilization of Mental Defectives," The British Medical Journal Vol. 2, No. 3221 (Sep. 23, 1922): 579 580, accessed 23 October 2014, http://www.jstor.org/stable/20421176. 86 W. Arnott Dickson and L. Margaret Lister, "Sterilization of Mental Defectives," The British Medical Journal Vol. 2, No. 3215 (Aug. 12, 1922): 285, accessed 23 October 2014, http://www.jstor.org/stable/20420815.

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54 medical professionals continued to defend the role of heredity using empirical evidence. For example, L Margaret Lister referred to her time as a medical officer during which she was able to visit a number of schools. She explain ed that each time she visited a school she typically encountered at least one student with a mental defect. In one anecdote she writes, "In one school I had a mentally defective boy of 13 years of age. He could learn nothing and could not even speak intelligibly. His mother came to me complaining bitterly that it was hard that he could not leave school to go to work. She did not in the least realize that he w as mentally defective, because she said, When I was at school I could never learn anything myself.' 87 Lister's assessment of the situation was that it was clear that the boy had inherited his defect. Similarly, George Riddell also refers to case studies i nvolving mental defects to support his claim about the role of heredity. One story he provides is of a woman who was accused of killing her baby. He indicates that she had a very bad family history in which many of her relatives had committed suicide sugge sting that she had inherited the mental problem. Additionally, he reports that in one ci rcumstance he witnessed a three week old child who had been living in appalling conditions. Riddell explains that both parents of the child were mentally deficient. Mor eover, he indicates that the parents had a total of eleven children of which four were in mental homes, two had died previously, and another was found dead in the home. In this case, Riddell argues that not only were the parents the cause of the mental def ect, but also, it was clear from the situation that these mentally defective adults made 87 Dickson and Lister, "Sterilization," 285.

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55 poor parents who were unable to properly care for their children. 88 Although it unclear why there was a strong desire among members of the medical community to prove th at heredity was the primary cause of mental defect this desire may have been due to the prevalence of Darwinian theory in European medical thought or even an impulse to show that medical professionals maintained their authority over understandings of the body and heredity. However, a necdotal and empirical evidence suggested the same findings as the medical science at the time there was clearly a link between heredity and deficiency, but possibly only a tendency. One argument that was new to the mental deficiency/sterilization discourse following World War I was a fear that if the government were to legislate the reproductive abilities of those individuals who were identified as mentally defective, they could also actually contribute to population degene racy. James R. Whitwell provide d findings from a particular study conducted in Denmark. Whitwell explain ed that while the study found that heredity was a cause of mental defect, it also found a large number of individuals who were born to families in which mental deficiency had been a problem who had actually made astonishing contributions to society. He writes: These same forty four families, however, also produced two cabinet ministers, one ambassador, three bishops, eight prominent clergymen, three gene rals, several other military officers, three admirals, several other high naval officers, three members of the High Court of Justice, two headmasters, two directors of well known institutions, eight hospital physicians, nine university professors, at least twenty three holders of academic doctorates, and a large number of eminent 88 George Allardice Riddell, Baron 1865 1934, Medico Legal Problems ( London: H.K. Lewis and Co. Ltd., 1929 ), 77 78

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56 officials, business men, members of Parliament, physicians, teacher, and others of value to the community. 89 This statement created some controversy among members of the medical co mmunity who directly responded. In one response, Norman Haire explains that it did not matter that some successful individuals came from families with mental defects because, in his opinion, the consequences of defect far outweigh ed the contributions of th ose individuals. 90 In another response, Reid argues that it did not really matter if individuals with titles resulted from family lines containing "idiocy." He writes, "Idiocy may be latent even in these exalted personages. Moreover, dignity of that sort do es not usually imply genius, but, as a rule, only a golden spoon." 91 Reid's argument indicates a skepticism both that degeneracy necessarily resulted from heredity and that positions of authority or success necessarily resulted from intelligence, skill, or merit. In both cases, this statement directly challenges the position that heredity was the primary cause of degeneracy and expresses fear of the loss to society that may take place from sterilizing individuals who some believed were likely to give birth t o degenerated offspring. 89 James R. Whitwell Claude A P. Truman and P. Broome Giles, "Ste rilization of Mental Defectives, The British Medical Journal Vol. 2, N o. 3210 (Jul. 8, 1922): 64, a ccessed 23 October 2014, http://www.jstor.org/stable/20420511. 90 Norman Haire, "Sterilization of Mental Defectives, The British Medical Journal Vol. 2 No. 3216 (Aug. 19, 1922): 328, a ccessed 23 October 2014. http://www.jsto r.org/stable/20420874. 91 G. Archdall Reid, "Sterilization of Mental Defectives, The British Medical Journal Vol. 2, No. 3217 (Aug. 26, 1922): 401, a ccessed 23 Oct ober 2014, http://www.jstor.org/stable/20420947.

