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A Simple and Painless Procedure

On a cloudy afternoon on October 19, 1927, as a chilly autumn wind swept down off the Blue Ridge Mountains, rattling the windows of the infirmary at the Virginia Colony for Epileptics and Feeble-minded, Dr. John H. Bell jotted a few notes about an operation he had performed earlier that day. He was the superintendent of this sprawling institution, a campus of regimented brick dormitories and rolling farmland set amid the bluffs overlooking Lynchburg, and one of the country's finest. The morning's procedure was simple, and dozens of such operations had taken place here over the years. But for this patient he wrote with particular care, since it was a case that might draw a bit of attention.

"Patient sterilized this morning under authority of Act of Assembly in 1926, providing for the sterilization of mental defectives, and as ordered by the Board of Directors of this institution," he wrote. "She went to the operating room at 9:30 and returned to her bed at 10:30, recovered promptly from the anaesthesia with no untoward after effects anticipated. One inch was removed from each Fallopian tube, the tubes ligated and the ends cauterized by carbolic acid followed by alcohol, and the edges of the broad ligaments brought together with continuous suture. Abdominal wound was united with layer sutures and the approximation of the closure was good."

The patient lying before him on the operating table that morning was Carrie Buck, a plump, twenty-one-year-old woman who had been under his care at the Colony for over three years. He knew her well. On the day she was admitted, he had been the first to examine her, and he took special note of her dark eyes and slight features, her low, narrow forehead and high cheekbones. He would see her in the Colony's cafeteria, where she was assigned to work, and his words to her were usually cordial and kind. Yet during most of this time, Dr. Bell and Carrie Buck had been, in name at least, legal adversaries.

So, as he finished his surgical report, he decided to add another formal comment: "This is the first case operated on under the sterilization law, and the case was carried through the courts of the State and the United States Supreme Court to test the constitutionality of the Virginia act, and an appeal before the Supreme Court for a rehearing recently having been denied."

It was a momentous day. It had taken over three years to test and litigate Carrie's case, but less than an hour to cut and ligate her Fallopian tubes. But for Dr. Bell, this operation was far more than a legal victory. As a "test case," it had been a carefully orchestrated lawsuit meant not only to sterilize Carrie against her will, but also to protect a bold but controversial social policy he believed would improve the welfare of the nation. Today was the beginning. It was cold, but outside the window, beyond the white, two-tiered veranda on the front façade of the infirmary, Dr. Bell could look out over the Colony and consider the long battle he and other reformers had been fighting for decades.

Beyond the veranda, the parallel rows of austere brick dormitories made this state-run institution look something like a military camp, its geometric precision imposing order on a vast Virginia wilderness, even as magnolias and elms gave the Colony the gentle, pastoral feel of a Southern plantation, peaceful and decorous, like Jefferson's Monticello just hours to the north. Dr. Bell, too, had devoted his life, both as a physician and a scientist, to building a more perfect land. Sterilizing Carrie just may have been one of the most important things he had ever done, and as he considered her surgery he may have even dared to think, as a colleague would later tell him, that "a hundred years from now you will still have a place in this history of which your descendents may well be proud."

Excerpted from Better for All the World by Harry Bruinius Copyright © 2006 by Harry Bruinius. Excerpted by permission of Knopf, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.