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57 Moreover, arguments about sterilization following World War I were also different from the arguments that occurred prior to World War I because they directly incorporated issues regarding masculinity. Medical professionals cited c ases of shell shock as one indicator of British degeneracy following World War I. They explained that men who suffered from shell shock did not exhibit the strength required of British masculinity, thereby showing their degeneracy. Ward explained that in t he period leading up to WWI, Br itish masculinity was defined by the "conquest, extension and defence of the Greater Britain' of the Empire." 92 According to Joanna Bourke, by the end of World War I, the British Army had addressed over 80,000 cases of shell shock that resulted from the experience of the war. Bourke explains that symptoms included hallucination like events involving individuals imagining war scenes while in situations completely removed from the war both in time and space as well as phantom pa ins in various body parts when an individual had killed an enemy by causing harm in the same bodily location. 93 These symptoms showed a kind of weakness that defied expectations of masculinity. In Martin Stone's, "Shellshock and the Psychologists," he expl ains that cases of shell shock both during and after World War I posed a particular threat to the mental health world because they identified nonphysical indicators for mental health issues Doctors examined brains of those who had suffered from shell shoc k and did not find 92 Ward, Britishness, 38. 93 Joanna Bourke "Shell Shock During World War I, BBC, updated 10 March 2011 http://www.bbc.co.uk/history/worldwars/wwone/shellshock_01.shtm a ccessed 8 January 2016.

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58 physical indicators that the disease existed in such a form A dditionally, they identified a problem in mental health at a period when they were attempting to link the hereditary causes of the disease and those who ended up with shell sh ock got it as a result of their experience in the war clearly identifying environmental or conditional causes, not heredity Some medical professionals continued to support the idea that shell shock was simply an indicator of a greater issue of inherited degeneracy Stone describes one military officer C.S. Myers who argued that shell shock patients should be locked up in asylums or even court martialed and shot for shirking their duties both as members of the military and as men. These cases, Stone explai ns, caused some medical professionals to conclude that patients who appeared to have symptoms of shell shock were actually faking their ailments. To some, Stone argues, these behaviors, both the shell shock itself and the supposed feigning of its symptoms, also cause d many to call into question shell shock patients' masculinity. Yet, the questioning of the individual's masculinity was at odds with the fact that a vast number of shell shock patients were military officers who had volunteered for their servic e. 94 Medical professionals in The British Medical Journal also debated the implications cases of shell shock posed to society P. Broome Giles, who was a physician for over fifty one years, had worked in county hospitals with mental cases and acted as a c ommandant of two military convalescent hospitals during the war, expressed in the British Medical Journal that not only did he believe that "no mental deficient 94 Martin Stone, "S hellshock and the Psychologists," i n The Anatomy of Madness: Essays in the History o f Psychiatry, eds. W.F. Bynum, Roy Porter, and Michael Shepherd, 242 271 ( London: Tavistock Publications, 1985 )

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59 should by law be allowed to be a parent," but also that "so called shell shock could often be t raced to family mental weakness" and that taxpayer money should not be wasted attempting to treat cases of shell shock. 95 Similarly, William A. Potts explains that some of the cases of shell shock that occurred during the war involved individuals who could be labeled as mentally defective. As such, Potts argues that these cases should not receive treatment from the government If the government were to offer treatment, then that treatment would be ineffective due to the fact that these people were mentally d efective and the cost would place an unnecessary burden upon taxpayers and the government. 96 In both arguments the inclusion of shell shock cases in debates about the proper treatment of defective s suggests that some medical professionals questioned both t he validity of shell shock as an actual malady and also questioned the masculinity of men diagnosed with shell shock. This allowed them to group shell shock victims from the war with other groups marked as "deficient" and disqualify them as truly British. M any of the arguments regarding deficiency found in the British Medical Journal in the decade following World War I identif ied additional negative qualities and behaviors that many believed coincided with mental deficiency. McCandless described the associ ations medical professionals made between a variety of behaviors and insanity as part of his argument about wrongful confinement of individuals. He asserted that doctors often had subjective standards of insanity and explains that that subjectivity could l ead to wrongful confinement in asylums. McCandless wrote "it can hardly be surprising 95 Whitwell, et al., "Sterilization," 64 65, quote page 65. 96 Potts, et al., "Discussion," 219 234.

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60 that they [medical professionals] frequently confused insanity with immorality and other forms of nonconformity." 97 One of the behaviors often cited in The British Medica l Journal as an indicator of defying British ideals was a voracious sexual appetite. In a review of A. F. Tredgold's book, Mental Deficiency, the reviewer cited Tredgold's statement that one way mentally deficient people threatened society w as their "rate of propagation." 98 Similarly, R.A. Gibbons wrote "It is extraordinary how prolifi c these mental defectives are." 99 Both statements suggest that some medical professionals thought that birthrates among mentally deficient people were higher than birthrates am ong the general population indicating an unchecked sexual drive. Gibbons continued "Dr. Barr states that the sexual impulses are over exaggerated, and they reproduce their kind from two to six times more rapidly than normal people." 100 Arguments regarding increased sexual expression among the mentally defective are also identified in references to statements found in the BMJ that segregating the mentally defective population would result in decreased problems related to both prostitution and venereal diseas e. 101 From the way s each of these professionals discusses hyper sexuality they 97 McCandless, Wrongful Confinement, 350 35 1. 98 Review: Mental Deficiency, The British Medical Journal Vol. 1, No. 3242 (Feb. 17, 1923): 291 a ccessed 17 November 2015. 99 R. A. Gibbons, "Sterilization of The Unfit." The British Medical Journal Vol. 1, No. 3253 (May 5, 1923): 756, accessed 23 October 2014, http://www.jstor.org/stable/20423318 100 Gibbons "Sterilization of the Unfit," 756. 101 "The Social Aspects of Mental Defect, The British Medical Journal Vol. 2, No. 3267 (Aug. 11, 1923): 249 250, accessed 23 October 2014, http://www.jstor .org/stable/20424277.

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61 associated with mentally defective people they reveal a shared belief that to be able to control one s sexual desires was a characteristic they valued in British citizenry. In add ition, because mentally defective people could not control these desires, in their professional opinions, defectives posed a threat to British society. They, in fact, were not "normal." Yet, sexual desire and expression were not the only fears regarding t he mentally defective and the threat defectives posed to society Additional claims regarding indecency among the mentally defective include d both alcoholism and criminal behavior. In "The Social Aspects of Mental Defect the author suggests that removing mentally defective people from society both by segregation and sterilization would result in fewer cases of "inebriety, prostitution, pauperism, and crime." 102 Similarly, William A. Potts identifie d alcoholism as a character istic present in many mentally de fective individuals and that although mental defect and alcoholism do not exist in a purely cause and effect relationship he explains, alcoholism "often claims as victims men and women whose judgment and self control are so poorly developed as to constitut e a form of feeble mindedness." 103 For this reason, both Potts and Henry Devine argue that the mentally defective should be segregated in institutions. 104 Proof of mental deficiency alone was not enough for medical professionals to convince government officia ls or the public that 102 The Social Aspects of Mental Defect ," The British Medical Journal, 249. 103 William A. Potts, et al, "Discussion On Mental Deficiency in Its Social Aspects, The British Medical Journal Vol. 2, No. 3267 (Aug. 11, 1923): 219 234 a ccessed 21 October 2014. 104 Potts, et al., "Discussion," 219 234.

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62 mentally deficient individuals did not belong in the general population and should not procreate. In order to bolster their arguments, medical professionals not only broa dened the definition of mental deficiency they also provided ev idence that beyond the fear that mentally deficient people would reproduce they presented additional challenges to society. While there was some agreement among medical professionals that mentally defective individuals posed a particular threat to the Brit ish population in the decade following World War I, medical professionals did not necessarily agree on the proper treatment of these individuals. By the time of the F irst World War, asylums had increased to such alarming numbers that, Showalter explains, t hey could no longer be seen as the familial place of respite for the insane. Instead, they became increasingly jail like in nature where the need for control and management outweighed the desire for clinical treatment. 105 Prior to World War I, a great deal of the conversations that took place among medical professionals regarding the treatment of the mentally defective involved the solution to sterilize such individuals. However, in the years following the war, sterilization no longer occupied the same domin ance in these professional conversations and was replaced with other solutions. One reason that sterilization seems to have gone away as the primary solution is that it remained difficult to scientifically prove that heredity was a direct cause of mental d efect even though eugenic minded groups focused on proving hereditary cause s Additionally, some medical professionals continued to argue that sterilization was not morally correct. Potts writes, "If defectives have a right to 105 Showalter, The Female Malady, 50.

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63 live, they have a right to li ve as unmutilated individuals," indicating his belief that British society could not morally/ethically choose to alter the body of another individual. 106 Another reason was that with the arguments regarding additional undesirable characteristics associated with mental defect, many believed that sterilization would not adequately resolve the problem of the mental ly defective. For example, Parry, explains in his 1927 article, The Problem of Mental Deficiency that while sterilization may attempt to regulate the ability of the mentally defective to have children, it would not address their promiscuous behavior which would allow mentally defective people to continue to contribute to sexual offenses as well as cases of venereal disease. In reference to steriliza tion he writes: It does not make the defective criminal into an honest man. It does not make the unemployable ament into a useful citizen. It does not make the immoral feeble minded into a moral being. It does not enable the pauper or vagrant defective to earn his own living. 107 This not only shows that Parry did not believe that sterilization would resolve the problem of the mentally defective, it also identifies Parry's perspective on true Britishness and his understanding that the mentally defective could not meet these qualities. According to Parry, true British characteristics included honesty, usefulness, morality, and the ability to work for a living. 108 Due to the fact that these characteristics became so closely identified with how to cure the mentally defective, sterilization could no longer be the primary proposal for addressing the those cures 106 Potts, et al., "Discussion," 221. 107 Parry, The Proble m," 1166. 108 Parry, "The Problem," 1166.

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64 While sterilization no longer seemed like a viable solution, Parry, and others like him, offered segregation of the mentally defective as a more effective re sponse. Parry argue d that placing mentally defective people into institutions would remove any potential harm that these individuals could cause to society. In addition, he also argue d that the mentally defective would actually be happier in institutions w here they can be "anti social" as he claims is in their nature to be. Similarly, Devine argue d that segregation would actually be a two fold solution in that it would achieve "[t]he prevention of delinquency, vagrancy, prostitution, etc." as well as ensure that mentally defective people would not produce "inferior children." 109 One of the problems with segregation Devine identifies is that under the system that existed in Britain in the 1920s, segregation was limited to the people who diagnosed with the worst kind s of mental defect s who were also the individuals that were least likely to have children among the mentally defective. Devine argues that the State should extend segregation for all people labeled as defective as a means of "prevent[ing] in some degr ee the propagation of the unfit." 110 While the application of the idea of segregation was broader in the 1920s than efforts to segregate the mental ly deficient in the nineteenth and early twentieth centuries, both solutions could achieve the same desired eff ect of eliminating the mentally defective from the reproducing population. Medical professionals also offered State regulation of marriage certificates as an alternative to sterilization in the post war years. In "Sterilization of Mental Defectives" 109 Potts, et al., "Discussion," 224. 110 Potts, et al., "Discussion," 225.

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65 (1922 ), Gibbons advocates the use of marriage certificates in addition to sterilization. Gibbons suggests that while anyone who could potentially have child with a mental defect as a result of hereditary factors, the State should only offer marriage certificate s in situations in which the couple would not be likely to have a child with a mental defect as a result of hereditary factors. In the following year, Gibbons continued to argue for marriage certificates as a regulatory policy as it would "prevent the unio n of those with strong tendencies to insanity on either side, or those who showed signs of mental weakness, for they cannot be cured, and their offspring are defective." 111 This reflects a belief that procreation necessarily resulted from marriage unions and that if British society could properly regulate who could and could not obtain marriage certificates, it could also regulate who could reproduce. Th r ough this regulation of marriage then, procreation could also be limited even in cases where sterilization may or may not have been carried out. Similarly, Norman Haire reiterates the same argument regarding the regulation of marriage certificates for the mentally defective in his book, Hymen: Or the Future of Marriage. H e explains that society fully suppor ted the idea of regulating marriage in situations where incest could occur because society perceived harm that could result from such marriages However, he argues that marriages involving the mentally defective would result in greater harm to society by p roducing "unfit" children ; yet, the public was not equally interested in regulating marriage of mental defectives. Haire suggests that while many individuals claim that marriage certificates and sterilization challenge British 111 Gibbons "Sterilization of the Unfit," 756.

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66 morals, he believes that allo wing individuals with illnesses, including mental defects, to marry and reproduce is actually more morally questionable and, in his opinion: P hysically or mentally defective children are of no use to Society they are indeed a burden to it, both in times of peace and in times of war. They are often not only unproductive they actually handicap the progress of useful citizens by competing with them in the struggle for existence; and indeed, with our modern extreme humanitarianism, we often pamper the weed t o the detriment of the useful plant. 112 Haire frames his argument in direct conjunction with his vision of true Britishness. He supports marriage certificates and sterilization in cases of mental defect because he acknowledges that this particular group of people do not fit his vision of British character. Therefore, not only could these individuals not fit into British society, they would actually place a burden upon the rest of society. Much like Haire's support of marriage certificates and sterilization Marie Carmichael Stopes advocated the use of contraceptives as an option for addressing procreation among elements of British society that she argued posed a danger to the nation Stopes was an expert in both palaeobotany and philosophy who became a voca l advocate for the use of contraceptives and the eugenic movement. In her book, Contraception (Birth Control) Its Theory, History and Practice: A Manual for the Medical and Legal Professions she defends the use of contraceptives in cases of active syphili s, congenital blindness, virulent tuberculosis, acute heart disease of various types, kidney diseases of various types, epilepsy, leprosy, diabetes, and [m] arked feeble mindedness' [For such cases sterilization is to be preferred as they are likely to be to 112 Norman Haire, H ymen: Or The Future of Marriage ( London : Kegan Pa ul, Trench, Trubner & Co., 1927), 77.

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67 careless to use contraceptives effe ctively.]. 113 In addition, she also argues that any woman who experienced any of the following as a result pregnancy should also use contraceptives: puerperal insanity, severe albuminuria, serious eclampsia, toxaemis spinal and pelvic deformation, caesarean section within two years ." 114 Stopes frames her support of contraception as a societal need. She claims that if individuals who had any of the diseases or defects mentioned above did have children, then these proble ms would only be perpetuated resulting in a weaker population. Stopes also incorporated her own class pe rceptions in her argument. She claimed that contraception could also be a solution to some of the abortion issue s in that abortion "most frequently us ed by poor and ignorant women who are denied the necessary contraceptive knowledge, and many and various as they are, all can fairly be described as physiologically harmful as well as legally criminal." 115 Stopes was very much against the use of abortion and offered contraception as an alternative. Additionally, she argued that in impoverished homes contraception should be used in cases where the household was already raising as many children as it c ould financially support : "contraception is obviously indic ated rather than the saddling of the community with children or a very doubtful racial value." 116 By defining the use of abortion as being more often utilized by "poor and ignorant women" and a desire to regulate procreation among the poor who 113 Marie Carmichael Stopes, Contraception (Birth Control) Its Theory, History and P ractice: A Manual for th e Medical and Legal Professions ( London: John Bale, Sons and Danielson, 1923), 35. 114 Stopes, Contraception, 35. 115 Stopes, Contraception, 54. 116 Stopes, Contraception, 37.

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68 would produce children that would then become a burden on society, Stopes revealed her bias a gainst the poor and also centered her advocacy of the use of contraception for the poor in particular. While Stopes wrote, "[a] ll will agree" in her argument that contraception should be used in eugenic circumstances her proposals caused a great deal of controversy, even among the medical community. In Contraception she anticipates some of the backlash against her position and attempts to defuse those anticipated arguments. For example, she explains that some people were against the use of contraceptives because they violated nature. Yet, she argues, all medicine is "against nature" in that humans developed it. In addition, Stopes explains that many criticized the use of contrac eptives because it would result in "race suicide." She refutes this argument indicating that allowing the "unfit" to procreate was actually a greater threat to the British race. 117 Stopes' argument shows her support for the desire among eugenists to regulate the procreation of individuals in British society who did not meet their definitions of Britishness. Even though Stopes strongly advocated for the use of contraceptives in order to meet eugenic goal s, Deborah Cohen has shown that in the administration of the Mother's Clinics, Stopes' actions did not fully align with her eugenic ideology. In 1921, Stopes and her husband, Humphrey Verdon Roe, opened their first Mothers' Clinic in a North London working class district. Mothers' clinics were birth control clin ics that worked to help women prevent unwanted pregnancies, regulate the number of years between the birth of children within a family, and assist couples who could not have children. In this 117 Stopes, Contraception, 211 212.

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69 capacity, Cohen explains, Stopes established a system that worke d to make women feel empowered to control their own reproductive capabilities. While Cohen acknowledged Stopes' unwavering public support of eugenic regulation of reproduction, Cohen also demonstrated that the clinics themselves offered contraceptive optio ns to upper middle and working class women. In the act of offering contraceptives to upper and middle class women, Cohen argued, Stopes' actually violated her advocacy of positive' eugenics and the propagation of the "fittest" members of British soci ety. According to Cohen, the actions Stopes took to make contraceptives available to the female population demonstrated Stopes' prioritization of her concern for the health and happiness of her patients above her eugenic ideology. 118 118 Deborah A. Cohen, "Pri vate Lives in Public Spaces: Marie Stopes, the Mothers' Clinics and the Practice of Contraception i n History Workshop No. 35 (Spring, 1993), 95 116, accessed 27 April 2016, http://0 www.jstor.org.skyline.ucdenver.edu/stable/4289208. Figure 6.1: This graphic from Stopes' Contraception visually demonstrates Scopes' belief that the use of contraception could resolve population issu es in post World War I Britain.

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70 Ultimately, through th e process of determining the best course of action regarding the mentally deficient, medical professional s established themselves as expert advisors on public policy regarding the mentally deficient and advised that it was the State 's responsibility and in the State's best interest to regulate the propagation of those individuals they deemed unfit for British society. According to Potts, "the majority of defectives can only be detected by careful investigation, their diagnosis requiring thorough and sometim es repeated examinations by those who have made a special study." 119 Those who have made a special study indicate that expertise in the area of mental deficiency belonged to medical professionals. By fortifying medicine as the f o unt of knowledge in mental he alth, medical professionals created a situation in which others, including political leaders, could not question their authority on the subject. This allowed medical professionals to advise the State in the area of mental health. Thereby medical profession als professed their own versions of "unfit" and advised policy makers in terms of their own ideals of Britishness. Additionally, professionals like Gibbons framed their arguments in terms of what was best for the State regarding the treatm ent of the "unfit ." These arguments included statements such as "this would be done for the advantage of the State" in reference to keeping feeble minded people f rom procreating. Some medical professionals even blamed the State for interfering with what they thought was k eeping a natural process of elimination from occurring. Gibbons explains that policies like the Poor Law actually allowed "unfit" people to continue to pose a threat to society. 120 Yet, "unfit" was a classification established by individuals who posited thei r own perspectives 119 Potts, et al., "D iscussion," 219. 120 Gibbons "Sterilization of the Unfit," 755. !!

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71 as absolute truths established through science even when the scientific evidence could not prove their perspectives to be true. In fact, the science suggested that their hypotheses regarding procreation and natural elimination of unfit i ndividuals from the population were false hypotheses. In the end, because there was not sufficient data supporting heredity as a primary cause of insanity and other forms of degeneration, the State did not implement sterilization policies in Britain.

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72 C HAPTER VI CONCLUSION During the nineteenth and early twentieth centuries in Britain, medical professionals established themselves as experts in their field and then utilized that expertise as a platform from which to advise on policies that sought to regu late reproduction. In an effort to provide specialized care to mentally defective individuals, medical professionals recommended the creation of a pauper asylum system. When the asylums first opened, although medical knowledge of the care and treatment of insanity was limited, medical men optimistically believed they could learn about and cure many kinds of mental defect. Over time, the patient population in London's pauper asylum s grew at what became an alarming rate. Medical and political experts feared a serious mental health crisis was rising throughout Britain. Some interpreted this perceived crisis to indicate a degeneration problem among British citizens and looked for ways to control reproduction The State asylum system offered an opportunity to exe rt reproductive control over individuals who qualified for asylum treatment. While neither the State nor asylum administrators directly referenced the role of the asylum in reproductive control, State regulations demanded strict oversight of asylum patient s and rules and structures that enforced gender segregation at the asylums. These regulations, rules, and structures established environments in which it was incredibly difficult, if not impossible, for the patient population to procreate. By the beginnin g of the twentieth century, the growth of the asylum population had increased to such a level that it could no longer sustain itself. As a result, medical professionals, beginning with Robert Rentoul, recommended alternatives for the asylum

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73 system to contr ol reproduction Sterilization, marriage certificates, and contraceptives gained popularity in both the medical and political arenas as alternatives to the asylum system. However, the very notion that the asylum system could be replaced by policies that wo uld directly regulate procreation among people who had been labeled as "defective" or "degenerated" indicates that at least part of the goal of State asylums in the nineteenth century was to control the reproductive ability of asylum patients. Taking a c loser look at the structure and operation of the asylums reveals that the asylums were set up to effectively regulate procreation. While there was not documentation in which medical men or policy makers cited the regulation of procreation as an asylum goal they did build structures that physically separated males and females within the asylums Additionally, the asylums were located in areas where there was quite a distance between asylum patients and the general population. These structures actively maint ained environments in which those who did not fit medical experts' definitions of proper British character were deterred from cross gender social interaction thereby keeping them from reproducing. During World War I, Britain suffered a great deal of popu lation loss that caused a number of medical and political professionals to write about a population crisis and suggest possible actions for addressing this population concern. Yet c onversations about the population continued to include sterilization to ma intain State regulations over procreation. Some medical professionals attempted to prove that various forms of degeneration from insanity to criminal behavior were directly caused by inherited characteristics. Eventually, these opinions led to the rise of a eugenic movement in Britain,

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74 Although, the scientific community in Britain was unable to prove that heredity was the primary cause of degeneration a number of medical professionals continued to support theories of inherited degeneration often based on t heir own experience with different populations. Some, like Marie Stopes, even offered suggest ions including the widespread use of contraception among certain elements of society as a solution to the degenerating race problem. Each of these arguments was ba sed on beliefs about true Britishness. The convergence of these conversations proves that one of the most important elements of truly being British both in the nineteenth and twentieth century was the ability to reproduce, thereby creating the next genera tion of British citizens T he power to control that ability represented the greatest level of control one individual could have over him or herself, or that a government could have over an individual Begi nning with the ability to influence legislation over abortion, medical men/professionals claimed their own legitimacy in deciding who could and could not meet the most fundamental requirements of British national identity. They claim ed their position as th e keepers of true Britishness by establishing themselves as experts on the body, but e xtended their claim into expertise on inheritance of charac teristics. In both the period before and after World War I, British medical experts and political stakeholders argued that the British race was deteriorating as Britain lost the economic and political hegemony they maintained throughout the nineteenth century. This challenge to the British national identity caused a great deal of fear about the role of Britain not only internationally but domestically as well. Racial degenera tion was just part of that fear. Baron Riddell wrote, The propagation of undesirables is a national menace, and the

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75 condemnation of high grades to a celibate life an unjustifiable act of cruelty. 121 While actions and arguments again st the reproduction of group s of people in a society who medical professionals defined as outside of the British ideal remained prevalent through the nineteenth and early twentieth century, it is important to remember that there were also dissenting voices Those dissenting voices offered humanity as a pr iority over control. People like psychiatrist John Conolly imagined moral management of asylums where patients would be well treated and would not be subject to the violence and restraint of earlier generations. Even Doctor Marie Stopes, a staunch advocate of eugenics, placed women's ability to control their own reproduction through contraceptives above her own eugenic thinki ng in the administration of her Mother s Clinics. While both Conolly and Stopes ultimately supported policies that maintained control over individuals, they show that while certain ideologies coul d lead to greater State control over the population, the State must also keep in mind the value of rights and in dividuals. Sometimes, humanity however flawed, is more important than what may seem like a difficult decision made for the greater good. 121 Riddell, Medico Legal, 88.

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76 B IBLIOGRAPHY Secondary Sources Bourke, Joanna. "Shell Shock During World War I." BBC. Updated 10 March 2011. http://www.bbc.co.uk/history/worldwars/wwone/she llshock_01.shtml Accessed January 08, 2016. Cohen, Deborah A. "Private Lives in Public Spaces: Marie Stopes, the Mothers' Clinics and the Practice of Contraception In History Workshop No. 35 (Spring, 1993), 95 116. Accessed 27 April 2016. http://0 www.j stor.org.skyline.ucdenver.edu/stable/4289208. Colley, Linda. Britons: Forging the Nation 1707 1837. New Haven: Yale University Press, 1992. Farmer, Ann. By Their Fruits: Eugenics, Population Control, and the Abortion Campaign. Washington, D.C.: Catholic Un iversity of America Press, 2008. Herv ey, N. "A Slavish Bowing Down: T he Lunacy Commission and the Psychiatric Profession 1845 60." In The Anatomy of Madness: Essays in the History of Psychiatry, edited by W.F. Bynum, Roy Porter, and Michael Shepherd, 98 13 1. London: Tavistock Publications, 1985. Jdanov, Dmitri, Evgeny Andreev, Domantas Jasilionis, and Vladimir M. Shkolnikov. "Estimates of Mortality and Population Changes in England and Wales Over the Two World Wars." In Demographic Research, Vol. 13 (Nov. 1 7, 2005), 389 414. Accessed 10 March 2016. http://www.demographic research.org/Volumes/Vol13/16/. Levine Clark, Marjorie. "'Embarrassed Circumstances': Gender, Poverty, and Insanity in the West Riding of England in the Mid Victori an Years." In Sex and Secl usion, Class and Custody : Perspectives on Gender and Class in the History of British and Irish Psychiatry, edited by Jonathan Andrews and Anne Digby 123 148. Amsterdam: Rodopi, 2004. Loudon, Irvine. Medical Care and the General Practitioner, 1750 1850. Ox ford: Clarendon Press, 1986. Mazumdar, Pauline M.H. Eugenics, Human Genetics and Human Failings: The Eugenics Society, its Sources and its Critics in Britain. London: Routledge, 1992. McCandless, Peter. "Liberty and Lunacy: The Victorians and Wrongful Conf inement." In Madhouses, Mad Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era, edited by Andrew Scull, 339 362. Philadelphia: University of Pennsylvania Press, 1981.

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77 Meanwood Park Hospital. The Mental Deficiency Act 1913. Accessed 15 March 2016. http://www.meanwoodpark.co.uk/a resource/the mental deficiency act 1913/ Mougel, Nadege. "World War I Casualties." Translated by Julie Gratz. Last modified 2011. http://www.centre robert schuman.org/userfiles/files/REPERES%20 %20module%201 1 1%20 %20explanatory%20notes%20 %20World%20War%20I%20casualties%20 %20EN.pdf Murphy, Elaine. "The Administration of Insanity in England 1800 to 1870." In The Confinement of the Insane: International Perspectives, 1800 1965, edited by Roy Porter and Davi d Wright, 334 349. Cambridge: Cambridge University Press, 2003. Overy, Richard. The Twilight Years: The Paradox of Britain Between the Wars. New York: Viking, 2009. Paul, Kathleen. Whitewashing Britain: Race and Citizenship in the Postwar Era. Ithaca: Corn ell University Press, 1997. Peterson, M. Jeanne. The Medical Profession in Mid Victorian London. Berkeley: University of California Press, 1978. Risse, Guenter B. and John Harley Warner. "Reconstructing Clinical Activities: Patient Records in Medical Histo ry." The Journal of the Society for the Social History of Medicine 5 (1992): 183 205. Scull, Andrew. "From Madness to Mental Illness: Medi cal Men as Moral Entrepreneurs." In European Journal of 16 (2). Cambridge University Press: 218 61. Accessed 20 Mar ch 2106. http://0 www.jstor.org.skyline.ucdenver.edu/stable/23998602. Scull, Andrew. Madness: A Very Short Introduction. Oxford: Oxford University Press, 2011. Showalter, Elaine. The Female Malady: Women, Madness, and Engish Culture 1830 1980. New York: Pa ntheon Books, 1985. Soloway, Richard. "Counting the Degenerates: The Statistics of Race Deterioration in Edwardian England." Journal of Contemporary History Vol. 17 No. 1 (Jan., 1982): 137 164. Accessed 9 August 2015. http://www.jstor.org/stable/260448 St one, Martin. "Shellshock and the Psychologists." In The Anatomy of Madness: Essays in the History of Psychiatry, edited by W.F. Bynum, Roy Porter, and Michael Shepherd, 242 271. London: Tavistock Publications, 1985. Walton, J.K. "Casting Out and Bringing B ack in Victorian England: Pauper Lunatics, 1840 70." In The Anatomy of Madness: Essays in the History of Psychiatry, edited by W.F. Bynum, Roy Porter, and Michael Shepherd, 132 146. London: Tavistock Publications, 1985.

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